Short-term exposure to ambient air pollution and daily atherosclerotic heart disease mortality in a cool climate

Association between daily circulatory emergency ambulance dispatches and short-term PM2.5 exposure in a heavily polluted area

Emergency ambulance dispatches (EAD) have been proven to be associated with ambient particulate matter with diameter < 2.5 μm (PM2.5) concentration, but the associations of circulatory EAD remained inconclusive, especially in heavily polluted areas. In this time series conducted in Shenyang City, Northeastern China, we explored the associations between circulatory EAD and ambient PM2.5 and its constituents. Data including 113,508 circulatory EAD records, five types of PM2.5 constituents, and meteorological information spanning from 2014 to 2019 were retrieved. Using generalized additive models (GAMs), we explored the association between circulatory EAD and calculated excess risks induced by a 10 μg/m3 increase (ERR10) in PM2.5 mass and its constituents. ERR by percentage change (ERRpc) to compare among the different constituents were also calculated. Positive associations between circulatory EAD and PM2.5 mass, sulfates, organic matters, and black carbon, were found particularly at lag0 and lag0-5, with the ERR10 of 3.8% (3.2%-4.4%), 6.5% (2.2%-10.8%), 4.2% (1.7%-6.6%), and 30.2% (17.2%-43.4%) at lag0-5, respectively. Similar associations were observed for cardiovascular EAD, while cerebrovascular EAD suggested a positive association with O3 rather than PM2.5 or its constituents. Notably, PM2.5 mass exhibited the largest ERRpc for circulatory and cardiovascular EAD, followed by sulfates and black carbon. Moreover, the risks were enhanced for circulatory and cardiovascular EAD in males compared to females and during warmer seasons compared to colder seasons. Our findings contribute new evidence on PM2.5 exposure and circulatory EAD in relatively polluted areas.

Short-term effects of PM2.5 and its components exposure on endothelial function in Chinese elders

Particulate matter (PM2.5) and its components have been studied widely around the world and are associated with many adverse health events (e.g. cardiovascular diseases and death). Flow-mediated dilation (FMD) is a non-invasive assessment that is able to detect endothelial damage at an early stage, therefore, improving the prognosis of atherosclerotic cardiovascular disease. The current study used data from Shanghai to explore the relationship between PM2.5 and its components and FMD using multiple statistical models. The results of the analysis of 812 patients' data (age ≥ 65) suggested that as PM2.5 level rises, endothelial function reduces. Among the five PM2.5 components included in this study, black carbon was shown by both models to be the dominating factor three days post-exposure (lag3). However, results from lag4 and lag5 were inconclusive in the two models with some evidence proposing the significance of sulphate, organic matter, and ammonium. Our results are in concordance with previous literature and further prove the significance of black carbon as an individual pollutant in the atmosphere. More research is needed to confirm the role of sulphate, organic matter, and ammonium as independent pollutants in relation to health.

A Gender Differentiated Analysis of Healthy Life Expectancy in South Asia: The Role of Greenhouse Gas Emission

The sluggish progress concerning SDG-9 and SDG 13 has made South Asia an epicentre of household and ambient greenhouse gases emissions. Furthermore, the regional progress concerning attainment of SDG-3 is considerably low. The major research objectives are twofold. First, to explore the impact of GHGs emissions from agriculture, transportation, and manufacturing sector on disaggregated life expectancy. Second, to examine the mitigating impact of renewable energy use, trade integration, and human capital development for practice policy recommendations. These research objectives are realized by employing recently advanced cross-sectional auto regressive distributed lag (CS-ARDL) model on panel data of five South Asian countries such as Bangladesh, India, Pakistan, Nepal, and Sri Lanka from 1990 to 2019. The estimation outcome reveals that the emissions from transportation, manufacturing, and agricultural sectors significantly deteriorate healthy life expectancy of male and female healthy life expectancy in South Asia with different intensity. Especially, we find that long-run impact of GHG is more profound on male healthy life expectancy than female life expectancy. The result further shows that renewable energy and human capital substantially improve healthy life expectancy, whereas the effects of trade integration are insignificant. The finding of moderating variables shows that renewable energy, human capital development, and trade integration have high potential to reduce GHGs emissions. The findings of this study urge South Asia for investments in human capital development and renewable energy along with fostering regional integration to decrease GHG and improve healthy life expectancy.

Long-term exposure to ambient fine particulate matter and carotid intima media thickness at bilateral, left and right in adults from Mexico City: Results from GEA study

BACKGROUND

PM2.5 exposure has been associated with intima-media thickness (cIMT) increase. However, very few studies distinguished between left and right cIMT in relation to PM2.5 exposure.

AIM

To evaluate associations between chronic exposure to PM2.5 and cIMT at bilateral, left, and right in adults from Mexico City.

METHODS

This study comprised 913 participants from the control group, participants without personal or family history of cardiovascular disease, of the Genetics of Atherosclerosis Disease Mexican study (GEA acronym in Spanish), recruited at the Instituto Nacional de Cardiología Ignacio Chávez from June 2008 to January 2013. To assess the associations between chronic exposure to PM2.5 (per 5 μg/m3 increase) at different lag years (1-4 years) and cIMT (bilateral, left, and right) we applied distributed lag non-linear models (DLNMs).

RESULTS

The median and interquartile range for cIMT at bilateral, left, and right, were 630 (555, 735), 640 (550, 750), and 620 (530, 720) μm, respectively. Annual average PM2.5 exposure was 26.64 μg/m3, with median and IQR, of 24.46 (23.5-25.46) μg/m3. Results from DLNMs adjusted for age, sex, body mass index, low-density lipoproteins, and glucose, showed that PM2.5 exposure for year 1 and 2, were positively and significantly associated with right-cIMT [6.99% (95% CI: 3.67; 10.42) and 2.98% (0.03; 6.01), respectively]. Negative associations were observed for PM2.5 at year 3 and 4 and right-cIMT; however only year 3 was statistically significant [-2.83% (95% CI: 5.12; -0.50)]. Left-cIMT was not associated with PM2.5 exposure at any lag year. The increase in bilateral cIMT followed a similar pattern as that observed for right-cIMT, but with lower estimates.

CONCLUSIONS

Our results suggest different susceptibility between left and right cIMT associated with PM2.5 exposure highlighting the need of measuring both, left and right cIMT, regarding ambient air pollution in epidemiological studies.

Time series analyses based on the joint lagged effect analysis of pollution and meteorological factors of hemorrhagic fever with renal syndrome and the construction of prediction model

BACKGROUND

Hemorrhagic fever with renal syndrome (HFRS) is a rodent-related zoonotic disease induced by hantavirus. Previous studies have identified the influence of meteorological factors on the onset of HFRS, but few studies have focused on the stratified analysis of the lagged effects and interactions of pollution and meteorological factors on HFRS.

METHODS

We collected meteorological, contaminant and epidemiological data on cases of HFRS in Shenyang from 2005-2019. A seasonal autoregressive integrated moving average (SARIMA) model was used to predict the incidence of HFRS and compared with Holt-Winters three-parameter exponential smoothing model. A distributed lag nonlinear model (DLNM) with a maximum lag period of 16 weeks was applied to assess the lag, stratification and extreme effects of pollution and meteorological factors on HFRS cases, followed by a generalized additive model (GAM) to explore the interaction of SO2 and two other meteorological factors on HFRS cases.

RESULTS

The SARIMA monthly model has better fit and forecasting power than its own quarterly model and the Holt-Winters model, with an optimal model of (1,1,0) (2,1,0)12. Overall, environmental factors including humidity, wind speed and SO2 were correlated with the onset of HFRS and there was a non-linear exposure-lag-response association. Extremely high SO2 increased the risk of HFRS incidence, with the maximum RR values: 2.583 (95%CI:1.145,5.827). Extremely low windy and low SO2 played a significant protective role on HFRS infection, with the minimum RR values: 0.487 (95%CI:0.260,0.912) and 0.577 (95%CI:0.370,0.898), respectively. Interaction indicated that the risk of HFRS infection reached its highest when increasing daily SO2 and decreasing humidity.

CONCLUSIONS

The SARIMA model may help to enhance the forecast of monthly HFRS incidence based on a long-range dataset. Our study had shown that environmental factors such as humidity and SO2 have a delayed effect on the occurrence of HFRS and that the effect of humidity can be influenced by SO2 and wind speed. Public health professionals should take greater care in controlling HFRS in low humidity, low windy conditions and 2-3 days after SO2 levels above 200 μg/m3.

Particulate matter and ozone might trigger deaths from chronic ischemic heart disease

AIMS

To study the association between short-term exposure to air pollutants and mortality of Chronic Ischemic Heart Disease (CIHD).

METHODS

Using a case-crossover design, we investigated 148,443 CIHD deaths from 2015 to 2020 in Jiangsu Province, China. Exposure to six ambient pollutants, including PM₁₀, PM_2.5, NO₂, CO, SO₂, and O_3, was assessed by extracting daily concentrations from validated 10 km × 10 km pollutant grids at each subject's residential address. A conditional logistic regression approach was used to explore the exposure-response relationship with adjustment for temperature and relative humidity. We calculated the Population Attributable Fractions (PAFs) and the attributable deaths number of CIHD.

RESULTS

An increase of 10 μg/m³ in PM₁₀ and PM_2.5 exposure was associated with a 1.16% (95% CI: 0.85-1.48%) and 1.80% (1.36-2.24%) increase in CIHD mortality, respectively. A threshold value of 123 µg/m³ was identified for the association between O₃ exposure and CIHD mortality. Controlling for PM_2.5, each increase of 10 µg/m³ in O₃ (>threshold) was statistically significantly associated with a 0.94% (0.19-1.71%) increase in CIHD mortality, however there was no association between NO₂, SO₂, CO exposure and CIHD mortality. Reducing PM_2.5, PM₁₀ and O₃ to the WHO air quality guidelines would prevent 6.16% (95% CI: 4.70-7.58%), 4.30% (3.18-5.43%) and 1.29% (0.48-4.20%) of CIHD deaths, respectively. During the warm season, mortality and PAFs of CIHD associated with PM_2.5, PM₁₀, and O₃ were significantly higher.

CONCLUSIONS

Short-term exposure to ambient PM_2.5, PM_10, and O₃ might trigger deaths from CIHD. These findings indicate that the premature deaths of CIHD patients can be alleviated by reducing exposure to polluted air.

Time series analysis of short-term effects of particulate matter pollution on the circulatory system disease mortality risk in Lishui District, China

Epidemiological evidence has shown a significant association between short-term exposure to air pollution and mortality risk for circulatory system diseases (CSD). However, informative insights on the significance and magnitude of its relationship in the process of government interventions on abating air pollution are still lacking, particularly in a burgeoning Chinese city. In this study, we conducted a time series study in Lishui District, Nanjing, to examine the effect of ambient particulate matter (PM), e.g., PM_2.5 and PM₁₀, on daily death counts of CSD which included cardiovascular disease (CVD), cerebrovascular disease (CEVD), and arteriosclerotic heart disease (ASHD) mortality from January 1, 2015, to December 31, 2019. The results revealed that each 10 μg/m³ increase in PM_2.5 and PM₁₀ concentration at lag0 day was associated with an increase of 1.33% (95% confidence interval, 0.08%, 2.60%) and 1.12% (0.43%, 1.82%) in CSD mortality; 2.42% (0.44%, 4.43%) and 1.43% (0.32%, 2.55%) in CVD mortality; 1.20% (- 0.31%, 2.73%) and 1.21% (0.38%, 2.05%) in CEVD mortality; and 2.78% (0.00%, 5.62%) and 1.66% (0.14%, 3.21%) in ASHD mortality, respectively. For cumulative risk, the corresponding increase in daily mortality for the same change in PM_2.5 concentration at lag03 day was significantly associated with 1.94% (0.23%, 3.68%), 3.17% (0.58%, 5.84%), 2.38% (0.17%, 4.63%), and 4.92% (1.18%, 8.81%) for CSD, CVD, CEVD, and ASHD, respectively. The exposure-response curves were approximately nonlinear over the entire exposure range of the PM concentrations. We also analyzed the effect modifications by season (warm or cold), age group (0-64 years, 65-74 years, or ≥ 75 years), and sex (male or female). Although not statistically significant, stratified analysis showed greater vulnerability to PM exposure for cold season, population over 65 years of age, and female group.

Temperature might increase the hospital admission risk for rheumatoid arthritis patients in Anqing, China: a time-series study

Temperature has been studied in relation to many health outcomes. However, few studies have explored its effect on the risk of hospital admission for rheumatoid arthritis (RA). A distributed lag non-linear model (DLNM) was used to analyze associations between mean temperature, diurnal temperature range (DTR), temperature change between neighboring days (TCN), and daily admissions for RA from 2015 to 2019 in Anqing, China. Subgroup analyses based on age, gender, rheumatoid factors, and admission route were performed. In total, 1456 patients with RA were hospitalized. Regarding the cumulative-lag effects of extreme cold temperature (5th percentile = 3℃), the risks of admissions for RA were increased and highest at lag 0-11 (RR = 2.68, 95% CI: 1.23-5.86). Exposing to low (5th percentile = 1.9℃) and high (95th percentile = 14.2℃) DTRs both had increased risks of RA admission, with highest RRs of 1.40 (95% CI: 1.03-1.91) and 1.24 (95% CI: 1.0-1.53) at lag 0 day, respectively. As for TCN, the marginal risk of admission in RA patients was found when exposed to high TCN (95th percentile = 2.9℃) with the largest single-day effect at lag 10 (RR = 1.11, 95% CI: 1.01-1.23). In subgroup analyses, females were more susceptible to extreme cold temperature, low and high DTRs, and high TCN. In regard to extreme cold temperature, significant risk of hospital admission in females only appeared at lag 2 (RR = 1.48, 95% CI: 1.02-2.15) and lag 0-2 (RR = 2.35, 95% CI: 1.11-4.95). It is clear that RA patients exposed to changing temperature may increase risks of admission.

Association between short-term exposure to sulfur dioxide and carbon monoxide and ischemic heart disease and non-accidental death in Changsha city, China

Background

To investigate the effects of short-term exposure to sulfur dioxide (SO₂) and carbon monoxide (CO) in the central and southern China areas on ischemic heart disease (IHD) and non-accidental deaths.

Method

We investigated the associations between short-term exposure to SO₂ and CO in a city in south-central China and IHD and non-accidental death using a time-series design and generalized additive models with up to a 5-day lag adjusting for day of the week, temperature, air pressure, wind speed, and relative humidity. The relative risks of IHD and non-accidental death per 10-unit increase in SO₂ and CO were derived from zero to five days in single-pollutant models.

Results

Between 2016 and 2018, a total of 10,507 IHD and 44,070 non-accidental deaths were identified. The largest significant relative risk for IHD death was lag 02 for both SO₂ (1.080; 95% confidence interval: 1.075–1.084) and CO (5.297; 95% confidence interval: 5.177–5.418) in single-pollutants models. A significant association was shown at all lag multiple-day moving averages. Two-pollutant models identified an association between SO₂ and mortality when adjusting for CO. In stratified analyses, SO₂ exhibited a stronger association with death during the cold season, while CO exhibited a stronger association with mortality from IHD during the warm season. The risk of death was more robust in the elderly for both pollutants, but was greater in men for CO and in women for SO₂.

Conclusions

Overall, we found an association between short-term exposure to low-level SO₂ and CO and the risk of IHD and non-accidental death.

The Gender-Based Differences in Vulnerability to Ambient Air Pollution and Cerebrovascular Disease Mortality: Evidences Based on 26781 Deaths

The gender-based differences in the vulnerability to ambient air pollution have not been widely explored. This study aimed to investigate vulnerability differences to the short-term effects of PM2.5, PM10 and O3 between cerebrovascular diseases (CEVD) deaths of men and women. The general additive models (GAMs) and distributed lag non-linear models (DLNMs) were adopted, and both single-pollutant and two-pollutant models were performed to analyze the associations between ambient air pollution and daily CEVD deaths. Both models indicated that O3 was the most suspicious pollutant that could induce excess CEVD deaths, and women tended to be more vulnerable to O3. These results were confirmed by seasonal analysis, in which we also found both genders were more vulnerable to O3 in winter. The exposure-response relationships revealed that women were usually more vulnerable to ambient air pollution than men, and the exposure-response curves differed significantly between genders. Our findings suggested that more attention should be paid on the adverse effects of ambient O3, and the protection of women CEVD population against air pollution should be emphasized.

Health benefits on cardiocerebrovascular disease of reducing exposure to ambient fine particulate matter in Tianjin, China

With the development of the industrialization level in China, high concentrations of fine particulate matter (≤ 2.5 μg/m³ in aerodynamic diameter (PM_2.5)) could have a great impact on the health of the population. Our study is to quantify the health benefits on cardiocerebrovascular disease of reducing exposure to PM_2.5 in Tianjin, China. We obtained the data on cardiovascular disease (CVD), ischemic heart disease (IHD), and cerebrovascular disease (CD) mortalities to quantify the association between CVD, CD, and IHD mortalities and PM_2.5 and calculate health and economic benefits when the annual average concentration of PM_2.5 was reduced to National Ambient Air Quality Standard (NAAQS) and World Health Organization (WHO) guidelines by using our concentration response (C-R) functions. There were 435.22 (95% CI 253.86 to 616.57) all-cause, 130.22 (95% CI 66.34 to194.09) IHD, and 204.07 (95% CI 111.66 to 296.47) CD deaths attributed to PM_2.5 and the economic benefits obtained by preventing all-cause, IHD, and CD mortalities were equivalent to be 2.79%, 0.83%, and 1.31% of Baodi's GDP in Tianjin in 2017, respectively. PM_2.5 concentration was positive with all-cause, IHD, and CD mortalities in rural, suburban, and urban area of Tianjin, China. Meanwhile, the number of avoidable deaths and economic cost of reducing PM_2.5 concentrations to NAAQS and WHO guidelines was highest in the rural area.