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Khalaf EM, Mohammadi MJ, Sulistiyani S, Ramírez-Coronel AA, Kiani F, Jalil AT, Almulla AF, Asban P, Farhadi M, Derikondi M. Effects of sulfur dioxide inhalation on human health: a review. REVIEWS ON ENVIRONMENTAL HEALTH 2024; 39:331-337. [PMID: 36635910 DOI: 10.1515/reveh-2022-0237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Sulfur dioxide (SO2) is one of the most important gaseous air pollutants and the chemical index of sulfur oxides (SOx). SO2 is one of the six criteria pollutants in the air quality index (AQI). SO2 can be emitted by natural and anthropogenic sources. Although efforts have been made to reduce sulfur dioxide emissions worldwide, this pollutant and its adverse effects remain a major concern, especially in developing countries. The aim of this study was the investigated the effects of sulfur dioxide inhalation on human health. This narrative review was done based on the literature published from 2000 to 2022 through PubMed, Springer, Web of Science, Science Direct, and Google Scholar databases. In this study, was done screened first based on the abstract and Final assessment done based on the full text of the article. Finally, 38 articles were selected for inclusion in the study. The results of this study showed that sulfur dioxide has adverse health effects on the human respiratory, cardiovascular, and nervous systems and causes type 2 diabetes and non-accidental deaths. Although some evidence suggests that sulfur dioxide in given concentrations has no adverse health effect, its synergistic effects in combination with other air pollutants may be significant. Among the most important practical results of this study can be mentioned to increase the health awareness of the general public, help the politicians of the health sector in making decisions in the health field, creating awareness among polluting producing units and industries and efforts to reduce the emission of Sulfur dioxide.
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Affiliation(s)
- Eman M Khalaf
- Department of Pharmacy, Al Maarif University College, Ramadi 31001, Anbar, Iraq
| | - Mohammad Javad Mohammadi
- Department of Environmental Health Engineering, School of Public Health and Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Andrés Alexis Ramírez-Coronel
- Doctor in Epidemiology and Biostatistics, Universidad Nacional de Educación (UNAE), Universidad de Palermo, Argentina; Universidad Católica de Cuenca campus, Universidad CES, Colombia, Azogues, Ecuador
| | - Fatemeh Kiani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abduladheem Turki Jalil
- Medical Laboratories Techniques Department, Al-Mustaqbal University College, Babylon 51001, Hilla, Iraq
| | - Abbas F Almulla
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf, Iraq
| | - Parisa Asban
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Farhadi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehrsa Derikondi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Calzetta L, Di Daniele N, Chetta A, Vitale M, Gholamalishahi S, Cazzola M, Rogliani P. The Impact of Thermal Water in Asthma and COPD: A Systematic Review According to the PRISMA Statement. J Clin Med 2024; 13:1071. [PMID: 38398384 PMCID: PMC10889407 DOI: 10.3390/jcm13041071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are global health challenges leading to substantial morbidity and mortality. While existing guidelines emphasize evidence-based treatments, the potential therapeutic role of thermal water (TW) inhalation remains under-investigated. METHODS This systematic review followed PRISMA-P guidelines and sought to evaluate the impact of TW in asthma and COPD. A thorough literature search, performed up to May 2023, encompassed in vitro, in vivo, randomized controlled trial (RCT), non-RCT, and observational studies. RESULTS The review included 12 studies reporting different findings. In vitro studies suggested TW could enhance antioxidant capacity and cell proliferation. In a murine model of non-atopic asthma, TW inhalation reduced airway hyperresponsiveness and inflammation. RCTs in COPD patients indicated mixed effects, including improved quality of life, reduced airway oxidant stress, and enhanced exercise tolerance. Asthma patients exposed to water aerosols exhibited improved lung function and reduced airway inflammation. Non-RCTs showed improved lung function and antioxidant activity after TW therapy. Additionally, observational studies reported enhanced lung function and reduced airway inflammation. CONCLUSION The current evidence suggests potential benefits of TW therapy in asthma and COPD. However, limited high-quality RCTs and concerns regarding occupational TW exposure necessitate further investigation. While TW therapy offers a non-invasive treatment, its therapeutic potential still needs definitive demonstration. Future research should therefore prioritize well-designed RCTs to thoroughly establish the efficacy and safety of TW as a potential therapeutic intervention for asthma and COPD.
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Affiliation(s)
- Luigino Calzetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Nicola Di Daniele
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Fondazione Leonardo per le Scienze Mediche Onlus, Policlinico Abano, 35031 Abano Terme, Italy
| | - Alfredo Chetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
- Cardio-Thoracic and Vascular Department, University Hospital of Parma, 43126 Parma, Italy
| | - Marco Vitale
- Faculty of Medicine, Vita-Salute University-San Raffaele, 20132 Milan, Italy;
- Italian Foundation for Research in Balneology (FoRST), 00198 Rome, Italy
| | - Shima Gholamalishahi
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (S.G.); (M.C.); (P.R.)
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (S.G.); (M.C.); (P.R.)
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (S.G.); (M.C.); (P.R.)
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Wang P, Li K, Xu C, Fan Z, Wang Z. Spatial analysis of overweight prevalence in China: exploring the association with air pollution. BMC Public Health 2023; 23:1595. [PMID: 37608324 PMCID: PMC10463435 DOI: 10.1186/s12889-023-16518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/13/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Overweight is a known risk factor for various chronic diseases and poses a significant threat to middle-aged and elderly adults. Previous studies have reported a strong association between overweight and air pollution. However, the spatial relationship between the two remains unclear due to the confounding effects of spatial heterogeneity. METHODS We gathered height and weight data from the 2015 China Health and Retirement Long-term Survey (CHARLS), comprising 16,171 middle-aged and elderly individuals. We also collected regional air pollution data. We then analyzed the spatial pattern of overweight prevalence using Moran's I and Getis-Ord Gi* statistics. To quantify the explanatory power of distinct air pollutants for spatial differences in overweight prevalence across Southern and Northern China, as well as across different age groups, we utilized Geodetector's q-statistic. RESULTS The average prevalence of overweight among middle-aged and elderly individuals in each city was 67.27% and 57.39%, respectively. In general, the q-statistic in southern China was higher than that in northern China. In the north, the prevalence was significantly higher at 54.86% compared to the prevalence of 38.75% in the south. SO2 exhibited a relatively higher q-statistic in middle-aged individuals in both the north and south, while for the elderly in the south, NO2 was the most crucial factor (q = 0.24, p < 0.01). Moreover, fine particulate matter (PM2.5 and PM10) also demonstrated an important effect on overweight. Furthermore, we found that the pairwise interaction between various risk factors improved the explanatory power of the prevalence of overweight, with different effects for different age groups and regions. In northern China, the strongest interaction was found between NO2 and SO2 (q = 0.55) for middle-aged individuals and PM2.5 and SO2 (q = 0.27) for the elderly. Conversely, in southern China, middle-aged individuals demonstrated the strongest interaction between SO2 and PM10 (q = 0.60), while the elderly showed the highest interaction between NO2 and O3 (q = 0.42). CONCLUSION Significant spatial heterogeneity was observed in the effects of air pollution on overweight. Specifically, air pollution in southern China was found to have a greater impact on overweight than that in northern China. And, the impact of air pollution on middle-aged individuals was more pronounced than on the elderly, with distinct pollutants demonstrating significant variation in their impact. Moreover, we found that SO2 had a greater impact on overweight prevalence among middle-aged individuals, while NO2 had a greater impact on the elderly. Additionally, we identified significant statistically interactions between O3 and other pollutants.
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Affiliation(s)
- Peihan Wang
- Key Laboratory of Regional Sustainable Development Modeling, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, P.R. China
| | - Kexin Li
- Key Laboratory of Land Surface Pattern and Simulation, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, P.R. China
| | - Chengdong Xu
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, P.R. China.
- University of Chinese Academy of Sciences, Beijing, 100049, P.R. China.
| | - Zixuan Fan
- Key Laboratory of Regional Sustainable Development Modeling, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, P.R. China.
- School of Health Policy and Management, Peking Union Medical College, Beijing, 100730, P.R. China.
| | - Zhenbo Wang
- Key Laboratory of Regional Sustainable Development Modeling, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, P.R. China
- University of Chinese Academy of Sciences, Beijing, 100049, P.R. China
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Pironti C, Ricciardi M, Motta O, Venier M, Faggiano A, Cucciniello R, Proto A. Sulphurous air pollutants and exposure events of workers in thermal-mineral springs: a case study of Contursi Terme (Salerno, Italy). ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:3112-3120. [PMID: 35945319 PMCID: PMC9892073 DOI: 10.1007/s11356-022-22432-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Thermo-mineral springs are widely spread over the volcanic areas of Salerno, a city in southern Italy. Although the water of thermal structures provides beneficial effects on human health, the air is characterized by the presence of potentially toxic compounds, such as hydrogen sulphide (H2S) and sulphur dioxide (SO2). Exposure to sulphurous compounds may have detrimental effects on human health, with asthma being the most common. In this study, air concentrations of H2S and SO2 in the thermal springs of Contursi Terme (Salerno, Italy) were monitored for 4 months (using both active and passive sampling), along with the chemical and microclimatic characterization of thermal water, to assess workers' exposure to these pollutants. An in-depth characterization of indoor air at the springs is paramount to establish emission control limits for occupational exposure and to take protective measures. The air concentration of SO2 varied from 0.11 ± 0.02 to 0.91 ± 0.02 mg/m3, following a seasonal pattern (higher values in winter and lower in spring). Conversely, indoor H2S concentrations did not vary significantly with time, but outdoor levels (from 0.40 ± 0.03 to 1.90 ± 0.03 mg/m3) were always higher than indoor ones (from 0.11 ± 0.03 to 0.56 ± 0.03 mg/m3). Not negligible air concentrations of these pollutants were detected in this thermal spring workplace, so further investigations are needed to ensure workers' safety.
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Affiliation(s)
- Concetta Pironti
- Department of Medicine Surgery and Dentistry, University of Salerno, via S. Allende, 84081, Baronissi, SA, Italy
| | - Maria Ricciardi
- Department of Medicine Surgery and Dentistry, University of Salerno, via S. Allende, 84081, Baronissi, SA, Italy
| | - Oriana Motta
- Department of Medicine Surgery and Dentistry, University of Salerno, via S. Allende, 84081, Baronissi, SA, Italy.
| | - Marta Venier
- O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington, IN, USA
| | - Antonio Faggiano
- Department of Chemistry and Biology, University of Salerno, via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Raffaele Cucciniello
- Department of Chemistry and Biology, University of Salerno, via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Antonio Proto
- Department of Chemistry and Biology, University of Salerno, via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
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Nouri F, Taheri M, Ziaddini M, Najafian J, Rabiei K, Pourmoghadas A, Shariful Islam SM, Sarrafzadegan N. Effects of sulfur dioxide and particulate matter pollution on hospital admissions for hypertensive cardiovascular disease: A time series analysis. Front Physiol 2023; 14:1124967. [PMID: 36891138 PMCID: PMC9986430 DOI: 10.3389/fphys.2023.1124967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023] Open
Abstract
Background and aims: Air pollution is a major environmental risk factor and the leading cause of disease burden with detrimental effects on cardiovascular systems. Cardiovascular diseases are predisposed by various risk factors, including hypertension, as the most important modifiable risk factor. However, there is a lack of sufficient data concerning the impact of air pollution on hypertension. We sought to study the associations of short-term exposure to Sulfur dioxide (SO2) and particulate matter (PM10) with the number of daily hospital admissions of hypertensive cardiovascular diseases (HCD). Methods: All hospitalized patients between March 2010 to March 2012 were recruited with the final diagnosis of HCD based on the International Classification of Diseases 10 (codes: I10-I15) from 15 hospitals in Isfahan, one of the most polluted cities in Iran. The 24-hour average concentrations of pollutants were obtained from 4 monitoring stations. In addition to single- and two-pollutant models, we used Negative Binomial and Poisson models with covariates of holidays, dew point, temperature, wind speed, and extracted latent factors of other pollutants controlling for multi-collinearity to examine the risk for hospital admissions for HCD affected by SO2 and PM10 exposures in the multi-pollutant model. Results: A total of 3132 hospitalized patients (63% female) with a mean (standard deviation) age of 64.96 (13.81) were incorporated in the study. The mean concentrations of SO2 and PM10 were 37.64 μg/m3 and 139.08 μg/m3, respectively. Our findings showed that a significantly increased risk of HCD-induced hospital admission was detected for a 10 μg/m3 increase in the 6-day and 3-day moving average of SO2 and PM10 concentrations in the multi-pollutant model with a percent change of 2.11% (95% confidence interval: 0.61 to 3.63%) and 1.19% (0.33 to 2.05%), respectively. This finding was robust in all models and did not vary by gender (for SO2 and PM10) and season (for SO2). However, people aged 35-64 and 18-34 years were vulnerable to SO2 and PM10 exposure-triggered HCD risk, respectively. Conclusions: This study supports the hypothesis of the association between short-term exposure to ambient SO2 and PM10 and the number of hospital admissions due to HCD.
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Affiliation(s)
- Fatemeh Nouri
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Taheri
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdi Ziaddini
- Student Research Committee, Department of Occupational Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamshid Najafian
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Katayoun Rabiei
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Pourmoghadas
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Solid Sampling Pyrolysis Adsorption-Desorption Thermal Conductivity Method for Rapid and Simultaneous Detection of N and S in Seafood. Molecules 2022; 27:molecules27248909. [PMID: 36558042 PMCID: PMC9786581 DOI: 10.3390/molecules27248909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
In this work, a rapid method for the simultaneous determination of N and S in seafood was established based on a solid sampling absorption-desorption system coupled with a thermal conductivity detector. This setup mainly includes a solid sampling system, a gas line unit for controlling high-purity oxygen and helium, a combustion and reduction furnace, a purification column system for moisture, halogen, SO2, and CO2, and a thermal conductivity detector. After two stages of purging with 20 s of He sweeping (250 mL/min), N2 residue in the sample-containing chamber can be reduced to <0.01% to improve the device’s analytical sensitivity and precision. Herein, 100 s of heating at 900 °C was chosen as the optimized decomposition condition. After the generated SO2, H2O, and CO2 were absorbed by the adsorption column in turn, the purification process executed the vaporization of the N-containing analyte, and then N2 was detected by the thermal conductivity cell for the quantification of N. Subsequently, the adsorbed SO2 was released after heating the SO2 adsorption column and then transported to the thermal conductivity cell for the detection and quantification of S. After the instrumental optimization, the linear range was 2.0−100 mg and the correlation coefficient (R) was more than 0.999. The limit of detection (LOD) for N was 0.66 μg and the R was less than 4.0%, while the recovery rate ranged from 95.33 to 102.8%. At the same time, the LOD for S was 2.29 μg and the R was less than 6.0%, while the recovery rate ranged from 92.26 to 105.5%. The method was validated using certified reference materials (CRMs) and the measured N and S concentrations agreed with the certified values. The method indicated good accuracy and precision for the simultaneous detection of N and S in seafood samples. The total time of analysis was less than 6 min without the sample preparation process, fulfilling the fast detection of N and S in seafood. The establishment of this method filled the blank space in the area of the simultaneous and rapid determination of N and S in aquatic product solids. Thus, it provided technical support effectively to the requirements of risk assessment and detection in cases where supervision inspection was time-dependent.
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Yan M, Hou F, Xu J, Liu H, Liu H, Zhang Y, Liu H, Lu C, Yu P, Wei J, Tang NJ. The impact of prolonged exposure to air pollution on the incidence of chronic non-communicable disease based on a cohort in Tianjin. ENVIRONMENTAL RESEARCH 2022; 215:114251. [PMID: 36063911 DOI: 10.1016/j.envres.2022.114251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/21/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Evidence on the associations of prolonged ambient pollutants exposure with chronic non-communicable diseases among middle-aged and elderly residents is still limited. This prospective cohort study intends to investigate the long-term effects of ambient pollution on hypertension and diabetes incidence among relatively older residents in China. Individual particulate matter exposure levels were estimated by satellite-based model. Individual gaseous pollutants exposure levels were estimated by Inverse Distance Weighted model. A Cox regression model was employed to assess the risks of hypertension and diabetes morbidity linked to air pollutants exposures. The cross-product term of ambient pollutants exposure and covariates was further added into the regression model to test whether covariates would modify these air pollution-morbidity associations. During the period from 2014 to 2018, a total of 97,982 subjects completed follow-up. 12,371 incidents of hypertension and 2034 of diabetes occurred. In the multi-covariates model, the hazard ratios (HR) and 95% confidence interval (CI) were 1.49 (1.45-1.52), 1.28 (1.26-1.30), 1.17 (1.15-1.18), 1.21 (1.17-1.25) and 1.33 (1.31-1.35) for hypertension morbidity per 10 μg/m3 increment in PM1, PM2.5, PM10, NO2 and SO2, respectively. For diabetes onsets, the HR (95% CI) were 1.17 (1.11-1.23), 1.09 (1.04-1.13), 1.06 (1.02-1.09), 1.02 (0.95-1.10), and 1.24 (1.19-1.29), respectively. In addition, for hypertension analyses, the effect estimates were more pronounced in the participants with age <60 years old, BMI ≥24 kg/m2, and frequent alcohol drinking. These findings provided the evidence on elevated risks of morbidity of hypertension and diabetes associated with prolonged ambient pollutants exposure at relatively high levels.
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Affiliation(s)
- Mengfan Yan
- Department of Occupational and Environmental Health Science, School of Public Health, Tianjin Medical University, Tianjin, 300070, China; School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, 300070, China
| | - Fang Hou
- Community Health Service Center, Jiefang Road, Tanggu Street, Binhai New District, Tianjin, China
| | - Jiahui Xu
- Department of Occupational and Environmental Health Science, School of Public Health, Tianjin Medical University, Tianjin, 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, 300070, China
| | - Huanyu Liu
- Department of Occupational and Environmental Health Science, School of Public Health, Tianjin Medical University, Tianjin, 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, 300070, China
| | - Hongyan Liu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China
| | - Yourui Zhang
- Community Health Service Center, Jiefang Road, Tanggu Street, Binhai New District, Tianjin, China
| | - Hao Liu
- Community Health Service Center, Jiefang Road, Tanggu Street, Binhai New District, Tianjin, China
| | - Chunlan Lu
- Community Health Service Center, Jiefang Road, Tanggu Street, Binhai New District, Tianjin, China
| | - Pei Yu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China.
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, 20742, United States.
| | - Nai-Jun Tang
- Department of Occupational and Environmental Health Science, School of Public Health, Tianjin Medical University, Tianjin, 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, 300070, China.
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Yan M, Ge H, Zhang L, Chen X, Yang X, Liu F, Shan A, Liang F, Li X, Ma Z, Dong G, Liu Y, Chen J, Wang T, Zhao B, Zeng Q, Lu X, Liu Y, Tang NJ. Long-term PM 2.5 exposure in association with chronic respiratory diseases morbidity: A cohort study in Northern China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 244:114025. [PMID: 36049332 PMCID: PMC10380089 DOI: 10.1016/j.ecoenv.2022.114025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
Several literatures have examined the risk of chronic respiratory diseases in association with short-term ambient PM2.5 exposure in China. However, little evidence has examined the chronic impacts of PM2.5 exposure on morbidity of chronic respiratory diseases in cohorts from high pollution countries. Our study aims to investigate the associations. Based on a retrospective cohort among adults in northern China, a Cox regression model with time-varying PM2.5 exposure and a concentration-response (C-R) curve model were performed to access the relationships between incidence of chronic respiratory diseases and long-term PM2.5 exposure during a mean follow-up time of 9.8 years. Individual annual average PM2.5 estimates were obtained from a satellite-based model with high resolution. The incident date of a chronic respiratory disease was identified according to self-reported physician diagnosis time and/or intake of medication for treatment. Among 38,047 urban subjects analyzed in all-cause chronic respiratory disease cohort, 482 developed new cases. In CB (38,369), asthma (38,783), and COPD (38,921) cohorts, the onsets were 276, 89, and 14, respectively. After multivariable adjustment, hazard ratio and 95% confidence interval for morbidity of all-cause chronic respiratory disease, CB, asthma, and COPD were 1.15 (1.01, 1.31), 1.20 (1.00, 1.42), 0.76 (0.55, 1.04), and 0.66 (0.29, 1.47) with each 10 μg/m3 increment in PM2.5, respectively. Stronger effect estimates were suggested in alcohol drinkers across stratified analyses. Additionally, the shape of C-R curve showed an increasing linear relationship before 75.00 μg/m3 concentrations of PM2.5 for new-onset all-cause chronic respiratory disease, and leveled off at higher levels. These findings indicated that long-term exposure to high-level PM2.5 increased the risks of incident chronic respiratory diseases in China. Further evidence of C-R curves is warranted to clarify the associations of adverse chronic respiratory outcomes involving air pollution.
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Affiliation(s)
- Mengfan Yan
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Han Ge
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Liwen Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Xi Chen
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Xueli Yang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Fangchao Liu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Anqi Shan
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Fengchao Liang
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen 518055, China
| | - Xuejun Li
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Zhao Ma
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
| | - Guanghui Dong
- Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yamin Liu
- School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, Jinan 250062, China
| | - Jie Chen
- Department of Occupational and Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Tong Wang
- School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - Baoxin Zhao
- Taiyuan Center for Disease Control and Prevention, Taiyuan 030001, China
| | - Qiang Zeng
- Tianjin Center for Disease Control and Prevention, Tianjin 300011, China
| | - Xiangfeng Lu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yang Liu
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Nai-Jun Tang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China.
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9
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Zha Q, Chai G, Zhang ZG, Sha Y, Su Y. Short-term effects of main air pollutants exposure on LOS and costs of CVD hospital admissions from 30,959 cases among suburban farmers in Pingliang, Northwest China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:50819-50831. [PMID: 35239119 DOI: 10.1007/s11356-022-18870-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although cardiovascular disease (CVD) has been the major contributor to global mortality and disability especially in undeveloped and developing countries/areas with severer air pollutions, studies are quite limited and evidence is insufficient of short-term main air pollutants exposure on health burden of CVD hospital admissions in those regions particularly through direct costs. METHOD Based on an analysis of 30,959 CVD hospital admissions among suburban farmers from 2018 to 2019 through multiple linear regression (MLR), our study evaluated the impact of main air pollutants (PM2.5, PM10, SO2, CO, NO2 and O3) exposure on number of cases, length of stay (LOS) and costs of CVD hospital admissions in Pingliang, China. RESULTS Concentration of SO2 and O3 rising from a low level was found to lower the costs, LOS and daily cases of CVD hospital admissions and PM2.5, PM10, CO and NO2 were found to aggravate the burden. Besides, the NO2 could put more economic stress on those CVD patients in Pingliang (China) which implies that some improvements could be done on public medical insurance policy and benefit local suburban farmers by strengthening the supports on specific drugs and therapies. CONCLUSIONS More efforts should be made to lower the concentration of air pollution by coordinated control managements even in a low-level scenario. Concentration levels and interactions between main air pollutants may play an important role in air pollution-induced CVD health burden. Future research is needed to explore more evidence in different areas, especially with low-level SO2 effects.
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Affiliation(s)
- Qunwu Zha
- School of Management, Lanzhou University, Lanzhou, 730000, People's Republic of China
- Hospital Management Research Center, Lanzhou University, Lanzhou, 730000, People's Republic of China
- Research Center for Emergency Management, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Guorong Chai
- School of Management, Lanzhou University, Lanzhou, 730000, People's Republic of China.
- Hospital Management Research Center, Lanzhou University, Lanzhou, 730000, People's Republic of China.
- Research Center for Emergency Management, Lanzhou University, Lanzhou, 730000, People's Republic of China.
| | - Zhe-George Zhang
- School of Management, Lanzhou University, Lanzhou, 730000, People's Republic of China.
- Department of Decision Sciences, Western Washington University, Bellingham, WA, 98225-9077, USA.
- Beedie School of Business, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.
| | - Yongzhong Sha
- School of Management, Lanzhou University, Lanzhou, 730000, People's Republic of China
- Hospital Management Research Center, Lanzhou University, Lanzhou, 730000, People's Republic of China
- Research Center for Emergency Management, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Yana Su
- School of Management, Lanzhou University, Lanzhou, 730000, People's Republic of China
- College of Economics and Management, Lanzhou Institute of Technology, Lanzhou, 730050, People's Republic of China
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10
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Yu Q, Zuo G. Relationship of indoor solid fuel use for cooking with blood pressure and hypertension among the elderly in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:53444-53455. [PMID: 35284972 PMCID: PMC9343286 DOI: 10.1007/s11356-022-19612-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
Indoor air pollution caused by solid fuel use for cooking affects 2.5 billion people worldwide and may elevate blood pressure (BP) and increase the burden of hypertension. Although the elderly are the most at risk of an elevated BP and hypertension, few studies have evaluated the effect of indoor solid fuel use for cooking on BP in persons over the age of 65. Therefore, in this study, we randomly selected 8067 elderly people over 65 years of age from the 2018 Chinese Longitudinal Healthy Longevity Survey to determine the impact of indoor solid fuel use on BP/hypertension. The results showed that, compared with those who cooked with clean fuel, those who cooked with solid fuel had a 1.87 mmHg higher systolic blood pressure, a 0.09 mmHg higher diastolic blood pressure, a 0.97 mmHg higher pulse pressure, and a 1.22 mmHg higher mean arterial pressure. However, we did not find any association between indoor solid fuel use and hypertension. We further observed that northern China residents, women, people aged over 90 years, hypertensive and heart patients, and those with natural ventilation in the kitchen that used indoor solid fuel experienced a greater BP impact. Replacing solid fuel with clean fuel may be an important way to lower BP. Regarding this, priority access to clean fuel should be given to the susceptible population, including the elderly aged ≥ 75 years, northern China residents, women, and hypertensive and heart patients.
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Affiliation(s)
- Qiutong Yu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine Shandong University, 44 Wen-hua-xi Road, Jinan, 250012, Shandong, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, 44 Wen-hua-xi Road, Jinan, 250012, Shandong, China
| | - Genyong Zuo
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine Shandong University, 44 Wen-hua-xi Road, Jinan, 250012, Shandong, China.
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, 44 Wen-hua-xi Road, Jinan, 250012, Shandong, China.
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11
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Liu Q, Li G, Zhang L, Liu J, Du J, Shao B, Li Z. Effects of household cooking with clean energy on the risk for hypertension among women in Beijing. CHEMOSPHERE 2022; 289:133151. [PMID: 34871615 DOI: 10.1016/j.chemosphere.2021.133151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/09/2021] [Accepted: 12/01/2021] [Indexed: 06/13/2023]
Abstract
Outdoor air pollution and indoor burning of biomass fuel can cause high blood pressure. However, little is known about the effects of cooking with clean energy on hypertension. We thus explored whether cooking with clean energy is associated with the risk for hypertension. The study used baseline data from 12,349 women from a large population-based cohort study in Beijing, China. Information on cooking habits, health status, and other characteristics was collected by questionnaire and physical examination. Fasting blood samples were collected to measure total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and homocysteine (HCY). An index of cooking exposure was constructed. Log-binomial regression models were used to estimate the association between cooking exposure and risk for hypertension. The prevalence of hypertension was 26.7%. Any cooking exposure at all was associated with an increased risk for hypertension with an adjusted prevalence ratio (aPR) of 2.27 (95% confidence interval [CI]: 2.01, 2.57). The risk for hypertension increased with increases in cooking frequency, time spent cooking, and the cooking index, all showing a dose-effect relationship (P < 0.001). An increased risk for hypertension was associated with both cooking using mainly electricity (aPR: 1.75, 95% CI: 1.41, 2.17) and cooking using mainly natural gas (aPR: 2.30, 95% CI: 2.03, 2.60). The cooking index was positively correlated with plasma concentrations of TC, TG, LDL-C, and HCY and negatively correlated with HDL-C. Abnormal levels of all these biomarkers were associated with an increased prevalence of hypertension after adjustment for confounding factors. Cooking with clean energy, mainly cooking habit, may contribute to an increased risk for hypertension among female residents of Beijing. Abnormal metabolism of lipids or HCY may be an important mechanism involved in the development of cooking-related hypertension.
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Affiliation(s)
- Qingping Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, PR China; Beijing Center for Disease Prevention and Control, Beijing, 100013, PR China.
| | - Gang Li
- Beijing Center for Disease Prevention and Control, Beijing, 100013, PR China.
| | - Le Zhang
- Institute of Reproductive and Child Health, Peking University/ Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, 100191, PR China.
| | - Jufen Liu
- Institute of Reproductive and Child Health, Peking University/ Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, 100191, PR China.
| | - Jing Du
- Beijing Center for Disease Prevention and Control, Beijing, 100013, PR China.
| | - Bing Shao
- Beijing Center for Disease Prevention and Control, Beijing, 100013, PR China.
| | - Zhiwen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, PR China; Institute of Reproductive and Child Health, Peking University/ Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, 100191, PR China.
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12
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HU YANRU, WU TINGTING, LIU XIAOLI, QIAO DECAI. Effects of exercise on the cardiovascular function of rats in a sulfur dioxide polluted environment. AN ACAD BRAS CIENC 2022; 94:e20211180. [DOI: 10.1590/0001-3765202220211180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- YANRU HU
- School of Humanities, Beijing Dance Academy, China; College of Physical Education and Sports, China
| | | | - XIAOLI LIU
- College of Physical Education and Sports, China
| | - DECAI QIAO
- College of Physical Education and Sports, China
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13
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Qin P, Luo X, Zeng Y, Zhang Y, Li Y, Wu Y, Han M, Qie R, Wu X, Liu D, Huang S, Zhao Y, Feng Y, Yang X, Hu F, Sun X, Hu D, Zhang M. Long-term association of ambient air pollution and hypertension in adults and in children: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 796:148620. [PMID: 34274662 DOI: 10.1016/j.scitotenv.2021.148620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/16/2021] [Accepted: 06/19/2021] [Indexed: 06/13/2023]
Abstract
AIMS The association of long-term ambient air pollution and hypertension has been inconsistently reported. We performed an updated systematic review and meta-analysis to assess the association between long-term exposure to ambient air pollution and risk of hypertension in adults and in children. METHODS PubMed, EMBASE, and Web of Science were searched up to August 7, 2020 for published articles examining the association of long-term exposure to ambient air pollution, including particulate matter (PM; ultrafine particles, PM1, PM1-2.5, PM2.5, PM2.5-10 and PM10), nitrogen dioxide (NO2), nitrogen oxides (NOx), sulfur dioxide (SO2), ozone (O3), carbon monoxide (CO) and hypertension. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for hypertension with each 10-μg/m3 increase in air pollutants were calculated by random-effects models. RESULTS We included 57 studies (53 of adults and 4 of children) in the meta-analysis. Risk of hypertension was significantly increased in adults with each 10-μg/m3 increase in exposure to PM2.5 (OR 1.10, 95% CI 1.07-1.14; I2 = 93.1%; n = 37), PM10 (1.04, 1.02-1.07; I2 = 44.8%; n = 22), and SO2 (1.21, 1.08-1.36; I2 = 96.6%; n = 3). Hypertension was not significantly associated with PM1 (n = 2), PM2.5-10 (n = 16), NO2 (n = 27), or NOx (n = 17). In children, the summary ORs (95% CIs) for each 10-μg/m3 increase in PM2.5, PM10, SO2 and O3 were 2.82 (0.51-15.68; I2 = 83.8%; n = 2), 1.15 (1.01-1.32; I2 = 0; n = 2), 8.57 (0.13-575.58; I2 = 94.2%; n = 2), and 1.26 (0.81-1.09, I2 = 91.6%; n = 2), respectively. CONCLUSIONS Long-term ambient air pollution is a potential risk factor for hypertension in adults. More studies are needed to explore the effects of long-term air pollution on hypertension in children.
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Affiliation(s)
- Pei Qin
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China; Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Xinping Luo
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China; Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Yunhong Zeng
- Department of Health Management, Shenzhen Hospital of University of Chinese Academy of Sciences, Shenzhen, China
| | - Yanyan Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China; Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Yang Li
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China; Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China; The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Yuying Wu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China; Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Minghui Han
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, China
| | - Ranran Qie
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, China
| | - Xiaoyan Wu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China; Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China; Department of Health Management, Shenzhen Hospital of University of Chinese Academy of Sciences, Shenzhen, China
| | - Dechen Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, China
| | - Shengbing Huang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, China
| | - Yifei Feng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, China
| | - Xingjin Yang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, China
| | - Fulan Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China; Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Xizhuo Sun
- The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Dongsheng Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China; Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China; The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, China; Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, China
| | - Ming Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China; Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathology, Shenzhen University School of Medicine, Shenzhen, Guangdong, China.
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