Health impact assessment of air pollutants during the COVID-19 pandemic in a Brazilian metropolis

Burden of cardiovascular disease attributed to air pollution: a systematic review

BACKGROUND

Cardiovascular diseases (CVDs) are estimated to be the leading cause of global death. Air pollution is the biggest environmental threat to public health worldwide. It is considered a potentially modifiable environmental risk factor for CVDs because it can be prevented by adopting the right national and international policies. The present study was conducted to synthesize the results of existing studies on the burden of CVDs attributed to air pollution, namely prevalence, hospitalization, disability, mortality, and cost characteristics.

METHODS

A systematic search was performed in the Scopus, PubMed, and Web of Science databases to identify studies, without time limitations, up to June 13, 2023. Exclusion criteria included prenatal exposure, exposure to indoor air pollution, review studies, conferences, books, letters to editors, and animal and laboratory studies. The quality of the articles was evaluated based on the Agency for Healthcare Research and Quality Assessment Form, the Newcastle-Ottawa Scale, and Drummond Criteria using a self-established scale. The articles that achieved categories A and B were included in the study.

RESULTS

Of the 566 studies obtained, based on the inclusion/exclusion criteria, 92 studies were defined as eligible in the present systematic review. The results of these investigations supported that chronic exposure to various concentrations of air pollutants, increased the prevalence, hospitalization, disability, mortality, and costs of CVDs attributed to air pollution, even at relatively low levels. According to the results, the main pollutant investigated closely associated with hypertension was PM2.5. Furthermore, the global DALY related to stroke during 2016-2019 has increased by 1.8 times and hospitalization related to CVDs in 2023 has increased by 8.5 times compared to 2014.

CONCLUSION

Ambient air pollution is an underestimated but significant and modifiable contributor to CVDs burden and public health costs. This should not only be considered an environmental problem but also as an important risk factor for a significant increase in CVD cases and mortality. The findings of the systematic review highlighted the opportunity to apply more preventive measures in the public health sector to reduce the footprint of CVDs in human society.

Effect of particulate matter (PM2.5 and PM10) on health indicators: climate change scenarios in a Brazilian metropolis

Recife is recognized as the 16th most vulnerable city to climate change in the world. In addition, the city has levels of air pollutants above the new limits proposed by the World Health Organization (WHO) in 2021. In this sense, the present study had two main objectives: (1) To evaluate the health (and economic) benefits related to the reduction in mean annual concentrations of PM₁₀ and PM_2.5 considering the new limits recommended by the WHO: 15 µg/m³ (PM₁₀) and 5 µg/m³ (PM_2.5) and (2) To simulate the behavior of these pollutants in scenarios with increased temperature (2 and 4 °C) using machine learning. The averages of PM_2.5 and PM₁₀ were above the limits recommended by the WHO. The scenario simulating the reduction in these pollutants below the new WHO limits would avoid more than 130 deaths and 84 hospital admissions for respiratory or cardiovascular problems. This represents a gain of 15.2 months in life expectancy and a cost of almost 160 million dollars. Regarding the simulated temperature increase, the most conservative (+ 2 °C) and most drastic (+ 4 °C) scenarios predict an increase of approximately 6.5 and 15%, respectively, in the concentrations of PM_2.5 and PM₁₀, with a progressive increase in deaths attributed to air pollution. The study shows that the increase in temperature will have impacts on air particulate matter and health outcomes. Climate change mitigation and pollution control policies must be implemented for meeting new WHO air quality standards which may have health benefits.

Weekend effect on air pollutant levels in southernmost cities of Brazil with different economic activities

In view of the current premises of the need to investigate air pollution in small- and medium-sized cities, combined with concerns regarding the weekly behavior of air pollutants, this study aimed to investigate the weekly pattern of air pollution (O₃, NO₂, SO₂, PM_2.5) and the weekend effect in 4 Brazilian cities with different main economic activities. Our main findings include (1) positive weekend effect for all the assessed air pollutants in the four cities; therefore, in the southernmost region of Brazil, there was an increase in the concentration of air pollutants during weekends when compared to weekdays; (2) the highest levels of NO₂ and SO₂ were observed in the city characterized by the economic activity revolving around coal mining and generation of electricity through the burning of this mineraloid in a coal-fired power plant, while the highest levels of PM_2.5 were in the city with economic activity linked to industries, due to its recognized industrial complex; and (3) the seasonal evaluation of the weekend effect showed different behaviors for the air pollutants in each location, which is related to the set of meteorological conditions, economic activities, and population mobility in each location. In conclusion, our results demonstrate the aspects of pollution between cities and highlight that the comprehensive understanding of the weekend effect and its intricacies allows the responsible personal and government authorities to gain deep insights into the true effectiveness of future control strategies and the development of possible action plans.

Health impacts of PM2.5-bound metals and PAHs in a medium-sized Brazilian city

Rio Grande is a medium-sized industrial city located in the extreme south of Brazil, and previous studies in this city have shown contamination by metal(loids) and polycyclic aromatic hydrocarbons (PAHs) in water, soil, and sediment and in the atmosphere. In Brazil, the incorporation of PM_2.5 monitoring in environmental legislation is recent (2018) and, like other developing countries, the number of studies is still small. This study aimed to investigate the levels of PM_2.5 in the industrial and urban area of Rio Grande, to determine the concentration of metal(loid)s As, Cd, Cu, and Pb and of 16 PAHs in the samples of PM_2.5, to perform the health risk assessment for these contaminants and the health impact assessment for two possible scenarios of reduction of PM_2.5 levels. Our main findings regarding the PM_2.5 samples include the following: (1) The levels of this pollutant in the city of Rio Grande were higher than those allowed in current Brazilian legislation, in both the industrial and urban areas; (2) the existence of non-carcinogenic and carcinogenic risks for metals present in all samples; (3) the absence of carcinogenic risk for the assessed PAHs; and (4) the reduction scenarios proposed pointed to a reduction of up to 22 deaths annually in conjunction with reductions in health-related expenditures. Thus, these results may serve as a basis for the development of public health policies aimed at improving air quality, jointly assisting health surveillance and directing future studies towards a better intrinsic approach to the problem.

Modeling health impacts of air pollutant emissions from the coal-fired power industry based on LCA and oriented by WTP: a case study

Coal-fired power plants are one of the major sources of coal consumption in China; they discharge various air pollutants and cause serious human health damage. There is an urgent need to focus on the associated health effects. Thus, this study aims to advance an integrated life cycle assessment (LCA)-based health damage model to quantify the health burden of air pollutant emissions from coal-fired power generation (CFPG) and to achieve an economic interpretation of health damage. A case study of the Zaozhuang coal-fired power project was conducted to better visualize and mitigate the impacts. The results reveal that willingness to pay (WTP) for health damage caused by the CFPG project in 1 year amounted to USD 15.71 million, and the total amount of life lost was 155.81 years. During the CFPG process, coal combustion caused the most health damage, respiratory disease was the type of damage with the greatest influence on health, and SO₂ was the air pollutant that causes the most serious health damage. The model developed in this study can be broadly applied to assess the potential life loss due to air pollutant emissions from CFPG systems. The identified key points for health damage prevention can also be used as practical solutions for decision-making regarding the prioritization of control sources for environmental management.

Association between Particulate Matter Pollution Concentration and Hospital Admissions for Hypertension in Ganzhou, China

Fine particulate matter (PM_2.5) and respirable particulate matter (PM₁₀) are two major air pollutants with toxic effects on the cardiovascular system. Hypertension, as a chronic noncommunicable cardiovascular disease, is also a risk factor for several diseases. We applied generalized linear models with a quasi-Poisson link to assess the effect of air pollution exposure on the number of daily admissions for patients with hypertension. In addition, we established a two-pollutant model to evaluate PM_2.5 and PM₁₀ hazard effect stability by adjusting the other gaseous pollutants. Results showed that during the study period, 24 h mean concentrations of ambient PM_2.5 and PM₁₀ at 38.17 and 59.84 μg/m³, respectively, and a total of 2,611 hypertension hospital admissions were recorded. Air pollution concentrations significantly affected the number of hospitalizations for hypertension approximately 2 months after exposure. For each 10 μg/m³ increase in PM_2.5 and PM₁₀ in single-pollutant models, the number of hospitalizations for hypertension increased by 7.92% (95% CI: 5.48% to 10.42%) and 4.46% (95% CI: 2.86% to 5.65%), respectively, at the lag day with the strongest effect. NO₂, O₃, CO, and SO₂ had different significant effects on the number of hospitalizations over the same time period, and PM_2.5 and PM₁₀ still showed robust significant effects after adjustment of gas pollutants through a two-pollutant model. These findings may contribute to a better understanding of the health effects of ambient particulate matter.

Health impact assessment of air pollution in an area of the largest coal mine in Brazil

Coal exploration and burning activities are among the activities with the greatest potential to cause atmospheric pollution due to the combustion process of this mineral and the consequent release of particles that, in significant quantities, can pose a potential health risk, mainly respiratory and cardiovascular diseases. The Candiota region, in the extreme south of Brazil, concentrates 40% of the national reserves of mineral coal, and its burning is capable of releasing air pollutants, including particulate matter (PM). Some environmental and epidemiological studies have been carried out in the region, but so far, there is no investigation to estimate the impact of PM on health outcomes. The current study aimed to estimate the mortality attributed to the PM, as well as the benefits in health indicators associated with the reduction of air pollution to the limits set forth in local legislation and the WHO. Daily data on PM levels collected from an air quality monitoring station over a year were used, as well as population data and health indicators from 7 cities influenced by mining activities, such as total mortality and cardiovascular diseases and hospitalizations for cardiac and respiratory problems. In a scenario where PM levels are within legal limits, a percentage greater than 11% of cardiovascular deaths was attributed to pollution by PM2.5, and the reduction in PM10 and PM2.5 levels may be responsible for the increase in the expectation of life in up to 17 months and monetary gains of more than $ 24 million, due to the reduction in hospitalizations and mortality. Studies of this nature should be important tools made available to decision-makers, with a view to improving environmental laws and a consequent improvement in the quality of life and health indicators of the population.

Excess deaths from all causes and by COVID-19 in Brazil in 2020

OBJECTIVE

To estimate the 2020 all-cause and COVID-19 excess mortality according to sex, age, race/color, and state, and to compare mortality rates by selected causes with that of the five previous years in Brazil.

METHODS

Data from the Mortality Information System were used. Expected deaths for 2020 were estimated from 2015 to 2019 data using a negative binomial log-linear model.

RESULTS

Excess deaths in Brazil in 2020 amounted to 13.7%, and the ratio of excess deaths to COVID-19 deaths was 0.90. Reductions in deaths from cardiovascular diseases (CVD), respiratory diseases, and external causes, and an increase in ill-defined causes were all noted. Excess deaths were also found to be heterogeneous, being higher in the Northern, Center-Western, and Northeastern states. In some states, the number of COVID-19 deaths was lower than that of excess deaths, whereas the opposite occurred in others. Moreover, excess deaths were higher in men aged 20 to 59, and in black, yellow, or indigenous individuals. Meanwhile, excess mortality was lower in women, in individuals aged 80 years or older, and in whites. Additionally, deaths among those aged 0 to 19 were 7.2% lower than expected, with reduction in mortality from respiratory diseases and external causes. There was also a drop in mortality due to external causes in men and in those aged 20 to 39 years. Moreover, reductions in deaths from CVD and neoplasms were noted in some states and groups.

CONCLUSION

There is evidence of underreporting of COVID-19 deaths and of the possible impact of restrictive measures in the reduction of deaths from external causes and respiratory diseases. The impacts of COVID-19 on mortality were heterogeneous among the states and groups, revealing that regional, demographic, socioeconomic, and racial differences expose individuals in distinct ways to the risk of death from both COVID-19 and other causes.