Quantification of mortality and morbidity attributed to the ambient air criteria pollutants in Shiraz city, Iran

Two Decades of Air Pollution Health Risk Assessment: Insights From the Use of WHO's AirQ and AirQ+ Tools

Objectives

We evaluated studies that used the World Health Organization's (WHO) AirQ and AirQ+ tools for air pollution (AP) health risk assessment (HRA) and provided best practice suggestions for future assessments.

Methods

We performed a comprehensive review of studies using WHO's AirQ and AirQ+ tools, searching several databases for relevant articles, reports, and theses from inception to Dec 31, 2022.

Results

We identified 286 studies that met our criteria. The studies were conducted in 69 countries, with most (57%) in Iran, followed by Italy and India (∼8% each). We found that many studies inadequately report air pollution exposure data, its quality, and validity. The decisions concerning the analysed population size, health outcomes of interest, baseline incidence, concentration-response functions, relative risk values, and counterfactual values are often not justified, sufficiently. Many studies lack an uncertainty assessment.

Conclusion

Our review found a number of common shortcomings in the published assessments. We suggest better practices and urge future studies to focus on the quality of input data, its reporting, and associated uncertainties.

Evaluating the mortality and health rate caused by the PM2.5 pollutant in the air of several important Iranian cities and evaluating the effect of variables with a linear time series model

All over the world, the level of special air pollutants that have the potential to cause diseases is increasing. Although the relationship between exposure to air pollutants and mortality has been proven, the health risk assessment and prediction of these pollutants have a therapeutic role in protecting public health, and need more research. The purpose of this research is to evaluate the ill-health caused by PM2.5 pollution using AirQ + software and to evaluate the different effects on PM2.5 with time series linear modeling by R software version 4.1.3 in the cities of Arak, Esfahan, Ahvaz, Tabriz, Shiraz, Karaj and Mashhad during 2019-2020. The pollutant hours, meteorology, population and mortality information were calculated by the Environmental Protection Organization, Meteorological Organization, Statistics Organization and Statistics and Information Technology Center of the Ministry of Health, Treatment and Medical Education for 24 h of PM2.5 pollution with Excel software. In addition, having 24 h of PM2.5 pollutants and meteorology is used to the effect of variables on PM2.5 concentration. The results showed that the highest and lowest number of deaths due to natural deaths, ischemic heart disease (IHD), lung cancer (LC), chronic obstructive pulmonary disease (COPD), acute lower respiratory infection (ALRI) and stroke in The effect of disease with PM2.5 pollutant in Ahvaz and Arak cities was 7.39-12.32%, 14.6-17.29%, 16.48-8.39%, 10.43-18.91%, 12.21-22.79% and 14.6-18.54 % respectively. Another result of this research was the high mortality of the disease compared to the mortality of the nose. The analysis of the results showed that by reducing the pollutants in the cities of Karaj and Shiraz, there is a significant reduction in mortality and linear modeling provides a suitable method for air management planning.

Climate change and human health in the Eastern Mediterranean and Middle East: Literature review, research priorities and policy suggestions

Human health is linked to climatic factors in complex ways, and climate change can have profound direct and indirect impacts on the health status of any given region. Susceptibility to climate change is modulated by biological, ecological and socio-political factors such as age, gender, geographic location, socio-economic status, occupation, health status and housing conditions, among other. In the Eastern Mediterranean and Middle East (EMME), climatic factors known to affect human health include extreme heat, water shortages and air pollution. Furthermore, the epidemiology of vector-borne diseases (VBDs) and the health consequences of population displacement are also influenced by climate change in this region. To inform future policies for adaptation and mitigation measures, and based on an extensive review of the available knowledge, we recommend several research priorities for the region. These include the generation of more empirical evidence on exposure-response functions involving climate change and specific health outcomes, the development of appropriate methodologies to evaluate the physical and psychological effects of climate change on vulnerable populations, determining how climate change alters the ecological determinants of human health, improving our understanding of the effects of long-term exposure to heat stress and air pollution, and evaluating the interactions between adaptation and mitigation strategies. Because national boundaries do not limit most climate-related factors expected to impact human health, we propose that adaptation/mitigation policies must have a regional scope, and therefore require collaborative efforts among EMME nations. Policy suggestions include a decisive region-wide decarbonisation, the integration of environmentally driven morbidity and mortality data throughout the region, advancing the development and widespread use of affordable technologies for the production and management of drinking water by non-traditional means, the development of comprehensive strategies to improve the health status of displaced populations, and fostering regional networks for monitoring and controlling the spread of infectious diseases and disease vectors.

Increased tropospheric ozone levels as a public health issue during COVID-19 lockdown and estimation the related pulmonary diseases

The aims of this study were to i) investigate the variation of tropospheric ozone (O₃) levels during the COVID-19 lockdown; ii) determine the relationships between O₃ concentrations with the number of COVID-19 cases; and iii) estimate the O₃-related health effects in Southwestern Iran (Khorramabad) over the time period 2019-2021. The hourly O₃ data were collected from ground monitoring stations, as well as retrieved from Sentinel-5 satellite data for showing the changes in O₃ levels pre, during, and after lockdown period. The concentration-response function model was applied using relative risk (RR) values and baseline incidence (BI) to assess the O₃-related health effects. Compared to 2019, the annual O₃ mean concentrations increased by 12.2% in 2020 and declined by 3.9% in 2021. The spatiotemporal changes showed a significant O₃ increase during COVID-19 lockdown, and a negative correlation between O₃ levels and the number of COVID-19 cases was found (r = - 0.59, p < 0.05). In 2020, the number of hospital admissions for cardiovascular diseases increased by 4.0 per 10⁵ cases, the mortality for respiratory diseases increased by 0.7 per 10⁵ cases, and the long-term mortality for respiratory diseases increased by 0.9 per 10⁵ cases. Policy decisions are now required to reduce the surface O₃ concentrations and O₃-related health effects in Iran.

Association Between Air Pollution, Climate Change, and COVID-19 Pandemic: A Review of the Recent Scientific Evidence

Background: Recent studies indicated the possible relationship between climate change, environmental pollution, and Coronavirus Disease 2019 (COVID-19) pandemic. This study reviewed the effects of air pollution, climate parameters, and lockdown on the number of cases and deaths related to COVID-19. Methods: The present review was performed to determine the effects of weather and air pollution on the number of cases and deaths related to COVID-19 during the lockdown. Articles were collected by searching the existing online databases, such as PubMed, Science Direct, and Google Scholar, with no limitations on publication dates. Afterwards, this review focused on outdoor air pollution, including PM2.5, PM10, NO2, SO2, and O3, and weather conditions affecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/COVID-19. Results: Most reviewed investigations in the present study showed that exposure to air pollutants, particularly PM2.5 and NO2, is positively related to COVID-19 patients and mortality. Moreover, these studies showed that air pollution could be essential in transmitting COVID-19. Local meteorology plays a vital role in coronavirus spread and mortality. Temperature and humidity variables are negatively correlated with virus transmission. The evidence demonstrated that air pollution could lead to COVID-19 transmission. These results support decision-makers in curbing potential new outbreaks. Conclusions: Overall, in environmental perspective-based COVID-19 studies, efforts should be accelerated regarding effective policies for reducing human emissions, bringing about air pollution and weather change. Therefore, using clean and renewable energy sources will increase public health and environmental quality by improving global air quality.

Ambient air pollutants and respiratory health outcomes in Tabriz and Urmia, two metropolises of Iran

Polluted air affects human life and it is crucial to assess air pollutants to inform policy and protect human lives. In this study, we sought to assess the respiratory outcomes associated with PM₁₀, O₃, SO₂, and NO₂ in the Iranian population. The required data, which included concentrations of air pollutants, meteorology, and population size, were obtained from the department of environment and meteorological organizations. The validity of the data was evaluated, and appropriate calculations were conducted on the data to extract the required values and parameters for modeling (using the AirQ2.2.3). This study was conducted in two megacities of Iran (Tabriz and Urmia) with over 2 million population. The annual averages of SO₂, NO₂, and PM₁₀ concentrations were 9, 73, and 43 μg/m³ in Tabriz and 76, 29, and 76 μg/m³ in Urmia, respectively. Excess deaths from respiratory diseases associated with PM₁₀ and SO₂ were estimated to be 33.1 and 1.2 cases in Tabriz and 31.6 and 24.7 cases in Urmia, respectively. The proportions of hospitalizations for chronic obstructive pulmonary disease (COPD) attributable to SO₂ and NO₂ in Tabriz were 0.07% and 1.61%, respectively, whereas they were 2.84% and 0.48% in Urmia. O₃ had an annual average of 56 μg/m³ in Tabriz and with 44.5 excess respiratory deaths and 42.5 excess hospital admissions for COPD, it had the greatest health impacts among the pollutants studied. Findings from this study add to the growing literature, especially from developing countries, that provides insights to help authorities and decision-makers develop and implement effective interventions to curb air pollution and save lives.

Health impacts quantification attributed to ambient particulate matter in the nearest Iranian city to the main dust source

Urban air contamination is one of the ten most dangerous parameters for human health, which causes cardiovascular disease, respiratory, metabolic diseases, and decreased lung function. Air Q is a reliable software for studying the impacts of atmospheric contaminants on human health, and today, it is widely used in the environment. The purpose of this research was to quantify the mortality and morbidity rates that corresponded to ambient particulate matter (PM) in Rigan City. To perform this, the Air Q software was used. The findings reflected that the yearly mean values of PM₁₀ and PM_2.5 are 264.83 and 50.45 μg/m³. The findings indicated that the PM₁₀ and PM_2.5 content in Rigan was above standard levels described by WHO. The total number of deaths, cardiovascular deaths, and respiratory deaths due to PM in Rigan were estimated as 70.3, 45.8, and 10.7 persons, respectively. Hospital admissions for cardiovascular and respiratory diseases correlated to PM₁₀ were estimated at 154.2 and 59 persons, respectively. Acute myocardial infarction associated with PM_2.5 was 2.7 persons. Overall, the data in this study may be helpful to national and regional policymakers who are responsible for managing and preventing atmospheric contamination and assessing the costs of health risks.

Ozone modelling and mapping for risk assessment: An overview of different approaches for human and ecosystems health

Tropospheric ozone (O₃) is one of the most concernedair pollutants dueto its widespread impacts on land vegetated ecosystems and human health. Ozone is also the third greenhouse gas for radiative forcing. Consequently, it should be carefully and continuously monitored to estimate its potential adverse impacts especially inthose regions where concentrations are high. Continuous large-scale O₃ concentrations measurement is crucial but may be unfeasible because of economic and practical limitations; therefore, quantifying the real impact of O₃over large areas is currently an open challenge. Thus, one of the final objectives of O₃ modelling is to reproduce maps of continuous concentrations (both spatially and temporally) and risk assessment for human and ecosystem health. We here reviewedthe most relevant approaches used for O₃ modelling and mapping starting from the simplest geo-statistical approaches andincreasing in complexity up to simulations embedded into the global/regional circulation models and pro and cons of each mode are highlighted. The analysis showed that a simpler approach (mostly statistical models) is suitable for mappingO₃concentrationsat the local scale, where enough O₃concentration data are available. The associated error in mapping can be reduced by using more complex methodologies, based on co-variables. The models available at the regional or global level are used depending on the needed resolution and the domain where they are applied to. Increasing the resolution corresponds to an increase in the prediction but only up to a certain limit. However, with any approach, the ensemble models should be preferred.

A Review of Studies Using Air Q Software for Prediction of Air Pollution Health Effects in Iran

PURPOSE OF REVIEW

Exposure to air pollutants may lead to various health effects and is a major public health issue. Concerns about these effects exist in both developed and developing countries. The Air Q software was developed to estimate the health impacts of air pollution based on reported levels of air pollutants in real world studies. In Iran several studies have been conducted to estimate human morbidity and mortality based on this software. We conducted this review to summarize articles which have predicted the effects of air pollution on human health in Iran using Air Q. We conducted a systematic search for relevant studies published until 24 April 2021 in Web of Science, PubMed, Scopus, and SID (Scientific Information Database which includes articles in Farsi language). We applied no time or language restrictions.

RECENT FINDINGS

A total of 44 studies out of 525 identified articles met our inclusion criteria. The main air pollutants under investigation were particulate matter (PM), NO₂, O₃, and SO₂. Most studies were conducted in metropolitan areas, such as Ahvaz (9 studies), Tehran (9 studies), and Shiraz (7 studies). In all studies, the levels of most air pollutants were higher than the 2005 WHO guideline levels and were predicted to be related to considerable health effects. However, it was not possible to aggregate the results and report the total number of casualties during these years, because studies were done in different cities with fluctuating levels of multiple pollutants and in different years and time frames. This systematic review showed that air pollution remains at unacceptably high levels resulting in substantial detrimental health effects in various Iranian cities. Using clean renewable energies, increasing human capital, and increasing green spaces and vegetation can help improve air pollution and decrease human casualties in Iran.

The prospective effects of long-term exposure to ambient PM2.5 and constituents on mortality in rural East China

Few cohort studies explored the associations of long-term exposure to ambient fine particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) and its chemical constituents with mortality risk in rural China. We conducted a 12-year prospective study of 28,793 adults in rural Deqing, China from 2006 to 2018. Annual mean PM2.5 and its constituents, including black carbon (BC), organic carbon (OC), ammonium (NH4+), nitrate (NO3-), sulfate (SO42-), and soil dust were measured at participants' addresses at enrollment from a satellite-based exposure predicting model. Cox proportional hazard model was used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs) of long-term exposure to PM2.5 for mortality. A total of 1960 deaths were identified during the follow-up. We found PM2.5, BC, OC, NH4+, NO3-, and SO42- were significantly associated with an increased risk of non-accidental mortality. The HR for non-accidental mortality was 1.17 (95%CI: 1.07, 1.28) for each 10 μg/m3 increase in PM2.5. As for constituents, the strongest association was found for BC (HR = 1.21, 95%CI: 1.11, 1.33), followed by NO3-, NH4+, SO42-, and OC (HR = 1.14-1.17 per interquartile range). A non-linear relationship was found between PM2.5 and non-accidental mortality. Similar associations were found for cardio-cerebrovascular and cancer mortality. Associations were stronger among men and ever smokers. Conclusively, we found long-term exposure to ambient PM2.5 and its chemical constituents (especially BC and NO3-) increased mortality risk. Our results suggested the importance of adopting effective targeted emission control to improve air quality for health protection in rural East China.

Short-term effect of multi-pollutant air quality indexes and PM2.5 on cardiovascular hospitalization in Hamadan, Iran: a time-series analysis

Air pollutants are the most important environmental factors that contributed to cardiovascular disease (CVD). The present study aimed to investigate the number of hospitalization due to heart failure (HF) and myocardial infarction (MI) following the air pollutant exposure using a time-series regression analysis with a distributed lag model in Hamadan, Iran (2015-2019). A total of 2091 cases of CVD were registered. Based on the findings, the highest health effects on HF hospitalization were observed with air quality health index (AQHI) at lag 9 (RR = 1.043, 95% CI 0.991-1.098), and air quality index (AQI) at lags 2, 7, and 9 (RR = 1.001, 95% CI 0.998-1.002), for an increase in 1 unit of the indexes, and with PM_2.5 at lag 0 (RR = 1.001, 95% CI 0.996-1.004) for 10 μg/m³ increase in PM_2.5 levels. The highest health effects on MI hospitalization were calculated with AQHI at lag 10 (RR = 1.059, 95% CI 1.001-1.121) and AQI at lags 1 and 2 (RR = 1.001, 95% CI 0.998-1.002), for an increase in 1 unit of the indexes, and with PM_2.5 at lag 8 (RR = 1.002, 95% CI 0.997-1.005) for 10 μg/m³ increase in PM_2.5 levels. According to a seasonal classification, results showed that hospitalization in the warm season was higher than that of the cold season. Based on our knowledge, the current study is the first study that investigated the effect of air quality indexes on hospitalization due to HF and MI in Iran. Findings can provide basic information to plan preventive measures for reducing exposure chance and hospitalization rate in high-risk people.

Impact of exposure to ambient air pollutants on the admission rate of hospitals for asthma disease in Shiraz, southern Iran

Asthma is a common chronic respiratory disease in the world. Short-term exposure to ambient air pollutants is closely related to acute respiratory diseases and asthmatic symptoms. The purpose of this research was to estimate the correlation between exposure to three air pollutants (O₃, NO₂, and SO₂) and hospital admission because of asthmatic disease (HAAD) in the city of Shiraz, southern Iran. The data were collected from the two real-time monitoring stations located in this city. The acquired information was used for developing predictive models by the AirQ software. The findings of this study were reported for two age groups (<15 and 15-64 years old). The highest levels of O₃, NO₂, and SO₂ were obtained 187.33 μg/m³, 34.1 μg/m³, and 491.2 μg/m³ in 2016, respectively, and 227.75 μg/m³, 92.26 μg/m³, and 190.21 μg/m³, respectively, in 2017. Among the mentioned pollutants, the yearly average concentration of SO₂ was 8.62 times more than the WHO guideline, during the studied times. The number of extra cases of HAAD for <15 years and 15-64 years caused by the air pollutants in Shiraz were estimated to be 273 and 36, respectively, in 2016, and 243 and 30 for 2017, respectively. The results of this work displayed that air pollutants have caused respiratory problems in Shiraz city. The AirQ model is a facile and potential tool for the prediction of asthma disease to reduce the health risk of atmospheric pollutants in the worldwide.