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Duan R, Niu H, Ma L, Yang T. Genome-Wide DNA methylation profile analysis identifies differentially methylated loci associated with personal PM 2.5 exposure in adults with asthma. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 282:116743. [PMID: 39024952 DOI: 10.1016/j.ecoenv.2024.116743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/27/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024]
Abstract
Particulate matter with aerodynamic diameters ≤2.5 µm (PM2.5) is a major environmental risk factor for acute asthma exacerbation, and the underlying mechanism is not completely understood. Studies have indicated that DNA methylation is a potential mechanism linking PM2.5 to its health effects. We conducted a panel study involving 24 adult patients with asthma in Beijing,China between 2017 and 2019. PM2.5 and other atmospheric pollutant exposure data were repeatedly measured. Blood samples were collected for genome-wide DNA methylation analysis. A linear mixed-effects (LME) model was conducted to identify differentially methylated probes (DMPs) associated with PM2.5 exposure. After filtering out probes that did not meet the criteria through quality control, 811,001 CpG sites were included in the LME model, and 36 DMPs were strongly associated with personal PM2.5 exposure at false discovery rate (FDR) < 0.05, of which 22 and 14 DMPs negatively and positively correlated with personal PM2.5 exposure, respectively. Functional analysis revealed that DMPs affected smooth muscle cell contraction and development, extracellular matrix synthesis and secretion, T cell activation and differentiation, and inflammatory factor production. This study provides evidence linking personal PM2.5 exposure to genome-wide DNA methylation in adult patients with asthma. Identifying enrichment pathways can provide biological insights into the acute health effects of PM2.5.
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Affiliation(s)
- Rurui Duan
- Department of Pulmonary and Critical Care Medicine China-Japan Friendship Hospital, Beijing, China; National Center for Respiratory Medicine, Beijing, China; State Key Laboratory of Respiratory Health and Multi-morbidity, Beijing, China
| | - Hongtao Niu
- Department of Pulmonary and Critical Care Medicine China-Japan Friendship Hospital, Beijing, China; National Center for Respiratory Medicine, Beijing, China
| | - Linxi Ma
- Department of Pulmonary and Critical Care Medicine China-Japan Friendship Hospital, Beijing, China; National Center for Respiratory Medicine, Beijing, China; State Key Laboratory of Respiratory Health and Multi-morbidity, Beijing, China; Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine China-Japan Friendship Hospital, Beijing, China; National Center for Respiratory Medicine, Beijing, China; State Key Laboratory of Respiratory Health and Multi-morbidity, Beijing, China.
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Chen T, Shi S, Li X, Zhou L, Yu Y, Cai Y, Wang J, Kan H, Xu Y, Huang C, Tan Y, Meng X, Zhao Z. Improved ambient air quality is associated with decreased prevalence of childhood asthma and infancy shortly after weaning is a sensitive exposure window. Allergy 2024; 79:1166-1179. [PMID: 37458141 DOI: 10.1111/all.15815] [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: 11/16/2022] [Revised: 04/30/2023] [Accepted: 05/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The urban ambient air quality has been largely improved in the past decade. It is unknown whether childhood asthma prevalence is still increasing in ever top-ranking city of Shanghai, whether the improved air quality is beneficial for children's asthma and what time window of exposure plays critical roles. METHODS Using a repeat cross-sectional design, we analyzed the association between early life exposure to particles and wheezing/asthma in each individual and combined surveys in 2011 and 2019, respectively, in 11,825 preschool children in Shanghai. RESULTS A significantly lower prevalence of doctor-diagnosed asthma (DDA) (6.6% vs. 10.5%, p < 0.001) and wheezing (10.5% vs. 23.2%, p < 0.001) was observed in 2019 compared to 2011. Exposure to fine particulate matter (PM2.5), coarse particles (PM2.5-10) and inhalable particles (PM10) was decreased in 2019 by 6.3%, 35.4%, and 44.7% in uterus and 24.3%, 20.2%, and 31.8% in infancy, respectively. Multilevel log-binomial regression analysis showed exposure in infancy had independent association with wheezing/DDA adjusting for exposure in uterus. For each interquartile range (IQR) increase of infancy PM2.5, PM2.5-10 and PM10 exposure, the odds ratios were 1.39 (95% confidence interval (CI): 1.24-1.56), 1.51 (95% CI:1.15-1.98) and 1.53 (95% CI:1.27-1.85) for DDA, respectively. The distributed lag non-linear model showed the sensitive exposure window (SEW) was 5.5-11 months after birth. Stratified analysis showed the SEWs were at or shortly after weaning, but only in those with <6 months of exclusive breastfeeding. CONCLUSIONS Improved ambient PM benefits in decreasing childhood asthma prevalence. We firstly reported the finding of SEW to PM at or closely after weaning on childhood asthma.
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Affiliation(s)
- Tianyi Chen
- Department of Environmental Health, School of Public Health, the Key Laboratory of Public Health Safety of the Ministry of Education, and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Su Shi
- Department of Environmental Health, School of Public Health, the Key Laboratory of Public Health Safety of the Ministry of Education, and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Xinyue Li
- Department of Environmental Health, School of Public Health, the Key Laboratory of Public Health Safety of the Ministry of Education, and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Lu Zhou
- Department of Environmental Health, School of Public Health, the Key Laboratory of Public Health Safety of the Ministry of Education, and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yunfei Cai
- Department of General Management and Statistics, Shanghai Environment Monitoring Center, Shanghai, China
| | - Jing Wang
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, the Key Laboratory of Public Health Safety of the Ministry of Education, and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health IRDR International Center of Excellence on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health WMO/IGAC MAP-AQ Asian Office Shanghai, Fudan University, Shanghai, China
| | - Yanyi Xu
- Department of Environmental Health, School of Public Health, the Key Laboratory of Public Health Safety of the Ministry of Education, and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health IRDR International Center of Excellence on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health WMO/IGAC MAP-AQ Asian Office Shanghai, Fudan University, Shanghai, China
| | - Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Yongqiang Tan
- Department of Pediatrics, Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Xia Meng
- Department of Environmental Health, School of Public Health, the Key Laboratory of Public Health Safety of the Ministry of Education, and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health IRDR International Center of Excellence on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health WMO/IGAC MAP-AQ Asian Office Shanghai, Fudan University, Shanghai, China
| | - Zhuohui Zhao
- Department of Environmental Health, School of Public Health, the Key Laboratory of Public Health Safety of the Ministry of Education, and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
- Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health IRDR International Center of Excellence on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health WMO/IGAC MAP-AQ Asian Office Shanghai, Fudan University, Shanghai, China
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Hsiao CC, Cheng CG, Hong ZT, Chen YH, Cheng CA. The Influence of Fine Particulate Matter and Cold Weather on Emergency Room Interventions for Childhood Asthma. Life (Basel) 2024; 14:570. [PMID: 38792592 PMCID: PMC11122191 DOI: 10.3390/life14050570] [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: 04/05/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: Children are the most vulnerable to pollution due to their decreased stature, heightened respiratory rate, and frequent outdoor engagement. PM2.5, nitrogen dioxide (NO2), ozone, and cold weather are associated with pediatric asthma. In this study, we investigated the nexus between air pollution, climate factors, and pediatric asthma emergency room visits (ERVs). (2) Method: Pediatric asthma ERV data for healthcare quality from the Taiwanese National Insurance in the Taipei area were obtained from 2015 to 2019. Air pollution and climate factor data were also collected. Poisson regression was employed to determine the relationships with relative risks (RRs). (3) Results: The incidence of pediatric asthma ERVs decreased, with a crude RR of 0.983 (95% CI: 0.98-0.986, p < 0.001). Fine particulate matter (PM2.5) had an adjusted RR of 1.102 (95% CI: 1.037-1.172, p = 0.002) and a 7.7 µg/m3 increase, and air temperature had an adjusted RR of 0.813 (95% CI: 0.745-0.887, p < 0.001) comparing between the highest and lowest quarter air temperature associated with pediatric asthma ERVs. (4) Conclusions: This inquiry underscores the positive associations of PM2.5 and cold weather with pediatric asthma ERVs. The findings could guide the government to establish policies to reduce air pollution and promote children's health.
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Affiliation(s)
- Chih-Chun Hsiao
- Department of Nursing, Taoyuan Armed Forces General Hospital, Taoyuan 32549, Taiwan
| | - Chun-Gu Cheng
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32549, Taiwan
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Zih-Tai Hong
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32549, Taiwan
| | - Yu-Hsuan Chen
- Division of Chest Medicine, Department of Internal Medicine, Cheng Hsin General Hospital, Taipei 11220, Taiwan
| | - Chun-An Cheng
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
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Lu Y, Jie X, Zou F, Wang D, Da H, Li H, Zhao H, He J, Liu J, Fan X, Liu Y. Investigation analysis of the acute asthma risk factor and phenotype based on relational analysis with outdoor air pollutants in Xi'an, China. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2024; 46:75. [PMID: 38367077 DOI: 10.1007/s10653-023-01816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 10/08/2023] [Indexed: 02/19/2024]
Abstract
Asthma is a common chronic heterogeneous disease. Outdoor air pollutants are an important cause of acute asthma. Until now, the association between the risk of acute asthma and outdoor air pollutants is unclear. And the relationship between the different phenotypes of asthma and outdoor air pollutants has not been reported. Thus, an analysis of the association between outdoor air pollutants and daily acute asthma inpatient and outpatient visits in Xi'an, China, from January 1 to December 31, 2018, was conducted. A total of 3395 people were included in the study. The statistical analysis and relational analysis based on the logistic regression were used for illustrating the relatedness of the acute asthma risk factor and phenotype with outdoor air pollutants, while the age, gender, pollen peak and non-pollen peak periods, high type 2 (T2) asthma and non-high T2 asthma were also stratified. Results showed that particulate matter with particle size below 10 μm and 2.5 μm (PM10 and PM2.5), sulfur dioxide(SO2), nitrogen dioxide(NO2), and carbon monoxide(CO) increase the risk of acute asthma and that air pollutants have a lagged effect on asthma patients. PM10, NO2, CO, and Ozone (O3) are associated with an increased risk of acute attacks of high T2 asthma. PM10, PM2.5, SO2, NO2 and CO are associated with an increased risk of acute asthma in males of 0-16 years old. PM10 and PM2.5 are more harmful to asthma patients with abnormal lung function.
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Affiliation(s)
- Yiyi Lu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
- Department of Respiratory and Critical Care Medicine, Ganzhou Institute of Respiratory Diseases, Ganzhou Fifth People's Hospital, Ganzhou, 341007, Jiangxi Province, China
| | - Xueyan Jie
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Fan Zou
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Dan Wang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Hongju Da
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Hongxin Li
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Hongyan Zhao
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Jin He
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Jianghao Liu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Xinping Fan
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Yun Liu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China.
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Gao C, Yao X, Wang X, Li Z, Wang Y, Xu X, Li L, Zhang X, Fang X. Effects of air pollutants and temperature on the number of asthma outpatient visits in Hohhot, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:183-190. [PMID: 36288535 DOI: 10.1080/09603123.2022.2136364] [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: 06/23/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Although numerous studies have linked asthma to air temperature and pollution, few studies have examined their interactive effects on asthma outpatient visits. This study investigated how air pollutants and their interactions with temperature affect asthma outpatient visits in a city in northern Chinaduring the time period 2018 - 2020 . . As the results, 24,163 asthma outpatients were recorded, a 10-μg/m3 increase in PM10, PM2.5, SO2, and NO2 concentrations was associated with significant increases in visits of 3.47% (95% CI: 2.35%-4.60%), 0.83% (95% CI: 0.36%-1.30%), 3.17% (95% CI: 1.47%-4.90%), and 8.90% (95% CI: 6.09%-11.79%), respectively. The effect was stronger in females than males, and stronger in the elderly (≥65 years) than among the young. The interaction between low temperatures and high air pollution levels significantly increased the number of asthma outpatient visits. This study emphasizesthe importance of reducing air pollution in order to lessen the effects of cold.
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Affiliation(s)
- Chenghua Gao
- Public Health College, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Xing Yao
- Outpatient Department of Medical Department, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia, China
| | - Xue Wang
- Public Health College, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Zichao Li
- Public Health College, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Yaping Wang
- Public Health College, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Xiaoqian Xu
- Public Health College, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Lehui Li
- Public Health College, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Xingguang Zhang
- Public Health College, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Xin Fang
- Public Health College, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
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Sarikloglou E, Fouzas S, Paraskakis E. Prediction of Asthma Exacerbations in Children. J Pers Med 2023; 14:20. [PMID: 38248721 PMCID: PMC10820562 DOI: 10.3390/jpm14010020] [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: 11/26/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Asthma exacerbations are common in asthmatic children, even among those with good disease control. Asthma attacks result in the children and their parents missing school and work days; limit the patient's social and physical activities; and lead to emergency department visits, hospital admissions, or even fatal events. Thus, the prompt identification of asthmatic children at risk for exacerbation is crucial, as it may allow for proactive measures that could prevent these episodes. Children prone to asthma exacerbation are a heterogeneous group; various demographic factors such as younger age, ethnic group, low family income, clinical parameters (history of an exacerbation in the past 12 months, poor asthma control, poor adherence to treatment, comorbidities), Th2 inflammation, and environmental exposures (pollutants, stress, viral and bacterial pathogens) determine the risk of a future exacerbation and should be carefully considered. This paper aims to review the existing evidence regarding the predictors of asthma exacerbations in children and offer practical monitoring guidance for promptly recognizing patients at risk.
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Affiliation(s)
| | - Sotirios Fouzas
- Department of Pediatrics, University of Patras Medical School, 26504 Patras, Greece;
| | - Emmanouil Paraskakis
- Paediatric Respiratory Unit, Paediatric Department, University of Crete, 71500 Heraklion, Greece
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Ma Y, Zhao H, Su Y. Ozone Pollution and Acute Exacerbation of Asthma in Residents of China: An Ecological Study. J Asthma Allergy 2023; 16:951-960. [PMID: 37700876 PMCID: PMC10493139 DOI: 10.2147/jaa.s422476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/17/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose The evidence for a causal relationship between high-level ozone (O3) exposure and acute exacerbation of asthma among adults is limited, and the conclusions are less definitive. Patients and methods Here we collected the daily data on asthma cases, O3 exposure, and meteorological factors from 2010 to 2016 in Shijiazhuang, China. We investigated the risk of asthma exacerbation associated with high-level ozone exposure using a polynomial distributed lag model (PDLM). Using a generalized additive model (GAM), we estimated the interactive effects between O3 and other pollutants as well as meteorological factors on asthma exacerbation. Results A total of 7270 patients with asthma were enrolled from 22 governmental hospitals in 13 counties. Each 10 μg/m3 increase in O3 concentration on the exacerbation of asthma was associated with a 1.92% (95% CI = 0.80-3.03%) higher risk of asthma exacerbation on day lag 7. The cumulative risk of O3 on asthma exacerbation increased by 18.9% (95% CI = 12.8-25.4%) on the 14th day. High consecutive levels of O3 increase the risk of asthma exacerbation, and the interactive effect of O3 and sulfur dioxide (SO2) appears before the exacerbation onset. Conclusion These findings suggested that O3 should be an important risk factor for asthma exacerbation, and health benefits in reducing asthma exacerbation risk would be gained with continued efforts to improve the air quality in China.
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Affiliation(s)
- Yunlei Ma
- Department of Respiratory Medicine, Traditional Chinese Medicine Hospital of Hebei Province, Shijiazhuang, People’s Republic of China
| | - Hanjun Zhao
- Department of Respiratory Medicine, Fourth Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Yinghao Su
- Department of Respiratory Medicine, Traditional Chinese Medicine Hospital of Hebei Province, Shijiazhuang, People’s Republic of China
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Zhang Y, Yin X, Zheng X. The relationship between PM2.5 and the onset and exacerbation of childhood asthma: a short communication. Front Pediatr 2023; 11:1191852. [PMID: 37593445 PMCID: PMC10429171 DOI: 10.3389/fped.2023.1191852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Much is known about the link between air pollution and asthma in adults, particularly fine particulate matter (PM2.5). Studies have found that certain levels of fine PM2.5 can increase airway responsiveness and worsen asthma. PM2.5 may play a role in the onset and exacerbation of childhood asthma. However, there is little in the literature on how PM2.5 affects asthma attacks and exacerbations in children. Asthma is a common chronic disease in children, and air pollution can aggravate it. The effect of PM2.5 on childhood asthma needs further research. By evaluating, reviewing, and collating existing results in this area, this paper aims to explore the relationship between PM2.5 and asthma onset and exacerbation in children.
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Affiliation(s)
- Yue Zhang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- The Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xixi Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- The Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xiangrong Zheng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- The Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
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Kuang L, Ren C, Liao X, Zhang X, Zhou X. Percent Recovery Index Predicts Poor Asthma Control and Exacerbation in Adults. J Asthma Allergy 2023; 16:711-722. [PMID: 37465370 PMCID: PMC10351680 DOI: 10.2147/jaa.s414164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
Background Previous studies indicate that the percent recovery index (PRI: the percentage increase from the maximally reduced FEV1 after bronchodilator inhalation), one of the indexes of methacholine bronchial provocation, may predict acute asthma exacerbations in childhood and elderly asthmatics. It is known that childhood (<12) and elder (>60) asthmatics may be different to adult patients in many aspect including prognosis. However, in adults, a research for predicting value of PRI to exacerbation is still absence. Besides exacerbation, predicting value of PRI to poor asthma control is also unknown. We try to detect whether PRI can predict poor asthma control and exacerbation in adults in this research. Meanwhile, we try to detect whether treatment can influence PRI. Methods In 61 adults with asthma, baseline PRI was measured during enrollment. And then baseline PRI was evaluated as a predictor of exacerbation or poor asthma control at an upcoming 3-month follow-up. The covariates included age, sex, BMI, previous exacerbation, smoking status and baseline lung function. After treatment for 3 months, PRI was measured again and compared with baseline PRI. Results After the 3-month follow-up, we found that baseline PRI was significantly related to asthma exacerbation (P = 0.023), poor asthma control (ACT at 3 months, P = 0.014), decreased quality of life (decrease of MiniAQLQ, P = 0.010) and cumulative number of EDHO at 3 months (P = 0.039). Meanwhile, no significant correlation was observed between baseline PRI and inflammation factors (FENO, CaNO, and EOS). Finally, PRI was dramatically reduced after standard treatment for 3 months. Conclusion PRI is efficient in the prediction of poor asthma control and exacerbation in adults. The predictive value of PRI may rely on the inherent property of asthmatic airway smooth muscle (ASM) independent of inflammation factors. Effective treatment can alleviate PRI dramatically and that indicate PRI may also be valuable in evaluation of curative effect.
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Affiliation(s)
- Lisha Kuang
- Department of Health Management Center, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
| | - Cheng Ren
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
| | - Xiuqing Liao
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
| | - Xiaobin Zhang
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
| | - Xuegang Zhou
- Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, People’s Republic of China
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Liu Y, Yang X, Tan J, Li M. Concentration prediction and spatial origin analysis of criteria air pollutants in Shanghai. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 327:121535. [PMID: 37003588 DOI: 10.1016/j.envpol.2023.121535] [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: 03/06/2023] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 06/19/2023]
Abstract
Severe air pollution events still occur frequently in Shanghai. In order to predict when Shanghai air quality satisfies the National Ambient Air Quality Standards of China (NAAQSC) and identify potential source areas of criteria air pollutants for the regional joint prevention and control of air pollution, concentration data of PM2.5, PM10, SO2, NO2 and O3 were collected in 2014-2022 at fourteen monitoring sites across Shanghai and surrounding areas. A first - order rate equation with harmonic regression analysis was employed for time series analysis and concentration prediction. Decreasing concentrations were observed widely over all sites except O3 and NO2. It is very likely that the secondary NAAQSC standards for PMx, and SO2 would be met by 2025 and O3 and NO2 would likely become the critical pollutants that determine air quality level after 2025. Regional transport was predominant for PMx and SO2 pollution. A 3D - CWT multisite joint location method was developed to identify their potential source areas at different spatial resolutions. Weighting function correction was assigned via information entropy of endpoint numbers in each cell. A probabilistic parameter WIPSA was proposed to quantify and normalize the probability that grid cells are source areas in order to achieve fourteen - site joint location, and it was comparable and compatible at different spatial resolutions. Potential source areas of PM2.5 and PM10 were similar, including Henan, Shandong, Hebei and Anhui, while origin domains of SO2 mainly covered Henan and Hebei. In all seasons, air pollution that was transported to Shanghai (i.e., PMx and SO2) originated mainly from the North China Plain; the contribution of marine sources was neglectable.
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Affiliation(s)
- Ying Liu
- State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, China; Key Laboratory of Cities' Mitigation and Adaptation to Climate Change, Shanghai, China Meteorological Administration (CMA), Tongji University, Shanghai, 200092, China; Key Laboratory of Yangtze River Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, China.
| | - Xinxin Yang
- State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, China; Key Laboratory of Yangtze River Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, China
| | - Jianguo Tan
- Key Laboratory of Cities' Mitigation and Adaptation to Climate Change, Shanghai, China Meteorological Administration (CMA), Tongji University, Shanghai, 200092, China; Shanghai Meteorological IT Support Center, Shanghai Meteorological Service, Shanghai, 200030, China
| | - Mingli Li
- State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, China
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Ren J, Zhu L, Li Y, Li H, Hu Q, Zhu J, Zhang Q, Zhang Y. Intraday exposure to ambient ozone and emergency department visits among children: a case-crossover study in southern China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-27462-8. [PMID: 37209338 DOI: 10.1007/s11356-023-27462-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/02/2023] [Indexed: 05/22/2023]
Abstract
Most existing studies have investigated short-term associations between ozone exposure and acute disease events among children at a daily timescale, which might neglect risk effects happening within several hours after ozone exposure. In this research, we aimed to depict intraday associations between pediatric emergency department visits (PEDVs) and exposure to ozone in order to better detect ultra-short-term effects of ozone exposure on children. We obtained hourly data of all-cause PEDVs, air pollutants, and meteorological factors in Shenzhen and Guangzhou, China, 2015-2018. We applied time-stratified case-crossover design and conditional logistic regression models to estimate odds ratios per 10-μg/m3 rise of ozone concentrations at various exposure periods (e.g., 0-3, 4-6, 7-12, 13-24, 25-48, and 49-72 h) prior to PEDVs, controlling for hourly relative humidity and temperature. Subgroup analyses divided by gender, age, and season were undertaken to identify the potential susceptible population and period. A total of 358,285 cases of PEDVs were included in two cities, and hourly average concentration of ozone was 45.5 μg/m3 in Guangzhou and 58.9 μg/m3 in Shenzhen, respectively. Increased risks of PEDVs occurred within a few hours (0-3 h) after exposure to ozone and remained up to 48 h. Population risks for PEDVs increased by 0.8% (95% confidence interval, 0.6 to 1.0) in Shenzhen and 0.7% (0.5 to 0.9) in Guangzhou for a 10-μg/m3 increase in ozone concentrations at lag 4-6 h and lag 7-12 h, respectively. These findings were robust to co-exposure adjustments in our sensitivity analyses. Significantly greater ozone-associated risks were consistently observed during cold months (October to March of the following year) in both cities, while we did not identify evidence for effect modification of children's age and gender. This study provided novel evidence for increased risks of acute disease events among children within several hours after ozone exposure, highlighting the significant implications for policymakers to establish hourly air quality standards for better protecting children's health.
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Affiliation(s)
- Jiahong Ren
- Department of Pediatric Respiratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Lifeng Zhu
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Yachen Li
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Haiyi Li
- Department of Child Gastroenterology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Qian Hu
- Department of Pediatric Respiratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Jian Zhu
- Department of Pediatric Respiratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China
| | - Qingyan Zhang
- Department of Pediatric Respiratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China.
| | - Yunquan Zhang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, 430065, China
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Cui Z, Ma Y, Yu Y, Li N, Wang J, Wang A, Tan Q. Short-term exposure to ambient fine particulate pollution aggravates ventilator-associated pneumonia in pediatric intensive care patients undergoing cardiovascular surgeries. Environ Health 2023; 22:39. [PMID: 37101281 PMCID: PMC10132412 DOI: 10.1186/s12940-023-00991-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/19/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Ambient air pollutants can be hazardous to human health, especially for vulnerable children. The impact of ambient air pollutant exposure before and during intensive care unit (ICU) stays on the development of ventilator-associated pneumonia (VAP) in critically ill children has not been established. We aimed to determine the correlations between short-term exposures to ambient fine particulate matter (PM2.5) and VAP in pediatric cardiac surgery patients in the ICU, and explore the effect of delayed exposure. METHODS The medical record of 1755 child patients requiring artificial ventilation in the ICU between December 2013 to December 2020, were analyzed. The daily average concentrations of particulate matters (PM2.5 and PM10), sulfur dioxide (SO2), and ozone (O3) were calculated from public data. Interactions between these pollutants and VAP were simulated with the distributed lag non-linear model. RESULTS Three hundred forty-eight cases (19.829%) of VAP were identified in this study, while the average concentrations of PM2.5, PM10, O3 and SO2 were 58, 118, 98 and 26 μg/m3, respectively. Exposure to increased levels of PM2.5 two days prior (lag 2-day) to VAP diagnosis is significantly correlated with an enhanced risk for VAP development. Even a slight increase of 10 μg/m3 in PM2.5 can translate to a 5.4% increase in VAP incidence (95% CI: 1.4%-9.5%) while the VAP incidence increased to 11.1% (95%CI: 4.5-19.5%) when PM2.5 concentration is well below the National Ambient Air Quality standard (NAAQS) of 50 μg/m3. The association was more pronounced in those aged below 3-months, with low body mass index or suffered from pulmonary arterial hypertension. CONCLUSION Short-term PM2.5 exposure is a significant risk for development of VAP in pediatric patients. This risk is present even with PM2.5 levels below the NAAQS. Ambient PM2.5 may represent a previously unrecognized risk factor for pneumonia and the current environmental pollution standards need to be reevaluated to consider susceptible populations. TRIAL REGISTRATION The trial was registered with the National Clinical Trial Center: The correlation between ambient air pollution and the complications in ICU underwent cardiac surgery. TRIAL REGISTRATION NUMBER ChiCTR2000030507. Date of registration: March 5, 2020. URL of trial registry record: http://www.chictr.org.cn/index.aspx .
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Affiliation(s)
- Zhaomei Cui
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021 China
| | - Yingying Ma
- Medical Engineering Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yuanyuan Yu
- Data Science Institute, Shandong University, Jinan, Shandong China
| | - Na Li
- Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong China
| | - Jun Wang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Anbiao Wang
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021 China
| | - Qi Tan
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021 China
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Wang Q, Chen Z, Huang W, Kou B, Li J. Short-Term Effect of Moderate Level Air Pollution on Outpatient Visits for Multiple Clinic Departments: A Time-Series Analysis in Xi'an China. TOXICS 2023; 11:166. [PMID: 36851041 PMCID: PMC9967132 DOI: 10.3390/toxics11020166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
There is limited evidence concerning the association between air pollution and different outpatient visits in moderately polluted areas. This paper investigates the effects of moderate-level air pollution on outpatient visits associated with six categories of clinic department. We analyzed a total of 1,340,791 outpatient visits for the pediatric, respiratory, ear-nose-throat (ENT), cardiovascular, ophthalmology, and orthopedics departments from January 2016 to December 2018. A distributed lag nonlinear model was used to analyze the associations and was fitted and stratified by age and season (central heating season and nonheating season). We found SO2 had the largest effect on pediatrics visits (RR = 1.105 (95%CI: 1.090, 1.121)). Meanwhile, PM2.5 and SO2 had greater effects on ENT visits for people under 50 years old. The results showed a strong association between O3 and cardiovascular outpatient visits in the nonheating season (RR = 1.273, 95% CI: 1.189,1.358). The results showed every 10 μg/m3 increase in SO2 was associated with a lower number of respiratory outpatient visits. Significant different associations were observed in PM2.5, NO2, CO, and O3 on ophthalmology visits between the heating and nonheating seasons. Although no significant association has been found in existing studies, our findings showed PM2.5 and NO2 were significantly related to orthopedic outpatient visits for people under 60 (RR = 1.063 (95%CI: 1.032, 1.095), RR = 1.055 (95%CI: 1.011, 1.101)). This study also found that the effect-level concentrations of air pollutants for some clinic departments were lower than the national standards, which means that people should also pay more attention when the air quality is normal.
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Affiliation(s)
- Qingnan Wang
- Department of Information Management, School of Management, Xi’an Jiaotong University, Xi’an 710049, China
| | - Zhuo Chen
- College of Public Health, University of Georgia, Athens, GA 30602, USA
- School of Economics, University of Nottingham Ningbo China, Ningbo 315000, China
| | - Wei Huang
- Department of Information Management, School of Management, Xi’an Jiaotong University, Xi’an 710049, China
- College of Business, Southern University of Science and Technology, Shenzhen 518055, China
| | - Bo Kou
- Department of Otolaryngology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710016, China
| | - Jingwei Li
- Department of Information Management, School of Management, Xi’an Jiaotong University, Xi’an 710049, China
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Chen S, Xu B, Shi T, Yang Q. Short-term effect of ambient air pollution on outpatient visits for children in Guangzhou, China. Front Public Health 2023; 11:1058368. [PMID: 36741946 PMCID: PMC9895100 DOI: 10.3389/fpubh.2023.1058368] [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: 09/30/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023] Open
Abstract
This study examined the short-term relationship between ambient air pollutants and children's outpatient visits, and identified the effect of modifications by season. Daily recordings of air pollutants (CO, NO2, O3, SO2, PM10, and PM2.5) and children's outpatient visit data were collected in Guangzhou from 2015 to 2019. A generalized additive model adjusted for potential confounding was introduced to verify the association between ambient air pollution and outpatient visits for children. Subgroup analysis by season was performed to evaluate the potential effects. A total of 5,483,014 children's outpatient visits were recorded. The results showed that a 10 μg/m3 increase in CO, NO2, O3, SO2, PM10, and PM2.5 corresponded with a 0.19% (95% CI: 0.15-0.24%), 2.46% (2.00-2.92%), 0.27% (0.07-0.46%), 7.16% (4.80-9.57%), 1.16% (0.83-1.49%), and 1.35% (0.88-1.82%) increase in children's outpatient visits on the lag0 of exposure, respectively. The relationships were stronger for O3, PM10, and PM2.5 in the warm seasons, and for CO, NO2, and SO2 in the cool seasons. When adjusting for the co-pollutants, the effects of CO, NO2, and PM10 were robust. The results of this study indicate that six air pollutants might increase the risk of children's outpatient visits in Guangzhou, China, especially in the cool season.
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Affiliation(s)
- Sili Chen
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Binhe Xu
- Department of Clinical Medicine, Basic Medicine College, Zunyi Medical University, Zunyi, China
| | - Tongxing Shi
- Department of Environmental Hygiene, Guangzhou Center for Disease Control and Prevention, Guangzhou, China,Department of Environmental Health, Institute of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Qiaoyuan Yang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China,Department of Environmental Health, Institute of Public Health, Guangzhou Medical University, Guangzhou, China,*Correspondence: Qiaoyuan Yang ✉
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15
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Liu W, Wei J, Cai M, Qian Z, Long Z, Wang L, Vaughn MG, Aaron HE, Tong X, Li Y, Yin P, Lin H, Zhou M. Particulate matter pollution and asthma mortality in China: A nationwide time-stratified case-crossover study from 2015 to 2020. CHEMOSPHERE 2022; 308:136316. [PMID: 36084833 DOI: 10.1016/j.chemosphere.2022.136316] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND A national and comprehensive evaluation is lacking on the relationship between short-term exposure to submicron particulate matter (PM1) pollution and asthma mortality. METHODS Data was obtained from 29,553 asthma deaths from the China National Mortality Surveillance System from 2015 to 2020. We used a bilinear interpolation approach to estimate each participant's daily ambient particulate matter pollution and meteorological variables exposure based on their geocoded residential address and a 10 km × 10 km grid from China High Air Pollutants and the fifth generation of European ReAnalysis-Land reanalysis data set. The associations were estimated using a time-stratified case-crossover design and conditional logistic regressions. RESULTS Our results revealed significant associations between short-term exposure to various particulate matter and asthma mortality. The 5-day moving average of particulate matter exposure produced the most pronounced effect. Compared to fine particulate matter (PM2.5) and inhalable particulate matter (PM10), significantly stronger effects on asthma mortality related to PM1 pollution were noted. The ERs% for asthma mortality associated with each interquartile range (IQR) increase of exposures to PM1 (IQR: 19.2 μg/m3) was 5.59% (95% CI: 2.11-9.19), which is 14% and 22% higher than that for PM2.5 (IQR: 32.0 μg/m3, 4.82% (95% CI: 1.84-7.90)) and PM10 (IQR: 52.2 μg/m3, 4.37% (95% CI: 1.16-7.69)), respectively. The estimates remained consistent in various sensitivity analyses. CONCLUSIONS Our study provided national evidence that acute exposures to various ambient particulate matter pollution can increase mortality due to asthma in China, highlighting stronger associations with ambient PM1 than PM2.5 and PM10. China needs to adjust the current ambient air quality standards urgently and pay greater attention to the adverse health effects of PM1.
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Affiliation(s)
- Wei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, 20740, USA
| | - Miao Cai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Zheng Long
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Michael G Vaughn
- School of Social Work, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Hannah E Aaron
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA
| | - Xunliang Tong
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanming Li
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Lagged acute respiratory outcomes among children related to ambient pollutant exposure in a high exposure setting in South Africa. Environ Epidemiol 2022; 6:e228. [PMID: 36530932 PMCID: PMC9746739 DOI: 10.1097/ee9.0000000000000228] [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: 04/28/2022] [Accepted: 09/05/2022] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED Acute ambient air pollution impacts on the respiratory health of children may be lagged across time. We determined the short-term lagged effects of particulate matter (PM2.5), sulphur dioxide (SO2), and oxides of nitrogen (NOx) on the respiratory health of children living in low-income communities. METHODS A school-based study was conducted using a repeated measures design, across summer and winter, in four schools in each of four suburbs in the Vaal Triangle, South Africa. Data for PM2.5, NOx, and SO2 were obtained from monitoring stations within close proximity of the schools. Over 10 school days in each phase, grade 4 children completed a symptoms log and lung function tests. Parents completed a child respiratory questionnaire. Generalized estimation equations models adjusted for covariates of interest in relation to lung function outcomes and air pollutants including lag effects of 1-5 days. RESULTS Daily PM2.5, NOx, and SO2 median concentration levels were frequently higher than international standards. Among the 280 child participants (mean age 9 years), the prevalence of symptoms based on probable asthma was 9.6%. There was a consistent increased pollutant-related risk for respiratory symptoms, except for NOx and shortness of breath. Lung function, associated with pollutant fluctuations across the different lags, was most pronounced for peak expiratory flow rate (PEFR) for PM2.5 and SO2. A preceding 5-day average SO2 exposure had the largest loss (7.5 L/minute) in PEFR. CONCLUSIONS Lagged declines in daily lung function and increased odds of having respiratory symptoms were related to increases in PM2.5 and SO2 among a school-based sample of children.
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Li L, Zhu Y, Han B, Chen R, Man X, Sun X, Kan H, Lei Y. Acute exposure to air pollutants increase the risk of acute glaucoma. BMC Public Health 2022; 22:1782. [PMID: 36127653 PMCID: PMC9487138 DOI: 10.1186/s12889-022-14078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Ambient air pollution is related to the onset and progression of ocular disease. However, the effect of air pollutants on the acute glaucoma remains unclear. Objective To investigate the effect of air pollutants on the incidence of acute glaucoma (acute angle closure glaucoma and glaucomatocyclitic crisis) among adults. Methods We conducted a time-stratified case-crossover study based on the data of glaucoma outpatients from January, 2015 to Dec, 2021 in Shanghai, China. A conditional logistic regression model combined with a polynomial distributed lag model was applied for the statistical analysis. Each case serves as its own referent by comparing exposures on the day of the outpatient visit to the exposures on the other 3–4 control days on the same week, month and year. To fully capture the delayed effect of air pollution, we used a maximum lag of 7 days in main model. Results A total of 14,385 acute glaucoma outpatients were included in this study. We found exposure to PM2.5, PM10, nitrogen dioxide (NO2) and carbon monoxide (CO) significantly increased the odds of outpatient visit for acute glaucoma. Wherein the odds of acute glaucoma related to PM2.5 and NO2 were higher and more sustained, with OR of 1.07 (95%CI: 1.03–1.11) and 1.12 (95% CI: 1.08–1.17) for an IQR increase over lag 0–3 days, than PM10 and CO over lag 0–1 days (OR:1.03; 95% CI: 1.01–1.05; OR: 1.04; 95% CI: 1.01–1.07). Conclusions This case-crossover study provided first-hand evidence that air pollutants, especially PM2.5 and NO2, significantly increased risk of acute glaucoma. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14078-9.
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Affiliation(s)
- Liping Li
- Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, China
| | - Yixiang Zhu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, P.O. Box 249, 130 Dong-An Road, Shanghai, 200032, China
| | - Binze Han
- Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, P.O. Box 249, 130 Dong-An Road, Shanghai, 200032, China.,Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai, 200030, China
| | - Xiaofei Man
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, China.
| | - Xinghuai Sun
- Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, China. .,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, P.O. Box 249, 130 Dong-An Road, Shanghai, 200032, China. .,Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, China.
| | - Yuan Lei
- Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, China.
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Li H, Liu L, Chen R, Feng R, Zhou Y, Hong J, Cao L, Lu Y, Dong X, Xia M, Ding B, Weng Y, Qian L, Wang L, Zhou W, Gui Y, Han X, Zhang X. Size-segregated particle number concentrations and outpatient-department visits for pediatric respiratory diseases in Shanghai, China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 243:113998. [PMID: 36057178 DOI: 10.1016/j.ecoenv.2022.113998] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Few studies have simultaneously explored which size of particles has the greatest impact on the risk for pediatric asthma, bronchitis and upper respiratory tract infections (URTIs). OBJECTIVES To investigate the short-term association between size-segregated particle number concentrations (PNCs) and outpatient-department visits (ODVs) for major pediatric respiratory diseases. METHODS Daily counts of pediatric ODVs for asthma, bronchitis and URTIs were obtained from 66 hospitals in Shanghai, China, from 2016 to 2018. Pollutant effects were estimated using Poisson generalized additive models combined with polynomial distributed lag models. We also fitted co-pollutant cumulative effects models included six criteria air pollutants and conducted stratifying analyses by gender, age, season and geographic distances. RESULTS We identified a total of 430,103 patients with asthma, 1,547,013 patients with bronchitis, and 2,155,738 patients with URTIs from the hospitals. Effect estimates increased with decreasing particle size. Ultrafine particle (UFP) and PNCs of 0.10-0.40 µm particles (PNC0.10-0.40) were associated with increased ODVs for asthma, bronchitis and URTIs at cumulative lags up to 3d. Associations tended to appear stable after adjusting for criteria air pollutants. At the cumulative lag 0-2d, each interquartile range increase in UFP was associated with increased ODVs due to asthma (relative risk 1.21, 95% CI: 1.07, 1.38), bronchitis (1.20, 95% CI: 1.07, 1.34) and URTI (1.17, 95% CI: 1.06, 1.30), whereas the associations for PNC0.10-0.40 remained significant but attenuated in magnitude. CONCLUSIONS UFP may be a leading contributor to the adverse respiratory effects of particulate air pollution and the effects increased with decreasing particle size.
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Affiliation(s)
- Hongjin Li
- Institute for Infectious Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350012, Fujian, China; School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Lijuan Liu
- Department of Respiratory Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Rui Feng
- Shanghai Key Laboratory of Intelligent Information Processing, School of Computer Science, Fudan University, Shanghai 200433, China
| | - Yufeng Zhou
- Institute of Pediatrics, Children's Hospital of Fudan University, National Children's Medical Center, and the Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism, Ministry of Science and Technology, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China; National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai 201102, China
| | - Jianguo Hong
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China
| | - Lanfang Cao
- Department of Pediatrics, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Yanming Lu
- Department of Pediatrics, South Campus, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201112, China
| | - Xiaoyan Dong
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai 200062, China
| | - Min Xia
- Department of Pediatrics, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Bo Ding
- Department of Pediatrics, South Campus, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201112, China
| | - Yuwei Weng
- Institute for Infectious Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350012, Fujian, China
| | - Liling Qian
- Department of Respiratory Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - Libo Wang
- Department of Respiratory Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - Wenhao Zhou
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - Yonghao Gui
- Cardiovascular Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - Xiao Han
- Institute of Pediatrics, Children's Hospital of Fudan University, National Children's Medical Center, and the Shanghai Key Laboratory of Medical Epigenetics, International Co-laboratory of Medical Epigenetics and Metabolism, Ministry of Science and Technology, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China; National Health Commission (NHC) Key Laboratory of Neonatal Diseases, Fudan University, Shanghai 201102, China.
| | - Xiaobo Zhang
- Department of Respiratory Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China.
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Zhou J, Lei R, Xu J, Peng L, Ye X, Yang D, Yang S, Yin Y, Zhang R. The Effects of Short-Term PM 2.5 Exposure on Pulmonary Function among Children with Asthma-A Panel Study in Shanghai, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11385. [PMID: 36141658 PMCID: PMC9517124 DOI: 10.3390/ijerph191811385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Fine particulate matter (PM2.5) has been reported to be an important risk factor for asthma. This study was designed to evaluate the relationship between PM2.5 and lung function among children with asthma in Shanghai, China. From 2016 to 2019, a total of 70 Chinese children aged 4 to 14 in Shanghai were recruited for this panel study. The questionnaire was used to collect baseline information, and the lung function covering forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF) were carried out for each child more than twice during follow-up. Meanwhile, the simultaneous daily air atmospheric pollutants and meteorological data were collected. The linear mixed effect (LME) model was used to assess the relationship between air pollutants and lung function. A significantly negative association was found between PM2.5 and lung function in children with asthma. In the single-pollutant model, the largest effects of PM2.5 on lung function were found for lag 0-2, with FVC and FEV1 decreasing by 0.91% [95% confidence interval (CI): -1.75, -0.07] and 1.05% (95% CI: -2.09, 0.00), respectively, for each 10 μg/m3 increase in PM2.5. In the multi-pollution model (adjusted PM2.5 + SO2 + O3), the maximum effects of PM2.5 on FVC and FEV1 also appeared for lag 0-2, with FVC and FEV1 decreasing by 1.57% (95% CI: -2.69, -0.44) and 1.67% (95% CI: -3.05, -0.26), respectively, for each 10 μg/m3 increase in PM2.5. In the subgroup analysis, boys, preschoolers (<6 years old) and hot seasons (May to September) were more sensitive to changes. Our findings may contribute to a better understanding of the short-term exposure effects of PM2.5 on lung function in children with asthma.
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Affiliation(s)
- Ji Zhou
- Department of Atmospheric and Oceanic Sciences & Institute of Atmospheric Sciences, Fudan University, Shanghai 200437, China
- Shanghai Typhoon Institute, China Meteorological Administration (CMA), Shanghai 200030, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Bureau, Shanghai 200030, China
| | - Ruoyi Lei
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Jianming Xu
- Shanghai Typhoon Institute, China Meteorological Administration (CMA), Shanghai 200030, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Bureau, Shanghai 200030, China
| | - Li Peng
- Shanghai Typhoon Institute, China Meteorological Administration (CMA), Shanghai 200030, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Bureau, Shanghai 200030, China
| | - Xiaofang Ye
- Shanghai Typhoon Institute, China Meteorological Administration (CMA), Shanghai 200030, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Bureau, Shanghai 200030, China
| | - Dandan Yang
- Shanghai Typhoon Institute, China Meteorological Administration (CMA), Shanghai 200030, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Bureau, Shanghai 200030, China
| | - Sixu Yang
- Shanghai Typhoon Institute, China Meteorological Administration (CMA), Shanghai 200030, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Bureau, Shanghai 200030, China
| | - Yong Yin
- Department of Respiratory, School of Medicine, Shanghai Children’s Medical Center, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Renhe Zhang
- Department of Atmospheric and Oceanic Sciences & Institute of Atmospheric Sciences, Fudan University, Shanghai 200437, China
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20
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Joint association between ambient air pollutant mixture and pediatric asthma exacerbations. Environ Epidemiol 2022; 6:e225. [PMID: 36249268 PMCID: PMC9556053 DOI: 10.1097/ee9.0000000000000225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Exposure to air pollutants is known to exacerbate asthma, with prior studies focused on associations between single pollutant exposure and asthma exacerbations. As air pollutants often exist as a complex mixture, there is a gap in understanding the association between complex air pollutant mixtures and asthma exacerbations. We evaluated the association between the air pollutant mixture (52 pollutants) and pediatric asthma exacerbations. Method This study focused on children (age ≤ 19 years) who lived in Douglas County, Nebraska, during 2016-2019. A seasonal-scale joint association between the outdoor air pollutant mixture adjusting for potential confounders (temperature, precipitation, wind speed, and wind direction) in relation to pediatric asthma exacerbation-related emergency department (ED) visits was evaluated using the generalized weighted quantile sum (qWQS) regression with repeated holdout validation. Results We observed associations between air pollutant mixture and pediatric asthma exacerbations during spring (lagged by 5 days), summer (lag 0-5 days), and fall (lag 1-3 days) seasons. The estimate of the joint outdoor air pollutant mixture effect was higher during the summer season (adjusted-βWQS = 1.11, 95% confidence interval [CI]: 0.66, 1.55), followed by spring (adjusted-βWQS = 0.40, 95% CI: 0.16, 0.62) and fall (adjusted-βWQS = 0.20, 95% CI: 0.06, 0.33) seasons. Among the air pollutants, PM2.5, pollen, and mold contributed higher weight to the air pollutant mixture. Conclusion There were associations between outdoor air pollutant mixture and pediatric asthma exacerbations during the spring, summer, and fall seasons. Among the 52 outdoor air pollutant metrics investigated, PM2.5, pollen (sycamore, grass, cedar), and mold (Helminthosporium, Peronospora, and Erysiphe) contributed the highest weight to the air pollutant mixture.
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21
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He M, Zhong Y, Chen Y, Zhong N, Lai K. Association of short-term exposure to air pollution with emergency visits for respiratory diseases in children. iScience 2022; 25:104879. [PMID: 36065191 PMCID: PMC9440288 DOI: 10.1016/j.isci.2022.104879] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/07/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Ambient air pollutants are health hazards to children. This study comprised 773,504 emergency department visits (EDVs) at 0–14 years of age with respiratory diseases in southern China. All air pollutants were positively associated with EDVs of total respiratory diseases, especially pneumonia. NO2, PM10, and PM2.5 had intraday effects and cumulative effects on asthma EDVs. The effect of SO2, PM10, and PM2.5 on pneumonia EDVs was stronger in girls than in boys. The effect of NO2 on acute upper respiratory tract infection EDVs was greater in children aged 0–5 years old; however, the effect of PM10 on acute upper respiratory tract infection EDVs was greater in the 6–14 years group. In a two-pollutant model, NO2 was associated with bronchitis and pneumonia, and PM10 was associated with acute upper respiratory tract infection. In this time-series study, NO2 and PM10 were risk indicators for respiratory diseases in children. Air pollution associates with children emergency visits for respiratory diseases NO2 and PM10 are risk indicators for respiratory diseases in children Young children are more sensitive to gaseous pollutants School-age children are more sensitive to PM10
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22
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Zhou Q, Kang SL, Lin X, Zhang XY. Impact of air pollutants on hospital visits for pediatric asthma in Fuzhou city, southeast China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:58664-58674. [PMID: 35366721 DOI: 10.1007/s11356-022-19928-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
Rapid social development in China has resulted in severe air pollution and adverse impacts on people's health. Although studies have been conducted on the relationship between exposure to air pollutants and asthma exacerbation, most studies were performed in relatively heavily polluted areas, while little is known about the effect of air pollutants in less polluted areas. We assessed the effects of air pollutants on the risk of asthma-related outpatient and emergency visits of infants and children aged from 0 to 13 years during 2018 to 2020 in Fuzhou city, southeast China. Data of six air pollutants: sulfur dioxide (SO2), nitrogen dioxides (NO2), carbon monoxide (CO), daily maximum 8-h average ozone (O3-8 h), particulate matter with an aerodynamic diameter ≤ 10 μm (PM10), and particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM2.5), were obtained from the Environmental Protection Administration of Fuzhou. Data of temperature, humidity, and wind speed were provided by the Meteorological Bureau of Fuzhou. Results revealed that on lag day 6, NO2, SO2, and CO were positively associated with the number of outpatient and emergency visits. Among the pollutants, SO2 had the highest effects on both outpatient visits (RR = 1.672, 95%CI 1.545, 1.809) and emergency visits (RR = 1.495, 95%CI 1.241, 1.800), and its effect on outpatient visits was stronger in children aged 0-4 years than in those aged 5-13 years (RR = 2.331 vs. 1.439). In conclusion, SO2 contributes substantially to the adverse effects of air pollutants on pediatric respiratory health in Fuzhou. Younger children were more affected by air pollution than their older counterparts.
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Affiliation(s)
- Quan Zhou
- Fuzhou Center for Disease Control and Prevention, Fuzhou, 350004, Fujian, China
- Fuzhou Center for Disease Control and Prevention affiliated to Fujian Medical University, Fuzhou, China
| | - Shu-Ling Kang
- Fuzhou Center for Disease Control and Prevention, Fuzhou, 350004, Fujian, China
- Fuzhou Center for Disease Control and Prevention affiliated to Fujian Medical University, Fuzhou, China
| | - Xin Lin
- Fuzhou Center for Disease Control and Prevention, Fuzhou, 350004, Fujian, China.
- Fuzhou Center for Disease Control and Prevention affiliated to Fujian Medical University, Fuzhou, China.
| | - Xiao-Yang Zhang
- Fuzhou Center for Disease Control and Prevention, Fuzhou, 350004, Fujian, China.
- Fuzhou Center for Disease Control and Prevention affiliated to Fujian Medical University, Fuzhou, China.
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23
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Zhao Y, Kong D, Fu J, Zhang Y, Chen Y, Liu Y, Chang Z, Liu Y, Liu X, Xu K, Jiang C, Fan Z. Increased Risk of Hospital Admission for Asthma in Children From Short-Term Exposure to Air Pollution: Case-Crossover Evidence From Northern China. Front Public Health 2022; 9:798746. [PMID: 34976938 PMCID: PMC8718688 DOI: 10.3389/fpubh.2021.798746] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Previous studies suggested that exposure to air pollution could increase risk of asthma attacks in children. The aim of this study is to investigate the short-term effects of exposure to ambient air pollution on asthma hospital admissions in children in Beijing, a city with serious air pollution and high-quality medical care at the same time. Methods: We collected hospital admission data of asthma patients aged ≤ 18 years old from 56 hospitals from 2013 to 2016 in Beijing, China. Time-stratified case-crossover design and conditional Poisson regression were applied to explore the association between risk of asthma admission in children and the daily concentration of six air pollutants [particulate matter ≤ 2.5 μm (PM2.5), particulate matter ≤ 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3)], adjusting for meteorological factors and other pollutants. Additionally, stratified analyses were performed by age, gender, and season. Results: In the single-pollutant models, higher levels of PM2.5, SO2, and NO2 were significantly associated with increased risk of hospital admission for asthma in children. The strongest effect was observed in NO2 at lag06 (RR = 1.25, 95%CI: 1.06-1.48), followed by SO2 at lag05 (RR = 1.17, 95%CI: 1.05–1.31). The robustness of effects of SO2 and NO2 were shown in two-pollutant models. Stratified analyses further indicated that pre-school children (aged ≤ 6 years) were more susceptible to SO2. The effects of SO2 were stronger in the cold season, while the effects of NO2 were stronger in the warm season. No significant sex-specific differences were observed. Conclusions: These results suggested that high levels of air pollution had an adverse effect on childhood asthma, even in a region with high-quality healthcare. Therefore, it will be significant to decrease hospital admissions for asthma in children by controlling air pollution emission and avoiding exposure to air pollution.
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Affiliation(s)
- Yakun Zhao
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dehui Kong
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Fu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongqiao Zhang
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuxiong Chen
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanbo Liu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhen'ge Chang
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yijie Liu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaole Liu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Kaifeng Xu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chengyu Jiang
- National Key Laboratory of Medical Molecular Biology, Department of Biochemistry, Institute of Basic Medical Sciences, Peking Union Medical Colleges, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhongjie Fan
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Chen L, Wang X, Qian ZM, Sun L, Qin L, Wang C, Howard SW, Aaron HE, Lin H. Ambient gaseous pollutants and emergency ambulance calls for all-cause and cause-specific diseases in China: a multicity time-series study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:28527-28537. [PMID: 34988821 DOI: 10.1007/s11356-021-18337-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
Much attention has been paid to the health effects of ambient particulate matter pollution; the effects of gaseous air pollutants have not been well studied. Emergency ambulance calls (EACs) may provide a better indicator of the acute health effects than the widely used health indicators, such as mortality and hospital admission. We estimated the short-term associations between gaseous air pollutants [nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3)] and EACs for all-cause, cardiovascular, and respiratory diseases in seven Chinese cities from 2014 to 2019. We used generalized additive models and random-effects meta-analysis to examine the city-specific and pooled associations. Stratified analyses were conducted by age, sex, and season. A total of 1,626,017 EACs were observed for all-cause EACs, including 230,537 from cardiovascular diseases, and 96,483 from respiratory diseases. Statistically significant associations were observed between NO2 and EACs for all-cause diseases, while the effects of SO2 were positive, but not statistically significant in most models. No significant relationship was found between O3 and EACs. Specifically, each 10 μg/m3 increase in the 2-day moving average concentration of NO2 was associated with a 1.07% [95% confidence interval (CI): 0.40%, 1.76%], 0.76% (95% CI: 0.19%, 1.34%) and 0.06% (95% CI: -1.57%, 1.73%) increase in EACs due to all-cause, cardiovascular and respiratory diseases, respectively. Stratified analysis showed a larger effect of NO2 on all-cause EACs in the cold season [excess relative risk (ERR): 0.33% (95% CI: 0.05%, 0.60%) for warm season, ERR: 0.77% (95% CI: 0.31%, 1.23%) for cold season]. Our study indicates that acute exposures to NO2 might be an important trigger of the emergent occurrence of all-cause, cardiovascular and respiratory diseases, and this effect should be of particular concern in the cold season. Further policy development for controlling gaseous air pollution is warranted to reduce the emergent occurrence of cardiopulmonary diseases.
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Affiliation(s)
- Lan Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiaojie Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhengmin Min Qian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Liwen Sun
- Huairou District Center for Disease Control and Prevention, Beijing, 101400, China
| | - Lijie Qin
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, China
| | - Steven W Howard
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Hannah E Aaron
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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25
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Lin H, Long Y, Su Y, Song K, Li C, Ding N. Air pollution and hospital admissions for critical illness in emergency department: a tertiary-center research in Changsha, China, 2016-2020. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:21440-21450. [PMID: 34761317 DOI: 10.1007/s11356-021-17295-8] [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: 08/27/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
We aimed to comprehensively investigate the associations of air pollutants with hospital admissions for critical illness in ED. Patients with critical illness including level 1 and level 2 of the Emergency Severity Index admitted in ED of Changsha Central Hospital from January 2016 to December 2020 were enrolled. Meteorological and air pollutants data source were collected from the National Meteorological Science Data Center. A Poisson generalized linear regression combined with a polynomial distributed lag model (PDLM) was utilized to explore the effect of air pollution on hospital admissions for critical illness in ED. Benchmarks as references (25th) were conducted for comparisons with high levels of pollutant concentrations (75th). At first, lagged effects of all different air pollutants were analyzed. Then, based on the most significant factor, analyses in subgroups were performed by gender (male and female), age (< 45, 45-65, and > 65), disorders (cardiovascular, neurological, respiratory), and seasons (spring, summer, autumn, and winter). A total of 47,290 patients with critical illness admitted in ED were included. The effects of air pollutants (PM2.5, PM10, SO2, NO2, O3 and CO) on critical illness ED visits were statistically significant. Strong collinearity between PM2.5 and PM10 (r = 0.862) was found. Both single-day lag and cumulative-day lag day models showed that PM2.5 had the strongest effects (lag 0, RR = 1.025, 95% CI 1.008-1.043, and lag 0-14, RR = 1.067, 95% CI 1.017-1.120, respectively). In both PM2.5 and PM10, the risks of critical illness in male, > 65 ages, respiratory diseases, and winter increased the most significant. Air pollutants, especially PM2.5 and PM10 exposure, could increase the risk of critical illness admission.
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Affiliation(s)
- Hang Lin
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, Hunan, 410004, China
| | - Yong Long
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, Hunan, 410004, China
| | - Yingjie Su
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, Hunan, 410004, China
| | - Kun Song
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, Hunan, 410004, China
| | - Changluo Li
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, Hunan, 410004, China
| | - Ning Ding
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO. 161 Shaoshan South Road, Changsha, Hunan, 410004, China.
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Lei J, Yang T, Huang S, Li H, Zhu Y, Gao Y, Jiang Y, Wang W, Liu C, Kan H, Chen R. Hourly concentrations of fine and coarse particulate matter and dynamic pulmonary function measurements among 4992 adult asthmatic patients in 25 Chinese cities. ENVIRONMENT INTERNATIONAL 2022; 158:106942. [PMID: 34689038 DOI: 10.1016/j.envint.2021.106942] [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: 07/16/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
The short-term associations of fine particulate matter (PM2.5) and coarse particulate matter (PM2.5-10) with pulmonary function were inconsistent and rarely evaluated by dynamic measurements. Our study aimed to investigate the associations of PM2.5 and PM2.5-10 with real-time pulmonary function. We conducted a longitudinal study based on dynamic pulmonary function measurements among adult asthmatic patients in 25 cities of 19 provincial regions of China from 2017 to 2020. Linear mixed-effects models combined with polynomial distributed lag models were used for statistical analysis. A total of 298,396 records among 4,992 asthmatic patients were evaluated. We found generally inverse associations of PM2.5 and PM2.5-10 with 16 pulmonary function indicators that were independent of gaseous pollutants. The associations occurred at lag 1 d, became the strongest at lag 4 d, and vanished a week later. PM2.5-10 had stronger associations than PM2.5, especially in southern China. Nationally, an interquartile increase in PM2.5-10 (28.0 μg/m3) was significantly associated with decreases in forced expiratory volume in 1 s (FEV1, 41.6 mL), the ratio of FEV1 in forced vital capacity (1.1%), peak expiratory flow (136.9 mL/s), and forced expiratory flow at 25-75% of forced vital capacity (54.3 mL/s). We observed stronger associations in patients of male, BMI ≥ 25 kg/m2, age ≥ 45 years old, and during warm seasons. In conclusion, this study provided robust evidence for impaired pulmonary function by short-term exposure to PM2.5 and PM2.5-10 in asthmatic patients using the largest dataset of dynamic monitoring. The associations can last for one week and PM2.5-10 may be more hazardous.
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Affiliation(s)
- Jian Lei
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, Center of RespiratorEIy Medicine and National Center for Respiratory Medicine & National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Suijie Huang
- Guangzhou Homesun Medical Technology Co., Ltd, Guangdong Province, China
| | - Huichu Li
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yixiang Zhu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Ya Gao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yixuan Jiang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Weidong Wang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China; Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai, China.
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Bozigar M, Lawson AB, Pearce JL, Svendsen ER, Vena JE. Using Bayesian time-stratified case-crossover models to examine associations between air pollution and "asthma seasons" in a low air pollution environment. PLoS One 2021; 16:e0260264. [PMID: 34879071 PMCID: PMC8654232 DOI: 10.1371/journal.pone.0260264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
Many areas of the United States have air pollution levels typically below Environmental Protection Agency (EPA) regulatory limits. Most health effects studies of air pollution use meteorological (e.g., warm/cool) or astronomical (e.g., solstice/equinox) definitions of seasons despite evidence suggesting temporally-misaligned intra-annual periods of relative asthma burden (i.e., “asthma seasons”). We introduce asthma seasons to elucidate whether air pollutants are associated with seasonal differences in asthma emergency department (ED) visits in a low air pollution environment. Within a Bayesian time-stratified case-crossover framework, we quantify seasonal associations between highly resolved estimates of six criteria air pollutants, two weather variables, and asthma ED visits among 66,092 children ages 5–19 living in South Carolina (SC) census tracts from 2005 to 2014. Results show that coarse particulates (particulate matter <10 μm and >2.5 μm: PM10-2.5) and nitrogen oxides (NOx) may contribute to asthma ED visits across years, but are particularly implicated in the highest-burden fall asthma season. Fine particulate matter (<2.5 μm: PM2.5) is only associated in the lowest-burden summer asthma season. Relatively cool and dry conditions in the summer asthma season and increased temperatures in the spring and fall asthma seasons are associated with increased ED visit odds. Few significant associations in the medium-burden winter and medium-high-burden spring asthma seasons suggest other ED visit drivers (e.g., viral infections) for each, respectively. Across rural and urban areas characterized by generally low air pollution levels, there are acute health effects associated with particulate matter, but only in the summer and fall asthma seasons and differing by PM size.
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Affiliation(s)
- Matthew Bozigar
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
- * E-mail:
| | - Andrew B. Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - John L. Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Erik R. Svendsen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
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Das M, Das A, Sarkar R, Mandal P, Saha S, Ghosh S. Exploring short term spatio-temporal pattern of PM 2.5 and PM 10 and their relationship with meteorological parameters during COVID-19 in Delhi. URBAN CLIMATE 2021; 39:100944. [PMID: 34580626 PMCID: PMC8459164 DOI: 10.1016/j.uclim.2021.100944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 05/09/2023]
Abstract
Present study aims to examine the impact of lockdown on spatio-temporal concentration of PM2.5 and PM10 - categorized and recorded based on its levels during pre-lockdown, lockdown and unlock phases while noting the relationship of these levels with meteorological parameters (temperature, wind speed, relative humidity, rainfall, pressure, sun hour and cloud cover) in Delhi. To aid the study, a comparison was made with the last two years (2018 to 2019), covering the same periods of pre-lockdown, lockdown and unlock phases of 2020. Correlation analysis, linear regression (LR) was used to examine the impact of meteorological parameters on particulate matter (PM) concentrations in Delhi, India. The findings showed that (i) substantial decline of PM concentration in Delhi during lockdown period, (ii) there were substantial seasonal variation of particulate matter concentration in city and (iii) meteorological parameters have close associations with PM concentrations. The findings will help planners and policy makers to understand the impact of air pollutants and meteorological parameters on infectious disease and to adopt effective strategies for future.
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Affiliation(s)
- Manob Das
- Department of Geography, University of Gour Banga, Malda, West Bengal, India
| | - Arijit Das
- Department of Geography, University of Gour Banga, Malda, West Bengal, India
| | - Raju Sarkar
- Department of Civil Engineering, Delhi Technological University, Bawana Road, Delhi, India
| | - Papiya Mandal
- Delhi Zonal Centre, CSIR-National Environmental Engineering Research Institute, New Delhi, India
| | - Sunil Saha
- Department of Geography, University of Gour Banga, Malda, West Bengal, India
| | - Sasanka Ghosh
- Department of Geography, Kazi Nazrul University, Asansol, West Bengal, India
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Li H, Li X, Zheng H, Liu L, Wu Y, Zhou Y, Meng X, Hong J, Cao L, Lu Y, Dong X, Xia M, Ding B, Qian L, Wang L, Zhou W, Gui Y, Kan H, Chen R, Zhang X. Ultrafine particulate air pollution and pediatric emergency-department visits for main respiratory diseases in Shanghai, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 775:145777. [PMID: 33631593 DOI: 10.1016/j.scitotenv.2021.145777] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/31/2021] [Accepted: 02/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Few studies have explored the short-term effects of ultrafine particles (UFPs, particles < 0.1 μm) air pollution on the exacerbations of pediatric respiratory diseases. OBJECTIVES We aimed to evaluate short-term association between UFP and emergency-department visits (EDVs) for main pediatric respiratory diseases. METHODS We collected daily data on UFP and pediatric EDVs for main respiratory diseases [asthma, pneumonia, bronchitis and upper respiratory tract infections (URTI)] from 66 hospitals in Shanghai, China from 2016 to 2018. Generalized additive models combined with polynomial distributed lag models were applied to explore the associations between UFP level and pediatric EDVs for respiratory diseases. We fitted two-pollutant models with criteria air pollutants and performed stratified analyses by gender and age. RESULTS UFP was associated with increased EDVs for all respiratory diseases in cumulative lags up to 2 d and 3 d. The greatest risk was found at cumulative lags (0-2 d) for all respiratory diseases. At cumulative lags (0-2 d), an interquartile range increase in concentrations of UFP (1800 particles/cm3) was associated with relative risks of EDVs due to asthma [1.35, 95% confidence interval (CI): 1.14-1.59], pneumonia (1.20, 95% CI: 1.04-1.38), bronchitis (1.17, 95% CI: 1.03-1.33) and URTI (1.14, 95% CI: 1.02-1.28). These associations were almost unchanged when controlling for criteria air pollutants, and there was no threshold below which the associations were not present. There were stronger associations in children aged 0-13 years. CONCLUSIONS Short-term exposure to UFP may independently increase the risks of EDVs for asthma, pneumonia, bronchitis and URTI exacerbations among children.
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Affiliation(s)
- Hongjin Li
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Xiaoling Li
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Hongmei Zheng
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Lijuan Liu
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Yihan Wu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Yufeng Zhou
- Institute of Pediatrics, Children's Hospital of Fudan University, Shanghai 201102, China; Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Xia Meng
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Jianguo Hong
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China
| | - Lanfang Cao
- Department of Pediatrics, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yanming Lu
- Department of Pediatrics, South Campus, Renji Hospital, Shanghai Jiao Tong University, Shanghai 201112, China
| | - Xiaoyan Dong
- Department of Respiratory Medicine, Children's Hospital of Shanghai Jiaotong University, Shanghai 200040, China
| | - Min Xia
- Department of Pediatrics, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Bo Ding
- Department of Pediatrics, South Campus, Renji Hospital, Shanghai Jiao Tong University, Shanghai 201112, China
| | - Liling Qian
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Libo Wang
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Wenhao Zhou
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Yonghao Gui
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China.
| | - Xiaobo Zhang
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai 201102, China.
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