The long-term trend of PM2.5-related mortality in China: The effects of source data selection

Exploring the Burden of PM2.5-Related Deaths and Economic Health Losses in Beijing

Air pollution is one of the major global public health challenges. Using annual fine particulate matter (PM2.5) concentration data from 2016 to 2021, along with the global exposure mortality model (GEMM), we estimated the multi-year PM2.5-pollution-related deaths divided by different age groups and diseases. Then, using the VSL (value of statistical life) method, we assessed corresponding economic losses and values. The number of deaths attributed to PM2.5 in Beijing in 2021 fell by 33.74 percent from 2016, while health economic losses would increase by USD 4.4 billion as per capita disposable income increases year by year. In 2021, the average annual concentration of PM2.5 in half of Beijing's municipal administrative districts is less than China's secondary ambient air quality standard (35 μg/m3), but it can still cause 48,969 deaths and corresponding health and economic losses of USD 16.31 billion, equivalent to 7.9 percent of Beijing's GDP. Therefore, it is suggested that more stringent local air quality standards should be designated to protect public health in Beijing.

Secular trends of asthma mortality in China and the United States from 1990 to 2019

BACKGROUND

Asthma imposes a large healthcare burden in China and the United States (US). However, the trends of asthma mortality and the relative risk factors have not been comparatively analyzed between the countries. The aim of this study was to compare the mortality and risk factors between China and the US.

METHODS

The deaths, and mortality rates of asthma in China and the US during 1990-2019 were obtained from the Global Burden of Disease Study 2019. The age-period-cohort model was used to estimate these mortality rates based on a log-linear scale with additive age, period, and cohort effects. The population attributable fractions of risk factors for asthma were estimated.

RESULTS

In 1990-2019, the asthma mortality rate was higher in China than in the US. The crude and age-standardized asthma mortality rates trended downward in both China and the US from 1990 to 2019. The decline in mortality was more obvious in China. Mortality gap between the two countries was narrowing. A sex difference in asthma mortality was observed with higher mortality in males in China and females in the US. The age effects showed that mortality increased with age in adults older than 20 years, particularly in the elderly. Downward trends were generally observed in the period and cohort rate ratios in both countries, with China experiencing a more obvious decrease. Smoking and high body mass index (BMI) were the leading risk factors for asthma mortality in China and the US, respectively. Mortality attributable to occupational asthmagens and smoking decreased the most in China and the US, respectively.

CONCLUSIONS

In 1990-2019, the asthma mortality rate was higher in China than in the US; however, the mortality gap has narrowed. Mortality increased with age in adults. The improvements in asthma death risk with period and birth cohort were more obvious in China than in the US. Smoking, high BMI, and aging are major health problems associated with asthma control. The role of occupational asthmagens in asthma mortality underscores the importance of management and prevention of occupational asthma.

Ambient PM2.5 and cardiopulmonary mortality in the oldest-old people in China: A national time-stratified case-crossover study

BACKGROUND

Evidence on the associations of fine particulate matter (PM2.5) with cardiopulmonary mortality in the oldest-old (aged 80+ years) people remains limited.

METHODS

We conducted a time-stratified case-crossover study of 1,475,459 deaths from cardiopulmonary diseases in China to estimate the associations between short-term exposure to ambient PM2.5 and cardiopulmonary mortality among the oldest-old people.

FINDINGS

Each 10 μg/m3 increase in PM2.5 concentration (6-day moving average [lag05]) was associated with higher mortality from cardiopulmonary diseases (excess risks [ERs] = 1.69%, 95% confidence interval [CI]: 1.54%, 1.84%), cardiovascular diseases (ER = 1.72%, 95% CI: 1.54%, 1.90%), and respiratory diseases (ER = 1.62%, 95% CI: 1.33%, 1.91%). Compared to the other groups, females (ER = 1.94%, 95% CI: 1.73%, 2.15%) (p for difference test = 0.043) and those aged 95-99 years (ER = 2.31%, 95% CI: 1.61%, 3.02%) (aged 80-85 years old was the reference, p for difference test = 0.770) presented greater mortality risks. We found 14 specific cardiopulmonary causes associated with PM2.5, out of which emphysema (ER = 3.20%, 95% CI: 1.57%, 4.86%) had the largest association. Out of the total deaths, 6.27% (attributable fraction [AF], 95% CI: 5.72%, 6.82%) were ascribed to short-term PM2.5 exposure.

CONCLUSIONS

This study provides evidence of PM2.5-induced cardiopulmonary mortality and calls for targeted prevention actions for the oldest-old people.

FUNDING

This work was supported by the National Key Research and Development Program of China, the National Natural Science Foundation of China, the Foreign Expert Program of the Ministry of Science and Technology, the Natural Science Foundation of Guangdong, China, and the Science and Technology Program of Guangzhou.

Ultra-high-resolution mapping of ambient fine particulate matter to estimate human exposure in Beijing

With the decreasing regional-transported levels, the health risk assessment derived from fine particulate matter (PM2.5) has become insufficient to reflect the contribution of local source heterogeneity to the exposure differences. Here, we combined the both ultra-high-resolution PM2.5 concentration with population distribution to provide the personal daily PM2.5 internal dose considering the indoor/outdoor exposure difference. A 30-m PM2.5 assimilating method was developed fusing multiple auxiliary predictors, achieving higher accuracy (R2 = 0.78-0.82) than the chemical transport model outputs without any post-simulation data-oriented enhancement (R2 = 0.31-0.64). Weekly difference was identified from hourly mobile signaling data in 30-m resolution population distribution. The population-weighted ambient PM2.5 concentrations range among districts but fail to reflect exposure differences. Derived from the indoor/outdoor ratio, the average indoor PM2.5 concentration was 26.5 μg/m3. The internal dose based on the assimilated indoor/outdoor PM2.5 concentration shows high exposure diversity among sub-groups, and the attributed mortality increased by 24.0% than the coarser unassimilated model.

Drivers of ozone-related premature mortality in China: Implications for historical and future scenarios

Long-term exposure to ambient ozone (O3) poses a severe public health threat in China. However, the drivers of premature mortality caused by O3 pollution are still poorly constrained, despite being prerequisites for addressing the threat. Here, we demonstrate the contributions of historical and future changes in peak-season O3, population size, age structure, and baseline mortality to China's O3-related mortality using decomposition analysis. From 2013 to 2021, O3-related mortality decreased dramatically from 78.8 (40.8-124.6) to 68.7 (36.0-107.2) thousand, especially in densely populated areas with high pollution. Variations in peak-season O3, population size, age structure, and baseline mortality led to changes in O3-related mortality of +27.3 (14.8-41.3), +2.6 (1.4-4.1), +22.3 (11.5-35.2), and -40.3 (20.9-63.7) thousand, respectively. The influence of peak-season O3 on O3-related mortality shifted from positive during 2013-2019 (+8.4% per year) to negative during 2019-2021 (-8.8% per year), which highly regulated the interannual trend of mortality. From 2021 to 2035, O3-related mortality is expected to increase by 31% in the current context of peak-season O3 levels, primarily caused by increased aging. Even reducing peak-season O3 to the WHO interim target 1 (IT-1) would only reduce O3-related mortality by 3.9%, while a more rigorous standard (IT-2) would prevent 83.7% of mortality. These findings suggest that improving ambient O3 can lead to significant health benefits, but substantial mitigation strategies are merited given the future trend of population aging.

Quantifying the potential effects of air pollution reduction on population health and health expenditure in Taiwan

Air pollution, particularly ambient fine particulate matter (PM2.5) pollution, poses a significant risk to public health, underscoring the importance of comprehending the long-term impact on health burden and expenditure at national and subnational levels. Therefore, this study aims to quantify the disease burden and healthcare expenditure associated with PM2.5 exposure in Taiwan and assess the potential benefits of reducing pollution levels. Using a comparative risk assessment framework that integrates an auto-aggressive integrated moving average model, we evaluated the avoidable burden of cardiopulmonary diseases (including ischemic heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, and diabetes mellitus) and related healthcare expenditure under different air quality target scenarios, including status quo and target scenarios of 15, 10, and 5 μg/m3 reduction in PM2.5 concentration. Our findings indicate that reducing PM2.5 exposure has the potential to significantly alleviate the burden of multiple diseases. Comparing the estimated attributable disease burden and healthcare expenditure between reference and target scenarios from 2022 to 2050, the avoidable disability-adjusted life years were 0.61, 1.83, and 3.19 million for the 15, 10, and 5 μg/m3 target scenarios, respectively. Correspondingly, avoidable healthcare expenditure ranged from US$ 0.63 to 3.67 billion. We also highlighted the unequal allocation of resources and the need for policy interventions to address health disparities due to air pollution. Notably, in the 5 μg/m3 target scenario, Kaohsiung City stands to benefit the most, with 527,368 disability-adjusted life years avoided and US$ 0.53 billion saved from 2022 to 2050. Our findings suggest that adopting stricter emission targets can effectively reduce the health burden and associated healthcare expenditure in Taiwan. Overall, this study provides policymakers in Taiwan with valuable insights for mitigating the negative effects of air pollution by establishing a comprehensive framework for evaluating the co-benefits of air pollution reduction on healthcare expenditure and disease burden.

Individual and joint associations of long-term exposure to air pollutants and cardiopulmonary mortality: a 22-year cohort study in Northern China

Background

Evidence on the associations between long-term exposure to multiple air pollutants and cardiopulmonary mortality is limited, especially for developing regions with higher pollutant levels. We aimed to characterise the individual and joint (multi-pollutant) associations of long-term exposure to air pollutants with cardiopulmonary mortality, and to identify air pollutant that primarily contributes to the mortality risk.

Methods

We followed 37,442 participants with a mean age of 43.5 years in four cities in northern China (Tianjin, Shenyang, Taiyuan, and Rizhao) from January 1998 to December 2019. Annual particulate matter (PM) with diameters ≤2.5 μm (PM2.5), ≤10 μm (PM10), sulfur dioxide (SO2) and nitrogen dioxide (NO2) were estimated using daily average values from satellite-derived machine learning models and monitoring stations. Time-varying Cox proportional hazards model was used to evaluate the individual association between air pollutants and mortality from non-accidental causes, cardiovascular diseases (CVDs), non-malignant respiratory diseases (RDs) and lung cancer, accounting for demographic and socioeconomic factors. Effect modifications by age, sex, income and education level were also examined. Quantile-based g-Computation integrated with time-to-event data was additionally applied to evaluate the co-effects and the relative weight of contributions for air pollutants.

Findings

During 785,807 person-years of follow-up, 5812 (15.5%) died from non-accidental causes, among which 2932 (7.8%) were from all CVDs, 479 (1.3%) from non-malignant RDs, and 552 (1.4%) from lung cancer. Long-term exposure to PM10 (mean [baseline]: 136.5 μg/m3), PM2.5 (mean [baseline]: 70.2 μg/m3), SO2 (mean [baseline]: 113.0 μg/m3) and NO2 (mean [baseline]: 39.2 μg/m3) were adversely and consistently associated with all mortality outcomes. A 10 μg/m3 increase in PM2.5 was associated with higher mortality from non-accidental causes (hazard ratio 1.20; 95% confidence interval 1.17-1.23), CVDs (1.23; 1.19-1.28), non-malignant RDs (1.37; 1.25-1.49) and lung cancer (1.14; 1.05-1.23). A monotonically increasing curve with linear or supra-linear shape with no evidence of a threshold was observed for the exposure-response relationship of mortality with individual or joint exposure to air pollutants. PM2.5 consistently contributed most to the elevated mortality risks related to air pollutant mixture, followed by SO2 or PM10.

Interpretation

There was a strong and positive association of long-term individual and joint exposure to PM10, PM2.5, SO2, and NO2 with mortalities from non-accidental causes, CVDs, non-malignant RDs and lung cancer in high-exposure settings, with PM2.5 potentially being the main contributor. The shapes of associations were consistent with a linear or supra-linear exposure-response relationship, with no lower threshold observed within the range of concentrations in this study.

Funding

National Key Research and Development Program of China, the China Scholarship Council, the National Natural Science Foundation of China, Natural Science Foundation of Guangdong Province.

Influence of spatial resolution of PM2.5 concentrations and population on health impact assessment from 2010 to 2020 in China

Ambient PM_2.5 pollution is a leading environmental health risk factor worldwide. The spatial resolution of PM_2.5 concentrations and population strongly impacts PM_2.5-related health impact estimates. However, long-term variations and regional differences in this impact have rarely been explored, particularly in China. Here, by aggregating satellite-derived PM_2.5 concentration and population datasets at 1-km resolution in China to coarser resolutions (10, 50, and 100 km), we evaluated decadal changes in the impact of resolution on health assessments at national and local scales. For the sensitivity of population-weighted mean (PWM) PM_2.5 concentrations to resolution, we found that the national PWM PM_2.5 concentration decreased with coarser resolutions; this pattern was widely observed and was more obvious in southern and central China and the Sichuan Basin. The results showed that the sensitivity of national PWM PM_2.5 concentrations to resolution continuously weakened from 2010 to 2020, likely due to a reduction in the spatial heterogeneity of PM_2.5 concentrations in regions with high sensitivity. This weakness caused a large underestimation of the long-term trend of national PWM PM_2.5 using a 100-km resolution, which was 7% lower than the trend at 1 km. Regarding the sensitivity of PM_2.5-attributable mortality to resolution, most of China exhibited a pattern in which attributable mortality decreased with coarser resolution. The sensitivity of the estimated PM_2.5-attributable mortality to resolution also weakened over time on a national scale and in most parts of China. Nevertheless, the weakness for mortality sensitivity was not as apparent as for PWM PM_2.5 sensitivity. This was likely because different drivers played distinct roles in the temporal variation of the mortality sensitivity: population aging enhanced the sensitivity, and variations in PM_2.5 concentrations and population distribution both weakened the sensitivity. However, the national attributable mortality trend at a 100-km resolution was still underestimated by 1.75% relative to the 1-km resolution.

PM2.5 exposure and its interaction of oxidative balance score on ovarian cancer survival: A prospective cohort study

Recent evidence advises particles with a diameter of 2.5 µm or less (PM_2.5) might be a prognostic factor for ovarian cancer (OC) survival. The oxidative balance score (OBS) incorporates diet-lifestyle factors to estimate individuals' anti-oxidant exposure status which may be relevant to cancer prognosis. We aimed to investigate the roles of PM_2.5, and OBS and their interaction in OC prognosis. 663 patients with OC were enrolled in the current study. Satellite-derived annual average exposures to PM_2.5 based on patients' residential locations. The OBS was calculated based on 16 different diet-lifestyle components derived using an acknowledged self-reported questionnaire. The Cox regression model was performed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS). We also assessed the effect of modification between PM_2.5 and OS by OBS via interaction terms. During a median follow-up of 37.57 (interquartile:35.27-40.17) months, 123 patients died. Compared to low-concentration PM_2.5 exposure, high PM_2.5 during 1 year before diagnosis was associated with worse OC survival (HR= 1.19, 95% CI = 1.01-1.42). We observed an improved OS with the highest compared with the lowest OBS (HR = 0.46, 95% CI = 0.27-0.79, P for trend < 0.05). Notably, we also found an additive interaction between low OBS and high exposure to PM_2.5, with the corresponding associations of PM_2.5 being more pronounced among participants with lower OBS (HR = 1.42, 95% CI = 1.09-1.86). PM_2.5 may blunt OC survival, but high OBS represented an antioxidative performance that could alleviate the adverse association of PM_2.5 and OS.

County level study of the interaction effect of PM2.5 and climate sustainability on mortality in China

Introduction

PM2.5 and climate change are two major public health concerns, with majority of the research on their interaction focused on the synergistic effect, particularly for extreme events such as hot or cold temperatures. The climate sustainability index (CLS) was introduced to comprehensively explore the impact of climate change and the interactive effect on human health with air pollution.

Methods

In this study, a county-level panel data in China was collected and used. The generalized additive model (GAM) and geographically and temporally weighted regression (GTWR) was used to explore the interactive and spatial effect on mortality between CLS and PM2.5.

Results and discussions

Individually, when CLS is higher than 150 or lower than 50, the mortality is higher. Moreover, when PM2.5 is more than 35 μg/m3, the influence on mortality is significantly increased as PM2.5 concentration rises; when PM2.5 is above 70 μg/m3, the trend is sharp. A nonlinear antagonistic effect between CLS and PM2.5 was found in this study, proving that the combined adverse health effects of climate change and air pollution, especially when CLS was lower (below 100) and PM2.5 was higher (above 35 μg/m3), the antagonistic effect was much stronger. From a spatial perspective, the impact of CLS and PM2.5 on mortality varies in different geographical regions. A negative and positive influence of CLS and PM2.5 was found in east China, especially in the northeastern and northern regions, -which were heavily polluted. This study illustrated that climate sustainability, at certain level, could mitigate the adverse health influence of air pollution, and provided a new perspective on health risk mitigation from pollution reduction and climate adaptation.

Mathematical modeling in the health risk assessment of air pollution-related disease burden in China: A review

This review paper covers an overview of air pollution-related disease burden in China and a literature review on the previous studies which have recently adopted a mathematical modeling approach to demonstrate the relative risk (RR) of air pollution-related disease burden. The associations between air pollution and disease burden have been explored in the previous studies. Therefore, it is necessary to quantify the impact of long-term exposure to ambient air pollution by using a suitable mathematical model. The most common way of estimating the health risk attributable to air pollution exposure in a population is by employing a concentration-response function, which is often based on the estimation of a RR model. As most of the regions in China are experiencing rapid urbanization and industrialization, the resulting high ambient air pollution is influencing more residents, which also increases the disease burden in the population. The existing RR models, including the integrated exposure-response (IER) model and the global exposure mortality model (GEMM), are critically reviewed to provide an understanding of the current status of mathematical modeling in the air pollution-related health risk assessment. The performances of different RR models in the mortality estimation of disease are also studied and compared in this paper. Furthermore, the limitations of the existing RR models are pointed out and discussed. Consequently, there is a need to develop a more suitable RR model to accurately estimate the disease burden attributable to air pollution in China, which contributes to one of the key steps in the health risk assessment. By using an updated RR model in the health risk assessment, the estimated mortality risk due to the impacts of environment such as air pollution and seasonal temperature variation could provide a more realistic and reliable information regarding the mortality data of the region, which would help the regional and national policymakers for intensifying their efforts on the improvement of air quality and the management of air pollution-related disease burden.

Tracking PM2.5 and O3 Pollution and the Related Health Burden in China 2013-2020

Based on the exposure data sets from the Tracking Air Pollution in China (TAP, http://tapdata.org.cn/), we characterized the spatiotemporal variations in PM_2.5 and O₃ exposures and quantified the long- and short-term exposure related premature deaths during 2013-2020 with respect to the two-stage clean air actions (2013-2017 and 2018-2020). We find a 48% decrease in national PM_2.5 exposure during 2013-2020, although the decrease rate has slowed after 2017. At the same time, O₃ pollution worsened, with the average April-September O₃ exposure increased by 17%. The improved air quality led to 308 thousand and 16 thousand avoided long- and short-term exposure related deaths, respectively, in 2020 compared to the 2013 level, which was majorly attributed to the reduction in ambient PM_2.5 concentration. It is also noticed that with smaller PM_2.5 reduction, the avoided long-term exposure associated deaths in 2017-2020 (13%) was greater than that in 2013-2017 (9%), because the exposure-response curve is nonlinear. As a result of the efforts in reducing PM_2.5-polluted days with the daily average PM_2.5 higher than 75 μg/m³ and the considerable increase in O₃-polluted days with the daily maximum 8 h average O₃ higher than 160 μg/m³, deaths attributable to the short-term O₃ exposure were greater than those due to PM_2.5 exposure since 2018. Future air quality improvement strategies for the coordinated control of PM_2.5 and O₃ are urgently needed.

Satellite-Based Long-Term Spatiotemporal Patterns of Surface Ozone Concentrations in China: 2005-2019

BACKGROUND

Although short-term ozone (O3) exposure has been associated with a series of adverse health outcomes, research on the health effects of chronic O3 exposure is still limited, especially in developing countries because of the lack of long-term exposure estimates.

OBJECTIVES

The present study aimed to estimate the spatiotemporal distribution of monthly mean daily maximum 8-h average O3 concentrations in China from 2005 to 2019 at a 0.05° spatial resolution.

METHODS

We developed a machine learning model with a satellite-derived boundary-layer O3 column, O3 precursors, meteorological conditions, land-use information, and proxies of anthropogenic emissions as predictors.

RESULTS

The random, spatial, and temporal cross-validation R2 of our model were 0.87, 0.86, and 0.76, respectively. Model-predicted spatial distribution of ground-level O3 concentrations showed significant differences across seasons. The highest summer peak of O3 occurred in the North China Plain, whereas southern regions were the most polluted in winter. Most large urban centers showed elevated O3 levels, but their surrounding suburban areas may have even higher O3 concentrations owing to nitrogen oxides titration. The annual trend of O3 concentrations fluctuated over 2005-2013, but a significant nationwide increase was observed afterward.

DISCUSSION

The present model had enhanced performance in predicting ground-level O3 concentrations in China. This national data set of O3 concentrations would facilitate epidemiological studies to investigate the long-term health effect of O3 in China. Our results also highlight the importance of controlling O3 in China's next round of the Air Pollution Prevention and Control Action Plan. https://doi.org/10.1289/EHP9406.

Health risk and disease burden attributable to long-term global fine-mode particles

Particulate matter 2.5 (PM_2.5) pollution has long been a global environmental problem and still poses a great threat to public health. This study investigates global spatiotemporal variations in PM_2.5 using the newly developed satellite-derived PM_2.5 dataset from 1998 to 2018. An integrated exposure-response (IER) model was employed to examine the characteristics of PM_2.5-related deaths caused by chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), lung cancer (LC), and stroke in adults (age≥25), as well as lower respiratory infection (LRI) in children (age≤5). The results showed that high annual PM_2.5 concentrations were observed mainly in East Asia and South Asia. Over the 19-year period, PM_2.5 concentrations constantly decreased in developed regions, but increased in most developing regions. Approximately 84% of the population lived in regions where PM_2.5 concentrations exceeded 10 μg/m³. Meanwhile, the vast majority of the population (>60%) in East and South Asia was consistently exposed to PM_2.5 levels above 35 μg/m³. PM_2.5 exposure was linked to 3.38 (95% UI: 3.05-3.70) million premature deaths globally in 2000, a number that increased to 4.11 (95% UI: 3.55-4.69) million in 2018. Premature deaths related to PM_2.5 accounted for 6.54%-7.79% of the total cause of deaths worldwide, with a peak in 2011. Furthermore, developing regions contributed to the majority (85.95%-95.06%) of PM_2.5-related deaths worldwide, and the three highest-ranking regions were East Asia, South Asia, and Southeast Asia. Globally, IHD and stroke were the two main contributors to total PM_2.5-related deaths, followed by COPD, LC, and LRI.

An Integration Method for Regional PM2.5 Pollution Control Optimization Based on Meta-Analysis and Systematic Review

PM_2.5 pollution in China is becoming increasingly severe, threatening public health. The major goal of this study is to evaluate the mortality rate attributed to PM_2.5 pollution and design pollution mitigation schemes in a southern district of China through a two-objective optimization model. The mortality rate is estimated by health effect evaluation model. Subjected to limited data information, it is assumed that the meta-analysis method, through summarizing and combining the research results on the same subject, was suitable to estimate the percentage of deaths caused by PM_2.5 pollution. The critical parameters, such as the total number of deaths and the background concentration of PM_2.5, were obtained through on-site survey, data collection, literature search, policy analysis, and expert consultation. The equations for estimating the number of deaths caused by PM_2.5 pollution were established by incorporating the relationship coefficient of exposure to reaction, calculated residual PM_2.5 concentration of affected region, and statistical total base number of deaths into a general framework. To balance the cost from air quality improvement and human health risks, a two-objective optimization model was developed. The first objective is to minimize the mortality rate attributable to PM_2.5 pollution, and the second objective is to minimize the total system cost over three periods. The optimization results demonstrated that the combination of weights assigned to the two objectives significantly influenced the model output. For example, a high weight value assigned to minimizing the number of deaths results in the increased use of treatment techniques with higher efficiencies and a dramatic decrease in pollutant concentrations. In contrast, a model weighted more toward minimizing economic loss may lead to an increase in the death toll due to exposure to higher air pollution levels. The effective application of this model in the Nanshan District of Shenzhen City, China, is expected to serve as a basis for similar work in other parts of the world in the future.

Effects of using different exposure data to estimate changes in premature mortality attributable to PM2.5 and O3 in China

The assessment of premature mortality associated with the dramatic changes in fine particulate matter (PM_2.5) and ozone (O₃) has important scientific significance and provides valuable information for future emission control strategies. Exposure data are particularly vital but may cause great uncertainty in health burden assessments. This study, for the first time, used six methods to generate the concentration data of PM_2.5 and O₃ in China between 2014 and 2018, and then quantified the changes in premature mortality due to PM_2.5 and O₃ using the Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE) model. The results show that PM_2.5-related premature mortality in China decreases by 263 (95% confidence interval (CI95): 142-159) to 308 (CI95: 213-241) thousands from 2014 to 2018 by using different concentration data, while O₃-related premature mortality increases by 67 (CI95: 26-104) to 103 (CI95: 40-163) thousands. The estimated mean changes are up to 40% different for the PM_2.5-related mortality, and up to 30% for the O₃-related mortality if different exposure data are chosen. The most significant difference due to the exposure data is found in the areas with a population density of around 10³ people/km², mostly located in Central China, for both PM_2.5 and O₃. Our results demonstrate that the exposure data source significantly affects mortality estimations and should thus be carefully considered in health burden assessments.

Trends in epidemiology: the role of denominator fluctuation in population based estimates

Background

Population estimates are of paramount importance for calculating occurrence and association measures although they can be affected by problems of accuracy and completeness. This study has performed a simulation of the impact of Italian population size variability on incidence rates.

Methods

Data have been obtained by the Italian National Institute of Statistics. For each year expected cases were calculated at increasing fixed rates (up to 1,000/100,000) and were considered constant in the “following year”, calculating statistical differences (P < 0.05).

Results

In Italy and in other regions, statistically significant higher RRs were found in 2012 vs. 2011 whereas statistically significant lower RRs were found in 2013 vs. 2012 and in 2014 vs. 2013.

Contribution

The simulation confirms that significant differences due to population fluctuation could be found between consecutive years when investigating diseases with medium-high rates. Researchers should be encouraged to implement actions for reducing the risk of biased population denominators.

Analysis of Spatial Heterogeneity and the Scale of the Impact of Changes in PM2.5 Concentrations in Major Chinese Cities between 2005 and 2015

Deteriorating air quality is one of the most important environmental factors posing significant health risks to urban dwellers. Therefore, an exploration of the factors influencing air pollution and the formulation of targeted policies to address this issue are critically needed. Although many studies have used semi-parametric geographically weighted regression and geographically weighted regression to study the spatial heterogeneity characteristics of influencing factors of PM2.5 concentration change, due to the fixed bandwidth of these methods and other reasons, those studies still lack the ability to describe and explain cross-scale dynamics. The multi-scale geographically weighted regression (MGWR) method allows different variables to have different bandwidths, which can produce more realistic and useful spatial process models. By applying the MGWR method, this study investigated the spatial heterogeneity and spatial scales of impact of factors influencing PM2.5 concentrations in major Chinese cities during the period 2005–2015. This study showed the following: (1) Factors influencing changes in PM2.5 concentrations, such as technology, foreign investment levels, wind speed, precipitation, and Normalized Difference Vegetation Index (NDVI), evidenced significant spatial heterogeneity. Of these factors, precipitation, NDVI, and wind speed had small-scale regional effects, whose bandwidth ratios are all less than 20%, while foreign investment levels and technologies had medium-scale regional effects, whose bandwidth levels are 23% and 32%, respectively. Population, urbanization rates, and industrial structure demonstrated weak spatial heterogeneity, and the scale of their influence was predominantly global. (2) Overall, the change of NDVI was the most influential factor, which can explain 15.3% of the PM2.5 concentration change. Therefore, an enhanced protection of urban surface vegetation would be of universal significance. In some typical areas, dominant factors influencing pollution were evidently heterogeneous. Change in wind speed is a major factor that can explain 51.6% of the change in PM2.5 concentration in cities in the Central Plains, and change in foreign investment levels is the dominant influencing factor in cities in the Yunnan-Guizhou Plateau and the Sichuan Basin, explaining 30.6% and 44.2% of the PM2.5 concentration change, respectively. In cities located within the lower reaches of the Yangtze River, NDVI is a key factor, reducing PM2.5 concentrations by 9.7%. Those results can facilitate the development of region-specific measures and tailored urban policies to reduce PM2.5 pollution levels in different regions such as Northeast China and the Sichuan Basin.

All-Cause Mortality Risk and Attributable Deaths Associated with Long-Term Exposure to Ambient PM2.5 in Chinese Adults

Several recent studies in China have associated raised mortality risks with chronic exposure to ambient PM_2.5. However, cohort evidence covering general populations and more homogeneous regions is extensively scarce. We conceived a nationwide perspective cohort study from 2010 through 2018, by enrolling 30 946 adult men and women aged 16-110 years from 25 provincial regions in mainland China. Cox proportional hazards models with time-varying exposures were adopted to quantify longitudinal association of PM_2.5 exposure with all-cause mortality. A total of 1762 death events occurred during a median follow-up of 8.1 years. Participants were exposed to a broad range of annual mean PM_2.5 concentrations (2.4-112 μg/m³), with an average estimate of 47.5 μg/m³. A 10-μg/m³ increase in annual average of PM_2.5 exposure was associated with an hazard ratio of 1.055 (95% confidence interval: 1.022-1.088, p < 0.001) for all-cause mortality. We estimated totally 2.68 million deaths attributable to ambient PM_2.5 in 2015, yielding a remarkable reduction of 36.7 thousand compared to the estimate in 2010 (2.72 million deaths). This study added nationally representative evidence regarding concentration-response function for long-term PM_2.5-mortality association in Chinese adults, which may significantly contribute to national and global assessments of PM_2.5-attributable death burden.