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Yu P, Xu R, Huang W, Yang Z, Coelho MSZS, Saldiva PHN, Wen B, Wu Y, Ye T, Zhang Y, Sun HZ, Abramson MJ, Li S, Guo Y. Short-term ozone exposure and cancer mortality in Brazil: A nationwide case-crossover study. Int J Cancer 2024. [PMID: 38985095 DOI: 10.1002/ijc.35069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/24/2024] [Accepted: 06/06/2024] [Indexed: 07/11/2024]
Abstract
Exposure to ambient ozone (O3) is linked to increased mortality risks from various diseases, but epidemiological investigations delving into its potential implications for cancer mortality are limited. We aimed to examine the association between short-term O3 exposure and site-specific cancer mortality and investigate vulnerable subgroups in Brazil. In total 3,459,826 cancer death records from 5570 Brazilian municipalities between 2000 and 2019, were included. Municipal average daily O3 concentration was calculated from a global estimation at 0.25°×0.25° spatial resolution. The time-stratified case-crossover design was applied to assess the O3-cancer mortality association. Subgroup analyses by age, sex, season, time-period, region, urban hierarchy, climate classification, quantiles of GDP per capita and illiteracy rates were performed. A linear and non-threshold exposure-response relationship was observed for short-term exposure to O3 with cancer mortality, with a 1.00% (95% CI: 0.79%-1.20%) increase in all-cancer mortality risks for each 10-μg/m3 increment of three-day average O3. Kidney cancer was most strongly with O3 exposure, followed by cancers of the prostate, stomach, breast, lymphoma, brain and lung. The associated cancer risks were relatively higher in the warm season and in southern Brazil, with a decreasing trend over time. When restricting O3 concentration to the national minimum value during 2000-2019, a total of 147,074 (116,690-177,451) cancer deaths could be avoided in Brazil, which included 17,836 (7014-28,653) lung cancer deaths. Notably, these associations persisted despite observed adaptation within the Brazilian population, highlighting the need for a focus on incorporating specific measures to mitigate O3 exposure into cancer care recommendations.
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Affiliation(s)
- Pei Yu
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rongbin Xu
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Wenzhong Huang
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Zhengyu Yang
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Micheline S Z S Coelho
- Laboratory of Urban Health Insper/ Faculty of Medicine of the University of São Paulo, Sao Paulo, Brazil
| | - Paulo H N Saldiva
- Laboratory of Urban Health Insper/ Faculty of Medicine of the University of São Paulo, Sao Paulo, Brazil
| | - Bo Wen
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yao Wu
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tingting Ye
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yiwen Zhang
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Haitong Z Sun
- Centre for Sustainable Medicine (CoSM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Michael J Abramson
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shanshan Li
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuming Guo
- Climate Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Hu W, Yang J. Effect of ambient ozone pollution on disease burden globally: A systematic analysis for the global burden of disease study 2019. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 926:171739. [PMID: 38508259 DOI: 10.1016/j.scitotenv.2024.171739] [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: 01/28/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Exposure to ambient ozone pollution causes health loss and even death, and both are the main risk factors for the disease burden worldwide. We comprehensively evaluated the ozone pollution-related disease burden. METHODS First, numbers and age-standardized rates of deaths and disability-adjusted life years (DALYs) were assessed globally and by sub-types in 2019. Furthermore, the temporal trend of the disease burden was explored by the linear regression model from 1990 to 2019. The cluster analysis was used to evaluate the changing pattern of related disease burden across Global Burden of Disease Study (GBD) regions. Finally, the age-period-cohort (APC) model and the Bayesian age-period-cohort (BAPC) model were used to predict the future disease burden in the next 25 years. RESULT Exposure to ozone pollution contributed to 365,222 deaths and 6,210,145 DALYs globally in 2019, which accounted for 0.65 % of deaths globally and 0.24 % of DALYs globally. The disease burden was consistently increasing with age. Males were high-risk populations and low-middle socio-demographic index (SDI) regions were high-risk areas. The disease burden of ozone pollution varied considerably across the GBD regions and the countries. In 2019, the number of deaths and DALYs cases increased by 76.11 % and 56.37 %, respectively compared to those in 1990. The predicted results showed that the number of deaths cases and DALYs cases for both genders would still increase from 2020 to 2044. CONCLUSION In conclusion, ambient ozone pollution has threatened public health globally. More proactive and effective strategic measures should be developed after considering global-specific circumstances.
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Affiliation(s)
- Wan Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Junnan Yang
- School of Public Health, BengBu Medical University, 2600 Donghai Avenue, Bengbu, Anhui 233030, China.
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Zhang Y, Hu M, Xiang B, Yu H, Wang Q. Urban-rural disparities in the association of nitrogen dioxide exposure with cardiovascular disease risk in China: effect size and economic burden. Int J Equity Health 2024; 23:22. [PMID: 38321458 PMCID: PMC10845777 DOI: 10.1186/s12939-024-02117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Together with rapid urbanization, ambient nitrogen dioxide (NO2) exposure has become a growing health threat. However, little is known about the urban-rural disparities in the health implications of short-term NO2 exposure. This study aimed to compare the association between short-term NO2 exposure and hospitalization for cardiovascular disease (CVD) among urban and rural residents in Shandong Province, China. Then, this study further explored the urban-rural disparities in the economic burden attributed to NO2 and the explanation for the disparities. METHODS Daily hospitalization data were obtained from an electronic medical records dataset covering a population of 5 million. In total, 303,217 hospital admissions for CVD were analyzed. A three-stage time-series analytic approach was used to estimate the county-level association and the attributed economic burden. RESULTS For every 10-μg/m3 increase in NO2 concentrations, this study observed a significant percentage increase in hospital admissions on the day of exposure of 1.42% (95% CI 0.92 to 1.92%) for CVD. The effect size was slightly higher in urban areas, while the urban-rural difference was not significant. However, a more pronounced displacement phenomenon was found in rural areas, and the economic burden attributed to NO2 was significantly higher in urban areas. At an annual average NO2 concentration of 10 μg/m3, total hospital days and expenses in urban areas were reduced by 81,801 (44,831 to 118,191) days and 60,121 (33,002 to 86,729) thousand CNY, respectively, almost twice as much as in rural areas. Due to disadvantages in socioeconomic status and medical resources, despite similar air pollution levels in the urban and rural areas of our sample sites, the rural population tended to spend less on hospitalization services. CONCLUSIONS Short-term exposure to ambient NO2 could lead to considerable health impacts in either urban or rural areas of Shandong Province, China. Moreover, urban-rural differences in socioeconomic status and medical resources contributed to the urban-rural disparities in the economic burden attributed to NO2 exposure. The health implications of NO2 exposure are a social problem in addition to an environmental problem. Thus, this study suggests a coordinated intervention system that targets environmental and social inequality factors simultaneously.
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Affiliation(s)
- Yike Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
- National Institute of Health Data Science of China, Shandong University, Jinan, China
| | - Mengxiao Hu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
- National Institute of Health Data Science of China, Shandong University, Jinan, China
| | - Bowen Xiang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
- National Institute of Health Data Science of China, Shandong University, Jinan, China
| | - Haiyang Yu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
- National Institute of Health Data Science of China, Shandong University, Jinan, China
| | - Qing Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.
- National Institute of Health Data Science of China, Shandong University, Jinan, China.
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Wei Y, Fei L, Wang Y, Zhang M, Chen Z, Guo H, Ge S, Zhu S, Dong P, Yang K, Xie N, Zhao G. A time-series analysis of short-term ambient ozone exposure and hospitalizations from acute myocardial infarction in Henan, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:93242-93254. [PMID: 37507564 PMCID: PMC10447277 DOI: 10.1007/s11356-023-28456-2] [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: 03/15/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023]
Abstract
Epidemiological studies in recent years have identified an association between exposure to air pollutants and acute myocardial infarction (AMI); however, the association between short-term ozone (O3) exposure and AMI hospitalization remains unclear, particularly in developing countries. Therefore, this study collected information on 24,489 AMI patients, including daily air pollutant and meteorological data in Henan, China, between 2016 and 2021. A distributed lagged nonlinear model combined with a Poisson regression model was used to estimate the nonlinear lagged effect of O3 on AMI hospitalizations. We also quantified the effects of O3 on the number of AMI hospitalizations, hospitalization days, and hospitalization costs. The results showed that single- and dual-pollution models of O3 at lag0, lag1, and lag (01-07) were risk factors for AMI hospitalizations, with the most significant effect at lag03 (RR = 1.132, 95% CI:1.083-1.182). Further studies showed that males, younger people (15-64 years), warm seasons, and long sunshine duration were more susceptible to O3. Hospitalizations attributable to O3 during the study period accounted for 11.66% of the total hospitalizations, corresponding to 2856 patients, 33,492 hospital days, and 90 million RMB. Maintaining O3 at 10-130 µg/m3 can prevent hundreds of AMI hospitalizations and save millions of RMB per year in Henan, China. In conclusion, we found that short-term exposure to O3 was significantly associated with an increased risk of hospitalization for AMI in Henan, China, and that further reductions in ambient O3 levels may have substantial health and economic benefits for patients and local healthcare facilities.
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Affiliation(s)
- Yulong Wei
- Department of Cardiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Lin Fei
- Department of Cardiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
- Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Yongbin Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, China
| | - Min Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, 453003, China
- School of Cardiovascular and Metabolic Medicine & Sciences, King's College London British Heart Foundation Centre of Research Excellence, London, SE5 9NU, UK
| | - Zhigang Chen
- Department of Cardiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Huige Guo
- Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Shiqi Ge
- Department of Cardiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Sen Zhu
- Department of Cardiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Pingshuan Dong
- Department of Cardiology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, 471003, China
| | - Kan Yang
- Department of Cardiovascular Surgery, Nanyang Affiliated Hospital of Zhengzhou University, Nanyang Central Hospital, Nanyang, 473009, China
| | - Na Xie
- The Cardiology Department of the Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453003, China
| | - Guoan Zhao
- Department of Cardiology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China.
- Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China.
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