Spatial vulnerability under extreme events: a case of Asian dust storm's effects on children's respiratory health

Ambient carbon monoxide and relative risk of daily hospital outpatient visits for respiratory diseases in Lanzhou, China

At present, evidence of the associations between carbon monoxide (CO) and respiratory diseases (RD) in Northwest China is limited and controversial. The aim of this study is to evaluate the impact of ambient CO on outpatient visits for RD in Lanzhou, China. The daily amount of outpatient visits for total and cause-specific RD, air pollutant, and weather variables were collected in Lanzhou, China from 1st January 2013 to 31st December 2019. A generalized additive model and distributed lag nonlinear model were used to assess associations between CO and outpatient visits for RD. During the study period, a total of 1,623,361 RD outpatient visits were recorded. For each interquartile range (IQR) (0.77 mg/m3) increase in CO, the relative risk (RR) was 1.163 (95% CI: 1.138, 1.188) for total RD at lag07, 1.153 (95% CI: 1.128,1.179) for upper respiratory tract infection (URTI) at lag07, 1.379 (95% CI: 1.338,1.422) for pneumonia at lag07, 1.029 (95% CI: 0.997,1.062) for chronic obstructive pulmonary disease (COPD) lag04, 1.068 (95% CI: 1.028,1.110) for asthma lag03, and 1.212 (95% CI: 1.178,1.247) for bronchitis lag07, respectively. In the subgroup analyses, the impacts of CO were more pronounced on total RD, pneumonia, COPD, and bronchitis in males than females, while the opposite was true in URTI and asthma. The impact of CO on RD was the strongest for children under 15 years-of-age. We also found significantly stronger effects during cold seasons compared to warm seasons. In addition, we observed a roughly linear exposure-response curve between CO and RD with no threshold effect. This study in Lanzhou revealed a remarkable association between CO level and an elevated risk of total and cause-specific RD outpatient visits, especially for pneumonia.

Air Pollutants in Metropolises of Eastern Coastal China

Recently released hourly particular matter (PM:PM_2.5 and PM₁₀) and gaseous pollutants (SO₂, NO₂, CO, and O₃) data observed in Qingdao, Hangzhou, and Xiamen from 2015 to 2019 were utilized to reveal the current situation of air pollution over eastern coastal China. The PM pollution situation over the three metropolises ameliorated during studied period with the concentrations decreasing about 20-30%. Gas pollutants, excepting SO₂, generally exhibit no evident reduction tendencies, and a more rigorous control standard on gaseous pollutants is neededEven for the year 2018 with low pollution levels among the study period, these levels (<10% of PM_2.5, <6% of PM₁₀, and <15% of O₃) surpass the Grade II of the Chinese Ambient Air Quality Standard (CAAQS) over these metropolises of eastern coast China. No matter in which year, both SO₂ and CO concentrations are always below the Grade-II standards. According to the comparative analysis of PM_2.5/PM₁₀ and PM_2.5/CO during episode days and non-episode days, the formation of secondary aerosols associated with stagnant weather systems play an important role in the pollutant accumulation as haze episodes occurred. The stronger seasonal variations and higher magnitude occur in Qingdao and Hangzhou, while weaker seasonal variations and lower magnitudes occur in Xiamen. In Qingdao and Hangzhou, PM, NO₂, SO₂, and CO show relatively high levels in the cold wintertime and low levels in summer, whereas O₃ shows a completely opposite pattern. Xiamen exhibits high levels of all air pollutants except O₃ in spring due to its subtropical marine monsoon climate with mild winters. According to the back trajectory hierarchical clustering and concentration weighted trajectory (CWT) analysis, the regional transmission from adjacent cities has a significant impact on the atmospheric pollutant concentrations under the control of the prejudiced winds. Thus, besides local emission reduction, strengthening regional environmental cooperation and implementing joint prevention are effective measures to mitigate air pollution in the eastern coastal areas of China.

Spatial modeling of mortality from acute lower respiratory infections in children under 5 years of age in 2000-2017: a global study

BACKGROUND

Over the past few decades, various goals have been defined to reduce the mortality of children caused by acute lower respiratory infections (ALRIs) worldwide. However, few spatial studies to date have reported on ALRI deaths.

PURPOSE

We aimed to assess the spatial modeling of mortality from ALRI in children under 5 years of age during 2000-2017 using a global data.

METHODS

The data on the mortality of children under 5 years old caused by ALRI were initially obtained from the official website of the World Health Organization. The income status of their home countries was also gathered from the Country Income Groups (World Bank Classification) website and divided into 5 categories. After that, in the ArcGIS 10.6 environment, a database was created and the statistical tests and related maps were extracted. The Global Moran's I statistic, Getis-Ord Gi statistic, and geographically weighted regression were used for the analyses. In this study, higher z scores indicated the hot spots, while lower z scores indicated the cold spots.

RESULTS

In 2000-2017, child mortality showed a downward trend from 17.6 per 100,000 children to 8.1 and had a clustered pattern. Hot spots were concentrated in Asia in 2000 but shifted toward African countries by 2017. A cold spot that formed in Europe in 2007 showed an ascending trend by 2017. Based on the results of geographically weighted regression test, the regions identified as the hot spots of mortality from ALRI in children under 5 years old were among the middle-income countries (R2=0.01, adjusted R2=8.77).

CONCLUSION

While the total number of child deaths in 2000-2017 has decreased, the number of hot spots has increased among countries. This study also concluded that, during the study period, Central and Western Africa countries became the main new hot spots of deaths from ALRI.

Analysis on the Characteristics of Air Pollution in China during the COVID-19 Outbreak

The COVID-19 pandemic poses a serious global threat to human health. In China, the government immediately implemented lockdown measures to curb the spread of this virus. These measures severely affected transportation and industrial production across the country, resulting in a significant change in the concentration of air pollutants. In this study, the Euclidean distance method was used to select the most similar meteorological field during the COVID-19 lockdown period. Changes in the concentration of air pollutants in China were analyzed under similar meteorological background conditions. Results indicate that, compared with data from 2015–2019, air quality in China significantly improved; with the exception of ozone (O3), the concentration of major air pollutants declined. Compared with baseline conditions, the reduction of air pollutants in China from 25 January to 22 February 2020 (Period 2) was the most significant. In particular, NO2 decreased by 41.7% in the Yangtze River Delta. In Period 2, the reduction of air pollutants in areas other than Hubei gradually decreased, but the reduction of NO2 in Wuhan reached 61.92%, and the reduction of air pollutants in various regions after February 23 was significantly reduced. By excluding the influence of meteorological factors and calculating the contribution of human activities to atmospheric pollutants by linear fitting, in Period 2 the effect of artificial controls on NO2 in Wuhan attained 30.66%, and reached 48.17% from 23 February to 23 March (Period 3). Results from this investigation provides effective theoretical support for pollution prevention and control in China.

Identifying sources of dust aerosol using a new framework based on remote sensing and modelling

Dust particles are transported globally. Dust storms can adversely impact both human health and the environment, but they also impact transportation infrastructure, agriculture, and industry, occasionally severely. The identification of the locations that are the primary sources of dust, especially in arid and semi-arid environments, remains a challenge as these sites are often in remote or data-scarce regions. In this study, a new method using state-of-the-art machine-learning algorithms - random forest (RF), support vector machines (SVM), and multivariate adaptive regression splines (MARS) - was evaluated for its ability to spatially model the distribution of dust-source potential in eastern Iran. To accomplish this, empirically identified dust-source locations were determined with the ozone monitoring instrument aerosol index and the Moderate-Resolution Imaging Spectroradiometer (MODIS) Deep Blue aerosol optical thickness methods. The identified areas were divided into training (70%) and validation (30%) sets. Measurements of the conditioning factors (lithology, wind speed, maximum air temperature, land use, slope angle, soil, rainfall, and land cover) were compiled for the study area and predictive models were developed. The area-under-the-receiver operating characteristics curve (AUC) and true-skill statistics (TSS) were used to validate the maps of the models' predictions. The results show that the RF algorithm performed best (AUC = 89.4% and TSS = 0.751), followed by the SVM (AUC = 87.5%, TSS = 0.73) and the MARS algorithm (AUC = 81%, TSS = 0.69). The results of the RF indicated that wind speed and land cover are the most important factors affecting dust generation. The region of highest dust-source potential that was identified by the RF is in the eastern parts of the study region. This model can be applied to other arid and semi-arid environments that experience dust storms to promote management that prevents desertification and reduces dust production.

Air pollution characteristics and human health risks in key cities of northwest China

Air pollution events occur frequently in northwest China, which results in serious detrimental effects on human health. Therefore, it is essential to understand the air pollution characteristics and assess the risks to humans. In this study, we analyzed the pollution characteristics of criteria pollutants in six key cities in northwest China from 2015 to 2018. We used the air quality index (AQI), aggregate AQI (AAQI), and health-risk based AQI (HAQI) to assess the health risks and determine the proportion of people exposed to air pollution. Additionally, on this basis, the AirQ_2.2.3 model was used to quantify the health effects of the pollutants. The results showed that PM₁₀ pollution occurred mainly in spring and winter and was caused by frequent dust storms. PM_2.5 pollution was caused mainly by anthropogenic activities (especially coal-fired heating in winter). Because of a series of government policies and pollutant reduction measures, PM_2.5, SO₂, NO₂, and CO concentrations showed a downward trend during the study period (except for a small increase in the case of NO₂ in some years.). However, O₃ showed high concentrations due to the high intensity of solar radiation in summer and inadequate emission reduction measures. The air quality levels based on their classification were generally higher than the Chinese ambient air quality standard classified by the AQI index. We also found that the higher the AQI index was, the more serious the air pollution classified based on the AAQI and HAQI indices was. The HAQI index could better reflect the impact of pollutants on human health. Based on the HAQI index, 20% of the population in the study area was exposed to polluted air. The total mortality values attributable to PM₁₀, PM_2.5, SO₂, O₃, NO₂, and CO, quantified by the AirQ_2.2.3 model, were 3.00%, 1.02%, 1.00%, 4.22%, 1.57%, and 0.95% (Confidence Interval:95%), respectively; the attributable proportions of mortality for respiratory system and cardiovascular diseases were consistent with the change rule of total mortality, because the number of deaths attributable to the latter was greater than that for the former. According to the exposure reaction curves of pollutants, PM₁₀ and PM_2.5 still showed a large change at high concentrations. However, the tendencies of SO₂, NO₂, CO, and O₃ were more obvious under low concentration exposure, which indicated that the expected mortality rate due to lower air pollution concentrations was much higher than the mortality due to high air pollution concentrations.

Health Effects of Asian Dust: A Systematic Review and Meta-Analysis

BACKGROUND

Potential adverse health effects of Asian dust exposure have been reported, but systematic reviews and quantitative syntheses are lacking.

OBJECTIVE

We reviewed epidemiologic studies that assessed the risk of mortality, hospital admissions, and symptoms/dysfunction associated with exposure to Asian dust.

METHODS

We performed a systematic search of PubMed and Web of Science to identify studies that reported the association between Asian dust exposure and human health outcomes. We conducted separate meta-analyses using a random-effects model for mortality and hospital admissions for a specific health outcome and assessed pooled estimates for each lag when at least three studies were available for a specific lag.

RESULTS

We identified 89 studies that met our inclusion criteria for the systematic review, and 21 studies were included in the meta-analysis. The pooled estimates (percentage changes) of mortality from circulatory and respiratory causes for Asian dust days vs. non-Asian dust days were 2.33% [95% confidence interval (CI): 0.76, 3.93] increase at lag 0 and 3.99% (95% CI: 0.08, 8.06) increase at lag 3, respectively. The increased risk for hospital admissions for respiratory disease, asthma, and pneumonia peaked at lag 3 by 8.85% (95% CI: 0.80, 17.55), 14.55% (95% CI: 6.74, 22.94), and 8.51% (95% CI: 2.89, 14.44), respectively. Seven of 12 studies reported reduced peak expiratory flow, and 16 of 21 studies reported increased respiratory symptoms associated with Asian dust exposure. There were substantial variations between the studies in definitions of Asian dust, study designs, model specifications, and confounder controls.

DISCUSSION

We found evidence of increased mortality and hospital admissions for circulatory and respiratory events. However, the number of studies included in the meta-analysis was not large and further evidences are merited to strengthen our conclusions. Standardized protocols for epidemiological studies would facilitate interstudy comparisons. https://doi.org/10.1289/EHP5312.

The impact of exposure to desert dust on infants' symptoms and countermeasures to reduce the effects

BACKGROUND

The association between particulate matter (PM), including desert dust, and allergic symptoms has not been well studied. We examined whether PM exacerbated nose/eye/respiratory symptoms in infants, with a focus on the desert dust element, and assessed possible countermeasures.

METHODS

We conducted a panel study of 1492 infants from October 2014 to July 2016 in 3 regions in Japan as an adjunct study of the Japan Environment and Children's Study. Infants' daily symptom scores and behaviors were acquired by web-based questionnaires sent to mothers, who answered within a day using mobile phones. Odds ratios (OR) for symptom development per increased fine PM or desert dust exposure were estimated. Regular use of medications and behaviors on the day of exposure were investigated as possible effect modifiers.

RESULTS

Infants developed nose/eye/respiratory symptoms significantly more often in accordance with fine particulate levels (adjusted OR per 10 µg/m³ increase: 1.04, 95% confidence interval [CI]: 1.01-1.07). A model including both fine particulates and desert dust showed reduced OR for fine particulates and robust OR for desert dust (adjusted OR per 0.1/km increase: 1.16, 95% CI: 1.09-1.23). An increased OR was observed both in infants who had previously wheezed and in those who had never wheezed. Receiving information on the particulate forecast, reducing time outdoors, closing windows, and regular use of leukotriene receptor antagonists were significant effect modifiers.

CONCLUSIONS

Transborder desert dust arrival increased the risk of nose/eye/respiratory symptoms development in infants. Regular use of leukotriene receptor antagonists and other countermeasures reduced the risk.

Association between Asian dust exposure and respiratory function in children with bronchial asthma in Nagasaki Prefecture, Japan

BACKGROUND

Studies on the adverse effects of Asian dust (AD) on respiratory function in children are scarce. The objective of this study was to examine the association between AD and respiratory function by measuring peak expiratory flow rates (PEFRs) in asthmatic children.

METHODS

The study was carried out from March to May from 2014 through 2016. One hundred ten children with bronchial asthma were recruited from four hospitals in the Goto Islands and south Nagasaki area in Nagasaki prefecture. The parents were asked to record their children's PEFRs every morning/evening and clinical symptoms in an asthma diary. AD was assessed from light detection and ranging data, and a linear mixed-effects model was used to estimate the effects of AD on daily PEFR. Time-stratified case-crossover analyses were performed to examine the association between AD and asthma attacks defined by reduction levels in PEFR.

RESULTS

AD was detected on 11 days in the Goto Islands, and on 23 days in the south Nagasaki area. After adjusting for age, sex, temperature, and daily oxidants, we found a consistent association between AD and a 1.1% to 1.7% decrease in PEFR in the mornings and a 0.7% to 1.3% decrease in the evenings at a lag of 0 to 5 days. AD was not associated with the number of asthma attacks, respiratory symptoms, or other symptoms at any lag days examined.

CONCLUSIONS

Exposure to AD was associated with reduced PEFR, although the effects were not large enough to induce clinically apparent symptoms, in clinically well-controlled asthmatic children.

[Health Effects of Asian Dust Events: A Literature Review Update of Epidemiological Evidence]

Asian dust is a phenomenon involving the long-range transport of atmospheric pollutants originating from the desert areas of China and Mongolia. In recent years, the health effects of Asian dust have raised public concerns. Numerous studies on the health effects of Asian dust have been published since the last review in 2010. Thus, a literature review was conducted to shed light on the latest epidemiologic findings. PubMed and Science Direct databases were used for the review of epidemiologic studies published between June 2009 and April 2018. We identified 53 epidemiologic studies. Mortality, ambulance transportation, hospitalization/medical examination, changes in symptomatic, functional, and examination findings, as well as birth outcomes have been reported as outcomes. When the outcomes were categorized by disease, the effects of Asian dust on respiratory, cardiovascular, and allergic diseases raised concerns. The common evidences of causation between Asian dust and these diseases were the consistency of findings and temporal sequence of association. As results of research on dose-response relationships have become available, and the possibility that the health effects of Asian dust may vary depending on its chemical composition has been pointed out, further research using the exposure level indicators of Asian dust or its chemical composition should be conducted. Furthermore, with focus on the crucial issue of reducing exposure, research related to prevention and raising awareness should be further promoted.

The Influence of Multi-Scale Atmospheric Circulation on Severe Haze Events in Autumn and Winter in Shanghai, China

Severe haze events have many adverse effects on agricultural production and human activity. Haze events are often associated with specific patterns of atmospheric circulation. Therefore, studying the relationship between atmospheric circulation and haze is particularly important for early warning and forecasting of urban haze events. In order to study the relationship between multi-scale atmospheric circulation and severe haze events in autumn and winter in Shanghai, China, we used a T-mode objective classification method to classify autumn and winter atmospheric circulation patterns into six types based on sea level pressure data from 2007 to 2016 in the Shanghai area. For the period between September 2016 and February 2017, we used the Allwine–Whiteman method to classify the local wind in Shanghai into three categories: stagnation, recirculation, and ventilation. By further studying the PM2.5 concentration distribution, visibility distribution, and other meteorological characteristics of each circulation type (CT) and local wind field type, we found that the Shanghai area is most prone to severe haze when exposed to certain circulation patterns (CT1, CT2, and CT4), mainly associated to the cold air activity and the displacement of the high pressure system relative to Shanghai. We also found that the local wind fields in the Shanghai area are dominated by recirculation and stagnation events. These conclusions were further verified by studying a typical pollution process in Shanghai in November 2016 and the pollutant diffusion path using the HYSPLIT (Hybrid Single Particle Lagrangian Integrated Trajectory model) simulation model.

Reinforcement of Tobacco Control and Reduction in Medical Utilization for Asthma in Taiwan: A Population-Based Study

Environmental air quality can affect asthma control and the development of overt asthmatic manifestations. In this population-based study, we investigated the effect of reinforcing a smoking ban in Taiwan through the enactment of the Tobacco Hazards and Prevention Act (THPA) on healthcare utilization rate by asthmatics. Analysis was performed based on data relevant to non-hospitalized asthmatic patients with insurance claims between 2005 and 2013 from the National Health Insurance Research Database of Taiwan, reported data on Asian dust storms, and penalty rates for violations of the tobacco ban. Poisson regression showed that the risk for outpatient visits for asthma was lower after enactment of the THPA (RR = 0.98, 95% CI = 0.98-0.99), with a yearly trend of a reduced risk (RR = 0.99, 95% CI = 0.99-1.00), also lower in geographic regions with medium (RR = 0.79, 95% CI = 0.79-0.80) and high (RR = 0.91, 95% CI = 0.91-0.92) penalty rates. Subgroup analysis showed that asthma visit rates were reduced in both male and female groups after the enactment of the THPA. The risk of an asthma ER visit was increased after the enactment of the amended THPA (RR = 1.07, 95% CI = 1.05-1.09), although the yearly trend was not significant (RR = 1.00, 95% CI = 1.00-1.00). The risk of emergency room visits for asthma was significantly reduced in regions with medium (RR = 0.68, 95% CI = 0.68-0.69) and high (RR = 0.75, 95% CI = 0.74-0.76) penalty rates. Subgroup analysis showed that the visit rates were similar in both male and female groups. The effectiveness of reinforcing the smoking ban warrants further policies aimed at further reducing passive smoking.

Prediction of health effects of cross-border atmospheric pollutants using an aerosol forecast model

Health effects of cross-border air pollutants and Asian dust are of significant concern in Japan. Currently, models predicting the arrival of aerosols have not investigated the association between arrival predictions and health effects. We investigated the association between subjective health symptoms and unreleased aerosol data from the Model of Aerosol Species in the Global Atmosphere (MASINGAR) acquired from the Japan Meteorological Agency, with the objective of ascertaining if these data could be applied to predicting health effects. Subjective symptom scores were collected via self-administered questionnaires and, along with modeled surface aerosol concentration data, were used to conduct a risk evaluation using generalized estimating equations between October and November 2011. Altogether, 29 individuals provided 1670 responses. Spearman's correlation coefficients were determined for the relationship between the proportion of the participants reporting the maximum score of two or more for each symptom and the surface concentrations for each considered aerosol species calculated using MASINGAR; the coefficients showed significant intermediate correlations between surface sulfate aerosol concentration and respiratory, throat, and fever symptoms (R = 0.557, 0.454, and 0.470, respectively; p < 0.01). In the general estimation equation (logit link) analyses, a significant linear association of surface sulfate aerosol concentration, with an endpoint determined by reported respiratory symptom scores of two or more, was observed (P trend = 0.001, odds ratio [OR] of the highest quartile [Q4] vs. the lowest [Q1] = 5.31, 95% CI = 2.18 to 12.96), with adjustment for potential confounding. The surface sulfate aerosol concentration was also associated with throat and fever symptoms. In conclusion, our findings suggest that modeled data are potentially useful for predicting health risks of cross-border aerosol arrivals.

Spatio-temporal variability of particulate matter in the key part of Gansu Province, Western China

To investigate the spatial and temporal behaviors of particulate matter in Lanzhou, Jinchang and Jiayuguan during 2014, the hourly concentrations of PM2.5 and PM10 were collected from the Ministry of Environmental Protection (MEP) in this study. The analysis indicated that the mean annual PM10 (PM2.5) concentrations during 2014 were 115 ± 52 μg/m³ (57 ± 28 μg/m³), 104 ± 75 μg/m³ (38 ± 22 μg/m³) and 114 ± 72 μg/m³ (32 ± 17 μg/m³) in Lanzhou, Jinchang and Jiayuguan, respectively, all of which exceeded the Chinese national ambient air quality II standards for PM. Higher values for both PM fractions were generally observed in spring and winter, and lower concentrations were found in summer and autumn. Besides, the trend of seasonal variation of particulate matter (PM) in each city monitoring site is consistent with the average of the corresponding cities. Anthropogenic activities along with the boundary layer height and wind scale contributed to diurnal variations in PM that varied bimodally (Lanzhou and Jinchang) or unimodally (Jiayuguan). With the arrival of dust events, the PM10 concentrations changed dramatically, and the PM10 concentrations during dust storm events were, respectively, 19, 43 and 17 times higher than the levels before dust events in Lanzhou, Jinchang and Jiayuguan. The ratios (PM2.5/PM10) were lowest, while the correlations were highest, indicating that dust events contributed more coarse than fine particles, and the sources of PM are similar during dust storms. The relationships between local meteorological parameters and PM concentrations suggest a clear association between the highest PM concentrations, with T ≤ 7 °C, and strong winds (3-4 scale). However, the effect of relative humidity is complicated, with more PM10 and PM2.5 exceedances being registered with a relative humidity of less than 40% and 40-60% in Lanzhou, while higher exceedances in Jinchang appeared at a relative humidity of 80-100%.

Elemental and carbonaceous characterization of TSP and PM10 during Middle Eastern dust (MED) storms in Ahvaz, Southwestern Iran

Middle Eastern dust (MED) storms carry large amounts of dust particles to the Southern and Western cities of Iran. This study aimed to characterize the elemental and carbonaceous composition of total suspended particles (TSP) and PM₁₀ in Ahvaz, Iran. TSP and PM₁₀ samples were collected using two separate high-volume air samplers. The sampling program was performed according to EPA guidelines and resulted in 72 samples. Twenty-eight elements and two carbonaceous components in TSP and PM₁₀ were measured. Over the entire study period, the mean concentration (SD) of TSP and PM₁₀ was 1548.72 μg/m³ (1965.11 μg/m³) and 1152.35 μg/m³ (1510.34 μg/m³), respectively. The order of concentrations of major species were Si > Al > Ca > OC > Na > B > Zn > Mn > K > Mg and Si > Ca > Al > Na > OC > B > K > Mn > Cu > Mg for TSP and PM₁₀, respectively. Almost all elements (except for Cd, Cr, and Cu) and carbonaceous components (except for organic carbon) had dust days/non-dust days (DD/NDD) ratios higher than 1, implying that all components are somehow affected by dust storms. Crustal elements constituted the major portion of particles for both TSP and PM₁₀ in both DDs and NDDs. The enrichment factor of elements such as Ca, Fe, K, Mg, Na, and Ti was near unity. Species such as Al, Ca, Fe, K, Na, Si, and EC had high correlation coefficients in both TSP and PM₁₀ (except for EC). In conclusion, Ahvaz is exposed to high concentrations of TSP and PM₁₀ during the MED period. Immediate actions must be planned to decrease the high concentrations of particulate matter in Ahvaz's ambient air.

Components of Population Vulnerability and Their Relationship With Climate-Sensitive Health Threats

Climate change is increasingly being framed as risks that will impact the poorest and most vulnerable communities among us. This has led to more efforts to estimate climate change risks across populations and in the context of human health and health equity. We describe the public health dimensions of climate vulnerability-exposure, population sensitivity, and adaptive capacity-and explore how these dimensions can modify population health impacts and their distribution. An overview of health disparities associated with specific climate risks is presented, and we offer potential solutions grounded in equitable urban development and improved characterization of climate vulnerabilities.

Asian Dust and Pediatric Emergency Department Visits Due to Bronchial Asthma and Respiratory Diseases in Nagasaki, Japan

Background

The adverse health effects of Asian dust (AD) on the respiratory system of children are unclear. We hypothesized that AD events may lead to increased visits by children to emergency medical centers due to bronchial asthma and respiratory diseases, including bronchial asthma.

Methods

We used anonymized data on children receiving primary emergency treatment at Nagasaki Municipal Primary Emergency Medical Center, Japan between March 2010 and September 2013. We used Light Detection and Ranging (LIDAR) data to assess AD exposure and performed time-stratified case-crossover analyses to examine the association between AD exposure and emergency department visits. The main analysis was done with data collected from March through May each year.

Results

The total number of emergency department visits during the study period was 756 for bronchial asthma and 5421 for respiratory diseases, and the number of “AD days” was 47. In school children, AD events at lag day 3 and lag day 4 were associated with increased emergency department visits due to bronchial asthma, with odds ratios of 1.837 (95% confidence interval [CI], 1.212–2.786) and 1.829 (95% CI, 1.179–2.806), respectively. AD events were significantly associated with respiratory diseases among preschool children at lag day 0, lag day 1, and lag day 2, with odds ratios of 1.244 (95% CI, 1.128–1.373), 1.314 (95% CI, 1.189–1.452), and 1.273 (95% CI, 1.152–1.408), respectively. These associations were also significant when the results were adjusted for meteorological variables and other air pollutants.

Conclusions

The study findings suggested that AD exposure increases emergency department visits by children.

Exposure to mould allergens and rhinoconjunctivitis in Korean children

BACKGROUND

Although rhinitis is the most common allergic disease in children, few studies have explored the causal relationships between mould allergens and rhinitis. Thus, this study aimed to identify factors, especially prior exposure to mould allergens, related to rhinitis and rhinoconjunctivitis in Korean children.

METHODS

Subjects in this study were 12- to 13-year-old children from 40 national middle schools who were participants of the International Study of Asthma and Allergies in Childhood (ISAAC) study in Korea. A total of 3852 children who completed the ISAAC questionnaire in 2010 and underwent a skin prick test (SPT) and blood test were enrolled in this study.

RESULTS

The prevalence of symptoms suggestive of rhinitis or rhinoconjunctivitis in last 12 months was 42.7% and 19.4%, respectively. A parental history of allergies (OR = 2.03, 95% CI = 1.75-2.35; OR = 2.55, 95% CI = 2.13-3.06), visible mould or dampness (OR = 1.28, 95% CI = 1.09-1.51; OR = 1.23, 95% CI = 1.00-1.51), previous exposure to mould allergens (OR = 4.53, 95% CI = 2.32-8.84; OR = 4.98, 95% CI = 2.43-10.20), total IgE levels ≥78 kU/l (OR = 1.44, 95% CI = 1.22-1.69; OR = 1.99, 95% CI = 1.60-2.48) were risk factors for rhinitis and rhinoconjunctivitis.

CONCLUSIONS

This study suggested that previous exposure to mould allergens more influenced rhinitis and rhinoconjunctivitis than visible mould or dampness, and that total IgE levels of ≥78 kU/l, which was the criterion suggested in a study of Asian children, were risk factors for rhinitis diseases.

Short-term population-based non-linear concentration-response associations between fine particulate matter and respiratory diseases in Taipei (Taiwan): a spatiotemporal analysis

Fine particulate matter <2.5 μm (PM2.5) has been associated with human health issues; however, findings regarding the influence of PM2.5 on respiratory disease remain inconsistent. The short-term, population-based association between the respiratory clinic visits of children and PM2.5 exposure levels were investigated by considering both the spatiotemporal distributions of ambient pollution and clinic visit data. We applied a spatiotemporal structured additive regression model to examine the concentration-response (C-R) association between children's respiratory clinic visits and PM2.5 concentrations. This analysis was separately performed on three respiratory disease categories that were selected from the Taiwanese National Health Insurance database, which includes 41 districts in the Taipei area of Taiwan from 2005 to 2007. The findings reveal a non-linear C-R pattern of PM2.5, particularly in acute respiratory infections. However, a PM2.5 increase at relatively lower levels can elevate the same-day respiratory health risks of both preschool children (<6 years old) and schoolchildren (6-14 years old). In preschool children, same-day health risks rise when concentrations increase from 0.76 to 7.44 μg/m(3), and in schoolchildren, same-day health risks rise when concentrations increase from 0.76 to 7.52 μg/m(3). Changes in PM2.5 levels generally exhibited no significant association with same-day respiratory risks, except in instances where PM2.5 levels are extremely high, and these occurrences do exhibit a significant positive influence on respiratory health that is especially notable in schoolchildren. A significant high relative rate of respiratory clinic visits are concentrated in highly populated areas. We highlight the non-linearity of the respiratory health effects of PM2.5 on children to investigate this population-based association. The C-R relationship in this study can provide a highly valuable alternative for assessing the effects of ambient air pollution on human health.

Emergency room visits associated with particulate concentration and Asian dust storms in metropolitan Taipei

This study evaluated risks of emergency room visits (ERV) for all causes, circulatory diseases, and respiratory diseases associated with concentrations of particulate matter (PM10 and PM2.5) and Asian dust storms (ADS) from 2000 to 2008 in metropolitan Taipei. Cumulative 4-day (lag 0-3) relative risks (RR) and confidence intervals (CI) of cause-specific ERV associated with daily concentrations of PM10 or PM2.5 and ADS based on study period (ADS frequently inflicted period: 2000-2004 and less-inflicted period: 2005-2008) were estimated using a distributed lag non-linear model with Poisson distribution. Risks associated with ADS-inflicted season (winter and spring), strength (ratio of stations with Pollutant Standard Index above 100 is < 0.5 or ≥ 0.5), and duration (ADS lasting for 1-3 days or ≥ 4 days) were especially evaluated. In non-linear models, an increase in PM10 from 10 μg/m(3) to 50 μg/m(3) was associated with increased risk of ERV for all causes and respiratory disease with cumulative 4- day RR of 1.18 (95% CI: 1.13, 1.24) and 1.37 (95% CI: 1.23, 1.54), respectively. From 2005 to 2008, the cumulative 4-day RR for an ERV related to an increase in PM2.5 from 5 μg/m(3) to 30 μg/m(3) is 1.21 (95% CI: 1.03, 1.41) for respiratory diseases, and 1.15 (95% CI: 1.08, 1.22) for all causes. In comparison with normal days, elevated ERV of all causes and respiratory diseases was also associated with winter ADS (with corresponding RRs of 1.10 (95% CI: 1.07, 1.13) and 1.14 (95% CI: 1.08, 1.21)) and shorter and less area-affected ADS (with corresponding RRs of 1.07 (95% CI: 1.01, 1.10) and 1.09 (95% CI: 1.03, 1.14)) from 2000 to 2004. Results of this study demonstrate that population health risk varies not only with PM concentration, but also with the ADS characteristics.

Acute increase of children's conjunctivitis clinic visits by Asian dust storms exposure - a spatiotemporal study in Taipei, Taiwan

Adverse health impacts of Asian dust storms (ADS) have been widely investigated and discussed in respiratory disease, but no study has examined the association between ADS events and their impact on eye diseases, especially in children. The impact of ADS events on the incidence of children's conjunctivitis is examined by analyzing the data from children's clinic visits registered in the 41 districts of Taipei area in Taiwan during the period 2002-2007. The structural additive regression modeling approach was used to assess the association between ADS events and clinic visits for conjunctivitis in children with consideration of day-of-the-week effects, temperature, and air quality levels. This study identifies an acute increase in the relative rate for children's conjunctivitis clinic visits during ADS periods with 1.48% (95% CI = 0.79, 2.17) for preschool children (aged <6 years old) and 9.48% (95% CI = 9.03, 9.93) for schoolchildren (aged ≥6 years old), respectively. The relative rates during post-ADS periods were still statistically significant, but much lower than those during ADS periods. The spatial analysis presents geographic heterogeneity of children's conjunctivitis clinic visits where higher relative rates were more likely observed in the most populated districts Compared to previous ADS studies related to respiratory diseases, our results reveals significantly acute impacts on children's conjunctivitis during ADS periods, and much influence on schoolchildren. Vulnerable areas were also identified in high density population.