Long-term exposure to high particulate matter pollution and cardiovascular mortality: a 12-year cohort study in four cities in northern China

Reporting of gridded ammonia emission and assessment of hotspots across India: A comprehensive study of 24 anthropogenic sources

Ammonia (NH3) acts as a key precursor of the particulate matter, could reduce visibility, deplete stratospheric ozone, and trigger perturbation in ecosystems. Being an agrarian country with a large livestock population and uncontrolled fertilizer application, India could be accountable as a major stakeholder of global NH3 emissions. This study developed a comprehensive gridded (0.1° x 0.1°) ammonia inventory for India considering 24 types of sources. The total NH3 emission is estimated to be 10.54 Tg/yr in 2022, where synthetic fertilizer application accounts for ∼47 % followed by livestock (∼34 %). Minor unattended sectors such as biomass burning, agricultural soil, human excrement, waste disposal, etc. contribute 0.68 Tg/yr, 0.32 Tg/yr, 0.3 Tg/yr, and 0.14 Tg/yr, respectively. The overall uncertainty of the inventory ranges around ± 55 %. These emission datasets are essential for atmospheric chemistry models and could be a crucial tool for policymakers to combat ammonia pollution.

Health risks and sources of trace elements and black carbon in PM2.5 from 2019 to 2021 in Beijing

A comprehensive health risk assessment of PM2.5 is meaningful to understand the current status and directions regarding further improving air quality from the perspective of human health. In this study, we evaluated the health risks of PM2.5 as well as highly toxic inorganic components, including heavy metals (HMs) and black carbon (BC) based on long-term observations in Beijing from 2019 to 2021. Our results showed that the relative risks of chronic obstructive pulmonary disease, lung cancer, acute lower respiratory tract infection, ischemic heart disease, and stroke decreased by 4.07%-9.30% in 2020 and 2.12%-6.70% in 2021 compared with 2019. However, they were still at high levels ranging from 1.26 to 1.77, in particular, stroke showed the highest value in 2021. Mn had the highest hazard quotient (HQ, from 2.18 to 2.56) for adults from 2019 to 2021, while Ni, Cr, Pb, As, and BC showed high carcinogenic risks (CR > 1.0×10-6) for adults. The HQ values of Mn and As and the CR values of Pb and As showed constant or slight upwards trends during our observations, which is in contrast to the downward trends of other HMs and PM2.5. Mn, Cr, and BC are crucial toxicants in PM2.5. A significant shrink of southern region sourcesof HMs and BCshrank suggests the increased importance of local sources. Industry, dust, and biomass burning are the major contributors to the non-carcinogenic risks, while traffic emissions and industry are the dominant contributors to the carcinogenic risks in Beijing.

Investigating the impact of urban-environmental factors on air pollutants: a land use regression model approach and health risk assessment

The presence of pollutants in the earth's atmosphere has a direct impact on human health and the environment. So that pollutants such as carbon monoxide (CO) and particulate matter (PM) cause respiratory diseases, cough headache, etc. Since the amount of pollutants in the air is related to environmental and urban factors, the aim of the current research is to investigate the relationship between the concentration of CO, PM2.5 and PM10 with urban-environmental factors including land use, wind speed and wind direction, topography, traffic, road network, and population through a Land use regression (LUR) model. The concentrations of CO, PM2.5 and PM10 were measured during four seasons from 26th of March 2022 to 16th of March 2023 at 25 monitoring stations and then the information about pollutant measurement points and Land use data were entered into the ArcGIS software. The annual average concentrations of CO, PM2.5 and PM10 were 0.7 ppm, 18.94 and 60.76 µg/m3, respectively, in which the values of annual average concentration of CO and PMs were outside the air quality guideline standard. The results of the health risk assessment showed that the hazard quotient values for all three investigated pollutants were lower than 1 and therefore, they were not in adverse conditions in terms of health effects. Among the urban-environmental factors affecting air pollution, the traffic variable is the most important factor affecting the annual LUR model of CO, PM2.5 and PM10, and then the topography variable is the second most effective factor on the annual LUR model of the aforementioned pollutants.

Ambient air pollution and mortality: The role of socioeconomic conditions

Background

There is a vast body of literature covering the association between air pollution exposure and nonaccidental mortality. However, the role of socioeconomic status (SES) in this relationship is still not fully understood.

Objectives

We investigated if individual and contextual SES modified the relationship between short-term exposure to ozone (O3), nitrogen dioxide (NO2), and particulate matter with aerodynamic diameter <10 µm (PM10) on cardiovascular, respiratory, and all nonaccidental mortality.

Methods

We conducted a time-stratified case-crossover study. Analyses were based on information on 280,685 deaths from 2011 to 2015 in the city of São Paulo. Education was used as an individual SES, and information on the district of residence was used to build a contextual SES. Exposure to PM10, NO2, and O3 was accessed from monitoring stations and linked to each case based on the date of death. Conditional logistic regression models were used to estimate the effects of air pollutants, and interaction terms were added to access the effect modification of SES.

Results

Individuals with lower education had an increased chance of dying for all nonaccidental outcomes (1.54% [0.91%, 2.14%]) associated with exposure to PM10. Individuals living in lower SES areas had an increased chance of dying for nonaccidental (0.52% [0.16%, 0.88%]), cardiovascular (1.17% [0.88%, 1.46%]), and respiratory (1.70% [0.47%, 2.93%]) causes owing to NO2 exposure.

Conclusion

Exposure to air pollutants increases the chance of dying by nonaccidental, cardiovascular, and respiratory causes. Lower educational levels and living on lower contextual SES increased the risk of mortality associated with air pollution exposure.

Decoding the effect of demographic factors on environmental health based on city-level PM2.5 pollution in China

Although considerable health effects are gained from air quality improvement action plans implemented in China recently, they may have been amplified or offset due to the complexity and uncertainty of the changing demographic factors. In this study, we developed a framework for analyzing the effects of demographic factors on environmental health effects, focusing on three aspects: population scale, age structure, and spatial distribution. We quantified the above three effects by investigating how the health endpoint changed by the three demographic factors, based on a strategy of counterfactual and step-by-step relaxing hypothesis. We found that the increasing population scale and population aging caused 44,279 to 292,442 premature deaths, which offset the health effect of air quality improvement efforts for China. The change in population spatial distribution, in general, has little impact on the health effects of air quality improvement. Furthermore, the three effects are distributed unevenly across regions, especially the spatial distribution effect. Considering the widespread effect of demographic factors, PM2.5 concentration should be further reduced, and the aged population and mega-cities should be targeted for managing air quality in a cost-effective manner.

Identifying the nexus among environmental performance, digital finance, and green innovation: New evidence from prefecture-level cities in China

Globally, nations are increasingly focusing on green innovation in their environmental protection efforts as part of sustainable development, and digital finance is playing a vital role in enhancing green innovation. Employing annual data from 220 prefecture-level cities between 2011 and 2019, we empirically analyze the connections among environmental performance, digital finance, and green innovation via the Karavias panel unit root test with structural breaks, the Gregory-Hansen structural break cointegration test and pooled mean group (PMG) estimation. The following four points are the key conclusions: (1) The results support cointegration links between these variables when structural breaks are considered. (2) The PMG estimation outcomes indicate that green innovation and digital finance may have a favorable long-term effect on environmental performance. (3) For better environmental performance and more green innovation, the level of digitalization of digital finance is crucial. (4) The potential of digital finance and green innovation to improve environmental performance has not been fully realized in the western region of China.

Air pollution exposure and heart failure: A systematic review and meta-analysis

While the literature strongly supports a positive association between particulate matter with diameter ≤ 2.5 μm (PM_2.5) exposure and heart failure (HF), there is uncertainty regarding the other pollutants and the dose and duration of exposure that triggers an adverse response. To comprehensively assess and quantify the association of air pollution exposure with HF incidence and mortality, we performed separate meta-analyses according to pollutant types [PM_2.5, PM₁₀, sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), ozone (O₃)], and exposure duration (short- and long-term). We systematically searched PubMed, EMBASE, and Web of Science for relevant articles with publication dates up to July 12, 2022, identifying 35 eligible studies. Random-effects models were used to summarize the pooled odds ratios (ORs) and 95 % confidence intervals (95 % CIs). For long-term exposure, the growing risk of HF was significantly associated with each 10 μg/m³ increase in PM_2.5 (OR = 1.196, 95 % CI: 1.079-1.326; I² = 76.8 %), PM₁₀ (1.190, 1.045-1.356; I² = 76.2 %), and NO₂ (1.072, 1.028-1.118; I² = 78.3 %). For short-term exposure, PM_2.5, PM₁₀, NO₂, and O₃ (per 10 μg/m³ increment) increased the risk of HF, with estimated ORs of 1.019 (1.008-1.030; I² = 39.9 %), 1.012 (1.007-1.017; I² = 28.3 %), 1.016 (1.005-1.026; I² = 53.7 %), and 1.006 (1.002-1.010; I² = 0.0 %), respectively. No significant effects of SO₂ and CO exposure on the risk of HF were observed. In summary, our study powerfully highlights the deleterious impact of PM_2.5, PM₁₀, and NO₂ exposure (either short- or long-term) on HF risk. Serious efforts should be made to improve air quality through legislation and interdisciplinary cooperation.

Long-term exposure to particulate matter on cardiovascular and respiratory diseases in low- and middle-income countries: A systematic review and meta-analysis

Background

Long-term exposure to particulate matter (PM) has essential and profound effects on human health, but most current studies focus on high-income countries. Evidence of the correlations between PM and health effects in low- and middle-income countries (LMICs), especially the risk factor PM1 (particles &lt; 1 μm in size), remains unclear.

Objective

To explore the effects of long-term exposure to particulate matter on the morbidity and mortality of cardiovascular and respiratory diseases in LMICs.

Methods

A systematic search was conducted in the PubMed, Web of Science, and Embase databases from inception to May 1, 2022. Cohort studies and case-control studies that examine the effects of PM1, PM2.5, and PM10 on the morbidity and mortality of cardiovascular and respiratory diseases in LMICs were included. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Outcomes were analyzed via a random effects model and are reported as the relative risk (RR) with 95% CI.

Results

Of the 1,978 studies that were identified, 38 met all the eligibility criteria. The studies indicated that long-term exposure to PM2.5, PM10, and PM1 was associated with cardiovascular and respiratory diseases: (1) Long-term exposure to PM2.5 was associated with an increased risk of cardiovascular morbidity (RR per 1.11 μg/m3, 95% CI: 1.05, 1.17) and mortality (RR per 1.10 μg/m3, 95% CI: 1.06, 1.14) and was significantly associated with respiratory mortality (RR 1.31, 95% CI: 1.25, 1.38) and morbidity (RR 1.08, 95% CI: 1.02, 1.04); (2) An increased risk of respiratory mortality was observed in the elderly (65+ years) (RR 1.21, 95% CI: 1.00, 1.47) with long-term exposure to PM2.5; (3) Long-term exposure to PM10 was associated with cardiovascular morbidity (RR 1.07, 95% CI 1.01, 1.13), respiratory morbidity (RR 1.43, 95% CI: 1.21, 1.69) and respiratory mortality (RR 1.28, 95% CI 1.10, 1.49); (4) A significant association between long-term exposure to PM1 and cardiovascular disease was also observed.

Conclusions

Long-term exposure to PM2.5, PM10 and PM1 was all related to cardiovascular and respiratory disease events. PM2.5 had a greater effect than PM10, especially on respiratory diseases, and the risk of respiratory mortality was significantly higher for LMICs than high-income countries. More studies are needed to confirm the effect of PM1 on cardiovascular and respiratory diseases.

Reduced Transcriptome Analysis of Zebrafish Embryos Prioritizes Environmental Compounds with Adverse Cardiovascular Activities

Cardiovascular diseases are the leading cause of premature death in humans and remain a global public health challenge. While age, sex, family history, and false nutrition make a contribution, our understanding of compounds acting as cardiovascular disruptors is far from complete. Here, we aim to identify cardiovascular disruptors via a reduced transcriptome atlas (RTA) approach, which integrates large-scale transcriptome data sets of zebrafish and compiles a specific gene panel related to cardiovascular diseases. Among 767 gene expression profiles covering 81 environmental compounds, 11 priority compounds are identified with the greatest effects on the cardiovascular system at the transcriptional level. Among them, metals (AgNO₃, Ag nanoparticles, arsenic) and pesticides/biocides (linuron, methylparaben, triclosan, and trimethylchlorotin) are identified with the most significant effects. Distinct transcriptional signatures are further identified by the percentage values, indicating that different physiological endpoints exist among prioritized compounds. In addition, cardiovascular dysregulations are experimentally confirmed for the prioritized compounds via alterations of cardiovascular physiology and lipid profiles of zebrafish. The accuracy rate of experimental verification reaches up to 62.9%. The web-based RTA analysis tool, Cardionet, for rapid cardiovascular disruptor discovery was further provided at http://www.envh.sjtu.edu.cn/cardionet.jsp. Our integrative approach yields an efficient platform to discover novel cardiovascular-disrupting chemicals in the environment.

Long-term ambient air pollution exposure and cardio-respiratory disease in China: findings from a prospective cohort study

BACKGROUND

Existing evidence on long-term ambient air pollution (AAP) exposure and risk of cardio-respiratory diseases in China is mainly on mortality, and based on area average concentrations from fixed-site monitors for individual exposures. Substantial uncertainty persists, therefore, about the shape and strength of the relationship when assessed using more personalised individual exposure data. We aimed to examine the relationships between AAP exposure and risk of cardio-respiratory diseases using predicted local levels of AAP.

METHODS

A prospective study included 50,407 participants aged 30-79 years from Suzhou, China, with concentrations of nitrogen dioxide (NO2), sulphur dioxide (SO2), fine (PM2.5), and inhalable (PM10) particulate matter, ozone (O3) and carbon monoxide (CO) and incident cases of cardiovascular disease (CVD) (n = 2,563) and respiratory disease (n = 1,764) recorded during 2013-2015. Cox regression models with time-dependent covariates were used to estimate adjusted hazard ratios (HRs) for diseases associated with local-level concentrations of AAP exposure, estimated using Bayesian spatio-temporal modelling.

RESULTS

The study period of 2013-2015 included a total of 135,199 person-years of follow-up for CVD. There was a positive association of AAP, particularly SO2 and O3, with risk of major cardiovascular and respiratory diseases. Each 10 µg/m3 increase in SO2 was associated with adjusted hazard ratios (HRs) of 1.07 (95% CI: 1.02, 1.12) for CVD, 1.25 (1.08, 1.44) for COPD and 1.12 (1.02, 1.23) for pneumonia. Similarly, each 10 µg/m3 increase in O3 was associated with adjusted HR of 1.02 (1.01, 1.03) for CVD, 1.03 (1.02, 1.05) for all stroke, and 1.04 (1.02, 1.06) for pneumonia.

CONCLUSIONS

Among adults in urban China, long-term exposure to ambient air pollution is associated with a higher risk of cardio-respiratory disease.

Long-term PM2.5 exposure in association with chronic respiratory diseases morbidity: A cohort study in Northern China

Several literatures have examined the risk of chronic respiratory diseases in association with short-term ambient PM2.5 exposure in China. However, little evidence has examined the chronic impacts of PM2.5 exposure on morbidity of chronic respiratory diseases in cohorts from high pollution countries. Our study aims to investigate the associations. Based on a retrospective cohort among adults in northern China, a Cox regression model with time-varying PM2.5 exposure and a concentration-response (C-R) curve model were performed to access the relationships between incidence of chronic respiratory diseases and long-term PM2.5 exposure during a mean follow-up time of 9.8 years. Individual annual average PM2.5 estimates were obtained from a satellite-based model with high resolution. The incident date of a chronic respiratory disease was identified according to self-reported physician diagnosis time and/or intake of medication for treatment. Among 38,047 urban subjects analyzed in all-cause chronic respiratory disease cohort, 482 developed new cases. In CB (38,369), asthma (38,783), and COPD (38,921) cohorts, the onsets were 276, 89, and 14, respectively. After multivariable adjustment, hazard ratio and 95% confidence interval for morbidity of all-cause chronic respiratory disease, CB, asthma, and COPD were 1.15 (1.01, 1.31), 1.20 (1.00, 1.42), 0.76 (0.55, 1.04), and 0.66 (0.29, 1.47) with each 10 μg/m3 increment in PM2.5, respectively. Stronger effect estimates were suggested in alcohol drinkers across stratified analyses. Additionally, the shape of C-R curve showed an increasing linear relationship before 75.00 μg/m3 concentrations of PM2.5 for new-onset all-cause chronic respiratory disease, and leveled off at higher levels. These findings indicated that long-term exposure to high-level PM2.5 increased the risks of incident chronic respiratory diseases in China. Further evidence of C-R curves is warranted to clarify the associations of adverse chronic respiratory outcomes involving air pollution.

Elder people can be more susceptible to the association between short-term ambient air pollution and sleep disorder outpatient visits: a time-series study

Sleep disorders attract increasing concerns. However, the evidence of the association between ambient air pollution and sleep disorders is limited. Therefore, our aim was to determine the association between short-term air pollution exposure and outpatient visits for sleep disorders in Xi'an, the largest city in Northwest China. Baseline outpatient data of daily sleep disorders between 2011 and 2013 were collected. Quasi-Poisson distribution was applied by adjusting the day of the week and weather conditions. A total of 49,282 sleep disorder outpatient visits were recorded. The most significant association between air pollutants and outpatient visits was observed on concurrent day: per 10 μg/m3 increase of NO2, SO2, and PM10 at lag 0 corresponded to increased outpatient sleep disorder visits at 0.22% (95% CI: 0.03%, 0.42%), 1.53% (95% CI: 0.53, 2.53%), and 2.57% (95% CI: 1.33%, 3.82%), respectively. As for gender-specific analysis, there was no statistically significant difference between males and females. The result of season-specific analysis showed no statistically significant difference between warm seasons and cool seasons, either. As for age-specific analysis, obvious associations were observed in 20-40 age group (NO2) and > 40 age group (PM10 and SO2), while no evident association was found for the young age group (< 20 years old). Conclusively, short-term exposure to air pollutants, especially gaseous air pollutants, might increase the risk of sleep disorders, and such association appears to be more obvious in elder people. We provide novel data that there may be age differences in the relationship between short-term air pollution exposure and sleep disorders.

Occupational Exposure to Poorly Soluble Low Toxicity Particles and Cardiac Disease: A Look at Carbon Black and Titanium Dioxide

Environmental particulate exposure and the potential risk to people with various types of cardiac diseases, most notably cardiovascular disease, have aroused scientific and regulatory interest worldwide. Epidemiological studies have shown associations between exposure to airborne environmental particulate matter (PM) and mortality from cardiovascular disease (CVD). The associations reported, however, are complex and may not involve a direct role for PM, since air pollutants are diverse and highly correlated. This study examines the potential role of occupational exposure to two types of particles, namely, manufactured carbon black (CB) and titanium dioxide (TiO₂), on the risk of cardiovascular disease. To address the risk of cardiovascular disease from exposure to carbon black and titanium dioxide, as reflective of poorly soluble low toxicity particles, we reviewed the published cohort mortality studies of occupational exposure to carbon black and titanium dioxide. Mortality studies of carbon black have been conducted in the United States, Germany, and the United Kingdom. Five mortality studies related to workers involved in the manufacture of titanium dioxide in the United States and Europe have also been conducted. In addition, a meta-analysis of the three-carbon black mortality studies was performed. In the random-effects meta-analysis, full cohort meta-SMRs were 1.01 (95% confidence interval (CI): 0.79–1.29) for heart disease; 1.02 (95% CI: 0.80–1.30) for ischemic heart disease; and 1.08 (95% CI: 0.74–1.59) for acute myocardial infarction (AMI) mortality. A small but imprecise increased AMI mortality risk was suggested for cumulative exposure by a meta-HR = 1.10 per 100 mg/m³-years (95% CI: 0.92–1.31) but not for lugged exposures, that is, for recent exposures. Results of five cohort mortality studies of titanium dioxide workers in the United States and Europe showed no excess in all heart disease or cardiovascular disease. In the most recent study in the United States, an internal analysis, that is, within the cohort itself, with no lag time, showed that the exposure group 15–35 mg/m³-years yielded a significantly increased risk for heart disease; however, there was no evidence of increasing risk with increasing exposure for any of the exposure categories. In contrast to environmental studies, the results of cohort mortality studies do not demonstrate that airborne occupational exposure to carbon black and titanium dioxide particulates increases cardiovascular disease mortality. The lack of a relationship between carbon black and titanium dioxide and CVD mortality suggests that the associations reported in air pollution studies may not be driven by the particulate component.

Environmental Regulation, Digital Financial Inclusion, and Environmental Pollution: An Empirical Study Based on the Spatial Spillover Effect and Panel Threshold Effect

Environmental regulation is a crucial tool for controlling environmental pollution. Digital finance is essential for the development of green finance. The relationship between environmental regulation and digital finance concerning environmental pollution is an issue worth exploring. This paper uses the spatial econometric model and the panel threshold model to empirically analyze the impact of environmental regulation and digital financial inclusion on environmental pollution using panel data from 30 Chinese provinces between 2011 and 2019. It mainly discusses the independent impact and synergy of environmental regulation and digital inclusive finance on environmental pollution. The research results show that the improvement of the intensity of environmental regulation and the development level of digital-inclusive finance can effectively alleviate the problem of environmental pollution. Moreover, environmental regulation and digital inclusive finance can coordinately control environmental pollution. A panel threshold analysis shows that as the intensity of environmental regulation increases, digital financial inclusion will reflect the function of environmental governance. Similarly, with the development of digital financial inclusion, environmental regulation has shown a significant inhibitory effect on environmental pollution. The results of a heterogeneity analysis show that the intensity of environmental regulation in the eastern region has a significant inhibitory effect on environmental pollution. Digital financial inclusion in the central region shows a strong environmental governance function. The intersection of environmental regulation and digital financial inclusion has shown a significant synergistic governance effect in the eastern region. Therefore, the government gives full play to the functions of environmental regulation and digital inclusive finance environmental governance to achieve coordinated governance of environmental pollution.

Social, Economic, Technological, and Environmental Factors Affecting Cardiovascular Diseases: A Systematic Review and Thematic Analysis

Background

Today, cardiovascular disease (CVD) is the leading cause of mortality in both sexes. There are several risk factors for heart diseases; some controllable, others not. However, socioeconomic, technological, and environmental factors can impact CVD as well as exclusive risk factors. Accurate identification and assessment of these factors are often difficult. In the present systematic review, we aimed to explore factors affecting CVD.

Methods

Multiple databases (MEDLINE, Scopus, ISI Web of Science, and Cochrane) and gray literature were searched. The included studies described at least one determinant of CVD. The framework method was applied to analyze the qualitative data.

Results

A total of 64 studies from 26 countries were included. The contextual determinants of CVD were categorized into 45 determinants, 15 factors, and 4 main social, economic, technological, and environmental categories. The 15 potentially reversible factors were identified as sociodemographic, violence, smoking, occupation, positive childhood experience, social inequalities, psychological distress, eating habits, neighborhood, family income, rapid technology, environmental pollution, living environments, noise, and disaster.

Conclusions

Devolution and more efficient health policies are required to achieve further sustained reduction in CVD mortality, increase life expectancy, and reduce its associated risk factors. Policymakers should fully address the value of social, economic, technological, and environmental factors. In fact, a prevention agenda should be developed and updated collaboratively in terms of the determinant factors.

A comprehensive high-resolution gridded emission inventory of anthropogenic sources of air pollutants in Indian megacity Kolkata

Abstract

In this study, we present a first-ever effort made to develop an ultra-high-resolution gridded emission inventory (i.e. ~ 0.4 km ×  ~ 0.4 km) for the Indian megacity Kolkata. As the rising demand for fossil fuels based energy along with the spread of urban corridors have forced the anthropogenic activities to a mounting level, therefore determining the sources responsible is of paramount importance. This has worsened not only the regional air quality but also has an indirect effect on the global air quality. The spatial and temporal variation of the source requires an accurate estimation of the surface emission which is the most essential parameter to study the air quality, that positively has been fulfilled in this study. The annual emission for 2020 is calculated to be 37.2 Gg/yr of PM2.5, 61.4 Gg/yr of PM10, 222.6 Gg/yr of CO, 131.3 Gg/yr of NOx, 60.3 Gg/yr of SO2, 120.4 Gg/yr of VOC, 9.5 Gg/yr of BC and 16.8 Gg/yr of OC that prevails in the toxic air of megacity Kolkata. The present surface chemistry dataset will be the first line of detailed information regarding emission hotspots in the megacity that could be used as important tool for clean air mitigation strategies, input into the air quality modeling study to tackle environmental issues, and public health.

Article Highlights

Tissue-Protective Effect of Erdosteine on Multiple-Organ Injuries Induced by Fine Particulate Matter

Background

Fine particulate matter (PM2.5) is the air pollutant that most threatens global public health. The purpose of this study was to observe the inflammatory and oxidative stress injury of multiple organs induced by PM2.5 in rats and to explore the tissue-protective effect of erdosteine.

Material/Methods

We randomly divided 40 male Wistar rats into a blank control group, a saline group, a PM2.5 exposure group, and an erdosteine intervention group. We assessed changes in organs tissue homogenate and biomarkers of inflammation and oxidative stress in serum and bronchoalveolar lavage fluid (BALF).

Results

(1) The expressions of IL-6, IL-1β, TNF-α, 8-OHdG, 4-HNE, and PCC in serum and BALF of the PM2.5 exposure group increased, but decreased after treatment with erdosteine, suggesting that erdosteine treatment attenuates inflammatory and oxidative stress injury. (2) The expression of γ-GCS in serum and lungs in the PM2.5 exposure group increased, but did not change significantly after treatment with erdosteine. This suggests that PM2.5 upregulates the level of γ-GCS, while erdosteine does not affect this protective response. (3) The expression of T-AOC in serum, lungs, spleens, and kidneys of the PM2.5 exposure group decreased, but increased after treatment with erdosteine. Our results suggest that PM2.5 can cause imbalance of oxidation/anti-oxidation in multiple organs, and erdosteine can alleviate this imbalance.

Conclusions

PM2.5 exposure can lead to inflammatory and oxidative stress damage in serum and organ tissues of rats. Erdosteine may be an effective anti-inflammatory and antioxidant that can reduce this injury.

Will Smog Cause Mental Health Problems? Indication from a Microsurvey of 35 Major Cities in China

Using the survey data of 21,861 participants from 35 major cities in China in 2018 and 2019, the effect of air quality on participants’ mental health was empirically tested based on the ordered probit model. The results showed that smog can significantly influence the mental health of participants. The better the air quality, the better the participants’ mental health, while poor air quality results in poor mental health. The older and higher-paid participants demonstrated poorer mental health. Additionally, for different health conditions, the air quality had different effects on the participants’ mental health. The healthier the participants, the more sensitive their mental health to changes in air pollution; the poorer the physical condition of the participants, the less sensitive their mental health to changes in air quality. Therefore, we need to more comprehensively and scientifically understand the effect of air quality on health. We need to pay attention not only to the adverse effects of smog on participants’ physical health, but also to its effects on participants’ mental health to improve both the physical and mental health of participants by improving the air quality.

Long-term exposure to PM2.5 and cardiovascular disease incidence and mortality in an Eastern Mediterranean country: findings based on a 15-year cohort study

BACKGROUND

Evidence concerning the impact of long-term exposure to fine Particulate Matter ≤2.5 μm (PM2.5) on Cardio-Vascular Diseases (CVDs) for those people subject to ambient air pollution in developing countries remains relatively scant. This study assessed the relationship of 15-year PM2.5 exposure with cardiovascular incidence and mortality rate in Isfahan province, Iran.

METHODS

The cohort comprised 3081 participants over 35 years old who were free of CVDs. They were selected through multi-stage cluster sampling in Isfahan, Iran. PM2.5 exposure was determined separately for each individual via satellite-based spatiotemporal estimates according to their residential addresses. In this context, CVD is defined as either fatal and non-fatal Acute Myocardial Infarctions (AMI) or stroke and sudden cardiac death. The incidence risk for CVD and the ensuing mortality was calculated based on the average PM2.5 exposure within a study period of 15 years using the Cox proportional hazards frailty model upon adjusting individual risk factors. The mean annual rate of PM2.5 and the follow-up data of each residential area were combined.

RESULTS

Mean three-year PM2·5 exposure for the cohort was measured at 45.28 μg/m3, ranging from 20.01 to 69.80 μg/m3. The median time period for conducting necessary follow-ups was 12.3 years for the whole population. Notably, 105 cardiovascular and 241 all-cause deaths occurred among 393,786 person-months (27 and 61 per 100,000 person-months, respectively). In well-adjusted models, 10 μg/m3 increase in PM2.5 corresponded to a 3% increase in the incidence rate of CVDs [0.95 CI = 1.016, 1.036] (in case of p = 0.000001 per 10 μg/m3 increase in PM2.5, the Hazard Ratio (HR) for AMI and Ischemic Heart Disease (IHD) was 1.031 [0.95 CI = 1.005, 1.057] and 1.028 [0.95 CI = 1.017, 1.039]), respectively. No consistent association was observed between PM2.5 concentration and fatal CVD (fatal AMI, fatal stroke, SCD (Sudden Cardiac Death)) and all-cause mortality.

CONCLUSIONS

Results from analyses suggest that the effect of PM2.5 on cardiovascular disease occurrence was stronger in the case of older people, smokers, and those with high blood pressure and diabetes. The final results revealed that long-term exposure to ambient PM2.5 with high concentrations positively correlated with IHD incidence and its major subtypes, except for mortality. The outcome accentuates the need for better air quality in many countries.

The Environmental Effects of International Trade in China: Measuring the Mediating Effects of Technology Spillovers of Import Trade on Industrial Air Pollution

China is in a strategic phase of an industrial green transformation. Industrial air pollution is a key environmental target for governance. Because import trade is a core channel through which advanced environmental protection technology is absorbed, the question of whether technology spillovers brought about by import trade can reduce industrial air pollution emissions is a topic worth exploring. This paper uses a generalized spatial two-stage least-square (GS2SLS) model to explore the impact of import trade technology spillovers on industrial air pollution emission intensities using panel data from 30 provinces and cities between 2000 and 2017. Economic scale, industrial structure, and technological innovation are used as intermediary variables to test whether they play mediating effects. The results show that: (1) capital and intermediate goods technology spillovers directly reduce industrial air pollution emission intensity and (2) import trade technology spillovers indirectly reduce emission intensities by expanding economic scale, optimizing industrial structure, and enhancing technological innovation through mediating variables. Furthermore, industrial structure optimization and technological innovation have the largest mediating effects on industrial SO2, while economic expansion has the most significant mediating effect on industrial smoke and dust. The mediating effects of technology spillovers from intermediate goods exceed those of capital technology spillovers. Finally, industrial air pollution emission intensity demonstrates both spatial agglomeration and time lag effects. Environmental regulations and energy structure are shown to increase industrial air pollution emissions, while urbanization and foreign direct investment reduce industrial air pollution. Based upon these research results, some pertinent policy implications are proposed for China.

Spatial Analysis of Ambient Air Pollution and Cardiovascular Disease (CVD) Hospitalization Across Sweden

The associations of multiple pollutants and cardiovascular disease (CVD) morbidity, and the spatial variations of these associations have not been nationally studied in Sweden. The main aim of this study was, thus, to spatially analyze the associations between ambient air pollution (black carbon, carbon monoxide, particulate matter (both <10 µm and <2.5 µm in diameter) and Sulfur oxides considered) and CVD admissions while controlling for neighborhood deprivation across Sweden from 2005 to 2010. Annual emission estimates across Sweden along with admission records for coronary heart disease, ischemic stroke, atherosclerotic and aortic disease were obtained and aggregated at Small Areas for Market Statistics level. Global associations were analyzed using global Poisson regression and spatially autoregressive Poisson regression models. Spatial non-stationarity of the associations was analyzed using Geographically Weighted Poisson Regression. Generally, weak but significant associations were observed between most of the air pollutants and CVD admissions. These associations were non-homogeneous, with more variability in the southern parts of Sweden. Our study demonstrates significant spatially varying associations between ambient air pollution and CVD admissions across Sweden and provides an empirical basis for developing healthcare policies and intervention strategies with more emphasis on local impacts of ambient air pollution on CVD outcomes in Sweden.

Long-term exposure to ambient PM2.5 and stroke mortality among urban residents in northern China

Evidence is still limited for the role of long-term PM_2.5 exposure in cerebrovascular diseases among residents in high pollution regions. The study is aimed to investigate the long-term effects of PM_2.5 exposure on stroke mortality, and further explore the effect modification of temperature variation on the PM_2.5-mortality association in northern China. Based on a cohort data with an average follow-up of 9.8 years among 38,435 urban adults, high-resolution estimates of PM_2.5 derived from a satellite-based model were assigned to each participant. A Cox regression model with time-varying exposures and strata of geographic regions was employed to assess the risks of stroke mortality associated with PM_2.5, after adjusting for individual risk factors. The cross-product term of PM_2.5 exposure and annual temperature range was further added into the regression model to test whether the long-term temperature variation would modify the association of PM_2.5 with stroke mortality. Among the study participants, the annual mean level of PM_2.5 concentration was 66.3 μg/m³ ranging from 39.0 μg/m³ to 100.6 μg/m³. For each 10 μg/m³ increment in PM_2.5, the hazard ratio (HR) was 1.31 (95% CI: 1.04-1.65) for stroke mortality after multivariable adjustment. In addition, the HRs of PM_2.5 decreased gradually as the increase of annual temperature range with the HRs of 1.95 (95% CI: 1.36-2.81), 1.53 (95% CI: 1.06-2.22), and 1.11 (95% CI: 0.75-1.63) in the low, middle, and high group of annual temperature range, respectively. The findings provided further evidence of long-term PM_2.5 exposure on stroke mortality in high-exposure settings such as northern China, and also highlighted the view that assessing the adverse health effects of air pollution might not ignore the role of temperature variations in the context of climate change.

Air pollution effects on adult mortality rate in developing countries

Although industrialisation is a crucial aspect of economic growth across developing nations, through the release of air contaminants, industrial activities may also create adverse environmental health consequences. Noting that continuous production and other economic activities are crucial for continued survival, this study explores this issue by including the role of governance that is deemed essential but the literature is relatively sparse particularly in the context of developing countries. This research empirically analyses the relationship between air pollution and adult mortality rates from 72 developing countries from the period of 2010 until 2017. Particulate matter (PM_2.5) and carbon dioxide (CO₂) are used as indicators of air pollution. From the generalized method of moments (GMM) estimations, the results reveal that air pollution negatively affects adult mortality rate. The result reveals that a 10% increase in the PM_2.5 level induces the adult mortality rates to increase between 0.04% and 0.06%. In addition, the government significantly moderates the negative effect of air pollution on adult mortality, whereby a one-unit enhancement in governance quality index reduces mortality among the adults in the developing countries by 0.01%. On the other hand, CO₂ emission also appears to be positive, but not statistically significant. The results suggest that governance and public health interplay in the sense of a transition towards economic development for improved living and health states can be achievable with improved governance quality.

Long-term exposure to high particulate matter pollution and incident hypertension: a 12-year cohort study in northern China

Numerous cohort studies have reported the association of long-term exposure to particulate matter <10 μm in diameter (PM₁₀) and hypertension in American and European countries. However, these results have been inconsistent and subject to various confounding factors. The study aimed to explore the effect of long-term exposure to high-level concentrations of PM₁₀ on incident hypertension in a large-scale cohort from northern China. A retrospective cohort study of 39,054 participants aged between 23 and 98 years old from four cities in northern China was followed from 1998 to 2009. Excluding those with hypertension, 37,386 non-hypertensive participants (overall population) were followed for self-reported hypertension. The individuals' exposure to PM₁₀ was the mean concentration during the follow-up period, according to the data of local environmental monitoring centers. Hazard ratios (HRs) were calculated by Cox proportional hazards models. The adjusted potential confounding factors included sociodemographic information, lifestyle, and diet. There were 2619 (7.0%) incident cases of hypertension among the overall population. In multivariable models, the HR (95% CI) of incident hypertension was 1.537 (1.515, 1.560) for each 10 μg/m³ increase in PM₁₀. Stratified analyses showed individuals (age <65) were prone to developing hypertension. Moreover, the effects of PM₁₀ increased and produced an HR (95% CI) of 1.555 (1.527, 1.584) for the healthy population in the sensitivity analysis. We found that the association between long-term exposure to PM₁₀ air pollution and incident hypertension was significantly positive.

Investigation on daily exposure to PM2.5 in Bandung city, Indonesia using low-cost sensor

Daily exposure to PM_2.5 in developing countries has not been thoroughly studied partly due to limited resources available. In this research, personal PM_2.5 exposures in urban communities in Indonesia were examined using a low-cost sensor, AS-LUNG. Fifty subjects were recruited in both wet and dry seasons. Their personal PM_2.5 concentrations, environmental temperature, and relative humidity were measured using corrected AS-LUNG Portable worn or placed in their vicinity. Details on their activities and locations, air quality (air pollution sources), and weather conditions during monitoring were recorded in time-activity diaries completed at 30 min intervals. Results revealed mosquito coil burning as the source of highest exposure, reaching 241.5 μg/m³ but with significant difference between wet and dry seasons. With ambient PM_2.5 and relative humidity controlled for, mosquito coil burning contributed 12.02 μg/m³ and 4.84 μg/m³ of personal PM_2.5 exposure in wet and dry season, respectively, which was several times higher than the contribution from vehicle emission. The second most contributive source was factory smoke, which increased 4.99 μg/m³ and 3.17 μg/m³ of exposure in wet and dry season, respectively. Findings on contributive factors of high daily personal exposures can serve as useful references for formulating policies and recommendations on exposure reduction and health protection.

Long-term exposure to PM and all-cause and cause-specific mortality: A systematic review and meta-analysis

As new scientific evidence on health effects of air pollution is generated, air quality guidelines need to be periodically updated. The objective of this review is to support the derivation of updated guidelines by the World Health Organization (WHO) by performing a systematic review of evidence of associations between long-term exposure to particulate matter with diameter under 2.5 µm (PM_2.5) and particulate matter with diameter under 10 µm (PM₁₀), in relation to all-cause and cause-specific mortality. As there is especially uncertainty about the relationship at the low and high end of the exposure range, the review needed to provide an indication of the shape of the concentration-response function (CRF). We systematically searched MEDLINE and EMBASE from database inception to 9 October 2018. Articles were checked for eligibility by two reviewers. We included cohort and case-control studies on outdoor air pollution in human populations using individual level data. In addition to natural-cause mortality, we evaluated mortality from circulatory diseases (ischemic heart disease (IHD) and cerebrovascular disease (stroke) also specifically), respiratory diseases (Chronic Obstructive Pulmonary Disease (COPD) and acute lower respiratory infection (ALRI) also specifically) and lung cancer. A random-effect meta-analysis was performed when at least three studies were available for a specific exposure-outcome pair. Risk of bias was assessed for all included articles using a specifically developed tool coordinated by WHO. Additional analyses were performed to assess consistency across geographic region, explain heterogeneity and explore the shape of the CRF. An adapted GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment of the body of evidence was made using a specifically developed tool coordinated by WHO. A large number (N = 107) of predominantly cohort studies (N = 104) were included after screening more than 3000 abstracts. Studies were conducted globally with the majority of studies from North America (N = 62) and Europe (N = 25). More studies used PM_2.5 (N = 71) as the exposure metric than PM₁₀ (N = 42). PM_2.5 was significantly associated with all causes of death evaluated. The combined Risk Ratio (RR) for PM_2.5 and natural-cause mortality was 1.08 (95%CI 1.06, 1.09) per 10 µg/m³. Meta analyses of studies conducted at the low mean PM_2.5 levels (<25, 20, 15, 12, 10 µg/m³) yielded RRs that were similar or higher compared to the overall RR, consistent with the finding of generally linear or supra-linear CRFs in individual studies. Pooled RRs were almost identical for studies conducted in North America, Europe and Western Pacific region. PM₁₀ was significantly associated with natural-cause and most but not all causes of death. Application of the risk of bias tool showed that few studies were at a high risk of bias in any domain. Application of the adapted GRADE tool resulted in an assessment of "high certainty of evidence" for PM_2.5 with all assessed endpoints except for respiratory mortality (moderate). The evidence was rated as less certain for PM₁₀ and cause-specific mortality ("moderate" for circulatory, IHD, COPD and "low" for stroke mortality. Compared to the previous global WHO evaluation, the evidence base has increased substantially. However, studies conducted in low- and middle- income countries (LMICs) are still limited. There is clear evidence that both PM_2.5 and PM₁₀ were associated with increased mortality from all causes, cardiovascular disease, respiratory disease and lung cancer. Associations remained below the current WHO guideline exposure level of 10 µg/m³ for PM_2.5. Systematic review registration number (PROSPERO ID): CRD42018082577.

Fiscal decentralization, environmental regulation, and pollution: a spatial investigation

To investigate the effects of regulation on environmental pollution under Chinese-style fiscal decentralization, this research analyzes annual data over the period 2003 to 2017 covering 30 provinces in China with the spatial economic model. The empirical results show significant spatial agglomeration effects on the emissions of wastewater, sulfur dioxide, and solid waste. Environmental regulation helps reduce discharge of wastewater and solid waste, but does not help reduce the emission of sulfur dioxide; because there is significantly positive externality in treating pollutants with high fluidity, cost is larger than revenue for local governments. The relationship between fiscal decentralization and pollutants shapes an inverted U-shaped curve. We finally offer some implications in accordance with our empirical finding, such as the intensity of environmental regulation should be suitable for economic development, different measures should be taken based on the fluidity of pollutants, and a new evaluation system should be established.

A spatial joint analysis of metal constituents of ambient particulate matter and mortality in England

Few studies have investigated associations between metal components of particulate matter on mortality due to well-known issues of multicollinearity. Here, we analyze these exposures jointly to evaluate their associations with mortality on small area data. We fit a Bayesian profile regression (BPR) to account for the multicollinearity in the elemental components (iron, copper, and zinc) of PM₁₀ and PM_2.5. The models are developed in relation to mortality from cardiovascular and respiratory disease and lung cancer incidence in 2008-2011 at a small area level, for a population of 13.6 million in the London-Oxford area of England. From the BPR, we identified higher risks in the PM₁₀ fraction cluster likely to represent the study area, excluding London, for cardiovascular mortality relative risk (RR) 1.07 (95% credible interval [CI] 1.02, 1.12) and for respiratory mortality RR 1.06 (95%CI 0.99, 1.31), compared with the study mean. For PM_2.5 fraction, higher risks were seen for cardiovascular mortality RR 1.55 (CI 95% 1.38, 1.71) and respiratory mortality RR 1.51 (CI 95% 1.33, 1.72), likely to represent the "highways" cluster. We did not find relevant associations for lung cancer incidence. Our analysis showed small but not fully consistent adverse associations between health outcomes and particulate metal exposures. The BPR approach identified subpopulations with unique exposure profiles and provided information about the geographical location of these to help interpret findings.

Physical activity attenuated association of air pollution with estimated 10-year atherosclerotic cardiovascular disease risk in a large rural Chinese adult population: A cross-sectional study

BACKGROUND

Although long-term exposure to air pollution and physical inactivity are linked to increased risk for atherosclerotic cardiovascular diseases (ASCVD), however, the interactive effect of air pollution and physical activity (PA) on high 10-year ASCVD risk is largely unknown.

METHODS

A total of 31,162 individuals aged 35-74 years were derived from the Henan Rural Cohort Study, after individuals with personal histories of ASCVD or missing data on predictors of high 10-year ASCVD risk were excluded. Concentrations of air pollutants (nitrogen dioxide (NO₂), particulate matter with an aerodynamics diameters ≤ 1.0 µm (PM₁), ≤2.5 µm (PM_2.5) or ≤10 µm (PM₁₀)) of individuals were estimated using a spatiotemporal model based on satellites data. The metabolic equivalent (MET) of PA of each individual was evaluated using the formula: duration (hour/time) × frequency/week × MET coefficient of each type of activity. Logistic regression models were used to analyze associations between air pollutants, PA and high 10-year ASCVD risk. Interaction plots were used to describe interactive effects of air pollutants and PA on high 10-year ASCVD risk.

RESULTS

Each 1 µg/m³ increase in PM₁, PM_2.5, PM₁₀ and NO₂ were related to a 4.4% (odds ratio (OR): 1.044, 95% confidence interval (CI): 1.034, 1.056), 9.1% (OR: 1.091, 95% CI: 1.079, 1.104), 4.6% (OR: 1.046, 95% CI: 1.040, 1.051) or 6.4% (OR: 1.064, 95% CI: 1.055, 1.072) increase in high 10-year ASCVD risk (all p < 0.001), respectively; each one unit-increase in PA MET (hour/day) value was related to a 1.8% (OR: 0.982, 95% CI: 0.980, 0.985) decrease in high 10-year ASCVD risk. Negative interactive effects of PA and PM₁, PM_2.5, PM₁₀ and NO₂ on high 10-year ASCVD risk were observed (all p < 0.001).

CONCLUSION

Exposure to high levels of air pollutants were related to increase high 10-year ASCVD risk and these associations were attenuated by PA, implying that PA may be an effective method to the prevention of high 10-year ASCVD risk in highly polluted rural regions.

Associations between the incidence and mortality rates of type 2 diabetes mellitus and long-term exposure to ambient air pollution: A 12-year cohort study in northern China

BACKGROUND

Ambient air pollution has recently been related to type 2 diabetes mellitus (T2DM), a disease that has caused an economic and health burden worldwide. Evidence of an association between air pollution and T2DM was reported in the United States and Europe. However, few studies have focused on the association with high levels of air pollutants in a developing country.

OBJECTIVES

We conducted a 12-year cohort study to assess the incidence and mortality of T2DM associated with long-term exposure to PM₁₀, SO₂, and NO₂.

METHODS

A retrospective cohort with participants from four cities in northern China was conducted to assess mortality and incidence of T2DM from 1998 to 2009. Incidence of T2DM was self-reported, and incident intake of an antidiabetic drug or injection of insulin simultaneously and mortality of T2DM was obtained from a family member and double checked against death certificates provided from the local center for disease control and prevention. Individual pollution exposures were the mean concentrations of pollutants estimated from the local environmental monitoring centers over the survival years. Hazard ratios (HRs) were estimated using Cox regression models after adjusting for potential confounding factors.

RESULTS

A total of 39 054 participants were recruited into the mortality cohort, among which 59 subjects died from T2DM; 38 529 participants were analyzed in the incidence cohort, and 1213 developed new cases of T2DM. For each 10 μg/m³ increase in PM₁₀, SO₂, and NO₂, the adjusted HRs and 95% confidence interval (CI) for diabetic incidence were 1.831 (1.778, 1.886), 1.287 (1.256, 1.318), and 1.472 (1.419, 1.528), respectively. Similar results can be observed in the analysis of diabetic mortality with HRs (95% CI) up to 2.260 (1.732, 2.950), 1.130 (1.042, 1.225), and 1.525 (1.280, 1.816), respectively.

CONCLUSIONS

Our results suggested that long-term exposure to high levels of PM₁₀, SO₂, and NO₂ increase risk of incident and mortality of T2DM in China.

Cardiac dysfunction and metabolic remodeling due to seasonally ambient fine particles exposure

Increasing epidemiological evidences have revealed the association between ambient fine particulate matter (PM_2.5) pollution and cardiovascular disease's morbidity and mortality. However, how seasonal PM_2.5 exposure influence cardiac function and the underlying mechanism converged in energy metabolic remodeling remain to be elucidated. This study focused on seasonal PM_2.5-induced cardiac dysfunction and metabolic remodeling, and the toxicity differences of PM_2.5 samples from different sampling seasons and different exposure dosages were discussed. The results showed that seasonal haze caused cardiac dysfunctions, including decreases in heart rate (HR) and heart rate variability (HRV), abnormal changes in hemodynamic and echocardiographic parameters. Concurrently, the energy production in myocardial tissues was evidently disturbed. In particular, low dose of PM_2.5 exposure notably induced the elevation of beta oxidation (β-oxidation) and tricarboxylic acid cycle (TCA cycle) as the compensation for the disturbed energy metabolism in animals, whereas high dose of PM_2.5 exposure attenuated this process and the glycolysis levels were strikingly promoted, thus causing the reduced energy production and cardiac dysfunction. Comparatively, winter PM_2.5 exposure caused more severe cardiac toxicity than did summer haze samples, possibly due to the existence of different components and pollutant levels in seasonal hazes. The findings on seasonal PM_2.5 induced cardiac dysfunction and myocardial metabolic remodeling provided new insights into cardiovascular disease risks from haze exposure.

Forecasting PM2.5-induced lung cancer mortality and morbidity at county level in China using satellite-derived PM2.5 data from 1998 to 2016: a modeling study

The serious ambient fine particulate matter (PM2.5) is one of the key risk factors for lung cancer. However, existing studies on the health effects of PM2.5 in China were less considered the regional transport of PM2.5 concentration. In this study, we aim to explore the association between lung cancer and PM2.5 and then forecast the PM2.5-induced lung cancer morbidity and mortality in China. Ridge regression (RR), partial least squares regression (PLSR), model tree-based (MT) regression, regression tree (RT) approach, and the combined forecasting model (CFM) were alternative forecasting models. The result of the Pearson correlation analysis showed that both local and regional scale PM2.5 concentration had a significant association with lung cancer mortality and morbidity and compared with the local lag and regional lag exposure to ambient PM2.5; the regional lag effect (0.172~0.235 for mortality; 0.146~0.249 for morbidity) was not stronger than the local lag PM2.5 exposure (0.249~0.294 for mortality; 0.215~0.301 for morbidity). The overall forecasting lung cancer morbidity and mortality were 47.63, 47.86, 39.38, and 39.76 per 100,000 population. The spatial distributions of lung cancer morbidity and mortality share a similar spatial pattern in 2015 and 2016, with high lung cancer morbidity and mortality areas mainly located in the central to east coast areas in China. The stakeholders would like to implement a cross-regional PM2.5 control strategy for the areas characterized as a high risk of lung cancer.

Association between long-term exposure to Sulfur dioxide pollution and hypertension incidence in northern China: a 12-year cohort study

Several studies have researched the short-term effect of sulfur dioxide (SO₂) exposure on hypertension. However, no evidence has provided the relationship between long-term high pollution exposure of SO₂ and morbidity of hypertension in cohort studies in China. This retrospective cohort study aimed to evaluate this association. We used Cox proportional hazards regression models to examine the hazard ratios (HR) for hypertension risks from 1998 to 2009 associated with accumulative exposure of air SO₂ among adults in northern China. Annual average concentrations of sulfur dioxide (SO₂) were obtained from 15 local environmental monitoring centers. Hypertension was identified according to self-reported diagnostic time and treatment for hypertension with anti-hypertensive medication. Among 37,386 participants, 2619 new cases of hypertension were identified during 426,334 person-years. In the fully adjusted model, HR and 95% confidence interval (CI) of hypertension incidence for each 10 μg/m³ increase in SO₂ were 1.176 (1.163 and 1.189). Results from stratified analyses suggested that effects of SO₂ on hypertension morbidity were more pronounced in participants < 60 years old, tea drinkers, and those with high education, high poultry consumption, and active (occasional and frequent) exercise. We found that long-term exposure to high levels of SO₂ increased the risk of incidence of hypertension in China.

Land Use Impacts on Particulate Matter Levels in Seoul, South Korea: Comparing High and Low Seasons

Seoul, a city in South Korea, experiences high particulate matter (PM) levels well above the recommended standards suggested by the World Health Organization. As concerns about public health and everyday lives are being raised, this study investigates the effects of land use on PM levels in Seoul. Specifically, it attempts to identify which land use types increase or decrease PM10 and PM2.5 levels and compare the effects between high and low seasons using two sets of land use classifications: one coarser and the other finer. A series of partial least regression models identifies that industrial land use increases the PM levels in all cases. It is also reported that residential and commercial land uses associated with lower density increase these levels. Other uses, such as green spaces and road, show mixed or unclear effects. The findings of this study may inform planners and policymakers about how they can refine future land use planning and development practice in cities that face similar challenges.

microRNAs expression in relation to particulate matter exposure: A systematic review

MicroRNAs (miRNAs) are a class of small, non-coding RNAs with a post-transcriptional regulatory function on gene expression and cell processes, including proliferation, apoptosis and differentiation. In recent decades, miRNAs have attracted increasing interest to explore the role of epigenetics in response to air pollution. Air pollution, which always contains kinds of particulate matters, are able to reach respiratory tract and blood circulation and then causing epigenetics changes. In addition, extensive studies have illustrated that miRNAs serve as a bridge between particulate matter exposure and health-related effects, like inflammatory cytokines, blood pressure, vascular condition and lung function. The purpose of this review is to summarize the present knowledge about the expression of miRNAs in response to particulate matter exposure. Epidemiological and experimental studies were reviewed in two parts according to the size and source of particles. In this review, we also discussed various functions of the altered miRNAs and predicted potential biological mechanism participated in particulate matter-induced health effects. More rigorous studies are worth conducting to understand contribution of particulate matter on miRNAs alteration and the etiology between environmental exposure and disease development.

Effect of ambient air pollution exposure on renal dysfunction among hospitalized patients in Shanghai, China

OBJECTIVES

We investigated whether long-term ambient air pollutants (AAP) exposure was associated with estimated glomerular filtration rate (eGFR) among hospitalized patients living in urban areas of Shanghai, China.

STUDY DESIGN

This was a cross-sectional observational study.

METHODS

A total of 3622 newly hospitalized inpatients were investigated from October 2014 to May 2015. The prior year's average exposure to particulate matter (PM) of each participant was estimated using the Kriging interpolation method of ArcGIS. The estimated eGFR was calculated according to the chronic kidney disease epidemiology collaboration (CKD-EPI) equation. Both generalized linear and logistic regression models were applied to assess the associations between AAP and renal function.

RESULTS

One-year PM₁₀ exposure was associated with lower eGFR; each standard deviation (SD) increase in PM₁₀ was significantly associated with the increased prevalence of CKD [adjusted odds ratio (OR) 1.11; 95% confidence interval (CI): 1.02, 1.21], and lower eGFR by -0.40 (95%CI: -0.80, -0.01) ml/min/1.73 m². Moreover, the effect of PM₁₀ was significantly greater in people over 65 years old.

CONCLUSION

Our results supported that exposure to ambient PM₁₀ increased the risk of CKD and negatively affected renal function among Chinese adults.

Associations between metal constituents of ambient particulate matter and mortality in England: an ecological study

OBJECTIVES

To investigate long-term associations between metal components of particulate matter (PM) and mortality and lung cancer incidence.

DESIGN

Small area (ecological) study.

SETTING

Population living in all wards (~9000 individuals per ward) in the London and Oxford area of England, comprising 13.6 million individuals.

EXPOSURE AND OUTCOME MEASURES

We used land use regression models originally used in the Transport related Air Pollution and Health Impacts-Integrated Methodologies for Assessing Particulate Matter study to estimate exposure to copper, iron and zinc in ambient air PM. We examined associations of metal exposure with Office for National Statistics mortality data from cardiovascular disease (CVD) and respiratory causes and with lung cancer incidence during 2008-2011.

RESULTS

There were 108 478 CVD deaths, 48 483 respiratory deaths and 24 849 incident cases of lung cancer in the study period and area. Using Poisson regression models adjusted for area-level deprivation, tobacco sales and ethnicity, we found associations between cardiovascular mortality and PM_2.5 copper with interdecile range (IDR 2.6-5.7 ng/m³) and IDR relative risk (RR) 1.005 (95%CI 1.001 to 1.009) and between respiratory mortality and PM₁₀ zinc (IDR 1135-153 ng/m³) and IDR RR 1.136 (95%CI 1.010 to 1.277). We did not find relevant associations for lung cancer incidence. Metal elements were highly correlated.

CONCLUSION

Our analysis showed small but not fully consistent adverse associations between mortality and particulate metal exposures likely derived from non-tailpipe road traffic emissions (brake and tyre wear), which have previously been associated with increases in inflammatory markers in the blood.

Development of respirable virtual-cyclone samplers

Health-based aerosol sampling should reflect how particles penetrate and deposit in various regions of the human respiratory system. Therefore, size-selective sampling should be adopted when monitoring aerosol concentration in the atmosphere. However, cyclone samplers, the most commonly used respirable sampler type in the workplace, show specific particle size-dependent bias toward the international respirable convention. Additionally, cyclone samplers are vulnerable to the dust loading effect resulting in an underestimation of respirable particulate matter. In the previous study, a virtual cyclone has been employed to overcome the dust loading effect, but still had the disadvantage of high aerosol penetration of large particle sizes. Therefore, in this work, the effects of key dimensions of virtual cyclones including chamber width (or inlet width), chamber size and inlet height on the separation performance were further studied and the configurations of virtual cyclones were modified to best fit the ISO/CEN/ACGIH respirable convention. Experimental results demonstrated that a better match with the ISO/CEN/ACGIH respirable convention curve can be achieved by increasing the chamber width to over 20 mm. Moreover, the new virtual cyclones can operate at a flow rate up to 21.5 L/min to collect more respirable particulate matter for the increasingly stringent respirable dust standards. The new virtual cyclones demonstrate accurate and constant measurement of the respirable dust for exposure assessment.

Assessment of Traffic-Related Air Pollution: Case Study of Pregnant Women in South Texas

Population groups vulnerable to adverse effects of traffic-related air pollution correspond to children, pregnant women and elderly. Despite these effects, literature is limited in terms of studies focusing on these groups and a reason often cited is the limited information on their mobility important for exposure assessment. The current study presents a method for assessing individual-level exposure to traffic-related air pollution by integrating mobility patterns tracked by global positioning system (GPS) devices with dynamics of air pollutant concentrations. The study is based on a pool of 17 pregnant women residing in Hidalgo County, Texas. The traffic-related particulate matter with diameter of less than 2.5 micrometer (PM_2.5) emissions and air pollutant concentrations are predicted using MOVES and AERMOD models, respectively. The daily average traffic-related PM_2.5 concentration was found to be 0.32 µg/m³, with the highest concentration observed in transit (0.56 µg/m³), followed by indoors (0.29 µg/m³), and outdoor (0.26 µg/m³) microenvironment. The obtained exposure levels exhibited considerable variation between time periods, with higher levels during peak commuting periods, close to the US–Mexico border region and lower levels observed during midday periods. The study also assessed if there is any difference between traffic-related dynamic exposure, based on time-varying mobility patterns, and static exposure, based solely on residential locations, and found a difference of 9%, which could be attributed to the participants’ activity patterns being focused mostly indoors.

Bayesian spatial modelling for quasi-experimental designs: An interrupted time series study of the opening of Municipal Waste Incinerators in relation to infant mortality and sex ratio

BACKGROUND

There is limited evidence on potential health risks from Municipal Waste Incinerators (MWIs), and previous studies on birth outcomes show inconsistent results. Here, we evaluate whether the opening of MWIs is associated with infant mortality and sex ratio in the surrounding areas, extending the Interrupted Time Series (ITS) methodological approach to account for spatial dependencies at the small area level.

METHODS

We specified a Bayesian hierarchical model to investigate the annual risks of infant mortality and sex-ratio (female relative to male) within 10 km of eight MWIs in England and Wales, during the period 1996-2012. We included comparative areas matched one-to-one of similar size and area characteristics.

RESULTS

During the study period, infant mortality rates decreased overall by 2.5% per year in England. The opening of an incinerator in the MWI area was associated with -8 deaths per 100,000 infants (95% CI -62, 40) and with a difference in sex ratio of -0.004 (95% CI -0.02, 0.01), comparing the period after opening with that before, corrected for before-after trends in the comparator areas.

CONCLUSION

Our method is suitable for the analysis of quasi-experimental time series studies in the presence of spatial structure and when there are global time trends in the outcome variable. Based on our approach, we do not find evidence of an association of MWI opening with changes in risks of infant mortality or sex ratio in comparison with control areas.

PM2.5 aggravates the lipid accumulation, mitochondrial damage and apoptosis in macrophage foam cells

Epidemiological evidence showed that the particulate matter exposure is associated with atherosclerotic plaque progression, which may be related to foam cell formation, but the mechanism is still unknown. The study was aimed to investigate the toxic effects and possible mechanism of PM_2.5 on the formation of macrophage foam cells induced by oxidized low density lipoprotein (ox-LDL). Results showed that PM_2.5 induced cytotoxicity by decreasing the cell viability and increasing the LDH level in macrophage foam cells. PM_2.5 aggravated the lipid accumulation in ox-LDL-stimulated macrophage RAW264.7 within markedly increasing level of intracellular lipid by Oil red O staining. The level of ROS increased obivously after co-exposure to PM_2.5 and ox-LDL than single exposure group. In addition, serious mitochondrial damage such as the mitochondrial swelling, cristae rupturing and disappearance were observed in macrophage foam cells. The loss of the mitochondrial membrane potential (MMP) further exacerbated the mitochondrial damage in PM_2.5-induced macrophage foam cells. The apoptotic rate increased more severely via up-regulated protein level of Bax, Cyt C, Caspase-9, Caspase-3, and down-regulated that of Bcl-2, indicating that PM_2.5 activated the mitochondrial-mediated apoptosis pathway. In summary, our results demonstrated that PM_2.5 aggravated the lipid accumulation, mitochondrial damage and apoptosis in macrophage foam cells, suggesting that PM_2.5 was a risk factor of atherosclerosis progression.

Comparing two teaching methods based on concept map and lecture on the level of learning in basic life support

Education and training about Basic Life Support is necessary for different medical groups such as nurses. Different teaching methods have been developed to preserve essential medical information, knowledge and skills. The purpose of the study was to determine the effect of concept map-based and lecture-based teaching methods on the level of nursing students' learning in Basic Life Support. This quasi-experimental study was conducted in 2015 on 57 nursing students from a nursing school in Tehran. Students were selected by census and then divided into lecture (n = 29) and concept map groups (n = 28) by random allocation. The effect of education on knowledge (before, immediately after, one week after and one month after session) and practice (before and immediately after session) was studied. No significant differences were found between the mean scores of knowledge and practice before intervention (P > 0.05). After intervention the mean scores of knowledge were not statistically significant between the two groups (P > 0.05) but mean scores of practice were significantly higher in the concept map group (P = 0.03). In achieving skill and practice goals, it seems that the concept map-based teaching method was more effective than the lecture method.

All-cause mortality risk associated with long-term exposure to ambient PM2·5 in China: a cohort study

BACKGROUND

Evidence from cohort studies in North America and Europe indicates that long-term exposure to fine particulate matter (PM_2·5) is associated with an increased mortality risk. However, this association has rarely been quantified at higher ambient concentrations. We estimated the hazard ratio (HR) for all-cause mortality from long-term exposure to PM_2·5 in a well established Chinese cohort of older adults.

METHODS

The Chinese Longitudinal Healthy Longevity Survey (CLHLS) is a prospective cohort study of men and women aged 65 years and older enrolled in 2008 and followed up through 2014 for mortality events. We studied individuals for whom residential locations were available in 2008 for linkage to 1 km grids of PM_2·5 concentrations, derived from satellite remote sensing. Cox proportional hazards models were used to estimate the effect of long-term exposure to PM_2·5 on all-cause mortality, controlling for age, sex, smoking status, drinking status, physical activity, body-mass index, household income, marital status, and education. We then used our results to estimate premature mortality related to PM_2·5 exposure in the population aged 65 years and older in China in 2010.

FINDINGS

13 344 individuals in the CLHLS cohort had data for all timepoints, yielding follow-up data for 49 440 person-years. In a 3-year window, these individuals were exposed to a median PM_2·5 concentration of 50·7 μg/m³ (range 6·7-113·3). The overall HR for a 10 μg/m³ increase in this value was 1·08 (95% CI 1·06-1·09). In stratified analyses, HRs were higher in rural than in urban locations, in southern versus northern regions, and with exposure to lower versus higher PM_2·5 concentrations. Based on the overall HR, we estimated that 1 765 820 people aged 65 years and older in China in 2010 had premature mortality related to PM_2·5 exposure.

INTERPRETATION

Long-term exposure to PM_2·5 is associated with an increased risk of all-cause mortality among adults aged 65 years and older in China, but the magnitude of the risk declines as the concentration of PM_2·5 increases.

FUNDING

National Natural Science Foundation of China, National High-Level Talents Special Support Plan of China for Young Talents, US National Aeronautics and Space Administration, and the Columbia University Global Policy Initiative.

Smog and risk of overall and type-specific cardiovascular diseases: A pooled analysis of 53 cohort studies with 21.09 million participants

The reported associations of smog with the risk of cardiovascular disease (CVD) and CVD subtypes were inconsistent. We systematically searched the Pubmed (Medline) and Embase databases (from the inception to April 25, 2018) to identify the cohort studies investigating the association between smog and CVD and specific types of CVD. We conducted a meta-analysis for different types of air pollutants (PM_2.5, PM₁₀, NO₂, and O₃) in smog with the risk of specific types of CVD separately. We summarized the study-specific effect estimates using both the fixed effect model and the random effect model. The meta-analysis included 35 publications with 53 cohort studies. Overall, the associations between per 10 μg/m³ increase in PM_2.5 exposure and risk of CVD events, stroke events, ischemic heart disease(IHD) events were significant, with relative risks (RRs) of 1.11 (95% confidence interval: 1.07-1.15), 1.12 (95% CI: 1.08-1.16) and 1.14(95% CI: 1.08-1.21), respectively. PM_2.5, PM₁₀, NO₂, and O₃ exposure were associated with an increased risk of CVD mortality, with RRs of 1.11 (95% CI: 1.07-1.15), 1.09 (95% CI: 1.02-1.16), 1.23 (95% CI: 1.15-1.31) and 1.03 (95% CI: 1.02-1.05), respectively. Compared with PM₁₀, NO₂, and O₃ exposure, PM_2.5 exposure had a greater risk of stroke incidence and IHD incidence (RR 1.12, 95% CI 1.05-1.19 for stroke incidence; 1.19, 1.09-1.30 for IHD). However, no clear evidence for the associations of PM10 exposure with risk of CVD incidence, stroke incidence, and IHD incidence was observed. This meta-analysis confirms the evidence that PM_2.5 exposure was significantly associated with increased risk of CVD, stroke, and IHD. PM2.5, PM₁₀, NO₂, and O₃ exposure were separately associated with an increased risk of CVD mortality. There was a stronger association between PM_2.5 exposure and the risk of stroke and IHD incidence. It urgently needs well-designed studies to further to elaborate the biological and epidemiological mechanisms that link smog with CVD. MAIN FINDINGS: Compared with PM₁₀, NO₂, and O₃ exposures, PM_2.5 exposure was positively associated with increased risk of stroke and IHD incidence. For air pollutants and CVD events, the association of NO₂ with the risk CVD mortality is more significant.

Air pollution intervention and life-saving effect in China

As a critical air pollutant, PM_2.5 is proved to be associated with numerous adverse health impacts and pose serious challenges to human life. This situation is especially important for China as the most populous and one of the heaviest PM_2.5 polluted country in the world. However, health burden estimations reported for China in previous studies may be biased due to the usage of PM_2.5 concentrations at a coarsely spatial resolution, as well as the ignorance of the spatial discrepancies of parameters (e.g. respiratory rate) employed in the exposure-response function. This study therefore utilized a hybrid remote sensing-geostatistical approach to refine PM_2.5 concentrations at 1 km resolution across mainland China from 2013 to 2017. Meanwhile, nationwide exposure parameters were for the first time introduced to weight the integrated exposure response (IER) function to calculate and spatially reallocate the corresponding PM_2.5-attributable premature deaths at 1 km resolution. Results showed that annually averaged PM_2.5 concentrations in mainland China decreased by 39.5%, from 59.1 μg/m³ in 2013 to 35.8 μg/m³ in 2017. Subsequently, PM_2.5 attributable premature deaths reduced 12.6%, from 1.20 million (95% CI: 0.57; 1.71) in 2013 to 1.05 million (95% CI: 0.44; 1.44) in 2017. This declining trend was found in most parts of China except some areas in Xinjiang, Jilin, and Heilongjiang provinces. As a result, 214,821 (95% CI: 96,675; 302,897) life were saved with an estimated monetary value of US$ 210.14 billion (2011 values). However, it has to be acknowledged that, the central and northern China within priority areas of air pollution control were still experiencing high numbers of premature deaths due to the severe PM_2.5 pollution and high-density population. But more worrying than these priority areas are those Harbin-Changchun Metropolitan Region, City Belt in Central Henan and Yangtze-Huaihe City Belt in non-priority areas, which also have been seriously suffering PM_2.5 attributable premature deaths over 28, 000 cases per year. In conclusion, despite the huge gain in life-saving effects in China over the past five years with the help of air pollution intervention policy, future work on cleaner air and better human health is still strongly needed, especially in non-priority areas of air pollution control.

Long-term trends in ambient fine particulate matter from 1980 to 2016 in United Arab Emirates

This paper presents the most comprehensive datasets of ambient fine particulate matter (PM_2.5) for the UAE from 1980 to 2016. The long-term distributions of PM_2.5 showed the annual average PM_2.5 concentrations constantly exceeded the EPA and WHO guidelines. They varied from 77 to 49 μg/m³ with an overall average of 61.25 μg/m³. While the inter-annual variability in PM_2.5 concentrations showed relatively a cyclic pattern, with successive ups and downs, it broadly exhibited an increasing trend, particularly, over the last 14 years. PM_2.5 concentrations displayed a strong seasonal pattern, with greatest values observed during warm summer season, a period of high demand of electricity and dust events. The lowest values found in autumn are attributable to reduced demand of energy. Decreased atmospheric temperatures and high relative humidity coinciding with this period are likely to reduce the secondary formation of PM_2.5. The spatial changes in PM_2.5 concentrations exhibited gradual downward trends to the north and northeast directions. Airborne PM_2.5 is prevalent in the southern and western regions, where the majority of oil and gas fields are located. PM_2.5/PM₁₀ ratio indicated that ambient aerosols are principally associated with anthropogenic sources. Peaks in PM_2.5/CO ratio were frequently observed during June, July, and August, although few were concurrent with March. This indicates that secondary formation plays an important role in PM_2.5 levels measured in these months, especially as the photochemical activities become relatively strong in these periods. The lowest PM_2.5/CO ratios were found during September, October, and November (autumn) suggesting a considerable contribution of primary combustion emissions, especially vehicular emissions, to PM_2.5 concentration. PM_2.5 concentrations are positively correlated with sulfate levels. In addition to sea and dust aerosols, sulfate concentration in the coastal region is also related to fossil fuel burning from power plants, oil and gas fields, and oil industries. The population-weighted average of PM_2.5 in UAE was 63.9 μg/m³, which is more than three times greater than the global population-weighted mean of 20 μg/m³.

An urban-rural and sex differences in cancer incidence and mortality and the relationship with PM2.5 exposure: An ecological study in the southeastern side of Hu line

This study investigates the urban-rural and sex differences in the increased risks of the ten most common cancers in China related to high PM_2.5 concentration in the southeastern side of Hu line. Pearson correlation coefficient is estimated to reveal how the cancers closely associated with PM_2.5 long-term exposure. Then linear regression is conducted to evaluate sex- and area-specific increased risks of those cancers from high level PM_2.5 long-term exposure. The major finding is with the increase of every 10 μg/m³ of annual mean PM_2.5 concentration, the increase of relative risks for lung cancer incidence and mortality are 15% and 23% for males, and 22% and 24% for females in rural area. For urban area, the increase of relative risk for ovarian cancer incidence is 9% for females, while that for prostatic cancer increases 17% for males. For leukemia, the increase of relative risks for incidence and mortality are 22% and 19% for females in rural area, while in urban area the increase of relative risk for mortality is 9% for males and for incidence is 6% for females. It is also found that with increased PM_2.5 exposure, the risks for ovarian and prostatic cancer rise significantly in urban area, while risks for lung cancer and leukemia rise significantly in rural area. The results demonstrate the higher risks for lung cancer and leukemia with increased PM_2.5 exposure are more significant for female. This study also suggests that the carcinogenic effects of PM_2.5 have obvious sex and urban-rural differences.

Does utilizing WHO's interim targets further reduce the risk - meta-analysis on ambient particulate matter pollution and mortality of cardiovascular diseases?

Long-term exposed to ambient particulate matter (PM) has been recognized as a risk factor for cardiovascular diseases (CVDs) mortality but few studies examine the utility of WHO's interim targets (2006) concerning PM control on CVD mortality. This review aimed to synthesize the long-term exposed to ambient PM exposures on overall CVD mortality according to WHO's interim targets; meanwhile, subgroup analysis by ethnicity, smoking status and PM assessment method were also conducted. We systematically searched studies published between January 1974 and Jul 2017 in PubMed and Embase. Quality of each study was assessed using Critical Appraisal Skill Programme (CASP) checklist. Fixed-effects or random-effects model of meta-analysis was determined by the test of heterogeneity. Subgroup analyses were conducted according to ethnicity, smoking status, PM assessment method and interim PM targets of WHO guidelines. Overall, 16 eligible studies were included, covering 15,511,997 participants and 542,991 CVD deaths. Five studies concerning PM2.5 were rated as good quality. The pooled hazard ratio (HR) of every 10μg/m3 increment of PM2.5 exposure for CVD mortality was 1.12 (95%CI = 1.08-1.16), but it was not significant for PM10 (HR = 1.02, 95%CI = 0.89-1.16). Compared with the annual PM2.5 exposure level within WHO's interim targets (1.11-1.16), significantly smaller HR was observed for subjects with an exposure level below WHO's air quality guideline (HR = 1.03, 95%CI = 1.02-1.04). The pooled HR was relatively higher for studies in Asian and with at least 11 years' follow-up and those adopting relatively poor methods (category 1) in assessing PM2.5, whilst the risk was similar regardless of smoking status. Egger and Begg's tests showed no evidence for publication bias. Long-term ambient PM2.5 exposure level was positively associated with the overall CVD mortality. Different interim targets above the WHO's Air Quality Guideline level exerted a similar scale of CVD risk, but there is no evidence for a threshold.

Air Pollution and Cardiovascular Disease: A Focus on Vulnerable Populations Worldwide

Purpose of review

Certain subgroups defined by sociodemographics (race/ethnicity, age, sex and socioeconomic status [SES]), geographic location (rural vs. urban), comorbid conditions and country economic conditions (developed vs. developing) may disproportionately suffer the adverse cardiovascular effects of exposure to ambient air pollution. Yet, previous reviews have had a broad focus on the general population without consideration of these potentially vulnerable populations.

Recent findings

Over the past decade, a wealth of epidemiologic studies have linked air pollutants including particulate matter, oxides of nitrogen, and carbon monoxide to cardiovascular disease (CVD) risk factors, subclinical CVD, clinical cardiovascular outcomes and cardiovascular mortality in certain susceptible populations. Highest risk for poor CVD outcomes from air pollution exist in racial/ethnic minorities, especially in blacks compared to whites in the U.S, those at low SES, elderly populations, women, those with certain comorbid conditions and developing countries compared to developed countries. However, findings are less consistent for urban compared to rural populations.

Summary

Vulnerable subgroups including racial/ethnic minorities, women, the elderly, smokers, diabetics and those with prior heart disease had higher risk for adverse cardiovascular outcomes from exposure to air pollution. There is limited data from developing countries where concentrations of air pollutants are more extreme and cardiovascular event rates are higher than that of developed countries. Further epidemiologic studies are needed to understand and address the marked disparities in CVD risk conferred by air pollution globally, particularly among these vulnerable subgroups.