Which specific causes of death are associated with short term exposure to fine and coarse particles in Southern Europe? Results from the MED-PARTICLES project

Impact of environmental factors on diabetes mortality: A comparison between inland and coastal areas

BACKGROUND

Diabetes mortality varies between coastal and inland areas in Shandong Province, China. However, evidence about the reasons for this disparity is limited. We assume that distinct environmental conditions may contribute to the disparities in diabetes mortality patterns between coastal and inland areas.

METHOD

Qingdao and Jinan were selected as typical coastal and inland cities in Shandong Province, respectively, with similar socioeconomic but different environmental characteristics. Data on diabetes deaths and environmental factors (i.e., temperature, relative humidity and air pollution particles with a diameter of 2.5 μm or less (PM2.5)) were collected from 2013 to 2020. Spatial kriging methods were used to estimate the aggregated diabetes mortality at the city level. A distributed lag non-linear model (DLNM) was used to quantify the possible cumulative and non-cumulative associations between environmental factors and diabetes mortality by age, sex and location.

RESULTS

In the coastal city (Qingdao), the maximum cumulative relative risks (RRs) of temperature and PM2.5 associated with diabetes deaths were 2.54 (95 % confidence interval (CI): 1.25-5.15), and 1.17 (95 % CI: 1.01-1.37) respectively, at lag 1 week. In the inland city (Jinan), only temperature exhibited significant cumulative associations with diabetes deaths (RR = 1.54, 95 % CI: 1.07-2.23 at 29 °C). Lower relative humidity (22 %-45 %) had a lag-specific association with diabetes deaths in inland areas at lag 3 weeks (RR = 1.33, 95 % CI: 1.03-1.70 at 22 %).

CONCLUSION

Despite the lower PM2.5 concentrations in the coastal location, diabetes mortality exhibited stronger links to environmental variables in the coastal city than in the inland city. These findings suggest that the control of air pollution could decrease the mortality burden of diabetes, even in the region with relatively good air quality. Additionally, the spatial estimation method is recommended to identify associations between environmental factors and diseases in studies with limited data.

Criteria air pollutants and diabetes mortality classified by different subtypes and complications: A nationwide, case-crossover study

The associations between air pollution and diabetes mortality of different subtypes and complications were largely unclear. We performed an individual-level, time-stratified case-crossover study among over 0.9 million diabetes deaths from all administrative regions of Chinese mainland during 2013-2019. Daily concentrations of fine particles (PM2.5), coarse particles (PM2.5-10), nitrogen dioxide (NO2) and ozone (O3) were obtained for each decedent using high-resolution prediction models. Conditional logistic regression models were utilized to analyze the data. Each interquartile range increment in PM2.5, PM2.5-10, NO2 and O3 concentrations on lag 0-2 d increased the risks of overall diabetes mortality by 2.81 %, 1.92 %, 3.96 % and 2.15 %, respectively. Type 2 diabetes had stronger associations with air pollution than type 1 diabetes. Air pollutants were associated with diabetic ketoacidosis and diabetic nephropathy, but not other complications. The exposure-response curves were approximately linear with a plateau at higher concentrations of PM2.5, PM2.5-10, and NO2, while the associations for O3 appear to be statistically significant beyond 60 μg/m3. This nationwide study reinforces the evidence of higher risks of acute diabetic events following short-term air pollution exposure. We identified differential effects of air pollutants on various subtypes and complications of diabetes, which require further mechanistic investigations.

Associations of long-term exposure to air pollution with prevalence of pulmonary nodules: A cross-sectional study in Shijiazhuang, China

A complete understanding of the associations of ambient air pollution with prevalence of pulmonary nodule is lacking. We aimed to investigate the associations of ambient air pollutants with prevalence of pulmonary nodule. A total of 9991 health examination participants was enrolled and 3166 was elected in the final in Shijiazhuang between April 1st, 2018, and December 31st, 2018. 107 participants were diagnosed in pulmonary nodule while 3059 participants were diagnosed in non-pulmonary (named control). The individual exposure of participants was evaluation by Empirical Bayesian Kriging model according to their residential or work addresses. The pulmonary nodules were found and diagnosed by health examination through chest x-ray detection. Our results suggested that there were positive associations between prevalence of pulmonary nodules and PM2.5 (OR = 1.06, 95% CI: 1.02, 1.11) as well as O3 (OR = 1.49, 95% CI: 1.35, 1.66) levels. The platelet count (PLT) acted as the mediator of pulmonary nodules related with the PM2.5 exposure, while the neutrophil-to-lymphocyte ratio (NLR) as well as platelet-to-lymphocyte ratio (PLR) were the mediators of pulmonary nodules related with the O3 exposure. This study suggests that long-term exposure to PM2.5 and O3 may significantly associated with prevalence of pulmonary nodules, and the above associations are mediated by PLT, NLR and PLR.

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.

Does the meteorological origin of heat waves influence their impact on health? A 6-year morbidity and mortality study in Madrid (Spain)

BACKGROUND

In Spain, two synoptic-scale conditions influence heat wave formation. The first involves advection of warm and dry air masses carrying dust of Saharan origin (North African Dust (NAF) = 1). The second entails anticyclonic stagnation with high insolation and stability (NAF) = 0). Some studies show that the meteorological origin of these heat waves may affect their impact on morbidity and mortality.

OBJECTIVE

To determine whether the impact of heat waves on health outcomes in Madrid (Spain) during 2013-2018 varied by synoptic-scale condition.

METHODOLOGY

Outcome data consist of daily mortality and daily hospital emergency admissions (morbidity) for natural, circulatory, and respiratory causes. Predictors include daily maximum and minimum temperatures and daily mean concentrations of NO₂, PM₁₀, PM_2.5, NO₂, and O₃. Analyses adjust for insolation, relative humidity, and wind speed. Generalized linear models were performed with Poisson link between the variables controlling for trend, seasonality, and auto-regression in the series. Relative Risks (RR) and Attributable Risks (AR) were determined. The RRs for mortality attributable to high temperatures were similar regardless of NAF status. For hospital admissions, however, the RRs for hot days with NAF = 0 are higher than for days with NAF = 1. We also found that atmospheric pollutants worsen morbidity and mortality, especially PM₁₀ concentrations when NAF = 1 and O₃ concentrations when NAF = 0.

RESULTS

The effect of heat waves on morbidity and mortality depends on the synoptic situation. The impact is greater under anticyclonic stagnation conditions than under Saharan dust advection. Further, the health impact of pollutants such as PM₁₀ and O₃ varies according to the synoptic situation.

CONCLUSIONS

Based on these findings, we strongly recommend prevention plans to include data on the meteorological situation originating the heat wave, on a synoptic-scale, as well as comprehensive preventive measures against the compounding effect of high temperatures and pollution.

Research progress on distribution and exposure risk of microbial aerosols in animal houses

Environmental aerosols in animal houses are closely related to the productive performance and health level of animals living in the houses. Preferable housing environments can improve animal welfare and production efficiency, so it is necessary to monitor and study these environments. In recent years, there have been many large-scale outbreaks of respiratory diseases related to biological aerosols, especially the novel coronavirus that has been sweeping the world. This has attracted much attention to the mode of aerosol transmission. With the rapid development of large-scale and intensive breeding, microbial aerosols have gradually become the main factor of environmental pollution in animal houses. They not only lead to a large-scale outbreak of infectious diseases, but they also have a certain impact on the health of animals and employees in the houses and increase the difficulty of prevention and control of animal-borne diseases. This paper reviews the distribution, harm, and control measures of microbial aerosols in animal house environments in order to improve people's understanding of them.

Multi-sectoral impact assessment of an extreme African dust episode in the Eastern Mediterranean in March 2018

In late March 2018, a large part of the Eastern Mediterranean experienced an extraordinary episode of African dust, one of the most intense in recent years, here referred to as the "Minoan Red" event. The episode mainly affected the Greek island of Crete, where the highest aerosol concentrations over the past 15 yeas were recorded, although impacts were also felt well beyond this core area. Our study fills a gap in dust research by assessing the multi-sectoral impacts of sand and dust storms and their socioeconomic implications. Specifically, we provide a multi-sectoral impact assessment of Crete during the occurrence of this exceptional African dust event. During the day of the occurrence of the maximum dust concentration in Crete, i.e. March 22nd, 2018, we identified impacts on meteorological conditions, agriculture, transport, energy, society (including closing of schools and cancellation of social events), and emergency response systems. As a result, the event led to a 3-fold increase in daily emergency responses compare to previous days associated with urban emergencies and wildfires, a 3.5-fold increase in hospital visits and admissions for Chronic Obstructive Pulmonary Disease (COPD) exacerbations and dyspnoea, a reduction of visibility causing aircraft traffic disruptions (eleven cancellations and seven delays), and a reduction of solar energy production. We estimate the cost of direct and indirect effects of the dust episode, considering the most affected socio-economic sectors (e.g. civil protection, aviation, health and solar energy production), to be between 3.4 and 3.8 million EUR for Crete. Since such desert dust transport episodes are natural, meteorology-driven and thus to a large extent unavoidable, we argue that the efficiency of actions to mitigate dust impacts depends on the accuracy of operational dust forecasting and the implementation of relevant early warning systems for social awareness.

Associating Air Pollution with Cytokinesis-Block Micronucleus Assay Parameters in Lymphocytes of the General Population in Zagreb (Croatia)

Air pollution is recognized as one of the most serious public health issues worldwide and was declared to be a leading environmental cause of cancer deaths. At the same time, the cytokinesis-block micronucleus (CBMN) assay serves as a cancer predictive method that is extensively used in human biomonitoring for populations exposed to environmental contamination. The objective of this cross-sectional study is two-fold: to evaluate genomic instability in a sample (N = 130) of healthy, general population residents from Zagreb (Croatia), chronically exposed to different levels of air pollution, and to relate them to air pollution levels in the period from 2011 to 2015. Measured frequencies of CBMN assay parameters were in agreement with the baseline data for the general population of Croatia. Air pollution exposure was based on four factors obtained from a factor analysis of all exposure data obtained for the examined period. Based on the statistical results, we did not observe a significant positive association between any of the CBMN assay parameters tested and measured air pollution parameters for designated time windows, except for benzo(a)pyrene (B[a]P) that showed significant negative association. Our results show that measured air pollution parameters are largely below the regulatory limits, except for B[a]P, and as such, they do not affect CBMN assay parameters’ frequency. Nevertheless, as air pollution is identified as a major health threat, it is necessary to conduct prospective studies investigating the effect of air pollution on genome integrity and human health.

Acute Effects of Particulate Matter on All-Cause Mortality in Urban, Rural, and Suburban Areas, Italy

Background: Short-term exposure to particulate matter (PM) has been related to mortality worldwide. Most evidence comes from studies conducted in major cities, while little is known on the effects of low concentrations of PM and in less urbanized areas. We aim to investigate the relationship between PM and all-cause mortality at national level in Italy. Methods: Daily numbers of all-cause mortality were collected for all 8092 municipalities of Italy, from 2006 to 2015. A satellite-based spatiotemporal model was developed to estimate daily PM₁₀ (inhalable particles) and PM_2.5 (fine particles) concentrations at 1-km resolution. Multivariate Poisson regression models were fit to estimate the association between daily PM and mortality at province level, and then, results were pooled with a random-effects meta-analysis. Associations were estimated by combination of age and sex and degree of urbanization of the municipalities. Flexible functions were estimated to explore the shape of the associations at low PM concentrations. Results: We analyzed 5,884,900 deaths (40% among subjects older than 85 years, 60% occurring outside the main urban areas). National daily mean (interquartile range) PM₁₀ and PM_2.5 concentrations were 23 (14) μg/m³ and 15 (11) μg/m³, respectively. Relative increases of mortality per 10 μg/m³ variation in lag 0–5 (average of last six days since death) PM₁₀ and PM_2.5 were 1.47% (95% Confidence Intervals (CI): 1.15%, 1.79%) and 1.96% (1.33%, 2.59%), respectively. Associations were highest among elderly and women for PM₁₀ only, similar between rural and urbanized areas, and were present even at low concentrations, e.g., below WHO guidelines. Conclusions: Air pollution was robustly associated with peaks in daily all-cause mortality in Italy, both in large cities and in less urbanized areas of Italy. Current WHO Air Quality Guidelines (2021) for PM₁₀ and PM_2.5 are not sufficient to protect public health.

Short-term exposure to ambient air pollution and type 2 diabetes mortality: A population-based time series study

Acute health effects of air pollution on diabetes risk have not been fully studied in developing countries and the results remain inconsistent. This study aimed to investigate the association between short-term exposure to ambient air pollution and Type 2 diabetes mellitus (T2DM) mortality in China. Data on T2DM mortality from 2013 to 2019 were obtained from the Cause of Death Reporting System (CDRS) of Wuhan Center for Disease Control and Prevention. Air pollution data for the same period were collected from 10 national air quality monitoring stations of Wuhan Ecology and Environment Institute, including daily average PM_2.5, PM₁₀, SO₂, and NO₂. Meteorological data including daily average temperature and relative humidity were collected from Wuhan Meteorological Bureau. Generalized additive models (GAM) based on quasi-Poisson distribution were applied to evaluate the association between short-term exposure to air pollution and daily T2DM deaths. A total of 9837 T2DM deaths were recorded during the study period in Wuhan. We found that short-term exposure to PM_2.5, PM₁₀, SO₂, and NO₂ were positively associated with T2DM mortality, and gaseous pollutants appeared to have greater effects than particulate matter (PM). For the largest effect, per 10 μg/m³ increment in PM_2.5 (lag 02), PM₁₀ (lag 02), SO₂ (lag 03), and NO₂ (lag 02) were significantly associated with 1.099% (95% CI: 0.451, 1.747), 1.016% (95% CI: 0.517, 1.514), 3.835% (95% CI: 1.480, 6.189), and 1.587% (95% CI: 0.646, 2.528) increase of daily T2DM deaths, respectively. Stratified analysis showed that females or elderly population aged 65 and above were more susceptible to air pollution exposure. In conclusion, short-term exposure to air pollution was significantly associated with a higher risk of T2DM mortality. Further research is required to verify our findings and elucidate the underlying mechanisms.

The use of multi-criteria method in the process of threat assessment to the environment

Measurements of the content of trace elements, including toxic and carcinogenic metals, in various fractions of particulate matter PM are an important element of environmental monitoring and research involving their impact on human health. The article presents the measurement results of atmospheric composition of suspended dust (PM₁₀), respirable fraction (PM_2.5) and submicron particulate matter (PM₁) collected with the Dekati PM₁₀ cascade impactor. Samples were collected in the vicinity of four working power plants (from 28 May to 23 September 2014) and four coking plants (from 4 May to 28 August 2015) in Upper Silesia, Poland. The qualitative and quantitative analysis of the solutions: arsenic (As), cadmium (Cd), cobalt (Co), chromium (Cr), mercury (Hg), manganese (Mn), nickel (Ni), lead (Pb), antimony (Sb) and selenium (Se) obtained for individual fractions was performed by inductively coupled plasma mass spectrometry, using the apparatus ICP-MS. The research results were used to determine a synthetic assessment of the threat to the anthropogenic environment and for the preparation of the ranking of the measured points.

Effects of PM2.5 on Chronic Airway Diseases: A Review of Research Progress

The adverse effects of polluted air on human health have been increasingly appreciated worldwide. It is estimated that outdoor air pollution is associated with the death of 4.2 million people globally each year. Accumulating epidemiological studies indicate that exposure to ambient fine particulate matter (PM2.5), one of the important air pollutants, significantly contributes to respiratory mortality and morbidity. PM2.5 causes lung damage mainly by inducing inflammatory response and oxidative stress. In this paper, we reviewed the research results of our group on the effects of PM2.5 on chronic obstructive pulmonary disease, asthma, and lung cancer. And recent research progress on epidemiological studies and potential mechanisms were also discussed. Reducing air pollution, although remaining a major challenge, is the best and most effective way to prevent the onset and progression of respiratory diseases.

Characteristics of PCDD/Fs in PM2.5 from emission stacks and the nearby ambient air in Taiwan

This study aimed to find the characteristics of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in fine particulate matter from different stationary emission sources (coal-fired boiler, CFB; municipal waste incinerator, MWI; electric arc furnace, EAF) in Taiwan and the relationship between PM_2.5 and PM_2.5-bound PCDD/Fs with Taiwanese mortality risk. PM_2.5 was quantified using gravimetry and corresponding chemical analyses were done for PM_2.5-bound chemicals. Mortality risks of PM_2.5 exposure and PCDD/Fs exposure were calculated using Poisson regression. The highest concentration of PM_2.5 (0.53 ± 0.39 mg/Nm³) and PCDD/Fs (0.206 ± 0.107 ng I-TEQ/Nm³) was found in CFB and EAF, respectively. Higher proportions of PCDDs over PCDFs were observed in the flue gases of CFB and MWI whereas it was reversed in EAF. For ambient air, PCDD/F congeners around the stationary sources were dominated by PCDFs in vapor phase. Positive matrix factorization (PMF) analysis found that the sources of atmosphere PCDD/Fs were 14.6% from EAF (r = 0.81), 52.6% from CFB (r = 0.74), 18.0% from traffic (r = 0.85) and 14.8% from MWI (r = 0.76). For the dioxin congener distribution, PCDDs were dominant in flue gases of CFB and MWI, PCDFs were dominant in EAF. It may be attributed to the different formation mechanisms among wastes incineration, steel-making, and coal-burning processes.

Short-term effect of fine particular matter on daily hospitalizations for ischemic stroke: A time-series study in Yancheng, China

OBJECTIVE

To investigate the associations between short-term exposure to fine particular matter (PM_2.5) and ischemic stroke (IS) in Yancheng, China, from 2017 to 2019.

METHODS

We designed a time-series study based on generalized additive models to explore the association of PM_2.5 and IS admitted in two major hospitals in Yancheng. We built different lag patterns and conducted stratification analyses by age, gender, and season. Moreover, we examined the robustness of the associations adopting two-pollutant models and fitted the concentration-response curves.

RESULT

We observed positive and significant associations at lag 0 day. Every 10 μg/m³ increase in PM_2.5 (lag0) was associated with 1.06% (95% CI: 0.21%-1.91%) increases in hospitalizations for IS. The association remained stable and statistically significant to the adjustment of carbon monoxide and ozone. We observed that the associations were stronger in females and during cold seasons. The overall concentration-response relationship curve was linear positive and increased slowly but rose sharply at higher concentrations in the cold season.

CONCLUSION

Our study added to the evidence that short-term exposure to PM_2.5 may induce IS, and the government should take action to address the air pollution issues and protect susceptible populations.

Differentiating the effects of ambient fine and coarse particles on mortality from cardiopulmonary diseases: A nationwide multicity study

BACKGROUND

Both inhalable particles (PM₁₀) and fine particles (PM_2.5) are regulated in various countries mainly due to their adverse health effects. However, there is increasing evidence that PM_2.5 might be responsible for these effects and coarse particles (PM_c) plays little role in adverse health effects, if so, it might be not necessary to monitor PM₁₀.

METHODS

In this study, we conducted a time-series analysis using a generalized additive model to explore the effects of PM_2.5, PM_c, and PM₁₀ on mortality from ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) in 96 Chinese cities during 2013-2016. The mortality number and attributable fraction were further estimated using the national air quality standard and WHO's guideline as the reference.

RESULTS

We observed significant effects of PM_2.5 on IHD and COPD mortality; each 10 ug/m³ increase in lag₀₁ PM_2.5 was associated with a 0.26% (95% CI: 0.17%, 0.34%) increase in IHD mortality and a 0.19% (95% CI: 0.09%, 0.29%) increase in COPD mortality. We also found significant effects of PM_c and PM₁₀ on mortality from IHD and COPD, but the magnitudes of effects were weaker than those of PM_2.5. The results were robust when adjusting for co-pollutants and altering model parameters. We further estimated that about 1.27% (95% CI: 0.29%, 2.30%) of IHD mortality and 1.25% (95% CI: 0.08%, 2.46%) of COPD mortality could be attributable to PM_2.5 exposure using WHO's guideline (25 ug/m³) as a reference, corresponding to 15,337 (95% CI: 3,375, 27,842) mortalities from IHD and 5,653 (95% CI: 379, 11,152) COPD mortalities in the 96 cities. Across all of China, almost fifty thousand cases of IHD mortality and twenty thousand cases of COPD mortality might be avoidable if the PM_2.5 concentration declined to the WHO guideline.

CONCLUSIONS

Our study indicates that short-term exposure to PM_2.5 could be an important risk factor of mortality from IHD and COPD, and substantial cardiopulmonary mortality could be avoidable by reducing daily PM_2.5 concentrations. It is nonnegligible to consider the role of PM_c in triggering in cardiopulmonary mortality. And it could be necessary to continue monitoring PM₁₀ in the study regions due to the adverse effects of PM_c.

Chemical characterization of fine particles (PM2.5) at a coastal site in the South Western Mediterranean during the ChArMex experiment

As part of the ChArMEx project (Chemistry-Aerosol Mediterranean Experiment, http://charmex.lsce.ipsl.fr), one year of continuous filter sampling was conducted from August 2012 to August 2013 at a rural (coastal) site in Algeria aiming to better document fine aerosol seasonal variability and chemical composition in the Southern part of the Mediterranean. Over 350 filters have been collected, weighted, and analyzed for the main ions and organic and elemental carbon. The obtained mass concentrations varied between 2.5 and 50.6 μg/m³ for PM_2.5. The annual modulations of PM_2.5 showed higher concentrations in the end summer 2012 and the early summer 2013 (28.50 μg/m³ in August 2012, 20.23 μg/m³ in September 2012, 20.19 μg/m³ in July 2013, and 17.88 μg/m³in August 2013). The particulate organic matter (POM) presented the greatest contribution (50%), followed by the secondary inorganic aerosols (SIA, 27%). The average organic carbon OC concentrations ranged from 1.66 to 6.05 μgC/m³. The average elemental carbon EC concentrations ranged from 0.92 to 3.49 μgC/m³ and contributed 7% of the PM_2.5 mass to Bou-Ismail. The average value of the OC /EC ratio was close to 5.1 in Bou-Ismail, and was close to that found in Finokalia 4 (Greece 2004, 2006) but was lower than that of Montseny 11 (Spain 2002-2007) Western Mediterranean Basin (WMB). The concentrations of water-soluble organic carbon WSOC in the PM_2.5 ranging from 0.66 to 3.70 μg/m³ recorded the minimum level in March 2013, and the maximum level in August 2012, with an average of 2.02 μg/m³.

Temperature modulation of the adverse consequences on human mortality due to exposure to fine particulates: A study of multiple cities in China

Exposure to particulate matter of smaller than 2.5 μm in diameter (PM_2.5) is linked to increased human mortality, and could be further complicated by concurrent ambient air temperatures. Published reports indicate that the association between ambient temperatures and mortality due to PM_2.5 exposure is dissimilar across different geographic areas. Thus, it is unclear how ambient temperatures at different geographic locations can together modulate the influence of PM_2.5 on mortality. In this paper, we examined how temperature modulated the association between mortality and PM_2.5 exposure in 15 Chinese cities during 2014-2016. For analysis, First, Poisson generalized additive models under different temperature stratifications (<10th, 10-90th, and >90th temperature percentiles) was used to estimate PM_2.5 associations to mortality, which were specific to different cities. Second, we used a meta-analysis to combine the effects at each temperature stratum and region (southern and northern China). Results revealed that high temperatures (daily mean temperature >90th percentile) robustly amplified observed associations of mortality and PM_2.5 exposure, and the modifications were heterogeneous geographically. In the northern regions, a 10 μg/m³ increment in PM_2.5 was associated with 0.18%, 0.28%, and 1.54% increase in non-accidental mortalities and 0.33%, 0.39%, and 1.32% increase in cardiovascular mortalities at low, moderate, and high temperature levels, respectively. In the southern regions, a 10 μg/m³ increment in PM_2.5 was associated with 0.52%, 0.62%, and 1.90% increase in non-accidental mortalities and 0.55%, 0.98%, and 2.25% increase in cardiovascular mortalities at low, moderate, and high temperature levels, respectively. It is concluded that temperature altered PM_2.5-mortality associations in southern and northern China synergistically, but the effect was more pronounced in the south. Therefore, geography and temperature need to be considered when studying how PM_2.5 affects health.

Diabetes mortality burden attributable to short-term effect of PM10 in China

Ambient air pollution may be associated with diabetes mellitus. However, evidence from developing countries is limited although the concentrations of air pollution are disproportionably higher in these countries. We collected daily data on diabetes mortality, air pollution, and weather conditions from 16 Chinese provincial cities during 2007-2013. A quasi-Poisson regression combined with a distributed lag model was used to quantify the city-specific mortality risk of PM₁₀ (particulate matter with aerodynamic diameter < 10 μm). Then, a random-effect meta-analysis was conducted to pool effect estimates from 16 cities. We also calculated the attributable fraction and attributable number of diabetes mortality due to PM₁₀. Effects of PM₁₀ were found to be acute and limited to 3 days. Harvesting effect of PM₁₀ was found during lag 4-10 days on diabetes mortality. An increase of 0.17% (95%CI: 0.01-0.34), 0.48% (95%CI: 0.22-0.73), and 0.53% (95%CI: 0.27-0.80) in diabetes mortality was associated with per 10 μg/m³ increase in PM₁₀ at lag 0, 0-4 and 0-10 days, respectively. Totally, 5.76% (95%CI: 2.59-8.00%) and 5878 (95%CI: 2639-8163) deaths due to diabetes could be attributable to PM₁₀. If the concentration of PM₁₀ attained the Chinese government and WHO targets, the reduction in number of PM_2.5-attributed diabetes deaths was 2016 and 5528, respectively. Higher effect estimates of PM₁₀ were observed among females and those aged 0-64 years old at lag 0 day, while greater cumulative effects of PM₁₀ were among males, the elderly aged 75 or over, and the illiterate at lag 0-10 days. However, the between-group differences were not statistically significant. It is one of the few studies on examining the attributable burden of diabetes mortality caused by particulate matter. Our findings indicated that effective efforts on controlling air pollution could reduce a prominent number of air pollution-related diabetes deaths.

PM2.5-bound potentially toxic elements (PTEs) fractions, bioavailability and health risks before and after coal limiting

Fractions, bioavailability, health risks of fine particulate maters (PM_2.5)-bound potentially toxic elements (PTEs) (Pb, Cd, Cr, Cu and Zn) were investigated before and after coal limiting in Baoding city. The winter PM_2.5 samples were collected at different functional areas such as residential area (RA), industrial area (IA), suburb (SB), street (ST) and Botanical Garden Park (BG) in 2016 (coal dominated year) and 2017 (gas dominated year). The fractions and bioavailability of PTEs were determined and evaluated based on BCR sequential extraction. Health risks through inhalation exposure were evaluated by US EPA health risk assessment model. The results from different years and functional areas were compared and discussed. The fractions and bioavailability of PM_2.5-bound PTEs varied with functional areas. The percentages of cadmium (Cd) and zinc (Zn) in acid-soluble fraction (F1-Cd and F1-Zn) to the total amount of Cd and Zn were low in BG samples (p < 0.05). Bioavailability of Cd were high in SB samples (p < 0.05). Total contents of PM-bound PTEs in 2017 generally decreased compared with 2016. The differences of fraction and bioavailability between 2016 and 2017 depended on the elements and areas. Higher proportions of copper (Cu) in acid-soluble fraction (F1-Cu) and bioavailability of Cu (p < 0.05) were found in 2017 samples. Significant differences were found just at IA and RA for Pb, Cd and Zn. Our results indicated that the health risks from inhalation exposure for PTEs in PM_2.5 declined about 11%-52% after the coal limiting in this city.

Source Apportionment of Fine Organic and Inorganic Atmospheric Aerosol in an Urban Background Area in Greece

Fine particulate matter (PM) originates from various emission sources and physicochemical processes. Quantification of the sources of PM is an important step during the planning of efficient mitigation strategies and the investigation of the potential risks to human health. Usually, source apportionment studies focus either on the organic or on the inorganic fraction of PM. In this study that took place in Patras, Greece, we address both PM fractions by combining measurements from a range of on- and off-line techniques, including elemental composition, organic and elemental carbon (OC and EC) measurements, and high-resolution Aerosol Mass Spectrometry (AMS) from different techniques. Six fine PM2.5 sources were identified based on the off-line measurements: secondary sulfate (34%), biomass burning (15%), exhaust traffic emissions (13%), nonexhaust traffic emissions (12%), mineral dust (10%), and sea salt (5%). The analysis of the AMS spectra quantified five factors: two oxygenated organic aerosols (OOA) factors (an OOA and a marine-related OOA, 52% of the total organic aerosols (OA)), cooking OA (COA, 11%) and two biomass burning OA (BBOA-I and BBOA-II, 37% in total) factors. The results of the two methods were synthesized, showcasing the complementarity of the two methodologies for fine PM source identification. The synthesis suggests that the contribution of biomass burning is quite robust, but that the exhaust traffic emissions are not due to local sources and may also include secondary OA from other sources.

Short-term associations between size-fractionated particulate air pollution and COPD mortality in Shanghai, China

Particulate air pollution is a continuing challenge in China, and its adverse effects on chronic obstructive pulmonary disease (COPD) have been widely reported. However, epidemiological evidence on the associations between size-fractionated particle number concentrations (PNCs) and COPD mortality is limited. In this study, we utilized a time-series approach to investigate the associations between PNCs of particles at 0.25-10 μm in diameter and COPD mortality in Shanghai, China. Quasi-Poisson regression generalized additive models were applied to evaluate these associations, with adjustment of time trend, day of week, holidays, temperature and relative humidity. Stratification analyses were performed by season and gender. There were a total of 3238 deaths due to COPD during the study period. We found that daily COPD deaths were significantly associated with PNCs of particles <0.5 μm, and the magnitude of associations increased with decreasing particle size. An interquartile range (IQR) increase in PNC_0.25-0.28, PNC_0.28-0.3, PNC_0.3-0.35, PNC_0.35-0.4, PNC_0.4-0.45 and PNC_0.45--0.5 was associated with increments of 7.51% (95%CI: 2.45%, 12.81%), 7.22% (95%CI: 2.16%, 12.53%), 6.95% (95%CI: 1.81%, 12.35%), 6.26% (95%CI: 1.25%, 11.52%), 5.24% (95%CI: 0.56%, 10.13%) and 4.15% (95%CI: 0.14%, 8.32%), respectively. The associations remained robustness after controlling for the mass concentrations of gaseous air pollutants. In stratification analyses, significant associations between PNCs and COPD mortality were observed in the cold seasons, and in males. Our results suggested that particles <0.5 μm in diameter might be most responsible for the adverse effects of particulate air pollution on COPD mortality, and COPD patients are more susceptible to PM air pollution in the cold seasons, especially for males.

Risk Analysis of Air Pollution and Meteorological Factors Affecting the Incidence of Diabetes in the Elderly Population in Northern China

BACKGROUND

Research investigating the effect of air pollution on diabetes incidence is mostly conducted in Europe and the United States and often produces conflicting results. The link between meteorological factors and diabetes incidence remains to be explored. We aimed to explore associations between air pollution and diabetes incidence and to estimate the nonlinear and lag effects of meteorological factors on diabetes incidence.

METHODS

Our study included 19,000 people aged ≥60 years from the Binhai New District without diabetes at baseline. The generalized additive model (GAM) and the distributed lag nonlinear model (DLNM) were used to explore the effect of air pollutants and meteorological factors on the incidence of diabetes. In the model combining the GAM and DLNM, the impact of each factor (delayed by 30 days) was first observed separately to select statistically significant factors, which were then incorporated into the final multivariate model. The association between air pollution and the incidence of diabetes was assessed in subgroups based on age, sex, and body mass index (BMI).

RESULTS

We found that cumulative RRs for diabetes incidence were 1.026 (1.011-1.040), 1.019 (1.012-1.026), and 1.051 (1.019-1.083) per 10 μg/m³ increase in PM_2.5, PM₁₀, and NO₂, respectively, as well as 1.156 (1.058-1.264) per 1 mg/m³ increase in CO in a single-pollutant model. Increased temperature, excessive humidity or dryness, and shortened sunshine duration were positively correlated with the incidence of diabetes in single-factor models. After adjusting for temperature, humidity, and sunshine, the risk of diabetes increased by 9.2% (95% confidence interval (CI):2.1%-16.8%) per 10 μg/m³ increase in PM_2.5. We also found that women, the elderly (≥75 years), and obese subjects were more susceptible to the effect of PM_2.5.

CONCLUSION

Our data suggest that PM_2.5 is positively correlated with the incidence of diabetes in the elderly, and the relationship between various meteorological factors and diabetes in the elderly is nonlinear.

Fraction distribution of arsenic in different-sized atmospheric particulate matters

The sequential extraction method was used to determine the fraction of arsenic (As) in different-sized particulate matters (PMs) (i.e., PM_2.5, PM₁₀, and total suspended particles (TSP)). Samples were collected from Baoding, a typical medium-sized city with the serious haze pollution in China. The bioavailabilities of As in the samples were estimated based on the fraction results. A large percentage of fine particles were detected in TSP, with the average PM_2.5/PM₁₀ and PM₁₀/TSP ratios all above 0.69. The total concentrations of As in PM_2.5, PM₁₀, and TSP samples were in the range of 4.5-296.4, 14.1-708.0, and 32.8-798.0 ng m^-3, respectively. The mass percentages of As in PM_2.5, PM_2.5-10, and PM_10-100 were calculated; the results indicated that As tended to concentrate in fine particles. PM-bound As mainly presented in the nonspecifically sorbed fraction (F1) during all of the sampling periods. The percentages of F1-As and bioavailability of As were higher in PM_2.5, followed by PM₁₀ and TSP. By contrast, the residual fraction (F5-As) contents declined in the order of TSP > PM₁₀ > PM_2.5. Significant differences in the speciation and bioavailability of As in different-sized PMs were found, and the influence of particle size on the speciation and bioavailability of As in PMs was verified. Fine particles adsorbed more As with higher bioavailability, and potentially led to more serious adverse effects on human health than the larger ones.

The effects of ambient particulate matter on human adipose tissue

The effects of particulate matter (PM) air pollution on adipose tissue have mainly been studied in animal models. The aim of this study was to examine the potential associations between PM exposure and 25 cellular markers in human omental (OM) and subcutaneous (SC) adipose tissue. The PM exposure assessments for both PM_2.5 (PM <2.5 μm in diameter) and PM₁₀ (<10 μm) were based upon a novel hybrid satellite-based spatio-temporally resolved model. We calculated the PM exposure above the background threshold for 1 week (acute phase), 3 and 6 months (intermediate phase), and 1 year (chronic phase) prior to tissue harvesting and tested the associations with adipose cell metabolic effects using multiple linear regressions and heat maps strategy. Chemokine levels were found to increase after acute and intermediate exposure duration to PM₁₀. The levels of stress signaling biomarkers in the SC and OM tissues rose after acute exposure to PM₁₀ and PM_2.5. Macrophage and leucocyte counts were associated with severity of PM exposure in all three duration groups. Adipocyte diameter decreased in all exposure periods. Our results provide evidence for significant contribution of air pollutants exposure to adipose tissue inflammation as well as for pathophysiological mechanisms of metabolic dysregulation that may be involved in the observed responses.

Technological improvement in modern health care applications using Internet of Things (IoT) and proposal of novel health care approach

Purpose

With the development of emerging engineering technology and industrialization, there are greater changes in the life style of people in smart urban cities; therefore, there is also more chance of various health problems in urban areas. The life style of persons in metro urban areas with the expansive volume of population is similarly influenced by different application and administration frameworks. These are affecting the human health system up to an extended extent and there are more health-related issues and health hazard concerns that can be identified in urban areas. The purpose of this paper is to present an analytical study on various aspects of the smart health care system in a smart perspective by analyzing them with respect to emerging engineering technologies such as mobile network, cloud computing, Internet of Things (IoT), big data analytics and ubiquitous computing. This paper also carries out a detailed survey of health issues and improved solutions in automated systems using these technologies. Second, the paper also presents a novel health care system using smart and safe ambulances and their appropriate control at traffic points with safety and security features in a smart city, so that the valuable life of patients can be saved in time by immediate treatment in nearest hospital or health care units.

Design/methodology/approach

In this paper, an analytical survey was conducted for improvement in the health care sector using computer technology and IoT-based various modern health care applications. An idea of Smart Health Care Hospital using sensors, mobile agent smart vehicle configuration and safety traffic control for ambulance was proposed.

Findings

A simulation was carried out to see the performance of a safety mechanism in the proposed approach. Comparative analysis was carried out with other approaches to know the execution time, response time and probable delay due to the implementation of this approach.

Originality/value

It is an original research work with motivation inspired from current emergent technology to apply in the health care system.

A Systematic Review and Meta-Analysis on Short-Term Particulate Matter Exposure and Chronic Obstructive Pulmonary Disease Hospitalizations in China

OBJECTIVE

We conducted a meta-analysis of short-term particulate matter (PM) exposure and chronic obstructive pulmonary disease (COPD) hospitalizations in China, including data from two-pollutant model.

METHODS

From PubMed and Web of Science, we selected case-crossover or time-series studies conducted in Mainland China, Hong Kong, Macao, or Taiwan to investigate the association between PM exposure and COPD hospitalizations. The meta-analysis was performed using data from both single-pollutant and two-pollutant models for PM2.5 and PM10.

RESULTS

A total of 16 studies were included in our analysis. Short-term exposure to PM2.5 and PM10 were both significantly associated with COPD hospitalizations. The results remained robust in two-pollutant model, whereas subgroup analyses demonstrated a modest heterogeneity.

CONCLUSIONS

Our review shows a small but obvious exposure-hospitalization effect in China. More studies are needed to generate the needed evidence, and advocacy is needed to stimulate initiation of solutions to the problem.

COPD Patients as Vulnerable Subpopulation for Exposure to Ambient Air Pollution

PURPOSE OF REVIEW

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide with no known cure and an increasing number of triggers that exacerbate symptoms and speed up progression. This review aims to summarize the evidence for COPD patients being more vulnerable to air pollution exposure assessed as acute effects.

RECENT FINDINGS

Several recent systematic reviews show consistently increased risks for COPD mortality and COPD hospital admission, ranging between 2 and 3% with increasing PM_2.5 or PM₁₀. Similar adverse impacts were shown for NO_2. Also_, adverse health effects among COPD patients were also found for other gaseous pollutants such as ozone and SO₂; most of these studies could not be included in the meta-analysis we reviewed. Data from ten panel studies of COPD patients reported a small but statistically significant decline of FEV1 [- 3.38 mL (95% CI - 6.39 to - 0.37)] per increment of 10 μg/m³ PM₁₀, supporting an impact on respiratory health with increasing PM₁₀ exposure. The combined information from systematic reviews and more recent findings lead us to conclude that COPD patients are more vulnerable to ambient air pollution than healthier people.

Association of fine particulate matter on acute exacerbation of chronic obstructive pulmonary disease in Yancheng, China

BACKGROUND

Epidemiological evidence on the association between short-term exposure to fine particulate matter (PM_2.5) air pollution and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is limited in China.

OBJECTIVES

To explore the associations between PM_2.5 and AECOPD in Yancheng, China from 2015 to 2017.

METHODS

In this time-series study, we used a generalized linear model with quasi-Poisson regression to investigate the association between PM_2.5 and AECOPD admitted in two major hospitals in Yancheng. We tested the robustness of the associations using two-pollutant models and examined the potential effect modification by age, gender and season via stratification analyses. Lastly, we fitted the concentration-response curves.

RESULTS

We identified a total of 4761 AECOPD inpatients during the study period. The average daily-mean PM_2.5 concentration was 45.2 μg/m³. Each 10 μg/m³ increase in PM_2.5 concentration on the concurrent day of the onset of AECOPD was associated with a 1.05% (95% confidence interval: 0.14%, 1.96%) increase in AECOPD. The association was robust to the adjustment of ozone, but not to sulfur dioxide, nitrogen dioxide, and carbon monoxide. The association was larger in females, elderly patients, and was restricted within the cold season, but all between-group differences were insignificant. The concentration-response relationship curves were generally linear but flatted at concentrations over 40 μg/m³.

CONCLUSIONS

This study demonstrated a higher risk of AECOPD associated with present-day PM_2.5 exposure in a Chinese city. We further provided important information on lag patterns, susceptible subgroups, sensitive seasons, as well as the characteristics of the concentration-response relationship curves.

Metabolic Syndrome and Air Pollution: A Narrative Review of Their Cardiopulmonary Effects

Particulate matter (PM) exposure and metabolic syndrome (MetSyn) are both significant global health burdens. PM exposure has been implicated in the pathogenesis of MetSyn and cardiopulmonary diseases. Individuals with pre-existing MetSyn may be more susceptible to the detrimental effects of PM exposure. Our aim was to provide a narrative review of MetSyn/PM-induced systemic inflammation in cardiopulmonary disease, with a focus on prior studies of the World Trade Center (WTC)-exposed Fire Department of New York (FDNY). We included studies (1) published within the last 16-years; (2) described the epidemiology of MetSyn, obstructive airway disease (OAD), and vascular disease in PM-exposed individuals; (3) detailed the known mechanisms of PM-induced inflammation, MetSyn and cardiopulmonary disease; and (4) focused on the effects of PM exposure in WTC-exposed FDNY firefighters. Several investigations support that inhalation of PM elicits pulmonary and systemic inflammation resulting in MetSyn and cardiopulmonary disease. Furthermore, individuals with these preexisting conditions are more sensitive to PM exposure-related inflammation, which can exacerbate their conditions and increase their risk for hospitalization and chronic disease. Mechanistic research is required to elucidate biologically plausible therapeutic targets of MetSyn- and PM-induced cardiopulmonary disease.

Short-term effects of desert and non-desert PM10 on mortality in Sicily, Italy

BACKGROUND

Increased PM₁₀ concentrations are commonly observed during Saharan dust advections. Limited epidemiological evidence suggests that PM₁₀ from anthropogenic and desert sources increase mortality. We aimed to evaluate the association between source-specific PM₁₀ (non-desert and desert) and cause-specific mortality in Sicily during 2006-2012 period.

METHODS

Daily PM₁₀ concentrations at 1-km² were estimated in Sicily using satellite-based data, fixed monitors and land use variables. We identified Saharan dust episodes using meteorological models, back-trajectories, aerosol maps, and satellite images. For each dust day, we estimated desert and non-desert PM₁₀ concentrations. We applied a time-series approach on 390 municipalities of Sicily to estimate the association between PM₁₀ (non-desert and desert) and daily cause-specific mortality.

RESULTS

33% of all days were affected by Saharan dust advections. PM₁₀ concentrations were 8 μg/m³ higher during dust days compared to other days. We found positive associations of both non-desert and desert PM₁₀ with cause-specific mortality. We estimated percent increases of risk (IR%) of non-accidental mortality equal to 2.3% (95% Confidence Interval [CI]: 1.4, 3.1) and 3.8% (3.2, 4.4), per 10 μg/m³ increases in non-desert and desert PM₁₀ at lag 0-5, respectively. We also observed significant associations with cardiovascular (2.4% [1.3, 3.4] and 4.5% [3.8, 5.3]) and respiratory mortality (8.1% [6.8, 9.5], and 6.3% [5.4, 7.2]). We estimated higher effects during April-September, with IR% = 4.4% (3.2, 5.7) and 6.3% (5.4, 7.2) for non-desert and desert PM₁₀, respectively.

CONCLUSIONS

Our results confirm previous evidence of harmful effects of desert PM₁₀ on non-accidental and cardio-respiratory mortality, especially during the warm season.

Acute effect of fine and coarse particular matter on cardiovascular visits in Ningbo, China

Although a growing number of epidemiological studies have been conducted on size-specific health effects of particulate matter in China, results remain inconsistent. In this study, we investigated acute effect of fine and coarse particular matter on cardiovascular hospital visits in Ningbo, China. We used generalized additive models to examine short-term effects of PM_2.5 and PM_10-2.5 on cardiovascular hospital visits by adjustment for temporal, seasonal, and meteorological effects. Subgroup analyses were conducted by age, sex, and season. We also examined the stability of their effects in multi-pollutant models. We found that PM_2.5 were associated with cardiovascular hospital visits (RR = 1.006; 95% CI 1.000, 1.011) and results remained similar after adjustment for PM_10-2.5 (RR = 1.005; 95% CI 0.998, 1.013). There was a borderline association between PM_10-2.5 and cardiovascular hospital visits (RR = 1.007; 95% CI 0.997, 1.016), which disappeared after controlling for PM_2.5 (RR = 1.000; 95% CI 0.988, 1.013). The associations appeared to be stronger in the cold season and among the elderly (≥ 75 years). The findings of this study suggested significant adverse effects of PM_2.5, but no independent effects of PM_10-2.5 on cardiovascular hospital visits. Additional studies are needed to confirm these findings.

Exploring the association between polycyclic aromatic hydrocarbons and diabetes among adults in the United States

OBJECTIVE

To explore the association between polycyclic aromatic hydrocarbons (PAHs) and diabetes and to determine whether effects are heterogeneous when examined by body mass index (BMI).

METHODS

Cross-sectional data from 8664 participants were analyzed from the National Health and Nutrition Examination Survey for years 2005-2014. Multivariable logistic regression was used to explore the association between urinary biomarkers of PAHs and diabetes. All models were adjusted for age, sex, race, poverty-income ratio, and serum cotinine.

RESULTS

When compared with the lowest quintiles of exposure, the highest quintiles of exposure to 2-hydroxynaphthalene, 2-hydroxyfluorene, 9-hydroxyfluorene, 2-hydroxyphenanthrene, and a summed variable of all low molecular weight PAHs (aOR = 1.73; 95% CI: 1.17-2.55) showed a positive association with diabetes. Stratified analyses by BMI indicated that the positive association between PAHs and diabetes was found among both normal weight and obese participants.

CONCLUSIONS

High levels of exposure to PAHs are positively associated with diabetes in the U.S. general population and these effects are modified by BMI. These findings suggest the importance of strong environmental regulation of PAHs to protect population health.

Ambient coarse particulate pollution and mortality in three Chinese cities: Association and attributable mortality burden

The short-term mortality effects of ambient fine particulate matter air pollution have been widely investigated in China. However, the associations between day-to-day variation in ambient coarse particles pollution (PM_c) and mortality, as well as the corresponding mortality burden, remain understudied. We estimated the short-term PM_c-mortality association in three Chinese cities of the Pearl River Delta (PRD) region during the period of 2013-16. The city-specific association was first estimated using generalized additive models and then combined to obtain the overall effect estimates. We further estimated PM_c related attributable fraction and attributable mortality. Our study found a significant association between PM_c and mortality. Each 10μg/m³ increase of a current day's PM_c was associated with a 1.37% (95% CI: 0.55%, 2.22%) increase in total mortality, a 1.63% increase (95% CI: 0.31%, 2.98%) in cardiovascular mortality, and a 0.97% increase (95% CI: -0.17%, 2.13%) in respiratory mortality in the three cities. We estimated that 0.37% (95% CI: 0.14%, 0.61%) and 2.72% (95% CI: 1.03%, 4.50%) of total mortalities were attributable to PM_c by using China's standards and WHO's air quality guidelines as references-corresponding to 1394 (95% CI: 528, 2291) and 10,305 (95% CI: 3884, 17,000) attributable premature mortalities in the three cities, respectively. This study suggests that ambient coarse particulate pollution might be one important risk factor of total, cardiovascular, and respiratory mortality, as well as account for substantial mortality burdens in the three Chinese cities of the PRD.

An approach estimating the short-term effect of NO2 on daily mortality in Spanish cities

BACKGROUND

Road traffic is the most significant source of urban air pollution. PM_2.5 is the air pollutant whose health effects have been most closely studied, and is the variable most commonly used as a proxy indicator of exposure to air pollution, whereas evidence on NO₂ concentrations per se is still under study. In the case of Spain, there are no specific updated studies which calculate short-term NO₂-related mortality.

OBJECTIVE

To quantify the relative risks (RRs) and attributable risks (ARs) of daily mortality associated with NO₂ concentrations recorded in Spain across the study period, 2000-2009; and to calculate the number of NO₂-related deaths.

MATERIAL AND METHODS

We calculated daily mortality due to natural causes (ICD-10: A00 R99), circulatory causes (ICD-10: I00 I99) and respiratory causes (ICD-10: J00 J99) for each province across the period 2000-2009, using data supplied by the National Statistics Institute. Mean daily NO₂ concentrations in μg/m³ for each provincial capital were furnished by the Ministry of Agriculture & Environment, along with the equivalent figures for the control pollutants (PM₁₀). To estimate RRs and ARs, we used generalised linear models with a Poisson link, controlling for maximum and minimum daily temperature, trend of the series, seasonalities, and the autoregressive nature of the series. A meta-analysis with random effects was used to estimate RRs and ARs nationwide.

RESULTS

The overall RRs obtained for Spain, corresponding to increases of 10 μg/m³ in NO₂ concentrations were 1.012 (95% CI: 1.010 1.014) for natural-cause mortality, 1.028 (95% CI: 1.019 1.037) for respiratory-cause mortality, and 1.016 (95% CI: 1.012 1.021) for circulatory-cause mortality. This amounted to an annual overall 6085 deaths (95% CI: 3288 9427) due to natural causes, 1031 (95% CI: 466 1585) due to respiratory causes, and 1978 (95% CI: 828 3197) due to circulatory causes.

CONCLUSION

By virtue of the number of cities involved and the nature of the analysis performed, with quantification of the RRs and ARs of the short-term impact of NO₂ on daily mortality in Spain, this study provides an updated estimate of the effect had by this type of pollutant on causes of mortality, and constitutes an important basis for reinforcing public health measures at a national level.

Association between short-term exposure to ambient air pollution and daily mortality: a time-series study in Eastern China

Few studies were conducted to evaluate health effects of acute exposure to PM_2.5 and daily mortality in Asian countries due to lack of large-scale PM_2.5 monitoring data. We conducted a time-series study to examine the associations of short-term exposure to four common air pollutants (PM_2.5, PM₁₀, NO₂, and SO₂) and daily mortality in Ningbo, Zhejiang, China. We used generalized addictive model (GAM) to estimate relative risks (RRs) and 95% confidence intervals (CIs) for the association of these four air pollutants with daily mortality. The study included 9365 people in the 2-year study period from 2014 to 2015. SO₂ were significantly associated with risk of NAD, RD, and CD mortality with RRs of 1.034 (95% CI 1.004, 1.064), 1.067 (95% CI 1.010, 1.127), and 1.049 (95% CI 1.001, 1.098), respectively.PM_2.5 and PM₁₀ were significantly associated with risk of death from NAD mortality in warm season. Similar associations were observed for PM₁₀ (RR = 1.056, 95% CI 1.004, 1.111) and risk of CD mortality. The study provides further evidence that short-term exposure to PM_2.5, PM₁₀, NO₂, and SO₂ are associated with increased risk of daily mortality.

PM2.5 Exposure Elicits Oxidative Stress Responses and Mitochondrial Apoptosis Pathway Activation in HaCaT Keratinocytes

Background:

PM_2.5 (aerodynamic diameter ≤ 2.5 μm) is a dominant and ubiquitous air pollutant that has become a global concern as PM_2.5 exposure has been linked to many adverse health effects including cardiovascular and pulmonary diseases. Emerging evidence supports a correlation between increased air PM_2.5 levels and skin disorders although reports on the underlying pathophysiological mechanisms are limited. Oxidative stress is the most common mechanism of PM_2.5-induced adverse health effects. This study aimed to investigate PM_2.5-induced oxidative damage and apoptosis in immortalized human keratinocyte (HaCaT) cells.

Methods:

HaCaT cells were exposed to 0, 25, 50, 100, or 200 μg/ml PM_2.5 for 24 h. Reactive oxygen species (ROS) generation, lipid peroxidation products, antioxidant activity, DNA damage, apoptotic protein expression, and cell apoptosis were measured.

Results:

PM_2.5 exposure (0-200 μg/ml) for 24 h resulted in increased ROS levels (arbitrary unit: 201.00 ± 19.28, 264.50 ± 17.91, 305.05 ± 19.57, 427.95 ± 18.32, and 436.70 ± 17.77) and malondialdehyde production (0.54 ± 0.05 nmol/mg prot, 0.61 ± 0.06 nmol/mg prot, 0.68 ± 0.05 nmol/mg prot, 0.70 ± 0.05 nmol/mg prot, and 0.76 ± 0.05 nmol/mg prot), diminished superoxide dismutase activity (6.47 ± 0.28 NU/mg prot, 5.97 ± 0.30 NU/mg prot, 5.15 ± 0.42 NU/mg prot, 4.08 ± 0.20 NU/mg prot, and 3.76 ± 0.37 NU/mg prot), and increased DNA damage and apoptosis in a dose-dependent manner in HaCaT cells. Moreover, cytochrome-c, caspase-3, and caspase-9 expression also increased proportionately with PM_2.5 dosing.

Conclusion:

PM_2.5 might elicit oxidative stress and mitochondria-dependent apoptosis that likely manifests as skin irritation and damage.

Ovarian Damages Produced by Aerosolized Fine Particulate Matter (PM2.5) Pollution in Mice: Possible Protective Medications and Mechanisms

Background:

Ambient aerosol fine particulate matter (PM_2.5) is associated with male reproductive toxicity in experiments and may have adverse effects in the female. However, studies evaluating the protective effects and precise mechanisms of aspirin, Vitamin C, Vitamin E, or ozone against toxic effects of PM_2.5 are sparse. This study was conducted to investigate the possible protective effects and mechanisms of aspirin, Vitamin C, Vitamin E, or ozone on fertility in female mice treated with PM_2.5.

Methods:

Eighty-four ICR mice were divided into six groups: control group, PM_2.5 group, PM_2.5 + aspirin group, PM_2.5 + Vitamin C group, PM_2.5 + Vitamin E group, and PM_2.5 + ozone group. PM_2.5 was given by intratracheal instillation every 2 days for 3 weeks. Aspirin, Vitamin C, and Vitamin E were given once a day by oral gavage for 3 weeks, and ozone was administered by intraperitoneal injection once a day for 3 weeks. The levels of anti-Müllerian hormone (AMH), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and 8-hydroxy-2’-deoxyguanosine (8-OHdG) were measured using enzyme-linked immunosorbent assay. Western blotting analysis was used to analyze the expressions of Bcl-2, Bax, and caspase-3 in ovaries. Changes in histological structure were examined by light microscope and electron microscopy was used to detect ultramicrostructure.

Results:

The results demonstrated that PM_2.5 decreased AMH levels (P < 0.001); however, aspirin (P < 0.001), Vitamin C (P < 0.001), Vitamin E (P = 0.001), and ozone (P = 0.002) alleviated the decrease. Changes of IL-6, TNF-α, 8-OHdG, Bax/Bcl-2, and caspase-3 in PM_2.5 group were increased compared to control group (P < 0.001), while in PM_2.5 + aspirin, PM_2.5 + Vitamin C, PM_2.5 + Vitamin E, and PM_2.5 + ozone groups, they were statistically decreased compared to PM_2.5 group (P < 0.001 or P < 0.05).

Conclusions:

PM_2.5 cause the damage of ovaries, and aspirin, Vitamin C, Vitamin E, and ozone antagonizes the damage. The protective mechanism is probably due to its ability to blunt the inflammatory and oxidative stress caused by PM_2.5, which subsequently suppressing the expression of apoptotic regulatory protein and reducing the incidence of ovary apoptosis.

Daily exceedance concentration hours: A novel indicator to measure acute cardiovascular effects of PM2.5 in six Chinese subtropical cities

BACKGROUND

Daily mean concentration cannot fully address the hourly variations of air pollution within one day. As such, we proposed a new indicator, daily exceedance concentration hours (DECH), to explore the acute cardiovascular effects of ambient PM_2.5 (particles with aerodynamic diameters less than 2.5μm). The DECH in PM_2.5 was defined as daily total concentration-hours >25μg/m³.

METHODS

A generalized additive model with a quasi-Poisson link was applied to estimate the associations between day-to-day variation in PM_2.5 DECH and day-to-day variation in cardiovascular mortality in six subtropical cities in Guangdong Province, China.

RESULTS

The analysis revealed significant associations between PM_2.5 DECHs and cardiovascular mortality. A 500μg/m³∗h increase in PM_2.5 DECHs at lag₀₃ was associated with an increase of 4.55% (95% confidence interval (CI): 3.59%, 5.52%) in cardiovascular mortality, 4.45% (95% CI: 2.81%, 6.12%) in ischemic cardiovascular mortality, 5.02% (95% CI: 3.41%, 6.65%) in cerebrovascular mortality, and 3.00% (95% CI: 1.13%, 4.90%) in acute myocardial infarction mortality. We further observed a greater mortality burden using PM_2.5 DECHs than daily mean PM_2.5 (6478 (95% CI: 5071, 7917) VS 5136 (95% CI: 3990, 6305)).

CONCLUSION

This study reveals that PM_2.5 DECH is one important exposure indicator of ambient PM_2.5 to measure its cardiovascular mortality effects in Pearl River Delta region; and that using daily mean concentration could under-estimate the mortality burden compared with this new indicator.

Fine particulate air pollution and hospital visits for asthma in Beijing, China

Data on fine particulate matter (PM_2.5) in China were first announced in 2013. The primary objective of this study was to evaluate the acute effects of PM_2.5 on asthma morbidity in Beijing, China. A total of 978,658 asthma hospital visits consisting of 928,607 outpatient visits, 40,063 emergency room visits and 9988 hospital admissions from January 1, 2010, to June 30, 2012, were identified from the Beijing Medical Claim Data for Employees. A generalized additive Poisson model was applied to explore the association between PM_2.5 and health service use. The mean daily PM_2.5 concentration was 99.5 μg/m³ with a range from 7.2 μg/m³ to 492.8 μg/m³. Ambient PM_2.5 concentration was significantly associated with increased use of asthma-related health services. Every 10 μg/m³ increase in PM_2.5 concentration on the same day was significantly associated with a 0.67% (95% CI, 0.53%-0.81%), 0.65% (95% CI, 0.51%-0.80%), and 0.49% (95% CI, 0.35%-0.64%) increase in total hospital visits, outpatient visits and emergency room visits, respectively. The exposure-response association between PM_2.5 concentration and hospital visits for asthma exacerbations was approximately linear. In conclusion, this study found that short-term elevations in PM_2.5 concentration may increase the risk of asthma exacerbations. Our findings contribute to the limited scientific literature concerning the acute effects of PM_2.5 on asthma morbidity outcomes in developing countries.

Fractionation of trace elements and human health risk of submicron particulate matter (PM1) collected in the surroundings of coking plants

Samples of PM1 were collected in the surroundings of coking plants located in southern Poland. Chemical fractionation provided information on the contents of trace elements As, Cd, Co, Cr, Hg, Mn, Ni, Pb, Sb and Se in all mobile (F1-F3) and not mobile (F4) fractions of PM1 in the vicinity of large sources of emissions related to energochemical processing of coal during the summer. The determined enrichment factors indicate the influence of anthropogenic sources on the concentration of the examined elements contained in PM1 in the areas subjected to investigation. The analysis of health risk for the assumed scenario of inhabitant exposure to the toxic effect of elements, based on the values of the hazard index, revealed that the absorption of the examined elements contained in the most mobile fractions of particulate matter via inhalation by children and adults can be considered potentially harmless to the health of people inhabiting the surroundings of coking plants during the summer (HI < 1). It has been estimated that due to the inhalation exposure to carcinogenic elements, i.e., As, Cd, Co, Cr, Ni and Pb, contained in the most mobile fractions (F1 + F2) of PM1, approximately four adults and one child out of one million people living in the vicinity of the coking plants may develop cancer.

Evaluation of short-term mortality attributable to particulate matter pollution in Spain

According to the WHO, 3 million deaths are attributable to air pollution due to particulate matter (PM) world-wide. However, there are no specific updated studies which calculate short-term PM-related cause specific mortality in Spain. The objective is to quantify the relative risks (RRs) and attributable risks (ARs) of daily mortality associated with PM₁₀ concentrations, registered in Spanish provinces and to calculate the number of PM-related deaths. We calculated daily mortality due to natural (ICD-10: A00 R99), circulatory (ICD-10: I00 I99) and respiratory causes (ICD-10: J00 J99) for each province across the period 2000-2009. Mean daily concentrations of PM₁₀, NO₂ and O₃ was used. For the estimate of RRs and ARs, we used generalised linear models with a Poisson link. A meta-analysis was used to estimate RRs and ARs in the provinces with statically significant results. The overall RRs obtained for these provinces, corresponding to increases of 10 μ g/m³ in PM₁₀ concentrations were 1.009 (95% CI: 1.006 1011) for natural, 1.026 (95% CI: 1.019 1033) for respiratory, and 1.009 (95% CI: 1.006 1012) for circulatory-cause mortality. This amounted to an annual overall total of 2683 deaths (95% CI: 852 4354) due to natural, 651 (95% CI: 359 1026) due to respiratory, and 556 (95% CI: 116 1012) due to circulatory causes, with 90% of this mortality lying below the WHO guideline values. This study provides an updated estimate of the effect had by this type of pollutant on causes of mortality, and constitutes an important basis for reinforcing public health measures.

Acute exposure to fine particulate matter and cardiovascular hospital emergency room visits in Beijing, China

Fine particulate matter (PM_2.5) air pollution outbreaks have recently occurred frequently in China. However, evidence of the associations between short-term exposure to PM_2.5 and cardiovascular morbidity is still limited in China. This study aimed to evaluate the associations between PM_2.5 and hospital emergency room visits (ERVs) for cardiovascular diseases in urban areas in Beijing. Daily counts of cardiovascular ERVs were collected from ten large general hospitals from Jan 1 to Dec 31, 2013. Air pollution data were obtained from the Beijing Environmental Protection Bureau including 17 monitoring stations. A generalized additive Poisson model was used to examine the associations between PM_2.5 and cardiovascular ERVs after controlling for seasonality, day of the week, public holidays, influenza outbreaks, and weather conditions. In total, there were 56,221 cardiovascular ERVs during the study period. The daily mean PM_2.5 concentration was 102.1 μg/m³, ranging from 6.7 μg/m³ to 508.5 μg/m³. Per 10 μg/m³ increase in PM_2.5 was associated with a 0.14% (95% confidence interval [CI]: 0.01%-0.27%) increase in cardiovascular ERVs at lag₃. Cumulative delayed estimates were greatest at lag_0-5 (0.30%, 95% CI: 0.09%-0.52%). The estimates of percentage change in daily ERVs per 10 μg/m³ increase in PM_2.5 were 0.56% (95%CI: 0.16%-0.95%) for ischemic heart disease (IHD) at lag_0-1, 0.81% (95%CI: 0.05%-1.57%) for heart rhythm disturbances (HRD) at lag_0-1 and 1.21% (95%CI: 0.27%-2.15%) for heart failure (HF) at lag₀, respectively. The effects of PM_2.5 on IHD ERVs during high temperature days (>11.01 °C) were significantly higher than that on low temperature days (≤11.01 °C) at lag₀, lag_0-1, lag_0-3 and lag_0-5 (P < 0.05). The study suggests that PM_2.5 has acute impacts on cardiovascular ERVs in Beijing, especially on IHD, HRD and HF. The effects of PM_2.5 on IHD ERVs vary by temperature.

PM2.5 induces embryonic growth retardation: Potential involvement of ROS-MAPKs-apoptosis and G0/G1 arrest pathways

Airborne fine particulate matter (PM_2.5 ) is an "invisible killer" to human health. There is increasing evidence revealing the adverse effects of PM_2.5 on the early embryonic development and pregnancy outcome, but the molecular mechanism underlying PM_2.5 -induced embryotoxicity is largely unknown. Previous studies have documented that exposure to PM triggers ROS generation, leads to subsequent activation of MAPKs signaling, and results in corresponding cell biological changes including enhanced apoptosis and altered cell cycle in the cardiopulmonary system. Here, we investigated whether ROS-MAPKs-apoptosis/cell cycle arrest pathways play an important role in PM_2.5 -induced embryotoxicity using the rat whole embryo culture system. The results showed that PM_2.5 treatment led to embryonic growth retardation at concentrations of 50 μg/ml and above, as evidenced by the reduced yolk sac diameter, crown-rump length, head length and somite number. PM_2.5 -induced embryonic growth retardation was accompanied by cell apoptosis and G0/G1 phase arrest. Furthermore, ROS generation and subsequent activation of JNK and ERK might be involved in PM_2.5 -induced apoptosis and G0/G1 phase arrest by downregulating Bcl-2/Bax protein ratio and upregulating p15^INK4B , p16^INK4A , and p21^WAF1/CIP1 transcription level. In conclusion, our results indicate that ROS-JNK/ERK-apoptosis and G0/G1 arrest pathways are involved in PM_2.5 -induced embryotoxicity, which not only provides insights into the molecular mechanism of PM_2.5 -induced embryotoxicity, but also may help to identify specific interventions to improve adverse pregnancy outcomes of PM_2.5 . © 2015 Wiley Periodicals, Inc. Environ Toxicol 31: 2028-2044, 2016.

Chemical components of respirable particulate matter associated with emergency hospital admissions for type 2 diabetes mellitus in Hong Kong

BACKGROUND

Epidemiological studies have shown that short-term exposure to particulate matter (PM) mass is associated with diabetes morbidity and mortality, although inconsistencies still exist. Variation of chemical components in PM may have contributed to these inconsistencies. We hypothesize that certain components of respirable particulate matter (PM₁₀), not simply PM₁₀ mass, can exacerbate symptoms or cause acute complications for type 2 diabetes mellitus (T2DM).

METHODS

We used a Poisson time-series model to examine the association between 17 chemical components of PM₁₀ and daily emergency hospital admissions for T2DM among residents aged 65years or above from January 1998 to December 2007 in Hong Kong. We estimated excess risk (ER%) for T2DM hospitalizations per interquartile range (IQR) increment in chemical component concentrations of days at lag₀ through lag₃, and the moving average of the same-day and previous-day (lag_0-1) in single-pollutant models. To further evaluate the independent effects of chemical components on T2DM, we controlled for PM₁₀ mass, major PM₁₀ chemical components, and gaseous pollutants in two-pollutant models.

RESULTS

In the single-pollutant models, PM₁₀ components associated with T2DM admissions include: elemental carbon, organic carbon, nitrate, and nickel. The ER% estimates per IQR increment at lag_0-1 for these four components were 3.79% (1.63, 5.95), 3.74% (0.83, 6.64), 4.58% (2.17, 6.99), and 1.91% (0.43, 3.38), respectively. Risk estimates for nitrate and elemental carbon were robust to adjustment for co-pollutant concentrations.

CONCLUSIONS

Short-term exposure to some PM₁₀ chemical components such as nitrate and elemental carbon increases the risk of acute complications or exacerbation of symptoms for the T2DM patients. These findings may have potential biological and policy implications.

Using spatio-temporal modeling for exposure assessment in an investigation of fine particulate air pollution and cardiovascular mortality

BACKGROUND

U.S. urban air quality has improved dramatically over the past decades. We evaluated acute effects of fine particulate matter (PM_2.5) on cardiovascular (CVD) mortality among residents of Allegheny County in SW Pennsylvania (1999-2011) using spatio-temporal modeling of air pollutants (AP) to reduce misclassification error in exposure assessment.

METHODS

Spatio-temporal kriging of daily PM_2.5 and ozone (O₃) was used to produce daily exposure estimates at the residence ZIP code. Time-stratified case-crossover analysis was conducted to examine short-term effects of PM_2.5 on CVD mortality, adjusting for O₃ and apparent mean temperature. We studied both single and distributed lags for days 0-5. All CVD mortality and subcategories of ischemic heart disease (IHD), acute myocardial infarction, cerebrovascular disease, peripheral vascular disease (PVD), heart failure and cardiac arrhythmia were examined.

RESULTS

A total of 62,135 deaths were identified. We found significant associations of PM_2.5 with IHD and PVD mortality at lag day 5: (2.1% (95% CI, 0.2-4.1%) and (7.6%, 95% CI, 0.05-15.7%) per 10µg/m³ increase of PM_2.5 in single lag models and for IHD in distributed lag models. There were no statistically significant associations with PM_2.5 for any of the other outcomes.

CONCLUSIONS

The application of finer scale geographically resolved AP exposures made it possible to study acute effects of PM_2.5 on CVD mortality in a large metropolitan area. Our study results demonstrated the continued presence of a dose response relationship of increased risk of CVD mortality within this lower range of PM_2.5 exposure.

Outdoor Air Pollution and COPD-Related Emergency Department Visits, Hospital Admissions, and Mortality: A Meta-Analysis

A systematic literature review was performed to identify all peer-reviewed literature quantifying the association between short-term exposures of particulate matter <2.5 microns (PM_2.5), nitrogen dioxide (NO₂), and sulfur dioxide (SO₂) and COPD-related emergency department (ED) visits, hospital admissions (HA), and mortality. These results were then pooled for each pollutant through meta-analyses with a random effects model. Subgroup meta-analyses were explored to study the effects of selected lag/averaging times and health outcomes. A total of 37 studies satisfied our inclusion criteria, contributing to a total of approximately 1,115,000 COPD-related acute events (950,000 HAs, 80,000 EDs, and 130,000 deaths) to our meta-estimates. An increase in PM_2.5 of 10 ug/m³ was associated with a 2.5% (95% CI: 1.6-3.4%) increased risk of COPD-related ED and HA, an increase of 10 ug/m³ in NO₂ was associated with a 4.2% (2.5-6.0%) increase, and an increase of 10 ug/m³ in SO₂ was associated with a 2.1% (0.7-3.5%) increase. The strength of these pooled effect estimates, however, varied depending on the selected lag/averaging time between exposure and outcome. Similar pooled effects were estimated for each pollutant and COPD-related mortality. These results suggest an ongoing threat to the health of COPD patients from both outdoor particulates and gaseous pollutants. Ambient outdoor concentrations of PM_2.5, NO₂, and SO₂ were significantly and positively associated with both COPD-related morbidity and mortality.

Impact of air quality guidelines on COPD sufferers

Background

COPD is one of the leading causes of morbidity and mortality in both high- and low-income countries and a major public health burden worldwide. While cigarette smoking remains the main cause of COPD, outdoor and indoor air pollution are important risk factors to its etiology. Although studies over the last 30 years helped reduce the values, it is not very clear if the current air quality guidelines are adequately protective for COPD sufferers.

Objective

This systematic review was to summarize the up-to-date literature on the impact of air pollution on the COPD sufferers.

Methods

PubMed and Google Scholar were utilized to search for articles related to our study’s focus. Search terms included “COPD exacerbation”, “air pollution”, “air quality guidelines”, “air quality standards”, “COPD morbidity and mortality”, “chronic bronchitis”, and “air pollution control” separately and in combination. We focused on articles from 1990 to 2015. We also used articles prior to 1990 if they contained relevant information. We focused on articles written in English or with an English abstract. We also used the articles in the reference lists of the identified articles.

Results

Both short-term and long-term exposures to outdoor air pollution around the world are associated with the mortality and morbidity of COPD sufferers even at levels below the current air quality guidelines. Biomass cooking in low-income countries was clearly associated with COPD morbidity in adult nonsmoking females.

Conclusion

There is a need to continue to improve the air quality guidelines. A range of intervention measures could be selected at different levels based on countries’ socioeconomic conditions to reduce the air pollution exposure and COPD burden.

Fine Particulate Air Pollution and Hospital Emergency Room Visits for Respiratory Disease in Urban Areas in Beijing, China, in 2013

Background

Heavy fine particulate matter (PM_2.5) air pollution occurs frequently in China. However, epidemiological research on the association between short-term exposure to PM_2.5 pollution and respiratory disease morbidity is still limited. This study aimed to explore the association between PM_2.5 pollution and hospital emergency room visits (ERV) for total and cause-specific respiratory diseases in urban areas in Beijing.

Methods

Daily counts of respiratory ERV from Jan 1 to Dec 31, 2013, were obtained from ten general hospitals located in urban areas in Beijing. Concurrently, data on PM_2.5 were collected from the Beijing Environmental Protection Bureau, including 17 ambient air quality monitoring stations. A generalized-additive model was used to explore the respiratory effects of PM_2.5, after controlling for confounding variables. Subgroup analyses were also conducted by age and gender.

Results

A total of 92,464 respiratory emergency visits were recorded during the study period. The mean daily PM_2.5 concentration was 102.1±73.6 μg/m³. Every 10 μg/m³ increase in PM_2.5 concentration at lag₀ was associated with an increase in ERV, as follows: 0.23% for total respiratory disease (95% confidence interval [CI]: 0.11%-0.34%), 0.19% for upper respiratory tract infection (URTI) (95%CI: 0.04%-0.35%), 0.34% for lower respiratory tract infection (LRTI) (95%CI: 0.14%-0.53%) and 1.46% for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (95%CI: 0.13%-2.79%). The strongest association was identified between AECOPD and PM_2.5 concentration at lag_0-3 (3.15%, 95%CI: 1.39%-4.91%). The estimated effects were robust after adjusting for SO₂, O₃, CO and NO₂. Females and people 60 years of age and older demonstrated a higher risk of respiratory disease after PM_2.5 exposure.

Conclusion

PM_2.5 was significantly associated with respiratory ERV, particularly for URTI, LRTI and AECOPD in Beijing. The susceptibility to PM_2.5 pollution varied by gender and age.

Desert Dust Outbreaks in Southern Europe: Contribution to Daily PM₁₀ Concentrations and Short-Term Associations with Mortality and Hospital Admissions

BACKGROUND

Evidence on the association between short-term exposure to desert dust and health outcomes is controversial.

OBJECTIVES

We aimed to estimate the short-term effects of particulate matter ≤ 10 μm (PM10) on mortality and hospital admissions in 13 Southern European cities, distinguishing between PM10 originating from the desert and from other sources.

METHODS

We identified desert dust advection days in multiple Mediterranean areas for 2001-2010 by combining modeling tools, back-trajectories, and satellite data. For each advection day, we estimated PM10 concentrations originating from desert, and computed PM10 from other sources by difference. We fitted city-specific Poisson regression models to estimate the association between PM from different sources (desert and non-desert) and daily mortality and emergency hospitalizations. Finally, we pooled city-specific results in a random-effects meta-analysis.

RESULTS

On average, 15% of days were affected by desert dust at ground level (desert PM10 > 0 μg/m3). Most episodes occurred in spring-summer, with increasing gradient of both frequency and intensity north-south and west-east of the Mediterranean basin. We found significant associations of both PM10 concentrations with mortality. Increases of 10 μg/m3 in non-desert and desert PM10 (lag 0-1 days) were associated with increases in natural mortality of 0.55% (95% CI: 0.24, 0.87%) and 0.65% (95% CI: 0.24, 1.06%), respectively. Similar associations were estimated for cardio-respiratory mortality and hospital admissions.

CONCLUSIONS

PM10 originating from the desert was positively associated with mortality and hospitalizations in Southern Europe. Policy measures should aim at reducing population exposure to anthropogenic airborne particles even in areas with large contribution from desert dust advections.

CITATION

Stafoggia M, Zauli-Sajani S, Pey J, Samoli E, Alessandrini E, Basagaña X, Cernigliaro A, Chiusolo M, Demaria M, Díaz J, Faustini A, Katsouyanni K, Kelessis AG, Linares C, Marchesi S, Medina S, Pandolfi P, Pérez N, Querol X, Randi G, Ranzi A, Tobias A, Forastiere F, MED-PARTICLES Study Group. 2016. Desert dust outbreaks in Southern Europe: contribution to daily PM10 concentrations and short-term associations with mortality and hospital admissions. Environ Health Perspect 124:413-419; http://dx.doi.org/10.1289/ehp.1409164.