Acute effects of air pollution on mortality: A 17-year analysis in Kuwait

The challenge of identifying dust events in a highly polluted Eastern Mediterranean region

Dust pollution largely impacts our environment, health and well-being. However, there is no agreement on how dust-contaminated days are identified to study exposures, as methods differ across disciplines. Different quantitative thresholds, which rely on ground measurements, are generally used to define these events. In this study, we used ground-based lidar measurements to detect dust layers. The dataset was then compared to methods that are widely used to define the presence of dust on the ground. Our results show that dust layers extend to a height of up to 10 km and a depth of up to 6.3 km. We show that at least 50 % of days that include dust components according to the lidar were not included by any of the methods that we investigated. As a result, these days are not considered in many health-related studies and climate models. Many dust events exhibit a high anthropogenic component and can be misinterpreted: (Ångström exponent>1.2), high-altitude (on average above 1.7 km) and relatively shallow (average depth 1.4 km) dust layers, and low PM10 on the ground. Mixed pollution (0.8 < Ångström exponent < 1.2) accounts for 45 % of these events. The most accurate dust-detection method considered the aerosol optical depth and Ångström exponent parameters, and provided 60 % of the dust days as determined by lidar. It does not seem to be possible to differentiate between anthropogenic and dust events because most measurements contained dust, resulting in further biased estimations. Our results indicate that there is a need to change our perception of what constitutes a dust day, when studying the impact of dust exposure. We suggest that in arid and semiarid, and in particular Eastern Mediterranean climates, where dust is a frequent and strong meteorological component, a greater number of days need to be included in the analyses or critically evaluated.

Airborne particle radioactivity during desert dust days in Cyprus

Mediterranean countries are often affected by desert dust storms, which have significant effects on the environment and public health. We compared airborne particle radioactivity levels during desert dust and non-dust days in Cyprus. Gross α- and β-radioactivity from Total Suspended Particle (TSP) samples, collected at two urban routine monitoring stations in Limassol and Nicosia, were available for the period 2017-2020 and 2008-2020, respectively. Radionuclides 137Cs and 40K, from TSP samples, were also available from a semi-industrial monitoring station in Nicosia during 2008-2020. Information on desert dust presence, dust origin, particulate matter (PM) levels, and solar activity (KP index and solar sunspot numbers - SSN) were also obtained. We used linear regression models adjusting for seasonality and long-term trends, and solar activity to assess the effect of dust storms on TSP gross α- and β-, and 137Cs and 40K radioactivity levels. Gross α- and β-radioactivity, and 137Cs and 40K radioactivity levels were significantly higher on days with desert dust compared to days characterized with no influence of desert dust. Levels of gross α- and β-radioactivity during dust days were higher when dust originated from the Middle East deserts than from the Sahara Desert. The same trend was observed for the ratios 137Cs to 40K and 137Cs to PM10. Conversely, ratios of TSP gross α- and β-radioactivity to PM10 were significantly lower during desert dust days in comparison to days without dust influence. This study suggests that desert dust increase both TSP gross α- and β-radioactivity, as well as 137Cs and 40K radioactivity levels. Further studies should clarify the contribution of anthropogenic and other natural sources to the emission or transportation of particles radioactivity, to better mitigate future exposures.

Associations Between Self-Reported Burn Pit Exposure and Functional Status, 1990-2021

INTRODUCTION

The Airborne Hazards and Open Burn Pit Registry (AHOBPR) allows service members to self-report exposure to burn pits during military deployments and functional status (a composite metric of physical fitness status). This study investigated whether general exposure to burn pits, specific performance of burn pit duties, or the cumulative number of days deployed in Southwest Asia was associated with a change in functional status.

MATERIALS AND METHODS

A retrospective cross-sectional analysis of 234,061 participants in the AHOBPR who completed questionnaires before August 2021 was conducted. Exposure was presumed if an individual reported any burn pits exposure during deployment or if an individual reported having to work at a burn pit as part of their duties and was quantified by the cumulative-reported exposure days. The outcome was the reported composite functional score. Statistical analysis used linear regression, which was adjusted for significant variables. A possible dose-response effect from cumulative deployment and burn pits exposure days was evaluated. Statistical significance was determined at P < 0.05.

RESULTS

The burn pit exposure groups were notably different in size (exposed: 230,079, non-exposed: 3982) and were significantly different for all compared variables. There was a negative association between cumulative exposure days and functional score with a significant test for trend. There was a marginal positive significant association between cumulative deployment days and functional score with a significant test for trend. Reporting exposure to burn pit duties was also significantly associated with a lower functional score.

CONCLUSION

This study suggests a dose-response relationship between cumulative burn pit exposure and decreased functional status. It also suggests a modest positive relationship between cumulative deployment days and reported function, which may represent a "healthy deployer" effect.

Temperature modification of air pollutants and their synergistic effects on respiratory diseases in a semi-arid city in Northwest China

Air pollutants and temperature are significant threats to public health, and the complex linkages between the environmental factors and their interactions harm respiratory diseases. This study is aimed to analyze the impact of air pollutants and meteorological factors on respiratory diseases and their synergistic effects in Dingxi, a city in northwestern China, from 2018 to 2020 using a generalized additive model (GAM). Relative risk (RR) was employed to quantitatively evaluate the temperature modification on the short-term effects of PM2.5 and O3 and the synergistic effects of air pollutants (PM2.5 and O3) and meteorological elements (temperature and relative humidity) on respiratory diseases. The results indicated that the RRs per inter-quatile range (IQR) rise in PM2.5 and O3 concentrations were (1.066, 95% CI: 1.009-1.127, lag2) and (1.037, 95% CI: 0.975-1.102, lag4) for respiratory diseases, respectively. Temperature stratification suggests that the influence of PM2.5 on respiratory diseases was significantly enhanced at low and moderate temperatures, and the risk of respiratory diseases caused by O3 was significantly increased at high temperatures. The synergy analysis demonstrated significant a synergistic effect of PM2.5 with low temperature and high relative humidity and an antagonistic effect of high relative humidity and O3 on respiratory diseases. The findings would provide a scientific basis for the impact of pollutants on respiratory diseases in Northwest China.

A nationwide case-referent study on elevated risks of adenocarcinoma lung cancer by long-term PM2.5 exposure in Taiwan since 1997

BACKGROUND

The effects of long-term PM2.5 exposures since 1968 on adenocarcinoma lung cancer (AdLC) were not studied before.

METHODS

This case-referent study used nationwide cancer registry data since 1997 and air pollution data since 1968 in Taiwan to estimate risks of 30-year PM2.5 exposures on AdLC. Cases were all AdLC, while references were all non-AdLC. Individuals' 30-year PM2.5 exposures were estimated by PM2.5 levels at their residence for 30 years prior their diagnosis dates. We applied multiple logistic regression analyses to estimate PM2.5 exposures on incidence rate ratios (IRRs) between cases and references, adjusting for sex, age, smoking, cancer stage, and EGFR mutation.

RESULTS

Elevation in annual ambient PM2.5 concentrations since 1968 were associated with increase in annual age-adjusted AdLC incidence since 1997. AdLC incidences were higher among females, nonsmokers, the elderly aged above 65, cases of stages IIIB to IV, and EGFR mutation. Study subjects' PM2.5 exposures averaged at 33.7 ± 7.4 μg/m3 with 162 ± 130 high PM2.5 pollution days over 30 years. Multiple logistic models showed an increase in 10 μg/m3 of PM2.5 exposures were significantly associated with 1.044 of IRR between all AdLC and all non-AdLC cases during 2011-2020. Our models also showed that females and nonsmokers and adults less than 65 years had higher IRRs than their respective counterparts. Restricted analyses showed similar effects of PM2.5 exposures on IRRs between stage 0-IIIA and IIIB-IV cases and between EGFR+ and EGFR- cases.

CONCLUSIONS

Long-term exposures to PM2.5 over 30 years were associated with elevated risks of AdLC against non-AdLC, regardless of gender, age, smoking status, cancer stage, or EGFR mutation.

Bidirectional modification effects on nonlinear associations of summer temperature and air pollution with first-ever stroke morbidity

High temperature and air pollution may induce stroke morbidity. However, whether associations between high temperature and air pollution with stroke morbidity are modified by each other is still unclear. Data on 23,578 first-ever stroke patients in Shenzhen, China, during the summers of 2014-2018 were collected. Distributed lag nonlinear models were used to assess the modifying effects of air pollution stratified by the median for the associations between summer temperature and stroke morbidity at 0-3 lag days; modifying effects of temperature stratified by the minimum morbidity temperature on the associations between air pollution and stroke morbidity at the same lags were also estimated. The attributable risks of high temperature and high pollution on stroke morbidity were quantified. Stratified analyses of gender, age, migration type, and complication type were conducted to assess vulnerable population characteristics. Summer high temperature may induce stroke morbidity at high-level PM2.5, PM10, O3, SO2, and NO2 conditions, with attributable fraction (AF) of 2.982% (95% empirical confidence interval [eCI]: 0.943, 4.929), 3.113% (0.948, 5.200), 2.841% (0.943, 4.620), 3.617% (1.539, 5.470), and 2.048% (0.279, 3.637), respectively. High-temperature effects were statistically insignificant at corresponding low-level air pollution conditions. High-level PM2.5, PM10, and O3 may induce stroke morbidity at high-temperature conditions, with AF of 3.664% (0.036, 7.196), 4.129% (0.076, 7.963), and 4.574% (1.009, 7.762), respectively. High-level PM2.5, PM10, and O3 were not associated with stroke morbidity at low-temperature conditions. The effects of high temperature and high pollution on stroke morbidity were statistically significant among immigrants and patients with hypertension, dyslipidemia, or diabetes but insignificant among natives and patients without complications. The associations of summer temperature and air pollution with first-ever stroke morbidity may be enhanced bidirectionally. Publicity on the health risks of combined high temperature and high pollution events should be strengthened to raise protection awareness of relevant vulnerable populations.

Ambient dust pollution with all-cause, cardiovascular and respiratory mortality: A systematic review and meta-analysis

A severe health crisis has been well-documented regarding dust particle exposure. We aimed to present the risk of all-cause, cardiovascular, and respiratory mortality due to particulate matter (PM) exposure during non-dust and dust storm events by performing a meta-analysis. A systematic review of the literature was conducted by an online search of the databases (Google Scholar, Web of Science, Scopus, and PubMed) with no restrictions according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines until December 2022. We performed a random-effects model to compute the pooled rate ratio (RR) of mortality with 95 % confidence intervals (CI). The Office of Health Assessment and Translation (OHAT) risk of bias rating tool was prepared to assess the quality of the individual study. The registration number in PROSPERO was CRD42023423212. We found a 16 % (95 % CI: 0.7 %, 24 %) increase in all-cause, 25 % (95 % CI: 14 %, 37 %) increase in cardiovascular, and 18 % (95 % CI: 13 %, 22 %) increase in respiratory mortality per 10 μg/m3 increment in dust exposure. Furthermore, the RRs per 10 μg/m3 increment in PM10-2.5 were 1.046 (95 % CI: 1.019, 1.072)¸ 1.085 (95 % CI: 1.045, 1.0124), and 1.089 (95 % CI: 0.939, 1.24) for all-cause, cardiovascular, and respiratory mortality, respectively. PM10 during dust days significantly increased the all-cause (1.013, 95 % CI: 1.007, 1.018) cardiovascular mortality risk (1.014, 95 % CI: 1.009, 1.02). We also found significant evidence for all-cause, cardiovascular, and respiratory mortality among females and the elderly age group due to dust particle (PM10-2.5 and PM10) exposure. Our results provided significant evidence about high concentrations of PM10-2.5 and PM10 during dust storm events related to mortality risk.

Quantifying the contributions of natural and anthropogenic dust sources in Shanxi Province, northern China

Dust storms have direct or indirect impacts on climate change and human health. Identifying and quantifying natural/anthropogenic dust sources can facilitate effective prevention and control of dust events. Based on surface real-time PM10 monitoring data, satellite remote sensing and the HYSPLIT model, this study determined the specific timing, coverage and sources of dust events in Shanxi Province, Northern China. Thus, a composite fingerprinting technique was established to quantify potential dust sources and dust contributions of single dust events. The dust oxidation model was validated, indicating that the composite fingerprinting technique was well suited to the study region. The results show that natural dust sources (67%) contributed more to the study region than anthropogenic dust sources. They were mainly from the northwest and north of the study region. Particularly, the contributions of Taiyuan (TY) and Linfen (LF) accounted for the largest (82%) and smallest (55%) proportions, respectively, both exceeding 50%. Anthropogenic dust sources contributed 33%, mainly from the east and south of the study region. The contribution of anthropogenic dust sources increased in the study region from north to south. In terms of potential dust sources, the Tengger Desert and Badain Jaran Desert (TDBD) contributed the most (26%), followed by the Otindag Sandy Land (OL) (22%). The Taklimakan Desert (TD) contributed the least (2%). The Middle Farmland region of the Hexi Corridor (HMF) in the west (15%) had the largest proportion of anthropogenic dust sources. Differences in the regional contribution of potential dust sources mainly resulted from winter winds, surface drought severity and particle size. At an insignificant distance from the study region, the contribution of potential dust sources was larger in the west than in the east and increased from south to north overall. These methods and findings can contribute to improving the ecological environment in Northern China.

Acute exposure to total and source-specific ambient fine particulate matter and risk of respiratory disease hospitalization in Kuwait

Many epidemiologic studies concerned with acute exposure to ambient PM2.5 have reported positive associations for respiratory disease hospitalization. However, few studies have investigated this relationship in Kuwait and extrapolating results from other regions may involve considerable uncertainty due to variations in concentration levels, particle sources and composition, and population characteristics. Local studies can provide evidence for strategies to reduce risks from episodic exposures to high levels of ambient PM2.5 and generating hypotheses for evaluating health risks from chronic exposures. Therefore, using speciated PM2.5 data from local samplers, we analyzed the impact of daily total and source-specific PM2.5 exposure on respiratory hospitalizations in Kuwait using a case-crossover design with conditional quasi-Poisson regression. Total and source-specific ambient PM2.5 were modeled using 0-5-day cumulative distributed lags. For total PM2.5, we observed a 0.16% (95% confidence interval [CI] = 0.05, 0.27%) increase in risk for respiratory hospitalization per 1 μg/m3 increase in concentration. Of the source factors assessed, dust demonstrated a statistically significant increase in risk (0.16%, 95% CI = 0.04, 0.29%), and the central estimate for regional PM2.5 was positive (0.11%) but not statistically significant (95% CI = -0.11, 0.33%). No effect was observed from traffic emissions and 'other' source factors. When hospitalizations were stratified by sex, nationality, and age, we found that female, Kuwaiti national, and adult groups had higher effect estimates. These results suggest that exposure to ambient PM2.5 is harmful in Kuwait and provide some evidence of differential toxicity and effect modification depending on the PM2.5 source and population affected.

Connections Between Air Pollution, Climate Change, and Cardiovascular Health

Globally, more people die from cardiovascular disease than any other cause. Climate change, through amplified environmental exposures, will promote and contribute to many noncommunicable diseases, including cardiovascular disease. Air pollution, too, is responsible for millions of deaths from cardiovascular disease each year. Although they may appear to be independent, interchangeable relationships and bidirectional cause-and-effect arrows between climate change and air pollution can eventually lead to poor cardiovascular health. In this topical review, we show that climate change and air pollution worsen each other, leading to several ecosystem-mediated effects. We highlight how increases in hot climates as a result of climate change have increased the risk of major air pollution events such as severe wildfires and dust storms. In addition, we show how altered atmospheric chemistry and changing patterns of weather conditions can promote the formation and accumulation of air pollutants: a phenomenon known as the climate penalty. We demonstrate these amplified environmental exposures and their associations to adverse cardiovascular health outcomes. The community of health professionals-and cardiologists, in particular-cannot afford to overlook the risks that climate change and air pollution bring to the public's health.

Burden of fine air pollution on mortality in the desert climate of Kuwait

BACKGROUND

Middle Eastern desert countries like Kuwait are known for intense dust storms and enormous petrochemical industries affecting ambient air pollution. However, local health authorities have not been able to assess the health impacts of air pollution due to limited monitoring networks and a lack of historical exposure data.

OBJECTIVE

To assess the burden of PM_2.5 on mortality in the understudied dusty environment of Kuwait.

METHODS

We analyzed the acute impact of fine particulate matter (PM_2.5) on daily mortality in Kuwait between 2001 and 2016. To do so, we used spatiotemporally resolved estimates of PM_2.5 in the region. Our analysis explored factors such as cause of death, sex, age, and nationality. We fitted quasi-Poisson time-series regression for lagged PM_2.5 adjusted for time trend, seasonality, day of the week, temperature, and relative humidity.

RESULTS

There was a total of 70,321 deaths during the study period of 16 years. The average urban PM_2.5 was estimated to be 46.2 ± 19.8 µg/m³. A 10 µg/m³ increase in a 3-day moving average of urban PM_2.5 was associated with 1.19% (95% CI: 0.59, 1.80%) increase in all-cause mortality. For a 10 µg/m³ reduction in annual PM_2.5 concentrations, a total of 52.3 (95% CI: 25.7, 79.1) deaths each year could be averted in Kuwait. That is, 28.6 (95% CI: 10.3, 47.0) Kuwaitis, 23.9 (95% CI: 6.4, 41.5) non-Kuwaitis, 9.4 (95% CI: 1.2, 17.8) children, and 20.9 (95% CI: 4.3, 37.6) elderly deaths each year.

IMPACT STATEMENT

The overwhelming prevalence of devastating dust storms and enormous petrochemical industries in the Gulf and the Middle East has intensified the urgency to address air pollution and its detrimental health effects. Alarmingly, the region's epidemiological research lags behind, hindered by a paucity of ground monitoring networks and historical exposure data. In response, we are harnessing the power of big data to generate predictive models of air pollution across time and space, providing crucial insights into the mortality burden associated with air pollution in this under-researched yet critically impacted area.

Extreme heat and work injuries in Kuwait's hot summers

BACKGROUND

Hot, desert Gulf countries are host to millions of migrant workers doing outdoor jobs such as construction and hospitality. The Gulf countries apply a summertime ban on midday work to protect workers from extreme heat, although without clear evidence of effectiveness. We assessed the risk of occupational injuries associated with extreme hot temperatures during the summertime ban on midday work in Kuwait.

METHODS

We collected daily occupational injuries in the summer months that are reported to the Ministry of Health's Occupational Health Department for 5 years from 2015 to 2019. We fitted generalised additive models with a quasi-Poisson distribution in a time series design. A 7-day moving average of daily temperature was modelled with penalised splines adjusted for relative humidity, time trend and day of the week.

RESULTS

During the summertime ban, the daily average temperature was 39.4°C (±1.8°C). There were 7.2, 7.6 and 9.4 reported injuries per day in the summer months of June, July and August, respectively. Compared with the 10th percentile of summer temperatures in Kuwait (37.0°C), the average day with a temperature of 39.4°C increased the relative risk of injury to 1.44 (95% CI 1.34 to 1.53). Similarly, temperatures of 40°C and 41°C were associated with relative risks of 1.48 (95% CI 1.39 to 1.59) and 1.44 (95% CI 1.27 to 1.63), respectively. At the 90th percentile (42°C), the risks levelled off (relative risk 1.21; 95% CI 0.93 to 1.57).

CONCLUSION

We found substantial increases in the risk of occupational injury from extremely hot temperatures despite the ban on midday work policy in Kuwait. 'Calendar-based' regulations may be inadequate to provide occupational heat protections, especially for migrant workers.

Improved indoor air quality during desert dust storms: The impact of the MEDEA exposure-reduction strategies

Desert dust storms (DDS) are natural events that impact not only populations close to the emission sources but also populations many kilometers away. Countries located across the main dust sources, including countries in the Eastern Mediterranean, are highly affected by DDS. In addition, climate change is expanding arid areas exacerbating DDS events. Currently, there are no intervention measures with proven, quantified exposure reduction to desert dust particles. As part of the wider "MEDEA" project, co-funded by LIFE 2016 Programme, we examined the effectiveness of an indoor exposure-reduction intervention (i.e., decrease home ventilation during DDS events and continuous use of air purifier during DDS and non-DDS days) across homes and/or classrooms of schoolchildren with asthma and adults with atrial fibrillation in Cyprus and Crete-Greece. Participants were randomized to a control or intervention groups, including an indoor intervention group with exposure reduction measures and the use of air purifiers. Particle sampling, PM₁₀ and PM_2.5, was conducted in participants' homes and/or classrooms, between 2019 and 2022, during DDS-free weeks and during DDS days for as long as the event lasted. In indoor and outdoor PM₁₀ and PM_2.5 samples, mass and content in main and trace elements was determined. Indoor PM_2.5 and PM₁₀ mass concentrations, adjusting for premise type and dust conditions, were significantly lower in the indoor intervention group compared to the control group (PM_{2.5-intervention}/PM_2.5-control = 0.57, 95% CI: 0.47, 0.70; PM_{10-intervention}/PM_10-control = 0.59, 95% CI: 0.49, 0.71). In addition, the PM_2.5 and PM₁₀ particles of outdoor origin were significantly lower in the intervention vs. the control group (PM_2.5 infiltration intervention-to-control ratio: 0.49, 95% CI: 0.42, 0.58; PM₁₀ infiltration intervention-to-control ratio: 0.68, 95% CI: 0.52, 0.89). Our findings suggest that the use of air purifiers alongside decreased ventilation measures is an effective protective measure that reduces significantly indoor exposure to particles during DDS and non-DDS in high-risk population groups.

Military deployment-related respiratory problems: an update

PURPOSE OF REVIEW

Military personnel deployed to Southwest Asia and Afghanistan were potentially exposed to high levels of fine particulate matter and other pollutants from multiple sources, including dust storms, burn pit emissions from open-air waste burning, local ambient air pollution, and a range of military service-related activities that can generate airborne exposures. These exposures, individually or in combination, can have adverse respiratory health effects. We review exposures and potential health impacts, providing a framework for evaluation.

RECENT FINDINGS

Particulate matter exposures during deployment exceeded U.S. National Ambient Air Quality Standards. Epidemiologic studies and case series suggest that in postdeployment Veterans with respiratory symptoms, asthma is the most commonly diagnosed illness. Small airway abnormalities, most notably particularly constrictive bronchiolitis, have been reported in a small number of deployers, but many are left without an established diagnosis for their respiratory symptoms. The Promise to Address Comprehensive Toxics Act was enacted to provide care for conditions presumed to be related to deployment exposures. Rigorous study of long-term postdeployment health has been limited.

SUMMARY

Veterans postdeployment to Southwest Asia and Afghanistan with respiratory symptoms should undergo an exposure assessment and comprehensive medical evaluation. If required, more advanced diagnostic considerations should be utilized in a setting that can provide multidisciplinary expertise and long-term follow-up.

New insights into submicron particles impact on visibility

The aim of the study was to analyze the impact of very fine atmospheric particles (submicron particulate matter; PM₁) on visibility deterioration. Taking into consideration not only their entirely different physio-chemical properties in comparison to a well-recognized PM₁₀ but also the origin and a growing environmental awareness of PM₁, the main research problem has been solved in few steps. At first, the chemical composition of PM₁ was determined in two selected urban areas in Poland. Measurements of meteorological parameters, i.e., air temperature and humidity, precipitation, atmospheric pressure, wind speed, and visibility, were also conducted. The next step of the work was the analysis of (1) seasonal changes of the concentration of PM₁ and its main components, (2) the influence of chemical components of PM₁ on light extinction, and (3) the influence of PM₁ and humidity on visibility. Hierarchical cluster analysis, correlation matrixes and a heat map, and classification and regression tree analysis were used. The light extinction coefficient is influenced mainly by coarse mass of PM, and PM₁-bound ammonium nitrate, organic matter, and by Rayleigh scattering. The less important in the light extinction coefficient shaping has PM₁-bound ammonium sulfate, elemental carbon, and soil. In this way, the secondary origin PM₁ components were proved to most significantly influence the visibility. The obtained results confirmed the possibility of the use of statistical agglomeration techniques to identify ranges of variation of visibility, including independent variables adopted to analyses (meteorological conditions, chemical composition of PM₁, etc.).

Climate change and cardiovascular disease: implications for global health

Climate change is the greatest existential challenge to planetary and human health and is dictated by a shift in the Earth's weather and air conditions owing to anthropogenic activity. Climate change has resulted not only in extreme temperatures, but also in an increase in the frequency of droughts, wildfires, dust storms, coastal flooding, storm surges and hurricanes, as well as multiple compound and cascading events. The interactions between climate change and health outcomes are diverse and complex and include several exposure pathways that might promote the development of non-communicable diseases such as cardiovascular disease. A collaborative approach is needed to solve this climate crisis, whereby medical professionals, scientific researchers, public health officials and policymakers should work together to mitigate and limit the consequences of global warming. In this Review, we aim to provide an overview of the consequences of climate change on cardiovascular health, which result from direct exposure pathways, such as shifts in ambient temperature, air pollution, forest fires, desert (dust and sand) storms and extreme weather events. We also describe the populations that are most susceptible to the health effects caused by climate change and propose potential mitigation strategies, with an emphasis on collaboration at the scientific, governmental and policy levels.

Air Pollution and Respiratory Hospital Admissions in Kuwait: The Epidemiological Applicability of Predicted PM2.5 in Arid Regions

Dust is a major component of fine particulate matter (PM_2.5) in arid regions; therefore, concentrations of this pollutant in countries such as Kuwait exceed air quality standards. There is limited understanding on the impact and burden of high PM_2.5 concentrations on morbidity in these countries. In this study, we explore the association of PM_2.5 and the risk of respiratory hospital admissions in Kuwait. A time-series regression model was used to investigate daily variations in respiratory admissions and PM_2.5 concentrations from 2010 to 2018. Due to the lack of historical air quality sampling in Kuwait, we used estimated daily PM_2.5 levels from a hybrid PM_2.5 prediction model. Individual and cumulative lag effects of PM_2.5 over a 5-day period were estimated using distributed lag linear models. Associations were stratified by sex, age, and nationality. There were 218,749 total respiratory admissions in Kuwait during the study period. Results indicate that for every 10 μg/m³ increase in PM_2.5, a 1.61% (95% CI = 0.87, 2.35%) increase in respiratory admissions followed over a 5-day cumulative lag. Our estimates show that a 10 μg/m³ reduction in average exposure will potentially avert 391 yearly respiratory admissions (95% CI = 211,571), with 265 fewer admissions among Kuwaitis (95% CI = 139,393) and 262 fewer admissions among children under 15 years of age (95% CI = 125,351). Different strata of the Kuwaiti population are vulnerable to respiratory hospitalization with short-term exposure to PM_2.5, especially those under 15 years of age. The findings are informative for public health authorities in Kuwait and other dust-prone countries.

Modeling mortality rates and environmental degradation in Asia and the Pacific: does income group matter?

This two-dimensional study makes significant incursions into the health-environment literature by interrogating whether non-renewable energy moderates the impact of environmental degradation on mortality rates. It further aligns with the 2030 United Nations Sustainable Development Goals and 11, which aim to ensure healthy lives and promote well-being for all at all ages and make cities and human settlements inclusive, safe, resilient and sustainable. It contributes to the health-environment literature by investigating the intrinsic relationships among mortality rates, carbon emissions (environmental degradation), and non-renewable energy consumption. The study uses an unbalanced sample of 42 Asia and Pacific countries to determine (1) whether carbon emissions exaggerate the incidence of mortality rates and (2) if the interaction of non-renewable energy with carbon emissions enhances or alters the impact of carbon emissions on mortality rates. Consistent findings from the panel spatial correlation consistent least-squares dummy variables (PSCC-LSDV) and two-step system generalized method of moments (GMM) techniques reveal that (i) carbon emissions exacerbate mortality rates; (ii) non-renewable energy consumption exhibit mortality-reducing properties; (iii) non-renewable energy attenuates the impact of carbon emissions on mortality rates, (iv) persistency in mortalities occurs; and (v) the health-environment-energy dynamics differ across income groups. The paper's conjecture is expected to channel a new line of discourse on how non-renewable energy influences the environment and health outcomes.

PM2.5 and PM10 during COVID-19 lockdown in Kuwait: Mixed effect of dust and meteorological covariates

This study investigated the impact of COVID-19 lockdown on particulate matter concentrations, specifically PM2.5 and PM10, in Kuwait. We studied the variations in PM2.5 and PM10 between the lockdown in 2020 with the corresponding periods of the years 2017-2019, and also investigated the differences in PM variations between the 'curfew' and 'non curfew' hours. We applied mixed-effect regression to investigate the factors that dictate PM variability (i.e., dust and meteorological covariates), and also processed satellite-based aerosol optical depths (AOD) to determine the spatial variability in aerosol loads. The results showed low PM2.5 concentration during the lockdown (33 μg/m3) compared to the corresponding previous three years (2017-2019); however, the PM10 concentration (122.5 μg/m3) increased relative to 2017 (116.6 μg/m3), and 2019 (92.8 μg/m3). After removing the 'dust effects', both PM2.5 and PM10 levels dropped by 18% and 31%, respectively. The mixed-effect regression model showed that high temperature and high wind speed were the main contributors to high PM2.5 and PM10, respectively, in addition to the dust haze and blowing dust. This study highlights that the reductions of anthropogenic source emissions are overwhelmed by dust events and adverse meteorology in arid regions, and that the lockdown did not reduce the high concentrations of PM in Kuwait.

Effect of Dust Storms on Non-Accidental, Cardiovascular, and Respiratory Mortality: A Case of Dezful City in Iran

BACKGROUND

Despite the fact that Iran has been exposed to severe dust storms during the past 2 decades, few studies have investigated the health effects of these events in Iran. This study was conducted to assess the association between dust storms and daily non-accidental, cardiovascular, and respiratory mortality in Dezful City (Khuzestan Province, Iran) during 2014 to 2019.

METHODS

In this study, mortality, meteorological, and climatological data were obtained from the Dezful University of Medical Sciences, Iranian Meteorological Organization, and Department of Environment in Khuzestan Province, respectively. Days of dust storm were identified based on the daily concentration threshold of particulate matter with an aerodynamic diameter of less than 10 μm (PM10) according to Hoffmanns҆ definition, and then an ecological time-series was used to estimate the short-term effects of dust storms on daily mortality. Statistical analysis was performed using a distributed lag linear model (DLM) and a distributed lag non-linear model (DLNM) packages by R software and the study results were reported as excess mortality.

RESULTS

During the study period, 15 223 deaths were recorded, and 139 dust storms occurred in Dezful city. In addition, there was statistically significant excess risk of mortality due to dust storms in Dezful City (mortality in the group under 15 years of age, lag4: 34.17% and 15-64 years of age groups, lag5: 32.19%, lag6: 3.28%), also dust storms had statistically significant effects on respiratory mortality (lag6: 5.49%).

CONCLUSION

The findings of the current study indicate that dust storms increase the risk of mortality with some lags. An evidence-based early warning system may be able to aware the people of the health effects of dust storms.

Disparities in excess deaths from the COVID-19 pandemic among migrant workers in Kuwait

BACKGROUND

The actual human cost of the pandemic cannot be viewed through the COVID-19 mortality rates alone, especially when the pandemic is widening the existing health disparities among different subpopulations within the same society. In Kuwait, migrant workers were already disproportionately impacted by COVID-19 and its unintended consequences. The totality of that effect on mortality is yet to be fully understood.

OBJECTIVE

To estimate excess deaths in the pandemic year of 2020 among the Kuwaiti and non-Kuwaiti migrant populations.

METHODS

We analyzed publicly available retrospective data in Kuwait on total annual mortality historically (from 2005 to 2019) and in 2020. We fitted a quasi-poisson generalized linear model adjusted for yearly trend and nationality to estimate the expected deaths in 2020 in the absence of the pandemic. We calculated excess deaths as the difference between observed and expected mortality for the year of the pandemic in both Kuwaitis and non-Kuwaitis.

RESULTS

In the absence of the pandemic, we expected the total mortality in Kuwait to be 6629 (95% CI: 6472 to 6789) deaths. However, the observed total mortality in 2020 was 9975 deaths; about 3346 (3186 to 3503) more deaths above the expected historical trend. Deaths among migrant workers would have been approximately 71.9% (67.8 to 76.0) lower in the absence of the pandemic. On the other hand, deaths among Kuwaitis would have been 32.4% (29.3 to 35.6) lower if the country had not been hit by the pandemic.

CONCLUSION

The burden of mortality brought on by the COVID-19 pandemic is substantially higher than what the official tally might suggest. Systematically disadvantaged migrant workers shouldered a larger burden of deaths in the pandemic year. Public health interventions must consider structural and societal determinants that give rise to the health disparities seen among migrant workers.

Characterization and exposure assessment to urban air toxics across Middle Eastern and North African countries: a review

Middle East and North African (MENA) countries over the decades are experiencing rapid industrial and infrastructural growth combined with being the global hub of oil and gas industries. These economic transformations are associated with release of air pollutants including urban air toxics (UAT) through industrial, traffic, and constructional activities into ambient urban environments. UAT concentrations levels may exacerbate in most MENA countries considering high number of vehicular traffic populations and petrochemical industries which are one of the main sources of this pollutant. Therefore, the main objective of the study is to review major findings of UAT levels in urban areas across thirteen (13) MENA countries. The study characterizes various measured UAT, assesses their concentrations in ambient environment, and identifies their major sources of emissions by reviewing more than 100 relevant UAT papers across the selected MENA countries. It was found that benzene, heavy metals, formaldehyde, and dioxin-like compounds are the most reported UAT. The study concluded that road traffic, fuel stations, and petrochemical industries were identified as the main sources of ambient UAT levels. It was further reported that most of the studies were based on short-term ambient environment with limited studies in indoor environments. Therefore, it is highly recommended that future research should focus on innovative health impact assessment and epidemiological studies from exposure to UAT levels. Also embarking on sustainable mitigation approaches through urban greenery, eco-industrial estates infrastructural developments, and renewable energy shares will reduce UAT levels and improve human health.

Impact of Ambient Air Quality Standards revision on the exposure-response of air pollution in Tianjin, China

To improve air quality, China issued a new version of Ambient Air Quality Standards in 2012, and Tianjin officially implemented these new standards in 2013. In order to observe whether the atmospheric quality and health had been improved after the release of the new standards, this study compared the exposure-response relationships between pollutant concentrations and daily deaths (and years of life lost, YLL) in the six central districts of Tianjin in 2007-2010 and 2014-2017, which were the two periods around the release of the new standards. The exposure-response coefficients were calculated by using the generalized additive model with the time series data. The results showed that the effects of PM₁₀ and NO₂ during 2014-2017 were lower than those during 2007-2010 (PM₁₀: 0.10<0.30, 2.07<4.52; NO2: 0.24<0.87, 6.39<11.98), while the results of SO₂ were opposite (SO₂: 0.61>0.31, 10.31>1.64). And the excess deaths and YLL caused by the portion of the pollutants that exceeded the new standards also declined (PM₁₀: 156<206 persons, 3493<3913 person-years; NO₂: 64<136 persons, 1844<2895 person-years; SO₂ did not exceed the new standards). The results proved that the new standards had a certain protective effect on the health of the population in the central districts of Tianjin. These findings may provide evidence for the formulation of public health policies and further improvement and development of the Ambient Air Quality Standards.

Heart Failure and PAHs, OHPAHs, and Trace Elements Levels in Human Serum: Results from a Preliminary Pilot Study in Greek Population and the Possible Impact of Air Pollution

Cardiovascular diseases (CVDs) have been associated with environmental pollutants. The scope of this study is to assess any potential relation of polycyclic aromatic hydrocarbons (PAHs), their hydroxylated derivatives, and trace elements with heart failure via their direct determination in human serum of Greek citizens residing in different areas. Therefore, we analyzed 131 samples including cases (heart failure patients) and controls (healthy donors), and the respective demographic data were collected. Significantly higher concentrations (p < 0.05) were observed in cases' serum regarding most of the examined PAHs and their derivatives with phenanthrene, fluorene, and fluoranthene being the most abundant (median of >50 μg L-1). Among the examined trace elements, As, Cd, Cu, Hg, Ni, and Pb were measured at statistically higher concentrations (p < 0.05) in cases' samples, with only Cr being significantly higher in controls. The potential impact of environmental factors such as smoking and area of residence has been evaluated. Specific PAHs and trace elements could be possibly related with heart failure development. Atmospheric degradation and smoking habit appeared to have a significant impact on the analytes' serum concentrations. PCA-logistic regression analysis could possibly reveal common mechanisms among the analytes enhancing the hypothesis that they may pose a significant risk for CVD development.

Global Health Impacts of Dust Storms: A Systematic Review

BACKGROUND

Dust storms and their impacts on health are becoming a major public health issue. The current study examines the health impacts of dust storms around the world to provide an overview of this issue.

METHOD

In this systematic review, 140 relevant and authoritative English articles on the impacts of dust storms on health (up to September 2019) were identified and extracted from 28 968 articles using valid keywords from various databases (PubMed, WOS, EMBASE, and Scopus) and multiple screening steps. Selected papers were then qualitatively examined and evaluated. Evaluation results were summarized using an Extraction Table.

RESULTS

The results of the study are divided into two parts: short and long-term impacts of dust storms. Short-term impacts include mortality, visitation, emergency medical dispatch, hospitalization, increased symptoms, and decreased pulmonary function. Long-term impacts include pregnancy, cognitive difficulties, and birth problems. Additionally, this study shows that dust storms have devastating impacts on health, affecting cardiovascular and respiratory health in particular.

CONCLUSION

The findings of this study show that dust storms have significant public health impacts. More attention should be paid to these natural hazards to prepare for, respond to, and mitigate these hazardous events to reduce their negative health impacts.Registration: PROSPERO registration number CRD42018093325.

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.

Accuracy, uncertainty, and interpretability assessments of ANFIS models to predict dust concentration in semi-arid regions

Accurate prediction of the dust concentration (DC) is necessary to reduce its undesirable environmental effects in different geographical areas. Although the adaptive neuro-fuzzy inference system (ANFIS) is a powerful model for predicting dust events, no attempt has been made to investigate its uncertainty and interpretability. In this study, therefore, the uncertainty of the ANFIS model was quantified using uncertainty estimation based on local errors and clustering methods. Furthermore, we used a model-agnostic interpretation to make the ANFIS model interpretable. In addition, we used the bat optimization algorithm (BAT) to increase the prediction accuracy of the ANFIS model. Seven explanatory variables were chosen for predicting DC in the cold and warm months across semi-arid regions of Iran. The results showed that the ANFIS+BAT model increased the correlation coefficient by 10% and 16% for predicting DC in the cold and warm months, respectively, compared with the ANFIS model. Furthermore, the uncertainty analysis indicated a lower prediction interval (i.e., lower uncertainty) for the ANFIS+BAT model compared with the ANFIS model for predicting DC in the cold and warm months. In addition, the model-agnostic interpretation tool findings indicated the highest contributions of air temperature and maximum wind speed for predicting DC in the cold and warm months, respectively. Prediction of DC using the proposed model will allow decision-makers to better plan for measures to mitigate the risks of wind erosion and air pollution.

Bad Air Can Also Kill: Residential Indoor Air Quality and Pollutant Exposure Risk during the COVID-19 Crisis

During the first outbreak of the SARS-CoV-2 pandemic the population, focusing primarily on the risk of infection, was generally inattentive to the quality of indoor air. Spain, and the city of Madrid in particular, were among the world's coronavirus hotspots. The country's entire population was subject to a 24/7 lockdown for 45 days. This paper describes a comparative longitudinal survey of air quality in four types of housing in the city of Madrid before and during lockdown. The paper analysed indoor temperatures and variations in CO2, 2.5 μm particulate matter (PM2.5) and total volatile organic compound (TVOC) concentrations before and during lockdown. The mean daily outdoor PM2.5 concentration declined from 11.04 µg/m3 before to 7.10 µg/m3 during lockdown. Before lockdown the NO2 concentration values scored as 'very good' 46% of the time, compared to 90.9% during that period. Although the city's outdoor air quality improved, during lockdown the population's exposure to indoor pollutants was generally more acute and prolonged. Due primarily to concern over domestic energy savings, the lack of suitable ventilation and more intensive use of cleaning products and disinfectants during the covid-19 crisis, indoor pollutant levels were typically higher than compatible with healthy environments. Mean daily PM2.5 concentration rose by approximately 12% and mean TVOC concentration by 37% to 559%. The paper also puts forward a series of recommendations to improve indoor domestic environments in future pandemics and spells out urgent action to be taken around indoor air quality (IAQ) in the event of total or partial quarantining to protect residents from respiratory ailments and concomitantly enhanced susceptibility to SARS-CoV-2, as identified by international medical research.

COVID-19 clinical outcomes and nationality: results from a Nationwide registry in Kuwait

BACKGROUND

In light of the COVID-19 pandemic, many have flagged racial and ethnic differences in health outcomes in western countries as an urgent global public health priority. Kuwait has a unique demographic profile with two-thirds of the population consisting of non-nationals, most of which are migrant workers. We aimed to explore whether there is a significant difference in health outcomes between non-Kuwaiti and Kuwaiti patients diagnosed with COVID-19.

METHODS

We used a prospective COVID-19 registry of all patients (symptomatic and asymptomatic) in Kuwait who tested positive from February 24th to April 20th, 2020, collected from Jaber Al-Ahmad Al-Sabah Hospital, the officially-designated COVID-19 healthcare facility in the country. We ran separate logistic regression models comparing non-Kuwaitis to Kuwaitis for death, intensive care unit (ICU) admission, acute respiratory distress syndrome (ARDS) and pneumonia.

RESULTS

The first 1123 COVID-19 positive patients in Kuwait were all recruited in the study. About 26% were Kuwaitis and 73% were non-Kuwaiti. With adjustments made to age, gender, smoking and selected co-morbidities, non-Kuwaitis had two-fold increase in the odds of death or being admitted to the intensive care unit compared to Kuwaitis (OR: 2.14, 95% CI 1.12-4.32). Non-Kuwaitis had also higher odds of ARDS (OR:2.44, 95% CI 1.23-5.09) and pneumonia (OR: 2.24, 95% CI 1.27-4.12).

CONCLUSION

This is the first study to report on COVID-19 outcomes between Kuwaiti and non-Kuwaiti patients. The current pandemic may have amplified the differences of health outcomes among marginalized subpopulations. A number of socioeconomic and environmental factors could explain this health disparity. More research is needed to advance the understanding of policymakers in Kuwait in order to make urgent public health interventions.

Activity size distributions of radioactive airborne particles in an arid environment: a case study of Kuwait

Atmospheric radioactive airborne released from several natural and artificial sources can travel for long distances and disperse in different directions. Both the physical and chemical characteristics of the atmospheric aerosols control this movement. The concentrations of ²¹⁰Pb, ²¹⁰Po, ⁷Be, ⁴⁰K and ¹³⁷Cs radionuclides in the ground surface air were determined in three particle sizes (2.4-10.2, 0.73-2.4 and less than 0.73 μm). High-volume air samples were collected from five different locations representing the five governorates of Kuwait using high-volume air samplers connected to a five-stage cascade impactor. The radioactivity concentrations of almost all fallout radionuclides were concentrated on the fine particle size fractions. The cosmogenic ⁷Be radioactivity level in all locations was relatively comparable and varied between 1.16 and 18.38 mBq/m³, with a geometric mean value of 6.80 mBq/m³. ¹³⁷Cs was infrequently recorded with concentration varied between 4 and 14.3 μBq/m³. The geometric mean levels of the ²¹⁰Po and ²¹⁰Pb were 0.899 mBq/m³ and 1.03 mBq/m³, respectively, indicating that anthropogenic sources likely enrich ²¹⁰Po. ⁴⁰K was concentrated on large particle size fractions with a geometric mean value of 2.34 mBq/m³, reflecting the effects of the local dust sources. It was concluded that the radiological hazards due to airborne radioactive inhalation are low and can be negligible, where the annual estimated effective dose is about 64.0 μSv. The radioactive airborne measurements compose the base of estimating the aerosols residence time, resuspension rate of dust, soil redistribution and source apportionment, particularly the ²¹⁰Pb and ²¹⁰Po radionuclides.

Extreme temperatures and mortality in Kuwait: Who is vulnerable?

BACKGROUND

Previous climate change temperature-related health studies have been performed mostly in western countries with relatively cooler temperatures than the Gulf region. Regions that are inherently hot, like Kuwait, are witnessing soaring temperatures unlike ever before. Meanwhile, Kuwait and other Gulf countries are unique in their demographic profiles due to the large number of non-national migrant workers.

OBJECTIVE

To examine the associations of hot and cold temperature extremes on the risk of mortality across gender, age groups and nationality in Kuwait.

METHODS

We investigated daily variations of all-cause non-accidental and cardiovascular mortality death counts and ambient temperatures from 2010 to 2016 in a time-series design using a negative binomial distribution. The temperature lag was modeled with distributed lag non-linear models.

RESULTS

A total of 33,472 all-cause non-accidental deaths happened during the study period. For the extreme hot temperatures and over the entire lag period, comparing the 99th percentile of temperature to the minimum mortality temperature, the risk of dying among males was 2.08 (95% CI: 1.23-3.52). Among non-Kuwaitis, males and working age group (15-64 year) had relative risks of death from extreme hot temperatures of 2.90 (1.42-5.93), and 2.59 (1.20-5.59), respectively. For extreme cold temperatures and over the entire lag period, comparing the 1st percentile of temperature to the minimum mortality temperature, the relative risk of death among Kuwaitis was 2.03 (1.05-3.93). Elderly Kuwaitis (65+ year) exposed to extreme cold temperatures had a relative risk of 2.75 (1.16-6.52).

CONCLUSIONS

Certain subpopulations in Kuwait are vulnerable to extreme temperatures with doubling to tripling risk of mortality. Nationality is an important effect modifier in temperature-related mortality studies in Kuwait and possibly the Gulf region. To the best of our knowledge, we are the first study to examine specific subpopulation vulnerabilities to temperature in this region. Our findings could carry a potential for broader insight into similar hyper-arid and hot regions.

Seasonal variation in health impacts associated with visibility in Beijing, China

Visibility has been continuously and stably observed for more than half a century, while particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM_2.5) was not introduced to the national monitoring system in China until 2013. It is a scientific issue as to whether visibility can be used as an alternative to assess the health risks of air pollution in periods and areas without pollutant monitoring data. A generalized additive model (GAM) was adopted to estimate the impacts of seasonal changes in visibility on mortality in Beijing, China. Moreover, we estimated the contributions of particulate matter in the health effects of visibility by adjusting for dry extinction coefficient (β_dryext) and PM_2.5 in the model, respectively. We found that the acute health impacts of visibility varied by season, with the highest risks in winter. For respiratory mortality, the effect estimates per 1 km decrease in visibility were 0.40% (95% CI: 0.17-0.62%) in spring, 0.10% (95% CI: -0.14-0.34%) in summer, 0.27% (95% CI: 0.09-0.45%) in autumn, and 0.62% (95% CI: 0.38-0.85%) in winter. For cardiovascular mortality, the effect estimates per 1 km decrease in visibility were 0.20% (95% CI: 0.08-0.31%) in spring, 0.16% (95% CI: 0.04-0.27%) in summer, 0.25% (95% CI: 0.13-0.37%) in autumn, and 0.24% (95% CI: 0.13-0.35%) in winter. The seasonal pattern of health impacts related to visibility reflected the seasonal variations in the characteristics of air pollution emission sources and meteorological conditions that are unfavorable for pollutant dispersion. Particulate matter, particularly PM_2.5, made significant contributions to the health impacts of visibility. The results indicated that controlling pollutant emissions in winter would be of significant importance to improve air quality and mitigate the health hazard of air pollution in Beijing. Our study also provides further evidence on the feasibility of using visibility to assess the health impacts of particulate matter pollution.

COVID-19 stressors on migrant workers in Kuwait: cumulative risk considerations

As a marginalised subpopulation, migrant workers often fall short from protection by public policies, they take precarious jobs with unsafe working and living conditions and they grapple with cultural and linguistic barriers. In light of the current COVID-19 pandemic, migrant workers are now exposed to additional stressors of the virus and related responses. We applied a comprehensive qualitative cumulative risk assessment framework for migrant workers living in Kuwait. This pandemic could be one of the few examples where the stressors overlap all domains of migrant workers' lives. No single intervention can solve all the problems; there must be a set of interventions to address all domains. Local authorities and employers must act quickly to stop the spread, ensure easy access to testing and treatment, provide adequate housing and clear communication, encourage wide social support, safeguard financial protection and mental well-being and continuously re-evaluate the situation as more data are collected.

Spatio-temporal variability of desert dust storms in Eastern Mediterranean (Crete, Cyprus, Israel) between 2006 and 2017 using a uniform methodology

The characteristics of desert dust storms (DDS) have been shown to change in response to climate change and land use. There is limited information on the frequency and intensity of DDS over the last decade at a regional scale in the Eastern Mediterranean. An algorithm based on daily ground measurements (PM₁₀, particulate matter ≤10 μm), satellite products (dust aerosol optical depth) and meteorological parameters, was used to identify dust intrusions for three Eastern Mediterranean locations (Crete-Greece, Cyprus, and Israel) between 2006 and 2017. Days with 24-hr average PM₁₀ concentration above ~30 μg/m³ were found to be a significant indicator of DDS for the background sites of Cyprus and Crete. Higher thresholds were found for Israel depending on the season (fall and spring: PM₁₀ > 70 μg/m³, winter and summer: PM₁₀ > 90 μg/m³). We observed a high variability in the frequency and intensity of DDS during the last decade, characterized by a steady trend with sporadic peaks. The years with the highest DDS frequency were not necessarily the years with the most intense episodes. Specifically, the highest dust frequency was observed in 2010 at all three locations, but the highest annual median dust-PM₁₀ level was observed in 2012 in Crete (55.8 μg/m³) and Israel (137.4 μg/m³), and in 2010 in Cyprus (45.3 μg/m³). Crete and Cyprus experienced the same most intense event in 2006, with 24 h-PM₁₀ average of 705.7 μg/m³ and 1254.6 μg/m³, respectively, which originated from Sahara desert. The highest 24 h-PM10 average concentration for Israel was observed in 2010 (3210.9 μg/m³) during a three-day Saharan dust episode. However, a sub-analysis for Cyprus (years 2000-2017) suggests a change in DDS seasonality pattern, intensity, and desert of origin. For more robust conclusions on DDS trends in relation to climate change, future work needs to study data over several decades from different locations.

Impacts of meteorology and vegetation on surface dust concentrations in Middle Eastern countries

Severe dust events have occurred frequently in arid regions, which greatly impacted air quality, climate, and public health. The Middle East is one of the areas in the world impacted by intense dust storms. We investigated the characteristics of airborne dust levels in five Middle Eastern countries (Kuwait, Iraq, Iran, Saudi Arabia, and Syria) from 2001 to 2017. Surface level dust concentrations were determined using the Modern-Era Retrospective analysis for Research and Applications version 2. Kuwait was selected as an example to assess sources and other factors influencing dust levels in arid regions. We performed backward trajectory analysis to identify the dust transport pathways. We quantitatively assessed the impacts of meteorological parameters along with the Normalized Difference Vegetation Index (NDVI). Dust levels in Kuwait were higher than the other four countries, and had a distinct seasonal pattern, with the highest in summer and the lowest in winter. Our results showed that dust levels in Kuwait in January were influenced largely by local emissions, whereas in June they were affected more by emissions attributable to long-distance transport. There were significant positive associations between wind speed in the five countries, particularly Iraq, with dust levels in Kuwait, indicating the impact of nearby desert areas. Significant negative associations were observed between NDVI in Kuwait, Iraq, and Saudi Arabia with dust levels in Kuwait. Our result highlights that climatic variations and vegetation conditions are associated with changes in dust levels in arid regions.

Dust Events and Indoor Air Quality in Residential Homes in Kuwait

Kuwait is a developed Middle Eastern country that is impacted by frequent dust storms from regional and/or remote deserts. The effectiveness of keeping homes tightly closed during these events to reduce dust exposures was assessed using indoor and outdoor particle samples at 10 residences within the metropolitan Kuwait City area. Specifically, this study compared indoor and outdoor levels of black carbon and 19 trace elements (Na, Mg, Al, Si, S, Cl, K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, Zn, Br, Sr, and Zr) during dust and non-dust events and found that particle penetration efficiencies were lower during dust storm events (less than 20–30%) than during non-dust storm events (40–60%). Coarse particles had lower penetration efficiency compared to fine particles, which is due to differences in infiltration rates and settling velocities between these two size fractions. Our findings suggest that increasing home insulation could be an effective strategy to reduce indoor exposure to crustal particles from dust storm events in residential houses of Kuwait City.

Sand and dust storm trajectories from Iraq Mesopotamian flood plain to Kuwait

Although Kuwait is greatly impacted by sand and dust storms (SDS) from Southern Iraq, to date little is known about the nature of these storms. Kuwait is vulnerable to SDS trajectories from the middle Euphrates region, specifically, from two "hot spot" areas (Al-Batha and Mamlahat Al-Samawah) of 4550 km² located 250 km from its northern border. This study explores the transboundary SDS jets originating from Southern Iraq using Moderate Resolution Imaging Spectroradiometer (MODIS) images obtained from Aqua and Terra satellites over a twelve-year period (2007-2018). Furthermore, an analysis of a 5-day diurnal variation (two days prior, the day of the SDS occurrence, and two days after) explored the hourly patterns of visibility and wind speed, as well as grain size distribution of soil samples to better understand grain size compositions and sediment transport mechanisms. Satellite images confirmed that dust storm jets originated from the "hot spot" in southern Iraq and spread over Kuwait and extended to neighboring Arab Gulf countries as far as Bahrain (900 km) and Qatar (1200 km). In general, the highest wind speed and lowest visibility values were recorded in Northern of Kuwait, with suspended dust sustained for two days following the dust storm. The largest silt and clay fractions (grains ≤63 μm) were identified at the center and west Sabkha region of the "hot spot" area. Very fine sand particles (63-250 μm) were identified within the crescent sand dunes (Barchans) and artificial sand dunes (Al-Fajr). It is recommended that sustainable rehabilitation and land restoration of the "hot spot" area will result in the elimination of the long-range transport of SDS jet streams affecting the downwind Gulf countries.

Health disparities attributable to air pollutant exposure in North Carolina: Influence of residential environmental and social factors

Understanding the environmental justice implications of the mortality impacts of air pollution exposure is a public health priority, as some subpopulations may face a disproportionate health burden. We examined which residential environmental and social factors may affect disparities in the air pollution-mortality relationship in North Carolina, US, using a time-stratified case-crossover design. Results indicate that air pollution poses a higher mortality risk for some persons (e.g., elderly) than others. Our findings have implications for environmental justice regarding protection of those who suffer the most from exposure to air pollution and policies to protect their health.

Nonrenewable energy-environmental and health effects on human capital: empirical evidence from Pakistan

This research work reconnoiters the impact of nonrenewable energy (NRE) consumptions, environmental pollution, and mortality rate on human capital in the presence of economic growth and two common diseases, measles and tuberculosis (TB) in Pakistan. The study uses data from 1995 to 2017 and employs the Autoregressive Distributive Lag (ARDL) model to investigate cointegration and long-run dynamics. Results indicate that nonrenewable energy (oil, coal, and gas) increase air pollution, measles, TB cases, and mortality rate, which affect the human capital in Pakistan. The results of the ARDL confirm the long-run and short-run effects of fossils fuels, air pollution, and diseases on human capital. The results of the Granger Causality confirm the feedback hypothesis between nonrenewable consumption and human capital, between air pollution and human capital. Measles and TB diseases Granger cause human capital. The study recommends some essential points for energy management, environmental management, and diseases control programs to uplift the human capital in Pakistan.