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Zhu W, Al-Kindi SG, Rajagopalan S, Rao X. Air Pollution in Cardio-Oncology and Unraveling the Environmental Nexus: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2024; 6:347-362. [PMID: 38983383 PMCID: PMC11229557 DOI: 10.1016/j.jaccao.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 07/11/2024] Open
Abstract
Although recent advancements in cancer therapies have extended the lifespan of patients with cancer, they have also introduced new challenges, including chronic health issues such as cardiovascular disease arising from pre-existing risk factors or cancer therapies. Consequently, cardiovascular disease has become a leading cause of non-cancer-related death among cancer patients, driving the rapid evolution of the cardio-oncology field. Environmental factors, particularly air pollution, significantly contribute to deaths associated with cardiovascular disease and specific cancers, such as lung cancer. Despite these statistics, the health impact of air pollution in the context of cardio-oncology has been largely overlooked in patient care and research. Notably, the impact of air pollution varies widely across geographic areas and among individuals, leading to diverse exposure consequences. This review aims to consolidate epidemiologic and preclinical evidence linking air pollution to cardio-oncology while also exploring associated health disparities and environmental justice issues.
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Affiliation(s)
- Wenqiang Zhu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Sadeer G Al-Kindi
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Xiaoquan Rao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Ebrahimifakhar A, Poursadegh M, Hu Y, Yuill DP, Luo Y. A systematic review and meta-analysis of field studies of portable air cleaners: Performance, user behavior, and by-product emissions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:168786. [PMID: 38008326 DOI: 10.1016/j.scitotenv.2023.168786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
Indoor air quality is important for the health of building occupants, and public interest in controlling indoor airborne pathogens increased dramatically with the COVID-19 pandemic. Pollutant concentrations can be controlled locally using portable air cleaners (sometimes called air purifiers), which allow occupants to apply air cleaning technology to meet their needs in the location and times that they find appropriate. This paper provides a systematic review of scientific literature that describes field studies of the effectiveness of portable air cleaners. Over 500 papers were considered, and 148 were reviewed in detail, to extract 35 specific research results (e.g., particulate removal performance) or characteristics (e.g., type of building). These were aggregated to provide an overview of results and approaches to this type of research, and to provide meta-analyses of the results. The review includes: descriptions of the geographical location of the research; rate of publications over time; types of buildings and occupants in the field study; types of air cleaner technology being tested; pollutants being measured; resulting pollutant removal effectiveness; patterns of usage and potential barriers to usage by occupants; and the potential for by-product emissions in some air cleaner technologies. An example result is that 83 of the 148 papers measured reductions in fine particulates (PM2.5) and found a mean reduction of 49 % with standard deviation of 20 %. The aggregated results were approximately normally distributed, ranging from finding no significant reduction up to a maximum above 90 % reduction. Sixteen of the 148 papers considered gaseous pollutants, such as volatile organic compounds, nitrogen dioxide, and ozone; 36 papers considered biological pollutants, such as bacteria, viruses, pollen, fungi, etc. An important challenge, common to several studies, is that occupants run the air cleaners for shorter periods and on low airflow rate settings, because of concerns about noise, drafts, and electricity cost, which significantly reduces air cleaning effectiveness.
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Affiliation(s)
- Amir Ebrahimifakhar
- Delos Labs, Delos, New York, NY 10014, USA; Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA.
| | - Mehrdad Poursadegh
- Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA.
| | - Yifeng Hu
- Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA; Buildings and Transportation Science Division, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA.
| | - David P Yuill
- Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA.
| | - Yu Luo
- Department of Applied Physics and Applied Mathematics, Columbia University, 500 W. 120th Street, New York, NY 10027, USA.
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Lin LZ, Chen JH, Yu YJ, Dong GH. Ambient air pollution and infant health: a narrative review. EBioMedicine 2023:104609. [PMID: 37169689 PMCID: PMC10363448 DOI: 10.1016/j.ebiom.2023.104609] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/26/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
The extensive evidence regarding the effects of ambient air pollution on child health is well documented, but limited review summarized their health effects during infancy. Symptoms or health conditions attributed to ambient air pollution in infancy could result in the progression of severe diseases during childhood. Here, we reviewed previous empirical epidemiological studies and/or reviews for evaluating the linkages between ambient air pollution and various infant outcomes including adverse birth outcomes, infant morbidity and mortality, early respiratory health, early allergic symptoms, early neurodevelopment, early infant growth and other relevant outcomes. Patterns of the associations varied by different pollutants (i.e., particles and gaseous pollutants), exposure periods (i.e., pregnancy and postpartum) and exposure lengths (i.e., long-term and short-term). Protection of infant health requires that paediatricians, researchers, and policy makers understand to what extent infants are affected by ambient air pollution, and a call for action is still necessary to reduce ambient air pollution.
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Affiliation(s)
- Li-Zi Lin
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jin-Hui Chen
- School of Public Policy and Management, Tsinghua University, Beijing, 100084, China; High-Tech Research and Development Center, Ministry of Science and Technology, Beijing, 100044, China
| | - Yun-Jiang Yu
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou, 510655, China.
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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Liang X, Liu F, Liang F, Ren Y, Tang X, Luo S, Huang D, Feng W. Association of decreases in PM2.5 levels due to the implementation of environmental protection policies with the incidence of obesity in adolescents: A prospective cohort study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 247:114211. [PMID: 36306623 DOI: 10.1016/j.ecoenv.2022.114211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
AIMS To explore the association between decreased levels of particulate matter (≤2.5 µm; PM2.5) due to the implementation of environmental protection policies and the incidence of obesity in adolescents in Chongqing, China through a prospective cohort study. METHODS A total of 2105 children (52.02% male; aged 7.33 ± 0.60 years at baseline) were enrolled from the Chongqing Children's Health Cohort. A mixed linear regression model was used to analyse the relationships of PM2.5 levels with obesity indicators after adjusting for covariates. Additionally, a Poisson regression model was used to determine the relationship between PM2.5 exposure and the incidence of overweight/obesity. RESULTS The average PM2.5 exposure levels from participant conception to 2014, from 2015 to 2017, and from 2018 to 2019 were 66.64 ± 5.33 μg/m3, 55.49 ± 3.78 μg/m3, and 42.50 ± 1.87 μg/m3, respectively; these levels significantly decreased over time (P < 0.001). Throughout the entire follow-up period, the incidence of overweight/obesity after a ≥ 25 μg/m3 decrease in the PM2.5 level was 4.57% among females; this incidence was the lowest among females who experienced remarkable decreases in PM2.5 exposure. A 1-µg/m3 decrease in the PM2.5 level significantly decreased the body mass index (BMI), BMI z score (BMIz), and weight of adolescents (all P < 0.001). Compared with a < 20-μg/m3 decrease in the PM2.5 level, a ≥ 25-μg/m3 decrease protected against increased BMI (net difference= -0.93; 95% confidence interval [CI]: (-1.23,-0.63) kg/m2), BMIz (-0.28 (-0.39, -0.17)), weight (-1.59 (-2.44, -0.74) kg), and incidence of overweight/obesity (0.48 (0.37, 0.62), P < 0.001). Moreover, compared with a < 20-μg/m3 decrease in the PM2.5 level, a ≥ 25-μg/m3 decrease resulted in significant absolute differences in BMI (-1.26 (-1.56, -0.96) kg/m2), BMIz (-0.53 (-0.65, -0.40)) and weight (-3.01 (-3.8, -2.19) kg) (all P < 0.001). CONCLUSIONS This study showed the etiological relevance of declining PM2.5 concentrations for the incidence of obesity in children and adolescents, suggesting that controlling ambient air pollutants may prevent the development of obesity in this age group. Continuous implementation of environmental protection policies in China has led to substantial health benefits.
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Affiliation(s)
- Xiaohua Liang
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400016, China.
| | - Fangchao Liu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Fengchao Liang
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen 518055, China
| | - Yanling Ren
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400016, China
| | - Xian Tang
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400016, China
| | - Shunqing Luo
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400016, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen 518055, China
| | - Daochao Huang
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400016, China
| | - Wei Feng
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400016, China
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Sensitivity analysis for live birth bias in the Ulaanbaatar Gestation and Air Pollution Research study. Environ Epidemiol 2022; 6:e229. [DOI: 10.1097/ee9.0000000000000229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
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Enkhbat U, Gombojav E, Banzrai C, Batsukh S, Boldbaatar B, Enkhtuya E, Bellinger DC, Lanphear BP, McCandless LC, Allen RW. Portable HEPA filter air cleaner use during pregnancy and children's autistic behaviors at four years of age: The UGAAR randomized controlled trial. ENVIRONMENT INTERNATIONAL 2022; 168:107432. [PMID: 36007302 DOI: 10.1016/j.envint.2022.107432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/22/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Developmental exposure to airborne particulate matter (PM) may increase children's risk of developing autism spectrum disorder. We quantified the impact of reducing PM exposure during pregnancy on the development of autistic traits in children. We also assessed associations between indoor fine PM (PM2.5) concentrations during pregnancy and autistic traits. METHODS In this parallel-group randomized controlled trial, we randomized 540 non-smoking pregnant women to receive HEPA filter air cleaners or to a control group, which did not receive air cleaners. We administered the Social Responsiveness Scale (SRS-2) to caregivers when children were a median of 48 months (range: 48 to 51 months). Our primary outcome was the SRS-2 total T-score. We imputed missing data using multiple imputation with chained equations and our primary analysis was by intention to treat. In secondary analyses, we estimated associations between full pregnancy and trimester-specific indoor PM2.5 concentrations and T-scores. RESULTS We enrolled participants at a median of 11 weeks' gestation. Our analysis included 478 children (233 control, 245 intervention). The intervention reduced average indoor PM2.5 concentrations by 29 % (95 % CI: 21, 37 %). The mean SRS-2 total T-score was 0.5 units lower (95 % CI: -2.5, 1.5) among intervention participants, with evidence of larger benefits for children at the high end of the T-score distribution. An interquartile range (9.6 µg/m3) increase in indoor PM2.5 during pregnancy was associated with 1.8-unit (95 % CI: 0.3, 3.2) increase in mean SRS-2 total T-score. Effect estimates for PM2.5 concentrations by trimester were smaller and confidence intervals spanned no effect. CONCLUSION Reducing indoor PM during pregnancy had little impact on mean autism-related behavior scores in children. However, indoor PM2.5 concentrations during pregnancy were associated with higher scores. Exposure to particulate matter during pregnancy may influence the development of autistic traits in childhood. TRIAL REGISTRATION ClinicalTrials.gov: NCT01741051.
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Affiliation(s)
- Undarmaa Enkhbat
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
| | - Enkhjargal Gombojav
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
| | - Chimeglkham Banzrai
- Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
| | - Sarangerel Batsukh
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Buyantushig Boldbaatar
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
| | - Enkhtuul Enkhtuya
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - David C Bellinger
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | | | - Ryan W Allen
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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Shi X, Zheng Y, Cui H, Zhang Y, Jiang M. Exposure to outdoor and indoor air pollution and risk of overweight and obesity across different life periods: A review. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 242:113893. [PMID: 35917711 DOI: 10.1016/j.ecoenv.2022.113893] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
Due to the highly evolved industrialization and modernization, air quality has deteriorated in most countries. As reported by the World Health Organization (WHO), air pollution is now considered as one of the major threats to global health and a principal risk factor for noncommunicable diseases. Meanwhile, the increasing worldwide prevalence of overweight and obesity is attracting more public attentions. Recently, accumulating epidemiological studies have provided evidence that overweight and obesity may be partially attributable to environmental exposure to air pollution. This review summarizes the epidemiological evidence for the correlation between exposure to various outdoor and indoor air pollutants (mainly particulate matter (PM), nitrogen oxides (NOx), ozone (O3), and polycyclic aromatic hydrocarbons (PAHs)) and overweight and obesity outcomes in recent years. Moreover, it discusses the multiple effects of air pollution during exposure periods throughout life and sex differences in populations. This review also describes the potential mechanism underlying the increased risk of obesity caused by air pollution, including inflammation, oxidative stress, metabolic imbalance, intestinal flora disorders and epigenetic modifications. Finally, this review proposes macro- and micro-measures to prevent the negative effects of air pollution exposure on the obesity prevalence.
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Affiliation(s)
- Xiaoyi Shi
- School of Public Health, Qingdao University, 308 Ningxia Road, Qingdao 266071, China
| | - Yuxin Zheng
- School of Public Health, Qingdao University, 308 Ningxia Road, Qingdao 266071, China
| | - Haiwen Cui
- School of Public Health, Qingdao University, 308 Ningxia Road, Qingdao 266071, China
| | - Yuxi Zhang
- School of Public Health, Qingdao University, 308 Ningxia Road, Qingdao 266071, China
| | - Menghui Jiang
- School of Public Health, Qingdao University, 308 Ningxia Road, Qingdao 266071, China.
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The Effects of Indoor Air Filter on Reductions in PM2.5 Associated Health Risks of Respiratory Function in Mouse. ATMOSPHERE 2022. [DOI: 10.3390/atmos13071005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
This study aimed to assess whether protective measures could reduce the health risks of air pollution in mice living in the chambers situated at a suburban site in Beijing. The living chambers of mice were divided into four groups: male mice with and without the high-efficiency particulate air (HEPA) filter (male group A and group B), as well as female mice with and without the HEPA filter (female group A and group B). The experiment was carried out from 1 December 2017 to 31 May 2018. Parameters of respiratory function during periods of clean air and air pollution were determined for all groups to evaluate the role of the indoor air filter (i.e., HEPA) in protection against respiratory health risks in mice. Significant differences in minute volumes were observed in male and female groups with versus without the HEPA. Additionally, respiratory health parameters including respiratory rate, duration of breaking, expiratory time, and relaxation time exhibited differences in female groups with HEPA versus without HEPA. Levels of inflammatory factors in the lungs were measured for all groups after 6months of exposure. Greater mean levels of IL-6 and TNF-α were found in the male groups without HEPA than in those with HEPA. Higher average concentrations of IL-6, T-AOC, SOD, GSH-Px, LDH, TNF-α, and TGF-β1 were found in the female group without HEPA than those without HEPA. Our study has proved the effective protection provided by indoor air filters (i.e., HEPA filters) in reducing respiratory health risks associated with PM2.5.
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