Air pollution and asthma attacks in children: A case-crossover analysis in the city of Chongqing, China

Association between short-term exposure to ambient air pollutants and the risk of hospital visits for acute upper respiratory tract infections among adults: a time-series study in Ningbo, China

OBJECTIVES

Acute upper respiratory tract infections (AURTIs) are prevalent in the general population. However, studies on the association of short-term exposure to air pollution with the risk of hospital visits for AURTIs in adults are limited. This study aimed to explore the short-term exposure to air pollutants among Chinese adults living in Ningbo.

METHODS

Quasi-Poisson time serious regressions with distributed lag non-linear models (DLNM) were applied to explore the association between ambient air pollution and AURTIs cases. Patients ≥ 18 years who visit three hospitals, being representative for urban, urban-rural junction and rural were included in this retrospective study.

RESULTS

In total, 104,441 cases with AURTIs were enrolled in hospital during 2015-2019. The main results showed that particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5), nitrogen dioxide (NO2) and nitrogen dioxide (SO2), were positively associated to hospital visits for AURTIs, except for nitrogen dioxide (O3), which was not statistically significant. The largest single-lag effect for PM2.5 at lag 8 days (RR = 1.02, 95%CI: 1.08-1.40), for NO2 at lag 13 days (RR = 1.03, 95%CI: 1.00-1.06) and for SO2 at lag 5 days (RR = 1.27, 95%CI: 1.08-1.48), respectively. In the stratified analysis, females, and young adults (18-60 years) were more vulnerable to PM2.5 and SO2 and the effect was greater in rural areas and urban-rural junction.

CONCLUSIONS

Exposure to ambient air pollution was significantly associated with hospital visits for AURTIs. This study provides epidemiological evidence for policymakers to control better air quality and establish an enhanced system of air pollution alerts.

Short-Term Nitrogen Dioxide Exposure and Emergency Hospital Admissions for Asthma in Children: A Case-Crossover Analysis in England

Background

There is an increasing body of evidence associating short-term ambient nitrogen dioxide (NO2) exposure with asthma-related hospital admissions in children. However, most studies have relied on temporally resolved exposure information, potentially ignoring the spatial variability of NO2. We aimed to investigate how daily NO2 estimates from a highly resolved spatio-temporal model are associated with the risk of emergency hospital admission for asthma in children in England.

Methods

We conducted a time-stratified case-crossover study including 111,766 emergency hospital admissions for asthma in children (aged 0-14 years) between 1st January 2011 and 31st December 2015 in England. Daily NO2 levels were predicted at the patients' place of residence using spatio-temporal models by combining land use data and chemical transport model estimates. Conditional logistic regression models were used to obtain the odds ratios (OR) and confidence intervals (CI) after adjusting for temperature, relative humidity, bank holidays, and influenza rates. The effect modifications by age, sex, season, area-level income deprivation, and region were explored in stratified analyses.

Results

For each 10 µg/m³ increase in NO2 exposure, we observed an 8% increase in asthma-related emergency admissions using a five-day moving NO2 average (mean lag 0-4) (OR 1.08, 95% CI 1.06-1.10). In the stratified analysis, we found larger effect sizes for male (OR 1.10, 95% CI 1.07-1.12) and during the cold season (OR 1.10, 95% CI 1.08-1.12). The effect estimates varied slightly by age group, area-level income deprivation, and region.

Significance

Short-term exposure to NO2 was significantly associated with an increased risk of asthma emergency admissions among children in England. Future guidance and policies need to consider reflecting certain proven modifications, such as using season-specific countermeasures for air pollution control, to protect the at-risk population.

Investigation analysis of the acute asthma risk factor and phenotype based on relational analysis with outdoor air pollutants in Xi'an, China

Asthma is a common chronic heterogeneous disease. Outdoor air pollutants are an important cause of acute asthma. Until now, the association between the risk of acute asthma and outdoor air pollutants is unclear. And the relationship between the different phenotypes of asthma and outdoor air pollutants has not been reported. Thus, an analysis of the association between outdoor air pollutants and daily acute asthma inpatient and outpatient visits in Xi'an, China, from January 1 to December 31, 2018, was conducted. A total of 3395 people were included in the study. The statistical analysis and relational analysis based on the logistic regression were used for illustrating the relatedness of the acute asthma risk factor and phenotype with outdoor air pollutants, while the age, gender, pollen peak and non-pollen peak periods, high type 2 (T2) asthma and non-high T2 asthma were also stratified. Results showed that particulate matter with particle size below 10 μm and 2.5 μm (PM10 and PM2.5), sulfur dioxide(SO2), nitrogen dioxide(NO2), and carbon monoxide(CO) increase the risk of acute asthma and that air pollutants have a lagged effect on asthma patients. PM10, NO2, CO, and Ozone (O3) are associated with an increased risk of acute attacks of high T2 asthma. PM10, PM2.5, SO2, NO2 and CO are associated with an increased risk of acute asthma in males of 0-16 years old. PM10 and PM2.5 are more harmful to asthma patients with abnormal lung function.

Impact of air pollution changes and meteorology on asthma outpatient visits in a megacity in North China Plain

The effects of air pollution and meteorology on asthma is less studied in North China Plain. In the last decade, air quality in this region is markedly mitigated. This study compared the short-term effects of air pollutants on daily asthma outpatient visits (AOV) within different sex and age groups from 2014 to 2016 and 2017-2019 in Tianjin, with the application of distributed lag nonlinear model. Moreover, relative humidity (RH) and temperature as well as the synergistic impact with air pollutants were assessed. Air pollutants-associated risk with linear (different reference values were used) and non-linear assumptions were compared. In 2014-2016, PM10 and PM2.5 exhibited a larger impact on AOV, with the corresponding cumulative excess risks (ER) for every 10 μg/m3 increase at 1.04 % (95%CI:0.67-1.40 %, similarly hereafter) and 0.79 % (0.35-1.23 %), as well as increased to 43 % (26-63 %) and 20 % (10-31 %) at severe pollution. In 2017-2019, NO2 and MDA8 O3 exhibited a larger impact on AOV, with a cumulative ER for every 10 μg/m3 increase at 1.0 (0.63-1.4 %) and 0.36 % (0.15-0.57 %), with corresponding values of 7.9 % (4.8-11 %) and 5.6 % (2.3-9.0 %), at severe pollution. SO2 associated risk was only significant from 2014 to 2016. Cold effect, including extremely low temperature exposure and sharp temperature drop could generate a pronounced increase in AOV at 9.6 % (3.8-16 %) and 24 % (9.1-41 %), respectively. Moderate low temperature combined with air pollutants can enhance AOV during winter. Higher temperature in spring and autumn could trigger asthma by increasing pollen levels. Low RH resulted in AOV increase by 4.6 % (2.4-6.9), while higher RH generated AOV increase by 3.4 % (1.6-5.3). Females, children, and older adults tended to have a higher risk for air pollution, non-optimum temperature, and RH. As air pollution-associated risks on AOV tends to be weaker due to air quality improvement in recent years, the impact of extreme meteorological condition amidst climate change on asthma visits warrants further attention.

Effects of air pollution on emergency visits for acute otitis media among children: a case-crossover study in Chongqing, China

Background

Many epidemiological studies have demonstrated the short-term effects of air pollution on acute otitis media (AOM) in children, but few studies have explored the association between AOM and air pollution in Chinese children. This study aimed to analyze the effects of air pollution on emergency visits for AOM among children through a time-stratified case-crossover design in Chongqing, China.

Methods

The outpatient medical records of children from nine main urban districts who presented with AOM between December 22, 2018 and December 21, 2021 were collected from the Children's Hospital of Chongqing Medical University. Data for air pollution variables, including the air quality index (AQI), particulate matter ≤ 10 μm (PM10), PM2.5, SO2, CO, NO2 and O3 from 17 monitoring sites were collected. Data for meteorological factors as confounding variables also were collected. Conditional logistic regression was used to analyze the data with single-pollutant models, multi-pollutant models, and stratified analyses.

Results

Increases in AQI, PM10, PM2.5, SO2, CO and NO2 were positively associated with emergency visits for AOM among children in single-pollutant models and stratified analyses. Increases in PM10, SO2, CO and NO2 were positively associated with emergency visits for AOM among children in multi-pollutant models. NO2 had the most statistically significant OR values in all models, whereas significant effects of O3 were observed only in seasonal stratification. In single-pollutant models, we found that the best lag periods were lag 0-7 for air pollution variables except for O3 and the largest OR values were 1.185 (95%CI: 1.129-1.245) for SO2 in single-pollutant models. In stratified analyses, there were no difference between groups in these statistically significant OR values through gender and age stratification, while the differences between seasons in these OR values of PM10, SO2, CO, NO2 and O3 were statistically significant. Children aged 0 years and 3-5 years represented the most susceptible population, and among the seasons, susceptibility was greater during Winter and Spring.

Conclusion

Short-term exposure to air pollution can increase emergency visits for AOM among children in Chongqing, China.

Breathing zone pollutant levels are associated with asthma exacerbations in high-risk children

Background

Indoor and outdoor air pollution levels are associated with poor asthma outcomes in children. However, few studies have evaluated whether breathing zone pollutant levels associate with asthma outcomes.

Objective

Determine breathing zone exposure levels of NO 2 , O 3 , total PM 10 and PM 10 constituents among children with exacerbation-prone asthma, and examine correspondence with in-home and community measurements and associations with outcomes.

Methods

We assessed children's personal breathing zone exposures using wearable monitors. Personal exposures were compared to in-home and community measurements and tested for association with lung function, asthma control, and asthma exacerbations.

Results

81 children completed 219 monitoring sessions. Correlations between personal and community levels of PM 10 , NO 2 , and O 3 were poor, whereas personal PM 10 and NO 2 levels correlated with in-home measurements. However, in-home monitoring underdetected brown carbon (Personal:79%, Home:36.8%) and ETS (Personal:83.7%, Home:4.1%) personal exposures, and detected black carbon in participants without these personal exposures (Personal: 26.5%, Home: 96%). Personal exposures were not associated with lung function or asthma control. Children experiencing an asthma exacerbation within 60 days of personal exposure monitoring had 1.98, 2.21 and 2.04 times higher brown carbon (p<0.001), ETS (p=0.007), and endotoxin (p=0.012), respectively. These outcomes were not associated with community or in-home exposure levels.

Conclusions

Monitoring pollutant levels in the breathing zone is essential to understand how exposures influence asthma outcomes, as agreement between personal and in-home monitors is limited. Inhaled exposure to PM 10 constituents modifies asthma exacerbation risk, suggesting efforts to limit these exposures among high-risk children may decrease their asthma burden.

CLINICAL IMPLICATIONS

In-home and community monitoring of environmental pollutants may underestimate personal exposures. Levels of inhaled exposure to PM 10 constituents appear to strongly influence asthma exacerbation risk. Therefore, efforts should be made to mitigate these exposures.

CAPSULE SUMMARY

Leveraging wearable, breathing-zone monitors, we show exposures to inhaled pollutants are poorly proxied by in-home and community monitors, among children with exacerbation-prone asthma. Inhaled exposure to multiple PM 10 constituents is associated with asthma exacerbation risk.

Spatial variance and estimation of nitrogen dioxide levels as a contributing factor to asthma epidemiology in Rawalpindi, Pakistan

Asthma prevalence and morbidity are increasing rapidly worldwide, especially in developing countries. Previous studies have shown nitrogen dioxide as an important contributor to asthma prevalence along with extreme temperatures, relative humidity, and land use change. The present study aimed to assess the asthma epidemiology and association of nitrogen dioxide, temperature, and land use as a contributing factor for increasing asthma prevalence in Rawalpindi, Pakistan. Secondary data related to the frequency of asthmatics hospital visits were analyzed to figure out the hotspots of asthma by using Getis ord Gi* statistics in ArcGIS 10.2. Moreover, intraurban variation of nitrogen dioxide concentration was analyzed by passive sampling method and its association with the rate of asthmatics hospital visits in Rawalpindi, Pakistan was also researched. Results revealed the random distribution of disease with significant hotspots along with spatial variability of nitrogen dioxide in urban and rural locations. Indoor and outdoor levels of nitrogen dioxide exceed the national and world health organization standards on asthma high risk areas especially in winter season. Congested housing with poor ventilation, unplanned urbanization, cold temperature, and unclean fuel use are revealed as strong determinants of asthma prevalence in Rawalpindi, Pakistan. Extensive monitoring and interventions are needed for the reduction of both indoor and outdoor nitrogen dioxide levels to overcome the increasing rate of asthma prevalence.

Long-term spatiotemporal evolution and coordinated control of air pollutants in a typical mega-mountain city of Cheng-Yu region under the "dual carbon" goal

Clarifying the spatiotemporal distribution and impact mechanism of pollution is the prerequisite for megacities to formulate relevant air pollution prevention and control measures and achieve carbon neutrality goals. Chongqing is one of the dual-core key megacities in Cheng-Yu region and as a typical mountain-city in China, environmental problems are complex and sensitive. This research aims to investigate the exceeding standard levels and spatio-temporal evolution of criteria pollutants between 2014 and 2020. The results indicated that PM10, PM2.5, CO and SO2 were decreased significantly by 45.91%, 52.86%, 38.89% and 66.67%, respectively. Conversely, the concentration of pollutant O3 present a fluctuating growth and found a "seesaw" phenomenon between it and PM. Furthermore, PM and O3 are highest in winter and summer, respectively. SO2, NO2, CO, and PM showed a "U-shaped", and O3 showed an inverted "U-shaped" seasonal variation. PM and O3 concentrations are still far behind the WHO, 2021AQGs standards. Significant spatial heterogeneity was observed in air pollution distribution. These results are of great significance for Chongqing to achieve "double control and double reduction" of PM2.5 and O3 pollution, and formulate a regional carbon peaking roadmap under climate coordination. Besides, it can provide an important platform for exploring air pollution in typical terrain around the world and provide references for related epidemiological research.Implications: Chongqing is one of the dual-core key megacities in Cheng-Yu region and as a typical mountain city, environmental problems are complex and sensitive. Under the background of the "14th Five-Year Plan", the construction of the "Cheng-Yu Dual-City Economic Circle" and the "Dual-Carbon" goal, this article comprehensively discussed the annual and seasonal excess levels and spatiotemporal evolution of pollutants under the multiple policy and the newest international standards (WHO,2021AQG) backgrounds from 2014 to 2020 in Chongqing. Furthermore, suggestions and measures related to the collaborative management of pollutants were discussed. Finally, limitations and recommendations were also put forward.Clarifying the spatiotemporal distribution and impact mechanism of pollution is the prerequisite for cities to formulate relevant air pollution control measures and achieve carbon neutrality goals. This study is of great significance for Chongqing to achieve "double control and double reduction" of PM2.5 and O3 pollution, study and formulate a regional carbon peaking roadmap under climate coordination and an action plan for sustained improvement of air quality.In addition, this research can advanced our understanding of air pollution in complex terrain. Furthermore, it also promote the construction of the China national strategic Cheng-Yu economic circle and build a beautiful west. Moreover, it provides scientific insights for local policymakers to guide smart urban planning, industrial layout, energy structure, and transportation planning to improve air quality throughout the Cheng-Yu region. Finally, this is also conducive to future scientific research in other regions of China, and even megacities with complex terrain in the world.

Intraday exposure to ambient ozone and emergency department visits among children: a case-crossover study in southern China

Most existing studies have investigated short-term associations between ozone exposure and acute disease events among children at a daily timescale, which might neglect risk effects happening within several hours after ozone exposure. In this research, we aimed to depict intraday associations between pediatric emergency department visits (PEDVs) and exposure to ozone in order to better detect ultra-short-term effects of ozone exposure on children. We obtained hourly data of all-cause PEDVs, air pollutants, and meteorological factors in Shenzhen and Guangzhou, China, 2015-2018. We applied time-stratified case-crossover design and conditional logistic regression models to estimate odds ratios per 10-μg/m³ rise of ozone concentrations at various exposure periods (e.g., 0-3, 4-6, 7-12, 13-24, 25-48, and 49-72 h) prior to PEDVs, controlling for hourly relative humidity and temperature. Subgroup analyses divided by gender, age, and season were undertaken to identify the potential susceptible population and period. A total of 358,285 cases of PEDVs were included in two cities, and hourly average concentration of ozone was 45.5 μg/m³ in Guangzhou and 58.9 μg/m³ in Shenzhen, respectively. Increased risks of PEDVs occurred within a few hours (0-3 h) after exposure to ozone and remained up to 48 h. Population risks for PEDVs increased by 0.8% (95% confidence interval, 0.6 to 1.0) in Shenzhen and 0.7% (0.5 to 0.9) in Guangzhou for a 10-μg/m³ increase in ozone concentrations at lag 4-6 h and lag 7-12 h, respectively. These findings were robust to co-exposure adjustments in our sensitivity analyses. Significantly greater ozone-associated risks were consistently observed during cold months (October to March of the following year) in both cities, while we did not identify evidence for effect modification of children's age and gender. This study provided novel evidence for increased risks of acute disease events among children within several hours after ozone exposure, highlighting the significant implications for policymakers to establish hourly air quality standards for better protecting children's health.

Spatio-temporal patterns and trends of the air pollution integrating MERRA-2 and in situ air quality data over Egypt (2013-2021)

For best-informed decision-making to improve climate change adaptation and reduce present and future air pollution health hazards, it is essential to identify major trends in spatiotemporal air quality patterns of common air contaminants. This study examined the patterns and trends of SO2, NO2, CO, O3, and particulate matter (PM) air pollutants over 91 monitoring stations in Egypt during 93 months in the August (2013)-April (2021) period. In situ data with their monthly, seasonal, and yearly spatial trends are defined and used to validate the counterpart satellite reanalysis MERRA-2 data. The Mann-Kendall test characterized the seasonal monotonic trends and their Sen's slope, and annual change rate for both data series. Regression analysis of MERRA-2 against in situ concentrations of SO2 and PM10 revealed underestimation with RMSE values of 13.38 g m-3 and 69.46 g m-3, respectively. Local plumes with variable magnitudes characterized distinct industrial places clarified by patterns of in situ pollutants. As a result of the COVID-19 lockdown, the in situ air pollutants showed a considerable regional decline in the yearly average in 2020 compared to the years before. The in situ air pollutants showed annual trends far more significant than those seen in the MERRA-2 data. The shortcomings of the few and spatiotemporal discontinuities of the in situ contaminants are addressed by MERRA-2 air quality products. The in situ data made trends and magnitudes clear that were hidden in their MERRA-2 counterparts. The results clarified air pollution patterns, trends, and spatial variability over Egypt that are essential for climate risk management and for reducing environmental/health concerns.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11869-023-01357-6.

Investigating the associations between organophosphate flame retardants (OPFRs) and fine particles in paired indoor and outdoor air: A probabilistic prediction model for deriving OPFRs in indoor environments

Contaminants of emerging concern such as organophosphate flame retardants (OPFRs) are associated with atmospheric fine particles (PM_2.5), which pose the greatest health risk in the world. However, few surveys have explored the interaction between PM_2.5 and OPFRs in residential paired indoor/outdoor environments. 11 priority OPFRs and PM_2.5 were investigated across 178 paired indoor and outdoor air samples taken from 89 children's households in southern Taiwan, across cold and warm seasons. This involved exploring their associations with building characteristics, interior materials, and human activities. We developed a probabilistic predictive model for indoor OPFRs based on the indoor/outdoor (I/O) ratio of contaminants and an air quality index. The significant associations of paired indoor/outdoor OPFRs and PM_2.5 were explored. The indoor level of OPFRs was greater than that of outdoor households, contrasting with PM_2.5. The I/O OPFRs ratio was higher than 1 (except for TEHP, EHDPP, and TCP), which suggests that the sources of OPFRs were primarily emitted from indoors. Indoor TCEP was significantly positively associated with indoor and outdoor PM_2.5. The OPFR level detected in apartments was higher than in houses due to the greater decoration, furniture and electronic devices. However, this was not the case for PM_2.5. TCIPP was the dominant compound in paired indoor and outdoor air. The indoor OPFR predictive model obtained a high accuracy with an R² value of 0.87. The material used in mattresses, the use of purifiers and heaters, and the total material area were the main influencing factors for indoor OPFRs in households. These findings could provide important evidence of the interaction between paired indoor/outdoor OPFRs and PM_2.5 and interior equipment in different building types. In addition, it could prevent the potential risks posed by indoor/outdoor air pollutants and eliminate OPFR emissions through the selection of better construction and building materials.

Comparison of the association between different ozone indicators and daily respiratory hospitalization in Guangzhou, China

Background

Epidemiological studies have widely proven the impact of ozone (O₃) on respiratory mortality, while only a few studies compared the association between different O₃ indicators and health.

Methods

This study explores the relationship between daily respiratory hospitalization and multiple ozone indicators in Guangzhou, China, from 2014 to 2018. It uses a time-stratified case-crossover design. Sensitivities of different age and gender groups were analyzed for the whole year, the warm and the cold periods. We compared the results from the single-day lag model and the moving average lag model.

Results

The results showed that the maximum daily 8 h average ozone concentration (MDA8 O₃) had a significant effect on the daily respiratory hospitalization. This effect was stronger than for the maximum daily 1 h average ozone concentration (MDA1 O₃). The results further showed that O₃ was positively associated with daily respiratory hospitalization in the warm season, while there was a significantly negative association in the cold season. Specifically, in the warm season, O₃ has the most significant effect at lag 4 day, with the odds ratio (OR) equal to 1.0096 [95% confidence intervals (CI): 1.0032, 1.0161]. Moreover, at the lag 5 day, the effect of O₃ on the 15-60 age group was less than that on people older than 60 years, with the OR value of 1.0135 (95% CI: 1.0041, 1.0231) for the 60+ age group; women were more sensitive than men to O₃ exposure, with an OR value equal to 1.0094 (95% CI: 0.9992, 1.0196) for the female group.

Conclusion

These results show that different O₃ indicators measure different impacts on respiratory hospitalization admission. Their comparative analysis provided a more comprehensive insight into exploring associations between O₃ exposure and respiratory health.

Associations between Different Ozone Indicators and Cardiovascular Hospital Admission: A Time-Stratified Case-Crossover Analysis in Guangzhou, China

Epidemiological studies reported that ozone (O₃) is associated with cardiovascular diseases. However, only few of these studies examined the impact of multiple O₃ indicators on cardiovascular hospital admissions. This study aimed to explore and compare the impacts of different O₃ indicators on cardiovascular hospital admissions in Guangzhou, China. Based upon the data on daily cardiovascular hospital admissions, air pollution, and meteorological factors in Guangzhou from 2014 to 2018, a time-stratified case-crossover design model was used to analyze the associations between different O₃ indicators and cardiovascular hospital admissions. Moreover, the sensitivities of different age and gender groups were analyzed for the whole year and different seasons (i.e., warm and cold). During the warm season, for the single-pollutant model, the odds ratio (OR) value of cardiovascular hospital admissions was 1.0067 (95% confidence interval (CI): 1.0037, 1.0098) for every IQR increase in MDA8 O₃ at a lag of five days. The effect of O₃ on people over 60 year was stronger than that on the 15-60 years age group. Females were more sensitive than males to O₃ exposure. These results provided valuable references for further scientific research and environmental improvement in Guangzhou. Given that short-term O₃ exposure poses a threat to human health, the government should therefore pay attention to prevention and control policies to reduce and eliminate O₃ pollution and protect human health.

Effects of transboundary PM2.5 transported from China on the regional PM2.5 concentrations in South Korea: A spatial panel-data analysis

This study identifies causal links between a high-PM2.5 episode in Korea and air pollutants originating from China during a high-PM2.5 episode that occurred in Korea between February 23 and March 12, 2019. Datasets on ground-based PM2.5 levels in Korea and China, airflows from the back-trajectory models, and satellite images were investigated, and long-range transboundary transport (LRTT) effects were statistically analyzed using spatial panel-data models. The findings are: 1) visual presentations of the observed PM2.5 concentration in China and Korea, back-trajectory air flows, and satellite images from the Moderate Resolution Imaging Spectroradiometer Aerosol Optical Depth and the Copernicus Atmosphere Monitoring Service clearly show that transboundary air pollutants from China affect PM2.5 concentration in Korea; 2) the effect of LRTT from China is likely to intensify under certain meteorological conditions, such as westerly winds from China to Korea, the formation of high pressure in China and low pressure in Korea, relatively high temperature, and stagnant air flow in Korea; 3) the results from the spatial panel-data models provide statistical evidence of the positive effect of LRTT from China on increasing local PM2.5 concentration in Korea. The nationwide average LRTT contributions to PM2.5 concentration in Korea are 38.4%, while regional contributions are 41.3% for the Seoul Metropolitan Area, 38.6% for the northwest region, and 27.5% for the southeast regions in Korea, indicating the greatest impact on the Seoul Metropolitan Area.

Effect of Acute PM2.5 Exposure on Lung Function in Children: A Systematic Review and Meta-Analysis

Objective

The objective of this study was to conduct a systematic review and meta-analysis to identify the adverse effects of acute PM2.5 exposure on lung function in children.

Design

Systematic review and meta-analysis. Setting, participants and measures: Eligible studies analyzing PM2.5 level and lung function in children were screened out. Effect estimates of PM2.5 measurements were quantified using random effect models. Heterogeneity was investigated with Q-test and I² statistics. We also conducted meta-regression and sensitivity analysis to explore the sources of heterogeneity, such as different countries and asthmatic status. Subgroup analyses were conducted to determine the effects of acute PM2.5 exposure on children of different asthmatic status and in different countries.

Results

A total of 11 studies with 4314 participants from Brazil, China and Japan were included finally. A 10 μg/m³ increase of PM2.5 was associated with a 1.74L/min (95% CI: -2.68, -0.90) decrease in peak expiratory flow (PEF). Since the asthmatic status and country could partly explain the heterogeneity, we conducted the subgroup analysis. Children with severe asthma were more susceptible to PM2.5 exposure (-3.11 L/min per 10 μg/m³ increase, 95% CI -4.54, -1.67) than healthy children (-1.61 L/min per 10 μg/m³ increase, 95% CI -2.34, -0.91). In the children of China, PEF decreased by 1.54 L/min (95% CI -2.33, -0.75) with a 10 μg/m³ increase in PM2.5 exposure. In the children of Japan, PEF decreased by 2.65 L/min (95% CI -3.82, -1.48) with a 10 μg/m³ increase of PM2.5 exposure. In contrast, no statistic association was found between every 10 μg/m³ increase of PM2.5 and lung function in children of Brazil (-0.38 L/min, 95% CI -0.91, 0.15).

Conclusion

Our results demonstrated that the acute PM2.5 exposure exerted adverse impacts on children's lung function, and children with severe asthma were more susceptible to the increase of PM2.5 exposure. The impacts of acute PM2.5 exposure varied across different countries.

Association between sub-daily exposure to ambient air pollution and risk of asthma exacerbations in Australian children

Short-term exposure to ambient air pollution is associated with risk of asthma attacks. We investigated the association between ultra-short-term exposure to air pollution and risk of childhood asthma exacerbations. Hourly data on emergency department visits (EDVs) for asthma in children during 2013-2015 in Brisbane, Australia, were obtained. We undertook time-stratified case-crossover analyses to examine the hourly association between exposure to air pollutants (particles with diameter ≤10 μm (PM₁₀), particles with diameter ≤2.5 μm (PM_2.5), ozone (O₃), and nitrogen dioxide (NO₂)) and risk of EDVs for asthma after controlling for temperature, relative humidity, public holidays and circulating levels of influenza and respiratory syncytial virus. Risk of EDVs for asthma increased within a few hours after exposure to O₃ (odds ratio [OR]: 1.170, 95% confidence interval (CI): 1.003-1.365) or NO₂ (OR: 1.359, 95%CI: 1.049-1.760). The association between O₃ exposure and risk of EDVs for asthma was stronger in boys (OR: 1.244, 95%CI: 1.025-1.511) than that in girls (OR: 1.055, 95%CI: 0.818-1.361). The association between NO₂ exposure and risk of EDVs for asthma was stronger in school-age children [OR ranged from 1.376 (95%CI: 1.044-1.813) to 3.607 (95%CI: 1.552-8.385) across different lags] than that in preschool-age children, whereas the association between PM₁₀ exposure and risk of EDVs for asthma was greater in preschool-age children [OR ranged from 1.873 (95%CI: 1.022-3.433) to 1.878 (95%CI: 1.028-3.431)] than that in school-age children. We observed an association of risk of EDVs for asthma with daytime air pollution exposure, but not with night-time air pollution exposure. This study suggests that risk of childhood asthma exacerbations increases within a few hours of air pollution exposure.

The Association Between Air Pollutants and Daily Outpatient Visits for Allergic Rhinitis: A Time-Series Analysis Based on Distribution Lag Nonlinear Model in Chongqing, China

Background

Allergic rhinitis (AR) is a severe and the most common chronic allergic disease, affecting 10-40% of the world population. The effect of air pollutants on AR has been confirmed in clinical experiments.

Purpose

This study aimed to quantify the association between air pollutants and daily outpatient visits for AR in Chongqing, China.

Methods

Based on the data of AR outpatients in the primary urban area of Chongqing from 2016 to 2017, along with the atmospheric pollutants and meteorological data in the same period, the distributed lag nonlinear model (DLNM) and generalized additive model (GAM) were used to analyze the time-series. We examined the effects of the single and double pollutant models with a maximum lag day of 30 days. Effect estimates were described as relative risk (RR) and 95% confidence intervals (CIs) in daily outpatient visits for AR per 10 μg/m³ increases in PM_2.5, PM₁₀, SO₂, NO₂, O₃, and per 1 mg/m³ increase in CO.

Results

A single pollutant's O₃ level had an immediate positive effect on AR within two days, the relative risks (RR, 95% CI) were 1.066 (1.008-1.127), 1.057 (1.005-1.112) and 1.048 (1.002-1.097). PM_2.5 had a lag effect within 11-18 days, the max relative risks (RR, 95% CI) were 1.083 (1.010-1.160). Moreover, O₃, PM_2.5, PM₁₀, SO₂ and NO₂ had significant effects on AR in the two-pollutant model. The RR cumulative effect of PM_2.5 became more pronounced as the concentration increased. The cumulative effect of NO₂ was lesser than PM_2.5.

Conclusion

Air pollutants were associated with the daily outpatient visits for AR, which may have considerable implications for developing tailored health policies and services to prevent AR in Chongqing and even all over the world.

The association between short-term exposure to ambient carbon monoxide and hospitalization costs for bronchitis patients: A hospital-based study

Ambient carbon monoxide (CO) is associated with bronchitis morbidity, but there is no evidence concerning its correlation with hospitalization costs for bronchitis patients. This study aimed to investigate the relationship between short-term ambient CO exposure and hospitalization costs for bronchitis patients in Chongqing, China. Baseline data for 3162 hospitalized bronchitis patients from November 2013 to December 2019 were collected. Multiple linear regression analysis was used to determine the association, delayed and cumulative, between short-term CO exposure and hospitalization costs. Additionally, subgroup analyses were performed by gender, age, season, and comorbidity. Positive association between CO and hospitalization costs for bronchitis patients was observed. The strongest association was observed at lag 015 days, with per 1 mg/m³ increase of CO concentrations corresponded to 5834.40 Chinese Yuan (CNY) (95% CI: 2318.71, 9350.08; P < 0.001) (845.97 US dollars) increment in hospitalization costs. Stratified analysis results showed that the association was more obvious among those males, elderly, with comorbidities, and in warm seasons. More importantly, there was strongest correlation between CO and bronchitis patients with coronary heart disease. In summary, short-term exposure to ambient CO, even lower than Chinese and WHO standards, can be associated with increased hospitalization costs for bronchitis. Controlling CO exposure can be helpful to reduce medical burden associated with bronchitis patients. The results also suggest that when setting air quality standards and formulating preventive measures, susceptible subpopulations ought to be considered.

Children's exposure to air pollution in a natural gas industrial area and their risk of hospital admission for respiratory diseases

The rapid expansion of the natural gas industry to meet the global demand have raised environmental health concerns. Few studies have found that areas with natural gas industrial activity have poor air quality. However, the negative health impacts of ambient air pollution in a natural gas industrial area remain unclear. This study aimed to explore the relationship between short-term exposure to air pollution and hospital admissions for respiratory diseases among children in a natural gas industrial area in Bintulu, Malaysia. Daily hospital admissions for respiratory diseases among children were collected from a hospital in Bintulu from 2010 to 2019. Data on six air pollutants (PM₁₀, PM_2.5, SO₂, NO₂, O₃, and CO) in the study area were obtained from the Department of Environment Malaysia. Quasi-Poisson time series regressions with distributed lag non-linear models (DLNM) were applied to explore the associations between ambient air pollution and childhood hospitalisations for respiratory diseases. Stratification analyses were performed by gender and age group to identify the vulnerable populations. A 10 μg/m³ increased PM_2.5 and SO₂ was associated with hospital admissions for respiratory diseases among children with the greatest relative risk of RR 1.089 (95% CI 1.001-1.183) at cumulative lag 0-2 days and RR 1.229 (95% CI 1.073-1.409) at cumulative lag 0-6 days, respectively. There was no significant association between short-term exposure of PM₁₀, NO₂, CO, and O₃ with childhood respiratory hospitalisation. The association between PM_2.5 and SO₂ exposure and hospital admissions for childhood respiratory diseases in the two pollutants model remained statistically significant. There were stronger associations in younger children aged 0-4 years and girls. This study reveals that short-term exposure to SO₂ was associated with a higher risk of respiratory hospitalisations among children in Bintulu than PM_2.5. Better air quality control is necessary for children's health living in the natural gas industrial area.

Increased Risk of Hospital Admission for Asthma in Children From Short-Term Exposure to Air Pollution: Case-Crossover Evidence From Northern China

Background: Previous studies suggested that exposure to air pollution could increase risk of asthma attacks in children. The aim of this study is to investigate the short-term effects of exposure to ambient air pollution on asthma hospital admissions in children in Beijing, a city with serious air pollution and high-quality medical care at the same time.

Methods: We collected hospital admission data of asthma patients aged ≤ 18 years old from 56 hospitals from 2013 to 2016 in Beijing, China. Time-stratified case-crossover design and conditional Poisson regression were applied to explore the association between risk of asthma admission in children and the daily concentration of six air pollutants [particulate matter ≤ 2.5 μm (PM_2.5), particulate matter ≤ 10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃)], adjusting for meteorological factors and other pollutants. Additionally, stratified analyses were performed by age, gender, and season.

Results: In the single-pollutant models, higher levels of PM_2.5, SO₂, and NO₂ were significantly associated with increased risk of hospital admission for asthma in children. The strongest effect was observed in NO₂ at lag06 (RR = 1.25, 95%CI: 1.06-1.48), followed by SO₂ at lag05 (RR = 1.17, 95%CI: 1.05–1.31). The robustness of effects of SO₂ and NO₂ were shown in two-pollutant models. Stratified analyses further indicated that pre-school children (aged ≤ 6 years) were more susceptible to SO₂. The effects of SO₂ were stronger in the cold season, while the effects of NO₂ were stronger in the warm season. No significant sex-specific differences were observed.

Conclusions: These results suggested that high levels of air pollution had an adverse effect on childhood asthma, even in a region with high-quality healthcare. Therefore, it will be significant to decrease hospital admissions for asthma in children by controlling air pollution emission and avoiding exposure to air pollution.

[Short-term effects and seasonal variation of ozone on daily hospital outpatient visits for childhood asthma in Lanzhou]

OBJECTIVE

To analyze the effects of ozone (O₃) concentrations measured with different approaches across different seasons on the total number of childhood asthma-related clinical visits, as well as the differentiation of such effects across different groups of patients.

METHODS

The outpatient data of three grade A tertiary hospitals in Lanzhou City spanning from 1 January 2014 to 31 December 2017, as well as air pollution and meteorological data during the same period were collected. Considering the nonlinear relationship between O₃ concentrations and the total number of childhood asthma-related clinical visits and meteorological factors, a generalized additive temporal sequence model was employed to analyze the short-term association between changes in O₃ concentrations and the total number of childhood asthma-related clinical visits. Taking into account of the variations in O₃ concentrations within 1 day, this study adopted different measurement approaches to address the three types of O₃ exposures, namely, the maximum 1 h daily concentration (O₃max1h), the maximum 8 h daily concentration (O₃8h) and the mean 24 h daily concentration (O₃24h) as the short term exposure indicators to O₃, followed by a model-based analysis.

RESULTS

The increase in short-term exposure levels to O₃ in summer had a significant effect on the increase in the total number of childhood asthma-related clinical visits. With lag0 for the current day, every 10 μg/m³ increase in atmospheric concentration of O₃max1h was associated with an increase in the total number of childhood asthma-related clinical visits by 3.351% (95%CI: 1.231%-5.516%); for every 10 μg/m³ increase in O₃8h concentration, the total number of childhood asthma-related clinical visits increased by 3.320% (95%CI: 0.197%-3.829%); for every 10 μg/m³increase in O₃24h concentration, the total number of childhood asthma-related clinical visits in summer increased by 6.600% (95%CI: 0.914%-12.607%); moreover, an increase in exposure to O₃max1h also led to a significant rise in the total number of childhood asthma-related clinical visits among the males.

CONCLUSION

The increase in short-term exposure levels to O₃ in summer in Lanzhou City has a significant effect on the increase in the total number of childhood asthma-related clinical visits; O₃max1h is more closely correlated with the increase in the total number of childhood asthma-related clinical visits.

Exploring the Spatiotemporal Evolution and Socioeconomic Determinants of PM2.5 Distribution and Its Hierarchical Management Policies in 366 Chinese Cities

From 2013 to 2017, progress has been made by implementing the Air Pollution Prevention and Control Action Plan. Under the background of the 3 Year Action Plan to Fight Air Pollution (2018–2020), the pollution status of PM2.5, a typical air pollutant, has been the focus of continuous attention. The spatiotemporal specificity of PM2.5 pollution in the Chinese urban atmospheric environment from 2018 to 2020 can be summarized to help conclude and evaluate the phased results of the battle against air pollution, and further, contemplate the governance measures during the period of the 14th Five-Year Plan (2021–2025). Based on PM2.5 data from 2018 to 2020 and taking 366 cities across China as research objects, this study found that PM2.5 pollution has improved year by year from 2018 to 2020, and that the heavily polluted areas were southwest Xinjiang and North China. The number of cities with a PM2.5 concentration in the range of 25–35 μg/m³ increased from 34 in 2018 to 86 in 2019 and 99 in 2020. Moreover, the spatial variation of the PM2.5 gravity center was not significant. Concretely, PM2.5 pollution in 2018 was more serious in the first and fourth quarters, and the shift of the pollution's gravity center from the first quarter to the fourth quarter was small. Global autocorrelation indicated that the space was positively correlated and had strong spatial aggregation. Local Moran's I and Local Geti's G were applied to identify hotspots with a high degree of aggregation. Integrating national population density, hotspots were classified into four areas: the Beijing–Tianjin–Hebei region, the Fenwei Plain, the Yangtze River Delta, and the surrounding areas were selected as the key hotspots for further geographic weighted regression analysis in 2018. The influence degree of each factor on the average annual PM2.5 concentration declined in the following order: (1) the proportion of secondary industry in the GDP, (2) the ownership of civilian vehicles, (3) the annual grain planting area, (4) the annual average population, (5) the urban construction land area, (6) the green space area, and (7) the per capita GDP. Finally, combined with the spatiotemporal distribution of PM2.5, specific suggestions were provided for the classified key hotspots (Areas A, B, and C), to provide preliminary ideas and countermeasures for PM2.5 control in deep-water areas in the 14th Five-Year Plan.

Review of Ground-Level Ozone Impact in Respiratory Health Deterioration for the Past Two Decades

Background: Ground-level ozone has been gaining notoriety with increasing evidence of its nefarious effects on health, especially respiratory diseases. Where do we stand on the solidity of this data and is there room for improvement? Objectives: Evaluate this evidence for incongruities or heterogeneity in this field of research. How is the exposure assessment conducted, where does Portugal stand in this field, and what can be improved? Health deterioration concerning asthma, chronic obstructive pulmonary disease (COPD), and acute respiratory distress syndrome (ARDS) are analysed. Methods: A review of 1735 studies was conducted through PubMed and Google Scholar engines for the past two decades. We identified 59 eligible studies and included an array of variables, including O3 measurements, number of air-quality monitoring stations used, relative risks, odds ratios, hazard ratios, number of hospital admissions, visits, or mortality, and size of population dataset used. Results: Approximately 83% of data in this review presents significant correlations of ozone with asthma, COPD, and ARDS. Studies that report negative or not significant associations mention a lack of data or topographic differences as the main issue with these divergent results. Studies consistently report summer as a period of particular concern. Portuguese data in this field is lacking. Conclusions: This research field is growing in interest and there is evidence that ozone plays a non-negligible role in health deterioration. The few Portuguese studies in this field seem aligned with the literature reviewed but more research is needed. Suggested improvements are more and better data through denser air-quality networks to accurately depict personal exposure to ozone. Homogenization of the exposure assessment concerning averaging times of ozone to daily maximum 8 h averages whenever possible. Risk increments based on 10 ppb instead of interquartile ranges. Lastly, contrary to some studies in this review, the topographic effect on concentrations and health deterioration should not be underestimated and seasonality should always be checked.

Fresh Air–Natural Microclimate Comfort Index: A New Tourism Climate Index Applied in Chinese Scenic Spots

Severe air pollution in China has caused significant tourism transformation for pursuing fresh air in microclimate tourism markets. Contemporary practices simply measure the air freshness of destinations and scenic spots using a single index, i.e., primarily negative oxygen ions (O2−). This index cannot comprehensively reveal scenic spots’ air freshness degree and determine the dynamic interactions between air freshness and scenic spots’ tourism development, thus inducing an illusion of air freshness for the target scenic spots. Meanwhile, the current fresh air index primarily ignores connections with the microclimate index of scenic spots and cannot provide a multidimensional index for scenic spots to take advantage of both air and microclimate resources for diverse tourism products and service production. Therefore, this study proposes a multidimensional index, the fresh air–natural microclimate comfort index (FAI-NMCI), connecting the fresh air index with the natural microclimate comfort index of scenic spots together from transdisciplinary and multidisciplinary perspectives. This study utilizes FAI-NMCI to measure four scenic spots of Fujian Province, and reveals in-depth results of scenic spots’ air freshness and natural microclimate comfort degree together. The results demonstrate that the four scenic spots in Fujian province of China had different levels of air freshness degree and natural microclimate comfort degree in 2018. The natural scenic spots were mostly distributed in Healing Fresh, Very Fresh, and Super Fresh levels of FAI with the most comfortable and comfortable levels of NMCI. The cultural scenic spots were mostly distributed in Relatively Fresh and Healing Fresh levels of FAI with the most comfortable and comfortable levels of NMCI. Meanwhile, the FAI-NMCI of natural and cultural scenic spots also had significant differences within 24 Jieqi, which will promote dynamic and creative utilization of those resources in microclimate tourism development.

Communicating respiratory health risk among children using a global air quality index

Air pollution poses a serious threat to children's respiratory health around the world. Satellite remote-sensing technology and air quality models can provide pollution data on a global scale, necessary for risk communication efforts in regions without ground-based monitoring networks. Several large centers, including NASA, produce global pollution forecasts that may be used alongside air quality indices to communicate local, daily risk information to the public. Here we present a health-based, globally applicable air quality index developed specifically to reflect the respiratory health risks among children exposed to elevated outdoor air pollution. Additive, excess-risk air quality indices were developed using 51 different coefficients derived from time-series health studies evaluating the impacts of ambient fine particulate matter, nitrogen dioxide, and ozone on children's respiratory morbidity outcomes. A total of four indices were created which varied based on whether or not the underlying studies controlled for co-pollutants and in the adjustment of excess risks of individual pollutants. Combined with historical estimates of air pollution provided globally at a 25 × 25 km² spatial resolution from the NASA's Goddard Earth Observing System composition forecast (GEOS-CF) model, each of these indices were examined in a global sample of 664 small and 140 large cities for study year 2017. Adjusted indices presented the most normal distributions of locally-scaled index values, which has been shown to improve associations with health risks, while indices based on coefficients controlling for co-pollutants had little effect on index performance. We provide the steps and resources need to apply our final adjusted index at the local level using freely-available forecasting data from the GEOS-CF model, which can provide risk communication information for cities around the world to better inform individual behavior modification to best protect children's respiratory health.

Assessing short-term impacts of PM2.5 constituents on cardiorespiratory hospitalizations: Multi-city evidence from China

Apart from concentrations of particulate mass, PM_2.5-associated effects on health may largely depend on its chemical components. However, little is known regarding the underlying effects of specific PM_2.5 constituents. The study included nearly 1 million hospital admissions from five Chinese cities during 2015-2017. Based on the modified Community Multiscale Air Quality model, our study simulated daily concentrations of PM_2.5 and five main components. We used a time-stratified case-crossover design with conditional logistic regression models to estimate short-term effects of PM_2.5 constituents on cause-specific hospital admissions. Per interquartile range increase in exposure to PM_2.5, elemental carbon, organic carbon, nitrate, sulfate and ammonium at lag 04-day was related to an excess risk (ER%) for non-accidental admissions of 1.6% [95% confidence interval: 1.1-2.0], 1.9% [1.3-2.4], 1.0% [0.5-1.6], 1.2% [0.4-2.0], 1.2% [0.9-1.5] and 1.4% [0.9-1.9], respectively. Great heterogeneities of constituents-admission associations existed in diverse causes and constituents. This study provided multi-center high-quality evidence that hospital admissions, particularly those for ischemic heart disease (ER% ranging from 2.3 to 5.4% at lag 04-day) and pneumonia (1.9-5.1% at lag 4-day), could be triggered by short-term exposures to ambient PM_2.5 constituents. Relatively stronger constituents-admission associations were found among females for respiratory causes and the elderly for cardiovascular causes.

An association between PM2.5 and pediatric respiratory outpatient visits in four Chinese cities

BACKGROUND

The effects of exposure to particulate matter with aerodynamic diameter less than 2.5 μm (PM_2.5) on children's respiratory system were investigated in numerous epidemiological literatures. However, studies on the association between PM_2.5 and pediatric outpatient visits for respiratory diseases, especially considering the multicenter studies were limited in China.

OBJECTIVES

To study the association between the short-term exposure to PM_2.5 and the number of children's outpatient visits for respiratory diseases in four Chinese cities as well as the pooled health effects.

METHODS

Data of pediatric outpatient visits for respiratory diseases (RD, ICD: J00-J99) from representative hospitals in Shijiazhuang (SJZ), Xi'an (XA), Nanjing (NJ) and Guangzhou (GZ) in China from 2015 to 2018 were collected and the air quality data for the same period were collected from environmental protection departments. Generalized additive model (GAM) with quasi-Poisson regression was conducted to analyze the effects of PM_2.5 on the number of pediatric outpatient visits in each city. Single-day lag model (lag0 to lag7) and moving average lag model (lag01 and lag07) were used to examine the lag effects and cumulative effects. Random-effects meta-analysis was used to pool the estimated risks of four cities. The interactions between PM_2.5 and temperature were also explored.

RESULTS

The average daily/total outpatient visits for RD, in SJZ, XA, NJ and GZ from 2015 to 2018 were 854.2/1,245,384, 2353.9/3,439,025, 1267.2/1,851,438 and 1399.5/2,044,740 respectively. The percentages of acute upper respiratory infections (URD, ICD: J00-J06) and other acute lower respiratory infections (LRD, ICD: J20-J22) in RD were 33%, 13% (SJZ), 43%, 32% (XA), 26%, 21% (NJ) and 54%, 26% (GZ). The largest pooled estimates of single-day lag effects for RD, URD, and LRD were at lag0, lag0 and lag1. Every 10 μg/m³ increase in PM_2.5 concentration was associated with a 0.46% (95%CI: 0.21%-0.70%), 0.50% (95%CI: 0.19%-0.81%) and 0.42% (95%CI: 0.06%-0.79%) increased number of outpatient visits significantly. While max cumulative effects which were all at lag 07 were 1.10% (95%CI: 0.46%-1.74%), 0.96% (95%CI: 0.20%-1.73%) and 1.06% (95%CI: 0.12%-2.00%). Less polluted cities (GZ and NJ) showed greater city-specific excess risks, but the excess risks significantly decreased after adjusting for NO₂ in two-pollutant models. Generally, PM_2.5 showed larger health hazards on lower temperature days.

CONCLUSIONS

Our study showed that exposure to the ambient PM_2.5 was associated with the increase of the number of outpatient visits with pediatric respiratory diseases in four Chinese cities. The health effects of PM_2.5 may not be independent of other air pollutants and could be modified by temperature.

Effects of Air Pollutants on Airway Diseases

Air pollutants include toxic particles and gases emitted in large quantities from many different combustible materials. They also include particulate matter (PM) and ozone, and biological contaminants, such as viruses and bacteria, which can penetrate the human airway and reach the bloodstream, triggering airway inflammation, dysfunction, and fibrosis. Pollutants that accumulate in the lungs exacerbate symptoms of respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). Asthma, a heterogeneous disease with complex pathological mechanisms, is characterized by particular symptoms such as shortness of breath, a tight chest, coughing, and wheezing. Patients with COPD often experience exacerbations and worsening of symptoms, which may result in hospitalization and disease progression. PM varies in terms of composition, and can include solid and liquid particles of various sizes. PM concentrations are higher in urban areas. Ozone is one of the most toxic photochemical air pollutants. In general, air pollution decreases quality of life and life expectancy. It exacerbates acute and chronic respiratory symptoms in patients with chronic airway diseases, and increases the morbidity and risk of hospitalization associated with respiratory diseases. However, the mechanisms underlying these effects remain unclear. Therefore, we reviewed the impact of air pollutants on airway diseases such as asthma and COPD, focusing on their underlying mechanisms.

EKC Test of the Relationship between Nitrogen Dioxide Pollution and Economic Growth-A Spatial Econometric Analysis Based on Chinese City Data

During the just concluded 13th Five-Year Plan, China continued to maintain the momentum of rapid economic development, but still faced environmental pollution problems caused by this. Finding the relationship between Nitrogen Dioxide pollution and economic development is helpful and significant in better achieving and optimizing sustainable environmental development. Taking China’s 333 prefecture-level cities as samples from 2016 to 2018, the spatial lag model (SAR) was used to study the impact of economic growth on urban Nitrogen Dioxide pollution. The results show that Nitrogen Dioxide has strong positive characteristics of spatial spillover, but there is a linear relationship between economic growth and Nitrogen Dioxide concentration that slowly rises, and there is no inverted U-shaped relationship, which does not support the Environmental Kuznets Curve (EKC) hypothesis; The results also show the impact of per capita GDP, natural gas consumption, residential natural gas consumption, industrialization, and transportation development on the increase of Nitrogen Dioxide concentration, and the impact of green coverage on the decrease of Nitrogen Dioxide concentration. However, there is no significant relationship between technological investment and Nitrogen Dioxide concentration. The above conclusions are still valid after the robustness test, and recommendations are put forward to reduce Nitrogen Dioxide pollution.

Seasonal and areal variability in PM2.5 poses differential degranulation and pro-inflammatory effects on RBL-2H3 cells

PM_2.5 pollution is a widespread environmental and health problem, particularly in China. Besides leading to well-known diseases in the respiratory system, PM_2.5 can also alter immune function to induce or aggravate allergic diseases. To determine whether there are temporal and spatial differences in the allergic responses to PM_2.5, monthly samples were collected from four regions (urban, industrial, suburban, and rural areas) through a whole year in Nanjing city, China. Inorganic chemical components (metals and water-soluble ions) of PM_2.5 were analyzed, and the rat basophil cells (RBL-2H3) exposed to PM_2.5 were assessed through quantitative measures of degranulation (β-hex and histamine) and pro-inflammation cytokine (IL-4 and TNF-α) expression. The highest levels of β-hex were measured in winter and spring PM_2.5 from urban and industrial areas, or autumn PM_2.5 from suburban and rural areas. With respect to histamine, autumn PM_2.5 samples were most potent irrespective of the location. Autumn and winter PM_2.5 induced higher levels of IL-4 than spring and summer samples. However, spring and autumn PM_2.5 caused higher levels of TNF-α. The concentrations of water-soluble ions (NH₄⁺, K⁺ and Cl^-), as well as heavy metals (Pb and Cr), were directly and statistically correlated to the inflammation observed in vitro. In general, the differences between regional and seasonal PM_2.5 in stimulating cell degranulation may depend on endotoxin and airborne allergen content of PM_2.5. The heavy metals and water-soluble ions in PM_2.5 were mostly anthropogenic, which increased the particles' mass-based cellular inflammatory potential, therefore, their health risks, e.g. from vehicular exhaust, coal, and biomass combustion, cannot be ignored.

Air pollution-related asthma profiles among children/adolescents: A multi-group latent class analysis

BACKGROUND

This study aimed to investigate the asthma profile among children/adolescents and the relationship of the prevalence of air pollution profiles using latent class analysis (LCA).

OBJECTIVES

In this cross-sectional study, a case rural community was selected in an industrial area, and two rural control communities were selected in unexposed areas.

METHODS

Hourly concentrations of PM₁₀, SO₂, NO_2, and total volatile organic compounds were obtained from the records of a fixed air quality monitoring station, and the concentrations of benzene, toluene, xylenes styrene were measured during six campaigns. Asthma data was collected using the International Study of Asthma and Allergies in Childhood in 7-18 years old children/adolescents. The modeling was conducted using LCA.

RESULTS

A higher amount of air pollution indices were observed in the case than both control communities. LCA divided the participants into three clusters; "healthy" (92.8%), "moderate" (2.8%), and "severe" (4.4%). A higher probability of severe asthma (6.8%) was observed in the case than control communities (2.6% and 1.8%). Additionally, after adjusting for possible confounders, the odds of asthma was lower in the control communities than the case in both moderate and sever classes (Odds Ratios in the range of 0.135-0.697).

CONCLUSIONS

This study indicates asthma profiles of children/adolescents and the higher prevalence of severe class in the area, explaining the possible effect of air pollution.

The short-term association of ambient fine particulate air pollution with hypertension clinic visits: A multi-community study in Guangzhou, China

BACKGROUND

The association of ambient fine particulate pollution with daily outpatient clinic visits (OCV) for hypertension in China remains to be investigated.

OBJECTIVES

This study aimed to examine short-term impacts of exposure to fine particulate matter of aerodynamic diameter < 2.5μm (PM_2.5) on daily OCV for hypertension, using a large-scale multi-center community database in Guangzhou, one of the most densely-populated cities in Southern China.

METHODS

We collected a total of 28,548 individual records of OCV from 22 community healthcare facilities in Guangzhou from January 1st to May 7th 2020. Hourly data on air pollutants and daily information on meteorological factors were obtained. According to the World Health Organization air-quality guidelines, daily excessive concentration hours (DECH) was calculated. PM_2.5 daily mean, hourly-peak concentration and DECH were used as the exposure variables. Based on a case-time-control design, the Cox regression model was applied to evaluate the short-term relative risks (RR) of daily OCV for hypertension. Sensitivity analyses were conducted, with nitrogen dioxide, sulfur dioxide, carbon monoxide, and ozone being adjusted.

RESULTS

Daily mean and hourly-peak of PM_2.5 were significantly associated with daily OCV for hypertension, while weaker associations were observed for DECH. The estimated RRs at lag day 0 were 1.039 (95% confidence interval [CI]: 1.037, 1.040), 1.851 (95%CI: 1.814, 1.888), and 1.287 (95%CI: 1.276, 1.298), respectively, in association with a 1-unit increase in DECH, daily mean, and hourly-peak concentration of PM_2.5. For the lagged effect, lag₄ models estimated the greatest RRs for PM_2.5 DECH and hourly-peak, whereas a lag₂ model produced the highest for PM_2.5 daily mean.

DISCUSSION

This study consolidates the evidence for a positive correlation between ambient PM_2.5 exposure and risks of hypertensive OCV. It also provides profound insight regarding planning for health services needs and establishing early environmental responses to the worsening air pollution in the communities.

Effects of ambient air pollution on childhood asthma exacerbation in the Philadelphia metropolitan Region, 2011-2014

Fine particulate matter (PM_2.5) and ozone (O₃) air pollutants are known risk factors for asthma exacerbation. We studied the association of these air pollutants with pediatric asthma exacerbation in the Philadelphia metropolitan region, and evaluated potential effect modification by children's characteristics (e.g., race/ethnicity, atopic conditions) and environmental factors (e.g., neighborhood tree canopy, meteorological factors, aeroallergens). We conducted a time-stratified case-crossover study of 54,632 pediatric (age ≤18 years) asthma exacerbation cases occurring from 2011 to 2014, identified through electronic health records (EHR) of the Children's Hospital of Philadelphia (CHOP) health system. We applied conditional logistic regression to estimate associations between air pollution and asthma exacerbation, using daily census-tract level pollutant concentrations estimated from the EPA Fused Air Quality Surface Using Downscaling (FAQSD) files. The associations were estimated within warm (Apr-Sep) and cold (Oct-Mar) months for unlagged exposure and for cumulative effects up to 5 days after exposure, with adjustment for temperature, relative humidity, and holidays. We found small increases in odds of asthma exacerbation with higher pollutant concentrations, with positive associations (OR, comparing concentrations of 75th to 25th percentile) observed for PM_2.5 during both warm (1.03, 95% CI: 0.98-1.08) and cold months (1.05, 95% CI: 1.02-1.07), and for O₃ during cold months (1.08, 95% CI: 1.02-1.14). The exposure-response relationship with PM_2.5 during the cold months was essentially linear, whereas thresholds of effect were observed for the other associations at low-medium pollutant concentrations. Results were robust to multi-pollutant modeling and adjustment for additional covariates. We found no effect modification by most children's characteristics, while effect sizes were higher on days with detected tree and grass pollens during warm months. Our results suggest that even small decreases in pollutant concentrations could potentially reduce risk of childhood asthma exacerbation - an important finding, given the high burden of childhood asthma and known disparities in asthma control.

Outdoor air pollution and the onset and exacerbation of asthma

Exposure to outdoor air pollution has been consistently associated with asthma. In this study, we reviewed the epidemiological studies published within the last 5 years on the association between outdoor air pollution and exacerbation and onset of asthma. A large number of studies have been published within the last 5 years. Short-term exposure to outdoor air pollution is associated with exacerbation of pre-existing asthma, manifested as worsening of symptoms and increasing of asthma-related emergency room visits and hospital admissions. Furthermore, increasing evidence suggests that long-term exposure to outdoor air pollution can result in onset of asthma. Children are more susceptible to outdoor air pollution. Future studies should be conducted to explore the mechanisms underlying the association between air pollutants and onset of asthma, including gene involvement. In addition, disentangling the effect of a mixture of air pollutants and identifying the key components of air pollution will complete the existing evidence. More importantly, a better understanding is required on the future impact of air pollution on asthma under a changing climate.

Impact of atmospheric pollution on asthma and bronchitis based on lichen biomonitoring using IAP, IHI and GIS in Algiers Bay (Algeria)

We investigated the association between air pollution and asthma and bronchitis hospital admissions in Algiers city (Algeria). In addition, we used geographic information systems (GIS) and statistical methods to evaluate their correlation with the atmospheric pollution estimated by the lichen biomonitoring method of the index of atmospheric purity (IAP), the index of human impact (IHI) and environmental parameters. Thus, we georeferenced 976 local patients (including 771 patients with asthma and 205 patients with bronchitis). Then, we compared the patients to the spatial distribution of IAP in thirty-five areas (communities). The results revealed a significant difference in the mean spatial variation in the diseases among those areas. In fact, maps and generalized linear models (GLMs) revealed a significant negative correlation between IAP and diseases. Therefore, redundancy analysis (RDA) and Monte Carlo tests described a significant effect of IAP, urbanization and the number of roads on the distribution of diseases. We hope our findings contribute to enriching the literature on health research with a low-cost method of monitoring outdoor air pollution.

Source-specific contributions of particulate matter to asthma-related pediatric emergency department utilization

Ambient particulate matter smaller than 2.5 μm (PM_2.5) is associated with different chronic diseases. It is crucial to identify the sources of ambient particulate matter to reduce the impact on health. Still, only a few studies have been linked with specific ambient particulate matter sources. In this study, we estimated the contributions of sources of PM_2.5 and examined their association with daily asthma hospital utilization in Cincinnati, Ohio, USA. We used a model-based clustering method to group days with similar source-specific contributions into six distinct clusters. Specifically, elevated PM_2.5 concentrations occurring on days characterized by low coal combustion contributions showed a significantly reduced risk of hospital utilization for asthma (rate ratio: 0.86, 95% CI: [0.77, 0.95]) compared to other clusters. Reducing coal combustion contribution to PM_2.5 levels could be an effective intervention for lowering asthma-related hospital utilization.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13755-021-00141-z.

Ambient air pollutants and hospital visits for pneumonia: a case-crossover study in Qingdao, China

Background

Pneumonia is one of the principal reasons for incidence and death in the world. The former research mainly concentrated on specific sources of patients. Besides, due to the heterogeneity among regions, there are inconsistencies in the outcome of these surveys. To explore the relationship between atmospheric pollution and hospital visits for pneumonia under the climate and pollution conditions in Qingdao, we carried out this study.

Methods

The medical records of pneumonia patients were gathered from the affiliated hospital of Qingdao University during Jan 1st, 2014, and Dec 31st,2018. Daily concentrations of PM_2.5, PM₁₀, SO₂, NO₂, as well as CO, were collected from the national air quality monitoring stations in Qingdao. Case-crossover study design and conditional logistic regression model were used to estimate the associations. Daily temperature, relative humidity, and atmospheric pressure were adjusted as the covariates in all models. A principal component analysis was used to solve the multicollinearity between atmospheric pollutants and investigate the relationship between various air pollutants and pneumonia occurs.

Results

In the single pollutant model, with interquartile range increment of the density of PM_2.5, PM₁₀, NO₂ and SO₂ at the lag2 days, the odds ratio of hospital visits for pneumonia patients increased by 6.4% (95%CI, 2.3–10.7%), 7.7% (95%CI, 3.2–12.4%), 6.7% (95%CI, 1.0–12.7%), and 7.2% (95%CI, 1.1–13.5%). Stratified analysis showed that pollutants were more significant in the cold period. Besides, the impact of atmospheric particulates on different ages mainly occurs in the young child (0 to 3-year-old). The odds ratio was 1.042 (95%CI, 1.012–1.072) when the principal components of atmospheric pollutants were included in the conditional logistic model.

Conclusions

Our study found a significant relationship between short-term uncovering to PM_2.5, PM₁₀, NO₂, SO₂, and hospital visits for pneumonia in Qingdao. The effect of atmospheric pollutants mainly arose in a cold period. The particulate matter might be the principal reason in inducing hospital visits for pneumonia.

Associations of short-term exposure to air pollution and emergency department visits for pediatric asthma in Shanghai, China

There is limited evidence regarding the relationship between air pollution and pediatric asthma in developing countries. This study aimed to investigate the association between short-term exposure to ambient air pollutants and pediatric asthma emergency department (ED) visits in Shanghai, China. We collected data on six criteria air pollutants (PM_2.5, PM₁₀, NO₂, SO₂, CO, and O₃) and daily ED visits for pediatric asthma patients from 66 hospitals in Shanghai from 2016 to 2018. The generalized additive model combined with polynomial distributed lag model was applied to explore the associations. We fitted two-pollutant models and stratified the analyses by sex, age, and season. In total, we identified 108,817 emergency department visits for pediatric asthma. A 10 μg/m³ increase in the concentrations of PM_2.5, NO₂, SO₂, and O₃ was significantly associated with increased risks of pediatric asthma ED visits, with relative risk of pediatric asthma of 1.011 [95% confidence interval (CI): 1.002, 1.021], 1.030 (95%CI: 1.017, 1.043), 1.106 (95%CI: 1.041, 1.174), and 1.009 (95%CI: 1.001, 1.017), respectively. The associations of NO₂ remained robust in the two-pollutant models. There were stronger associations for older children (6-18 years) and in warm seasons. The concentration-response curves for pediatric asthma and PM_2.5, NO₂, SO₂, and O₃ were steeper at lower and moderate concentrations but became flatter at higher concentrations. This analysis provided evidence that short-term exposure to air pollutants (PM_2.5, NO₂, SO₂, and O₃) could increase the risk of asthma exacerbations among children, and health benefits would be gained from improved air quality.

Assessing NO2-related health effects by non-linear and linear methods on a national level

Exposure to NO₂ pollution has a significant adverse effect on residents' health. However, few studies have assessed the health effects associated with NO₂ pollution. Compared with PM_2.5 pollution, the harmfulness of NO₂ pollution has not been quantitatively studied or clearly identified. In this study, we assessed the NO₂ exposure-related health effects by non-linear and linear methods, taking advantage of online monitoring and survey data. We also assessed the economic cost of NO₂ pollution in 338 cities in China. Our results showed that the average annual concentration of NO₂ in the top fifteen cities with more than ten million permanent residents (except for Shenzhen, in the Guangdong province) exceeded the annual Grade II standards (40 μg/m³). The estimated national NO₂-related all-cause mortality for non-linear and linear methods were 388.5 × 10³ (95% CI: 198.1 × 10³-748.2 × 10³) and 374.1 × 10³ (95% CI: 194.3 × 10³-695.9 × 10³), respectively. The total calculated national economic cost was about 28.8 billion US$ (95% CI: 14.7-55.4) in 2016. In addition, the comparison results showed that the harm caused by PM_2.5 pollution was about four times that of NO₂ pollution. Our statistics contribute to the limited research on NO₂ pollution's effects on health and the economy in China.

The Impact of Air Pollution on Intestinal Microbiome of Asthmatic Children: A Panel Study

Air pollution could impact on the alteration of intestinal microbiome. Maturation of intestinal microbiome in early life played an important role in the development of allergic diseases, including asthma. Recent studies presented an increase in the evidence of association between the shift of gut microbiota and asthma. This article is aimed at exploring whether the alteration in the intestinal microbiome triggered by a short wave of air pollution could influence the colonization of bacteria that have been related to the immunological mechanisms of the asthma attack. The impact of air pollution on intestinal microbiome was assessed by longitudinal comparison. Fecal samples were collected twice for twenty-one children in clean and smog days, respectively, including eleven asthmatic children and ten healthy children. Intestinal bacteria were discriminated by using the method of 16S rRNA gene sequence. The results showed that the composition of intestinal microbiome changed between clean and smog days among all children (PERMANOVA, P = 0.03). During smog days, Bifidobacteriaceae, Erysipelotrichaceae, and Clostridium sensu stricto 1 decreased, and Streptococcaceae, Porphyromonadaceae, Rikenellaceae, Bacteroidales S24-7 group, and Bacteroides increased in asthmatic children (Wilcoxon test, P < 0.05), while Fusicatenibacter decreased and Rikenellaceae and Terrisporobacter increased in healthy children (Wilcoxon test, P < 0.05). After controlling for food consumption, the relative abundance of some bacteria belonging to Firmicutes negatively associated with concentration of PM_2.5, PM₁₀, NO₂, and SO₂ (multiple linear regression, P < 0.05). This study demonstrated that short wave of air pollution had an impact on the intestinal microbiome of asthmatic children. Intestinal bacteria, which have been related to immunological mechanisms of asthma attack, were also found to be associated with air pollution. This finding suggested that a short wave of air pollution may trigger asthma by impacting on intestinal bacteria.

Association between air pollutants and outpatient and emergency hospital visits for childhood asthma in Shenyang city of China

Effects of air pollution on asthma vary in different study areas, and long-term time series research on the effects of air pollution on asthma outpatients and emergency hospital visits has not been conducted in Northeast China. We assessed the impact of air pollutants on the risk of asthma outpatients and emergency hospital visits in Shenyang, China. A distributed lag non-linear model with a Poisson regression was used to assess the short-term effects of air pollutants on asthma outpatient and emergency hospital visits between January 1, 2013 and December 31, 2017. Confounding factors were adjusted using natural cubic splines. Ozone (O₃), carbon monoxide (CO), and suspended particulates < 10 μm in aerodynamic diameter (PM₁₀) were positively associated with the number of asthma hospital visits. The largest cumulative effects of O₃, CO, and PM₁₀ on hospital visits were on lag day 2 (RR = 1.163, 95% CI 1.051-1.287) for 0-5-year-old childhood asthma, on lag day 3 (RR = 1.386, 95% CI 1.136-1.69) for asthma in winter, and on lag day 10 (RR = 1.148, 95% CI 0.942-1.399) for female asthma, respectively. The cumulative effect of air pollution represented by the air quality index (AQI) was largest on lag day 10 for 0-5-year-old childhood asthma with an increase of 28.6% (95% CI 6.5-55.4) hospital visits every IQR increment of the AQI. CO, O₃, and PM₁₀ were the main air pollutants in Shenyang city. Children with bronchitis asthma were more vulnerable to air pollution during the cold season.

The heterogeneous effect of socioeconomic driving factors on PM2.5 in China's 30 province-level administrative regions: Evidence from Bayesian hierarchical spatial quantile regression

China has become one of the most serious PM_2.5-dominated air pollution country. Despite a great deal of research has focused on analysing the influence of social and economic driving forces of PM_2.5 pollution in China, most research in existence either applying mean regression or failing to consider the spatial autocorrelation. Motivated by this, this paper utilizes a Bayesian hierarchical spatial quantile regression method to explore the effect of socioeconomic activity on PM_2.5 air pollution. By introducing spatial random effects into the model, the spatial autocorrelations of residuals are significantly reduced. The empirical study demonstrated that the PM_2.5 concentration levels were strongly correlated with total population, urbanization rate, industrialization level and energy efficiency at all quantiles. For upper quantiles, the impact of urbanization rate on the haze is the greatest among all the predictors, then followed by the total population; while for lower quantiles, industrialization has the greatest impact on the PM_2.5 concentration. The impacts of energy efficiency in the lower 15% and upper 15% quantiles are higher compared to any of the other quantiles.

Adolescent Haze-Related Knowledge Level Study: A Cross-Sectional Survey With Sensitivity Analysis

Objective: This study aimed to investigate the level of haze-related knowledge adolescents have and to explore relevant influencing factors. Methods: From June 2015 to January 2016, researchers randomly selected 2 districts from the 20 districts of Baoding, China. Then, researchers randomly selected two middle schools from two districts. By conducting a stratified cluster sampling and considering one class as a unit, researchers randomly selected, from the other middle school, five first-grade classes, five second-grade classes, five third-grade classes from the one middle school, and three first-grade classes, two second-grade classes, and two third-grade classes. Finally, 1,100 adolescents were investigated by using the demographic questionnaire and the Adolescent Haze-Related Knowledge Awareness Assessment Scale (AHRKAAS). Multiple linear regressions were conducted to explore factors affecting the adolescent haze-related knowledge. Sensitivity analysis was used to confirm associations between influencing factors and AHRKAAS scores. Results: The AHRKAAS score rate was 69.9%. The dimension of human factors of haze formation was the highest (score rate = 85.6%). The dimension of haze harms on the human body was the lowest (score rate = 57.1%). Compared with the group (monthly expenses <300 yuan), the group (monthly expenses ≥ 600 yuan) had a higher AHRKAAS score (β = 4.882, 95% CI: 0.979, 8.784). Compared with the group (Do not live with parents), the group (Live with parents) had a higher AHRKAAS score (β = 14.675, 95% CI: 9.494, 19.855). Compared with the group (Never undergo a physical examination), the group (Once a year) (β = 7.444, 95% CI: 2.922, 11.966) and the group (A few times a year) (β = 7.643, 95% CI: 2.367, 12.919) had a higher AHRKAAS score. Compared with the group (Know nothing), the group (Know most) (β = 9.623, 95% CI: 2.929, 16.316) and the group (Know very well) (β = 15.367, 95% CI: 7.220, 23.515) had a higher AHRKAAS score. These associations were still reliable and consistent in different sensitivity analysis models. Conclusion: The level of adolescent haze-related knowledge is low and is affected by monthly expenses, living condition, physical examination frequency, and knowledge of respiratory system diseases. Government bodies, schools, and research institutions should strengthen cooperation of health publicity and health education to improve adolescent haze-related knowledge.

Effect of Ambient Air Pollution on Hospital Readmissions among the Pediatric Asthma Patient Population in South Texas: A Case-Crossover Study

Few studies have evaluated the association between ambient air pollution and hospital readmissions among children with asthma, especially in low-income communities. This study examined the short-term effects of ambient air pollutants on hospital readmissions for pediatric asthma in South Texas. A time-stratified case-crossover study was conducted using the hospitalization data from a children’s hospital and the air pollution data, including particulate matter 2.5 (PM_2.5) and ozone concentrations, from the Centers for Disease Control and Prevention between 2010 and 2014. A conditional logistic regression analysis was performed to investigate the association between ambient air pollution and hospital readmissions, controlling for outdoor temperature. We identified 111 pediatric asthma patients readmitted to the hospital between 2010 and 2014. The single-pollutant models showed that PM_2.5 concentration had a significant positive effect on risk for hospital readmissions (OR = 1.082, 95% CI = 1.008–1.162, p = 0.030). In the two-pollutant models, the increased risk of pediatric readmissions for asthma was significantly associated with both elevated ozone (OR = 1.023, 95% CI = 1.001–1.045, p = 0.042) and PM_2.5 concentrations (OR = 1.080, 95% CI = 1.005–1.161, p = 0.036). The effects of ambient air pollutants on hospital readmissions varied by age and season. Our findings suggest that short-term (4 days) exposure to air pollutants might increase the risk of preventable hospital readmissions for pediatric asthma patients.

Association between Ambient Air Pollution and Hospital Length of Stay among Children with Asthma in South Texas

Although hospital length of stay (LOS) has been identified as a proxy measure of healthcare expenditures in the United States, there are limited studies investigating the potentially important association between outdoor air pollution and LOS for pediatric asthma. This study aims to examine the effect of ambient air pollution on LOS among children with asthma in South Texas. It included retrospective data on 711 children aged 5–18 years old admitted for asthma to a pediatric tertiary care hospital in South Texas between 2010 and 2014. Air pollution data including particulate matter (PM_2.5) and ozone were collected from the U.S. Centers for Disease Control and Prevention. The multivariate binomial logistic regression analyses were performed to determine the association between each air pollutant and LOS, controlling for confounders. The regression models showed the increased ozone level was significantly associated with prolonged LOS in the single- and two-pollutant models (p < 0.05). Furthermore, in the age-stratified models, PM_2.5 was positively associated with LOS among children aged 5–11 years old (p < 0.05). In conclusion, this study revealed a concerning association between ambient air pollution and LOS for pediatric asthma in South Texas.

Mining sequential patterns of PM2.5 pollution between 338 cities in China

Serious PM2.5 air pollution has persistently plagued and endangered most urban areas in China in recent years, and targeted policies are necessary to improve urban air quality ranging from macro policy (national level) to medium policy (city level) to micro policy (site specific). However, the macro-pattern study of air pollution between Chinese cities is inadequate, and not conducive to the formulation of macro-policy. To bridge this gap, we applied a sequential pattern mining algorithm to analyze the spatial-temporal patterns of PM2.5 pollution across Chinese cities during the period 2015 to 2018. The sequential patterns were collected from three levels of granularity on geographic areas and ten temporal scenarios covering time intervals from 10 to 100 h. Many underlying associative relationships were revealed between different cities by the mined patterns. The patterns were heterogeneous and presented five characteristics (i.e., clustering, symmetry, imbalance, decay, and stability). Each of the urban areas under investigation at different granularities was analyzed to identify the occurrence of associative relationships between it and other urban areas; moreover, we determined the degree of severity of such relationships. Our research results provide solid data that can be used as a reference by the various levels of Chinese governments for decision-making; overall, they can be used to improve the design of joint policies to prevent and control PM2.5 pollution in Chinese urban areas.

Investigating air pollutant concentrations, impact factors, and emission control strategies in western China by using a regional climate-chemistry model

In this study, in situ observations were conducted for six criteria air pollutants (PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃) at 23 sites in western China for 1 year. Subsequently, the detailed Weather Research and Forecasting model coupled with Chemistry (WRF-Chem) results for the pollutants were determined. The WRF-Chem model provided a clear perspective on the spatiotemporal distribution of air pollutants. High pollutant concentrations were mainly observed over highly populated mega-city regions, such as Sichuan and Guanzhong basins, whereas low concentration levels were observed over the Tibetan Plateau (TP). The TP also showed an increased concentration of O₃. Seasonally, all six pollutants except O₃ exhibited high concentration values during winter and low values during summer. O₃ concentrations exhibited an opposite seasonal variation in low-altitude regions. Unlike other pollutants that exhibited gradually decreasing concentrations with an increase in altitude, O₃ concentrations revealed an increasing trend. Furthermore, NO₂ concentrations gradually increased in the upper atmosphere possibly due to lighting and stratospheric transmission. Atmospheric pollution is closely related to emissions and meteorological variations in western China. Meteorological conditions in the summer are conducive to pollutant dispersion and wet scavenging; however, unfavourable weather conditions (high pressure as well as a low planetary boundary layer height and precipitation level) in the winter can further worsen air pollution. Atmospheric pollutants from various emission sectors generally exhibited varying monthly profiles. In six typical cities, pollutants were positively correlated with multiple emission sources except for industrial emissions. Further sensitivity simulations indicated that eliminating residential emissions resulted in the largest decrease (up to 70%) in PM_2.5 and PM₁₀ concentrations. The most significant reductions in the concentrations of SO₂ and NO₂ were achieved by eliminating industrial and transportation emissions, respectively. The outcomes of this study could be helpful for future studies on pollution formation mechanisms as well as environmental and health risk assessments in western China.

Acute Effects of Air Pollution on Hospital Admissions for Asthma, COPD, and Bronchiectasis in Ahvaz, Iran

Background and Aim

Although air pollution is a serious problem in Ahvaz, the association between air pollution and respiratory diseases has not been studied enough in this area. The aim of this study was to determine the relation between short-term exposure to air pollutants and the risk of hospital admissions due to asthma, COPD, and bronchiectasis in Ahvaz.

Methods

Hospital admissions data and air pollutants including O3, NO, NO2, SO2, CO, PM10, and PM2.5 were obtained from 2008 to 2018. Adjusted Quasi-Poisson regression with a distributed lag model, controlled for trend, seasonality, weather, weekdays, and holidays was used for data analysis.

Results

The results showed a significant increase in hospital admissions for asthma (RR=1.004, 95% CI: 1.002-1.007) and COPD (RR=1.003, 95% CI: 1.001-1.005) associated with PM2.5. PM10 was associated with increased hospital admissions due to bronchiectasis in both genders (Men: RR=1.003, 95% CI: 1.001-1.006) (Female: RR=1.003, 95% CI: 1.000-1.006). NO2 was also associated with an increased risk of hospital admissions for asthma (RR=1.040, 95% CI: 1.008-1.074) and COPD (RR=1.049, 95% CI: 1.010-1.090). SO2 was associated with the risk of hospital admissions of asthma (RR=1.069, 95% CI: 1.017-1.124) and bronchiectasis (RR=1.030, 95% CI: 1.005-1.056). Finally, CO was associated with COPD (RR=1.643, 95% CI: 1.233-2.191) and bronchiectasis (RR=1.542, 95% CI: 1.035-2.298) hospital admissions.

Conclusion

Short-term exposure to air pollutants significantly increases the risk of hospital admissions for asthma, COPD, and bronchiectasis in the adult and elderly population.

Short-term impacts of ambient fine particulate matter on emergency department visits: Comparative analysis of three exposure metrics

BACKGROUND

Research argued that daily excessive concentration hours (DECH) could be more informative through accounting for within-day variations, when assessing population-level exposure to ambient fine particle (PM_2.5). However, few studies have comparatively investigated PM_2.5-associated risks using DECH and two common metrics of daily mean and hourly peak concentration.

METHODS

We collected daily records of all-cause emergency department visits (EDVs) and hourly data on air pollutants and meteorological factors from Shenzhen, China, 2015-2018. According to guidelines proposed by the World Health Organization, DECH was calculated by summing up daily concentrations exceeding 25 μg/m³. Based on time-stratified case-crossover design, we adopted conditional logistic regression models to assess short-term attributable risks of EDVs associated with PM_2.5 using three exposure metrics.

RESULTS

DECH and daily average of PM_2.5 strongly elevated risks of EDVs, while less evident associations were observed using hourly peak metric. Estimated excess relative risks at lag 0 day were 0.56% (95% confidence interval [CI]: 0.21 to 0.91), 0.69% (95% CI: 0.25 to 1.13) and 0.37% (95% CI: 0.02 to 0.76), respectively, associated with an interquartile range increase in DECH (420.2 μg/m³), 24-h average (24.9 μg/m³) and hourly peak concentration (38 μg/m³). More emergency visits could be attributed to DECH than daily mean PM_2.5, with attributable fractions of 2.02% (95% CI: 1.42 to 2.61) and 1.09% (95% CI: 0.69 to 1.49), respectively.

CONCLUSIONS

This study added evidence for increased risk of EDVs associated with exposure to ambient PM_2.5. DECH was a potential alternative exposure metric for PM_2.5 assessment, which may have implications for future revision of air quality standards.

Children's acute respiratory symptoms associated with PM2.5 estimates in two sequential representative surveys from the Mexico City Metropolitan Area

BACKGROUND

Respiratory diseases are a major component of morbidity in children and their symptoms may be spatially and temporally exacerbated by exposure gradients of fine particulate matter (PM_2.5) in large polluted urban areas, like the Mexico City Metropolitan Area (MCMA).

OBJECTIVES

To analyze the association between satellite-derived and interpolated PM_2.5 estimates with children's (≤9 years old) acute respiratory symptoms (ARS) in two probabilistic samples representing the MCMA.

METHODS

We obtained ARS data from the 2006 and 2012 National Surveys for Health and Nutrition (ENSaNut). Two week average exposure to PM_2.5 was assessed for each household with spatial estimates from a hybrid model with satellite measurements of aerosol optical depth (AOD-PM_2.5) and also with interpolated PM_2.5 measurements from ground stations, from the Mexico City monitoring network (MNW-PM_2.5). We used survey-adjusted logistic regressions to analyze the association between PM_2.5 estimates and ARS reported on children.

RESULTS

A total of 1,005 and 1,233 children were surveyed in 2006 and 2012 representing 3.1 and 3.5 million children, respectively. For the same years and over the periods of study, the estimated prevalence of ARS decreased from 49.4% (95% CI: 44.9,53.9%) to 37.8% (95% CI: 34,41.7%). AOD-PM_2.5 and MNW-PM_2.5 estimates were associated with significantly higher reports of ARS in children 0-4 years old [OR₂₀₀₆ = 1.29 (95% (CI): 0.99,1.68) and OR₂₀₀₆ = 1.24 (95% CI: 1.08,1.42), respectively]. We observed positive non-significant associations in 2012 in both age groups and in 2006 for children 5-9 years old. No statistically significant differences in health effect estimates of PM_2.5 were found comparing AOD-PM_2.5 or MNW-PM_2.5 for exposure assessment.

CONCLUSIONS

Our findings suggest that PM_2.5 is a risk factor for the prevalence of ARS in children and expand the growing evidence of the utility of new satellite AOD-based methods for estimating health effects from acute exposure to PM_2.5.