Respiratory mortality associated with ozone in China: A systematic review and meta-analysis

High temperature exacerbates ozone-induced airway inflammation: Implication of airway microbiota and metabolites

Short-term exposure to ozone (O3) has been associated with airway inflammation. Given that high temperature (HT) accelerates O3 production, it is of significance to determine whether co-exposure to HT exacerbates O3-induced airway inflammation. The aim of this study was to examine the possible promotive effect of HT on O3-induced airway inflammation and underlying mechanisms. Forty-eight C57BL/6 N male mice were randomly divided into four groups: filtered air (control), O3, HT, and HT + O3 (co-exposure) groups. Mice in control and O3 groups were exposed to filtered air or 1 ppm O3 at 24 °C, respectively, while mice in HT and co-exposure groups were exposed to filtered air or 1 ppm O3 at 36 °C, respectively. The exposure scenario for four groups was 4 h/d for 5 consecutive days. Bronchoalveolar lavage fluids (BALF) were collected 24 h after the last exposure and subjected to examinations of oxidative stress and inflammation biomarkers, 16S rRNA sequencing, and metabolic profiling. Lung tissues were processed for H&E histological staining. The results showed that O3 inhalation triggered oxidative stress and inflammation in the airways, which was worsen by co-exposure to HT. Further studies revealed that co-exposure to HT strengthened O3-induced decline in Firmicutes and Allobaculum in airways. Moreover, co-exposure to HT promoted O3-induced airway metabolic disorder. Spearman correlation analysis revealed correlations among microbiota dysbiosis, metabolic disorder, oxidative stress and inflammation induced by co-exposure to HT and O3. Taken together, HT exposure aggravates O3-induced airway oxidative stress and inflammation, possibly through modulation of microbiota and metabolism of the airways.

The impact of air pollution on respiratory diseases in an era of climate change: A review of the current evidence

The impacts of climate change and air pollution on respiratory diseases present significant global health challenges. This review aims to investigate the effects of the interactions between these challenges focusing on respiratory diseases. Climate change is predicted to increase the frequency and intensity of extreme weather events amplifying air pollution levels and exacerbating respiratory diseases. Air pollution levels are projected to rise due to ongoing economic growth and population expansion in many areas worldwide, resulting in a greater burden of respiratory diseases. This is especially true among vulnerable populations like children, older adults, and those with pre-existing respiratory disorders. These challenges induce inflammation, create oxidative stress, and impair the immune system function of the lungs. Consequently, public health measures are required to mitigate the effects of climate change and air pollution on respiratory health. The review proposes that reducing greenhouse gas emissions contribute to slowing down climate change and lessening the severity of extreme weather events. Enhancing air quality through regulatory and technological innovations also helps reduce the morbidity of respiratory diseases. Moreover, policies and interventions aimed at improving healthcare access and social support can assist in decreasing the vulnerability of populations to the adverse health effects of air pollution and climate change. In conclusion, there is an urgent need for continuous research, establishment of policies, and public health efforts to tackle the complex and multi-dimensional challenges of climate change, air pollution, and respiratory health. Practical and comprehensive interventions can protect respiratory health and enhance public health outcomes for all.

Short-term exposure to ambient ozone and cardiovascular mortality in China: a systematic review and meta-analysis

Air pollution is a major public health concern in China. Notwithstanding this, there is limited evidence regarding the impact of short-term exposure to ambient ozone on cardiovascular mortality in the Chinese population. Therefore, we conducted this meta-analysis to address this important question. The random-effects model was applied to pool the results from individual studies. Finally, 32 effect estimates extracted from 19 studies were pooled in this meta-analysis. The pooled relative risk for cardiovascular mortality for each 10 µg/m3 increment in ozone concentration was 1.0068 (95% CI: 1.0049, 1.0086). Ths significant positive association between ozone exposure and cardiovascular mortality was also observed in different two-pollutant models. This meta-analysis revealed that exposure to ozone was associated with an increased risk of cardiovascular mortality in China, and more efforts on controlling the population from ozone are needed to improve cardiovascular health of Chinese population.

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.

Temperature modifies the effects of air pollutants on respiratory diseases

Increasing studies have reported temperature modification effects on air pollutants-induced respiratory diseases. In the current study, daily data of respiratory emergency room visits (ERVs), meteorological factors, and concentrations of air pollutants were collected from 2013 to 2016 in Lanzhou, a northwest city in China. Daily average temperature was stratified into low (≤ 25 percentile, P₂₅), medium (25-75 percentile, P₂₅-P₇₅) and high (≥ 75 percentile, P₇₅) to explore how temperature modifies the effects of air pollutants (PM_2.5, PM₁₀, SO₂, and NO₂) on respiratory ERVs by using generalized additive Poisson regression model (GAM). Seasonal modification was also investigated. Results showed that (a) PM₁₀, PM_2.5, and NO₂ had the strongest effects on respiratory ERVs in low temperature; (b) males and 15-and-younger were more vulnerable in low temperature while females and those older than 46 years were highly affected in high temperature; (c) PM₁₀, PM_2.5, and NO₂ were mostly associated with the total and both males and females in winter, while SO₂ resulted in the highest risk for the total and males in autumn and females in spring. In conclusion, this study found significant temperature modification effects and seasonal differences on the risks of respiratory ERVs due to air pollutants in Lanzhou, China.

The Minderoo-Monaco Commission on Plastics and Human Health

Background

Plastics have conveyed great benefits to humanity and made possible some of the most significant advances of modern civilization in fields as diverse as medicine, electronics, aerospace, construction, food packaging, and sports. It is now clear, however, that plastics are also responsible for significant harms to human health, the economy, and the earth's environment. These harms occur at every stage of the plastic life cycle, from extraction of the coal, oil, and gas that are its main feedstocks through to ultimate disposal into the environment. The extent of these harms not been systematically assessed, their magnitude not fully quantified, and their economic costs not comprehensively counted.

Goals

The goals of this Minderoo-Monaco Commission on Plastics and Human Health are to comprehensively examine plastics' impacts across their life cycle on: (1) human health and well-being; (2) the global environment, especially the ocean; (3) the economy; and (4) vulnerable populations-the poor, minorities, and the world's children. On the basis of this examination, the Commission offers science-based recommendations designed to support development of a Global Plastics Treaty, protect human health, and save lives.

Report Structure

This Commission report contains seven Sections. Following an Introduction, Section 2 presents a narrative review of the processes involved in plastic production, use, and disposal and notes the hazards to human health and the environment associated with each of these stages. Section 3 describes plastics' impacts on the ocean and notes the potential for plastic in the ocean to enter the marine food web and result in human exposure. Section 4 details plastics' impacts on human health. Section 5 presents a first-order estimate of plastics' health-related economic costs. Section 6 examines the intersection between plastic, social inequity, and environmental injustice. Section 7 presents the Commission's findings and recommendations.

Plastics

Plastics are complex, highly heterogeneous, synthetic chemical materials. Over 98% of plastics are produced from fossil carbon- coal, oil and gas. Plastics are comprised of a carbon-based polymer backbone and thousands of additional chemicals that are incorporated into polymers to convey specific properties such as color, flexibility, stability, water repellence, flame retardation, and ultraviolet resistance. Many of these added chemicals are highly toxic. They include carcinogens, neurotoxicants and endocrine disruptors such as phthalates, bisphenols, per- and poly-fluoroalkyl substances (PFAS), brominated flame retardants, and organophosphate flame retardants. They are integral components of plastic and are responsible for many of plastics' harms to human health and the environment.Global plastic production has increased almost exponentially since World War II, and in this time more than 8,300 megatons (Mt) of plastic have been manufactured. Annual production volume has grown from under 2 Mt in 1950 to 460 Mt in 2019, a 230-fold increase, and is on track to triple by 2060. More than half of all plastic ever made has been produced since 2002. Single-use plastics account for 35-40% of current plastic production and represent the most rapidly growing segment of plastic manufacture.Explosive recent growth in plastics production reflects a deliberate pivot by the integrated multinational fossil-carbon corporations that produce coal, oil and gas and that also manufacture plastics. These corporations are reducing their production of fossil fuels and increasing plastics manufacture. The two principal factors responsible for this pivot are decreasing global demand for carbon-based fuels due to increases in 'green' energy, and massive expansion of oil and gas production due to fracking.Plastic manufacture is energy-intensive and contributes significantly to climate change. At present, plastic production is responsible for an estimated 3.7% of global greenhouse gas emissions, more than the contribution of Brazil. This fraction is projected to increase to 4.5% by 2060 if current trends continue unchecked.

Plastic Life Cycle

The plastic life cycle has three phases: production, use, and disposal. In production, carbon feedstocks-coal, gas, and oil-are transformed through energy-intensive, catalytic processes into a vast array of products. Plastic use occurs in every aspect of modern life and results in widespread human exposure to the chemicals contained in plastic. Single-use plastics constitute the largest portion of current use, followed by synthetic fibers and construction.Plastic disposal is highly inefficient, with recovery and recycling rates below 10% globally. The result is that an estimated 22 Mt of plastic waste enters the environment each year, much of it single-use plastic and are added to the more than 6 gigatons of plastic waste that have accumulated since 1950. Strategies for disposal of plastic waste include controlled and uncontrolled landfilling, open burning, thermal conversion, and export. Vast quantities of plastic waste are exported each year from high-income to low-income countries, where it accumulates in landfills, pollutes air and water, degrades vital ecosystems, befouls beaches and estuaries, and harms human health-environmental injustice on a global scale. Plastic-laden e-waste is particularly problematic.

Environmental Findings

Plastics and plastic-associated chemicals are responsible for widespread pollution. They contaminate aquatic (marine and freshwater), terrestrial, and atmospheric environments globally. The ocean is the ultimate destination for much plastic, and plastics are found throughout the ocean, including coastal regions, the sea surface, the deep sea, and polar sea ice. Many plastics appear to resist breakdown in the ocean and could persist in the global environment for decades. Macro- and micro-plastic particles have been identified in hundreds of marine species in all major taxa, including species consumed by humans. Trophic transfer of microplastic particles and the chemicals within them has been demonstrated. Although microplastic particles themselves (>10 µm) appear not to undergo biomagnification, hydrophobic plastic-associated chemicals bioaccumulate in marine animals and biomagnify in marine food webs. The amounts and fates of smaller microplastic and nanoplastic particles (MNPs <10 µm) in aquatic environments are poorly understood, but the potential for harm is worrying given their mobility in biological systems. Adverse environmental impacts of plastic pollution occur at multiple levels from molecular and biochemical to population and ecosystem. MNP contamination of seafood results in direct, though not well quantified, human exposure to plastics and plastic-associated chemicals. Marine plastic pollution endangers the ocean ecosystems upon which all humanity depends for food, oxygen, livelihood, and well-being.

Human Health Findings

Coal miners, oil workers and gas field workers who extract fossil carbon feedstocks for plastic production suffer increased mortality from traumatic injury, coal workers' pneumoconiosis, silicosis, cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer. Plastic production workers are at increased risk of leukemia, lymphoma, hepatic angiosarcoma, brain cancer, breast cancer, mesothelioma, neurotoxic injury, and decreased fertility. Workers producing plastic textiles die of bladder cancer, lung cancer, mesothelioma, and interstitial lung disease at increased rates. Plastic recycling workers have increased rates of cardiovascular disease, toxic metal poisoning, neuropathy, and lung cancer. Residents of "fenceline" communities adjacent to plastic production and waste disposal sites experience increased risks of premature birth, low birth weight, asthma, childhood leukemia, cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer.During use and also in disposal, plastics release toxic chemicals including additives and residual monomers into the environment and into people. National biomonitoring surveys in the USA document population-wide exposures to these chemicals. Plastic additives disrupt endocrine function and increase risk for premature births, neurodevelopmental disorders, male reproductive birth defects, infertility, obesity, cardiovascular disease, renal disease, and cancers. Chemical-laden MNPs formed through the environmental degradation of plastic waste can enter living organisms, including humans. Emerging, albeit still incomplete evidence indicates that MNPs may cause toxicity due to their physical and toxicological effects as well as by acting as vectors that transport toxic chemicals and bacterial pathogens into tissues and cells.Infants in the womb and young children are two populations at particularly high risk of plastic-related health effects. Because of the exquisite sensitivity of early development to hazardous chemicals and children's unique patterns of exposure, plastic-associated exposures are linked to increased risks of prematurity, stillbirth, low birth weight, birth defects of the reproductive organs, neurodevelopmental impairment, impaired lung growth, and childhood cancer. Early-life exposures to plastic-associated chemicals also increase the risk of multiple non-communicable diseases later in life.

Economic Findings

Plastic's harms to human health result in significant economic costs. We estimate that in 2015 the health-related costs of plastic production exceeded $250 billion (2015 Int$) globally, and that in the USA alone the health costs of disease and disability caused by the plastic-associated chemicals PBDE, BPA and DEHP exceeded $920 billion (2015 Int$). Plastic production results in greenhouse gas (GHG) emissions equivalent to 1.96 gigatons of carbon dioxide (CO2e) annually. Using the US Environmental Protection Agency's (EPA) social cost of carbon metric, we estimate the annual costs of these GHG emissions to be $341 billion (2015 Int$).These costs, large as they are, almost certainly underestimate the full economic losses resulting from plastics' negative impacts on human health and the global environment. All of plastics' economic costs-and also its social costs-are externalized by the petrochemical and plastic manufacturing industry and are borne by citizens, taxpayers, and governments in countries around the world without compensation.

Social Justice Findings

The adverse effects of plastics and plastic pollution on human health, the economy and the environment are not evenly distributed. They disproportionately affect poor, disempowered, and marginalized populations such as workers, racial and ethnic minorities, "fenceline" communities, Indigenous groups, women, and children, all of whom had little to do with creating the current plastics crisis and lack the political influence or the resources to address it. Plastics' harmful impacts across its life cycle are most keenly felt in the Global South, in small island states, and in disenfranchised areas in the Global North. Social and environmental justice (SEJ) principles require reversal of these inequitable burdens to ensure that no group bears a disproportionate share of plastics' negative impacts and that those who benefit economically from plastic bear their fair share of its currently externalized costs.

Conclusions

It is now clear that current patterns of plastic production, use, and disposal are not sustainable and are responsible for significant harms to human health, the environment, and the economy as well as for deep societal injustices.The main driver of these worsening harms is an almost exponential and still accelerating increase in global plastic production. Plastics' harms are further magnified by low rates of recovery and recycling and by the long persistence of plastic waste in the environment.The thousands of chemicals in plastics-monomers, additives, processing agents, and non-intentionally added substances-include amongst their number known human carcinogens, endocrine disruptors, neurotoxicants, and persistent organic pollutants. These chemicals are responsible for many of plastics' known harms to human and planetary health. The chemicals leach out of plastics, enter the environment, cause pollution, and result in human exposure and disease. All efforts to reduce plastics' hazards must address the hazards of plastic-associated chemicals.

Recommendations

To protect human and planetary health, especially the health of vulnerable and at-risk populations, and put the world on track to end plastic pollution by 2040, this Commission supports urgent adoption by the world's nations of a strong and comprehensive Global Plastics Treaty in accord with the mandate set forth in the March 2022 resolution of the United Nations Environment Assembly (UNEA).International measures such as a Global Plastics Treaty are needed to curb plastic production and pollution, because the harms to human health and the environment caused by plastics, plastic-associated chemicals and plastic waste transcend national boundaries, are planetary in their scale, and have disproportionate impacts on the health and well-being of people in the world's poorest nations. Effective implementation of the Global Plastics Treaty will require that international action be coordinated and complemented by interventions at the national, regional, and local levels.This Commission urges that a cap on global plastic production with targets, timetables, and national contributions be a central provision of the Global Plastics Treaty. We recommend inclusion of the following additional provisions:The Treaty needs to extend beyond microplastics and marine litter to include all of the many thousands of chemicals incorporated into plastics.The Treaty needs to include a provision banning or severely restricting manufacture and use of unnecessary, avoidable, and problematic plastic items, especially single-use items such as manufactured plastic microbeads.The Treaty needs to include requirements on extended producer responsibility (EPR) that make fossil carbon producers, plastic producers, and the manufacturers of plastic products legally and financially responsible for the safety and end-of-life management of all the materials they produce and sell.The Treaty needs to mandate reductions in the chemical complexity of plastic products; health-protective standards for plastics and plastic additives; a requirement for use of sustainable non-toxic materials; full disclosure of all components; and traceability of components. International cooperation will be essential to implementing and enforcing these standards.The Treaty needs to include SEJ remedies at each stage of the plastic life cycle designed to fill gaps in community knowledge and advance both distributional and procedural equity.This Commission encourages inclusion in the Global Plastic Treaty of a provision calling for exploration of listing at least some plastic polymers as persistent organic pollutants (POPs) under the Stockholm Convention.This Commission encourages a strong interface between the Global Plastics Treaty and the Basel and London Conventions to enhance management of hazardous plastic waste and slow current massive exports of plastic waste into the world's least-developed countries.This Commission recommends the creation of a Permanent Science Policy Advisory Body to guide the Treaty's implementation. The main priorities of this Body would be to guide Member States and other stakeholders in evaluating which solutions are most effective in reducing plastic consumption, enhancing plastic waste recovery and recycling, and curbing the generation of plastic waste. This Body could also assess trade-offs among these solutions and evaluate safer alternatives to current plastics. It could monitor the transnational export of plastic waste. It could coordinate robust oceanic-, land-, and air-based MNP monitoring programs.This Commission recommends urgent investment by national governments in research into solutions to the global plastic crisis. This research will need to determine which solutions are most effective and cost-effective in the context of particular countries and assess the risks and benefits of proposed solutions. Oceanographic and environmental research is needed to better measure concentrations and impacts of plastics <10 µm and understand their distribution and fate in the global environment. Biomedical research is needed to elucidate the human health impacts of plastics, especially MNPs.

Summary

This Commission finds that plastics are both a boon to humanity and a stealth threat to human and planetary health. Plastics convey enormous benefits, but current linear patterns of plastic production, use, and disposal that pay little attention to sustainable design or safe materials and a near absence of recovery, reuse, and recycling are responsible for grave harms to health, widespread environmental damage, great economic costs, and deep societal injustices. These harms are rapidly worsening.While there remain gaps in knowledge about plastics' harms and uncertainties about their full magnitude, the evidence available today demonstrates unequivocally that these impacts are great and that they will increase in severity in the absence of urgent and effective intervention at global scale. Manufacture and use of essential plastics may continue. However, reckless increases in plastic production, and especially increases in the manufacture of an ever-increasing array of unnecessary single-use plastic products, need to be curbed.Global intervention against the plastic crisis is needed now because the costs of failure to act will be immense.

Air pollution and its associated health risks before and after COVID-19 in Shaanxi Province, China

Air pollution is a serious environmental problem that damages public health. In the present study, we used the segmentation function to improve the health risk-based air quality index (HAQI) and named it new HAQI (NHAQI). To investigate the spatiotemporal distribution characteristics of air pollutants and the associated health risks in Shaanxi Province before (Period I, 2015-2019) and after (Period II, 2020-2021) COVID-19. The six criteria pollutants were analyzed between January 1, 2015, and December 31, 2021, using the air quality index (AQI), aggregate AQI (AAQI), and NHAQI. The results showed that compared with AAQI and NHAQI, AQI underestimated the combined effects of multiple pollutants. The average concentrations of the six criteria pollutants were lower in Period II than in Period I due to reductions in anthropogenic emissions, with the concentrations of PM_2.5 (particulate matter ≤2.5 μm diameter), PM₁₀ (PM ≤ 10 μm diameter) SO₂, NO₂, O₃, and CO decreased by 23.5%, 22.5%, 45.7%, 17.6%, 2.9%, and 41.6%, respectively. In Period II, the excess risk and the number of air pollution-related deaths decreased considerably by 46.5% and 49%, respectively. The cumulative population distribution estimated using the NHAQI revealed that 61% of the total number of individuals in Shaanxi Province were exposed to unhealthy air during Period I, whereas this proportion decreased to 16% during Period II. Although overall air quality exhibited substantial improvements, the associated health risks in winter remained high.

Association analysis between socioeconomic factors and urban ozone pollution in China

Ozone pollution in China has gradually increased, attracting extensive attention. Existing studies on ozone pollution typically take environmental and chemical perspectives. As air pollution is closely related to social and economic activities, it is also important to study ozone pollution from a socioeconomic perspective. Using the association rule mining technique, we uncovered hidden patterns between ozone variance and socioeconomic factors in macro-, meso-, and micro-scenarios in 297 Chinese cities. We found that the acceleration of urbanization and industrialization has indeed aggravated urban ozone pollution. The supply of water and power resources may be a significant factor influencing urban ozone pollution. Transportation hub cities with more developed economies and industries are more likely to suffer from ozone pollution in summer and autumn. Human behavior is a critical factor influencing the weekly variance in ozone concentration during weekdays and weekends. The influence of plant-derived VOC emissions on the formation of ozone cannot be overlooked. Our results deepen the understanding of ozone pollution in Chinese cities, and we provide corresponding policy recommendations to alleviate ozone pollution and improve air quality.

Meta analysis of health effects of ambient air pollution exposure in low- and middle-income countries

It is well established that exposure to ambient air pollution affects human health. A majority of literature concentrated on health effects of air pollution in high income countries. Only fewer studies analyzing health effects of air pollution in Low- and Middle-Income Countries (LMICs) are available. To bridge this gap in literature, this study investigated short term and long-term health impacts of ambient air pollutants focussed in LMICs. We evaluated Total Non-accidental mortality, Respiratory Mortality, Stroke Mortality, Cardio-vascular Mortality, Chronic Obstructive Pulmonary Disease (COPD), Ischemic Heart Disease (IHD) and Lung Cancer Mortality in LMICs particularly. Random Effects Model was utilised to derive overall risk estimate. Relative Risk (RR) estimates per 10 μg/m³ was used as input for model. Subgroup and Sensitivity Analysis by Design and Country was conducted. A total of 152 studies were included for quantitative analysis. We found positive associations between pollutants and Total Non-accidental mortality for PM₁₀ ((RR:1.0043-1.0036), p < 0.0001), NO₂ (RR:1.0222 (1.0111-1.0336), p < 0.0001), SO₂ (RR:1.0107 - (1.0073-1.0140), p < 0.0001), O₃ (RR: 1.0038 (1.0023-1.0053), p < 0.0001) and PM_2.5 (RR: 1.0048 (1.0037-1.0059), p < 0.0001) for every 10 μg/m³ increase. We found positive association between Long-term exposure to PM₁₀ and Total Non-accidental mortality (RR: 1.0430 (1.0278-1.0583), p < 0.0001) We also found statistically significant positive associations between pollutants and Cardiorespiratory and Cardiovascular morbidity. The positive associations persisted when analysed amongst sub-groups. However, the high heterogeneity amongst studies persisted even after performing sub-group analysis. The study has found statistically significant positive associations between short-term and long-term exposure to Ambient air pollution with various health-outcome combinations.

Increased tropospheric ozone levels as a public health issue during COVID-19 lockdown and estimation the related pulmonary diseases

The aims of this study were to i) investigate the variation of tropospheric ozone (O3) levels during the COVID-19 lockdown; ii) determine the relationships between O3 concentrations with the number of COVID-19 cases; and iii) estimate the O3-related health effects in Southwestern Iran (Khorramabad) over the time period 2019-2021. The hourly O3 data were collected from ground monitoring stations, as well as retrieved from Sentinel-5 satellite data for showing the changes in O3 levels pre, during, and after lockdown period. The concentration-response function model was applied using relative risk (RR) values and baseline incidence (BI) to assess the O3-related health effects. Compared to 2019, the annual O3 mean concentrations increased by 12.2% in 2020 and declined by 3.9% in 2021. The spatiotemporal changes showed a significant O3 increase during COVID-19 lockdown, and a negative correlation between O3 levels and the number of COVID-19 cases was found (r = - 0.59, p < 0.05). In 2020, the number of hospital admissions for cardiovascular diseases increased by 4.0 per 105 cases, the mortality for respiratory diseases increased by 0.7 per 105 cases, and the long-term mortality for respiratory diseases increased by 0.9 per 105 cases. Policy decisions are now required to reduce the surface O3 concentrations and O3-related health effects in Iran.

Tracking short-term health impacts attributed to ambient PM2.5 and ozone pollution in Chinese cities: an assessment integrates daily population

Joint and synergistic control of PM_2.5 and ozone pollution is an urgent need in China and a global-widely concerned issue. Health impact assessment could provide a comprehensive perspective for PM_2.5-ozone coordinated control strategies. For a detailed understanding of the seasonality and regionality of the health impacts attributed to PM_2.5 and ozone in China, this study extended the classic health impact function by daily population and assessed the short-term (daily) health impacts in 335 Chinese cities in 2021. Population migration indexes from Baidu were introduced to estimate the cities' daily population. Using this method, we quantitatively investigated the influence of population on short-term health impact assessment and identified which was significant in the Pearl River Delta (PRD) region and other populous cities. Although the annual sums of PM_2.5- and ozone-related daily health impacts were close for all Chinese cities, the PM_2.5-related health impact was equivalent to 333.96% and 32.07% of that ozone-related, during the cold and warm periods. The correlation and local spatial association analysis found significant city-specific and city-cluster associations of daily health impacts during the warm period and in Beijing-Tianjin-Hebei and surrounding regions (BTHS) and the Yangtze River Delta (YRD). Policymakers could promote period- and pollutant-targeted control actions for the major city groups, especially the BTHS, YRD, and PRD. Our methods and findings investigated the various influences of the population on short-term health impact assessment and proposed the PM_2.5-ozone collaborative control idea for key regions and city groups.

Short-term health impacts related to ozone in China before and after implementation of policy measures: A systematic review and meta-analysis

This paper presents a meta-analysis of the impacts of short-term exposure to ozone (O₃) on three health endpoints: all-cause, cardiovascular, and respiratory mortality in China. All relevant studies from January 1990 to December 2021 were searched from four databases. After screening, 30 studies were included for the meta-analysis. The results showed that a significant rise of 0.41 % (95 % confidence interval (CI): 0.35 %-0.48 %) in all-cause, 0.60 % (95 % CI: 0.51 %-0.68 %) in cardiovascular and 0.45 % (95 % CI: 0.28 %-0.62 %) in respiratory mortality for each 10 μg m^-3 increase in the maximum daily 8 h average O₃ concentration (MDA8 O₃). Moreover, results stratified by heterogeneous time periods before and after implementing a policy measure in 2013, showed that the pooled effects for all-cause and respiratory mortality before were greater than those after, while the pooled effects for cardiovascular mortality before 2013 were slightly smaller than those after. The finding that short-term exposure to O₃ was positively related to the three health endpoints was validated by means of a sensitivity analysis. Furthermore, we did not observe any publication bias. Our results present an updated and better understanding of the relationship between short-term exposure to O₃ and the three health endpoints, while providing a reference for further assessment of the impact of short-term O₃ exposure on human health.

Short-term exposure to ozone and economic burden of premature mortality in Italy: A nationwide observation study

Italy is among the countries with the highest ozone concentration in Europe. However, the mortality burden of ozone and related economic loss has not been fully characterized. This study aimed to estimate the ozone-mortality association in Italy and evaluate attributable mortality burden and related economic loss in 2015-2019. We collected daily all-cause mortality data stratified by age and sex from 2015 to 2019 in 107 provinces of Italy. A two-stage time-series framework was applied to estimate the association between daily maximum eight-hour average ozone and mortality as well as economic loss. An overall increase in the risk of mortality (RR=1.0043, 95% CI: 1.0029, 1.0057) was associated with every 10 µg/m³ increase in ozone. Generally, a total of 70,060 deaths and $65 billion economic loss were attributed to ozone exposure, corresponding to 3.11% of mortality and about 0.5% of the national GDP during the study period, respectively. The highest ozone-related mortality burden (30,910 deaths) and economic loss ($29.24 billion) were observed in the hot season. This nationwide study suggested considerable mortality burden and economic loss were associated with exposure to ozone. More actions and policies should be proposed to reduce ozone levels and help the public protect their health.

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.