Cardiopulmonary mortality and COPD attributed to ambient ozone

Estimating the health impacts of exposure to Air pollutants and the evaluation of changes in their concentration using a linear model in Iran

In big and industrial cities of developing countries, illness and mortality from long-term exposure to air pollutants have become a serious issue. This research was carried out in 2019-2020 to estimate the health impacts of PM10, NO2 and O3 pollutants by using AirQ+ and R statistical programming software in Arak, Isfahan, Tabriz, Shiraz, Karaj, and Mashhad. Mortality statistics, number of people in required age groups, and amount of pollutants were gathered respectively from different agencies like Statistics and Information Technology of the Ministry of Health, Statistical Center, and Department of Environment and by using Excel, the average 24-hour and 1-hour concentration and maximum 8-hour concentration for PM10, NO2 and O3 pollutants were gathered. We used linear mixed impacts model to account for the longitudinal observations and heterogeneity of the cities. The results of the study showed high number of deaths due to chronic bronchitis in adults, premature death of infants, and respiratory diseases in Mashhad. This research highlights the importance of estimation of health impacts from exposure to air pollutants on residents of the studied cities.

COPD with elevated sputum group 2 innate lymphoid cells is characterized by severe disease

Rationale

Pulmonary innate immune cells play a central role in the initiation and perpetuation of chronic obstructive pulmonary disease (COPD), however the precise mechanisms that orchestrate the development and severity of COPD are poorly understood.

Objectives

We hypothesized that the recently described family of innate lymphoid cells (ILCs) play an important role in COPD.

Methods

Subjects with COPD and healthy controls were clinically evaluated, and their sputum samples were assessed by flow cytometry. A mouse model of spontaneous COPD [genetically deficient in surfactant protein-D (SP-D -/- )] and ozone (O 3 ) exposure were used to examine the mechanism by which lack of functional SP-D may skew ILC2s to produce IL-17A in combination with IL-5 and IL-13, leading to a mixed inflammatory profile and more severe disease.

Measurements and Main Results

COPD was characterized by poor spirometry, sputum inflammation, and the emergence of sputum GATA3 + ILCs (ILC2s), but not T-bet + ILCs (ILC1s) nor RORγt + ILCs (ILC3s). COPD subjects with elevated sputum ILC2s (the ILC2 high group) had worse spirometry and sputum neutrophilia and eosinophilia than healthy and ILC2 low subjects. This was associated with the presence of dual-positive IL-5 + IL-17A + and IL-13 + IL-17A + ILCs and nonfunctional SP-D in the sputum in ILC2 high subjects. SP-D -/- mice showed spontaneous airway neutrophilia. Lack of SP-D in the mouse lung licensed ILC2s to produce IL-17A, which was dose-dependently inhibited by recombinant SP-D. SP-D -/- mice showed enhanced susceptibility to O 3 -induced airway neutrophilia, which was associated with the emergence of inflammatory IL-13 + IL-17A + ILCs.

Conclusions

We report that the presence of sputum ILC2s predicts the severity of COPD, and unravel a novel pathway of IL-17A plasticity in lung ILC2s, prevented by the immunomodulatory protein SP-D.

Combined effect of ozone and household air pollution on COPD in people aged less than 50 years old

OBJECTIVES

Air pollution has been suggested as an important risk factor for chronic obstructive pulmonary disease (COPD); however, evidence of interactive effects on COPD between different factors was sparse, especially for young adults. We aimed to assess the combined effects of ambient ozone (O3) and household air pollution on COPD in young individuals.

METHODS

We conducted a population-based study of residents aged 15-50 years in the low-income and middle-income regions of western China. We used multivariable logistic regression models to examine the associations between long-term ozone exposure and COPD in young individuals.

RESULTS

A total of 6537 young cases were identified among the participants, with a COPD prevalence rate of 7.8 (95% CI 7.2% to 8.5%), and most young COPD individuals were asymptomatic. Exposure to household air pollution was associated with COPD in young patients after adjustment for other confounding factors (OR 1.82, 95% CI 1.41 to 2.37). We also found positive associations of COPD with O3 per IQR increase of 20 ppb (OR 1.92, 95% CI 1.59 to 2.32). The individual effects of household air pollution and O3 were 1.68 (95% CI 1.18 to 2.46) and 1.55 (95% CI 0.99 to 2.43), respectively, while their joint effect was 3.28 (95% CI 2.35 to 4.69) with the relative excess risk due to interaction of 1.05 (95% CI 0.33 to 1.78).

CONCLUSIONS

This study concludes that exposure to ambient O3 and household air pollution might be important risk factors for COPD among young adults, and simultaneous exposure to high levels of the two pollutants may intensify their individual effects.

Assessing the effect of COVID-19 pandemic on air quality change and human health outcomes in a capital city, southwestern Iran

The aimsof this study were to assess the spatial variation of PM2.5, NO2, and O3 between 2019 (before) and 2020 (during COVID-19 pandemic); and calculation the health outcomes of exposure to these pollutants. The daily PM2.5, NO2, and O3 concentrations were applied to assess health effects by relative risk, and baseline incidence. The annual PM2.5 and NO2 mean concentrations exceeded the WHO guideline values, while O3 did not exceed. The restrictive measures associated to COVID-19 led to reduction at the annual means of PM2.5 and NO2 by -25.5% and -23.1%, respectively, while the annual mean of O3 increased by +7.9%. The number of M-CVD and M-RD (-25.6%, -26.1%) related to PM2.5 exposure, and HA-COPD and HA-RD >65 years old (-21% and -3.84%) related to NO2 exposure were reduced in 2020, and O3 exposure-related M-CVD (+30.1%) and HA-RD >65 years old (+23.4%) increased compared to the previous year 2019.

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.

Adverse short-term effects of ozone on cardiovascular mortalities modified by season and temperature: a time-series study

Introduction

Ambient ozone pollution becomes critical in China. Conclusions on the short-term effects of ozone on cardiovascular mortality have been controversial and limited on cause-specific cardiovascular mortalities and their interactions with season and temperature. This research aimed to investigate the short-term effects of ozone and the modifications of season and temperature on cardiovascular mortality.

Methods

Cardiovascular death records, air pollutants, and meteorological factors in Shenzhen from 2013 to 2019 were analyzed. Daily 1-h maximum of ozone and daily maximum 8-h moving average of ozone were studied. Generalized additive models (GAMs) were applied to evaluate their associations with cardiovascular mortalities in sex and age groups. Effect modifications were assessed by stratifying season and temperature.

Results

Distributed lag impacts of ozone on total cardiovascular deaths and cumulative effects on mortality due to ischemic heart disease (IHD) were most significant. Population under 65 years old was most susceptible. Majority of significant effects were found in warm season, at high temperature, and at extreme heat. Ozone-associated risks in total deaths caused by hypertensive diseases reduced in warm season, while risks in IHD in males increased at high temperature. Extreme heat enhanced ozone effects on deaths caused by CVDs and IHD in the population under 65 years old.

Discussion

The revealed cardiovascular impacts of ozone below current national standard of air quality suggested improved standards and interventions in China. Higher temperature, particularly extreme heat, rather than warm season, could significantly enhance the adverse effects of ozone on cardiovascular mortality in population under 65 years old.

Deep learning mapping of surface MDA8 ozone: The impact of predictor variables on ozone levels over the contiguous United States

The limited number of ozone monitoring stations imposes uncertainty in various applications, calling for accurate approaches to capturing ozone values in all regions, particularly those with no in-situ measurements. This study uses deep learning (DL) to accurately estimate daily maximum 8-hr average (MDA8) ozone and examines the spatial contribution of several factors on ozone levels over the contiguous U.S. (CONUS) in 2019. A comparison between in-situ observations and DL-estimated MDA8 ozone values shows a correlation coefficient (R) of 0.95, an index of agreement (IOA) of 0.97, and a mean absolute bias (MAB) of 2.79 ppb, highlighting the promising performance of the deep convolutional neural network (Deep-CNN) at estimating surface MDA8 ozone. Spatial cross-validation also confirms the high spatial accuracy of the model, which obtains an R of 0.91, and IOA of 0.96 and an MAB of 3.46 ppb when it is trained and tested on separate stations. To interpret the black-box nature of our DL model, we use Shapley additive explanations (SHAP) to generate a spatial feature contribution map (SFCM), the results of which confirm an advanced ability of Deep-CNN to capture the interactions between most predictor variables and ozone. For instance, the model shows that solar radiation (SRad) SFCM, with higher values, enhances the formation of ozone, particularly in the south and southwestern CONUS. As SRad triggers ozone precursors to produce ozone via photochemical reactions, it increases ozone concentrations. The model also shows that humidity, with its low values, increases ozone concentrations in the western mountainous regions. The negative correlation between humidity and ozone levels can be attributed to factors such as higher ozone decomposition resulting from increased levels of humidity and OH radicals. This study is the first to introduce the SFCM to investigate the spatial role of predictor variables on changes in estimated MDA8 ozone levels.

Ambient PM2.5 and O3 pollution and health impacts in Iranian megacity

The main objectives of this study were to (i) assess variation within fine particles (PM_2.5) and tropospheric ozone (O₃) time series in Khorramabad (Iran) between 2019 (before) and 2020 (during COVID-19 pandemic); (ii) assess relationship between PM_2.5 and O₃, the PM_2.5/O₃ ratio, and energy consumption; and (iii) estimate the health effects of exposure to ambient PM_2.5 and O₃. From hourly PM_2.5 and O₃ concentrations, we applied both linear-log and integrated exposure-response functions, city-specific relative risk, and baseline incidence values to estimate the health effects over time. A significant correlation was found between PM_2.5 and O₃ (r =-0.46 in 2019, r =-0.55 in 2020, p < 0.05). The number of premature deaths for all non-accidental causes (27.5 and 24.6), ischemic heart disease (7.3 and 6.3), chronic obstructive pulmonary disease (17 and 19.2), and lung cancer (9.2 and 6.25) attributed to ambient PM_2.5 exposure and for respiratory diseases (4.7 and 5.4) for exposure to O₃ above 10 µg m^-3 for people older than 30-year-old were obtained in 2019 and 2020. The number of years of life lost declined by 11.6% in 2020 and exposure to PM_2.5 reduced the life expectancy by 0.58 and 0.45 years, respectively in 2019 and 2020. Compared to 2019, the restrictive measures associated to COVID-19 pandemic led to reduction in PM_2.5 (-25.5%) and an increase of O₃ concentration (+ 8.0%) in Khorramabad.

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.

Evaluation of data preprocessing and feature selection process for prediction of hourly PM10 concentration using long short-term memory models

Studies have confirmed that PM₁₀, defined as respirable particles with diameters of 10 μm and smaller, has adverse effects on human health and the environment. Various estimation methods are employed to determine the PM₁₀ concentration using historical data on controlling PM₁₀ air pollution, early warning, and protecting public health and the environment. The present study analyses different Long Short-Term Memory (LSTM) models that can predict hourly PM₁₀ concentration. In parallel, the study also investigates the effectiveness of the data preprocessing and feature selection (DPFS) process on the prediction accuracy of the LSTM models. For this purpose, three different LSTM models, namely Vanilla, Bi-Directional, and Stacked, were developed. Then, a comprehensive data preprocessing stage is used to eliminate missing and erroneous data and outliers from real-world raw data, and a feature selection process is applied to extract unnecessary features. The LSTM models consider three air quality parameters, including SO₂, O₃, and CO, and three meteorological factors, including relative humidity, wind direction, and wind speed. The prediction performances of the LSTM models are compared using the RMSE, MAE and R² performance index according to whether DPFS is used in the models or not. As a result, when the DPFS process was applied, the proposed LSTM models achieved high prediction performance and can be used to predict hourly PM₁₀ concentrations. Overall, the DPFS process significantly enhanced the developed LSTM models' prediction performance. Furthermore, the proposed model might be a useful tool for city administrators to make decisions and improve air quality management efforts.

Effect of ambient O3 on mortality due to circulatory and respiratory diseases in a high latitude city of northeast China

In recent years, O₃ pollution had been worsening in China and became a major challenge for human health. To evaluate the O₃ effects on circulatory and respiratory mortality in Harbin, a high latitude city of northeast China, we applied a time-series study from 2014 to 2016. After collecting data and adjusting for the effects of confounders, we built the generalized additive model to assess the associations between O₃ and mortality at different lag days. The results showed that an interquartile-range (IQR) increase in O₃ concentration corresponded to excess risk (ER) of 2.00% (95%CI: - 0.25-4.30%) for circulatory mortality at lag 0 and 8.02% (95%CI: 4.18-12.01%) for respiratory mortality at lag 2 days in the single-pollutant model. Stratified analysis showed that O₃ had a greater effect on females than on males. The effect of O₃ exposure on circulatory mortality was stronger during the warm period, while the opposite trend was founded for respiratory mortality. The sensitivity analysis showed that the effects of O₃ were relatively independent and the major results were robust.

A Scoping Review on Wearable Devices for Environmental Monitoring and Their Application for Health and Wellness

This scoping review is focused on wearable devices for environmental monitoring. First, the main pollutants are presented, followed by sensing technologies that are used for the parameters of interest. Selected examples of wearables and portables are divided into commercially available and research-level projects. While many commercial products are in fact portable, there is an increasing interest in using a completely wearable technology. This allows us to correlate the pollution level to other personal information (performed activity, position, and respiratory parameters) and thus to estimate personal exposure to given pollutants. The fact that there are no univocal indices to estimate outdoor or indoor air quality is also an open problem. Finally, applications of wearables for environmental monitoring are discussed. Combining environmental monitoring with other devices would permit better choices of where to perform sports activities, especially in highly polluted areas, and provide detailed information on the living conditions of individuals.

O3 concentration and duration of exposure are factors influencing the environmental health risk of exercising in Rio Grande, Brazil

Ozone (O₃) represents a great threat to human health, contributing to respiratory diseases and premature mortality. This pollutant is often considered a critical pollutant in regions of southern Brazil. Exposure to this pollutant during vigorous physical activity should be the subject of thorough investigations due to the increased ventilation rate and altered breathing pattern present during vigorous physical activity that result in greater inhalation of O₃. Thus, this study aimed to evaluate the health risk of exposure to low, mean, and high concentrations of O₃ during different durations of exercise in the city of Rio Grande (southern Brazil). Healthy young men (n = 45) performed cardiopulmonary exercise testing, and ventilation rate data were collected to predict total ventilation and pollutant inhalation during a 5 km running session. The O₃ concentration in the city of Rio Grande was obtained from data reported by the Copernicus Atmosphere Monitoring Service (CAMS). The environmental health risk was calculated based on the potential intake dose. The lowest, mean, and highest concentrations of O₃ detected during the monitoring period were 32.5, 64.9, and 115.2 µg/m³, respectively. In all evaluated scenarios, there was a toxicological risk (RQ > 1), except when exercising when the O₃ concentration was lowest for the shortest length of time (p < 0.001). As the concentration of O₃ and the duration of the exposure increase, the health risk is increased. Therefore, O₃ concentration and duration of exposure are factors influencing the health risk of exercising. These findings are extremely relevant in cities that have high levels of O₃, such as the city of Rio Grande.

Health impact assessment and evaluation of economic costs attributed to PM2.5 air pollution using BenMAP-CE

Air pollution is considered the most prominent public health. Economically, air pollution imposes additional costs on governments. This study aimed to quantify health effects and associated economic values of reducing PM_2.5 air pollution using BenMAP-CE in Qom in 2019. The air quality data were acquired from Qom Province Environmental Protection Agency, and the population data were collected from Qom Province Management and Planning Organization website. The number of deaths due to Stroke, Chronic Obstructive Pulmonary Disease, Lung Cancer, and Ischemic Heart Disease attributable to PM_2.5 were estimated using BenMAP-CE based on two control scenarios, 2.4 and 10 μg/m³, known as scenarios I and II, respectively. The associated economic effect of premature deaths was assessed by value of a statistical life (VSL) approach. The annual average of PM_2.5 concentration was found to be 16.32 μg/m³ (SD: 9.93). A total of 4694.5 and 2475.94 premature deaths in scenarios I and II were found to be attributable to PM_2.5 in overall, respectively. The total associated cost was calculated to be 855.91 and 451.40 million USD in scenarios I and II, respectively. The total years of life lost due to PM_2.5 exposure in 2019 was 158,657.06 and 78,351.51 in scenarios I and II, respectively. The results of both health and economic assessment indicate the importance of solving the air pollution problem in Qom, as well as other big cities in Iran. The elimination of limitations, such as insufficient local data, should be regarded in future studies.

Exposed to NO2 in the center, NOx polluters in the periphery: Evidence from the Paris region

Air pollution is the cause of many health problems. In cities, combustion vehicles are a major contributor to emissions of key air pollutants. While many studies have focused on populations exposed to pollutants and the resulting environmental and social inequalities, few compare exposures and contributions. In this research, the population of the Household Travel Survey of the Paris region is studied by confronting two elements: the average individual exposure to NO₂ during an average working day and the average traffic NO_x emitted during a day by the motorized trips for each resident surveyed. The dynamic exposure to NO₂ of each resident is estimated according to activities in an average working day. The results confirm an environmental inequality according to the place of residence: on average, the center residents contribute little to pollutant emissions but are highly exposed. Some categories of the population, including women and the socially disadvantaged, are the most affected by these inequalities.

Long-Term Air Pollution Exposure and Ischemic Heart Disease Mortality Among Elderly in High Aging Asian Economies

In the epidemiological literature, the impact of environmental pollution on cardiac mortality has been well documented. There is, however, a paucity of evidence on the impact of air pollution exposure on ischemic heart disease (IHD) mortality among the Asian aged population. In response, this research seeks to investigate the degree of proximity between exposure to ambient PM2.5, household PM2.5, ground-level ozone (O3), and IHD mortality in the top seven Asian economies with the highest aging rates. This investigation is held in two phases. In the first phase, grey modeling is employed to assess the degree of proximity among the selected variables, and then rank them based on their estimated grey weights. In addition, a grey-based Technique for Order of Preference by Similarity to Ideal Solution (G-TOPSIS) is adopted to identify the key influencing factor that intensifies IHD mortality across the selected Asian economies. According to the estimated results, South Korea was the most afflicted nation in terms of IHD mortality owing to ambient PM2.5 and ground-level O3 exposure, whereas among the studied nations India was the biggest contributor to raising IHD mortality due to household PM2.5 exposure. Further, the outcomes of G-TOPSIS highlighted that exposure to household PM2.5 is a key influencing risk factor for increased IHD mortality in these regions, outweighing all other air pollutants. In conclusion, this grey assessment may enable policymakers to target more vulnerable individuals based on scientific facts and promote regional environmental justice. Stronger emission regulations will also be required to mitigate the adverse health outcomes associated with air pollution exposure, particularly in regions with a higher elderly population.

Global burden of chronic obstructive pulmonary disease attributable to ambient ozone in 204 countries and territories during 1990-2019

Ambient ozone becomes one of significant environmental threats to chronic obstructive pulmonary disease (COPD) in recent decades. To date, however, few systematic analyses have been performed to quantify ozone-attributable disease burden, globally and regionally. In this study, we aimed to comprehensively depict the global trend of ozone-related COPD premature deaths and disability-adjusted life years (DALYs). We derived estimates of COPD burden attributable to ambient ozone for 204 countries and territories during 1990-2019 from the Global Burden of Disease Study 2019. We examined the number of deaths and DALYs, as well as age-standardized mortality rate (ASMR) and DALYs rate (ASDR) by sex, socio-demographic index (SDI), countries, and regions. Population attributable fractions (PAFs) were adopted to identify age groups vulnerable to ozone-related COPD. Estimated annual percentage changes (EAPCs) were calculated to assess the temporal trend of ozone-attributable COPD burden (e.g., ASMR and ASDR) between 1990 and 2019, using generalized linear models. Spearman rank correlation was applied to measure the relationships of estimated ASMR, ASDR, and EAPC with SDI. In 2019, COPD attributable to ambient ozone gave rise to 365.22 (95% uncertainty interval: 174.93 to 564.27) thousand deaths and 6.21 (2.99 to 9.63) million DALYs globally, representing a corresponding increase of 76.11% and 56.37% versus 1990. During 1990-2019, however, a yearly decline of 1.07% (0.81 to 1.33) was observed for ASMR and 1.30% (1.07 to 1.52) for ASDR. Considerable gender inequality continues in ozone-attributable COPD burden, with much greater impacts among men, and the gap is enlarged with the increase of age. In all age groups, the fractional contribution of ozone to COPD burden exhibited an overall increasing trend globally for both deaths (8.22% in 1990 versus 11.13% in 2019) and DALYs (6.70% in 1990 versus 8.34% in 2019). The burden of COPD caused by ambient ozone varied substantially by geographical and socioeconomic regions. In 2019, the greatest ASMR and ASDR were seen in South Asia, followed by East Asia and Central Sub-Saharan Africa. Despite the clear drop of age-standardized rates (EAPC<0) in high, high-middle, and middle SDI regions, ASMR and ASDR in low and low-middle SDI regions continuously raised between 1990 and 2019. Higher SDI was found to be associated with lower EAPCs in ASMR (r_s=-0.4405, p<0.001) and ASDR (r_s=-0.4510, p<0.001). Although the global ASMR and ASDR of COPD attributable to ambient ozone have decreased from 1990 to 2019, there has been an unnegligible increase in some low and low-middle SDI regions such as Southeast Asia, South Asia, and Andean Latin America. Findings may have some implications for formulating targeted plans and policies for future COPD prevention and ambient ozone management in different regions.

Long-term ozone exposure and cognitive impairment among Chinese older adults: A cohort study

Ambient particulate matter pollution has been linked to impaired cognitive performance, but the effect of ambient ozone exposure on cognitive function remains largely unknown. We examined the association of long-term ozone exposure with the risk of cognitive impairment among a national representative cohort of 9,544 Chinese older adults (aged 65 years and over) with baseline normal cognition from the Chinese Longitudinal Healthy Longevity Survey (2005-2018). The ozone exposure of each participant was measured by annual mean ozone concentrations for the county of residence. Cognitive function was assessed by the Chinese version of the Mini-Mental State Examination (MMSE). We defined cognitive impairment as an MMSE score below 18 points accompanied by an MMSE score that declined ≥ 4 points from baseline. Cox proportional hazards models were applied to explore the association of ozone exposure with cognitive impairment. During the mean follow-up time of 6.5 years, 2,601 older adults developed cognitive impairment. Each 10-μg/m³ increase in annual mean ozone exposure was associated with a 10.4% increased risk of cognitive impairment. The exposure-response relationship between ozone exposure and risk of cognitive impairment showed a linear trend. Sensitivity analyses revealed the association to be robust. We found that older adults from Eastern, Central, and Southern China were particularly susceptible. Our results show that ozone is a risk factor for late-life cognitive decline. Reducing ambient ozone pollution may help delay the onset of cognitive impairment among older adults.

A 10-year assessment of ambient fine particles and related health endpoints in a large Mediterranean city

Fine particles i.e., with an aerodynamic diameter lower than 2.5 μm (PM_2.5) have potentially the most significant effects on human health compared to other air pollutants. The main objectives of this study were to i) investigate the temporal variations of ambient PM_2.5 in Marseille (Southern France), where air pollution is again a major public health issue, and ii) estimate their short-term health effects and annual trend (Mann-Kendall test) over a 10-year period from 2010 to 2019. In Marseille, the main sources of PM_2.5 could be related to road traffic, industrial complexes, and oil refineries surrounded the city. The number of premature deaths and hospital admissions attributable to ambient PM_2.5 exposure for non-accidental causes, cardiovascular and respiratory diseases were estimated by using in-situ air quality data, city-specific relative risk values and baseline incidence. Despite significant reduction of PM_2.5 (- 0.80 μg m^-3 year^-1), Marseille citizens were exposed to PM_2.5 levels exceeding the World Health Organization (WHO) Air Quality Guideline for human health protection (10 μg m^-3) during entire study period. Exposure to ambient PM_2.5 substantially contributed to mortality and hospital admissions: 871 deaths for non-accidental causes, 515 deaths for cardiovascular diseases, 47 deaths for respiratory diseases, as well as 1034 hospital admissions for cardiovascular diseases and 834 for respiratory diseases were reported between 2010 and 2019. Compliance with WHO annual limit values can result in substantial socio-economic benefits by preventing premature deaths and hospital admissions. For instance, based on the value of a statistical life and average cost of a hospital admission, the associated benefit for healthcare would have been €131 million in 2019. Between 2010 and 2019, the number of PM_2.5-related non-accidental deaths decreased by 1.15 per 10⁵ inhabitants annually. Compared to 2010-2019, the restrictive measures associated to COVID-19 pandemic led to a reduction in PM_2.5 of 11% in Marseille, with 2.6 PM_2.5-related deaths averted in 2020.

Elemental and isotopic compositions in blank filters collecting atmospheric particulates

Background

The atmospheric particulates can be harmful to human health due to toxic substances sorbed onto particulates. Although the atmospheric particulates have been collected using different types of filters, few studies have reported background contents of major and trace element, and isotopic compositions in the blank filters used for collecting the particulates yet. Here, we first report background contents of major and trace elements, and isotopic compositions (Zn and Pb isotopes) in the blank filters. Then, we evaluate the best type of filter for elemental and isotope analyses in the particulates.

Findings

The contents of major elements are the lowest in the PTFE filter and become higher in the order of the Nylon, NC, and GF filters, indicating that either PTFE and/or Nylon filters are the most suitable for major element analysis in the atmospheric particulates. Likewise, the contents of trace elements are the lowest in the PTFE filter and become much higher in the order of the Nylon, NC, and GF filters, indicating that PTFE filter is the most suitable for trace element analysis in the atmospheric particulates. Otherwise, background elemental contents result in overestimating their concentrations in the atmospheric particulates. All δ66ZnJMC-Lyon values in two GF filters are within those from samples of the Chinese deserts and of the Chinese Loess Plateau. Likewise, their 206Pb/204Pb ratios are similar with those of samples from Xi’an and Beijing, indicating that the GF filter is not suitable for Zn and Pb isotope study in the atmospheric particulates.

Conclusions

This study suggests that the PTFE filter is the most suitable for elemental and isotope study in the atmospheric particulates and that the GF filter cannot be used for source identification in the atmospheric particulates using Zn and Pb isotopes.

Understanding linkages between environmental risk factors and noncommunicable diseases-A review

Environmental factors such as climate change are now underway, which have substantial impacts on health and well-being of human kind, but still imprecisely quantified, implications for human health. At present, one of the most significant discussions among scientists worldwide is interdependency of escalating environmental risk factors and the increasing rates of noncommunicable diseases (NCDs), which are the leading cause of death and disability worldwide. Climate change also triggers the occurrence of NCDs through a variety of direct and indirect pathways. Therefore, it is likely that the interdependence of climate change, environmental risk factors, and NCDs as a whole poses great threat to global health. Hence, this paper aims to review the latest evidence on impacts of environmental risk factors on NCDs and methods used in establishing the cause or correlation of environmental risk factors and NCDs. The literature review leveraged online databases such as PubMed and Google Scholar with articles that matched keywords "climate change", "environmental risk factors," and "noncommunicable diseases". This review shows that the burden of NCDs is increasing globally and attribution of environmental risk factors such as climate change is significant. Understanding the nature of the relation between NCDs and the environment is complex and has relied on evidence generated from multiple study designs. This paper reviews eight types of study designs that can be used to identify and measure causal and correlational nature between environment and NCDs. Future projections suggest that increases in temperatures will continue and also increase the public health burden of NCDs.

Preadmission Exposure to Air Pollution and 90-Day Mortality in Critically ill Patients: A Retrospective Study

OBJECTIVE

We investigated the association between preadmission exposure to air pollutants and 90-day mortality in critically ill patients.

METHODS

This retrospective cohort study analyzed the medical records of adult patients (more than or equal to 18 years) admitted to the intensive care unit of a tertiary academic hospital from 2015 to 2016.

RESULTS

Four air pollutants were not significantly associated with 90-day mortality and pulmonary disease-related 90-day mortality (P > 0.05). In patients with preadmission chronic obstructive lung disease (COPD), a 1 ppm increase in ozone (O3) and carbon monoxide (CO) was associated with a 1.04-fold and 5.99-fold increase in pulmonary disease-related 90-day mortality, respectively.

CONCLUSIONS

Preadmission exposure to air pollution was not associated with 90-day mortality in critically ill patients. However, a higher concentration of CO and O3 was associated with an increase in pulmonary disease-related 90-day mortality in patients with preadmission COPD.

Different immune and functional effects of urban dust and diesel particulate matter inhalation in a mouse model of acute air pollution exposure

Increased global industrialization has increased air pollution resulting in 3 million annual deaths globally. Air pollutants could have different health effects, so specific models to identify the different immune effects are needed. The aim of this study was to determine the immune effects and lung function of acute exposure to two different pollution sources using a mouse model. Three intranasal challenges with either urban dust or diesel particulate matter resulted in significant (P < 0.001) immune cell infiltration into the lung, which was mostly because of an increased (P < 0.001) percentage of neutrophils. We found that exposure to either urban dust or diesel particulate matter significantly increased the lung tissue concentration of the neutrophil chemoattractant cytokine CXCL5 when compared with naïve controls. The urban dust challenge also significantly increased the concentration of the proinflammatory cytokine CCL20, but diesel particulate matter did not. The urban dust challenge significantly (P < 0.001) decreased tissue compliance and ability to stretch, and increased total airways constriction and lung tissue stiffness. In comparison, diesel particulate matter exposure slightly, but significantly (P = 0.022), increased tissue compliance and did not affect other lung function parameters. Although both urban dust and diesel particulate matter induced immune cell infiltration into the lung resulting in lung inflammation, their detrimental effects on cytokine production and lung function were quite different. This may be attributed to the variation in particulates that comprise these pollutants that directly interact with the lung tissue and consequently elicit a different functional response.

Association of hospital admission for bronchiectasis with air pollution: A province-wide time-series study in southern China

The relation of acute fluctuations of air pollution to hospital admission for bronchiectasis remained uncertain, and large-scale studies were needed. We collected daily concentrations of particulate matter (PM), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), ozone (O₃), and daily hospitalizations for bronchiectasis for 21 cities across Guangdong Province from 2013 through 2017. We examined their association using two-stage time-series analysis. Our analysis was stratified by specific sub-diagnosis, sex and age group to assess potential effect modifications. Relative risks of hospitalization for bronchiectasis were 1.060 (95%CI 1.014-1.108) for PM₁₀ at lag0-6, 1.067 (95%CI 1.020-1.116) for PM_2.5 at lag0-6, 1.038 (95%CI 1.005-1.073) for PM_coarse at lag0-6, 1.058 (95%CI 1.015-1.103) for SO₂ at lag0-4, 1.057 (95%CI 1.030-1.084) for NO₂ at lag0 and 1.055 (95%CI 1.025-1.085) for CO at lag0-6 per interquartile range increase of air pollution. Specifically, acute fluctuations of air pollution might be a risk factor for bronchiectasis patients with lower respiratory infection but not with hemoptysis. Patients aged ≥65 years, and female patients appeared to be particularly susceptible to air pollution. Acute fluctuations of air pollution, particularly PM may increase the risk of hospital admission for bronchiectasis exacerbations, especially for the patients complicated with lower respiratory infection. This study strengthens the importance of reducing adverse impact on respiratory health of air pollution to protect vulnerable populations.

The Impact of Chronic Ambient Exposure to PM2.5 and Ozone on Asthma Prevalence and COPD Mortality Rates in the Southeastern United States

Respiratory diseases affect millions of people across the United States annually. Two of the most common respiratory diseases are chronic obstructive pulmonary disease (COPD) and asthma. Mortality rates due to COPD have increased by an estimated 30% between 1980 and 2014, with significant variances among geographic regions. Both acute and chronic ambient exposures to fine particulate matter (PM_2.5) and ozone have been associated with exacerbations of respiratory diseases in numerous studies, and exposure to air pollutants are considered as the largest health risk factor globally. This study adds to the current literature by reporting the results of a time series analysis of the impact of PM_2.5 and ozone on prevalence rates of asthma and mortality rates for COPD at regional and county levels across the southeastern United States for the years 2005-2014. While general reductions in levels of PM_2.5 and ozone were demonstrated across all years, a distributed lag model showed continued strong associations between PM_2.5 and prevalence of asthma and mortality due to COPD, even at relatively small increases in ambient exposure (<1 μg/m³) across the southeastern United States. The results of the study support the need for additional research that considers factors such as patient demographics, medical histories, and health disparities in combination with ambient exposures to known pollutants.

Spatiotemporal distribution of ground-level ozone in China at a city level

In recent years, ozone (O3) pollution in China has shown a worsening trend. Due to the vast territory of China, O3 pollution is a widespread and complex problem. It is vital to understand the current spatiotemporal distribution of O3 pollution in China. In this study, we collected hourly data on O3 concentrations in 338 cities from January 1, 2016, to February 28, 2019, to analyze O3 pollution in China from a spatiotemporal perspective. The spatial analysis showed that the O3 concentrations exceeded the limit in seven geographical regions of China to some extent, with more serious pollution in North, East, and Central China. The O3 concentrations in the eastern areas were usually higher than those in the western areas. The temporal analysis showed seasonal variations in O3 concentration, with the highest O3 concentration in the summer and the lowest in the winter. The weekend effect, which occurs in other countries (such as the USA), was found only in some cities in China. We also found that the highest O3 concentration usually occurred in the afternoon and the lowest was in the early morning. The comprehensive analysis in this paper could improve our understanding of the severity of O3 pollution in China.

Mapping ozone source-receptor relationship and apportioning the health impact in the Pearl River Delta region using adjoint sensitivity analysis

While fine particulate matters are decreasing in the Pearl River Delta (PRD) region, the regional ozone (O₃) shows an increasing trend that affects human health, leading to an urgent need for scientific understanding of source-receptor relationship between O₃ and its precursor emissions given the changing background composition. We advanced and applied an adjoint air quality model to map contributions of individual O₃ precursor emission sources [nitrogen oxides (NO_x) and volatile organic compound (VOC)] at each location to annual regional O₃ concentrations and to identify the possible dominant influential pathways of emission sources to O₃ at different spatiotemporal scales. Additionally, we introduced the novel adjoint sensitivity approach to assess the relationship between precursor emissions and O₃-induced premature mortality. Adjoint results show that Shenzhen was a major source contributor to regional O₃ throughout all seasons, of which 49.4% (3.8%) were from its NO_x (VOC) emissions. Local emissions (within PRD) contributed to 83% of the regional O₃ whereas only ~54% of the estimated ~4000 regional O₃-induced premature mortalities. The discrepancy between these two contributions was because O₃-induced mortalities are dependent on not only O₃ concentration, but incident rate and population density. We also found that a city with low O₃-induced mortalities could have significant emission contributions to health impact in the region since the transport pathways could be through transport of local O₃ or through transport of O₃ precursors that form regional O₃ thereafter. It is therefore necessary to formulate emission control policies from both air quality and public health perspectives, and it is also critical to have better understanding of influential pathways of emission sources to O₃.

A novel optimal-hybrid model for daily air quality index prediction considering air pollutant factors

Accurate and reliable air quality index (AQI) forecasting is extremely crucial for ecological environment and public health. A novel optimal-hybrid model, which fuses the advantage of secondary decomposition (SD), AI method and optimization algorithm, is developed for AQI forecasting in this paper. In the proposed SD method, wavelet decomposition (WD) is chosen as the primary decomposition technique to generate a high frequency detail sequence WD(D) and a low frequency approximation sequence WD(A). Variational mode decomposition (VMD) improved by sample entropy (SE) is adopted to smooth the WD(D), then long short-term memory (LSTM) neural network with good ability of learning and time series memory is applied to make it easy to be predicted. Least squares support vector machine (LSSVM) with the parameters optimized by the Bat algorithm (BA) considers air pollutant factors including PM_2.5, PM₁₀, SO₂, CO, NO₂ and O₃, which is suitable for forecasting WD(A) that retains original information of AQI series. The ultimate forecast result of AQI can be obtained by accumulating the prediction values of each subseries. Notably, the proposed idea not only gives full play to the advantages of conventional SD, but solve the problem that the traditional time series prediction model based on decomposition technology can not consider the influential factors. Additionally, two daily AQI series from December 1, 2016 to December 31, 2018 respectively collected from Beijing and Guilin located in China are utilized as the case studies to verify the proposed model. Comprehensive comparisons with a set of evaluation indices indicate that the proposed optimal-hybrid model comprehensively captures the characteristics of the original AQI series and has high correct rate of forecasting AQI classes.

Associations between daily air quality and hospitalisations for acute exacerbation of chronic obstructive pulmonary disease in Beijing, 2013-17: an ecological analysis

BACKGROUND

Air pollution in Beijing has been improving through implementation of the Air Pollution Prevention and Control Action Plan (2013-17), but its implications for respiratory morbidity have not been directly investigated. We aimed to assess the potential effects of air-quality improvements on respiratory health by investigating the number of cases of acute exacerbations of chronic obstructive pulmonary disease (COPD) advanced by air pollution each year.

METHODS

Daily city-wide concentrations of PM10, PM2·5, PMcoarse (particulate matter >2·5-10 μm diameter), nitrogen dioxide (NO2), sulphur dioxide (SO2), carbon monoxide (CO), and ozone (O3) in 2013-17 were averaged from 35 monitoring stations across Beijing. A generalised additive Poisson time-series model was applied to estimate the relative risks (RRs) and 95% CIs for hospitalisation for acute exacerbation of COPD associated with pollutant concentrations.

FINDINGS

From Jan 18, 2013, to Dec 31, 2017, 161 613 hospitalisations for acute exacerbation of COPD were recorded. Mean ambient concentrations of SO2 decreased by 68% and PM2·5 decreased by 33% over this 5-year period. For each IQR increase in pollutant concentration, RRs for same-day hospitalisation for acute exacerbation of COPD were 1·029 (95% CI 1·023-1·035) for PM10, 1·028 (1·021-1·034) for PM2·5, 1·018 (1·013-1·022) for PMcoarse, 1·036 (1·028-1·044) for NO2, 1·019 (1·013-1·024) for SO2, 1·024 (1·018-1·029) for CO, and 1·027 (1·010-1·044) for O3 in the warm season (May to October). Women and patients aged 65 years or older were more susceptible to the effects of these pollutants on hospitalisation risk than were men and patients younger than 65 years. In 2013, there were 12 679 acute exacerbations of COPD cases that were advanced by PM2·5 pollution above the expected number of cases if daily PM2·5 concentrations had not exceeded the WHO target (25 μg/m3), whereas the respective figure in 2017 was 7377 cases.

INTERPRETATION

Despite improvement in overall air quality, increased acute air pollution episodes were significantly associated with increased hospitalisations for acute exacerbations of COPD in Beijing. Stringent air pollution control policies are important and effective for reducing COPD morbidity, and long-term multidimensional policies to safeguard public health are indicated.

FUNDING

UK Medical Research Council.

An Exposure Appraisal of Outdoor Air Pollution on the Respiratory Well-being of a Developing City Population

Zaria is the educational hub of northern Nigeria. It is a developing city with a pollution level high enough to be ranked amongst the World Health Organization’s (WHO) most polluted cities. The study appraised the influence of outdoor air pollution on the respiratory well-being of a population in a limited resource environment. With the approved ethics, the techniques utilized were: portable pollutant monitors, respiratory health records, WHO AirQ+ software, and the American Thoracic Society (ATS) questionnaire. They were utilized to acquire day-time weighted outdoor pollution levels, health respiratory cases, assumed baseline incidence (BI), and exposure respiratory symptoms among selected study participants respectively. The study revealed an average respiratory illness incidence rate of 607 per 100,000 cases. Findings showed that an average of 2648 cases could have been avoided if the theoretical WHO threshold limit for the particulate matter with diameter of <2.5/10 micron (PM_2.5/PM₁₀) were adhered to. Using the questionnaire survey, phlegm was identified as the predominant respiratory symptom. A regression analysis showed that the criteria pollutant PM_2.5, was the most predominant cause of respiratory symptoms among interviewed respondents. The study logistics revealed that outdoor pollution is significantly associated with respiratory well-being of the study population in Zaria, Nigeria.

Interactive effects of changing stratospheric ozone and climate on tropospheric composition and air quality, and the consequences for human and ecosystem health

The composition of the air we breathe is determined by emissions, weather, and photochemical transformations induced by solar UV radiation. Photochemical reactions of many emitted chemical compounds can generate important (secondary) pollutants including ground-level ozone (O₃) and some particulate matter, known to be detrimental to human health and ecosystems. Poor air quality is the major environmental cause of premature deaths globally, and even a small decrease in air quality can translate into a large increase in the number of deaths. In many regions of the globe, changes in emissions of pollutants have caused significant changes in air quality. Short-term variability in the weather as well as long-term climatic trends can affect ground-level pollution through several mechanisms. These include large-scale changes in the transport of O₃ from the stratosphere to the troposphere, winds, clouds, and patterns of precipitation. Long-term trends in UV radiation, particularly related to the depletion and recovery of stratospheric ozone, are also expected to result in changes in air quality as well as the self-cleaning capacity of the global atmosphere. The increased use of substitutes for ozone-depleting substances, in response to the Montreal Protocol, does not currently pose a significant risk to the environment. This includes both the direct emissions of substitutes during use and their atmospheric degradation products (e.g. trifluoroacetic acid, TFA).

Mortality and morbidity for cardiopulmonary diseases attributed to PM2.5 exposure in the metropolis of Rome, Italy

The aim of the study was to evaluate the health effects associated with the exposure to ground-level of particulate matters with aerodynamic diameter ≤ 2.5 μm (PM_2.5) on citizens in Rome (Italy) in 2015 and 2016. Based on the new version of the World Health Organization's AirQ+ model, we have estimated the short- and long-term effects of PM_2.5 on hospital admissions due to cardiovascular (HA-CVD) and respiratory diseases (HA-RD) as well as on mortality for ischemic heart disease (M-IHD) and chronic obstructive pulmonary disease (M-COPD). In this study, city-specific relative risk values and baseline incidence rates were used to calculate the association between PM_2.5 and daily counts of emergency hospitalizations and mortality. The annual mean PM_2.5 concentrations were 18 μg m^-3 and 14 μg m^-3 in 2015 and 2016, respectively. In Rome, the citizens are mostly exposed to daily mean PM_2.5 concentrations of 10-20 μg m^-3 during the study period. In 2015-2016, 0.4-0.6% for HA-CVD, 1.1-1.5% for HA-RD, 16.5-18.1% for M-IHD and 8.5-9.2% for M-COPD are attributed to PM_2.5. In 2015-2016, 134-186 HA-CVD, 126-175 HA-RD, 947-1037 M-IHD and 244-279 M-COPD, caused by PM_2.5 exposure, could be "avoided" if PM_2.5 concentrations would not exceed 10 μg m^-3, i.e. the threshold recommended by the World Health Organization. Thus, a consistent air quality management and sustainable city planning are needed, urgently, to mitigate the adverse effects of PM_2.5 exposure in Rome.

The burden of ozone pollution on years of life lost from chronic obstructive pulmonary disease in a city of Yangtze River Delta, China

OBJECTIVE

Ambient ozone is one of the most important air pollutants with respect to its impacts on human health and its increasing concentrations globally. However, studies which explored the burden of ozone pollution on chronic obstructive pulmonary disease (COPD) and estimated the relevant economic loss were rare.

OBJECTIVE

We explored the relationships between ambient ozone exposure and years of life lost (YLL) from COPD mortality and estimated the relevant economic loss in Ningbo, in the Yangtze River Delta of China, 2011-2015.

METHODS

A time-series study was conducted to explore the effects of ozone on YLL from COPD. Seasonal stratified analyses were performed, and the effect modification of demographic factors was estimated. In addition, the related economic loss was calculated using the method of the value per statistical life year (VSLY).

RESULTS

Averaged daily mean maximum 8-h average ozone concentration was 40.90 ppb in Ningbo, China, 2011-2015. The effect of short term ambient ozone exposure on COPD YLL was more pronounced in the cool season than in the warm season, with 10 ppb increment of ozone corresponding to 7.09(95%CI: 3.41, 10.78) years increase in the cool season and 0.31 (95%CI: -2.15, 2.77) years change in the warm season. The effect was higher in the elderly than the young. Economic loss due to excess COPD YLL related to ozone exposure accounted for 7.30% of the total economic loss due to COPD YLL in Ningbo during the study period.

CONCLUSIONS

Our findings highlight that ozone exposure was related to tremendous disease burden of COPD in Ningbo, China. The effects were more pronounced in the cool season, and the elderly were more susceptible populations.

Estimation of Short-term Mortality and Morbidity Attributed to Fine Particulate Matter in the Ambient Air of Eight Iranian Cities

Amongst the various pollutants in the air, particulate matters (PM) have significant adverse effects on human health. The current research is based on existing epidemiological literature for quantitative estimation of the current health impacts related to particulate matters in some selected principal Iranian megacities. In order to find the influence of air pollution on human health, we used the AirQ software tool presented by the World Health Organization (WHO) European Centre for Environment and Health (ECEH), Bilthoven Division. The adverse health outcomes used in the study consist of mortality (all causes excluding accidental causes), due to cardiovascular (CVD) and respiratory (RES) diseases, and morbidity (hospital admissions for CVD and RES causes). For this purpose, hourly PM₁₀ data were taken from the monitoring stations in eight study cities during 2011 and 2012. Results showed annual average concentrations of PM₁₀ and PM_2.5 in all megacities exceeded national and international air quality standards and even reached levels nearly ten times higher than WHO guidelines in some cities. Considering the short-term effects, PM_2.5 had the maximum effects on the health of the 19,048,000 residents of the eight Iranian cities, causing total mortality of 5,670 out of 87,907 during a one-year time-period. Hence, reducing concentrations and controlling air pollution, particularly the presence of particles, is urgent in these metropolises.

Personal Ozone Exposure and Respiratory Inflammatory Response: The Role of DNA Methylation in the Arginase-Nitric Oxide Synthase Pathway

Little is known regarding the molecular mechanisms behind respiratory inflammatory response induced by ozone. We performed a longitudinal panel study with four repeated measurements among 43 young adults in Shanghai, China from May to October in 2016. We collected buccal samples and measured the fractional exhaled nitric oxide (FeNO) after 3-day personal ozone monitoring. In buccal samples, we measured concentrations of inducible nitric oxide synthase (iNOS) and arginase (ARG), and DNA methylation of NOS2A and ARG2. We used linear mixed-effect models to analyze the effects of ozone on FeNO, two enzymes and their DNA methylation. A 10 ppb increase in ozone (lag 0-8 h) was significantly associated with a 3.89% increase in FeNO, a 36.33% increase in iNOS, and a decrease of 0.36 in the average methylation (%5mC) of NOS2A. Ozone was associated with decreased ARG and elevated ARG2 methylation, but the associations were not significant. These effects were more pronounced among allergic subjects than healthy subjects. The effects were much stronger when using personal exposure monitoring than fixed-site measurements. Our study demonstrated that personal short-term exposure to ozone may result in acute respiratory inflammation, which may be mainly modulated by NOS2A hypomethylation in the arginase-nitric oxide synthase pathway.

Increasing Probability of Heat-Related Mortality in a Mediterranean City Due to Urban Warming

Extreme temperatures impose thermal stress on human health, resulting in increased hospitalizations and mortality rate. We investigated the circulatory and respiratory causes of death for the years 2007 to 2014 inclusive for the urban and rural areas of Nicosia, Cyprus under urban heatwave and non-heatwave conditions. Heatwaves were defined as four or more consecutive days with mean urban daily temperature over the 90th percentile threshold temperature of the eight investigated years. Lag period of adverse health effects was found to be up to three days following the occurrence of high temperatures. The relative risk (RR) for mortality rate under heatwave and non-heatwave conditions was found taking in consideration the lag period. The results showed the increase of mortality risk particularly for men of ages 65⁻69 (RR = 2.38) and women of ages 65⁻74 (around RR = 2.54) in the urban area, showing that women were more vulnerable to heat extremities. High temperatures were also associated with high ozone concentrations, but they did not impose an excess risk factor, as they did not reach extreme values. This analysis highlights the importance of preparing for potential heat related health impacts even in Cyprus, which is an island with frequent heatwaves.

Enhanced near-surface ozone under heatwave conditions in a Mediterranean island

Near-surface ozone is enhanced under particular chemical reactions and physical processes. This study showed the seasonal variation of near-surface ozone in Nicosia, Cyprus and focused in summers when the highest ozone levels were noted using a seven year hourly dataset from 2007 to 2014. The originality of this study is that it examines how ozone levels changed under heatwave conditions (defined as 4 consecutive days with daily maximum temperature over 39 °C) with emphasis on specific air quality and meteorological parameters with respect to non-heatwave summer conditions. The influencing parameters had a medium-strong positive correlation of ozone with temperature, UVA and UVB at daytime which increased by about 35% under heatwave conditions. The analysis of the wind pattern showed a small decrease of wind speed during heatwaves leading to stagnant weather conditions, but also revealed a steady diurnal cycle of wind speed reaching a peak at noon, when the highest ozone levels were noted. The negative correlation of NOx budget with ozone was further increased under heatwave conditions leading to steeper lows of ozone in the morning. In summary, this research encourages further analysis into the persistent weather conditions prevalent during HWs stimulating ozone formation for higher temperatures.

Chronic obstructive pulmonary diseases related to outdoor PM10, O3, SO2, and NO2 in a heavily polluted megacity of Iran

This study was conducted to quantify, by an approach proposed by the World Health Organization (WHO), the daily hospital admissions for chronic obstructive pulmonary disease (COPD) related to exposure to particulate matter (PM₁₀) and oxidants such as ozone (O₃), sulfur dioxide (SO₂), and nitrogen dioxide (NO₂) in a heavily polluted city in Iran. For the health impact assessment, in terms of COPD, the current published relative risk (RR) and baseline incidence (BI) values, suggested by the WHO, and the 1-h O₃ concentrations and daily PM₁₀, NO₂, and SO₂ concentrations were compiled. The results showed that 5.9, 4.1, 1.2, and 1.9% of the COPD daily hospitalizations in 2011 and 6.6, 1.9, 2.3, and 2.1% in 2012 were attributed to PM₁₀, O₃, SO₂, and NO₂ concentrations exceeding 10 μg/m³, respectively. This study indicates that air quality and the high air pollutant levels have an effect on COPD morbidity. Air pollution is associated with visits to emergency services and hospital admissions. A lower relative risk can be achieved if some stringent control strategies for reducing air pollutants or emission precursors are implemented.

The Short-Term Effects of Visibility and Haze on Mortality in a Coastal City of China: A Time-Series Study

Few studies have been conducted to investigate the acute health effects of visibility and haze, which may be regarded as proxy indicators of ambient air pollution. We used a distributed lag non-linear model (DLNM) combined with quasi-Poisson regression to estimate the relationship between visibility, haze and mortality in Ningbo, a coastal city of China. We found that the mortality risk of visibility was statistically significant only on the current day, while the risk of haze and PM₁₀ peaked on the second day and could last for three days. When the visibility was less than 10 km, each 1 km decrease of visibility at lag 0 day was associated with a 0.78% (95% CI: 0.22–1.36%) increase in total mortality and a 1.61% (95% CI: 0.39–2.85%) increase in respiratory mortality. The excess risk of haze at lag 0–2 days on total mortality, cardiovascular and respiratory mortality was 7.76% (95% CI: 3.29–12.42%), 7.73% (95% CI: 0.12–15.92%) and 17.77% (95% CI: 7.64–28.86%), respectively. Greater effects of air pollution were observed during the cold season than in the warm season, and the elderly were at higher risk compared to youths. The effects of visibility and haze were attenuated by single pollutants. These findings suggest that visibility and haze could be used as surrogates of air quality where pollutant data are scarce, and strengthen the evidence to develop policy to control air pollution and protect vulnerable populations.

Health benefits of PM10 reduction in Iran

Air pollution contains a complex mixture of poisonous compounds including particulate matter (PM) which has wide spectrum of adverse health effects. The main purpose of this study was to estimate the potential health impacts or benefits due to any changes in annual PM₁₀ level in four major megacities of Iran. The required data of PM₁₀ for AirQ software was collected from air quality monitoring stations in four megacities of Iran. The preprocessing was carried out using macro coding in excel environment. The relationship between different presumptive scenarios and health impacts was determined. We also assessed the health benefits of reducing PM₁₀ to WHO Air Quality Guidelines (WHO-AQGs) and National Ambient Air Quality Standards (NAAQSs) levels with regard to the rate of mortality and morbidity in studied cities. We found that the 10 μg/m³ increase in annual PM₁₀ concentration is responsible for seven (95% CI 6-8) cases increase in total number of deaths per 2 × 10⁵ person. We also found that 10.7, 7.2, 5.7, and 5.3% of total death is attributable to short-term exposure to air pollution for Ahvaz, Isfahan, Shiraz, and Tehran, respectively. We found that by attaining the WHO's proposed value for PM₁₀, the potential health benefits of 89, 84, 79, and 78% were obtained in Ahvaz, Isfahan, Shiraz, and Tehran, respectively. The results also indicated that 27, 10, 3, and 1% of health impacts were attributed to dust storm days for Ahvaz, Isfahan, Shiraz, and Tehran, respectively.

Hospital admissions in Iran for cardiovascular and respiratory diseases attributed to the Middle Eastern Dust storms

The main objective of this study was to assess the possible effects of airborne particulate matter less than 10 μm in diameter (PM₁₀) from the Middle Eastern Dust (MED) events on human health in Khorramabad (Iran) in terms of estimated hospital admissions (morbidity) for cardiovascular diseases (HACD) and for respiratory diseases (HARD) during the period of 2015 to 2016. The AirQ program developed by the World Health Organization (WHO) was used to estimate the potential health impacts to daily PM₁₀ exposures. The numbers of excess cases for cardiovascular/respiratory morbidity were 20/51, 72/185, and 20/53 on normal, dusty, and MED event days, respectively. The highest number of hospital admissions was estimated for PM₁₀ concentrations in the range of 40 to 49 μg/m³, i.e, lower than the daily (50 μg/m³) limit value established by WHO. The results also showed that 4.7% (95% CI 3.2-6.7%) and 4.2% (95% CI 2.6-5.8%) of HARD and HACD, respectively, were attributed to PM₁₀ concentrations above 10 μg/m³. The study demonstrates a significant impact of air pollution on people, which is manifested primarily as respiratory and cardiovascular problems. To reduce these effects, several immediate actions should be taken by the local authorities to control the impacts of dust storms on residents' health, e.g., developing a green beltway along the Iran-Iraq border and management of water such as irrigation of dry areas that would be effective as mitigation strategies.

Acute myocardial infarction and COPD attributed to ambient SO2 in Iran

Acute myocardial infarction (MI) and chronic obstructive pulmonary disease (COPD) are important diseases worldwide. Inhalation is the major route of short-term exposure to air sulfur dioxide (SO₂) that negatively affect human health. The objective of this study was to estimate the health effects of short-term exposure to SO₂ in Khorramabad, Iran using the AirQ software developed by the World Health Organization (WHO). Daily mean SO₂ concentrations were used as the estimates of human short-term exposure and allow calculation of the attributable excess relative risk of an acute MI and hospital admissions due to COPD (HACOPD). The annual mean SO₂ concentration in Khorramabad was 51.33µg/m³. Based on the relative risk (RR) and baseline incidence (BI) approach of WHO, an increased risk of 2.7% (95% CI: 1.1-4.2%) of acute MI and 2.0% (95% CI: 0-4.6%) of HACOPD, respectively, were attributed to a 10µg/m³ SO₂ increase. Since the geographic, demographic, and climatic characteristics are different from the areas in which the risk relationships were developed and not evaluated here, further investigations will be needed to fully quantify other health impacts of SO₂. A decreased risk for MIs and COPD attributable to SO₂ could be achieved if mitigation strategies and measures are implemented to reduce the exposure.

Health risk assessment of exposure to the Middle-Eastern Dust storms in the Iranian megacity of Kermanshah

OBJECTIVE

This study assessed the effects of particulate matter (PM), equal or less than 10 μm in aerodynamic diameter (PM₁₀), from the Middle-Eastern Dust events on public health in the megacity of Kermanshah (Iran).

STUDY DESIGN

This study used epidemiological modeling and monitored ambient air quality data to estimate the potential PM₁₀ impacts on public health.

METHODS

The AirQ2.2.3 model was used to calculate mortality and morbidity attributed to PM₁₀ as representative of dust events. Using Visual Basic for Applications, the programming language of Excel software, hourly PM₁₀ concentrations obtained from the local agency were processed to prepare input files for the AirQ2.2.3 model.

RESULTS

Using baseline incidence, defined by the World Health Organization, the number of estimated excess cases for respiratory mortality, hospital admissions for chronic obstructive pulmonary disease, for respiratory diseases, and for cardiovascular diseases were 37, 39, 476, and 184 persons, respectively, from 21st March, 2014 to 20th March, 2015. Furthermore, 92% of mortality and morbidity cases occurred in days with PM₁₀ concentrations lower than 150 μg/m³. The highest percentage of person-days occurred for daily concentrations range of 100-109 μg/m³, causing the maximum health end-points among the citizens of Kermanshah.

CONCLUSIONS

Calculating the number of cumulative excess cases for mortality or morbidity attributed to PM₁₀ provides a good tool for decision and policy-makers in the field of health care to compensate their shortcomings particularly at hospital and healthcare centers for combating dust storms. To diminish these effects, several immediate actions should be managed in the governmental scale to control dust such as spreading mulch and planting new species that are compatible to arid area.