Public health benefits of reducing air pollution in Shanghai: a proof-of-concept methodology with application to BenMAP

Estimation of health risk and economic loss attributable to PM2.5 and O3 pollution in Jilin Province, China

Ambient pollutants, particularly fine particulate matter (PM2.5) and ozone (O3), pose significant risks to both public health and economic development. In recent years, PM2.5 concentration in China has decreased significantly, whereas that of O3 has increased rapidly, leading to considerable health risks. In this study, a generalized additive model was employed to establish the relationship of PM2.5 and O3 exposure with non-accidental mortality across 17 districts and counties in Jilin Province, China, over 2015-2016. The health burden and economic losses attributable to PM2.5 and O3 were assessed using high-resolution satellite and population data. According to the results, per 10 µg/m3 increase in PM2.5 and O3 concentrations related to an overall relative risk (95% confidence interval) of 1.004 (1.001-1.007) and 1.009 (1.005-1.012), respectively. In general, the spatial distribution of mortality and economic losses was uneven. Throughout the study period, a total of 23,051.274 mortalities and 27,825.015 million Chinese Yuan (CNY) in economic losses were attributed to O3 exposure, which considerably surpassing the 5,450.716 mortalities and 6,553,780 million CNY in economic losses attributed to PM2.5 exposure. The O3-related health risks and economic losses increased by 3.75% and 9.3% from 2015 to 2016, while those linked to PM2.5 decreased by 23.33% and 18.7%. Sensitivity analysis results indicated that changes in pollutant concentrations were the major factors affecting mortality rather than baseline mortality and population.

Regional joint PM2.5-O3 control policy benefits further air quality improvement and human health protection in Beijing-Tianjin-Hebei and its surrounding areas

Beijing-Tianjin-Hebei and its surrounding areas (hereinafter referred to as "2+26" cities) are one of the most severe air pollution areas in China. The fine particulate matter (PM_2.5) and surface ozone (O₃) pollution have aroused a significant concern on the national scale. In this study, we analyzed the pollution characteristics of PM_2.5 and O₃ in "2+26" cities, and then estimated the health burden and economic loss before and after the implementation of the joint PM_2.5-O₃ control policy. During 2017-2019, PM_2.5 concentration reduced by 19% while the maximum daily 8 hr average (MDA8) O₃ stayed stable in "2+26" cities. Spatially, PM_2.5 pollution in the south-central area and O₃ pollution in the central region were more severe than anywhere else. With the reduction in PM_2.5 concentration, premature deaths from PM_2.5 decreased by 18% from 2017 to 2019. In contrast, premature deaths from O₃ increased by 5%. Noticeably, the huge potential health benefits can be gained after the implementation of a joint PM_2.5-O₃ control policy. The premature deaths attributed to PM_2.5 and O₃ would be reduced by 91.6% and 89.1%, and the avoidable economic loss would be 60.8 billion Chinese Yuan (CNY), and 68.4 billion CNY in 2035 compared with that in 2019, respectively. Therefore, it is of significance to implement the joint PM_2.5-O₃ control policy for improving public health and economic development.

Chronic and acute health effects of PM2.5 exposure and the basis of pollution control targets

Ho Chi Minh City (HCMC) is changing and expanding quickly, leading to environmental consequences that seriously threaten human health. PM2.5 pollution is one of the main causes of premature death. In this context, studies have evaluated strategies to control and reduce air pollution; such pollution-control measures need to be economically justified. The objective of this study was to assess the socio-economic damage caused by exposure to the current pollution scenario, taking 2019 as the base year. A methodology for calculating and evaluating the economic and environmental benefits of air pollution reduction was implemented. This study aimed to simultaneously evaluate the impacts of both short-term (acute) and long-term (chronic) PM2.5 pollution exposure on human health, providing a comprehensive overview of economic losses attributable to such pollution. Spatial partitioning (inner-city and suburban) on health risks of PM2.5 and detailed construction of health impact maps by age group and sex on a spatial resolution grid (3.0 km × 3.0 km) was performed. The calculation results show that the economic loss from premature deaths due to short-term exposure (approximately 38.86 trillion VND) is higher than that from long-term exposure (approximately 14.89 trillion VND). As the government of HCMC has been developing control and mitigation solutions for the Air Quality Action Plan towards short- and medium-term goals in 2030, focusing mainly on PM2.5, the results of this study will help policymakers develop a roadmap to reduce the impact of PM2.5 during 2025-2030.

Association between ambient air pollution and hospital admissions, length of hospital stay and hospital cost for patients with cardiovascular diseases and comorbid diabetes mellitus: Base on 1,969,755 cases in Beijing, China, 2014-2019

BACKGROUND

Evidence on the effects of the air pollutants on the hospital admissions, hospital cost and length of stay (LOS) among patients with comorbidities remains limited in China, particularly for patients with cardiovascular diseases and comorbid diabetes mellitus (CVD-DM).

METHODS

We collected daily data on CVD-DM patients from 242 hospitals in Beijing between 2014 and 2019. Generalized additive model was employed to quantify the associations between admissions, LOS, and hospital cost for CVD-DM patients and air pollutants. We further evaluated the attributable risk posed by air pollutants to CVD-DM patients, using both Chinese and WHO air quality guidelines as reference.

RESULTS

Per 10 ug/m³ increase of particles with an aerodynamic diameter < 2.5 μm (PM_2.5), particles with an aerodynamic diameter < 10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbonic oxide (CO) and ozone (O₃) corresponded to a 0.64% (95% CI: 0.57 to 0.71), 0.52% (95% CI: 0.46 to 0.57), 0.93% (95% CI: 0.67 to 1.20), 0.98% (95% CI: 0.81 to 1.16), 1.66% (95% CI: 1.18 to 2.14) and 0.53% (95% CI: 0.45 to 0.61) increment for CVD-DM patients' admissions. Among the six pollutants, particulate pollutants (PM_2.5 and PM₁₀) in most lag days exhibited adverse effects on LOS and hospital cost. For every 10 ug/m³ increase in PM_2.5 and PM₁₀, the absolute increase with LOS will increase 62.08 days (95% CI: 28.93 to 95.23) and 51.77 days (95% CI:22.88 to 80.66), respectively. The absolute increase with hospital cost will increase 105.04 Chinese Yuan (CNY) (95% CI: 49.27 to 160.81) and 81.76 CNY (95% CI: 42.01 to 121.51) in PM_2.5 and PM₁₀, respectively. Given WHO 2021 air quality guideline as the reference, PM_2.5 had the maximum attributable fraction of 3.34% (95% CI: 2.94% to 3.75%), corresponding to an avoidable of 65,845 (95% CI: 57,953 to 73,812) patients with CVD-DM.

CONCLUSION

PM_2.5 and PM₁₀ are positively associated with hospital admissions, hospital cost and LOS for patients with CVD-DM. Policy changes to reduce air pollutants exposure may reduce CVD-DM admissions and substantial savings in health care spending and LOS.

Relationship between Environmental Pollution, Environmental Regulation and Resident Health in the Urban Agglomeration in the Middle Reaches of Yangtze River, China: Spatial Effect and Regulating Effect

The Healthy China 2030 Initiative is closely related to the coordinated development between national health, economy, and society. This major move demonstrates China’s active engagement in global health governance and in the fulfillment of the 2030 Agenda for Sustainable Development (SDGs). Based on Grossman’s health production function, this paper introduces key factors such as environmental pollution and environmental regulation to empirically investigate the regulating effect of environmental regulation, as well as the spatial spillover of environmental pollution and environmental regulation acting on resident health. We examine these effects by using the panel data of 28 cities of the urban agglomeration in the middle reaches of the Yangtze River (UAMYRY) between 2009 and 2019. The results show that: (1) Environmental pollution brings a loss to resident health. Among the urban agglomerations, the circum-Changsha–Zhuzhou–Xiangtan urban agglomeration (CCZXUA) and the Poyang Lake urban agglomeration (PLUA) have a much lower health effect of environmental pollution than the Wuhan urban agglomeration (WUA). (2) With the growing intensity of environmental regulation, the negative effect of environmental pollution on resident health will gradually decrease. Regionally, the environmental regulation in the CCZXUA has the best effect on residents’ health, followed by the WUA and the PLUA, which have the worst. (3) As a whole, the spatial spillover of environmental regulation and pollution has a significant impact on residents’ health, and the spatial spillover effect between urban agglomerations is stronger than that between cities in each urban agglomeration. The conclusions remain robust with various tests such as replacing control variables, introducing lagged explanatory variables, and considering endogeneity. Based on robust empirical evidence, several specific region policy suggestions, including rolling out proper environmental regulation policies, and establishing a linking mechanism of environmental management, were put forward to improve the environmental pollution state and resident health level of the UAMYRY.

Public Expenditure and Green Total Factor Productivity: Evidence from Chinese Prefecture-Level Cities

Whilst effective public expenditure policies are essential for transforming the traditional factor-driven economy into a green and innovation-driven economy, the impacts of public expenditure’s size and composition on green economic development have not been comprehensively investigated. This paper attempts to fill this research gap. Based on the data of Chinese prefecture-level cities from 2010 to 2018, we first measure green total factor productivity (GTFP), the proxy variable for green development, and briefly analyze its spatial-temporal trends. Then, using the dynamic panel models, dynamic panel mediation models, and dynamic panel threshold models, we evaluate how public expenditure affects GTFP. The main findings are fourfold: (1) there is a significant inverted U-shaped relationship between the expenditure size and GTFP. (2) The expansion of social expenditures and science and technology (S&T) and environmental protection expenditures play an important role in stimulating green growth, while economic expenditures and administrative expenditures have adverse effects. (3) Public expenditure mainly promotes green development through four channels: human capital accumulation, technological innovation, environmental quality improvement, and labor productivity increase. (4) The expenditure composition influences the turning point of the inverted U-shaped relationship. Based on these findings, we propose some targeted policy suggestions to promote green development.

How Air Quality Affect Health Industry Stock Returns: New Evidence From the Quantile-on-Quantile Regression

This paper discusses the asymmetric effect of air quality (AQ) on stock returns (SR) in China's health industry through the quantile-on-quantile (QQ) regression method. Compared to prior literature, our study provides the following contributions. Government intervention, especially industrial policy, is considered a fresh and essential component of analyzing frameworks in addition to investors' physiology and psychology. Next, because of the heterogeneous responses from different industries to AQ, industrial heterogeneity is thus considered in this paper. In addition, the QQ method examines the effect of specific quantiles between variables and does not consider structural break and temporal lag effects. We obtain the following empirical results. First, the coefficients between AQ and SR in the health service and health technology industries change from positive to negative as AQ deteriorates. Second, AQ always positively influences the health business industry, but the values of the coefficients are larger in good air. In addition, different from other industries, the coefficients in the health equipment industry are negative, but the values of the coefficients change with AQ. The conclusions provide important references for investors and other market participants to avoid biased decisions due to poor AQ and pay attention to government industrial policies.

Health Benefits in California of Strengthening the Fine Particulate Matter Standards

The Clean Air Act requires the United States Environmental Protection Agency to review routinely the National Ambient Air Quality Standards, including fine particulate matter (PM_2.5). A non-governmental Independent Particulate Matter Review Panel recently concluded that the current PM_2.5 standards do not protect public health adequately and recommended revising the daily standard from 35 to 25-30 μg/m³ and the annual standard from 12 to 8-10 μg/m³. To assess the public health implications of adopting the PM_2.5 standards proposed by the panel, the health benefits are quantified from their implementation based on both current (observed) and future (simulated) air quality data for California. The findings indicate that strengthening the standards would provide significant public health benefits valued at $42-$149 billion. Additionally, the stronger standards are shown to benefit environmental justice via health savings that are allocated more within environmentally and socioeconomically disadvantaged communities.

The application of land use regression model to investigate spatiotemporal variations of PM2.5 in Guangzhou, China: Implications for the public health benefits of PM2.5 reduction

Understanding the intra-city variation of PM_2.5 is important for air quality management and exposure assessment. In this study, to investigate the spatiotemporal variation of PM_2.5 in Guangzhou, we developed land use regression (LUR) models using data from 49 routine air quality monitoring stations. The R², adjust R² and 10-fold cross validation R² for the annual PM_2.5 LUR model were 0.78, 0.72 and 0.66, respectively, indicating the robustness of the model. In all the LUR models, traffic variables (e.g., length of main road and the distance to nearest ancillary) were the most common variables in the LUR models, suggesting vehicle emission was the most important contributor to PM_2.5 and controlling vehicle emissions would be an effective way to reduce PM_2.5. The predicted PM_2.5 exhibited significant variations with different land uses, with the highest value for impervious surfaces, followed by green land, cropland, forest and water areas. Guangzhou as the third largest city that PM_2.5 concentration has achieved CAAQS Grade II guideline in China, it represents a useful case study city to examine the health and economic benefits of further reduction of PM_2.5 to the lower concentration ranges. So, the health and economic benefits of reducing PM_2.5 in Guangzhou was further estimated using the BenMAP model, based on the annual PM_2.5 concentration predicted by the LUR model. The results showed that the avoided all cause mortalities were 992 cases (95% CI: 221-2140) and the corresponding economic benefits were 1478 million CNY (95% CI: 257-2524) (willingness to pay approach) if the annual PM_2.5 concentration can be reduced to the annual CAAQS Grade I guideline value of 15 μg/m³. Our results are expected to provide valuable information for further air pollution control strategies in China.

Role of emission controls in reducing the 2050 climate change penalty for PM2.5 in China

Previous studies demonstrated that global warming can lead to deteriorated air quality even when anthropogenic emissions were kept constant, which has been called a climate change penalty on air quality. It is expected that anthropogenic emissions will decrease significantly in the future considering the aggressive emission control actions in China. However, the dependence of climate change penalty on the choice of emission scenario is still uncertain. To fill this gap, we conducted multiple independent model simulations to investigate the response of PM_2.5 to future (2050) climate warming (RCP8.5) in China but with different emission scenarios, including the constant 2015 emissions, the 2050 CLE emissions (based on Current Legislation), and the 2050 MTFR emissions (based on Maximum Technically Feasible Reduction). For each set of emissions, we estimate climate change penalty as the difference in PM_2.5 between a pair of simulations with either 2015 or 2050 meteorology. Under 2015 emissions, we find a PM_2.5 climate change penalty of 1.43 μg m^-3 in Eastern China, leading to an additional 35,000 PM_2.5-related premature deaths [95% confidence interval (CI), 21,000-40,000] by 2050. However, the PM_2.5 climate change penalty weakens to 0.24 μg m^-3 with strict anthropogenic emission controls under the 2050 MTFR emissions, which decreases the associated PM_2.5-related deaths to 17,000. The smaller MTFR climate change penalty contributes 14% of the total PM_2.5 decrease when both emissions and meteorology are changed from 2015 to 2050, and 24% of total health benefits associated with this PM_2.5 decrease in Eastern China. This finding suggests that controlling anthropogenic emissions can effectively reduce the climate change penalty on PM_2.5 and its associated premature deaths, even though a climate change penalty still occurs even under MTFR. Strengthened controls on anthropogenic emissions are key to attaining air quality targets and protecting human health in the context of future global climate change.

The aggravated short-term PM2.5-related health risk due to atmospheric transport in the Yangtze River Delta

Severe fine particulate matter (PM_2.5) pollution and the associated health risks remain pressing issues in the Yangtze River Delta (YRD), although significant efforts have been made locally, such as the Clean Air Action since 2013. Regional transport is an important contributor to high PM_2.5 levels during haze episodes in the YRD, but its impact on human health is rarely analyzed. In this study, we evaluate the short-term PM_2.5-related health risks and associated economic losses due to different source regions by estimating daily mortality based on model results in the YRD. The results show that regional transport induces significant health risks in the YRD during haze days, contributing over 60% of daily premature mortality in Shanghai and Nanjing (major cities in the YRD). Moreover, in Hangzhou and Jiaxing, regional transport's contribution can be as high as 70%. The total daily mean economic loss in the YRD is estimated as 526.8 million Chinese Yuan (approximately 81.4 million U.S. dollar) in winter of 2015 and 2016, accounting for 1.4% of the daily averaged gross domestic product (GDP) of the YRD. Emission control (in accordance with the 13th Five-year Energy Conservation and Emission Reduction Plan) is an effective way to reduce health risks in the YRD, reducing premature deaths during haze days by 12-33%. More stringent emission control measures are suggested for further reduce PM_2.5-related health risks.

Health benefits of achieving fine particulate matter standards in India - A nationwide assessment

BACKGROUND

Ambient fine particulate matter (PM_2.5) is one of the leading risk factors in India. The elevated levels of PM_2.5 exposure concentration in India are related to higher premature mortality. However, health benefits or avoidable premature mortality by reducing PM_2.5 concentration is uncertain.

OBJECTIVES

Here we simulated the health benefits by assuming the achievement of 1) National Ambient Air Quality Standards of India (PM_2.5 annual average = 40 μg m^-3), 2) National Clean Air Programme policy (30% reduction) and 3) World Health Organization standard (10 μg m^-3).

METHODOLOGY

Using Environmental Benefits Mapping and Analysis Program - Community Edition (BenMAP-CE), the health benefits are estimated at national, state and district levels for various health endpoints viz., all-cause, ischaemic heart disease (IHD), chronic obstructive pulmonary disease (COPD), lung cancer and stroke. PM_2.5 data, concentration-response coefficient, population, and baseline incidence rate are specified as input data in BenMAP-CE.

RESULTS

At the national level, all-cause health benefits in three simulations range from 0.79 to 2.1 million cases during 2019. Similarly, IHD, COPD, lung cancer, and stroke related health benefits are in the range of 0.28-0.68, 0.17-0.39, 0.01-0.03, and 0.14-0.34 million cases, respectively. State-level estimates showed that Uttar Pradesh, Bihar, and West Bengal are having maximum health benefits whereas north-eastern states are found with lowest estimates. Districts such as Allahabad, Lucknow, Muzaffarpur, Patna, and Sultanpur are estimated to have highest health benefits. States and districts with higher PM_2.5 concentration and exposed population are found with maximum health benefits. Among the three simulations, achievement of the World Health Organization standard resulted in highest estimates. Further, the limitations and sensitivity of input parameters used in this study are discussed in detail.

CONCLUSION

Study results highlighted the need for state and district-specific air quality management measures to increase PM_2.5 related health benefits.

Quantifying the impact of particle matter on mortality and hospitalizations in four Brazilian metropolitan areas

Air quality management involves investigating areas where pollutant concentrations are above guideline or standard values to minimize its effect on human health. Particulate matter (PM) is one of the most studied pollutants, and its relationship with health has been widely outlined. To guide the construction and improvement of air quality policies, the impact of PM on the four Brazilian southeast metropolitan areas was investigated. One-year long modeling of PM₁₀ and PM_2.5 was performed with the WRF-Chem model for 2015 to quantify daily and annual PM concentrations in 102 cities. Avoidable mortality due to diverse causes and morbidity due to respiratory and circular system diseases were estimated concerning WHO guidelines, which was adopted in Brazil as a final standard to be reached in the future; although there is no deadline set for its implementation yet. Results showed satisfactory representation of meteorology and ambient PM concentrations. An overestimation in PM concentrations for some monitoring stations was observed, mainly in São Paulo metropolitan area. Cities around capitals with high modelled annual PM_2.5 concentrations do not monitor this pollutant. The total avoidable deaths estimated for the region, related to PM_2.5, were 32,000 ± 5,300 due to all-cause mortality, between 16,000 ± 2,100 and 51,000 ± 3,000 due non-accidental causes, between 7,300 ± 1,300 and 16,700 ± 1,500 due to cardiovascular disease, between 4,750 ± 900 and 10,950 ± 870 due ischemic heart diseases and 1,220 ± 330 avoidable deaths due to lung cancer. Avoidable respiratory hospitalizations were greater for PM_2.5 among 'children' age group than for PM₁₀ (all age group) except in São Paulo metropolitan area. For circulatory system diseases, 9,840 ± 3,950 avoidable hospitalizations in the elderly related to a decrease in PM_2.5 concentrations were estimated. This study endorses that more restrictive air quality standards, human exposure, and health effects are essential factors to consider in urban air quality management.

Using Costs and Health Benefits to Estimate the Priority of Air Pollution Control Action Plan: A Case Study in Taiwan

A comparative analysis was conducted between the costs and health benefits of the Air Pollution Control Action Plan (APCAP), which can be implemented in any country to improve air quality and human health. In this study, air quality modeling was used to simulate several scenarios and implement the Kriging method to describe the PM2.5 reduction concentration instantly. Then, health benefits were estimated using the environmental benefit mapping and analysis program (BenMAP) with results from the air quality modeling and Kriging method. To estimate the priority of APCAP, 14 pollution control measures that cover point, mobile, and area sources of air pollution in Taiwan were analyzed. The results indicate that the health benefits of the Taiwan APCAP (TAPCAP) are generally greater than the technical costs. Thus, the implementation of this strategy may result in net benefits. In addition, the benefit-to-control cost ratio for health for the 14 pollution control measures was calculated. The results provide evidence to prioritize the implementation of air quality policies with a higher benefit-cost ratio.

A study of cardiorespiratory related mortality as a result of exposure to black carbon

INTRODUCTION

Air pollution is a global phenomenon which invariably leads to a serious environmental and health related sequalae. "Black carbon" (BC), a subset of fine particulate matter ≤2.5 μm (PM_2.5), is a fossil fuel emission by-product and has more recently been recognized as a major health hazard. The objective of this study is to statistically analyze the BC concentration and its correlation with cardiorespiratory related mortality and to estimate the benefits of BC reduction on the health of the population in the capital city of Tehran.

METHODS

We analyzed the ambient air BC concentration and its correlation with cardiorespiratory related mortality and conducted health impact assessment of BC in Tehran (Jan 2018-Jan 2019). The data pertaining to BC concentration was obtained from Tehran's four major pollution monitoring stations. The mortality data was obtained from Tehran's cemetery registry. We calculated and analyzed BC concentration statistics including the mean, standard deviation, coefficient of variation, skewness, and kurtosis. We then assessed the cross-correlation and temporal relationship (0-7 days) between the daily mean concentration of BC for the entire city and cardiorespiratory related mortality. The BenMAP software was utilized to estimate the potential reduction in cardiorespiratory related mortality rates if BC concentration is reduced. Three hypothetical scenarios were employed in the analysis, utilizing the BenMAP software: (I) BC concentration was completely removed from the ambient air; (II) BC concentration was eliminated, and the remaining (non-BC portion of) PM_2.5 concentration was reverted to the United States Environmental Protection Agency (EPA)'s standard level (i.e., 35 μg/m³); and (III) The BC emission during the night (22:00 h-6:00 h, when heavy-duty vehicles (HDVs) are allowed to commute in the city) was distributed throughout the whole day. Since the planetary boundary layer during daytime is much higher than that of nighttime, with the same rate of emission, lower concentrations are spread during the whole day.

RESULTS

The trend of BC concentration variation revealed a persistently higher emission of BC during the nighttime, which is consistent with the large-scale operation of HDVs during these hours in the city of Tehran. We observed a direct correlation between BC concentration and cardiorespiratory related mortality. Analysis also showed a 1.4-day lag period from the time of exposure to BC polluted air and respiratory related deaths, and 2 days for cardiovascular related deaths. As a result, the reduction in BC has significant beneficial effects in reducing potentially preventable cardiorespiratory related mortality. The aforementioned three scenarios for age groups of 30 and above yielded the following results: (I) 11,369 (126 per 100,000 population), (II) 15,386 (171 per 100,000 population), and (III) 2552 (28 per 100,000 population) potentially preventable all-cause (including cardiorespiratory) related deaths annually.

CONCLUSIONS

The BC concentration is relatively high in Tehran and HDVs have a major role in emission of this pollutant. A direct correlation between BC concentration and cardiorespiratory related mortality is observed. There are considerable health benefits in reducing BC concentration in this city. Our findings highlight the urgent need to actively curtail emissions of this harmful pollutant. This can be achieved through utilizing control mechanisms such as particulate filters or amending traffic laws.

Quantifying public health benefits of PM2.5 reduction and spatial distribution analysis in China

In recent years, particulate matter (PM) air pollution has become a significant and growing public health problem in China. In this study, the daily PM_2.5 exposure level at a spatial resolution of 100 km² was simulated based on the data of 1328 monitoring sites and the Voronoi Neighborhood Averaging (VNA) interpolation method. The results reveal that the daily mean PM_2.5 concentration reduced from 47.82 μg/m³ (2016) to 40.87 μg/m³ (2018), a reduction of 14.53%. We first calculated the heath impacts and economic benefits of this reduction (Scenario 1) by using Environmental Benefits Mapping and Analysis Program (BenMAP). The estimated avoided premature mortalities for all-cause, cardiovascular diseases, respiratory diseases, and lung cancer were in the range of 7214 to 81,681 cases (total of 154,176 cases). The estimated economic benefits based on willingness to pay (WTP) ranged from 3.96 to 44.85 billion RMB (total of 84.66 billion RMB). Moreover, the PM_2.5 concentration in the control scenario was rolled back to the Grade I standards (35 μg/m³, Scenario 2). The avoided deaths are in the range of 58,820 to 590,464 cases (total of 1,217,671 cases). The estimated monetary value of the avoided cases of all health endpoints range from 36.63 to 367.66 billion RMB based on WTP (total of 758.21 billion RMB). In addition, the spatial autocorrelation analysis reveals that the distribution of both avoided premature mortality and economic benefits exhibit a certain spatial aggregation.

Spatial Assessment of Health Economic Losses from Exposure to Ambient Pollutants in China

Increasing emissions of ambient pollutants have caused considerable air pollution and negative health impact for human in various regions of China over the past decade. The resulting premature mortality and excessive morbidity caused huge human economic losses to the entire society. To identify the differences of health economic losses in various regions of China and help decision-making on targeting pollutants control, spatial assessment of health economic losses due to ambient pollutants in China is indispensable. In this study, to better represent the spatial variability, the satellite-based retrievals of the concentrations of various pollutants (PM10, PM2.5, O3, NO2, SO2 and CO) for the time period from 2007 to 2017 in China are used instead of using in-situ data. Population raster data were applied together with exposure-response function to calculate the spatial distribution of health impact and then the health impact is further quantified by using amended human capital (AHC) approach. The results which presented in a spatial resolution of 0.25° × 0.25°, show the signification contribution from the spatial assessment to revealing the spatial distribution and variance of health economic losses in various regions of China. Spatial assessment of overall health economic losses is different from conventional result due to more detail spatial information. This spatial assessment approach also provides an alternative method for losses measurement in other fields.

PM2.5-Related Health Economic Benefits Evaluation Based on Air Improvement Action Plan in Wuhan City, Middle China

On the basis of PM_2.5 data of the national air quality monitoring sites, local population data, and baseline all-cause mortality rate, PM_2.5-related health economic benefits of the Air Improvement Action Plan implemented in Wuhan in 2013–2017 were investigated using health-impact and valuation functions. Annual avoided premature deaths driven by the average concentration of PM_2.5 decrease were evaluated, and the economic benefits were computed by using the value of statistical life (VSL) method. Results showed that the number of avoided premature deaths in Wuhan are 21,384 (95% confidence interval (CI): 15,004 to 27,255) during 2013–2017, due to the implementation of the Air Improvement Action Plan. According to the VSL method, the obtained economic benefits of Huangpi, Wuchang, Hongshan, Xinzhou, Jiang’an, Hanyang, Jiangxia, Qiaokou, Jianghan, Qingshan, Caidian, Dongxihu, and Hannan District were 8.55, 8.19, 8.04, 7.39, 5.78, 4.84, 4.37, 4.04, 3.90, 3.30, 2.87, 2.42, and 0.66 billion RMB (1 RMB = 0.1417 USD On 14 October 2019), respectively. These economic benefits added up to 64.35 billion RMB (95% CI: 45.15 to 82.02 billion RMB), accounting for 4.80% (95% CI: 3.37% to 6.12%) of the total GDP of Wuhan in 2017. Therefore, in the process of formulating a regional air quality improvement scheme, apart from establishing hierarchical emission-reduction standards and policies, policy makers should give integrated consideration to the relationship between regional economic development, environmental protection and residents’ health benefits. Furthermore, for improving air quality, air quality compensation mechanisms can be established on the basis of the status quo and trends of air quality, population distribution, and economic development factors.

Estimating the Health and Economic Impacts of Changes in Local Air Quality

OBJECTIVES

To demonstrate the benefits-mapping software Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE), which integrates local air quality data with previously published concentration-response and health-economic valuation functions to estimate the health effects of changes in air pollution levels and their economic consequences.

METHODS

We illustrate a local health impact assessment of ozone changes in the 10-county nonattainment area of the Dallas-Fort Worth region of Texas, estimating the short-term effects on mortality predicted by 2 scenarios for 3 years (2008, 2011, and 2013): an incremental rollback of the daily 8-hour maximum ozone levels of all area monitors by 10 parts per billion and a rollback-to-a-standard ambient level of 65 parts per billion at only monitors above that level.

RESULTS

Estimates of preventable premature deaths attributable to ozone air pollution obtained by the incremental rollback method varied little by year, whereas those obtained by the rollback-to-a-standard method varied by year and were sensitive to the choice of ordinality and the use of preloaded or imported data.

CONCLUSIONS

BenMAP-CE allows local and regional public health analysts to generate timely, evidence-based estimates of the health impacts and economic consequences of potential policy options in their communities.

Contribution of transregional transport to particle pollution and health effects in Shanghai during 2013-2017

Transregional transport plays an important role in air pollution. This study investigated the impact of transregional transport on particle pollution in Shanghai from 2013 to 2017. A conditional potential source contribution function (CPSCF) method with high time resolution (1 h) PM_2.5 and PM₁₀ data was used to quantify the contribution of transregional transport. The corresponding health impact was also assessed. The average annual contribution of transregional transport to PM_2.5 (PM_{2.5_CTRT}) and PM₁₀ (PM_{10_CTRT}) was 22 and 30 μg/m³, 18 and 24 μg/m³, 19 and 24 μg/m³, 14 and 19 μg/m³, and 14 and 19 μg/m³, for 2013 to 2017, respectively, thus accounting for 31-37% of total PM_2.5 and PM₁₀. As PM_{2.5_CTRT} is a dominant component of PM_{10_CTRT}, the health effects related to PM_{2.5_CTRT} were assessed to avoid double counting. The number of annual deaths associated with PM_{2.5_CTRT} in Shanghai during the study period ranged from 636 (95% confidence intervals: 350, 936) to 1039 (573, 1530), among which cardiovascular disease and respiratory disease accounted for 62.8-67.6% and 16.6-19.5% of mortality, respectively. PM_{2.5_CTRT}-related deaths accounted for 5.3-8.2‰ of the total mortality in Shanghai during the study period. Between 9764 (9251, 10,277) and 12,190 (11,549, 12,830) cases of all-cause hospital admissions were attributable to PM_{2.5_CTRT} in Shanghai in one year, among which cardiovascular disease and respiratory disease hospital admissions accounted for 15.9-20.0% and 7.9-9.2%, respectively. Internal medicine and pediatrics outpatient visits related to PM_{2.5_CTRT} ranged from 70,684 (39,009, 100,829) to 97,380 (53,788, 138,793) cases and 23,185 (8302, 37,173) to 32,702 (11,726, 52,361) cases, respectively. The current work provides scientific evidence of the impact of transregional transport on air pollution and its health burden in Shanghai.

Including intangible costs into the cost-of-illness approach: a method refinement illustrated based on the PM2.5 economic burden in China

The concentrations of particulate matter with aerodynamic diameters less than 2.5 µm (PM_2.5) and 10 µm (PM₁₀) is a widespread concern and has been demonstrated for 103 countries. During the past few years, the exposure-response function (ERf) has been widely used to estimate the health effects of air pollution. However, past studies are either based on the cost-of-illness or the willingness-to-pay approach, and therefore, either do not cover intangible costs or costs due to the absence of work. To address this limitation, a hybrid health effect and economic loss model is developed in this study. This novel approach is applied to a sample of environmental and cost data in China. First, the ERf is used to link PM_2.5 concentrations to health endpoints of chronic mortality, acute mortality, respiratory hospital admission, cardiovascular hospital admission, outpatient visits-internal medicine, outpatient visits-pediatrics, asthma attack, acute bronchitis, and chronic bronchitis. Second, the health effect of PM_2.5 is monetized into the economic loss. The mean economic loss due to PM_2.5 was much heavier in the North than the South of China. Furthermore, the empirical results from 76 cities in China show that the health effects and economic losses were over 4.98 million cases and 382.30 billion-yuan in 2014 and decreased dramatically compared with those in 2013.

An interactive group decision model for selecting treatment schemes for mitigating air pollution

Air pollution has caused huge losses of life and property. So, how to choose a practically effective scheme to m.itigate air pollution is of great significance. However, such a selection problem of treatment schemes represents really a group negotiation process of many decision makers (DMs), involving a variety of fuzzy information and preferences. To successfully address this selection problem, this paper proposes a novel group negotiation decision model by jointly employing various approaches, such as hesitant fuzzy set, grey target, grey incidence analysis, and graph model for conflict resolution (GMCR). Then, this model is used to determine the equilibrium schemes for treating air pollution. It is expected that this work provides a method for Chinese government to introduce programs to target air pollution control.

The Shape of the Concentration-Response Association between Fine Particulate Matter Pollution and Human Mortality in Beijing, China, and Its Implications for Health Impact Assessment

BACKGROUND

Studies found approximately linear short-term associations between particulate matter (PM) and mortality in Western communities. However, in China, where the urban PM levels are typically considerably higher than in Western communities, some studies suggest nonlinearity in this association. Health impact assessments (HIA) of PM in China have generally not incorporated nonlinearity in the concentration-response (C-R) association, which could result in large discrepancies in estimates of excess deaths if the true association is nonlinear.

OBJECTIVES

We investigated nonlinearity in the C-R associations between with PM with aerodynamic diameter [Formula: see text] ([Formula: see text]) and mortality in Beijing, China, and the sensitivity of HIA to linearity assumptions.

METHODS

We modeled the C-R association between [Formula: see text] and cause-specific mortality in Beijing, China (2009-2012), using generalized linear models (GLM). [Formula: see text] was included through either linear, piecewise-linear, or spline functions to investigate evidence of nonlinearity. To determine the sensitivity of HIA to linearity assumptions, we estimated [Formula: see text]-attributable deaths using both linear- and nonlinear-based C-R associations between [Formula: see text] and mortality.

RESULTS

We found some evidence that, for nonaccidental and circulatory mortality, the shape of the C-R association was relatively flat at lower concentrations of [Formula: see text], but then had a positive slope at higher concentrations, indicating nonlinearity. Conversely, the shape for respiratory mortality was positive and linear at lower concentrations of [Formula: see text], but then leveled off at the higher concentrations. Estimates of excess deaths attributable to short-term [Formula: see text] exposure were, in some cases, very sensitive to the linearity assumption in the association, but in other cases robust to this assumption.

CONCLUSIONS

Our results demonstrate some evidence of nonlinearity in [Formula: see text]-mortality associations and that an assumption of linearity in this association can influence HIAs, highlighting the importance of understanding potential nonlinearity in the [Formula: see text]-mortality association at the high concentrations of [Formula: see text] in developing megacities like Beijing. https://doi.org/10.1289/EHP4464.

Interventions to reduce ambient particulate matter air pollution and their effect on health

BACKGROUND

Ambient air pollution is associated with a large burden of disease in both high-income countries (HICs) and low- and middle-income countries (LMICs). To date, no systematic review has assessed the effectiveness of interventions aiming to reduce ambient air pollution.

OBJECTIVES

To assess the effectiveness of interventions to reduce ambient particulate matter air pollution in reducing pollutant concentrations and improving associated health outcomes.

SEARCH METHODS

We searched a range of electronic databases with diverse focuses, including health and biomedical research (CENTRAL, Cochrane Public Health Group Specialised Register, MEDLINE, Embase, PsycINFO), multidisciplinary research (Scopus, Science Citation Index), social sciences (Social Science Citation Index), urban planning and environment (Greenfile), and LMICs (Global Health Library regional indexes, WHOLIS). Additionally, we searched grey literature databases, multiple online trial registries, references of included studies and the contents of relevant journals in an attempt to identify unpublished and ongoing studies, and studies not identified by our search strategy. The final search date for all databases was 31 August 2016.

SELECTION CRITERIA

Eligible for inclusion were randomized and cluster randomized controlled trials, as well as several non-randomized study designs, including controlled interrupted time-series studies (cITS-EPOC), interrupted time-series studies adhering to EPOC standards (ITS-EPOC), interrupted time-series studies not adhering to EPOC standards (ITS), controlled before-after studies adhering to EPOC standards (CBA-EPOC), and controlled before-after studies not adhering to EPOC standards (CBA); these were classified as main studies. Additionally, we included uncontrolled before-after studies (UBA) as supporting studies. We included studies that evaluated interventions to reduce ambient air pollution from industrial, residential, vehicular and multiple sources, with respect to their effect on mortality, morbidity and several air pollutant concentrations. We did not restrict studies based on the population, setting or comparison.

DATA COLLECTION AND ANALYSIS

After a calibration exercise among the author team, two authors independently assessed studies for inclusion, extracted data and assessed risk of bias. We conducted data extraction, risk of bias assessment and evidence synthesis only for main studies; we mapped supporting studies with regard to the types of intervention and setting. To assess risk of bias, we used the Graphic Appraisal Tool for Epidemiological studies (GATE) for correlation studies, as modified and employed by the Centre for Public Health Excellence at the UK National Institute for Health and Care Excellence (NICE). For each intervention category, i.e. those targeting industrial, residential, vehicular and multiple sources, we synthesized evidence narratively, as well as graphically using harvest plots.

MAIN RESULTS

We included 42 main studies assessing 38 unique interventions. These were heterogeneous with respect to setting; interventions were implemented in countries across the world, but most (79%) were implemented in HICs, with the remaining scattered across LMICs. Most interventions (76%) were implemented in urban or community settings.We identified a heterogeneous mix of interventions, including those aiming to address industrial (n = 5), residential (n = 7), vehicular (n = 22), and multiple sources (n = 4). Some specific interventions, such as low emission zones and stove exchanges, were assessed by several studies, whereas others, such as a wood burning ban, were only assessed by a single study.Most studies assessing health and air quality outcomes used routine monitoring data. Studies assessing health outcomes mostly investigated effects in the general population, while few studies assessed specific subgroups such as infants, children and the elderly. No identified studies assessed unintended or adverse effects.The judgements regarding the risk of bias of studies were mixed. Regarding health outcomes, we appraised eight studies (47%) as having no substantial risk of bias concerns, five studies (29%) as having some risk of bias concerns, and four studies (24%) as having serious risk of bias concerns. Regarding air quality outcomes, we judged 11 studies (31%) as having no substantial risk of bias concerns, 16 studies (46%) as having some risk of bias concerns, and eight studies (23%) as having serious risk of bias concerns.The evidence base, comprising non-randomized studies only, was of low or very low certainty for all intervention categories and primary outcomes. The narrative and graphical synthesis showed that evidence for effectiveness was mixed across the four intervention categories. For interventions targeting industrial, residential and multiple sources, a similar pattern emerged for both health and air quality outcomes, with essentially all studies observing either no clear association in either direction or a significant association favouring the intervention. The evidence base for interventions targeting vehicular sources was more heterogeneous, as a small number of studies did observe a significant association favouring the control. Overall, however, the evidence suggests that the assessed interventions do not worsen air quality or health.

AUTHORS' CONCLUSIONS

Given the heterogeneity across interventions, outcomes, and methods, it was difficult to derive overall conclusions regarding the effectiveness of interventions in terms of improved air quality or health. Most included studies observed either no significant association in either direction or an association favouring the intervention, with little evidence that the assessed interventions might be harmful. The evidence base highlights the challenges related to establishing a causal relationship between specific air pollution interventions and outcomes. In light of these challenges, the results on effectiveness should be interpreted with caution; it is important to emphasize that lack of evidence of an association is not equivalent to evidence of no association.We identified limited evidence for several world regions, notably Africa, the Middle East, Eastern Europe, Central Asia and Southeast Asia; decision-makers should prioritize the development and implementation of interventions in these settings. In the future, as new policies are introduced, decision-makers should consider a built-in evaluation component, which could facilitate more systematic and comprehensive evaluations. These could assess effectiveness, but also aspects of feasibility, fidelity and acceptability.The production of higher quality and more uniform evidence would be helpful in informing decisions. Researchers should strive to sufficiently account for confounding, assess the impact of methodological decisions through the conduct and communication of sensitivity analyses, and improve the reporting of methods, and other aspects of the study, most importantly the description of the intervention and the context in which it is implemented.

Health benefit assessment of PM2.5 reduction in Pearl River Delta region of China using a model-monitor data fusion approach

The Pearl River Delta (PRD), one of the most polluted and populous regions of China, experienced a 28% reduction in fine particulate matter (PM_2.5) concentration between 2013 (47 μg/m³) and 2015 (34 μg/m³) under a stringent national policy known as the Air Pollution Prevention and Control Action Plan (hereafter Action Plan). In this study, the health and economic benefits associated with PM_2.5 reductions in PRD during 2013-2015 were estimated using the Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE) software. To create reliable gridded PM_2.5 surfaces for BenMAP-CE calculations, a data fusion tool which incorporates the accuracy of monitoring data and the spatial coverage of predictions from the Community Multiscale Air Quality (CMAQ) model has been developed. The population-weighted average PM_2.5 concentration over PRD was predicted to decline by 24%. PM_2.5-related mortality was estimated to decrease by more than 3800 due to decreases in stroke (48%), ischemic heart disease (IHD) (35%), chronic obstructive pulmonary disease (COPD) (10%), and lung cancer (LC) (7%). A 13% reduction in PM_2.5-related premature deaths from these four causes yielded a large economic benefit of about 1300 million US dollars. Our research suggests that the Action Plan played a major role in reducing emissions and additional measures should be implemented to further reduce PM_2.5 pollution and protect public health in the future.

Analysis of the adverse health effects of PM2.5 from 2001 to 2017 in China and the role of urbanization in aggravating the health burden

In this study, the trend of PM_2.5 concentrations and its adverse health effects in China from 2001 to 2017 are estimated utilizing 1-km high-resolution annual satellite-retrieved PM_2.5 data. PM_2.5 concentrations for most of the provinces/cities remained stable from 2001 to 2012; however, following the issue of the Air Pollution Prevention and Control Action Plan (APPCAP) by the central government of China, a dramatic decrease in PM_2.5 concentrations from 2013 to 2017 occurred. Premature mortality caused by PM_2.5 dropped from 1,078,800 in 2014 to 962,900 in 2017. The PM_2.5 caused 17-year average mortality ranges from 3800 in Hainan Province to 124,800 in Henan Province. The health cost benefits gained by the reduction of PM_2.5 pollution amounted to US $193,800 in 2017 (compared to the costs due to PM_2.5 concentrations in 2013), amounting to 1.58% of the total national GDP. The impacts of urbanization on PM_2.5 concentration and mortality are analyzed. The PM_2.5 concentration and its induced mortality density in dense urban areas are much higher than those in rural areas. The aggravation of PM_2.5 associated premature mortality in urban areas is mainly due to the larger amount of emissions and to urban migration, and 6500 deaths in 2014 could have been avoided were the population ratios in dense-urban/normal-urban/rural areas to be reversed to the ones in 2001. It is recommended that people with respiratory-related diseases live in rural areas, where the pollutant concentration is relatively low.

Potential reductions in premature mortality attributable to PM2.5 by reducing indoor pollution: A model analysis for Beijing-Tianjin-Hebei of China

BACKGROUND

China has one of the highest PM_2.5 (particulate matter with an aerodynamic diameter smaller than 2.5 μm) pollution levels in the world. It might still be long before air quality reaches the National Class II standard of 35 μg/m³.

OBJECTIVE

We aim to estimate the potential reduction in premature mortality by reducing indoor PM_2.5 levels in the Beijing-Tianjin-Hebei (BTH) region and compare it with reducing outdoor levels.

METHODS

We combined PM_2.5 transport model and the Global Burden of Disease (2016) methodology to estimate potential reductions in premature mortality attributable to PM_2.5 by reducing indoor PM_2.5 to National Class I standard of 15 μg/m³, and compared with reducing outdoor PM_2.5 to Government 2020 Interim target of 64 μg/m³ or National Class II standard of 35 μg/m³.

RESULTS

A total of 74,000 (95% confidence interval (CI): 43,000-111,000) premature deaths were attributable to PM_2.5 exposure in 2013. Thirty percent, or 22,000 (95% CI: 17,000-32,000) deaths, would have been averted if indoor PM_2.5 had reached the National Class I standard. The benefit is greater than that from reaching the Government 2020 Interim target for outdoor PM_2.5 [22%, or 16,000 (95% CI: 12,000-23,000), deaths], although still smaller than that from reaching the National Class II standard [42%, or 31,000 (95% CI: 24,000-45,000), deaths].

CONCLUSIONS

Reaching the National Class I level of indoor PM_2.5 at current outdoor pollution levels could bring considerable health benefits, which are comparable to those from reaching the Government 2020 Interim target for outdoor PM_2.5.

MAIN FINDINGS

The avertable premature deaths gained from cleaning indoor PM_2.5 to National Class I standard level would be greater than reducing outdoor PM_2.5 to Government 2020 Interim target.

Air quality improvement and health benefit of PM2.5 reduction from the coal cap policy in the Beijing-Tianjin-Hebei (BTH) region, China

Large amounts of air pollutants emitted from massive coal combustion result in the air quality deterioration and threaten public health in China. To improve air quality, the Chinese government released the coal cap policy to reduce coal consumption. So it is important and necessary to understand the possible environmental impact and relevant health benefits from the coal cap policy. The purpose of this paper is to quantify the air quality improvement and to evaluate the health benefits from the implementation of the coal cap policy, with the Beijing-Tianjin-Hebei (BTH) region as the study area. The results showed that the emissions of SO₂, NOx, CO, VOCs, PM₁₀, and PM_2.5 could be reduced by 20-40% in the BTH region in 2020 and all pollutants from industrial boilers notably decreased. Under the coal cap policy, the PM_2.5 concentration in the whole region would fall by 11.27%, and the total economic benefit from health impacts could achieve 26.61 (13.29 to 39.14) billion RMB (3.9 billion USD) in the BTH region in 2020, accounting for 0.43% (0.21 to 0.63%) of regional GDP in 2013. This study demonstrated the quantification of environmental effect and health benefit from the coal cap policy, which could be used for the complete cost-benefit analysis and provide the sufficient support for policy makers to implement the coal cap policy in the BTH region and other areas of China.

Does chronic disease influence susceptibility to the effects of air pollution on depressive symptoms in China?

Background

Exogenous stressors resulting from air pollution can lead to depression and chronic disease. Chinese levels of air pollution are among the highest in the world, and although associated adverse health effects are gradually emerging, research determining individual vulnerability is limited. This study estimated the association between air pollution and depressive symptoms and identified whether chronic disease influences an individual’s susceptibility to depressive symptoms relating to air pollution.

Methods

Individual sample data from the China Health and Retirement Longitudinal Study and a group of city-level variables in 2011 and 2013 were used with the random effects model and Tobit model. Adjustments were made for demographic, socioeconomic status, health behavior, and city-level climate variables with respect to living areas. Analysis was also stratified using chronic disease characteristics.

Results

The total Center for Epidemiological Studies Depression scale evaluating depressive symptoms ranged between 7 and 28 [average 11.623 (SD = 4.664)]. An 1% increase in sulfur dioxide and total suspended particulate emission intensities was associated with depressive symptoms scores that were 1.266 (SE = 0.107, P < 0.001, 95% CI 1.057–1.475) and 1.318 (SE = 0.082, P < 0.001, 95% CI 1.157–1.480) higher, respectively. Compared to respondents without chronic disease, those with chronic diseases such as hypertension, dyslipidemia, diabetes or high blood sugar, cardiovascular diseases, cancer or malignant tumor, liver disease, chronic lung diseases, kidney disease, stomach or other digestive disease, arthritis or rheumatism, and asthma had scores that were higher for depressive symptoms.

Conclusions

Results confirm that the adverse health effects of air pollution should be considered when developing air pollution policies. Findings also provide justification for mental health interventions targeting air pollution exposure, especially for people with chronic diseases.

The January 2013 Beijing "Airpocalypse" and its Acute Effects on Emergency and Outpatient Visits at a Beijing Hospital

Severe air pollution episodes in Europe and the USA in the early- to mid-twentieth century caused large health impacts, spurring national legislation. Similarly severe episodes currently affect developing regions, as exemplified by a particularly extreme episode in January 2013 in Beijing, China. We investigated associations between this episode and medical visits at a Beijing hospital. We obtained fine particulate matter (PM_2.5) measurements from the US State Department's Embassy monitor and daily counts of all-cause, cardiovascular, and respiratory emergency visits, and outpatient visits from a nearby hospital in the Liufang Nanli community. We analyzed whether risks increased during this episode (with daily PM_2.5 ≥ 350 μg/m³) using generalized linear modeling, controlling for potential confounders. The episode brought exceptionally high PM2.5 (peak daily average, 569 μg/m³). Risk increased during the episode for all-cause (relative risk 1.29 [95% CI 1.13, 1.46]), cardiovascular (1.55 [0.90, 2.68]) and respiratory (1.33 [1.10, 1.62]) emergency medical visits, and respiratory outpatient visits (1.16 [1.00, 1.33]). Relative risks of all-cause (0.95 [0.82, 1.10]) and cardiovascular (0.83 [0.67, 1.02]) outpatient visits were not statistically significant. Results were robust to modeling choices and episode definitions. This episode was extraordinarily severe, with maximum daily PM_2.5 concentration nearly 22-fold above the World Health Organization guideline. During the episode, risk increased for all-cause, cardiovascular, and respiratory emergency medical visits, and respiratory outpatient visits, consistent with previous US-based research. However, no association was found for all-cause or cardiovascular outpatient visits. China-based studies like this one provide critical evidence in developing efforts regarding air pollution remediation in China.

Potential Cardiovascular and Total Mortality Benefits of Air Pollution Control in Urban China

BACKGROUND

Outdoor air pollution ranks fourth among preventable causes of China's burden of disease. We hypothesized that the magnitude of health gains from air quality improvement in urban China could compare with achieving recommended blood pressure or smoking control goals.

METHODS

The Cardiovascular Disease Policy Model-China projected coronary heart disease, stroke, and all-cause deaths in urban Chinese adults 35 to 84 years of age from 2017 to 2030 if recent air quality (particulate matter with aerodynamic diameter ≤2.5 µm, PM_2.5) and traditional cardiovascular risk factor trends continue. We projected life-years gained if urban China were to reach 1 of 3 air quality goals: Beijing Olympic Games level (mean PM_2.5, 55 μg/m³), China Class II standard (35 μg/m³), or World Health Organization standard (10 μg/m³). We compared projected air pollution reduction control benefits with potential benefits of reaching World Health Organization hypertension and tobacco control goals.

RESULTS

Mean PM_2.5 reduction to Beijing Olympic levels by 2030 would gain ≈241,000 (95% uncertainty interval, 189 000-293 000) life-years annually. Achieving either the China Class II or World Health Organization PM_2.5 standard would yield greater health benefits (992 000 [95% uncertainty interval, 790 000-1 180 000] or 1 827 000 [95% uncertainty interval, 1 481 00-2 129 000] annual life-years gained, respectively) than World Health Organization-recommended goals of 25% improvement in systolic hypertension control and 30% reduction in smoking combined (928 000 [95% uncertainty interval, 830 000-1 033 000] life-years).

CONCLUSIONS

Air quality improvement in different scenarios could lead to graded health benefits ranging from 241 000 life-years gained to much greater benefits equal to or greater than the combined benefits of 25% improvement in systolic hypertension control and 30% smoking reduction.

Quantifying public health benefits of environmental strategy of PM2.5 air quality management in Beijing-Tianjin-Hebei region, China

In 2013, China issued "Air Pollution Prevention and Control Action Plan (Action Plan)" to improve air quality. To assess the benefits of this program in Beijing-Tianjin-Hebei (BTH) region, where the density of population and emissions vary greatly, we simulated the air quality benefit based on BenMAP to satisfy the Action Plan. In this study, we estimate PM_2.5 concentration using Voronoi spatial interpolation method on a grid with a spatial resolution of 1×1km². Combined with the exposure-response function between PM_2.5 concentration and health endpoints, health effects of PM_2.5 exposure are analyzed. The economic loss is assessed by using the willingness to pay (WTP) method and human capital (HC) method. When the PM_2.5 concentration falls by 25% in BTH and reached 60μg/m³ in Beijing, the avoiding deaths will be in the range of 3175 to 14051 based on different functions each year. Of the estimated mortality attributable to all causes, 3117 annual deaths were due to lung cancer, 1924 - 6318 annual deaths were due to cardiovascular, and 343 - 1697 annual deaths were due to respiratory. Based on WTP, the estimated monetary values for the avoided cases of all cause mortality, cardiovascular mortality, respiratory mortality and lung cancer ranged from 1110 to 29632, 673 to 13325, 120 to 3579, 1091 to 6574 million yuan, respectively. Based on HC, the corresponding values for the avoided cases of these four mortalities were 267 to 1178, 161 to 529, 29 to 143 and 261 million yuan, respectively.

Burden of disease attributed to ambient PM2.5 and PM10 exposure in 190 cities in China

Particulate air pollution is becoming a serious public health concern in urban cities of China. Association of disability-adjusted life years (DALYs) and economic loss with air pollution-related health effects demand quantitative analysis for correctional measures in air quality. This study applies an epidemiology-based exposure-response function to obtain the quantitative estimate of health impact of particulate matter PM_2.5 and PM₁₀ across 190 cities of China during years 2014-2015. The annual average concentration of PM_2.5 and PM₁₀ is 57 ± 18 μg/m³ (ranging from 18 to 119 μg/m³) and 97.7 ± 34.2 μg/m³ (ranging from 33.5 to 252.8 μg/m³), respectively. Based on the present study, the total estimated annual premature mortality due to PM_2.5 is 722,370 [95% confidence interval (CI) = 322,716-987,519], 79% of which accounts for adult cerebrovascular disease (stroke) and ischemic heart disease (IHD). The premature mortality in megacities is very high, such as Chongqing (25,162/year), Beijing (19,702/year), Shanghai (19,617/year), Tianjin (13,726/year), and Chengdu (12,356/year). PM₁₀ pollution has caused 1,491,774 (95% CI = 972,770-1,960,303) premature deaths (age >30) in China. Further, 3,614,064 cases of chronic bronchitis (CB); 13,759,894 cases of asthma attack among all ages; 191,709 COPD-related hospital admission (HA) cases; 499,048 respiratory-related HA; 357,816 cerebrovascular HA; and 308,129 cardiovascular-related HA due to PM₁₀ pollution have been estimated during 2014-2015. Chongqing, Beijing, Baoding, Tianjin, and Shijiazhuang are the top five contributors to pollution-related mortality, accounting for 3.10, 2.71, 2.49, 2.20, and 2.02%, respectively, of the total deaths caused by PM₁₀ pollution. The total DALYs associated with PM_2.5 and PM₁₀ pollution in China is 7.2 and 20.66 million in 2014-2015, and mortality and chronic bronchitis shared about 93.3% of the total DALYs for PM₁₀. During this period, the economic cost of health impact due to PM₁₀ is approximately US$304,122 million, which accounts for about 2.94% of China's gross domestic product (GDP). Megacities are expected to contribute relatively more to the total costs. The present methodology could be used as a tool to help policy makers and pollution control board authorities, to further analyze costs and benefits of air pollution management programs in China.

Assessment of population exposure to PM2.5 for mortality in China and its public health benefit based on BenMAP

Along with the rapid socioeconomic development, air pollution in China has become a severe problem. One component of air pollution, in particular, PM_2.5 has aroused wide public concern because of its high concentration. In this study, data were collected from over 900 monitoring sites of the newly constructed PM_2.5 monitoring network in China. The interpolation methods were used to simulate the PM_2.5 exposure level of China especially in rural areas, thus reflecting the spatial variation of PM_2.5 pollution. We calculated the health benefit caused by PM_2.5 in China in 2014 based on Environmental Benefits Mapping and Analysis Program (BenMAP), assuming achievement of China National Ambient Air Quality Standard (No. GB3095-2012). By reducing the annual average concentration of PM_2.5 to the annual Grade II standard (35 μg/m³), the avoided deaths for cardiovascular disease, respiratory disease and lung cancer could reach 89,000 (95% CI, 8000-170,000), 47,000 (95% CI, 3000-91,000) and 32,000 (95% CI, 6000-58,000) per year using long term health function, respectively. The attributable fractions of cardiovascular disease, respiratory disease and lung cancer to all cause were 42%, 22% and 15%, respectively. The total economic benefits for rolling back the concentration of PM_2.5 to the level of 35 μg/m³ were estimated to be 260 (95%CI: (73, 440) billion RMB and 72 (95%CI: (45, 99) billion RMB using willingness to pay (WTP) and human capital (HC) methods, respectively, which account for 0.40% (95%CI: (0.11%, 0.69%) and 0.11% (95%CI: (0.07%, 0.15%) of the total annual Gross Domestic Product (GDP) of China in 2014.

Disability-adjusted life years and economic cost assessment of the health effects related to PM2.5 and PM10 pollution in Mumbai and Delhi, in India from 1991 to 2015

Particulate air pollution is becoming a serious public health concern in urban cities in India due to air pollution-related health effects associated with disability-adjusted life years (DALYs) and economic loss. To obtain the quantitative result of health impact of particulate matter (PM) in most populated Mumbai City and most polluted Delhi City in India, an epidemiology-based exposure-response function has been used to calculate the attributable number of mortality and morbidity cases from 1991 to 2015 in a 5-year interval and the subsequent DALYs, and economic cost is estimated of the health damage based on unit values of the health outcomes. Here, we report the attributable number of mortality due to PM₁₀ in Mumbai and Delhi increased to 32,014 and 48,651 in 2015 compared with 19,291 and 19,716 in year 1995. And annual average mortality due to PM_2.5 in Mumbai and Delhi was 10,880 and 10,900. Premature cerebrovascular disease (CEV), ischemic heart disease (IHD), and chronic obstructive pulmonary disease (COPD) causes are about 35.3, 33.3, and 22.9% of PM_2.5-attributable mortalities. Total DALYs due to PM10 increased from 0.34 million to 0.51 million in Mumbai and 0.34 million to 0.75 million in Delhi from average year 1995 to 2015. Among all health outcomes, mortality and chronic bronchitis shared about 95% of the total DALYs. Due to PM₁₀, the estimated total economic cost at constant price year 2005 US$ increased from 2680.87 million to 4269.60 million for Mumbai City and 2714.10 million to 6394.74 million for Delhi City, from 1995 to 2015, and the total amount accounting about 1.01% of India's gross domestic product (GDP). A crucial presumption is that in 2030, PM₁₀ levels would have to decline by 44% (Mumbai) and 67% (Delhi) absolutely to maintain the same health outcomes in year 2015 levels. The results will help policy makers from pollution control board for further cost-benefit analyses of air pollution management programs in Mumbai and Delhi.

A cooperative reduction model for regional air pollution control in China that considers adverse health effects and pollutant reduction costs

How to effectively control severe regional air pollution has become a focus of global concern recently. The non-cooperative reduction model (NCRM) is still the main air pollution control pattern in China, but it is both ineffective and costly, because each province must independently fight air pollution. Thus, we proposed a cooperative reduction model (CRM), with the goal of maximizing the reduction in adverse health effects (AHEs) at the lowest cost by encouraging neighboring areas to jointly control air pollution. CRM has two parts: a model of optimal pollutant removal rates using two optimization objectives (maximizing the reduction in AHEs and minimizing pollutant reduction cost) while meeting the regional pollution control targets set by the central government, and a model that allocates the cooperation benefits (i.e., health improvement and cost reduction) among the participants according to their contributions using the Shapley value method. We applied CRM to the case of sulfur dioxide (SO₂) reduction in Yangtze River Delta region. Based on data from 2003 to 2013, and using mortality due to respiratory and cardiovascular diseases as the health endpoints, CRM saves 437 more lives than NCRM, amounting to 12.1% of the reduction under NCRM. CRM also reduced costs by US $65.8×10⁶ compared with NCRM, which is 5.2% of the total cost of NCRM. Thus, CRM performs significantly better than NCRM. Each province obtains significant benefits from cooperation, which can motivate them to actively cooperate in the long term. A sensitivity analysis was performed to quantify the effects of parameter values on the cooperation benefits. Results shown that the CRM is not sensitive to the changes in each province's pollutant carrying capacity and the minimum pollutant removal capacity, but sensitive to the maximum pollutant reduction capacity. Moreover, higher cooperation benefits will be generated when a province's maximum pollutant reduction capacity increases.

Mortality effects assessment of ambient PM2.5 pollution in the 74 leading cities of China

BACKGROUND

Ambient fine particulate matter (PM2.5) pollution is currently a most severe and worrisome environmental problem in China. However, current knowledge of the health effects of this pollution is insufficient.

OBJECTIVES

This study aims to provide an overall understanding regarding the long-term mortality effects of current PM2.5 pollution in China and the potential health benefits of realizing the goals stipulated in the ongoing action plan of Air Pollution Prevention and Control (APPC) and the targets suggested by the WHO.

METHODS

Three typical causes and all-cause of PM2.5-related mortality were considered. The log-linear exposure-response function was adopted, and a meta-analysis was used to determine the exposure-response coefficients, based on newly available data in China and abroad.

RESULTS

In the 74 leading cities of China, approximately 32% of the reported deaths, with a mortality rate of 1.9‰, were associated with PM2.5 in 2013, in which deaths from cardiovascular, respiratory and lung-cancer causes accounted for 20% of the reported deaths, with a mortality rate of 1.2‰. The regional difference is remarkable for the mortalities and proportions of the different causes. If the PM2.5 concentration goals of the APPC plan, the first interim and the guideline targets of the WHO could be achieved, the PM2.5-related all-cause mortality would be reduced by 25%, 64% and 95%, respectively, compared with that of 2013.

CONCLUSIONS

PM2.5 pollution in China has incurred great health risks that are even worse than those of tobacco smoking. The health benefits of the APPC plan could be outstanding, although there is still great potential to improve future air quality.

Estimation of health and economic costs of air pollution over the Pearl River Delta region in China

The Pearl River Delta region (PRD) is the economic growth engine of China and also one of the most urbanized regions in the world. As a two-sided sword, rapid economic development causes air pollution and poses adverse health effects to the citizens in this area. This work estimated the negative health effects in the PRD caused by the four major ambient pollutants (SO2, NO2, O3 and PM10) from 2010 to 2013 by using a log linear exposure-response function and the WRF-CMAQ modeling system. Economic loss due to mortality and morbidity was evaluated by the value of statistical life (VSL) and cost of illness (COI) methods. The results show that the overall possible short-term all-cause mortality due to NO2, O3 and PM10 reached the highest in 2013 with the values being 13,217-22,800. The highest total economic loss, which ranged from 14,768 to 25,305million USD, occurred in 2013 and was equivalent to 1.4%-2.3% of the local gross domestic product. The monthly profile of cases of negative health effects varied by city and the types of ambient pollutants. The ratio of mortality attributed to air pollutants to total population was higher in urban areas than in rural areas. People living in the countryside should consider the possible adverse health effects of urban areas before they plan a move to the city. The results show that the health burden caused by the ambient pollutants over this region is serious and suggest that tighter control policies should be implemented in the future to reduce the level of air pollution.

Unexpected Benefits of Reducing Aerosol Cooling Effects

Impacts of aerosol cooling are not limited to changes in surface temperature since modulation of atmospheric dynamics resulting from the increased stability can deteriorate local air quality and impact human health. Health impacts from two manifestations of the aerosol direct effects (ADE) are estimated in this study: (1) the effect on surface temperature and (2) the effect on air quality through atmospheric dynamics. Average mortalities arising from the enhancement of surface PM2.5 concentration due to ADE in East Asia, North America and Europe are estimated to be 3-6 times higher than reduced mortality from decreases of temperature due to ADE. Our results suggest that mitigating aerosol pollution is beneficial in decreasing the impacts of climate change arising from these two manifestations of ADE health impacts. Thus, decreasing aerosol pollution gets direct benefits on health, and indirect benefits on health through changes in local climate and not offsetting changes associated only with temperature modulations as traditionally thought. The modulation of air pollution due to ADE also translates into an additional human health dividend in regions (e.g., U.S. Europe) with air pollution control measures but a penalty for regions (e.g., Asia) witnessing rapid deterioration in air quality.

Evaluation of health benefit using BenMAP-CE with an integrated scheme of model and monitor data during Guangzhou Asian Games

Guangzhou is the capital and largest city (land area: 7287 km(2)) of Guangdong province in South China. The air quality in Guangzhou typically worsens in November due to unfavorable meteorological conditions for pollutant dispersion. During the Guangzhou Asian Games in November 2010, the Guangzhou government carried out a number of emission control measures that significantly improved the air quality. In this paper, we estimated the acute health outcome changes related to the air quality improvement during the 2010 Guangzhou Asian Games using a next-generation, fully-integrated assessment system for air quality and health benefits. This advanced system generates air quality data by fusing model and monitoring data instead of using monitoring data alone, which provides more reliable results. The air quality estimates retain the spatial distribution of model results while calibrating the value with observations. The results show that the mean PM2.5 concentration in November 2010 decreased by 3.5 μg/m(3) compared to that in 2009 due to the emission control measures. From the analysis, we estimate that the air quality improvement avoided 106 premature deaths, 1869 cases of hospital admission, and 20,026 cases of outpatient visits. The overall cost benefit of the improved air quality is estimated to be 165 million CNY, with the avoided premature death contributing 90% of this figure. The research demonstrates that BenMAP-CE is capable of assessing the health and cost benefits of air pollution control for sound policy making.

Health impact metrics for air pollution management strategies

Health impact assessments (HIAs) inform policy and decision making by providing information regarding future health concerns, and quantitative HIAs now are being used for local and urban-scale projects. HIA results can be expressed using a variety of metrics that differ in meaningful ways, and guidance is lacking with respect to best practices for the development and use of HIA metrics. This study reviews HIA metrics pertaining to air quality management and presents evaluative criteria for their selection and use. These are illustrated in a case study where PM2.5 concentrations are lowered from 10 to 8μg/m(3) in an urban area of 1.8 million people. Health impact functions are used to estimate the number of premature deaths, unscheduled hospitalizations and other morbidity outcomes. The most common metric in recent quantitative HIAs has been the number of cases of adverse outcomes avoided. Other metrics include time-based measures, e.g., disability-adjusted life years (DALYs), monetized impacts, functional-unit based measures, e.g., benefits per ton of emissions reduced, and other economic indicators, e.g., cost-benefit ratios. These metrics are evaluated by considering their comprehensiveness, the spatial and temporal resolution of the analysis, how equity considerations are facilitated, and the analysis and presentation of uncertainty. In the case study, the greatest number of avoided cases occurs for low severity morbidity outcomes, e.g., asthma exacerbations (n=28,000) and minor-restricted activity days (n=37,000); while DALYs and monetized impacts are driven by the severity, duration and value assigned to a relatively low number of premature deaths (n=190 to 230 per year). The selection of appropriate metrics depends on the problem context and boundaries, the severity of impacts, and community values regarding health. The number of avoided cases provides an estimate of the number of people affected, and monetized impacts facilitate additional economic analyses useful to policy analysis. DALYs are commonly used as an aggregate measure of health impacts and can be used to compare impacts across studies. Benefits per ton metrics may be appropriate when changes in emissions rates can be estimated. To address community concerns and HIA objectives, a combination of metrics is suggested.

Analysis of residents' willingness to pay to reduce air pollution to improve children's health in community and hospital settings in Shanghai, China

BACKGROUND

Shanghai, along with many major cities in China, faces deterioration of air quality and increases in air pollution-related respiratory diseases (RDs) in children due to rapid industrialization and urbanization. The Contingent Valuation Method (CVM) was used to qualitatively and quantitatively measure the willingness to pay (WTP) for reducing children's RDs through air quality improvement.

METHODS

Between April and May, 2014, 975 face-to-face interviews were collected from parents in a community-based and a hospital-setting in Shanghai. Multiple imputation and the Probit model were used to determine the relationship between the WTP and the related environmental factors, child health factors and the socio-economic status.

RESULTS

Most respondents reported being willing to make a financial contribution to improve air quality in both the community (52.6%) and hospital (70.2%) samples. Those in the hospital setting were willing to pay significantly more ¥504 (USD$80.7) compared to the community sample ¥428 ($68.5) as expected. Reasons for those not being willing to pay included lack of disposable income and believing that responsibility of the air quality was a community issue. These did not differ by sample. Annual household income and education were related to WTP.

CONCLUSION

This study indicated that parents in Shanghai would be willing to pay for improved air quality. Children's health can be the incentive for the citizens' participation and support in the air quality improvement, therefore, hospital settings may present unique places to improve education about air quality and enhance advocacy efforts. This study also suggested that future environmental policies be addressed more rigorously for targeted populations.

Monetary Valuation of PM10-Related Health Risks in Beijing China: The Necessity for PM10 Pollution Indemnity

Severe health risks caused by PM₁₀ (particulate matter with an aerodynamic diameter ≤10 μm) pollution have induced inevitable economic losses and have rendered pressure on the sustainable development of society as a whole. In China, with the “Polluters Pay Principle”, polluters should pay for the pollution they have caused, but how much they should pay remains an intractable problem for policy makers. This paper integrated an epidemiological exposure-response model with economics methods, including the Amended Human Capital (AHC) approach and the Cost of Illness (COI) method, to value the economic loss of PM₁₀-related health risks in 16 districts and also 4 functional zones in Beijing from 2008 to 2012. The results show that from 2008 to 2012 the estimated annual deaths caused by PM₁₀ in Beijing are around 56,000, 58,000, 63,000, 61,000 and 59,000, respectively, while the economic losses related to health damage increased from around 23 to 31 billion dollars that PM₁₀ polluters should pay for pollution victims between 2008 and 2012. It is illustrated that not only PM₁₀ concentration but also many other social economic factors influence PM₁₀-related health economic losses, which makes health economic losses show a time lag discrepancy compared with the decline of PM₁₀ concentration. In conclusion, health economic loss evaluation is imperative in the pollution indemnity system establishment and should be considered for the urban planning and policy making to control the burgeoning PM₁₀ health economic loss.

Estimation of future PM2.5- and ozone-related mortality over the continental United States in a changing climate: An application of high-resolution dynamical downscaling technique

This paper evaluates the PM2.5- and ozone-related mortality at present (2000s) and in the future (2050s) over the continental United States by using the Environmental Benefits Mapping and Analysis Program (BenMAP-CE). Atmospheric chemical fields are simulated by WRF/CMAQ (horizontal resolution: 12×12 km), applying the dynamical downscaling technique from global climate-chemistry model under the Representative Concentration Pathways scenario (RCP 8.5). Future air quality results predict that the annual mean PM2.5 concentration in continental U.S. decreases nationwide, especially in the Eastern U.S. and west coast. However, the ozone concentration is projected to decrease in the Eastern U.S. but increase in the Western U.S. Future mortality is evaluated under two scenarios (1) holding future population and baseline incidence rate at the present level and (2) using the projected baseline incidence rate and population in 2050. For PM2.5, the entire continental U.S. presents a decreasing trend of PM2.5-related mortality by the 2050s in Scenario (1), primarily resulting from the emissions reduction. While in Scenario (2), almost half of the continental states show a rising tendency of PM2.5-related mortality, due to the dominant influence of population growth. In particular, the highest PM2.5-related deaths and the biggest discrepancy between present and future PM2.5-related deaths both occur in California in 2050s. For the ozone-related premature mortality, the simulation shows nation-wide rising tendency in 2050s under both scenarios, mainly due to the increase of ozone concentration and population in the future. Furthermore, the uncertainty analysis shows that the confidence interval of all causes mortality is much larger than that for specific causes, probably due to the accumulated uncertainty of generating datasets and sample size. The confidence interval of ozone-related all cause premature mortality is narrower than the PM2.5-related all cause mortality, due to its smaller standard deviation of the concentration-mortality response factor.

IMPLICATIONS

The health impact of PM2.5 is more linearly proportional to the emission reductions than ozone. The reduction of anthropogenic PM2.5 precursor emissions is likely to lead to the decrease of PM2.5 concentrations and PM2.5 related mortality. However, the future ozone concentrations could increase due to increase of the greenhouse gas emissions of methane. Thus, to reduce the impact of ozone related mortality, anthropogenic emissions including criteria pollutant and greenhouse gas (i.e. methane) need to be controlled.