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

High spatiotemporal resolution estimation and analysis of global surface CO concentrations using a deep learning model

Ambient carbon monoxide (CO) is a primary air pollutant that poses significant health risks and contributes to the formation of secondary atmospheric pollutants, such as ozone (O3). This study aims to elucidate global CO pollution in relation to health risks and the influence of natural events like wildfires. Utilizing artificial intelligence (AI) big data techniques, we developed a high-performance Convolutional Neural Network (CNN)-based Residual Network (ResNet) model to estimate daily global CO concentrations at a high spatial resolution of 0.07° from June 2018 to May 2021. Our model integrated the global TROPOMI Total Column of atmospheric CO (TCCO) product and reanalysis datasets, achieving desirable estimation accuracies with R-values (correlation coefficients) of 0.90 and 0.96 for daily and monthly predictions, respectively. The analysis reveals that the CO concentrations were relatively high in northern and central China, as well as northern India, particularly during winter months. Given the significant role of wildfires in increasing surface CO levels, we examined their impact in the Indochina Peninsula, the Amazon Rain Forest, and Central Africa. Our results show increases of 60.0%, 28.7%, and 40.8% in CO concentrations for these regions during wildfire seasons, respectively. Additionally, we estimated short-term mortality cases related to CO exposure in 17 countries for 2019, with China having the highest mortality cases of 23,400 (95% confidence interval: 0-99,500). Our findings highlight the critical need for ongoing monitoring of CO levels and their health implications. The daily surface CO concentration dataset is publicly available and can support future relevant sustainable studies, which is accessible at https://doi.org/10.5281/zenodo.11806178.

High-Resolution Spatiotemporal Modeling for PM2.5 Major Components in the Pearl River Delta and Its Implications for Epidemiological Studies

Distinguishing the effects of different fine particulate matter components (PMCs) is crucial for mitigating their effects on human health. However, the sparse distribution of locations where PM is collected for component analysis makes it challenging to investigate the relevant health effects. This study aimed to investigate the agreement between data-fusion-enhanced exposure assessment and site monitoring data in estimating the effects of PMCs on gestational diabetes mellitus (GDM). We first improved the spatial resolution and accuracy of exposure assessment for five major PMCs (EC, OM, NO3-, NH4+, and SO42-) in the Pearl River Delta region by a data fusion model that combined inputs from multiple sources using a random forest model (10-fold cross-validation R2: 0.52 to 0.61; root mean square error: 0.55 to 2.26 μg/m3). Next, we compared the associations between exposures to PMCs during pregnancy and GDM in a hospital-based cohort of 1148 pregnant women in Heshan, China, using both site monitoring data and data-fusion model estimates. The comparative analysis showed that the data-fusion-based exposure generated stronger estimates of identifying statistical disparities. This study suggests that data-fusion-enhanced estimates can improve exposure assessment and potentially mitigate the misclassification of population exposure arising from the utilization of site monitoring data.

Urban-rural disparities in the association of nitrogen dioxide exposure with cardiovascular disease risk in China: effect size and economic burden

BACKGROUND

Together with rapid urbanization, ambient nitrogen dioxide (NO2) exposure has become a growing health threat. However, little is known about the urban-rural disparities in the health implications of short-term NO2 exposure. This study aimed to compare the association between short-term NO2 exposure and hospitalization for cardiovascular disease (CVD) among urban and rural residents in Shandong Province, China. Then, this study further explored the urban-rural disparities in the economic burden attributed to NO2 and the explanation for the disparities.

METHODS

Daily hospitalization data were obtained from an electronic medical records dataset covering a population of 5 million. In total, 303,217 hospital admissions for CVD were analyzed. A three-stage time-series analytic approach was used to estimate the county-level association and the attributed economic burden.

RESULTS

For every 10-μg/m3 increase in NO2 concentrations, this study observed a significant percentage increase in hospital admissions on the day of exposure of 1.42% (95% CI 0.92 to 1.92%) for CVD. The effect size was slightly higher in urban areas, while the urban-rural difference was not significant. However, a more pronounced displacement phenomenon was found in rural areas, and the economic burden attributed to NO2 was significantly higher in urban areas. At an annual average NO2 concentration of 10 μg/m3, total hospital days and expenses in urban areas were reduced by 81,801 (44,831 to 118,191) days and 60,121 (33,002 to 86,729) thousand CNY, respectively, almost twice as much as in rural areas. Due to disadvantages in socioeconomic status and medical resources, despite similar air pollution levels in the urban and rural areas of our sample sites, the rural population tended to spend less on hospitalization services.

CONCLUSIONS

Short-term exposure to ambient NO2 could lead to considerable health impacts in either urban or rural areas of Shandong Province, China. Moreover, urban-rural differences in socioeconomic status and medical resources contributed to the urban-rural disparities in the economic burden attributed to NO2 exposure. The health implications of NO2 exposure are a social problem in addition to an environmental problem. Thus, this study suggests a coordinated intervention system that targets environmental and social inequality factors simultaneously.

Can factor substitution reduce the shadow price of air pollution embodied in international trade? A worldwide perspective

The calculation of trade-embodied air pollution (TEAP) and its economic losses can be reasonably used to assess the impact of transboundary air pollution. However, these air pollutants, which are associated with international trade, can be easily ignored due to their concealment. Based on this, the global multiregional input‒output model (MRIO) is used to quantify the volume of five air pollutants that are embodied in the trade of 20 countries from 2000 to 2016. Then, the shadow price of trade-embodied air pollution (SPTEAP) and the elasticity of factor substitution (EFS) are both calculated by applying the translog production function. Finally, impulse response analysis is used to study the dynamic impact of EFS on the SPTEAP. The main conclusions are as follows: (1) All countries experienced a mass transfer of TEAP, among which China and the USA are the developing and developed countries with the largest amount of TEAP transfers, respectively. (2) The SPTEAP and EFS vary greatly among countries, and these values are generally higher in developed countries than in developing countries. The relationship between the three EFSs can be expressed as [Formula: see text] in all countries, thus indicating that improving the technological level of a country is the best solution for reducing the TEAP in that country while incurring the lowest cost and the least difficulty. (3) Over the long run, the increase in [Formula: see text] and [Formula: see text] reduces the SPTEAP. Conversely, an increase in [Formula: see text] increases the SPTEAP. Therefore, policymakers should weigh these three factors according to the fluctuation of the SPTEAP and constantly adjust the allocation structure and ratio of these factors to maximize the benefits of transboundary air pollution governance.

Change in disease burden associated with influenza and air pollutants during the COVID-19 pandemic in Hong Kong

Objectives

This study aimed to estimate the variation in disease burden associated with air pollutants and other respiratory viruses during the COVID-19 pandemic.

Methods

We adopted a machine learning approach to calculate the excess mortality attributable to air pollutants and influenza, during the pre-pandemic and pandemic period.

Results

In the first 2 years of the COVID-19 pandemic, there were 8762 (95% confidence interval, 7503-9993), and 12,496 (11,718-13,332) excess all-cause deaths in Hong Kong. These figures correspond to 117.4 and 167.9 per 100,000 population, and 12.6% and 8.5% of total deaths in 2020 and 2021, respectively. Compared to the period before the pandemic, excess deaths from all-causes, cardiovascular and respiratory diseases, pneumonia and influenza attributable to influenza A and B significantly decreased in all age groups. However, excess deaths associated with ozone increased in all age-disease categories, while the relative change of nitrogen dioxide (NO2) and particular matters less than 10 µm (PM10) associated burden showed a varied pattern.

Conclusions

A notable shift in disease burden attributable to influenza and air pollutants was observed in the pandemic period, suggesting that both direct and indirect impacts shall be considered when assessing the global and regional burden of the COVID-19 pandemic.

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.

Effect of short-term exposure to ambient air pollutants on non-accidental mortality in emergency department visits: a time-series study

Objectives

Exposure to air pollution has been linked to an increased risk of premature mortality. However, the acute effects of air pollution on the risk of non-accidental mortality have not been extensively researched in developing countries, and the findings thus far have been inconsistent. Therefore, this study aimed to examine the association between short-term exposure to six pollutants (PM_2.5, PM₁₀, SO₂, NO₂, O₃, and CO) and non-accidental mortality in Beijing, China.

Methods

Daily data on non-accidental deaths were gathered from 1 January 2017 to 31 December 2018. Air pollution data for the same period were collected from 35 fixed-site air quality monitoring stations in Beijing. Generalized additive models (GAM) based on Poisson regression were used to investigate the association between non-accidental mortality in emergency department visits and the daily average levels of air pollutants.

Results

There were 8,676 non-accidental deaths recorded during 2017-2018. After sensitivity analysis, short-term exposure to air pollutants, particularly gaseous pollutants, was linked to non-accidental mortality. Specifically, for every 10 μg/m³ increase (5 μg/m³ in SO₂, 0.5 mg/m³ in CO) of SO₂ (lag 04), NO₂ (lag 04), O₃ (lag 05), and CO (lag 04), the relative risk (RR) values were 1.054 (95% CI: 1.009, 1.100), 1.038 (95% CI: 1.013, 1.063), 1.032 (95% CI: 1.011, 1.054), and 1.034 (95% CI: 1.004, 1.066), respectively. In terms of causes of death, short-term exposure to NO₂, SO₂, and O₃ increased the risk of circulatory mortality. Further stratified analysis revealed that the stronger associations were presented in females for O₃ while in males for CO. People aged 65 and over were strongly associated with ambient air pollution.

Conclusions

Our study showed that ambient air pollutants were associated with non-accidental mortality. Our findings suggested that efforts to control gaseous pollution should be stepped up, and vulnerable groups should be the focus of health protection education.

The effects of short-term exposure to air pollution on mortality in Baotou, China, during 2015-2019

Air pollution was considered one of the main causes linked to increased morbidity and mortality around the world. This study aimed to estimate the effect of air pollutants on daily death in Baotou city of Inner Mongolia. Daily deaths data were provided by Baotou Centers for Disease Control and Prevention for the years 2015-2019 (Baotou CDC). The air pollutants, PM_2.5, PM₁₀, NO₂, SO₂, CO and maximum 8-h average concentrations of O₃, came from the eight environmental monitoring stations in Baotou city. Time-series plots were used to exploit the trend of air pollutants at calendar time. Generalized additive model was used to estimate the effect of air pollutants on daily death. Restricted cubic spline was employed to investigate non-line relationships between air pollutants and daily death. After adjusting the meteorological factors, non-accidental daily deaths were related to PM_2.5 (ER = 0.074%) and PM₁₀ (ER = 0.023%), respectively. In stratified analysis, population aged over 65 years and females were more sensitive to air pollutants exposure and warm season might make people more susceptible to air pollutants compared with cold season. PM_2.5 and PM₁₀ increase the risk of non-accidental and cardiovascular daily death, but not respiratory daily death.

Microplastic occurrence and ecological risk assessment in the eight outlets of the Pearl River Estuary, a new insight into the riverine microplastic input to the northern South China Sea

Estuaries are unique transition zones connecting terrestrial and coastal environments and are recognized as primary conveyors for land-derived plastics to open oceans. Riverine microplastics (MPs) have been commonly investigated using sequential sampling which might not effectively reflect the actual load. In this study, sampling at eight outlets was performed during a complete tidal cycle to estimate the MP flux to the Pearl River Estuarine (PRE) using a concurrent sampling strategy. The MP abundances ranged from 2.90 ± 0.57-5.9 ± 2.27 particles/L. A remarkable difference between tides in MP abundances suggests tidal effect should not be overlooked in assessment. The MP load through the eight outlets was estimated at 304 trillion particles or 1102 tons into the PRE annually. Additionally, similar potential ecological risk assessment among eight rivers implied that environmental threats posed by less urbanized and populated rural areas on the western side have been under-evaluating for decades.

Air pollution impacts on public health: Evidence from 110 cities in Yangtze River Economic Belt of China

This study intends to further reveal the relationship between air pollution and public health on a city scale in China and explore the spillover effect among cities. On the basis of collecting the panel data of 110 cities in the Yangtze River Economic Belt from 2010 to 2018, we establish a spatial econometric model to analyze the impacts of air pollution, economic development, and other factors on public health. According to the results, a significant spatial correlation exists between the public health and air pollution levels in all of the cities in the Yangtze River Economic Belt. Air pollution also shows a spillover effect among these cities; the relationships between the industrial fume (dust) emissions, industrial sulfur dioxide emissions, and particulate matter (PM 2.5) concentration and the public health level are not simple linear relationships, but instead U-shaped curvilinear relationships. The economic development in recent years has contributed to the improvement of the public health level of the cities in the Yangtze River Economic Belt. The economic development of their neighboring cities, however, has adversely affected the public health levels of these cities.

Heavy metal contamination of soil, sediment and water due to galena mining in Ebonyi State Nigeria: Economic costs of pollution based on exposure health risks

In this study, the effect of galena mining with respect to heavy metal pollution of groundwater, surface water, soil and sediments in Enyimagalagu and Mkpuma-Akpatakpa Communities in Ebonyi State, Nigeria, was investigated to estimate the health and economic burden. The heavy metals were measured using atomic absorption spectrometry (AAS). The water quality of the groundwater and surface water was determined using the water quality index (WQI). The potential health burden was estimated by determining carcinogenic and non-carcinogenic health risks via risk index (RI) and hazard index (HI), respectively. The potential economic burden was estimated using the value of statistical life (VSL) and cost of illness (COI). Obtained results revealed that the WQI of the groundwater and surface water ranged from 197 to 327 indicating very poor to unsuitable water for drinking. No non-carcinogenic risks were associated with exposure to the soil and sediment components of the environment. However, there were non-carcinogenic risks associated with the surface and groundwater, with the HIs ranging from 1.8 to 5.4. Based on the carcinogenic risk threshold of 10^-6, there were carcinogenic risks across all the environmental media ranging from 8.4*10^-5 - 2.1*10^-3. The economic cost of heavy metal pollution ranged from 20.7 million USD (10.35 billion) to 543.3 million USD (271.6 billion) for the VSL, whereas it ranged from 0.141 million USD (70.8 million) to 3.72 million USD (1.86 billion) for the COI. These costs are quite huge and can be avoided via pollution abatement measures.

Legacy PAHs in effluent receiving river sediments near a large petroleum products depot in Enugu, Nigeria: Human health risks and economic cost of pollution

This study assessed the human health risk of exposure to legacy PAHs in the Nwaenebo River sediments that received effluents for over two decades from the Nigeria National Petroleum Corporation (NNPC) petroleum product Depot in Emene, Enugu, Nigeria. The study went further to estimate economic costs of the sediment PAHs pollution based on the human health risk of exposure. The human health risks were determined by estimating carcinogenic and mutagenic risks via Benzo[a]pyrene total potential equivalent (BaP TPE) and mutagenic equivalent quotient (MEQ). The economic costs of the sediment pollution comprised costs due to mortality and those due to morbidity and were estimated using the value of statistical lives (VSLs) and cost of illness (CoI), respectively. The study, with an appropriate selection of sampling points established that the NNPC petroleum Depot was responsible for the Nwaenebo River sediment PAHs pollution with ƩPAHs concentration 14.3-163 mg/kg. The carcinogenic and mutagenic risks varied from 1.3*10^-5 to 4.7*10^-5 and 1.4*10^-5 to 6.0*10^-5 respectively. Based on risk threshold of 10^-6, these risks were high. The long term economic costs of pollution of the sediments by the PAHs were estimated at 60.5 million USD and 0.46 million USD for mortality and morbidity costs, respectively.

Mortality burden due to long-term exposure to ambient PM2.5 above the new WHO air quality guideline based on 296 cities in China

OBJECTIVE

Quantifying the spatial and socioeconomic variation of mortality burden attributable to particulate matters with aerodynamic diameter ≤ 2.5 µm (PM2.5) has important implications for pollution control policy. This study aims to examine the regional and socioeconomic disparities in the mortality burden attributable to long-term exposure to ambient PM2.5 in China.

METHODS

Using data of 296 cities across China from 2015 to 2019, we estimated all-cause mortality (people aged ≥ 16 years) attributable to the long-term exposure to ambient PM2.5 above the new WHO air quality guideline (5 µg/m3). Attributed fraction (AF), attributed deaths (AD), attributed mortality rate (AMR) and total value of statistical life lost (VSL) by regional and socioeconomic levels were reported.

RESULTS

Over the period of 2015-2019, 17.0% [95% confidence interval (CI): 7.4-25.2] of all-cause mortality were attributable to long-term exposure to ambient PM2.5, corresponding to 1,425.2 thousand deaths (95% CI: 622.4-2,099.6), 103.5/105 (95% CI: 44.9-153.3) AMR, and 1006.9 billion USD (95% CI: 439.8-1483.4) total VSL per year. The AMR decreased from 120.5/105 (95% CI: 52.9-176.6) to 92.7/105 (95% CI:39.9-138.5) from 2015 to 2019. The highest mortality burden was observed in the north region (annual average AF = 24.2%, 95% CI: 10.8-35.1; annual average AMR = 137.0/105, 95% CI: 60.9-198.5). The highest AD and economic loss were observed in the east region (annual average AD = 390.0 thousand persons, 95% CI: 170.3-574.6; annual total VSL = 275.6 billion USD, 95% CI: 120.3-406.0). Highest AMR was in the cities with middle level of GDP per capita (PGDP)/urbanization. The majority of the top ten cities of AF, AMR and VSL were in high and middle PGDP/urbanization regions.

CONCLUSION

There were significant regional and socioeconomic disparities in PM2.5 attributed mortality burden among Chinese cities, suggesting differential mitigation policies are required for different regions in China.

Impact of Particulate Matter on Hospitalizations for Respiratory Diseases and Related Economic Losses in Wuhan, China

Background

Prior studies have reported the effects of particulate matter (PM) on respiratory disease (RD) hospitalizations, but few have quantified PM-related economic loss in the central region of China. This investigation aimed to assess the impacts of PM pollution on the risk burden and economic loss of patients admitted with RD.

Methods

Daily cases of RD admitted to the hospital from 1 January 2015 to 31 December 2020 were collected from two class-A tertiary hospitals in Wuhan, China. Time series analysis incorporated with a generalized additive model (GAM) was adopted to assess the impacts of fine particulate matter (PM_2.5) and inhalable particulate matter (PM₁₀) exposures on patients hospitalized with RD. Stratified analyses were performed to investigate underlying effect modification of RD risk by sex, age, and season. The cost of illness (COI) approach was applied to evaluate the related economic losses caused by PM.

Results

A total of 51,676 inpatients with a primary diagnosis of RD were included for the analysis. PM_2.5 and PM₁₀ exposures were associated with increased risks of hospitalizations for RD. Subgroup analysis demonstrated that men and children in the 0–14 years age group were more vulnerable to PM, and the adverse effects were promoted by low temperature in the cold season. A 152.4 million China Yuan (CNY) economic loss could be avoided if concentrations of PM_2.5 and PM₁₀ declined to 10 and 20 μg/m³, respectively.

Conclusions

PM_2.5 and PM₁₀ concentrations were positively associated with RD hospitalization. Men and children were more vulnerable to PM. Effective air pollution control measures can reduce hospitalizations significantly and save economic loss substantially.

Coordinated health effects attributable to particulate matter and other pollutants exposures in the North China Plain

Hebei Province, located in the North China Plain (NCP) and encircling Beijing and Tianjin, has been suffering from severe air pollution. The monthly average fine particulate matter (PM_2.5) concentration was up to 276 μg/m³ in Hebei Province, which adversely affects human health. However, few studies evaluated the coordinated health impact of exposure to PM (PM_2.5 and PM₁₀) and other key air pollutants (SO₂, NO₂, CO, and surface ozone (O₃)). In this study, we systematically analyzed the health risks (both mortality and morbidity) due to multiple air pollutants exposures in Hebei Province. The economic loss associated with these health consequences was estimated using the value of statistical life (VSL) and cost of illness (COI) methods. Our results show the health burden and economic loss attributable to multiple ambient air pollutants exposures in Hebei Province is substantial. In 2017, the total premature mortality from multiple air pollutants exposures in Hebei Province was 69,833 (95% CI: 55,549-83,028), which was 2.9 times higher than that of the Pearl River Delta region (PRD). Most of the potential economic loss (79.65%) was attributable to premature mortality from air pollution. The total economic loss due to the health consequences of multiple air pollutants exposures was 175.16 (95% CI: 134.61-224.61) billion Chinese Yuan (CNY), which was 4.92% of Hebei Province's annual gross domestic product (GDP). Thus, the adverse health effects and economic loss caused by exposure to multiple air pollutants should be seriously taken into consideration. To alleviate these damages, Hebei's government ought to establish more stringent measures and regulations to better control air pollution.

Exploring the Roles of Renewable Energy, Education Spending, and CO2 Emissions towards Health Spending in South Asian Countries

This research is mainly aimed at determining the effect of renewable energy (RE), education expenditures, and CO2 emissions on health expenditures in selected South Asian countries. There is an insufficient number of studies that investigate the linkages between health expenditures (HE) and CO2 emissions in South Asian countries. This study combined RE and gross domestic product (GDP) to identify their effect on health spending. We utilized the annual data of 1990–2018, and applied FMOLS and DOLS estimators over the panel data of five South Asian countries. According to the DOLS and FMOLS long-run results, GDP, RE, and education expenditures are negatively associated with health expenditures. This suggests that renewable energy puts less pressure on environmental quality, which leads to less health spending in the five South Asian countries studied. The empirical results also show that HE and CO2 emissions are positively and significantly related, which implies that an increase in CO2 emissions increases the financial burden on the various countries’ health sector. This study, therefore, recommends the usage of renewable sources to improve public health and to help lower health expenditures. To achieve sustainable development, it is also important to increase investment in the educational sector in the various countries.

Association of abnormal-glucose tolerance during pregnancy with exposure to PM2.5 components and sources

Maternal exposure to PM_2.5 has been associated with abnormal glucose tolerance during pregnancy, but little is known about which constituents and sources are most relevant to glycemic effects. We conducted a retrospective cohort study of 1148 pregnant women to investigate associations of PM_2.5 chemical components with gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) and to identify the most harmful sources in Heshan, China from January 2015 to July 2016. We measured PM_2.5 using filter-based method and analyzed them for 28 constituents, including carbonaceous species, water-soluble ions and metal elements. Contributions of PM_2.5 sources were assessed by positive matrix factorization (PMF). Logistic regression model was used to estimate composition-specific and source-specific effects on GDM/IGT. Random forest algorithm was applied to evaluate the relative importance of components to GDM and IGT. PM_2.5 total mass and several chemical constituents were associated with GDM and IGT across the early to mid-gestation periods, as were the PM_2.5 sources fossil fuel/oil combustion, road dust, metal smelting, construction dust, electronic waster, vehicular emissions and industrial emissions. The trimester-specific associations differed among pollutants and sources. The third and highest quartile of elemental carbon, ammonium (NH₄⁺), iron (Fe) and manganese (Mn) across gestation were consistently associated with higher odds of GDM/IGT. Maternal exposures to zinc (Zn), titanium (Ti) and vehicular emissions during the first trimester, and vanadium (V), nickel (Ni), road dust and fossil fuel/oil combustion during the second trimester were more important for GDM/IGT. This study provides important new evidence that maternal exposure to PM_2.5 components and sources is significantly related to elevated risk for abnormal glucose tolerance during pregnancy.

Ambient sulfur dioxide and hospital expenditures and length of hospital stay for respiratory diseases: A multicity study in China

BACKGROUND

Ambient sulfur dioxide (SO2) has been associated with morbidity and mortality of respiratory diseases, however, its effect on length of hospital stays (LOS) and cost for these diagnoses remain unclear.

METHODS

We collected hospital admission information for respiratory diseases from all 11 cities in the Shanxi Province of China during 2017-2019. We assessed individual-level exposure by using an inverse distance weighting approach based on geocoded residential addresses. A generalized additive model was built to delineate city-specific effects of SO2 on hospitalization, hospital expenditure, and length of hospital stay for respiratory diseases. The overall effects were obtained by random-effects meta-analysis. We further estimated the respiratory burden attributable to SO2 by comparing different reference concentrations.

RESULTS

We observed significant effects of SO2 exposure on respiratory diseases. At the provincial level, each 10 μg/m3 increase in SO2 on lag03 was associated with a 0.63% (95% CI: 0.14-0.11) increase in hospital admission, an increase of 4.56 days (95% CI: 1.16-7.95) of hospital stay, and 3647.97 renminbi (RMB, Chinese money) (95% CI: 1091.05-6204.90) in hospital cost. We estimated about 6.13 (95% CI: 1.33-11.10) thousand hospital admissions, 65.77 million RMB (95% CI: 19.67-111.87) in hospital expenditure, and 82.13 (95% CI: 20.87-143.40) thousand days of hospital stay could have potentially been avoided had the daily SO2 concentrations been reduced to WHO's reference concentration (40 µg/m3). Variable values in correspondence with this reference concentration could reduce the hospital cost and LOS of each case by 52.67 RMB (95% CI: 15.75-89.59) and 0.07 days (95% CI: 0.02-0.117).

CONCLUSION

This study provides evidence that short-term ambient SO2 exposure is an important risk factor of respiratory diseases, indicating that continually tightening policies to reduce SO2 levels could effectively reduce respiratory disease burden in Shanxi Province.

Heterogeneity and threshold effects of environmental regulation on health expenditure: Considering the mediating role of environmental pollution

A comprehensive understanding of the heterogeneity and threshold effects of environmental regulation on health expenditure is essential for policy design and decision-making. This case study seeks to analyze the heterogeneity and threshold effects using panel data, which covers 30 Chinese provinces from 2007 to 2017. We examine the linear and nonlinear impacts of environmental regulation on health expenditure by using the Bayesian quantile regression and panel threshold regression, respectively. The empirical research results indicate a significant heterogeneous effect of environmental regulation on health expenditure in provinces where health expenditure falls in different quintiles. It shows mainly two effects: a positive effect of environmental regulation on health expenditure in provinces in the low quintiles and high quintiles of health expenditure; and a negative interrelationship between environmental regulation and health expenditure for provinces in the medium quintiles of health expenditure. A single threshold effect of environmental regulation on health expenditure is found to be different among three regions: the eastern, central and western regions. Specifically, in eastern and western China, the environmental regulations are stricter, and this helps reduce the health expenditures relating to environmental pollution. However, it was found that stricter environmental regulations do not reduce health expenditures in central China.

Air pollution and hospitalization in megacities: empirical evidence from Pakistan

Air pollution has become a threat to human health in urban settlements, ultimately leading to negative impacts on overall economic system as well. Already developed nations and still developing countries both are at the risk of air pollution globally. In this scenario, this work aims to investigate the associations of asthma (AS) and acute upper respiratory infection (ARI) patients with satellite-based aerosol optical depth (AOD) and meteorological factors, i.e., relative humidity (RH), temperature (TEMP), and wind speed (WS). We applied second-generation unit root tests to provide empirical evidence. Two sets of unit root tests confirmed mix order of integration, and the other Westerlund co-integration test further showed strong linkages between estimated variables. Fully modified ordinary least square (FMOLS) and dynamic ordinary least square (DOLS) tests were applied, only to explore that TEMP and WS lower the number of AS and ARI patients, but RH and AOD increase the number of patients. Therefore, in accordance with these findings, our study provides some important policy instruments to improve the health status in megacities of Pakistan.

Health Cost Estimation of Traffic-Related Air Pollution and Assessing the Pollution Reduction Potential of Zero-Emission Vehicles in Toronto, Canada

Fossil fuel vehicles, emitting air toxics into the atmosphere, impose a heavy burden on the economy through additional health care expenses and ecological degradation. Air pollution is responsible for millions of deaths and chronic and acute health problems every year, such as asthma and chronic obstructive pulmonary disease. The fossil-fuel-based transportation system releases tons of toxic gases into the atmosphere putting human health at risk, especially in urban areas. This analysis aims to determine the economic burden of environmental and health impacts caused by Highway 401 traffic. Due to the high volume of vehicles driving on the Toronto Highway 401 corridor, there is an annual release of 3771 tonnes of carbon dioxide equivalent (CO2e). These emissions are mainly emitted onsite through the combustion of gasoline and diesel fuel. The integration of electric and hydrogen vehicles shows maximum reductions of 405–476 g CO2e per vehicle-kilometer. Besides these carbon dioxide emissions, there is also a large amount of hazardous air pollutants. To examine the impact of air pollution on human health, the mass and concentrations of criteria pollutants of PM2.5 and NOx emitted by passenger vehicles and commercial trucks on Highway 401 were determined using the MOVES2014b software. Then, an air dispersion model (AERMOD) was used to find the concentration of different pollutants at the receptor’s location. The increased risk of health issues was calculated using hazard ratios from literature. Finally, the health cost of air pollution from Highway 401 traffic was estimated to be CAD 416 million per year using the value of statistical life, which is significantly higher than the climate change costs of CAD 55 million per year due to air pollution.

Does Industrial Air Pollution Increase Health Care Expenditure? Evidence From China

This paper discusses the impact of air pollution on medical expenditure in eastern, central, and western China by applying the fixed-effect model, random-effect model, and panel threshold regression model. According to theoretical and empirical analyses, there are different relationships between the two indexes in different regions of China. For eastern and central regions, it is obvious that the more serious the air pollution is, the more medical expenses there are. However, there is a non-linear single threshold effect between air pollution and health care expenditure in the western region. When air pollution is lower than this value, there is a negative correlation between them. Conversely, the health care expenditure increases with the aggravation of air pollution, but the added value is not enough to make up for the health problems caused by air pollution. The empirical results are basically consistent with the theoretical analysis, which can provide enlightenment for the government to consider the role of air pollution in medical expenditure. Policymakers should arrange the medical budget reasonably, according to its situation, to make up for the loss caused by air pollution.

Spatiotemporal assessment of health burden and economic losses attributable to short-term exposure to ground-level ozone during 2015-2018 in China

BACKGROUND

Ground-level ozone (O3) pollution is currently the one of the severe environmental problems in China. Although existing studies have quantified the O3-related health impact and economic loss, few have focused on the acute health effects of short-term exposure to O3 and have been limited to a single temporal and spatial dimension.

METHODS

Based on the O3 concentration obtained from ground monitoring networks in 334 Chinese cities in 2015-2018, this study used a two-stage exposure parameter weighted Log-linear exposure-response function to estimate the cause-specific mortality for short-term exposure to O3.

RESULTS

The value of statistical life (VSL) method that were used to calculate the economic loss at the city-level. Our results show that in China, the national all-cause mortality attributed to O3 was 0.27(95% CI: 0.14-0.55) to 0.39 (95% CI: 0.20-0.67) million across 2015-2018. The estimated economic loss caused by O3 was 387.76 (95% CI: 195.99-904.50) to 594.08 (95% CI: 303.34-1140.65) billion CNY, accounting for 0.52 to 0.69% of total reported GDP. Overall, the O3 attributed health and economic burden has begun to decline in China since 2017. However, highly polluted areas still face severe burden, and undeveloped areas suffer from high GDP losses.

CONCLUSIONS

There are substantial health impacts and economic losses related to short-term O3 exposure in China. The government should pay attention to the emerging ozone pollution, and continue to strengthen the intervention in traditional priority areas while solving the pollution problem in non-priority areas.

An updated model-ready emission inventory for Guangdong Province by incorporating big data and mapping onto multiple chemical mechanisms

An accurate characterization of spatial-temporal emission patterns and speciation of volatile organic compounds (VOCs) for multiple chemical mechanisms is important to improving the air quality ensemble modeling. In this study, we developed a 2017-based high-resolution (3 km × 3 km) model-ready emission inventory for Guangdong Province (GD) by updating estimation methods, emission factors, activity data, and allocation profiles. In particular, a full-localized speciation profile dataset mapped to five chemical mechanisms was developed to promote the determination of VOC speciation, and two dynamic approaches based on big data were used to improve the estimation of ship emissions and open fire biomass burning (OFBB). Compared with previous emissions, more VOC emissions were classified as oxygenated volatile organic compound (OVOC) species, and their contributions to the total ozone formation potential (OFP) in the Pearl River Delta (PRD) region increased by 17%. Formaldehyde became the largest OFP species in GD, accounting for 11.6% of the total OFP, indicating that the model-ready emission inventory developed in this study is more reactive. The high spatial-temporal variability of ship sources and OFBB, which were previously underestimated, was also captured by using big data. Ship emissions during typhoon days and holidays decreased by 23-55%. 95% of OFBB emissions were concentrated in 9% of the GD area and 31% of the days in 2017, demonstrating their strong spatial-temporal variability. In addition, this study revealed that GD emissions have changed rapidly in recent years due to the leap-forward control measures implemented, and thus, they needed to be updated regularly. All of these updates led to a 5-17% decrease in the emission uncertainty for most pollutants. The results of this study provide a reference for how to reduce uncertainties in developing model-ready emission inventories.

Regional Policies Targeting Residential Solid Fuel and Agricultural Emissions Can Improve Air Quality and Public Health in the Greater Bay Area and Across China

Air pollution exposure is a leading public health problem in China. The majority of the total air pollution disease burden is from fine particulate matter (PM2.5) exposure, with smaller contributions from ozone (O3) exposure. Recent emission reductions have reduced PM2.5 exposure. However, levels of exposure and the associated risk remain high, some pollutant emissions have increased, and some sectors lack effective emission control measures. We quantified the potential impacts of relevant policy scenarios on ambient air quality and public health across China. We show that PM2.5 exposure inside the Greater Bay Area (GBA) is strongly controlled by emissions outside the GBA. We find that reductions in residential solid fuel use and agricultural fertilizer emissions result in the greatest reductions in PM2.5 exposure and the largest health benefits. A 50% transition from residential solid fuel use to liquefied petroleum gas outside the GBA reduced PM2.5 exposure by 15% in China and 3% within the GBA, and avoided 191,400 premature deaths each year across China. Reducing agricultural fertilizer emissions of ammonia by 30% outside the GBA reduced PM2.5 exposure by 4% in China and 3% in the GBA, avoiding 56,500 annual premature deaths across China. Our simulations suggest that reducing residential solid fuel or industrial emissions will reduce both PM2.5 and O3 exposure, whereas other policies may increase O3 exposure. Improving particulate air quality inside the GBA will require consideration of residential solid fuel and agricultural sectors, which currently lack targeted policies, and regional cooperation both inside and outside the GBA.

Impacts of urbanization and long-term meteorological variations on global PM2.5 and its associated health burden

PM_2.5 pollution has adverse health effects on humans. Urbanization and long-term meteorological variations play important roles in influencing the PM_2.5 concentration and its associated health effects. Our results indicate that the urbanization process can enhance the PM_2.5 concentration globally. The PM_2.5-caused mortality density (deaths/100 km²) is also positively correlated with the urbanization degree in both developed and developing countries. The results from machine learning technique revealed that the meteorology-driven variation in PM_2.5-caused health burden has increased with the increase in the urbanization degree from 1980 to 2018, suggesting that residents living in urban areas are more vulnerable to experiencing unfavorable meteorological conditions (e.g. low wind speed and planetary boundary layer height). The maximum difference in PM_2.5-caused mortality due to the variation in annual meteorological conditions (between 2013 and 1986) was 270 600 (196 800-317 900). Our findings indicate an urgent need to understand the driving force behind the appearance of unfavorable meteorological situations and propose suitable climate mitigation measures.

Combined effects of increased O3 and reduced NO2 concentrations on short-term air pollution health risks in Hong Kong

The reduction of NO_x emissions in a VOC-limited region can lead to an increase of the local O₃ concentration. An evaluation of the net health effects of such pollutant changes is therefore important to ascertain whether the emission control measures effectively improve the overall protection of public health. In this study, we use a short-term health risk (added health risk or AR) model developed for the multi-pollutant air quality health index (AQHI) in Hong Kong to examine the overall health impacts of these pollutant changes. We first investigate AR changes associated with NO₂ and O₃ changes, followed by those associated with changes in all four AQHI pollutants (NO₂, O₃, SO₂, and particulate matter (PM)). Our results show that for the combined health effects of NO₂ and O₃ changes, there is a significant reduction in AR in urban areas with dense traffic, but no statistically significant changes in other less urbanized areas. The increase in estimated AR for higher O₃ concentrations is offset by a decrease in the estimated AR for lower NO₂ concentrations. In areas with dense traffic, the reduction in AR as a result of decreased NO₂ is substantially larger than the increase in AR associated with increased O₃. When additionally accounting for the change in ambient SO₂ and PM, we found a statistically significant reduction in total AR everywhere in Hong Kong. Our results show that the emission control measures resulting in NO₂, SO₂, and PM reductions over the past decade have effectively reduced the AR over Hong Kong, even though these control measures may have partially contributed to an increase in O₃ concentrations. Hence, efforts to reduce NOx, SO₂, and PM should be continued.

Characteristics of the source apportionment of primary and secondary inorganic PM2.5 in the Pearl River Delta region during 2015 by numerical modeling

Fine particulate matter (PM_2.5) contains both primary and secondary components, and their source apportionment characteristics in the Pearl River Delta (PRD) region during 2015 were compared by applying an air quality model coupled with an on-line tracer-tagged module. The results of contributions from different source regions to primary PM_2.5 (PPM_2.5) and secondary inorganic PM_2.5 (SIPM_2.5) in four selected cities show that the effect of regional transport on the SIPM_2.5 level is stronger than that on the PPM_2.5 level in the PRD region. For both Guangzhou city and the average of the entire PRD region, the industrial (25-40%) and transportation (20-25%) sectors are major sources of PPM_2.5 and SIPM_2.5. However, the residential sector contributes approximately 25% to the PPM_2.5 level, mainly from residential biomass burning, but accounts for only approximately 10% of the SIPM_2.5 level. The relative importance of each sector to the contributions from local and regional transport indicates that industrial emissions appear to lead to regional air pollution, while the transportation emissions seem to mainly affect the local and surrounding areas. Considering the impact of regional contributions to air quality, efforts made to reduce emissions in each city could not only improve the local air quality but also benefit downstream regions. To further decrease the PM_2.5 level, the local government of each city in the PRD region should not only continue to strengthen the control of local emissions, such as those from transportation and residential biomass burning, but also increase their focus on regional joint prevention and control strategies with upstream area (such as northern Guangdong Province, and Jiangxi, Fujian and Hunan provinces).

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

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

Coarse particles (PM2.5-10) and cause-specific hospitalizations in southwestern China: Association, attributable risk and economic costs

The short-term morbidity effects of the coarse particle (diameter in 2.5-10 μm, PM_2.5-10), as well as the corresponding morbidity burden and economic costs, remain understudied, especially in developing countries. This study aimed to examine the associations of PM_2.5-10 with cause-specific hospitalizations in a multi-city setting in southwestern China and assess the attributable risk and economic costs. City-specific associations were firstly estimated using generalized additive models with quasi-poisson distribution to handle over-dispersion, and then combined to obtain the regional average association. City-specific and pooled concentration-response (C-R) associations of PM_2.5-10 with cause-specific hospitalizations were also modeled. Subgroup analyses were performed by age, sex, season and region. The health and economic burden of hospitalizations for multiple outcomes due to PM_2.5-10 were further evaluated. A total of 4,407,601 non-accidental hospitalizations were collected from 678 hospitals. The estimates of percentage change in hospitalizations per 10 μg/m³ increase in PM_2.5-10 at lag01 was 0.68% (95%CI: 0.33%-1.03%) for non-accidental causes, 0.86% (95% CI: 0.36%-1.37%) for circulatory diseases, 1.52% (95% CI: 1.00%-2.05%) for respiratory diseases, 1.08% (95% CI: 0.47%-1.69%) for endocrine diseases, 0.66% (95% CI: 0.12%-1.21%) for nervous system diseases, and 0.84% (95% CI: 0.42%-1.25%) for genitourinary diseases, respectively. The C-R associations of PM_2.5-10 with cause-specific hospitalizations suggested some evidence of nonlinearity, except for endocrine diseases. Meanwhile, the adverse effects were modified by age and season. Overall, about 0.70% (95% CI: 0.35%-1.06%) of non-accidental hospitalizations and 0.78% (95% CI: 0.38%-1.17%) of total hospitalization expenses could be attributed to PM_2.5-10. The largest morbidity burden and economic costs were observed in respiratory diseases. Our findings indicate that PM_2.5-10 exposure may increase the risk of hospitalizations for multiple outcomes, and account for considerable morbidity and economic burden.

Air pollution and hospitalization: an autoregressive distributed lag (ARDL) approach

Air pollution is one of the biggest global environmental problems in urban regions. This study aimed to investigate the validity of the relationship between air pollution and respiratory and cardiovascular hospitalization using time series methods. This time series study was conducted in Isfahan, Iran. We used data of hospitalized cases in three main university hospitals (Alzahra, Noor, Chamran) and air pollution data from 2014 to 2016. We applied the autoregressive distributed lag (ARDL) bounds testing approach of cointegration to examine the relationship between the air pollution and hospitalizations of respiratory and cardiovascular diseases. The results of air quality assessment on the number of respiratory and cardiovascular hospitalization demonstrate that in the case of cardiovascular disease, both in the long run and in the short run, the air quality index has a significant impact on men and women with a bigger impact in the long run compared to the short run. The value of the long-run coefficient indicates the relationship between air pollution index and cardiovascular hospitalization is stronger than respiratory hospitalizations. In the long term, the effect of the air quality index (AQI) on the number of hospitalizations is more than that in the short term. Based on the results, a 10-unit increase in AQI leads to 5.3% increase in the number of respiratory hospitalization. Accordingly, a 10-unit increase in AQI will result in 7.3% increase in the number of cardiovascular hospitalizations.

Spatial distribution and temporal variation of atmospheric pollution in the South Gobi Desert, China, during 2016-2019

The rapid pace of economic growth and urbanization in China affects both large and small cities of the country, causing an increase of pollutant concentrations in the air. The South Gobi is one of the main deserts and semidesert regions of the country; therefore, the study of air pollution near the potential source of natural aerosols is of great importance. Data obtained in the period from 1 January 2016 to 31 December 2019 was used to analyze spatial-temporal characteristics of atmospheric pollutants (PM_2.5, PM₁₀, SO₂, NO₂, and CO) in eight cities. Total mean concentrations of PM_2.5 and PM₁₀ were 36.1 ± 21.1 μg/m³ and 98.6 ± 108.7 μg/m³. The occurrence rates of concentrations exceeding the Chinese National Ambient Air Quality Standard (CNAAQS) grade 1 and grade 2 were 40.1% and 5.4% for PM_2.5 and 82.9% and 11.64% for PM₁₀ in the region. Total concentrations of SO₂, NO₂, and CO did not exceed the CNAAQS standard and were 20.8 ± 23.6 μg/m³, 22.6 ± 11.9 μg/m³, and 0.72 ± 0.39 mg/m³, respectively. The PM_2.5 to PM₁₀ ratio increased from 0.35 in spring to 0.46 in winter suggesting the predominance of coarse aerosol fractions in the atmosphere. Based on data on aerosol optical depth (AOD) and Ångström exponent (AE) ratio obtained from Moderate Resolution Imaging Spectroradiometer (MODIS), the predominant aerosol types in the region are Clean Сontinental and Mixed. Maximum concentrations of pollutants and the highest AOD values in the region air are observed in spring and winter. Results set forth in this article will be an important basis for further regional studies on air quality and distribution of sources.

Is environmental pressure distributed equally in China? Empirical evidence from provincial and industrial panel data analysis

China's rapid economic development has resulted in increasingly serious environmental pollution that is negatively affecting the health of Chinese citizens. Notably, the unfair distribution of resources may cause the uneven distribution of the environmental burden. In this study, panel data of 30 Chinese provinces and 32 industries for the period 2004 to 2017 is used to investigate how the environmental burden is distributed across different regions and industries. To manage potential endogeneity and allow for dynamics, the generalized method of moments and panel vector autoregression models are employed. The estimation results indicate that, on the whole, urban residents endure the most serious environmental pollution. Notably, a big gap is observed between urban and rural residents' share of environmental pressure, and a similar gap is also observed between developed and underdeveloped areas in China. Moreover, the government is responsible for less environmental pressure than companies for urban residents and rural residents. The subindustry regression results indicate that the "polluting department" bears the most environmental pressure, and the "green department" also bore some negative environmental pressure.

Health and Economic Loss Assessment of PM2.5 Pollution during 2015-2017 in Gansu Province, China

Many studies have reported that air pollution, especially fine particulate matter (PM2.5), has a significant impact on health and causes economic loss. Gansu Province is in the northwest of China, which is a typical economically underdeveloped area. However, few studies have evaluated the economic loss of PM2.5 related to health effects in this province. In this study, a log-linear exposure-response function was used to estimate the health impact of PM2.5 in 14 cities in Gansu Province from 2015 to 2017, and the amended human capital (AHC) and cost of illness (COI) method were used to evaluate the related economic loss caused by the health impact from PM2.5. The results show that the estimated total number of health endpoints attributed to PM2.5 pollution were 1,644,870 (95%CI: 978,484-2,215,921), 1,551,447 (95%CI: 917,025-2,099,182) and 1,531,372 (95%CI: 899,769-2,077,772) in Gansu Province from 2015 to 2017, respectively. Correspondingly, the economic losses related to health damage caused by PM2.5 pollution were 42,699 (95%CI: 32,380-50,768) million Chinese Yuan (CNY), 43,982 (95%CI: 33,305-52,386) million CNY and 44,261 (95%CI: 33,306-52,954) million CNY, which were equivalent to 6.45% (95%CI: 4.89%-7.67%), 6.28% (95%CI: 4.75%-7.48%), and 5.93% (95%CI: 4.64%-7.10%) of the region Gross Domestic Product (GDP) from 2015 to 2017, respectively. It could be seen that the proportions of health economic loss to GDP were generally high, although the proportion had a slight downward trend. The economic loss from chronic bronchitis and all-cause mortality accounted for more than 94% of the total economic loss. The health impact, economic loss and per capita economic loss in Lanzhou, the provincial capital city of Gansu, were obviously higher than other cities from the same province. The economic loss in Linxia accounted for the highest proportion of GDP. The health impacts in the Hexi region, including the cities of Jiuquan, Jiayuguan, Zhangye, Jinchang and Wuwei, were generally lower, but the economic loss and per capita economic loss were still higher. We also found that urbanization and industrialization were highly correlated with health economic loss caused by PM2.5 pollution. In conclusion, the PM2.5-related health economic burden in Gansu Province was serious. As an economically underdeveloped region, it was very important to further adopt rigid and effective pollution control policies.

Estimation of abatement potentials and costs of air pollution emissions in China

Understanding the air pollution emission abatement potential and associated control cost is a prerequisite to design cost efficient control policies. In this study, a linear programming algorithm model, International Control Cost Estimate Tool, was updated with cost data for applications of 56 types of end-of-pipe technologies and five types of renewable energy in 10 major sectors namely power generation, industry combustion, cement production, iron and steel production, other industry processes, domestic combustion, transportation, solvent use, livestock rearing, and fertilizer use. The updated model was implemented to estimate the abatement potential and marginal cost of multiple pollutants in China. The total maximum abatement potentials of sulfur dioxide (SO₂), nitrogen oxides (NO_x), primary particulate matter (PM_2.5), non-volatile organic compounds (NMVOCs), and ammonia (NH₃) in China were estimated to be 19.2, 20.8, 9.1, 17.2 and 8.6 Mt, respectively, which accounted for 89.7%, 89.9%, 94.6%, 74.0%, and 80.2% of their total emissions in 2014, respectively. The associated control cost of such reductions was estimated as 92.5, 469.7, 75.7, 449.0, and 361.8 billion CNY in SO₂, NO_x, primary PM_2.5, NMVOCs and NH₃, respectively. Shandong, Jiangsu, Henan, Zhejiang, and Guangdong provinces exhibited large abatement potentials for all pollutants. Provincial disparity analysis shows that high GDP regions tend to have higher reduction potential and total abatement costs. End-of-pipe technologies tended be a cost-efficient way to control pollution in industries processes (i.e., cement plants, iron and steel plants, lime production, building ceramic production, glass and brick production), whereas such technologies were less cost-effective in fossil fuel-related sectors (i.e., power plants, industry combustion, domestic combustion, and transportation) compared with renewable energy. The abatement potentials and marginal abatement cost curves developed in this study can further be used as a crucial component in an integrated model to design optimized cost-efficient control policies.

Estimating health burden and economic loss attributable to short-term exposure to multiple air pollutants in China

Existing studies focused on the evaluation of health burden of long-term exposure to air pollutants, whereas limited information is available on short-term exposure, particularly in China. Air pollutant concentrations in 338 Chinese cities in 2017 were used to estimate the air pollutants related health burden which was defined as premature mortalities from all-cause, cardiovascular and respiratory disease as well as hospital admissions for cardiovascular and respiratory disease. Log-linear model was used as the exposure-response function to estimate the health burden attributable to each air pollutant. The value of statistical life and cost of illness methods were used to estimate economic loss of the premature mortalities and hospital admissions, respectively. The national all-cause premature mortalities attributable to all air pollutants was 1.35 million, accounting for 17.2% of reported deaths in China in 2017. Among all-cause premature mortality, contributions of PM_2.5, PM_2.5-10, NO₂, SO₂, O₃ and CO were11.1%, 5.2%, 28.9%, 9.6%, 23.0%, and 22.2%, respectively. The national cardiovascular and respiratory premature mortalities were 0.77 and 0.21 million, respectively. About 7.8 million cardiovascular and respiratory disease hospital admissions were attributed to short-term exposure to all air pollutants. The economic loss of the overall health burden (premature mortality and hospital admissions) was 2065.54 billion Yuan, which was equivalent to 2.5% of the national GDP in 2017. The health burden and economic loss attributable to short-term exposure to ambient air pollutant are substantial in China. It suggested that the adverse health effects attributable to short-term exposure to air pollutant should not be neglected in China. In order to reduce the health impact of air pollution, each city should develop air pollution prevention and control measures based on existing scientific evidence.

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.

The high-resolution estimation of sulfur dioxide (SO2) concentration, health effect and monetary costs in Beijing

Severe air pollution episodes with high SO₂ loading have been frequently observed during the last decades in Beijing and have caused a noticeable damage to human health. To advance the spatiotemporal prediction of SO₂ exposure in Beijing, we developed the monthly land use regression (LUR) models using daily SO₂ concentration data collected from 34 monitoring stations during 2016 and 7 categories of potential independent variables (socio-economic factors, traffic and transport, emission source, land use, meteorological data, building morphology and Geographic location) in Beijing. The average adjusted R² of 12 final LUR models was 0.62, and the root-mean-squared error (RMSE) was 4.12 μg/m³. The LOOCV R² and RMSE of LUR models reached 0.56 and 5.43 μg/m³, respectively, suggesting that the LUR models achieved the satisfactory performance. The prediction results suggested that the average SO₂ level in Beijing was 11.06 μg/m³ with the highest one up to 22.49 μg/m³ but the lowest one down to 3.86 μg/m³. The SO₂ exposure showed strong spatial heterogeneity, which was much higher in the southern area than that in the northern in Beijing. The mortality and morbidity due to the excessive SO₂ concentration were estimated to be 73 (95% CI:(38-125)) and 27854 (95% CI:(13852-41659)) cases per year in Beijing, leading to economic cost of 35.76 (95% CI:(16.45-54.06)) and 441.47 (95% CI:(318.31-562.04)) million RMB Yuan in 2016, respectively. This study clarified the intra- and inter-regional transport modeling of the SO₂ pollution in Beijing and supplied an important support for the future air-quality and public health management strategies.

Valuing urban air quality: a hedonic price analysis in Beijing, China

Although Chinese government has implemented a series of laws, regulations, and policies to deal with air pollutants, air pollution is still one of the biggest concerns in China. Most of the cities in China suffered from extremely high air pollution levels and cannot meet the national air quality standards. In this study, we attempt to measure individuals' average marginal willingness to pay (MWTP) in Beijing with the hedonic price model. We combine an extensive housing transaction dataset with emission data of six air pollutants from 2013 to 2016 in Beijing, China. When estimating the hedonic price function, we apply both ordinary least squares (OLS) and panel model with various fixed effects to better control for unobservables. The empirical results reveal that the concentrations of CO, NO₂, PM_2.5, and PM₁₀ are significantly negatively correlated with housing prices. However, we found an insignificant relationship with the concentration of SO₂ and the concentration of O₃ appears to positively increase the housing values. Policy implications based on these results were also discussed.

Effects of an Educational Glass Recycling Program against Environmental Pollution in Spain

In this article, we analyzed the effects of an educational glass recycling program on primary schools and their students in Castilla-La Mancha (Spain). A sample of 89 schools, with 20,710 elementary students, was selected by simple random sampling. For the statistical analysis, descriptive techniques (frequencies and statistics), parametric (One Way ANOVA test), and non-parametric (Chi-Square test) inferential techniques were used, with a 5% significance level (p < 0.05). The program’s results showed that 153,576.3 kg of glass (with a value of 17,064.03 €) were recycled. Significant determinants of glass recycling were: School category (p = 0.043), previous environmental/recycling education (p = 0.046), geographic location of school (p = 0.030), gender (p = 0.007), and academic year (p < 0.05). With the program, students learned the importance of glass recycling, obtained a greater knowledge of and habits related to the same, acquired favorable attitudes towards the environment, and promoted glass recycling in their social circles. We conclude that environmental education about glass recycling has positive effects on glass recycling attitudes and behaviors in elementary school students and may be used as a measure to combat the problem of environmental pollution.

A Four-Dimensional Evaluation of the Urban Comprehensive Carrying Capacity of the Yangtze River Delta, China

The evaluation of urban comprehensive carrying capacity (UCC) is of great importance in maintaining urban socio-economic sustainable development. However, UCC is still in its nascent period with limited applications and a lack of credible assessment methods. To enrich this field, this study constructed an objective scientific index to evaluate the UCC of the Yangtze River Delta (YRD) region from a four-dimensional perspective, examining economy, society, environmental, and transportation subsystems. The improved entropy method based on 18 weighted indicators was used to measure the UCC of the 26 cities of the YRD for the period 1990–2018. Results indicate that nine cities were overloaded in 2018, meaning comprehensive carrying capacity demand exceeds supply, and the other seventeen were in loadable condition, meaning such demand did not exceed supply; the social and transportation subsystems are the most important because their index weights and UCC levels are higher than the other two subsystems; the overall UCC for all cities in the YRD is at a medium level, and there are large disparities between the various cities. The empirical results imply that the government should take effective measures to improve UCC in these cities, combining cities’ specific advantages to enhance the efficiency of resource allocation and utilization and improve carrying capacities, and changing the mode of economic development. Based on UCC levels, it is also important to improve environmental conditions and coordination and integration in the development of urbanization. Policy implications on improving UCC have been highlighted in the final section.

Is Carbon Dioxide (CO2) Emission an Important Factor Affecting Healthcare Expenditure? Evidence from China, 2005-2016

As a result of China’s economic growth, air pollution, including carbon dioxide (CO₂) emission, has caused serious health problems and accompanying heavy economic burdens on healthcare. Therefore, the effect of carbon dioxide emission on healthcare expenditure (HCE) has attracted the interest of many researchers, most of which have adopted traditional empirical methods, such as ordinary least squares (OLS) or quantile regression (QR), to analyze the issue. This paper, however, attempts to introduce Bayesian quantile regression (BQR) to discuss the relationship between carbon dioxide emission and HCE, based on the longitudinal data of 30 provinces in China (2005–2016). It was found that carbon dioxide emission is, indeed, an important factor affecting healthcare expenditure in China, although its influence is not as great as the income variable. It was also revealed that the effect of carbon dioxide emission on HCE at a higher quantile was much smaller, which indicates that most people are not paying sufficient attention to the correlation between air pollution and healthcare. This study also proves the applicability of Bayesian quantile regression and its ability to offer more valuable information, as compared to traditional empirical tools, thus expanding and deepening research capabilities on the topic.

Dynamic assessment of PM2.5 exposure and health risk using remote sensing and geo-spatial big data

In the past few decades, extensive epidemiological studies have focused on exploring the adverse effects of PM_2.5 (particulate matters with aerodynamic diameters less than 2.5 μm) on public health. However, most of them failed to consider the dynamic changes of population distribution adequately and were limited by the accuracy of PM_2.5 estimations. Therefore, in this study, location-based service (LBS) data from social media and satellite-derived high-quality PM_2.5 concentrations were collected to perform highly spatiotemporal exposure assessments for thirteen cities in the Beijing-Tianjin-Hebei (BTH) region, China. The city-scale exposure levels and the corresponding health outcomes were first estimated. Then the uncertainties in exposure risk assessments were quantified based on in-situ PM_2.5 observations and static population data. The results showed that approximately half of the population living in the BTH region were exposed to monthly mean PM_2.5 concentration greater than 80 μg/m³ in 2015, and the highest risk was observed in December. In terms of all-cause, cardiovascular, and respiratory disease, the premature deaths attributed to PM_2.5 were estimated to be 138,150, 80,945, and 18,752, respectively. A comparative analysis between five different exposure models further illustrated that the dynamic population distribution and accurate PM_2.5 estimations showed great influence on environmental exposure and health assessments and need be carefully considered. Otherwise, the results would be considerably over- or under-estimated.

How Does Industrial Waste Gas Emission Affect Health Care Expenditure in Different Regions of China: An Application of Bayesian Quantile Regression

Industrial development has brought about not only rapid economic growth, but also serious environmental pollution in China, which has led to serious health problems and heavy economic burdens on healthcare. Therefore, the relationship between the industrial air pollution and health care expenditure (HCE) has attracted the attention of researchers, most of which used the traditional empirical methods, such as ordinary least squares (OLS), logistic and so on. By collecting the panel data of 30 provinces of China during 2005-2016, this paper attempts to use the Bayesian quantile regression (BQR) to reveal the impact of industrial air pollution represented by industrial waste gas emission (IWGE) on HCE in high-, middle-, low-income regions. It was found that double heterogeneity in the influence of IWGE on HCE was obvious, which revealed that people in high-, middle-, low-income regions have significantly different understandings of environmental pollution and health problems. In addition, the BQR method provided more information than the traditional empirical methods, which verified that the BQR method, as a new empirical method for previous studies, was applicable in this topic and expanded the discussion space of this research field.

Estimation of Health Effects and Economic Losses from Ambient Air Pollution in Undeveloped Areas: Evidence from Guangxi, China

Guangxi Zhuang Autonomous Region, located in the southwest of China, has rapidly developed since the late 2000s. Similar to other regions, economic development has been accompanied by environmental problems, especially air pollution, which can adversely affect the health of residents in the area. In this study, we estimated the negative health effects of three major ambient pollutants, Particulate Matter with a diameter of 10 μm or less (PM10), Sulfur Dioxide (SO₂) and Nitrogen Dioxide (NO₂) in Guangxi from 2011 to 2016 using a log-linear exposure–response function. We monetarized the economic loss using the value of statistical life (VSL) and the cost of illness (COI) methods. The results show that the total possible short-term all-cause mortality values due to PM10, SO₂, and NO₂ were 28,396, with the confidence intervals from 14,664 to 42,014 (14,664–42,014), 24,618 (15,480–33,371), and 46,365 (31,158–61,423), respectively. The mortality from the three pollutants was 48,098 (19,972–75,973). The economic loss of the health burden from the three pollutants was 40,555 (24,172–57,585), which was 2.86% (1.70–4.06%) of the regional gross domestic product. The result of the comparative analysis among different cities showed that urbanization, industrialization, and residents’ income are important factors in air-pollution-caused health damage and subsequent economic loss. We conclude that the health burden caused by ambient pollutants in developing regions, accompanied by its rapid socio-economic growth, is significant and tighter regulation is needed in the future to alleviate air pollution and mitigate the related health damage.

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.

Health benefit of air quality improvement in Guangzhou, China: Results from a long time-series analysis (2006-2016)

Numerous epidemiologic studies on adverse health effects of air pollution have been well documented; however, assessment on health benefits of air quality improvement from air pollution control measures has been limited in developing countries. We assessed the mortality benefits associated with air pollution improvement over 11 years in Guangzhou, China (2006-2016). A time series analysis with Generalized additive Poisson models was used to estimate mortality effects of ozone (O₃) and nitrogen dioxide (NO₂), adjusting for time trend, day of week, public holiday, temperature and relative humidity. We further estimated the changes in mortality burden of O₃ and NO₂, including attributable fraction (AF, in %) and attributable mortality (AM, in number of death) during study period. We lastly estimated mortality effects during the 2010 Asian Games (November 12 to December 18, 2010) compared to a baseline period consisting of 4-week before and 4-week after the game. During the study period, average annual concentrations of NO₂ decreased from 42.3 μg/m³ in 2006 to 33.8 μg/m³ in 2016; while O₃ levels remained stable over time. We observed significant increases in mortality of O₃ and NO₂, with approximately linear exposure-response relationships. In specific, each increase of 10 μg/m³ in O₃ and NO₂ at 2 prior days was associated with increases of 0.60% (95% confidence interval (CI): 0.47, 0.74) and 1.89% (95%CI: 1.49, 2.29) in total mortality, respectively. We further estimated that AF on total mortality attributed to NO₂ decreased from 1.38% (95%CI: 1.09, 1.68) in 2006-2010 to 0.43% (95%CI: 0.34, 0.52) in 2011-2016, corresponding to AM on total mortality of 2496 deaths (95%CI: 1964, 3033) to 1073 deaths (95%CI: 846, 1301). During the 2010 Asian Games, we observed decrease in total mortality of 9.3% (95%CI: -15.0, -3.2) in comparison with that observed in the baseline period. Similar mortality benefits in cardiovascular diseases were also observed. Our results showed reduced mortality burden from air pollution improvement in Guangzhou in recent years, which provide strong rationale for continuing to reduce air pollution through comprehensive and rigorous air quality management in the area.

Use of Bio-Based Plastics in the Fruit Supply Chain: An Integrated Approach to Assess Environmental, Economic, and Social Sustainability

The challenge of developing a sustainable production system includes the reduction of emissions, the efficient use of resources, and the transition to renewable energy. The bioeconomy proposes a development model aimed at reducing impacts and risks associated with the use of non-renewable resources considering the life cycle of products. The European Union is promoting products from renewable sources focused on biochemicals and bio-based plastics, which are high added value products when compared to biofuels. The aim of this paper is to consider sustainability in terms of the environmental, economic, and social aspects of use of bio-based plastics in the fruit chain, considering the case study of raspberry supply chains in northwestern Italy. Different analyses (life-cycle assessment (LCA), life-cycle costing (LCC), and externality assessment (ExA)) were used to assess the impacts along the whole chain by means of an integrated approach. The results show that the bio-based plastic scenario has lower environmental and social impacts than the conventional one, whereas the latter is the best choice according to a classic economic approach. The introduction of bio-based plastics as a replacement for traditional plastics in agri-food chains is the first step toward the use of renewable resources with a low impact on society.