Impact of temperature and air pollution on cardiovascular disease and death in Iran: A 15-year follow-up of Tehran Lipid and Glucose Study

Interactive effects of atmospheric oxidising pollutants and heat waves on the risk of residential mortality

BACKGROUND

The impact of heat waves and atmospheric oxidising pollutants on residential mortality within the framework of global climate change has become increasingly important.

OBJECTIVE

In this research, the interactive effects of heat waves and oxidising pollutants on the risk of residential mortality in Fuzhou were examined. Methods We collected environmental, meteorological, and residential mortality data in Fuzhou from 1 January 2016, to 31 December 2021. We then applied a generalised additive model, distributed lagged nonlinear model, and bivariate three-dimensional model to investigate the effects and interactions of various atmospheric oxidising pollutants and heat waves on the risk of residential mortality.

RESULTS

Atmospheric oxidising pollutants increased the risk of residential mortality at lower concentrations, and O3 and Ox were positively associated with a maximum risk of 2.19% (95% CI: 0.74-3.66) and 1.29% (95% CI: 0.51-2.08). The risk of residential mortality increased with increasing temperature, with a strong and long-lasting effect and a maximum cumulative lagged effect of 1.11% (95% CI: 1.01, 1.23). Furthermore, an interaction between atmospheric oxidising pollutants and heat waves may have occurred: the larger effects in the longest cumulative lag time on residential mortality per 10 µg/m3 increase in O3, NO2 and Ox during heat waves compared to non-heat waves were [-3.81% (95% CI: -14.82, 8.63)]; [-0.45% (95% CI: -2.67, 1.81)]; [67.90% (95% CI: 11.55, 152.71)]; 16.37% (95% CI: 2.43, 32.20)]; [-3.00% (95% CI: -20.80, 18.79)]; [-0.30% (95% CI: -3.53, 3.04)]. The risk on heat wave days was significantly higher than that on non-heat wave days and higher than the separate effects of oxidising pollutants and heat waves.

CONCLUSIONS

Overall, we found some evidence suggesting that heat waves increase the impact of oxidising atmospheric pollutants on residential mortality to some extent.

Ambient Air Pollution and Incident Cardiovascular Disease in People With Type 2 Diabetes Mellitus: A Cohort Study

OBJECTIVES

We aimed to assess the effect of air pollution on incident cardiovascular disease (CVD) in people with type 2 diabetes mellitus (T2DM).

METHODS

We tracked 486 T2DM patients from 2012 to 2021. Cox regression models were applied to assess the hazard of exposure to particulate matter, carbon monoxide (CO), ozone, nitrogen dioxide, and sulfur dioxide (SO 2 ) on incident CVD, revealing hazard ratios (HRs).

RESULTS

CVD incidents occurred in 73 individuals. Among men, each 1-ppm increase in CO levels raised the risk of CVD (HR: 2.66, 95% CI: 1.30-5.44). For women, a 5-ppb rise in SO 2 increased CVD risk (HR: 1.60, 95% CI: 1.11-2.30). No notable impact of particulate pollutants was found.

CONCLUSIONS

Persistent exposure to gaseous air pollutants, specifically CO and SO 2 , is linked to the development of CVD in men and women with T2DM.

Burden of cardiovascular disease attributed to air pollution: a systematic review

BACKGROUND

Cardiovascular diseases (CVDs) are estimated to be the leading cause of global death. Air pollution is the biggest environmental threat to public health worldwide. It is considered a potentially modifiable environmental risk factor for CVDs because it can be prevented by adopting the right national and international policies. The present study was conducted to synthesize the results of existing studies on the burden of CVDs attributed to air pollution, namely prevalence, hospitalization, disability, mortality, and cost characteristics.

METHODS

A systematic search was performed in the Scopus, PubMed, and Web of Science databases to identify studies, without time limitations, up to June 13, 2023. Exclusion criteria included prenatal exposure, exposure to indoor air pollution, review studies, conferences, books, letters to editors, and animal and laboratory studies. The quality of the articles was evaluated based on the Agency for Healthcare Research and Quality Assessment Form, the Newcastle-Ottawa Scale, and Drummond Criteria using a self-established scale. The articles that achieved categories A and B were included in the study.

RESULTS

Of the 566 studies obtained, based on the inclusion/exclusion criteria, 92 studies were defined as eligible in the present systematic review. The results of these investigations supported that chronic exposure to various concentrations of air pollutants, increased the prevalence, hospitalization, disability, mortality, and costs of CVDs attributed to air pollution, even at relatively low levels. According to the results, the main pollutant investigated closely associated with hypertension was PM2.5. Furthermore, the global DALY related to stroke during 2016-2019 has increased by 1.8 times and hospitalization related to CVDs in 2023 has increased by 8.5 times compared to 2014.

CONCLUSION

Ambient air pollution is an underestimated but significant and modifiable contributor to CVDs burden and public health costs. This should not only be considered an environmental problem but also as an important risk factor for a significant increase in CVD cases and mortality. The findings of the systematic review highlighted the opportunity to apply more preventive measures in the public health sector to reduce the footprint of CVDs in human society.

Characterization of microplastics in the atmosphere of megacity Tehran (Iran)

In this study, the characteristics of ambient airborne microplastics were investigated in Tehran to obtain insights into their origins. For this purpose, sampling operations took place at locations with different backgrounds in summer and autumn by using TSP and PM10 high-volume samplers. As a result of microscopic analysis and Raman spectroscopy, the color, shape, number, size, and type of microplastic particles were investigated. Seven types of chemical structures were identified in the particles, among which polypropylene (18.7%) in summer and polystyrene (20%) in autumn had the dominant share. The average number of particles collected using the TSP and PM10 samplers were 1165 ± 147.64 and 1006.5 ± 147.64, respectively. The size of microplastic particles in different stations varied between 4 and 3094 μm. In the seasonal examination of the identified colors, black (38-43%), red (17-19%), gold (13-14%), brown (12% in both seasons), blue (7-10%), yellow (3-5%), and green (2-5%) had the largest proportions, respectively. The examined microplastics were in three forms: fiber, bead, and fragment, among which the predominant form was fiber, and the most infrequent particles were fragments. Statistical comparisons showed that the sampling location does not have a significant effect on the number and size of particles (p value > 0.05). The season was not identified as a determining parameter for particle size (p value > 0.05). On the other hand, seasonal changes can have a tremendous effect on the microplastic particle number (p value < 0.05). Lastly, to obtain more detailed information about the origin of these particles, continuous and long-term monitoring near known industries and suspected sources of plastic materials and source apportionment studies were suggested.

Air pollution as a substantial threat to the improvement of agricultural total factor productivity: Global evidence

OBJECTIVE

This study aims to provide empirical evidence about whether and to what extent air pollution affects the global agricultural total factor productivity (TFP).

METHODS

The research sample covers 146 countries all over the world during 2010-2019. Two-way fixed effects panel regression models are used to estimate air pollution's impacts. A random forest analysis is conducted to assess the relative importance of independent variables.

RESULTS

The results show that, on average, a 1% increase in fine particulate matter (PM_2.5) and tropospheric ozone (O₃) concentration would cause the agricultural TFP to decline by 0.104% and 0.207%, respectively. Air pollution's adverse impact widely exists in various countries with different development levels, pollution degrees, and industrial structures. This study also finds that temperature has a moderating effect on the relationship between PM_2.5 and agricultural TFP. PM_2.5 pollution's detrimental impact is weaker (stronger) in a warmer (cooler) climate. In addition, the random forest analysis confirms that air pollution is among the most crucial predictors of agricultural productivity.

CONCLUSIONS

Air pollution is a substantial threat to the improvement of global agricultural TFP. Worldwide actions should be taken to ameliorate air quality, for the sake of agricultural sustainability and global food security.

The impact of long-term exposure to PM10, SO2, O3, NO2, and CO on incident dysglycemia: a population-based cohort study

To examine the associations between long-term exposure to five major air pollutants including SO₂, PM₁₀, O₃, NO₂, and CO_, and incident dysglycemia, impaired fasting glucose (IFG), and diabetes, separately. A total of 4254 (1720 men) normoglycemic individuals aged 20-69 years at baseline were followed from 2001 to 2018 every 3 years. To measure the long-term hazards of air pollutants for incident dysglycemia, the Weibull proportional hazards models for every 10-unit increment adjusted for diabetes risk factors were fitted. The air pollutants were put in the models in the form of averages of 1-, 2-, and 3-year periods. During a median follow-up of 12.2 years, we observed 1780 dysglycemia events. In contrast to NO₂, the increase in SO₂, O₃, and PM₁₀ levels were significantly associated with a higher risk of dysglycemia and IFG in all time spans excluding PM₁₀ at 2 years. The largest hazard ratios for incident dysglycemia and IFG were attributable to PM₁₀ in 3 years (2.20 (95% CI 1.67, 2.89) and 2.08 (1.55, 2.80), respectively). Moreover, exposure to all the pollutants except NO₂ in 1 year (0.89 (0.80, 0.98)) had no significant associations with incident diabetes. There was a signal that younger (< 45 years) and never-smoker individuals were more predispose to dysglycemic effects of air pollution (all P for interactions > 0.03). Our findings suggested that long-term exposure to air pollution increased incident dysglycemia risk, the effect which was mainly attributable to IFG status.

A review about COVID-19 in the MENA region: environmental concerns and machine learning applications

Coronavirus disease 2019 (COVID-19) has delayed global economic growth, which has affected the economic life globally. On the one hand, numerous elements in the environment impact the transmission of this new coronavirus. Every country in the Middle East and North Africa (MENA) area has a different population density, air quality and contaminants, and water- and land-related conditions, all of which influence coronavirus transmission. The World Health Organization (WHO) has advocated fast evaluations to guide policymakers with timely evidence to respond to the situation. This review makes four unique contributions. One, many data about the transmission of the new coronavirus in various sorts of settings to provide clear answers to the current dispute over the virus's transmission were reviewed. Two, highlight the most significant application of machine learning to forecast and diagnose severe acute respiratory syndrome coronavirus (SARS-CoV-2). Three, our insights provide timely and accurate information along with compelling suggestions and methodical directions for investigators. Four, the present study provides decision-makers and community leaders with information on the effectiveness of environmental controls for COVID-19 dissemination.

Mortality due to noninfectious lower respiratory diseases: A spatiotemporal, cross-sectional study

Background and Aims

Geography plays an important role in the incidence of respiratory diseases. The aim of this study was to investigate the epidemiology and geographical distribution of death due to noninfectious lower respiratory diseases (NILRDs).

Methods

Data related to all death due to NILRD in Kerman Province between 2012 and 2018 were extracted from the National Mortality Registry. The underlying causes of death were extracted from the registry based on the assigned codes from ICD-10 (International Classification of Diseases 10th Revision) classification. The existence of spatial clusters and outliers was evaluated using local indicators of spatial association statistics.

Results

The frequency of death due to NILRD was 8005 persons during the 7 years of the study. The main cause of death was chronic lower respiratory disease (54.2%). Other causes of death were, respectively, lung diseases due to external agents (1.09%), other respiratory diseases mainly affecting the interstitium (1.16%), other diseases of pleura (0.57%), and other diseases of the respiratory system (42.13%). The age- and sex-adjusted mortality rates due to NILRD in the north and center of the province increased significantly from 2012 to 2018. Also, the results of cluster analysis identified northern regions as the clustered areas of NILRD.

Conclusions

Our findings showed a significant increase in mortality due to NILRD in Kerman Province during the 7 years of the study. To reduce this type of death, health policymakers should have environmental health plans and basic solutions, such as a warning system to reduce the commuting on highly air-polluted days and to control pollutants, especially in the industrial areas of the north of this province.

Interactive short-term effects of meteorological factors and air pollution on hospital admissions for cardiovascular diseases

A substantial number of studies have demonstrated the association between air pollution and adverse health effects. However, few studies have explored the potential interactive effects between meteorological factors and air pollution. This study attempted to evaluate the interactive effects between meteorological factors (temperature and relative humidity) and air pollution ([Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text]) on cardiovascular diseases (CVDs). Next, the high-risk population susceptible to air pollution was identified. We collected daily counts of CVD hospitalizations, air pollution, and weather data in Nanning from January 1, 2014, to December 31, 2015. Generalized additive models (GAMs) with interaction terms were adopted to estimate the interactive effects of air pollution and meteorological factors on CVD after controlling for seasonality, day of the week, and public holidays. On low-temperature days, an increase of [Formula: see text] in [Formula: see text], [Formula: see text], and [Formula: see text] was associated with increases of 4.31% (2.39%, 6.26%) at lag 2; 2.74% (1.65%, 3.84%) at lag 0-2; and 0.13% (0.02%, 0.23%) at lag 0-3 in CVD hospitalizations, respectively. During low relative humidity days, a [Formula: see text] increment of lag 0-3 exposure was associated with increases of 3.43% (4.61%, 2.67%) and 0.10% (0.04%, 0.15%) for [Formula: see text] and [Formula: see text], respectively. On high relative humidity days, an increase of [Formula: see text] in [Formula: see text] was associated with an increase of 5.86% (1.82%, 10.07%) at lag 0-2 in CVD hospitalizations. Moreover, elderly (≥ 65 years) and female patients were vulnerable to the effects of air pollution. There were interactive effects between air pollutants and meteorological factors on CVD hospitalizations. The risk that [Formula: see text], [Formula: see text], and [Formula: see text] posed to CVD hospitalizations could be significantly enhanced by low temperatures. For [Formula: see text] and [Formula: see text], CVD hospitalization risk increased in low relative humidity. The effects of [Formula: see text] were enhanced at high relative humidity.

"Medical Assistance in Contextual Awareness" (AMICO): A Project for a Better Quality of Care for Patients in Cardiac Rehabilitation Unit

The "Medical Assistance in Contextual Awareness" (AMICO) project proposes an infrastructure, called an "instrumented environment", consisting of the home environment and the person, both of which are suitably equipped with sensors, a telemedicine service platform (in the Internet of Things) and a Robot who acts as a mediator/master between the person, the surrounding environment and the external environment. This infrastructure, oriented to the citizen's well-being, can offer both services oriented to the person in his home environment, monitoring their behavior and psycho-physical state, and telemedicine services to support the remote monitoring of citizens affected by a cardiovascular event undergoing rehabilitation therapies from part of doctors or caregiver.

Sex differences in the association between diabetes and hypertension and the risk of stroke: cohort of the Tehran Lipid and Glucose Study

Background

We assessed the sex differences in the association between blood pressure categories and glucose intolerance status with overall and ischemic stroke among Iranian adults.

Methods

This prospective study was conducted on 5349 individuals (2446 men) aged ≥ 40 years. Cox models were used to estimate adjusted hazard ratios (HRs) and men-to-women ratios of HRs (RHRs) of overall and ischemic stroke for systolic (SBP) and diastolic (DBP) blood pressure, pre-hypertension, hypertension, fasting plasma glucose (FPG), pre-diabetes and type 2 diabetes (T2D).

Results

Each 0.55 mmol/L increase in FPG was associated with a higher HR of overall stroke in men than women [RHRs 1.05 (1.01–1.09)]. The associations between each 10 mmHg increase in DBP and stroke events were stronger in men than women, with RHRs of 1.20 (1.00–1.45) and 1.29 (1.04–1.60) for overall and ischemic stroke, respectively. Hypertension was associated with a higher HR of overall [RHRs: 2.41 (1.21–4.8)] and ischemic stroke [2.37 (1.12–5.01)] in men than women. We also found that T2D was associated with higher risks of overall and ischemic stroke in men than women: the RHRs were 2.16 (1.24–3.75) and 1.93 (1.05–3.55) for overall and ischemic stroke, respectively.

Conclusion

Hypertension and T2D induced higher risk of overall and ischemic stroke in men than women among Iranian population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13293-022-00421-7.

The associations between diastolic blood pressure and stroke events were stronger in men than women.

The fasting blood plasma level was associated with higher risk of stroke events in men than women.

Hypertension and diabetes were associated with higher risk of stroke events in men than women.

The association between systolic blood pressure with ischemic stroke was higher in men than women.

Effects of ambient air pollutants on hospital admissions and deaths for cardiovascular diseases: a time series analysis in Tehran

Short-term exposures to air pollution have been associated with various adverse health effects. In this study, we investigated the associations between ambient air pollutants with the number of hospital admissions and mortality from cardiovascular diseases (CVDs). This time series study was conducted in Tehran for the years 2014-2017 (1220 day). We collected the ambient air pollutant concentration data from the regulatory monitoring stations. The health data were obtained from the Ministry of Health and Medical Education. A distributed lag non-linear model (DLNM) was used for the analyses. Total CVDs and ischemic heart disease (IHD) admissions were associated with CO for each 1 mg/m³ increase at lags of 6 and 7 days. Also, there was a positive association between total CVDs (RR 1.01; 1.001 to 1.03), IHD (RR 1.04; 1.006 to 1.07), and cerebrovascular diseases (RR 1.03; 1.005 to 1.07) mortality with SO₂ at a lag of 4 days. PM_2.5 and PM₁₀ were associated with cerebrovascular disease admissions in females aged 16-65 years and 16 years and younger for each 10 µg/m³ increase, respectively. Short-term exposure to SO₂, NO₂, and CO was associated with hospital admissions and mortality for CVDs, IHD, cerebrovascular diseases, and other cardiovascular diseases at different lags. Moreover, females were more affected by ambient air pollutants than males in terms of their burden of CVDs. Therefore, identifying the likely harmful effects of pollutants given their current concentrations requires the planning and implementation of strategies to reduce air pollution.

Synergistic effects of gaseous pollutants on hospital admissions for cardiovascular disease in Liuzhou, China

Previous studies demonstrated that short-term exposure to gaseous pollutants (nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and ozone (O₃)) had a greater adverse effect on cardiovascular disease. However, little evidence exists regarding the synergy between gaseous pollutants and cardiovascular disease (CVD). Therefore, we aimed to estimate the effect of individual gaseous pollutants on hospital admissions for CVD and to explore the possible synergistic effects between gaseous pollutants. Daily hospitalization counts for CVD were collected from January 1, 2014, to December 31, 2015. We also collected daily time series on gaseous pollutants from the Environment of the People's Republic of China, including NO₂, SO₂, and O₃. We used distributed lag nonlinear models (DLNMs) to assess the association of individual gaseous pollutants on CVD hospitalization, after controlling for seasonality, day of the week, public holidays, and weather variables. Then, we explored the variability across age and sex groups. In addition, we analyzed the synergistic effects between gaseous pollutants on CVD. Extremely low NO₂ and SO₂ increase the risk of CVD in all subgroup at lag 7 days. The greatest effect of high concentration of SO₂ was observed in male and the elderly (≥ 65 years) at lag 3 days. Greater effects of high concentration of O₃ were more pronounced in the young (< 65 years) and female at lag 3 days, while the effect of low concentration of O₃ was greater in male and the young (< 65 years) at lag 0 day. We found a synergistic effect between NO₂ and SO₂ for CVD, as well as between SO₂ and O₃. The synergistic effects of NO₂ and SO₂ on CVD were stronger in the elderly (≥ 65) and female. The female was sensitive to synergistic effects of SO₂-O₃ and NO₂-O₃. Interestingly, we found that there was a risk of CVD in the susceptible population even for gaseous pollutant concentrations below the National Environmental Quality Standard. The synergy between NO₂ and SO₂ was significantly associated with cardiovascular disease hospitalization in the elderly (≥ 65). This study provides evidence for the synergistic effect of gaseous pollutants on hospital admissions for cardiovascular disease.

Contribution of obesity and cardiometabolic risk factors in developing cardiovascular disease: a population-based cohort study

This study aims to assess the effects of central and general adiposity on development of cardiovascular diseases (CVDs) mediated by cardiometabolic risk factors and to analyze their degree of dependency for mediating their effects. To this end, data from the the Tehran Lipid and Glucose Study cohort with 6280 participants were included in this study. The hazard ratios were calculated using a 2-stage regression model in the context of a survival model. Systolic blood pressure (BP), total serum cholesterol, and fasting plasma glucose were designated as mediators. Assessing the interactions revealed that BP was the most important mediator for general ( (HRNIE: 1.11, 95% CI 1.17-1.24) and central obesity (CO) (HRNIE: 1.11, 95% CI 1.07-1.15) with 60% and 36% proportion of the effects mediated in the total population, respectively. The proportion of mediated risk for all three metabolic risk factors was 46% (95% CI 31-75%) for overweight, 66% (45-100%) for general obesity and 52% (39-87%) for central obesity. BP was the most important mediator for overweight and central obesity in men, comprising 29% and 36% of the risk, respectively. The proportion of the risk mediated through all three metabolic risk factors in women was 23% (95% CI 13-50%) for overweight, 36% (21-64%) for general obesity and 52% (39-87%) for central obesity. Based on the results of this study, cardiometabolic mediators have conciliated more than 60% of the adverse effects of high BMI on CVDs in men. Controlling the metabolic risk factors in women does not efficiently contribute to decreasing CVDs as effectively.

Acute effects of ambient nitrogen oxides and interactions with temperature on cardiovascular mortality in Shenzhen, China

BACKGROUND

Though inconsistent, acute effects of ambient nitrogen oxides on cardiovascular mortality have been reported. Whereas, interactive roles of temperature on their relationships and joint effects of different indicators of nitrogen oxides were less studied. This study aimed to extrapolate the independent roles of ambient nitrogen oxides and temperature interactions on cardiovascular mortality.

METHODS

Data on mortality, air pollutants, and meteorological factors in Shenzhen from 2013 to 2019 were collected. Three indicators including nitric oxide (NO), nitrogen dioxide (NO₂), and nitrogen oxides (NO_X) were studied. Adjusted generalized additive models (GAMs) were applied to analyse their associations with cardiovascular mortality in different groups.

RESULTS

The average daily concentrations of NO, NO₂, and NO_X were 11.7 μg/m³, 30.7 μg/m³, and 53.2 μg/m³, respectively. Significant associations were shown with each indicator. Cumulative effects of nitrogen oxides were more obvious than distributed lag effects. Males, population under 65 years old, and population with stroke-related condition were more susceptible to nitrogen oxides. Adverse effects of nitrogen oxides were more significant at low temperature. Impacts of NO₂ on cardiovascular mortality, and NO on stroke mortality were the most robust in the multi-pollutant models, whereas variations were shown in the other relationships.

CONCLUSIONS

Low levels of nitrogen oxides showed acute and adverse impacts and the interactive roles of temperature on cardiovascular mortality. Cumulative effects were most significant and joint effects of nitrogen oxides required more attention. Population under 65 years old and population with stroke-related health condition were susceptible, especially days at lower temperature.

Ambient air pollution and cardiovascular disease rate an ANN modeling: Yazd-Central of Iran

This study was aimed to investigate the air pollutants impact on heart patient's hospital admission rates in Yazd for the first time. Modeling was done by time series, multivariate linear regression, and artificial neural network (ANN). During 5 years, the mean concentrations of PM₁₀, SO₂, O₃, NO₂, and CO were 98.48 μg m^-3, 8.57 ppm, 19.66 ppm, 18.14 ppm, and 4.07 ppm, respectively. The total number of cardiovascular disease (CD) patients was 12,491, of which 57% and 43% were related to men and women, respectively. The maximum correlation of air pollutants was observed between CO and PM₁₀ (R = 0.62). The presence of SO₂ and NO₂ can be dependent on meteorological parameters (R = 0.48). Despite there was a positive correlation between age and CD (p = 0.001), the highest correlation was detected between SO₂ and CD (R = 0.4). The annual variation trend of SO₂, NO₂, and CO concentrations was more similar to the variations trend in meteorological parameters. Moreover, the temperature had also been an effective factor in the O₃ variation rate at lag = 0. On the other hand, SO₂ has been the most effective contaminant in CD patient admissions in hospitals (R = 0.45). In the monthly database classification, SO₂ and NO₂ were the most prominent factors in the CD (R = 0.5). The multivariate linear regression model also showed that CO and SO₂ were significant contaminants in the number of hospital admissions (R = 0.46, p = 0.001) that both pollutants were a function of air temperature (p = 0.002). In the ANN nonlinear model, the 14, 12, 10, and 13 neurons in the hidden layer were formed the best structure for PM, NO₂, O₃, and SO₂, respectively. Thus, the R_all rate for these structures was 0.78-0.83. In these structures, according to the autocorrelation of error in lag = 0, the series are stationary, which makes it possible to predict using this model. According to the results, the artificial neural network had a good ability to predict the relationship between the effect of air pollutants on the CD in a 5 years' time series.

The Adverse Impact of Air Pollution on China’s Economic Growth

This study empirically evaluates the impact of air pollution on China’s economic growth, based on a province-level sample for the period 2002–2017. Air pollution is measured by the concentration of fine particulate matter (PM2.5), and economic growth is measured by the annual growth rate of gross domestic product (GDP) per capita. A panel data fixed-effects regression model is built, and the instrumental variables estimation method is utilized for quantitative analyses. The study reports a significant negative impact of air pollution on the macroeconomic growth of China. According to our instrumental variables estimation, holding other factors constant, if the concentration of PM2.5 increases by 1%, then the GDP per capita growth rate will decline by 0.05818 percentage points. In addition, it is found that the adverse effect of atmospheric pollution is heterogeneous across different regions. The effect is stronger in the eastern region and in provinces with smaller state-owned enterprise shares, fewer governmental expenditures for public health services, and fewer medical resources. The study results reveal that air pollution poses a substantial threat to the sustainable economic growth of China. Taking actions to abate air pollution will generate great economic benefits, especially for those regions which are heavily damaged by pollution.

Association between Atrial Fibrillation Incidence and Temperatures, Wind Scale and Air Quality: An Exploratory Study for Shanghai and Kunming

As a common cardiovascular disease, atrial fibrillation has the characteristics of high morbidity, high disability, and high fatality rates, seriously endangering human health and sustainability. Some research has confirmed that environmental factors are related to the risk of illness and death from cardiovascular diseases (including atrial fibrillation), while there is still little comparison on the situation of the two cities in China. This research uses medical data in Shanghai and Kunming establishing, through two-step research, logistic models to compare the impacts on atrial fibrillation incidence to figure out the association between environmental factors (including air pollution, weather, temperature, and wind scales) and atrial fibrillation. Finally, this research shows that environmental impacts on atrial fibrillation prevalence have generality, regionality, and lagging characteristics. The result is significant for atrial fibrillation patients and provides a reliable medical theory basis for nursing measures. Besides, this research provides a prospective method of offering early warning for potential atrial fibrillation patients, helping to maintain human beings’ sustainable development.

No impact of weather conditions on the outcome of intensive care unit patients

Global warming leads to increased exposure of humankind to meteorological variation, including short-term weather changes. Weather conditions involve changes in temperature, heat and cold, in air pressure and in air humidity. Every single condition influences the incidence and mortality of different diseases such as myocardial infarction and stroke. This study investigated the impact of weather conditions on short- and long-term mortality of 4321 critically ill patients (66 ± 14 years, 2638 men) admitted to an intensive care unit (ICU) over a period of 5 years. Meteorological information (air temperature, air pressure and humidity) for the same period was retrieved. The influence of absolute weather parameters, different seasons, sudden weather changes including "warm" and "cold" spells on ICU and long-term mortality was analyzed. After correction for Simplified Acute Physiology Score (SAPS-2), no impact of meteorological conditions on mortality was found. Different seasons, sudden weather changes, "warm spells" or "cold spells" did not affect the outcome of critically ill patients.

The impact of air pollution on R&D input and output in China

This study examines the impact of air pollution on research and development (R&D) in China on the basis of province-level data for the period 2007-2016. The study discovers a significant adverse impact of air pollution on both R&D input and output in China. The estimation results in this study are robust to the different indicators used to measure R&D input and output and control for possible endogeneity problems via the instrumental variable approach. According to our estimates, if the concentration of particulate matter with a diameter of 2.5 μm or less (PM_2.5) increases by 1%, then the scales of annual R&D personnel, expenditures, and new patents will decline by 0.359%, 0.169%, and 0.293%, respectively. The findings indicate that air pollution is a considerable threat to innovation and technological progress in China.

Sex-specific prevalence of coronary heart disease among Tehranian adult population across different glycemic status: Tehran lipid and glucose study, 2008-2011

Background

Coronary heart disease (CHD) is one of the leading causes of death. Alarmingly Iranian populations had a high rank of CHD worldwide. The current study aimed to assess the prevalence of CHD across different glycemic categories.

Methods

This study was conducted on 7718 Tehranian participants (Men = 3427) aged ≥30 years from 2008 to 2011. They were categorized based on glycemic status. The prevalence of CHD was calculated in each group separately. CHD was defined as hospital records adjudicated by an outcome committee. The association of different glycemic categories with CHD was calculated using multivariate logistic regression, compared with normal fasting glucose /normal glucose tolerance (NFG/NGT) group as reference.

Results

The age-standardized prevalence of isolated impaired fasting glucose (iIFG), isolated impaired glucose tolerance (iIGT), both impaired fasting glucose and impaired glucose tolerance (IFG/IGT), newly diagnosed diabetes mellitus (NDM), and known diabetes mellitus (KDM) were 14.30% [95% confidence interval (CI): 13.50–15.09], 4.81% [4.32–5.29], 5.19% [4.71–5.67], 5.79% [5.29–6.28] and 7.72% [7.17–8.27], respectively.

Among a total of 750 individuals diagnosed as cases of CHD (398 in men), 117 (15.6%), 453 (60.4%), and 317 (42.3%) individuals had a history of myocardial infarction (MI), cardiac procedure, and unstable angina, respectively. The age-standardized prevalence of CHD for the Tehranian population was 7.71% [7.18–8.24] in the total population, 8.62 [7.81–9.44] in men and 7.19 [6.46–7.93] in women. Moreover, among diabetic participants, the age-standardized prevalence of CHD was 13.10 [9.83–16.38] in men and 10.67 [8.90–12.44] in women, significantly higher than corresponding values for NFG/NGT and prediabetic groups.

Across six levels of glycemic status, CHD was associated with IFG/IGT [odds ratio (OR) and 95% CI: 1.38 (1.01–1.89)], NDM [1.83 (1.40–2.41)], and KDM [2.83 (2.26–3.55)] groups, in the age- and sex-adjusted model. Furthermore, in the full-adjusted model, only NDM and KDM status remained to be associated with the presence of CHD by ORs of 1.40 (1.06–1.86) for NDM and 1.91 (1.51–2.43) for KDM.

Conclusion

The high prevalence of CHD, especially among diabetic populations, necessitates the urgent implementation of behavioral interventions in the Tehranian population, according to evidence-based guidelines for the clinical management of diabetic patients.

Mortality rates due to respiratory tract diseases in Tehran, Iran during 2008-2018: a spatiotemporal, cross-sectional study

BACKGROUND

Tehran, the 22nd most populous city in the world, has the highest mortality rate due to respiratory system diseases (RSDs) in Iran. This study aimed to investigate spatiotemporal patterns of mortality due to these diseases in Tehran between 2008 and 2018.

METHODS

We used a dataset available from Tehran Municipality including all cases deceased due RSDs in this city between 2008 and 2018. Global Moran's I was performed to test whether the age-adjusted mortality rates were randomly distributed or had a spatial pattern. Furthermore, Anselin Local Moran's I was conducted to identify potential clusters and outliers.

RESULTS

During the 10-year study, 519,312 people died in Tehran, 43,177 because of RSDs, which corresponds to 831.1 per 10,000 deaths and 5.0 per 10,000 population. The death rate was much higher in men (56.8%) than in women (43.2%) and the highest occurred in the > 65 age group (71.2%). Overall, three diseases dominated the mortality data: respiratory failure (44.2%), pneumonia (15.9%) and lung cancer (10.2%). The rates were significantly higher in the central and southeastern parts of the city and lower in the western areas. It increased during the period 2008-2018 and showed a clustered spatial pattern between 2008 and 2013 but presented a random geographical pattern afterwards.

CONCLUSIONS

This study provides a first report of the spatial distribution of mortality due to RSDs in Tehran and shows a significant increase in respiratory disease mortality in the last ten years. Effective control of the excess fatality rates would warrant a combination of urban prevention and treatment strategies including environmental health plans.

Cumulative effect of indoor temperature on cardiovascular disease-related emergency department visits among older adults in Taiwan

Studies have demonstrated that exposure to extreme outdoor temperatures increases cardiovascular disease mortality and morbidity. However, people spend 80%-90% of their time indoors, and the cumulative effects of exposure to high or low temperature on the risk of cardiovascular diseases had not been considered. This study investigated the cumulative effects of high or low indoor temperature exposure on the risk of cardiovascular diseases. We estimated indoor temperatures by using a prediction model of indoor temperature from a previous study and further calculated the cumulative degree hours at different indoor temperature ranges. Samples of emergency department visits due to cardiovascular diseases were collected from the Longitudinal Health Insurance Database (LHID) from 2000 to 2014 in Taiwan. We used a distributed lag nonlinear model to analyze the data. Our data demonstrated a significant risk of emergency department visits due to cardiovascular diseases at 27, 28, 29, 30, and 31 °C when cooling cumulative degree hours exceeded 62, 43, 16, 1, and 1 during the hot season (May to October), respectively, and at 19, 20, 21, 22, and 23 °C when heating cumulative degree hours exceeded 1, 1, 1, 11, and 33 during the cold season (November to April), respectively. Cumulative degree hours were different according to gender and age groups. Policymakers should further consider the cumulative effects to prevent hot- or cold-related cardiovascular diseases for populations.

Predictive value of three thermal comfort indices in low temperatures on cardiovascular morbidity in the Iberian peninsula

The natural environment has been considered an important determinant of cardiovascular morbidity. This work seeks to assess the impact of the winter thermal environment on hospital admissions from diseases of the circulatory system by using three biometeorological indices in five regions of the Iberian Peninsula. A theoretical index based on a thermophysiological model (Universal Thermal Climate Index [UTCI]) and two experimental biometeorological ones (Net Effective Temperature [NET] and Apparent Temperature [AT]) were estimated in two metropolitan areas of Portugal (Porto and Lisbon) and in three provinces of Spain (Madrid, Barcelona and Valencia). Subsequently, their relationship with hospital admissions, adjusted by NO₂ concentration, time, and day of the week, was analyzed using a Generalized Additive Model. As the estimation method, a semi-parametric quasi-Poisson regression was used. Around 53% of the hospitalizations occurred during the cold periods. The admissions rate followed an upward trend over the 9-year period in both capitals (Madrid and Lisbon) as well as in Barcelona. An inverse and statistically significant relationship was found between thermal comfort and hospital admissions in the five regions (p < 0.001). The highest relative risk (RR) was found after a cumulative 7-day exposure in Lisbon, where there was a 1.4% increase in hospital admissions for each NET and AT degree Celsius, and 1.0% for each UTCI degree Celsius. In conclusion, low air temperatures are a significant risk factor for hospital admissions from diseases of the circulatory system in the Iberian Peninsula, regardless of the index calculated.

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.

Applying landscape metrics and structural equation modeling to predict the effect of urban green space on air pollution and respiratory mortality in Tehran

Green space and its spatial formation are important elements of public welfare in urban environments and green ecosystems in big cities largely contribute to the mental and physical health of citizens. Tehran is Iran's biggest and most polluted city and air pollution in this city causes loss of human lives due to respiratory diseases. The effect of green area has been less studied in former researches in Tehran, and the reducing effects of green landscape on the mortality of respiratory diseases have not yet been evaluated. To measure the effects of green area landscape patterns (fragmentation, area-edge, shape, and aggregation) on public health, the current study evaluated the pathways and effects of green space on air pollution and the mortality of respiratory diseases using structural equation modeling approach and the partial least squares method. The results of the study indicated green space has a significant mitigating effect on air pollution and mortality of respiratory diseases and also air pollution has a meaningful increasing effect on mortality due to respiratory diseases in Tehran. The most important latent variable in green space is class area that indicates more area of green space is correlated with less mortality of respiratory diseases. The most important indicator of air pollution was the PM_2.5 that needs to be considered and controlled by urban policymakers. Accordingly, maximizing the green area and its cohesion and minimizing fragmentation and green patch edge can contribute to a reduction in air pollution and consequently lower mortality of citizens.

Utilizing daily excessive concentration hours to estimate cardiovascular mortality and years of life lost attributable to fine particulate matter in Tehran, Iran

BACKGROUND

Evidence for associations between fine particulate matter (PM_2.5) and cardiovascular diseases (CVDs) in Iran is scarce. Given large within-day variations of PM_2.5 concentration, using the daily mean of PM_2.5 (PM_2.5mean) as exposure metric might bias the health-related assessment. This study applied a novel indicator, daily excessive concentration hours (DECH), to evaluate the effect of ambient PM_2.5 on CVD mortality and years of life lost (YLL) in Tehran, the capital city of Iran.

METHODS

Hourly concentration data for PM_2.5, daily information for meteorology and records of registered cardiovascular deaths from 2012 to 2016 were obtained from Tehran, Iran. Daily excessive concentration hours of PM_2.5 (PM_2.5DECH) was defined as daily total concentration-hours exceeding 35 μg/m³. Using a time-series design, we applied generalized linear models to assess the attributable effects of PM_2.5DECH and PM_2.5mean on CVD mortality and YLL.

RESULTS

For an interquartile range (IQR) rise in PM_2.5DECH, total CVD mortality at lag 0-10 days and YLL at lag 0-8 days increased 2.26% (95% confidence interval (CI): 0.85-3.69%) and 23.24 (6.07-40.42) person years, respectively. Corresponding increases were 3.45% (1.44-5.49%) and 35.21 (10.85-59.58) person years for an IQR rise in PM_2.5mean. Significant associations between PM_2.5 pollution (i.e., PM_2.5mean and PM_2.5DECH) and cause-specific cardiovascular health (i.e., mortality and YLL) were only identified in stroke. Subgroup analyses showed that male and people aged 0-64 years suffered more from PM_2.5 pollution. Furthermore, we attributed a greater CVD burden to PM_2.5DECH (1.67% for mortality and 2.67% for YLL) than PM_2.5mean (0.63% for mortality and 0.70% for YLL) during the study period.

CONCLUSIONS

This study strengthened the evidence for the aggravated CVD mortality burden associated with short-term exposure to PM_2.5. Our findings also suggested that PM_2.5DECH might be a potential alternative indicator of exposure assessment in PM_2.5-related health investigations.

Short-term associations between daily mortality and ambient particulate matter, nitrogen dioxide, and the air quality index in a Middle Eastern megacity

There is limited evidence for short-term association between mortality and ambient air pollution in the Middle East and no study has evaluated exposure windows of about a month prior to death. We investigated all-cause non-accidental daily mortality and its association with fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), and the Air Quality Index (AQI) from March 2011 through March 2014 in the megacity of Tehran, Iran. Generalized additive quasi-Poisson models were used within a distributed lag linear modeling framework to estimate the cumulative effects of PM_2.5, NO₂, and the AQI up to a lag of 45 days. We further conducted multi-pollutant models and also stratified the analyses by sex, age group, and season. The relative risk (95% confidence interval (CI)) for all seasons, both sexes and all ages at lag 0 for PM_2.5, NO₂, and AQI were 1.004 (1.001, 1.007), 1.003 (0.999, 1.007), and 1.004 (1.001, 1.007), respectively, per inter-quartile range (IQR) increment (18.8 μg/m³ for PM_2.5, 12.6 ppb for NO₂, and 31.5 for AQI). In multi-pollutant models, the PM_2.5 associations were almost independent from NO₂. However, the RRs for NO₂ were slightly attenuated after adjustment for PM_2.5 but they were still largely independent from PM_2.5. The cumulative relative risks (95% CI) per IQR increment reached maximum during the cooler months, including: 1.13 (1.06, 1.20) for PM_2.5 at lag 0-31 (for females, all ages); 1.17 (1.10, 1.25) for NO₂ at lag 0-45 (for males, all ages); and 1.13 (1.07, 1.20) for the AQI at lag 0-30 (for females, all ages). Generally, the RRs were slightly larger for NO₂ than PM_2.5 and AQI. We found somewhat larger RRs in females, age group >65 years of age, and in cooler months. In summary, positive associations were found in most models. This is the first study to report short-term associations between all-cause non-accidental mortality and ambient PM_2.5 and NO₂ in Iran.