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Feng C, Yang B, Wang Z, Zhang J, Fu Y, Yu B, Dong S, Ma H, Liu H, Zeng H, Reinhardt JD, Yang S. Relationship of long-term exposure to air pollutant mixture with metabolic-associated fatty liver disease and subtypes: A retrospective cohort study of the employed population of Southwest China. ENVIRONMENT INTERNATIONAL 2024; 188:108734. [PMID: 38744043 DOI: 10.1016/j.envint.2024.108734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND While evidence suggests that PM2.5 is associated with overall prevalence of Metabolic (dysfunction)-Associated Fatty Liver Disease (MAFLD), effects of comprehensive air pollutant mixture on MAFLD and its subtypes remain unclear. OBJECTIVE To investigate individual and joint effects of long-term exposure to comprehensive air pollutant mixture on MAFLD and its subtypes. METHODS Data of 27,699 participants of the Chinese Cohort of Working Adults were analyzed. MAFLD and subtypes, including overweight/obesity, lean, and diabetes MAFLD, were diagnosed according to clinical guidelines. Concentrations of NO3-, SO42-, NH4+, organic matter (OM), black carbon (BC), PM2.5, SO2, NO2, O3 and CO were estimated as a weighted average over participants' residential and work addresses for the three years preceding outcome assessment. Logistic regression and weighted quantile sum regression were used to estimate individual and joint effects of air pollutant mixture on presence of MAFLD. RESULTS Overall prevalence of MAFLD was 26.6 % with overweight/obesity, lean, and diabetes MAFLD accounting for 92.0 %, 6.4 %, and 1.6 %, respectively. Exposure to SO42-, NO3-, NH4+, BC, PM2.5, NO2, O3and CO was significantly associated with overall MAFLD, overweight/obesity MAFLD, or lean MAFLD in single pollutant models. Joint effects of air pollutant mixture were observed for overall MAFLD (OR = 1.10 [95 % CI: 1.03, 1.17]), overweight/obesity (1.09 [1.02, 1.15]), and lean MAFLD (1.63 [1.28, 2.07]). Contributions of individual air pollutants to joint effects were dominated by CO in overall and overweight/obesity MAFLD (Weights were 42.31 % and 45.87 %, respectively), while SO42- (36.34 %), SO2 (21.00 %) and BC (12.38 %) were more important in lean MAFLD. Being male, aged above 45 years and smoking increased joint effects of air pollutant mixture on overall MAFLD. CONCLUSIONS Air pollutant mixture was associated with MAFLD, particularly the lean MAFLD subtype. CO played a pivotal role in both overall and overweight/obesity MAFLD, whereas SO42- were associated with lean MAFLD.
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Affiliation(s)
- Chuanteng Feng
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu 610200, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Bo Yang
- Department of Health Management Center, Clinical Medical College & Affiliated Hospital, Chengdu University, Chengdu 610106, China
| | - Zihang Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Jiayi Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yao Fu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu 610200, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Shu Dong
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Hua Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Hongyun Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Honglian Zeng
- Department of Health Management Center, Clinical Medical College & Affiliated Hospital, Chengdu University, Chengdu 610106, China
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu 610200, China; Department of Rehabilitation Medicine, Jiangsu Province Hospital/Nanjing Medical University First Affiliated Hospital, Nanjing 210009, China; Department of Health Sciences and Medicine, University of Lucerne, Lucerne 6002, Switzerland.
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China; Department of Health Management Center, Clinical Medical College & Affiliated Hospital, Chengdu University, Chengdu 610106, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan 430079, China.
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Ma X, Wu H, Huang H, Tang P, Zeng X, Huang D, Liu S, Qiu X. The role of liver enzymes in the association between ozone exposure and diabetes risk: a cross-sectional study of Zhuang adults in China. ENVIRONMENTAL SCIENCE. PROCESSES & IMPACTS 2024; 26:765-777. [PMID: 38517292 DOI: 10.1039/d3em00463e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Background: Growing evidence has demonstrated the role of ambient air pollutants in driving diabetes incidence. However, epidemiological evidence linking ozone (O3) exposure to diabetes risk has been scarcely studied in Zhuang adults in China. We aimed to investigate the associations of long-term exposure to O3 with diabetes prevalence and fasting plasma glucose (FPG) and estimate the mediating role of liver enzymes in Zhuang adults. Methods: We recruited 13 843 ethnic minority adults during 2018-2019 based on a cross-sectional study covering nine districts/counties in Guangxi. Generalized linear mixed models were implemented to estimate the relationships between O3 exposure and diabetes prevalence and FPG. Mediation effect models were constructed to investigate the roles of liver enzymes in the associations of O3 exposure with diabetes prevalence and FPG. Subgroup analyses were conducted to identify potential effect modifications. Results: Long-term exposure to O3 was positively associated with diabetes prevalence and FPG levels in Zhuang adults, with an excess risk of 7.32% (95% confidence interval [CI]: 2.56%, 12.30%) and an increase of 0.047 mmol L-1 (95% CI: 0.032, 0.063) for diabetes prevalence and FPG levels, respectively, for each interquartile range (IQR, 1.18 μg m-3) increment in O3 concentrations. Alanine aminotransferase (ALT) significantly mediated 8.10% and 29.89% of the associations of O3 with FPG and diabetes prevalence, respectively, and the corresponding mediation proportions of alkaline phosphatase (ALP) were 8.48% and 30.00%. Greater adverse effects were observed in females, obese subjects, people with a low education level, rural residents, non-clean fuel users, and people with a history of stroke and hypertension in the associations of O3 exposure with diabetes prevalence and/or FPG levels (all P values for interaction < 0.05). Conclusion: Long-term exposure to O3 is related to an increased risk of diabetes, which is partially mediated by liver enzymes in Chinese Zhuang adults. Promoting clean air policies and reducing exposure to environmental pollutants should be a priority for public health policies geared toward preventing diabetes.
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Affiliation(s)
- Xiaoyun Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning, Guangxi, China.
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Han Wu
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Huishen Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning, Guangxi, China.
| | - Peng Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning, Guangxi, China.
| | - Xiaoyun Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning, Guangxi, China.
| | - Dongping Huang
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Shun Liu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning, Guangxi, China.
| | - Xiaoqiang Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, No. 22, Shuangyong Road, Nanning, Guangxi, China.
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Xu H, Liang X, Wang L, Wei J, Guo B, Zeng C, Feng S, Wang S, Yang X, Pan Y, Wang Z, Xie L, Reinhardt JD, Tang W, Zhao X. Role of metabolic risk factors in the relationship between ambient fine particulate matter and depressive symptoms: Evidence from a longitudinal population study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 270:115839. [PMID: 38118332 DOI: 10.1016/j.ecoenv.2023.115839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND There is growing evidence indicating a connection between fine particulate matter (PM2.5) and depressive symptoms. Metabolic risk factors are critical determinants of depressive symptoms. However, the mediating role of these factors on the association between PM2.5 and depressive symptoms remains elusive. We aimed to investigate whether and to what extent metabolic risk factors mediated the link between long-term PM2.5 exposure and depressive symptoms. METHODS This study comprised 7794 individuals aged between 30 and 79 years who participated in two waves of the on-site surveys in the China Multi-Ethnic Cohort. Ambient PM2.5 concentrations were assessed utilizing a random forest method based on satellite data. We employed the Patient Health Questionnaire-9 to assess depressive symptoms at wave 2, and the overall as well as three sub-domain symptom scores (emotional, neurovegetative, and neurocognitive symptoms) were calculated. Three metabolic risk factors, including hypertension, diabetes, and dyslipidemia, were considered. Mediation analyses were conducted to assess the indirect effects of PM2.5 on depressive symptoms through metabolic risk factors. RESULTS We found a positive association between chronic exposure to ambient PM2.5 and overall depressive symptoms as well as the three sub-domains. In mediation analyses, metabolic risk factors partially mediated the associations of PM2.5 on depressive symptoms. The natural indirect effects (RR, 95% CI) of PM2.5 on overall, emotional, neurovegetative, and neurocognitive symptoms mediated through metabolic risk factors were 1.004(1.001, 1.007), 1.004 (1.001, 1.008), 1.004 (1.001, 1.007), and 1.003(0.999, 1.007), respectively. Larger indirect effects were found in elderly participants (mediated proportion, 29.3%), females (13.3%), and people who did not consume alcohol (19.6%). CONCLUSIONS Metabolic risk factors may act as mediators in the relationship between chronic PM2.5 exposure and depression. Treatment of metabolic risk factors may be an opportunity to reduce the burden of depression caused by long-term exposure to PM2.5.
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Affiliation(s)
- Huan Xu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hongkong Polytechnic University, Chengdu, Sichuan, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xian Liang
- Chengdu Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Lei Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA
| | - Bing Guo
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunmei Zeng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shiyu Feng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Songmei Wang
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Xianxian Yang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Yongyue Pan
- School of Medicine, Tibet University, Lhasa, Tibet, China
| | - Ziyun Wang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Linshen Xie
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hongkong Polytechnic University, Chengdu, Sichuan, China; Department of Rehabilitation Medicine, Jiangsu Province Hospital/Nanjing Medical University First Affiliated Hospital, Nanjing, China; Swiss Paraplegic Research, Nottwil, Switzerland; Faculty for Health and Medicine, University of Lucerne, Switzerland.
| | - Wenge Tang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China.
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Zeng Q, Zhou J, Meng Q, Qian W, Wang Z, Yang L, Wang Z, Yang T, Liu L, Qin Z, Zhao X, Kan H, Hong F. Environmental inequalities and multimorbidity: Insights from the Southwest China Multi-Ethnic Cohort Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 908:167744. [PMID: 37863237 DOI: 10.1016/j.scitotenv.2023.167744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
Multimorbidity is an increasingly significant public health challenge worldwide. Although the association between environmental factors and the morbidity and mortality of individual chronic diseases is well-established, the relationship between environmental inequalities and multimorbidity, as well as the patterns of multimorbidity across different areas and ethnic groups, remains unclear. We first focus on analyzing the differences in environmental exposures and patterns of multimorbidity across diverse areas and ethnic groups. The results show that individuals of Han ethnicity residing in Chongqing and Sichuan are exposure to higher levels of air pollutants such as PM2.5, PM10, and NO2. Conversely, Tibetans in Tibet and Yi people in Yunnan face elevated concentrations of O3. Furthermore, the Dong, Miao, Buyi ethnicities in Guizhou and Bai in Yunnan have greater access to green spaces. The key multimorbidity patterns observed in Southwest China are related to metabolic abnormalities combined with digestive system diseases. However, significant differences in multimorbidity patterns exist among different regions and ethnic groups. Further utilizing the logistic regression model, the analysis demonstrates that increased exposure to environmental pollutants (PM2.5, PM10, NO2, O3) is significantly associated with higher odds ratios of multimorbidity. Conversely, a greater presence of green spaces (NDVI 250, NDVI 500, NDVI 1000) significantly reduces the risk of multimorbidity. This large-scale epidemiological study provides some evidence of a significant association between environmental inequalities and multimorbidity. By addressing these environmental inequalities and promoting healthy environments for all, we can work towards reducing the prevalence of multimorbidity and improving overall population health.
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Affiliation(s)
- Qibing Zeng
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Jingbo Zhou
- Lab of Computational Chemistry and Drug Design, State Key Laboratory of Chemical Oncogenomics, Peking University Shenzhen Graduate School, Shenzhen, 518055, China
| | - Qiong Meng
- School of Public Health, Kunming Medical University, Kunming, 650500, China
| | - Wen Qian
- Chengdu Center for Disease Control and Prevention, Chengdu, 610044, China
| | - Zihao Wang
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - La Yang
- High Altitude Health Science Research Center of Tibet University, Lhasa, 850013, China
| | - Ziyun Wang
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Tingting Yang
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Leilei Liu
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Zixiu Qin
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China.
| | - Haidong Kan
- School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education and National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
| | - Feng Hong
- The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education & Guizhou Provincial Ecological Food Creation Engineering Research Center & School of Public Health, Guizhou Medical University, Guiyang, 550025, China.
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Pham KCT, Chiew KS. The impact of air pollution on neurocognitive development: Adverse effects and health disparities. Dev Psychobiol 2023; 65:e22440. [PMID: 38010305 PMCID: PMC10683861 DOI: 10.1002/dev.22440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 09/30/2023] [Accepted: 10/21/2023] [Indexed: 11/29/2023]
Abstract
Air pollution is recognized as a major public health concern. The number of deaths related to ambient air pollution has increased in recent years and is projected to continue rising. Additionally, both short- and long-term air pollution exposure has been linked with deleterious effects on neurocognitive function and development. While air pollution poses as a threat to everyone, people of color and individuals of lower socioeconomic status are often exposed to elevated levels of air pollution as a function of systemic racism and classism. Further, given additional disparities in access to healthcare and other compounding stressors, adverse effects of air pollution on neurocognitive health are exacerbated among individuals who hold marginalized identities-making effects both less likely to be detected and treated. This review examines evidence of the effects of air pollution on neurocognitive development across the lifespan and incorporates an environmental justice perspective to highlight disparities in air pollution exposure across race and socioeconomic status. Last, upon the reviewed evidence, limitations of past research and recommendations for policy are discussed.
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Affiliation(s)
- Kim-Chi T Pham
- Department of Psychology, University of Denver, Denver, Colorado, USA
| | - Kimberly S Chiew
- Department of Psychology, University of Denver, Denver, Colorado, USA
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Lin L, Huang H, Lei F, Sun T, Chen Z, Qin K, Li M, Hu Y, Huang X, Zhang X, Zhang P, Zhang XJ, She ZG, Cai J, Yang S, Jia P, Li H. Long-Term Exposure to Fine Particulate Constituents and Vascular Damage in a Population with Metabolic Abnormality in China. J Atheroscler Thromb 2023; 30:1552-1567. [PMID: 37032101 PMCID: PMC10627764 DOI: 10.5551/jat.64062] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/23/2023] [Indexed: 04/11/2023] Open
Abstract
AIM To date, PM2.5-associated vascular damage in metabolic abnormalities has remained controversial. We knew little about the vascular damage of PM2.5 constituents. Thus, this study aimed to investigate the relationship between long-term exposure to PM2.5 and its constituents and vascular damage in metabolic abnormalities. METHODS A total of 124,387 participants with metabolic abnormalities (defined as at least one metabolic disorder, such as obesity, elevated blood pressure, elevated triglyceride level, elevated fasting glucose level, or low HDL cholesterol level) were recruited in this study from 11 representative centers in China between January 2011 and December 2017. PM2.5 and its constituents (black carbon [BC], organic matter [OM], sulfate [SO42-], nitrate [NO3-], and ammonium salts [NH4+]) were extracted. Elevated brachial-ankle pulse wave velocity (baPWV) (≥ 1,400 cm/s) and declined ankle-brachial index (ABI) (<0.9) indicated vascular damage. Multivariable logistic regression and Quantile g-Computation models were utilized to explore the impact on outcomes. RESULTS Of the 124,387 participants (median age, 49 years), 87,870 (70.64%) were men. One-year lag exposure to PM2.5 and its constituents was significantly associated with vascular damage in single pollutant models. The adjusted odds ratios (OR) for each 1-µg/m3 increase in PM2.5 was 1.013 (95% CI, 1.012-1.015) and 1.031 (95% CI, 1.025-1.037) for elevated baPWV and decreased ABI, respectively. PM2.5 constituents were also associated with vascular damage in multi-pollutant models. Among the PM2.5 constituents, BC (47.17%), SO42- (33.59%), and NH4+ (19.23%) have the highest contribution to elevated baPWV and NO3- (47.89%) and BC (23.50%) to declined ABI. CONCLUSION Chronic exposure to PM2.5 and PM2.5 constituents was related to vascular damage in the abnormal metabolic population in China. The heterogeneous contribution of different PM2.5 constituents to vessel bed damage is worthy of attention when developing targeted strategies.
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Affiliation(s)
- Lijin Lin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huxiang Huang
- Department of Respiratory and Critical Care Medicine, Huanggang central Hospital of Yangtze University, Huanggang, China
- Huanggang Institute of Translational Medicine, Huanggang, China
| | - Fang Lei
- Institute of Model Animal, Wuhan University, Wuhan, China
- School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Tao Sun
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Ze Chen
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kun Qin
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Manyao Li
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Yingying Hu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Xuewei Huang
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xingyuan Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China
- School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Peng Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China
- School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Xiao-Jing Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China
- School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Jingjing Cai
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Shujuan Yang
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
- Hubei Luojia Laboratory, Wuhan, China
- School of Public Health, Wuhan University, Wuhan, China
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
- Huanggang Institute of Translational Medicine, Huanggang, China
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
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Yang S, Yu B, Yu W, Dai S, Feng C, Shao Y, Zhao X, Li X, He T, Jia P. Development and validation of an age-sex-ethnicity-specific metabolic syndrome score in the Chinese adults. Nat Commun 2023; 14:6988. [PMID: 37914709 PMCID: PMC10620391 DOI: 10.1038/s41467-023-42423-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023] Open
Abstract
Metabolic syndrome (MetS) is characterized by metabolic dysfunctions and could predict future risk for cardiovascular diseases (CVDs). However, the traditionally defined dichotomous MetS neither reflected MetS severity nor considered demographic variations. Here we develop a continuous, age-sex-ethnicity-specific MetS score based on continuous measures of the five metabolic dysfunctions (waist circumference [WC], triglycerides [TG], high-density lipoprotein cholesterol [HDL-C], mean arterial pressure [MAP], and fasting blood glucose [FBG]). We find that the weights of metabolic dysfunctions in the score vary across age-sex-ethnicity-specific subgroups, with higher weights for TG, HDL-C, and WC. Each unit increase in the score is associated with increased risks for hyperlipidemia, diabetes, and hypertension, and elevated levels of HbA1c, cholesterol, body mass index, and serum uric acid. The score shows high sensitivity and accuracy for detecting CVD-related risk factors and is validated in different geographical regions. Our study would advance early identification of CVD risks and, more broadly, preventive medicine and sustainable development goals.
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Affiliation(s)
- Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China.
| | - Bin Yu
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China
| | - Wanqi Yu
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Shaoqing Dai
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
- Faculty of Geo-information Science and Earth Observation, University of Twente, Enschede, the Netherlands
| | - Chuanteng Feng
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China
| | - Ying Shao
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiaoqing Li
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Tianjing He
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Peng Jia
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China.
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China.
- Hubei Luojia Laboratory, Wuhan, China.
- School of Public Health, Wuhan University, Wuhan, China.
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8
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Xue Y, Li J, Xu YN, Cui JS, Li Y, Lu YQ, Luo XZ, Liu DZ, Huang F, Zeng ZY, Huang RJ. Mediating effect of body fat percentage in the association between ambient particulate matter exposure and hypertension: a subset analysis of China hypertension survey. BMC Public Health 2023; 23:1897. [PMID: 37784103 PMCID: PMC10544618 DOI: 10.1186/s12889-023-16815-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Hypertension caused by air pollution exposure is a growing concern in China. The association between air pollutant exposure and hypertension has been found to be potentiated by obesity, however, little is known about the processes mediating this association. This study investigated the association between fine particulate matter (aerodynamic equivalent diameter ≤ 2.5 microns, PM2.5) exposure and the prevalence of hypertension in a representative population in southern China and tested whether obesity mediated this association. METHODS A total of 14,308 adults from 48 communities/villages in southern China were selected from January 2015 to December 2015 using a stratified multistage random sampling method. Hourly PM2.5 measurements were collected from the China National Environmental Monitoring Centre. Restricted cubic splines were used to analyze the nonlinear dose-response relationship between PM2.5 exposure and hypertension risk. The mediating effect mechanism of obesity on PM2.5-associated hypertension was tested in a causal inference framework following the approach proposed by Imai and Keele. RESULTS A total of 20.7% (2966/14,308) of participants in the present study were diagnosed with hypertension. Nonlinear exposure-response analysis revealed that exposure to an annual mean PM2.5 concentration above 41.8 µg/m3 was associated with increased hypertension risk at an incremental gradient. 9.1% of the hypertension burden could be attributed to exposure to elevated annual average concentrations of PM2.5. It is noteworthy that an increased body fat percentage positively mediated 59.3% of the association between PM2.5 exposure and hypertension risk, whereas body mass index mediated 34.3% of this association. CONCLUSIONS This study suggests that a significant portion of the estimated effect of exposure to PM2.5 on the risk of hypertension appears to be attributed to its effect on alterations in body composition and the development of obesity. These findings could inform intersectoral actions in future studies to protect populations with excessive fine particle exposure from developing hypertension.
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Affiliation(s)
- Yan Xue
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, China
| | - Jin Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, China
| | - Yu-Nan Xu
- Department of Medical Research, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jia-Sheng Cui
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, China
| | - Yue Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, China
| | - Yao-Qiong Lu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, China
| | - Xiao-Zhi Luo
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, China
| | - De-Zhao Liu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, China
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, China
| | - Feng Huang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China.
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, China.
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, China.
| | - Zhi-Yu Zeng
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China.
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, China.
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, China.
| | - Rong-Jie Huang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, China.
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Nanning, China.
- Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, China.
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Qin K, Jia P, Yang S. Editorial: Occupational exposure and cardiometabolic disorders. Front Public Health 2023; 11:1171033. [PMID: 37397771 PMCID: PMC10313318 DOI: 10.3389/fpubh.2023.1171033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- Kun Qin
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
- Hubei Luojia Laboratory, Wuhan, China
- School of Public Health, Wuhan University, Wuhan, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Department of Health Management Center, Clinical Medical College & Affiliated Hospital, Chengdu University, Chengdu, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
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10
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Sun T, Wang Z, Lei F, Lin L, Zhang X, Song X, Ji YX, Zhang XJ, Zhang P, She ZG, Cai J, Jia P, Li H. Long-term exposure to air pollution and increased risk of atrial fibrillation prevalence in China. Int J Cardiol 2023; 378:130-137. [PMID: 36841290 DOI: 10.1016/j.ijcard.2023.02.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/06/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common type of treated heart arrhythmia contributing to adverse cardiovascular events. The association between short-term air pollution exposure and AF episodes has been recognized. But the evidence of the association between long-term air pollution exposure and AF was limited, especially in developing countries. METHODS We performed a nationwide cross-sectional study among 1,374,423 individuals aged ≥35 years from 13 health check-up centers. Using logistic regression models, we assessed the association between long-term exposure to single air pollution and AF prevalence, including particulate matter (PM2.5 and PM10), ozone (O3) and PM2.5 compositions, which were estimated by high-resolution and high-quality spatiotemporal datasets of ground-level air pollutants for China. The quantile g-computation model was used to explore the joint effect of all exposures to air pollution and the contribution of an individual component to the mixture. RESULTS In single-pollutant models, an increase of 10 μg/m3 in PM2.5 (OR 1.031[95%CI 1.010,1.053]) and PM10 (OR = 1.021 [95%CI 1.009,1.033]) was positively associated with AF prevalence. The stratified analyses revealed that these associations were significantly stronger in females, people <65 years old, and those with hypertension and diabetes. In the further exploration of the joint effect of PM2.5 compositions (OR 1.060 [95%CI 1.022,1.101]) per quintile increase in all five PM2.5 components), we found that PM2.5 sulfate contributed the most. CONCLUSIONS These findings provide important evidence for the positive relationship between long-term exposure to air pollution and AF prevalence in China and identify sulfate particles of PM2.5 as having the highest contribution to the overall mixture effects among all PM2.5 chemical constituents.
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Affiliation(s)
- Tao Sun
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Zhanpeng Wang
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Fang Lei
- Institute of Model Animal, Wuhan University, Wuhan, China; School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Lijin Lin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Xingyuan Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China; School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Xiaohui Song
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Yan-Xiao Ji
- Institute of Model Animal, Wuhan University, Wuhan, China; School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Xiao-Jing Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China; School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Peng Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China; School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Jingjing Cai
- Institute of Model Animal, Wuhan University, Wuhan, China; Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; Hubei Luojia Laboratory, Wuhan, China; School of Public Health, Wuhan University, Wuhan, China.
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China; Huanggang Institute of Translational Medicine, Huanggang, China; Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China.
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11
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Yu W, Liu Z, La Y, Feng C, Yu B, Wang Q, Liu M, Li Z, Feng Y, Ciren L, Zeng Q, Zhou J, Zhao X, Jia P, Yang S. Associations between residential greenness and the predicted 10-year risk for atherosclerosis cardiovascular disease among Chinese adults. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 868:161643. [PMID: 36657685 DOI: 10.1016/j.scitotenv.2023.161643] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Exposure to build environments, especially residential greenness, offers benefits to reduce the development of atherosclerotic cardiovascular diseases (ASCVD). The 10-year ASCVD risk is a useful indicator for long-term ASCVD risk, but the evidence on the association and potential pathway of residential greenness in mitigating its development remains unclear. OBJECTIVES This study aimed to investigate the associations between residential greenness and the 10-year predicted ASCVD risks, and potentially mediation effect on this association by air pollution, body mass index (BMI) and physical activity (PA). METHODS The baseline of the China Multi-Ethnic Cohort (CMEC) study, enrolling 99,556 adults during 2018-2019, was used in this cross-sectional study. The participants' 10-year ASCVD risks were predicted as low-, moderate-, and high-risk groups, based on the six risk factors: age, smoking, hypertension, low-density lipoprotein cholesterol (LDL-C), high high-density lipoprotein cholesterol (HDL-C), and high total cholesterol (TC). The 3-year mean value within the circular buffer of 500 m and 1000 m of Enhanced Vegetation Index (EVI500m and EVI1000m) were used to assess greenness exposure. Multiple logistic regression was used to evaluate the association between residential greenness and the 10-year ASCVD risks. Stratified analyses by sex, age and smoking status were performed to identify susceptible populations. Causal mediation analysis was used to explore the mediation effects of air pollution, BMI and PA. RESULTS A total of 75,975 participants were included, of which 17.9 % (n = 13,614) and 5.6 % (n = 4253) had the moderate and high 10-year ASCVD risks, respectively. Compared to the low-risk group, each interquartile increase in EVI500m and EVI1000m reduced the ASCVD risk of the moderate-risk group by 4 % (OR = 0.96 [0.94, 0.98]) and 4 % (OR = 0.96 [0.94, 0.98]), respectively; and reduced the risk of the high-risk group by 8 % (OR = 0.92 [0.90, 0.96]) and 7 % (OR = 0.93 [0.90, 0.97]), respectively. However, the increased greenness did not affect the ASCVD risk of the high-risk group when compared to the moderate-risk group. Effects of residential greenness on the ASCVD risk were stronger in women than in men (p < 0.05), and were not observed in those aged ≥55. PA and BMI partially mediated the association between greenness and the 10-year ASCVD risk. CONCLUSIONS ASCVD prevention strategies should be tailored to maximize the effectiveness within the groups with different ASCVD risks, better at early stages when the ASCVD risk is low.
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Affiliation(s)
- Wanqi Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zhu Liu
- Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Yang La
- School of Medicine, Tibet University, Tibet, China
| | - Chuanteng Feng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Institute for Disaster Management and Reconstruction, Sichuan University-The Hongkong Polytechnic University, Chengdu, China
| | - Bing Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Institute for Disaster Management and Reconstruction, Sichuan University-The Hongkong Polytechnic University, Chengdu, China
| | - Qinjian Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Meijing Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zhifeng Li
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Yuemei Feng
- School of Public Health, Kunming Medical University, Kunming, China
| | - Laba Ciren
- Tibet Center for Disease Control and Prevention, Tibet, China
| | - Qibing Zeng
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Junmin Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; Hubei Luojia Laboratory, Wuhan, China; School of Public Health, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China.
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China.
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12
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Zhang F, Li H, Xu W, Song G, Wang Z, Mao X, Wei Y, Dai M, Zhang Y, Shen Q, Fu F, Tan J, Ge L, He X, Yin T, Yang S, Li S, Yang P, Jia P, Zhang Y. Sulfur dioxide may predominate in the adverse effects of ambient air pollutants on semen quality among the general population in Hefei, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 867:161472. [PMID: 36638985 DOI: 10.1016/j.scitotenv.2023.161472] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/24/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Previous studies have reported potential adverse effects of exposure to ambient air pollutants on semen quality in infertile men, but studies on the general population have been limited and inconsistent, and the pollutants that play a major role remain unclear. This study aimed to explore the potential association between exposure to six air pollutants (PM2.5, PM10, NO2, SO2, O3 and CO) during different sperm development periods and semen quality among the general population, and to explore the interaction between different air pollutant exposures. We included 1515 semen samples collected from the Human Sperm Bank. We improved individuals' exposure level estimation by combining inverse distance weighting (IDW) interpolation with satellite remote sensing data. Multivariate linear regression models, restricted cubic spline functions and double-pollutant models were used to assess the relationship between exposure to six air pollutants and sperm volume, concentration, total sperm number and sperm motility. A negative association was found between SO2 exposure and progressive motility and total motility during 0-90 lag days and 70-90 lag days, and SO2 exposure during 10-14 lag days adversely affected sperm concentration and total sperm number. Sensitive analyses for qualified sperm donors and the double-pollutant models obtained similar results. Additionally, there were nonlinear relationships between exposure to PM, NO2, O3, CO and a few semen parameters, with NO2 and O3 exposure above the threshold showing negative correlations with total motility and progressive motility, respectively. Our study suggested that SO2 may play a dominant role in the adverse effects of ambient air pollutants on semen quality in the general population by decreasing sperm motility, sperm concentration and total sperm number. Also, even SO2 exposure lower than the recommended standards of the World Health Organization (WHO) could still cause male reproductive toxicity, which deserves attention.
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Affiliation(s)
- Feng Zhang
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hang Li
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Wenting Xu
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, Hubei, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, Hubei, China
| | - Ge Song
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, Hubei, China
| | - Zhanpeng Wang
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, Hubei, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, Hubei, China
| | - Xiaohong Mao
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Yiqiu Wei
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Mengyang Dai
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yuying Zhang
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qunshan Shen
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Feifei Fu
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Jing Tan
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Lei Ge
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Xiaojin He
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Tailang Yin
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, Hubei, China
| | - Siwei Li
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, Hubei, China; State Key Laboratory of Information Engineering in Surveying, Mapping and Remote Sensing, Wuhan University, Wuhan, Hubei, China.
| | - Pan Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, Hubei, China; Hubei Luojia Laboratory, Wuhan, Hubei, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, Hubei, China; School of Public Health, Wuhan University, Wuhan, Hubei, China.
| | - Yan Zhang
- Department of Clinical Laboratory, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
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13
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Yu W, Li X, Zhong W, Dong S, Feng C, Yu B, Lin X, Yin Y, Chen T, Yang S, Jia P. Rural-urban disparities in the associations of residential greenness with diabetes and prediabetes among adults in southeastern China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 860:160492. [PMID: 36435247 DOI: 10.1016/j.scitotenv.2022.160492] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 06/16/2023]
Abstract
AIMS Greenness offers health benefits to prevent diabetes in urban areas. However, urban-rural disparities in this association have not been explored, with the underlying pathways understudied as well. We aimed to investigate and compare the associations and potential pathways between residential greenness and the risks for diabetes and prediabetes in urban and rural areas. METHODS Diabetes and prediabetes were diagnosed by fasting blood glucose (FBG). The participants' residential greenness exposure was estimated by the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). The association of residential greenness with the risks for diabetes and prediabetes was estimated by logistic regression and the generalized additive model. The potential mediation effects of air pollution, body mass index (BMI), and physical activity (PA) were examined by causal mediation analysis. RESULTS Of the 50,593 included participants, and the prevalence of prediabetes and diabetes were 21.22 % and 5.63 %, respectively. Each 0.1-unit increase in EVI500m and NDVI500m for healthy people reduced the risk for prediabetes by 12 % and 8 %, respectively, and substantially reduced the risk for diabetes by 23 % and 19 %, respectively. For those with prediabetes, each 0.1-unit increase in EVI500m and NDVI500m reduced the diabetes risk by 14 % and 12 %, respectively. Compared to the risks for diabetes at the 25th percentile of EVI500m/NDVI500m, such risks significantly reduced when EVI500m (NDVI500m) increased over 0.43 (0.48) and 0.28 (0.39) in urban and rural areas, respectively. The residential greenness-prediabetes/diabetes associations were mediated by air pollution and PA in urban areas and by air pollution and BMI in rural areas. CONCLUSIONS Exposure to residential greenness was associated with a lower risk for prediabetes and diabetes in urban areas and, more strongly, in rural areas, which were partly mediated by air pollution, PA, and BMI.
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Affiliation(s)
- Wanqi Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiaoqing Li
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Wenling Zhong
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Shu Dong
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chuanteng Feng
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China
| | - Xi Lin
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Yanrong Yin
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Tiehui Chen
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; Department of Health Management Center, Clinical Medical College & Affiliated Hospital, Chengdu University, Chengdu, China.
| | - Peng Jia
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
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14
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Li X, Wang Q, Feng C, Yu B, Lin X, Fu Y, Dong S, Qiu G, Jin Aik DH, Yin Y, Xia P, Huang S, Liu N, Lin X, Zhang Y, Fang X, Zhong W, Jia P, Yang S. Associations and pathways between residential greenness and metabolic syndromes in Fujian Province. Front Public Health 2022; 10:1014380. [PMID: 36620251 PMCID: PMC9815145 DOI: 10.3389/fpubh.2022.1014380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background Greenness exposure is beneficial to human health, but its potential mechanisms through which the risk for metabolic syndrome (MetS) could be reduced have been poorly studied. We aimed to estimate the greenness-MetS association in southeast China and investigate the independent and joint mediation effects of physical activity (PA), body mass index (BMI), and air pollutants on the association. Methods A cross-sectional study was conducted among the 38,288 adults based on the Fujian Behavior and Disease Surveillance (FBDS), established in 2018. MetS was defined as the presence of three or more of the five components: abdominal obesity, elevated triglyceride, reduced high-density lipoprotein cholesterol (HDL-C), high blood pressure, and elevated fasting glucose. The residential greenness exposure was measured as the 3-year mean values of the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) within the 250, 500, and 1,000 meters (m) buffer zones around the residential address of each participant. Logistic regression models were used to estimate the greenness-MetS association. The causal mediation analysis was used to estimate the independent and joint mediation effects of PA, BMI, particulate matter with an aerodynamic diameter of 2.5 μm (PM2.5), particulate matter with an aerodynamic diameter ≤ 10 μm (PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2). Results Each interquartile range (IQR) increase in greenness was associated with a decrease of 13% (OR = 0.87 [95%CI: 0.83, 0.92] for NDVI500m and OR = 0.87 [95%CI: 0.82, 0.91] for EVI500m) in MetS risk after adjusting for covariates. This association was stronger in those aged < 60 years (e.g., OR = 0.86 [95%CI: 0.81, 0.92] for NDVI500m), males (e.g., OR = 0.73 [95%CI: 0.67, 0.80] for NDVI500m), having an educational level of primary school or above (OR = 0.81 [95%CI: 0.74, 0.89] for NDVI500m), married/cohabitation (OR = 0.86 [95%CI: 0.81, 0.91] for NDVI500m), businessman (OR = 0.82 [95%CI: 0.68, 0.99] for NDVI500m), other laborers (OR = 0.77 [95%CI: 0.68, 0.88] for NDVI500m), and non-smokers (OR = 0.77 [95%CI: 0.70, 0.85] for NDVI500m). The joint effect of all six mediators mediated about 48.1% and 44.6% of the total effect of NDVI500m and EVI500m on the MetS risk, respectively. Among them, BMI showed the strongest independent mediation effect (25.0% for NDVI500m), followed by NO2 and PM10. Conclusion Exposure to residential greenness was associated with a decreased risk for MetS. PA, BMI, and the four air pollutants jointly interpreted nearly half of the mediation effects on the greenness-MetS association.
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Affiliation(s)
- Xiaoqing Li
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Qinjian Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chuanteng Feng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China,Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China
| | - Bin Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China,Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China
| | - Xi Lin
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Yao Fu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Shu Dong
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ge Qiu
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China,International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Darren How Jin Aik
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China,International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Yanrong Yin
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Pincang Xia
- Department for HIV/AIDS and STDs Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Shaofen Huang
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Nian Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiuquan Lin
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Yefa Zhang
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Xin Fang
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Wenling Zhong
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China,*Correspondence: Wenling Zhong
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China,International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China,Peng Jia
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China,International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China,Shujuan Yang
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Wang Q, Duoji Z, Feng C, Fei T, Ma H, Wang S, Ciren W, Yang T, Ling H, Ma B, Yu W, Liu H, Zhou J, Zhao X, Jia P, Yang S. Associations and pathways between residential greenness and hyperuricemia among adults in rural and urban China. ENVIRONMENTAL RESEARCH 2022; 215:114406. [PMID: 36152883 DOI: 10.1016/j.envres.2022.114406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/01/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Residential greenness may decrease the risk for hyperuricemia in rural areas, but the urban-rural disparities in this association and underlying pathways have not been studied. OBJECTIVES To investigate the associations and potential pathways between residential greenness and hyperuricemia in urban and rural areas. METHODS The baseline survey of the China Multi-Ethnic Cohort (CMEC) was used. Hyperuricemia was defined as serum uric acid (SUA) > 417 μmol/L for men and >357 μmol/L for women. The satellite-based normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) were used to capture residential greenness. A propensity score inverse-probability weighting method was used to assess urban-rural differences in the associations between residential greenness and hyperuricemia, with possible mediation effects of physical activity (PA), body mass index (BMI), PM2.5, and NO2 examined by causal mediation analyses. RESULTS A total of 72,372 participants were included. The increases in the EVI500m and NDVI500m residential greenness were associated with a decreased risk for hyperuricemia and the SUA level in both urban and rural areas. For example, each 0.1-unit increase in EVI500m was associated with a decreased hyperuricemia risk of 7% (OR = 0.93 [0.91, 0.96]) and a decreased SUA level of -1.77 μmol/L [-2.60, -0.93], respectively; such associations were stronger in urban areas for both the risk for hyperuricemia (OR = 0.84 [0.83, 0.86]) and SUA level (-7.18 μmol/L [-7.91, -6.46]). The subgroup analysis showed that the greenness-hyperuricemia/SUA association varied by age, sex, and annual household income. The percentage of the joint mediation effect of PA, BMI, PM2.5, and NO2 on the association between EVI500m and the risk for hyperuricemia was higher in urban (34.92%) than rural areas (15.40%). BMI, PM2.5, and PA showed significantly independently mediation effects for the greenness-hyperuricemia association in both rural and urban areas. CONCLUSIONS Exposure to residential greenness was associated with a decreased risk for hyperuricemia, partially through the pathways of PA, BMI, PM2.5, and NO2, which varied in urban and rural areas.
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Affiliation(s)
- Qinjian Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zhuoma Duoji
- School of Medicine, Tibet University, Lhasa, China
| | - Chuanteng Feng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; Institute for Disaster Management and Reconstruction, Sichuan University-The Hongkong Polytechnic University, Chengdu, China
| | - Teng Fei
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
| | - Hua Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Songmei Wang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Wangla Ciren
- Lhasa Chengguan District Center for Disease Control and Prevention, Lhasa, China
| | - Tingting Yang
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Hua Ling
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Bangjing Ma
- Qingbaijiang District Center for Disease Control and Prevention, Chengdu, China
| | - Wanqi Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Hongyun Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Junmin Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China.
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China.
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Jin H, Chen X, Zhong R, Liu M. Influence and prediction of PM2.5 through multiple environmental variables in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 849:157910. [PMID: 35944645 DOI: 10.1016/j.scitotenv.2022.157910] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
Fine particulate matter (PM2.5) is an important indicator to measure the degree of air pollution. With the pursuit of sustainable development of China's economy and society, air pollution has been paid more and more attention. The spatial distribution of PM2.5 is affected by multiple factors. In this study, we selected Normalized Difference Vegetation Index (NDVI), precipitation, temperature, wind speed and elevation data to analyze the impact of each variable on PM2.5 in different regions of China. The results show that the high-value areas of PM2.5 were mainly concentrated in the North China Plain, the middle and lower reaches of the Yangtze River Plain, the Sichuan Basin, and the Tarim Basin. PM2.5 showed an upward trend in North China, Northeast China and Northwest China, while in most of South China, especially the Sichuan Basin, PM2.5 showed a downward trend. Therefore, the northern region of China needs to take measures to curb the growth of PM2.5. In Northwest China, wind speed and temperature had a greater impact on PM2.5. In North China, wind speed had a greater impact on PM2.5. In southern China, temperature and NDVI had a greater impact on PM2.5. The deep learning model can better simulate the spatial distribution of PM2.5 based on the selected variables. The clustering effect of single variable is better than multivariate spatial information clustering based on principal component analysis (PCA). It is difficult to explain which variable has the greatest impact on PCA clustering. This study can provide an important reference for PM2.5 prevention and control in different regions of China.
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Affiliation(s)
- Haoyu Jin
- School of Civil Engineering, Sun Yat-sen University, Guangzhou 510275, China; Guangdong Engineering Technology Research Center of Water Security Regulation and Control for Southern China, Sun Yat-sen University, Guangzhou 510275, China; Key Laboratory of Water Cycle and Water Security in Southern China of Guangdong High Education Institute, Sun Yat-sen University, Guangzhou 510275, China
| | - Xiaohong Chen
- School of Civil Engineering, Sun Yat-sen University, Guangzhou 510275, China; Guangdong Engineering Technology Research Center of Water Security Regulation and Control for Southern China, Sun Yat-sen University, Guangzhou 510275, China; Key Laboratory of Water Cycle and Water Security in Southern China of Guangdong High Education Institute, Sun Yat-sen University, Guangzhou 510275, China.
| | - Ruida Zhong
- School of Civil Engineering, Sun Yat-sen University, Guangzhou 510275, China; Guangdong Engineering Technology Research Center of Water Security Regulation and Control for Southern China, Sun Yat-sen University, Guangzhou 510275, China; Key Laboratory of Water Cycle and Water Security in Southern China of Guangdong High Education Institute, Sun Yat-sen University, Guangzhou 510275, China
| | - Moyang Liu
- The Fenner School of Environment and Society, The Australian National University (ANU), Canberra, ACT 0200, Australia
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