Public health benefits of strategies to reduce greenhouse-gas emissions: health implications of short-lived greenhouse pollutants

Associations of prenatal exposure to PM2.5 and its components with offsprings' neurodevelopmental and behavioral problems: A prospective cohort study from China

Prenatal exposure to fine particulate matter (PM2.5) has been linked with increased neurodevelopmental disorders. However, the most detrimental component of PM2.5 and the most vulnerable exposure time windows remain undetermined, especially in areas with high PM2.5 levels. In a prospective cohort study involving 4494 mother-child dyads, we examined the associations of prenatal exposure to PM2.5 and its four main components with children's neurodevelopmental and behavioral problems (NBPs), separately in three pregnancy trimesters. Poisson regression and generalized additive models were used to depict the linear and nonlinear associations, respectively. Weighted quantile sum and Bayesian kernel machine regression models were applied to examine the effects of exposure to both mixed and individual components. Results showed that exposure to PM2.5 and its components throughout the three trimesters increased the risk of children's NBPs (Risk ratio for PM2.5: 1.16, 95 % confidence interval 1.14-1.18 per μg/m3 in the first trimester; 1.15, 1.12-1.17 in the second trimester; 1.06, 1.04-1.08 in the third trimester), with associations gradually diminishing as pregnancy progressed (P values for trends < 0.05). Among the four main components of PM2.5, exposure to SO42- posed the highest risks on children's NBPs, while organic matter contributed the largest proportion to the overall impacts of PM2.5 exposure. These results underscore the significance of mitigating PM2.5 exposure in pregnant women to reduce the risk of neurodevelopmental disorders in offspring. Our findings would inform risk assessment of PM2.5 exposure and facilitate the development of precision preventive strategies targeting specific components of PM2.5 in similar areas with high levels of exposure.

Microscopic Characterization of Individual Aerosol Particles in a Typical Industrial City and Its Surrounding Rural Areas in China

Transmission electron microscopy was used to analyze individual aerosol particles collected in Lanzhou (urban site) and its surrounding areas (rural site) in early 2023. The results revealed that from the pre-Spring Festival period to the Spring Festival period, the main pollutants at the urban site decreased significantly, while the PM2.5 and SO2 concentrations increased at the rural site. During the entire sampling period, the main particles at the urban site were organic matter (OM), secondary inorganic aerosols (SIA), and OM-SIA particles, while those at the rural site were OM, SIA, and soot particles. The degree of external mixing of single particles in both sites increased from the pre-Spring Festival period to the Spring Festival period. The proportion of the OM particles increased by 11% at the urban site, and the proportion of SIA particles increased by 24% at the rural site. During the Spring Festival, the aging of the soot particles was enhanced at the urban site and weakened at the rural site. At the urban site, the SIA particle size was more strongly correlated with the thickness of the OM coating during the pre-Spring Festival period, while the correlation was stronger at the rural site during the Spring Festival.

Ambient fine particulate matter chemical composition associated with in-hospital case fatality, hospital expenses, and length of hospital stay among patients with heart failure in China

*Joint senior authorship.

BACKGROUND

Previous studies have observed the adverse effects of ambient fine particulate matter pollution (PM2.5) on heart failure (HF). However, evidence regarding the impacts of specific PM2.5 components remains scarce.

METHODS

We included 58 129 patients hospitalised for HF between 2013 and 2017 in 11 cities of Shanxi, China from inpatient discharge database. We evaluated exposure to PM2.5 and its components ((sulphate (SO42-), nitrate (NO3-), ammonium (NH4+), organic matter (OM) and black carbon (BC)), along with meteorological factors using bilinear interpolation at each patients' residential address. We used multivariable logistic and linear regression models to assess the associations of these components with in-hospital case fatality, hospital expenses, and length of hospital stay.

RESULTS

Increase equivalents to the interquartile range (IQR) in OM (odds ratio (OR) = 1.13; 95% confidence interval (CI) = 1.02, 1.26) and BC (OR = 1.14; 95% CI = 1.02, 1.26) were linked to in-hospital case fatality. Per IQR increments in PM2.5, SO42-, NO3-, OM, and BC were associated with cost increases of 420.62 (95% CI = 285.75, 555.49), 221.83 (95% CI = 96.95, 346.71), 214.93 (95% CI = 68.66, 361.21), 300.06 (95% CI = 176.96, 423.16), and 303.09 (95% CI = 180.76, 425.42) CNY. Increases of 1 IQR in PM2.5, SO42-, OM, and BC were associated with increases in length of hospital stay of 0.10 (95% CI = 0.02, 0.19), 0.09 (95% CI = 0.02, 0.17), 0.10 (95% CI = 0.03, 0.17), and 0.16 (95% CI = 0.08, 0.23) days.

CONCLUSIONS

Our findings suggest that ambient SO42-, OM, and BC might be significant risk factors for HF, emphasising the importance of formulating customised guidelines for the chemical constituents of PM and controlling the emissions of the most dangerous components.

Long-term mortality burden trends attributed to black carbon and PM2·5 from wildfire emissions across the continental USA from 2000 to 2020: a deep learning modelling study

BACKGROUND

Long-term improvements in air quality and public health in the continental USA were disrupted over the past decade by increased fire emissions that potentially offset the decrease in anthropogenic emissions. This study aims to estimate trends in black carbon and PM2·5 concentrations and their attributable mortality burden across the USA.

METHODS

In this study, we derived daily concentrations of PM2·5 and its highly toxic black carbon component at a 1-km resolution in the USA from 2000 to 2020 via deep learning that integrated big data from satellites, models, and surface observations. We estimated the annual PM2·5-attributable and black carbon-attributable mortality burden at each 1-km2 grid using concentration-response functions collected from a national cohort study and a meta-analysis study, respectively. We investigated the spatiotemporal linear-regressed trends in PM2·5 and black carbon pollution and their associated premature deaths from 2000 to 2020, and the impact of wildfires on air quality and public health.

FINDINGS

Our results showed that PM2·5 and black carbon estimates are reliable, with sample-based cross-validated coefficients of determination of 0·82 and 0·80, respectively, for daily estimates (0·97 and 0·95 for monthly estimates). Both PM2·5 and black carbon in the USA showed significantly decreasing trends overall during 2000 to 2020 (22% decrease for PM2·5 and 11% decrease for black carbon), leading to a reduction of around 4200 premature deaths per year (95% CI 2960-5050). However, since 2010, the decreasing trends of fine particles and premature deaths have reversed to increase in the western USA (55% increase in PM2·5, 86% increase in black carbon, and increase of 670 premature deaths [460-810]), while remaining mostly unchanged in the eastern USA. The western USA showed large interannual fluctuations that were attributable to the increasing incidence of wildfires. Furthermore, the black carbon-to-PM2·5 mass ratio increased annually by 2·4% across the USA, mainly due to increasing wildfire emissions in the western USA and more rapid reductions of other components in the eastern USA, suggesting a potential increase in the relative toxicity of PM2·5. 100% of populated areas in the USA have experienced at least one day of PM2·5 pollution exceeding the daily air quality guideline level of 15 μg/m3 during 2000-2020, with 99% experiencing at least 7 days and 85% experiencing at least 30 days. The recent widespread wildfires have greatly increased the daily exposure risks in the western USA, and have also impacted the midwestern USA due to the long-range transport of smoke.

INTERPRETATION

Wildfires have become increasingly intensive and frequent in the western USA, resulting in a significant increase in smoke-related emissions in populated areas. This increase is likely to have contributed to a decline in air quality and an increase in attributable mortality. Reducing fire risk via effective policies besides mitigation of climate warming, such as wildfire prevention and management, forest restoration, and new revenue generation, could substantially improve air quality and public health in the coming decades.

FUNDING

National Aeronautics and Space Administration (NASA) Applied Science programme, NASA MODIS maintenance programme, NASA MAIA satellite mission programme, NASA GMAO core fund, National Oceanic and Atmospheric Administration (NOAA) GEO-XO project, NOAA Atmospheric Chemistry, Carbon Cycle, and Climate (AC4) programme, and NOAA Educational Partnership Program with Minority Serving Institutions.

Independent risk evaluation associated with short-term black carbon exposure on mortality in two megacities of Yangtze River Delta, China

The adverse health effects of PM_2.5 have been well demonstrated by many studies. However, as a component of PM_2.5, evidence on the mortality risk of black carbon (BC) is still limited. In this study, based on the data of daily mean PM_2.5 concentration, BC concentration, meteorological factors, total non-accidental (all-cause) and cardiovascular mortality in Shanghai and Nanjing during 2015-2016, a semi-parameter generalized additive model (GAM) in the time series and the constituent residual approach were employed to explore the exposure-response relationship between BC and human mortality in these two megacities of Yangtze River Delta, China. The main objective was to separate the health effects of BC from total PM_2.5, and compare the difference of mortality ER related to BC original concentration and adjusted concentration after controlling PM_2.5. Results showed that there were all significantly associated with daily mortality for PM_2.5 and BC. The percentage excess risk (ER) increases in all-cause and cardiovascular categories were 1.68 % (95 % s 1.28, 2.08) and 2.16 % (95 % CI: 1.54, 2.79) with 1 μg/m³ increment in original BC concentration in Shanghai. And the ER in Nanjing was smaller than that in Shanghai. After eliminating PM_2.5 confounding effects by a constituent residual approach, the BC residual concentration still had a strong significant ER. The ER for BC residual in Shanghai got an obvious increase, and ER of the cardiovascular mortality for all, females and males increased by 0.55 %, 1.46 % and 0.62 %, respectively, while the ER in Nanjing decreased slightly. It also revealed that females were more sensitive to the health risk associated with short-term BC exposure than males. Our findings provide additional important evidence and ER for mortality related to independent BC exposure. Therefore, BC emission reduction should be paid more attention in air pollution control strategies to reduce BC-related health burdens.

Use of GRADE in systematic reviews of health effects on pollutants and extreme temperatures: A cross-sectional survey

OBJECTIVES

(i) To analyze trends and gaps in evidence of health effects on pollutants and extreme temperatures by evidence mapping; (ii) to conduct a cross-sectional survey on the use of the Grades of Recommendations Assessment Development and Evaluation (GRADE) in systematic reviews or meta-analyses (SR/MAs) of health effects on pollutants and extreme temperatures.

STUDY DESIGN AND SETTING

PubMed, Embase, the Cochrane Library, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched until July 7, 2022. SR/MAs investigated health effects of pollutants and extreme temperatures were included.

RESULTS

Out of 22,658 studies, 312 SR/MAs were included in evidence mapping, and the effects of pollutants on cancer and congenital malformations were new research hotspots. Among 16 SR/MAs involving 108 outcomes that were rated using GRADE, the certainty of evidence was mostly downgraded for inconsistency (50, 42.7%), imprecision (33, 28.2%), and risk of bias (24, 20.5%). In contrast, concentration-response gradient (26, 65.0%) was the main upgrade factor.

CONCLUSION

GRADE is not widely used in SR/MAs of health effects on pollutants and extreme temperatures. The certainty of evidence is generally low, mainly because of the serious inconsistency or imprecision. Use of the GRADE in SR/MAs of health effects on pollutants and extreme temperatures should strengthen.

Cooperative simultaneous inversion of satellite-based real-time PM2.5 and ozone levels using an improved deep learning model with attention mechanism

Ground-level fine particulate matter (PM_2.5) and ozone (O₃) are air pollutants that can pose severe health risks. Surface PM_2.5 and O₃ concentrations can be monitored from satellites, but most retrieval methods retrieve PM_2.5 or O₃ separately and disregard the shared information between the two air pollutants, for example due to common emission sources. Using surface observations across China spanning 2014-2021, we found a strong relationship between PM_2.5 and O₃ with distinct spatiotemporal characteristics. Thus, in this study, we propose a new deep learning model called the Simultaneous Ozone and PM_2.5 inversion deep neural Network (SOPiNet), which allows for daily real-time monitoring and full coverage of PM_2.5 and O₃ simultaneously at a spatial resolution of 5 km. SOPiNet employs the multi-head attention mechanism to better capture the temporal variations in PM_2.5 and O₃ based on previous days' conditions. Applying SOPiNet to MODIS data over China in 2022, using 2019-2021 to construct the network, we found that simultaneous retrievals of PM_2.5 and O₃ improved the performance compared with retrieving them independently: the temporal R² increased from 0.66 to 0.72 for PM_2.5, and from 0.79 to 0.82 for O₃. The results suggest that near-real time satellite-based air quality monitoring can be improved by simultaneous retrieval of different but related pollutants. The codes of SOPiNet and its user guide are freely available online at https://github.com/RegiusQuant/ESIDLM.

National Cohort Study of Long-Term Exposure to PM2.5 Components and Mortality in Medicare American Older Adults

There is increasing evidence linking long-term fine particulate matter (PM2.5) exposure to negative health effects. However, the relative influence of each component of PM2.5 on health risk is poorly understood. In a cohort study in the contiguous United States between 2000 and 2017, we examined the effect of long-term exposure to PM2.5 main components and all-cause mortality in older adults who had to be at least 65 years old and enrolled in Medicare. We estimated the yearly mean concentrations of six key PM2.5 compounds, including black carbon (BC), organic matter (OM), soil dust (DUST), nitrate (NO3-), sulfate (SO42-), and ammonium (NH4+), using two independently sourced well-validated prediction models. We applied Cox proportional hazard models to evaluate the hazard ratios for mortality and penalized splines for assessing potential nonlinear concentration-response associations. Results suggested that increased exposure to PM2.5 mass and its six main constituents were significantly linked to elevated all-cause mortality. All components showed linear concentration-response relationships in the low exposure concentration ranges. Our research indicates that long-term exposure to PM2.5 mass and its essential compounds are strongly connected to increased mortality risk. Reductions of fossil fuel burning may yield significant air quality and public health benefit.

The causal links between long-term exposure to major PM2.5 components and the burden of tuberculosis in China

BACKGROUND

We aimed to estimate the causal impacts of long-term exposure to major PM_2.5 components - including black carbon, organic matter, sulfate, nitrate, and ammonium - on the incidence and mortality of tuberculosis in China.

METHODS

We collected annual and provincial-level tuberculosis incidence and mortality, concentrations of PM_2.5 components, and socioeconomic indicators from between 2004 and 2018 in mainland China. We used the difference-in-differences (DID) causal inference approach with a generalized weighted quantile sum (gWQS) regression model to estimate the long-term effects and relative contributions of PM_2.5 components' exposure on tuberculosis incidence and mortality.

RESULTS

We found that long-term multi-components exposure was significantly associated with tuberculosis incidence (WQS index IR%:8.34 %, 95 % CI:4.54 %-12.27 %) and mortality (WQS index IR%:19.49 %, 95 % CI: 9.72 %-30.13 %). Primary pollutants, black carbon and organic matter, contributed most of the overall mixture effect (over 85 %). Nitrate showed a critical role in tuberculosis burden in not-aging provinces and in regions at the Q3 stratum (i.e., the 3rd quartile) of GDP per capita and urbanization rate. Meanwhile the contribution of sulfate to tuberculosis burden in regions at the Q1 stratum of GDP per capita and urbanization rate was the largest among the effect of secondary pollutants (i.e., sulfate, nitrate, and ammonium).

CONCLUSION

The mitigation of black carbon and organic matter pollution may significantly reduce the tuberculosis burden in China. Controlling nitrate emissions and increasing clean energy (i.e., energy sources with limited pollution emissions, such as natural gas and clean coal) may also be effective in certain regions.

Long-term exposure to ambient fine particulate matter chemical composition and in-hospital case fatality among patients with stroke in China

Background

There is little evidence on the association between PM_2.5 chemical components and fatality among hospitalized stroke patients.

Methods

This study used an inpatient discharge database from 2013 to 2019 in four provinces (Sichuan, Shanxi, Guangxi, and Guangdong) in China. Annual average exposure to PM_2.5 and its five chemical components [black carbon (BC), organic matter (OM), sulphate ( S O 4 2 - ), nitrate ( N O 3 - ), and ammonium ( N H 4 + )] were estimated using bilinear interpolation at patient's residential address. Mixed-effects logistic regression models were conducted to estimate the odds ratios (ORs). Counterfactual analyses were used to estimate the population attributable burden (PAF).

Findings

Among 3,069,093 hospitalized patients with stroke, each interquartile (IQR) increment in PM_2.5 and its chemical components was significantly associated with stroke fatality: the ORs were 1.137 [95% confidence interval (CI): 1.118-1.157; IQR: 15.14 μg/m³] for PM_2.5, 1.108 (95% CI: 1.091-1.126; IQR: 0.71 μg/m³) for BC, 1.086 (95% CI: 1.069-1.104; IQR: 3.47 μg/m³) for OM, and 1.065 (95% CI: 1.048-1.083; IQR: 2.81 μg/m³) for S O 4 2 - . We did not find significant associations for N O 3 - (OR: 0.991, 95% CI: 0.975-1.008; IQR: 3.30 μg/m³). The associations were larger among patients with ischemic stroke than those with hemorrhagic stroke. The PAFs were 10.6% (95% CI: 9.1-12.2%) for BC, 9.9% (95% CI: 8.2-11.7%) for OM, and 6.6% (4.9-8.3%) for S O 4 2 - .

Interpretation

Ambient BC, OM, and S O 4 2 - might be important risk factors for stroke fatality. The findings advocate the need to develop tailored guidelines for PM chemical components and curb the emissions of the most hazardous chemical components.

Funding

Bill & Melinda Gates Foundation (INV-016826).

Insight into the oxidation of glutathione mediated by black carbon from three typical emission sources

Black carbon (BC) is released into the atmosphere in large quantities from different emission sources each year and poses a serious threat to human health. These BC possessed a variety of characteristics and different mediation abilities for the reactive oxygen species (ROS) generation. In this study, we collected BC (i.e., diesel BC, coal BC and wood BC) from three typica emission sources, and examined their mediation abilities to the oxidation of glutathione (GSH). Results showed that all three BC significantly promoted the GSH oxidation, and the mediation efficiencies were as follows: diesel BC > coal BC > wood BC. In comparison with the water-soluble fraction, the mediation abilities of three BC mainly came from their solid phase fractions. In the coal BC and wood BC systems, the oxidation of GSH was attributed to the catalysis of transition metals in BC. By contrast, the transition metals, phenolic -OH and persistent free radicals in diesel BC were identified as the active sites responsible for the GSH oxidation. In addition, the graphitic surface of diesel BC could synergize with these active sites to accelerate the oxidation of GSH. Under the catalysis of BC, dissolved oxygen was first reduced to ROS (O₂^•- and H₂O₂) and then caused the GSH oxidation. These findings not only help to better assess the adverse health effects of different BC, but also deepen the understanding of the reaction mechanisms.

Long-term exposure to ambient ozone and mortality in a population-based cohort of South Korea: Considering for an alternative exposure time metric

Studies on the health effects of long-term ozone exposure remain limited with mixed results. One potential source of this inconsistency is the difference in exposure time metrics. This study aimed to investigate the association between long-term exposure to ambient ozone and mortality in South Korea, using different exposure metrics. We also examined whether heterogeneity between previous studies was due to the different exposure metrics. The study population comprised 179,806 participants from the National Health Insurance Service-National Sample Cohort (2002-2015) residing in seven major cities in South Korea. Several ozone exposure metrics (year-round 24-h, year-round 8-h, warm-season 24-h, and warm-season 8-h) were calculated. Time-varying Cox proportional hazards models were used to estimate the association between ozone and all-cause and cause-specific mortalities. Random-effect meta-analysis and meta-regression analysis were performed to pool the effect estimates of previous studies and examine whether the exposure metric can explain the between-study heterogeneity. The hazard ratios (HRs) per 10 ppb increment in year-round 24-h ozone for all-cause (HR, 1.18; 95% CI, 1.07-1.29) and circulatory (HR, 1.52; 95% CI, 1.25-1.84) mortality were higher than those of the other metrics. Year-round 8-h ozone exhibited the largest association with respiratory mortality (HR, 1.43; 95% CI, 1.04-1.96). A meta-analysis of 29 previous studies and the present study showed the largest HR for all-cause mortality from studies using year-round 8-h exposure (HR, 1.014; 95% CI, 0.994-1.033). The exposure metric was significantly associated with effect estimates in the multivariable meta-regression model. In conclusion, in the population-based cohort in South Korea, we found positive associations between several long-term ozone exposure metrics and mortality. The different ozone exposure metrics exhibited heterogeneous effect estimates. A year-round 24-h average ozone metric also could be considered an alternative long-term standard for ozone.

Acute ambulatory blood pressure response to short-term black carbon exposure: The MobiliSense sensor-based study

Documented relationships between black carbon (BC) exposure and blood pressure (BP) have been inconsistent. Very few studies measured both BC exposure and ambulatory BP across the multiple daily environments visited in the general population, and none adjusted for personal noise exposure, a major confounder. Our study addresses these gaps by considering 245 adults living in the Grand Paris region. Personal exposure to BC was monitored for 2 days using AE51 microaethalometers. Ambulatory BP was measured every 30 min after waking up using Arteriograph 24 monitors (n = 6772). Mixed effect models with a random intercept at the individual level and time-autocorrelation structure adjusted for personal noise exposure were used to evaluate the associations between BC exposure (averaged from 5 min to 1 h before each BP measurement) and BP. To increase the robustness of findings, we eliminated confounding by unmeasured time-invariant personal variables, by modelling the associations with fixed-effect models. All models were adjusted for potential confounders and short-term time trends. Results from mixed models show that a 1-μg/m³ increase in 5-minute averaged BC exposure was associated with an increase of 0.57 mmHg in ambulatory systolic blood pressure (SBP) (95 % CI: 0.30, 0.83) and with an increase of 0.36 mmHg in diastolic blood pressure (DBP) (95 % CI: 0.14, 0.58). The slope of the exposure-response relationship gradually decreased for both SBP and DBP with the increase in the averaging period of BC exposure from 5 min to 1 h preceding each BP measurement. Findings from the fixed-effect models were consistent with these results. There was no effect modification by noise in the associations, across all exposure windows. We found evidence of a relationship between BC exposure and acute increase in ambulatory SBP and DBP after adjustment for personal noise exposure, with potential implications for the development of adverse cardiovascular outcomes.

The Accuracy of Semi-Empirical Quantum Chemistry Methods on Soot Formation Simulation

Soot molecules are hazardous compounds threatening human health. Computational chemistry provides efficient tools for studying them. However, accurate quantum chemistry calculation is costly for the simulation of large-size soot molecules and high-throughput calculations. Semi-empirical (SE) quantum chemistry methods are optional choices for balancing computational costs. In this work, we validated the performances of several widely used SE methods in the description of soot formation. Our benchmark study focuses on, but is not limited to, the validation of the performances of SE methods on reactive and non-reactive MD trajectory calculations. We also examined the accuracy of SE methods of predicting soot precursor structures and energy profiles along intrinsic reaction coordinate(s) (IRC). Finally, we discussed the spin density predicted by SE methods. The SE methods validated include AM1, PM6, PM7, GFN2-xTB, DFTB2, with or without spin-polarization, and DFTB3. We found that the shape of MD trajectory profiles, the relative energy, and molecular structures predicted by SE methods are qualitatively correct. We suggest that SE methods can be used in massive reaction soot formation event sampling and primary reaction mechanism generation. Yet, they cannot be used to provide quantitatively accurate data, such as thermodynamic and reaction kinetics ones.

The impact of black carbon (BC) on mode-specific galvanic skin response (GSR) as a measure of stress in urban environments

Previous research has shown that walking and cycling could help alleviate stress in cities, however there is poor knowledge on how specific microenvironmental conditions encountered during daily journeys may lead to varying degrees of stress experienced at that moment. We use objectively measured data and a robust causal inference framework to address this gap. Using a Bayesian Doubly Robust (BDR) approach, we find that black carbon exposure statistically significantly increases stress, as measured by Galvanic Skin Response (GSR), while cycling and while walking. Augmented Outcome Regression (AOR) models indicate that greenspace exposure and the presence of walking or cycling infrastructure could reduce stress. None of these effects are statistically significant for people in motorized transport. These findings add to a growing evidence-base on health benefits of policies aimed at decreasing air pollution, improving active travel infrastructure and increasing greenspace in cities.

Geographically resolved social cost of anthropogenic emissions accounting for both direct and climate-mediated effects

The magnitude and distribution of physical and societal impacts from long-lived greenhouse gases are insensitive to the emission source location; the same is not true for major coemitted short-lived pollutants such as aerosols. Here, we combine novel global climate model simulations with established response functions to show that a given aerosol emission from different regions produces divergent air quality and climate changes and associated human system impacts, both locally and globally. The marginal global damages to infant mortality, crop productivity, and economic growth from aerosol emissions and their climate effects differ by more than an order of magnitude depending on source region, with certain regions creating global external climate changes and impacts much larger than those felt locally. The complex distributions of aerosol-driven societal impacts emerge from geographically distinct and region-specific aerosol-climate interactions, estimation of which is enabled by the full Earth System Modeling Framework used here.

Mortality risk and long-term exposure to ultrafine particles and primary fine particle components in a national U.S. Cohort

The objective of this study was to estimate all-cause, cardiopulmonary, and cancer mortality associations for long-term exposure to ultrafine particles (UFP) and primary PM_2.5 components. We utilized high-resolution, national-scale exposure estimates for UFP (measured as particle number concentration; PNC) and three primary PM_2.5 components, namely black carbon (BC), traffic-emitted organic PM_2.5 (hereafter, hydrocarbon-like organic aerosols; HOA), and cooking-emitted organic PM_2.5 (cooking organic aerosols; COA). Two analytic cohorts were constructed from a nationally representative U.S. health survey. The larger cohort consisted of 617,997 adults with information on a broad set of individual-level risk factors; the smaller cohort was further restricted to those with information on physical activity (n = 396,470). In single-pollutant models, PNC was significantly associated with all-cause (larger cohort HR = 1.03, 95% CI [1.02, 1.04]; smaller cohort HR = 1.02, 95% CI [1.00, 1.04]) and cancer mortality (larger cohort HR = 1.05, 95% CI [1.02, 1.08]; smaller cohort HR = 1.06, 95% CI [1.02, 1.10]). In two-pollutant models, mortality associations varied based on co-pollutant adjustment; PNC mortality associations were generally robust to controlling for PM_10-2.5 and SO₂, but not PM_2.5. In contrast, we found some evidence that the HOA and COA mortality associations are independent of total PM_2.5 mass exposure. Nevertheless, PM_2.5 mass was the most robust predictor of air pollution related mortality, providing some support for current regulatory policies.

Increased energy use for adaptation significantly impacts mitigation pathways

Climate adaptation actions can be energy-intensive, but how adaptation feeds back into the energy system and the environment is absent in nearly all up-to-date energy scenarios. Here we quantify the impacts of adaptation actions entailing direct changes in final energy use on energy investments and costs, greenhouse gas emissions, and air pollution. We find that energy needs for adaptation increase considerably over time and with warming. The resulting addition in capacity for power generation leads to higher greenhouse gas emissions, local air pollutants, and energy system costs. In the short to medium term, much of the added capacity for power generation is fossil-fuel based. We show that mitigation pathways accounting for the adaptation-energy feedback would require a higher global carbon price, between 5% and 30% higher. Because of the benefits in terms of reduced adaptation needs, energy system costs in ambitious mitigation scenarios would be lower than previous estimates, and they would turn negative in well-below-2-degree scenarios, pointing at net gains in terms of power system costs.

Cardiopulmonary Mortality and Fine Particulate Air Pollution by Species and Source in a National U.S. Cohort

The purpose of this study was to estimate cardiopulmonary mortality associations for long-term exposure to PM_2.5 species and sources (i.e., components) within the U.S. National Health Interview Survey cohort. Exposures were estimated through a chemical transport model for six species (i.e., elemental carbon (EC), primary organic aerosols (POA), secondary organic aerosols (SOA), sulfate (SO₄), ammonium (NH₄), nitrate (NO₃)) and five sources of PM_2.5 (i.e., vehicles, electricity-generating units (EGU), non-EGU industrial sources, biogenic sources (bio), "other" sources). In single-pollutant models, we found positive, significant (p < 0.05) mortality associations for all components, except POA. After adjusting for remaining PM_2.5 (total PM_2.5 minus component), we found significant mortality associations for EC (hazard ratio (HR) = 1.36; 95% CI [1.12, 1.64]), SOA (HR = 1.11; 95% CI [1.05, 1.17]), and vehicle sources (HR = 1.06; 95% CI [1.03, 1.10]). HRs for EC, SOA, and vehicle sources were significantly larger in comparison to those for remaining PM_2.5 (per unit μg/m³). Our findings suggest that cardiopulmonary mortality associations vary by species and source, with evidence that EC, SOA, and vehicle sources are important contributors to the PM_2.5 mortality relationship. With further validation, these findings could facilitate targeted pollution regulations that more efficiently reduce air pollution mortality.

Applied Machine Learning in Industry 4.0: Case-Study Research in Predictive Models for Black Carbon Emissions

Industry 4.0 constitutes a major application domain for sensor data analytics. Industrial furnaces (IFs) are complex machines made with special thermodynamic materials and technologies used in industrial production applications that require special heat treatment cycles. One of the most critical issues while operating IFs is the emission of black carbon (EoBC), which is due to a large number of factors such as the quality and amount of fuel, furnace efficiency, technology used for the process, operation practices, type of loads and other aspects related to the process conditions or mechanical properties of fluids at furnace operation. This paper presents a methodological approach to predict EoBC during the operation of IFs with the use of predictive models of machine learning (ML). We make use of a real data set with historical operation to train ML models, and through evaluation with real data we identify the most suitable approach that best fits the characteristics of the data set and implementation constraints in real production environments. The evaluation results confirm that it is possible to predict the undesirable EoBC well in advance, by means of a predictive model. To the best of our knowledge, this paper is the first approach to detail machine-learning concepts for predicting EoBC in the IF industry.

Cohort-based long-term ozone exposure-associated mortality risks with adjusted metrics: A systematic review and meta-analysis

Long-term ozone (O3) exposure may lead to non-communicable diseases and increase mortality risk. However, cohort-based studies are relatively rare, and inconsistent exposure metrics impair the credibility of epidemiological evidence synthetization. To provide more accurate meta-estimations, this study updates existing systematic reviews by including recent studies and summarizing the quantitative associations between O3 exposure and cause-specific mortality risks, based on unified exposure metrics. Cross-metric conversion factors were estimated linearly by decadal observations during 1990-2019. The Hunter-Schmidt random-effects estimator was applied to pool the relative risks. A total of 25 studies involving 226,453,067 participants (14 unique cohorts covering 99,855,611 participants) were included in the systematic review. After linearly unifying the inconsistent O3 exposure metrics , the pooled relative risks associated with every 10 nmol mol-1 (ppbV) incremental O3 exposure, by mean of the warm-season daily maximum 8-h average metric, were as follows: 1.014 with 95% confidence interval (CI) ranging 1.009-1.019 for all-cause mortality; 1.025 (95% CI: 1.010-1.040) for respiratory mortality; 1.056 (95% CI: 1.029-1.084) for COPD mortality; 1.019 (95% CI: 1.004-1.035) for cardiovascular mortality; and 1.074 (95% CI: 1.054-1.093) for congestive heart failure mortality. Insignificant mortality risk associations were found for ischemic heart disease, cerebrovascular diseases, and lung cancer. Adjustment for exposure metrics laid a solid foundation for multi-study meta-analysis, and widening coverage of surface O3 observations is expected to strengthen the cross-metric conversion in the future. Ever-growing numbers of epidemiological studies supported the evidence for considerable cardiopulmonary hazards and all-cause mortality risks from long-term O3 exposure. However, evidence of long-term O3 exposure-associated health effects was still scarce, so more relevant studies are needed to cover more populations with regional diversity.

Variations of Black Carbon Concentrations in Two Sites in Mexico: A High-Altitude National Park and a Semi-Urban Site

Black carbon (BC), a component of carbonaceous material, has an important role in the environment, and it is considered a short-lived climate forcer that plays a vital role in the global climate system. BC concentrations were analyzed during 2017 in two sites in Mexico, Juriquilla and Altzomoni, which have different emission sources and atmospheric dynamics. The annual average BC concentrations in 2017 were 0.84 ± 0.70 and 0.58 ± 0.37 µg m−3 for Juriquilla and Altzomoni, respectively. The principal contributors for the highest BC concentration in Juriquilla were anthropogenic sources, while pollutants transport from nearby cities was more important for Altzomoni. Comparison between this analysis and previous reports from 2015 for both sampling sites demonstrated an increase in BC concentration. Results of this study could contribute to a better understanding of BC effects under different emission conditions and provide a scientific reference for developing BC reduction strategies over Mexico.

Long-term exposure to PM2.5 major components and mortality in the southeastern United States

BACKGROUND

Long-term exposure to fine particulate matter (PM_2.5) mass has been associated with adverse health effects. However, the health effects of PM_2.5 components have been less studied. There is a pressing need to better understand the relative contribution of components of PM_2.5, which can lay the scientific basis for designing effective policies and targeted interventions.

METHODS

We conducted a population-based cohort study, comprising all Medicare enrollees aged 65 or older in the southeastern United States from 2000 to 2016, to explore the associations between long-term exposure to PM_2.5 major components and all-cause mortality among the elderly. Based on well-validated prediction models, we estimated ZIP code-level annual mean concentrations for five major PM_2.5 components, including black carbon (BC), nitrate (NIT), organic matter (OM), sulfate (SO₄), and soil particles. Data were analyzed using Cox proportional hazards models, adjusting for potential confounders.

RESULTS

The cohort comprised 13,590,387 Medicare enrollees and a total of 107,191,652 person-years. In single-component models, all five major PM_2.5 components were significantly associated with elevated all-cause mortality. The hazard ratios (HR) per interquartile range (IQR) increase in exposure were 1.027 (95% CI: 1.025-1.030), 1.012 (95% CI: 1.010-1.013), 1.018 (95% CI: 1.017-1.020), 1.021 (95% CI: 1.017-1.024), and 1.004 (95% CI: 1.003-1.006) for BC, NIT, OM, SO₄, and soil particles, respectively. While the effect estimate of soil component was statistically significant, it is much smaller than those of combustion-related components.

CONCLUSION

Our study provides epidemiological evidence that long-term exposure to major PM_2.5 components is significantly associated with elevated mortality.

Contributions of internal emissions to peaks and incremental indoor PM2.5 in rural coal use households

Indoor air quality is critically important to the human as people spend most time indoors. Indoor PM_2.5 is related to the outdoor levels, but more directly influenced by internal sources. Severe household air pollution from solid fuel use has been recognized as one major risk for human health especailly in rural area, however, the issue is significantly overlooked in most national air quality controls and intervention policies. Here, by using low-cost sensors, indoor PM_2.5 in rural homes burning coals was monitored for ~4 months and analyzed for its temporal dynamics, distributions, relationship with outdoor PM_2.5, and quantitative contributions of internal sources. A bimodal distribution of indoor PM_2.5 was identified and the bimodal characteristic was more significant at the finer time resolution. The bimodal distribution maxima were corresponding to the emissions from strong internal sources and the influence of outdoor PM_2.5, respectively. Indoor PM_2.5 was found to be correlated with the outdoor PM_2.5, even though indoor coal combustion for heating was thought to be predominant source of indoor PM_2.5. The indoor-outdoor relationship differed significantly between the heating and non-heating seasons. Impacts of typical indoor sources like cooking, heating associated with coal use, and smoking were quantitatively analyzed based on the highly time-resolved PM_2.5. Estimated contribution of outdoor PM_2.5 to the indoor PM_2.5 was ~48% during the non-heating period, but decreased to about 32% during the heating period. The contribution of indoor heating burning coals comprised up to 47% of the indoor PM_2.5 during the heating period, while the other indoor sources contributed to ~20%. The study, based on a relatively long-term timely resolved PM_2.5 data from a large number of rural households, provided informative results on temporal dynamics of indoor PM_2.5 and quantitative contributions of internal sources, promoting scientific understanding on sources and impacts of household air pollution.

Environmental risk factors and cardiovascular diseases: a comprehensive review

Noncommunicable diseases (NCDs) are fatal for more than 38 million people each year and are thus the main contributors to the global burden of disease accounting for 70% of mortality. The majority of these deaths are caused by cardiovascular disease. The risk of NCDs is strongly associated with exposure to environmental stressors such as pollutants in the air, noise exposure, artificial light at night and climate change, including heat extremes, desert storms and wildfires. In addition to the traditional risk factors for cardiovascular disease such as diabetes, arterial hypertension, smoking, hypercholesterolemia and genetic predisposition, there is a growing body of evidence showing that physicochemical factors in the environment contribute significantly to the high NCD numbers. Furthermore, urbanization is associated with accumulation and intensification of these stressors. This comprehensive expert review will summarize the epidemiology and pathophysiology of environmental stressors with a focus on cardiovascular NCDs. We will also discuss solutions and mitigation measures to lower the impact of environmental risk factors with focus on cardiovascular disease.

Planetary Health, Climate Change, and Lifestyle Medicine: Threats and Opportunities

Global environmental degradation and climate change threaten the foundation of human health and well-being. In a confluence of crises, the accelerating pace of climate change and other environmental disruptions pose an additional, preventable danger to a global population that is both aging and carrying a growing burden of noncommunicable diseases (NCDs). Climate change and environmental disruption function as "threat multipliers," especially for those with NCDs, worsening the potential health impacts on those with suboptimal health. At the same time, these environmental factors threaten the basic pillars of health and prevention, increasing the risk of developing chronic disease. In the face of these threats, the core competencies of lifestyle medicine (LM) present crucial opportunities to mitigate climate change and human health impacts while also allowing individuals and communities to build resilience. LM health professionals are uniquely positioned to coach patients toward climate-healthy behavior changes that heal both people and the planet.

Ambient Air Pollution and Atherosclerosis: Recent Updates

Purpose of Review

During the past century, exposure to particulate matter (PM) air pollution < 2.5 μm in diameter (PM_2.5) has emerged as an all-pervading element of modern-day society. This increased exposure has come at the cost of heightened risk for cardiovascular (CV) morbidity and mortality. Not only can short-term PM_2.5 exposure trigger acute CV events in susceptible individuals, but longer-term exposure over years augments CV risk to a greater extent in comparison with short-term exposure. The purpose of this review is to examine the available evidence for how ambient air pollution exposure may precipitate events at various time frames.

Recent Findings

Recent epidemiological studies have demonstrated an association between ambient PM_2.5 exposure and the presence and progression of atherosclerosis in humans. Multiple animal exposure experiments over two decades have provided strong corroborative evidence that chronic exposure in fact does enhance the progression and perhaps vulnerability characteristics of atherosclerotic lesions.

Summary

Evidence from epidemiological studies including surrogates of atherosclerosis, human translational studies, and mechanistic investigations utilizing animal studies have improved our understanding of how ambient air pollution may potentiate atherosclerosis and precipitate cardiovascular events. Even so, future research is needed to fully understand the contribution of different constituents in ambient air pollution–mediated atherosclerosis as well as how other systems may modulate the impact of exposure including adaptive immunity and the gut microbiome. Nevertheless, due to the billions of people continually exposed to PM_2.5, the long-term pro-atherosclerotic effects of this ubiquitous air pollutant are likely to be of enormous and growing global public health importance.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11883-021-00958-9.

Exploring smoke: an ethnographic study of air pollution in rural Malawi

Air pollution adversely affects human health, and the climate crisis intensifies the global imperative for action. Low-/middle-income countries (LMIC) suffer particularly high attributable disease burdens. In rural low-resource settings, these are linked to cooking using biomass. Proposed biomedical solutions to air pollution typically involve ‘improved cooking technologies’, often introduced by high-income country research teams. This ethnography, set in a rural Malawian village, aimed to understand air pollution within its social and environmental context. The results provide a multifaceted account through immersive participant observations with concurrent air quality monitoring, interviews and participatory workshops. Data included quantitative measures of individuals’ air pollution exposures paired with activity, qualitative insights into how smoke is experienced in daily life throughout the village, and participants’ reflections on potential cleaner air solutions. Individual air quality monitoring demonstrated that particulate levels frequently exceeded upper limits recommended by the WHO, even in the absence of identified sources of biomass burning. Ethnographic findings revealed the overwhelming impact of economic scarcity on individual air pollution exposures. Scarcity affected air pollution exposures through three pathways: daily hardship, limitation and precarity. We use the theory of structural violence, as described by Paul Farmer, and the concept of slow violence to interrogate the origins of this scarcity and global inequality. We draw on the ethnographic findings to critically consider sustainable approaches to cleaner air, without re-enacting existing systemic inequities.

Science Policy to Advance a Climate Change and Health Research Agenda in the United States

Climate change is thought to be one of the greatest public health threats of the 21st century and there has been a tremendous growth in the published literature describing the health implications of climate change over the last decade. Yet, there remain several critical knowledge gaps in this field. Closing these gaps is crucial to developing effective interventions to minimize the health risks from climate change. In this commentary, we discuss policy trends that have influenced the advancement of climate change and health research in the United States context. We then enumerate specific knowledge gaps that could be addressed by policies to advance scientific research. Finally, we describe tools and methods that have not yet been fully integrated into the field, but hold promise for advancing the science. Prioritizing this advancement offers the potential to improve public health-related policies on climate change.

Relationship between ambient black carbon and daily mortality in Tehran, Iran: a distributed lag nonlinear time series analysis

PURPOSE

The aim of the present study was to investigate the effect of short-term exposure to ambient black carbon (BC) on daily cause-specific mortality, including mortality due to respiratory, cardiovascular, ischemic heart and cerebrovascular diseases in Tehran, Iran.

MATERIALS AND METHODS

Daily non-accidental death counts, meteorological data and hourly concentrations of air pollutants from 2014 to 2017 were collected in Tehran. A distributed lag non-linear model was used to assess the association between exposure to BC and daily mortality.

RESULTS

The mean daily BC concentration during the study period was 3.96 ± 1.19 µg/m³. The results indicated that BC was significantly associated with cardiovascular, ischemic heart disease, and cerebrovascular mortality, but not with respiratory mortality. In first model, each 10 µg/m³ increase in at lag 3, lag 4 and lag 5 were associated with cardiovascular mortality in 16-65 year age group with the relative risks (RRs) of 1.17 (95 % CI: 1.02-1.33), 1.17 (95 % CI: 1.04-1.31) and 1.12 (95 % CI: 1.02-1.24), respectively. The highest mortality rate per 10 µg/m³ increase in exposure was found for ischemic heart diseases with RR of 3.98 (95 % CI: 1.04-1.81, lag 01) for 16-65 age group. Cerebrovascular mortality was associated with 10 µg/m³ increases in non-cumulative exposure with RR of 1.17 (95 % 1.009-1.35, lag 5) in the age group ≥ 65 years. In the second model for a 10 µg/m³ increase in BC, cardiovascular mortality at specific lag days (5 and 6 days) in the age group ≤ 16 years were associated with RR of 1.34 (95 % CI 1.08-1.66) and 1.35(95 % CI 1.02-1.77), respectively.

CONCLUSIONS

This study in Tehran found significant effects of BC exposure on daily mortality for cardiovascular, ischemic heart disease, cerebrovascular disease.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40201-021-00659-0.

Positive Externalities of Climate Change Mitigation and Adaptation for Human Health: A Review and Conceptual Framework for Public Health Research

Anthropogenic climate change is adversely impacting people and contributing to suffering and increased costs from climate-related diseases and injuries. In responding to this urgent and growing public health crisis, mitigation strategies are in place to reduce future greenhouse gas emissions (GHGE) while adaptation strategies exist to reduce and/or alleviate the adverse effects of climate change by increasing systems' resilience to future impacts. While these strategies have numerous positive benefits on climate change itself, they also often have other positive externalities or health co-benefits. This knowledge can be harnessed to promote and improve global public health, particularly for the most vulnerable populations. Previous conceptual models in mitigation and adaptation studies such as the shared socioeconomic pathways (SSPs) considered health in the thinking, but health outcomes were not their primary intention. Additionally, existing guidance documents such as the World Health Organization (WHO) Guidance for Climate Resilient and Environmentally Sustainable Health Care Facilities is designed primarily for public health professionals or healthcare managers in hospital settings with a primary focus on resilience. However, a detailed cross sectoral and multidisciplinary conceptual framework, which links mitigation and adaptation strategies with health outcomes as a primary end point, has not yet been developed to guide research in this area. In this paper, we briefly summarize the burden of climate change on global public health, describe important mitigation and adaptation strategies, and present key health benefits by giving context specific examples from high, middle, and low-income settings. We then provide a conceptual framework to inform future global public health research and preparedness across sectors and disciplines and outline key stakeholders recommendations in promoting climate resilient systems and advancing health equity.

The public health implications of the Paris Agreement: a modelling study

BACKGROUND

nationally determined contributions (NDCs) serve to meet the goals of the Paris Agreement of staying "well below 2°C", which could also yield substantial health co-benefits in the process. However, existing NDC commitments are inadequate to achieve this goal. Placing health as a key focus of the NDCs could present an opportunity to increase ambition and realise health co-benefits. We modelled scenarios to analyse the health co-benefits of NDCs for the year 2040 for nine representative countries (ie, Brazil, China, Germany, India, Indonesia, Nigeria, South Africa, the UK, and the USA) that were selected for their contribution to global greenhouse gas emissions and their global or regional influence.

METHODS

Modelling the energy, food and agriculture, and transport sectors, and mortality related to risk factors of air pollution, diet, and physical activity, we analysed the health co-benefits of existing NDCs and related policies (ie, the current pathways scenario) for 2040 in nine countries around the world. We compared these health co-benefits with two alternative scenarios, one consistent with the goal of the Paris Agreement and the Sustainable Development Goals (ie, the sustainable pathways scenario), and one in line with the sustainable pathways scenario, but also placing health as a central focus of the policies (ie, the health in all climate policies scenario).

FINDINGS

Compared with the current pathways scenario, the sustainable pathways scenario resulted in an annual reduction of 1·18 million air pollution-related deaths, 5·86 million diet-related deaths, and 1·15 million deaths due to physical inactivity, across the nine countries, by 2040. Adopting the more ambitious health in all climate policies scenario would result in a further reduction of 462 000 annual deaths attributable to air pollution, 572 000 annual deaths attributable to diet, and 943 000 annual deaths attributable to physical inactivity. These benefits were attributable to the mitigation of direct greenhouse gas emissions and the commensurate actions that reduce exposure to harmful pollutants, as well as improved diets and safe physical activity.

INTERPRETATION

A greater consideration of health in the NDCs and climate change mitigation policies has the potential to yield considerable health benefits as well as achieve the "well below 2°C" commitment across a range of regional and economic contexts.

FUNDING

This work was in part funded through an unrestricted grant from the Wellcome Trust (award number 209734/Z/17/Z) and supported by an Engineering and Physical Sciences Research Council grant (grant number EP/R035288/1).

Transdisciplinary Research Priorities for Human and Planetary Health in the Context of the 2030 Agenda for Sustainable Development

Human health and wellbeing and the health of the biosphere are inextricably linked. The state of Earth's life-support systems, including freshwater, oceans, land, biodiversity, atmosphere, and climate, affect human health. At the same time, human activities are adversely affecting natural systems. This review paper is the outcome of an interdisciplinary workshop under the auspices of the Future Earth Health Knowledge Action Network (Health KAN). It outlines a research agenda to address cross-cutting knowledge gaps to further understanding and management of the health risks of these global environmental changes through an expert consultation and review process. The research agenda has four main themes: (1) risk identification and management (including related to water, hygiene, sanitation, and waste management); food production and consumption; oceans; and extreme weather events and climate change. (2) Strengthening climate-resilient health systems; (3) Monitoring, surveillance, and evaluation; and (4) risk communication. Research approaches need to be transdisciplinary, multi-scalar, inclusive, equitable, and broadly communicated. Promoting resilient and sustainable development are critical for achieving human and planetary health.

Estimation of Surface Concentrations of Black Carbon from Long-Term Measurements at Aeronet Sites over Korea

We estimated fine-mode black carbon (BC) concentrations at the surface using AERONET data from five AERONET sites in Korea, representing urban, rural, and background. We first obtained the columnar BC concentrations by separating the refractive index (RI) for fine-mode aerosols from AERONET data and minimizing the difference between separated RIs and calculated RIs using a mixing rule that can represent a real aerosol mixture (Maxwell Garnett for water-insoluble components and volume average for water-soluble components). Next, we acquired the surface BC concentrations by establishing a multiple linear regression (MLR) between in-situ BC concentrations from co-located or adjacent measurement sites, and columnar BC concentrations, by linearly adding meteorological parameters, month, and land-use type as the independent variables. The columnar BC concentrations estimated from AERONET data using a mixing rule well reproduced site-specific monthly variations of the in-situ measurement data, such as increases due to heating and/or biomass burning and long-range transport associated with prevailing westerlies in the spring and winter, and decreases due to wet scavenging in the summer. The MLR model exhibited a better correlation between measured and predicted BC concentrations than those based on columnar concentrations only, with a correlation coefficient of 0.64. The performance of our MLR model for BC was comparable to that reported in previous studies on the relationship between aerosol optical depth and particulate matter concentration in Korea. This study suggests that the MLR model with properly selected parameters is useful for estimating the surface BC concentration from AERONET data during the daytime, at sites where BC monitoring is not available.

Long-term exposure to NO2 and O3 and all-cause and respiratory mortality: A systematic review and meta-analysis

BACKGROUND

WHO has published several volumes of Global Air Quality Guidelines to provide guidance on the health risks associated with exposure to outdoor air pollution. As new scientific evidence is generated, air quality guidelines need to be periodically revised and, where necessary, updated.

OBJECTIVES

The aims of the study were 1) to summarise the available evidence on the effect of long-term exposure to ozone (O3) and nitrogen dioxide (NO2) on mortality; 2) and to assess concentration response functions (CRF), their shape and the minimum level of exposures measured in studies to support WHO's update of the global air quality guidelines.

DATA SOURCES

We conducted a systematic literature search of the Medline, Embase and Web of Science databases following a protocol proposed by WHO and applied Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines for reporting our results.

STUDY ELIGIBILITY CRITERIA

Cohort studies in human populations (including sub-groups at risk) exposed to long-term concentrations of NO2 and O3. Outcomes assessed were all-cause, respiratory, Chronic Obstructive Pulmonary Disease (COPD) and Acute Lower Respiratory Infection (ALRI) mortality.

STUDY APPRAISAL AND SYNTHESIS METHODS

Studies included in the meta-analyses were assessed using a new Risk of Bias instrument developed by a group of experts convened by WHO. Study results are presented in forest plots and quantitative meta-analyses were conducted using random effects models. The certainty of evidence was assessed using a newly developed adaptation of GRADE.

RESULTS

The review identified 2068 studies of which 95 were subject to full-text review with 45 meeting the inclusion criteria. An update in September 2018 identified 159 studies with 1 meeting the inclusion criteria. Of the 46 included studies, 41 reported results for NO2 and 20 for O3. The majority of studies were from the USA and Europe with the remainder from Canada, China and Japan. Forty-two studies reported results for all-cause mortality and 22 for respiratory mortality. Associations for NO2 and mortality were positive; random-effects summary relative risks (RR) were 1.02 (95% CI: 1.01, 1.04), 1.03 (1.00, 1.05), 1.03 (1.01, 1.04) and 1.06 (1.02, 1.10) per 10 μg/m3 for all-cause (24 cohorts), respiratory (15 cohorts), COPD (9 cohorts) and ALRI (5 cohorts) mortality respectively. The review identified high levels of heterogeneity for all causes of death except COPD. A small number of studies investigated the shape of the concentration-response relationship and generally found little evidence to reject the assumption of linearity across the concentration range. Studies of O3 using annual metrics showed the associations with all-cause and respiratory mortality were 0.97 (0.93, 1.02) and 0.99 (0.89, 1.11) per 10 μg/m3 respectively. For studies using peak O3 metrics, the association with all-cause mortality was 1.01 (1.00, 1.02) and for respiratory mortality 1.02 (0.99, 1.05), each per 10 μg/m3. The review identified high levels of heterogeneity. Few studies investigated the shape of the concentration-response relationship. Certainty in the associations (adapted GRADE) with mortality was rated low to moderate for each exposure-outcome pair, except for NO2 and COPD mortality which was rated high.

LIMITATIONS

The substantial heterogeneity for most outcomes in the review requires explanation. The evidence base is limited in terms of the geographical spread of the study populations and, for some outcomes, the small number of independent cohorts for meta-analysis precludes meaningful meta-regression to explore causes of heterogeneity. Relatively few studies assessed specifically the shape of the CRF or multi-pollutant models.

CONCLUSIONS

The short-comings in the existing literature base makes determining the precise nature (magnitude and linearity) of the associations challenging. Certainty of evidence assessments were moderate or low for both NO2 and O3 for all causes of mortality except for NO2 and COPD mortality where the certainty of the evidence was judged as high.

Sources of black carbon during severe haze events in the Beijing-Tianjin-Hebei region using the adjoint method

The Beijing-Tianjin-Hebei (BTH) region in China has been frequently suffering from severe haze events (observed daily mean surface fine particulate matter PM_2.5 concentrations larger than 150 μg m^-3) partially caused by certain types of large-scale synoptic patterns. Black carbon (BC), as an important PM_2.5 component and a primarily emitted species, is a good tracer for investigating sources and formation mechanisms leading to severe haze pollutions. We apply GEOS-Chem model and its adjoint to quantify the source contributions to BC concentrations at the surface and at the top of the planetary boundary layer (PBL) during typical types of severe haze events for April 2013-2017 in BTH. Four types of severe haze events, mainly occurred in December-January-February (DJF, 62.3%) and in September-October-November (SON, 26.3%), are classified based on the associated synoptic weather patterns using principal component analysis. Model results reasonably capture the daily variations of BC measurements at three ground sites in BTH. The adjoint method attributes BC concentrations to emissions from different source sectors and from local versus regional transport at the model spatial and temporal resolutions. By source sectors, the adjoint method attributes the daily BC concentrations during typical severe haze events (in winter heating season) in Beijing largely to residential emissions (48.1-62.0%), followed by transportation (16.8-25.9%) and industry (19.1-29.5%) sectors. In terms of regionally aggregated source influences, local emissions in Beijing (59.6-79.5%) predominate the daily surface BC concentrations, while contributions of emissions from Beijing, Hebei, and outside BTH regions are comparable to the daily BC concentrations at the top of PBL (~200-400 m). Our adjoint analyses would provide a scientific support for joint regional and targeted control policies on effectively mitigating the particulate pollutions when the dominant synoptic weather patterns are predicted.

Environmental determinants of cardiovascular disease: lessons learned from air pollution

Air pollution is well recognized as a major risk factor for chronic non-communicable diseases and has been estimated to contribute more to global morbidity and mortality than all other known environmental risk factors combined. Although air pollution contains a heterogeneous mixture of gases, the most robust evidence for detrimental effects on health is for fine particulate matter (particles ≤2.5 µm in diameter (PM2.5)) and ozone gas and, therefore, these species have been the main focus of environmental health research and regulatory standards. The evidence to date supports a strong link between the risk of cardiovascular events and all-cause mortality with PM2.5 across a range of exposure levels, including to levels below current regulatory standards, with no 'safe' lower exposure levels at the population level. In this comprehensive Review, the empirical evidence supporting the effects of air pollution on cardiovascular health are examined, potential mechanisms that lead to increased cardiovascular risk are described, and measures to reduce this risk and identify key gaps in our knowledge that could help address the increasing cardiovascular morbidity and mortality associated with air pollution are discussed.

1,4NQ-BC enhances the lung inflammation by mediating the secretion of IL-33 which derived from macrophages

Black carbon (BC) is a product of incomplete combustion of fossil fuels and vegetation. The compelling evidence has demonstrated that it has a close relationship with several respiratory and cardiovascular diseases. BC provides the reactive sites and surfaces to absorb various chemicals, such as polycyclic aromatic hydrocarbons (PAH). Naphthoquinone is a typical PAHs which was found in particulate matter (PM) and 1,4NQ-BC owned high oxidative potential and cytotoxicity. IL-33 is an alarmin which increases innate immunity through Th2 responses. It was reported that IL-33 was a potent inducer of pro-inflammatory cytokines, like IL-6. In our previous study, it was revealed that 1,4NQ-BC instilled intratracheally to mice could trigger the lung inflammation and stimulate the secretion of IL-33 in lung tissue. We found that IL-33 could induce inflammation in lung itself. When the macrophages were eliminated, the secretion of IL-33 was reduced and the pathological damage in the lung was relieved after exposure to 1,4NQ-BC. Both MAPK and PI3K/AKT signal pathways were involved in the process of IL-33 secretion and the lung inflammation induced by 1,4NQ-BC. The findings herein support the notion that after exposure to 1,4NQ-BC, the increased secretion of IL-33 was mainly derived from macrophages through both MAPK and PI3K/AKT signal pathways.

Environmental Factors Such as Noise and Air Pollution and Vascular Disease

Significance: According to the World Health Organization, noncommunicable diseases are the globally leading cause of mortality. Recent Advances: About 71% of 56 million deaths that occurred worldwide are due to noncommunicable cardiovascular risk factors, including tobacco smoking, unhealthy diets, lack of physical activity, overweight, arterial hypertension, diabetes, and hypercholesterolemia, which can be either avoided or substantially reduced. Critical Issues: Thus, it is estimated that 80% of premature heart disease, stroke, and diabetes can be prevented. More recent evidence indicates that environmental stressors such as noise and air pollution contribute significantly to the global burden of cardiovascular disease. In the present review, we focus primarily on important environmental stressors such as transportation noise and air pollution. We discuss the pathophysiology of vascular damage caused by these environmental stressors, with emphasis on early subclinical damage of the vasculature such as endothelial dysfunction and the role of oxidative stress. Future Directions: Lower legal thresholds and mitigation measures should be implemented and may help to prevent vascular damage.

Mapping the co-benefits of climate change action to issues of public concern in the UK: a narrative review

To avoid a 1·5°C rise in global temperatures above preindustrial levels, the next phase of reductions in greenhouse gas emissions will need to be comparatively rapid. Linking the co-benefits of climate action to wider issues that the public are concerned about can help decision makers to prioritise decarbonisation options that increase the chance of public support for such changes, while ensuring that a just transition is delivered. We identified key issues of concern to the UK public by use of Ipsos MORI public opinion data from 2007 to 2020 and used these data to guide a narrative review of academic and grey literature on the co-benefits of climate change action for the UK. Correspondence with civil servants, third sector organisations, and relevant academics allowed us to identify omissions and to ensure policy relevance of the recommendations. This evidence-based Review of the various co-benefits of climate change action for the UK identifies four main areas: health and the National Health Service; security; economy and unemployment; and poverty, housing, and inequality. Associated trade-offs are also discussed. City-level and regional-level governments are particularly well placed to incorporate co-benefits into their decision making because it is at this scale that co-benefits most clearly manifest, and where interventions can have the most immediate effects.

Long-term Exposure to Low Air Pollutant Concentrations and the Relationship with All-Cause Mortality and Stroke in Older Men

BACKGROUND

Long-term air pollution exposure has been associated with increased risk of mortality and stroke. Less is known about the risk at lower concentrations. The association of long-term exposure to PM2.5, PM2.5 absorbance, NO2, and NOx with all-cause mortality and stroke was investigated in a cohort of men aged ≥ 65 years who lived in metropolitan Perth, Western Australia.

METHODS

Land use regression models were used to estimate long-term exposure to air pollutants at participant's home address (n = 11,627) over 16 years. Different metrics of exposure were assigned: baseline; year before the outcome event; and average exposure across follow-up period. The Mortality Register and Hospital Morbidity Data from the Western Australia Data Linkage System were used to ascertain mortality and stroke cases. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazard models, adjusting for age, smoking, education, and body mass index for all-cause mortality. For fatal and hospitalized stroke, the models included variables controlled for all-cause mortality plus hypertension.

RESULTS

Fifty-four percent of all-participants died, 3% suffered a fatal stroke, and 14% were hospitalized stroke cases. PM2.5 absorbance increased the risk of all-cause mortality with adjusted HR of 1.12 (1.02-1.23) for baseline and average exposures, and 1.14 (1.02-1.24) for past-year exposure. There were no associations between PM2.5 absorbance, NO2, and NOx and stroke outcomes. However, PM2.5 was associated with reduced risks of fatal stroke.

CONCLUSION

Long-term exposure to PM2.5 absorbance was associated with all-cause mortality among older men exposed to low concentrations; and exposure to PM2.5 was associated with reduced risk of fatal stroke.

Size resolved aerosol respiratory doses in a Mediterranean urban area: From PM10 to ultrafine particles

In the framework of the 2017 "carbonaceous aerosol in Rome and Environs" (CARE) experiment, particle number size distributions have been continuously measured on February 2017 in downtown Rome. These data have been used to estimate, through MPPD model, size and time resolved particle mass, surface area and number doses deposited into the respiratory system. Dosimetry estimates are presented for PM₁₀, PM_2.5, PM₁ and Ultrafine Particles (UFPs), in relation to the aerosol sources peculiar to the Mediterranean basin and to the atmospheric conditions. Particular emphasis is focused on UFPs and their fraction deposited on the olfactory bulb, in view of their possible translocation to the brain. The site of PM₁₀ deposition within the respiratory system considerably changes, depending on the aerosol sources and then on its different size distributions. On making associations between health endpoints and aerosol mass concentrations, the relevant coarse and fine fractions would be more properly adopted, because they have different sources, different capability of penetrating deep into the respiratory system and different toxicological implications. The separation between them should be set at 1 µm, rather than at 2.5 µm, because the fine fraction is considerably less affected by the contribution of the natural sources. Mass dose is a suitable metric to describe coarse aerosol events but gives a poor representation of combustion aerosol. This fraction of particles, made of UFPs and of accumulation mode particles (mainly with size below 0.2 µm), is of high health relevance. It elicited the highest oxidative activity in the CARE experiment and is properly described by the particle surface area and by the number metrics. Such metrics are even more relevant for the UFP doses deposited on the olfactory bulb, in consideration of the role recognized to oxidative stress in the progression of neurodegenerative diseases. Such metrics would be more appropriate, rather than PM_x mass concentrations, to correlate neurodegenerative pathologies with aerosol pollution.

Oxidative stress pathways of air pollution mediated toxicity: Recent insights

Ambient air pollution is a leading environmental cause of morbidity and mortality globally with most of the outcomes of cardiovascular origin. While numerous mechanisms are proposed to explain the link between air pollutants and cardiovascular events, the evidence supports a role for oxidative stress as a critical intermediary pathway in the transduction of systemic responses in the cardiovascular system. Indeed, alterations in vascular function are a critical step in the development of cardiometabolic disorders such as hypertension, diabetes, and atherosclerosis. This review will provide an overview of the impact of particulate and gaseous pollutants on oxidative stress from human and animal studies published in the last five years. We discuss current gaps in knowledge and evidence to date implicating the role of oxidative stress with an emphasis on inhalational exposures. We conclude with the identification of gaps, and an exhortation for further studies to elucidate the impact of oxidative stress in air pollution mediated effects.

•

Particulate matter air pollution is the leading risk factor for cardiovascular morbidity and mortality globally.

•

Mechanisms of oxidative stress mediated pathways.

•

How does lung inflammation crucial to inhalational exposure mediate systemic toxicity?

•

Review of recent animal and human exposure studies providing insights into oxidative stress pathways.

Estimated health impacts from maritime transport in the Mediterranean region and benefits from the use of cleaner fuels

Ship traffic emissions degrade air quality in coastal areas and contribute to climate impacts globally. The estimated health burden of exposure to shipping emissions in coastal areas may inform policy makers as they seek to reduce exposure and associated potential health impacts. This work estimates the PM2.5-attributable impacts in the form of premature mortality and cardiovascular and respiratory hospital admissions, from long-term exposure to shipping emissions. Health impact assessment (HIA) was performed in 8 Mediterranean coastal cities, using a baseline conditions from the literature and a policy case accounting for the MARPOL Annex VI rules requiring cleaner fuels in 2020. Input data were (a) shipping contributions to ambient PM2.5 concentrations based on receptor modelling studies found in the literature, (b) population and health incidence data from national statistical registries, and (c) geographically-relevant concentration-response functions from the literature. Long-term exposure to ship-sourced PM2.5 accounted for 430 (95% CI: 220-650) premature deaths per year, in the 8 cities, distributed between groups of cities: Barcelona and Athens, with >100 premature deaths/year, and Nicosia, Brindisi, Genoa, Venice, Msida and Melilla, with tens of premature deaths/year. The more stringent standards in 2020 would reduce the number of PM2.5-attributable premature deaths by 15% on average. HIA provided a comparative assessment of the health burden of shipping emissions across Mediterranean coastal cities, which may provide decision support for urban planning with a special focus on harbour areas, and in view of the reduction in sulphur content of marine fuels due to MARPOL Annex VI in 2020.

Fine particulate air pollution and human mortality: 25+ years of cohort studies

Much of the key epidemiological evidence that long-term exposure to fine particulate matter air pollution (PM_2.5) contributes to increased risk of mortality comes from survival studies of cohorts of individuals. Although the first two of these studies, published in the mid-1990s, were highly controversial, much has changed in the last 25 + years. The objectives of this paper are to succinctly compile and summarize the findings of these cohort studies using meta-analytic tools and to address several of the key controversies. Independent reanalysis and substantial extended analysis of the original cohort studies have been conducted and many additional studies using a wide variety of cohorts, including cohorts constructed from public data and leveraging natural experiments have been published. Meta-analytic estimates of the mean of the distribution of effects from cohort studies that are currently available, provide substantial evidence of adverse air pollution associations with all-cause, cardiopulmonary, and lung cancer mortality.

Country-Scale Analysis of Methane Emissions with a High-Resolution Inverse Model Using GOSAT and Surface Observations

We employed a global high-resolution inverse model to optimize the CH4 emission using Greenhouse gas Observing Satellite (GOSAT) and surface observation data for a period from 2011–2017 for the two main source categories of anthropogenic and natural emissions. We used the Emission Database for Global Atmospheric Research (EDGAR v4.3.2) for anthropogenic methane emission and scaled them by country to match the national inventories reported to the United Nations Framework Convention on Climate Change (UNFCCC). Wetland and soil sink prior fluxes were simulated using the Vegetation Integrative Simulator of Trace gases (VISIT) model. Biomass burning prior fluxes were provided by the Global Fire Assimilation System (GFAS). We estimated a global total anthropogenic and natural methane emissions of 340.9 Tg CH4 yr−1 and 232.5 Tg CH4 yr−1, respectively. Country-scale analysis of the estimated anthropogenic emissions showed that all the top-emitting countries showed differences with their respective inventories to be within the uncertainty range of the inventories, confirming that the posterior anthropogenic emissions did not deviate from nationally reported values. Large countries, such as China, Russia, and the United States, had the mean estimated emission of 45.7 ± 8.6, 31.9 ± 7.8, and 29.8 ± 7.8 Tg CH4 yr−1, respectively. For natural wetland emissions, we estimated large emissions for Brazil (39.8 ± 12.4 Tg CH4 yr−1), the United States (25.9 ± 8.3 Tg CH4 yr−1), Russia (13.2 ± 9.3 Tg CH4 yr−1), India (12.3 ± 6.4 Tg CH4 yr−1), and Canada (12.2 ± 5.1 Tg CH4 yr−1). In both emission categories, the major emitting countries all had the model corrections to emissions within the uncertainty range of inventories. The advantages of the approach used in this study were: (1) use of high-resolution transport, useful for simulations near emission hotspots, (2) prior anthropogenic emissions adjusted to the UNFCCC reports, (3) combining surface and satellite observations, which improves the estimation of both natural and anthropogenic methane emissions over spatial scale of countries.

Cookstove Smoke Impact on Ambient Air Quality and Probable Consequences for Human Health in Rural Locations of Southern Nepal

Residential emission from traditional biomass cookstoves is a major source of indoor and outdoor air pollution in developing countries. However, exact quantification of the contribution of biomass cookstove emissions to outdoor air is still lacking. In order to address this gap, we designed a field study to estimate the emission factors of PM2.5 (particulate matter of less than 2.5 µ diameter) and BC (black carbon) indoors, from cookstove smoke using biomass fuel and with smoke escaping outdoors from the roof of the house. The field study was conducted in four randomly selected households in two rural locations of southern Nepal during April 2017. In addition, real-time measurement of ambient PM2.5 was performed for 20 days during the campaign in those two rural sites and one background location to quantify the contribution of cooking-related emissions to the ambient PM2.5. Emission factor estimates indicate that 66% of PM2.5 and 80% of BC emissions from biomass cookstoves directly escape into ambient air. During the cooking period, ambient PM2.5 concentrations in the rural sites were observed to be 37% higher than in the nearby background location. Based on the World Health Organization (WHO)'s AirQ+ model simulation, this 37% rise in ambient PM2.5 during cooking hours can lead to approximately 82 cases of annual premature deaths among the rural population of Chitwan district.