Estimation of PM2·5-associated disease burden in China in 2020 and 2030 using population and air quality scenarios: a modelling study

Cleaner heating policies contribute significantly to health benefits and cost-savings: A case study in Beijing, China

Cleaner heating policies aim to reduce air pollution and may bring about health benefits to individuals. Based on a fixed-effect model focusing on Beijing, this study found that after the onset of air pollution, daily clinic visits, hospitalization days, and hospitalization expenses increased several days after the occurrence of air pollution. These hospitalization changes were observed in males and females and three different age groups. A difference-in-differences (DID) model was constructed to identify the influences of cleaner heating policies on health consequences. The study revealed that the policy positively affects health outcomes, with an average decrease of 3.28 thousand clinic visits for all diseases. The total hospitalization days and expenses tend to decrease by 0.22 thousand days and 0.34 million CNY (Chinese Yuan), respectively. Furthermore, implementing the policy significantly reduced the number of daily clinic visits for respiratory diseases, asthma, stroke, diabetes, and chronic obstructive pulmonary diseases (COPDs).

Projecting non-communicable diseases attributable to air pollution in the climate change era: a systematic review

OBJECTIVES

Climate change is a major global issue with significant consequences, including effects on air quality and human well-being. This review investigated the projection of non-communicable diseases (NCDs) attributable to air pollution under different climate change scenarios.

DESIGN

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow checklist. A population-exposure-outcome framework was established. Population referred to the general global population of all ages, the exposure of interest was air pollution and its projection, and the outcome was the occurrence of NCDs attributable to air pollution and burden of disease (BoD) based on the health indices of mortality, morbidity, disability-adjusted life years, years of life lost and years lived with disability.

DATA SOURCES

The Web of Science, Ovid MEDLINE and EBSCOhost databases were searched for articles published from 2005 to 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The eligible articles were evaluated using the modified scale of a checklist for assessing the quality of ecological studies.

DATA EXTRACTION AND SYNTHESIS

Two reviewers searched, screened and selected the included studies independently using standardised methods. The risk of bias was assessed using the modified scale of a checklist for ecological studies. The results were summarised based on the projection of the BoD of NCDs attributable to air pollution.

RESULTS

This review included 11 studies from various countries. Most studies specifically investigated various air pollutants, specifically particulate matter <2.5 µm (PM2.5), nitrogen oxides and ozone. The studies used coupled-air quality and climate modelling approaches, and mainly projected health effects using the concentration-response function model. The NCDs attributable to air pollution included cardiovascular disease (CVD), respiratory disease, stroke, ischaemic heart disease, coronary heart disease and lower respiratory infections. Notably, the BoD of NCDs attributable to air pollution was projected to decrease in a scenario that promotes reduced air pollution, carbon emissions and land use and sustainable socioeconomics. Contrastingly, the BoD of NCDs was projected to increase in a scenario involving increasing population numbers, social deprivation and an ageing population.

CONCLUSION

The included studies widely reported increased premature mortality, CVD and respiratory disease attributable to PM2.5. Future NCD projection studies should consider emission and population changes in projecting the BoD of NCDs attributable to air pollution in the climate change era.

PROSPERO REGISTRATION NUMBER

CRD42023435288.

Exosome-encapsulated lncRNA HOTAIRM1 contributes to PM2.5-aggravated COPD airway remodeling by enhancing myofibroblast differentiation

Emphysema, myofibroblast accumulation and airway remodeling can occur in the lungs due to exposure to atmospheric pollution, especially fine particulate matter (PM2.5), leading to chronic obstructive pulmonary disease (COPD). Specifically, bronchial epithelium-fibroblast communication participates in airway remodeling, which results in COPD. An increasing number of studies are now being conducted on the role of exosome-mediated cell-cell communication in disease pathogenesis. Here, we investigated whether exosomes generated from bronchial epithelial cells could deliver information to normal stromal fibroblasts and provoke cellular responses, resulting in airway obstruction in COPD. We studied the mechanism of exosome-mediated intercellular communication between human bronchial epithelial (HBE) cells and primary lung fibroblasts (pLFs). We found that PM2.5-induced HBE-derived exosomes promoted myofibroblast differentiation in pLFs. Then, the exosomal lncRNA expression profiles derived from PM2.5-treated HBE cells and nontreated HBE cells were investigated using an Agilent Human LncRNA Array. Combining coculture assays and direct exosome treatment, we found that HBE cell-derived exosomal HOTAIRM1 facilitated the myofibroblast differentiation of pLFs. Surprisingly, we discovered that exosomal HOTAIRM1 enhanced pLF proliferation to secrete excessive collagen secretion, leading to airway obstruction by stimulating the TGF-β/SMAD3 signaling pathway. Significantly, PM2.5 reduced FEV1/FVC and FEV1 and increased the level of serum exosomal HOTAIRM1 in healthy people; moreover, serum exosomal HOTAIRM1 was associated with PM2.5-related reductions in FEV1/FVC and FVC. These findings show that PM2.5 triggers alterations in exosome components and clarify that one of the paracrine mediators of myofibroblast differentiation is bronchial epithelial cell-derived HOTAIRM1, which has the potential to be an effective prevention and therapeutic target for PM2.5-induced COPD.

PM2.5 air quality and health gains in the quest for carbon peaking: A case study of Fujian Province, China

China faces a dual challenge of improving air quality and reducing greenhouse gas (GHG) emissions. Stringent clean air actions gradually narrow the end-of-pipe (EOP) pollution control potential. Meanwhile, pursuing carbon peaking will reduce air pollution and health risks. However, the impact on air quality and health gains in individual Chinese provinces has not been assessed with a specific focus on local policies. Here, typical shared socio-economic pathways (SSPs) and local policies (i.e., business as usual, BAU; end-of-pipe controls, EOP; co-control mitigation, CCM) are combined to set three scenarios (i.e., BAU-SSP3, EOP-SSP4, CCM-SSP1). Under these three scenarios, we couple the Low Emissions Analysis Platform (LEAP) model, an air quality model and health risk assessment methodology to evaluate the characteristics of carbon peaking in Fujian Province. PM2.5 air quality and impacts on public health are assessed, using the metric of the deaths attributable to PM2.5 pollution (DAPP). The results show that energy-related CO2 emissions will only peak before 2030 in the CCM-SSP1 scenario. In this context, air pollutant emission pathways reveal that mitigation is limited under the EOP-SSP4 scenario, necessitating further mitigation under the CCM-SSP1 scenario. The annual average PM2.5 level is projected to be 16.5 μg·m-3 in 2035 with a corresponding decrease in DAPP of 297 (95 % confidence intervals: 217-308) compared with that of 2020. Despite the significant improvements in PM2.5 air quality and health gains under the CCM-SSP1 scenario, reaching the 5 μg·m-3 target of the World Health Organization (WHO) remains difficult. Furthermore, population aging will require stronger PM2.5 mitigation to enhance health gains. This study provides a valuable reference for other developing regions to co-control air pollution and GHGs.

Improving consistency in estimating future health burdens from environmental risk factors: Case study for ambient air pollution

Future changes in exposure to risk factors should impact mortality rates and population. However, studies commonly use mortality rates and population projections developed exogenously to the health impact assessment model used to quantify future health burdens attributable to environmental risks that are therefore invariant to projected exposure levels. This impacts the robustness of many future health burden estimates for environmental risk factors. This work describes an alternative methodology that more consistently represents the interaction between risk factor exposure, population and mortality rates, using ambient particulate air pollution (PM2.5) as a case study. A demographic model is described that estimates future population based on projected births, mortality and migration. Mortality rates are disaggregated between the fraction due to PM2.5 exposure and other factors for a historic year, and projected independently. Accounting for feedbacks between future risk factor exposure and population and mortality rates can greatly affect estimated future attributable health burdens. The demographic model estimates much larger PM2.5-attributable health burdens with constant 2019 PM2.5 (∼10.8 million deaths in 2050) compared to a model using exogenous population and mortality rate projections (∼7.3 million), largely due to differences in mortality rate projection methods. Demographic model-projected PM2.5-attributable mortality can accumulate substantially over time. For example, ∼71 million more people are estimated to be alive in 2050 when WHO guidelines (5 µg m-3) are achieved compared to constant 2019 PM2.5 concentrations. Accounting for feedbacks is more important in applications with relatively high future PM2.5 concentrations, and relatively large changes in non-PM2.5 mortality rates.

Unpacking the factors contributing to changes in PM2.5-associated mortality in China from 2013 to 2019

From 2013 to 2019, a series of air pollution control actions significantly reduced PM2.5 pollution in China. Control actions included changes in activity levels, structural adjustment (SA) policy, energy and material saving (EMS) policy, and end-of-pipe (EOP) control in several sources, which have not been systematically studied in previous studies. Here, we integrate an emission inventory, a chemical transport model, a health impact assessment model, and a scenario analysis to quantify the contribution of each control action across a range of major emission sources to the changes in PM2.5 concentrations and associated mortality in China from 2013 to 2019. Assuming equal toxicity of PM2.5 from all the sources, we estimate that PM2.5-related mortality decreased from 2.52 (95 % confidence interval, 2.13-2.88) to 1.94 (1.62-2.24) million deaths. Anthropogenic emission reductions and declining baseline incidence rates significantly contributed to health benefits, but population aging partially offset their impact. Among the major sources, controls on power plants and industrial boilers were responsible for the highest reduction in PM2.5-related mortality (∼80 %), followed by industrial processes (∼40 %), residential combustion (∼40 %), and transportation (∼30 %). However, considering the potentially higher relative risks of power plant PM2.5, the adverse effects avoided by their control could be ∼2.4 times the current estimation. Our power plant sensitivity analyses indicate that future estimates of source-specific PM2.5 health effects should incorporate variations in individual source PM2.5 effect coefficients when available. As for the control actions, while activity levels increased for most sources, SA policy significantly reduced the emissions in residential combustion and industrial boilers, and EOP control dominated the contribution in health benefits in most sources except residential combustion. Considering the emission reduction potential by source and control actions in 2019, our results suggest that promoting clean energy in residential combustion and enforcing more stringent EOP control in the iron and steel industry should be prioritized in the future.

Reconstructing aerosol optical depth using spatiotemporal Long Short-Term Memory convolutional autoencoder

Aerosol Optical Depth (AOD) is a crucial atmospheric parameter in comprehending climate change, air quality, and its impacts on human health. Satellites offer exceptional spatiotemporal AOD data continuity. However, data quality is influenced by various atmospheric, landscape, and instrumental factors, resulting in data gaps. This study presents a new solution to this challenge by providing a long-term, gapless satellite-derived AOD dataset for Texas from 2010 to 2022, utilizing Moderate Resolution Imaging Spectroradiometer (MODIS) Multi-angle Implementation of Atmospheric Correction (MAIAC) products. Missing AOD data were reconstructed using a spatiotemporal Long Short-Term Memory (LSTM) convolutional autoencoder. Evaluation against an independent test dataset demonstrated the model's effectiveness, with an average Root Mean Square Error (RMSE) of 0.017 and an R2 value of 0.941. Validation against the ground-based AERONET dataset indicated satisfactory agreement, with RMSE values ranging from 0.052 to 0.067. The reconstructed AOD data are available at daily, monthly, quarterly, and yearly scales, providing a valuable resource to advance understanding of the Earth's atmosphere and support decision-making concerning air quality and public health.

Projections of mortality risk attributable to short-term exposure to landscape fire smoke in China, 2021-2100: a health impact assessment study

BACKGROUND

Landscape fire smoke, including smoke from all vegetation burning in natural and cultural landscapes, remains a threat to the health of the population. However, the future health impacts of landscape fire smoke in China have not been sufficiently investigated. We aimed to estimate the mortality risk attributable to landscape fire-related PM2·5 under different scenarios.

METHODS

In this health impact assessment study, we used the projected population and landscape fire-related PM2·5 concentration to calculate deaths attributable to short-term exposure to landscape fire smoke PM2·5 during 2021-2100. We did the analysis in three defined future periods: 2021-40 (near term), 2051-70 (medium term), and 2081-2100 (long term), with 1986-2005 as the historical period. We used fire-specific short-term epidemiological functions with the regional parameters specific to China. We assessed the mortality risks of landscape fire-related smoke and further identified their spatiotemporal distribution under two shared socioeconomic pathway (SSP) scenarios: SSP1-2·6, an optimistic scenario with strict control of carbon emissions, and SSP2-4·5, an intermediate scenario with weaker control of carbon emissions.

FINDINGS

The national mortality rate attributable to short-term exposure (ie, a few days) to landscape fire-related PM2·5 is projected to increase compared with historical values. The national deaths attributable to landscape fire smoke PM2·5 could peak in 2021-40, with increases of 28·10% (95% CI 14·08-53·11) under the SSP1-2·6 scenario and 37·38% (14·08-53·11) under the SSP2-4·5 scenario. Deaths would then decrease slightly during 2051-70 and 2081-2100. The provinces with the highest projected number of deaths attributable to landscape fire-related PM2·5 are located in east and south-central China, and those with the largest percentage increase in projected deaths are located in northwest and southwest China.

INTERPRETATION

Our results suggest that global warming could increase the contribution of landscape fire smoke to the total PM2·5 concentration, leading to an increase in the mortality rate in China. Our findings could help policy makers implement effective interventions in hotspot areas during different periods to reduce the impact of landscape fire smoke on human health.

FUNDING

The National Natural Science Foundation of China, National Key Research and Development Program of China, and the Wellcome Trust.

The challenge of population aging for mitigating deaths from PM2.5 air pollution in China

Estimating the health burden of air pollution against the background of population aging is of great significance for achieving the Sustainable Development Goal 3.9 which aims to substantially reduce the deaths and illnesses from air pollution. Here, we estimated spatiotemporal changes in deaths attributable to PM2.5 air pollution in China from 2000 to 2035 and examined the drivers. The results show that from 2019 to 2035, deaths were projected to decease 15.4% (6.6%-20.7%, 95% CI) and 8.4% (0.6%-13.5%) under the SSP1-2.6 and SSP5-8.5 scenario, respectively, but increase 10.4% (5.1%-20.5%) and 18.1% (13.0%-28.3%) under SSP2-4.5 and SSP3-7.0 scenarios. Population aging will be the leading contributor to increased deaths attributable to PM2.5 air pollution, which will counter the positive gains achieved by improvements in air pollution and healthcare. Region-specific measures are required to mitigate the health burden of air pollution and this requires long-term efforts and mutual cooperation among regions in China.

The use of environmental scenarios to project future health effects: a scoping review

Environmental risks are a substantial factor in the current burden of disease, and their role is likely to increase in the future. Model-based scenario analysis is used extensively in environmental sciences to explore the potential effects of human activities on the environment. In this Review, we examine the literature on scenarios modelling environmental effects on health to identify the most relevant findings, common methods used, and important research gaps. Health outcomes and measures related to climate change (n=106) and air pollution (n=30) were most frequently studied. Studies examining future disease burden due to changes or policies related to dietary risks were much less common (n=10). Only a few studies assessed more than two environmental risks (n=3), even though risks can accumulate and interact with each other. Studies predominantly covered high-income countries and Asia. Sociodemographic, vulnerability, and health-system changes were rarely accounted for; thus, assessing the full effect of future environmental changes in an integrative way is not yet possible. We recommend that future models incorporate a broader set of determinants of health to more adequately capture their effect, as well as the effect of mitigation and adaptation efforts.

Global PM2.5 Prediction and Associated Mortality to 2100 under Different Climate Change Scenarios

Ambient fine particulate matter (PM_2.5) has severe adverse health impacts, making it crucial to reduce PM_2.5 exposure for public health. Meteorological and emissions factors, which considerably affect the PM_2.5 concentrations in the atmosphere, vary substantially under different climate change scenarios. In this work, global PM_2.5 concentrations from 2021 to 2100 were generated by combining the deep learning technique, reanalysis data, emission data, and bias-corrected CMIP6 future climate scenario data. Based on the estimated PM_2.5 concentrations, the future premature mortality burden was assessed using the Global Exposure Mortality Model. Our results reveal that SSP3-7.0 scenario is associated with the highest PM_2.5 exposure, with a global concentration of 34.5 μg/m³ in 2100, while SSP1-2.6 scenario has the lowest exposure, with an estimated of 15.7 μg/m³ in 2100. PM_2.5-related deaths for individuals under 75 years will decrease by 16.3 and 10.5% under SSP1-2.6 and SSP5-8.5, respectively, from 2030s to 2090s. However, premature mortality for elderly individuals (>75 years) will increase, causing the contrary trends of improved air quality and increased total PM_2.5-related deaths in the four SSPs. Our results emphasize the need for stronger air pollution mitigation measures to offset the future burden posed by population age.

Substantial short- and long-term health effect due to PM2.5 and the constituents even under future emission reductions in China

Heavy pollution events of fine particulate matter (PM_2.5) frequently occur in China, seriously affecting the human health. However, how meteorological factors and anthropogenic emissions affect PM_2.5 and the major constituents, as well as the subsequent health effect, remains unclear. Here, based on regional climate and air quality models Weather Research and Forecasting (WRF) and Community Multiscale Air Quality (CMAQ), the PM_2.5 and major constituents in China at present and mid-century under the carbon neutral scenario Shared Socioeconomic Pathways (SSP)1-2.6 are simulated. Due to anthropogenic emission reduction, concentrations of PM_2.5 and the constituents decrease substantially in SSP1-2.6. The long-term exposure premature deaths at present are 2.23 million per year in mainland China, which is projected to increase by 76 % under SSP1-2.6 despite emission reduction, primarily attributable to aging which strikingly offsets the effect of air quality improvement. The number of annual premature deaths resulting from short-term exposure is 228,104 in mainland China at present, which is projected to decrease in the future. Using North China Plain as an example, we identify that among the major constituents of PM_2.5, organic carbon leads to the most short-term exposure deaths considering the largest exposure-response coefficient. Regarding the abnormally meteorological conditions, we find, relative to low relative humidity (RH) and non-stagnation, the compound events, defined as concurrence of high RH and atmospheric stagnation, exhibit an amplified role inducing larger premature deaths compared to the additive effect of the individual event of high RH and atmospheric stagnation. This nonlinear effect occurs at both present and future, but diminished in future due to emission reductions. Our study highlights the importance of considering both the long- and short-term premature deaths associated with PM_2.5 and the constituents, as well as the critical effect of extreme weather events.

Exposure of Tibetan pregnant women to antibiotics in China: A biomonitoring-based study

Tibetan people are one Chinese ethnic minority living in Qinghai-Tibet Plateau with an average altitude of more than 4500 m. High altitude could cause a different antibiotic exposure, but relevant information is limited in Tibetan people. We investigated 476 Tibetan pregnant women in Lhasa, Tibet in 2021 and measured 30 antibiotics from five categories in urine, including 13 veterinary antibiotics (VAs), five human antibiotics (HAs), and 12 human/veterinary antibiotics (H/VAs). Food consumption was investigated by a brief food frequency questionnaire. Health risk was assessed by hazard quotient (HQ) and hazard index (HI) based on acceptable daily intakes (ADIs). All antibiotics were overall detected in 34.7% of urine samples with the 75th percentile concentration of 0.19 ng/mL (0.35 μg/g creatinine). HAs, VAs, and H/VAs were respectively detected in 5.3%, 13.0%, and 25.0% of urine samples, with the 95th percentiles of 0.01 ng/mL (0.01 μg/g creatinine), 0.50 ng/mL (0.99 μg/g creatinine), and 3.58 ng/mL (5.02 μg/g creatinine), respectively. Maternal age, smoking of family members, and housework time were associated with detection frequencies of HAs, VAs, or sum of all antibiotics. Pregnant women with a more frequent consumption of fresh milk, egg, yoghourt, poultry meat, and fish had a higher detection frequency of VAs or H/VAs. Only ciprofloxacin and tetracycline had a HQ of larger than one based on microbiological effect in 1.26% and 0.21% of pregnant women, respectively and a HI of larger than one was found in 1.47% of pregnant women. The findings suggested that there was an evident antibiotic exposure from various sources in Tibetan pregnant women with some basic characteristics of pregnant women as potential predictors and several animal-derived food items were important sources of exposure to antibiotic with a fraction of pregnant women in the health risk related to microbiological disruption of gut microbiota.

Type 1 diabetes and diet-induced obesity predispose C57BL/6J mice to PM2.5-induced lung injury: a comparative study

BACKGROUND

Pre-existing metabolic diseases may predispose individuals to particulate matter (PM)-induced adverse health effects. However, the differences in susceptibility of various metabolic diseases to PM-induced lung injury and their underlying mechanisms have yet to be fully elucidated.

RESULTS

Type 1 diabetes (T1D) murine models were constructed by streptozotocin injection, while diet-induced obesity (DIO) models were generated by feeding 45% high-fat diet 6 weeks prior to and throughout the experiment. Mice were subjected to real-ambient PM exposure in Shijiazhuang City, China for 4 weeks at a mean PM2.5 concentration of 95.77 µg/m3. Lung and systemic injury were assessed, and the underlying mechanisms were explored through transcriptomics analysis. Compared with normal diet (ND)-fed mice, T1D mice exhibited severe hyperglycemia with a blood glucose of 350 mg/dL, while DIO mice displayed moderate obesity and marked dyslipidemia with a slightly elevated blood glucose of 180 mg/dL. T1D and DIO mice were susceptible to PM-induced lung injury, manifested by inflammatory changes such as interstitial neutrophil infiltration and alveolar septal thickening. Notably, the acute lung injury scores of T1D and DIO mice were higher by 79.57% and 48.47%, respectively, than that of ND-fed mice. Lung transcriptome analysis revealed that increased susceptibility to PM exposure was associated with perturbations in multiple pathways including glucose and lipid metabolism, inflammatory responses, oxidative stress, cellular senescence, and tissue remodeling. Functional experiments confirmed that changes in biomarkers of macrophage (F4/80), lipid peroxidation (4-HNE), cellular senescence (SA-β-gal), and airway repair (CCSP) were most pronounced in the lungs of PM-exposed T1D mice. Furthermore, pathways associated with xenobiotic metabolism showed metabolic state- and tissue-specific perturbation patterns. Upon PM exposure, activation of nuclear receptor (NR) pathways and inhibition of the glutathione (GSH)-mediated detoxification pathway were evident in the lungs of T1D mice, and a significant upregulation of NR pathways was present in the livers of T1D mice.

CONCLUSIONS

These differences might contribute to differential susceptibility to PM exposure between T1D and DIO mice. These findings provide new insights into the health risk assessment of PM exposure in populations with metabolic diseases.

Source Contributions to PM2.5-Related Mortality and Costs: Evidence for Emission Allocation and Compensation Strategies in China

The emissions from various pollution sources were not proportional to their contributions to ambient PM_2.5 concentrations and associated health burdens. That means even with the same total abatement targets, different abatement allocation strategies across emission sources can have distinct health benefits. Insufficient knowledge of various sources' contributions to health burdens in China, the country suffering substantial PM_2.5-related deaths, hindered the government from seeking optimized abatement allocation strategies. In this context, we separated the contributions of 155 emission sources (31 provinces × 5 sectors) to PM_2.5-related mortality across China in 2017 by coupling the Comprehensive Air Quality Model with Extensions (CAMx), Weather Research and Forecasting model (WRF), and health impact assessment model. We further identified the priority-control emission sources and quantified interprovincial ecological compensation volumes to alleviate inequality induced by emission allocation strategies. Results showed that PM_2.5 pollution caused 899,443 excess deaths and around 127 billion USD costs in 2017. Approximately half of the deaths and costs were attributable to emissions from sources outside the boundary of the regions where the deaths occurred. Twenty-five out of 155 emission sources that contributed to the top 60% mortality burdens and had high marginal abatement efficiencies in China shall be the priority-control emission sources. A 1 μg/m³ decrease of PM_2.5 concentration in regions where these key emission sources occur shall be compensated by 76-153 million USD in their receptor regions. Our study sheds light on the sources' contributions to mortality burdens and costs and provides scientific evidence for optimizing the emission allocation and compensation strategies in China. It also has wide implications for other countries suffering similar problems.

Projecting the excess mortality related to diurnal temperature range: A nationwide analysis in China

The projection of excess mortality due to diurnal temperature range (DTR) in future has not been evaluated yet in China. Based on daily cause-specific mortality data from 266 cities in China, this study aimed to examine the association between DTR and mortality, which help project the future mortality burden attributable to DTR by considering the modification effects of altitude and population migration. We first found that every 10 °C increase in the DTR would result in a 3.3 % (95 % confidence interval: 2.6 %-4.1 %) excess risk of non-accidental mortality. The unit risk of DTR-associated cause-specific mortality at moderate or high altitudes was significantly lower than at lower altitudes, especially for cardiovascular disease. Subsequently, DTR-associated excess mortality in 2017 in China was 233,154 deaths (with a population-weighted attributable fraction of 2.9 %). Furthermore, we projected DTR-attributable additional mortality in the future, with the associated mortalities to be 221,860 deaths in 2050-2059 (2050s) and 132,305 deaths in 2090-2099 (2090s), under the SSP1-2.6 scenario. Meanwhile, the regional inequalities were exacerbated by 18 % in 2050s and 13 % in 2090s when considering the modification effects of city altitude. Future population migration would increase excess mortality in most areas in central and southern China, and reduce the disease burden in most areas in eastern, western, and northern China. Our findings underpinned that regional strategies should be adopted to mitigate excess mortality attributable to global climate change.

Air pollution, governance quality, and health outcomes: evidence from developing countries

While studies have demonstrated that air pollution can be catastrophic to the population's health, few empirical studies are found in the economic literature because a considerable proportion of the evidence comes from epidemiological studies. Because of the crucial role of governance in the health community, good governance has been a contentious issue in public sector management in recent years. Therefore, the aim of this study is to examine the effects of air pollution and the role of governance on health outcomes. This study employed the generalized method of moment (GMM) estimation techniques to analyse panel data for 72 developing countries from 2010 to 2017. The empirical results confirm that higher PM_2.5 and CO₂ levels have a detrimental influence on life expectancy and healthy life expectancy, whereas the role of governance has a positive impact on life expectancy and healthy life expectancy. Furthermore, the findings show governance quality plays a role in moderating the negative effect of PM_2.5 on health outcomes. The ongoing rise in air pollution has had a significant impact on the health of developing countries. It appears that governance quality has improved health outcomes. The findings have important policy implications, such that strengthening governance can reduce air pollution emissions in developing countries. However, to reduce the health effects of air pollution, developing countries must implement effective environmental development policies and track the implementation and enforcement of such policies.

Pollution source and chemicals structure of the water-soluble fractions in PM2.5 that induce apoptosis in China

Identify risk drivers is the key condition in air pollution control, and biological effect-directed analysis is the most commented method for combing chemical identify and human health. The water-soluble organic matter contained in PM_2.5 plays an important role in human health, while it is also the most difficult to identify its chemical information. Exploring the structural characteristics and pollution sources of its key toxic components is the optimized strategy to meet this question. In this study, the induction of apoptosis by the water-soluble fractions (WSF) of PM_2.5 samples collected in 10 major cities in China over a period of 1 year was observed in vitro in Beas-2b cells. Organic carbon structures were examined using nuclear magnetic resonance; air potential sources were identified using δ¹³C and ¹⁴C isotopic markers. Apoptosis induction by WSF in PM_2.5 was generally stronger in northern cities than in southern cities, and in winter than in summer. Organic compounds with aromatic and double-bond carbon structures from secondary products of motor vehicle exhausts, coal-derived emissions, and emissions derived from the burning of core residues may be primarily responsible for apoptosis induction by PM_2.5. Our results will contribute to understanding the toxic substances contained in WSF and provide basic data for accurate pollution control.

Air pollution exposure and ovarian reserve impairment in Shandong province, China: The effects of particulate matter size and exposure window

BACKGROUND

Lack of evidence exists on whether air pollution exposure may affect ovarian reserve, especially for Chinese women.

OBJECTIVES

To explore the association between exposure to various air pollutants and anti-Müllerian hormone (AMH), a predictor of ovarian reserve, over different exposure windows in Shandong Province, China.

METHODS

We enrolled 18,878 women who had AMH measurements in the Center for Reproductive Medicine, Shandong University during 2010-2019. Daily average concentrations of ambient particulate matter with diameters ≤1 μm/2.5 μm/10 μm (PM₁, PM_2.5, and PM₁₀), nitrogen dioxide (NO₂) and ozone (O₃) were developed at a spatial resolution of 0.01° × 0.01°, and assigned to the residential addresses. Three exposure windows were considered, i.e., the process from primary to small antral follicle stage (W1), from primary to secondary follicle stage (W2), and from secondary to small antral follicle stage (W3). The air pollution-AMH association was fitted using the multivariable linear mixed effect model with adjustment for potential confounders. Stratified analyses were performed by age group, overweight status, residential region, and educational level.

RESULTS

The level of AMH changed by -8.8% (95% confidence interval (CI): -12.1%, -5.3%), -2.1% (95% CI: -3.5%, -0.6%), -1.9% (95% CI: -3.3%, -0.5%), and -4.5% (95% CI: -7.1%, -1.9%) per 10 μg/m³ increase in PM₁, PM_2.5, PM₁₀, and NO₂, respectively, during W1. The effect estimates were significant during W2 for PM₁, PM_2.5 and NO₂ while minimal association was observed in W3. Greater vulnerability for certain air pollutants were observed for women who lived in inland areas and were less educated.

CONCLUSIONS

We found that ovarian reserve was negatively associated with air pollution exposure for women, particularly from the primary to secondary follicle stage. The effect estimate increased by the reduction in the diameter of PMs, which also varied across population sub-groups.

Spatiotemporal variation of PM2.5-related preterm birth in China and India during 1990-2019 and implications for emission controls

Preterm birth is the leading threat to neonatal health. The variation of PM_2.5-associated preterm birth in China and India from 1990 through 2019 was estimated in this study. Meanwhile, four mitigation scenarios were proposed, and the corresponding PM_2.5-related preterm birth was projected for 2030. Owing to differences in emission control policies and the effects of various factors (e.g., differences in population-control policies), the PM_2.5 concentration and PM_2.5-associated preterm birth in the two countries presented disparate spatiotemporal characteristics and variation trends during 1990-2019. The 30-year average of annual PM_2.5-associated preterm birth in India was 1018 (95% confidence interval, 718-1289) thousand, which was much larger than in China (280 [196-358] thousand). To fight air pollution, China launched several control strategies in the past two decades, and the nationwide maternal exposure risk dramatically decreased after 2010. In contrast, India's air-pollution control measures and policies have not effectively mitigated the nationwide PM_2.5 pollution. Under current mitigation measures and policies, the projected decrease in maternal exposure risk by 2030 is greater for China than India, and the scope for controlling air pollutant emissions and reducing maternal exposure risk is much large for India. The results of all four scenarios revealed that the annual PM_2.5-associated preterm birth in the two countries is likely to decrease in the future. In particular, if China and India implement more robust emission control strategies than those currently, the number of associated preterm birth is projected to be more than 50% lower in 2030 compared with 2019 rates.

Decadal changes in PM2.5-related health impacts in China from 1990 to 2019 and implications for current and future emission controls

In China, the rapid development of the economy and implementation of multiple emission control policies in recent decades have been accompanied by dramatic changes in air quality. In this study, PM_2.5 concentrations estimated by using MERRA-2 reanalysis data were integrated into the Global Exposure Mortality Model (GEMM) to explore the spatiotemporal variation of nationwide PM_2.5-related premature mortality from 1990 to 2019, and the driving factors behind decadal changes were evaluated. Since 2000, as a result of PM_2.5 pollution, air quality in China has deteriorated substantially, especially in the fast-developing eastern and southern parts. In 2009, the nationwide population-weighted (PW) PM_2.5 concentration peaked at 41.4 μg/m³ (95% confidence interval [CI], 36.7-46.2). Simultaneously, the GEMM results revealed that nationwide PM_2.5-related deaths increased remarkably from 1089 (95% CI, 965-1210) thousand in 1990 to 1795 (1597-1986) thousand in 2009. The implementation of the toughest-ever Air Pollution Prevention and Control Action Plan (APPCAP) in 2013 effectively controlled PM_2.5 pollution in China. By 2018, the nationwide PW PM_2.5 concentration had decreased to 34.0 (29.2-38.9) μg/m³. Dynamic trend prediction revealed that, although the APPCAP achieved substantial health benefits, the policy did not result in further remarkable reductions in PM_2.5-related deaths; in 2019, deaths peaked at 1932 (1716-2140) thousand. PM_2.5-related deaths in 2030 were projected for each of four emission control scenarios. The results of the driving factor analysis and the future projections indicated that the health benefits from improving air quality are likely to be counterbalanced by changes in the population age structure. Because population ageing is becoming more and more rapid in China and the challenge of climate change is increasing, the results of this study imply that policymakers need to implement more stringent measures and set more ambitious emission control targets to reduce nationwide PM_2.5-related premature mortality in the future.

Long-term PM0.1 exposure and human blood lipid metabolism: New insight from the 33-community study in China

Ambient particles with aerodynamic diameter <0.1 μm (PM_0.1) have been suggested to have significant health impact. However, studies on the association between long-term PM_0.1 exposure and human blood lipid metabolism are still limited. This study was aimed to evaluate such association based on multiple lipid biomarkers and dyslipidemia indicators. We matched the 2006-2009 average PM_0.1 concentration simulated using the neural-network model following the WRF-Chem model with the clinical and questionnaire data of 15,477 adults randomly recruited from 33 communities in Northeast China in 2009. After controlling for social demographic and behavior confounders, we assessed the association of PM_0.1 concentration with multiple lipid biomarkers and dyslipidemia indicators using generalized linear mixed-effect models. Effect modification by various social demographic and behavior factors was examined. We found that each interquartile range increase in PM_0.1 concentration was associated with a 5.75 (95% Confidence interval, 3.24-8.25) mg/dl and a 6.05 (2.85-9.25) mg/dl increase in the serum level of total cholesterol and LDL-C, respectively. This increment was also associated with an odds ratio of 1.25 (1.10-1.42) for overall dyslipidemias, 1.41 (1.16, 1.73) for hypercholesterolemia, and 1.90 (1.39, 2.61) for hyperbetalipoproteinemia. Additionally, we found generally greater effect estimates among the younger participants and those with lower income or with certain behaviors such as high-fat diet. The deleterious effect of long-term PM_0.1 exposure on lipid metabolism may make it an important toxic chemical to be targeted by future preventive strategies.

Effects of the COVID-19 Lockdown on Air Pollutant Levels and Associated Reductions in Ischemic Stroke Incidence in Shandong Province, China

Background

Local governments in China took restrictive measures after the outbreak of COVID-19 to control its spread, which unintentionally resulted in reduced anthropogenic emission sources of air pollutants. In this study, we intended to examine the effects of the COVID-19 lockdown policy on the concentration levels of particulate matter with aerodynamic diameters of ≤1 μm (PM₁), ≤2.5 μm (PM_2.5), and ≤10 μm (PM₁₀), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), ozone (O₃), and carbon monoxide (CO) and the potential subsequent reductions in the incidence of ischemic and hemorrhagic stroke in Shandong Province, China.

Methods

A difference-in-difference model combining the daily incidence data for ischemic and hemorrhagic stroke and air pollutant data in 126 counties was used to estimate the effect of the COVID-19 lockdown on the air pollutant levels and ischemic and hemorrhagic stroke incident counts. The avoided ischemic stroke cases related to the changes in air pollutant exposure levels were further estimated using concentration-response functions from previous studies.

Results

The PM₁, PM_2.5, PM₁₀, NO₂, and CO levels significantly decreased by −30.2, −20.9, −13.5, −46.3, and −13.1%, respectively. The O₃ level increased by 11.5% during the lockdown compared with that in the counterfactual lockdown phase of the past 2 years. There was a significant reduction in population-weighted ischemic stroke cases (−15,315, 95% confidence interval [CI]: −27,689, −2,942), representing a reduction of 27.6% (95% CI: −49.9%, −5.3%). The change in the number of hemorrhagic stroke cases was not statistically significant. The total avoided PM₁-, PM_2.5-, PM₁₀-, NO₂-, and CO–related ischemic stroke cases were 739 (95% CI: 641, 833), 509 (95% CI: 440, 575), 355 (95% CI: 304, 405), 1,132 (95% CI: 1,024, 1,240), and 289 (95% CI: 236, 340), respectively.

Conclusion

The COVID-19 lockdown indirectly reduced the concentration levels of PM₁, PM_2.5, PM₁₀, NO₂, and CO and subsequently reduced the associated ischemic stroke incidence. The health benefits due to the lockdown are temporary, and long-term measures should be implemented to increase air quality and related health benefits in the post-COVID-19 period.

Oral Administration of Omega-3 Fatty Acids Attenuates Lung Injury Caused by PM2.5 Respiratory Inhalation Simply and Feasibly In Vivo

For developing an effective interventional approach and treatment modality for PM2.5, the effects of omega-3 fatty acids on alleviating inflammation and attenuating lung injury induced by inhalation exposure of PM2.5 were assessed in murine models. We found that daily oral administration of the active components of omega-3 fatty acids, docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) effectively alleviated lung parenchymal lesions, restored normal inflammatory cytokine levels and oxidative stress levels in treating mice exposed to PM2.5 (20 mg/kg) every 3 days for 5 times over a 14-day period. Especially, CT images and the pathological analysis suggested protective effects of DHA and EPA on lung injury. The key molecular mechanism is that DHA and EPA can inhibit the entry and deposition of PM2.5, and block the PM2.5-mediated cytotoxicity, oxidative stress, and inflammation.

Spatio-Temporal Characteristics of Air Quality Index (AQI) over Northwest China

In recent years, air pollution has become a serious threat, causing adverse health effects and millions of premature deaths in China. This study examines the spatial-temporal characteristics of ambient air quality in five provinces (Shaanxi (SN), Xinjiang (XJ), Gansu (GS), Ningxia (NX), and Qinghai (QH)) of northwest China (NWC) from January 2015 to December 2018. For this purpose, surface-level aerosol pollutants, including particulate matter (PMx, x = 2.5 and 10) and gaseous pollutants (sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3)) were obtained from China National Environmental Monitoring Center (CNEMC). The results showed that fine particulate matter (PM2.5), coarse particulate matter (PM10), SO2, NO2, and CO decreased by 28.2%, 32.7%, 41.9%, 6.2%, and 27.3%, respectively, while O3 increased by 3.96% in NWC during 2018 as compared with 2015. The particulate matter (PM2.5 and PM10) levels exceeded the Chinese Ambient Air Quality Standards (CAAQS) Grade II standards as well as the WHO recommended Air Quality Guidelines, while SO2 and NO2 complied with the CAAQS Grade II standards in NWC. In addition, the average air quality index (AQI), calculated from ground-based data, improved by 21.3%, the proportion of air quality Class I (0–50) improved by 114.1%, and the number of pollution days decreased by 61.8% in NWC. All the pollutants’ (except ozone) AQI and PM2.5/PM10 ratios showed the highest pollution levels in winter and lowest in summer. AQI was strongly positively correlated with PM2.5, PM10, SO2, NO2, and CO, while negatively correlated with O3. PM10 was the primary pollutant, followed by O3, PM2.5, NO2, CO, and SO2, with different spatial and temporal variations. The proportion of days with PM2.5, PM10, SO2, and CO as the primary pollutants decreased but increased for NO2 and O3. This study provides useful information and a valuable reference for future research on air quality in northwest China.

Residential greenness and prevalence of chronic kidney disease: Findings from the China National Survey of Chronic Kidney Disease

Green space is associated with many health benefits, but evidence concerning the effects on chronic kidney disease (CKD) has not been investigated. Using the nationwide cross-sectional study of 47,204 adults from the China National Survey of Chronic Kidney Disease dataset and residential greenness assessed by the normalized difference vegetation index (NDVI), this study evaluated the association between residential greenness and CKD prevalence. An interquartile range increase in NDVI_1000m (0.26) was associated with decreased odds of CKD for all participants with an odds ratio (OR) of 0.79 (95% confidence interval [CI]: 0.73-0.86). Subgroup analyses demonstrated more apparent inverse associations in younger adults <65 years, male participants, people in higher socio-economic status, as well as people with smoking and alcohol drinking habit. In addition, more apparent inverse associations were found in regions with higher fine particulate matter (PM_2.5) concentration levels, with OR of 0.56 (95% CI: 0.49, 0.65) for higher pollution regions, and OR of 0.95 (95% CI: 0.83, 1.09) for lower pollution regions (P for interaction <0.001). The exposure-response curves captured more apparent declines in OR of CKD when in lower NDVI_1000m exposure ranges (<0.6), even controlling for the PM_2.5 concentration. Our results indicated that residential greenness might be beneficial for the prevention and control of CKD at the population level, suggesting the positive significance of strengthening green space construction, particularly in regions with low greenness.

Substantial health benefits of strengthening guidelines on indoor fine particulate matter in China

In 2020, China for the first time developed guidelines for indoor fine particulate matter (PM_2.5) in the draft document of indoor air standards, while the associated health implication remains unclear. Here, we first estimated the PM_2.5 associated premature deaths was 965 thousand in 2019, with the indoor PM_2.5 of outdoor origin accounting for 72.9%. Then, we examined the dynamic mortalities under a scenario matrix of 36 conditions, by incorporating various shared socioeconomic pathways in 2035, the draft guidelines and the contributions of ambient PM_2.5 to indoor exposure. Although it may be improbable, the averages of premature deaths associated with ambient PM_2.5 will be 1018-1361 thousand in 2035 when the worst-case scenario of guidelines mandating a yearly (rather than daily) indoor PM_2.5 concentration of 75 µg/m³, compared to the averages of estimation were 816-1304 thousand for better-case scenario of 35 µg/m³. Under these scenarios, the increase in the number of premature deaths was mainly driven by population aging. In 2035, an ambitious target of yearly indoor PM_2.5 concentrations of 15 µg/m³ is anticipated to reduce the number of deaths associated with ambient PM_2.5 by approximately 25% of the 2019 baseline. Stricter guidelines to restrict the indoor PM_2.5 concentrations are recommended to mitigate the mortality risk in the future.

Temporal and Spatial Heterogeneity of PM2.5 Related to Meteorological and Socioeconomic Factors across China during 2000-2018

In recent years, air pollution caused by PM_2.5 in China has become increasingly severe. This study applied a Bayesian space-time hierarchy model to reveal the spatiotemporal heterogeneity of the PM_2.5 concentrations in China. In addition, the relationship between meteorological and socioeconomic factors and their interaction with PM_2.5 during 2000-2018 was investigated based on the GeoDetector model. Results suggested that the concentration of PM_2.5 across China first increased and then decreased between 2000 and 2018. Geographically, the North China Plain and the Yangtze River Delta were high PM_2.5 pollution areas, while Northeast and Southwest China are regarded as low-risk areas for PM_2.5 pollution. Meanwhile, in Northern and Southern China, the population density was the most important socioeconomic factor affecting PM_2.5 with q values of 0.62 and 0.66, respectively; the main meteorological factors affecting PM_2.5 were air temperature and vapor pressure, with q values of 0.64 and 0.68, respectively. These results are conducive to our in-depth understanding of the status of PM_2.5 pollution in China and provide an important reference for the future direction of PM_2.5 pollution control.

PM2.5-associated risk for cardiovascular hospital admission and related economic burdens in Beijing, China

BACKGROUND

The study of ambient air particulate matter (PM_2.5)-associated health and economic burdens of cardiovascular disease are crucial for air pollution control and disease prevention strategies. Quantified evidence remains inadequate.

OBJECTIVES

This study aimed to estimate the PM_2.5 associated risk in cardiovascular hospital admission as well as attributable health burdens and economic costs.

METHODS

A total of 2,202,244 hospital admission records of cardiovascular disease and six common clinical subtypes in Beijing were included. A time-stratified case-crossover design was applied to estimate the associations and the concentration-response curve. Then, the annual average additional hospital admissions, days of hospital stay, and hospital expenditures were evaluated from 2013 to 2017 and compared between 2017 and 2013.

RESULTS

The results showed that each 10 μg/m³ increase in previous-day PM_2.5 concentration was associated with a risk increase of 0.44% (95%CI: 0.40%, 0.47%) for cardiovascular disease, 0.66% (95%CI: 0.58%, 0.73%) for angina pectoris, 0.53% (95%CI: 0.39%, 0.66%) for chronic ischemic heart disease, 0.48% (95%CI: 0.34%, 0.63%) for myocardial infarction, 0.44% (95%CI: 0.29%, 0.60%) for hypertensive heart disease and 0.40% (95%CI: 0.27%, 0.52%) for ischemic stroke. There were 1938 PM_2.5 attributed additional hospital admissions, resulting in 21,668 additional days in hospital, along with 5527.12 and 1947.04 ten-thousand of additional total hospital cost and self-afforded cost, respectively. Compared with 2013, the above-mentioned four burdens decreased by 18.17%, 28.80%, 18.90% and 13.72% in 2017, respectively.

CONCLUSION

PM_2.5 exposure was significantly associated with substantial burdens of cardiovascular hospital admission and economic expenditures. The results highlight the necessity of continuous PM_2.5 control from the perspective of healthy and sustainable city development in urban China.

Spatial Distribution of PM2.5-Related Premature Mortality in China

PM2.5 is a major component of air pollution in China and has a serious threat to public health. It is very important to quantify spatial characteristics of the health effects caused by outdoor PM2.5 exposure. This study analyzed the spatial distribution of PM2.5 concentration (45.9 μg/m3 national average in 2016) and premature mortality attributed to PM2.5 in cities at the prefectural level and above in China in 2016. Using the Global Exposure Mortality Model (GEMM), the total premature mortality in China was estimated to be 1.55 million persons, and the per capita mortality was 11.2 per 10,000 persons in the year 2016, resulting in higher estimates compared to the integrated exposure-response model. We assessed the premature mortality attributed to PM2.5 through common diseases, including ischemic heart disease (IHD), cerebrovascular disease (CEV), chronic obstructive pulmonary disease (COPD), lung cancer (LC), and lower respiratory infections (LRI). The premature mortality due to IHD and CEV accounted for 68.5% of the total mortality, and the per capita mortality (per 10,000 persons) for all ages due to IHD was 3.86, the highest among diseases. For the spatial distribution of disease-specific premature mortality, the top two highest absolute numbers of premature mortality associated with IHD, CEV, LC, and LRI, respectively, were found in Chongqing and Beijing. In 338 cities of China, we have found a significant positive spatial autocorrelation of per capita premature mortality, indicating the necessity of coordinated regional governance for an efficient control of PM2.5.

The association between ambient air pollution and scarlet fever in Qingdao, China, 2014-2018: a quantitative analysis

Background

We conducted a distributed lag non-linear time series analysis to quantify the association between air pollution and scarlet fever in Qingdao city during 2014–2018.

Methods

A distributed lag non-linear model (DLNM) combined with a generalized additive mixed model (GAMM) was applied to quantify the distributed lag effects of air pollutions on scarlet fever, with daily incidence of scarlet fever as the dependent variable and air pollutions as the independent variable adjusted for potential confounders.

Results

A total of 6316 cases of scarlet fever were notified, and there were 376 days occurring air pollution during the study period. Scarlet fever was significantly associated with air pollutions at a lag of 7 days with different relative risk (RR) of air pollution degrees [1.172, 95% confidence interval (CI): 1.038–1.323 in mild air pollution; 1.374, 95% CI 1.078–1.749 in moderate air pollution; 1.610, 95% CI 1.163–2.314 in severe air pollution; 1.887, 95% CI 1.163–3.061 in most severe air pollution].

Conclusions

Our findings show that air pollution is positively associated with scarlet fever in Qingdao, and the risk of scarlet fever could be increased along with the degrees of air pollution. It contributes to developing strategies to prevent and reduce health impact from scarlet fever and other non-vaccine-preventable respiratory infectious diseases in air polluted areas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06674-8.

Health Impact Attributable to Improvement of PM2.5 Pollution from 2014–2018 and Its Potential Benefits by 2030 in China

With the advancement of urbanization and industrialization, air pollution has become one of the biggest challenges for sustainable development. In recent years, ambient PM2.5 concentrations in China have declined substantially due to the combined effect of PM2.5 control and meteorological conditions. To this end, it is critical to assess the health impact attributable to PM2.5 pollution improvement and to explore the potential benefits which may be obtained through the achievement of future PM2.5 control targets. Based on PM2.5 and population data with a 1 km resolution, premature mortality caused by exposure to PM2.5 in China from 2014 to 2018 was estimated using the Global Exposure Mortality Model (GEMM). Then, the potential benefits of achieving PM2.5 control targets were estimated for 2030. The results show that premature mortality caused by PM2.5 pollution decreased by 22.41%, from 2,361,880 in 2014 to 1,832,470 in 2018. Moreover, the reduction of premature mortality in six major regions of China accounted for 52.82% of the national total reduction. If the PM2.5 control target can be achieved by 2030, PM2.5-related premature deaths will further decrease by 403,050, accounting for 21.99% of those in 2018. Among them, 87.02% of cities exhibited decreases in premature deaths. According to the potential benefits in 2030, all cities were divided into three types, of which type III cities should set stricter PM2.5 control targets and further strengthen the associated monitoring and governance. The results of this study provide a reference for the formulation of air pollution control policies based on regional differences.

Health benefits and cost of using air purifiers to reduce exposure to ambient fine particulate pollution in China

Understanding the cost-effectiveness of possible interventions to reduce air pollution levels is crucial to developing sustainable mitigation and adaption strategies. Although people spend more than 80% of their time indoors, the role of air purifiers in mitigating personal exposure to indoor PM_2.5 of outdoor origin has not yet been quantified, especially in under-developed regions. Here, we performed a comprehensive simulation at the 10 km × 10 km geographical resolution in mainland China to quantify the health benefits and costs of indoor air purification in four intervention scenarios, S1 to S4, where target indoor PM_2.5 concentrations were 35, 25, 15, and 10 μg/m³. In intervention scenarios S1 to S4, 93,200 (95% uncertainty interval 78,900-113,600), 115,300 (97,700-140,800), 163,400 (138,300-198,800), and 207,900 (176,300-251,800) deaths that cost 82, 175, 438, and 798 billion Chinese Yuan can be avoided and 93%, 80%, 53%, and 26% of the cities have a positive net monetary benefit. We found that achieving indoor PM_2.5 concentration of 35 or 25 μg/m³ using air purifiers is cost-effective at reducing PM_2.5 related deaths and PM_2.5 concentration of 25 μg/m³ is a suitable indoor PM_2.5 target for China. Multifaceted efforts are necessary to ensure equitable access to air purifiers and the knowledge to effectively operate them to make sure the benefits reach the whole population.

Regional Features of Long-Term Exposure to PM2.5 Air Quality over Asia under SSP Scenarios Based on CMIP6 Models

This study investigates changes in fine particulate matter (PM_2.5) concentration and air-quality index (AQI) in Asia using nine different Coupled Model Inter-Comparison Project 6 (CMIP6) climate model ensembles from historical and future scenarios under shared socioeconomic pathways (SSPs). The results indicated that the estimated present-day PM_2.5 concentrations were comparable to satellite-derived data. Overall, the PM_2.5 concentrations of the analyzed regions exceeded the WHO air-quality guidelines, particularly in East Asia and South Asia. In future SSP scenarios that consider the implementation of significant air-quality controls (SSP1-2.6, SSP5-8.5) and medium air-quality controls (SSP2-4.5), the annual PM_2.5 levels were predicted to substantially reduce (by 46% to around 66% of the present-day levels) in East Asia, resulting in a significant improvement in the AQI values in the mid-future. Conversely, weak air pollution controls considered in the SSP3-7.0 scenario resulted in poor AQI values in China and India. Moreover, a predicted increase in the percentage of aged populations (>65 years) in these regions, coupled with high AQI values, may increase the risk of premature deaths in the future. This study also examined the regional impact of PM_2.5 mitigations on downward shortwave energy and surface air temperature. Our results revealed that, although significant air pollution controls can reduce long-term exposure to PM_2.5, it may also contribute to the warming of near- and mid-future climates.

MiR-939-5p suppresses PM2.5-induced endothelial injury via targeting HIF-1α in HAECs

Ambient air pollution is a leading cause of non-communicable disease in the world. PM_2.5 has the potential to change the miRNAs profiles, which in turn causes cardiovascular effects. Hypoxia-inducible factor (HIF)-1 plays a critical role in the development of atherosclerosis. Yet, the possible role of miR-939-5p/HIF-1α in PM_2.5-induced endothelial injury remains elusive. Therefore, the study aims to investigate the effects of miR-939-5p and HIF-1α on PM_2.5-triggered endothelial injury. The results from immunofluorescence, qRT-PCR, LSCM, and western blot assays demonstrated that PM_2.5 increased the levels of HIF-1α, inflammation and apoptosis in human aortic endothelial cells (HAECs). Yet, the inflammatory response and mitochondrial-mediated apoptosis pathway were effectively inhibited in HIF-1α knockdown HAECs lines. The expression of miR-939-5p was significantly down-regulated in HAECs after exposed to PM_2.5. The luciferase reporter, qRT-PCR and western blot results demonstrated that miR-939-5p could directly targeted HIF-1α. And the miR-939-5p overexpression restricted PM_2.5-triggered decreases in cell viability and increases in lactic dehydrogenase (LDH) activity, reactive oxygen species (ROS), mitochondrial membrane potential (MMP) and inflammation. In addition, miR-939-5p overexpression remarkably suppressed PM_2.5-triggered BcL-2/Bax ratio reduction and Cytochrome C, Cleaved Caspase-9 and Cleaved Caspase-3 expression increase, revealed that miR-939-5p hampered PM_2.5-induced endothelial apoptosis through mitochondrial-mediated apoptosis pathway. Our results demonstrated that PM_2.5 increased the expression of HIF-1α followed by a pro-inflammatory and apoptotic response in HAECs. The protective effect of miR-939-5p on PM_2.5-triggered endothelial cell injury by negatively regulating HIF-1α. miR-939-5p might present a new therapeutic target for PM_2.5 induced endothelial injury.

Pathways of China's PM2.5 air quality 2015–2060 in the context of carbon neutrality

Clean air policies in China have substantially reduced particulate matter (PM_2.5) air pollution in recent years, primarily by curbing end-of-pipe emissions. However, reaching the level of the World Health Organization (WHO) guidelines may instead depend upon the air quality co-benefits of ambitious climate action. Here, we assess pathways of Chinese PM_2.5 air quality from 2015 to 2060 under a combination of scenarios that link global and Chinese climate mitigation pathways (i.e. global 2°C- and 1.5°C-pathways, National Determined Contributions (NDC) pledges and carbon neutrality goals) to local clean air policies. We find that China can achieve both its near-term climate goals (peak emissions) and PM_2.5 air quality annual standard (35 μg/m³) by 2030 by fulfilling its NDC pledges and continuing air pollution control policies. However, the benefits of end-of-pipe control reductions are mostly exhausted by 2030, and reducing PM_2.5 exposure of the majority of the Chinese population to below 10 μg/m³ by 2060 will likely require more ambitious climate mitigation efforts such as China's carbon neutrality goals and global 1.5°C-pathways. Our results thus highlight that China's carbon neutrality goals will play a critical role in reducing air pollution exposure to the level of the WHO guidelines and protecting public health.

Impact of SARS-CoV-2 on Ambient Air Quality in Northwest China (NWC)

SARS-CoV-2 was discovered in Wuhan (Hubei) in late 2019 and covered the globe by March 2020. To prevent the spread of the SARS-CoV-2 outbreak, China imposed a countrywide lockdown that significantly improved the air quality. To investigate the collective effect of SARS-CoV-2 on air quality, we analyzed the ambient air quality in five provinces of northwest China (NWC): Shaanxi (SN), Xinjiang (XJ), Gansu (GS), Ningxia (NX) and Qinghai (QH), from January 2019 to December 2020. For this purpose, fine particulate matter (PM2.5), coarse particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) were obtained from the China National Environmental Monitoring Center (CNEMC). In 2020, PM2.5, PM10, SO2, NO2, CO, and O3 improved by 2.72%, 5.31%, 7.93%, 8.40%, 8.47%, and 2.15%, respectively, as compared with 2019. The PM2.5 failed to comply in SN and XJ; PM10 failed to comply in SN, XJ, and NX with CAAQS Grade II standards (35 µg/m3, 70 µg/m3, annual mean). In a seasonal variation, all the pollutants experienced significant spatial and temporal distribution, e.g., highest in winter and lowest in summer, except O3. Moreover, the average air quality index (AQI) improved by 4.70%, with the highest improvement in SN followed by QH, GS, XJ, and NX. AQI improved in all seasons; significant improvement occurred in winter (December to February) and spring (March to May) when lockdowns, industrial closure etc. were at their peak. The proportion of air quality Class I improved by 32.14%, and the number of days with PM2.5, SO2, and NO2 as primary pollutants decreased while they increased for PM10, CO, and O3 in 2020. This study indicates a significant association between air quality improvement and the prevalence of SARS-CoV-2 in 2020.

Melatonin ameliorates PM2.5 -induced cardiac perivascular fibrosis through regulating mitochondrial redox homeostasis

Fine particulate matter (PM2.5 ) exposure is correlated with the risk of developing cardiac fibrosis. Melatonin is a major secretory product of the pineal gland that has been reported to prevent fibrosis. However, whether melatonin affects the adverse health effects of PM2.5 exposure has not been investigated. Thus, this study was aimed to investigate the protective effect of melatonin against PM2.5 -accelerated cardiac fibrosis. The echocardiography revealed that PM2.5 had impaired both systolic and diastolic cardiac function in ApoE-/- mice. Histopathological analysis demonstrated that PM2.5 induced cardiomyocyte hypertrophy and fibrosis, particularly perivascular fibrosis, while the melatonin administration was effective in alleviating PM2.5 -induced cardiac dysfunction and fibrosis in mice. Results of electron microscopy and confocal scanning laser microscope confirmed that melatonin had restorative effects against impaired mitochondrial ultrastructure and augmented mitochondrial ROS generation in PM2.5 -treated group. Further investigation revealed melatonin administration could significantly reverse the PM2.5 -induced phenotypic modulation of cardiac fibroblasts into myofibroblasts. For the first time, our study found that melatonin effectively alleviates PM2.5 -induced cardiac dysfunction and fibrosis via inhibiting mitochondrial oxidative injury and regulating SIRT3-mediated SOD2 deacetylation. Our findings indicate that melatonin could be a therapy medicine for prevention and treatment of air pollution-associated cardiac diseases.

Associations between short-term exposure to PM2.5 and stroke incidence and mortality in China: A case-crossover study and estimation of the burden

Stroke and fine particulate matter (PM_2.5) are two important public health concerns worldwide. Although numerous studies have reported the associations between PM_2.5 and stroke, scientific evidence in China is incomplete, particularly the effect of PM_2.5 on the acute incidence and national acute health burdens of stroke attributed to PM_2.5 pollution. This study identified about 131,947 registered patients and 23,018 deaths due to stroke in 10 counties located in various regions from 2013 to 2017. Using a time-stratified case-crossover design, this study evaluated the associations between short-term exposure to PM_2.5 and the risks of acute incidence and mortality for different types of stroke on the same spatiotemporal scale. With a 10 μg/m³ increase in the PM_2.5 concentration, the acute incidence risk increased by 0.37% (0.15%, 0.60%) for stroke, 0.46% (0.21%, 0.72%) for ischemic stroke, and -0.13% (-0.73%, 0.48%) for hemorrhagic stroke. The corresponding values for the mortality risk were 0.71% (0.08%, 1.33%), 1.09% (0.05%, 2.14%), and 0.43% (-0.44%, 1.31%) for stroke, ischemic stroke and hemorrhagic stroke, respectively. Compared with the other groups, females and patients aged over 64 years presented higher incidence and mortality risks, while the group aged >75 years may exhibit a greater risk of mortality. Based on the estimated effects, we evaluated 43,300 excess deaths and 48,800 acute incidences attributed to short-term PM_2.5 exposure across China in 2015. This study provided robust estimates of PM_2.5-induced stroke incidence and mortality risks, and susceptible populations were identified. Excess mortality and morbidity attributed to short-term PM_2.5 exposure indicate the necessity to implement health care and prevention strategies, as well as medical resource allocation for noncommunicable diseases in regions with high levels of air pollution.

PM2.5 organic extract mediates inflammation through the ERβ pathway to contribute to lung carcinogenesis in vitro and vivo

An increasing number of researches have shown that fine particulate matter (PM2.5) is closely related to increased respiratory inflammation and can even lead to lung cancer. Estrogen receptor β (ERβ) has been demonstrated to be involved in several cancers. However, the exact role of ERβ in PM2.5 organic extract (Po)-promoted inflammation and lung cancer remains unknown. The purpose of this study was to investigate whether ERβ is involved in Po induced inflammation and lung cancer. In vitro, our results showed that interleukin-6 (IL-6) and ERβ were simultaneously increased in lung bronchial epithelial cells exposed to Po; additionally, inhibition of ERβ decreased IL-6 expression and secretion through inactivating ERK and AKT and further promoted cells malignant transformation. Moreover, we performed an animal model of inhalation exposure to Po using female C57BL/6 mice. Although we were unable to find tumor tissue in mice exposed to Po, we detected evidence of lung inflammation, epithelial-to-mesenchymal transition (EMT) phenotype and severe pulmonary injury; in addition, intraperitoneal injection of PHTPP (an ERβ inhibitor) showed that the above phenomena have been improved, which demonstrate that Po stimulates IL-6 expression to promote inflammation, EMT phenotype and lung injury through the ERβ pathway. In conclusion, our results confirmed the potential toxic effect of PM2.5, and increased our understanding of PM2.5 carcinogenic potential by exploring the mechanism of ERβ regulating inflammation.

Specific differences and responses to reductions for premature mortality attributable to ambient PM2.5 in China

Although recent assessments have quantified the impact of ambient PM_2.5 on public health in China, air quality managers would benefit from assessing specific differences in premature mortality and its responses to air quality improvement. Using PM_2.5 data simulated by an observation-fused air quality model and an integrated exposure-response model for the full range of PM_2.5, we determined the premature mortality attributable to ambient PM_2.5 across mainland China in 2016. Overall, the total number of PM_2.5-related deaths nationwide was 1.31 million, of which lung cancer, chronic obstructive pulmonary disease, ischemic heart disease, and stroke represented 0.13, 0.13, 0.42, and 0.62 million, respectively. Per capita PM_2.5-related mortality in China was 95 per 100,000 person-years, and that of elderly people aged ≥75 years (1166 deaths per 100,000) was much higher than that of young people aged 25-44 years (11 deaths per 100,000). Additionally, there were significant spatial differences in premature deaths, which mainly occurred in regions with high PM_2.5 levels or/and population density. Halving deaths across mainland China required an average of 63% reduction of PM_2.5 nationwide and a decrease by 73% in high concentration regions exceeding 70 μg/m³ and 19% in low concentration locales below 10 μg/m³. Moreover, reducing PM_2.5 to the WHO interim target I (IT-1) of 35 μg/m³ would only result in a 12.6% reduction in premature mortality, while a more exacting standard (reducing PM_2.5 to 10 μg/m³) would avoid 73.0% of mortality. In particular, there is a large potential for reducing the high PM_2.5-related mortality in heavily polluted locales. In conclusion, to further reduce premature mortality across mainland China, targets stricter than the IT-1 and tight policies to improve air quality and protect public health are necessary, especially for vulnerable groups such as the elderly and patients with cardio-cerebrovascular diseases, particularly in areas with high premature mortality.

County-level variation in the long-term association between PM2.5 and lung cancer mortality in China

INTRODUCTION

The relative risk (RR) of long-term exposure to PM_2.5 in lung cancer mortality (LCM) may vary spatially in China. However, previous studies applying global regression have been unable to capture such variation. We aimed to employ a geographically weighted Poisson regression (GWPR) to estimate the RRs of LCM among the elderly (≥65 years) related to long-term exposure to PM_2.5 and the LCM attributable to PM_2.5 at the county level in China.

METHODS

We obtained annual LCM in the elderly between 2013 and 2015 from the National Death Surveillance. We linked annual mean concentrations of PM_2.5 between 2000 and 2004 with LCM using GWPR model at 148 counties across mainland China, adjusting for smoking and socioeconomic covariates. We used county-specific GWPR models to estimate annual average LCM in the elderly between 2013 and 2015 attributable to PM_2.5 exposure between 2000 and 2004.

RESULTS

The magnitude of the association between long-term exposure to PM_2.5 and LCM varied with county. The median of county-specific RRs of LCM among elderly men and women was 1.52 (range: 0.90, 2.40) and 1.49 (range: 0.88, 2.56) for each 10 μg/m³ increment in PM_2.5, respectively. The RRs were positively significant (P < 0.05) at 95% (140/148) of counties among both elderly men and women. Higher RRs of PM_2.5 among elderly men were located at Southwest and South China, and higher RRs among elderly women were located at Northwest, Southwest, and South China. There were 99,967 and 54,457 lung cancer deaths among elderly men and women that could be attributed to PM_2.5, with the attributable fractions of 31.4% and 33.8%, respectively.

CONCLUSIONS

The relative importance of long-term exposure to PM_2.5 in LCM differed by county. The results could help the government design tailored and efficient interventions. More stringent PM_2.5 control is urgently needed to reduce LCM in China.

miR-205/IRAK2 signaling pathway is associated with urban airborne PM2.5-induced myocardial toxicity

Exposure to fine particulate matter (PM_2.5) is closely linked with cardiovascular diseases. However, the underlying mechanism of PM_2.5 on cardiac function remains unknown. This study was aimed to investigate the role of microRNA-205 (miR-205) on PM_2.5-induced myocardial inflammation and cardiac dysfunction. PM_2.5 increased the levels of reactive oxygen species (ROS) and malondialdehyde (MDA), following by decreased cell viability and antioxidant enzymes, resulting in apoptosis of cardiomyocytes (AC16). The histopathological and ultrastructural analysis demonstrated that PM_2.5 caused myocardial damage via interstitial edema, inflammatory cell infiltration, and myocardial fiber destruction. PM_2.5 enhanced the release of inflammatory factors in AC16 cells and heart tissue. Microarray analysis and dual-luciferase reporter gene assays demonstrated that PM_2.5-induced down-regulation of miR-205 regulated interleukin 1 receptor-associated kinase 2 (IRAK2), which further activated the TNF receptor-associated factor 6 (TRAF6)/nuclear transcription factor-κB (NF-κB) signaling pathway in vivo. Moreover, the chemical mimics of miR-205 markedly inhibited the IRAK2/TRAF6/NF-κB signaling pathway, whereas the chemical inhibitors of miR-205 amplified PM_2.5-induced activation of the IRAK2 signaling pathway in vitro. In summary, our results found that PM_2.5 could trigger myocardial toxicity via miR-205 negative regulating the IRAK2/TRAF6/NF-κB signaling pathway. Our study suggests that miR-205 could be a promising target molecule for mitigating the hazardous effects of PM_2.5 on the cardiovascular system.

The changing PM2.5 dynamics of global megacities based on long-term remotely sensed observations

Satellite observations show that the rapid urbanization and emergence of megacities with 10 million or more residents have raised PM2.5 concentrations across the globe during the past few decades. This study examines PM2.5 dynamics for the 33 cities included on the UN list of megacities published in 2018. These megacities were classified into densely (>1500 residents per km²), moderately (300-1500 residents per km²) and sparsely (<300 residents per km²) populated areas to examine the effect of human population density on PM2.5 concentrations in these areas during the period 1998-2016. We found that: (1) the higher population density areas experienced higher PM2.5 concentrations; and (2) the megacities with high PM2.5 concentrations in these areas had higher concentrations than those in the moderately and sparsely populated areas of other megacities as well. The numbers of residents experiencing poor air quality is substantial: approximately 452 and 163 million experienced average annual PM2.5 levels exceeding 10 and 35 μg/m³, respectively in 2016. We also examined PM2.5 trends during the past 18 years and predict that high PM2.5 levels will likely continue in many of these megacities in the future without substantial changes in their economies and/or pollution abatement practices. There will be more megacities in the highest PM2.5 pollution class and the number of megacities in the lowest PM2.5 pollution class will likely not change. Finally, we analyzed how the PM2.5 pollution burden varies geographically and ranked the 33 megacities in terms of PM2.5 pollution in 2016. The most polluted regions are China, India, and South Asia and the least polluted regions are Europe and Japan. None of the 33 megacities currently fall in the WHO's PM2.5 attainment class (<10 μg/m³) while 9 megacities fall into the PM2.5 non-attainment class (>35 μg/m³). In 2016, the least polluted megacity was New York and most polluted megacity was Delhi whose average annual PM2.5 concentration of 110 μg/m³ is nearly three times the WHO's non-attainment threshold.

Exposure to air pollution and scarlet fever resurgence in China: a six-year surveillance study

Scarlet fever has resurged in China starting in 2011, and the environment is one of the potential reasons. Nationwide data on 655,039 scarlet fever cases and six air pollutants were retrieved. Exposure risks were evaluated by multivariate distributed lag nonlinear models and a meta-regression model. We show that the average incidence in 2011-2018 was twice that in 2004-2010 [RR = 2.30 (4.40 vs. 1.91), 95% CI: 2.29-2.31; p < 0.001] and generally lower in the summer and winter holiday (p = 0.005). A low to moderate correlation was seen between scarlet fever and monthly NO₂ (r = 0.21) and O₃ (r = 0.11). A 10 μg/m³ increase of NO₂ and O₃ was significantly associated with scarlet fever, with a cumulative RR of 1.06 (95% CI: 1.02-1.10) and 1.04 (95% CI: 1.01-1.07), respectively, at a lag of 0 to 15 months. In conclusion, long-term exposure to ambient NO₂ and O₃ may be associated with an increased risk of scarlet fever incidence, but direct causality is not established.

Substantial changes in PM2.5 pollution and corresponding premature deaths across China during 2015-2019: A model prospective

Long-term exposure to the ambient fine particulate matter (PM_2.5) is the major public health risk factor in China. Several past studies have assessed premature mortalities associated with PM_2.5 in China at varying levels of temporal and spatial scales using different methodological approaches. However, recently developed global exposure mortality model [GEMM NCD + LRI and GEMM 5-COD] provides a much more sophisticated methodology in capturing mortality due to PM_2.5-exposure than the commonly accepted integrated exposure-response (IER) model, which this study applied to China. This study provides a comparative assessment of the excess long-term PM_2.5-attributed nonaccidental deaths as well as cause-specific deaths for 349 cities in mainland China during five years (from 2015 to 2019) and compares the results with the spatial resolution scale of 0.1° × 0.1° across overall China. The results demonstrate that the national annual average PM_2.5 concentration declined from 51.9 ± 18.2 μg/m³ in 2015 to 39.0 ± 13.2 μg/m³ in 2019, and the overall annual negative trend was around -3.1 ± 2.2 μg/m³/year [-5.6 ± 3.4%/year] across China. Consequently, the number of PM_2.5-related deaths decreased by 383 thousand [95% CI: 331-429] to 1755 thousand [95% Confidence Interval: 1470-2025; GEMM NCD + LRI]; 315 thousand [95% CI: 227-370] to 1380 thousand [95% CI: 948-1740; GEMM 5-COD] and 125 thousand [95% CI: 64-140] to 876 thousand [95% CI: 394-1262; IER] in 2019, derived from the pre-established models (GEMM and IER). The estimate PM_2.5-attributed death with a spatial resolution of 0.1° × 0.1° was 2419 thousand [95% CI: 2041-2771; GEMM NCD + LRI], 1918 thousand [95% CI: 1333-2377; GEMM 5-COD] and 1162 thousand [95% CI: 534-1611; IER] in 2015, which is about 11-16% higher value than the city-level health risk assessment study. The estimated deaths by GEMM NCD + LRI and GEMM 5-COD were 104% and 61% higher than the estimated by IER, highlighting that total premature mortalities associated with PM_2.5 were substantially left behind based on the pre-existing model. The "other noncommunicable diseases" mortality, which IER method doesn't account for, was 375 thousand in 2019, 68 thousand less than in 2015. Such significant mortality was previously overlooked in estimation methods, which should now be considered for the air pollution-related policy development in China. The high number of premature deaths in central and northern parts of China, calls for the need for the Government to quickly impose even more stringent and effective pollution control measures.

Provincial and gridded population projection for China under shared socioeconomic pathways from 2010 to 2100

In response to a growing demand for subnational and spatially explicit data on China’s future population, this study estimates China’s provincial population from 2010 to 2100 by age (0–100+), sex (male and female) and educational levels (illiterate, primary school, junior-high school, senior-high school, college, bachelor’s, and master’s and above) under different shared socioeconomic pathways (SSPs). The provincial projection takes into account fertility promoting policies and population ceiling restrictions of megacities that have been implemented in China in recent years to reduce systematic biases in current studies. The predicted provincial population is allocated to spatially explicit population grids for each year at 30 arc-seconds resolution based on representative concentration pathway (RCP) urban grids and historical population grids. The provincial projection data were validated using population data in 2017 from China’s Provincial Statistical Yearbook, and the accuracy of the population grids in 2015 was evaluated. These data have numerous potential uses and can serve as inputs in climate policy research with requirements for precise administrative or spatial population data in China.

Measurement(s)	population
Technology Type(s)	computational modeling technique
Factor Type(s)	age • sex • education level • Shared Socioeconomic Pathway • year • province
Sample Characteristic - Location	China

Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.11898405

Ambient air pollution is associated with airway inflammation in older women: a nested cross-sectional analysis

BACKGROUND

Air pollution is a risk factor for chronic obstructive pulmonary disease (COPD). Fraction of exhaled nitric oxide (FeNO) could be a useful biomarker for health effects of air pollutants. However, there were limited data from older populations with higher prevalence of COPD and other inflammatory conditions.

METHODS

We obtained data from the German Study on the influence of Air pollution on Lung function, Inflammation and Ageing. Spirometry and FeNO were measured by standard techniques. Air pollutant exposures were estimated following the European Study of Cohorts for Air Pollution Effects protocols, and ozone (O3) measured at the closest ground level monitoring station. Multiple linear regression models were fitted to FeNO with each pollutant separately and adjusted for potential confounders.

RESULTS

In 236 women (mean age 74.6 years), geometric mean FeNO was 15.2ppb. Almost a third (n=71, 30.1%) of the women had some chronic inflammatory respiratory condition. A higher FeNO concentration was associated with exposures to fine particles (PM2.5), PM2.5absorbance and respirable particles (PM10). There were no significant associations with PMcoarse, NO2, NOx, O3 or length of major roads within a 1 km buffer. Restricting the analysis to participants with a chronic inflammatory respiratory condition, with or without impaired lung function produced similar findings. Adjusting for diabetes did not materially alter the findings. There were no significant interactions between individual pollutants and asthma or current smoking.

CONCLUSIONS

This study adds to the evidence to reduce ambient PM2.5 concentrations as low as possible to protect the health of the general population.