Spatial Analysis of Ambient Air Pollution and Cardiovascular Disease (CVD) Hospitalization Across Sweden

Applicability of evaluation metrics/schemes for human health burden attributable to regional ozone pollution: A case study in the Guangdong-Hong Kong-Macao Greater Bay Area (GBA), South China

This is a study to identify the applicable/preferable short- and long-term metrics/schemes to evaluate the premature mortality attributable to the ozone pollution in the Guangdong-Hong Kong-Macao Greater Bay Area (GBA), one of the most representative populous ozone pollution regions in China, by comprehensively accounting the uncertainty sources. The discrepancy between the observation and the CAQRA reanalysis datasets (2013-2019) was investigated in terms of the concentration variation pattern, which determines the exposure metric change. A set of domestic short-term C-R coefficients for the all-age population were integrated using the meta-analysis respectively corresponding to the metrics of MDA1, MDA8, and Daily average. The dataset-based deviations of the short-term attributable factors (AFs) and their corresponding premature mortalities were respectively about 16.9 ± 13.3 % and <5 % based on MDA8, much smaller than other two metrics; and the MDA8-based evaluation results were the most sensitive to the deteriorative ozone pollution, with the maximum upward trends of 0.095-0.129 %/year. Accordingly, MDA8 was recognized as the most applicable short-term metric. For the long-term exposure, the domestic summer metric SMDA8 could not exactly represent the peak-season ozone maximum level in the GBA, with the deviation from 6MMDA8 as much as 30 %. By considering the ability of metric to represent the peak-season ozone, the relatively smaller dataset-based discrepancies of AFs (6MMDA8-WHO2021: 23.3 ± 16.9 %, AMDA8-T2016: 20.7 ± 15.8 %) and the attributable premature mortalities (6MMDA8-WHO2021: 5 %, AMDA8-T2016: 8 %), and the higher sensitivity of the evaluation results to the deteriorative ozone pollution (6MMDA8-WHO2021: 0.13 %;year, p = 0.01; AMDA8-T2016: 0.15 %/year, p = 0.03), the schemes of 6MMDA8-WHO2021 and AMDA8-T2016 were recognized relatively more preferable for the adult (≥25-year) long-term evaluation. Based on the recognized metric/schemes, the central and the eastern PRE areas of higher NO2 level in the GBA were experiencing the highest health burdens from 2013 to 2019.

Research progress of different components of PM2.5 and ischemic stroke

PM2.5 is a nonhomogeneous mixture of complex components produced from multiple sources, and different components of this mixture have different chemical and biological toxicities, which results in the fact that the toxicity and hazards of PM2.5 may vary even for the same mass of PM2.5. Previous studies on PM2.5 and ischemic stroke have reached different or even opposing conclusions, and considering the heterogeneity of PM2.5 has led researchers to focus on the health effects of specific PM2.5 components. However, due to the complexity of PM2.5 constituents, assessing the association between exposure to specific PM2.5 constituents and ischemic stroke presents significant challenges. Therefore, this paper reviews and analyzes studies related to PM2.5 and its different components and ischemic stroke, aiming to understand the composition of PM2.5 and identify its harmful components, elucidate their relationship with ischemic stroke, and thus provide some insights and considerations for studying the biological mechanisms by which they affect ischemic stroke and for the prevention and treatment of ischemic stroke associated with different components of PM2.5.

Association between ambient air pollution and hospital admissions, length of hospital stay and hospital cost for patients with cardiovascular diseases and comorbid diabetes mellitus: Base on 1,969,755 cases in Beijing, China, 2014-2019

BACKGROUND

Evidence on the effects of the air pollutants on the hospital admissions, hospital cost and length of stay (LOS) among patients with comorbidities remains limited in China, particularly for patients with cardiovascular diseases and comorbid diabetes mellitus (CVD-DM).

METHODS

We collected daily data on CVD-DM patients from 242 hospitals in Beijing between 2014 and 2019. Generalized additive model was employed to quantify the associations between admissions, LOS, and hospital cost for CVD-DM patients and air pollutants. We further evaluated the attributable risk posed by air pollutants to CVD-DM patients, using both Chinese and WHO air quality guidelines as reference.

RESULTS

Per 10 ug/m³ increase of particles with an aerodynamic diameter < 2.5 μm (PM_2.5), particles with an aerodynamic diameter < 10 μm (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbonic oxide (CO) and ozone (O₃) corresponded to a 0.64% (95% CI: 0.57 to 0.71), 0.52% (95% CI: 0.46 to 0.57), 0.93% (95% CI: 0.67 to 1.20), 0.98% (95% CI: 0.81 to 1.16), 1.66% (95% CI: 1.18 to 2.14) and 0.53% (95% CI: 0.45 to 0.61) increment for CVD-DM patients' admissions. Among the six pollutants, particulate pollutants (PM_2.5 and PM₁₀) in most lag days exhibited adverse effects on LOS and hospital cost. For every 10 ug/m³ increase in PM_2.5 and PM₁₀, the absolute increase with LOS will increase 62.08 days (95% CI: 28.93 to 95.23) and 51.77 days (95% CI:22.88 to 80.66), respectively. The absolute increase with hospital cost will increase 105.04 Chinese Yuan (CNY) (95% CI: 49.27 to 160.81) and 81.76 CNY (95% CI: 42.01 to 121.51) in PM_2.5 and PM₁₀, respectively. Given WHO 2021 air quality guideline as the reference, PM_2.5 had the maximum attributable fraction of 3.34% (95% CI: 2.94% to 3.75%), corresponding to an avoidable of 65,845 (95% CI: 57,953 to 73,812) patients with CVD-DM.

CONCLUSION

PM_2.5 and PM₁₀ are positively associated with hospital admissions, hospital cost and LOS for patients with CVD-DM. Policy changes to reduce air pollutants exposure may reduce CVD-DM admissions and substantial savings in health care spending and LOS.