Association between particulate matter and emergency room visits, hospital admissions and mortality in Spokane, Washington

Four year long simulation of carbonaceous aerosols in India: Seasonality, sources and associated health effects

India's air quality is in a dismal state, with many studies ascribing it to PM_2.5. Most of these corroborate that carbonaceous aerosol (CA) constitute significant fraction of PM_2.5. However, investigations on the effect of long-term meteorological or emission changes on PM_2.5 and its components, and their associated health effects are rare. In this work, WRF-Chem simulations for three seasons over four years (2016-2019) were carried out to cogitate the spatial and temporal changes in PM_2.5 and its components in India. Model predicted PM_2.5 concentrations were in good agreement with the ground-based observations for 25 cities. PM_2.5 was highest in winter and lowest in pre-monsoon. PM_2.5 reduced by ∼8% in Indo-Gangetic Plain (IGP) but increased by ∼38% and ∼130% in south and northeast India, respectively, from 2016 to 2019. IGP witnessed three times higher average PM_2.5 concentrations than south India. No significant interannual change in CA contributions was observed, however, it peaked in the winter season. Other inorganics (OIN) were the major component of PM_2.5, contributing more than 40%. Primary organic aerosol (POA) fractions were higher in north India, while secondary inorganic aerosol (SIA) dominated south India. Transport and residential sectors were the chief contributors to CA across India. Biomass burning contributed up to ∼23% of PM_2.5 in regions of IGP during post-monsoon, with CA fractions up to 50%. Associations between PM_2.5 and its components with daily inpatient admissions from a tertiary care centre in Delhi showed that PM_2.5 and OIN had lower associations with daily hospital admissions than CA. Every 10 μg/m³ increase in POA, black carbon (BC), and secondary organic aerosol (SOA) were associated with ∼1.09%, ∼3.07% and ∼4.93% increase in the risk of daily hospital admissions. This invigorates the need for more policies targeting CA rather than PM_2.5 to mitigate associated health risks, in India.

Personal NO2 sensor demonstrates feasibility of in-home exposure measurements for pediatric asthma research and management

BACKGROUND

One of the most common pollutants in residences due to gas appliances, NO₂ has been shown to increase the risk of asthma attacks after small increases in short term exposure. However, standard environmental sampling methods taken at the regional level overlook chronic intermittent exposure due to lack of temporal and spatial granularity. Further, the EPA and WHO do not currently provide exposure recommendations to at-risk populations.

AIMS

A pilot study with pediatric asthma patients was conducted to investigate potential deployment challenges as well as benefits of home-based NO₂ sensors and, when combined with a subject's hospital records and self-reported symptoms, the richness of data available for larger-scale epidemiological studies.

METHODS

We developed a compact personal NO₂ sensor with one minute temporal resolution and sensitivity down to 15 ppb to monitor exposure levels in the home. Patient hospital records were collected along with self-reported symptom diaries, and two example hypotheses were created to further demonstrate how data of this detail may enable study of the impact of NO₂ in this sensitive population.

RESULTS

17 patients (55%) had at least 1 h each day with average NO₂ exposure >21 ppb. Frequency of acute NO₂ exposure >21 ppb was higher in the group with gas stoves (U = 27, p ≤ 0.001), and showed a positive correlation (r_s = 0.662, p = 0.037, 95% CI 0.36-0.84) with hospital admissions.

SIGNIFICANCE

Similar studies are needed to evaluate the true impact of NO₂ in the home environment on at-risk populations, and to provide further data to regulatory bodies when developing updated recommendations.

Individual exposure to ambient PM2.5 and hospital admissions for COPD in 110 hospitals: a case-crossover study in Guangzhou, China

Few studies have evaluated the short-term association between hospital admissions and individual exposure to ambient particulate matter (PM_2.5). Particularly, no studies focused on hospital admissions for chronic obstructive pulmonary disease (COPD) at the individual level. We assessed the short-term effects of PM_2.5 on hospitalization admissions for COPD in Guangzhou, China, during 2014-2015, based on satellite-derived estimates of ambient PM_2.5 concentrations at a 1-km resolution near the residential address as individual-level exposure for each patient. Around 40,002 patients with COPD admitted to 110 hospitals were included in this study. A time-stratified case-crossover design with conditional logistic regression models was applied to assess the effects of PM_2.5 based on a 1-km grid data of aerosol optical depth provided by the National Aeronautics and Space Administration on hospital admissions for COPD. Further, we performed stratified analyses by individual demographic characteristics and season of hospital admission. Around 10 μg/m³ increase in individual-level PM_2.5 was associated with an increase of 1.6% (95% confidence interval [CI]: 0.6%, 2.7%) in hospitalization for COPD at a lag of 0-5 days. The impact of PM_2.5 on hospitalization for COPD was greater significantly in males and patients admitted in summer. Our study strengthened the evidence for the adverse effect of PM_2.5 based on satellite-based individual-level exposure data.

Uncertainty in Health Impact Assessments of Smoke From a Wildfire Event

Wildfires cause elevated air pollution that can be detrimental to human health. However, health impact assessments associated with emissions from wildfire events are subject to uncertainty arising from different sources. Here, we quantify and compare major uncertainties in mortality and morbidity outcomes of exposure to fine particulate matter (PM2.5) pollution estimated for a series of wildfires in the Southeastern U.S. We present an approach to compare uncertainty in estimated health impacts specifically due to two driving factors, wildfire-related smoke PM2.5 fields and variability in concentration-response parameters from epidemiologic studies of ambient and smoke PM2.5. This analysis, focused on the 2016 Southeastern wildfires, suggests that emissions from these fires had public health consequences in North Carolina. Using several methods based on publicly available monitor data and atmospheric models to represent wildfire-attributable PM2.5, we estimate impacts on several health outcomes and quantify associated uncertainty. Multiple concentration-response parameters derived from studies of ambient and wildfire-specific PM2.5 are used to assess health-related uncertainty. Results show large variability and uncertainty in wildfire impact estimates, with comparable uncertainties due to the smoke pollution fields and health response parameters for some outcomes, but substantially larger health-related uncertainty for several outcomes. Consideration of these uncertainties can support efforts to improve estimates of wildfire impacts and inform fire-related decision-making.

Outdoor air pollution and the risk of asthma exacerbations in single lag0 and lag1 exposure patterns: a systematic review and meta-analysis

Objective: To synthesize evidence regarding the relationship between outdoor air pollution and risk of asthma exacerbations in single lag0 and lag1 exposure patterns.Methods: We performed a systematic literature search using PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials, China National Knowledge Internet, Chinese BioMedical, and Wanfang databases. Articles published until August 1, 2020 and the reference lists of the relevant articles were reviewed. Two authors independently evaluated the eligible articles and performed structured extraction of the relevant information. Pooled relative risks (RRs) and 95% confidence intervals (CIs) of lag0 and lag1 exposure patterns were estimated using random-effect models.Results: Eighty-four studies met the eligibility criteria and provided sufficient information for meta-analysis. Outdoor air pollutants were associated with increased risk of asthma exacerbations in both single lag0 and lag1 exposure patterns [lag0: RR (95% CI) (pollutants), 1.057(1.011, 1.103) (air quality index, AQI), 1.007 (1.005, 1.010) (particulate matter of diameter ≤ 2.5 μm, PM_2.5), 1.009 (1.005, 1.012) (particulate matter of diameter, PM₁₀), 1.010 (1.006, 1.014) (NO₂), 1.030 (1.011, 1.048) (CO), 1.005 (1.002, 1.009) (O₃); lag1:1.064(1.022, 1.106) (AQI), 1.005 (1.002, 1.008) (PM_2.5), 1.007 (1.004, 1.011) (PM₁₀), 1.008 (1.004, 1.012) (NO₂), 1.025 (1.007, 1.042) (CO), 1.010 (1.006, 1.013) (O₃)], except SO₂ [lag0: RR (95% CI), 1.004 (1.000, 1.007); lag1: RR (95% CI), 1.003 (0.999, 1.006)]. Subgroup analyses revealed stronger effects in children and asthma exacerbations associated with other events (including symptoms, lung function changes, and medication use).Conclusion: Outdoor air pollution increases the asthma exacerbation risk in single lag0 and lag1 exposure patterns.Trial registration: PROSPERO, CRD42020204097. https://www.crd.york.ac.uk/.Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2021.2008429 .

Potential impacts of prescribed fire smoke on public health and socially vulnerable populations in a Southeastern U.S. state

Prescribed fire is an essential tool for wildfire risk mitigation and ecosystem restoration in the Southeastern United States. It is also one of the region's largest sources of atmospheric emissions. The public health impacts of prescribed fire smoke, however, remain uncertain. Here, we use digital burn permit records, reduced-complexity air quality modeling, and epidemiological associations between fine particulate matter concentrations and multiple health endpoints to assess the impacts of prescribed burning on public health across Georgia. Additionally, we examine the social vulnerability of populations near high prescribed burning activity using a demographic- and socioeconomic-based index. The analysis identifies spatial clusters of burning activity in the state and finds that areas with intense prescribed fire have levels of social vulnerability that are over 25% higher than the state average. The results also suggest that the impacts of burning in Georgia can potentially include hundreds of annual morbidity and mortality cases associated with smoke pollution. These health impacts are concentrated in areas with higher fractions of low socioeconomic status, elderly, and disabled residents, particularly vulnerable to air pollution. Estimated smoke-related health incidence rates are over 3 times larger than the state average in spatial clusters of intense burning activity, and over 40% larger in spatial clusters of high social vulnerability. Spatial clusters of low social vulnerability experience substantially lower negative health effects from prescribed burning relative to the rest of the state. The health burden of smoke from prescribed burns in the state is comparable to that estimated for other major emission sectors, such as vehicles and industrial combustion. Within spatial clusters of socially-vulnerable populations, the impacts of prescribed fire considerably outweigh those of other emission sectors. These findings call for greater attention to the air quality impacts of prescribed burning in the Southeastern U.S. and the communities most exposed to fire-related smoke.

Elemental Carbon and Its Fractions during Evolved Gas Analysis with Respect to Pyrolytic Carbon and Split Time

We demonstrated the relationships between elemental carbon (EC) and EC fractions during evolved gas analysis (EGA) for PM2.5 sampled at KOREATECH from 29 March 2018 to 12 May 2018. The EC concentrations were compared to the concentrations of equivalent black carbon to confirm that the level of EC concentrations analyzed in this study was valid. Among various EC fractions and their combination, EC1+EC3 fractions were best correlated with the EC concentrations. Especially, dominant EC fraction was related with the dependence of carbon oxidation quantity on the oxidation temperature. We also examined the relationships between pyrolytic carbon (PyC) and EC concentration with respect to the split time. PyC was correlated with the split time in the phase of oxygen-helium mixture. PyC was close to zero for the split time in the helium phase. It is novel, as far as the authors know, that the correlation between PyC and the split time under NIOSH 5040 protocol was reported with regard to EGA. We believe that our study helps to identify what causes uncertainty in the quantification of PyC.

Evaluation of adverse effects of particulate matter on human life

Particulate matter (PM_2.5) has a severe impact on human health. The concentration of PM_2.5, related to air-quality changes, may be associated with perceptible effects on people's health. In this study, computer intelligence was used to assess the negative effects of PM_2.5. The input data, used for the evaluation, were grid definitions (shape-file), PM_2.5, air-quality data, incidence/prevalence rates, a population dataset, and the (Krewski) health-impact function. This paper presents a local (Pakistan) health-impact assessment of PM_2.5 in order to estimate the long-term effects on mortality. A rollback-to-a-standard scenario was based on the PM_2.5 concentration of 15 μg m^-3. Health benefits for a population of about 73 million people were calculated. The results showed that the estimated avoidable mortality, linked to ischemic heart disease and lung cancer, was 2,773 for every 100,000 people, which accounts for 2,024,290 preventable deaths of the total population. The total cost, related to the above mortality, was estimated to be US $ 1,000 million. Therefore, a policy for a PM_2.5-standard up to 15 μg m^-3 is suggested.

Associations between PM1 exposure and daily emergency department visits in 19 hospitals, Beijing

Although the adverse health effects caused by PM_2.5 (particulate matter (PM) with an aerodynamic diameter <2.5 μm) and PM₁₀ (PM with an aerodynamic diameter <10 μm) have been examined in numeric studies, far less scientific evidence is available for PM with an aerodynamic diameter <1 μm (PM₁). We performed a time series analysis to elucidate the associations between PM₁ exposure and emergency department visits (EDVs) in 19 hospitals within Beijing. During the study period from January 2016 to December 2017, the average PM₁ (mean ± standard deviation) was determined to be 39 ± 39 μg/m³, which was approximately 36% lower than that of 61 ± 56 μg/m³ for PM_2.5. Results based on meta-analysis suggest that non-accidental and respiratory EDVs increased by 0.47% (95% confidence interval, CI: 0.35, 0.59%) and 0.59% (95%CI: 0.38, 0.8%) per 10 μg/m³ uptick in PM₁ exposure. By comparison, the magnitude downgraded to 0.27% (95%CI: 0.15, 0.39%) in non-accidental and 0.32% (95%CI: 0.18, 0.47%) in respiratory EDVs for PM_2.5 exposure, indicating that PMs of a smaller size may be a higher risk factor for EDVs. No significant differences in PM-associated EDV effects were noted between males and females, while stratified analysis by age and season illustrated that stronger effects were found for a warm season and young population. Our analysis reinforces the notion that PM₁ exhibited a higher risk for EDVs, suggesting more efforts may be required to mitigate PM₁ pollution.

Carbon monoxide-triggered health effects: the important role of the inflammasome and its possible crosstalk with autophagy and exosomes

Carbon monoxide (CO) has long been known as a "silent killer" because of its ability to bind hemoglobin (Hb), leading to reduced oxygen carrying capacity of Hb, which is the main cause of CO poisoning (COP) in humans. Emerging studies suggest that mitochondria is a key target of CO action that can impact key biological processes, including apoptosis, cellular proliferation, inflammation, and autophagy. Despite its toxicity at high concentrations, CO also exhibits cyto- and tissue-protective effects at low concentrations in animal models of organ injury and disease. Specifically, CO modulates the production of pro- or anti-inflammatory cytokines and mediators by regulating the NLRP3 inflammasome. Given that human diseases are strongly associated with inflammation, a deep understanding of the exact mechanism is helpful for treatment. Autophagic factors and inflammasomes interact in various situations, including inflammatory disease, and exosomes might function as the bridge between the inflammasome and autophagy activation. Thus, the interplay among autophagy, mitochondrial dysfunction, exosomes, and the inflammasome may play pivotal roles in the health effects of CO. In this review, we summarize the latest research on the beneficial and toxic effects of CO and their underlying mechanisms, focusing on the important role of the inflammasome and its possible crosstalk with autophagy and exosomes. This knowledge may lead to the development of new therapies for inflammation-related diseases and is essential for the development of new therapeutic strategies and biomarkers of COP.

Evaluating changes in ambient ozone and respiratory-related healthcare utilization in the Washington, DC metropolitan area

Ozone pollution is a known respiratory irritant, yet we do not fully understand the magnitude or timing of respiratory effects based on short-term exposure. We investigated the associations between ambient ozone concentrations and respiratory symptoms as measured by healthcare utilization events. We used comprehensive electronic health records to identify respiratory responses to changes in ambient ozone levels. We constructed a dataset from Kaiser Permanente Mid-Atlantic States (KPMAS) that included information on 2013 and 2014 daily utilization rates for a broad range of healthcare utilization - nurse calls/emails, provider visits, emergency department and urgent care visits (ED/UC) and hospital admissions - by census block. We used 8-h average ozone concentrations collected from 48 air monitoring stations in the region via the Air Data database of the USEPA. We estimated the association between changes in ambient ozone (exposure windows of current day, 1-day lag and 3-day moving average) and changes in healthcare utilization using linear regression controlling for census tract-level socioeconomic indicators and temperature. Increases in ozone were associated with increases in three of the four utilization event types. A 10 ppb increase in 1-day ozone was associated with a 2.95% (95% CI: 1.93%, 3.96%) increase in calls/emails, a 1.56% (95% CI: 0.38%, 2.74%) increase in ED/UC visits and a 1.10% (95% CI: 0.48%, 1.73%) increase in provider visits. We did not find associations between ozone and hospital admissions. Proportionally, highest effects were found for nurse calls/emails possibly indicating a high number of mild effects that may be underreported in studies that examine only ED visits or hospital admissions.

Real-Ambient Particulate Matter Exposure-Induced Cardiotoxicity in C57/B6 Mice

It is generally accepted that exposure to particulate matter (PM) increases the risk of cardiovascular-related morbidity and mortality, though the exact mechanism behind this has yet to be elucidated. Oxidative stress plays a potentially important role in the mechanism of toxicity, with Nrf2 serving as a major antioxidant gene. In the current study, a Nrf2 knockout mouse model was used in combination with an individual ventilated cage (IVC)-based real-ambient PM exposure system to assess the potential cardiotoxicity induced by real-ambient PM exposure and the potential role of Nrf2 and related signaling in this endpoint. After 6- or 11-weeks exposure to PM, ICP-mass spectrometry was used to assess the metal depositions in the heart tissue following PM exposure. Functional and morphological changes in the hearts were investigated with echocardiography and histopathology, and oxidative stress levels were assessed with a serum malondialdehyde content assay. In the further mechanistic study, an RNA-seq technique was utilized to assess the gene transcription status in the hearts of C57/B6 mice exposed to PM with or without Nrf2 knockout. The expression levels of genes of interest were then further investigated with quantitative real-time PCR and western blotting. The results indicated that PM exposure resulted in significant elevation of sodium, potassium, selenium, and ferrum levels in mouse heart tissue. Meanwhile, significantly altered heart function and morphology were observed. Interestingly, Nrf2 knockout led to abolishment of PM-induced effects in several functional parameters but not the morphological changes. Meanwhile, elevated malondialdehyde content was observed in Nrf2 knockout animals. RNA-seq results revealed thousands of genes altered by PM exposure and/or Nrf2 knockout, and this affected several pathways, such as MAPK, phagosome, calcium signaling, and JAK-STAT. In subsequent molecular studies, enhanced nuclear translocation of Nrf2 was also observed following PM exposure, while the MAPK signaling pathway along with related JAK-STAT and TGF-β1 pathway genes, such as p38MAPK, AKT, TAK1, JAK1, STAT3, GRB2, TGFb1, and SMAD2, were confirmed to be affected by PM exposure and/or Nrf2 knockout. The data suggested that PM may induce cardiotoxicity in C57/B6 mice in which Nrf2 plays both protective and detrimental roles involving cardiac-related pathways, such as MAPK, JAK-STAT, and TGF-β1.

Short-term effects of particulate matter exposure on emergency room visits for cardiovascular disease in Lanzhou, China: a time series analysis

Cardiovascular disease (CVD) has been the leading cause of death in China. Identifying the relationship between particulate matter (PM) and CVD in China is a significant challenge. In this study, daily CVD emergency room visit, environmental monitoring, and weather data from January 1, 2017, to December 31, 2018, in Lanzhou were collected. Generalized additive models (GAMs) were constructed to estimate the short-term effects of daily PM_2.5, PM_C, and PM₁₀ concentrations on CVD emergency room visits with different lag structures after controlling for the influence of meteorological elements and gaseous pollutants. Stratified analyses were conducted according to age (≥ 65 years and < 65 years), sex (male and female), cold season (from November to April), and warm season (from May to October). The results showed that each 10 μg/m³ increase in PM_2.5 was associated with a 1.93% (95% CI 0.12-3.78%) increase in CVD emergency room visits at lag03, and no single lag model was statistically significant. The excess relative risks (ERRs) of PM₁₀ and PM_C were not statistically significant at any lag pattern. The exposure-response curves demonstrated a nonlinear upward trend for these three PM pollutants. When adjusting for other gaseous pollutants, such as NO₂, SO₂, CO, and O₃, in the two-pollutant models, the associations between PM₁₀ and PM_C and CVD emergency room visits did not change compared with the single-pollutant models. The ERRs of PM_2.5 were 1.67% (95% CI 0.03-3.34%) at lag02 after adjustment for NO₂ and 1.65% (95% CI 0.02-3.30%) at lag02 after adjustment for SO₂. The ERRs of PM_2.5 were still statistically significant at lag03 when we adjusted for any one of the gaseous pollutants. Susceptibility to PM_2.5 was increased in people aged < 65 years, in males, and in the warm season. The findings are very important for local governments to develop environmental policies and strategies to reduce ambient PM_2.5 levels.

Age-Specific Associations of Ozone and Fine Particulate Matter with Respiratory Emergency Department Visits in the United States

RATIONALE

Whereas associations between air pollution and respiratory morbidity for adults 65 years and older are well documented in the United States, the evidence for people under 65 is less extensive. To address this gap, the Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program collected respiratory emergency department (ED) data from 17 states.

OBJECTIVES

To estimate age-specific acute effects of ozone and fine particulate matter (particulate matter ≤2.5 mm in aerodynamic diameter [PM_2.5]) on respiratory ED visits.

METHODS

We conducted time-series analyses in 894 counties by linking daily respiratory ED visits with estimated ozone and PM_2.5 concentrations during the week before the date of the visit. Overall effect estimates were obtained with a Bayesian hierarchical model to combine county estimates for each pollutant by age group (children, 0-18; adults, 19-64; adults ≥ 65, and all ages) and by outcome group (acute respiratory infection, asthma, chronic obstructive pulmonary disease, pneumonia, and all respiratory ED visits).

MEASUREMENTS AND MAIN RESULTS

Rate ratios (95% credible interval) per 10-μg/m³ increase in PM_2.5 and all respiratory ED visits were 1.024 (1.018-1.029) among children, 1.008 (1.004-1.012) among adults younger than 65 years, and 1.002 (0.996-1.007) among adults 65 and older. Per 20-ppb increase in ozone, rate ratios were 1.017 (1.011-1.023) among children, 1.051 (1.046-1.056) among adults younger than 65, and 1.033 (1.026-1.040) among adults 65 and older. Associations varied in magnitude by age group for each outcome group.

CONCLUSIONS

These results address a gap in the evidence used to ensure adequate public health protection under national air pollution policies.

Health and Environmental Justice Implications of Retiring Two Coal-Fired Power Plants in the Southern Front Range Region of Colorado

Despite improvements in air quality over the past 50 years, ambient air pollution remains an important public health issue in the United States. In particular, emissions from coal-fired power plants still have a substantial impact on both nearby and regional populations. Of particular concern is the potential for this impact to fall disproportionately on low-income communities and communities of color. We conducted a quantitative health impact assessment to estimate the health benefits of the proposed decommissioning of two coal-fired electricity generating stations in the Southern Front Range region of Colorado. We estimated changes in exposures to fine particulate matter and ozone using the Community Multiscale Air Quality model and predicted avoided health impacts and related economic values. We also quantitatively assessed the distribution of these benefits by population-level socioeconomic status. Across the study area, decommissioning the power plants would result in 2 (95% CI: 1-3) avoided premature deaths each year due to reduced PM2.5 exposures and greater reductions in hospitalizations and other morbidities. Health benefits resulting from the modeled shutdowns were greatest in areas with lower educational attainment and other economic indicators. Our results suggest that decommissioning these power plants and replacing them with zero-emissions sources could have broad public health benefits for residents of Colorado, with larger benefits for those that are socially disadvantaged. Our results also suggested that researchers and decision makers need to consider the unique demographics of their study areas to ensure that important opportunities to reduce health disparities associated with point-source pollution.

Ecological determinants of respiratory health: Examining associations between asthma emergency department visits, diesel particulate matter, and public parks and open space in Los Angeles, California

Los Angeles County (LAC) low-income communities of color experience uneven asthma rates, evidenced by asthma emergency department visits (AEDV). This has partly been attributed to inequitable exposure to diesel particulate matter (DPM). Promisingly, public parks and open space (PPOS) contribute to DPM mitigation. However, low-income communities of color with limited access to PPOS may be deprived of associated public health benefits. Therefore, this novel study investigates the AEDV, DPM, PPOS nexus to address this public health dilemma and inform public policy in at-risk communities. Optimized Hotspot Analysis was used to examine geographic clustering of AEDVs, DPM, and PPOS at the census tract unit of analysis in LAC. Ordinary Least Squares (OLS) regression analysis was used to examine the extent to which DPM and PPOS predict AEDVs. Finally, Geographic Weighted Regression (GWR) was employed to account for spatial dependence in the global OLS model. Optimized Hotspot Analysis confirmed significant clustering of elevated AEDVs and DPM in census tracts with reduced PPOS. After controlling for pertinent demographic characteristics (poverty, children, race/ethnicity), regression analysis confirmed that DPM was significantly positively associated with AEDVs, whereas PPOS was significantly negatively associated with AEDVs. Furthermore, GWR revealed that 71.5% of LACs census tracts would benefit from DPM reductions and 79.4% would benefit from PPOS increases toward redressing AEDVs. This is the first study to identify AEDV reductions in census tracts with higher concentrations of PPOS. Thus, reducing DPM and increasing PPOS may serve to improve asthma outcomes, particularly in low-income communities of color.

Carbon monoxide and risk of outpatient visits due to cause-specific diseases: a time-series study in Yichang, China

BACKGROUND

Previous studies showed inconsistent results on risk of increased outpatient visits for cause-specific diseases associated with ambient carbon monoxide (CO).

METHODS

Daily data for CO exposure and outpatient visits for all-causes and five specific diseases in Yichang, China from 1st January 2016 to 31st December 2017 were collected. Generalised additive models with different lag structures were used to examine the short-term effects of ambient CO on outpatient visits. Potential effect modifications by age, sex and season were examined.

RESULTS

A total of 5,408,021 outpatient visits were recorded. We found positive and statistically significant associations between CO and outpatient visits for multiple outcomes and all the estimated risks increased with longer moving average lags. An increase of 1 mg/m³ of CO at lag06 (a moving average of lag0 to lag6), was associated with 24.67% (95%CI: 14.48, 34.85%), 21.79% (95%CI: 12.24, 31.35%), 39.30% (95%CI: 25.67, 52.92%), 25.83% (95%CI: 13.91, 37.74%) and 19.04% (95%CI: 8.39, 29.68%) increase in daily outpatient visits for all-cause, respiratory, cardiovascular, genitourinary and gastrointestinal diseases respectively. The associations for all disease categories except for genitourinary diseases were statistically significant and stronger in warm seasons than cool seasons.

CONCLUSION

Our analyses provide evidences that the CO increased the total and cause-specific outpatient visits and strengthen the rationale for further reduction of CO pollution levels in Yichang. Ambient CO exerted adverse effect on respiratory, cardiovascular, genitourinary, gastrointestinal and neuropsychiatric diseases especially in the warm seasons.

DIFFERENT RESPONSE TO EXPOSURE TO AIR POLLUTANTS IN GIRLS AND BOYS

Objective:

Identify the association between exposure to fine particulate matter and hospitalizations due to respiratory diseases in children up to ten years of age in the city of Cuiabá, Mato Grosso, stratifying the analysis by sex and calculating excess costs.

Methods:

Ecological study of time series. The dependent variable was daily hospitalizations according to the 10^th Revision of the International Classification of Diseases (ICD10): J04.0, J12.0 to J18.9, J20.0 to J21.9 and J45.0 to J45.0. The independent variables were the concentration of fine particulate, estimated by a mathematical model, temperature and relative air humidity, controlled by short and long-term trends. Generalized additive model of Poisson regression was used. Relative risks, proportional attributable risk (PAR) and excess hospitalizations and their respective costs by the population attributable fraction (PAF) were calculated.

Results:

1,165 children were hospitalized, 640 males and 525 females. The mean concentration, estimated by the mathematical model, was 15.1±2.9 mcg/m³ for PM_2.5. For boys, there was no significant association; for girls a relative risk of up to 1.04 of daily hospitalizations due to respiratory diseases was observed for exposure to PM 2.5 in lags 1, 2 and 6. Increase of 5 µg/m³ in these concentrations increased the percentage of the risk in 18%; with an excess 95 hospital admissions and with excess expenses in the order of US$ 35 thousand.

Conclusions:

Significant effect in daily hospitalizations due to respiratory diseases related to exposure to fine particulate matter was noted for girls, suggesting the need for stratification by sex in further studies.

A Systematic Review and Meta-Analysis on Short-Term Particulate Matter Exposure and Chronic Obstructive Pulmonary Disease Hospitalizations in China

OBJECTIVE

We conducted a meta-analysis of short-term particulate matter (PM) exposure and chronic obstructive pulmonary disease (COPD) hospitalizations in China, including data from two-pollutant model.

METHODS

From PubMed and Web of Science, we selected case-crossover or time-series studies conducted in Mainland China, Hong Kong, Macao, or Taiwan to investigate the association between PM exposure and COPD hospitalizations. The meta-analysis was performed using data from both single-pollutant and two-pollutant models for PM2.5 and PM10.

RESULTS

A total of 16 studies were included in our analysis. Short-term exposure to PM2.5 and PM10 were both significantly associated with COPD hospitalizations. The results remained robust in two-pollutant model, whereas subgroup analyses demonstrated a modest heterogeneity.

CONCLUSIONS

Our review shows a small but obvious exposure-hospitalization effect in China. More studies are needed to generate the needed evidence, and advocacy is needed to stimulate initiation of solutions to the problem.

Association of particulate matter air pollution and hospital visits for respiratory diseases: a time-series study from China

Fine particulate matter (PM_2.5) is a mixture of multiple components, which is associated with several chronic diseases, including respiratory and cardiovascular diseases. We evaluated the association between daily PM_2.5 and PM_2.5-10 exposure and hospital visits for respiratory diseases. Hospital visits for respiratory diseases were collected from Yinzhou Health Information System database. We used generalized additive models to examine the excess relative risk (ERR) and 95% confidence interval for hospital visits for respiratory diseases associated with each 10-μg/m³ increase in PM_2.5 and PM_2.5-10 concentration. Non-linear exposure-response relationship between PM exposure and hospital visits for respiratory diseases was evaluated by a smooth spline. The ERRs for hospital visits for respiratory diseases associated with a 10-μg/m³ increase in the 6-day cumulative average concentration of PM_2.5 and PM_2.5-10 were 5.40 (95% CI 2.32, 8.57) and 6.37% (95% CI 1.84, 11.10), respectively. The findings remained stable when we adjusted other gaseous air pollution. PM_2.5 and PM_2.5-10 were associated with the increased visits for the acute upper respiratory infection, pneumonia, asthma, and COPD. In this time-series study, we found a positive association between daily particulate matter exposure and hospital visits for respiratory diseases.

Effects of exposure to fine particulate matter in elderly hospitalizations due to respiratory diseases in the South of the Brazilian Amazon

Exposure to air pollution is an important cause of hospital admissions due to respiratory diseases. Nevertheless, few studies use pollutant concentration data estimated by mathematical models. A time-series ecological study was developed, using data from hospitalizations due to respiratory diseases in people over 60 years of age, residents of Cuiabá, Brazil, during 2012, obtained from the Brazilian Ministry of Health. The independent variables were the concentrations of fine particulate matter (PM_2.5) and carbon monoxide (CO) estimated by mathematical modeling, minimum temperature, and relative humidity (obtained from the Brazilian Meteorological Agency), and the number of forest fires. The generalized linear regression model of Poisson was used, with lags of 0 to 7 days. The coefficients obtained were transformed into relative risk of hospitalization, with respective 95% confidence intervals; alpha=5% was adopted. In that year, 591 hospitalizations were evaluated, with a daily average of 1.61 (SD=1.49), the PM_2.5 average concentration was 15.7 µg/m³, and the CO average concentration was 144.2 ppb. Significant associations between exposure to these contaminants and hospitalizations in lags 3 and 4 in 2012 were observed. There was a hospitalization risk increase of 31.8%, with an increase of 3.5 µg/m³ of PM_2.5 concentrations and an increase of 188 in the total number of hospitalizations, with an expense of more than ≈US$ 96,000 for the Brazilian Public Health System. This study provided information on the cost of air pollution to the health system and the feasibility of using a mathematical model to estimate environmental concentration of air pollutants.

Association between Atmospheric Particulate Pollutants and Mortality for Cardio-Cerebrovascular Diseases in Chinese Korean Population: A Case-Crossover Study

Background: Air pollution in large Chinese cities has led to recent studies that highlighted the relationship between particulate matters (PM) and elevated risk of cardio-cerebrovascular mortality. However, it is unclear as to whether: (1) The same adverse relations exist in cities with relatively low levels of air pollution; and (2) the relationship between the two are similar across ethnic groups. Methods: We collected data of PM_2.5 (PM with an aerodynamic diameter ≤ 2.5 µm) and PM₁₀ (aerodynamic diameter ≤ 10 µm) in the Yanbian Korean Autonomous Prefecture between 1 January 2015 and 31 December 2016. Using a time-stratified case-crossover design, we investigated whether levels of particulate pollutants influence the risk of cardio-cerebrovascular disease mortality among ethnic Korean vs. ethnic Han residents residing in the Yanbian Korean Autonomous Prefecture. Results: Under the single air pollutant model, the odds ratios (ORs) of cardio-cerebrovascular disease were 1.025 (1.024–1.026) for each 10 μg/m³ increase in PM_2.5 at lag0 day, 1.012 (1.011–1.013) for each 10 μg/m³ increase in PM₁₀ at lag1 day. In the multi-pollutant model adjusted by PM₁₀, SO₂, and NO₂, the ORs of cardio-cerebrovascular disease were 1.150 (1.145–1.155) for ethnic Koreans and 1.154 (1.149–1.158) for ethnic Hans for each 10 μg/m³ increase in PM_2.5. In the multi-pollutant model adjusted by PM_2.5, SO₂, and NO₂, the ORs of cardio-cerebrovascular disease were 1.050 (1.047–1.053) for ethnic Koreans and 1.041 (1.039–1.043) for ethnic Hans for each 10 μg/m³ increase in PM₁₀. Conclusion: This study showed that PM_2.5 and PM₁₀ were associated with increased risks of acute death events in residential cardio-cerebrovascular disease in Yanbian, China.

Impacts of prescribed fires and benefits from their reduction for air quality, health and visibility in the Pacific Northwest of the United States

Using a WRF-SMOKE-CMAQ modeling framework, we investigate the impacts of smoke from prescribed fires on model performance, regional and local air quality, health impacts, and visibility in protected natural environments using three different prescribed fire emission scenarios - 100% fire, no fire, and 30% fire. The 30% fire case reflects a 70% reduction in fire activities due to harvesting of logging residues for use as a feedstock for a potential aviation biofuel supply chain. Overall model performance improves for several performance metrics when fire emissions are included, especially for organic carbon, irrespective of the model goals and criteria used. This effect on model performance is more pronounced for the rural and remote IMPROVE sites for organic carbon and total PM2.5. A reduction in prescribed fire emissions (30% fire case) results in significant improvement in air quality in areas in western Oregon, northern Idaho and western Montana where most prescribed fires occur. Prescribed burning contributes to visibility impairment and a relatively large portion of protected class I areas will benefit from a reduced emission scenario. For the haziest 20% days, prescribed burning is an important source of visibility impairment and approximately 50% of IMPROVE sites in the model domain show a significant improvement in visibility for the reduced fire case. Using BenMAP, a health impact assessment tool, we show that several hundred additional deaths, several thousand upper and lower respiratory symptom cases, several hundred bronchitis cases, and more than 35,000 work day losses can be attributed to prescribed fires and these health impacts decrease by 25-30% when a 30% fire emission scenario is considered. Implications This study assesses the potential regional and local air quality, public health and visibility impacts from prescribed burning activities as well as benefits that can be achieved by a potential reduction in emissions for a scenario where biomass is harvested for conversion to biofuel. As prescribed burning activities become more frequent, they can be more detrimental for air quality and health. Forest residue based biofuel industry can be source of cleaner fuel with co-benefits of improved air quality, reduction in health impacts and improved visibility.

Lagged Influence of Fine Particulate Matter and Geographic Disparities on Clinic Visits for Children's Asthma in Taiwan

Recent studies have revealed the influence of fine particulate matter (PM_2.5) on increased medication use, hospital admission, and emergency room visits for asthma attack in children, but the lagged influence of PM_2.5 on children’s asthma and geographic disparities of children’s asthma have rarely been discussed simultaneously. This study investigated the documented diagnosis of children’s asthma in clinic visits for children aged less than 15 years old that were associated with PM_2.5 in two counties located in west-central Taiwan during 2005–2010. The result shows that PM_2.5 had a significant lagged effect on children’s asthma for up to 6 days. A significantly higher relative risk for children’s asthma was more likely to happen at 2-day lag compared to the present day when PM_2.5 increased from 36.17 μg/m³ to 81.26 μg/m³. Considering all lagged effects, the highest relative risk for children’s asthma was 1.08 (95% CI = 1.05, 1.11) as PM_2.5 increased as high as 64.66 μg/m³. In addition, geographic disparities of children’s asthma were significant, and 47.83% of areas were identified to have children vulnerable to asthma. To sum up, our findings can serve as a valuable reference for the implementation of an early warning to governmental agencies about a susceptible population of children.

Effects of exposure to air pollutants on children's health in Cuiabá, Mato Grosso State, Brazil

Exposure to air pollutants, usually measured by environmental agencies that are not present in all states, may be associated with respiratory admissions in children. An ecological time series study was conducted with data on hospitalizations due to selected respiratory diseases in children under 10 years of age in 2012 in the city of Cuiabá, Mato Grosso State, Brazil. Mean levels of fine particulate matter (PM2.5) were estimated with a mathematical model, data on low temperatures and relative humidity were obtained from the Brazilian National Institute of Meteorology, and the numbers of brush burnings were obtained from the Environmental Information System. The statistical approach used the Poisson regression generalized additive model with lags of 0 to 7 days. The financial costs and increases in hospitalizations due to increments in PM2.5 were estimated. There were 565 hospitalizations (mean 1.54 admissions/day; SD = 1.52), and mean PM2.5 concentration was 15.7µg/m3 (SD = 3.2). Associations were observed between exposure and hospitalizations in the second semester at lags 2 and 3, and at lag 2 when the entire year was analyzed. An increment of 5µg/m3 in PM2.5 was associated with an increase of 89 hospitalizations and costs exceeding BRL 95,000 (≈ USD 38,000) for the Brazilian Unified National Health System. Data estimated by mathematical models can be used in locations where pollutants are not monitored.

Short-term associations of ambient air pollution and cause-specific emergency department visits in Guangzhou, China

BACKGROUND

Evidence of association of ambient air pollution with cause-specific emergency department visits in China is still limited. This study aimed to investigate short-term associations between exposures to air pollutants and daily cause-specific emergency department visits using a large-scale multicenter database involving a total of 65 sentinel hospitals in Guangzhou, the most densely-populated city in south China, during 2013-2015.

MATERIAL AND METHODS

We obtained data on 162,771 emergency department visits from 65 hospitals from the Emergency Medical Command Center in Guangzhou between January 1, 2013 and December 31, 2015. Daily air pollution data on particulate matter (PM) of aerodynamic diameter<10 and 2.5μm (PM₁₀, and PM_2.5, respectively), sulfur dioxide (SO₂), nitrogen dioxide (NO₂) and ozone (O₃) were collected from the Daily Quality Report of the Guangzhou Environmental Protection Bureau during the study period. Visits for neurologic, respiratory and circulatory diseases were assessed in relation to air pollutants using Poisson generalized additive models.

RESULTS

Mean daily number of emergency department visits for neurologic, respiratory and circulatory diseases was 89, 24 and 35, respectively. After adjustment for other pollutants (PM_2.5, PM₁₀, NO₂ and O₃), meteorological factors and time-varying confounders, a 7.98-μg/m³ (interquartile range) increment in 2-day moving average of same-day and previous-day SO₂ concentrations was associated with the statistically significant increase of 4.89% (95% confidence interval: 2.86, 6.95) in neurologic emergency department visits; elevation in SO₂ level (per 7.98μg/m³) was linked to a 5.19% (95% confidence interval: 2.03, 8.44) increase in circulatory emergency department visits. Most positive links were seen during the cold season.

CONCLUSIONS

The results of this study contribute to the evidence of the significant associations between SO₂ and specific neurologic and circulatory conditions, and also provide insight into the planning of clinical services and emergency contingency response for air pollution exposures in Guangzhou.

The Association between Air Pollution and Outpatient and Inpatient Visits in Shenzhen, China

Nowadays, air pollution is a severe environmental problem in China. To investigate the effects of ambient air pollution on health, a time series analysis of daily outpatient and inpatient visits in 2015 were conducted in Shenzhen (China). Generalized additive model was employed to analyze associations between six air pollutants (namely SO₂, CO, NO₂, O₃, PM₁₀, and PM_2.5) and daily outpatient and inpatient visits after adjusting confounding meteorological factors, time and day of the week effects. Significant associations between air pollutants and two types of hospital visits were observed. The estimated increase in overall outpatient visits associated with each 10 µg/m³ increase in air pollutant concentration ranged from 0.48% (O₃ at lag 2) to 11.48% (SO₂ with 2-day moving average); for overall inpatient visits ranged from 0.73% (O₃ at lag 7) to 17.13% (SO₂ with 8-day moving average). Our results also suggested a heterogeneity of the health effects across different outcomes and in different populations. The findings in present study indicate that even in Shenzhen, a less polluted area in China, significant associations exist between air pollution and daily number of overall outpatient and inpatient visits.

Epidemiological study of PM2.5 and risk of COPD-related hospital visits in association with particle constituents in Chuncheon, Korea

Background and objective

Aside from smoking, which is already recognized as a strong risk factor for COPD, interest in the impact of particulate matter (PM) on COPD is increasing. This study aimed to investigate the effect of PM, especially with an aerodynamic diameter ≤2.5 µm (PM2.5), and its chemical constituents on the exacerbation of COPD.

Methods

Data on hospital visits including admission and outpatient clinic visits for exacerbation of COPD in Chuncheon, Korea, between 2006 and 2012 were extracted from the National Health Insurance Service database. PM2.5 and its chemical constituents were measured on the roof of the four-story Kangwon National University Natural Sciences building once every 3 days. Meteorological data were provided by the Korean Meteorological Administration.

Results

During the study period, the mean level of PM2.5 was 35.0±25.2 µg/m3, and the number of daily hospital visits were 6.42±4.28 and 2.07±1.93 for males and females, respectively. The number of COPD-related hospital visits increased with increasing PM2.5 after adjusting for meteorological covariates and females tended to be more affected sooner than males. Among the PM2.5 constituents, Al, Si, and elemental carbon were associated with increased hospital visits and there was a difference according to sex. In males, some constituents of PM2.5 were related to an increased risk of a hospital visit, mainly on the first and second days of measurement (Lag1 and Lag2). In contrast, there was no significant increase in the risk of hospital visits due to any of the PM2.5 constituents in females.

Conclusion

Concentrations of PM2.5 mass and some of the PM2.5 constituents were associated with increased COPD-related hospital visits in Chuncheon.

Global Associations between Air Pollutants and Chronic Obstructive Pulmonary Disease Hospitalizations. A Systematic Review

RATIONALE

Exacerbations are key events in chronic obstructive pulmonary disease (COPD), affecting lung function decline and quality of life. The effect of exposure to different air pollutants on COPD exacerbations is not clear.

OBJECTIVES

To carry out a systematic review, examining associations between air pollutants and hospital admissions for COPD exacerbations.

METHODS

MEDLINE, Embase, BIOSIS, Science Citation Index, and the Air Pollution Epidemiology Database were searched for publications published between 1980 and September 2015. Inclusion criteria were focused on studies presenting solely a COPD outcome defined by hospital admissions and a measure of gaseous air pollutants and particle fractions. The association between each pollutant and COPD admissions was investigated in metaanalyses using random effects models. Analyses were stratified by geographical clusters for investigation of the consistency of the evidence worldwide.

MEASUREMENTS AND MAIN RESULTS

Forty-six studies were included, and results for all the pollutants under investigation showed marginal positive associations; however, the number of included studies was small, the studies had high heterogeneity, and there was evidence of small-study bias. Geographical clustering of the effects of pollution on COPD hospital admissions was evident and reduced heterogeneity significantly.

CONCLUSIONS

The most consistent association was between a 1-mg/m³ increase in carbon monoxide level and COPD-related admissions (odds ratio, 1.02; 95% confidence interval, 1.01-1.03). The heterogeneity was moderate, and there was a consistent positive association in both Europe and North America, although levels were clearly below World Health Organization guideline values. There is mixed evidence on the effects of environmental pollution on COPD exacerbations. Limitations of previous studies included the low spatiotemporal resolution of pollutants, inadequate control for confounding factors, and the use of aggregated health data that ignored personal characteristics. The need for more targeted exposure estimates in a large number of geographical locations is evident.

Ambient Air Pollution and Risk for Ischemic Stroke: A Short-Term Exposure Assessment in South China

Data on the association between air pollution and risk of ischemic stroke in China are still limited. This study aimed to investigate the association between short-term exposure to ambient air pollution and risk of ischemic strokes in Guangzhou, the most densely-populated city in south China, using a large-scale multicenter database of stroke hospital admissions. Daily counts of ischemic stroke admissions over the study years 2013-2015 were obtained from the Guangzhou Cardiovascular and Cerebrovascular Disease Event Surveillance System. Daily particulate matter <2.5 μm in diameter (PM_2.5), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), and meteorological data were collected. The associations between air pollutants and hospital admissions for stroke were examined using relative risks (RRs) and their corresponding 95% confidence intervals (CIs) based on time-series Poisson regression models, adjusting for temperature, public holiday, day of week, and temporal trends in stroke. Ischemic stroke admissions increased from 27,532 to 35,279 through 2013 to 2015, increasing by 28.14%. Parameter estimates for NO₂ exposure were robust regardless of the model used. The association between same-day NO₂ (RR = 1.0509, 95% CI: 1.0353-1.0668) exposure and stroke risk was significant when accounting for other air pollutants, day of the week, public holidays, temperature, and temporal trends in stroke events. Overall, we observed a borderline significant association between NO₂ exposure modeled as an averaged lag effect and ischemic stroke risk. This study provides data on air pollution exposures and stroke risk, and contributes to better planning of clinical services and emergency contingency response for stroke.

Seasonal ambient particulate matter and population health outcomes among communities impacted by road dust in British Columbia, Canada

In recent years, many air quality monitoring programs have favored measurement of particles less than 2.5 µm (PM_2.5) over particles less than 10 µm (PM₁₀) in light of evidence that health impacts are mostly from the fine fraction. However, the coarse fraction (PM_10-2.5) may have independent health impacts that support continued measurement of PM₁₀ in some areas, such as those affected by road dust. The objective of this study was to evaluate the associations between different measures of daily PM exposure and two daily indicators of population health in seven communities in British Columbia, Canada, where road dust is an ongoing concern. The measures of exposure were PM₁₀, PM_2.5, PM_10-2.5, PM_2.5 adjusted for PM_10-2.5, and PM_10-2.5 adjusted for PM_2.5. The indicators of population health were dispensations of the respiratory reliever medication salbutamol sulfate and nonaccidental mortality. This study followed a time-series design using Poisson regression over a 2003-2015 study period, with analyses stratified by three seasons: residential woodsmoke in winter; road dust in spring; and wildfire smoke in summer. A random-effects meta-analysis was conducted to establish a pooled estimate. Overall, an interquartile range increase in daily PM_10-2.5 was associated with a 3.6% [1.6, 5.6] increase in nonaccidental mortality during the road dust season, which was reduced to 3.1% [0.8, 5.4] after adjustment for PM_2.5. The adjusted coarse fraction had no effect on salbutamol dispensations in any season. However, an interquartile range increase in PM_2.5 was associated with a 2.7% [2.0, 3.4] increase in dispensations during the wildfire season. These analyses suggest different impacts of different PM fractions by season, with a robust association between the coarse fraction and nonaccidental mortality in communities and periods affected by road dust. We recommend that PM₁₀ monitoring networks be maintained in these communities to provide feedback for future dust mitigation programs.

IMPLICATIONS

There was a significant association between daily concentrations of the coarse fraction and nonaccidental mortality during the road dust season, even after adjustment for the fine fraction. The acute and chronic health effects associated with exposure to the coarse fraction remain unclear, which supports the maintenance of PM₁₀ monitoring networks to allow for further research in communities affected by sources such as road dust.

Saharan dust and the impact on adult and elderly allergic patients: the effect of threshold values in the northern sector of Gran Canaria, Spain

Gran Canaria Island is frequently impacted by Saharan dust, a health hazard of particular concern to the island population and health agencies. Airborne mineral dust has the severest impact on the higher age groups of the population, and those with respiratory conditions; despite that, on average, the ambient particulate matter (PM) concentrations fall within international PM guidelines. During 2010 and 2011, an epidemiological survey, in parallel with an air quality study, was conducted at the Dr Negrín hospital in Gran Canaria. This included the quarterly monitoring of outpatients and recording of emergency patients with respiratory diseases, together with the measurement of aerosol, meteorological, and PM-related air quality levels. The finer more toxic particles were collected with PM_2.5 (particulate matter with aerodynamic diameter less than 2.5 μm) aerosol samplers. The filter samples were gravimetrically and chemically analyzed for their elemental, water-soluble ions, carbon, and mineralogical contents. Individual particle morphology was measured by Scanning Electron Microscopy. Statistical analysis of the chemical and clinical data included the analysis of variance and calculation of Spearman correlation coefficients. No statistically significant relations were found between the allergic control group, the emergency room admissions, pulmonary conditions, medication, and elevated Saharan dust levels. However, changing environmental conditions, such as an increase in humidity or a reduction in ambient air temperature made a significant difference to the outcomes recorded on the health statements of the allergic and respiratory illness groups of the Gran Canary population.

The association between particulate air pollution and respiratory admissions among young children in Hanoi, Vietnam

While the effects of ambient air pollution on health have been studied extensively in many developed countries, few studies have been conducted in Vietnam, where the population is exposed to high levels of airborne particulate matter. The aim of our study was to examine the short-term effects of PM₁₀, PM_2.5, and PM₁ on respiratory admissions among young children in Hanoi. Data on daily admissions from the Vietnam National Hospital of Paediatrics and daily records of PM₁₀, PM_2.5, PM₁ and other confounding factors as NO₂, SO₂, CO, O₃ and temperature were collected from September 2010 to September 2011. A time-stratified case-crossover design with individual lag model was applied to evaluate the associations between particulate air pollution and respiratory admissions. Significant effects on daily hospital admissions for respiratory disease were found for PM₁₀, PM_2.5 and PM₁. An increase in 10μg/m³ of PM₁₀, PM_2.5 or PM₁ was associated with an increase in risk of admission of 1.4%, 2.2% or 2.5% on the same day of exposure, respectively. No significant difference between the effects on males and females was found in the study. The study demonstrated that infants and young children in Hanoi are at increased risk of respiratory admissions due to the high level of airborne particles in the city's ambient air.

Associations of short-term exposure to air pollution with respiratory hospital admissions in Arak, Iran

BACKGROUND

Ambient air pollution, is one of the most frequently stated environmental problems. Many epidemiological studies have documented adverse health effects for ambient air pollution. This study aimed to investigate the association between ambient air pollution and respiratory hospital admissions.

METHODS

In this ecological time series study data about air pollutant concentrations including CO, NO₂, O₃, PM_2.5, PM₁₀ and SO₂ and, respiratory hospital admissions in the urban population of Arak, from January 1st 2010 to December 31st 2015; were inquired, from the Arak Department of Environment, and two major hospitals, respectively. Meteorological data were inquired for the same period as well. Time-series regression analysis with a distributed lag model, controlled for seasonality long-time trends, weather and day of the week, was used for data analysis.

RESULTS

Every 10 μg/m³ increase in NO₂, and PM₁₀ and every 1 mg/m³ increase in CO at lag 0 corresponded to a RR = 1.032 (95%CI, 1.003-1.06), RR = 1.01 (95%CI, 1.004-1.017) and RR = 1.09 (95%CI, 1.04-1.14), increase in respiratory disease hospitalizations, respectively. Males and the elderly were found to be more susceptible than females and other age groups to air pollutants in regard to respiratory disease admissions.

CONCLUSIONS

The results of this study showed that outdoor air pollutants significantly increase respiratory hospital admissions; especially among the men and elders in Arak.

Air quality co-benefits of subnational carbon policies

To mitigate climate change, governments ranging from city to multi-national have adopted greenhouse gas (GHG) emissions reduction targets. While the location of GHG reductions does not affect their climate benefits, it can impact human health benefits associated with co-emitted pollutants. Here, an advanced modeling framework is used to explore how subnational level GHG targets influence air pollutant co-benefits from ground level ozone and fine particulate matter. Two carbon policy scenarios are analyzed, each reducing the same total amount of GHG emissions in the Northeast US: an economy-wide Cap and Trade (CAT) program reducing emissions from all sectors of the economy, and a Clean Energy Standard (CES) reducing emissions from the electricity sector only. Results suggest that a regional CES policy will cost about 10 times more than a CAT policy. Despite having the same regional targets in the Northeast, carbon leakage to non-capped regions varies between policies. Consequently, a regional CAT policy will result in national carbon reductions that are over six times greater than the carbon reduced by the CES in 2030. Monetized regional human health benefits of the CAT and CES policies are 844% and 185% of the costs of each policy, respectively. Benefits for both policies are thus estimated to exceed their costs in the Northeast US. The estimated value of human health co-benefits associated with air pollution reductions for the CES scenario is two times that of the CAT scenario.

IMPLICATIONS

In this research, an advanced modeling framework is used to determine the potential impacts of regional carbon policies on air pollution co-benefits associated with ground level ozone and fine particulate matter. Study results show that spatially heterogeneous GHG policies have the potential to create areas of air pollution dis-benefit. It is also shown that monetized human health benefits within the area covered by policy may be larger than the model estimated cost of the policy. These findings are of particular interest both as U.S. states work to develop plans to meet state-level carbon emissions reduction targets set by the EPA through the Clean Power Plan, and in the absence of comprehensive national carbon policy.

Outdoor Air Pollution and COPD-Related Emergency Department Visits, Hospital Admissions, and Mortality: A Meta-Analysis

A systematic literature review was performed to identify all peer-reviewed literature quantifying the association between short-term exposures of particulate matter <2.5 microns (PM_2.5), nitrogen dioxide (NO₂), and sulfur dioxide (SO₂) and COPD-related emergency department (ED) visits, hospital admissions (HA), and mortality. These results were then pooled for each pollutant through meta-analyses with a random effects model. Subgroup meta-analyses were explored to study the effects of selected lag/averaging times and health outcomes. A total of 37 studies satisfied our inclusion criteria, contributing to a total of approximately 1,115,000 COPD-related acute events (950,000 HAs, 80,000 EDs, and 130,000 deaths) to our meta-estimates. An increase in PM_2.5 of 10 ug/m³ was associated with a 2.5% (95% CI: 1.6-3.4%) increased risk of COPD-related ED and HA, an increase of 10 ug/m³ in NO₂ was associated with a 4.2% (2.5-6.0%) increase, and an increase of 10 ug/m³ in SO₂ was associated with a 2.1% (0.7-3.5%) increase. The strength of these pooled effect estimates, however, varied depending on the selected lag/averaging time between exposure and outcome. Similar pooled effects were estimated for each pollutant and COPD-related mortality. These results suggest an ongoing threat to the health of COPD patients from both outdoor particulates and gaseous pollutants. Ambient outdoor concentrations of PM_2.5, NO₂, and SO₂ were significantly and positively associated with both COPD-related morbidity and mortality.

Effects of Air Pollution on Hospital Emergency Room Visits for Respiratory Diseases: Urban-Suburban Differences in Eastern China

A study on the relationships between ambient air pollutants (PM_2.5, SO₂ and NO₂) and hospital emergency room visits (ERVs) for respiratory diseases from 2013 to 2014 was performed in both urban and suburban areas of Jinan, a heavily air-polluted city in Eastern China. This research was analyzed using generalized additive models (GAM) with Poisson regression, which controls for long-time trends, the “day of the week” effect and meteorological parameters. An increase of 10 μg/m³ in PM_2.5, SO₂ and NO₂ corresponded to a 1.4% (95% confidence interval (CI): 0.7%, 2.1%), 1.2% (95% CI: 0.5%, 1.9%), and 2.5% (95%: 0.8%, 4.2%) growth in ERVs for the urban population, respectively, and a 1.5% (95%: 0.4%, 2.6%), 0.8% (95%: −0.7%, 2.3%), and 3.1% (95%: 0.5%, 5.7%) rise in ERVs for the suburban population, respectively. It was found that females were more susceptible than males to air pollution in the urban area when the analysis was stratified by gender, and the reverse result was seen in the suburban area. Our results suggest that the increase in ERVs for respiratory illnesses is linked to the levels of air pollutants in Jinan, and there may be some urban-suburban discrepancies in health outcomes from air pollutant exposure.

Short-term population-based non-linear concentration-response associations between fine particulate matter and respiratory diseases in Taipei (Taiwan): a spatiotemporal analysis

Fine particulate matter <2.5 μm (PM2.5) has been associated with human health issues; however, findings regarding the influence of PM2.5 on respiratory disease remain inconsistent. The short-term, population-based association between the respiratory clinic visits of children and PM2.5 exposure levels were investigated by considering both the spatiotemporal distributions of ambient pollution and clinic visit data. We applied a spatiotemporal structured additive regression model to examine the concentration-response (C-R) association between children's respiratory clinic visits and PM2.5 concentrations. This analysis was separately performed on three respiratory disease categories that were selected from the Taiwanese National Health Insurance database, which includes 41 districts in the Taipei area of Taiwan from 2005 to 2007. The findings reveal a non-linear C-R pattern of PM2.5, particularly in acute respiratory infections. However, a PM2.5 increase at relatively lower levels can elevate the same-day respiratory health risks of both preschool children (<6 years old) and schoolchildren (6-14 years old). In preschool children, same-day health risks rise when concentrations increase from 0.76 to 7.44 μg/m(3), and in schoolchildren, same-day health risks rise when concentrations increase from 0.76 to 7.52 μg/m(3). Changes in PM2.5 levels generally exhibited no significant association with same-day respiratory risks, except in instances where PM2.5 levels are extremely high, and these occurrences do exhibit a significant positive influence on respiratory health that is especially notable in schoolchildren. A significant high relative rate of respiratory clinic visits are concentrated in highly populated areas. We highlight the non-linearity of the respiratory health effects of PM2.5 on children to investigate this population-based association. The C-R relationship in this study can provide a highly valuable alternative for assessing the effects of ambient air pollution on human health.

Short-term Exposure to Ambient Fine Particulate Matter Increases Hospitalizations and Mortality in COPD: A Systematic Review and Meta-analysis

BACKGROUND

Many epidemiologic studies have documented variable relationships between ambient particulate matter (PM) and COPD hospitalizations and mortality in cities worldwide.

METHODS

Comprehensive and systematic searches were performed in the electronic reference databases (PubMed, EMBASE, Google Scholar, Ovid, and Web of Science) with specific search terms and selection criteria for relevant studies. Summary ORs and 95% CIs were calculated to evaluate the relationship between short-term exposure to PM with aerodynamic diameters ≤ 2.5 μm (PM2.5) and COPD hospitalizations and mortality. The sources of heterogeneity and the effect of potential confounders were explored using subgroup analyses. Study findings were analyzed using a random effects model and a fixed effects model in COPD hospitalizations and mortality, respectively.

RESULTS

The search yielded 12 studies suitable for meta-analysis of hospitalizations and six studies suitable for the mortality meta-analysis until April 15, 2015. A 10-μg/m(3) increase in daily PM2.5 (lag days 0-7) was associated with a 3.1% (95% CI, 1.6%-4.6%) increase in COPD hospitalizations and a 2.5% (95% CI, 1.5%-3.5%) increase in COPD mortality. Significant publication bias was not found in studies focusing on the relationship between short-term PM2.5 exposure and COPD hospitalizations and mortality.

CONCLUSIONS

Our combined analysis indicated that short-term exposure to a 10-μg/m(3) increment of ambient PM2.5 is associated with increased COPD hospitalizations and mortality. Further study is needed to elucidate to what extent this relationship is causal, together with other factors, and to elucidate the mechanism by which PM2.5 induces activation of cellular processes promoting COPD exacerbations.

The impact of PM2.5 on asthma emergency department visits: a systematic review and meta-analysis

Although the relationship between asthma and exposure to fine particulate matter (PM2.5) has been frequently measured, reported conclusions have not been consistent. As emergency department (ED) visits are an effective way to estimate health outcomes for people with asthma and short-term exposure to PM2.5, this review systematically searched five databases without language or geographical restrictions from inception to January 13, 2015 to study the impact of PM2.5 on asthma ED visits. A random-effects model was used to calculate the pooled risk ratio (RR) and 95% confidence intervals (CI). With respect to short-term effects, asthma ED visits increased at higher PM2.5 concentrations (RR 1.5% per 10 μg/m(3); 95% CI 1.2-1.7%), and children were more susceptible (3.6% per 10 μg/m(3); 95% CI 1.8, 5.3%) than adults (1.7, 95% CI 0.7%, 2.8%) to increased PM2.5; the ED visits increased during the warm season by 3.7% (95% CI 0.5, 6.9%) per 10 μg/m(3) increase in PM2.5, which was higher than the corresponding increase during the cold season (2.6, 95% CI 0.7-4.6%). This demonstrates that ambient PM2.5 has an adverse impact on asthma ED visits after short-term exposure and that children are a high-risk population when PM2.5 concentrations are high, particularly in warm seasons, during which measures should be taken to prevent PM2.5.

Association between Air Pollutants and Asthma Emergency Room Visits and Hospital Admissions in Time Series Studies: A Systematic Review and Meta-Analysis

BACKGROUND

Air pollution constitutes a significant stimulus of asthma exacerbations; however, the impacts of exposure to major air pollutants on asthma-related hospital admissions and emergency room visits (ERVs) have not been fully determined.

OBJECTIVE

We sought to quantify the associations between short-term exposure to air pollutants [ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter ≤10 μm (PM10) and PM2.5] and the asthma-related emergency room visits (ERV) and hospitalizations.

METHODS

Systematic computerized searches without language limitation were performed. Pooled relative risks (RRs) and 95% confidence intervals (95%CIs) were estimated using the random-effect models. Sensitivity analyses and subgroup analyses were also performed.

RESULTS

After screening of 246 studies, 87 were included in our analyses. Air pollutants were associated with significantly increased risks of asthma ERVs and hospitalizations [O3: RR(95%CI), 1.009 (1.006, 1.011); I2 = 87.8%, population-attributable fraction (PAF) (95%CI): 0.8 (0.6, 1.1); CO: RR(95%CI), 1.045 (1.029, 1.061); I2 = 85.7%, PAF (95%CI): 4.3 (2.8, 5.7); NO2: RR(95%CI), 1.018 (1.014, 1.022); I2 = 87.6%, PAF (95%CI): 1.8 (1.4, 2.2); SO2: RR(95%CI), 1.011 (1.007, 1.015); I2 = 77.1%, PAF (95%CI): 1.1 (0.7, 1.5); PM10: RR(95%CI), 1.010 (1.008, 1.013); I2 = 69.1%, PAF (95%CI): 1.1 (0.8, 1.3); PM2.5: RR(95%CI), 1.023 (1.015, 1.031); I2 = 82.8%, PAF (95%CI): 2.3 (1.5, 3.1)]. Sensitivity analyses yielded compatible findings as compared with the overall analyses without publication bias. Stronger associations were found in hospitalized males, children and elderly patients in warm seasons with lag of 2 days or greater.

CONCLUSION

Short-term exposures to air pollutants account for increased risks of asthma-related ERVs and hospitalizations that constitute a considerable healthcare utilization and socioeconomic burden.

Ambient carbon monoxide and the risk of hospitalization due to chronic obstructive pulmonary disease

Data from recent experimental and clinical studies have indicated that lower concentrations of inhaled carbon monoxide might have beneficial antiinflammatory effects. Inhaled carbon monoxide has the potential to be a therapeutic agent for chronic obstructive pulmonary diseases (COPD). However, population-based epidemiologic studies of environmentally relevant carbon monoxide exposure have generated mixed findings. We conducted a time-series study in Hong Kong to estimate the association of short-term exposure to ambient carbon monoxide with emergency hospitalizations for COPD. We collected daily emergency hospital admission data and air pollution data from January 2001 to December 2007. We used log-linear Poisson models to estimate the associations between daily hospital admissions for COPD and the average daily concentrations of carbon monoxide while controlling for the traffic-related co-pollutants nitrogen dioxide and particulate matter with an aerodynamic diameter less than 2.5 μm. Results showed that ambient carbon monoxide was negatively associated with the risk of hospitalizations for COPD. After adjustment for levels nitrogen dioxide or particulate matter with an aerodynamic diameter less than 2.5 μm, the negative associations of carbon monoxide with COPD hospitalizations became stronger. The risk estimates were similar for female and male subjects. In conclusion, short-term exposure to ambient carbon monoxide was associated with a decreased risk of hospitalization for COPD, which suggests that carbon monoxide exposure provides some acute protection of against exacerbation of COPD.

Tree and forest effects on air quality and human health in the United States

Trees remove air pollution by the interception of particulate matter on plant surfaces and the absorption of gaseous pollutants through the leaf stomata. However, the magnitude and value of the effects of trees and forests on air quality and human health across the United States remains unknown. Computer simulations with local environmental data reveal that trees and forests in the conterminous United States removed 17.4 million tonnes (t) of air pollution in 2010 (range: 9.0-23.2 million t), with human health effects valued at 6.8 billion U.S. dollars (range: $1.5-13.0 billion). This pollution removal equated to an average air quality improvement of less than one percent. Most of the pollution removal occurred in rural areas, while most of the health impacts and values were within urban areas. Health impacts included the avoidance of more than 850 incidences of human mortality and 670,000 incidences of acute respiratory symptoms.

Structured expert judgment to characterize uncertainty between PM2.5 exposure and mortality in Chile

To further the understanding and implementation of expert elicitation methods in the evaluation of public policies related to air pollution, the present study's main goal was to explore the potential strengths and weaknesses of structured expert judgment (SEJ) methodology as a way to derive a C-R function for chronic PM(2.5) exposure and premature mortality in Chile. Local experts were classified in two groups according to background and experience: physicians (Group 1) and engineers (Group 2). Experts were required to provide an estimate of the true percent change in nonaccidental mortality resulting from a permanent 1 μg/m(3) reduction in PM2.5 annual average ambient concentration across the entire Chilean territory. Cooke's Classical Model was used to combine the individual experts' assessments. Experts' mortality estimations varied markedly across groups: while experts in Group 1 delivered higher estimations than those reported in major international cohort studies, estimations from Group 2 were, to varying degrees, anchored to previous studies. Accordingly, combined distributions for each group and all experts were significantly different, due to the high sensitivity of the weighted distribution to experts' performance in calibration variables. Results of this study suggest that, while the use of SEJ has great potential for estimating C-R functions for chronic exposure to PM2.5 and premature mortality and its major sources of uncertainty in countries where no studies are available, its successful implementation is conditioned by a number of factors, which are analyzed and discussed.

Ambient Coarse Particulate Matter and Human Health: A Systematic Review and Meta-Analysis

Airborne particles have been linked to increased mortality and morbidity. As most research has focused on fine particles (PM2.5), the health implications of coarse particles (PM10-2.5) are not well understood. We conducted a systematic review and meta-analysis of associations for short- and long-term PM10-2.5 concentrations with mortality and hospital admissions. Using 23 mortality and 10 hospital admissions studies, we documented suggestive evidence of increased morbidity and mortality in relation to higher short-term PM10-2.5 concentrations, with stronger relationships for respiratory than cardiovascular endpoints. Reported associations were highly heterogeneous, however, especially by geographic region and average PM10-2.5 concentrations. Adjustment for PM2.5 and publication bias resulted in weaker and less precise effect estimates, although positive associations remained for short-term PM10-2.5 concentrations. Inconsistent relationships between effect estimates for PM10-2.5 and correlations between PM10-2.5 and PM2.5 concentrations, however, indicate that PM10-2.5 associations cannot be solely explained by co-exposure to PM2.5. While suggestive evidence was found of increased mortality with long-term PM10-2.5 concentrations, these associations were not robust to control for PM2.5. Additional research is required to better understand sources of heterogeneity of associations between PM10-2.5 and adverse health outcomes.

Geospatial relationships of air pollution and acute asthma events across the Detroit-Windsor international border: study design and preliminary results

The Geospatial Determinants of Health Outcomes Consortium (GeoDHOC) study investigated ambient air quality across the international border between Detroit, Michigan, USA and Windsor, Ontario, Canada and its association with acute asthma events in 5- to 89-year-old residents of these cities. NO2, SO2, and volatile organic compounds (VOCs) were measured at 100 sites, and particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) at 50 sites during two 2-week sampling periods in 2008 and 2009. Acute asthma event rates across neighborhoods in each city were calculated using emergency room visits and hospitalizations and standardized to the overall age and gender distribution of the population in the two cities combined. Results demonstrate that intra-urban air quality variations are related to adverse respiratory events in both cities. Annual 2008 asthma rates exhibited statistically significant positive correlations with total VOCs and total benzene, toluene, ethylbenzene and xylene (BTEX) at 5-digit zip code scale spatial resolution in Detroit. In Windsor, NO2, VOCs, and PM10 concentrations correlated positively with 2008 asthma rates at a similar 3-digit postal forward sortation area scale. The study is limited by its coarse temporal resolution (comparing relatively short term air quality measurements to annual asthma health data) and interpretation of findings is complicated by contrasts in population demographics and health-care delivery systems in Detroit and Windsor.

Comparison of the effects of air pollution on outpatient and inpatient visits for asthma: a population-based study in Taiwan

Background

A nationwide asthma survey on the effects of air pollution is lacking in Taiwan. The purpose of this study was to evaluate the time trend and the relationship between air pollution and health care services for asthma in Taiwan.

Methods

Health care services for asthma and ambient air pollution data were obtained from the National Health Insurance Research database and Environmental Protection Administration from 2000 through 2009, respectively. Health care services, including those related to the outpatient and inpatient visits were compared according to the concentration of air pollutants.

Results

The number of asthma-patient visits to health-care facilities continue to increase in Taiwan. Relative to the respective lowest quartile of air pollutants, the adjusted relative risks (RRs) of the outpatient visits in the highest quartile were 1.10 (P-trend  = 0.013) for carbon monoxide (CO), 1.10 (P-trend  = 0.015) for nitrogen dioxide (NO₂), and 1.20 (P-trend <0.0001) for particulate matter with an aerodynamic diameter ≦10µm (PM₁₀) in the child group (aged 0–18). For adults aged 19–44, the RRs of outpatient visits were 1.13 (P-trend = 0.078) for CO, 1.17 (P-trend = 0.002) for NO_2, and 1.13 (P-trend <0.0001) for PM₁₀. For adults aged 45–64, the RRs of outpatient visits were 1.15 (P-trend = 0.003) for CO, 1.19 (P-trend = 0.0002) for NO_2, and 1.10 (P-trend = 0.001) for PM₁₀. For the elderly (aged≥ 65), the RRs of outpatient visits in were 1.12 (P-trend  = 0.003) for NO₂ and 1.10 (P-trend  = 0.006) for PM_10. For inpatient visits, the RRs across quartiles of CO level were 1.00, 1.70, 1.92, and 1.86 (P-trend  = 0.0001) in the child group. There were no significant linear associations between inpatient visits and air pollutants in other groups.

Conclusions

There were positive associations between CO levels and childhood inpatient visits as well as NO₂, CO and PM₁₀ and outpatient visits.