Acute Effects of Nitrogen Dioxide on Cardiovascular Mortality in Beijing: An Exploration of Spatial Heterogeneity and the District-specific Predictors

Interactive effects of atmospheric oxidising pollutants and heat waves on the risk of residential mortality

BACKGROUND

The impact of heat waves and atmospheric oxidising pollutants on residential mortality within the framework of global climate change has become increasingly important.

OBJECTIVE

In this research, the interactive effects of heat waves and oxidising pollutants on the risk of residential mortality in Fuzhou were examined. Methods We collected environmental, meteorological, and residential mortality data in Fuzhou from 1 January 2016, to 31 December 2021. We then applied a generalised additive model, distributed lagged nonlinear model, and bivariate three-dimensional model to investigate the effects and interactions of various atmospheric oxidising pollutants and heat waves on the risk of residential mortality.

RESULTS

Atmospheric oxidising pollutants increased the risk of residential mortality at lower concentrations, and O3 and Ox were positively associated with a maximum risk of 2.19% (95% CI: 0.74-3.66) and 1.29% (95% CI: 0.51-2.08). The risk of residential mortality increased with increasing temperature, with a strong and long-lasting effect and a maximum cumulative lagged effect of 1.11% (95% CI: 1.01, 1.23). Furthermore, an interaction between atmospheric oxidising pollutants and heat waves may have occurred: the larger effects in the longest cumulative lag time on residential mortality per 10 µg/m3 increase in O3, NO2 and Ox during heat waves compared to non-heat waves were [-3.81% (95% CI: -14.82, 8.63)]; [-0.45% (95% CI: -2.67, 1.81)]; [67.90% (95% CI: 11.55, 152.71)]; 16.37% (95% CI: 2.43, 32.20)]; [-3.00% (95% CI: -20.80, 18.79)]; [-0.30% (95% CI: -3.53, 3.04)]. The risk on heat wave days was significantly higher than that on non-heat wave days and higher than the separate effects of oxidising pollutants and heat waves.

CONCLUSIONS

Overall, we found some evidence suggesting that heat waves increase the impact of oxidising atmospheric pollutants on residential mortality to some extent.

Associations between PM2.5 Components and Mortality of Ischemic Stroke, Chronic Obstructive Pulmonary Disease and Diabetes in Beijing, China

Ischemic stroke (IS), chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) account for a large burden of premature deaths. However, few studies have investigated the associations between fine particular matter (PM2.5) components and mortality of IS, COPD and DM. We aimed to examine these associations in Beijing, China. Data on daily mortality, air pollutants and meteorological factors from 2008 to 2011 in Beijing were collected. Daily concentrations of five PM2.5 components, namely, sulfate ion (SO42-), ammonium ion (NH4+), nitrate ion (NO3-), organic matter (OM) and black carbon (BC), were obtained from the Tracking Air Pollution (TAP) database in China. The association between PM2.5 components and daily deaths was explored using a quasi-Poisson regression with the distributed lag nonlinear model (DLNM). The average daily concentrations of SO42-, NH4+, NO3-, OM and BC were 11.24, 8.37, 12.00, 17.34 and 3.32 μg/m3, respectively. After adjusting for temperature, relative humidity, pressure, particulate matter less than 10 μm in aerodynamic diameter (PM10), nitrogen dioxide (NO2) and sulfur dioxide (SO2), an IQR increase in OM at lag day 2 and lag day 6 was associated with an increased DM mortality risk (RR 1.038; 95% CI: 1.005-1.071) and COPD mortality risk (RR 1.013; 95% CI: 1.001-1.026). An IQR increase in BC at lag day 0 and lag day 6 was associated with increased COPD mortality risk (RR 1.228; 95% CI: 1.017-1.48, RR 1.059; 95% CI: 1.001-1.121). Cumulative exposure to SO42- and NH4+ was associated with an increased mortality risk for IS, with the highest effect found for lag of 0-7 days (RR 1.085; 95% CI: 1.010-1.167, RR 1.083; 95% CI: 1.003-1.169). These effects varied by sex and age group. This study demonstrated associations of short-term exposure to PM2.5 components with increased risk of IS, COPD and DM mortality in the general population. Our study also highlighted susceptible subgroups.

Advancing application of satellite remote sensing technologies for linking atmospheric and built environment to health

Background

The intricate interplay between human well-being and the surrounding environment underscores contemporary discourse. Within this paradigm, comprehensive environmental monitoring holds the key to unraveling the intricate connections linking population health to environmental exposures. The advent of satellite remote sensing monitoring (SRSM) has revolutionized traditional monitoring constraints, particularly limited spatial coverage and resolution. This innovation finds profound utility in quantifying land covers and air pollution data, casting new light on epidemiological and geographical investigations. This dynamic application reveals the intricate web connecting public health, environmental pollution, and the built environment.

Objective

This comprehensive review navigates the evolving trajectory of SRSM technology, casting light on its role in addressing environmental and geographic health issues. The discussion hones in on how SRSM has recently magnified our understanding of the relationship between air pollutant exposure and population health. Additionally, this discourse delves into public health challenges stemming from shifts in urban morphology.

Methods

Utilizing the strategic keywords "SRSM," "air pollutant health risk," and "built environment," an exhaustive search unfolded across prestigious databases including the China National Knowledge Network (CNKI), PubMed and Web of Science. The Citespace tool further unveiled interconnections among resultant articles and research trends.

Results

Synthesizing insights from a myriad of articles spanning 1988 to 2023, our findings unveil how SRMS bridges gaps in ground-based monitoring through continuous spatial observations, empowering global air quality surveillance. High-resolution SRSM advances data precision, capturing multiple built environment impact factors. Its application to epidemiological health exposure holds promise as a pioneering tool for contemporary health research.

Conclusion

This review underscores SRSM's pivotal role in enriching geographic health studies, particularly in atmospheric pollution domains. The study illuminates how SRSM overcomes spatial resolution and data loss hurdles, enriching environmental monitoring tools and datasets. The path forward envisions the integration of cutting-edge remote sensing technologies, novel explorations of urban-public health associations, and an enriched assessment of built environment characteristics on public well-being.

Air Pollution and Cardiac Diseases: A Review of Experimental Studies

Air pollution is associated with around 6.5 million premature deaths annually, which are directly related to cardiovascular diseases, and the most dangerous atmospheric pollutants to health are as follows: NO2, SO2, CO, and PM. The mechanisms underlying the observed effects have not yet been clearly defined. This work aims to conduct a narrative review of experimental studies to provide a more comprehensive and multiperspective assessment of how the effect of atmospheric pollutants on cardiac activity can result in the development of cardiac diseases. For this purpose, a review was carried out in databases of experimental studies, excluding clinical trials, and epidemiological and simulation studies. After analyzing the available information, the existence of pathophysiological effects of the different pollutants on cardiac activity from exposure during both short-term and long-term is evident. This narrative review based on experimental studies is a basis for the development of recommendations for public health.

The association between air pollution and the daily hospital visits for atrial fibrillation recorded by ECG: a cross-sectional study

BACKGROUND

The relationship between air pollution and atrial fibrillation (AF) recorded by electrocardiograph (ECG) has not yet been illustrated which worsens AF precaution and treatment. This research evaluated the association between air pollution and daily hospital visits for AF with ECG records.

METHODS

The study enrolled 4933 male and 5392 female patients whose ECG reports indicated AF from 2015 to 2018 in our hospital. Such data were then matched with meteorological data, including air pollutant concentrations, collected by local weather stations. A case-crossover study was performed to assess the relationship between air pollutants and daily hospital visits for AF recorded by ECG and to investigate its lag effect.

RESULTS

Our analysis revealed statistically significant associations between AF occurrence and demographic data, including age and gender. This effect was stronger in female (k = 0.02635, p < 0.01) and in patients over 65 y (k = 0.04732, p < 0.01). We also observed a hysteretic effect that when exposed to higher nitrogen dioxide(NO2), counting AF cases recorded by ECG may elevate at lag 0 with a maximum odds ratio(OR) of 1.038 (95% CI 1.014-1.063), on the contrary, O3 reduced the risk of daily visits for AF and its maximum OR was at lag 2, and the OR value was 0.9869 (95% CI 0.9791-0.9948). Other air pollutants such as PM2.5, PM10, and SO2 showed no clear relationship with the recorded AF.

CONCLUSION

The associations between air pollution and AF recorded with ECG were preliminarily discovered. Short-term exposure to NO2 was significantly associated with daily hospital visits for AF management.

Ambient NO2 exposure induced cardiotoxicity associated with gut microbiome dysregulation and glycerophospholipid metabolism disruption

An average daily increase of 10 μg/m³ in NO₂ concentrations could lead to an increased mortality in cardiovascular, cerebrovascular of 1.89%, 2.07%, but the mechanism by which NO₂ contributes to cardiotoxicity is rarely reported. In order to assess the cardiotoxicity of NO₂ inhalation (5 ppm), we firstly investigate the change of gut microbiota, serum metabonomics and cardiac proteome. Non-targeted LC-MS/MS metabonomics showed that NO₂ stress could perturb the glycerophospholipid metabolism in the serum, which might destabilize the bilayer configuration of cardiac lipid membranes. Furthermore, we observed that NO₂ inhalation caused augmented intercellular gap and inflammatory infiltration in the heart. Although 16 S rRNA gene amplification sequencing demonstrated that NO₂ exposure did not influence the intestinal microbial abundance and diversity, but glycerophospholipid metabolism disruption might be finally reflected in gut microbiom dysregulation, such as Sphingomonas, Koribacter, Actinomarina and Bradyrhizobium Turicibacter, Rothia, Globicatella and Aerococcus. Proteome mining revealed that differentially expressed genes (DEGs) in the heart after NO₂ stress were involved in necroptosis, mitophagy and ferroptosis. We further revealed that NO₂ increased the number of cardiac mitochondria with depletion of cristae by regulating the expression of Mfn2 and Hsp70. This study indicating Mfn2-meidcated imbalanced mitochondrial dynamics as a potential mechanism after NO₂-induced heart injury and suggesting microbiome dysregulation/glycerophospholipid metabolism exerts critical roles in cardiotoxicity caused by NO₂.

Effects of ambient air pollutants on hospital admissions and deaths for cardiovascular diseases: a time series analysis in Tehran

Short-term exposures to air pollution have been associated with various adverse health effects. In this study, we investigated the associations between ambient air pollutants with the number of hospital admissions and mortality from cardiovascular diseases (CVDs). This time series study was conducted in Tehran for the years 2014-2017 (1220 day). We collected the ambient air pollutant concentration data from the regulatory monitoring stations. The health data were obtained from the Ministry of Health and Medical Education. A distributed lag non-linear model (DLNM) was used for the analyses. Total CVDs and ischemic heart disease (IHD) admissions were associated with CO for each 1 mg/m³ increase at lags of 6 and 7 days. Also, there was a positive association between total CVDs (RR 1.01; 1.001 to 1.03), IHD (RR 1.04; 1.006 to 1.07), and cerebrovascular diseases (RR 1.03; 1.005 to 1.07) mortality with SO₂ at a lag of 4 days. PM_2.5 and PM₁₀ were associated with cerebrovascular disease admissions in females aged 16-65 years and 16 years and younger for each 10 µg/m³ increase, respectively. Short-term exposure to SO₂, NO₂, and CO was associated with hospital admissions and mortality for CVDs, IHD, cerebrovascular diseases, and other cardiovascular diseases at different lags. Moreover, females were more affected by ambient air pollutants than males in terms of their burden of CVDs. Therefore, identifying the likely harmful effects of pollutants given their current concentrations requires the planning and implementation of strategies to reduce air pollution.

Acute effects of ambient nitrogen oxides and interactions with temperature on cardiovascular mortality in Shenzhen, China

BACKGROUND

Though inconsistent, acute effects of ambient nitrogen oxides on cardiovascular mortality have been reported. Whereas, interactive roles of temperature on their relationships and joint effects of different indicators of nitrogen oxides were less studied. This study aimed to extrapolate the independent roles of ambient nitrogen oxides and temperature interactions on cardiovascular mortality.

METHODS

Data on mortality, air pollutants, and meteorological factors in Shenzhen from 2013 to 2019 were collected. Three indicators including nitric oxide (NO), nitrogen dioxide (NO₂), and nitrogen oxides (NO_X) were studied. Adjusted generalized additive models (GAMs) were applied to analyse their associations with cardiovascular mortality in different groups.

RESULTS

The average daily concentrations of NO, NO₂, and NO_X were 11.7 μg/m³, 30.7 μg/m³, and 53.2 μg/m³, respectively. Significant associations were shown with each indicator. Cumulative effects of nitrogen oxides were more obvious than distributed lag effects. Males, population under 65 years old, and population with stroke-related condition were more susceptible to nitrogen oxides. Adverse effects of nitrogen oxides were more significant at low temperature. Impacts of NO₂ on cardiovascular mortality, and NO on stroke mortality were the most robust in the multi-pollutant models, whereas variations were shown in the other relationships.

CONCLUSIONS

Low levels of nitrogen oxides showed acute and adverse impacts and the interactive roles of temperature on cardiovascular mortality. Cumulative effects were most significant and joint effects of nitrogen oxides required more attention. Population under 65 years old and population with stroke-related health condition were susceptible, especially days at lower temperature.

Mutual effects of fine particulate matter, nitrogen dioxide, and fireworks on cause-specific acute cardiovascular mortality: A case-crossover study in communities affected by aircraft noise

Ambient air pollution is the leading cause of environmental mortality and morbidity worldwide. However, the individual contributions to acute mortality of traffic-related air pollutants such as nitrogen dioxide (NO₂) and fine particulate matter (PM_2.5) are still debated. We conducted a time-stratified case-crossover study for a population located around Zurich airport in Switzerland, including 24,886 adult cardiovascular deaths from the Swiss National Cohort. We estimated the risk of cause-specific cardiovascular mortality associated with daily NO₂ and PM_2.5 concentrations at home using distributed lag models up to 7 days preceding death, adjusted for daily temperature, precipitation, acute night-time aircraft noise, firework celebrations, and holidays. Cardiovascular mortality was associated with NO₂, whereas the association with PM_2.5 disappeared upon adjustment for NO₂. The strongest association was observed between NO₂ and ischemic stroke mortality (odds ratio = 1.55 per 10 μg/m³, 95% confidence intervals = 1.20-2.00). Cause-specific mortality analyses showed differences in terms of delayed effect: odds ratios were highest at 1-3 days after exposure for most outcomes but at lags of 3-5 days for heart failure. Individual vulnerabilities to NO₂ associated cardiovascular mortality also varied by cause of death, possibly highlighting the role of different behaviours and risk factors in the most susceptible groups. The risk of cardiovascular mortality was also increased on firework days and after public holidays, independent from NO₂ and PM_2.5 concentrations. This study confirms the association between ambient NO₂, as a marker for primary emissions, and acute cardiovascular mortality in a specific setting around a major airport. Future research should clarify the role of additional air pollutants including ultra-fine particles on cardiovascular diseases to inform most efficient control measures.

Short-term exposure to nitrogen dioxide and mortality: A systematic review and meta-analysis

BACKGROUND

Ambient air pollution has been characterized as a leading cause of mortality worldwide and has been associated with cardiovascular and respiratory diseases. There is increasing evidence that short-term exposure to nitrogen dioxide (NO₂), is related to adverse health effects and mortality.

METHODS

We conducted a systematic review of short-term NO₂ and daily mortality, which were indexed in PubMed and Embase up to June 2021. We calculated random-effects estimates by different continents and globally, and tested for heterogeneity and publication bias.

RESULTS

We included 87 articles in our quantitative analysis. NO₂ and all-cause as well as cause-specific mortality were positively associated in the main analysis. For all-cause mortality, a 10 ppb increase in NO₂ was associated with a 1.58% (95%CI 1.28%-1.88%, I² = 96.3%, Eggers' test p < 0.01, N = 57) increase in the risk of death. For cause-specific mortality, a 10 ppb increase in NO₂ was associated with a 1.72% (95%CI 1.41%-2.04%, I² = 87.4%, Eggers' test p < 0.01, N = 42) increase in cardiovascular mortality and a 2.05% (95%CI 1.52%-2.59%, I² = 78.5%, Eggers' test p < 0.01, N = 38) increase in respiratory mortality. In the sensitivity analysis, the meta-estimates for all-cause mortality, cardiovascular and respiratory mortality were nearly identical. The heterogeneity would decline to varying degrees through regional and study-design stratification.

CONCLUSIONS

This study provides evidence of an association between short-term exposure to NO₂, a proxy for traffic-sourced air pollutants, and all-cause, cardiovascular and respiratory mortality.

Untangling the contributions of meteorological conditions and human mobility to tropospheric NO2 in Chinese mainland during the COVID-19 pandemic in early 2020

In early 2020, unprecedented lockdowns and travel bans were implemented in Chinese mainland to fight COVID-19, which led to a large reduction in anthropogenic emissions. This provided a unique opportunity to isolate the effects from emission and meteorology on tropospheric nitrogen dioxide (NO2). Comparing the atmospheric NO2 in 2020 with that in 2017, we found the changes of emission have led to a 49.3 ± 23.5% reduction, which was ∼12% more than satellite-observed reduction of 37.8 ± 16.3%. The discrepancy was mainly a result of changes of meteorology, which have contributed to an 8.1 ± 14.2% increase of NO2. We also revealed that the emission-induced reduction of NO2 has significantly negative correlations to human mobility, particularly that inside the city. The intra-city migration index derived from Baidu Location-Based-Service can explain 40.4% ± 17.7% variance of the emission-induced reduction of NO2 in 29 megacities, each of which has a population of over 8 million in Chinese mainland.

Short-term effect of NO2 on outpatient visits for dermatologic diseases in Xinxiang, China: a time-series study

OBJECTIVES

As the largest organ of the human body, the skin is the major exposure route of NO₂. However, the evidence for a relationship between NO₂ exposure and dermatologic diseases (DMs) is limited. This time-series study was conducted to assess the short-term effect of nitrogen dioxide (NO₂) exposure on DMs outpatient visits in Xinxiang, China.

METHODS

Daily recordings of NO₂ concentrations, meteorological data, and the outpatient visits data for DMs were collected in Xinxiang from January 1st, 2015, to December 31st, 2018. The analysis method used was based on the generalized additive model (GAM) with quasi-Poisson regression to investigate the relationship between NO₂ exposure and DMs outpatient visits. Several covariates, such as long-term trends, seasonality, and weather conditions were controlled.

RESULTS

A total of 164,270 DMs outpatients were recorded. A 10 μg/m³ increase in NO₂ concentrations during the period was associated with a 1.86% increase in DMs outpatient visits (95% confidence intervals [Cl]: 1.06-2.66%). The effect was stronger (around 6 times) in the cool seasons than in warmer seasons and younger patients (< 15 years of age) appeared to be more vulnerable.

CONCLUSIONS

The findings of this study indicate that short-term exposure to NO₂ increases the risk of DMs in Xinxiang, China, especially in the cool seasons. Policymakers should implement more stringent air quality standards to improve air quality.

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

The associations of multiple pollutants and cardiovascular disease (CVD) morbidity, and the spatial variations of these associations have not been nationally studied in Sweden. The main aim of this study was, thus, to spatially analyze the associations between ambient air pollution (black carbon, carbon monoxide, particulate matter (both <10 µm and <2.5 µm in diameter) and Sulfur oxides considered) and CVD admissions while controlling for neighborhood deprivation across Sweden from 2005 to 2010. Annual emission estimates across Sweden along with admission records for coronary heart disease, ischemic stroke, atherosclerotic and aortic disease were obtained and aggregated at Small Areas for Market Statistics level. Global associations were analyzed using global Poisson regression and spatially autoregressive Poisson regression models. Spatial non-stationarity of the associations was analyzed using Geographically Weighted Poisson Regression. Generally, weak but significant associations were observed between most of the air pollutants and CVD admissions. These associations were non-homogeneous, with more variability in the southern parts of Sweden. Our study demonstrates significant spatially varying associations between ambient air pollution and CVD admissions across Sweden and provides an empirical basis for developing healthcare policies and intervention strategies with more emphasis on local impacts of ambient air pollution on CVD outcomes in Sweden.

Spatiotemporal characteristics of nitrogen dioxide pollution in mainland China from 2015 to 2018

With the rapid industrial development and urbanisation in China, nitrogen dioxide [Formula: see text] pollution has become a severe environmental problem that threatens public health. Based on hourly concentration monitoring data of the six main air pollutants in mainland China, a space-time Bayesian hierarchy model was employed to analyse the spatiotemporal trends of the absolute and relative [Formula: see text] concentrations (i.e., the proportion of [Formula: see text] in the six main air pollutants: [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text]). Both the absolute and relative [Formula: see text] concentrations were higher in the autumn and winter of each year during the study period. Four regions in particular-the North China Plain, the Yangtze River Delta, the Sichuan Basin, and the Pearl River Delta-experience the largest amounts of [Formula: see text] pollution, with a high local magnitude of more than 1.0 relative to the overall absolute and relative [Formula: see text] concentrations; this affects an area with a human population of 571.85 million, which is 42.47% of the total population. Central China (i.e., the Shaanxi-Shanxi-Henan region) and the Tarim Basin (northwest of Xinjiang) were heavily polluted by [Formula: see text] and other pollutants throughout the year, with a high local magnitude of more than 1.0 relative to the overall absolute [Formula: see text] concentration. The [Formula: see text] pollution in most of the cities in western and southern China is less serious, along with cities in the northeast. Local trends reveal that in general, cities with high [Formula: see text] pollution are accompanied by upward trends. Specifically, except for in the summer, there were about 86 cities showing the increasing trend, of which 66 cities are located in areas with higher absolute and relative [Formula: see text] concentrations. Taiyuan, for example, represents the maximal local trend, with an average annual increase of 4.39 (95% CI 1.61-7.43) [Formula: see text] and 0.43 (95% CI 0.16-0.73) %, respectively, which will lead to further increases in the population exposure-risk in heavily polluted areas.

Strategy and Future Prospects to Develop Room-Temperature-Recoverable NO2 Gas Sensor Based on Two-Dimensional Molybdenum Disulfide

Nitrogen dioxide (NO2), a hazardous gas with acidic nature, is continuously being liberated in the atmosphere due to human activity. The NO2 sensors based on traditional materials have limitations of high-temperature requirements, slow recovery, and performance degradation under harsh environmental conditions. These limitations of traditional materials are forcing the scientific community to discover future alternative NO2 sensitive materials. Molybdenum disulfide (MoS2) has emerged as a potential candidate for developing next-generation NO2 gas sensors. MoS2 has a large surface area for NO2 molecules adsorption with controllable morphologies, facile integration with other materials and compatibility with internet of things (IoT) devices. The aim of this review is to provide a detailed overview of the fabrication of MoS2 chemiresistance sensors in terms of devices (resistor and transistor), layer thickness, morphology control, defect tailoring, heterostructure, metal nanoparticle doping, and through light illumination. Moreover, the experimental and theoretical aspects used in designing MoS2-based NO2 sensors are also discussed extensively. Finally, the review concludes the challenges and future perspectives to further enhance the gas-sensing performance of MoS2. Understanding and addressing these issues are expected to yield the development of highly reliable and industry standard chemiresistance NO2 gas sensors for environmental monitoring.

Short-term effects of air pollution on daily single- and co-morbidity cardiorespiratory outpatient visits

Several studies have noted that the existence of comorbidities lead to an increase in the risk of premature mortality and morbidity. Most of the studies examining the effects of air pollution on comorbidity visits were from Northern American countries, with scarce literature from Asia. This study contributes to existing, yet limited understanding of air pollution-comorbidity by examining the effects of daily air pollutants on outpatient single morbidity and comorbid cardiorespiratory visits in Japan. A total of 1,452,505 outpatient cardiorespiratory visits were recorded among the 21 Japanese cities from 2013 to 2016. Daily outpatient cardiorespiratory visit data were obtained from a health insurance claims database managed by the Japan Medical Data Center Co., Ltd. (JMDC). A time-stratified case crossover analysis coupled with Generalized Additive Mixed Model was used to analyze the association of daily air pollutants (particulate matter 2.5 μm or less in diameter, ozone and nitrogen dioxide) on daily single (respiratory and cardiovascular) and comorbidity health outcomes. We further examined single and cumulative effects for 0-3 and 0-14 lag periods. Ozone, NO₂, and PM_2.5 were positively associated with cardiorespiratory visits in either shorter or longer lags, with more apparent comorbidity associations with NO₂ exposure. A 10-unit increase in NO₂, after adjusting for ozone, was associated with a 2.24% (95% CI: 1.34-3.15) and 6.49% (95% CI: 5.00-8.01) increase in comorbidity visit at Lag 0 (of Lag 0-3) and cumulative lag 0-3, respectively. Our results contribute to existing evidence suggesting that short-term and extended exposure to air pollution elicit health risks on cardiovascular, respiratory and comorbid clinic visits. Exposure to NO₂, in particular, was associated with increase in the risk of single and comorbidity cardiorespiratory visits. Results can be potentially utilized for both individual health (e.g. risk population health management) and health facility management (e.g. health visit influx determination).

Association between air pollutants and development of chronic kidney disease: A systematic review and meta-analysis

BACKGROUND

The association between incident chronic kidney disease (CKD) or end-stage renal disease (ESRD) and exposure to outdoor air pollution is under debate. We aimed to examine this relationship based on a systematic review with random-effects meta-analysis.

METHODS

We screened the literature on long-term air pollution exposure assessment in the general population using an electronic search of PubMed, Medline, Embase, and Cochrane Library from inception to 20 October 2019. Observational studies investigating the association between long-term exposure to gaseous (CO, SO₂, NO₂, O₃) or particulate (PM_2.5 or PM₁₀) outdoor air pollutants and CKD, ESRD, or renal dysfunction were included, and summary risks were estimated.

RESULTS

Of 4419 identified articles, 23 met our inclusion criteria after screening and 14 were included in the meta-analysis. Pooled effect estimates had the following summary risk ratios (RRs) for CKD: 1.10 (95% confidence intervals [CI] 1.00, 1.21; derived from four studies) per 10 μg/m³ increase in PM_2.5 and 1.16 (95% CI 1.05, 1.29; derived from four studies) for PM₁₀; 1.31 (95% CI 0.86, 2.00; derived from two studies) per 10 ppm increase in CO; and 1.11 (95% CI 1.09, 1.14; derived from three studies) per 10 ppb increase in NO₂. For the pooled effect on eGFR, increases in PM₁₀ and PM_2.5 (of 10 μg/m³) were associated with eGFR decline by -0.83 (95% CI -1.54, -0.12; derived from two studies) and -4.11 (95% CI -12.64, 4.42; derived from two studies) mL/min/1.73 m², respectively.

CONCLUSIONS

Air pollution was observed to be associated with CKD and renal function decline. Although more longitudinal studies are required, we argue that air pollution is pernicious to kidney health.

Spatial variation in the effects of air pollution on cardiovascular mortality in Beijing, China

Due to lack of data from multiple air quality monitoring stations, studies about spatial association between concentrations of ambient pollutants and mortality in China are rare. To investigate the spatial variation of association between concentrations of particulate matter less than 10 μm in aerodynamic diameter (PM₁₀) and nitrogen dioxide (NO₂) and cardiovascular mortality in Beijing, China, we collected data including daily deaths, concentrations of PM₁₀ and NO₂, and meteorological factors from January 1, 2009, to December 31, 2010, in all 16 districts of Beijing. Generalized additive model (GAM) and generalized additive mixed model (GAMM) were used to examine the citywide and district-specific effects of PM₁₀ and NO₂ on cardiovascular mortality. The citywide effect derived from GAMM was lower than that derived from GAM and the strongest effects were identified for 2-day moving average lag 0-1. For every 10 μg/m³ increases in concentrations of PM₁₀ and NO₂, the corresponding daily cardiovascular mortality increases in 0.31% (95%CI 0.15%, 0.46%) and 1.63% (95%CI 1.11%, 2.13%), respectively. The death risk associated with air pollutants varied across different geographic districts in Beijing. We found spatially varied adverse effects of air pollution on cardiovascular deaths in Beijing. But there was insufficient evidence to show the significant spatial heterogeneity in mortality effects of PM₁₀ and NO₂ in this study.

Rapid increases in nitrogen oxides are associated with acute myocardial infarction: A case-crossover study

Aims High concentrations of air pollutants are associated with increased risk for myocardial infarction. The European Union has defined statutory limits for air pollutants based on upper absolute concentrations. We evaluated the association between rapid changes in air pollutants and the risk of myocardial infarction independently of absolute concentrations. Methods and results Using a hospital-based case-crossover study, effects of 24h changes of nitrogen oxides (NO_X/2), particulate matter (PM₁₀), and ozone on the risk of myocardial infarction was assessed in 693 patients. In the overall population, increases of NO_X of more than 20 µg/m³ within 24 h were associated with an increase in the risk of myocardial infarction by up to 121% (odds ratio (OR) 2.21, 95% confidence interval (CI) 1.19-4.08). Comparably, rapid increases of NO₂ of more than 8 µg/m³ tended to increase myocardial infarction risk by 73% (OR 1.73, 95% CI 0.91-3.28) while myocardial infarction risk decreased by 60% after a decrease of NO₂ concentration of more than 8 µg/m³ (OR 0.4, 95% CI 0.21-0.77), suggesting a close-to-linear association. While results for ozone concentrations were ambiguous, rapid change in PM₁₀ was not associated with myocardial infarction risk. Conclusion Dynamics and extent of increase in nitrogen oxide concentrations may be an independent risk factor for myocardial infarction. As there are currently no European Union statutory limits reflecting this dynamic variation of air pollutants on a daily basis, the results urgently call for confirming studies in different geographical regions to verify the observations.

Effect modification of the association between temperature variability and daily cardiovascular mortality by air pollutants in three Chinese cities

There is limited evidence showing the mortality effects of temperature variability (TV) on cardiovascular diseases. The joint effects between TV and air pollutants are also less well-established. This study aims to assess the effect modification of TV-cardiovascular mortality by air pollutants in three Chinese cities (Beijing, Nanjing and Chengdu). Data of daily mortality, air pollutants and meteorological factors from 2008 to 2011 was collected from each city. TV was calculated as the standard deviation of daily maximum and minimum temperatures over exposure days. The city-specific effect estimates of TV on cardiovascular mortality were calculated using a quasi-Poisson regression model, adjusting for potential confounders (e.g., seasonality and temperature). An interaction term of TV and a three-level air pollutants stratum indicator was included in the models. Effect modifications by air pollutants were assessed by comparing the estimates of TV's effect between pollutant stratums and calculating the corresponding 95% confidential interval of the differences. Multivariate meta-analysis was conducted to obtain the pooled estimates. The data showed that TV was associated with increased risk of cardiovascular mortality, especially for longer TV exposure days (0-8 days, TV08). This association was still observed after adjusting for air pollutants on current day or the previous two days. Stronger estimates were observed in females, but no significant difference between males and females was detected, indicating the absence of evidence of effect modification by gender. Estimates of TV-cardiovascular mortality varied across two season periods (warm and cool season) and age groups, but the evidence of effect modification by age and seasons was absent. Regarding the effect modification of TV-cardiovascular mortality association by air pollutants, a significant effect modification was identified for PM_10, but not for NO₂ and SO₂ in the whole population for all TV exposure days. This finding also persisted in subgroups, specifically in females and the elderly.