Energy and air pollution benefits of household fuel policies in northern China

Unclean but affordable solid fuels effectively sustained household energy equity

Extensive use of traditional solid fuels necessitates a clean transition to modern energy, yet rising costs hinder equitable progress, presenting a challenge that remains underexplored. Here we quantify household energy inequities in China and evaluate shifts during the cooking and heating transition by compiling data from nationwide questionnaire surveys and statistic datasets. We find that by meeting 42.6% of household energy needs at low costs, solid fuels sustain equitable energy consumption across different income groups, being measured by the Concentration Index (CI). However, energy burden inequity remains substantially with the CI value increases by up to 43% during the transition, particularly when moving away from biomass for cooking. Switching to electric heating with natural gas cooking would limit such increases by only 15.5%. The study underscores the negative equity impacts of solid fuel cessation, advocating for phased transitions and targeted subsidies to ensure a just clean energy transition.

Guiding clean energy transitions in rural households: Insights from China's pilot low-carbon policies

The impact of Low Carbon Pilot Policies (LCPPs) on carbon reduction and energy efficiency has been extensively studied. However, the potential of these policies to promote clean energy transition (CET) in rural households remains underexplored. This article constructed a staggered-DID model using data from the China Family Panel Studies (CFPS) to investigate the impact and mechanisms of LCPPs on rural households' CET. The findings indicate that LCPPs significantly enhance the CET among rural households. Moreover, the effects of LCPPs vary across cities, while differences within communities and households are less pronounced. Mechanism analysis reveals that LCPPs facilitate rural households' CET through income effects, infrastructure improvements, and enhanced low-carbon awareness. Notably, the income and low-carbon awareness effects are heterogeneous. Additionally, LCPPs have increased rural households' expenditures on home-cooked meals. We estimate the average fixed cost of the CET for rural households to be approximately $404.495. These insights provide valuable empirical evidence that can guide other countries and regions in promoting CET in rural areas.

Reduction in polycyclic aromatic hydrocarbon exposure in Beijing following China's clean air actions

Exposure to polycyclic aromatic hydrocarbons (PAHs) in the Chinese population was among the highest globally and associated with various adverse effects. This study examines the impact of China's two-phase clean air initiatives, namely the Air Pollution Prevention and Control Action Plan (APPCAP) in 2013-2017 and the Blue-Sky Defense War (BSDW) in 2018-2020, on PAH levels and human exposures in Beijing. To evaluate the effects of APPCAP, we measured 16 PAHs in 287 PM2.5 samples collected in Beijing and 9 PAH metabolites in 358 urine samples obtained from 54 individuals who traveled from Los Angeles to Beijing between 2014 and 2018. The concentration of PM2.5-bound benzo[a]pyrene equivalents (BaPeq) decreased by 88.5% in 2014-2018 due to reduced traffic, coal, and biomass emissions. PAH metabolite concentrations in travelers' urine decreased by 52.3% in Beijing, correlated with changes in PM2.5 and NO2 levels. In contrast, no significant changes were observed in Los Angeles. To evaluate BSDW's effects, we collected 123 additional PM2.5 samples for PAH measurements in 2019-2021. We observed sustained reductions in BaPeq concentrations attributable to reductions in coal and biomass emissions during the BSDW phase, but those from traffic sources remained unchanged. After accounting for meteorological factors, China's two-phase clean air initiatives jointly reduced Beijing's PM2.5-bound BaPeq concentrations by 96.6% from 2014 to 2021. These findings provide compelling evidence for the effectiveness of China's clean air actions in mitigating population exposure to PAHs in Beijing.

Status and frontier analysis of indoor PM2.5-related health effects: a bibliometric analysis

Epidemiological data indicate atmospheric particulate matter, especially fine particulate matter (PM2.5), has many negative effects on human health. Of note, people spend about 90% of their time indoors. More importantly, according to the World Health Organization (WHO) statistics, indoor air pollution causes nearly 1.6 million deaths each year, and it is considered as one of the major health risk factors. In order to obtain a deeper understanding of the harmful effects of indoor PM2.5 on human health, we used bibliometric software to summarize articles in this field. In conclusion, since 2000, the annual publication volume has increased year by year. America topped the list for the number of articles, and Professor Petros Koutrakis and Harvard University were the author and institution with the most published in this research area, respectively. Over the past decade, scholars gradually paid attention to molecular mechanisms, therefore, the toxicity can be better explored. Particularly, apart from timely intervention and treatment for adverse consequences, it is necessary to effectively reduce indoor PM2.5 through technologies. In addition, the trend and keywords analysis are favorable ways to find out future research hotspots. Hopefully, various countries and regions strengthen academic cooperation and integration of multi-disciplinary.

Identifying Key Sources for Air Pollution and CO2 Emission Co-control in China

China is confronting the dual challenges of air pollution and climate change, mandating the co-control of air pollutants and CO2 emissions from their shared sources. Here we identify key sources for co-control that prioritize the mitigation of PM2.5-related health burdens, given the homogeneous impacts of CO2 emissions from various sources. By applying an integrated analysis framework that consists of a detailed emission inventory, a chemical transport model, a multisource fused dataset, and epidemiological concentration-response functions, we systematically evaluate the contribution of emissions from 390 sources (30 provinces and 13 socioeconomic sectors) to PM2.5-related health impacts and CO2 emissions, as well as the marginal health benefits of CO2 abatement across China. The estimated source-specific contributions exhibit substantial disparities, with the marginal benefits varying by 3 orders of magnitude. The rural residential, transportation, metal, and power and heating sectors emerge as pivotal sources for co-control, with regard to their relatively large marginal benefits or the sectoral total benefits. In addition, populous and heavily industrialized provinces such as Shandong and Henan are identified as the key regions for co-control. Our study highlights the significance of incorporating health benefits into formulating air pollution and carbon co-control strategies for improving the overall social welfare.

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

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

Unequal Health Risks and Attributable Mortality Burden of Source-Specific PM2.5 in China

Anthropogenic emissions, originating from human activities, stand as the primary contributors to PM2.5, which is recognized as a global health threat. The disease burden associated with PM2.5 has been extensively documented. However, the prevailing estimations have predominantly relied on PM2.5 exposure-response functions, neglecting the distinct risks posed by PM2.5 from various sources. China has experienced a significant reduction in the PM2.5 concentration due to stringent emission controls. With diverse sources and abundant mortality data, this situation provides a unique opportunity to estimate short-term source-specific attributable mortality. Our approach involves an integrated unequal health risk-oriented modeling in China, incorporating a source-oriented Community Multiscale Air Quality model, an adjustment and downscaling method for exposure measurement, a generalized linear model with random-effects meta-analysis, and premature mortality estimation. Adhering to the unequal health risk concept, we calculated the attributable mortality of multiple PM2.5 sources by determining the source risk-adjusted factor. In this study, we observed varying excess risks associated with multiple PM2.5 sources, with transportation-related PM2.5 exhibiting the most substantial association. An interquartile range increase (7.65 μg/m3) was linked to a 1.98% higher daily nonaccidental mortality. Residential use- and transportation-related PM2.5 emerged as the two principal sources of premature mortality. In 2018, a remarkable 53,381 avoiding deaths were estimated compared to 2013, and over 67% of these were attributed to reductions in coal-dependent sources. Notably, transportation-related PM2.5 emerged as the largest contributor to premature mortality in 2018. This study underscores the significance of a new source-oriented health risk assessment to support actions aimed at reducing air pollution. It strongly advocates for heightened attention to PM2.5 reductions in the transportation sector in China.

Global Burden of Lung Cancer Attributable to Household Fine Particulate Matter Pollution in 204 Countries and Territories, 1990 to 2019

INTRODUCTION

Household particulate matter (PM) air pollution is substantially associated with lung cancer. Nevertheless, the global burden of lung cancer attributable to household PM2.5 is still uncertain.

METHODS

In this study, data from the Global Burden and Disease Study 2019 are used to thoroughly assess the burden of lung cancer associated with household PM2.5.

RESULTS

The number of deaths and disability-adjusted life-years (DALYs) attributable to household PM2.5 was found to be 0.08 million and 1.94 million, respectively in 2019. Nevertheless, the burden of lung cancer attributable to household PM2.5 decreased from 1990 to 2019. At the sociodemographic index (SDI) district level, the middle SDI region had the most number of lung cancer deaths and DALYs attributable to household PM2.5. Moreover, the burden of lung cancer was mainly distributed in low-SDI regions, such as Sub-Saharan Africa. Conversely, in high-SDI regions, the age-standardized mortality rate and age-standardized DALY rate of lung cancer attributable to household PM2.5 exhibit the most rapid declines. The burden of lung cancer attributable to household PM2.5 is heavier for men than for women. The sex difference is more obvious in the elderly.

CONCLUSIONS

The prevalence of lung cancer attributable to household PM2.5 has exhibited a declining trend from 1990 to 2019 owing to a concurrent decline in household PM2.5 exposure.

The Long Hazy Tail: Analysis of the Impacts and Trends of Severe Outdoor and Indoor Air Pollution in North China

China, especially the densely populated North China region, experienced severe haze events in the past decade that concerned the public. Although the most extreme cases have been largely eliminated through recent mitigation measures, severe outdoor air pollution persists and its environmental impact needs to be understood. Severe indoor pollution draws less public attention due to the short visible distance indoors, but its public health impacts cannot be ignored. Herein, we assess the trends and impacts of severe outdoor and indoor air pollution in North China from 2014 to 2021. Our results demonstrate the uneven contribution of severe hazy days to ambient and exposure concentrations of particulate matter with an aerodynamic diameter <2.5 (PM2.5). Although severe indoor pollution contributes to indoor PM2.5 concentrations (23%) to a similar extent as severe haze contributes to ambient PM2.5 concentrations (21%), the former's contribution to premature deaths was significantly higher. Furthermore, residential emissions contributed more in the higher PM2.5 concentration range both indoors and outdoors. Notably, severe haze had greater health impacts on urban residents, while severe indoor pollution was more impactful in rural areas. Our findings suggest that, besides reducing severe haze, mitigating severe indoor pollution is an important aspect of combating air pollution, especially toward improving public health.

Accountability analysis of health benefits related to National Action Plan on Air Pollution Prevention and Control in China

China is one of the largest producers and consumers of coal in the world. The National Action Plan on Air Pollution Prevention and Control in China (2013-2017) particularly aimed to reduce emissions from coal combustion. Here, we show whether the acute health effects of PM2.5 changed from 2013 to 2018 and factors that might account for any observed changes in the Beijing-Tianjin-Hebei (BTH) and the surrounding areas where there were major reductions in PM2.5 concentrations. We used a two-stage analysis strategy, with a quasi-Poisson regression model and a random effects meta-analysis, to assess the effects of PM2.5 on mortality in the 47 counties of BTH. We found that the mean daily PM2.5 levels and the SO42- component ratio dramatically decreased in the study period, which was likely related to the control of coal emissions. Subsequently, the acute effects of PM2.5 were significantly decreased for total and circulatory mortality. A 10 μg/m3 increase in PM2.5 concentrations was associated with a 0.16% (95% CI: 0.08, 0.24%) and 0.02% (95% CI: -0.09, 0.13%) increase in mortality from 2013 to 2015 and from 2016 to 2018, respectively. The changes in air pollution sources or PM2.5 components appeared to have played a core role in reducing the health effects. The air pollution control measures implemented recently targeting coal emissions taken in China may have resulted in significant health benefits.

Household fuel and direct carbon emission disparity in rural China

Universal access to clean fuels in household use is one explicit indicator of sustainable development while currently still billions of people rely on solid fuels for daily cooking. Despite of the recognized clean transition trend in general, disparities in household energy mix in different activities (e.g. cooking and heating) and historical trends remain to be elucidated. In this study, we revealed the historical changing trend of the disparity in household cooking and heating activities and associated carbon emissions in rural China. The study found that the poor had higher total direct energy consumption but used less modern energy, especially in cooking activities, in which the poor consumed 60 % more energy than the rich. The disparity in modern household energy use decreased over time, but conversely the disparity in total residential energy consumption increased due to the different energy elasticities as income increases. Though per-capita household CO2 and Black Carbon (BC) emissions were decreasing under switching to modern energies, the disparity in household CO2 and BC deepened over time, and the low-income groups emitted ∼ 10 kg CO2 more compared to the high-income population. Relying solely on spontaneous clean cooking transition had limited impacts in reducing disparities in household energy and carbon emissions, whereas improving access to modern energy had substantial potential to reduce energy consumption and carbon emissions and its disparity. Differentiated energy-related policies to promote high-efficiency modern heating energies affordable for the low-income population should be developed to reduce the disparity, and consequently benefit human health and climate change equally.

Direct and indirect consumption activities drive distinct urban-rural inequalities in air pollution-related mortality in China

Household consumption in China is associated with substantial PM2.5 pollution, through activities directly (i.e., fuel use) and/or indirectly (i.e., consumption of goods and services) causing pollutant emissions. Urban and rural households exhibit different consumption preferences and living areas, thus their contributions to and suffering from air pollution could differ. Assessing this contrast is crucial for comprehending the environmental impacts of the nation's ongoing urbanization process. Here we quantify Chinese urban and rural households' contributions to ambient PM2.5 pollution and the health risks they suffer from, by integrating economic, atmospheric, and health models and/or datasets. The national premature deaths related to long-term exposure to PM2.5 pollution contributed by total household consumption are estimated to be 1.1 million cases in 2015, among which 56% are urban households and 44% are rural households. For pollution contributed indirectly, urban households, especially in developed provinces, tend to bear lower mortality risks compared with the portions of deaths or pollution they contribute. The opposite results are true for direct pollution. With China's rapid urbanization process, without adequate reduction in emission intensity, the increased indirect pollution-associated premature deaths could largely offset that avoided by reduced direct pollution, and the indirect pollution-associated urban-rural inequalities might become severer. Developing pollution mitigation strategies from both production and consumption sides could help with reducing pollution-related mortality and associated urban-rural inequality.

Burden of lung cancer attributed to particulate matter pollution in China: an epidemiological study from 1990 to 2019

OBJECTIVES

The aim of this study was to examine the disease burden of lung cancer attributable to particulate matter (PM2.5) pollution in China from 1990 to 2019.

STUDY DESIGN

Data from the Global Burden of Disease Study 2019 were used to estimate the disease burden of tracheal, bronchus and lung cancer attributed to PM2.5 over time in China.

METHODS

Joinpoint regression models were applied to disability-adjusted life years (DALYs) to assess the time trends and estimate the impact of PM2.5 on the overall disease burden of lung cancer. Furthermore, age-period-cohort models were conducted to assess the relationships between lung cancer DALYs attributed to PM2.5 exposure and age, calendar period and birth cohort trends in China from 1990 to 2019.

RESULTS

Lung cancer DALYs attributable to household air pollution from solid fuels decreased with an average annual percent change (AAPC) of 2.9 % per 100,000 population, while those attributable to ambient particular matter pollution (APE) increased (AAPC: -4.7 % per 100,000 population) over the past 30 years. The burden of lung cancer in terms of DALYs in males was higher than in females, and it demonstrated an age-dependent increase. The period and cohort effects also had significant impacts on the DALYs rates of lung cancer attributable to APE, indicating an overall increase in lung cancer DALYs for all age groups in each year.

CONCLUSIONS

This study highlights the need for effective strategies to reduce PM2.5 exposure in China, particularly from outdoor sources. Gender differences and age, period and cohort effects observed in the study provide valuable insights into long-term trends of lung cancer burden attributed to PM2.5.

Age-Period-Cohort Analysis of Cardiovascular Mortality Attributable to Environmental Risks in China

INTRODUCTION

This study aimed to analyze changes in cardiovascular disease (CVD) mortality attributable to major environmental risks in China during 1990-2019, and their associations with age, period, and birth cohort.

METHODS

Mortality data were obtained from the Global Burden of Disease Study 2019. Major environmental risks included ambient particulate matter pollution (APMP), household air pollution from solid fuels (HAP), low temperature, high temperature, and lead exposure. Age-period-cohort modeling was used to estimate the overall annual percentage change in CVD mortality (net drift), annual percentage change for each age group (local drift), expected longitudinal age-specific rate (longitudinal age curve), period and cohort relative risks (RRs, period/cohort effects) between 1990 and 2019. Analyses were conducted in 2021-2022.

RESULTS

In China, five major environmental risks led to 1.62 million CVD deaths in 2019. Among these risks, the primary contributor to CVD mortality transited from HAP in 1990 to APMP in 2019. There was also an improvement in attributable CVD mortality rates for low temperature and lead exposure during 1990-2019, while an unfavorable trend was noted for high temperature. The longitudinal age curve demonstrated increased attributable CVD mortality rates with age groups for all environmental risks, with similar patterns for both sexes. Period and cohort RRs suggested generally improved risks of attributable CVD mortality for HAP, low temperature, and lead exposure, but worsening risks for APMP and high temperature in both genders, except for period risks after 2010-2014 for APMP in both sexes, period risks after 2000-2004 for high temperature in females, and cohort risks in cohorts born after 1955 for APMP and high temperature in females.

CONCLUSIONS

Over the study period, there was a significant improvement in attributable CVD mortality rates in China for HAP, low temperature and lead exposure, but an unfavorable trend was noted for APMP and high temperature.

China's Coal Ban policy: Clearing skies, challenging growth

China's Coal Ban policy is one of the world's most extensive and ambitious programs designed to mitigate air pollution. However, the effects of this policy on the environment and the economy remain unknown. This study examines the impacts of the Coal Ban policy, which has been implemented in 28 cities in Beijing and its adjacent provinces, on air quality and economic growth. Based on a panel dataset spanning 138 cities between 2010 and 2019, the policy was found to have reduced atmospheric particulate matter with a diameter less than or equal to 2.5 μm (PM2.5) by 4.74 μg/m3 in the 28 cities, but have also reduced per capita gross domestic product (GDP) by 5.8%. Further, the policy has also produced spatial spillover effects. In cities near the 28 cities, the policy has reduced PM2.5 by 4.40 μg/m3 and per capita GDP by 0.9%. Robustness tests corroborated the reliability of the conclusions. These findings underscore the importance of fostering a harmonious relationship between efforts to mitigate air pollution and the pursuit of economic growth objectives.

Costs and Benefits of Household Fuel Policies and Alternative Strategies in the Jing-Jin-Ji Region

Air pollution is still one of the most severe problems in northern China, especially in the Jing-Jin-Ji region around Beijing. In recent years, China has implemented many stringent policies to address the air quality issue, including promoting energy transition toward cleaner fuels in residential sectors. But until 2020, even in the Jing-Jin-Ji region, nearly half of the rural households still use solid fuels for heating. For residents who are not covered by the clean heating campaign, we analyze five potential mitigation strategies and evaluate their environmental effects as well as the associated health benefits and costs. We estimate that substitution with electricity or gas would reduce air pollution and premature mortality more strongly, while the relatively low investment costs of implementing clean coal or biomass pellet lead to a larger benefit-cost ratio, indicating higher cost efficiency. Hence, clean coal or biomass pellet could be transitional substitution options for the less developed or remote areas which cannot afford a total transition toward electricity or natural gas in the short term.

Time trends in the burden of autoimmune diseases across the BRICS: an age-period-cohort analysis for the GBD 2019

BACKGROUND

This study aims to evaluate the long-term trend of prevalence and DALY (disability-adjusted life-year) rate on the age, period and cohort (APC) of the BRICS (Brazil, Russia, India, China and South Africa) country for autoimmune diseases (rheumatoid arthritis (RA), inflammatory bowel disease (IBD), multiple sclerosis (MS) and psoriasis).

METHODS

The data are sourced from the Global Burden of Disease Study 2019, and it uses the Joinpoint regression model to estimate the time trends of autoimmune diseases from 1990 to 2019. Additionally, it employs the Age-Period-Cohort (APC) model to estimate the age, period, and cohort effects from 1990 to 2019.

RESULTS

For 1990 to 2019, the ASPR (age-standardised prevalence rate) of IBD increased significantly for China and South Africa, and decreased significantly for Brazil, India, Russian. The Russian ASPR of MS demonstrated a significantly decreasing trend (average annual percent change=-0.5%, 95% CI -0.6 to -0.5), with the most increased occurring in Brazil at 2009-2014. The cohort effect on DALY rates for Psoriasis displayed an ongoing decreasing trend from the 1929-1933 birth cohort to the 1999-2003 birth cohort. Specifically, the five countries relative risk values (RRs) of DALYs due to RA increased significantly by 7.98, 16.07, 5.98, 3.19, 9.13 times, from 20 to 24 age group to 65 to 69 age group.

CONCLUSIONS

The population of the BRICS countries accounts for more than 40% of the global population. And we found that the age effect of various autoimmune diseases is heavily influenced by population ageing.

Trade-offs between cold protection and air pollution-induced mortality of China's heating policy

The winter heating policy in northern China was designed to safeguard households from the harsh subfreezing temperatures. However, it has inadvertently resulted in seasonal spikes in air pollution levels because of the reliance on coal as an energy source. While the loss of life years attributable to mortality from air pollution caused by winter heating has been estimated, the beneficial effect of protection from cold temperatures has not been assessed, primarily due to a lack of individual-level data linking these variables. Our study aims to address this research gap. We provide individual-level empirical evidence that quantifies the impact of protection from cold temperatures and air pollution on mortality, studying 5,334 older adults living around the Huai River during the period between 2000 and 2018. Our adjusted Cox-proportional hazard models show that winter heating was associated with a 22% lower mortality rate (95% CI: 16-28%). Individuals residing in areas without access to winter heating are subjected to heightened mortality risks during periods of cold temperatures. The protective effect is offset by a 27.8% rise attributed to elevated PM2.5 levels. Our results imply that the equilibrium between the effects of these two factors is achieved when PM2.5 concentration exceeds 24.3 µg/m3 (95% CI: 18.4-30.2). Our research suggests that while the existing winter heating policy significantly mitigates winter mortality by lessening the detrimental effects of cold temperatures, future air pollution reduction could provide further health benefits.

Antagonism between ambient ozone increase and urbanization-oriented population migration on Chinese cardiopulmonary mortality

Ever-increasing ambient ozone (O3) pollution in China has been exacerbating cardiopulmonary premature deaths. However, the urban-rural exposure inequity has seldom been explored. Here, we assess population-scale O3 exposure and mortality burdens between 1990 and 2019 based on integrated pollution tracking and epidemiological evidence. We find Chinese population have been suffering from climbing O3 exposure by 4.3 ± 2.8 ppb per decade as a result of rapid urbanization and growing prosperity of socioeconomic activities. Rural residents are broadly exposed to 9.8 ± 4.1 ppb higher ambient O3 than the adjacent urban citizens, and thus urbanization-oriented migration compromises the exposure-associated mortality on total population. Cardiopulmonary excess premature deaths attributable to long-term O3 exposure, 373,500 (95% uncertainty interval [UI]: 240,600-510,900) in 2019, is underestimated in previous studies due to ignorance of cardiovascular causes. Future O3 pollution policy should focus more on rural population who are facing an aggravating threat of mortality risks to ameliorate environmental health injustice.

Clean energy transitions and health

Clean energy can lead to significant health benefits. Making it accessible throughout the world can address many ills. We delve deeply into one example-the transition toward clean residential heating and its relationship to health benefits-in China. We find that the health benefits can outweigh costs from energy expenses in northern provinces. Low-income households enjoy larger health benefits but also experience a higher expense increase, suggesting that extra subsidies or stimuli are needed to help them benefit from clean energy. Our findings suggest that clean energy transitions should be promoted in developing economies due to improved social health, lessened medical costs, and significant environmental improvements.

Understanding the time-activity pattern to improve the measurement of personal exposure: An exploratory and experimental research

Although ambient fine particulate matter (PM2.5) concentrations and their components are commonly used as proxies for personal exposure monitoring, developing an accurate and cost-effective method to use these proxies for personal exposure measurement continues to pose a significant challenge. Herein, we propose a scenario-based exposure model to precisely estimate personal exposure level of heavy metal(loid)s (HMs) using scenario HMs concentrations and time-activity patterns. Personal exposure levels and ambient pollution levels for PM2.5 and HMs differed significantly with corresponding personal/ambient ratios of approximately 2, and exposure scenarios could narrow the assessment error gap by 26.1-45.4%. Using a scenario-based exposure model, we assessed the associated health risks of a large sample population and identified that the carcinogenic risk of As exceeded 1 × 10-6, while we observed non-carcinogenic risks from As, Cd, Ni, and Mn in personal exposure to PM2.5. We conclude that the scenario-based exposure model is a preferential alternative for monitoring personal exposure compared to ambient concentrations. This method ensures the feasibility of personal exposure monitoring and health risk assessments in large-scale studies.

Costs and health benefits of the rural energy transition to carbon neutrality in China

The rural energy transition is critical in China's efforts to achieve carbon neutrality and improve air quality. However, the costs and health benefits associated with the transition to carbon neutrality remain unclear. Here we explore the cost-effective transition pathways and air quality-related health impacts using an integrated energy-air quality-health modeling framework. We find that decarbonizing rural cooking and heating would triple contemporary energy consumption from 2014 to 2060, considerably reducing energy poverty nationwide. By 2060, electric cooking ranges and air-to-air heat pumps should be widely integrated, costing an additional 13 billion USD nationally in transformation costs, with ~40% concentrated in Shandong, Heilongjiang, Shanxi and Hebei provinces. Rural residential decarbonization would remarkably improve air quality in northern China, yielding substantial health co-benefits. Notably, monetized health benefits in most provinces are projected to offset transformation costs, except for certain relatively lower-development southwestern provinces, implying more financial support for rural residents in these areas will be needed.

Revealing Inter-regional Environmental Inequities Hidden in China's Energy Transition

Energy transition is an important way to control air pollution, but it may conflict with the economic goal of alleviating regional inequality due to its inherently different cost burdens. As one of the effective measures of energy transition, this paper takes small coal-fired boiler (SCB) upgrading as an example to explore the regional mismatch between upgrading costs and health benefits. Here, we construct a boiler-level inventory of SCB upgrades for the North China Plain (NCP) during 2013-2017 and propose an integrated modeling framework to quantify the spatial contribution of economic costs and health benefits associated with SCB upgrading. We find that although the total health benefits could offset the total costs for the entire region, the developed municipalities (Beijing and Tianjin) are likely to gain more health benefits from less-developed neighboring provinces at lower costs. These developed municipalities contribute only 14% to the total health benefits but gain 21% of the benefits within their territories, 56% of which come from neighboring provinces. Their benefits are approximately 5.6 times their costs, which is much higher than the 1.5 benefit-cost ratio in neighboring provinces. Our findings may be useful in shaping more equitable and sound environmental policies in China or other regions of the world with serious coal-related air pollution.

Testing for quadratic impact of industrial robots on environmental performance and reaction to green technology and environmental cost

Industrial robots play a crucial role in enhancing productivity but their impact on the environment has produced debates. Some researchers have focused on the relation between industrial robots and energy efficiency (or environmental performance), such as Huang et al. (Energy Econ 107:105837, 2022) and Luan et al. (Sustain Prod Consum 30:870-888, 2022). However, their arguments mainly depend on the assumption of linear relationship between the two. This study infers that there is a nonlinear relationship between them from the theories of energy-saving effect, rebound effect, and scale effect. Our research, using data from 74 countries and regions worldwide between 1997 and 2020, reveals an inverted U-shaped relationship between the use of robots and their environmental impact. This means that the environment benefits from robot use up to a certain point, beyond which it starts to incur damage. Two moderating factors, green technology and environmental cost, are analyzed and tested. Our findings suggest that the high-green-tech left shifts and steepens the inverted U-shaped relationship whereas the high cost right shifts and flattens the relationship. This study explains the influencing mechanism of industrial robots on environmental performance by integrating the energy-saving effect, the rebound effect, and the scale effect. Our findings enrich the understanding of the robot-environment nexus and emphasize the importance of government in balancing robot use and environmental protection.

Significant but Inequitable Cost-Effective Benefits of a Clean Heating Campaign in Northern China

Residential emissions significantly contribute to air pollution. To address this issue, a clean heating campaign was implemented to replace coal with electricity or natural gas among 13.9 million rural households in northern China. Despite great success, the cost-benefits and environmental equity of this campaign have never been fully investigated. Here, we modeled the environmental and health benefits, as well as the total costs of the campaign, and analyzed the inequality and inequity. We found that even though the campaign decreased only 1.1% of the total energy consumption, PM_2.5 emissions and PM_2.5 exposure experienced 20% and 36% reduction, respectively, revealing the amplification effects along the causal pathway. Furthermore, the number of premature deaths attributable to residential emissions reduced by 32%, suggesting that the campaign was highly beneficial. Governments and residents shared the cost of 2,520 RMB/household. However, the benefits and the costs were unevenly distributed, as the residents in mountainous areas were not only less benefited from the campaign but also paid more because of the higher costs, resulting in a notably lower cost-effectiveness. Moreover, villages in less developed areas tended to choose natural gas with a lower initial investment but a higher total cost (2,720 RMB/household) over electricity (2,190 RMB/household). With targeted investment and subsidies in less developed areas and the promotion of electricity and other less expensive alternatives, the multidevelopment goals of improved air quality, reduced health impacts, and reduced inequity in future clean heating interventions could be achieved.

Associations between cooking fuels and hypertension prevalence in Chinese adults: A prospective cohort analysis focusing on fuel transitioning

BACKGROUND

Using polluting cooking fuels is a suggested risk factor for hypertension. Transitioning to clean cooking fuels has occurred widely in China in the past 30 years. This provides an opportunity to examine whether the transition could reduce hypertension risk and to ascertain the inconsistent literature on the relationship between cooking fuels and hypertension prevalence.

METHODS

Initiated in 1989, the China Health and Nutrition Survey (CHNS) enrolled participants from 12 provinces in China. By 2015, nine waves of follow-up have been conducted. Based on self-reported cooking fuels, participants were classified into persistent clean fuel users, persistent polluting fuel users and those who transitioned from polluting fuels to clean fuels. Hypertension was defined as having systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or self-reported current use of antihypertension medication.

FINDINGS

Among 12,668 participants, 3963 (31.28%) were persistent polluting fuel users; 4299 (33.94%) transitioned to clean fuels; and 4406 (34.78%) were persistent clean fuel users. During the period of follow-up (7.8 ± 6.1 years), hypertension was diagnosed in 4428 participants. Compared to persistent clean fuel users, persistent polluting fuel users had a higher risk for hypertension (hazard ratio [HR] 1.69, 95%CI 1.55-1.85), while those transitioned to clean fuels did not. The effects were consistent by gender and urbanicity, respectively. The HRs for hypertension were 1.99 (95%CI 1.75-2.25), 1.55 (95%CI 1.32-1.81) and 1.36 (95%CI 1.13-1.65) among those persistent polluting fuel users aged 18-44, 45-59 and ≥60 years old, respectively.

INTERPRETATION

Transitioning from using polluting fuels to clean fuels prevented an increase in hypertension risk. The finding highlights the importance of promoting the fuel transition as a risk-reduction strategy for reducing the disease burden from hypertension.

Drinking Water in Rural China: Water Sources, Treatment, and Boiling Energy

Access to safe drinking water is a major public concern in China. A national survey of 57 029 households was conducted to fill major knowledge gaps on drinking water sources, end-of-use treatment methods, and energy used to boil water. Herein, we show that surface water and well water were frequently used by >147 million rural residents living in low-income inland and mountainous areas. Driven by socioeconomic development and government intervention, the level of access to tap water in rural China increased to 70% by 2017. Nevertheless, the rate was considerably lower than that in cities and unevenly distributed across the country. Approximately 90% of drinking water was boiled, an increase from 85% a decade ago. The contribution of electricity, mainly electric kettles, to the boiling of water was 69%. Similar to cooking, living conditions and heating requirements are the main influencing indicators of energy used to boil water. In addition to socioeconomic development, government intervention is a key factor driving the transition to safe water sources, universal access to tap water, and clean energy. Further improvement in drinking water safety in poor and remote rural areas remains challenging, and more intervention and more investment are needed.

Comparison of Secular Trends in Peptic Ulcer Diseases Mortality in China, Brazil and India during 1990-2019: An Age-Period-Cohort Analysis

BACKGROUND

Peptic ulcer disease (PUD) is a common disease worldwide, especially in developing countries. China, Brazil, and India are among the world's fastest-growing emerging economies. This study aimed to assess long-term trends in PUD mortality and explore the effects of age, period, and cohort in China, Brazil, and India.

METHODS

We collected data from the 2019 Global Burden of Disease Study and used an age-period-cohort (APC) model to estimate the effects of age, period, and cohort. We also obtained net drift, local drift, longitudinal age curve, and period/cohort rate ratios using the APC model.

RESULTS

Between 1990 and 2019, the age-standardized mortality rates (ASMRs) of PUD and PUD attributable to smoking showed a downward trend in all countries and both sexes. The local drift values for both sexes of all ages were below zero, and there were obvious sex differences in net drifts between China and India. India had a more pronounced upward trend in the age effects than other countries. The period and cohort effects had a similar declining trend in all countries and both sexes.

CONCLUSIONS

China, Brazil, and India had an inspiring decrease in the ASMRs of PUD and PUD attributable to smoking and to period and cohort effects during 1990-2019. The decreasing rates of Helicobacter pylori infection and the implementation of tobacco-restricting policies may have contributed to this decrease.

Identifying the fundamental drives behind the 10-year evolution of northern China's rural household energy and emission: Implications for 2030 and beyond

Rural household energy, particularly solid fuels, in northern China is thought to be a major source of air pollution. However, there is no complete, systematic, and reliable dataset for northern China's rural areas owing to the diversity of energy types used and the difficulty in acquiring data, particularly for solid fuels. Here we assessed existing progress in estimating solid fuels and proposed a practical route for deriving the information on rural household energy consumption and structure in northern China spanning 2010-2020, with important findings. (i) In 2010, the total rural household energy consumption for northern China was 287.51 million tons standard coal equivalent (TCE), while for 2020, it decreased to 205.14 million TCE, showing a 29 % decrease and an annual down 3.3 % averagely. Among a number of underlying reasons, China's urbanization process, which made the rural population shrink year by year, was primarily responsible. (ii) The share of clean energy in northern rural areas began at 4.2 % in 2010 and grew to 15.6 % in 2020, displaying a sustained improvement in energy structure. Particularly in the second 5 years, the clean energy share of policy priority areas grew by 20.0 percentage points (from 15.0 % in 2010 to 35.0 % in 2020), which is more than 18 percentage points higher than the growth of non-priority areas (from 2.9 % in 2010 to 4.5 % in 2020). Clean air policy, particularly the "two replacements" (replace coal with gas and electricity), in priority areas played a core role in changing the energy structure. (iii) Although both air pollutants and CO₂ are predicted to decrease in 2030, there is a large gap between expected 2030 emissions and hoped 2060 carbon neutrality in northern rural households. It is thus necessary to gradually boost the share of green electricity (non-fossil) and to reverse the trend of "biomass fuel curtailment" in rural residential sector. This calls for the improvement in biomass style (e.g., biomass pellets) and in stove efficiency (e.g., complete combustion).

Reduced rural residential emissions in the Northern China Plain from 2015 to 2021

China's rapid economic growth over the past few decades has been fueled by the fossil-fuel dominated energy system. In Northern China, coal and biomass are important fuel types for household cooking and heating. The use of coal and biomass not only contributes to CO₂ emissions, but also worsens the ambient air quality and further causes adverse health outcomes. Since 2016, action plans have been implemented annually to promote the substitution of solid fuel use in the rural households of the Beijing-Tianjin-Hebei and surrounding region ("2 + 26" region). However, a comprehensive evaluation of the emission reductions by the control policies is still lacking. In this study, we built a rural residential emission inventory in the "2 + 26" region based on two-phase national household surveys in 2010 and 2015. We evaluated the air pollutant and CO₂ reduction benefits of various control measures from 2015 to 2021 and discussed the opportunities for the synergistical control of air pollutant and CO₂ emissions. We estimated that, in 2015, the coal and biomass fuel consumption from rural households in the "2 + 26" region was 28.7 Mt. and 30.6 Mt., respectively, which resulted in 93.8 Mt., 416.5kt, 402.5kt, 80.1kt, 268.0kt, and 6122.2kt of CO₂, PM_2.5, SO₂, NO_x, VOCs, and CO emissions. With the implementation of household solid fuel substitution policies, air pollutant emissions were estimated to decrease by 53- 74 % from 2015 to 2021, while the percentage reduction of CO₂ was only 39 % due to additional emissions from the alternative clean energy sources. If biomass was treated as carbon-neutral fuel, the CO₂ reducing potential was even lower. Building a clean and sustainable rural energy system is a multi-win option for China to achieve the "Beautiful China", "Healthy China" and carbon-neutrality goals.

A global review of the state of the evidence of household air pollution's contribution to ambient fine particulate matter and their related health impacts

Direct exposure to household fine particulate air pollution (HAP) associated with inefficient combustion of fuels (wood, charcoal, coal, crop residues, kerosene, etc.) for cooking, space-heating, and lighting is estimated to result in 2.3 (1.6-3.1) million premature yearly deaths globally. HAP emitted indoors escapes outdoors and is a leading source of outdoor ambient fine particulate air pollution (AAP) in low- and middle-income countries, often being a larger contributor than well-recognized sources including road transport, industry, coal-fired power plants, brick kilns, and construction dust. We review published scientific studies that model the contribution of HAP to AAP at global and major sub-regional scales. We describe strengths and limitations of the current state of knowledge on HAP's contribution to AAP and the related impact on public health and provide recommendations to improve these estimates. We find that HAP is a dominant source of ambient fine particulate matter (PM2.5) globally - regardless of variations in model types, configurations, and emission inventories used - that contributes approximately 20 % of total global PM2.5 exposure. There are large regional variations: in South Asia, HAP contributes ∼ 30 % of ambient PM2.5, while in high-income North America the fraction is ∼ 7 %. The median estimate indicates that the household contribution to ambient air pollution results in a substantial premature mortality burden globally of about 0.77(0.54-1) million excess deaths, in addition to the 2.3 (1.6-3.1) million deaths from direct HAP exposure. Coordinated global action is required to avert this burden.

Co-Benefits of China's Carbon Emissions Trading Scheme: Impact Mechanism and Spillover Effect

Based on the panel data of 281 prefecture-level cities in China, from 2007 to 2017, we empirically explore the co-benefits of the carbon emissions trading scheme. We found that the carbon emissions trading scheme effectively achieved the coordinated control of carbon dioxide and air pollutants, by improving the green production level of the pilot areas, reducing the regional industrial output, and promoting the upgrading of the industrial structure. In terms of heterogeneity, the emissions trading scheme shows obvious urban location and level heterogeneity, in terms of coordinated control. The synergistic emission reduction effects of eastern and central cities are significantly better than those of cities in central and western regions and non-central cities. It has also had positive spillover effects on the surrounding cities of the pilot areas, but pollution levels in farther areas may have increased due to possible "pollution shelter problems".

Attitudes and willingness to pay for clean heating by typical households: a case study of rural areas in Yongcheng City, Henan Province, China

Understanding households' attitudes and willingness to pay (WTP) for clean heating can provide a scientific basis for decision-makers to assess the potential to develop clean heating, choose heating methods, and formulate subsidy standards in the region. In this paper, the double-bounded dichotomous contingent valuation method-modified by the spike model-was used to better estimate the actual WTP of households through a sample survey of 456 households in rural areas of Yongcheng City, China, in 2021. The factors influencing attitudes and WTP were examined to reveal mechanisms of accepting clean heating. The results showed that 94.96% of households were willing to pay for clean heating. The annual WTP was 1071 yuan per household, more than eight times the current heating cost. Factors that affect clean heating attitudes do not necessarily affect the WTP. Specifically, gender, length of time spent living at home, and family income had significant influences on WTP, whereas the educational level, adaptive perceptions in relation to environmental perceptions, and the recognition variables for gender equality in energy consumption had a significant impact on attitudes. It is worth noting that elderly people and females were identified as vulnerable groups in the implementation of clean heating.

Time Trends in Ischemic Heart Disease Mortality Attributable to PM2.5 Exposure in Southeastern China from 1990 to 2019: An Age-Period-Cohort Analysis

PM2.5 exposure is a major environmental risk factor for the mortality of ischemic heart disease (IHD). This study aimed to analyze trends in IHD mortality attributable to PM2.5 exposure in Jiangsu Province, China, from 1990 to 2019, and their correlation with age, period, and birth cohort.

METHODS

Data were extracted from the Global Burden of Disease study 2019 (GBD2019). The magnitude and direction of the trends in IHD mortality attributable to PM2.5 exposure were analyzed by Joinpoint regression. The age-period-cohort (APC) model was used to evaluate the cohort and period effect.

RESULTS

Age-standardized mortality rate (ASMR) of IHD attributable to PM2.5 exposure decreased from 1990 to 2019, with an average annual percentage change (AAPC) of -1.71% (95%CI: -2.02~-1.40), which, due to ambient PM2.5 (APM) exposure and household PM2.5 (HPM) exposure increased with AAPCs of 1.45% (95%CI: 1.18~1.72) and -8.27% (95%CI: -8.84~-7.69), respectively. APC analysis revealed an exponential distribution in age effects on IHD mortality attributable to APM exposure, which rapidly increased in the elderly. The risk for IHD mortality due to HPM exposure showed a decline in the period and cohort effects, which, due to APM, increased in the period and cohort effects. However, favorable period effects were found in the recent decade. The overall net drift values for APM were above zero, and were below zero for HPM. The values for local drift with age both for APM and HPM exposures were initially reduced and then enhanced.

CONCLUSION

The main environmental risk factor for IHD mortality changed from HPM to APM exposure in Jiangsu Province, China. Corresponding health strategies and prevention management should be adopted to reduce ambient air pollution and decrease the effects of APM exposure on IHD mortality.

The diminishing effects of winter heating on air quality in northern China

Cleaner winter heating has been promoted to abate the winter air pollution in northern China. Although improvements in air quality have been observed, the effectiveness and mechanism of cleaner heating measures on air quality have not been examined on the empirical ground. In this study, we estimate the annual effects of winter heating policy on air quality from 2014 to 2017 using a regression discontinuity design (RDD) and dynamic regression model. The results show that winter heating aggravates Air Quality Index (AQI). Specifically, the AQI raised by winter heating reduce from 85.3 in 2014 to 24.1 in 2017, indicating diminishing effects of winter heating with the implementation of clean heating measures. The heterogeneous characteristics of winter heating in terms of different pollutants and city scales are further quantified. The effects of clean heating are more evident for particulate pollutants (PM_2.5 and PM₁₀) than for SO₂, NO₂, CO and O₃. The promotion of clean heating is more effective in larger cities. These findings provided insights into the diminishing air pollution change with continuous advancement in clean heating policy and the heterogeneity among cities and pollutants should be taken into account when formulating future policies in response to energy transition and climate change.

Emission factors and chemical profile of I/SVOCs emitted from household biomass stove in China

Household combustion of biomass straw for cooking or heating is one of the most important emission sources of intermediate volatility and semi-volatile organic compounds (I/SVOCs). However, there are limited studies on the emission factors (EFs) and speciation profiles of I/SVOCs from household stoves burning biomass straw. In this study, experiments were conducted in a typical Chinese stove to test the EFs and species of I/SVOCs in three commonly used straws. It was revealed that EFs of I/SVOCs emitted from the burning of corn straw, rice straw, and wheat straw were 6.7, 1.9, and 9.8 g/kg, respectively, which accounted for 48.3 %, 36.8 %, and 48.6 % of total organic compounds emitted. Particulate organic compounds were dominated by ketones, oxygenated aromatics, acids, esters, and nitrogen-containing compounds, whereas the gaseous phase was dominated by aldehydes, acids, and aromatics. Although I/SVOCs only accounted for 18.1-23.6 % of the gaseous emissions from burning of straw, they represented 64.8-72.9 % of the secondary organic aerosol formation potential (SOAFP). The EFs of 16 priority polycyclic aromatic hydrocarbons (PAHs) were 362.0, 262.5, and 1145.2 mg/kg for corn straw, rice straw, and wheat straw, respectively, among which 3-ring and 4-ring PAHs were the main components. Thus, the results of this study provide new reliable I/SVOCs data that are useful for the development of an accurate emission inventory of organic compounds, simulation of secondary organic aerosol (SOA) formation, and health risk assessment.

Characterization of the vertical variation in indoor PM2.5 in an urban apartment in China

Indoor air pollution has aroused increasing concerns due to its significant adverse health impacts. Indoor PM_2.5 exposure assessments often rely on PM_2.5 concentration measured at a single height, which overlooks the vertical variation of PM_2.5 concentrations accompanied by various indoor activities. In this study, we characterize the vertical profile of PM_2.5 concentration by monitoring PM_2.5 concentration at eight different heights in the kitchen and the bedroom, respectively, using low-cost sensors with high temporal resolution. The localized enhancement of PM_2.5 concentration in elevated heights in the kitchen during cooking was observed on clean and polluted days, showing dominating contribution from cooking activities. The source contribution from cooking and outdoor penetration was semi-quantified using regression models. Stratified source contribution from cooking activities was evident in the kitchen during the cooking period. The contribution in elevated heights (above 170 cm) almost tripled the contrition in bottom layers (below 140 cm). In contrast, little vertical variation was observed during other times of the day in the kitchen or the bedroom. The exposure level calculated using the multi-height measurement in this study is consistently higher than the exposure level estimated from the single-height (at 110 cm) measurement. A more significant discrepancy existed for the cookers (17.8%) than the non-cookers (13.5%). By profiling the vertical gradient of PM_2.5 concentration, we show the necessity to conduct multi-height measurements or proper breathing-height measurements to obtain unbiased concentration information for source apportionment and exposure assessment. In particular, the multi-height measuring scheme will be crucial to inform household cooking emission regulations.

Investigating the relationship between mass concentration of particulate matter and reactive oxygen species based on residential coal combustion source tests

Particulate matter (PM) has been considered to be closely related to human health, especially fine particulate matter. However, whether PM mass concentration alone is a good indicator for health impact remains a challenging question. In this study, emissions from residential coal combustion (RCC), one of the important PM sources in northern China, were tested to examine the relationship between the emission factors of particle-generated reactive oxygen species (ROS) (EF_ROS) and PM (EF_PM). A total of 24 combinations of source tests were conducted, including eight types of coal with different geological maturities (two anthracites and six bituminous) burned in three types of stoves (one honeycomb coal stove, one old chunk stove, and one new chunk stove). Here, ROS was defined as generated hydroxyl radical (·OH) by PM, and results showed EF_ROS from 24 residential coal combustion varied greatly by nearly 20 times. EF_ROS ranged 0.78-14.85 and 2.99-12.91 mg kg^-1 for the emissions from honeycomb and chunk coals, respectively. Moreover, the correlation between EF_ROS and EF_PM was significantly positive in honeycomb coal emissions (r = 0.82, p < 0.05), but it was insignificant in chunk coal emissions (r = 0.07, p > 0.05). For honeycomb coal emissions, organic carbon (OC) was quite abundant in PM and it might be the predominant contributor to both EF_PM and EF_ROS, resulting in a strong and positive correlation. For chunk coal emissions, high EF_ROS was mainly related to relatively high metal emissions in AN and LVB, while the metals were not major components in PM, leading to a poor correlation between EF_PM and EF_ROS. Therefore, this study revealed that PM was not always positively correlated with ROS from residential coal burning, and the relationship was mainly determined by the compositions of PM, suggesting PM mass concentration alone may not be the best indicator for assessing health impacts.

Spatiotemporal Interaction and Socioeconomic Determinants of Rural Energy Poverty in China

This study investigated the energy poverty spatiotemporal interaction characteristics and socioeconomic determinants in rural China from 2000 to 2015 using exploratory time-space data analysis and a geographical detector model. We obtained the following results. (1) The overall trend of energy poverty in China's rural areas was "rising first and then declining", and the evolution trend of energy poverty in the three regions formed a "central-west-east" stepwise decreasing pattern. (2) There was a dynamic local spatial dependence and unstable spatial evolution process, and the spatial agglomeration of rural energy poverty in China had a relatively higher path dependence and locked spatial characteristics. (3) The provinces with negative connections were mainly concentrated in the central and western regions. Anhui and Henan, Inner Mongolia and Jilin, Jilin and Heilongjiang, Hebei and Shanxi, and Liaoning and Jilin constituted a strong synergistic growth period. (4) From a long-term perspective, the disposable income of rural residents had the greatest determinant power on rural energy poverty, followed by per capita GDP, rural labor education level, regulatory agencies, and energy investment. In addition, our findings showed that the selected driving factors all had enhanced effects on rural energy poverty in China through interaction effects.

Substantial transition to clean household energy mix in rural China

The household energy mix has significant impacts on human health and climate, as it contributes greatly to many health- and climate-relevant air pollutants. Compared to the well-established urban energy statistical system, the rural household energy statistical system is incomplete and is often associated with high biases. Via a nationwide investigation, this study revealed high contributions to energy supply from coal and biomass fuels in the rural household energy sector, while electricity comprised ∼20%. Stacking (the use of multiple sources of energy) is significant, and the average number of energy types was 2.8 per household. Compared to 2012, the consumption of biomass and coals in 2017 decreased by 45% and 12%, respectively, while the gas consumption amount increased by 204%. Increased gas and decreased coal consumptions were mainly in cooking, while decreased biomass was in both cooking (41%) and heating (59%). The time-sharing fraction of electricity and gases (E&G) for daily cooking grew, reaching 69% in 2017, but for space heating, traditional solid fuels were still dominant, with the national average shared fraction of E&G being only 20%. The non-uniform spatial distribution and the non-linear increase in the fraction of E&G indicated challenges to achieving universal access to modern cooking energy by 2030, particularly in less-developed rural and mountainous areas. In some non-typical heating zones, the increased share of E&G for heating was significant and largely driven by income growth, but in typical heating zones, the time-sharing fraction was <5% and was not significantly increased, except in areas with policy intervention. The intervention policy not only led to dramatic increases in the clean energy fraction for heating but also accelerated the clean cooking transition. Higher income, higher education, younger age, less energy/stove stacking and smaller family size positively impacted the clean energy transition.

Socioeconomic and Demographic Associations with Wintertime Air Pollution Exposures at Household, Community, and District Scales in Rural Beijing, China

The Chinese government implemented a national household energy transition program that replaced residential coal heating stoves with electricity-powered heat pumps for space heating in northern China. As part of a baseline assessment of the program, this study investigated variability in personal air pollution exposures within villages and between villages and evaluated exposure patterns by sociodemographic factors. We randomly recruited 446 participants in 50 villages in four districts in rural Beijing and measured 24 h personal exposures to fine particulate matter (PM_2.5) and black carbon (BC). The geometric mean personal exposure to PM_2.5 and BC was 72 and 2.5 μg/m³, respectively. The variability in PM_2.5 and BC exposures was greater within villages than between villages. Study participants who used traditional stoves as their dominant source of space heating were exposed to the highest levels of PM_2.5 and BC. Wealthier households tended to burn more coal for space heating, whereas less wealthy households used more biomass. PM_2.5 and BC exposures were almost uniformly distributed by socioeconomic status. Future work that combines these results with PM_2.5 chemical composition analysis will shed light on whether air pollution source contributors (e.g., industrial, traffic, and household solid fuel burning) follow similar distributions.

The Burden of COPD in China and Its Provinces: Findings From the Global Burden of Disease Study 2019

In China, chronic obstructive pulmonary disease (COPD) was accounted for a quarter of the global COPD population and has become a large economic burden. However, the comprehensive picture of the COPD burden, which could inform health policy, is not readily available for all of the provinces of China. Here, we aimed to describe the burden of COPD in China, providing an up-to-date and comprehensive analysis at the national and provincial levels, and time trends from 1990 to 2019. Following the methodology framework and general analytical strategies used in the GBD 2019, we analyzed the incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years with life lost (YLLs) attributable to COPD across China and the corresponding time trends from 1990 to 2019, stratified by age and province. In order to quantify the secular trends of the burden of COPD, the estimated annual percentage changes were calculated by the linear regression model of age-standardized rates (ASRs) and calendar years. We also presented the contribution of risk factors to COPD-related mortality and DALYs. The association between COPD burden and socio-demographic index (SDI) were also evaluated. From 1990 to 2019, the incidence and prevalence numbers of COPD increased by 61.2 and 67.8%, respectively, whereas the number of deaths and DALYs owing to COPD decreased. The ASRs of COPD burden, including incidence, prevalence, mortality, DALYs, YLDs, and YLLs continuously decreased from 1990 to 2019. The crude rates of COPD burden dramatically increased with age and reached a peak in the older than 95 years age group. In 2019, the leading risk factor for COPD mortality and DALYs was tobacco use in the whole population, but ambient particulate matter pollution was the most significant risk factor in females. At the provincial level, the ASRs of COPD burden was significantly associated with the SDIs, with the highest ASRs in the western provinces with low SDIs. Collectively, our study indicated that COPD remains an important public health problem in China. Geographically targeted considerations should be developed to enhance COPD health and reduce the COPD burden throughout China and in specific provinces.

On the fossil and non-fossil fuel sources of carbonaceous aerosol with radiocarbon and AMS-PMF methods during winter hazy days in a rural area of North China plain

Regional transport is a key source of carbonaceous aerosol in many Chinese megacities including Beijing. The sources of carbonaceous aerosol in urban areas have been studied extensively but are poorly known in upwind rural areas. This work aims to quantify the contributions of fossil and non-fossil fuel emissions to carbonaceous aerosols at a rural site in North China Plain in winter 2016. We integrated online high resolution-time of flight-aerosol mass spectrometer (HR-TOF-AMS) observations and radiocarbon (¹⁴C) measurements of fine particles with Positive Matrix Factorization (PMF) analysis as well as Extended Gelencsér (EG) method. We found that fine particle concentration is much higher at the rural site than in Beijing during the campaign (Dec 7, 2016 to Jan 8, 2017). PMF analysis of the AMS data showed that coal-combustion related organic aerosol (CCOA + Oxidized CCOA) and more oxidized oxygenated organic aerosol (MO-OOA) contributed 48% and 30% of organic matter to non-refractory PM₁ (NR-PM₁) mass. About 2/3 of the OC and EC were from fossil-fuel combustion. The EG method, combining AMS-PMF and ¹⁴C data, showed that primary and secondary OC from fossil fuel contribute 35% and 22% to total carbon (TC), coal combustion emission dominates the fossil fuel sources, and biomass burning accounted for 21% of carbonaceous aerosol. In summary, our results confirm that fossil fuel combustion was the dominant source of carbonaceous aerosol during heavy pollution events in the rural areas. Significant emissions of solid fuel carbonaceous aerosols at rural areas can affect air quality in downwind cities such as Beijing and Tianjin, highlighting the benefits of energy transition from solid fuels to cleaner energy in rural areas.

Variations of Personal Exposure to Particulate Nitrated Phenols from Heating Energy Renovation in China: The First Assessment on Associated Toxicological Impacts with Particle Size Distributions

The clean heating renovation has been executed for improving particulate matter (PM) pollution in northern China since 2017. This study determined particle size distributions of nitrated phenols (NPs) in personal exposure samples and their associations with biomarkers in saliva and urine from homemakers in rural households of the Fenwei Plain, China. Remarkable reductions of 28.6-66.3% and 52.2-82.4% on PMs and total quantified NPs, respectively, were found with the substitutions of raw coal chunk and biomass by advanced clean coal. 4-Nitroguaiacol (4NG) showed the largest reductions of 81.2% among individual NP. In addition, the clean coal efficiently reduced interleukin-6 (IL-6) and 8-hydrox-2'-deoxyguanosine (8-OHdG) in the urine and saliva by 12-72%. Furthermore, significant positive correlations between urinary 8-OHdG with most of NPs in all particle sizes, urinary IL-6 with 4NG for particles with D_p > 2.5 μm and D_p = 0.25-1.0 μm and salivary IL-6 with 4-nitrocatechol and 4-methyl-5-nitrocatechol for particles with D_p > 2.5 μm, D_p = 0.5-1.0 μm, and D_p < 0.25 μm were observed but not for salivary 8-OHdG or PMs. The results provide scientific support for the clean energy reformation and demonstrate the strong particle size dependence between NPs and biomarkers.

The Benefits of the Clean Heating Plan on Air Quality in the Beijing–Tianjin–Hebei Region

Coal-to-gas/electricity conversion (hereafter referred to as CTGC/CTEC) as the core project of a clean heating campaign has been widely adopted to replace and reduce the combustion of residential coal in Northern China since 2017. In this study, simulations based on the WRF-Chem model were carried out to quantitatively assess the impacts of the CTGC/CTEC project on air quality in the Beijing–Tianjin–Hebei (BTH) region. It was found that the CTGC/CTEC projects exert a remarkable effect on improving the air quality in the BTH region, especially in the plain area. The maximum decrease in the concentrations of PM2.5 and PM10 averaged during January can reach 30 and 40 μg/m3, respectively. In addition, the spillover effects due to CTGC/CTEC projects are rather small; that is, the local reduced emissions tend to provide more benefit to the local air quality but less for its surrounding regions. It is also noteworthy that the effects due to meteorological condition changes are comparable with, or even larger, than those due to CTGC/CTEC projects, which are not spatially uniform for the BTH region among various cities. Overall, these results not only demonstrate the effectiveness of CTGC/CTEC projects on air-quality improvement in the BTH region, but also indicate the importance of meteorological conditions in modulating the local air quality. To sustain better air quality in the future, residential coal replacement, all over China, can be further promoted. In addition, continued policy refinement can be essential for the nationwide implementation of clean heating projects.

City- and county-level spatio-temporal energy consumption and efficiency datasets for China from 1997 to 2017

Understanding the evolution of energy consumption and efficiency in China would contribute to assessing the effectiveness of the government's energy policies and the feasibility of meeting its international commitments. However, sub-national energy consumption and efficiency data have not been published for China, hindering the identification of drivers of differences in energy consumption and efficiency, and implementation of differentiated energy policies between cities and counties. This study estimated the energy consumption of 336 cities and 2,735 counties in China by combining Defense Meteorological Satellite Program/Operational Line-scan System (DMSP/OLS) and Suomi National Polar-Orbiting Partnership/Visible Infrared Imaging Radiometer Suite (NPP/VIIRS) satellite nighttime light data using particle swarm optimization-back propagation (PSO-BP). The energy efficiency of these cities and counties was measured using energy consumption per unit GDP and data envelopment analysis (DEA). These data can facilitate further research on energy consumption and efficiency issues at the city and county levels in China. The developed estimation methods can also be used in other developing countries and regions where official energy statistics are limited.

New open burning policy reshaped the aerosol characteristics of agricultural fire episodes in Northeast China

The massive agricultural sector in the Northeast Plain, which is of great importance for the food security in China, results in a huge amount of crop residues and thus substantial concern on haze pollution due to biomass burning (BB). To seek for effective control measures on BB emissions, a dramatic transition of open burning policy occurred in Heilongjiang Province, from the "legitimate burning" policy released in 2018 to the "strict prohibition" policy implemented in 2019 and beyond. Here we explored the BB aerosols during 2020-2021 in Harbin, the capital city of Heilongjiang. Although open burning was strictly prohibited by mandatory bans, agricultural fires were not actually eliminated, as indicated by the levoglucosan levels and fire count results. In general, the BB aerosols in Harbin were attributed to the overlaying of household burning and agricultural fire emissions. The former factor laid the foundation of biomass burning impacts, with BB contributions to organic carbon and elemental carbon (f_BBOC and f_BBEC) of 35 and 47%, respectively. The latter further enhanced the BB impacts during specific episodes breaking out in the spring of 2021 as well as the fall of 2020, when f_BBOC and f_BBEC increased to 64 and 57%, respectively. In addition, comparing to the fires of 2018-2019 which occurred in winter (in response to the "legitimate burning" policy), the agricultural fires were shifted to spring and fall in the 2020-2021 campaign, accompanied with an increase of combustion efficiency. This study illustrated how the agricultural fire emissions were influenced by the transition of open burning policy.

Time Trends in Stroke and Subtypes Mortality Attributable to Household Air Pollution in Chinese and Indian Adults: An Age-Period-Cohort Analysis Using the Global Burden of Disease Study 2019

Household air pollution (HAP) exposure is recognized as a major health concern in areas relied on residential burning of solid fuels for cooking and heating. However, previous study has focused on mortality across time and reported changes in age-specific mortality globally but failed to distinguish cohort from period effects. Therefore, this study aimed to differentiate the relative contributions of period and cohort effects to overall time trends of HAP-attributable stroke mortality between the most presentative East and South Asia countries. Data were obtained from the Global Burden of Disease (GBD) database. The age, period, and cohort effects were estimated using the age-period-cohort (APC) model. The overall age-standardized mortality rates (ASMRs) of stroke in China decreased by 39.8% compared with 35.8% in India, while stroke subtypes in both the sexes and countries showed consecutive significant declines from 1990 to 2019. The age-specific and cohort-specific HAP-attributable stroke mortality declined over time in China and India. By APC analysis, substantially increasing age effects were presented for stroke and subtypes from 25 to 84 years. China had a rapid reduction in the independent period and cohort effects. Also, the risk of death for subarachnoid hemorrhage (SAH) had the most striking decline for both sexes in period and cohort effects. Reductions of India were less favorable than China, but the independent period and cohort effects progressively decreased during the entire period for both the sexes. Males experienced a slightly higher mortality risk than females in both countries. Although prominent reductions were observed in HAP-attributable stroke and subtypes mortality during the past 30 years, China and India still suffered uneven HAP-attributable stroke burden. Thus, it is of high significance to introduce advanced solid fuels replace technology and knowledge regarding clean fuel use.

Source contributions and drivers of physiological and psychophysical cobenefits from major air pollution control actions in North China

North China is among the most polluted regions in the country, and human exposure to PM_2.5 (particulate matter with an aerodynamic diameter less than 2.5 μm) in this region has led to severe health consequences. The region has also benefited the most from emission reductions in recent years. It is of interest to understand to what extent and through which paths emissions from different sectors cause adverse health impacts. Here, we present the results of a full evaluation of the health benefits of emission control actions implemented in recent years based on segregated emission inventories with an emphasis on residential emissions. Two major causal paths, one from residential emissions to indoor air pollution, exposure, and premature deaths, and the other from nonresidential emissions to ambient air pollution and psychophysical impacts, were identified and quantified. From 2014 to 2019, both ambient (33%) and indoor (39%) PM_2.5 decreased significantly, leading to decreasing trends in exposure (36%), premature deaths (10%), and psychophysical impacts (21%). The Air Pollution Prevention and Control Action Plan, the Clean Heating Campaign, and spontaneous residential shifts to clean energy contributed significantly to these reductions when the effects of other drivers, such as population and economic growth, were excluded.