Association between ambient particulate matter and daily cause-specific mortality in Tanggu, Tianjin Binhai New Area, China

The impact of air pollution on hospitalization for COPD patients in China

BACKGROUND

With the rapid development of the global economy and the acceleration of urbanization, air pollution has become a major environmental problem threatening human health. There is limited evidence on the acute effects of air pollution on chronic obstructive pulmonary disease (COPD).

METHODS

From 2014 to 2019, we collected data on daily admissions for COPD patients from a city in China. We used the generalized additive model together with distributed lag models to fit the associations of air pollutants with hospital admissions.

RESULTS

We observed significant increments in the number of daily admissions (0.086-0.109%) for COPD for a unit range increase in air quality index, PM2.5 and PM10 over four lag days. The impact of air pollution on the number of daily admissions was mainly reflected in the COPD patients who were hospitalized through outpatient departments and tertiary hospitals.

DISCUSSION

Short-term exposure to outdoor air pollution may induce the occurrence or exacerbation of COPD patients; therefore, government departments should strengthen the management of air pollution, improve supervision and control mechanisms, pay attention to the quality of medical services, and reduce the adverse effects of air pollution on patients' health.

Association between NO2 cumulative exposure and influenza prevalence in mountainous regions: A case study from southwest China

While accumulating evidence shows that air pollution exposure is an important risk factor to influenza prevalence, their association has been inadequately investigated in mountainous regions with dense populations and high humidity. We aim to estimate the association and exposure-outcome effects between exposure to nitrogen dioxide (NO₂) and influenza prevalence in a mountainous region with a dense population and high humidity. We investigated 14,993 patients with confirmed influenza cases from January 2013 to December 2017 in Chongqing, a mountainous city in southwest China. We developed distributed lag non-linear models with quasi-Poisson link to take into account the lag and non-linear effects of NO₂ exposure on influenza prevalence. We estimated that the cumulative effect of a 10 μg/m³ increase in NO₂ with seven-day lag (i.e., summing all the contributions up to seven days) corresponded to relative risk of 1.24 (95% CI: 1.17-1.31) in daily influenza prevalence. Comparing to annual mean of the World Health Organization air quality guidelines of 40 μg/m³ for NO₂, we estimated that 14.01% (95% CI: 10.69-17.08%) of the influenza cases were attributable to excessive NO₂ exposure. Our results suggest that NO₂ exposure could worsen the risk of influenza infection in this mountainous city, filling the gap of relevant researches in densely populated and mountainous cities. Our findings provide evidence for developing influenza surveillance and early warning systems.

Association between short-term exposure to particulate matter air pollution and cause-specific mortality in Changzhou, China

BACKGROUND

Extensive studies have linked ambient particulate matter (PM) to an increased mortality burden from a wide range of causes. However, the effects of PM on mortality rates from specific causes were unclear. This study aimed to estimate the detrimental effects of PM on cause specific deaths in Changzhou, China.

METHOD

Data representing daily mortality rates, weather conditions and particulate air pollution levels were obtained from government-controlled agencies of Changzhou, from January 1, 2015 to December 31, 2016. An inverse distance weighting method was used to assess the population exposure to PM and a time-series was performed to detect the detrimental effects of PM.

RESULTS

Positive associations were identified between PMs and daily mortality rates from non-accidental, circulatory, hypertensive, respiratory and chronic lower respiratory causes at a lag of 0-3 days. The effects of PMs were strongest on hypertensive mortality, with an increase of 5.27% (95% confidence interval (CI): 2.43-8.19%) and 3.52% (95% CI: 1.55-5.53%), per 10 μg/m³ increment in PM_2.5 and PM₁₀ respectively. The elderly exhibited a higher mortality risk with PMs exposure. Females were more vulnerable to circulatory, hypertensive and respiratory death while males were more sensitive to chronic lower respiratory and neurodegenerative mortality. The effects were stronger in warm seasons for circulatory mortality and stronger in cold seasons for respiratory mortality.

CONCLUSION

These findings indicate that PM could exert adverse influences on the outcomes of several pathological processes, especially for women and the elderly with hypertension disease.

Short-Term Effects of Ambient Air Pollution on Hospitalization for Respiratory Disease in Taiyuan, China: A Time-Series Analysis

In this study, we estimated the short-term effects of ambient air pollution on respiratory disease hospitalization in Taiyuan, China. Daily data of respiratory disease hospitalization, daily concentration of ambient air pollutants and meteorological factors from 1 October 2014 to 30 September 2017 in Taiyuan were included in our study. We conducted a time-series study design and applied a generalized additive model to evaluate the association between every 10-μg/m³ increment of air pollutants and percent increase of respiratory disease hospitalization. A total of 127,565 respiratory disease hospitalization cases were included in this study during the present period. In single-pollutant models, the effect values in multi-day lags were greater than those in single-day lags. PM_2.5 at lag02 days, SO₂ at lag03 days, PM₁₀ and NO₂ at lag05 days were observed to be strongly and significantly associated with respiratory disease hospitalization. No significant association was found between O₃ and respiratory disease hospitalization. SO₂ and NO₂ were still significantly associated with hospitalization after adjusting for PM_2.5 or PM₁₀ into two-pollutant models. Females and younger population for respiratory disease were more vulnerable to air pollution than males and older groups. Therefore, some effective measures should be taken to strengthen the management of the ambient air pollutants, especially SO₂ and NO₂, and to enhance the protection of the high-risk population from air pollutants, thereby reducing the burden of respiratory disease caused by ambient air pollution.

Cardiorespiratory health effects of particulate ambient air pollution exposure in low-income and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Most prospective studies on the health effects of particulate ambient air pollution exposure have focused on high-income countries, which have much lower pollutant concentrations than low-income and middle-income countries (LMICs) and different sources of pollution. We aimed to investigate the cardiorespiratory health effects of particulate ambient air pollution exposure in LMICs exclusively.

METHODS

For this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, LILACS, Global Health, and Proquest for studies published between database inception and Nov 28, 2016, investigating the cardiorespiratory health effects of particulate ambient air pollution exposure in LMICs. Data were extracted from published studies by one author, and then checked and verified by all authors independently. We pooled estimates by pollutant type (particulate matter with a diameter of <2·5 μm [PM_2·5] or 2·5-10 μm [PM₁₀]), lag, and outcome, and presented them as excess relative risk per 10 μg/m³ increase in particulate ambient air pollution. We used a random-effects model to derive overall excess risk. The study protocol is registered with PROSPERO, number CRD42016051733.

FINDINGS

Of 1553 studies identified, 91 met the full eligibility criteria. Only four long-term exposure studies from China were identified and not included in the meta-analysis. A 10 μg/m³ increase in same-day PM_2·5 was associated with a 0·47% (95% CI 0·34-0·61) increase in cardiovascular mortality and a 0·57% (0·28-0·86) increase in respiratory mortality. A 10 μg/m³ increase in same-day PM₁₀ was associated with a 0·27% (0·11-0·44) increase in cardiovascular mortality and a 0·56% (0·24-0·87) increase in respiratory mortality.

INTERPRETATION

Short-term exposure to particulate ambient air pollution is associated with increases in cardiorespiratory morbidity and mortality in LMIC's, with apparent regional-specific variations.

FUNDING

None.

The impact of airborne particulate matter on pediatric hospital admissions for pneumonia among children in Jinan, China: A case-crossover study

This study aims to examine the effect of short-term changes in the concentration of particulate matter of diameter ≤2.5 µm (PM_2.5) and ≤10 µm (PM₁₀) on pediatric hospital admissions for pneumonia in Jinan, China. It explores confoundings factors of weather, season, and chemical pollutants. Information on pediatric hospital admissions for pneumonia in 2014 was extracted from the database of Jinan Qilu Hospital. The relative risk of pediatric hospital admissions for pneumonia was assessed using a case-crossover approach, controlling weather variables, day of the week, and seasonality. The single-pollutant model demonstrated that increased risk of pediatric hospital admissions for pneumonia was significantly associated with elevated PM_2.5 concentrations the day before hospital admission and elevated PM₁₀ concentrations 2 days before hospital admission. An increment of 10 μg/m³ in PM_2.5 and PM₁₀ was correlated with a 6% (95% CI 1.02--1.10) and 4% (95% CI 1.00-1.08) rise in number of admissions for pneumonia, respectively. In two pollutant models, PM_2.5 and PM₁₀ remained significant after inclusion of sulfur dioxide or nitrogen dioxide but not carbon monoxide. This study demonstrated that short-term exposure to atmospheric particulate matter (PM_2.5/PM₁₀) may be an important determinant of pediatric hospital admissions for pneumonia in Jinan, China.

IMPLICATIONS

This study demonstrated that short-term exposure to atmospheric particulate matter (PM_2.5/PM₁₀) may be an important determinant of pediatric hospital admissions for pneumonia in Jinan, China, and suggested the relevance of pollutant exposure levels and their effects. As a specific group, children are sensitive to airborne particulate matter. This study estimated the short-term effects attribute to other air pollutants to provide references for relevant studies.

Particulate Air Pollution Exposure and Expression of Viral and Human MicroRNAs in Blood: The Beijing Truck Driver Air Pollution Study

BACKGROUND

MicroRNAs (miRNAs) are post-transcriptional gene suppressors and potential mediators of environmental effects. In addition to human miRNAs, viral miRNAs expressed from latent viral sequences are detectable in human cells.

OBJECTIVE

In a highly exposed population in Beijing, China, we evaluated the associations of particulate air pollution exposure on blood miRNA profiles.

METHODS

The Beijing Truck Driver Air Pollution Study (BTDAS) included 60 truck drivers and 60 office workers. We investigated associations of short-term air pollution exposure, using measures of personal PM2.5 (particulate matter ≤ 2.5 μm) and elemental carbon (EC), and ambient PM10 (≤ 10 μm), with blood NanoString nCounter miRNA profiles at two exams separated by 1-2 weeks.

RESULTS

No miRNA was significantly associated with personal PM2.5 at a false discovery rate (FDR) of 20%. Short-term ambient PM10 was associated with the expression of 12 miRNAs in office workers only (FDR < 20%). Short-term EC was associated with differential expression of 46 human and 7 viral miRNAs, the latter including 3 and 4 viral miRNAs in office workers and truck drivers, respectively. EC-associated miRNAs differed between office workers and truck drivers with significant effect modification by occupational group. Functional interaction network analysis suggested enriched cellular proliferation/differentiation pathways in truck drivers and proinflammation pathways in office workers.

CONCLUSIONS

Short-term EC exposure was associated with the expression of human and viral miRNAs that may influence immune responses and other biological pathways. Associations between EC exposure and viral miRNA expression suggest that latent viral miRNAs are potential mediators of air pollution-associated health effects. PM2.5/PM10 exposures showed no consistent relationships with miRNA expression.

Systematic review and meta-analysis of the adverse health effects of ambient PM2.5 and PM10 pollution in the Chinese population

INTRODUCTION

As the largest developing country, China has some of the worst air quality in the world. Heavy smog in January 2013 led to unprecedented public concern about the health impact of exposure to particulate matter. Conducting health impact assessments of particulate matter has thus become an urgent task for public health practitioners. Combined estimates of the health effects of exposure to particulate matter from quantitative reviews could provide vital information for epidemiology-based health impact assessments, but estimates for the Chinese population are limited.

METHODS

On December 31, 2013, we systematically searched the PubMed, Web of Science, and China National Knowledge Infrastructure databases using as keywords names of 127 major cities in Mainland China, Hong Kong, and Taiwan. From among the 1464 articles identified, 59 studies were manually screened. Random-effects or fixed-effects models were used to combine their risk estimates, the funnel plots with Egger test were performed to evaluate the publication bias and Meta regression were run to explore the association between exposure to particulate matter with aerodynamic diameters less than 10 and 2.5 µm (PM10 and PM2.5) and the resulting health effects by the Comprehensive Meta Analysis.

RESULTS

In terms of short-term effects, the combined excess risks of total non-accidental mortality, mortality due to cardiovascular disease, and mortality due to respiratory disease were 0.36% (95% confidence interval [95%CI]: 0.26%, 0.46%), 0.36% (95%CI: 0.24%, 0.49%), and 0.42% (95%CI: 0.28%, 0.55%), for each 10 μg/m(3) increase in PM10. A 10 μg/m(3) increase in PM2.5 was associated with a 0.40% (95%CI: 0.22%, 0.59%) increase in total non-accidental mortality, a 0.63% (95%CI: 0.35%, 0.91%) increase in mortality due to cardiovascular disease, and a 0.75% (95%CI: 01.39%, 1.11%) increase in mortality due to respiratory disease. For constituent-specific mortality, increases of 0.40-3.11% were associated with an increase of 10 ng/m(3) for nickel in PM. The summary estimate ranges of hospital utilization were 0.08% ~ 0.72% and -0.58% ~ 1.32% for a 10 μg/m(3) increase in PM10 and PM2.5. In terms of long-term effects, a 10 μg/m(3) increase of PM10 corresponded to 23-67% increase in the risk of mortality.

CONCLUSION

Short exposures to PM10 and PM2.5 are associated with increases in mortality, but evidence of constituent-associated health effects, long-term effects and morbidity in China is still inadequate.

Air pollution exposure as a risk factor for cardiovascular disease morbidity and mortality

There is growing evidence of an association between increasing exposure to air pollutants (both short-term and long-term exposures) and elevated risk of mortality and incidence of cardiovascular diseases in certain high-risk populations and throughout different geographic regions. The pathophysiologic mechanisms of air pollutant-induced cardiovascular morbidity and mortality are actively being studied, with autonomic system dysregulation and inflammatory pathway activation believed to be among the key culprits. Policy changes at the local and global levels are addressing the need for more stringent air pollution standards. These initiatives are projected to lower costs and improve health outcomes. In this review, we examine some major studies of the cardiovascular health impacts of air pollution.

How air pollution influences clinical management of respiratory diseases. A case-crossover study in Milan

Background

Environmental pollution is a known risk factor for multiple diseases and furthermore increases rate of hospitalisations. We investigated the correlation between emergency room admissions (ERAs) of the general population for respiratory diseases and the environmental pollutant levels in Milan, a metropolis in northern Italy.

Methods

We collected data from 45770 ERAs for respiratory diseases. A time-stratified case-crossover design was used to investigate the association between air pollution levels and ERAs for acute respiratory conditions. The effects of air pollutants were investigated at lag 0 to lag 5, lag 0–2 and lag 3–5 in both single and multi-pollutant models, adjusted for daily weather variables.

Results

An increase in ozone (O₃) levels at lag 3–5 was associated with a 78% increase in the number of ERAs for asthma, especially during the warm season. Exposure to carbon monoxide (CO) proved to be a risk factor for pneumonia at lag 0–2 and in the warm season increased the risk of ERA by 66%. A significant association was found between ERAs for COPD exacerbation and levels of sulphur dioxide (SO₂), CO, nitrate dioxide (NO₂), and particulate matter (PM₁₀ and PM_2.5). The multipollutant model that includes all pollutants showed a significant association between CO (26%) and ERA for upper respiratory tract diseases at lag 0–2. For chronic obstructive pulmonary disease (COPD) exacerbations, only CO (OR 1.19) showed a significant association.

Conclusions

Exposure to environmental pollution, even at typical low levels, can increase the risk of ERA for acute respiratory diseases and exacerbation of obstructive lung diseases in the general population.