A reanalysis of fine particulate matter air pollution versus life expectancy in the United States

Ambient air pollution and posttransplant outcomes among kidney transplant recipients

Fine particulate matter (PM2.5 ), a common form of air pollution which can induce systemic inflammatory response, is a risk factor for adverse health outcomes. Kidney transplant (KT) recipients are likely vulnerable to PM2.5 due to comorbidity and chronic immunosuppression. We sought to quantify the association between PM2.5 and post-KT outcomes. For adult KT recipients (1/1/2010-12/31/2016) in the Scientific Registry of Transplant Recipients, we estimated annual zip-code level PM2.5 concentrations at the time of KT using NASA's SEDAC Global PM2.5 Grids. We determined the associations between PM2.5 and delayed graft function (DGF) and 1-year acute rejection using logistic regression and death-censored graft failure (DCGF) and mortality using Cox proportional hazard models. All models were adjusted for sociodemographics, recipient, transplant, and ZIP code level confounders. Among 87 233 KT recipients, PM2.5 was associated with increased odds of DGF (OR = 1.59; 95% CI: 1.48-1.71) and 1-year acute rejection (OR = 1.31; 95% CI: 1.17-1.46) and increased risk of all-cause mortality (HR = 1.15; 95% CI: 1.07-1.23) but not DCGF (HR = 1.05; 95% CI: 0.97-1.51). In conclusion, PM2.5 was associated with higher odds of DGF and 1-year acute rejection and elevated risk of mortality among KT recipients. Our study highlights the importance of considering environmental exposure as risk factors for post-KT outcomes.

Does environment quality and public spending on environment promote life expectancy in China? Evidence from a nonlinear autoregressive distributed lag approach

Environmental quality has become a growing concern for Chinese society since the last 2 decades in China. The large contribution of different pollutants severely affected the environmental quality that untimely affects life expectancy in the country. In this backdrop, the present study investigates the impact of environmental quality and public spending on the environment for life expectancy in China using the period 1999Q1-2017Q4. We employ nonlinear autoregressive distributed lag model (ARDL) approach for the empirical assessment. The outcomes of the study reveal the existence of a long-run relationship between environmental quality, public spending on the environment and life expectancy in China. The empirical finding reported that life expectancy reacts differently in response to positive and negative shocks of environmental quality both in the long- and short-run. Environmental quality and spending on the environment increase the life expectancy, furthermore, population has a positive and significant association with life expectancy only in short run while in long run it does not affect. Hence, the government needs to roll out policies to enhance environmental quality and ensure adequate funding for environmental preservation, to achieve both longevity of society and sustainability of the eco-system.

Estimates of the 2016 global burden of kidney disease attributable to ambient fine particulate matter air pollution

OBJECTIVE

To quantitate the 2016 global and national burden of chronic kidney disease (CKD) attributable to ambient fine particulate matter air pollution ≤ 2.5 μm in aerodynamic diameter (PM_2.5).

DESIGN

We used the Global Burden of Disease (GBD) study data and methodologies to estimate the 2016 burden of CKD attributable to PM_2.5 in 194 countries and territories. Population-weighted PM_2.5 levels and incident rates of CKD for each country were curated from the GBD study publicly available data sources.

SETTING

GBD global and national data on PM_2.5 and CKD.

PARTICIPANTS

194 countries and territories.

MAIN OUTCOME MEASURES

We estimated the attributable burden of disease (ABD), years living with disability (YLD), years of life lost (YLL) and disability-adjusted life-years (DALYs).

RESULTS

The 2016 global burden of incident CKD attributable to PM_2.5 was 6 950 514 (95% uncertainty interval: 5 061 533-8 914 745). Global YLD, YLL and DALYs of CKD attributable to PM_2.5 were 2 849 311 (1 875 219-3 983 941), 8 587 735 (6 355 784-10 772 239) and 11 445 397 (8 380 246-14 554 091), respectively. Age-standardised ABD, YLL, YLD and DALY rates varied substantially among geographies. Populations in Mesoamerica, Northern Africa, several countries in the Eastern Mediterranean region, Afghanistan, Pakistan, India and several countries in Southeast Asia were among those with highest age-standardised DALY rates. For example, age-standardised DALYs per 100 000 were 543.35 (391.16-707.96) in El Salvador, 455.29 (332.51-577.97) in Mexico, 408.41 (283.82-551.84) in Guatemala, 238.25 (173.90-303.98) in India and 178.26 (125.31-238.47) in Sri Lanka, compared with 5.52 (0.82-11.48) in Sweden, 6.46 (0.00-14.49) in Australia and 12.13 (4.95-21.82) in Canada. Frontier analyses showed that Mesoamerican countries had significantly higher CKD DALY rates relative to other countries with comparable sociodemographic development.

CONCLUSIONS

Our results demonstrate that the global toll of CKD attributable to ambient air pollution is significant and identify several endemic geographies where air pollution may be a significant driver of CKD burden. Air pollution may need to be considered in the discussion of the global epidemiology of CKD.

The economic benefits of fulfilling the World Health Organization's limits for particulates: A case study in Algeciras Bay (Spain)

Algeciras Bay is an important industrial and port zone in the south of Spain whose pollution by particulate matter surpasses the threshold levels recommended by the World Health Organization (WHO) in its 2005 Guide on Air Quality. This study analyses the mortality avoided and the economic benefit which would be derived from a reduction of the pollution of PM2.5 and PM10 to the levels recommended by the WHO in Algeciras Bay in the period 2005-2015. The analysis carried out shows that the industrial zones, such as Los Barrios and San Roque, are those which have greater levels of pollution and in which the relative risk is greater. The calculations for Algeciras Bay between 2000 and 2015 show 182 deaths which would be avoided if the particulate matter pollution were reduced to the levels recommended by the WHO. Likewise, the economic valuation which this impact has on health is carried out through two concepts: the cost of illness and the Value of Statistical Life (VSL). The result shows that the economic benefit that would come out with the cost of illness valuation is 5,329,110€ and from the VSL is 414,787,113€. Implications: PM_2.5 has a greater concentration in industrial localities and is linked to the industrial activity. When the particulate matter pollution is reduced to the levels recommended by the WHO in an industrialised area such as Algeciras (Spain), 182 deaths which would be avoided. The result shows that the economic benefit that would come out with the cost of illness valuation is 5,329,110€ and from the value of statistical life is 414,787,113€.

Caveats for causal interpretations of linear regression coefficients for fine particulate (PM2.5) air pollution health effects

Recent linear regression analyses have concluded that decreasing levels of fine particulate matter (PM2.5) air pollution have increased life expectancy in the United States. These findings have left unresolved questions about the causal relation between reductions in PM2.5 levels and changes in cause-specific (especially, cardiovascular disease, CVD) mortality risks. Their robustness (e.g., sensitivity to deletion of a single data point) has also been questioned. We investigate these issues in the National Mortality and Morbidity Air Pollution Study database. Comparing changes in PM2.5 levels and cause-specific mortality rates for elderly people in 24 cities between two periods separated by a decade (1987-1989 and 1999-2000) shows that reductions in PM2.5 were significantly associated with increases in respiratory mortality rates and with decreases in CVD mortality rates. CVD and all-cause mortality risks fell equally for all months of the year over this period, but average PM2.5 levels increased significantly for winter months. This casts doubts on the causal interpretation that declines in PM2.5 over the decade caused reduced short-term mortality risks. Nonlinear regression suggests that reduced or negative marginal health benefits are associated with reductions of PM2.5 below 1999-2000 levels (about 15 μg/m(3)). Such nonlinear relations imply that risk communication statements that project a constant incremental reduction in mortality risks per unit reduction in PM2.5 do not adequately reflect the realistic possibility of nonlinear exposure-response relations and diminishing returns to further exposure reductions.

Fine particulate air pollution and life expectancies in the United States: the role of influential observations

Changes in life expectancy (LE) across metropolitan areas in the United States have been associated with substantial differential reductions in fine particulate matter (aerodynamic diameter < 2.5 microm; PM2.5) air pollution that occurred during the 1980s and 1990s. It has been suggested that a single influential observation was largely responsible for the statistically significant LE-PM2.5 associations. In this paper, the role of influential observations is further explored. Stable and statistically significant LE-PM2.5 associations are observed in analyses that control for available socioeconomic, demographic, and proxy smoking variables and that use robust regression procedures that are relatively resistant to influential observations. These associations are not dependent upon the inclusion or exclusion of any single observation.

IMPLICATIONS

These results contribute to the large and growing literature indicating that exposure to fine particulate matter air pollution has substantive adverse effects on human health. These results, however, also provide encouraging evidence that the improvements in air quality that occurred during the 1980s and 1990s contributed to measurable improvements in human health and life expectancy in the United States.