New WHO global air quality guidelines help prevent premature deaths in China

Health-Oriented Emission Control Strategy of Energy Utilization and Its Co-CO2 Benefits: A Case Study of the Yangtze River Delta, China

Reducing air pollutants and CO2 emissions from energy utilization is crucial for achieving the dual objectives of clean air and carbon neutrality in China. Thus, an optimized health-oriented strategy is urgently needed. Herein, by coupling a CO2 and air pollutants emission inventory with response surface models for PM2.5-associated mortality, we shed light on the effectiveness of protecting human health and co-CO2 benefit from reducing fuel-related emissions and generate a health-oriented strategy for the Yangtze River Delta (YRD). Results reveal that oil consumption is the primary contributor to fuel-related PM2.5 pollution and premature deaths in the YRD. Significantly, curtailing fuel consumption in transportation is the most effective measure to alleviate the fuel-related PM2.5 health impact, which also has the greatest cobenefits for CO2 emission reduction on a regional scale. Reducing fuel consumption will achieve substantial health improvements especially in eastern YRD, with nonroad vehicle emission reductions being particularly impactful for health protection, while on-road vehicles present the greatest potential for CO2 reductions. Scenario analysis confirms the importance of mitigating oil consumption in the transportation sector in addressing PM2.5 pollution and climate change.

Health benefits from the rapid reduction in ambient exposure to air pollutants after China's clean air actions: progress in efficacy and geographic equality

Clean air actions (CAAs) in China have been linked to considerable benefits in public health. However, whether the beneficial effects of CAAs are equally distributed geographically is unknown. Using high-resolution maps of the distributions of major air pollutants (fine particulate matter [PM2.5] and ozone [O3]) and population, we aimed to track spatiotemporal changes in health impacts from, and geographic inequality embedded in, the reduced exposures to PM2.5 and O3 from 2013 to 2020. We used a method established by the Global Burden of Diseases Study. By analyzing the changes in loss of life expectancy (LLE) attributable to PM2.5 and O3, we calculated the gain of life expectancy (GLE) to quantify the health benefits of the air-quality improvement. Finally, we assessed the geographic inequality embedded in the GLE using the Gini index (GI). Based on risk assessments of PM2.5 and O3, during the first stage of CAAs (2013 to 2017), the mean GLE was 1.87 months. Half of the sum of the GLE was disproportionally distributed in about one quarter of the population exposed (GI 0.44). During the second stage of CAAs (2017 to 2020), the mean GLE increased to 3.94 months and geographic inequality decreased (GI 0.18). According to our assessments, CAAs were enhanced, from the first to second stages, in terms of not only preventing premature mortality but also ameliorating health inequalities. The enhancements were related to increased sensitivity to the health effects of air pollution and synergic control of PM2.5 and O3 levels. Our findings will contribute to optimizing future CAAs.

Estimating the exposure-response function between long-term ozone exposure and under-5 mortality in 55 low-income and middle-income countries: a retrospective, multicentre, epidemiological study

BACKGROUND

In 2021, WHO suggested new target concentration limits for long-term exposure to ambient ozone. However, the harmful effects of ozone on vulnerable children have not been sufficiently studied. We aimed to evaluate the association between long-term ozone exposure and mortality in children younger than 5 years (hereafter denoted under-5 mortality) in low-income and middle-income countries (LMICs) and to estimate this mortality burden for 97 LMICs.

METHODS

By combining information from 128 Demographic and Health Surveys, we evaluated the association between the survival status of more than 1·2 million children younger than 5 years from 2457 sampling strata in 55 LMICs and the average peak-season ozone concentration during the life course, using a fixed-effects Cox model. A non-linear exposure-response function was developed by integrating the marginal effects of within-strata variation in exposure. We extrapolated the function obtained from the 55 LMICs to estimate the under-5 mortality burden attributable to ozone exposure in 97 LMICs, in which more than 95% of global deaths in this age group occur.

FINDINGS

The fixed-effects model showed a robust association between ozone and under-5 mortality. According to the fully adjusted linear model, an increment of 10 ppb in the life-course average peak-season ozone concentration was associated with a 6·4% (95% CI 2·4-10·7) increase in the risk of under-5 mortality. The non-linear exposure-response function showed a sublinear curvature with a threshold, suggesting that the effect of ozone exposure was non-significant at concentrations lower than the first-stage interim target (100 μg/m3) recommended by WHO. Using this function, we estimate that, in 2010, long-term ozone exposure contributed to 153 361 (95% CI 17 077-276 768; 2·3% [0·3-4·1]) deaths of children younger than 5 years in 97 LMICs, which is equivalent to 56·8% of all ozone-related deaths in adults (269 785) in these countries. From 2003 to 2017, the ozone-related under-5 mortality burden decreased in most of the 97 LMICs.

INTERPRETATION

Long-term exposure to ozone concentrations higher than the WHO first-stage interim target is a risk factor for under-5 mortality, and ozone exposure contributes substantially to mortality in this age group in LMICs. Increased efforts should be made to control ambient ozone pollution as this will lead to positive health benefits.

FUNDING

Ministry of Science and Technology of the People's Republic of China and China National Natural Science Foundation.

Large-scale renewable energy brings regionally disproportional air quality and health co-benefits in China

Developing renewable energy could jointly reduce air pollution, greenhouse gas emissions, and bring air pollution-related health co-benefits. However, the temporal and sub-national distributions of investment costs and human health co-benefits from renewable energy deployment remain unclear. To investigate this gap, we linked multiple models for a more comprehensive assessment of the economic-environmental-health co-benefits of renewable energy development in China. The results show that developing renewable energy can avoid 0.6 million premature mortalities, 151 million morbidities, and 111 million work-loss days in 2050. Meanwhile, the human health and economic co-benefits vary substantially across regions in China. Renewable energy can undoubtedly bring health and economic co-benefits. Nevertheless, the economic benefits lag considerably behind the high initial investment cost, first negative in 2030 (-0.6 trillion Yuan) and then positive in 2050 (2.9 trillion Yuan). Hence, renewable energy deployment strategy must be carefully designed considering the regional disparities.

Recent Progress in Atmospheric Chemistry Research in China: Establishing a Theoretical Framework for the "Air Pollution Complex"

Atmospheric chemistry research has been growing rapidly in China in the last 25 years since the concept of the "air pollution complex" was first proposed by Professor Xiaoyan TANG in 1997. For papers published in 2021 on air pollution (only papers included in the Web of Science Core Collection database were considered), more than 24 000 papers were authored or co-authored by scientists working in China. In this paper, we review a limited number of representative and significant studies on atmospheric chemistry in China in the last few years, including studies on (1) sources and emission inventories, (2) atmospheric chemical processes, (3) interactions of air pollution with meteorology, weather and climate, (4) interactions between the biosphere and atmosphere, and (5) data assimilation. The intention was not to provide a complete review of all progress made in the last few years, but rather to serve as a starting point for learning more about atmospheric chemistry research in China. The advances reviewed in this paper have enabled a theoretical framework for the air pollution complex to be established, provided robust scientific support to highly successful air pollution control policies in China, and created great opportunities in education, training, and career development for many graduate students and young scientists. This paper further highlights that developing and low-income countries that are heavily affected by air pollution can benefit from these research advances, whilst at the same time acknowledging that many challenges and opportunities still remain in atmospheric chemistry research in China, to hopefully be addressed over the next few decades.

Changes in PM2.5-related health burden in China's poverty and non-poverty areas during 2000-2020: A health inequality perspective

China suffers from severe PM_2.5 pollution that has resulted in a huge health burden. Such PM_2.5-related health burden has long been suspected to differ between China's poverty-stricken areas (PAs) and non-poverty-stricken areas (NPAs). Yet, evidence-based examination of this long-held belief, which is critical as a barrier of environmental injustice to advancing China's sustainability, is still missing. Here our study shows that the PM_2.5 pollution is more serious in China's NPAs than PAs-with their annual averages being respectively 54.83 μg/m³ and 43.63 μg/m³-causing higher premature mortality in the NPAs. Compared to economic inequality, China's total PM_2.5-related premature mortality was relatively evenly distributed during 2000-2015 across regions of varying levels of gross domestic product (GDP) per capita but increased slightly in 2015-2020 owing to the dramatic change in age structure. The elderly population increased by 31 %. PM_2.5-related premature deaths were more severe for populations of low socioeconomic status, and such environmental health inequalities could be amplified by population aging. Additionally, population migration from China's PAs to developed cities contributed to 638, 779, 303, 954, and 896 premature deaths in 2000, 2005, 2010, 2015, and 2020, respectively. Changes in the age structure (53 %) and PM_2.5 concentration (28 %) had the greatest impact on premature deaths, followed by changes in population (12 %) and baseline mortality (8 %). The contribution rate of changes in the age structure and PM_2.5 concentration was higher in PAs than in NPAs. Our findings provide insight into PM_2.5-related premature death and environmental inequality, and may inform more equitable clean air policies to achieve China's sustainable development goals.

Characteristics of volatile organic compounds and secondary organic aerosol pollution in different functional areas of petrochemical industrial cities in Northwest China

The aim of this study was to better understand the characteristics of volatile organic compounds (VOCs) and secondary organic aerosol (SOA) pollution in different functional areas of petrochemical industrial cities. In Lanzhou, a typical petrochemical industrial city in Northwest China, with the use of an Integrated Atmospheric Mobile Monitoring Vehicle (IAMMV), various real-time online monitoring instruments, including a VOC monitoring instrument (TH-300B) and single-particle aerosol mass spectrometer (SPAMS), were used in combination. These instruments were employed to determine PM_2.5, VOCs and other factors at monitoring sites in Xigu (XG) and Chengguan (CG) districts in September 2020 and 2021, respectively. The results revealed that during the monitoring period, the average VOC concentrations at the XG and CG monitoring sites were 102.3 and 35.8 ppb, respectively. Benzene (45.58 %) and toluene (24.47 %) significantly contributed to the SOA formation potential at the XG site. M/P-xylene (27.88 %) and toluene (23.64 %) more notably contributed to the SOA formation potential at the CG site. The PM_2.5 mass concentration at the XG site (24.1 μg·m^-3) was similar to that at the CG site (21.2 μg·m^-3), but the proportion of particulate matter components greatly differed. The proportion of organic carbon (OC) at the XG site (19.00 %) was higher than that at the CG site (9.97 %). The number of particles containing C₂H₃O⁺ (m/z = 43) accounted for 36.96 % and 15.41 % of the total particles at the XG and CG sites, respectively. The mixing ratios of OC and hybrid carbon (OCEC) with C₂H₃O⁺ (m/z = 43) were 0.81 and 0.53, respectively, at the XG site and reached only 0.48 and 0.25, respectively, at the CG site. The secondary ageing degree of particles in XG district was high. These results could provide a reference for ambient air quality improvement and the formulation of governance measures in different functional areas of petrochemical industrial cities.

The PM2.5 concentration reduction improves survival rate of lung cancer in Beijing

INTRODUCTION

Long-term exposure to ambient fine particulate matter (PM_2.5) has been linked to increases in the incidence of lung cancer. However, more evidence is needed to conclude its effects on lung cancer survival.

OBJECTIVES

The study aimed to explore the relationship between long-term PM_2.5 exposure and lung cancer survival and evaluated the benefits of clean air actions in Beijing.

METHODS

A whole-population cohort study was conducted on lung cancer patients diagnosed between 2001 and 2017. An atmospheric chemical transport model was used to estimate exposure under a counterfactual scenario without the policy and then quantified the effect of the policy. Cox regression models were used with the seasonality-adjusted PM_2.5 as the main effect.

RESULTS

A 10 μg/m³ increase in PM_2.5 was estimated to be with a 6.5 % (95 % CI: 4.8 %, 8.2 %) increase in the mortality rates. The association was heterogeneous and modified by individual-level characteristics. The clean air actions were estimated to have prevented 3548 (95 % CI: 3280, 3825) premature deaths and to have prolonged survival time by 4.29 months (95 % CI: 0.01, 25.11).

CONCLUSION

Our findings suggest that PM_2.5 exposure lowers the survival rate for lung cancer. The clean air actions implemented in Beijing can protect lung cancer patients by increasing their survival time.

SYNOPSIS

Long-term exposure to PM_2.5 can lower lung patients' survival rates whereas the clean air actions in Beijing have prolonged these patients' survival time by reducing PM_2.5 level.

Estimation of stillbirths attributable to ambient fine particles in 137 countries

Gestational exposure to ambient fine particles (PM_2.5) increases the risk of stillbirth, but the related disease burden is unknown, particularly in low- and middle-income countries (LMICs). We combine state-of-the-art estimates on stillbirths, and multiple exposure-response functions obtained from previous meta-analyses or derived by a self-matched case-control study in 54 LMICs. 13,870 stillbirths and 32,449 livebirths are extracted from 113 geocoded surveys from the Demographic and Health Surveys. Each stillbirth is compared to livebirth(s) of the same mother using a conditional logit regression. We find that 10-µg/m³ increase of PM_2.5 is associated with an 11.0% (95% confidence interval [CI] 6.4, 15.7) increase in the risk of stillbirth, and the association is significantly enhanced by maternal age. Based on age-specific nonlinear PM_2.5-stillbirth curves, we evaluate the PM_2.5-related stillbirths in 137 countries. In 2015, of 2.09 (95% CI: 1.98, 2.20) million stillbirths, 0.83 (0.54, 1.08) million or 39.7% (26.1, 50.8) are attributable to PM_2.5 exposure exceeding the reference level of 10 μg/m³. In LMICs, preventing pregnant women from being exposed to PM_2.5 can improve maternal health.

Overview of particulate air pollution and human health in China: Evidence, challenges, and opportunities

Ambient particulate matter (PM) pollution in China continues to be a major public health challenge. With the release of the new WHO air quality guidelines in 2021, there is an urgent need for China to contemplate a revision of air quality standards (AQS). In the recent decade, there has been an increase in epidemiological studies on PM in China. A comprehensive evaluation of such epidemiological evidence among the Chinese population is central for revision of the AQS in China and in other developing countries with similar air pollution problems. We thus conducted a systematic review on the epidemiological literature of PM published in the recent decade. In summary, we identified the following: (1) short-term and long-term PM exposure increase mortality and morbidity risk without a discernible threshold, suggesting the necessity for continuous improvement in air quality; (2) the magnitude of long-term associations with mortality observed in China are comparable with those in developed countries, whereas the magnitude of short-term associations are appreciably smaller; (3) governmental clean air policies and personalized mitigation measures are potentially effective in protecting public and individual health, but need to be validated using mortality or morbidity outcomes; (4) particles of smaller size range and those originating from fossil fuel combustion appear to show larger relative health risks; and (5) molecular epidemiological studies provide evidence for the biological plausibility and mechanisms underlying the hazardous effects of PM. This updated review may serve as an epidemiological basis for China’s AQS revision and proposes several perspectives in designing future health studies.

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Acute effects of PM are smaller in China compared with developed countries

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Health effects caused by PM depend on particle composition, source, and size

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There are no thresholds for the health effects of PM

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Mechanistic studies support the biological plausibility of PM’s health effects