A 10-year time-series analysis of respiratory and cardiovascular morbidity in Nicosia, Cyprus: the effect of short-term changes in air pollution and dust storms

Dust storms and cardiorespiratory emergency department visits in three Southwestern United States: application of a monitoring-based exposure metric

Climate change is projected to increase the risk of dust storms, particularly in subtropical dryland, including the southwestern US. Research on dust storm's health impacts in the US is limited and hindered by challenges in dust storm identification. This study assesses the potential link between dust storms and cardiorespiratory emergency department (ED) visits in the southwestern US. We acquired data for 2005-2016 from eight IMPROVE (Interagency Monitoring of PROtected Visual Environments) sites in Arizona, California, and Utah. We applied a validated algorithm to identify dust storm days at each site. We acquired patient-level ED visit data from state agencies and ascertained visits for respiratory, cardiovascular, and cause-specific subgroups among patients residing in ZIP codes within 50 km of an IMPROVE site. Using a case-crossover design, we estimated short-term associations of ED visits and dust storms, controlling for temporally varying covariates. During 2005-2016, 40 dust storm days occurred at the eight IMPROVE sites. Mean PM10 and PM2.5 levels were three to six times greater on dust storm days compared to non-dust storm days. Over the study period, there were 2 524 259 respiratory and 2 805 925 cardiovascular ED visits. At lags of 1, 2, and 3 days after a dust storm, we observed 3.7% (95% CI: 1.0%, 7.6%), 4.9% (95% CI: 1.1%, 8.9%), and 5.0% (95% CI: 1.3%, 8.9%) elevated odds of respiratory ED visits compared to non-dust storm days. Estimated associations of dust storm days and cardiovascular disease ED visits were largely consistent with the null. Using a monitoring-based exposure metric, we observed associations among dust storms and respiratory ED visits. The results add to growing evidence of the health threat posed by dust storms. The dust storm metric was limited by lack of daily data; future research should consider information from satellite and numerical models to enhance dust storm characterization.

Airborne particle radioactivity during desert dust days in Cyprus

Mediterranean countries are often affected by desert dust storms, which have significant effects on the environment and public health. We compared airborne particle radioactivity levels during desert dust and non-dust days in Cyprus. Gross α- and β-radioactivity from Total Suspended Particle (TSP) samples, collected at two urban routine monitoring stations in Limassol and Nicosia, were available for the period 2017-2020 and 2008-2020, respectively. Radionuclides 137Cs and 40K, from TSP samples, were also available from a semi-industrial monitoring station in Nicosia during 2008-2020. Information on desert dust presence, dust origin, particulate matter (PM) levels, and solar activity (KP index and solar sunspot numbers - SSN) were also obtained. We used linear regression models adjusting for seasonality and long-term trends, and solar activity to assess the effect of dust storms on TSP gross α- and β-, and 137Cs and 40K radioactivity levels. Gross α- and β-radioactivity, and 137Cs and 40K radioactivity levels were significantly higher on days with desert dust compared to days characterized with no influence of desert dust. Levels of gross α- and β-radioactivity during dust days were higher when dust originated from the Middle East deserts than from the Sahara Desert. The same trend was observed for the ratios 137Cs to 40K and 137Cs to PM10. Conversely, ratios of TSP gross α- and β-radioactivity to PM10 were significantly lower during desert dust days in comparison to days without dust influence. This study suggests that desert dust increase both TSP gross α- and β-radioactivity, as well as 137Cs and 40K radioactivity levels. Further studies should clarify the contribution of anthropogenic and other natural sources to the emission or transportation of particles radioactivity, to better mitigate future exposures.

Fire-Pollutant-Atmosphere Components and Its Impact on Mortality in Portugal During Wildfire Seasons

This study analyzed fire-pollutant-meteorological variables and their impact on cardio-respiratory mortality in Portugal during wildfire season. Data of burned area, particulate matter with a diameter of 10 or 2.5 μm (μm) or less (PM10, PM2.5), carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), temperature, relative humidity, wind speed, aerosol optical depth and mortality rates of Circulatory System Disease (CSD), Respiratory System Disease (RSD), Pneumonia (PNEU), Chronic Obstructive Pulmonary Disease, and Asthma (ASMA), were used. Only the months of 2011-2020 wildfire season (June-July-August-September-October) with a burned area greater than 1,000 ha were considered. Principal component analysis was used on fire-pollutant-meteorological variables to create two indices called Pollutant-Burning Interaction (PBI) and Atmospheric-Pollutant Interaction (API). PBI was strongly correlated with the air pollutants and burned area while API was strongly correlated with temperature and relative humidity, and O3. Cluster analysis applied to PBI-API divided the data into two Clusters. Cluster 1 included colder and wetter months and higher NO2 concentration. Cluster 2 included warmer and dried months, and higher PM10, PM2.5, CO, and O3 concentrations. The clusters were subjected to Principal Component Linear Regression to better understand the relationship between mortality and PBI-API indices. Cluster 1 showed statistically significant (p-value < 0.05) correlation (r) between RSDxPBI (r RSD = 0.58) and PNEUxPBI (r PNEU = 0.67). Cluster 2 showed statistically significant correlations between RSDxPBI (r RSD = 0.48), PNEUxPBI (r PNEU = 0.47), COPDxPBI (r COPD = 0.45), CSDxAPI (r CSD = 0.70), RSDxAPI (r CSD = 0.71), PNEUxAPI (r PNEU = 0.49), and COPDxAPI (r PNEU = 0.62). Cluster 2 analysis indicates that the warmest, driest, and most polluted months of the wildfire season were associated with cardio-respiratory mortality.

Connections Between Air Pollution, Climate Change, and Cardiovascular Health

Globally, more people die from cardiovascular disease than any other cause. Climate change, through amplified environmental exposures, will promote and contribute to many noncommunicable diseases, including cardiovascular disease. Air pollution, too, is responsible for millions of deaths from cardiovascular disease each year. Although they may appear to be independent, interchangeable relationships and bidirectional cause-and-effect arrows between climate change and air pollution can eventually lead to poor cardiovascular health. In this topical review, we show that climate change and air pollution worsen each other, leading to several ecosystem-mediated effects. We highlight how increases in hot climates as a result of climate change have increased the risk of major air pollution events such as severe wildfires and dust storms. In addition, we show how altered atmospheric chemistry and changing patterns of weather conditions can promote the formation and accumulation of air pollutants: a phenomenon known as the climate penalty. We demonstrate these amplified environmental exposures and their associations to adverse cardiovascular health outcomes. The community of health professionals-and cardiologists, in particular-cannot afford to overlook the risks that climate change and air pollution bring to the public's health.

Pollutants, including Organophosphorus and Organochloride Pesticides, May Increase the Risk of Cardiac Remodeling and Atrial Fibrillation: A Narrative Review

Atrial fibrillation (AF) is the most common type of cardiac rhythm disorder. Recent clinical and experimental studies reveal that environmental pollutants, including organophosphorus-organochloride pesticides and air pollution, may contribute to the development of cardiac arrhythmias including AF. Here, we discussed the unifying cascade of events that may explain the role of pollutant exposure in the development of AF. Following ingestion and inhalation of pollution-promoting toxic compounds, damage-associated molecular pattern (DAMP) stimuli activate the inflammatory response and oxidative stress that may negatively affect the respiratory, cognitive, digestive, and cardiac systems. Although the detailed mechanisms underlying the association between pollutant exposure and the incidence of AF are not completely elucidated, some clinical reports and fundamental research data support the idea that pollutant poisoning can provoke perturbed ion channel function, myocardial electrical abnormalities, decreased action potential duration, slowed conduction, contractile dysfunction, cardiac fibrosis, and arrhythmias including AF.

Short-term effects of ambient ozone exposure on daily hospitalizations for circulatory diseases in Ganzhou, China: A time-series study

Adverse health effects of ambient ozone are getting widespread attention, but the evidence on the relationship between ozone levels and circulatory system diseases are limited and inconsistent. Daily data for ambient ozone levels and hospitalizations for total circulatory diseases and five subtypes in Ganzhou, China from January 1, 2016 to December 31, 2020 were collected. We constructed a generalized additive model with quasi-Poisson regression accounting for lag effects to estimate the associations between ambient ozone levels and the number of hospitalized cases of total circulatory diseases and five subtypes. The differences among gender, age, and season subgroups were furtherly assessed through stratified analysis. A total of 201,799 hospitalized cases of total circulatory diseases were included in the present study, including 94,844 hypertension (HBP), 28,597 coronary heart disease (CHD), 42,120 cerebrovascular disease (CEVD), 21,636 heart failure (HF), and 14,602 arrhythmia. Significantly positive associations were observed between ambient ozone levels and daily hospitalizations for total circulatory diseases and all subtypes except arrhythmia. Each 10 μg/m³ increase in ozone concentration, the risk of hospitalizations for total circulatory diseases, HBP, CHD, CEVD, and HF increased by 0.718% (95% confidence interval, 0.156%-1.284%), 0.956% (0.346%-1.570%), 0.499% (0.057%-0.943%), 0.386% (0.025%-0.748%), and 0.907% (0.118%-1.702%), respectively. The above associations remained significant after adjusting for other air pollutants. The risk of hospitalization for circulatory diseases was higher in warm season (May to October) and varied in gender and age subgroups. This study suggested that short-term exposure to ambient ozone may increase the risk of hospitalizations for circulatory diseases. Our findings reinforce the importance of reducing ambient ozone pollution levels for protecting public health.

MEDEA randomised intervention study protocol in Cyprus, Greece and Israel for mitigation of desert dust health effects in adults with atrial fibrillation

INTRODUCTION

Mediterranean countries experience frequent desert dust storm (DDS) events originating from neighbouring Sahara and Arabian deserts, which are associated with significant increase in mortality and hospital admissions, mostly from cardiovascular and respiratory diseases. Short-term exposure to ambient air pollution is considered as a trigger for symptomatic exacerbations of pre-existing paroxysmal atrial fibrillation (AF) and other types of heart arrhythmia. The Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches clinical randomised intervention study in adults with AF is funded by EU LIFE+programme to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related heart arrhythmia effects.

METHODS AND ANALYSIS

The study is performed in three heavily exposed to desert dust regions of the Eastern Mediterranean: Cyprus, Israel and Crete-Greece. Adults with paroxysmal AF and implanted pacemaker are recruited and randomised to three parallel groups: (a) no intervention, (b) interventions to reduce outdoor exposure to desert dust, (c) interventions to reduce both outdoor and indoor exposure to particulate matter during desert dust episodes. Eligible participants are enrolled on a web-based platform which communicates, alerts and makes exposure reduction recommendations during DDS events. Exposure changes are assessed by novel tools (smartwatches with Global Positioning System and physical activity sensors, air pollution samplers assessing air quality inside and outside participant's homes, etc). Clinical outcomes include the AF burden expressed as the percentage of time with paroxysmal AF over the total study period, the incidence of ventricular arrhythmia episodes as recorded by the participants' pacemakers or cardioverters/defibrillators and the disease-specific Atrial Fibrillation Effect on QualiTy-of-Life questionnaire.

ETHICS AND DISSEMINATION

Local bioethics' authorities approved the study at all sites, according to national legislations (Cyprus: National Bioethics Committee, Data Protection Commissioner and Ministry of Health; Greece, Scientific Committee and Governing Board of the University General Hospital of Heraklion; Israel: Institutional Review Board ('Helsinki committee') of the Soroka University Medical Center). The findings will be publicised in peer-reviewed scientific journals, in international conferences and in professional websites and newsletters. A summary of the results and participants' interviews will be included in a documentary in English, Greek and Hebrew.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier; NCT03503812.

Improved indoor air quality during desert dust storms: The impact of the MEDEA exposure-reduction strategies

Desert dust storms (DDS) are natural events that impact not only populations close to the emission sources but also populations many kilometers away. Countries located across the main dust sources, including countries in the Eastern Mediterranean, are highly affected by DDS. In addition, climate change is expanding arid areas exacerbating DDS events. Currently, there are no intervention measures with proven, quantified exposure reduction to desert dust particles. As part of the wider "MEDEA" project, co-funded by LIFE 2016 Programme, we examined the effectiveness of an indoor exposure-reduction intervention (i.e., decrease home ventilation during DDS events and continuous use of air purifier during DDS and non-DDS days) across homes and/or classrooms of schoolchildren with asthma and adults with atrial fibrillation in Cyprus and Crete-Greece. Participants were randomized to a control or intervention groups, including an indoor intervention group with exposure reduction measures and the use of air purifiers. Particle sampling, PM₁₀ and PM_2.5, was conducted in participants' homes and/or classrooms, between 2019 and 2022, during DDS-free weeks and during DDS days for as long as the event lasted. In indoor and outdoor PM₁₀ and PM_2.5 samples, mass and content in main and trace elements was determined. Indoor PM_2.5 and PM₁₀ mass concentrations, adjusting for premise type and dust conditions, were significantly lower in the indoor intervention group compared to the control group (PM_{2.5-intervention}/PM_2.5-control = 0.57, 95% CI: 0.47, 0.70; PM_{10-intervention}/PM_10-control = 0.59, 95% CI: 0.49, 0.71). In addition, the PM_2.5 and PM₁₀ particles of outdoor origin were significantly lower in the intervention vs. the control group (PM_2.5 infiltration intervention-to-control ratio: 0.49, 95% CI: 0.42, 0.58; PM₁₀ infiltration intervention-to-control ratio: 0.68, 95% CI: 0.52, 0.89). Our findings suggest that the use of air purifiers alongside decreased ventilation measures is an effective protective measure that reduces significantly indoor exposure to particles during DDS and non-DDS in high-risk population groups.

Responses of schoolchildren with asthma to recommendations to reduce desert dust exposure: Results from the LIFE-MEDEA intervention project using wearable technology

Current public health recommendations for desert dust storms (DDS) events focus on vulnerable population groups, such as children with asthma, and include advice to stay indoors and limit outdoor physical activity. To date, no scientific evidence exists on the efficacy of these recommendations in reducing DDS exposure. We aimed to objectively assess the behavioral responses of children with asthma to recommendations for reduction of DDS exposure. In two heavily affected by DDS Mediterranean regions (Cyprus & Crete, Greece), schoolchildren with asthma (6-11 years) were recruited from primary schools and were randomized to control (business as usual scenario) and intervention groups. All children were equipped with pedometer and GPS sensors embedded in smartwatches for objective real-time data collection from inside and outside their classroom and household settings. Interventions included the timely communication of personal DDS alerts accompanied by exposure reduction recommendations to both the parents and school-teachers of children in the intervention group. A mixed effect model was used to assess changes in daily levels of time spent, and steps performed outside classrooms and households, between non-DDS and DDS days across the study groups. The change in the time spent outside classrooms and homes, between non-DDS and DDS days, was 37.2 min (p_value = 0.098) in the control group and -62.4 min (p_value < 0.001) in the intervention group. The difference in the effects between the two groups was statistically significant (interaction p_value < 0.001). The change in daily steps performed outside classrooms and homes, was -495.1 steps (p_value = 0.350) in the control group and -1039.5 (p_value = 0.003) in the intervention group (interaction p_value = 0.575). The effects on both the time and steps performed outside were more profound during after-school hours. To summarize, among children with asthma, we demonstrated that timely personal DDS alerts and detailed recommendations lead to significant behavioral changes in contrast to the usual public health recommendations.

Health risk assessment for particulate matter: application of AirQ+ model in the northern Caribbean region of Colombia

Air pollution is considered the world's most important environmental and public health risk. The annual exposure for particulate matter (PM) in the northern Caribbean region of Colombia between 2011 and 2019 was determined using PM records from 25 monitoring stations located within the area. The impact of exposure to particulate matter was assessed through the updated Global Burden of Disease health risk functions using the AirQ+ model for mortality attributable to acute lower respiratory disease (in children ≤ 4 years); mortality in adults aged > 18 years old attributable to chronic obstructive pulmonary disease, ischaemic heart disease, lung cancer, and stroke; and all-cause post-neonatal infant mortality. The proportions of the prevalence of bronchitis in children and the incidence of chronic bronchitis in adults attributable to PM exposure were also estimated for the population at risk. Weather Research and Forecasting-California PUFF (WRF-CALPUFF) modeling systems were used to estimate the spatiotemporal trends and calculate mortality relative risk due to prolonged PM2.5 exposure. Proportions of mortality attributable to long-term exposure to PM2.5 were estimated to be around 11.6% of ALRI deaths in children ≤ 4 years of age, 16.1% for COPD, and 26.6% for IHD in adults. For LC and stroke, annual proportions attributable to PM exposure were estimated to be 9.1% and 18.9%, respectively. An estimated 738 deaths per year are directly attributed to particulate matter pollution. The highest number of deaths per year is recorded in the adult population over 18 years old with a mean of 401 events. The mean risk in terms of the prevalence of bronchitis attributable to air pollution in children was determined to be 109 per 100,000 inhabitants per year. The maximum RR values for mortality (up 1.95%) from long-term PM2.5 exposure were predicted to correspond to regions downwind to the industrial zone.

Supplementary information

The online version contains supplementary material available at 10.1007/s11869-023-01304-5.

Early-life exposure to Saharan dust storms and adolescence functional disability: Evidence from Cameroon

The direct link between early-life dust storm exposure and later-in-life outcomes is not fully understood. This study examines the association of functional disability in a large sample of adolescent Cameroonians (N = 112,855) with in-utero and early childhood exposure to Saharan dust storms. Adjusting all estimations for temperature, precipitation, time and location fixed-effects, and person and family sociodemographic characteristics, we documented adverse effects on functional disability in female adolescents due to exposure to dense dust storms during the third gestation trimester and the second postnatal trimester. We also found suggestive evidence that an effect exists for the first as well as the third through fifth postnatal trimesters. In the third trimester of gestation and the second postnatal trimester, exposure to an average length dust storm with PM₁₀ levels beyond 190 μg/m³ increased the likelihood of disability among female adolescents by approximately 229 (95 % CI: 10-464) in 100,000. The size of the adverse effects for the other periods followed similar patterns. These results show the value of creating infrastructures to mitigate or adapt to the effects of dust storms. These endeavors should focus on communities and populations in and around the Sahara where international organizations can play a role. In addition, establishing health data infrastructures not only improves public health but also advances our understanding of the long-term effects of dust storms. This study demonstrates the importance of research on the long-term effects of early-life exposure to dust storms and the need for additional work on this topic.

Climate change and human health in the Eastern Mediterranean and Middle East: Literature review, research priorities and policy suggestions

Human health is linked to climatic factors in complex ways, and climate change can have profound direct and indirect impacts on the health status of any given region. Susceptibility to climate change is modulated by biological, ecological and socio-political factors such as age, gender, geographic location, socio-economic status, occupation, health status and housing conditions, among other. In the Eastern Mediterranean and Middle East (EMME), climatic factors known to affect human health include extreme heat, water shortages and air pollution. Furthermore, the epidemiology of vector-borne diseases (VBDs) and the health consequences of population displacement are also influenced by climate change in this region. To inform future policies for adaptation and mitigation measures, and based on an extensive review of the available knowledge, we recommend several research priorities for the region. These include the generation of more empirical evidence on exposure-response functions involving climate change and specific health outcomes, the development of appropriate methodologies to evaluate the physical and psychological effects of climate change on vulnerable populations, determining how climate change alters the ecological determinants of human health, improving our understanding of the effects of long-term exposure to heat stress and air pollution, and evaluating the interactions between adaptation and mitigation strategies. Because national boundaries do not limit most climate-related factors expected to impact human health, we propose that adaptation/mitigation policies must have a regional scope, and therefore require collaborative efforts among EMME nations. Policy suggestions include a decisive region-wide decarbonisation, the integration of environmentally driven morbidity and mortality data throughout the region, advancing the development and widespread use of affordable technologies for the production and management of drinking water by non-traditional means, the development of comprehensive strategies to improve the health status of displaced populations, and fostering regional networks for monitoring and controlling the spread of infectious diseases and disease vectors.

Particulate Air Pollution and Primary Care Visits in Kosovo: A Time-Series Approach

This study aimed to investigate the effects of particulate air pollution (PM2.5) on cardiovascular and respiratory diseases in Pristina, Kosovo, in a time-series analysis using daily primary healthcare visits to primary care institutions from 2019 to 2022. For the observation period, 6440 cardiovascular and 15,141 respiratory visits were reported, whereas the daily mean concentrations of PM2.5 ranged between 2.41 and 120.3 µg/m³. Single-lag models indicated a bi-phasic lag structure with increasing effect estimates some days after the air pollution event. In the distributed lag model with seven lags, the effect estimates for the cardiovascular cases indicated the adverse effect of air pollution. The cumulative effect estimate (summed over lag 0 to 6) for an increase of 10 µg/m³ of PM2.5 was a relative risk of 1.010 (95% confidence interval: 1.001-1.019). For respiratory cases, a different lag model (lag 4 through 10) was additionally examined. In this model, significant increases in visits were observed on lags 7 and 8. Overall, no relevant increase in visits occurred during the seven days considered. Visits to general practitioners will often not occur immediately at disease onset because patients will wait, hoping that their health status improves spontaneously. Therefore, we expected some latency in the effects.

Multi-sectoral impact assessment of an extreme African dust episode in the Eastern Mediterranean in March 2018

In late March 2018, a large part of the Eastern Mediterranean experienced an extraordinary episode of African dust, one of the most intense in recent years, here referred to as the "Minoan Red" event. The episode mainly affected the Greek island of Crete, where the highest aerosol concentrations over the past 15 yeas were recorded, although impacts were also felt well beyond this core area. Our study fills a gap in dust research by assessing the multi-sectoral impacts of sand and dust storms and their socioeconomic implications. Specifically, we provide a multi-sectoral impact assessment of Crete during the occurrence of this exceptional African dust event. During the day of the occurrence of the maximum dust concentration in Crete, i.e. March 22nd, 2018, we identified impacts on meteorological conditions, agriculture, transport, energy, society (including closing of schools and cancellation of social events), and emergency response systems. As a result, the event led to a 3-fold increase in daily emergency responses compare to previous days associated with urban emergencies and wildfires, a 3.5-fold increase in hospital visits and admissions for Chronic Obstructive Pulmonary Disease (COPD) exacerbations and dyspnoea, a reduction of visibility causing aircraft traffic disruptions (eleven cancellations and seven delays), and a reduction of solar energy production. We estimate the cost of direct and indirect effects of the dust episode, considering the most affected socio-economic sectors (e.g. civil protection, aviation, health and solar energy production), to be between 3.4 and 3.8 million EUR for Crete. Since such desert dust transport episodes are natural, meteorology-driven and thus to a large extent unavoidable, we argue that the efficiency of actions to mitigate dust impacts depends on the accuracy of operational dust forecasting and the implementation of relevant early warning systems for social awareness.

Real-time measurements of mineral dust concentration in coarse particulate matter (PM10-2.5) by employing a novel optical-based technique in Los Angeles

As a primary component of coarse particulate matter (PM), ambient mineral dust has been linked to adverse health effects. Los Angeles, the largest metropolitan urban area of the United States, is impacted by both windblown and localized sources of mineral dust, often internally mixed with black carbon. The estimation of mineral dust concentrations with a high time resolution becomes critical in improving our understanding of its sources and temporal trends. Using Aethalometers combined with a high-volume virtual impactor (VI) to enrich coarse (2.5 <dp < 10 μm) particles, the light absorption and mass concentration of mineral dust were estimated in real-time during summer, fall, and winter over 2020-2021. The concentration-enriched coarse PM was collected on Teflon filters, and its chemical composition in terms of trace elements and metals was chemically quantified. The high time-resolution measurements enabled us to calculate the absorption coefficient of enriched dust particles by subtracting the light absorption of the post-VI coarse PM from that of the PM_2.5 aerosol fraction to reduce the impact of stronger light absorbers in ambient PM. Mineral dust was more prevalent during the fall and winter campaigns (i.e., 19.3 and 11.4 μg/m³, respectively), lower concentrations were observed during the summer campaign (i.e., 8.50 μg/m³). The calculated absorption Ångström exponent (AAE) was 2.18, highlighting the presence of dust particles during the sampling period. The dust mass absorption coefficient was estimated to be 2.7 ± 1.6 Mm^-1 at 370 nm and 0.41 ± 0.16 Mm^-1 at 880 nm wavelengths, respectively. The validation of the proposed approach was investigated by comparing the evaluated mineral dust mass concentrations in this study with the reported coarse PM concentrations by the California Air Resources Board (CARB). The results reported by the optical-based approach with high temporal resolution can provide crucial information on identifying sources of mineral dust in urban areas.

Lowering mortality risks in urban areas by containing atmospheric pollution

OBJECTIVES

Although studies collectively examining the traffic and residential heat pollutant emissions are abundant, research investigations dedicated to Cyprus are scarce. This investigation has simulated the levels of air pollutants, namely, CO, NO_x, PM_2.5, and PM₁₀ and reconciled them with actual air quality measurements in Nicosia, Cyprus, during a 9-month period at an hourly resolution. To this end, several scenarios and cases were formulated to tackle emissions and minimise human mortality risks in the city.

METHODS

The GRAL dispersion model was used to project pollution levels. Nine different traffic scenarios were devised to estimate variations in concentration of PM_2.5 and NO_x under various policies, such as banning diesel passenger vehicles (PV), light duty vehicles (LDV), non-Euro 6 standards vehicles, stringent speed limits and a ubiquitous roll-out of electric passenger vehicles. Moreover, 4 distinct cases were analysed to year 2030 considering a fluctuation in traffic of ±20% whereas all vehicles conform to Euro 6 standards. Three additional policies examined the prohibition of diesel PV and LDV, 80% electric PV and outlawing fireplaces. Drawing on the findings of these scenarios and cases, the total cardiovascular and respiratory mortality rates at the capital of Cyprus, Nicosia, were deduced.

RESULTS

The most promising scenario in terms of curbing emissions was to ban non-Euro 6 vehicles and diesel PV and LDV which could contain average NO_x concentration, in Nicosia, from 52.9 μg/m³ to 15.0 μg/m³. If this policy were to be implemented, it could have saved 70% of the premature deaths tied to NO_x emissions. For particulate matter, banning fireplaces and abandoning non-Euro 6 vehicles could lower average concentrations from 18.3 μg/m³ to 13.1 μg/m³, saving at least 30% of the people poised to lose their lives from particulate matter risks.

CONCLUSION

Traffic and residential heat policies are not easy to implement. However, our study has demonstrated that the most effective policies for curbing NO_x emissions would be to ensure that all vehicles abide with the Euro 6 standards and, concurrently, ban diesel passenger and light duty vehicles. Lastly, phasing out domestic fireplaces appears to be the most promising solution for containing particulate matter, in 2030.

Infectious Diseases Associated with Desert Dust Outbreaks: A Systematic Review

Background: Desert dust outbreaks and dust storms are the major source of particulate matter globally and pose a major threat to human health. We investigated the microorganisms transported with desert dust particles and evaluated their potential impact on human health. Methods: A systematic review of all reports on the association between non-anthropogenic desert dust pollution, dust microorganisms and human health is conducted. Results: In total, 51 articles were included in this review. The affected regions studied were Asia (32/51, 62.7%) followed by Europe (9/51, 17.6%), America (6/51, 11.8%), Africa (4/51, 7.8%) and Australia (1/51, 2.0%). The Sahara Desert was the most frequent source of dust, followed by Asian and American deserts. In 39/51 studies the dust-related microbiome was analyzed, while, in 12/51 reports, the association of desert dust with infectious disease outbreaks was examined. Pathogenic and opportunistic agents were isolated from dust in 24/39 (61.5%) and 29/39 (74.4%) of the studies, respectively. A significant association of dust events with infectious disease outbreaks was found in 10/12 (83.3%) reports. The infectious diseases that were mostly investigated with dust outbreaks were pneumonia, respiratory tract infections, COVID-19, pulmonary tuberculosis and coccidioidomycosis. Conclusions: Desert dust outbreaks are vehicles of a significant number of pathogenic or opportunistic microorganisms and limited data indicate an association between dust events and infectious disease outbreaks. Further research is required to strengthen the correlation between dust events and infectious diseases and subsequently guide preventive public health measures.

Thermal Conditions and Hospital Admissions: Analysis of Longitudinal Data from Cyprus (2009-2018)

The state of the thermal environment can affect human health and well-being. Heat stress is associated with a wide range of health outcomes increasing morbidity and mortality and is recognized as an important health risk posed by climate change. This study aims at examining the effect of thermal conditions on the daily number of hospital admissions in Cyprus. Data from eight public hospitals located in five districts of Cyprus were analyzed from 2009 to 2018. Meteorological hourly gridded data were extracted by the ERA-5 Land reanalysis database with a spatial horizontal resolution of 0.1° × 0.1°. The Physiologically Equivalent Temperature (PET) and the Universal Thermal Climate Index (UTCI) were calculated as measures of the integrated effect of meteorological variables. Negative binomial regression was fitted to examine associations between the daily number of hospital admissions and meteorological variables, PET, and UTCI. The results showed that the mean daily temperature (Tair) was positively associated with hospital admissions from any cause. Hospital admissions increased by 0.6% (p < 0.001) for each 1 °C increase of Tair and by 0.4% (p < 0.001) for each 1 °C increase of PET and UTCI. Ozone and nitrogen oxides act as confounding factors. An effect of particulate matter (less than 10 μm in diameter) was observed when the analysis focused on April to August. Thresholds above which hospital admissions are likely to increase include daily mean Tair = 26.1 °C, PET = 29 °C, and UTCI = 26 °C. Studies on heat-related health effects are necessary to monitor health patterns, raise awareness, and design adaptation and mitigation measures.

Evaluation of Nine Operational Models in Forecasting Different Types of Synoptic Dust Events in the Middle East

This study investigates four types of synoptic dust events in the Middle East region, including cyclonic, pre-frontal, post-frontal and Shamal dust storms. For each of these types, three intense and pervasive dust events are analyzed from a synoptic meteorological and numerical simulation perspective. The performance of 9 operational dust models in forecasting these dust events in the Middle East is qualitatively and quantitatively evaluated against Terra-MODIS observations and AERONET measurements during the dust events. The comparison of model AOD outputs with Terra-MODIS retrievals reveals that despite the significant discrepancies, all models have a relatively acceptable performance in forecasting the AOD patterns in the Middle East. The models enable to represent the high AODs along the dust plumes, although they underestimate them, especially for cyclonic dust storms. In general, the outputs of the NASA-GEOS and DREAM8-MACC models present greater similarity with the satellite and AERONET observations in most of the cases, also exhibiting the highest correlation coefficient, although it is difficult to introduce a single model as the best for all cases. Model AOD predictions over the AERONET stations showed that DREAM8-MACC exhibited the highest R2 of 0.78, followed by NASA_GEOS model (R2 = 0.74), which both initially use MODIS data assimilation. Although the outputs of all models correspond to valid time more than 24 h after the initial time, the effect of data assimilation on increasing the accuracy is important. The different dust emission schemes, soil and vegetation mapping, initial and boundary meteorological conditions and spatial resolution between the models, are the main factors influencing the differences in forecasting the dust AODs in the Middle East.

Respiratory symptoms, lung function, and fraction of exhaled nitric oxide before and after assignment in a desert environment-a cohort study

BACKGROUND

Inhalation of small particulate matter (PM 2.5) may be associated with development of respiratory disease. Increased respiratory symptoms have been reported among military staff after service in countries with recurrent desert storms.

OBJECTIVE

The aim was to investigate whether an assignment in a desert environment and exposure to desert storms are associated with negative effects on respiratory health.

METHODS

In two cohorts of Swedish soldiers serving in Mali as part of the United Nations stabilization forces, examination with spirometry, determination of fraction of exhaled nitric oxide (FeNO), and a questionnaire including participant characteristics, symptoms, and exposure was performed before and after service. Ambient air sampling was conducted on-site. Paired t-test was used to compare pre- and post-variables on lung function data, FeNO and symptom level.

RESULTS

Most indoor and outdoor air measurements of dust and silica were within the Swedish occupational exposure limit for PM2.5 and silica (<0.10-2.7 mg/m³ and <0.002-0.40 mg/m³, respectively) as well as for respirable dust and silica (0.056-0.078 mg/m³and 0.0033-0.025 mg/m³, respectively). In the subgroup of participants with reported exposure to desert storms during the stay in Mali, forced expiratory volume in 1 s (FEV₁) was significantly lower after exposure than before the mission (mean litres (SD) 4.21 ± 0.66 vs 4.33 ± 0.72, p = 0.021).

CONCLUSION

Exposure to a desert storm was associated with a decrease in FEV₁. Exposure to small particulate matter may contribute to the development of respiratory disease and thus spirometry should be performed after occupational exposure to desert storms.

North African dust intrusions and increased risk of respiratory diseases in Southern Portugal

The study of dust intrusions in Portugal is still a subject on which little investigation has been made, especially in terms of their effects. Thus, this work aims to achieve two goals: firstly, to characterize the dust intrusions in the study area; and secondly, to evaluate the possible statistical association between the dust intrusion days and hospital admissions due to respiratory diseases. Dust intrusions in Portugal are prevalent during the summer season. During this season, the dust plumes tend to cover broader areas than in the other seasons and they have origin in the North African countries. In the study area for the period between 2005 and 2015, the relative risk of urgent hospitalizations due to respiratory diseases was 12.6% higher during dust intrusion days. In order to obtain this statistical association, a Distributed Lag Nonlinear Model was developed. With this work, we expect to help the development of further studies regarding North African dust intrusions in Portugal, more precisely their effects on human health.

Long-term PM2.5 exposure and survival among cardiovascular disease patients in Beijing, China

Previous studies have proved that particulate air pollution was related to adverse cardiovascular effects. However, most studies focused on the acute effects of short-term fine particulate matter (PM_2.5) exposure and the general population. Evidence from long-term cohort studies based on the cardiovascular disease (CVD) patients was scarce. Our study aimed to explore the impact of long-term exposure to PM_2.5 on the mortality among post-CVD patients. This is a cohort study that involved 5143 post-CVD patients in Beijing, China. We collected records of CVD patients from hospitals in Beijing, China from 1 January 2012 to 31 December 2012 and followed up these patients from hospital admission until December 31, 2016. The vital status of the patients was determined using the National Death Surveillance Point System (DSPs). The PM_2.5 concentrations were obtained from the Atmospheric Composition Analysis Group. The Cox regression models were used for data analyses. Our findings suggested that increased mortality of CVD patients with an HR of 1.43 (95% CI: 1.24, 1.63) was related to long-term exposure to PM_2.5. The association was stronger for cardiovascular-related mortality, especially for mortality from myocardial infarction (MI). The HR for any CVD mortality was 1.57 (95% CI: 1.27, 1.94), HR for MI mortality was 1.82 (95% CI: 1.16, 2.83). Long-term PM_2.5 exposure may significantly affect the survival of CVD patients. Compared with the general population, patients with CVD are more susceptible to PM_2.5 exposure. Increased attention to the management of CVD patients is warranted.

Short-term effects of air pollution on daily asthma-related emergency department visits in an industrial city

BACKGROUND

Epidemiological studies from Europe and North America have provided evidence that exposure to air pollution can aggravate symptoms in asthmatic patients.

METHODS

Daily number of AEDv, air pollution levels (PM10, PM2.5, SO2, NO2 and CO) and meteorological variables was obtained from Jubail Industrial City, Saudi Arabia, for the period of 2007-11. Data were analyzed using a time-series approach. Relative risks (RRs) were estimated using Poisson regression.

RESULTS

The associations between AEDv and PM10, PM2.5, SO2 and NO2 remained positive and statistically significant after mutual adjustment in the multi-pollutant model.The RR of AEDv increased by 5.4, 4.4, 3.4 and 2.2% per an inter-quartile range increase in SO2 (2.0 ppb), PM2.5 (36 μg/m3), NO2 (7.6 ppb) and PM10 (140 μg/m3), respectively. No significant associations between AEDv and CO were found.

CONCLUSIONS

Current levels of ambient air pollution are associated with AEDv in this industrial setting in the Middle East. Greater awareness of environmental health protection and the implementation of effective measures to improve the quality of air in such settings would be beneficial to public health.

Global Health Impacts of Dust Storms: A Systematic Review

BACKGROUND

Dust storms and their impacts on health are becoming a major public health issue. The current study examines the health impacts of dust storms around the world to provide an overview of this issue.

METHOD

In this systematic review, 140 relevant and authoritative English articles on the impacts of dust storms on health (up to September 2019) were identified and extracted from 28 968 articles using valid keywords from various databases (PubMed, WOS, EMBASE, and Scopus) and multiple screening steps. Selected papers were then qualitatively examined and evaluated. Evaluation results were summarized using an Extraction Table.

RESULTS

The results of the study are divided into two parts: short and long-term impacts of dust storms. Short-term impacts include mortality, visitation, emergency medical dispatch, hospitalization, increased symptoms, and decreased pulmonary function. Long-term impacts include pregnancy, cognitive difficulties, and birth problems. Additionally, this study shows that dust storms have devastating impacts on health, affecting cardiovascular and respiratory health in particular.

CONCLUSION

The findings of this study show that dust storms have significant public health impacts. More attention should be paid to these natural hazards to prepare for, respond to, and mitigate these hazardous events to reduce their negative health impacts.Registration: PROSPERO registration number CRD42018093325.

Short-Term Associations of Ambient Fine Particulate Matter (PM2.5) with All-Cause Hospital Admissions and Total Charges in 12 Japanese Cities

The short-term association between ambient particulate matter ≤2.5 microns in diameter (PM_2.5) and hospital admissions is not fully understood. Studies of this association with hospital admission costs are also scarce, especially in entire hospitalized populations. We examined the association between ambient PM_2.5 and all-cause hospital admissions, the corresponding total charges, and the total charges per patient by analyzing the hospital admission data of 2 years from 628 hospitals in 12 cities in Japan. We used generalized additive models with quasi-Poisson regression for hospital admissions and generalized additive models with log-linear regression for total charges and total charges per patient. We first estimated city-specific results and the combined results by random-effect models. A total of 2,017,750 hospital admissions were identified. A 10 µg/m³ increase in the 2 day moving average was associated with a 0.56% (95% CI: 0.14–0.99%) increase in all-cause hospital admissions and a 1.17% (95% CI: 0.44–1.90%) increase in total charges, and a 10 µg/m³ increase in the prior 2 days was associated with a 0.75% (95% CI: 0.34–1.16%) increase in total charges per patient. Short-term exposure to ambient PM_2.5 was associated with increased all-cause hospital admissions, total charges, and total charges per patient.

Concentration-response relationships between hourly particulate matter and ischemic events: A case-crossover analysis of effect modification by season and air-mass origin

Most studies linking cardiovascular disease with particulate matter (PM) exposures have focused on total mass concentrations, regardless of their origin. However, the origin of an air mass is inherently linked to particle composition and possible toxicity. We examine how the concentration-response relation between hourly PM exposure and ischemic events is modified by air-mass origin and season. Using telemedicine data, we conducted a case-crossover study of 1855 confirmed ischemic cardiac events in Israel (2005-2013). Based on measurements at three fixed-sites in Tel Aviv and Haifa, ambient PM with diameter < 2.5 μm (PM_2.5) and 2.5-10 μm (PM_10-2.5) concentrations during the hours before event onset were compared with matched control periods using conditional logistic regression that allowed for non-linearity. We also examined effect modification of these associations based on the geographical origin of each air mass by season. Independent of the geographical origin of the air mass, we observed concentration-response curves that were supralinear. For example, the overall odds ratios (ORs) of ischemic events for an increase of 10-μg/m³ in the 2-h average of PM_10-2.5 were 1.08 (95% confidence interval (CI): 1.03-1.14) and 1.00 (0.99-1.01) at the median (17.8 μg/m³) and 95th percentile (82.3 μg/m³) values, respectively. Associations were strongest at low levels of PM_10-2.5 when air comes from central Europe in the summer (OR: 1.27; 95% CI: 1.06, 1.52). Our study demonstrates that hourly associations between PM_2.5 and PM_10-2.5 and ischemic cardiac events are supralinear during diverse pollution conditions in a single population that experiences a wide range of exposure levels.

Radiative Effect and Mixing Processes of a Long-Lasting Dust Event over Athens, Greece, during the COVID-19 Period

We report on a long-lasting (10 days) Saharan dust event affecting large sections of South-Eastern Europe by using a synergy of lidar, satellite, in-situ observations and model simulations over Athens, Greece. The dust measurements (11–20 May 2020), performed during the confinement period due to the COVID-19 pandemic, revealed interesting features of the aerosol dust properties in the absence of important air pollution sources over the European continent. During the event, moderate aerosol optical depth (AOD) values (0.3–0.4) were observed inside the dust layer by the ground-based lidar measurements (at 532 nm). Vertical profiles of the lidar ratio and the particle linear depolarization ratio (at 355 nm) showed mean layer values of the order of 47 ± 9 sr and 28 ± 5%, respectively, revealing the coarse non-spherical mode of the probed plume. The values reported here are very close to pure dust measurements performed during dedicated campaigns in the African continent. By utilizing Libradtran simulations for two scenarios (one for typical midlatitude atmospheric conditions and one having reduced atmospheric pollutants due to COVID-19 restrictions, both affected by a free tropospheric dust layer), we revealed negligible differences in terms of radiative effect, of the order of +2.6% (SWBOA, cooling behavior) and +1.9% (LWBOA, heating behavior). Moreover, the net heating rate (HR) at the bottom of the atmosphere (BOA) was equal to +0.156 K/d and equal to +2.543 K/d within 1–6 km due to the presence of the dust layer at that height. On the contrary, the reduction in atmospheric pollutants could lead to a negative HR (−0.036 K/d) at the bottom of the atmosphere (BOA) if dust aerosols were absent, while typical atmospheric conditions are estimated to have an almost zero net HR value (+0.006 K/d). The NMMB-BSC forecast model provided the dust mass concentration over Athens, while the air mass advection from the African to the European continent was simulated by the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model.

Assessment of metals in PM10 filters and Araucaria heterophylla needles in two areas of Quito, Ecuador

The reliability of Araucaria heterophylla needles as a biomonitor was evaluated by analyzing the concentration of metals in PM₁₀ filters and in Araucaria heterophylla needles. The sampling campaign was carried out at two sites in the city of Quito, Ecuador, in 2017–2019. Concentrations of Cr, Cu, K, Mn, Pb, Zn, Ca, Fe, Al and Mg were determined in PM₁₀ filters and in Araucaria heterophylla needles using an Inductively Coupled Plasma – Optical Emission Spectroscopy (ICP-OES). The annual mean concentrations of PM₁₀ ranged between 24.9 and 26.3 μg m⁻³, exceeding the limit established by the World Health Organization (20 μg m⁻³). Statistical analyses, performed for the PM₁₀ filters, showed that dust resuspension and anthropogenic activities were important sources for PM₁₀ emissions in the city. Metals related to natural emissions (Ca, Mg, K, Al and Fe) dominated in both types of samples, while the minor metals were those related to anthropogenic emissions (Zn, Cu, Cr and Pb). The former were positively associated with the needle samples, while the latter were associated with PM₁₀ filters. This work not only improved scientific knowledge on the concentrations of PM₁₀ and metals in the Andean city of Quito, but also greatly contributed to the progress of research on the use of Araucaria heterophylla needles as a biomonitor.

The MEDEA childhood asthma study design for mitigation of desert dust health effects: implementation of novel methods for assessment of air pollution exposure and lessons learned

BACKGROUND

Desert dust events in Mediterranean countries, originating mostly from the Sahara and Arabian deserts, have been linked to climate change and are associated with significant increase in mortality and hospital admissions from respiratory causes. The MEDEA clinical intervention study in children with asthma is funded by EU LIFE+ program to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related health effects.

METHODS

This paper describes the design, methods, and challenges of the MEDEA childhood asthma study, which is performed in two highly exposed regions of the Eastern Mediterranean: Cyprus and Greece-Crete. Eligible children are recruited using screening surveys performed at primary schools and are randomized to three parallel intervention groups: a) no intervention for desert dust events, b) interventions for outdoor exposure reduction, and c) interventions for both outdoor and indoor exposure reduction. At baseline visits, participants are enrolled on MEDena® Health-Hub, which communicates, alerts and provides exposure reduction recommendations in anticipation of desert dust events. MEDEA employs novel environmental epidemiology and telemedicine methods including wearable GPS, actigraphy, health parameters sensors as well as indoor and outdoor air pollution samplers to assess study participants' compliance to recommendations, air pollutant exposures in homes and schools, and disease related clinical outcomes.

DISCUSSION

The MEDEA study evaluates, for the first time, interventions aiming to reduce desert dust exposure and implement novel telemedicine methods in assessing clinical outcomes and personal compliance to recommendations. In Cyprus and Crete, during the first study period (February-May 2019), a total of 91 children participated in the trial while for the second study period (February-May 2020), another 120 children completed data collection. Recruitment for the third study period (February-May 2021) is underway. In this paper, we also present the unique challenges faced during the implementation of novel methodologies to reduce air pollution exposure in children. Engagement of families of asthmatic children, schools and local communities, is critical. Successful study completion will provide the knowledge for informed decision-making both at national and international level for mitigating the health effects of desert dust events in South-Eastern Europe.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03503812 , April 20, 2018.

Long-term air pollution exposure and self-reported morbidity: A longitudinal analysis from the Thai cohort study (TCS)

BACKGROUND

Several studies have shown the health effects of air pollutants, especially in China, North American and Western European countries. But longitudinal cohort studies focused on health effects of long-term air pollution exposure are still limited in Southeast Asian countries where sources of air pollution, weather conditions, and demographic characteristics are different. The present study examined the association between long-term exposure to air pollution and self-reported morbidities in participants of the Thai cohort study (TCS) in Bangkok metropolitan region (BMR), Thailand.

METHODS

This longitudinal cohort study was conducted for 9 years from 2005 to 2013. Self-reported morbidities in this study included high blood pressure, high blood cholesterol, and diabetes. Air pollution data were obtained from the Thai government Pollution Control Department (PCD). Particles with diameters ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) exposures were estimated with ordinary kriging method using 22 background and 7 traffic monitoring stations in BMR during 2005-2013. Long-term exposure periods to air pollution for each subject was averaged as the same period of person-time. Cox proportional hazards models were used to examine the association between long-term air pollution exposure with self-reported high blood pressure, high blood cholesterol, diabetes. Results of self-reported morbidity were presented as hazard ratios (HRs) per interquartile range (IQR) increase in PM10, O3, NO2, SO2, and CO.

RESULTS

After controlling for potential confounders, we found that an IQR increase in PM10 was significantly associated with self-reported high blood pressure (HR = 1.13, 95% CI: 1.04, 1.23) and high blood cholesterol (HR = 1.07, 95%CI: 1.02, 1.12), but not with diabetes (HR = 1.05, 95%CI: 0.91, 1.21). SO2 was also positively associated with self-reported high blood pressure (HR = 1.22, 95%CI: 1.08, 1.38), high blood cholesterol (HR = 1.20, 95%CI: 1.11, 1.30), and diabetes (HR = 1.21, 95%CI: 0.92, 1.60). Moreover, we observed a positive association between CO and self-reported high blood pressure (HR = 1.07, 95%CI: 1.00, 1.15), but not for other diseases. However, self-reported morbidities were not associated with O3 and NO2.

CONCLUSIONS

Long-term exposure to air pollution, especially for PM10 and SO2 was associated with self-reported high blood pressure, high blood cholesterol, and diabetes in subjects of TCS. Our study supports that exposure to air pollution increases cardiovascular disease risk factors for younger population.

Associations Between Dust Storms and Intensive Care Unit Admissions in the United States, 2000-2015

Anthropogenic climate change is influencing the incidence of dust storms and associated human exposure to coarse particulate matter (PM2.5-10) in the United States. Studies have found adverse health consequences related to dust exposure. These consequences include respiratory disease exacerbations and premature mortality, resulting in increased health care utilization. However, the impact of dust storms on critical care demand has not been studied in the United States. We seek to quantify the relationship between dust storms and surges in critical care demand by investigating the association between dust storms and intensive care unit (ICU) admissions at nearby hospitals from 2000 to 2015. ICU data were acquired from Premier, Inc. and encompass 15-20% of all ICU admissions in the United States. Dust storm, meteorology, and air pollutant data were downloaded from the U.S. National Weather Service, the U.S. National Climatic Data Center, and the U.S. Environmental Protection Agency websites, respectively. Associations between ICU admission and dust storms, controlling for temperature, dew point temperature, ambient PM2.5 and ozone, as well as seasonally varying confounders, were estimated using a distributed lag conditional Poisson model with overdispersion. We found a 4.8% (95% CI: 0.4, 9.4; p = 0.033) increase in total ICU admissions on the day of the dust storm (Lag 0) and a 9.2% (95% CI: 1.8, 17.0; p = 0.013) and 7.5% (95% CI: 0.3, 15.2; p = 0.040) increase in respiratory admissions at Lags 0 and 5. North American dust storms are associated with increases in same day and lagged demand for critical care services at nearby hospitals.

Global nature of airborne particle toxicity and health effects: a focus on megacities, wildfires, dust storms and residential biomass burning

Since air pollutants are difficult and expensive to control, a strong scientific underpinning to policies is needed to guide mitigation aimed at reducing the current burden on public health. Much of the evidence concerning hazard identification and risk quantification related to air pollution comes from epidemiological studies. This must be reinforced with mechanistic confirmation to infer causality. In this review we focus on data generated from four contrasting sources of particulate air pollution that result in high population exposures and thus where there remains an unmet need to protect health: urban air pollution in developing megacities, household biomass combustion, wildfires and desert dust storms. Taking each in turn, appropriate measures to protect populations will involve advocating smart cities and addressing economic and behavioural barriers to sustained adoption of clean stoves and fuels. Like all natural hazards, wildfires and dust storms are a feature of the landscape that cannot be removed. However, many efforts from emission containment (land/fire management practices), exposure avoidance and identifying susceptible populations can be taken to prepare for air pollution episodes and ensure people are out of harm's way when conditions are life-threatening. Communities residing in areas affected by unhealthy concentrations of any airborne particles will benefit from optimum communication via public awareness campaigns, designed to empower people to modify behaviour in a way that improves their health as well as the quality of the air they breathe.

Health Effects of Asian Dust: A Systematic Review and Meta-Analysis

BACKGROUND

Potential adverse health effects of Asian dust exposure have been reported, but systematic reviews and quantitative syntheses are lacking.

OBJECTIVE

We reviewed epidemiologic studies that assessed the risk of mortality, hospital admissions, and symptoms/dysfunction associated with exposure to Asian dust.

METHODS

We performed a systematic search of PubMed and Web of Science to identify studies that reported the association between Asian dust exposure and human health outcomes. We conducted separate meta-analyses using a random-effects model for mortality and hospital admissions for a specific health outcome and assessed pooled estimates for each lag when at least three studies were available for a specific lag.

RESULTS

We identified 89 studies that met our inclusion criteria for the systematic review, and 21 studies were included in the meta-analysis. The pooled estimates (percentage changes) of mortality from circulatory and respiratory causes for Asian dust days vs. non-Asian dust days were 2.33% [95% confidence interval (CI): 0.76, 3.93] increase at lag 0 and 3.99% (95% CI: 0.08, 8.06) increase at lag 3, respectively. The increased risk for hospital admissions for respiratory disease, asthma, and pneumonia peaked at lag 3 by 8.85% (95% CI: 0.80, 17.55), 14.55% (95% CI: 6.74, 22.94), and 8.51% (95% CI: 2.89, 14.44), respectively. Seven of 12 studies reported reduced peak expiratory flow, and 16 of 21 studies reported increased respiratory symptoms associated with Asian dust exposure. There were substantial variations between the studies in definitions of Asian dust, study designs, model specifications, and confounder controls.

DISCUSSION

We found evidence of increased mortality and hospital admissions for circulatory and respiratory events. However, the number of studies included in the meta-analysis was not large and further evidences are merited to strengthen our conclusions. Standardized protocols for epidemiological studies would facilitate interstudy comparisons. https://doi.org/10.1289/EHP5312.

The impact of exposure to desert dust on infants' symptoms and countermeasures to reduce the effects

BACKGROUND

The association between particulate matter (PM), including desert dust, and allergic symptoms has not been well studied. We examined whether PM exacerbated nose/eye/respiratory symptoms in infants, with a focus on the desert dust element, and assessed possible countermeasures.

METHODS

We conducted a panel study of 1492 infants from October 2014 to July 2016 in 3 regions in Japan as an adjunct study of the Japan Environment and Children's Study. Infants' daily symptom scores and behaviors were acquired by web-based questionnaires sent to mothers, who answered within a day using mobile phones. Odds ratios (OR) for symptom development per increased fine PM or desert dust exposure were estimated. Regular use of medications and behaviors on the day of exposure were investigated as possible effect modifiers.

RESULTS

Infants developed nose/eye/respiratory symptoms significantly more often in accordance with fine particulate levels (adjusted OR per 10 µg/m³ increase: 1.04, 95% confidence interval [CI]: 1.01-1.07). A model including both fine particulates and desert dust showed reduced OR for fine particulates and robust OR for desert dust (adjusted OR per 0.1/km increase: 1.16, 95% CI: 1.09-1.23). An increased OR was observed both in infants who had previously wheezed and in those who had never wheezed. Receiving information on the particulate forecast, reducing time outdoors, closing windows, and regular use of leukotriene receptor antagonists were significant effect modifiers.

CONCLUSIONS

Transborder desert dust arrival increased the risk of nose/eye/respiratory symptoms development in infants. Regular use of leukotriene receptor antagonists and other countermeasures reduced the risk.

Air pollutants disrupt iron homeostasis to impact oxidant generation, biological effects, and tissue injury

Air pollutants cause changes in iron homeostasis through: 1) a capacity of the pollutant, or a metabolite(s), to complex/chelate iron from pivotal sites in the cell or 2) an ability of the pollutant to displace iron from pivotal sites in the cell. Through either pathway of disruption in iron homeostasis, metal previously employed in essential cell processes is sequestered after air pollutant exposure. An absolute or functional cell iron deficiency results. If enough iron is lost or is otherwise not available within the cell, cell death ensues. However, prior to death, exposed cells will attempt to reverse the loss of requisite metal. This response of the cell includes increased expression of metal importers (e.g. divalent metal transporter 1). Oxidant generation after exposure to air pollutants includes superoxide production which functions in ferrireduction necessary for cell iron import. Activation of kinases and phosphatases and transcription factors and increased release of pro-inflammatory mediators also result from a cell iron deficiency, absolute or functional, after exposure to air pollutants. Finally, air pollutant exposure culminates in the development of inflammation and fibrosis which is a tissue response to the iron deficiency challenging cell survival. Following the response of increased expression of importers and ferrireduction, activation of kinases and phosphatases and transcription factors, release of pro-inflammatory mediators, and inflammation and fibrosis, cell iron is altered, and a new metal homeostasis is established. This new metal homeostasis includes increased total iron concentrations in cells with metal now at levels sufficient to meet requirements for continued function.

Spatio-temporal variability of desert dust storms in Eastern Mediterranean (Crete, Cyprus, Israel) between 2006 and 2017 using a uniform methodology

The characteristics of desert dust storms (DDS) have been shown to change in response to climate change and land use. There is limited information on the frequency and intensity of DDS over the last decade at a regional scale in the Eastern Mediterranean. An algorithm based on daily ground measurements (PM₁₀, particulate matter ≤10 μm), satellite products (dust aerosol optical depth) and meteorological parameters, was used to identify dust intrusions for three Eastern Mediterranean locations (Crete-Greece, Cyprus, and Israel) between 2006 and 2017. Days with 24-hr average PM₁₀ concentration above ~30 μg/m³ were found to be a significant indicator of DDS for the background sites of Cyprus and Crete. Higher thresholds were found for Israel depending on the season (fall and spring: PM₁₀ > 70 μg/m³, winter and summer: PM₁₀ > 90 μg/m³). We observed a high variability in the frequency and intensity of DDS during the last decade, characterized by a steady trend with sporadic peaks. The years with the highest DDS frequency were not necessarily the years with the most intense episodes. Specifically, the highest dust frequency was observed in 2010 at all three locations, but the highest annual median dust-PM₁₀ level was observed in 2012 in Crete (55.8 μg/m³) and Israel (137.4 μg/m³), and in 2010 in Cyprus (45.3 μg/m³). Crete and Cyprus experienced the same most intense event in 2006, with 24 h-PM₁₀ average of 705.7 μg/m³ and 1254.6 μg/m³, respectively, which originated from Sahara desert. The highest 24 h-PM10 average concentration for Israel was observed in 2010 (3210.9 μg/m³) during a three-day Saharan dust episode. However, a sub-analysis for Cyprus (years 2000-2017) suggests a change in DDS seasonality pattern, intensity, and desert of origin. For more robust conclusions on DDS trends in relation to climate change, future work needs to study data over several decades from different locations.

Impacts of climate change on the public health of the Mediterranean Basin population - Current situation, projections, preparedness and adaptation

The Mediterranean Basin is undergoing a warming trend with longer and warmer summers, an increase in the frequency and the severity of heat waves, changes in precipitation patterns and a reduction in rainfall amounts. In this unique populated region, which is characterized by significant gaps in the socio-economic levels particularly between the North (Europe) and South (Africa), parallel with population growth and migration, increased water demand and forest fires risk - the vulnerability of the Mediterranean population to human health risks increases significantly. Indeed, climatic changes impact the health of the Mediterranean population directly through extreme heat, drought or storms, or indirectly by changes in water availability, food provision and quality, air pollution and other stressors. The main health effects are related to extreme weather events (including extreme temperatures and floods), changes in the distribution of climate-sensitive diseases and changes in environmental and social conditions. The poorer countries, particularly in North Africa and the Levant, are at highest risk. Climate change affects the vulnerable sectors of the region, including an increasingly older population, with a larger percentage of those with chronic diseases, as well as poor people, which are therefore more susceptible to the effects of extreme temperatures. For those populations, a better surveillance and control systems are especially needed. In view of the climatic projections and the vulnerability of Mediterranean countries, climate change mitigation and adaptation become ever more imperative. It is important that prevention Health Action Plans will be implemented, particularly in those countries that currently have no prevention plans. Most adaptation measures are "win-win situation" from a health perspective, including reducing air pollution or providing shading solutions. Additionally, Mediterranean countries need to enhance cross-border collaboration, as adaptation to many of the health risks requires collaboration across borders and also across the different parts of the basin.

The effect of dust storm particles on single human lung cancer cells

Exposure to dust particles during dust storms can lead to respiratory problems, diseases, and even death. The effect of dust particles at the cellular level is poorly understood. In this study, we investigated the impact that dust storm particles (Montmorillonite) have on human lung epithelial cells (A549) at the single cell level. Using live-cell imaging, we continuously followed individual cells after exposure to a wide range of concentrations of dust particles. We monitored the growth trajectory of each cell including number and timing of divisions, interaction with the dust particles, as well as time and mechanism of cell death. We found that individual cells show different cellular fates (survival or death) even in response to the same dust concentration. Cells that died interacted with dust particles for longer times, and engulfed more dust particles, compared with surviving cells. While higher dust concentrations reduced viability in a dose-dependent manner, the effect on cell death was non-monotonic, with intermediate dust concentration leading to a larger fraction of dying cells compared to lower and higher concentrations. This non-monotonic relationship was explained by our findings that high dust concentrations inhibit cell proliferation. Using cellular morphological features, supported by immunoblots and proinflammatory cytokines, we determined that apoptosis is the dominant death mechanism at low dust concentrations, while higher dust concentrations activate necrosis. Similar single cell approaches can serve as a baseline for evaluating other aerosol types that will improve our understanding of the health-related consequences of exposure to dust storms.

The Alerting Effect from Rising Public Awareness of Air Quality on the Outdoor Activities of Megacity Residents

This study investigated how the public awareness of air quality affects people’s decisions to participate in outdoor activities. Given that the keyword search volume of particulate matter (PM) in Seoul, South Korea started to grow dramatically only after November 2013, we defined two periods (low and high public awareness of PM) and conducted a series of comparative analyses to investigate the impact of public awareness of air quality on the relationship between PM level and people’s outdoor activities. In the low public awareness period, people’s outdoor activities measured by the number of daily subway passengers did not significantly vary over PM levels, even in the ’unhealthy’ range (80 < PM10 < = 150 µg/m3). On the contrary, during the high awareness period, people’s activities were significantly affected by the PM level, even in the ’moderate’ range. Specifically, the perceived safety threshold of PM10 level that people use to decide for engaging outdoor activities has decreased from 120 to 70 µg/m3. These results suggest that public awareness of air quality and its harmful ramifications on health is a key determinant of outdoor activities rather than PM10 concentration itself. Thus, this study alludes to a need for more timely and effective dissemination of air quality information to the public as much as for curbing anthropogenic emissions.

ATR-FTIR Spectral Analysis and Soluble Components of PM10 And PM2.5 Particulate Matter over the Urban Area of Palermo (Italy) during Normal Days and Saharan Events

Several epidemiological studies have shown a close relationship between the mass of particulate matter (PM) and its effects on human health. This study reports the identification of inorganic and organic components by attenuated total reflectance-Fourier-transform infrared spectroscopy (ATR-FTIR) analysis in PM₁₀ and PM_2.5 filters collected from three air quality monitoring stations in the city of Palermo (Sicily, Italy) during non-Saharan dust events and Saharan events. It also provides information on the abundance and types of water-soluble species. ATR-FTIR analysis identified sulfate, ammonium, nitrate, and carbonate matter characterized by vibrational frequencies at 603, 615, 670, and 1100 cm^–1 (SO₄^2–); at 1414 cm^–1 (NH₄⁺); at 825 and 1356 cm^–1 (NO₃^–); and at 713, 730, and 877 cm^–1 (CO₃^2–) in PM₁₀ and PM_2.5 filters. Moreover, aliphatic hydrocarbons were identified in the collected spectra. Stretching frequencies at 2950 cm^–1 were assigned to CH₃ aliphatic carbon stretching absorptions, while frequencies at 2924 and 2850 cm^–1 indicated CH₂ bonds. In filters collected during Saharan dust events, the analysis also showed the presence of absorbance peaks typical of clay minerals. The measurement of soluble components confirmed the presence of a geogenic component (marine spray and local rocks) and secondary particles ((NH₄)₂SO₄, NH₄NO₃) in the PM filters. ATR-FTIR characterization of solid surfaces is a powerful analytical technique for identifying inorganic and organic compounds in samples of particulate matter.

Ambient air pollution and respiratory mortality in Xi'an, China: a time-series analysis

Background

Although air pollution is a known fundamental problem in China, few studies have investigated the associations between ambient air pollution and respiratory mortality in non-metropolitan cities of China. The study aimed to investigate a potential relationship between short-term exposure to ambient air pollutants and respiratory mortality in Xi’an, China.

Methods

Daily averages of PM_2.5, SO₂, O₃, temperature, relative humidity and daily counts of respiratory mortality were obtained (2014–2016). Using a single and multi-pollutant approach in time-series analysis, the generalized additive model with natural splines was used for analysis. Subgroup analysis stratified by gender and age group (≤ 64 years and ≥ 65 years) was conducted.

Results

Seven thousand nine hundred sixty-five cases of respiratory mortality were assessed, with 62.9, 28.5, and 8.6% of mortality attributed to chronic lower respiratory diseases, influenza and pneumonia, as well as other forms of respiratory diseases, respectively. Observed pollutants were significantly associated with respiratory mortality. In the single pollutant model, 10 μg/m³ increase in a two-day moving average of PM_2.5, and SO₂ concentrations were significantly associated with relative risk 1.313(1.032, 1.708) and 1.4020(0.827, 2.854) of respiratory mortality, respectively. The effects of both air pollutants remained statistically significant after adjusting for collinearity in the multi-pollutant model. Ozone was only statistically associated with respiratory mortality in females at lag 0 [RR: 0.964(0.938, 0.991)].

Conclusion

This study provided evidence that respiratory mortality in Xi’an was significantly associated with exposure to ambient air pollutants from 2014 to 2016.

Acute effects of air pollution on mortality: A 17-year analysis in Kuwait

BACKGROUND

The health burden from exposure to air pollution has been studied in many parts of the world. However, there is limited research on the health effects of air quality in arid areas where sand dust is the primary particulate pollution source.

OBJECTIVE

Study the risk of mortality from exposure to poor air quality days in Kuwait.

METHODS

We conducted a time-series analysis using daily visibility as a measure of particulate pollution and non-accidental total mortality from January 2000 through December 2016. A generalized additive Poisson model was used adjusting for time trends, day of week, and temperature. Low visibility (yes/no), defined as visibility lower than the 25th percentile, was used as an indicator of poor air quality days. Dust storm events were also examined. Finally, we examined these associations after stratifying by gender, age group, and nationality (Kuwaitis/non-Kuwaitis).

RESULTS

There were 73,748 deaths from natural causes in Kuwait during the study period. The rate ratio comparing the mortality rate on low visibility days to high visibility days was 1.01 (95% CI: 0.99-1.03). Similar estimates were observed for dust storms (1.02, 95% CI: 1.00-1.04). Higher and statistically significant estimates were observed among non-Kuwaiti men and non-Kuwaiti adolescents and adults.

CONCLUSION

We observed a higher risk of mortality during days with poor air quality in Kuwait from 2000 through 2016.

Economic Impact and Risk Assessment of Sand and Dust Storms (SDS) on the Oil and Gas Industry in Kuwait

There is a lack of published research on the economic effect and the risk associated with sand and dust storms (SDS) worldwide. The objectives of this study are to estimate the economic impact of SDS on the oil and gas industry in Kuwait, to estimate a risk index for each loss, and to recommend a sustainable system for the mitigation of the damaging effects and economic losses of infrastructures. Hot spots of wind erosion, wind corridors, and dust frequency and severity formed the basis to locate the most susceptible oil and gas fields and operations. Ten sectors with potential loss vulnerabilities were evaluated: exploration, drilling, production, gas, marine, soil remediation, project management, water handling, maintenance, and research and development. Sand encroachment, although not a sector per se, was also considered. The results indicate that sand, and to lesser extent dust, are damaging and costly to the oil and gas infrastructure of Kuwait, with an economic cost estimation of US$9.36 million, a total of 5159 nonproductive lost hours, and 347,310 m3 of annual sand removal. A risk assessment identified three sectors with the highest risk indices (RI): drilling (RI = 25), project management (RI = 20), and maintenance (RI = 16). Sand encroachment also constituted a high risk (RI = 25). Mitigation of sand storms using a hybrid biological–mechanical system was shown to be cost-effective with an equivalent saving of 4.6 years of sand encroachment. The hazard implications of sand storm events continue to be a major concern for policy-makers given their detrimental economic impacts, and require that government officials wisely allocate investment budgets to effectively control and mitigate their damaging effects.

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

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

Ischemic Heart Disease Mortality and Diesel Exhaust and Respirable Dust Exposure in the Diesel Exhaust in Miners Study

Diesel exhaust is a suggested risk factor for ischemic heart disease (IHD), but evidence from cohorts using quantitative exposure metrics is limited. We examined the impact of respirable elemental carbon (REC), a key surrogate for diesel exhaust, and respirable dust (RD) on IHD mortality, using data from the Diesel Exhaust in Miners Study in the United States. Using data from a cohort of male workers followed from 1948-1968 until 1997, we fitted Cox proportional hazards models to estimate hazard ratios for IHD mortality for cumulative and average intensity of exposure to REC and RD. Segmented linear regression models allowed for nonmonotonicity. Hazard ratios for cumulative and average REC exposure declined relative to the lowest exposure category before increasing to 0.79 and 1.25, respectively, in the highest category. Relative to the category containing the segmented regression change points, hazard ratios for the highest category were 1.69 and 1.54 for cumulative and average REC exposure, respectively. Hazard ratios for RD exposure increased across the full exposure range to 1.33 and 2.69 for cumulative and average RD exposure, respectively. Tests for trend were statistically significant for cumulative REC exposure (above the change point) and for average RD exposure. Our findings suggest excess risk of IHD mortality in relation to increased exposure to REC and RD.

Mortality burden attributable to PM1 in Zhejiang province, China

BACKGROUND

Limited evidence is available on the health effects of particulate matter with an aerodynamic diameter of <1 μm (PM₁), mainly due to the lack of its ground measurement worldwide.

OBJECTIVES

To identify and examine the mortality risks and mortality burdens associated with PM₁, PM_2.5, and PM₁₀ in Zhejiang province, China.

METHODS

We collected daily data regarding all-cause (stratified by age and gender), cardiovascular, stroke, respiratory, and chronic obstructive pulmonary disease (COPD) mortality, and PM₁, PM_2.5, and PM₁₀, from 11 cities in Zhejiang province, China during 2013 and 2017. We used a quasi-Poisson regression model to estimate city-specific associations between mortality and PM concentrations. Then we used a random-effect meta-analysis to pool the provincial estimates. To show the mortality burdens of PM₁, PM_2.5, and PM₁₀, we calculated the mortality fractions and deaths attributable to these PMs.

RESULTS

Daily concentrations of PM₁, PM_2.5, and PM₁₀ ranged between 0-199 μg/m³, 0-218 μg/m³, and 0-254 μg/m³, respectively; Mortality effects were significant in lag 0-2 days. The relative risks for all-cause mortality were 1.0064 (95% CI: 1.0034, 1.0094), 1.0061 (95% CI: 1.0034, 1.0089), and 1.0060 (95% CI: 1.0038, 1.0083) associated with a 10 μg/m³ increase in PM₁, PM_2.5, and PM₁₀, respectively. Age- and gender-stratified analysis shows that elderly people (aged 65+) and females are more sensitive to PMs. The mortality fractions of all-cause mortality were estimated to be 2.39% (95% CI: 1.28, 3.48) attributable to PM₁, 2.53% (95% CI: 1.42, 3.63) attributable to PM_2.5, and 3.08% (95% CI: 1.95, 4.19) attributable to PM₁₀. The ratios of attributable cause-specific deaths for PM₁/PM_2.5, PM₁/PM₁₀, and PM_2.5/PM₁₀ were higher than the ratios of their respective concentrations.

CONCLUSIONS

PM₁, PM_2.5 and PM₁₀ are risk factors of all-cause, cardiovascular, stroke, respiratory, and COPD mortality. PM₁ accounts for the vast majority of short-term PM_2.5- and PM₁₀-induced mortality. Our analyses support the notion that smaller size fractions of PM have a more toxic mortality impacts, which suggests to develop strategies to prevent and control PM₁ in China, such as to foster strict regulations for automobile and industrial emissions.

Acute effect of fine and coarse particular matter on cardiovascular visits in Ningbo, China

Although a growing number of epidemiological studies have been conducted on size-specific health effects of particulate matter in China, results remain inconsistent. In this study, we investigated acute effect of fine and coarse particular matter on cardiovascular hospital visits in Ningbo, China. We used generalized additive models to examine short-term effects of PM_2.5 and PM_10-2.5 on cardiovascular hospital visits by adjustment for temporal, seasonal, and meteorological effects. Subgroup analyses were conducted by age, sex, and season. We also examined the stability of their effects in multi-pollutant models. We found that PM_2.5 were associated with cardiovascular hospital visits (RR = 1.006; 95% CI 1.000, 1.011) and results remained similar after adjustment for PM_10-2.5 (RR = 1.005; 95% CI 0.998, 1.013). There was a borderline association between PM_10-2.5 and cardiovascular hospital visits (RR = 1.007; 95% CI 0.997, 1.016), which disappeared after controlling for PM_2.5 (RR = 1.000; 95% CI 0.988, 1.013). The associations appeared to be stronger in the cold season and among the elderly (≥ 75 years). The findings of this study suggested significant adverse effects of PM_2.5, but no independent effects of PM_10-2.5 on cardiovascular hospital visits. Additional studies are needed to confirm these findings.

Metals and metalloids in PM10 in Nandan County, Guangxi, China, and the health risks posed

Intense mining, smelting, and tailing activities of polymetallic ore deposits have affected the environment in Nandan County, Guangxi, China. Samples of particulates with aerodynamic diameters low or equal 10 μm (PM₁₀) were collected in Nandan County to investigate the concentrations of and health risks posed by 17 metals and metalloids in the PM₁₀. The metal and metalloid concentrations were lower than those found in other industrial cities. The mean Cr concentration was 7.48 ng/m³. Significant higher metal and metalloid concentrations were found in PM₁₀ from mining areas (Dachang and Chehe) than from the control area (Liuzhai) (p < 0.05). Principal component analysis indicated that the main sources of Ba, Co, Cr, Fe, K, Mg, Mo, Na, and Sr were resuspension of the soil produced through mineral erosion, the main sources of As, Cd, Cu, Pb, Sb, and Zn were smelting and mining activities, and the main source of Ni was fossil fuel combustion. Higher non-carcinogenic and carcinogenic risks were posed in Dachang and Chehe than in Liuzhai. The non-carcinogenic risks posed to adults and children by individual metals and metalloids in PM₁₀ at all the sites were low, but the non-carcinogenic risks posed to children by all the metals and metalloids together exceeded the safe level (i.e., risk value > 1). The carcinogenic risks posed by Cd, Ni, and Pb were negligible at all sites, while As, Co, and Cr posed potential carcinogenic risks to the residents.