Particulate air pollution on cardiovascular mortality in the tropics: impact on the elderly

Individual effects and interactions between ultrafine particles and extreme temperatures on hospital admissions of high burden diseases

BACKGROUND

Health effects of ultrafine particles (UFPs) and their interactions with temperature are less studied. We investigated the risks of UFPs concentrations and extreme temperatures on hospitalizations for high-burden diseases (HBDs) in New York State (NYS).

METHODS

This case-crossover study included hospitalizations for HBDs that contain ischemic heart diseases, diabetes, stroke, kidney diseases, and depression using NYS Hospital Discharge Data (2013-2018). Daily pollutants and temperature data were obtained from a chemical transport model validated by multiple prior studies. UFP changes were measured using interquartile range increase, and extreme heat and cold were defined as temperatures >= 90th% and <=10th% respectively by month and location. Conditional logistic regression was applied controlling for criteria pollutants, relative humidity, and time-varying variables.

RESULTS

Among 1,308,518 cases, significant risk ratios (RR) were observed for UFPs (RRs ranged: 1.009-1.012) and extreme heat (RRs ranged: 1.024-1.028) on overall HBDs, but extreme cold had protective effects on HBDs. The adverse effect of UFPs had significant interactions with extreme cold and was higher in winter and fall. UFPs affected all HBD subtypes except kidney diseases, and extreme heat increased the risks of ischemic heart disease and kidney disease. There were disparities across demographics in exposures-HBDs associations although they were not statistically significant. Elevated UFP concentrations were associated with four clinical indicators (hospital stays, charges etc.).

CONCLUSION

We observe positive associations between elevated UFP concentrations or extreme heat and HBD hospitalizations, but negative associations with extreme cold. The UFPs' risks were higher in children and during cold seasons.

Effect of Ozone Exposure on Cardiovascular and Cerebrovascular Disease Mortality in the Elderly

BACKGROUND

Ozone pollution has increased alongside China's economic development, contributing to public health issues such as cardiovascular and cerebrovascular diseases. At present, the problem of an aging population is aggravated, which is worth more attention in terms of the health problems of elderly people.

METHODS

This study employed a distributional lag nonlinear model (DLNM) with Poisson regression to analyze the impact of ozone on cardiovascular and cerebrovascular disease mortality among the elderly in Shenyang, China, from 2014 to 2018. In addition, a time-series generalized additive regression model (GAM) was used to analyze the joint effect between PM2.5 and ozone.

RESULTS

We found a positive correlation between ozone and mortality from cardiovascular and cerebrovascular diseases in the elderly. The maximum relative risk (RR) of mortality from cardiovascular and cerebrovascular diseases for every 10 μg/m3 increase in ozone was 1.005 (95% CI: 1.002-1.008). Males (RR: 1.018, 95% CI: 1.007-1.030), individuals in unconventional marital status (RR: 1.024, 95% CI: 1.011-1.038), and outdoor workers (RR: 1.017, 95% CI: 1.002-1.031) were more vulnerable to ozone pollution. This study did not find significant differences in the impact of ozone pollution on cardiovascular and cerebrovascular disease mortality risks among different educational groups. Additionally, a joint effect between ozone and PM2.5 was observed.

CONCLUSION

This study confirms that ozone exposure is positively associated with increased mortality from cardiovascular and cerebrovascular diseases. It emphasizes the joint effect of ozone and PM2.5 in exacerbating cardiovascular and cerebrovascular disease mortality.

Parathyroid hormone mediates the adverse impact of air pollution exposure on serum 25-hydroxyvitamin D: A nationwide cross-sectional study in China

BACKGROUND

Maintaining normal levels of 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) is crucial for preserving skeletal health. However, evidence regarding the associations of exposure to air pollution with serum 25(OH)D and PTH were limited and ambiguous. Hence, the objective of this cross-sectional study was to systematically evaluate the association between air pollution [particulate matter ≤ 2.5 μm (PM2.5) and ozone (O3)] exposure and serum 25(OH)D and PTH levels in males aged 50 and above and postmenopausal female.

MATERIALS AND METHODS

This study is multicenter, cross-sectional study within the framework of the ongoing China Community-based Cohort of Osteoporosis. The 1-year-average PM2.5 and O3 exposures prior to the baseline survey were estimated using random forest models with relatively high accuracy. Multiple linear regression models were employed to assess the associations between PM2.5 and O3 concentrations with the serum levels of 25(OH)D and PTH. Furthermore, mediation analysis was performed to scrutinize the potential mediating role of PTH in the interplay between PM2.5, O3, and serum 25(OH)D.

RESULTS

A total of 13194 participants were included. Our analysis showed that every 10 μg/m3 increase in the 1-year average PM2.5, were associated with -0.32 units (95% CI: 0.48, -0.17) of change in the 25(OH)D and 0.15 units (95% CI: 0.11, 0.19) of change in the PTH, respectively. Every 10 μg/m3 increase in the 1-year average O3, were associated with -0.78 units (95% CI: 1.05, -0.51) of change in the 25(OH)D and 0.50 units (95% CI: 0.43, 0.57) of change in the PTH, respectively. Estimates of the mediation ratio indicated that increased PTH mediated a 50.48% negative correlation between PM2.5 exposure and circulating 25(OH)D level. Increased PTH mediated 69.61% of the negative effects of O3 exposure on circulating 25(OH)D level.

CONCLUSIONS

Exposure to PM2.5 and O3 significantly diminished 25(OH)D while elevating PTH levels. Notably, the elevated PTH concentration partially mediates the associations between PM2.5 and O3 exposure and 25(OH)D level.

Estimation of PM2.5 using high-resolution satellite data and its mortality risk in an area of Iran

Satellite-based exposure of fine particulate matters has been seldom used as a predictor of mortality. PM2.5 was predicted using Aerosol Optical Depths (AOD) through a two-stage regression model. The predicted PM2.5 was corrected for the bias using two approaches. We estimated the impact by two different scenarios of PM2.5 in the model. We statistically found different distributions of the predicted PM2.5 over the region. Compared to the reference value (5 µg/m3), 90th and 95th percentiles had significant adverse effect on total mortality (RR 90th percentile:1.45; CI 95%: 1.08-1.95 and RR 95th percentile:1.53; CI 95%: 1.11-2.1). Nearly 1050 deaths were attributed to any range of the air pollution (unhealthy range), of which more than half were attributed to high concentration range. Given the adverse effect of extreme values compared to the both scenarios, more efforts are suggested to define local-specific reference values and preventive strategies.

[Personal nitrogen oxides exposure levels and related influencing factors in adults over 35 years old in Tianjin and Shanghai]

OBJECTIVE

To investigate personal exposures to nitrogen oxides (NOX) and nitrogen di-oxide (NO2) and the influence of baseline personal characteristics, living environment and daily activity patterns of the participants on the exposures among adults over 35 in Tianjin and Shanghai.

METHODS

In this panel study, 91 healthy nonsmoking adults aged over 35 from Tianjin and Shanghai participated in our study. The study was conducted in summer and winter. The participants were followed for three times with an interval of at least two weeks. Only participants in Shanghai were followed once in winter because of the COVID-19 pandemic. Twenty-seven participants completed follow-up visits in both seasons. We measured their 24 h personal exposures to NOX and NO2and collected their baseline and time-activity information through questionnaire/diary. The linear mixed model was used to analyze the associations between potential influencing factors and personal NOX and NO2 exposure levels.

RESULTS

There were 349 follow-up visits with valid 24 h personal NO2 and NOX exposure measurements in the two cities. The ave-rage 24 h personal exposures to NO2 and NOX (volume fraction) in Tianjin participants were 18.0×10-9 and 26.2×10-9 in summer, and 31.0×10-9 and 54.9×10-9 in winter, respectively; and the average 24 h personal exposures to NO2 and NOX in Shanghai participants were 38.7×10-9 and 100.0×10-9 in summer, and 45.5×10-9 and 139.2×10-9 in winter, respectively. The results of univariate regression analysis showed that their personal NOX exposure levels were significantly associated with city, season, gender, average daily cooking times, and ambient NO2 concentrations measured at fixed-site monitoring stations. In addition to the above factors, the personal NOX exposure levels were also significantly associated with educational level and the personal NO2 exposure levels were also significantly associated with passive smoking, average daily home time, cooking energy type, residential distance from main traffic road, and use of kitchen ventilators. Multivariate regression analysis showed that the personal exposure levels of NO2 and NOX were significantly lower in Tianjin than that in Shanghai, were significantly lower in summer than that in winter, and were significantly and positively associated with ambient NO2 concentrations measured at fixed-site monitoring stations. In addition, personal NOX exposure levels were significantly lower in females than in males, and personal NO2 exposure levels were significantly positively associated with average daily cooking times and significantly inversely associated with average daily home time. For every interquartile range (IQR) increase (12.7×10-9) in ambient NO2, the personal NO2 exposure levels increased by 27.5% (95%CI: 17.0%-38.9%), and personal NOX exposure levels increased by 16.1% (95%CI: 7.1%-25.8%).

CONCLUSION

Season, city and ambient NO2 concentrations are significant influencing factors of personal exposure levels of NO2and NOX. At the same time, the personal exposures levels of NO2are also affected by lifestyle factors. Our study provides scientific evidence for making precise air pollution control decisions and reducing the exposure levels of NOX in the population.

Effect Modification of Heat-Related Mortality Risk by Air Pollutants in Shandong, China

Although studies have reported the modification effect of air pollutants on heat-related health risk, little is known on the modification effect among various particulate matter with different particle size on mortality. We aimed to investigate whether the associations of hot temperatures with daily mortality were modified by different air pollutant levels in Shandong Province, China. Daily data of air pollutants, meteorological factors, and mortality of 1,822 subdistricts in Shandong province from 2013 to 2018 were collected. We used a time-stratified case-crossover model with an interaction term between the cross-basis term for ambient temperature and the linear function of particulate matter ≤1 µm (PM1), PM2.5, nitrogen dioxide (NO2), and ozone to obtain heat-mortality associations during the hot season. Results showed that the cumulative odds ratio of extreme heat on mortality over 0 to 10 days was 3.66 (95% CI: 3.10-4.31). The mortality risk during hot seasons was stronger at high air pollutant levels. The modification effect of particulate matters on heat-related mortality decreased by its aerodynamic diameter. Females and older adults over 75 years were more vulnerable to the modification effect of air pollutants, and significant differences were detected in the association between temperatures and mortality stratified by PM1 and PM2.5. Higher heat-related mortality risks were observed at high NO2 levels, especially for cardiorespiratory disease. The findings suggest that more consideration should be given to the combined effect of very fine particles and NO2 with ambient heat when developing healthcare strategies, and women and older adults should be given priority in health-related settings.

Short-term association of particulate matter and cardiovascular disease mortality in Shanghai, China between 2003 and 2020

Objective

Evidence regarding the effects of particulate matter (PM) pollutants on cardiovascular disease (CVD) mortality remains limited in Shanghai, China. Our objective was to thoroughly evaluate associations between PM pollutants and CVD mortality.

Methods

Daily data on CVD mortality, PM (PM10 and PM2.5) pollutants, and meteorological variables in Shanghai, China were gathered from 2003 to 2020. We utilized a time-series design with the generalized additive model to assess associations between PM pollutants and CVD mortality. Additionally, we conducted stratified analyses based on sex, age, education, and seasons using the same model.

Results

We found that PM pollutants had a significant association with CVD mortality during the study period. Specifically, there was a 0.29% (95%CI: 0.14, 0.44) increase in CVD mortality for every 10 μg/m3 rise in a 2-day average (lag01) concentration of PM10. A 0.28% (95% CI: 0.07, 0.49) increase in CVD mortality was associated with every 10 μg/m3 rise in PM2.5 concentration at lag01. Overall, the estimated effects of PM10 and PM2.5 were larger in the warm period compared with the cold period. Furthermore, males and the older adult exhibited greater susceptibility to PM10 and PM2.5 exposure, and individuals with lower education levels experienced more significant effects from PM10 and PM2.5 than those with higher education levels.

Conclusion

Our findings suggested that PM pollutants have a substantial impact on increasing CVD mortality in Shanghai, China. Moreover, the impacts of air pollution on health may be altered by factors such as season, sex, age, and educational levels.

Is biomagnetic leaf monitoring still an effective method for monitoring the heavy metal pollution of atmospheric particulate matter in clean cities?

The development of a reasonable method for predicting heavy metals (HMs) pollution in atmospheric particulate matter (PM) remains challenging. This paper presents an elution-filtration method to collect PM from the surface of Osmanthus fragrans in a very clean area (Guiyang, China). The aim is to evaluate the effectiveness of biomagnetic leaf monitoring as a simple and rapid method for assessing HMs pollution in clean cities. For this purpose, we determined the magnetic parameters and concentrations of selected HMs in PM samples to investigate their relationships. The results showed that the magnetic minerals in PM samples were mainly low coercivity ferrimagnetic minerals, with a small amount of high coercivity minerals. The types of magnetic minerals were generally single, and the magnetic domain state was pseudo-single domain (PSD). There was a significant correlation between magnetic parameters and the heavy metal (HM) concentrations in PM. Low-field magnetic susceptibility (χ) could be used as an ideal proxy for determining anthropogenic HM pollution. Traffic emissions were the main atmospheric pollution source in urban Guiyang. Due to the incomplete traffic network and large traffic flow, traffic congestion (TC) often occurred at road intersections in the northwest and southwest corners of the city, resulting in the highest concentration of magnetic minerals and the most severe PM pollution. To mitigate atmospheric PM pollution and protect public health, it is strongly recommended that municipal authorities prioritize urban planning and traffic management to address TC. Measures should be implemented urgently to alleviate stop-and-go traffic.

Evaluation of the effect of particulate matter on construction accidents using relative probability

PM10 is known to have a great adverse effect on the human body. However, there is a lack of research analyzing the impact of PM10 on the occurrence of accidents. Accordingly, the purpose of this study is to analyze the correlation between PM10 and accidents in the construction industry and to present a new concentration group to manage accidents caused by PM10 in the construction industry. This study was conducted in the following four stages. (i) collection of data, (ii) classification of data, (iii) relative probability analysis, and (iv) modified PM10 group classification. The main results of this study are as follows. When the frequency analysis of the traditional method was conducted, 3,721 accidents occurred at a PM10 concentration of 32 μg/m3. However, as a result of the relative probability analysis presented in this study, it was confirmed that the relative accident probability increased as the PM10 concentration increased. In addition, the current PM10 concentration is presented by the WHO in six groups from a health perspective. However, in this study, the newly proposed PM10 group was classified into three groups from the perspective of the probability of construction accidents. The group proposed in this study is not from a health perspective but a group for managing construction site accidents. The contribution of this study was to confirm that PM10 also affects accidents occurring at construction sites, and the impact of PM10 on accidents was quantitatively analyzed through the relative probability analysis presented in this study.

Association of physical activity and PM2.5-attributable cardiovascular disease mortality in the United States

Objective

The study aimed to explore the association between physical activity (PA) and PM2. 5-attributable cardiovascular disease (CVD) mortality trends across the United States (US) at the state level.

Methods

We conducted a cross-sectional study using data from the Global Burden of Disease 2019 study for PM2.5-attributable CVD mortality and the Behavioral Risk Factor Surveillance System for PA prevalence. The study covered all 50 US states and the District of Columbia from 2001 to 2019. We utilized Joinpoint Regression to calculate AAPC from 2011 to 2019 and Pearson correlation coefficients to assess state-level associations between PA and PM2.5-attributable CVD mortality AAPC.

Results

During 2011-2019, a total of 244,318 PM2.5-attributable CVD deaths were recorded. The age-adjusted mortality rates (AAMR) of PM2.5-attributable CVD declined substantially from 2011 to 2019 across all US states, with the most pronounced reductions observed in industrialized states such as West Virginia (51% decline), Kentucky (32%), and Ohio (22%). AAMR ratios for the US states varied substantially, ranging from 0.1 in Hawaii to 1.7 in Arkansas. The AAPC ranged from -9.4% (West Virginia) to -1.7% (New Mexico) in the majority of states, while a few states such as Alaska, Wyoming, and Washington saw slight positive AAPCs from 0.9 to 2.9%. A significant correlation was found between PA and PM2.5-attributable CVD mortality trends (r = 0.454, p = 0.001), with similar results in subgroup analyses.

Conclusion

Our findings suggest a correlation between increased physical activity (PA) and increased PM2.5-attributable CVD mortality, highlighting the potential need to consider PM2.5 exposure when engaging in PA to mitigate adverse cardiovascular health impacts. However, further research is warranted to establish causality and underlying mechanisms in the relationship between PA and PM2.5-attributable CVD mortality. Potential limitations include reliance on self-reported PA data.

Assessing heavy metal pollution load index (PLI) in biomonitors and road dust from vehicular emission by magnetic properties modeling

Vehicular traffic occupies a significant place among the sources of air pollution, due to population and urban growth that has led to an excessive increase in the vehicle fleet worldwide, and in Costa Rica as well. Vehicle emissions generate greenhouse gases (GHGs), particulate matter (PM), and heavy metals (HMs), due to combustion products from fossil-fuel engines, tire wear, and brake linings. HMs are important because they cannot be degraded or destroyed naturally; however, they can be diluted by physicochemical agents and be incorporated into trophic chains where they can be bioaccumulated causing significant negative effects on human well-being and ecological quality. This study aimed to assess the HM pollution load in biomonitors and road dust from vehicular emissions by chemical analyses and magnetic properties modeling. For this purpose, chemical and magnetic property analyses were carried out on samples of road dust and leaves of Cupressus lusitanica Mill. and Casuarina equisetifolia L., which were sampled during 2 different years in the Greater Metropolitan Area of Costa Rica known as GAM. Contamination factor (CF) and pollution load index (PLI) results showed significant metal pollution in some of the study sites. Contamination by the metals V, Cr, and Zn was most commonly present in the biomonitors, and for road dust, they were Cr, Zn, and Pb. The PLI estimates obtained with the validated support vector machine (SVM) magnetic properties models were consistent (sensitivity, specificity, and precision) with those obtained by chemical analysis, demonstrating the feasibility of this method for the identification of this index of contamination.

A Multi-Pollutant and Meteorological Analysis of Cardiorespiratory Mortality among the Elderly in São Paulo, Brazil-An Artificial Neural Networks Approach

Traditionally, studies that associate air pollution with health effects relate individual pollutants to outcomes such as mortality or hospital admissions. However, models capable of analyzing the effects resulting from the atmosphere mixture are demanded. In this study, multilayer perceptron neural networks were evaluated to associate PM₁₀, NO₂, and SO₂ concentrations, temperature, wind speed, and relative air humidity with cardiorespiratory mortality among the elderly in São Paulo, Brazil. Daily data from 2007 to 2019 were considered and different numbers of neurons on the hidden layer, algorithms, and a combination of activation functions were tested. The best-fitted artificial neural network (ANN) resulted in a MAPE equal to 13.46%. When individual season data were analyzed, the MAPE decreased to 11%. The most influential variables in cardiorespiratory mortality among the elderly were PM₁₀ and NO₂ concentrations. The relative humidity variable is more important during the dry season, and temperature is more important during the rainy season. The models were not subjected to the multicollinearity issue as with classical regression models. The use of ANNs to relate air quality to health outcomes is still very incipient, and this work highlights that it is a powerful tool that should be further explored.

Association between Outdoor Air Pollution and Fatal Acute Myocardial Infarction in Lithuania between 2006 and 2015: A Time Series Design

BACKGROUND

Air pollution has a significant effect on human health and there is a broad body of evidence showing that exposure to air pollution is associated with an increased risk of adverse health effects. The main objective of this study was to assess the association of traffic-related air pollutants with fatal AMI during the ten-year period.

METHODS

The study was conducted in Kaunas city, where the WHO MONICA register included a total of 2273 adult cases of fatal AMI cases during the 10-year study period. We focused on the period between 2006 and 2015. The associations between exposure to traffic-related air pollution and the risk of fatal AMI were evaluated by using a multivariate Poisson regression model, RR presented per an increase in IQR.

RESULTS

It was found that the risk of fatal AMI was significantly higher in all subjects (RR 1.06; 95% CI 1.00-1.12) and women (RR 1.12; 95% CI 1.02-1.22) when the concentration of PM₁₀ in the ambient air was increased 5-11 days before the onset of AMI, adjusting for NO₂ concentration. The effect was stronger during spring in all subjects (RR 1.12; 95% CI 1.03-1.22), in men (RR 1.13; 95% CI 1.01-1.26), in younger-aged (RR 1.15; 95% CI 1.03-1.28), and in winter in women (RR 1.24; 95% CI 1.03-1.50).

CONCLUSIONS

Our findings show that ambient air pollution increases the risk of fatal AMI, and this pertains to PM₁₀ specifically.

Air pollution, governance quality, and health outcomes: evidence from developing countries

While studies have demonstrated that air pollution can be catastrophic to the population's health, few empirical studies are found in the economic literature because a considerable proportion of the evidence comes from epidemiological studies. Because of the crucial role of governance in the health community, good governance has been a contentious issue in public sector management in recent years. Therefore, the aim of this study is to examine the effects of air pollution and the role of governance on health outcomes. This study employed the generalized method of moment (GMM) estimation techniques to analyse panel data for 72 developing countries from 2010 to 2017. The empirical results confirm that higher PM_2.5 and CO₂ levels have a detrimental influence on life expectancy and healthy life expectancy, whereas the role of governance has a positive impact on life expectancy and healthy life expectancy. Furthermore, the findings show governance quality plays a role in moderating the negative effect of PM_2.5 on health outcomes. The ongoing rise in air pollution has had a significant impact on the health of developing countries. It appears that governance quality has improved health outcomes. The findings have important policy implications, such that strengthening governance can reduce air pollution emissions in developing countries. However, to reduce the health effects of air pollution, developing countries must implement effective environmental development policies and track the implementation and enforcement of such policies.

County level study of the interaction effect of PM2.5 and climate sustainability on mortality in China

Introduction

PM2.5 and climate change are two major public health concerns, with majority of the research on their interaction focused on the synergistic effect, particularly for extreme events such as hot or cold temperatures. The climate sustainability index (CLS) was introduced to comprehensively explore the impact of climate change and the interactive effect on human health with air pollution.

Methods

In this study, a county-level panel data in China was collected and used. The generalized additive model (GAM) and geographically and temporally weighted regression (GTWR) was used to explore the interactive and spatial effect on mortality between CLS and PM2.5.

Results and discussions

Individually, when CLS is higher than 150 or lower than 50, the mortality is higher. Moreover, when PM2.5 is more than 35 μg/m3, the influence on mortality is significantly increased as PM2.5 concentration rises; when PM2.5 is above 70 μg/m3, the trend is sharp. A nonlinear antagonistic effect between CLS and PM2.5 was found in this study, proving that the combined adverse health effects of climate change and air pollution, especially when CLS was lower (below 100) and PM2.5 was higher (above 35 μg/m3), the antagonistic effect was much stronger. From a spatial perspective, the impact of CLS and PM2.5 on mortality varies in different geographical regions. A negative and positive influence of CLS and PM2.5 was found in east China, especially in the northeastern and northern regions, -which were heavily polluted. This study illustrated that climate sustainability, at certain level, could mitigate the adverse health influence of air pollution, and provided a new perspective on health risk mitigation from pollution reduction and climate adaptation.

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

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

METHODS

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

RESULTS

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

CONCLUSION

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

Leave no one behind: A case of ecosystem service supply equity in Singapore

Urban populations benefit greatly from the ecosystem services provided by urban green and blue spaces. While the equity of provision of and access to urban green and blue spaces has been widely explored, research on equity of ecosystem service provision is relatively scant. Using household level data, our study aims to assess the supply equity of five regulatory ecosystem services in Singapore. We employed linear mixed-effects models and Hot Spot Analysis to analyze their distributional equity across individual households of various demographic characteristics (horizontal inequality), and calculated Gini coefficient for the distribution of PM10 removal service among households categorised into demographic subgroups (vertical inequality). Our results show little evidence of inequitable ecosystem service provision among Singapore's diverse socio-demographic groups. This can be attributed to the early integration of environmental management strategies and meticulous socio-economic desegregation efforts into urban development plans, which maximised provision and maintenance of urban green spaces to all residents.

Daily Mortality in Different Age Groups Associated with Exposure to Particles, Nitrogen Dioxide and Ozone in Two Northern European Capitals: Stockholm and Tallinn

Although the association between air pollution and mortality is well established, less is known about the effects in different age groups. This study analyzes the short-term associations between mortality in different age groups (0–14 years of age, 15–64 years of age, and 65+ years of age) and a number of air pollutants in two relatively clean northern European capitals: Stockholm and Tallinn. The concentrations in PM10 (particles with an aerodynamic diameter smaller than or equal to 10 µm), PM2.5–10 (coarse particles), PM2.5 (particles with an aerodynamic diameter smaller than or equal to 2.5 µm), BC (black carbon), PNC4 (particle number count of particles larger than or equal to 4 nm), NO2 (nitrogen dioxide), and O3 (ozone) were measured during the period of 2000–2016 in Stockholm and 2001–2018 in Tallinn (except for BC and PNC4 which were only measured in Stockholm). The excess risks in daily mortality associated with an interquartile range (IQR) increase in the measured air pollutants were calculated in both single- and multi-pollutant models for lag01 and lag02 (average concentration during the same and the previous day, and the same and the previous two days, respectively) using a quasi-Poisson regression model with a logistic link function. In general, the calculated excess risks per IQR increase were highest in the age group 0–14 years of age in both Stockholm and Tallinn. However, in Stockholm, a statistically significant effect was shown for PM2.5–10, and in Tallinn for O3. In the oldest age group (65+), statistically significant effects were shown for both PM2.5–10, PM10, and O3 in Stockholm, and for O3 in Tallinn.

Systematic review and meta-analysis of studies between short-term exposure to ambient carbon monoxide and non-accidental, cardiovascular, and respiratory mortality in China

Although a growing number of original epidemiological studies imply a link between ambient pollution exposure and mortality risk, the findings associated with carbon monoxide (CO) exposure are inconsistent. Thus, we conducted a systematic review and meta-analysis of epidemiological studies to evaluate the correlations between ambient CO and non-accidental, cardiovascular, and respiratory mortality in China. Eight databases were searched from inception to 15 May 2021. A random-effect model was used to calculate the pooled relative risks (RRs) and 95% confidence intervals (CIs). Subgroup analyses as well as sensitivity analyses were performed. The I square value (I²) was used to assess heterogeneity among different studies. The assessment of publication bias on included studies was examined by funnel plot and Egger's test. The influence of a potential publication bias on findings was explored by using the trim-and-fill procedure. Ultimately, a total of 19 studies were included in our analysis. The pooled relative risk for each 1 mg/m³ increase of ambient carbon monoxide was 1.0220 (95%CI: 1.0102-1.0339) for non-accidental mortality, 1.0304 (95%CI:1.0154-1.0457) for cardiovascular mortality, and 1.0318 (95%CI:1.0132-1.0506) for respiratory mortality. None of subgroup analyses could explain the source of heterogeneity. Exclusion of any single study did not materially alter the pooled effect estimates. Although it was suggestive of publication bias, findings were generally similar with principal findings when we explored the influence of a potential publication bias using the trim-and-fill method. Our meta-analysis demonstrated that exposure to ambient CO was positive with risk of deaths from all non-accidental causes, total cardiovascular, and respiratory diseases. Based on these findings, tougher intervention policies and initiatives to reduce the health effects of CO exposure should be established.

Long-Term Air Pollution Exposure and Ischemic Heart Disease Mortality Among Elderly in High Aging Asian Economies

In the epidemiological literature, the impact of environmental pollution on cardiac mortality has been well documented. There is, however, a paucity of evidence on the impact of air pollution exposure on ischemic heart disease (IHD) mortality among the Asian aged population. In response, this research seeks to investigate the degree of proximity between exposure to ambient PM2.5, household PM2.5, ground-level ozone (O3), and IHD mortality in the top seven Asian economies with the highest aging rates. This investigation is held in two phases. In the first phase, grey modeling is employed to assess the degree of proximity among the selected variables, and then rank them based on their estimated grey weights. In addition, a grey-based Technique for Order of Preference by Similarity to Ideal Solution (G-TOPSIS) is adopted to identify the key influencing factor that intensifies IHD mortality across the selected Asian economies. According to the estimated results, South Korea was the most afflicted nation in terms of IHD mortality owing to ambient PM2.5 and ground-level O3 exposure, whereas among the studied nations India was the biggest contributor to raising IHD mortality due to household PM2.5 exposure. Further, the outcomes of G-TOPSIS highlighted that exposure to household PM2.5 is a key influencing risk factor for increased IHD mortality in these regions, outweighing all other air pollutants. In conclusion, this grey assessment may enable policymakers to target more vulnerable individuals based on scientific facts and promote regional environmental justice. Stronger emission regulations will also be required to mitigate the adverse health outcomes associated with air pollution exposure, particularly in regions with a higher elderly population.

Acute effects of ambient nitrogen oxides and interactions with temperature on cardiovascular mortality in Shenzhen, China

BACKGROUND

Though inconsistent, acute effects of ambient nitrogen oxides on cardiovascular mortality have been reported. Whereas, interactive roles of temperature on their relationships and joint effects of different indicators of nitrogen oxides were less studied. This study aimed to extrapolate the independent roles of ambient nitrogen oxides and temperature interactions on cardiovascular mortality.

METHODS

Data on mortality, air pollutants, and meteorological factors in Shenzhen from 2013 to 2019 were collected. Three indicators including nitric oxide (NO), nitrogen dioxide (NO₂), and nitrogen oxides (NO_X) were studied. Adjusted generalized additive models (GAMs) were applied to analyse their associations with cardiovascular mortality in different groups.

RESULTS

The average daily concentrations of NO, NO₂, and NO_X were 11.7 μg/m³, 30.7 μg/m³, and 53.2 μg/m³, respectively. Significant associations were shown with each indicator. Cumulative effects of nitrogen oxides were more obvious than distributed lag effects. Males, population under 65 years old, and population with stroke-related condition were more susceptible to nitrogen oxides. Adverse effects of nitrogen oxides were more significant at low temperature. Impacts of NO₂ on cardiovascular mortality, and NO on stroke mortality were the most robust in the multi-pollutant models, whereas variations were shown in the other relationships.

CONCLUSIONS

Low levels of nitrogen oxides showed acute and adverse impacts and the interactive roles of temperature on cardiovascular mortality. Cumulative effects were most significant and joint effects of nitrogen oxides required more attention. Population under 65 years old and population with stroke-related health condition were susceptible, especially days at lower temperature.

Daily nonaccidental mortality associated with short-term PM2.5 exposures in Delhi, India

Supplemental Digital Content is available in the text.

Ambient particulate matter of aerodynamic diameter less than 2.5 microns PM_2.5) levels in Delhi routinely exceed World Health Organization (WHO) guidelines and Indian National Ambient Air Quality Standards (NAAQS) for acceptable levels of daily exposure. Only a handful of studies have examined the short-term mortality effects of PM in India, with none from Delhi examining the contribution of PM_2.5.

Air Pollution and Mortality in the Elderly in Kerman, Iran

Background: Today, air pollution is a major issue in the world, particularly in metropolitan areas. Objectives: Accordingly, this study aimed to investigate the relation between air pollution and mortality in the elderly in Kerman City. Methods: This ecological study was conducted using 2006 - 2013 mortality data inquired from the Deputy of Health of Kerman University of Medical Sciences. The data on cardiovascular and respiratory mortality, as well as death due to trauma, diabetes, and other diseases that happened in men and women aged 60 and higher were extracted. Air pollution data (CO, SO2, O3, NO, NO2, NOx, and PM10) for the same time frame were inquired from the Environmental Protection Agency of Kerman Province. Negative binomial regression was used to evaluate the relation between air pollutants and mortality using STATA13 software. Results: During the study period, a total of 14,793 deaths occurred in elderly men and women in Kerman City. Cardiovascular diseases were the leading cause of death. The results of multivariate analysis of air pollutants indicated that NO was directly and significantly related to the total number of deaths in the elderly, and increase in sulfur dioxide, ozone and NO was significantly related to increased mortality among elderly women. Carbon monoxide was significantly related to cardiovascular death of the elderly. But air pollutants did not show any significant effect on respiratory-, trauma-, and diabetes-related deaths. Conclusions: Our findings indicate that there is a significant relation between air pollution and mortality in the elderly. Accordingly, a warning system is suggested to reduce the elderly’s commuting on highly air polluted days.

Impact of short-term air pollution exposure on acute coronary syndrome in two cohorts of industrial and non-industrial areas: A time series regression with 6,000,000 person-years of follow-up (ACS - Air Pollution Study)

BACKGROUND

There is a lack of studies directly comparing the effect of air pollution on acute coronary syndrome (ACS) occurrence in industrial and non-industrial areas.

OBJECTIVES

A comparison of association of air pollution exposure with ACS in two cohorts of industrially different areas.

MATERIALS AND METHODS

The study covered 6,000,000 person-years of follow-up and five pollutants between 2008 and 2017. A time series regression analysis with 7-lag was used to assess the effects air pollution on ACS.

RESULTS

A total of 9046 patients with ACS were included in the analysis, of whom 3895 (43.06%) had ST-elevation myocardial infarction (STEMI) - 45.39% from non-industrial area, and 42.37% from industrial area; and 5151 (56.94%) had non-ST-elevation myocardial infarction (NSTEMI) - 54.61% from non-industrial area and 57.63% from industrial area. The daily concentrations of PM_2.5, PM₁₀, NO₂, SO₂, CO were higher in industrial than in non-industrial area (P < 0.001). In non-industrial area, an increase of 10 μg/m³ of NO₂ concentration (Odds Ratio (OR) = 1.126, 95%CI = 1.009-1.257; P = 0.034, lag-0) and an increase of 1 mg/m³ in CO concentration (RR = 1.055, 95%CI = 1.010-1.103; P = 0.017, lag-0) were associated with an increase in the number of hospitalization due to NSTEMI (for industrial area increase of 10 μg/m³ in NO₂ (OR = 1.062, 95%CI = 1.020-1.094; P = 0.005, lag-0), SO₂ (OR = 1.061, 95%CI = 1.010-1.116; P = 0.018, lag-4), PM₁₀ (OR = 1.010, 95%CI = 1.001-1.030; P = 0.047, lag-6). In STEMI patients in industrial area, an increased hospitalization was found to be associated with an increase of 10 μg/m³ in SO₂ (OR = 1.094, 95%CI = 1.030-1.162; P = 0.002, lag-1), PM_2.5 (OR = 1.041, 95%CI = 1.020-1.073; P < 0.001, lag-1), PM₁₀ (OR = 1.030, 95%CI = 1.010-1.051; P < 0.001, lag-1). No effects of air pollution on the number of hospitalization due to STEMI were noted from non-industrial area.

CONCLUSION

The risk of air pollution-related ACS was higher in industrial over non-industrial area. The effect of NO₂ on the incidence of NSTEMI was observed in both areas. In industrial area, the effect of PMs and SO₂ on NSTEMI and STEMI were also observed. A clinical effect was more delayed in time in patients with NSTEMI, especially after exposure to PM₁₀. Chronic exposure to air pollution may underlie the differences in the short-term effect between particulate air pollution impact on the incidence of STEMI.

Spatio-temporal analysis of urban air pollutants throughout China during 2014-2019

Air pollution control has become the top priority of China's "green development" concept since 2013. The Chinese government has enacted a range of policies and statutes to control contaminant emissions and improve air quality. On the basis of the national air quality ground observation database, the spatial and temporal distribution of air quality index value (AQI), fine particulate matter (PM_2.5), coarse particles (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃) were explored in 336 cities throughout China from 2014 to 2019. AQI and most pollutants (except O₃) decreased in concentrations from 2014 to 2019. In 2019, all cities except Henan reached the level 2 of the ambient air quality index, and six cities had a lower ambient air quality index and reached the level 1. Spatially, higher pollutant concentrations were concentrated in large city clusters, whereas the areas with high O₃ concentration were found across the country. Furthermore, central heating was shown to have a negative impact on air quality. The observed AQI value, PM_2.5, PM₁₀, SO₂, NO₂, and CO concentrations were highest in north and northwest China and Henan province in central China. The correlations among pollutants suggest that the main sources of pollutants are fossil fuel combustion, industrial production, and motor vehicle emissions. The influence of meteorological factors on air quality, long-distance transportation, and the transformations of pollutants should be explored in future research.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11869-021-01043-5.

Biomass burning-derived airborne particulate matter in Southeast Asia: A critical review

Smoke haze episodes, resulting from uncontrolled biomass burning (BB) including forest and peat fires, continue to occur in Southeast Asia (SEA), affecting air quality, atmospheric visibility, climate, ecosystems, hydrologic cycle and human health. The pollutant of major concern in smoke haze is airborne particulate matter (PM). A number of fundamental laboratory, field and modeling studies have been conducted in SEA from 2010 to 2020 to investigate potential environmental and health impacts of BB-induced PM. The goal of this review is to bring together the most recent developments in our understanding of various aspects of BB-derived PM based on 127 research articles published from 2010 to 2020, which have not been conveyed in previous reviews. Specifically, this paper discusses the physical, chemical, toxicological and radiative properties of BB-derived PM. It also provides insights into the environmental and health impacts of BB-derived PM, summarizes the approaches taken to do the source apportionment of PM during BB events and discusses the mitigation of exposure to BB-derived PM. Suggestions for future research priorities are outlined. Policies needed to prevent future BB events in the SEA region are highlighted.

Climate change and antibiotic resistance: a deadly combination

Climate change is driven primarily by humanity's use of fossil fuels and the resultant greenhouse gases from their combustion. The effects of climate change on human health are myriad and becomingly increasingly severe as the pace of climate change accelerates. One relatively underreported intersection between health and climate change is that of infections, particularly antibiotic-resistant infections. In this perspective review, the aspects of climate change that have already, will, and could possibly impact the proliferation and dissemination of antibiotic resistance are discussed.

Gender Differences in Association between Air Pollution and Daily Mortality in the Capital of the Green Lungs of Poland-Population-Based Study with 2,953,000 Person-Years of Follow-Up

(1) Introduction: air pollution is considered to be one of the main risk factors for public health. According to the European Environment Agency (EEA), air pollution contributes to the premature deaths of approximately 500,000 citizens of the European Union (EU), including almost 5000 inhabitants of Poland every year. (2) Purpose: to assess the gender differences in the impact of air pollution on the mortality in the population of the city of Bialystok-the capital of the Green Lungs of Poland. (3) Materials and Methods: based on the data from the Central Statistical Office, the number-and causes of death-of Białystok residents in the period 2008-2017 were analyzed. The study utilized the data recorded by the Provincial Inspectorate for Environmental Protection station and the Institute of Meteorology and Water Management during the analysis period. Time series regression with Poisson distribution was used in statistical analysis. (4) Results: A total of 34,005 deaths had been recorded, in which women accounted for 47.5%. The proportion of cardiovascular-related deaths was 48% (n = 16,370). An increase of SO2 concentration by 1-µg/m3 (relative risk (RR) 1.07, 95% confidence interval (CI) 1.02-1.12; p = 0.005) and a 10 °C decrease of temperature (RR 1.03, 95% CI 1.01-1.05; p = 0.005) were related to an increase in the number of daily deaths. No gender differences in the impact of air pollution on mortality were observed. In the analysis of the subgroup of cardiovascular deaths, the main pollutant that was found to have an effect on daily mortality was particulate matter with a diameter of 2.5 μm or less (PM2.5); the RR for 10-µg/m3 increase of PM2.5 was 1.07 (95% CI 1.02-1.12; p = 0.01), and this effect was noted only in the male population. (5) Conclusions: air quality and atmospheric conditions had an impact on the mortality of Bialystok residents. The main air pollutant that influenced the mortality rate was SO2, and there were no gender differences in the impact of this pollutant. In the male population, an increased exposure to PM2.5 concentration was associated with significantly higher cardiovascular mortality. These findings suggest that improving air quality, in particular, even with lower SO2 levels than currently allowed by the World Health Organization (WHO) guidelines, may benefit public health. Further studies on this topic are needed, but our results bring questions whether the recommendations concerning acceptable concentrations of air pollutants should be stricter, or is there a safe concentration of SO2 in the air at all.

Health benefits on cardiocerebrovascular disease of reducing exposure to ambient fine particulate matter in Tianjin, China

With the development of the industrialization level in China, high concentrations of fine particulate matter (≤ 2.5 μg/m³ in aerodynamic diameter (PM_2.5)) could have a great impact on the health of the population. Our study is to quantify the health benefits on cardiocerebrovascular disease of reducing exposure to PM_2.5 in Tianjin, China. We obtained the data on cardiovascular disease (CVD), ischemic heart disease (IHD), and cerebrovascular disease (CD) mortalities to quantify the association between CVD, CD, and IHD mortalities and PM_2.5 and calculate health and economic benefits when the annual average concentration of PM_2.5 was reduced to National Ambient Air Quality Standard (NAAQS) and World Health Organization (WHO) guidelines by using our concentration response (C-R) functions. There were 435.22 (95% CI 253.86 to 616.57) all-cause, 130.22 (95% CI 66.34 to194.09) IHD, and 204.07 (95% CI 111.66 to 296.47) CD deaths attributed to PM_2.5 and the economic benefits obtained by preventing all-cause, IHD, and CD mortalities were equivalent to be 2.79%, 0.83%, and 1.31% of Baodi's GDP in Tianjin in 2017, respectively. PM_2.5 concentration was positive with all-cause, IHD, and CD mortalities in rural, suburban, and urban area of Tianjin, China. Meanwhile, the number of avoidable deaths and economic cost of reducing PM_2.5 concentrations to NAAQS and WHO guidelines was highest in the rural area.

Impact of Air Pollution and Trans-Boundary Haze on Nation-Wide Emergency Department Visits and Hospital Admissions in Singapore

Introduction: Air pollution is associated with adverse health outcomes. However, its impact on emergency health services is less well understood. We investigated the impact of air pollution on nation-wide emergency department (ED) visits and hospital admissions to public hospitals in Singapore. Materials and Methods: Anonymised administrative and clinical data of all ED visits to public hospitals in Singapore from January 2010 to December 2015 were retrieved and analysed. Primary and secondary outcomes were defined as ED visits and hospital admissions, respectively. Conditional Poisson regression was used to model the effect of Pollutant Standards Index (PSI) on each outcome. Both outcomes were stratified according to subgroups defined a priori based on age, diagnosis, gender, patient acuity and time of day. Results: There were 5,791,945 ED visits, of which 1,552,187 resulted in hospital admissions. No significant association between PSI and total ED visits (Relative risk [RR], 1.002; 99.2% confidence interval [CI], 0.995–1.008; P = 0.509) or hospital admissions (RR, 1.005; 99.2% CI, 0.996–1.014; P = 0.112) was found. However, for every 30-unit increase in PSI, significant increases in ED visits (RR, 1.023; 99.2% CI, 1.011–1.036; P = 1.24 × 10˗6) and hospital admissions (RR, 1.027; 99.2% CI, 1.010–1.043; P = 2.02 × 10˗5) for respiratory conditions were found. Conclusion: Increased PSI was not associated with increase in total ED visits and hospital admissions, but was associated with increased ED visits and hospital admissions for respiratory conditions in Singapore. Key words: Epidemiology, Healthcare utilisation, PSI, Public health, Time series

Particulate Matter and Its Impact on Mortality among Elderly Residents of Seoul, South Korea

Climate change, air pollution, and the rapidly aging population are important public health challenges. An understanding of air pollution impacts is imperative for preventing air-pollution-related deaths and illnesses, particularly in vulnerable subgroups such as the increasing population of older adults. To assess the effects of short-term air-pollution exposure on the elderly, we conducted a time-series analysis (1996–2015) of the associations between particulate matter with an aerodynamic diameter of <10 μm (PM10) and deaths among elderly residents of Seoul, South Korea, which has a rapidly aging population. We also investigated the synergistic effects of temperature and the lag structures of the effects by sex, cause of death, and season. A 10 μg/m3 rise in the 4-day moving average concentration of PM10 was associated with 0.31% (95% confidence interval (CI): 0.18% to 0.44%), 0.32% (95% CI: 0.09% to 0.55%), and 0.22% (95% CI: –0.23% to 0.66%) increases in non-accidental, cardiovascular, and respiratory mortalities, respectively. We found a significant and strong synergistic effect of PM10 concentration and ambient temperature on mortality in elderly people. PM10 posed an increased risk of non-accidental or cardiovascular mortality with increasing temperature, whereas the associated risk of respiratory death was highest on very cold days. The shape and length of the lag structure varied with the cause of death, sex, and season. Results indicate that elderly people exposed to PM10 are at increased risk of premature death. In the near future, these risks are likely to increase in step with the temperature rise associated with climate change and the continued population aging. Stronger emission controls will be needed to minimize the increased health risks associated with air pollution, especially in regions with high populations of elderly individuals.

Acute Health Impacts of the Southeast Asian Transboundary Haze Problem-A Review

Air pollution has emerged as one of the world’s largest environmental health threats, with various studies demonstrating associations between exposure to air pollution and respiratory and cardiovascular diseases. Regional air quality in Southeast Asia has been seasonally affected by the transboundary haze problem, which has often been the result of forest fires from “slash-and-burn” farming methods. In light of growing public health concerns, recent studies have begun to examine the health effects of this seasonal haze problem in Southeast Asia. This review paper aims to synthesize current research efforts on the impact of the Southeast Asian transboundary haze on acute aspects of public health. Existing studies conducted in countries affected by transboundary haze indicate consistent links between haze exposure and acute psychological, respiratory, cardiovascular, and neurological morbidity and mortality. Future prospective and longitudinal studies are warranted to quantify the long-term health effects of recurrent, but intermittent, exposure to high levels of seasonal haze. The mechanism, toxicology and pathophysiology by which these toxic particles contribute to disease and mortality should be further investigated. Epidemiological studies on the disease burden and socioeconomic cost of haze exposure would also be useful to guide policy-making and international strategy in minimizing the impact of seasonal haze in Southeast Asia.

Acute Health Impacts of the Southeast Asian Transboundary Haze Problem-A Review

Air pollution has emerged as one of the world's largest environmental health threats, with various studies demonstrating associations between exposure to air pollution and respiratory and cardiovascular diseases. Regional air quality in Southeast Asia has been seasonally affected by the transboundary haze problem, which has often been the result of forest fires from "slash-and-burn" farming methods. In light of growing public health concerns, recent studies have begun to examine the health effects of this seasonal haze problem in Southeast Asia. This review paper aims to synthesize current research efforts on the impact of the Southeast Asian transboundary haze on acute aspects of public health. Existing studies conducted in countries affected by transboundary haze indicate consistent links between haze exposure and acute psychological, respiratory, cardiovascular, and neurological morbidity and mortality. Future prospective and longitudinal studies are warranted to quantify the long-term health effects of recurrent, but intermittent, exposure to high levels of seasonal haze. The mechanism, toxicology and pathophysiology by which these toxic particles contribute to disease and mortality should be further investigated. Epidemiological studies on the disease burden and socioeconomic cost of haze exposure would also be useful to guide policy-making and international strategy in minimizing the impact of seasonal haze in Southeast Asia.