A replicable strategy for mapping air pollution's community-level health impacts and catalyzing prevention

Burden of cardiovascular disease attributed to air pollution: a systematic review

BACKGROUND

Cardiovascular diseases (CVDs) are estimated to be the leading cause of global death. Air pollution is the biggest environmental threat to public health worldwide. It is considered a potentially modifiable environmental risk factor for CVDs because it can be prevented by adopting the right national and international policies. The present study was conducted to synthesize the results of existing studies on the burden of CVDs attributed to air pollution, namely prevalence, hospitalization, disability, mortality, and cost characteristics.

METHODS

A systematic search was performed in the Scopus, PubMed, and Web of Science databases to identify studies, without time limitations, up to June 13, 2023. Exclusion criteria included prenatal exposure, exposure to indoor air pollution, review studies, conferences, books, letters to editors, and animal and laboratory studies. The quality of the articles was evaluated based on the Agency for Healthcare Research and Quality Assessment Form, the Newcastle-Ottawa Scale, and Drummond Criteria using a self-established scale. The articles that achieved categories A and B were included in the study.

RESULTS

Of the 566 studies obtained, based on the inclusion/exclusion criteria, 92 studies were defined as eligible in the present systematic review. The results of these investigations supported that chronic exposure to various concentrations of air pollutants, increased the prevalence, hospitalization, disability, mortality, and costs of CVDs attributed to air pollution, even at relatively low levels. According to the results, the main pollutant investigated closely associated with hypertension was PM2.5. Furthermore, the global DALY related to stroke during 2016-2019 has increased by 1.8 times and hospitalization related to CVDs in 2023 has increased by 8.5 times compared to 2014.

CONCLUSION

Ambient air pollution is an underestimated but significant and modifiable contributor to CVDs burden and public health costs. This should not only be considered an environmental problem but also as an important risk factor for a significant increase in CVD cases and mortality. The findings of the systematic review highlighted the opportunity to apply more preventive measures in the public health sector to reduce the footprint of CVDs in human society.

Particulate Matter Air Pollution is a Significant Risk Factor for Cardiovascular Disease

Air pollution is responsible worldwide for 9-12 million deaths annually. The major contributor to air pollution is particulate matter ≤2.5 µg per cubic meter of air (PM2.5) from vehicles, industrial emissions, and wildfire smoke. United States ambient air standards recommend annual average PM2.5 concentrations of ≤12 μg/m³ while European standards allow an average annual PM2.5 concentration of ≤20 μg/m3. However, significant PM2.5 cardiovascular and pulmonary health risks exist below these concentrations. Chronic PM2.5 exposure significantly increases major cardiovascular and pulmonary event risks in Americans by 8 to more than 20% for each 10-μg/m3 increase in PM2.5. PM2.5-induced increases in lipid peroxidation, induction of vascular inflammation and endothelial cell injury initiate and propagate respiratory diseases, coronary and carotid atherosclerosis. PM2.5 can cause atherosclerotic vascular plaque rupture and myocardial infarction and stroke by activating metalloproteinases. This article discusses PM2.5 effects on the cardiovascular and pulmonary systems, specific PM2.5 pathophysiologic mechanisms contributing to cardiopulmonary disease, and preventive measures to limit the cardiovascular and pulmonary effects of PM2.5.

PM2.5 pollution in Texas: a geospatial analysis of health impact functions

Background

Air pollution is the greatest environmental threat to human health in the world today and is responsible for an estimated 7-9 million deaths annually. One of the most damaging air pollutants is PM2.5 pollution, fine airborne particulate matter under 2.5 microns in diameter. Exposure to PM2.5 pollution can cause premature death, heart disease, lung cancer, stroke, diabetes, asthma, low birthweight, and IQ loss. To avoid these adverse health effects, the WHO recommends that PM2.5 levels not exceed 5 μg/m3.

Methods

This study estimates the negative health impacts of PM2.5 pollution in Texas in 2016. Local exposure estimates were calculated at the census tract level using the EPA's BenMAP-CE software. In BenMAP, a variety of exposure-response functions combine air pollution exposure data with population data and county-level disease and death data to estimate the number of health effects attributable to PM2.5 pollution for each census tract. The health effects investigated were mortality, low birthweight, stroke, new onset asthma, new onset Alzheimer's, and non-fatal lung cancer.

Findings

This study found that approximately 26.7 million (98.9%) of the 27.0 million people living in Texas in 2016 resided in areas where PM2.5 concentrations were above the WHO recommendation of 5 μg/m3, and that 2.6 million people (9.8%) lived in areas where the average PM2.5 concentration exceeded 10 μg/m3. This study estimates that there were 8,405 (confidence interval [CI], 5,674-11,033) premature deaths due to PM2.5 pollution in Texas in 2016, comprising 4.3% of all deaths. Statewide increases in air-pollution-related morbidity and mortality were seen for stroke (2,209 - CI: [576, 3,776]), low birthweight (2,841 - CI: [1,696, 3,925]), non-fatal lung cancers (636 - CI: [219, 980]), new onset Alzheimer's disease (24,575 - CI: [20,800, 27,540]), and new onset asthma (7,823 - CI: [7,557, 8,079]).

Conclusion

This study found that air pollution poses significant risks to the health of Texans, despite the fact that pollution levels across most of the state comply with the EPA standard for PM2.5 pollution of 12 μg/m3. Improving air quality in Texas could save thousands of lives from disease, disability, and premature death.

Air pollution, dementia, and lifespan in the socio-economic gradient of aging: perspective on human aging for planning future experimental studies

Air pollution (AirPoll) accelerates human aging, as assessed by increased adult mortality and earlier onset of cardiovascular diseases, and dementia. Socio-economic strata (SES) of wealth and education have parallel differences of mortality and these diseases. Children from impoverished homes differ in brain development at birth and in risk of early fat excess and hypertension. To further enhance the healthspan, biogerontologists may consider a wider range of environmental exposures from gestation through later life morbidity that comprise the Gero-Exposome. Experimental studies with rodents and nematodes document shared transcriptional responses to AirPoll. In rodents, AirPoll exposure activates gene systems for body-wide detoxification through Nrf2 and NFkB transcription factors that mediate multiple aging processes. Gestational environmental factors include maternal diet and exposure to AirPoll and cigarette smoke. Correspondingly, gestational exposure of mice to AirPoll increased adult body fat, impaired glucose clearance, and decreased adult neurogenesis in the hippocampus, a brain region damaged in dementia. Nematode larvae also respond to AirPoll with Alzheimer relevant responses. These experimental approaches could identify to interventions for expanded human health and longevity across SES gradients.

Uncovering the link between air pollution and neurodevelopmental alterations during pregnancy and early life exposure: A systematic review

Air pollution plays, nowadays, a huge role in human's health and in the personal economy. Moreover, there has been a rise in the prevalence of neurodevelopmental disorders like the Autism Spectrum Disorder (ASD) in recent years. Current scientific studies have established a link between prenatal or perinatal exposure to environmental pollutants and ASD. This systematic review summarizes the current literature available about the relationship between exposure to air pollutants (particulate matter [PM], Second Organic Aerosols [SOA], Diesel Exhaust [DE], and Traffic Related Air Pollution [TRAP]) and neurodevelopmental disorders in preclinical models using rats and mice. The articles were selected and filtered using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, and bias-evaluated using the SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) tool. Overall, our findings suggest that air pollutants are associated with negative developmental outcomes characterized by ASD-like behaviors, abnormal biochemical patterns, and impaired achievement of developmental milestones in rodents. However, there is not sufficient information in certain domains to establish a clear relationship. Short phrases for indexing terms: Air pollution affects neurodevelopment; PM exposure modifies glutamate system; Prenatal exposure combined with postnatal affect more to behavioral / cognitive domain; Air pollution modifies social behavior in rodents; Cognitive deficits can be detected after gestational exposure to air pollution.

[Climate change and (surgical) health in context]

BACKGROUND

The impacts of the climate crisis will result in a health crisis in addition to loss of habitats and increasing supply uncertainty. In this context, the health sector and especially surgery are relevant emitters of greenhouse gases, thus contributing to the magnitude of the climate crisis. Many reviews regarding the impacts on human health are available; however, a view from the surgical perspective has so far been underrepresented.

MATERIAL AND METHODS

This narrative review summarizes the relevance of climate-related changes for the surgical disciplines based on a literature search.

RESULTS

Immediate impacts are expected by the increasing number of extreme weather events, e.g., floods, droughts and wildfires. In these settings, surgery is a part of the disaster medicine chain but simultaneously the functionality of surgical departments can be impaired or even break down when they are themselves affected by extreme weather events. Heat waves cause an increase in surgical site infections, which may lead to postponement of elective surgery for patients at high risk. Collateral impacts are mirrored by an increase in the incidence of lung and skin cancers, which often need surgical treatment within a multidisciplinary setting. Additionally, there are indirect impacts that are of a very different nature, e.g., inadequate diet which leads to further deterioration of the greenhouse gas footprint of the health sector due to the necessity of bariatric surgical capacities.

CONCLUSION

The climate crisis represents a major challenge in surgery and all other medical disciplines. At the same time is it indispensable that the health sector and therefore surgery, take steps towards a zero emission pathway.