Acute Effects of Particulate Air Pollution on the Incidence of Coronary Heart Disease in Shanghai, China

Short-term exposure to various ambient air pollutants and emergency department visits for cause-stable ischemic heart disease: a time-series study in Shanghai, China

Studying the impact of local meteorological conditions and air pollution on cardiovascular disease is crucial for reducing the burden of cardiovascular disease. However, there have been few studies on the acute effects of various air pollutants on stable ischemic heart disease (SIHD), and the effects of these factors are not well defined and require further investigation. We performed a time-series study aimed at exploring the association between short-term exposure to various air pollutants and emergency department (ED) visits for SIHD during 2013-2020 in Baoshan District Renhe Hospital of Shanghai, China. The associations between air pollution (NO2, PM2.5, PM10, SO2 O3-8 h and CO) and ED visits were analyzed using quasi-Poisson regression. Subgroup and sensitivity analyses were conducted. From 2013 to 2020, a total of 18,241 ED visits for SIHD were recorded. Elevated PM2.5, PM10, NO2, SO2 and CO were significantly associated with increased ED visits for SIHD at lag (0, 5), lag 0, lag (0-4, 01-03), lag (0-3, 5, 01-03) and lag (3-5). When the concentration of O3-8 h was lower than the threshold recommended by the WHO, exposure to O3-8 h was associated with a slightly decreased risk of SIHD. Moreover, the relationship between different types of air pollution and the frequency of ED visits exhibited variations based on gender, age, and seasonality. This study suggests that short-term exposure to PM2.5, PM10, NO2, SO2 and CO might induce SIHD, especially in old females. Air pollution control measures should be encouraged to prevent the occurrence and development of SIHD.

City-level meteorological conditions modify the relationships between exposure to multiple air pollutants and the risk of pediatric hand, foot, and mouth disease in the Sichuan Basin, China

Background

Several studies have examined the effects of city-level meteorological conditions on the associations between meteorological factors and hand, foot, and mouth disease (HFMD) risk. However, evidence that city-level meteorological conditions modify air pollutant-HFMD associations is lacking.

Methods

For each of the 17 cities in the Sichuan Basin, we obtained estimates of the relationship between exposures to multiple air pollutants and childhood HFMD risk by using a unified distributed lag nonlinear model (DLNM). Multivariate meta-regression models were used to identify the effects of city-level meteorological conditions as effect modifiers. Finally, we conducted subgroup analyses of age and sex to explore whether the modification effects varied in different subgroups.

Results

The associations between PM2.5/CO/O3 and HFMD risk showed moderate or substantial heterogeneity among cities (I 2 statistics: 48.5%, 53.1%, and 61.1%). Temperature conditions significantly modified the PM2.5-HFMD association, while relative humidity and rainfall modified the O3-HFMD association. Low temperatures enhanced the protective effect of PM2.5 exposure against HFMD risk [PM2.5 <32.7  μg/m3 or PM2.5 >100  μg/m3, at the 99th percentile: relative risk (RR) = 0.14, 95% CI: 0.03-0.60]. Low relative humidity increased the adverse effect of O3 exposure on HFMD risk (O3 >128.7 μg/m3, at the 99th percentile: RR = 2.58, 95% CI: 1.48-4.50). However, high rainfall decreased the risk of HFMD due to O3 exposure (O3: 14.1-41.4  μg/m3). In addition, the modification effects of temperature and relative humidity differed in the female and 3-5  years-old subgroups.

Conclusion

Our findings revealed moderate or substantial heterogeneity in multiple air pollutant-HFMD relationships. Temperature, relative humidity, and rainfall modified the relationships between PM2.5 or O3 exposure and HFMD risk.

Association between air pollution exposure and coronary heart disease hospitalization in a humid sub-tropical region of China: A time-series study

Objective

Emerging evidence has highlighted the possible links of environmental pollution with several cardiovascular diseases (CVDs). The current study aimed to explore the impact of short-term air pollution exposure on CHD hospitalization in Hefei.

Methods

Data about the daily number of CHD admissions (from 2014 to 2021) were retrieved from the First Affiliated Hospital of Anhui Medical University. Air pollutants and meteorological data were obtained from the China Environmental Monitoring Station and the China Meteorological Data Service Center, respectively. The correlation between air pollution and CHD hospitalization was assessed using distributed lag non-linear model (DLNM) and Poisson generalized linear regression.

Results

In the single-pollutant model, NO₂, O₃, and CO strongly correlated with CHD hospitalization rate. Specifically, exposure to NO₂ (lag0, relative risk [RR]: 1.013, 95%CI: 1.002-1.024, per 10 μg/m³ increase) and CO (lag13, RR: 1.035, 95%CI: 1.001-1.071, per 1 μg/m³ increase) revealed a positive correlation with an increased rate of CHD hospitalization. Interestingly, O₃ had a protective association with hospitalization of CHD (lag0, RR: 0.993, 95%CI: 0.988-0.999, per 10 μg/m³ increase). Similar results, to those of the single-pollutant model, were revealed following verification using two-pollutant models. Subgroup analyses indicated that young people, women, and people in hot seasons were more susceptible to NO₂ exposure, while the elderly, women, and people in cold seasons were more susceptible to O₃. Furthermore, the elderly were more susceptible to CO exposure.

Conclusion

Overall, exposure to NO₂ and CO increases the rate of CHD hospitalization, but exposure to O₃ shows a protective association with the rate of CHD hospitalization. Therefore, early preventive measures against air pollutants should be applied to protect vulnerable patients with CHD.

A Time Series Study for Effects of PM10 on Coronary Heart Disease in Ganzhou, China

Objective: To investigate the effect of PM10 exposure in low concentration areas on the daily hospitalized patients with coronary heart disease. Methods: Daily air quality monitoring data, meteorological monitoring data and daily hospitalization data of coronary heart disease during 2019−2021 in Ganzhou, China were collected. Generalized additive model and distributed lag nonlinear model were used to evaluate the association between environmental PM10 and daily hospital visits for coronary heart disease. Stratified by sex and age to see their potential impact on this association. Results: PM10 exposure was correlated with an increased risk of hospitalization in coronary heart disease patients. Single-pollutant model analysis shows that at the day of lag1, for every 10 µg/m3 increase in PM10, the risk of coronary heart disease hospitalization increased by 1.69% (95%CI 0.39~3.00%); Subgroup analysis showed that females and older adults (>65 years) were more sensitive to PM10 exposure. In addition, in the dual-pollutant model, by adjusting other pollutants (including SO2, CO and O3), it was found that the relationship between PM10 exposure and coronary heart disease hospitalization was robust. And with changing the model’s degree of freedom was still robust. Conclusion: Short-term exposure to low concentrations of PM10 is associated with hospitalization for coronary heart disease. These results are important for local environmental public health policy development, so as to protect vulnerable populations.

Effect modification by sex for associations of fine particulate matter (PM2.5) with cardiovascular mortality, hospitalization, and emergency room visits: systematic review and meta-analysis

Particulate matter with aerodynamic diameter no larger than 2.5 μm (PM2.5) has been linked to cardiovascular diseases (CVDs) but evidence for vulnerability by sex remains unclear. We performed systematic review and meta-analysis to synthesize the state of scientific evidence on whether cardiovascular risks from PM2.5 differ for men compared to women. The databases Pubmed, Scopus, Embase, and GreenFILE were searched for studies published Jan. 1995 to Feb. 2020. Observational studies conducting subgroup analysis by sex for impacts of short-term or long-term exposure to PM2.5 on target CVDs were included. Data were independently extracted in duplicate and pooled with random-effects meta-regression. Risk ratios (RRs) for long-term exposure and percent changes in outcomes for short-term exposure were calculated per 10 μg/m3 PM2.5 increase. Quality of evidence of risk differences by sex was rated following Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 12,502 articles were screened, with 61 meeting inclusion criteria. An additional 32 studies were added from citation chaining. RRs of all CVD mortality for long-term PM2.5 for men and women were the same (1.14; 95% CI: 1.09, 1.22) indicating no statistically different risks. Men and women did not have statistically different risks of daily CVD mortality, hospitalizations from all CVD, ischemic heart disease, cardiac arrest, acute myocardial infarction, and heart failure from short-term PM2.5 exposure (difference in % change in risk per 10 μg/m3 PM2.5: 0.04 (95% CI, -0.42 to 0.51); -0.05 (-0.47 to 0.38); 0.17 (-0.90, 1.24); 1.42 (-1.06, 3.97); 1.33 (-0.05, 2.73); and -0.48 (-1.94, 1.01), respectively). Analysis using GRADE found low or very low quality of evidence for sex differences for PM2.5-CVD risks. In conclusion, this meta-analysis and quality of evidence assessment of current observational studies found very limited evidence of the effect modification by sex for effects of PM2.5 on CVD outcomes in adults, which can inform clinical approaches and policies.

Regional air pollution severity affects the incidence of acute myocardial infarction triggered by short-term pollutant exposure: a time-stratified case-crossover analysis

Long-term exposure to air pollution results in a high incidence of cardiovascular disease. Many studies have found that short-term exposure to air pollution can trigger acute myocardial infarction. This study aims to determine whether results in areas with different levels of severity of air pollution are similar. The study design is a time-stratified case-crossover analysis. This was a retrospective study based on hospital medical records. The study period was since 1 January 2017 to 31 December 2018. Research data were collected from Taoyuan Hospital, located in an area with low severity of pollution, and Taichung Hospital, located in an area with high severity of pollution. The correlation between short-term air pollution exposure and acute myocardial infarction was analyzed. The correlation between short-term exposure to ambient air pollutants and acute myocardial infarction was not significant for the cases collected from Taoyuan Hospital (PM_2.5 OR: 1.006 and 95% CI: 0.995-1.017; PM₁₀ OR: 0.996 and 95% CI: 0.988-1.003). However, for the cases collected from Taichung Hospital, short-term exposure to ambient PM_2.5 (odds ratio: 1.021; 95% confidence interval: 1.002-1.040) and PM₁₀ (odds ratio: 1.010; 95% confidence interval: 1.001-1.020) resulted in high incidence of acute myocardial infarction. Short-term pollutant exposure will increase the incidence of acute myocardial infarction based on the severity of regional air pollution. In addition to addressing traditional cardiovascular disease risk factors, the government must formulate relevant policies for reducing air pollution and the resulting hazards to citizens' health.

The short-term effects and burden of particle air pollution on hospitalization for coronary heart disease: a time-stratified case-crossover study in Sichuan, China

BACKGROUND

Coronary heart disease (CHD), the leading cause of death globally, might be developed or exacerbated by air pollution, resulting high burden to patients. To date, limited studies have estimated the relations between short-term exposure to air pollution and CHD disease burden in China, with inconsistent results. Hence, we aimed to estimate the short-term impact and burden of ambient PM pollutants on hospitalizations of CHD and specific CHD.

METHODS

PM10 and PM2.5 were measured at 82 monitoring stations in 9 cities in Sichuan Province, China during 2017-2018. Based on the time-stratified case-crossover design, the effects of short-term exposure to particle matter (PM) pollution on coronary heart disease (CHD) hospital admissions were estimated. Meanwhile, the linked burden of CHD owing to ambient PM pollution were estimated.

RESULTS

A total of 104,779 CHD records were derived from 153 hospitals from these 9 cities. There were significant effects of PM pollution on hospital admissions (HAs) for CHD and specific CHD in Sichuan Province. A 10 μg/m3 increase of PM10 and PM2.5 was linked with a 0.46% (95% CI: 0.08, 0.84%), and 0.57% (95% CI: 0.05, 1.09%) increments in HAs for CHD at lag7, respectively. The health effects of air pollutants were comparable modified by age, season and gender, showing old (≥ 65 years) and in cold season being more vulnerable to the effects of ambient air pollution, while gender-specific effects is positive but not conclusive. Involving the WHO's air quality guidelines as the reference, 1784 and 2847 total cases of HAs for CHD could be attributable to PM10 and PM2.5, separately. The total medical cost that could be attributable to exceeding PM10 and PM2.5 were 42.04 and 67.25 million CNY from 2017 to 2018, respectively.

CONCLUSIONS

This study suggested that the short-term exposure to air pollutants were associated with increased HAs for CHD in Sichuan Province, which could be implications for local environment improvement and policy reference.

Travelling to polluted cities: a systematic review on the harm of air pollution on international travellers' health

RATIONALE FOR REVIEW

In 2019, approximately, 1.4 billion people travelled internationally. Many individuals travel to megacities where air pollution concentrations can vary significantly. Short-term exposure to air pollutants can cause morbidity and mortality related to cardiovascular and respiratory disease, with the literature clearly reporting a strong association between short-term exposure to particulate matter ≤2.5 μm and ozone with adverse health outcomes in resident populations. However, limited research has been conducted on the health impacts of short-term exposure to air pollution in individuals who travel internationally. The objective of this systematic review was to review the evidence for the respiratory and cardiovascular health impacts from exposure to air pollution during international travel to polluted cities in adults aged ≥18 years old.

KEY FINDINGS

We searched PubMed, Scopus and EMBASE for studies related to air pollution and the health impacts on international travellers. Of the initially identified 115 articles that fit the search criteria, 6 articles were selected for the final review. All six studies found indications of adverse health impacts of air pollution exposure on international travellers, with most of the changes being reversible upon return to their home country/city. However, none of these studies contained large populations nor investigated vulnerable populations, such as children, elderly or those with pre-existing conditions.

CONCLUSIONS

More research is warranted to clearly understand the impacts of air pollution related changes on travellers' health, especially on vulnerable groups who may be at higher risk of adverse impacts during travel to polluted cities.

Exposure to air pollution and renal function

Air pollution contributes to the premature death of approximately 428,000 citizens of Europe every year. The adverse effects of air pollution can be observed in respiratory, circulatory systems but also in renal function. We decide to investigate the hypothesis indicating that we can observe not only long- but also short-term impact of air pollution on kidney function. We used linear, log-linear, and logistic regression models to assess the association between renal function and NO2, SO2, and PMs. Results are reported as beta (β) coefficients and odds ratios (OR) for an increase in interquartile range (IQR) concentration. 3554 patients (median age 66, men 53.2%) were included into final analysis. Chronic kidney disease (CKD) was diagnosed in 21.5%. The odds of CKD increased with increase in annual concentration of PM2.5 (OR for IQR increase = 1.07; 95% CI 1.01-1.15, P = 0.037) and NO2 (OR for IQR increase = 1.05; 95% CI 1.01-1.10, P = 0.047). The IQR increase in weekly PM2.5 concentration was associated with 2% reduction in expected eGFR (β = 0.02, 95% CI - 0.03; - 0.01). Medium- and short-term exposure to elevated air pollution levels was associated with a decrease in eGFR and development CKD. The main pollutants affecting the kidneys were PM2.5 and NO2.

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.

Effect of Short-Term Exposure to Fine Particulate Matter and Temperature on Acute Myocardial Infarction in Korea

BACKGROUND/AIM

Previous studies have suggested that the short-term ambient air pollution and temperature are associated with myocardial infarction. In this study, we aimed to conduct a time-series analysis to assess the impact of fine particulate matter (PM2.5) and temperature on acute myocardial infarction (AMI) among adults over 20 years of age in Korea by using the data from the Korean National Health Information Database (KNHID).

METHODS

The daily data of 192,567 AMI cases in Seoul were collected from the nationwide, population-based KNHID from 2005 to 2014. The monitoring data of ambient PM2.5 from the Seoul Research Institute of Public Health and Environment were also collected. A generalized additive model (GAM) that allowed for a quasi-Poisson distribution was used to analyze the effects of PM2.5 and temperature on the incidence of AMI.

RESULTS

The models with PM2.5 lag structures of lag 0 and 2-day averages of lag 0 and 1 (lag 01) showed significant associations with AMI (Relative risk [RR]: 1.011, CI: 1.003-1.020 for lag 0, RR: 1.010, CI: 1.000-1.020 for lag 01) after adjusting the covariates. Stratification analysis conducted in the cold season (October-April) and the warm season (May-September) showed a significant lag 0 effect for AMI cases in the cold season only.

CONCLUSIONS

In conclusion, acute exposure to PM2.5 was significantly associated with AMI morbidity at lag 0 in Seoul, Korea. This increased risk was also observed at low temperatures.

Racial Difference in the Association of Long-Term Exposure to Fine Particulate Matter (PM2.5) and Cardiovascular Disease Mortality among Renal Transplant Recipients

Ambient air pollutants are known risk factors for cardiovascular disease (CVD) morbidity and mortality with significant racial disparities. However, few studies have explored racial differences among highly susceptible subpopulations, such as renal transplant recipients (RTRs). Despite improvements in quality of life after transplantation, CVD remains the major cause of mortality, especially among Black recipients. This study aimed to evaluate potential racial differences in the association between long-term levels of PM2.5 and the risk of all-cause, total CVD, and coronary heart disease (CHD) mortality among RTRs. This retrospective study consists of 93,857 non-smoking adults who received a renal transplant between 2001 and 2015. Time-dependent Cox regression was used to assess the association between annual concentrations of PM2.5 and mortality risk. In the multivariable-adjusted models, a 10 μg/m3 increase in ambient PM2.5 levels found increased risk of all-cause (HR = 3.45, 95% CI: 3.08-3.78), CVD (HR = 2.38, 95% CI: 1.94-2.92), and CHD mortality (HR = 3.10, 95% CI: 1.96-4.90). Black recipients had higher risks of all-cause (HR = 4.09, 95% CI: 3.43-4.88) and CHD mortality (HR = 6.73, 95% CI: 2.96-15.32). High levels of ambient PM2.5 were associated with all-cause, CVD, and CHD mortality. The association tended to be higher among Black recipients than non-Blacks.

Diurnal variability of fine-particulate pollution concentrations: data from 14 low- and middle-income countries

BACKGROUND: Scientific understanding of indoor air pollution is predominately based on research carried out in cities in high-income countries (HICs). Less is known about how pollutant concentrations change over the course of a typical day in cities in low- and middle-income countries (LMICs).OBJECTIVE: To understand how concentrations of fine particulate matter smaller than 2.5 microns in diameter (PM_2.5) change over the course of the day outdoors (across a range of countries) and indoors (using measurements from Dhaka, Bangladesh).DESIGN: Data on PM_2.5 concentrations were gathered from 779 households in Dhaka as part of the MCLASS II (Muslim Communities Learning About Second-hand Smoke in Bangladesh) project, and compared to outdoor PM_2.5 concentrations to determine the temporal variation in exposure to air pollution. Hourly PM_2.5 data from 23 cities in 14 LMICs, as well as London (UK), Paris (France) and New York (NY, USA), were extracted from publicly available sources for comparison.RESULTS: PM_2.5 in homes in Dhaka demonstrated a similar temporal pattern to outdoor measurements, with greater concentrations at night than in the afternoon. This pattern was also evident in 19 of 23 LMIC cities.CONCLUSION: PM_2.5 concentrations are greater at night than during the afternoon in homes in Dhaka. Diurnal variations in PM_2.5 in LMICs is substantial and greater than in London, Paris or New York. This has implications for public health community approaches to health effects of air pollution in LMICs.

Cardiovascular effects of air pollution: current evidence from animal and human studies

Air pollution is a global health concern. Particulate matter (PM)_2.5, a component of ambient air pollution, has been identified by the World Health Organization as one of the pollutants that poses the greatest threat to public health. Cardiovascular health effects have been extensively documented, and these effects are still being researched to provide an overview of recent literature regarding air pollution-associated cardiovascular morbidity and mortality in humans. Additionally, potential mechanisms through which air pollutants affect the cardiovascular system are discussed based on human and additional animal studies. We used the strategy of a narrative review to summarize the scientific literature of studies that were published in the past 7 yr. Searches were carried out on PubMed and Web of Science using predefined search queries. We obtained an initial set of 800 publications that were filtered to 78 publications that were relevant to include in this review. Analysis of the literature showed significant associations between air pollution, especially PM_2.5, and the risk of elevated blood pressure (BP), acute coronary syndrome, myocardial infarction (MI), cardiac arrhythmia, and heart failure (HF). Prominent mechanisms that underlie the adverse effects of air pollution include oxidative stress, systemic inflammation, endothelial dysfunction, autonomic imbalance, and thrombogenicity. The current review underscores the relevance of air pollution as a global health concern that affects cardiovascular health. More rigorous standards are needed to reduce the cardiovascular disease burden imposed by air pollution. Continued research on the health impact of air pollution is needed to provide further insight.

Exposure to fine particulate matter induces self-recovery and susceptibility of oxidative stress and inflammation in rat lungs

PM_2.5 induces pulmonary inflammation via oxidative stress, and this role in the lungs is widely accepted, but studies on whether oxidative stress and inflammation can self-recover and be fully restored are limited. In this study, the oxidative stress and inflammation in the lungs of rats, which were first exposed to different PM_2.5 dosages (0, 0.5, 3.0, and 15.0 mg/kg body weight) and different recovery days (0, 15, and 30 days) and then were exposed to the same PM_2.5 dosages (30 mg/kg b.w.) after 30 days of recovery, were investigated. Results showed that the activity of superoxide dismutase (SOD) was significantly inhibited, and the levels of malondialdehyde (MDA), inducible nitric oxide synthase (iNOS), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β) significantly increased. These changes were accompanied with damage to the pathological structure of the rat lungs. After stopping PM_2.5 exposure, the difference between the PM_2.5 group and the control group gradually decreased with the extension of recovery time. However, when the rats were again exposed to the same dose of PM_2.5, the levels of IL-6, IL-1β, TNF-α, MDA, and iNOS were significantly increased, and the activities of SOD and GSH-Px were significantly inhibited in the high-dose group. And the high-dose group was accompanied by more severe lung pathological structural damage. Results showed that PM_2.5 could induce oxidative stress and inflammatory damage in the lungs of rats, and these damages gradually recovered as exposure ceased, but increased lung susceptibility in rats.

Prenatal exposure to ambient air pollution and adverse pregnancy outcomes in Ahvaz, Iran: a generalized additive model

OBJECTIVE

There is some evidence about the short-term effects of air pollutants on adverse pregnancy outcomes. The aim of this study was to determine the association between air pollutants and spontaneous abortion, stillbirth, gestational hypertension, preeclampsia, gestational diabetes and macrosomia in Ahvaz, which is one of the most polluted cities in the Middle East.

METHODS

Data on adverse pregnancy outcomes and air pollutants including ozone (O₃), nitric oxide (NO), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), carbon monoxide (CO), particles with a diameter of less than 10 µm (PM₁₀) and particles with a diameter less than 2.5 µm (PM_2.5) were inquired from the Health Department of Ahvaz Jundishapur University of Medical Sciences and the Environmental Protection Agency of Khuzestan Province for the years 2008-2018. A time series analysis using the generalized additive model (GAM) with up to 6-day lags was used.

RESULTS

The results showed that the SO₂ pollutant on 0, 1, 3, 4, and 6-day lags and PM₁₀ on lag 0 had direct and significant associations with spontaneous abortion. NO, NO₂ and CO on 0-6-day lags, and O₃ on 6-day lags showed direct and significant associations with preeclampsia. NO and NO₂ pollutants showed significant and direct associations with gestational diabetes, during 0- and 6-day lags. NO on 0-, 3- and 4-day lags, CO in all 0-6-day lags and PM_2.5 on 1-, 3-, 5-, and 6-day lags showed direct and significant associations with macrosomia. None of the pollutants showed significant associations with stillbirth or gestational hypertension.

CONCLUSIONS

The results of this study suggest that some air pollutants are associated with spontaneous abortion, preeclampsia, gestational diabetes and macrosomia. This study further emphasizes the need to control ambient air pollution.

Air pollution and hospital admissions due to deep vein thrombosis (DVT) in Ahvaz, Iran

There are limited studies on the relation between short-term exposure to air pollutants and the risk of deep venous thrombosis (DVT). The aim of this study was to determine the relation between the concentration of these pollutants and the risk of hospital admissions due to DVT in Ahvaz, which is one of the world's highly polluted cities. Daily data on pollutants including O₃, NO, NO₂, SO₂, CO, PM₁₀, and PM_2.5and DVT hospital admissions were collected from2008until 2018. Quasi-Poisson regression combined with linear distributed lag models; adjusted for trend, seasonality, temperature, relative humidity, weekdays, and holidays were used to assess the relation between the daily average of air pollutants and hospital admission for DVT. The results showed that there was a significant increase in hospital admissions due to DVT in the total, men, women, and elderly populations in relation to NO and NO₂. There was also a significant increase in DVT hospital admissions in the male and ≤60 years populations related to PM₁₀; and among the female and ≤60 years old populations, related to PM_2.5. Finally, the results showed that there were significant positive associations between SO2 and CO exposure and the incidence of DVT hospital admissions among men and women, respectively. The results of this study show the possible effect of short-term exposure to air pollution on the risk of DVT. Further studies are required to investigate whether direct interventions through industry and government policy may alter the impact of specific pollutants in order to alter the incidence of DVT and other identified health complications.

The COVID-19 Infection in Italy: A Statistical Study of an Abnormally Severe Disease

We statistically investigate the Coronavirus Disease 19 (COVID-19) pandemic, which became particularly invasive in Italy in March 2020. We show that the high apparent lethality or case fatality ratio (CFR) observed in Italy, as compared with other countries, is likely biased by a strong underestimation of the number of infection cases. To give a more realistic estimate of the lethality of COVID-19, we use the actual (March 2020) estimates of the infection fatality ratio (IFR) of the pandemic based on the minimum observed CFR and analyze data obtained from the Diamond Princess cruise ship, a good representation of a "laboratory" case-study from an isolated system in which all the people have been tested. From such analyses, we derive more realistic estimates of the real extent of the infection as well as more accurate indicators of how fast the infection propagates. We then isolate the dominant factors causing the abnormal severity of the disease in Italy. Finally, we use the death count-the only data estimated to be reliable enough-to predict the total number of people infected and the interval of time when the infection in Italy could end.

The COVID-19 Infection in Italy: A Statistical Study of an Abnormally Severe Disease

We statistically investigate the Coronavirus Disease 19 (COVID-19) pandemic, which became particularly invasive in Italy in March 2020. We show that the high apparent lethality or case fatality ratio (CFR) observed in Italy, as compared with other countries, is likely biased by a strong underestimation of the number of infection cases. To give a more realistic estimate of the lethality of COVID-19, we use the actual (March 2020) estimates of the infection fatality ratio (IFR) of the pandemic based on the minimum observed CFR and analyze data obtained from the Diamond Princess cruise ship, a good representation of a "laboratory" case-study from an isolated system in which all the people have been tested. From such analyses, we derive more realistic estimates of the real extent of the infection as well as more accurate indicators of how fast the infection propagates. We then isolate the dominant factors causing the abnormal severity of the disease in Italy. Finally, we use the death count-the only data estimated to be reliable enough-to predict the total number of people infected and the interval of time when the infection in Italy could end.

The Association Between Air Pollution and Low Birth Weight and Preterm Labor in Ahvaz, Iran

PURPOSE

Pregnant women and fetuses are sensitive to air pollution due to physiological changes in pregnancy. The aim of this study was to determine the relationship between exposure to air pollution, low birth weight and preterm labor in Ahvaz.

METHODS

This research was a time-series study. The research sample consisted of all data about low birth weight and preterm labor pregnant women from Imam Khomeini Hospital and Razi Hospital in Ahvaz city. Air pollutant data including O3, NO, NO2, SO2, CO, PM10 and PM2.5 and climate data were collected from the Environmental Protection Agency and the Khuzestan Province during a 10-year period from 2008 to 2018. The generalized additive models (GAMs) with different air pollutant lags up to 6 days were used.

RESULTS

The results of multiple GAM model have shown that there is a direct and significant relationship between exposure to PM10 at 0-6-day lag, SO2 at 2- and 3-day lag and low birth weight. In addition, there was a direct and significant correlation between exposure to NO2, NO, CO and PM2.5 at 0-6-day lag and preterm labor.

CONCLUSION

The results indicate the effect of air pollutants on low birth weight and preterm labor. Therefore, pregnant women should be informed about the negative consequences of air pollution and avoid exposure to polluted air during pregnancy.

Nrf2 deficiency aggravates PM2.5-induced cardiomyopathy by enhancing oxidative stress, fibrosis and inflammation via RIPK3-regulated mitochondrial disorder

PM_2.5 is a well-known air pollutant threatening public health, and long-term exposure to PM_2.5 increases the risk of cardiovascular diseases. Nrf2 plays a pivotal role in the amelioration of PM_2.5-induced lung injury. However, if Nrf2 is involved in PM_2.5-induced heart injury, and the underlying molecular mechanisms have not been explored. In this study, wild type (Nrf2^+/+) and Nrf2 knockout (Nrf2^-/-) mice were exposed to PM_2.5 for 6 months. After PM_2.5 exposure, Nrf2^-/- mice developed severe physiological changes, lung injury and cardiac dysfunction. In the PM_2.5-exposed hearts, Nrf2 deficiency caused significant collagen accumulation through promoting the expression of fibrosis-associated signals. Additionally, Nrf2^-/- mice exhibited greater oxidative stress in cardiac tissues after PM_2.5 exposure. Furthermore, PM_2.5-induced inflammation in heart samples were accelerated in Nrf2^-/- mice through promoting inhibitor of α/nuclear factor κB (IκBα/NF-κB) signaling pathways. We also found that Nrf2^-/- aggravated autophagy initiation and glucose metabolism disorder in hearts of mice with PM_2.5 challenge. Cardiac receptor-interacting protein kinase 3 (RIPK3) expression triggered by PM_2.5 was further enhanced in mice with the loss of Nrf2. Collectively, these results suggested that strategies for enhancing Nrf2 could be used to treat PM_2.5-induced cardiovascular diseases.

Acute Effects of Air Pollution on Hospital Admissions for Asthma, COPD, and Bronchiectasis in Ahvaz, Iran

Background and Aim

Although air pollution is a serious problem in Ahvaz, the association between air pollution and respiratory diseases has not been studied enough in this area. The aim of this study was to determine the relation between short-term exposure to air pollutants and the risk of hospital admissions due to asthma, COPD, and bronchiectasis in Ahvaz.

Methods

Hospital admissions data and air pollutants including O3, NO, NO2, SO2, CO, PM10, and PM2.5 were obtained from 2008 to 2018. Adjusted Quasi-Poisson regression with a distributed lag model, controlled for trend, seasonality, weather, weekdays, and holidays was used for data analysis.

Results

The results showed a significant increase in hospital admissions for asthma (RR=1.004, 95% CI: 1.002-1.007) and COPD (RR=1.003, 95% CI: 1.001-1.005) associated with PM2.5. PM10 was associated with increased hospital admissions due to bronchiectasis in both genders (Men: RR=1.003, 95% CI: 1.001-1.006) (Female: RR=1.003, 95% CI: 1.000-1.006). NO2 was also associated with an increased risk of hospital admissions for asthma (RR=1.040, 95% CI: 1.008-1.074) and COPD (RR=1.049, 95% CI: 1.010-1.090). SO2 was associated with the risk of hospital admissions of asthma (RR=1.069, 95% CI: 1.017-1.124) and bronchiectasis (RR=1.030, 95% CI: 1.005-1.056). Finally, CO was associated with COPD (RR=1.643, 95% CI: 1.233-2.191) and bronchiectasis (RR=1.542, 95% CI: 1.035-2.298) hospital admissions.

Conclusion

Short-term exposure to air pollutants significantly increases the risk of hospital admissions for asthma, COPD, and bronchiectasis in the adult and elderly population.

Short-term effects of particulate matter exposure on emergency room visits for cardiovascular disease in Lanzhou, China: a time series analysis

Cardiovascular disease (CVD) has been the leading cause of death in China. Identifying the relationship between particulate matter (PM) and CVD in China is a significant challenge. In this study, daily CVD emergency room visit, environmental monitoring, and weather data from January 1, 2017, to December 31, 2018, in Lanzhou were collected. Generalized additive models (GAMs) were constructed to estimate the short-term effects of daily PM_2.5, PM_C, and PM₁₀ concentrations on CVD emergency room visits with different lag structures after controlling for the influence of meteorological elements and gaseous pollutants. Stratified analyses were conducted according to age (≥ 65 years and < 65 years), sex (male and female), cold season (from November to April), and warm season (from May to October). The results showed that each 10 μg/m³ increase in PM_2.5 was associated with a 1.93% (95% CI 0.12-3.78%) increase in CVD emergency room visits at lag03, and no single lag model was statistically significant. The excess relative risks (ERRs) of PM₁₀ and PM_C were not statistically significant at any lag pattern. The exposure-response curves demonstrated a nonlinear upward trend for these three PM pollutants. When adjusting for other gaseous pollutants, such as NO₂, SO₂, CO, and O₃, in the two-pollutant models, the associations between PM₁₀ and PM_C and CVD emergency room visits did not change compared with the single-pollutant models. The ERRs of PM_2.5 were 1.67% (95% CI 0.03-3.34%) at lag02 after adjustment for NO₂ and 1.65% (95% CI 0.02-3.30%) at lag02 after adjustment for SO₂. The ERRs of PM_2.5 were still statistically significant at lag03 when we adjusted for any one of the gaseous pollutants. Susceptibility to PM_2.5 was increased in people aged < 65 years, in males, and in the warm season. The findings are very important for local governments to develop environmental policies and strategies to reduce ambient PM_2.5 levels.

Analysis of Short-Term Effects of Air Pollution on Cardiovascular Disease Using Bayesian Spatio-temporal Models

There has been an increasing number of clinical and epidemiologic research projects providing supporting evidence that short-term exposure to ambient air pollution contributes to the exacerbation of cardiovascular disease. However, few studies consider measurement error and spatial effects in the estimate of underlying air pollution levels, and less is known about the influence of baseline air pollution levels on cardiovascular disease. We used hospital admissions data for cardiovascular diseases (CVD) collected from an inland, heavily polluted city and a coastal city in Shandong Province, China. Bayesian spatio-temporal models were applied to obtain the underlying pollution level in each city, then generalized additive models were adopted to assess the health effects. The total cardiovascular disease hospitalizations were significantly increased in the inland city by 0.401% (0.029, 0.775), 0.316% (0.086, 0.547), 0.903% (0.252, 1.559), and 2.647% (1.607, 3.697) per 10 μg/m3 increase in PM2.5, PM10, SO2, and NO2, respectively. The total cardiovascular diseases hospitalizations were increased by 6.568% (3.636, 9.584) per 10μg/m3 increase in the level of NO2. Although the air pollution overall had a more significant adverse impact on cardiovascular disease hospital admissions in the heavily polluted inland city, the short-term increases in air pollution levels in the less polluted coastal areas led to excessive exacerbations of cardiovascular disease.

Study on the association between ambient air pollution and daily cardiovascular death in Hefei, China

Cardiovascular disease has always been the most serious public health problem in China. Although many studies have found that the risk of death caused by cardiovascular disease is related to air pollutants, the existing results are still inconsistent. The aim of this study was to investigate the effects of air pollutants on the risk of daily cardiovascular deaths in Hefei, China. Daily data on cardiovascular deaths, daily air pollutants, and meteorological factors from 2007 to 2016 were collected in this study. A time-series study design using a distributed lag nonlinear model was employed to evaluate the association between air pollutants and cardiovascular deaths. First, a single air pollutant model was established based on the minimum value of Akaike information criterion (AIC), and the single day lag effects and multi-day lag effects were discussed separately. Then, two-pollutant models were fitted. Subgroup analyses were conducted by gender (male and female), age (< 65 age and ≥ 65 age), and disease type (ischemic heart disease and cerebral vascular disease). There were 34,500 cases of cardiovascular deaths during the period 2007-2016, and the average concentrations of air pollutants (PM₁₀, SO₂, NO₂, PM_2.5, CO, O₃) were 106.11, 20.34, 30.49, 72.59, 958.7, and 67.88 μg/m³, respectively. An increase of interquartile range (IQR) in PM₁₀, SO₂, NO₂, PM_2.5, CO, and O₃ were associated with an increase of 4.34% (95%CI 1.54~7.23%) at lag 0-6, 5.79% (95%CI 2.43~9.27%) at lag 0-5, 4.47% (95%CI 1.64~7.37%) at lag 0-5, 3.14% (95%CI 0.03~6.36%) at lag 0-4, 3.11% (95%CI 0.21~6.10%) at lag 0-3, and 8.17% (95%CI 1.89~14.84%) at lag 0-5 in cardiovascular deaths, respectively. Females, older group (≥ 65 years) and deaths from cerebral vascular disease were more vulnerable to air pollution than males, younger individuals (< 65 years) and deaths from ischemic heart disease. Our results suggest that air pollution increased the risk of cardiovascular deaths in Hefei. These findings can provide evidence for effective air quality interventions in Hefei.

Study of Indoor Ventilation Based on Large-Scale [DNS by a Domain Decomposition Method

This paper presents a large-scale Domain Decomposition Method (DDM) based Direct Numerical Simulation (DNS) for predicting the behavior of indoor airflow, where the aim is to design a comfortable and efficient indoor air environment of modern buildings. An analogy of the single-phase convection problems is applied, and the pressure stabilized domain decomposition method is used to symmetrize the linear systems of Navier-Stokes equations and the convection-diffusion equation. Furthermore, a balancing preconditioned conjugate gradient method is utilized to deal with the interface problem caused by domain decomposition. The entire simulation model is validated by comparing the numerical results with that of recognized experimental and numerical data from previous literature. The transient behavior of indoor airflow and its complexity in the ventilated room are discussed; the velocity and vortex distribution of airflow are investigated, and its possible influence on particle accumulation is classified.

Air pollutants and outpatient visits for cardiovascular disease in a severe haze-fog city: Shijiazhuang, China

Background

Many studies have reported the impact of air pollution on cardiovascular disease (CVD), but few of these studies were conducted in severe haze-fog areas. The present study focuses on the impact of different air pollutant concentrations on daily CVD outpatient visits in a severe haze-fog city.

Methods

Data regarding daily air pollutants and outpatient visits for CVD in 2013 were collected, and the association between six pollutants and CVD outpatient visits was explored using the least squares mean (LSmeans) and logistic regression. Adjustments were made for days of the week, months, air temperature and relative humidity.

Results

The daily CVD outpatient visits for particulate matter (PM₁₀ and PM_2.5), sulphur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃) in the 90th-quantile group were increased by 30.01, 29.42, 17.68, 14.98, 29.34%, and − 19.87%, respectively, compared to those in the <10th-quantile group. Odds ratios (ORs) and 95% confidence intervals (CIs) for the increase in daily CVD outpatient visits in PM₁₀ 300- and 500-μg/m³, PM_2.5 100- and 300-μg/m³ and CO 3-mg/m³ groups were 2.538 (1.070–6.020), 7.781 (1.681–36.024), 3.298 (1.559–6.976), 8.72 (1.523–49.934), and 5.808 (1.016–33.217), respectively, and their corresponding attributable risk percentages (AR%) were 60.6, 87.15, 69.68, 88.53 and 82.78%, respectively. The strongest associations for PM₁₀, PM_2.5 and CO were found only in lag 0 and lag 1. The ORs for the increase in CVD outpatient visits per increase in different units of the six pollutants were also analysed.

Conclusions

All five air pollutants except O₃ were positively associated with the increase in daily CVD outpatient visits in lag 0. The high concentrations of PM₁₀, PM_2.5 and CO heightened not only the percentage but also the risk of increased daily CVD outpatient visits. PM₁₀, PM_2.5 and CO may be the main factors of CVD outpatient visits.

Short-term effect of relatively low level air pollution on outpatient visit in Shennongjia, China

BACKGROUND

Many cities in China are currently experiencing severe air pollution due to modernization. Previous studies investigating the effects of air pollutants exposure were particularly conducted in severe air polluted area and studies in low pollution areas were sparse.

METHODS

To quantitatively assess the short-term effects of ambient air pollutants (PM_2.5, PM₁₀, SO₂, NO₂, CO and O₃) on outpatient visits in low pollution area, we conducted a time-series analysis from Jan 1, 2015 to Dec 31, 2016 in Shennongjia, China. Generalized additive model (GAM) was used to evaluate the influence of PM_2.5 on daily hospital outpatient visits with different lag structures. We also conducted stratified analysis to explore the association between PM_2.5 concentration and outpatient visits in different seasons.

RESULTS

In the present study, per IQR increment of PM_2.5, PM₁₀, NO₂, CO and O₃ were related with 1.92% (0.76%-3.09%), 1.92% (0.77%-3.07%), 2.74% (95% CI: 1.65%-3.83%), 1.89% (95% CI: 0.68%-3.10%) and 2.30% (95% CI: 0.65%-3.95%) increase on respiratory outpatient visits. Significant associations were found between PM_2.5, PM₁₀, NO₂ and respiratory outpatient visits at lag0:1, lag0:2 days. The effects of PM_2.5 were more evident in the cool season than in the warm season.

CONCLUSIONS

Our study showed that short-term exposures to PM_2.5, PM₁₀, NO₂, CO and O₃ were related with increased risk of outpatient visits of respiratory diseases, and highlighted the adverse effect of air pollutants exposure, especially PM_2.5 exposure in cool season on health in low pollution area.

The toxicology of air pollution predicts its epidemiology

The epidemiologic investigation has successively delineated associations of air pollution exposure with non-malignant and malignant lung disease, cardiovascular disease, cerebrovascular disease, pregnancy outcomes, perinatal effects and other extra-pulmonary disease including diabetes. Defining these relationships between air pollution exposure and human health closely parallels results of an earlier epidemiologic investigation into cigarette smoking and environmental tobacco smoke (ETS), two other particle-related exposures. Humic-like substances (HULIS) have been identified as a chemical component common to cigarette smoke and air pollution particles. Toxicology studies provide evidence that a disruption of iron homeostasis with sequestration of host metal by HULIS is a fundamental mechanistic pathway through which biological effects are initiated by cigarette smoke and air pollution particles. As a result of a common chemical component and a shared mechanistic pathway, it should be possible to extrapolate from the epidemiology of cigarette smoking and ETS to predict associations of air pollution exposure with human disease, which are currently unrecognized. Accordingly, it is anticipated that the forthcoming epidemiologic investigation will demonstrate relationships of air pollution with COPD causation, peripheral vascular disease, hypertension, renal disease, digestive disease, loss of bone mass/risk of fractures, dental disease, eye disease, fertility problems, and extrapulmonary malignancies.

Exposure to Outdoor Particles (PM2.5) and Associated Child Morbidity and Mortality in Socially Deprived Neighborhoods of Nairobi, Kenya

Exposure to air pollution is associated with adverse health outcomes. However, the health burden related to ambient outdoor air pollution in sub-Saharan Africa remains unclear. This study examined the relationship between exposure to outdoor air pollution and child health in urban slums of Nairobi, Kenya. We conducted a semi-ecological study among children under 5 years of age from two slum areas and exposure measurements of particulate matter (PM2.5) at the village level were aligned to data from a retrospective cohort study design. We used logistic and Poisson regression models to ascertain the associations between PM2.5 exposure level and child morbidity and mortality. Compared to those in low-pollution areas (PM2.5 < 25 µg/m3), children in high-pollution areas (PM2.5 ≥ 25 µg/m3) were at significantly higher risk for morbidity in general (odds ratio (OR) = 1.25, 95% confidence interval (CI): 1.11–1.41) and, specifically, cough (OR = 1.38, 95% CI: 1.20–1.48). Exposure to high levels of pollution was associated with a high child mortality rate from all causes (IRR = 1.22, 95% CI: 1.08–1.39) and respiratory causes (IRR = 1.12, 95% CI: 0.88–1.42). The findings indicate that there are associated adverse health outcomes with air pollution in urban slums. Further research on air pollution health impact assessments in similar urban areas is required.

Time series analysis of death of residents with malignant granules in Shenyang, China

The aim of the study was to find out the association between air pollution and meteorological conditions with the death of residents living in Shenyang due to malignant tumors. Tumor related death data of residents of five urban districts in Shenyang were obtained from Shenyang Center for Disease Control and Prevention. Daily temperature, pressure, wind speed and humidity data of Shenyang from 2010 to 2015 were obtained from Shenyang Meteorological Bureau. Urban air pollution data were obtained from the Shenyang Environmental Monitoring Center Station, Shenyang Environmental Protection Bureau of China. All data were analyzed by the Poisson regression model. During the period from 2010 to 2015, the number of deaths among malignancies in Shenyang was 215,141,000, and the death rate of malignancies in Shenyang was increasing year by year from 2010 to 2015. Mortality rate is higher in men than in women, and mortality rate increased with aging and the highest mortality rate was observed in the 75–80 years age group. Average concentration of aerodynamic diameter of <10 µm particles, the aerodynamic diameter of <2.5 µm particles, sulfur dioxide (SO₂) and nitrogen dioxide (NO₂) was 122.37, 74.75, 79.36, and 47.65 µg/m³, respectively. After control of confounding factors, it was observed that every 10 µg/m³ increase of PM2.5 is followed by the 0.024% (95% confidence interval: 0.005% and 0.043%) increase of malignant tumor mortality rate. The results show that the increase of air pollution is related to the number of malignant tumors-related deaths in Shenyang, China, and season, sex and age are also influencing factors.

AMPKα2 deficiency exacerbates long-term PM2.5 exposure-induced lung injury and cardiac dysfunction

Previous studies have demonstrated that long-term exposure to fine particulate matter (PM_2.5) increases the risk of respiratory and cardiovascular diseases. As a metabolic sensor, AMP-activated protein kinase (AMPK) is a promising target for cardiovascular disease. However, the impact of AMPK on the adverse health effects of PM_2.5 has not been investigated. In this study, we exposed wild-type (WT) and AMPKα2^-/- mice to either airborne PM_2.5 (mean daily concentration ~64 µg/m³) or filtered air for 6 months through a whole-body exposure system. After exposure, AMPKα2^-/- mice developed severe lung injury and left ventricular dysfunction. In the PM_2.5-exposed lungs and hearts, loss of AMPKα2 resulted in higher levels of fibrotic genes, more collagen deposition, lower levels of peroxiredoxin 5 (Prdx5), and greater induction of oxidative stress and inflammation than observed in the lungs and hearts of WT mice. In PM_2.5-exposed BEAS-2B and H9C2 cells, inhibition of AMPK activity significantly decreased cell viability and Prdx5 expression, and increased the intracellular ROS and p-NF-κB levels. Collectively, our results provide the first direct evidence that AMPK has a marked protective effect on the adverse health effects induced by long-term PM_2.5 exposure. Our findings suggest that strategies to increase AMPK activity may provide a novel approach to attenuate air pollution associated disease.

The effect of meteorological conditions and air pollution on the occurrence of type A and B acute aortic dissections

To explore the association of weather conditions and air pollutants with incidence risk of acute aortic dissection (AAD), we included patients who consecutively admitted to the emergency units of our hospital for AAD between Dec. 1, 2013, and Apr. 30, 2017. Their medical records were reviewed. The meteorological data (daily precipitation, minimal and maximal temperatures, mean atmospheric pressure, relative humidity) and air pollutants values [air daily index (AQI), aerodynamic diameter of 2.5 mm or less (PM2.5), aerodynamic diameter of 10 mm or less (PM10), ozone, nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), and ozone (O3_8h)] over the same period were provided by the Chengdu Meteorological Bureau. Finally, a total of 345 patients were admitted with AAD. The results showed that the incidence of AAD was higher in winter than in summer (p < 0.001). Statistical analysis highlighted lower the atmospheric temperature, higher the incidence of AAD (p < 0.001). A significant correlation was found between air pollutants and AAD onset. AQI, PM2.5, SO2, and NO2 were independent predictors of incidence of AAD (OR = 1.006, p = 0.007; OR = 1.020, p < 0.001; OR = 1.037, p < 0.001; and OR = 0.925, p < 0.001; respectively). While, PM10, CO, and O3_8H had a neutral effect on risk of AAD onset. In conclusions, cold atmospheric temperature and larger daily temperature change were correlated with a higher incidence of AAD. AQI, PM2.5, and SO2 played important roles in triggering acute aortic events.

Association between the GPAM rs1129555 SNP and serum lipid profiles in the Maonan and Han populations

The glycerol-3-phosphate acyltransferase mitochondrial gene (GPAM) variant has been associated with serum lipid levels in the Eurpean ancestry, but little is known about such association in Chinese populations. The aim of the present study was to investigate the relationship between the GPAM rs1129555 single nucleotide polymorphism (SNP) and several environment factors with blood lipid profiles in the Guangxi Maonan and Han populations. A total of 720 individuals of Maonan nationality and 780 participants of Han nationality were randomly selected from our previous stratified randomized samples. Genotyping of the rs1129555 SNP was carried out using the polymerase chain reaction-restriction fragment length polymorphism technique, and then confirmed by direct sequencing. The frequencies of C and T alleles were 72.85% and 27.15% in Maonan, and 65.19% and 34.81% in Han (P < 0.001); respectively. The frequencies of CC, CT, and TT genotypes were 51.53%, 42.36%, and 5.97% in Maonan, and 43.08%, 44.23%, and 12.69% in Han populations (P < 0.001). The T allele carriers had higher serum triglyceride (TG) in Han and higher low-density lipoprotein cholesterol (LDL-C) in both Maonan and Han than the T allele non-carriers (P < 0.05-0.01). Gender subgroup analyses showed that the T allele carriers had higher TG levels in Han males (P < 0.05) and higher LDL-C levels in Maonan males but not in famales (P < 0.01). Serum lipid parameters were also associated with several environmental factors (P < 0.05-0.001). These findings suggest that racial/ethnic- and/or gender-specific association occurs between the GPAM rs1129555 variant and serum lipid parameters in our study populations.

Impact of Particulate Air Pollution on Cardiovascular Health

PURPOSE OF REVIEW

Air pollution is established as an independent risk factor for cardiovascular diseases (CVDs). Ambient particulate matter (PM), a principal component of air pollutant, has been considered as a main culprit of the adverse effects of air pollution on human health.

RECENT FINDINGS

Extensive epidemiological and toxicological studies have demonstrated particulate air pollution is positively associated with the development of CVDs. Short-term PM exposure can trigger acute cardiovascular events while long-term exposure over years augments cardiovascular risk to an even greater extent and can reduce life expectancy by a few years. Inhalation of PM affects heart rate variability, blood pressure, vascular tone, blood coagulability, and the progression of atherosclerosis. The potential molecular mechanisms of PM-caused CVDs include direct toxicity to the cardiovascular system or indirect injury by inducing systemic inflammation and oxidative stress in circulation. This review mainly focuses on the acute and chronic effects of ambient PM exposure on the development of cardiovascular diseases and the possible mechanisms for PM-induced increases in cardiovascular morbidity and mortality. Additionally, we summarized some appropriate interventions to attenuate PM air pollution-induced cardiovascular adverse effects, which may promote great benefits to public health.

Acute effects of air pollution on spontaneous abortion, premature delivery, and stillbirth in Ahvaz, Iran: a time-series study

Living in areas with high air pollution may have adverse effects on human health. There are few studies about the association between breathing polluted air and adverse pregnancy outcomes in the Middle East. The aim of this study was to determine the relationship between air pollution and spontaneous abortion, premature birth, and stillbirth in Ahvaz. A time-series study was conducted. Data about spontaneous abortion, premature deliveries, and stillbirth was collected from Ahvaz Imam Khomeini Hospital. Air pollution data including NO, CO, NO₂, PM₁₀, SO₂, O₃, and climate data were, respectively, collected from the Environmental Protection Agency and the Khuzestan Province Meteorology Office from March 2008 until March 2015. The relationship between air pollutants with the number of abortions, premature births, and stillbirths was found using a quasi-Poisson distributed lag model, adjusted by trend, seasonality, temperature, relative humidity, weekdays, and holidays. The average daily dust in Ahvaz on 7.2% days of the year was higher than 500 μg/m³ (very dangerous). Findings from this study indicate a significant association between each 10-unit increase in SO₂ and spontaneous abortion in lag 0 and 9 days. There was a significant relation between each 10-unit increase in NO₂ and CO, and premature birth in lag 0. Also, we found a significant association between each 10-unit increase in CO and premature delivery in lag 1; PM₁₀ and premature delivery in lags 10, 11, and 12; and NO and premature delivery in lags 3, 4, 10, 11, 12, and 13 (p value < 0.05). Contact with polluted air during pregnancy may increase adverse pregnancy outcomes and stillbirth. Pregnant women should avoid polluted air.

Cardiorespiratory health effects of particulate ambient air pollution exposure in low-income and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Most prospective studies on the health effects of particulate ambient air pollution exposure have focused on high-income countries, which have much lower pollutant concentrations than low-income and middle-income countries (LMICs) and different sources of pollution. We aimed to investigate the cardiorespiratory health effects of particulate ambient air pollution exposure in LMICs exclusively.

METHODS

For this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, LILACS, Global Health, and Proquest for studies published between database inception and Nov 28, 2016, investigating the cardiorespiratory health effects of particulate ambient air pollution exposure in LMICs. Data were extracted from published studies by one author, and then checked and verified by all authors independently. We pooled estimates by pollutant type (particulate matter with a diameter of <2·5 μm [PM_2·5] or 2·5-10 μm [PM₁₀]), lag, and outcome, and presented them as excess relative risk per 10 μg/m³ increase in particulate ambient air pollution. We used a random-effects model to derive overall excess risk. The study protocol is registered with PROSPERO, number CRD42016051733.

FINDINGS

Of 1553 studies identified, 91 met the full eligibility criteria. Only four long-term exposure studies from China were identified and not included in the meta-analysis. A 10 μg/m³ increase in same-day PM_2·5 was associated with a 0·47% (95% CI 0·34-0·61) increase in cardiovascular mortality and a 0·57% (0·28-0·86) increase in respiratory mortality. A 10 μg/m³ increase in same-day PM₁₀ was associated with a 0·27% (0·11-0·44) increase in cardiovascular mortality and a 0·56% (0·24-0·87) increase in respiratory mortality.

INTERPRETATION

Short-term exposure to particulate ambient air pollution is associated with increases in cardiorespiratory morbidity and mortality in LMIC's, with apparent regional-specific variations.

FUNDING

None.

Association of air particulate pollution with bone loss over time and bone fracture risk: analysis of data from two independent studies

BACKGROUND

Air particulate matter (PM) is a ubiquitous environmental exposure associated with oxidation, inflammation, and age-related chronic disease. Whether PM is associated with loss of bone mineral density (BMD) and risk of bone fractures is undetermined.

METHODS

We conducted two complementary studies of: (i) long-term PM <2.5 μm (PM_2.5) levels and osteoporosis-related fracture hospital admissions among 9.2 million Medicare enrollees of the Northeast/Mid-Atlantic United States between 2003-2010; (ii) long-term black carbon [BC] and PM_2.5 levels, serum calcium homeostasis biomarkers (parathyroid hormone, calcium, and 25-hydroxyvitamin D), and annualized BMD reduction over a 8-year follow-up of 692 middle-aged (46.7±12.3 yrs), low-income BACH/Bone cohort participants.

FINDINGS

In the Medicare analysis, risk of bone fracture admissions at osteoporosis-related sites was greater in areas with higher PM_2.5 levels (Risk ratio [RR] 1.041, 95% Confidence Interval [CI], 1.030, 1.051). This risk was particularly high among low-income communities (RR 1.076; 95% CI, 1.052, 1.100). In the longitudinal BACH/Bone study, baseline BC and PM_2.5 levels were associated with lower serum PTH (Estimate for baseline one interquartile increase in 1-year average BC= -1.16, 95% CI -1.93, -0.38; Estimate for baseline one interquartile increase in 1-year average PM_2.5= -7.39; 95%CI -14.17, -0.61). BC level was associated with higher BMD loss over time at multiple anatomical sites, including femoral neck (-0.08%/year per one interquartile increase; 95% CI -0.14, -0.02%/year) and ultradistal radius (-0.06%/year per one interquartile increase; 95% CI -0.12, -0.01%/year).

INTERPRETATION

Our results suggest that poor air quality is a modifiable risk factor for bone fractures and osteoporosis, especially in low-income communities.

Seasonal Effect on Association between Atmospheric Pollutants and Hospital Emergency Room Visit for Stroke

BACKGROUND

The relationship between air pollution and stroke is conflicting. This study was conducted to document the relationship between daily changes in atmospheric pollutants and hospital emergency room visits (ERVs) for stroke.

METHODS

Data of daily hospital ERVs for stroke and atmospheric pollutants in Changsha city between 2008 and 2009 were collected. Using a time-stratified bidirectional case-crossover design, we analyzed the association between atmospheric pollutants and stroke incidence in 4 seasons.

RESULTS

In the single-pollutant model, we found changes in sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and particulate matters (PM₁₀) were significantly associated with cerebral hemorrhage and cerebral infarction (P < .05) in lags of 0-2 days in autumn. A 10-µg/m³ increase in SO₂ in autumn was significantly associated with ERVs for both cerebral hemorrhage (odds ratio [OR], 1.166; 95% confidence interval [CI], 1.012-1.343) and cerebral infarction (OR, 1.214; 95% CI, 1.018-1.448). NO₂ in autumn was significantly associated with ERVs for cerebral hemorrhage and infarction with OR = 1.162 (95% CI, 1.005-1.344) and OR = 1.137 (95% CI, 1.011-1.279), respectively. PM₁₀ in autumn was significantly associated with ERVs for cerebral hemorrhage and infarction with OR = 1.147 (95% CI, 1.045-1.259) and OR = 1.091 (95% CI, 1.019-1.168), respectively. Results of the multipollutant model showed that in autumn after PM₁₀ and NO₂ adjustment, only a 10-µg/m³ increase in SO₂ was significantly associated with ERVs for cerebral infarction (OR, 1.158; 95% CI, 1.006-1.333; P < .05). SO₂, NO₂, and PM₁₀ were not associated with ERVs for cerebral hemorrhage (P > .05).

CONCLUSIONS

This study demonstrates that the change in atmospheric SO₂ levels in Changsha is significantly associated with the stroke incidence in autumn.

Practice of Comparative Effectiveness Research to Identify Treatment Characteristics of Similar Chinese Patent Medicine for Angina Pectoris

Objective

Individualized application of TCM is not easy and may lead to undesirable results, such as poor effect or even adverse reactions. This trial aims to compare two common Chinese patent medicines with similar effects.

Background of the Research

Four hospitals carried out the test at the same time in Tianjin city of China.

Participants

144 patients were involved in this study; all patients must meet the diagnostic criteria.

Interventions

Qishen Yiqi pills, compound danshen pills, and their placebos; an efficacy analysis was conducted after the first medication and after crossover medication.

Primary Outcome Measures

The primary index of end point includes Seattle Angina Questionnaire score-7 and score of 7-point Likert Scale; the curative effect was compared with minimal clinically important differences value.

Result

Two drugs have their respective advantages in treating SAP. In practical application, the two drugs shall be discriminated in use based on patients' specific symptoms.

Trial Registration

Chinese clinical trials register is ChiCTR-TTRCC-14004406 (registered 23 March 2014).

Different exposure levels of fine particulate matter and preterm birth: a meta-analysis based on cohort studies

The previous studies estimated the association between PM_2.5 (particulate matter with aerodynamic diameter less than or equal to 2.5 μm) exposure during pregnancy and preterm birth, only considered and highlighted the hazard effects of high levels of air pollutant exposure, and underestimated that low levels of pollutant exposure might also affect pregnancy outcome. We conducted a meta-analysis of 11 cohort studies, a total of more than 1,500,000 subjects. The results of these studies were pooled by exposure levels and study periods. PM_2.5 exposure during pregnancy was positively associated with preterm birth (OR = 1.15, 95% CI = 1.07-1.23), and during the first trimester of pregnancy, low levels of PM_2.5 exposure were also positively associated with preterm birth (OR = 1.17, 95% CI = 1.04-1.30). It is important to protect pregnant women from PM_2.5 exposures, especially during their first trimester of pregnancy even when the ambient PM_2.5 concentration is relatively low. More relevant health policy should be carried out to prevent hazard effect of air pollutants.

Ambient air pollution and daily hospital admissions for cardiovascular diseases in Arak, Iran

BACKGROUND

Outdoor air pollution has been considered as one of the most serious health concerns over the last decade. This study aimed to investigate the association between ambient air pollution and cardiovascular hospital admissions.

METHODS

This investigation was carried out from January 1, 2010 to December 31, 2015, in the urban population of Arak, Iran. Daily records of concentrations of air pollutants including particulate matter less than 10 µm (PM10), nitrogen dioxide (NO2), particulate matter less than 2.5 µm (PM2.5), ozone (O3), carbon monoxide (CO), and sulfur dioxide (SO2) as well as the daily number of hospital admissions due to cardiovascular disease were inquired from the Arak Department of Environment and two major hospitals, respectively. Time-series regression analysis was used to evaluate the effect of the pollutants on cardiovascular hospital admissions with different lag structures, controlling for weather variables, seasonality and long-term time trends, and day of the week.

RESULTS

Each 10 µg/m3 increase in PM10 and NO2 and 1 mg/m3 increase in CO concentrations at lag 0 (day) were significantly associated with an increase of 0.7% (P = 0.004), 3.3% (P = 0.006), and 9.4% (P < 0.001), respectively in overall cardiovascular hospital admissions. The elderly were more susceptible than those under 60 years to exposure to the pollutants (especially NO2) with regard to cardiovascular hospital admission.

CONCLUSION

The results of this study showed that hospital admission for cardiovascular disease is partly related to the levels of ambient air pollutions in Arak. Susceptibility to air pollutants varies by age groups and sex.

Environmental Exposures and Cardiovascular Disease: A Challenge for Health and Development in Low- and Middle-Income Countries

Environmental exposures in low- and middle-income countries lie at the intersection of increased economic development and the rising public health burden of cardiovascular disease. Increasing evidence suggests an association of exposure to ambient air pollution, household air pollution from biomass fuel, lead, arsenic, and cadmium with multiple cardiovascular disease outcomes, including hypertension, coronary heart disease, stroke, and cardiovascular mortality. Although populations in low- and middle-income countries are disproportionately exposed to environmental pollution, evidence linking these exposures to cardiovascular disease is derived from populations in high-income countries. More research is needed to further characterize the extent of environmental exposures.

Impact of seasonality and air pollutants on carotid-femoral pulse wave velocity and wave reflection in hypertensive patients

Objective

The effects of seasonality on blood pressure (BP) and cardiovascular (CV) events are well established, while the influence of seasonality and other environmental factors on arterial stiffness and wave reflection has never been analyzed. This study evaluated whether seasonality (daily number of hours of light) and acute variations in outdoor temperature and air pollutants may affect carotid-femoral pulse wave velocity (PWV) and pressure augmentation.

Design and method

731 hypertensive patients (30–88 years, 417 treated) were enrolled in a cross-sectional study during a 5-year period. PWV, central BP, Augmentation Index (AIx) and Augmentation Pressure (AP) were measured in a temperature-controlled (22–24°C) room. Data of the local office of the National Climatic Data Observatory were used to estimate meteorological conditions and air pollutants (PM₁₀, O₃, CO, N₂O) exposure on the same day.

Results

PWV (mean value 8.5±1.8 m/s) was related to age (r = 0.467, p<0.001), body mass index (r = 0.132, p<0.001), central systolic (r = 0.414, p<0.001) and diastolic BP (r = 0.093, p = 0.013), daylight hours (r = -0.176, p<0.001), mean outdoor temperature (r = -0.082, p = 0.027), O₃ (r = -0.135, p<0.001), CO (r = 0.096, p = 0.012), N₂O (r = 0.087, p = 0.022). In multiple linear regression analysis, adjusted for confounders, PWV remained independently associated only with daylight hours (β = -0.170; 95% CI: -0.273 to -0.067, p = 0.001). No significant correlation was found between pressure augmentation and daylight hours, mean temperature or air pollutants. The relationship was stronger in untreated patients and women. Furthermore, a positive, independent association between O₃ levels and PWV emerged in untreated patients (β: 0.018; p = 0.029; CI: 0.002 to 0.034) and in women (β: 0.027; p = 0.004; CI: 0.009 to 0.045).

Conclusions

PWV showed a marked seasonality in hypertensive patients. Environmental O₃ levels may acutely reduce arterial stiffness in hypertensive women and in untreated patients.

Acute Effects of Particulate Air Pollution on Ischemic Heart Disease Hospitalizations in Shanghai, China

Background: Air pollution has been demonstrated to be a major risk factor for the development of cardiovascular and respiratory diseases worldwide. This study examines the relationship between the exposure to fine particulate matter (PM) and patient hospitalizations as a result of ischemic heart disease (IHD) during 2013-2014 in Shanghai, China. Methods: Daily IHD hospitalization data were acquired from the Shanghai Health Insurance Bureau (SHIB) from 1 January 2013 to 21 December 2014. Daily average concentrations of air pollution as well as meteorological data were obtained from the database of Shanghai Environmental Monitoring Center (SEMC) during the same time period, and all data were analyzed using standard epidemiological methodology. Generalized linear model (GLM) adjusted for time trends, weather conditions, and medical insurance policy was used to estimate the immediate and delayed effects of PMs on IHD hospitalizations, and the effects of PMs were also examined based on gender, age group and seasonal variation. Results: A total of 188,198 IHD hospitalizations were recorded during 2013-2014 in Shanghai, China. During this period, the average concentrations of the fine particulate matter with aerodynamic diameter of <10 μm (PM₁₀) and ≤2.5 (PM_2.5) were 76 µg/m³ and 56.3 µg/m³, respectively. The effect of PMs was strongest on days when a 10 μg/m³ increment increase of PM_2.5 and PM₁₀, which coincided with an increase in IHD hospitalizations by 0.25% (95% CI: 0.10%, 0.39%) and 0.57% (95% CI: 0.46%, 0.68%), respectively. Furthermore, the effect of PMs was significantly greater in males and people between 41 and 65 years old. Conclusions: Hospitalizations of IHD was strongly associated with short-term exposure to high levels of PM₁₀ and PM_2.5 during 2013-2014 in Shanghai, China.

The Characteristics of Air Pollutants during Two Distinct Episodes of Fireworks Burning in a Valley City of North China

Background

The elevation and dissipation of pollutants after the ignition of fireworks in different functional areas of a valley city were investigated.

Methods

The Air Quality Index (AQI) as well as inter-day and intra-day concentrations of various air pollutants (PM₁₀, PM_2.5, SO₂, NO₂, CO, O₃) were measured during two episodes that took place during Chinese New Year festivities.

Results

For the special terrain of Jinan, the mean concentrations of pollutants increased sharply within 2–4 h of the firework displays, and concentrations were 4–6 times higher than the usual levels. It took 2–3 d for the pollutants to dissipate to background levels. Compared to Preliminary Eve (more fireworks are ignited on New Year’s Eve, but the amounts of other human activities are also lesser), the primary pollutants PM_2.5, PM₁₀, and CO reached higher concentrations on New Year’s Eve, and the highest concentrations of these pollutants were detected in living quarters. All areas suffered from serious pollution problems on New Year’s Eve (rural = urban for PM₁₀, but rural > urban for PM_2.5). However, SO₂ and NO₂ levels were 20%–60% lower in living quarters and industrial areas compared to the levels in these same areas on Preliminary Eve. In contrast to the other pollutants, O₃ concentrations fell instead of rising with the firework displays.

Conclusion

Interactions between firework displays and other human activities caused different change trends of pollutants. PM_2.5 and PM₁₀ were the main pollutants, and the rural living quarter had some of the highest pollution levels.

Associations of short-term exposure to air pollution with respiratory hospital admissions in Arak, Iran

BACKGROUND

Ambient air pollution, is one of the most frequently stated environmental problems. Many epidemiological studies have documented adverse health effects for ambient air pollution. This study aimed to investigate the association between ambient air pollution and respiratory hospital admissions.

METHODS

In this ecological time series study data about air pollutant concentrations including CO, NO₂, O₃, PM_2.5, PM₁₀ and SO₂ and, respiratory hospital admissions in the urban population of Arak, from January 1st 2010 to December 31st 2015; were inquired, from the Arak Department of Environment, and two major hospitals, respectively. Meteorological data were inquired for the same period as well. Time-series regression analysis with a distributed lag model, controlled for seasonality long-time trends, weather and day of the week, was used for data analysis.

RESULTS

Every 10 μg/m³ increase in NO₂, and PM₁₀ and every 1 mg/m³ increase in CO at lag 0 corresponded to a RR = 1.032 (95%CI, 1.003-1.06), RR = 1.01 (95%CI, 1.004-1.017) and RR = 1.09 (95%CI, 1.04-1.14), increase in respiratory disease hospitalizations, respectively. Males and the elderly were found to be more susceptible than females and other age groups to air pollutants in regard to respiratory disease admissions.

CONCLUSIONS

The results of this study showed that outdoor air pollutants significantly increase respiratory hospital admissions; especially among the men and elders in Arak.

The Novel Relationship between Urban Air Pollution and Epilepsy: A Time Series Study

Background and purpose

The data concerning the association between environmental pollution and epilepsy attacks are limited. The aim of this study was to explore the association between acute air pollution exposure and epilepsy attack.

Methods

A hospital record-based study was carried out in Xi’an, a heavily-polluted metropolis in China. Daily baseline data were obtained. Time-series Poisson regression models were applied to analyze the association between air pollution and epilepsy.

Results

A 10 μg/m³ increase of NO₂, SO₂, and O₃ concentrations corresponded to 3.17% (95%Cl: 1.41%, 4.93%), 3.55% (95%Cl: 1.93%, 5.18%), and -0.84% (95%Cl: -1.58%, 0.09%) increase in outpatient-visits for epilepsy on the concurrent days, which were significantly influenced by sex and age. The effects of NO₂ and SO₂ would be stronger when adjusted for PM_2.5. As for O₃, a -1.14% (95%Cl: -1.90%, -0.39%) decrease was evidenced when adjusted for NO₂. The lag models showed that the most significant effects were evidenced on concurrent days.

Conclusions

We discovered previously undocumented relationships between short-term air pollution exposure and epilepsy: while NO₂ and SO₂ were positively associated with outpatient-visits of epilepsy, O₃ might be associated with reduced risk.