Burden of disease attributed to ambient air pollution in Thailand: A GIS-based approach

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.

Trends of type 2 diabetes with pulmonary tuberculosis patients,2013-2022, and changes after the coronavirus disease 2019 (COVID-19) pandemic

BACKGROUND

To describe the trends of Type 2 Diabetes with Pulmonary Tuberculosis (T2DM-TB) patients from 2013 to 2022 and to investigate the impact of COVID-19 lockdown on glycemic control and associated factors in T2DM-TB.

METHODS

In this population-based study of the First Affiliated Yijishan Hospital of Wannan Medical College in China, we described the 10-year trends of patients diagnosed with T2DM-TB. We included patients diagnosed with TB, T2DM-TB and T2DM-TB patients for comparative analysis, aged 15 years or older. Data were missing, and both multidrug-resistant (MDR) TB patients and non-T2DM patients were excluded from our study.

RESULTS

We pooled Type 2 Diabetes (T2DM) and Tuberculosis (TB) data from The First Affiliated Yijishan Hospital of Wannan Medical College in China, gathered between January 1, 2013, and December 31, 2022. The data included 14,227 T2DM patients, 6130 TB patients, and 982 T2DM-TB patients. During the past 10 years, the number of inpatients with TB decreased, while the number of patients with T2DM and T2DM-TB increased year by year. To rule out any influence factors, we analyzed the ratio of the three groups. The ratio of TB/T2DM decreased year by year (p < 0.05), while the ratio of TB-T2DM/TB increasing year by year (p = 0.008). During the COVID-19 epidemic period, there was no significant change in the ratio of TB-T2DM/T2DM (p = 0.156). There was no significant change in the proportion of male patients with TB and TB-T2DM (p = 0.325; p = 0.190), but the proportion of male patients with T2DM showed an increasing trend (p < 0.001). The average age of TB patients over the past 10 years was 54.5 ± 18.4 years and showed an increasing trend year by year (p < 0.001). However, there was no significant change in the age of T2DM or TB-T2DM patients (p = 0.064; p = 0.241). Patients data for the first (2013-2017) and the last (2018-2022) five years were compared. We found that the number of T2DM and TB-T2DM in the last five years was significantly higher than in the first five years, but the number of TB was significantly lower than in the first five years. There is a significant statistical difference in the proportion of TB/T2DM and TB-T2DM/TB, which is similar to the previous results. The average age (56.0 ± 17.6 years) of TB patients in the last five years is significantly higher than in the first five years (53.1 ± 18.9) (p < 0.001). The number of male patients with T2DM in the last five years is higher than that in the first five years, with significant difference (p < 0.001).

CONCLUSION

The trends of T2DM-TB among hospitalized TB patients have increased significantly over the past 10 years, which may be related to the increase in the number of T2DM cases. The COVID-19 pandemic has been effective in controlling the transmission of TB, but it has been detrimental to the control of T2DM. Male patients with T2DM and elderly TB patients are the key populations for future prevention and control efforts.

Decadal Trends in Ambient Air Pollutants and Their Association with COPD and Lung Cancer in Upper Northern Thailand: 2013-2022

Air pollution in upper northern Thailand raises health concerns. This study examined trends and associations between air pollutants and respiratory diseases, focusing on COPD and lung cancer during haze (December-May) and non-haze (June-November) seasons in upper northern Thailand from 2013 to 2022. This study utilized data from the Pollution Control Department and Chiang Mai Provincial Public Health. The key air pollutants included PM10, PM2.5, SO2, NO2, CO, and O3. Respiratory disease data included fatality rates for lung cancer and COPD and the re-admission rate for COPD. Results indicated peak air pollutant levels and COPD re-admission rates in March, with PM2.5 concentrations exceeding air quality standards from January to April. During haze periods, COPD fatality and re-admission rates significantly increased (mean difference: 0.43 and 4.23 per 1000-case population, respectively; p < 0.001), while lung cancer fatality rates were higher without statistical significance. Pearson correlation analysis found positive correlations between PM10, PM2.5, O3, and NO2 concentrations and COPD re-admission and fatality rates at 0-1 month lag times, with a declining trend observed at subsequent lag intervals of 2 to 3 months. Overall, this study highlights the predictable pattern of air pollution in the region, correlating with higher COPD fatality and re-admission rates.

Estimation of premature death attributed to short- and long-term PM2.5 exposure in Thailand

Particulate matter with a diameter of less than 2.5 microns (PM2.5) has been identified as a global health concern in recent decades. Indeed, PM2.5 exposure causes detrimental health problems in the general population. Estimating the short- and long-term health impacts of PM2.5 exposure should help to shape public health policy concerning air pollution. Hence, this study sought to estimate the rate of premature death attributable to PM2.5 exposure among the Thai population if the PM2.5 concentration met the applied counterfactual factor. The PM2.5 concentration, population numbers, and numbers of health incidences were collected from secondary data sources in 2019. A health impact analysis was performed using AirQ+ software to estimate the incidences of premature deaths attributable to PM2.5 exposure. More specifically, the analysis provided the estimated proportion of attributable cases and the rate of premature death per 100,000 population aged ≥ 30 years. The annual average PM2.5 concentration in Thailand was found to be 24.15 µg per cubic meter (μg/m3) in 2019, while the natural mortality rate was around 1,107 per 100,000 population nationwide. With regard to short-term PM2.5 exposure, it was determined that 8 premature deaths per 100,000 population could be prevented if the PM2.5 concentration met the World Health Organization (WHO) short-term gold standard of 15 μg/m3. Moreover, 159 premature deaths per 100,000 population could be avoided if the PM2.5 concentration met the WHO's long-term gold standard of 5 μg/m3. This estimation of premature deaths due to the short- and long-term impacts of PM2.5 exposure can support policymakers and stakeholders in creating a roadmap to combating the adverse impacts of PM2.5 exposure and protect the health of the Thai population.

Association between ambient air particulate matter and human health impacts in northern Thailand

Air pollution in Thailand is regarded as a serious health threat, especially in the northern region. High levels of particulate matter (PM2.5 and PM10) are strongly linked to severe health consequences and mortality. This study analyzed the relationship between exposure to ambient concentrations of PM2.5 and PM10 by using data from the Pollution Control Department of Thailand and the burden of disease due to an increase in the ambient particulate matter concentrations in northern Thailand. This study was conducted using the Life Cycle Assessment methodology considering the human health damage impact category in the ReCiPe 2016 method. The results revealed that the annual average years of life lived with disability from ambient PM2.5 in northern Thailand is about 41,372 years, while from PM10 it is about 59,064 years per 100,000 population. The number of deaths from lung cancer and cardiopulmonary diseases caused by PM2.5 were approximately 0.04% and 0.06% of the population of northern Thailand, respectively. Deaths due to lung cancer and cardiopulmonary diseases caused by PM10, on the other hand, were approximately 0.06% and 0.08%, respectively. The findings expressed the actual severity of the impact of air pollution on human health. It can provide valuable insights for organizations in setting strategies to address air pollution. Organizations can build well-informed strategies and turn them into legal plans by exploiting the study's findings. This ensures that their efforts to tackle air pollution are successful, in accordance with regulations, and contribute to a healthier, more sustainable future guidelines on appropriate practices of air pollution act/policy linkage with climate change mitigation.

Assessment of health burden due to the emissions of fine particulate matter from motor vehicles: A case of Nakhon Ratchasima province, Thailand

Air pollution, owing to the ever-increasing transport vehicle fleet, and adverse health effects are increasing in provinces of Thailand. The study estimated that the vehicle fleet size of Nakhon Ratchasima (NR) province of Thailand will grow to 2 million vehicles by 2030, which was 1.36 million in 2021. In NR, the PM2.5 and PM10 concentrations already surpassed both WHO and NAAQS guidelines in 2019-2021. Using Pollution Control Department (PCD) approved Tier I and II Methodology of EMEP/EEA, this research estimated that the total tailpipe emission load will be 1039 tons of PM2.5, 16,630 tons of NO₂, 20,623 tons of CO, 195 tons NH₃, and 249 tons of SO₂ in NR during 2030. The emission load will increase to 1752 tons of PM2.5, 21,126 tons of NO2, 25,559 tons of CO, 361 tons of NH3 and 9344 tons of SO₂ during 2030 if upstream emissions are considered. This study has developed five control scenarios in line with the directives of PCD to mitigate the adverse health from vehicle-led air pollution in NR and implementation during 2024-2030. According to the study, different control scenarios to be implemented during 2024-2030, will be able to keep the fleet size of vehicles in the NR under control. The results show that the control scenarios will keep the annual tailpipe emission of PM2.5 at 604 tons in 2030, a 42 % reduction over the 2030 Business-As-Usual scenario (BAU). The health damage in the range of 6941 to 11,625 disability-adjusted life years (DALYs) under the 2030 BAU scenario in NR due to tailpipe and upstream emissions can be reduced to 4162-7318 DALYs with the implementation of different control scenarios. The control scenarios will also provide significant economic benefits ranging from 4465 to 6718 million THB during 2024-2030 through reduced DALYs and associated costs.

Air Pollution-Related Respiratory Diseases and Associated Environmental Factors in Chiang Mai, Thailand, in 2011–2020

The unfavorable effects of global climate change, which are mostly the result of human activities, have had a particularly negative effect on human health and the planet’s ecosystems. This study attempted to determine the seasonality and association of air pollution, in addition to climate conditions, with two respiratory infections, influenza and pneumonia, in Chiang Mai, Thailand, which has been considered the most polluted city on Earth during the hot season. We used a seasonal-trend decomposition procedure based on loess regression (STL) and a seasonal cycle subseries (SCS) plot to determine the seasonality of the two diseases. In addition, multivariable negative binomial regression (NBR) models were used to assess the association between the diseases and environmental variables (temperature, precipitation, relative humidity, PM2.5, and PM10). The data revealed that influenza had a clear seasonal pattern during the cold months of January and February, whereas the incidence of pneumonia showed a weak seasonal pattern. In terms of forecasting, the preceding month’s PM2.5 and temperature (lag1) had a significant association with influenza incidence, while the previous month’s temperature and relative humidity influenced pneumonia. Using air pollutants as an indication of respiratory disease, our models indicated that PM2.5 lag1 was correlated with the incidence of influenza, but not pneumonia. However, there was a linear association between PM10 and both diseases. This research will help in allocating clinical and public health resources in response to potential environmental changes and forecasting the future dynamics of influenza and pneumonia in the region due to air pollution.

Human Health Risks and Air Quality Changes Following Restrictions for the Control of the COVID-19 Pandemic in Thailand

The coronavirus (COVID-19) pandemic first impacted Thailand in early 2020. The government imposed lockdown measures from April to May 2020 to control the spread of infection. Daily lifestyles then morphed into a so-called new normal in which activities were conducted at home and people avoided congregation in order to prevent the spread of an infectious disease. This study evaluated the long-term air quality improvement which resulted from the restrictions enforced on normal human activities in Thailand. The air quality index (AQI) of six criteria pollutants and health risk assessments were evaluated in four areas, including metropolitan, suburban, industrial, and tourism areas in Thailand. The results showed that, after the restriction measures, the overall AQI improved by 30%. The subindex of each pollutant (sub-AQI) of most pollutants significantly improved (by 30%) in metropolitan areas after human activities changed due to the implementation of lockdown measures. With regard to industrial and tourism areas, only the sub-AQI of traffic-related pollutants decreased (34%) while the sub-AQIs of other pollutants before and after lockdown were similar. However, the changes in human activities were not clearly related to air quality improvement in the suburban area. The overall hazard index (HI) after lockdown decreased by 23% because of the reduction of traffic-related pollutants. However, the HI value remained above the recommended limits for the health of the adult residents in all areas. Therefore, strict regulations to control other pollutant sources, such as industry and open burning, will also be necessary for air quality improvement in Thailand.

Estimation of Excess All-Cause Mortality Due to COVID-19 in Thailand

Thailand has experienced the most prominent COVID-19 outbreak in 2021, resulting in a new record for COVID-19 cases and deaths. To assess the influence of the COVID-19 outbreak on mortality, we estimated excess all-cause and pneumonia mortality in Thailand during the COVID-19 outbreak from April to October 2021. We used mortality from the previous 5 years to estimate the baseline number of deaths using generalized linear mixed models. The models were adjusted for seasonality and demographics. We found that, during the outbreak in 2021, there was a significant rise in excess fatalities, especially in the older age groups. The estimated cumulative excess death was 14.3% (95% CI: 8.6–18.8%) higher than the baseline. The results also showed that the excess deaths in males were higher than in females by approximately 26.3%. The excess deaths directly caused by the COVID-19 infections accounted for approximately 75.0% of the all-cause excess deaths. Furthermore, excess pneumonia deaths were also found to be 26.2% (95% CI: 4.8–46.0%) above baseline.

Outpatient Department Visits and Mortality with Various Causes Attributable to Ambient Air Pollution in the Eastern Economic Corridor of Thailand

The Eastern Economic Corridor in Thailand is undergoing development, but industrial activities are causing serious air pollution. This study aimed to examine the effects of particulate matter (PM₁₀), fine particulate matter (PM_2.5), SO₂, NO₂, O₃, and CO on outpatient department (OPD) visits and mortality with various causes in the Eastern Economic Corridor, Thailand between 2013 and 2019 using a case-crossover design and conditional Poisson model. The corresponding burden of disease due to air pollution exposure was calculated. A 1 µg/m³ increase in the PM₁₀ was associated with significant increases in OPD visits for circulatory diseases (0.22, 95% CI 0.01, 0.34), respiratory diseases (0.21, 95% CI 0.13, 0.28), and skin and subcutaneous tissue diseases (0.18, 95% CI 0.10, 0.26). By contrast, a 1 µg/m³ increase in the PM₁₀ was associated with significant increases in mortality from skin and subcutaneous tissue diseases (0.79, 95% CI 0.04, 1.56). A 1 µg/m³ increase in PM_2.5 was associated with significant increases in mortality from circulatory diseases (0.75, 95% CI 0.20, 1.34), respiratory diseases (0.82, 95% CI 0.02, 1.63), and skin and subcutaneous tissue diseases (2.91, 95% CI 0.99, 4.86). The highest OPD burden was for circulatory diseases. Respiratory effects were attributed to PM₁₀ exceeding the national ambient air quality standards (NAAQS) of Thailand (120 μg/m³). The highest morbidity burden was for skin and subcutaneous tissue diseases attributed to PM_2.5 concentrations that exceeded the NAAQs (50 μg/m³). PM pollution in the EEC could strongly contribute to OPD visits and morbidity from various diseases. Preventing PM₁₀ concentrations from being higher than 60 µg/m³ could decrease OPD visits by more than 33,265 and 29,813 for circulatory and respiratory diseases, respectively. Our study suggests that such pollution increases the risks of OPD visits and mortality in various causes in the Thai EEC. Reducing the ambient air pollution concentration of NAAQSs in Thailand could reduce the health effect on the Thai population.

Assessing the Risk Factors For Diagnosed Symptomatic Dry Eye Using a Smartphone App: Cross-sectional Study

Background

Dry eye (DE) is a chronic inflammatory disease of the ocular surface of the eye that affects millions of people throughout the world. Smartphone use as an effective health care tool has grown exponentially. The “Dry eye or not?” app was created to evaluate the prevalence of symptomatic DE, screen for its occurrence, and provide feedback to users with symptomatic DE throughout Thailand.

Objective

The purpose of this study was to compare the prevalence of symptomatic dry eye (DE), blink rate, maximum blink interval (MBI), and best spectacle-corrected visual acuity (BSCVA) between people with and without symptomatic DE and to identify risk factors for symptomatic DE in Thailand.

Methods

This cross-sectional study sourced data from the “Dry eye or not?” smartphone app between November 2019 and July 2020. This app collected demographic data, Ocular Surface Disease Index (OSDI) score, blink rate, MBI, BSCVA, and visual display terminal (VDT) use data. The criterion for symptomatic DE was OSDI score ≥13.

Results

The prevalence of symptomatic DE among individuals using this smartphone app in Thailand was 85.8% (8131/9482), with the Northeastern region of Thailand having the highest prevalence, followed by the Northern region. Worse BSCVA (median 0.20, IQR 0.40; P=.02), increased blink rate (median 18, IQR 16; P<.001), reduced MBI (median 8.90, IQR 10.80; P<.001), female sex (adjusted OR 1.83; 95% CI 1.59-2.09; P<.001), more than 6 hours of VDT use (adjusted OR 1.59; 95% CI 1.15-2.19; P=.004), and lower than bachelor’s degree (adjusted OR 1.30; 95% CI 1.03-1.64; P=.02) were significantly associated with symptomatic DE. An age over 50 years (adjusted OR 0.77; 95% CI 0.60-0.99) was significantly less associated with symptomatic DE (P=.04).

Conclusions

This smartphone DE app showed that the prevalence of symptomatic DE in Thailand was 85.8%. Signs and risk factors could be also evaluated with this smartphone DE app. Screening for DE by this app may allow for the development of strategic plans for health care systems in Thailand.

The Elemental Characteristics and Human Health Risk of PM2.5 during Haze Episode and Non-Haze Episode in Chiang Rai Province, Thailand

Fine particle matter (PM_2.5) was directly related to seasonal weather, and has become the influencing factor of air quality that is harmful for human health in Chiang Rai province. The aims were determining the elemental composition in PM_2.5 and human health risk in haze (March 2021) and non-haze episodes (July–August 2021). Nine elements in PM_2.5 were measured by using an Atomic Absorption Spectrophotometer, and an enrichment factor was used to identify the emission source. The results showed that the average concentration of PM_2.5 was 63.07 μg/m³ in haze episodes, and 25.00 μg/m³ in a non-haze episode. The maximum concentration was 116.7 μg/m³ in March. The majority of elements originated from anthropogenic sources. In haze episodes, PM_2.5 mean concentration was approximately 4.2 times that of the WHO guidelines (15 μg/m³ 24 h), and 1.3 times that of the Thai Ambient Air Quality Standard (50 μg/m³). The analysis of backward air mass trajectory showed that transboundary and local sources significantly influenced PM_2.5 at the monitoring site in the sampling period. In the health risk assessment, the non-carcinogenic risk of Cd was the highest, with a Hazard Quotient (HQ) of 0.048, and the cancer risk of Cr was classified as the highest cancer risk, with the values of 1.29 × 10⁻⁵, higher than the minimum acceptable level.

Emissions Control Scenarios for Transport in Greater Cairo

Air pollution is a major cause of premature death in Greater Cairo, but studies on emission control are limited. We used local and international data to predict the impact of transport emission control measures on sector parameters including congestion. The International Vehicle Emission model accordingly estimated quantities of criteria, toxic and global warming emissions produced by on-road vehicles. Emissions were estimated for 2019 base case (2019-BC) and projected for 2030 under the 'do nothing' scenario (2030-DNS) and five scenarios: fuel subsidy removal (2030-FSR), road expansions (2030-RE), public transport improvements (2030-PTI), inspection and maintenance (I/M) programs (2030-I/MP), and fuel enhancements (2030-FE). The 2030-FSR would reduce emissions by 11.2% versus 2030-DNS. The 2030-RE resulted in an average increase of 37% in emissions compared with 2030-DNS since it induces more traffic. The 2030-PTI provides alternatives to car travel; hence, cars result in an average drop of 32.8% for all emission types compared with 2030-DNS. The 2030-I/MP exhibited reductions in PM₁₀ and toxic pollutants, of 35-54.8% compared with 2030-DNS. The 2030-FE reduced SO_x, benzene and N₂O emissions by 91.8%, 81% and 39.1%, respectively, compared with 2030-DNS. The 2030-I/MP is most effective in reducing health damaging pollutants while 2030-PTI positively impacts commuters' lifestyle.

Valuation of Local Demand for Improved Air Quality: The Case of the Mae Moh Coal Mine Site in Thailand

While the district of Mae Moh, Thailand has been well known for its atmospheric pollution associated with coal power production, economic assessment of demand for improved air quality has not been conducted to date. This study estimated local residents’ individual and aggregate willingness to pay (WTP) for mitigation of atmospheric pollution in Mae Moh using the contingent valuation method (CVM), and analyzed the factors associated with the individual WTP using the bivariate tobit and double-hurdle regression techniques. Primary data were collected through face-to-face interviews with a stratified sample of 200 residents. The hypothetical scenarios used in the CVM module were 50% and 80% mitigation of atmospheric concentrations of major pollutants. The weighted average WTP was found to be THB 251.3 and 307.9 per annum (USD 8.4 and 10.3) for the 50% and 80% reduction scenarios, respectively. The aggregate WTP for the entire population of Mae Moh was THB 10,008,733 and 12,264,761 per annum (USD 336,294 and 412,096), respectively. Education, occupation type, income, expenses, satisfaction with ambient quality, and perceived sources of pollution had significant associations with the individual WTP. The paper concludes by discussing policy implications for atmospheric pollution management and avenues for future research.

Mortality attributable to fine particulate matter in Asia, 2000-2015: a cross-sectional cause-of-death analysis

OBJECTIVES

To investigate the effect that particulate matter with a diameter of 2.5 μg (PM2.5) had on mortality in Asian populations in years 2000-2015.

SETTING

Mortality and level of PM2.5 data from the United Nations, Global Burden of Disease and University of Chicago were used.

OUTCOME MEASURES

Age pattern of mortality and the number of life-years lost (LYL) attributable to PM2.5 in years 2000-2015. LYL were further separated into causes of death to quantify the contribution of each cause.

RESULTS

Ischaemic heart disease (IHD) mortality increased to represent over 31% of the LYL attributable to PM2.5 between 2005-2010 and 2010-2015 in Asia (females 31% and males 35%). However, great diversity in LYL attributable to PM2.5 by causes-of-death were found across the region, with IHD proportions of LYL ranging from 25% to 63% for males from Eastern and Central Asia, respectively. Similar diversity was observed for mortality attributable to PM2.5 for other causes of death across Asia: chronic obstructive pulmonary disease (LYL ranging from 6% to 28%), lung cancer (4% to 20%) and stroke (11% to 22%).

CONCLUSION

PM2.5 is a crucial component in the rising health effects in Asia. The diverse trends in cause-specific mortality attributable to PM2.5 creates a further challenge for health systems in the region. These findings highlight that immediate interventions are needed to mitigate the increasing levels of air pollution and with that reduce its detrimental effect on the health and mortality of Asian populations.

The performance of a modified EWMA control chart for monitoring autocorrelated PM2.5 and carbon monoxide air pollution data

PM2.5 (particulate matter less than or equal to 2.5 micron) is found in the air and comprises dust, dirt, soot, smoke, and liquid droplets. PM2.5 and carbon monoxide emissions can have a negative impact on humans and animals throughout the world. In this paper, we present the performance of a modified exponentially weighted moving average (modified EWMA) control chart to detect small changes when the observations are autocorrelated with exponential white noise through the average run length evaluated (ARLs) by explicit formulas. The accuracy of the solution was verified with a numerical integral equation method. The efficacy of the modified EWMA control chart to monitor PM2.5 and carbon monoxide air pollution data and compare its performance with the standard EWMA control chart. The results suggest that the modified EWMA control chart is far superior to the standard one.

Changes in Air Quality during the COVID-19 Pandemic and Associated Health Benefits in Korea

The COVID-19 pandemic was caused by a highly contagious coronavirus that has triggered worldwide control actions such as social distancing and lockdowns. COVID-19 control actions have resulted in improved air quality locally and around the world in the short-term by limiting human activity. We analyzed the impacts of social distancing and transboundary pollutants on air quality changes using open data and examined the corresponding health benefits focusing on two domestic cities (Seoul and Daegu) in Korea where the spread of coronavirus was severe. During the COVID-19 pandemic, PM2.5, PM10, and NO2 concentrations decreased significantly by 31%, 61%, and 33%, respectively, compared to the previous three years. In particular, the PM2.5/PM10 ratio fell 24.5% after the implementation of social distancing, suggesting a decrease in anthropogenic emissions. Moreover, we found that the air quality index (AQI) also improved significantly, with a focus on reducing exposure to sensitive groups. In Seoul and Daegu, improved air quality prevented 250 and 78 premature deaths, and health costs were USD 884 million and USD 278 million, respectively. On the other hand, health loss due to COVID-19 deaths was in sharp contrast to USD 7.1 million and USD 543.6 million. Our findings indicate a significant association between COVID-19 prevalence patterns and health outcomes.

Association between tobacco control policies and hospital admissions for acute myocardial infarction in Thailand, 2006-2017: A time series analysis

Introduction

Studies in many countries have documented reductions of acute myocardial infarction (AMI) hospitalizations with smokefree policies. However, evidence on the association of cigarette tax with AMI events is unclear. There have been no studies of the associations between these two policies and AMI hospitalizations in Thailand.

Methods

We used negative binomial time series analyses of AMI hospitalizations (ICD-10 codes I21.0-I21.9), stratified by sex and age groups, from October 2006 to September 2017 to determine whether there was a change in AMI hospitalizations as a result of the changes in cigarette prices and the implementation of a 100% smokefree law.

Results

Cigarette price increases were associated with a significant 4.7% drop in AMI hospitalizations among adults younger than 45 (incidence rate ratio [IRR], 0.953; 95% confidence interval [CI], 0.914–0.993; p = 0.021). Implementation of the 100% smokefree law was followed by a significant 13.1% drop in AMI hospitalizations among adults younger than 45 (IRR, 0.869; 95% CI, 0.801–0.993; P = 0.001). There were not significant associations in older age groups.

Conclusions

The Thai cigarette tax policy and the smokefree law were associated with reduced AMI hospitalizations among younger adults. To improve effectiveness of the policies, taxes should be high enough to increase cigarette price above inflation rates, making cigarettes less likely to be purchased; smokefree laws should be strictly enforced.

An Assessment of Annual Mortality Attributable to Ambient PM2.5 in Bangkok, Thailand

Multiple studies indicate that PM2.5 is the most deleterious air pollutant for which there are ambient air quality standards. Daily concentrations of PM2.5 in Bangkok, Thailand, continuously exceed the World Health Organization (WHO) and the Thai National Ambient Air Quality Standards (NAAQSs). Bangkok has only recently begun to measure concentrations of PM2.5. To overcome this paucity of data, daily PM2.5/PM10 ratios were generated over the period 2012-2018 to interpolate missing values. Concentration-response coefficients (β values) for PM2.5 versus non-accidental, cardiopulmonary, and lung cancer mortalities were derived from the literature. Values were also estimated and were found to be comparable to those reported in the literature for a Chinese population, but considerably lower than those reported in the literature from the United States. These findings strongly suggest that specific regional β values should be used to accurately quantify the number of premature deaths attributable to PM2.5 in Asian populations. Health burden analysis using the Environmental Benefits Mapping and Analysis Program (BenMAP) showed that PM2.5 concentration in Bangkok contributes to 4240 non-accidental, 1317 cardiopulmonary, and 370 lung cancer mortalities annually. Further analysis showed that the attainment of PM2.5 levels to the NAAQSs and WHO guideline would reduce annual premature mortality in Bangkok by 33%and 75%, respectively.

Model for assessing health damage from air pollution in quarrying area - Case study at Tan Uyen quarry, Ho Chi Minh megapolis, Vietnam

Vietnam has a great demand for stone exploitation for the development of the country's infrastructure, reaching 181 million m³ in 2020. Mining activities are always accompanied by environmental pollution, negatively affecting public health. To accurately assess the level of pollution, as well as quantify the effect of air pollution on human health, a number of structures, methods, and models provide tools to assess the benefits of this control for public health and related economic values. However, there has been no research in Vietnam applied specifically to this type of stone exploitation. This study offers a model to evaluate the economic damage caused by dust exposure from activities related to quarrying, overcoming the lack of continuous monitoring data. The area selected for research is Binh Duong province, in the Ho Chi Minh megapolis, Vietnam, which has two construction quarries, Thuong Tan and Tan My, with a current annual production of approximately 4–5 million m³. The calculation results show that the damage to human health is estimated at approximately 9,643 billion dong a year, equivalent to 15.03 million USD. In addition, if the standard criteria are tightened, damage will continue to increase. This study also analyses some of the difficulties and limitations in the modelling process.

Effects of ambient particulate matter on vascular tissue: a review

Fine and ultra-fine particulate matter (PM) are major constituents of urban air pollution and recognized risk factors for cardiovascular diseases. This review examined the effects of PM exposure on vascular tissue. Specific mechanisms by which PM affects the vasculature include inflammation, oxidative stress, actions on vascular tone and vasomotor responses, as well as atherosclerotic plaque formation. Further, there appears to be a greater PM exposure effect on susceptible individuals with pre-existing cardiovascular conditions.

Thailand: country report on children's environmental health

Thailand is the home of 66.4 million people of which 17.21% are children aged 0-14 years. The total population of children has decreased from 20.23% in 2009 to 17.21% in 2018. The mortality ratio of infants and children under 5 years of age has also steadily decreased between 2008 and 2017. Urbanization, globalization, and industrialization appear to be the main contributors to the transition from infectious to chronic non-communicable diseases. The main types of environmental exposure to children are water, sanitation and hygiene, air pollution from traffic in inner cities, chemical hazards from pesticides which result from agricultural activities in countryside areas, heavy metal contaminants such as lead and arsenic from anthropogenic activities, e.g. from industrial zones, mining, electronic appliance waste, and ongoing climate change. It is concluded that economic development and rapid urbanization in Thailand have resulted in environmental degradation and pose a risk to children's health. Future development and implementation of measures to improve children's environmental health (CEH) in the country are needed. Some examples include research specific to environmental threats to children's health; international environmental health networks to share experience and expertise; and solutions to solve the problems.

Utilizing daily excessive concentration hours to estimate cardiovascular mortality and years of life lost attributable to fine particulate matter in Tehran, Iran

BACKGROUND

Evidence for associations between fine particulate matter (PM_2.5) and cardiovascular diseases (CVDs) in Iran is scarce. Given large within-day variations of PM_2.5 concentration, using the daily mean of PM_2.5 (PM_2.5mean) as exposure metric might bias the health-related assessment. This study applied a novel indicator, daily excessive concentration hours (DECH), to evaluate the effect of ambient PM_2.5 on CVD mortality and years of life lost (YLL) in Tehran, the capital city of Iran.

METHODS

Hourly concentration data for PM_2.5, daily information for meteorology and records of registered cardiovascular deaths from 2012 to 2016 were obtained from Tehran, Iran. Daily excessive concentration hours of PM_2.5 (PM_2.5DECH) was defined as daily total concentration-hours exceeding 35 μg/m³. Using a time-series design, we applied generalized linear models to assess the attributable effects of PM_2.5DECH and PM_2.5mean on CVD mortality and YLL.

RESULTS

For an interquartile range (IQR) rise in PM_2.5DECH, total CVD mortality at lag 0-10 days and YLL at lag 0-8 days increased 2.26% (95% confidence interval (CI): 0.85-3.69%) and 23.24 (6.07-40.42) person years, respectively. Corresponding increases were 3.45% (1.44-5.49%) and 35.21 (10.85-59.58) person years for an IQR rise in PM_2.5mean. Significant associations between PM_2.5 pollution (i.e., PM_2.5mean and PM_2.5DECH) and cause-specific cardiovascular health (i.e., mortality and YLL) were only identified in stroke. Subgroup analyses showed that male and people aged 0-64 years suffered more from PM_2.5 pollution. Furthermore, we attributed a greater CVD burden to PM_2.5DECH (1.67% for mortality and 2.67% for YLL) than PM_2.5mean (0.63% for mortality and 0.70% for YLL) during the study period.

CONCLUSIONS

This study strengthened the evidence for the aggravated CVD mortality burden associated with short-term exposure to PM_2.5. Our findings also suggested that PM_2.5DECH might be a potential alternative indicator of exposure assessment in PM_2.5-related health investigations.

The Effect of Treatment during A Haze/Post-Haze Year on Subsequent Respiratory Morbidity Status among Successful Treatment Tuberculosis Cases

The purpose of this study was to evaluate the respiratory morbidity status within the two to three years among successful (completed/cured) treatment of tuberculosis cases during a haze year (2015) and a post-haze year (2016). The study was conducted among 133 cases of a 2015 group and 103 cases of a 2016 group between January to March 2018 in Pekanbaru city, Indonesia. The St George Respiratory Questionnaire (SGRQ) was used to assess respiratory morbidity status. A higher score corresponds to worse respiratory morbidity. Based on a directed acyclic graph, quantile regression models were constructed to assess the associations between haze/post-haze year and the SGRQ (symptom, activity, impact, and total) domains score. The subsequent respiratory morbidity status of tuberculosis (TB) cases was poorer among respondents treated during a haze year (2015). Among SGRQ domains, only the activity domain score showed significant difference, in which the median for the 2015 group was 23.7 (inter-quartile range (IQR); 17.2, 30.9) compared to 18.4 (IQR; 11.9, 24.8) for the 2016 group. The effect was limited to the 2015 group who were exposed by an average PM₁₀ index ≥ 55 during TB treatment. This raises concern for monitoring and improving the quality of life of TB patients treated during a haze year.

Ambient air quality as risk factor for microscopic colitis - A geographic information system (GIS) study

BACKGROUND

Microscopic colitis (MC) is considered a multifactorial disease, strongly associated with smoking. However, little is known about the role of environmental factors such as ambient air pollution in MC pathophysiology. There is an overlap in components of cigarette smoke and ambient air pollution. Therefore, the aim of this study was to explore an independent association between ambient air quality and MC.

METHODS

A case-control study was performed. MC cases in South Limburg, the Netherlands, diagnosed between 2000 and 2012, were retrieved from the national pathology registry and matched to non-MC controls from the same area based on age (±2 years) and gender. A stable residential address for ≥3 years was required. Residential land use, proximity to major road, and concentrations of air pollution compounds, were determined using a Geographic Information System (GIS). Univariate and multivariable regression analyses were corrected for age, gender and smoking status.

RESULTS

In total, 345 MC cases (78.6% female) and 583 matched controls (77.2% female) were included. In the univariate analyses, the percentage of urban green within a 500 m buffer and residential proximity to the nearest highway were associated with MC (both p < 0.10). On the multivariable level only a higher age at diagnosis (OR 1.02, 95%-CI 1.01-1.04) and current smoking at index date (OR 4.30; 95%-CI 3.01-6.14) were significantly associated with MC.

CONCLUSION

Based on the current findings, ambient air quality does not seem to be an important risk factor for MC, in contrast to the well-known risk factors age and current smoking.

Comparison of methods for addressing the point-to-area data transformation to make data suitable for environmental, health and socio-economic studies

Soil lead (Pb) provides an important exposure pathway to the human body through soil ingestion and dust inhalation and is closely associated with human health as well as social behaviour. The challenge of transforming different spatial supports arises when linking point data (Pb concentration) to areal data (health status or social behaviour). A detailed review of methodologies for integrating point and areal data has been carried out. Among a number of methodologies, eight methods: (1) average, (2) median, (3) centroids inverse distance weighted (IDW), (4) average block IDW, (5) median block IDW, (6) centroids ordinary kriging (OK), (7) average block OK and (8) median block OK, have been compared using Pb data set in the Greater London Authority (GLA) area. The results indicated that the method of median block IDW was recommended for further investigation of the relationship between Pb concentration and socio-economic factors in the ward-level of the GLA area. The reasons were (i) spatial interpolations were useful for predicting unobserved values when simple average and median could not work in the locations where there were no samples collected in some areal units; (ii) the median value was more suitable than the average value for a skewed data set; (iii) the block method reduced estimation error and provided more representative values of areal units than the centroid method; (iv) IDW reserved more spatial variation than OK, containing more local maxima (hotspot) and local minima. Despite that it is still hard to decide the optimal method, this study has highlighted the point-to-area transformation issue and provided valuable examples to compare the different methods.

Opportunities and Challenges for Filling the Air Quality Data Gap in Low- and Middle-Income Countries

Given the millions of people suffering from air pollution, filling the air quality monitoring gap in low- and middle-income countries has been recognized as a global challenge. To meet this challenge and make it work will require private enterprise, multiple levels of government, international organizations, academia and civil society to work together toward the common goal of characterizing, understanding better, and then reducing, the air pollution that causes sickness and preventable death for millions of people each year in lowand middle-income countries around the world. This article offers concrete next steps on how to make progress toward increasing air quality monitoring using a combination of emerging technologies, adaptation to country-specific conditions, and building capacity towards the development of lasting institutions.

Exposure to outdoor air pollution and its human health outcomes: A scoping review

Despite considerable air pollution prevention and control measures that have been put into practice in recent years, outdoor air pollution remains one of the most important risk factors for health outcomes. To identify the potential research gaps, we conducted a scoping review focused on health outcomes affected by outdoor air pollution across the broad research area. Of the 5759 potentially relevant studies, 799 were included in the final analysis. The included studies showed an increasing publication trend from 1992 to 2008, and most of the studies were conducted in Asia, Europe, and North America. Among the eight categorized health outcomes, asthma (category: respiratory diseases) and mortality (category: health records) were the most common ones. Adverse health outcomes involving respiratory diseases among children accounted for the largest group. Out of the total included studies, 95.2% reported at least one statistically positive result, and only 0.4% showed ambiguous results. Based on our study, we suggest that the time frame of the included studies, their disease definitions, and the measurement of personal exposure to outdoor air pollution should be taken into consideration in any future research. The main limitation of this study is its potential language bias, since only English publications were included. In conclusion, this scoping review provides researchers and policy decision makers with evidence taken from multiple disciplines to show the increasing prevalence of outdoor air pollution and its adverse effects on health outcomes.

Enhanced mitochondrial DNA repair of the common disease-associated variant, Ser326Cys, of hOGG1 through small molecule intervention

The common oxidatively generated lesion, 8-oxo-7,8-dihydroguanine (8-oxoGua), is removed from DNA by base excision repair. The glycosylase primarily charged with recognition and removal of this lesion is 8-oxoGuaDNA glycosylase 1 (OGG1). When left unrepaired, 8-oxodG alters transcription and is mutagenic. Individuals homozygous for the less active OGG1 allele, Ser326Cys, have increased risk of several cancers. Here, small molecule enhancers of OGG1 were identified and tested for their ability to stimulate DNA repair and protect cells from the environmental hazard paraquat (PQ). PQ-induced mtDNA damage was inversely proportional to the levels of OGG1 expression whereas stimulation of OGG1, in some cases, entirely abolished its cellular effects. The PQ-mediated decline of mitochondrial membrane potential or nuclear condensation were prevented by the OGG1 activators. In addition, in Ogg1-/- mouse embryonic fibroblasts complemented with hOGG1S326C, there was increased cellular and mitochondrial reactive oxygen species compared to their wild type counterparts. Mitochondrial extracts from cells expressing hOGG1S326C were deficient in mitochondrial 8-oxodG incision activity, which was rescued by the OGG1 activators. These data demonstrate that small molecules can stimulate OGG1 activity with consequent cellular protection. Thus, OGG1-activating compounds may be useful in select humans to mitigate the deleterious effects of environmental oxidants and mutagens.