Environmental Regulation and Chronic Conditions: Evidence from China's Air Pollution Prevention and Control Action Plan

Improved ambient air quality is associated with decreased prevalence of childhood asthma and infancy shortly after weaning is a sensitive exposure window

BACKGROUND

The urban ambient air quality has been largely improved in the past decade. It is unknown whether childhood asthma prevalence is still increasing in ever top-ranking city of Shanghai, whether the improved air quality is beneficial for children's asthma and what time window of exposure plays critical roles.

METHODS

Using a repeat cross-sectional design, we analyzed the association between early life exposure to particles and wheezing/asthma in each individual and combined surveys in 2011 and 2019, respectively, in 11,825 preschool children in Shanghai.

RESULTS

A significantly lower prevalence of doctor-diagnosed asthma (DDA) (6.6% vs. 10.5%, p < 0.001) and wheezing (10.5% vs. 23.2%, p < 0.001) was observed in 2019 compared to 2011. Exposure to fine particulate matter (PM2.5), coarse particles (PM2.5-10) and inhalable particles (PM10) was decreased in 2019 by 6.3%, 35.4%, and 44.7% in uterus and 24.3%, 20.2%, and 31.8% in infancy, respectively. Multilevel log-binomial regression analysis showed exposure in infancy had independent association with wheezing/DDA adjusting for exposure in uterus. For each interquartile range (IQR) increase of infancy PM2.5, PM2.5-10 and PM10 exposure, the odds ratios were 1.39 (95% confidence interval (CI): 1.24-1.56), 1.51 (95% CI:1.15-1.98) and 1.53 (95% CI:1.27-1.85) for DDA, respectively. The distributed lag non-linear model showed the sensitive exposure window (SEW) was 5.5-11 months after birth. Stratified analysis showed the SEWs were at or shortly after weaning, but only in those with <6 months of exclusive breastfeeding.

CONCLUSIONS

Improved ambient PM benefits in decreasing childhood asthma prevalence. We firstly reported the finding of SEW to PM at or closely after weaning on childhood asthma.

Cancer incidence estimates in adults aged 60 years and older living in low-and-middle-income countries for the years 2020 and 2040

Previous studies have shown a disproportionate rise in cancer incidence in low-and-middle-income countries (LMICs) due to rapid population ageing. This study aims to describe the cancer incidence in adults aged 60 years and older in LMICs to inform cancer control planning. Using the latest GLOBOCAN estimates for 2020, we describe the cancer incidence and the top five cancer sites among adults aged 60 years and older living in LMICs. We also project the incidence in 2040 by applying population projections, assuming no changes in incidence rates and risk profiles over time. In 2020, 6.3 million new cancer cases were diagnosed in older adults in LMICs, constituting over half of the global incidence burden (55%). In females aged 60 years and older living in LMICs, breast, lung, colon, stomach, and cervix uteri were the most frequent cancer types representing 51% of the total number of new cancer cases in older females. In males aged 60 years and older living in LMICs, lung, prostate, stomach, liver and colon were the most frequent cancer types representing 58% of the total number of new cancer cases in this subgroup. Variations were observed between income categories. The number of new cancer diagnoses in adults aged 60 years and older living in LMICs will almost double by 2040, reaching 11.5 million new cancer cases. The greatest increase is expected to happen in lower-income countries (+158% in lower-middle-income countries (excluding India) and +99% in low-income countries versus +38% in upper-middle-income countries). In conclusion, our findings call for an urgent adaptation of healthcare systems in LMICs by developing geriatric oncology and by including older adults in research, clinical guidelines, insurance schemes and cancer prevention policies.

Assessment of Regional Differences in the Implementation of the Air Pollution Prevention and Control Action Plan in China

Air pollution is still an important risk factor that endangers the health of Chinese people, leading the government to implement a series of policies to address air pollution. This study takes the Air Pollution Prevention and Control Action Plan (APPCAP) proposed in 2013 as the object and uses the combined data set of China's 2000-2019 economic panel data and PM_2.5 remote sensing data to analyse the implementation effect of the policy by the multiperiod difference-in-differences method, considering regional heterogeneity. The results show that the implementation of the APPCAP significantly reduced the PM_2.5 concentration in China, and the effect was stronger in the Yangtze River Delta region. Future governance policies should further consider local characteristics and determine pollution control goals and measures according to local conditions.

How does the air pollution prevention and control action plan affect sulfur dioxide intensity in China?

As a part of China's efforts to mitigate and control air pollution in key areas, the Air Pollution Prevention and Control Action Plan was implemented in 2013, and several regulatory measures were introduced. Based on the data from 271 prefecture-level cities between 2008 and 2018, the difference-in-differences model is used to explore the effect of it on sulfur dioxide intensity in our study, and several significant results are as follows: (1) The baseline results suggest a 23% reduction in sulfur dioxide intensity in pilot cities compared to non-pilot cities. (2) The total factor productivity fails to play a partial mediating role in reducing the sulfur dioxide intensity under the implementation of the policy. (3) The results of the triple differences model suggest that the policy still exerts significant adverse effects on sulfur dioxide intensity in the pilot areas of the carbon emission trading scheme.