Mortality and morbidity due to ambient air pollution in Iran

Health effect of public sports services and public health services: empirical evidence from China

There is no clear explanation for the extraordinary rebound in China's population mortality over the past decade. This paper utilizes panel data from 31 Chinese provinces from 2010 to 2020 to determine the distinct impacts of public sports services (PSS), public health services (PMS), and their interaction on population mortality. Empirical results show that public sports services significantly reduce mortality. Every unit increase in public sports services reduces mortality by about 2.3%. It is characterized by delayed realization. Public health services were surprisingly associated with a rebound in mortality. Further studies found strong health effect from interaction of public sports and health services. The effect was significantly strengthened in areas with fewer extreme temperatures or developed economy. The findings have important policy implications for the high-quality development of public sports and health services. It also emphasizes integration of sports and medicine and mitigates health risks associated with extreme temperatures.

Simulating the effect of urban sprawl on air quality and outdoor human thermal comfort in a cold city, Erzurum, Turkey

Research on climate-sensitive urban planning is important to improve the quality of city life. Cold climate cities should respect climatic characteristics to diversify outdoor uses and increase air quality to maximize the benefits of winter. This study is aimed to explore the impact of changing urban pattern on air pollution and outdoor human thermal comfort conditions (HTCCs) in a newly developed urban area in Şükrüpaşa neighbourhood, Erzurum, among the coldest cities in Turkey, with high PM10 and low HTCCs levels. Sensitivity of urban development pattern to climate conditions and its suitability to eliminate the winter disturbances caused by HTCCs and air pollution were investigated by producing maps for HTCCs and air pollution using morphological, meteorological and spatial data and ENVI-met model in winter period of 2017 and 2022. It was found that newly developed areas increase the unfavourable conditions in terms of air quality, temperature and HTCCs due to the reasons like improper land uses, urban sprawl, high urban density and ventilation problems. In high-elevated cold cities, spatial planning and design principles should strictly be followed by incorporating climate knowledge and without revising the spatial decisions.

Short-term effects of air pollution on hospital admissions of respiratory diseases in Hamadan, Iran, 2015 to 2021

The short-term effects of air pollution on respiratory diseases have been reported in many countries. Urban areas are most affected because of the many sources of pollution and the large number of people living there. This study aims to investigate the effect of short-term exposure to air pollutants on respiratory hospital admissions in the city of Hamadan. In this ecological study, daily hospital admission data were collected from Shahid Beheshti Hospital in Hamadan. Daily information on air pollutants (CO, SO2, NO2, O3, PM2.5 and PM10) from Hamadan Department of Environment (DoE) organization and of climate factors from Hamadan Meteorological Office were collected. A negative binomial regression model was used to examine the effect of air pollution on daily respiratory hospitalizations. The effect of exposure to pollutants was measured whit different time lags (0-7 days). Furthermore, the effect of meteorological variables was controlled. Subgroup analyses were performed by sex and age group. A total of 12,454 hospitalizations for respiratory diseases were recorded. Results showed a strong and immediate effect of CO on respiratory hospital admissions with highest association at lag 7 (relative risk (RR) = 1.38, 95% CI: 1.33, 1.42). The effects of CO and SO2 on respiratory hospitalizations are greater for men than women. Regarding the short-term effects of PM2.5, SO2 and O3, adults (aged less than 65) were more prone to hospitalization for respiratory diseases. These results show that exposure to air pollution, particularly CO, may increase hospital admissions due to respiratory illness. So reducing the concentration of these pollutants can reduce the number of hospital admissions.

Meandered and muddled: a systematic review on the impact of air pollution on ocular health

From the years 1970-2023, a systematic overview of the diverse consequences of particulate matter on eye health and a disease classification according to acute, chronic, and genetic are presented using the PubMed, Research Gate, Google Scholar, and Science Direct databases. Various studies on medical aspects correlate with the eye and health. However, from an application perspective, there is limited research on the ocular surface and air pollution. The main objective of the study is to uncover the relationship between eye health and air pollution, particularly particulate matter, along with other external factors acting as aggravators. The secondary goal of the work is to examine the existing models for mimicking human eyes. The study is followed by a questionnaire survey in a workshop, in which the exposure-based investigation was tagged based on their activity. This paper establishes a relationship between particulate matter and its influence on human health, leading to numerous eye diseases like dry eyes, conjunctivitis, myopia, glaucoma, and trachoma. The results of the questionnaire survey indicate that about 68% of the people working in the workshop are symptomatic with tears, blurred vision, and mood swings, while 32% of the people were asymptomatic. Although there are approaches for conducting experiments, the evaluation is not well defined; empirical and numerical solutions for particle deposition on the eye are needed. There prevails a broad gap in the arena of ocular deposition modeling.

Ambient PM2.5 and O3 pollution and health impacts in Iranian megacity

The main objectives of this study were to (i) assess variation within fine particles (PM_2.5) and tropospheric ozone (O₃) time series in Khorramabad (Iran) between 2019 (before) and 2020 (during COVID-19 pandemic); (ii) assess relationship between PM_2.5 and O₃, the PM_2.5/O₃ ratio, and energy consumption; and (iii) estimate the health effects of exposure to ambient PM_2.5 and O₃. From hourly PM_2.5 and O₃ concentrations, we applied both linear-log and integrated exposure-response functions, city-specific relative risk, and baseline incidence values to estimate the health effects over time. A significant correlation was found between PM_2.5 and O₃ (r =-0.46 in 2019, r =-0.55 in 2020, p < 0.05). The number of premature deaths for all non-accidental causes (27.5 and 24.6), ischemic heart disease (7.3 and 6.3), chronic obstructive pulmonary disease (17 and 19.2), and lung cancer (9.2 and 6.25) attributed to ambient PM_2.5 exposure and for respiratory diseases (4.7 and 5.4) for exposure to O₃ above 10 µg m^-3 for people older than 30-year-old were obtained in 2019 and 2020. The number of years of life lost declined by 11.6% in 2020 and exposure to PM_2.5 reduced the life expectancy by 0.58 and 0.45 years, respectively in 2019 and 2020. Compared to 2019, the restrictive measures associated to COVID-19 pandemic led to reduction in PM_2.5 (-25.5%) and an increase of O₃ concentration (+ 8.0%) in Khorramabad.

Ecological study of ambient air pollution exposure and mortality of cardiovascular diseases in elderly

As an independent risk factor, ambient air pollution can assume a considerable part in mortality and worsening of cardiovascular disease. We sought to investigate the association between long-term exposure to ambient air pollution and cardiovascular disease mortality and their risk factors in Iranian's elderly population. This inquiry was conducted ecologically utilizing recorded data on cardiovascular disease mortality from 1990 to 2019 for males and females aged 50 years or more from the Global Burden of Disease dataset. Data was interned into Joinpoint software 4.9.0.0 to present Annual Percent Change (APC), Average Annual Percent Change (AAPC), and its confidence intervals. The relationship between recorded data on ambient air pollution and cardiovascular disease' mortality, the prevalence of high systolic blood pressure, high LDL cholesterol levels, high body mass index, and diabetes mellitus type2 was investigated using the Spearman correlation test in R 3.5.0 software. Our finding demonstrated that cardiovascular diseases in elderly males and females in Iran had a general decreasing trend (AAPC = -0.77% and -0.65%, respectively). The results showed a positive correlation between exposure to ambient ozone pollution (p ≤ 0.001, r = 0.94) ambient particulate and air pollution (p < 0.001, r = 0.99) and mortality of cardiovascular disease. Also, ambient air pollution was positively correlated with high systolic blood pressure (p < 0.001, r = 0.98), high LDL cholesterol levels (p < 0.001, r = 0.97), high body mass index (p < 0.001, r = 0.91), diabetes mellitus type2 (p < 0.001, r = 0.77). Evidence from this study indicated that ambient air pollution, directly and indirectly, affects cardiovascular disease mortality in two ways by increasing the prevalence of some traditional cardiovascular disease risk factors. Evidence-based clinical and public health methodologies are necessary to decrease the burden of death and disability associated with cardiovascular disease.

Increased tropospheric ozone levels as a public health issue during COVID-19 lockdown and estimation the related pulmonary diseases

The aims of this study were to i) investigate the variation of tropospheric ozone (O₃) levels during the COVID-19 lockdown; ii) determine the relationships between O₃ concentrations with the number of COVID-19 cases; and iii) estimate the O₃-related health effects in Southwestern Iran (Khorramabad) over the time period 2019-2021. The hourly O₃ data were collected from ground monitoring stations, as well as retrieved from Sentinel-5 satellite data for showing the changes in O₃ levels pre, during, and after lockdown period. The concentration-response function model was applied using relative risk (RR) values and baseline incidence (BI) to assess the O₃-related health effects. Compared to 2019, the annual O₃ mean concentrations increased by 12.2% in 2020 and declined by 3.9% in 2021. The spatiotemporal changes showed a significant O₃ increase during COVID-19 lockdown, and a negative correlation between O₃ levels and the number of COVID-19 cases was found (r = - 0.59, p < 0.05). In 2020, the number of hospital admissions for cardiovascular diseases increased by 4.0 per 10⁵ cases, the mortality for respiratory diseases increased by 0.7 per 10⁵ cases, and the long-term mortality for respiratory diseases increased by 0.9 per 10⁵ cases. Policy decisions are now required to reduce the surface O₃ concentrations and O₃-related health effects in Iran.

Investigating factors affecting university students' use of subway before and after COVID-19 outbreak: A case study in Tehran

Identifying and examining factors affecting the use of the subway is critical for developing countries as they struggle with high levels of auto use and resulting congestion, noise and air pollution. In this research, we surveyed students of a top-ranked university in the capital of Iran before and after the COVID-19 outbreak to identify the factors affecting their use of the subway. Chi-square tests show that gender, level of education, and being the only child of the family have the highest impact on using a private car. These variables had no significant influence on students' mode choice to university before the COVID-19 pandemic, when students' mode choice was only a function of their residence location. However, the pandemic has affected priorities for mode choice. For instance, hygiene and social distancing, which were previously insignificant to students, are now among their top criteria, and travel time and cost are less important for students than in the past. As a result, subway use has significantly decreased. Based on the results of the research, when making relevant policies, more attention should be paid to the groups of women, undergraduate students and single children that are more likely to use private cars.

Visualization and Analysis of Air Pollution and Human Health Based on Cluster Analysis: A Bibliometric Review from 2001 to 2021

Bibliometric techniques and social network analysis are employed in this study to evaluate 14,955 papers on air pollution and health that were published from 2001 to 2021. To track the research hotspots, the principle of machine learning is applied in this study to divide 10,212 records of keywords into 96 clusters through OmniViz software. Our findings highlight strong research interests and the practical need to control air pollution to improve human health, as evidenced by an annual growth rate of over 15.8% in the related publications. The cluster analysis showed that clusters C22 (exposure, model, mortality) and C8 (health, environment, risk) are the most popular topics in this field of research. Furthermore, we develop co-occurrence networks based on the cluster analysis results in which a more specific keyword classification was obtained. These key areas include: "Air pollutant source", "Exposure-Response relationship", "Public & Occupational Health", and so on. Future research hotspots are analyzed through characteristics of the cluster groups, including the advancement of health risk assessment techniques, an interdisciplinary approach to quantifying human exposure to air pollution, and strategies in health risk assessment.

Ambient air pollutants and respiratory health outcomes in Tabriz and Urmia, two metropolises of Iran

Polluted air affects human life and it is crucial to assess air pollutants to inform policy and protect human lives. In this study, we sought to assess the respiratory outcomes associated with PM₁₀, O₃, SO₂, and NO₂ in the Iranian population. The required data, which included concentrations of air pollutants, meteorology, and population size, were obtained from the department of environment and meteorological organizations. The validity of the data was evaluated, and appropriate calculations were conducted on the data to extract the required values and parameters for modeling (using the AirQ2.2.3). This study was conducted in two megacities of Iran (Tabriz and Urmia) with over 2 million population. The annual averages of SO₂, NO₂, and PM₁₀ concentrations were 9, 73, and 43 μg/m³ in Tabriz and 76, 29, and 76 μg/m³ in Urmia, respectively. Excess deaths from respiratory diseases associated with PM₁₀ and SO₂ were estimated to be 33.1 and 1.2 cases in Tabriz and 31.6 and 24.7 cases in Urmia, respectively. The proportions of hospitalizations for chronic obstructive pulmonary disease (COPD) attributable to SO₂ and NO₂ in Tabriz were 0.07% and 1.61%, respectively, whereas they were 2.84% and 0.48% in Urmia. O₃ had an annual average of 56 μg/m³ in Tabriz and with 44.5 excess respiratory deaths and 42.5 excess hospital admissions for COPD, it had the greatest health impacts among the pollutants studied. Findings from this study add to the growing literature, especially from developing countries, that provides insights to help authorities and decision-makers develop and implement effective interventions to curb air pollution and save lives.

Using Bayesian networks for environmental health risk assessment

The study investigated the potential relationships between air pollution, socio-economy, and proven pathologies (e.g., respiratory, cardiovascular) within an industrial area in Southern France (Etang de Berre), gathering steel industries, oil refineries, shipping, road traffic and experiencing a Mediterranean climate. A total of 178 variables were simultaneously integrated within a Bayesian model at intra-urban scale. Various unsupervised and supervised algorithms (maximum spanning tree, tree-augmented naive classifier) as well as sensitivity analyses were used to better understand the links between all variables, and highlighted correlations between population exposure to air pollutants and some pathologies. Adverse health effects (bronchus and lung cancers for 15-65 years old people) were observed for hydrofluoric acid at low background concentration (<0.003 μg m^-3) while exposure to particulate cadmium (0.210-0.250 μg m^-3) disrupts insulin metabolism for people over 65 years-old leading to diabetes. Bronchus and lung cancers for people over 65 years-old occurred at low background SO₂ concentration (6 μg m^-3) below European limit values. When benzo[k]fluoranthene exceeded 0.672 μg m^-3, we observed a high number of hospital admissions for respiratory diseases for 15-65 years-old people. The study also revealed the important influence of socio-economy (e.g., single-parent family, people with no qualification at 15 years-old) on pathologies (e.g., cardiovascular diseases). Finally, a diffuse polychlorinated biphenyl (PCB) pollution was observed in the study area and can potentially cause lung cancers.

Extraction and determination of organic/inorganic pollutants in the ambient air of two cities located in metropolis of Tehran

In the present study, PM_2.5, volatile organic compounds (VOC), heavy metals, and polycyclic aromatic hydrocarbons (PAHs)-bonded PM_2.5 as well as asbestos fibers were investigated in two cities in the east of Tehran, Iran. To this end, 72 samples were collected from six stations located in the cities of Varamin and Pakdasht from March 2018 to March 2019. The concentration of BTEX compounds, PAHs, and heavy metals were measured using gas chromatography-flame ionization detector (GC-FID), gas chromatography-mass spectrometry (GC-Mas), and inductively coupled plasma atomic emission spectroscopy (ICP-OES), respectively. In addition, phase contrast microscopy (PCM) method was used to identify the properties of asbestos fibers. The results obtained from the present showed that the mean concentrations of PM_2.5, heavy metals, PAHs, BTEX, and asbestos fibers were 52.05 µg/m³, 319.08 ng/m³, 3.97 ng/m³, 40.58 µg/m³, and 2.84 f/L, respectively. In addition, the results obtained from PCA and heavy metals sources showed that transport fleets were the natural source of most of these pollutants. In case of PAH sources, transport and incineration of coal had the highest contribution in the emission. Furthermore, the risk assessment showed that most of the compounds have a higher risk value than the guideline value spatial distribution and also showed that stations close to airports, city terminals, and highways were more polluted than other parts of the city. Therefore, in order to have healthy air and with the least pollution, it seems necessary to formulate the necessary strategies in the cities of Varamin and Pakdasht.

A New Wearable System for Sensing Outdoor Environmental Conditions for Monitoring Hyper-Microclimate

The rapid urbanization process brings consequences to urban environments, such poor air quality and the urban heat island issues. Due to these effects, environmental monitoring is gaining attention with the aim of identifying local risks and improving cities’ liveability and resilience. However, these environments are very heterogeneous, and high-spatial-resolution data are needed to identify the intra-urban variations of physical parameters. Recently, wearable sensing techniques have been used to perform microscale monitoring, but they usually focus on one environmental physics domain. This paper presents a new wearable system developed to monitor key multidomain parameters related to the air quality, thermal, and visual domains, on a hyperlocal scale from a pedestrian’s perspective. The system consisted of a set of sensors connected to a control unit settled on a backpack and could be connected via Wi-Fi to any portable equipment. The device was prototyped to guarantee the easy sensors maintenance, and a user-friendly dashboard facilitated a real-time monitoring overview. Several tests were conducted to confirm the reliability of the sensors. The new device will allow comprehensive environmental monitoring and multidomain comfort investigations to be carried out, which can support urban planners to face the negative effects of urbanization and to crowd data sourcing in smart cities.

The effectiveness of urban trees in reducing airborne particulate matter by dry deposition in Tehran, Iran

Deposition of atmospheric pollution as particulate matter (PM) has become a serious issue in many urban areas. This study measured and estimated the amount of atmospheric PM deposition onto oriental plane (Platanus orientalis L.) trees located in Tehran Megapolis, Iran. PM deposited on the leaves of urban trees during spring and summer was estimated using leaf wash measurements. In addition to direct measurements, the dry deposition velocity and the yearly whole-tree PM deposition were estimated using both field measurements and a theoretical model of deposition flux. We estimated air quality improvement as a result of the trees at respiratory height (1.5 m), tree height (10 m), and boundary layer height (1719 m). Foliar PM deposition during spring and summer was estimated to average 0.05 g/leaf and 41.39 g/tree using direct measurements. The annual PM deposited on the leaves, trunk, and branches of an average urban tree was calculated to be 78.60 g/tree. Trees were estimated to improve air quality at 1.5 m, 10 m, and 1719 m from ground level by 25.8%, 5.8%, and 0.1%, respectively. Hence, oriental plane trees substantially reduce PM at respiratory height.

Short-term effect of multi-pollutant air quality indexes and PM2.5 on cardiovascular hospitalization in Hamadan, Iran: a time-series analysis

Air pollutants are the most important environmental factors that contributed to cardiovascular disease (CVD). The present study aimed to investigate the number of hospitalization due to heart failure (HF) and myocardial infarction (MI) following the air pollutant exposure using a time-series regression analysis with a distributed lag model in Hamadan, Iran (2015-2019). A total of 2091 cases of CVD were registered. Based on the findings, the highest health effects on HF hospitalization were observed with air quality health index (AQHI) at lag 9 (RR = 1.043, 95% CI 0.991-1.098), and air quality index (AQI) at lags 2, 7, and 9 (RR = 1.001, 95% CI 0.998-1.002), for an increase in 1 unit of the indexes, and with PM_2.5 at lag 0 (RR = 1.001, 95% CI 0.996-1.004) for 10 μg/m³ increase in PM_2.5 levels. The highest health effects on MI hospitalization were calculated with AQHI at lag 10 (RR = 1.059, 95% CI 1.001-1.121) and AQI at lags 1 and 2 (RR = 1.001, 95% CI 0.998-1.002), for an increase in 1 unit of the indexes, and with PM_2.5 at lag 8 (RR = 1.002, 95% CI 0.997-1.005) for 10 μg/m³ increase in PM_2.5 levels. According to a seasonal classification, results showed that hospitalization in the warm season was higher than that of the cold season. Based on our knowledge, the current study is the first study that investigated the effect of air quality indexes on hospitalization due to HF and MI in Iran. Findings can provide basic information to plan preventive measures for reducing exposure chance and hospitalization rate in high-risk people.

A 10-year assessment of ambient fine particles and related health endpoints in a large Mediterranean city

Fine particles i.e., with an aerodynamic diameter lower than 2.5 μm (PM_2.5) have potentially the most significant effects on human health compared to other air pollutants. The main objectives of this study were to i) investigate the temporal variations of ambient PM_2.5 in Marseille (Southern France), where air pollution is again a major public health issue, and ii) estimate their short-term health effects and annual trend (Mann-Kendall test) over a 10-year period from 2010 to 2019. In Marseille, the main sources of PM_2.5 could be related to road traffic, industrial complexes, and oil refineries surrounded the city. The number of premature deaths and hospital admissions attributable to ambient PM_2.5 exposure for non-accidental causes, cardiovascular and respiratory diseases were estimated by using in-situ air quality data, city-specific relative risk values and baseline incidence. Despite significant reduction of PM_2.5 (- 0.80 μg m^-3 year^-1), Marseille citizens were exposed to PM_2.5 levels exceeding the World Health Organization (WHO) Air Quality Guideline for human health protection (10 μg m^-3) during entire study period. Exposure to ambient PM_2.5 substantially contributed to mortality and hospital admissions: 871 deaths for non-accidental causes, 515 deaths for cardiovascular diseases, 47 deaths for respiratory diseases, as well as 1034 hospital admissions for cardiovascular diseases and 834 for respiratory diseases were reported between 2010 and 2019. Compliance with WHO annual limit values can result in substantial socio-economic benefits by preventing premature deaths and hospital admissions. For instance, based on the value of a statistical life and average cost of a hospital admission, the associated benefit for healthcare would have been €131 million in 2019. Between 2010 and 2019, the number of PM_2.5-related non-accidental deaths decreased by 1.15 per 10⁵ inhabitants annually. Compared to 2010-2019, the restrictive measures associated to COVID-19 pandemic led to a reduction in PM_2.5 of 11% in Marseille, with 2.6 PM_2.5-related deaths averted in 2020.

Association between ambient air pollution and cause-specific mortality in Cape Town, Durban, and Johannesburg, South Africa: any susceptible groups?

Studies have confirmed that adverse human health effects that are associated with exposure to air pollution may differ depending on other factors such as age, gender, environmental conditions, and socio-economic factors. This study was conducted to assess the association between ambient air pollution and cause-specific mortality in the three big cities in South Africa and to determine the susceptible groups thereof. Cause-specific mortality data for all ages and PM10, NO2, and SO2 in Cape Town, Durban, and Johannesburg for the period from 1 January 2006 to 31 December 2010 were obtained. Statistical analyses were done to estimate the associations between air pollutants and cause-specific mortality. Susceptibility was therefore investigated in stratified analyses by sex and age (≥60 years) and environmental conditions (heat and cold) followed by models with interaction terms. Our estimates showed independent associations between these air pollutants, environmental conditions, and susceptible groups.

Water-Soluble Ions in Atmospheric Aerosol Measured in a Semi-Arid and Chemical-Industrialized City, Northwest China

We investigated water-soluble ions (WSIs) of aerosol samples collected from 2016 to 2017 in Lanzhou, a typical semi-arid and chemical-industrialized city in Northwest China. WSIs concentration was higher in the heating period (35.68 ± 19.17 μg/m3) and lower in the non-heating period (12.45 ± 4.21 μg/m3). NO3−, SO42−, NH4+ and Ca2+ were dominant WSIs. The concentration of SO42− has decreased in recent years, while the NO3− level was increasing. WSIs concentration was affected by meteorological factors. The sulfur oxidation and nitrogen oxidation ratios (SOR and NOR) exceeded 0.1, inferring the vital contribution of secondary transformation. Meanwhile higher O3 concentration and temperature promoted the homogeneous reaction of SO2. Lower temperature and high relative humidity (RH) were more suitable for heterogeneous reactions of NO2. Three-phase cluster analysis illustrated that the anthropogenic source ions and natural source ions were dominant WSIs during the heating and non-heating periods, respectively. The backward trajectory analysis and the potential source contribution function model indicated that Lanzhou was strongly influenced by the Hexi Corridor, northeastern Qinghai–Tibetan Plateau, northern Qinghai province, Inner Mongolia Plateau and its surrounding cities. This research will improve our understanding of the air quality and pollutant sources in the industrial environment.

Ambient air particulate matter (PM10) satellite monitoring and respiratory health effects assessment

PURPOSE

Air particulate matter with an aerodynamic diameter of 10 µm or less (PM₁₀) is one of the main causes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study explored the relationship between PM₁₀ by remote sensing and AECOPD in Chaharmahal-o-Bakhtiari province from 2014 to2018.

METHOD

PM₁₀ concentrations were predicted and validated based on aerosol optical depth (AOD) from 161 images processed by MODIS sensor and ground air quality monitoring station data. Demographic information and spirometric indices of 2038 patients with AECOPD were collected and analyzed from the hospital during the studied periods. SPSS software was used to analyze the relationships between these two categories of information.

RESULTS

There was a significant negative relationship between PM10 and FVC, FVC%, FEV1, FEV1%, FEF25-75, FEV1/FVC, PEF, and FEF25FVC indices (p < 0.05). The results showed that over 2014-2018, the annual mean of PM10 concentrations varied from 35 to 52 µg/m3. The result of the regression model showed that the patient's age, body mass index (BMI), and PM₁₀ concentrations were the most affecting variables on the two important spirometric indices i.e., FVC% and FEV₁%. The PM₁₀ concentrations and number of AECOPD patients had a similar pattern during the studied period. The women group, age group above 74 years, normal BMI, and non-smoking patients showed the most sensitivity to the PM₁₀ concentrations.

CONCLUSIONS

Our findings provide supplementary scientific information on PM₁₀ concentration related to the incidence of AECOPD and as a variable affecting the most important spirometry indicators by providing local decision-makers information needed to set a priority of air pollution control measures as well as health services.

Urban and air pollution: a multi-city study of long-term effects of urban landscape patterns on air quality trends

Most air pollution research has focused on assessing the urban landscape effects of pollutants in megacities, little is known about their associations in small- to mid-sized cities. Considering that the biggest urban growth is projected to occur in these smaller-scale cities, this empirical study identifies the key urban form determinants of decadal-long fine particulate matter (PM2.5) trends in all 626 Chinese cities at the county level and above. As the first study of its kind, this study comprehensively examines the urban form effects on air quality in cities of different population sizes, at different development levels, and in different spatial-autocorrelation positions. Results demonstrate that the urban form evolution has long-term effects on PM2.5 level, but the dominant factors shift over the urbanization stages: area metrics play a role in PM2.5 trends of small-sized cities at the early urban development stage, whereas aggregation metrics determine such trends mostly in mid-sized cities. For large cities exhibiting a higher degree of urbanization, the spatial connectedness of urban patches is positively associated with long-term PM2.5 level increases. We suggest that, depending on the city's developmental stage, different aspects of the urban form should be emphasized to achieve long-term clean air goals.

Mortality rates due to respiratory tract diseases in Tehran, Iran during 2008-2018: a spatiotemporal, cross-sectional study

BACKGROUND

Tehran, the 22nd most populous city in the world, has the highest mortality rate due to respiratory system diseases (RSDs) in Iran. This study aimed to investigate spatiotemporal patterns of mortality due to these diseases in Tehran between 2008 and 2018.

METHODS

We used a dataset available from Tehran Municipality including all cases deceased due RSDs in this city between 2008 and 2018. Global Moran's I was performed to test whether the age-adjusted mortality rates were randomly distributed or had a spatial pattern. Furthermore, Anselin Local Moran's I was conducted to identify potential clusters and outliers.

RESULTS

During the 10-year study, 519,312 people died in Tehran, 43,177 because of RSDs, which corresponds to 831.1 per 10,000 deaths and 5.0 per 10,000 population. The death rate was much higher in men (56.8%) than in women (43.2%) and the highest occurred in the > 65 age group (71.2%). Overall, three diseases dominated the mortality data: respiratory failure (44.2%), pneumonia (15.9%) and lung cancer (10.2%). The rates were significantly higher in the central and southeastern parts of the city and lower in the western areas. It increased during the period 2008-2018 and showed a clustered spatial pattern between 2008 and 2013 but presented a random geographical pattern afterwards.

CONCLUSIONS

This study provides a first report of the spatial distribution of mortality due to RSDs in Tehran and shows a significant increase in respiratory disease mortality in the last ten years. Effective control of the excess fatality rates would warrant a combination of urban prevention and treatment strategies including environmental health plans.

Dynamic linkages among economic development, environmental pollution and human health in Chinese

Background

Research on the relationships between economic development, energy consumption, environmental pollution, and human health has tended to focus on the relationships between economic growth and air pollution, energy and air pollution, or the impact of air pollution on human health. However, there has been little past research focused on all the above associations.

Methods

The few studies that have examined the interconnections between the economy, energy consumption, environmental pollution and health have tended to employ regression analyses, DEA (Data Envelopment Analysis), or DEA efficiency analyses; however, as these are static analysis tools, the analyses did not fully reveal the sustainable economic, energy, environmental or health developments over time, did not consider the regional differences, and most often ignored community health factors. To go some way to filling this gap, this paper developed a modified two stage Undesirable Meta Dynamic Network model to jointly analyze energy consumption, economic growth, air pollution and health treatment data in 31 Chinese high-income and upper-middle income cities from 2013-2016, for which the overall efficiency, production efficiency, healthcare resource utilization efficiency and technology gap ratio (TGR) for all input and output variables were calculated.

Results

It was found that: (1) the annual average overall efficiency in China's eastern region was the highest; (2) the production stage efficiencies were higher than the healthcare resource utilization stage efficiencies in most cities; (3) the high-income cities had lower TGRs than the upper-middle income cities; (4) the high-income cities had higher average energy consumption efficiencies than the upper-middle income cities; (5) the health expenditure efficiencies were the lowest of all inputs; (6) the high-income cities' respiratory disease and mortality rate efficiencies were higher than in the upper-middle income cities, which had improving mortality rate efficiencies; and (7) there were significant regional differences in the annual average input and output indicator efficiencies.

Conclusions

First, the high-income cities had higher average efficiencies than the upper-middle income cities. Of the ten eastern region high-income cities, Guangzhou and Shanghai had average efficiencies of 1, with the least efficient being Shijiazhuang. In the other regions, the upper-middle income cities required greater technology and health treatment investments. Second, Guangzhou, Lhasa, Nanning, and Shanghai had production efficiencies of 1, and Guangzhou, Lhasa, Nanning, Shanghai and Fuzhou had healthcare resource utilization efficiencies of 1. As the average production stage efficiencies in most cities were higher than the healthcare resource utilization stage efficiencies, greater efforts are needed to improve the healthcare resource utilization. Third, the technology gap ratios (TGRs) in the high-income cities were slightly higher than in the upper-middle income cities. Therefore, the upper-middle income cities need to learn from the high-income cities to improve their general health treatment TGRs. Fourth, while the high-income cities had higher energy consumption efficiencies than the upper-middle income cities, these were decreasing in most cities. There were few respiratory disease efficiency differences between the high-income and upper-middle income cities, the high-income cities had falling mortality rate efficiencies, and the upper-middle income cities had increasing mortality rate efficiencies. Overall, therefore, most cities needed to strengthen their health governance to balance economic growth and urban expansion. Fifth, the average AQI efficiencies in both the high-income and upper-middle income cities were higher than the average CO₂ efficiencies. However, the high-income cities had lower average CO₂ emissions and AQI efficiencies than the upper-middle income cities, with the AQI efficiency differences between the two city groups expanding. As most cities were focusing more on air pollution controls than carbon dioxide emissions, greater efforts were needed in coordinating the air pollution and carbon dioxide emissions treatments. Therefore, the following suggestions are given. (1) The government should reform the hospital and medical systems. (2) Local governments need to strengthen their air pollution and disease education. (3) High-income cities need to improve their healthcare governance to reduce the incidence of respiratory diseases and the associated mortality. (4) Healthcare governance efficiency needs to be prioritized in 17 upper-middle income cities, such as Hangzhou, Changchun, Harbin, Chengdu, Guiyang, Kunming and Xi'an, by establishing sound medical management systems and emergency environmental pollution treatments, and by increasing capital asset medical investments. (5) Upper-middle income cities need to adapt their treatment controls to local conditions and design medium to long-term development strategies. (6) Upper-middle income cities need to actively learn from the technological and governance experiences in the more efficient higher-income cities.

The Great Smog Month and Spatial and Monthly Variation in Air Quality in Ambient Air in Delhi, India

BACKGROUND

In recent years, poor urban air quality in Delhi, India has gained significant attention. Episodic events including crop stubble burning and Diwali celebrations are considered major factors in the worsening quality of ambient air.

OBJECTIVE

This study aimed to investigate spatial and monthly variation as well as the role of episodic events in ambient air quality in Delhi, including the 'Great Smog' month of November 2017.

METHODS

Monitoring of air pollutants (particulate matter (PM₁₀, PM_2.5, PM₁) and nitrogen dioxide (NO₂)) was carried out at three distinct locations of Delhi from April 2017-February 2018. The concentration of NO₂ was measured using a modified Jacob and Hochheiser method and PM was measured using a GRIMM aerosol spectrometer. Air quality index was also determined to identify the effects of air pollution on human health.

RESULTS

Overall, the levels of air pollution were found to be approximately 2.1-3.2 times higher along a traffic intersection and about 1.4-2.0 times higher in a commercial area compared with an institutional area. The highest average monthly concentrations of PM₁₀, PM_2.5, PM₁ and NO₂ were 768, 374, 298 and 149 μg/m₃, respectively, during the Great Smog month of November 2017. November and August were recorded as the most polluted and cleanest months, respectively, in the city. Generally, poor to severe categories of the air quality index (AQI) were obtained from October to February. Higher concentrations during November were attributed to stubble burning in the nearby states of Delhi with the additive effect of fireworks during Diwali celebrations.

CONCLUSIONS

Severe ambient air quality as observed in the present study is a serious matter of concern for the health of Delhi's population. To control spikes in poor air quality during episodic events, it is imperative to raise awareness among farmers regarding the severe health hazards of stubble burning.

COMPETING INTERESTS

The authors declare no competing financial interests.

Air Pollution and Cardiac Arrhythmias: A Comprehensive Review

Air pollution is the mixture of some chemical and environmental agents including dust, fumes, gases, particulate matters, and biological materials which can be harmful for the environment and the human body. The increasing trend of the air pollution, especially in developing countries, may exert its detrimental effects on human health. The potentially harmful effects of air pollution on the human health have been recognized and many epidemiological studies have clearly suggested the strong association between air pollution exposure and increased morbidities and mortalities. Air pollutants are classified into gaseous pollutants including carbon mono oxide, nitrogen oxides, ozone and sulfur dioxide, and particulate matters (PMs). All air pollutants have destructive effects on the health systems including cardiovascular system. Many studies have demonstrated the effect of air pollutant on the occurrence of ST elevation myocardial infarction, sudden cardiac death, cardiac arrythmias, and peripheral arterial disease. Recently, some studies suggested that air pollution may be associated with cardiac arrhythmias. In this study, we aimed to comprehensively review the last evidences related to the association of air pollutant and cardiac arrythmias. We found that particulate matters (PM₁₀, PM_2.5, and UFP) and gaseous air pollutants can exert undesirable effects on cardiac rhythms. Short-term and long-term exposure to the air pollutants can interact with the cardiac rhythms through oxidative stress, autonomic dysfunction, coagulation dysfunction, and inflammation. It seems that particulate matters, especially PM_2.5 have stronger association with cardiac arrhythmias among all air pollutants. However, future studies are needed to confirm these results.

The economic loss of health effect damages from PM2.5 pollution in the Central Plains Urban Agglomeration

The Central Plains Urban Agglomeration is an important growth pole of China's economy, but the rapid economic growth is accompanied by serious air pollution problems. In this paper, the latest available PM_2.5 monitoring data in 2015-2017 and exposure-response relationship model are used to quantitatively analyze the health effect damages due to PM_2.5 pollution. The way of disease cost, adjusted human capital, and willingness to pay were adopted to estimate the economic loss of health effect damages. The results show that health effect damages of PM_2.5 pollution in 2015-2017 were 11.9251 million, 11.4292 million, and 11.1012 million, respectively, accounting for 7.41%, 7.05%, and 6.94% of the total population of this area. The health effect economic loss was 97.398 billion RMB, 93.516 billion RMB, and 94.485 billion RMB, accounting for 1.73%, 1.53%, and 1.41% of the GDP. Chronic bronchitis and premature death due to PM_2.5 are the main sources of health effect economic loss. Elderly people and infants are vulnerable groups of PM_2.5 pollution. Affected by economic growth level, population density, and economic structure, Heze, Zhengzhou, Handan, and Liaocheng were greatly affected by PM_2.5 pollution, and their health effect damages was larger. The health effect damages and health effect economic loss due to PM_2.5 pollution in this area show a downward trend, indicating that air pollution reduction measures have played a positive role. However, the whole effect is still large. According to the results, this paper puts forward the policies.

Organ-on-a-Chip: Opportunities for Assessing the Toxicity of Particulate Matter

Recent developments in epidemiology have confirmed that airborne particulates are directly associated with respiratory pathology and mortality. Although clinical studies have yielded evidence of the effects of many types of fine particulates on human health, it still does not have a complete understanding of how physiological reactions are caused nor to the changes and damages associated with cellular and molecular mechanisms. Currently, most health assessment studies of particulate matter (PM) are conducted through cell culture or animal experiments. The results of such experiments often do not correlate with clinical findings or actual human reactions, and they also cause difficulty when investigating the causes of air pollution and associated human health hazards, the analysis of biomarkers, and the development of future pollution control strategies. Microfluidic-based cell culture technology has considerable potential to expand the capabilities of conventional cell culture by providing high-precision measurement, considerably increasing the potential for the parallelization of cellular assays, ensuring inexpensive automation, and improving the response of the overall cell culture in a more physiologically relevant context. This review paper focuses on integrating the important respiratory health problems caused by air pollution today, as well as the development and application of biomimetic organ-on-a-chip technology. This more precise experimental model is expected to accelerate studies elucidating the effect of PM on the human body and to reveal new opportunities for breakthroughs in disease research and drug development.

Air Microbiome and Pollution: Composition and Potential Effects on Human Health, Including SARS Coronavirus Infection

Polluted air poses a significant threat to human health. Exposure to particulate matter (PM) and harmful gases contributes to cardiovascular and respiratory diseases, including allergies and obstructive lung disease. Air pollution may also be linked to cancer and reduced life expectancy. Uptake of PM has been shown to cause pathological changes in the intestinal microbiota in mice and humans. Less is known about the effects of pollution-associated microbiota on human health. Several recent studies described the microbiomes of urban and rural air samples, of the stratosphere and sand particles, which can be transported over long distances, as well as the air of indoor environments. Here, we summarize the current knowledge on airborne bacterial, viral, and fungal communities and discuss their potential consequences on human health. The current data suggest that bacterial pathogens are typically too sparse and short-lived in air to pose a significant risk for infecting healthy people. However, airborne fungal spores may exacerbate allergies and asthma. Little information is available on viruses including phages, and future studies are likely to detect known and novel viruses with a yet unknown impact on human health. Furthermore, varying experimental protocols have been employed in the recent microbiome and virome studies. Therefore, standardized methodologies will be required to allow for better comparisons between studies. Air pollution has been linked to more severe outcomes of SARS (severe acute respiratory syndrome) coronavirus (SARS-CoV) infections. This may have contributed to severe SARS-CoV-2 outbreaks, especially those in China, Northern Italy, Iran, and New York City.

A Bibliometric Analysis of the Impacts of Air Pollution on Children

In recent years, many researchers have investigated the association between air pollution and children. However, there has been little research to provide a macroscopic overview in this field. The aim of this study is to characterize the scientific production around the world in this area and map the trends. The relevant literature was searched from 1999 to 2018. To guarantee the quality of the literature, we combined the PubMed and WoS databases. The built-in statistics tools of the Web of Science website were used to display the trend of articles published by year and the distribution of journals. By CiteSpace (5.5.R2), the reference co-citation and burst keywords were extracted. In total, 15,999 target English documents were obtained. We summarized the characteristics of published documents, of research institutes' cooperation, and of the contents. As part of a research hotspot, ten clusters are presented, four popular topics are elaborated. Twenty-four burst words were obtained and analyzed. China has received more attention in recent years. Researchers in this field could carry out more cohorts' studies and fine particulate matter is one good air pollution index. Household air pollution exposure and children's lung function should be paid more attention.

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 Energy Efficiency and the Impact of Air Pollution on Health in China

The rapid growth of China's economy in recent years has greatly improved its citizens' living standards, but economic growth consumes many various energy sources as well as produces harmful air pollution. Nitrogen oxides, SO₂ (sulfur dioxide), and other polluting gases are damaging the environment and people's health, with a particular spike in incidences of many air pollution-related diseases in recent years. While there have been many documents discussing China's energy and environmental issues in the past, few of them analyze economic development, air pollution, and residents' health together. Therefore, this study uses the modified undesirable dynamic two-stage DEA (data envelopment analysis) model to explore the economic, environmental, and health efficiencies of 30 provinces in China. The empirical results show the following: (1) Most provinces have lower efficiency values in the health stage than in the production stage. (2) Among the provinces with annual efficiency values below 1, their energy consumption, CO₂ (carbon dioxide), and NOx (nitrogen oxide) efficiency values have mostly declined from 2013 to 2016, while their SO₂ efficiency values have increased (less SO₂ emissions). (3) The growth rate of SO₂ efficiency in 2016 for 10 provinces is much higher than in previous years. (4) The health expenditure efficiencies of most provinces are at a lower level and show room for improvement. (5) In most provinces, the mortality rate is higher, but on a decreasing trend. (6) Finally, as representative for a typical respiratory infection, most provinces have a high level of tuberculosis efficiency, indicating that most areas of China are highly effective at respiratory disease governance.

Effect of O3, PM10 and PM2.5 on cardiovascular and respiratory diseases in cities of France, Iran and Italy

At present, both tropospheric ozone (O₃) and particulate matters (PM) are among the most threatening air pollutants for human health in cities. The air pollution effects over public health include increased risk of hospital admissions and mortality for respiratory and cardiovascular diseases even when air pollutant concentrations are below European and international standards. The aim of this study was to (i) estimate the burden of mortality and morbidity for cardiovascular and respiratory diseases attributed to PM_2.5, PM₁₀ and O₃ in nine selected cities in France, Iran and Italy in 2015 and 2016 and to (ii) compare estimated burdens at current O₃ and PM levels with pre-industrial levels. The selected Mediterranean cities are among the most affected by the air pollution in Europe, in particular by rising O₃ while the selected Iranian cities rank as the most polluted by PM in the world. The software AirQ+ was used to estimate the short-term health effects, in terms of mortality and morbidity by using in situ air quality data, city-specific relative risk values and baseline incidence. Compared to pre-industrial levels, long-term exposures to ambient PM_2.5, PM₁₀ and O₃ have substantially contributed to mortality and hospital admissions in selected cities: about 8200 deaths for non-accidental causes, 2400 deaths for cardiovascular diseases, 540 deaths for respiratory diseases, 220 deaths for chronic obstructive pulmonary diseases as well as 18,800 hospital admissions for cardiovascular diseases and 3400 for respiratory diseases were reported in 2015. The study supports the need of city-specific epidemiological data and urgent strategies to mitigate the health burden of air pollution.

Risks of hospital admissions from a spectrum of causes associated with particulate matter pollution

Ambient particulate matter (PM) pollution has been linked to elevated hospital admissions (HAs), especially from respiratory and cardiovascular diseases. However, few studies have estimated the associations between PM pollution and HAs for a wider range of broad disease categories. This study aimed to evaluate the effects of PM with aerodynamic diameter ≤ 2.5 μm (PM_2.5) and ≤10 μm (PM₁₀) on a range of broad and specific causes of HAs in Chengdu, China during 2015-2016, using a generalized additive model (GAM). Age-, gender- and season-specific analyses were also performed on the broad categories. We further calculated the corresponding morbidity burden due to PM exposure. During the study period, the daily mean level for PM_2.5 and PM₁₀ was 57.3 μg/m³ and 94.7 μg/m³, respectively. For broad disease categories, each 10 μg/m³ increase in PM₁₀ at lag06 was associated with increments of 0.65% (95% CI: 0.32%-0.99%) in HAs from respiratory, 0.49% (95% CI: 0.04%-0.95%) from circulatory and 0.91% (95% CI: 0.15%-1.69%) from skin and subcutaneous tissue diseases. By contrast, only respiratory HAs showed a significant positive association with elevated PM_2.5 at lag06 (1.03% increase per 10 μg/m³, 95% CI: 0.50%-1.56%, p < 0.001). Increased HAs risks for several more refined specific causes within respiratory, circulatory, skin and subcutaneous tissue, nervous and genitourinary diseases were also observed. Subgroup analyses indicated that effect estimates were modified by age, gender and season. Overall, the largest morbidity burden was observed in myocardial infarction, about 11.27% (95% CI: 3.45%-18.07%) and 11.11% (95% CI: 4.07%-17.27%) of HAs for myocardial infarction could be attributable to PM_2.5 and PM₁₀ levels exceeding the WHO's air quality guidelines (24-h mean: 25 μg/m³ for PM_2.5 and 50 μg/m³ for PM₁₀). Our study suggests that both PM_2.5 and PM₁₀ increase risks of morbidity from broad range of causes of HAs in Chengdu, and result in substantial morbidity burden.

Health damage assessment of particulate matter pollution in Jing-Jin-Ji region of China

Jing-Jin-Ji is the largest and most dynamic economic region in northern China, and its air pollution has attracted much public attention. Scientific evaluation of health losses caused by air pollution can provide decision-making basis for formulation and improvement of pollution reduction policies in the Jing-Jin-Ji region. This paper estimated the adverse effects of particulate matter pollution on health in the Jing-Jin-Ji region in 2016 by using logarithmic linear exposure-response function, and monetized the health effects by adjusting human capital method and disease cost method. The results show non-ignorable health hazards and economic impacts caused by atmospheric particulate pollution. The economic losses relevant to health hazards by PM2.5 in the Jing-Jin-Ji region are 122.40 billion yuan, and those relevant to PM10 are 118.34 billion yuan, accounting for 1.62% and 1.56% of the region's GDP, respectively. Similar evaluations previously conducted in other countries yielded figures within the same order of magnitude. Considering the difference in economic losses per unit among disease types, the economic losses caused by air pollution in the Jing-Jin-Ji region mainly come from premature deaths. Infants and elderly people are the main victims of particulate matter. Affected by population, pollutant concentration, industrial structure, and other factors, the economic losses of particulate matter pollution in Beijing, Tianjin, Shijiazhuang, Tangshan, and Baoding are large. In order to reduce health hazards and economic impacts caused by particulate matter pollution, this paper put forward to guide the urban population diversion, reduce the outgoing frequency of susceptible groups such as infants and the elderly in haze weather, adopt high-efficiency particulate matter air purifier indoors, and develop public transportation to reduce motor vehicle exhaust emissions. In Tianjin and Hebei, promoting cleaner production in industries such as steel and cement and reducing coal use in the power industry are also suggested.

Spatial Patterns of Satellite-Retrieved PM2.5 and Long-Term Exposure Assessment of China from 1998 to 2016

Previous studies have shown that particulate matter with an aerodynamic diameter of less than 2.5 micrometers (PM_2.5) is tightly associated with adverse effects on human health, i.e., morbidity and mortality. Based on long-term satellite-derived PM_2.5 datasets, this study analyzed the spatial patterns and temporal trends of PM_2.5 concentrations in China from 1998 to 2016 using standard deviational ellipse and statistical analyses. A long-term assessment of exposure and health impacts due to PM_2.5 was undertaken by the Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE) model. The results show that concentrations of PM_2.5 increased nonlinearly in most areas of China from 1998 to 2016. Higher concentrations were found in eastern China and western Tarim Basin, and most areas exceeded the World Health Organization’s (WHO) annual PM_2.5 standards. The median center of average PM_2.5 concentration of the country shifted to the southeast and then returned during the examined time period. The proportion of the population exposed to equal PM_2.5 concentrations increased at first, then trended downward. The proportion of the population exposed to PM_2.5 over WHO Interim Target-1 (35 µg/m³) increased 20.6%, which was the largest growth compared with other WHO standard levels. The extent of health risk in China increased and expanded from 1998 to 2016, especially in the Beijing-Tianjin-Hebei region, the Yangtze River Delta, and the Pearl River Delta, which are China’s top three urban areas. The implementation of the Air Pollution Prevention and Control Action Plan has gradually paid off. If the government can achieve long-term adherence to its plan, great economic and health benefits will be gotten through the BenMAP-CE model analysis.