Long-term effects of PM2.5 components on blood pressure and hypertension in Chinese children and adolescents

Impact of improved air quality on lung function and blood pressure of middle-aged and older population in China

Long-term exposure to fine particulate matters (PM2.5) has been associated with respiratory and cardiovascular diseases and the burden are potentially higher in China experiencing heavy air pollution. In this study, we established the exposure-response association between long-term exposures to PM2.5 and lung function and blood pressure in Chinese middle-aged and older adults using linear mixed-effects and generalized additive mixed models based on 3 waves longitudinal health outcomes data by enrolling 19,988 participants from 121 cities across the mainland of China. We also assessed the effect of Clean Air Policy (CAP) based on a quasi-experimental difference-in-differences (DID) design. A 10 µg/m3 increase in PM2.5 concentration was associated with a 7.18 (95 % confidence interval [CI]: -8.35, -6.02) L/min decrease in PEF (peak expiratory flow) and a 0.72 (95 % [CI]: 0.53, 0.90) and a 0.30 (95 % [CI]: 0.18, 0.42) mmHg increase in systolic and diastolic blood pressure, respectively. The associations were more pronounced in males and rural areas for PEF, but similar across subgroups for blood pressure. DID results suggested that the effect of CAP on health outcomes were sensitive to magnitudes of reduction in PM2.5. A 5 µg/m3 reduction in PM2.5 or more generally led to 18.70 (95 % [CI]: 0.79, 36.61) higher PEF and -2.05 (95 % [CI]: -3.87, -0.23) lower diastolic blood pressure, respectively, compared to no reduction or increase in exposure. However, the effects were significant only in rural areas. Our analysis support CAP aiming to benefit public health and provides insights to inform future control policy for efficiently decreasing air pollution exposure burden.

Healthier lifestyles can modify the air pollutants effect on cardiovascular disease among the middle-aged and elderly

There is increasing evidence that air pollutants significantly increase the risk of cardiovascular disease (CVD). Nevertheless, less research has been conducted to date to reveal protective factors. Therefore, this study aims to indicate whether a healthy lifestyle can modify the effects of environmental pollution on CVD. This study screened 3010 participants from the China Health and Retirement Longitudinal Study (CHARLS) Wave 3 (2015). The study aimed to systematically demonstrate the impact of environmental pollution on CVD and elucidate the role of a healthy lifestyle. Air pollutant data were obtained from the China High Air Pollutant (CHAP) datasets. We analyzed the relationship between these pollutants and cardiovascular disease risk using generalized linear mixed models. In addition, healthy lifestyles were categorized as low, medium, and high; stratified analyses were conducted to estimate the effect of healthy lifestyles on the risk of CVD due to air pollutants. 607 had CVD among 3010 participants, and the three-year mean concentrations of the pollutants chloride ion (Cl-), nitrate ion (NO3-), particulate matter with a diameter of 10 micrometers or less (PM10), particulate matter with a diameter of 10 micrometers or less (PM1), particulate matter with a diameter of 10 micrometers or less (PM2.5) were each linked 1.37 (95%CI:1.22,1.54), 1.03 (95%CI:1.00,1.06), 1.02 (95%CI:1.01,1.03), 1.01 (95%CI:1.00,1.01), and 1.01 (95%CI:1.00,1.01) fold risk of CVD, respectively. For the subgroups of low, medium, and high according to the healthy lifestyle score in model 2, the average concentration of Cl- pollutant was each associated with 1.34 (1.12,1.62), 1.34 (1.12,1.61), and 1.32 (1.03,1.71) times risk with CVD, respectively. The NO3 - was each associated with 1.06 (1.02,1.11), 1.01 (0.97,1.05), and 0.98 (0.93,1.04) times risk with CVD, respectively. The PM1 was each associated with 1.03 (1.01,1.05), 1.01 (0.99,1.02), and 1.00 (0.97,1.02) times risk with CVD, respectively. The PM10 was each associated with 1.01 (1.00,1.01), 1.01 (0.99,1.01), and 1.00 (0.99,1.01) times risk with CVD, respectively. PM2.5 was each associated with 1.02 (1.01,1.03), 1.00 (0.99,1.01), and 1.00 (0.99,1.01) times risk with CVD, respectively. Exposure to these pollutants(Cl-, NO3-, PM10, PM1, PM2.5)is associated with higher risk of CVD, and healthier lifestyles can reduce the risk of CVD due to overall air pollutants.

Long-term effects of PM2.5 and its components on incident hypertension among the middle-aged and elderly: a national cohort study

BACKGROUND

The long-term health effects of fine particulate matter (PM2.5) on hypertension remain incomprehensive. We evaluated the relationship of PM2.5 and its components with hypertension incidence in middle-aged and elderly adults.

METHODS

We utilised data from the China Health and Retirement Longitudinal Study collected between 2011 and 2018. We obtained annual modelled data from the dataset of Tracking Air Pollution in China, including black carbon (BC), sulphate (SO42-), organic matter (OM), ammonium (NH4+), and nitrate (NO3-). Time-varying Cox models and quantile g-computation models were employed to explore the associations. Exposure-response curves were portrayed to investigate potential non-linear effects.

RESULTS

We enrolled 7,032 individuals with a mean age of 57.14 (range: 45-95) years. Over 36,997 person-years of follow-up (average time: 5.26 years), 3,119 individuals suffered from hypertension. With per interquartile range increment, the hazard ratios and 95% confidence intervals (CIs) of PM2.5 (3.82 [95% CI: 3.48-4.18]), BC (4.17 [95% CI: 3.54-4.92]), SO42- (4.24 [95% CI: 3.50-5.12]), OM (3.76 [95% CI: 3.14-4.50]), NH4+ (3.20 [95% CI: 2.91-3.52]), and NO3- (1.94 [95% CI: 1.77-2.13]) were discovered with lag 1 year. And the mixed effect was 18.0% [95% CI: 16.8%-19.2%], which was mainly driven by BC (66.0%) and SO42- (34.0%). Approximate J-shaped exposure-response relationships were revealed.

CONCLUSIONS

The positive associations of long-term exposure to PM2.5 and its components with hypertension incidence were discovered in adults aged ≥ 45 years. Controlling the emissions of PM2.5 components, especially BC and SO42-, could alleviate the burden of hypertension.

Meeting clean air targets could reduce the burden of hypertension among women of reproductive age in India

BACKGROUND

Air pollution is one of the leading risk factors for hypertension globally. However, limited epidemiological evidence exists in developing countries, specifically with indigenous health data and for fine particulate matter (PM2.5) composition. Here, we addressed this knowledge gap in India.

METHODS

Using a logistic regression model, we estimated the association between hypertension (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) prevalence among women of reproductive age (WRA, 15-49 years) from the fifth round of the National Family Health Survey and long-term exposure to PM2.5 and its composition, after adjusting for confounders. We also explored the moderating effects of socioeconomic indicators through a multiplicative interaction with PM2.5.

RESULTS

Hypertension prevalence increased by 5.2% (95% uncertainty interval: 4.8%-5.7%) for every 10 μg/m3 increase in ambient PM2.5 exposure. Significant moderating effects were observed among smokers against nonsmokers and for various sociodemographic parameters. Among PM2.5 species, every interquartile range increase in black carbon (BC) and sulphate exposure was significantly associated with higher odds of hypertension than for organic carbon and dust. We estimated that achieving the National Clean Air Program target and World Health Organization air quality guidelines can potentially reduce hypertension prevalence by 2.42% and 4.21%, respectively.

CONCLUSION

Our results demonstrate that increasing ambient PM2.5 exposure is associated with a higher prevalence of hypertension among WRA in India. The risk is not uniform across various PM2.5 species and is higher with BC and sulphate. Achieving clean air targets can substantially reduce the hypertension burden in this population.

The effect of ambient temperature on lipid metabolism in children: From a prospective cohort study

BACKGROUND

Dyslipidemia is increasingly recognized as an essential risk factor for cardiovascular diseases. However, few studies illustrated the effects of ambient temperature exposure (TE) on lipid levels in children. The study aimed to examine the association between ambient TE and lipid levels in children.

METHODS

Based on a prospective cohort, a total of 2423 children (with 4466 lipids measure person-time) were collected from 2014 to 2019. The meteorological observation data and adjusted variables were collected. Mixed-effect models and generalized additive mixed model (GAMM) were applied to investigate the association between ambient TE and lipid levels.

RESULTS

A significant negative association was observed between TE and low-density lipoprotein cholesterol (LDL-C) or total cholesterol (TC) levels both in all children [LDL-C, β(95%CI) = -0.350(-0.434,-0.265), P < 0.001; TC, β(95%CI) = -0.274(-0.389,-0.160), P < 0.001] and by different sex group. However, no significant association was found in low-density lipoprotein cholesterol (HDL-C) or triglycerides (TG) levels. The estimated optimal ambient TEs for LDL-C were 18.273 °C and 18.024 °C for girls and boys, respectively. For TC, the optimal ambient TEs were 17.949 °C and 18.024 °C, respectively. With ambient TE decreased, the risk of dyslipidemia increased for both boys [OR = 0.032(0.006,0.179), P < 0.001] and girls [OR = 0.582(0.576,0.587), P < 0.001].

CONCLUSION

This study provided a comprehensive illustration about the associations between ambient TE and lipid levels in different sex and ages from a prospective cohort study. The findings will provide evidence for the government to prevent dyslipidemia in vulnerable children through regulating TE.

PM2.5 constituents associated with mortality and kidney failure in childhood-onset lupus nephritis: A 19-year cohort study

BACKGROUND

Childhood-onset lupus nephritis (cLN) is a severe form of systemic lupus erythematosus (SLE) with high morbidity and mortality. The impact of long-term exposure to fine particulate matter (PM2.5) on adverse outcomes in cLN remains unclear.

METHODS

We combined a 19-years cLN cohort from seven provinces in China with high-resolution PM2.5 dataset from 2001 to 2020, investigating the association between long-term exposure to PM2.5 and its constituents (sulfate, nitrate, organic matter, black carbon, ammonium) with the risk of death and kidney failure, analyzed with multiple variables Cox models. We also evaluated the association between 3-year average PM2.5 exposure before study entry and baseline SLE disease activity index (SLEDAI) scores using linear regression models.

RESULTS

Each 10 μg/m3 increase in annual average PM2.5 exposure was associated with an increased risk of death and kidney failure (HR = 1.58, 95 % CI: 1.24-2.02). Black carbon showed the strongest association (HR = 2.14, 95 % CI: 1.47-3.12). Higher 3-year average exposures to PM2.5 and its constituents were significantly associated with higher baseline SLEDAI scores.

CONCLUSIONS

These findings highlight the significant role of environmental pollutants in cLN progression and emphasize the need for strategies to mitigate exposure to harmful PM2.5 constituents, particularly in vulnerable pediatric populations.

A longitudinal study on the effect of PM2.5 components on blood pressure in the hypertensive patients from 2011 to 2019

Extensive research has established the link between PM2.5 exposure and blood pressure (BP) levels among normal individuals. However, the association between PM2.5 components and BP levels in hypertensive patients has not been fully explored. In this study, 12 971 hypertensive cases from Jinchang cohort (in Jinchang City, China) with nearly 9 years of follow-up were enrolled. Based on the linear mixed-effect model, the effects of fine particulate matter (PM2.5) and five major components [sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), black carbon (BC) and organic matter (OM)]on BP [systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP)]were evaluated by single-component model, component-joint model and component-residual model, respectively. A positive correlation was found between PM2.5 as well as its components (SO42-, NO3-, NH4+, BC and OM) exposure and BP levels. The effects of SO42-, BC and OM on BP were observed to be the most robust among the three models. Based on the results of interaction effects and stratified analysis, the effect of BC exposure on SBP, and the effect of PM2.5 and its five components on PP were greater in female than in males. Compared with elderly hypertensive patients, OM had more significant effects on SBP, DBP and MAP in young and (or) middle-aged hypertensive patients. During the heating season, the effect of PM2.5 and its components on BP was grater compared to the non-heating season. Meanwhile, PM2.5 and its components have a greater influence on BP in patients with hypertension combined with diabetes. Therefore, the findings suggested that both PM2.5 exposure and its components had a significant effect on BP in patients with hypertension. Women and young and middle-aged hypertensive patient were the sensitive population. The implementation of source control and reduction of PM2.5 emission (mainly for SO42-, BC and OM) may be of great significance to control BP level and could reduce the risk of cardiovascular disease in patients with hypertension.

Effects of long-term exposure to air pollutant mixture on blood pressure in typical areas of North China

BACKGROUND

Studies about the combined effects of gaseous air pollutants and particulate matters are still rare.

OBJECTIVES

This study was performed based on baseline survey of the Diverse Life-Course Cohort in the Beijing-Tianjin-Hebei (BTH) Region of North China to evaluate the association of long-term air pollutants with blood pressure and the combined effect of the air pollutants mixture among 32821 natural han population aged 20 years or above.

METHODS

Three-year average exposure to air pollutants (PM10, PM2.5, PM1, O3, SO2, NO2, and CO) and PM2.5 components [black carbon (BC), ammonium (NH4+), nitrate (NO3-), sulfate (SO42-), and organic matter (OM)] of residential areas were calculated based on well-validated models. Generalized linear mixed models (GLMMs) were used to estimate the associations of air pollutants exposure with the systolic blood pressure (SBP), diastolic blood pressure (DBP), Mean arterial pressure (MAP), pulse pressure (PP) and prevalent hypertension. Quantile g-Computation and Bayesian Kernel Machine Regression (BKMR) were employed to assess the combined effect of the air pollutant mixture.

RESULTS

We found that long-term exposures of O3, PM2.5, and PM2.5 components were stably and strongly associated with elevated SBP, DBP, and MAP and prevalent hypertension. O3 increased SBP, DBP, and MAP at a similar extent, but with greater effects; while, PM2.5 and PM2.5 components had a greater impact on SBP than DBP, which increased PP simultaneously. In multi-pollutant models, the combined effects of the air pollutant mixture on blood pressure and prevalent hypertension was predominantly influenced by O3, PM2.5, and O3, OM in different models, respectively. For example, O3, PM2.5 contributed 57.25 %, 39.22 % of the positive combined effect of the air pollutant mixture on SBP; and O3, OM positively contributed 70.00 %, 30.00 % on prevalent hypertension, respectively. There were interactions between O3, CO, SO2 and PM2.5 components on hbp, SBP and PP.

CONCLUSIONS

The results showed positive associations of air pollutant mixtures with blood pressure, where O3 and PM2.5 (especially OM) might be primary contributors. There were interactions between gaseous air pollutants and PM2.5 components on blood pressure and prevalent hypertension.

Differentiated impacts of short-term exposure to fine particulate constituents on infectious diseases in 507 cities of Chinese children and adolescents: A nationwide time-stratified case-crossover study from 2008 to 2021

This study assesses the association of short-term exposure to PM2.5 (particles ≤2.5 μm) on infectious diseases among Chinese children and adolescents. Analyzing data from 507 cities (2008-2021) on 42 diseases, it focuses on PM2.5 components (black carbon (BC), ammonium (NH4+), inorganic nitrate (NO3-), organic matter (OM), and sulfate (SO42-)). PM2.5 constituents significantly associated with incidence. Sulfate showed the most substantial effect, increasing all-cause infectious disease risk by 2.72 % per interquartile range (IQR) increase. It was followed by BC (2.04 % increase), OM (1.70 %), NO3- (1.67 %), and NH4+ (0.79 %). Specifically, sulfate and BC had pronounced impacts on respiratory diseases, with sulfate linked to a 10.73 % increase in seasonal influenza risk and NO3- to a 16.39 % rise in tuberculosis. Exposure to PM2.5 also marginally increased risks for gastrointestinal, enterovirus, and vectorborne diseases like dengue (7.46 % increase with SO42-). Sexually transmitted and bloodborne diseases saw an approximate 6.26 % increase in incidence, with specific constituents linked to diseases like hepatitis C and syphilis. The study concludes that managing PM2.5 levels could substantially reduce infectious disease incidence, particularly in China's middle-northern regions. It highlights the necessity of stringent air quality standards and targeted disease prevention, aligning PM2.5 management with international guidelines for public health protection.

Long-term exposure to PM2.5 and its components is associated with elevated blood pressure and hypertension prevalence: Evidence from rural adults

INTRODUCTION

The toxicity of fine particulate matter (PM2.5) is determined by its components, while the evidence regarding associations of PM2.5 components with blood pressure (BP) is limited, especially in rural areas.

OBJECTIVES

This study aimed to explore the associations of PM2.5 and its chemical components with systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), mean artery pressure (MAP) levels and hypertension prevalence, and to identify key components in Chinese rural areas.

METHODS

39,211 adults from the Henan Rural Cohort were included during 2015-2017. Different periods of PM2.5 and chemical components were estimated by hybrid satellite model. The single-pollutant, component-PM2.5 model, component-residual model and component-proportion model were applied to explore the associations of pollutants with BP levels and hypertension prevalence. Exposure-response (E-R) relationships, stratified analyses and sensitivity analyses were used to explore these associations further.

RESULTS

12,826 (32.71%) were identified with hypertension. For each 1 μg/m3 increase of pollutants, the adjusted odds ratio (OR) for hypertension prevalence was 1.03 for PM2.5 mass, 1.40 for BC, 1.16 for NH4+, 1.08 for NO3-, 1.17 for OM, 1.12 for SO42- and 1.25 for SOIL in the single-pollutant model. BC and SOIL were statistically significant in the component-PM2.5 model, component-residual model and component-proportion model. Similarly, associations of these pollutants with elevated BP levels were also found in aforementioned four models. These pollutants produced a stronger association with SBP than DBP, PP and MAP. Most of associations were non-linear in E-R relationships. The groups of older, the men, with lower per capita monthly income, lower educational level and higher BMI were more vulnerable to these pollutants in stratified analyses. The results remained stable in sensitivity analyses.

CONCLUSION

Long-term exposure to PM2.5 and its components, especially BC and SOIL, was associated with elevated BP and hypertension prevalence in rural adults, and decreasing pollutants may provide additional benefits.

Long-term exposure to major constituents of fine particulate matter and neurodegenerative diseases: A population-based survey in the Pearl River Delta Region, China

BACKGROUND

Exposure to PM2.5 has been linked to neurodegenerative diseases, with limited understanding of constituent-specific contributions.

OBJECTIVES

To explore the associations between long-term exposure to PM2.5 constituents and neurodegenerative diseases.

METHODS

We recruited 148,274 individuals aged ≥ 60 from four cities in the Pearl River Delta region, China (2020 to 2021). We calculated twenty-year average air pollutant concentrations (PM2.5 mass, black carbon (BC), organic matter (OM), ammonium (NH4+), nitrate (NO3-) and sulfate (SO42-)) at the individuals' home addresses. Neurodegenerative diseases were determined by self-reported doctor-diagnosed Alzheimer's disease (AD) and Parkinson's disease (PD). Generalized linear mixed models were employed to explore associations between pollutants and neurodegenerative disease prevalence.

RESULTS

PM2.5 and all five constituents were significantly associated with a higher prevalence of AD and PD. The observed associations generally exhibited a non-linear pattern. For example, compared with the lowest quartile, higher quartiles of BC were associated with greater odds for AD prevalence (i.e., the adjusted odds ratios were 1.81; 95% CI, 1.45-2.27; 1.78; 95% CI, 1.37-2.32; and 1.99; 95% CI, 1.54-2.57 for the second, third, and fourth quartiles, respectively).

CONCLUSIONS

Long-term exposure to PM2.5 and its constituents, particularly combustion-related BC, OM, and SO42-, was significantly associated with higher prevalence of AD and PD in Chinese individuals.

ENVIRONMENTAL IMPLICATION

PM2.5 is a routinely regulated mixture of multiple hazardous constituents that can lead to diverse adverse health outcomes. However, current evidence on the specific contributions of PM2.5 constituents to health effects is scarce. This study firstly investigated the association between PM2.5 constituents and neurodegenerative diseases in the moderately to highly polluted Pearl River Delta region in China, and identified hazardous constituents within PM2.5 that have significant impacts. This study provides important implications for the development of targeted PM2.5 prevention and control policies to reduce specific hazardous PM2.5 constituents.

Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents

China is home to the second largest population of children and adolescents in the world. Yet demographic shifts mean that the government must manage the challenge of fewer children with the needs of an ageing population, while considering the delicate tension between economic growth and environmental sustainability. We mapped the health problems and risks of contemporary school-aged children and adolescents in China against current national health policies. We involved multidisciplinary experts, including young people, with the aim of identifying actionable strategies and specific recommendations to promote child and adolescent health and wellbeing. Notwithstanding major improvements in their health over the past few decades, contemporary Chinese children and adolescents face distinct social challenges, including high academic pressures and youth unemployment, and new health concerns including obesity, mental health issues, and sexually transmitted infections. Inequality by gender, geography, and ethnicity remains a feature of health risks and outcomes. We identified a mismatch between current health determinants, risks and outcomes, and government policies. To promote the health of children and adolescents in China, we recommend a set of strategies that target government-led initiatives across the health, education, and community sectors, which aim to build supportive and responsive families, safe communities, and engaging and respectful learning environments. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Early-life exposure to ambient air pollution with cardiovascular risk factors in adolescents: Findings from the "Children of 1997" Hong Kong birth cohort

BACKGROUND

Long-term exposure to ambient air pollution is associated with cardiovascular disease (CVD) risk. Little is known about the impact of early-life exposure to air pollutants on CVD risk factors in late adolescence, which may track into adulthood. To clarify, we examined this question in a unique setting with high air pollution and a high level of economic development.

METHODS

This study leveraged the "Children of 1997" Hong Kong birth cohort (N = 8327), including here 3350 participants. We estimated ambient air pollutant exposure including inhalable particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2) and nitrogen monoxide (NO) by growth phase (in utero, infancy, childhood) and overall based on residential address. Generalized linear regression was used to assess the associations of air pollutants exposure by growth phase and sex with CVD risk factors (fasting blood glucose, glycosylated hemoglobin, lipid profile, blood pressure, and body mass index) at 17.6 years. We also assessed whether associations varied by sex.

RESULTS

Early life exposed had little association with glucose metabolism, blood pressure or body mass index, but after considering multiple comparisons early exposure to PM10 was associated with low density lipoprotein (LDL) in boys, with β and 95 % confidence intervals (95 % CI) of 0.184 (0.069 to 0.298) mmol/l, 0.151 (0.056 to 0.248) mmol/l, and 0.157 (0.063 to 0.252) mmol/l by per interquartile range (IQR) increment of PM10 for in utero, infancy, and overall, respectively. No such associations were evident for girls, differences by sex were evident.

CONCLUSIONS

Our study suggested sex-specific associations of early-life PM10 exposure with elevated LDL in adolescence, especially exposure in utero and infancy.

The role of lysosomes in airborne particulate matter-induced pulmonary toxicity

An investigation of the potential role of lysosomes in airborne particulate matter (APM) induced health risks is essential to fully comprehend the pathogenic mechanisms of respiratory diseases. It is commonly accepted that APM-induced lung injury is caused by oxidative stress, inflammatory responses, and DNA damage. In addition, there exists abundant evidence that changes in lysosomal function are essential for cellular adaptation to a variety of particulate stimuli. This review emphasizes that disruption of the lysosomal structure/function is a key step in the cellular metabolic imbalance induced by APMs. After being ingested by cells, most particles are localized within lysosomes. Thus, lysosomes become the primary locus where APMs accumulate, and here they undergo degradation and release toxic components. Recent studies have provided incontrovertible evidence that a wide variety of APMs interfere with the normal function of lysosomes. After being stimulated by APMs, lysosome rupture leads to a loss of lysosomal acidic conditions and the inactivation of proteolytic enzymes, promoting an inflammatory response by activating the nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome. Moreover, APMs interfere with autophagosome production or block autophagic flux, resulting in autophagy dysfunction. Additionally, APMs disrupt the normal function of lysosomes in iron metabolism, leading to disruption on iron homeostasis. Therefore, understanding the impacts of APM exposure from the perspective of lysosomes will provide new insights into the detrimental consequences of air pollution.

Cardiovascular Risk Factors in China

The Annual Report on Cardiovascular Health and Diseases in China (2022) intricate landscape of cardiovascular health in China. This section dissects cardiovascular risk factors in China which including hypertension, dyslipidemia, diabetes mellitus, chronic kidney disease, metabolic syndrome and air pollution. Hypertension prevalence has steadily increased in China, with efforts to control it facing challenges in achieving optimal rates, especially in rural areas. Interventions like salt substitutes and intensive blood pressure control show promise but need improvement. Abnormal lipid levels, indicative of dyslipidemia, have risen significantly, posing a risk for cardiovascular diseases. Despite efforts, many patients struggle to achieve target lipid levels, necessitating improved treatment strategies. Both type 1 and type 2 diabetes mellitus affect millions of adults in China, with long-term complications adding to the disease burden. Early intervention and effective management are crucial to mitigate its impact. Prevalent among older adults, chronic kidney disease is associated with diabetes mellitus, hypertension, and cardiovascular diseases, necessitating comprehensive management approaches. The prevalence of metabolic syndrome, characterized by a cluster of risk factors, has increased in both adults and adolescents, calling for lifestyle modifications and public health interventions. Ambient and household air pollution remain significant environmental risk factors, despite some improvements in air quality. Continued efforts to reduce emissions are essential for mitigating associated health risks. Addressing these risk factors requires a multifaceted approach, including public health initiatives, policy interventions, and individual-level strategies to promote healthy lifestyles and reduce environmental exposures. Surveillance and research efforts are crucial for monitoring trends and developing effective strategies to lessen the burden of cardiovascular diseases in China.

Exposure to ambient black carbon and particulate matter during pregnancy in associations with risk of pre-eclampsia: A meta-analysis based on population-based studies

Air pollution control protocols and policies formulated for PM2.5 and PM10 (particulate matter [PM] with an aerodynamic diameter of ≤2.5 and 10 μm), however, such protocols and policies have not been available for black carbon (BC). A growing number of studies have evaluated the association between long-term exposure to ambient air pollution with BC and PM and pre-eclampsia. We applied a meta-analysis to estimate pooled odds ratios (ORs) and 95 % confidence intervals (CIs) based on four exposure windows (first/second/third trimester and entire pregnancy). 24 studies meeting our selection criteria (8 for BC, 21 and 15 for PM2.5 and PM10) were finally included after screening studies published up to June 22, 2023. An increase of 1 μg/m3 BC during the second trimester and entire pregnancy were associated with a 16 % (OR: 1.16, 95 % CI: [1.02, 1.32]) and a 15 % (OR: 1.15, 95 % CI: [1.03, 1.29]) increased risk of pre-eclampsia, respectively. A 10 μg/m3 increase in second-trimester exposure to PM2.5 and PM10 was associated with a 1 % (OR: 1.01, 95 % CI: [1.00, 1.03]) and a 5 % (OR: 1.05, 95 % CI: [1.01, 1.10]) increased risk of pre-eclampsia. An 11 % (OR: 1.11, 95 % CI: [1.03, 1.21]) increased risk of pre-eclampsia was found to be associated with a 10 μg/m3 increase in PM10 exposure during the entire pregnancy. The results support the potential effect of exposure to ambient particulate pollutants on risk of pre-eclampsia and emphasize the necessity of strategies and protocols for controlling BC. Greater efforts in controlling ambient particulate pollution and especially BC are needed in order to prevent pregnant women from developing pre-eclampsia.

Ambient PM2.5 components and prevalence of chronic kidney disease: a nationwide cross-sectional survey in China

OBJECTIVES

Chronic kidney disease (CKD) is a global public health concern, and accumulating evidence has indicated that air pollution increases the odds of CKD. However, a limited number of studies have examined the long-term effects of ambient fine particulate matter (PM2.5) components on the risk of CKD among general population; thus, major knowledge gaps remain.

METHODS

Using data from a nationwide representative cross-sectional survey in China and a validated PM2.5 composition dataset, we established generalized linear models to quantify the association between five major components of PM2.5 and CKD prevalence.

RESULTS

There were significant associations between long-term exposure to three PM2.5 components [including black carbon (BC), sulfate (SO42-), organic matter (OM)] and increased odds of CKD prevalence. Along with an interquartile range (IQR) increment in BC (3.3 μg/m3), SO42- (9.7 μg/m3), and OM (16.2 μg/m3) at a 4-year moving average, the odds ratios (ORs) for CKD prevalence were 1.28 (95% CI 1.07, 1.54), 1.23 (95% CI 1.03, 1.45), and 1.23 (95% CI 1.02, 1.47), respectively. We did not detect any significant association of the other two PM2.5 components [nitrate (NO3-) or ammonium (NH4+)] with CKD prevalence. Stratified analyses revealed no differences (P ≥ 0.05) in the effect estimates of subgroups based on administrative region, sex, age, and other demographic characteristics. For instance, along with an IQR increment in BC at a 4-year moving average, the ORs of CKD prevalence among males and females were 1.30 (95% CI 0.98, 1.73) and 1.29 (95% CI 1.01, 1.65), respectively. The odds of CKD were generally higher with increasing PM2.5 composition concentration.

CONCLUSIONS

Our study demonstrated that long-term exposure to specific PM2.5 components including BC, SO42-, and OM increased CKD risk in the general population. This study could provide new insights into source-directed PM2.5 control and CKD prevention.

Effects of long-term exposure to ambient fine particulate matter and its specific components on blood pressure and hypertension incidence

BACKGROUND

Epidemiological evidence on the association of PM2.5 (particulate matter with aerodynamic diameter ≤ 2.5 μm) and its specific components with hypertension and blood pressure is limited.

METHODS

We applied information of participants from the World Health Organization's (WHO) Study on Global Ageing and Adult Health (SAGE) to estimate the associations of long-term PM2.5 mass and its chemical components exposure with blood pressure (BP) and hypertension incidence in Chinese adults ≥ 50 years during 2007-2018. Generalized linear mixed model and Cox proportional hazard model were applied to investigate the effects of PM2.5 mass and its chemical components on the incidence of hypertension and BP, respectively.

RESULTS

Each interquartile range (IQR = 16.80 μg/m3) increase in the one-year average of PM2.5 mass concentration was associated with a 17 % increase in the risk of hypertension (HR = 1.17, 95 % CI: 1.10, 1.24), and the population attributable fraction (PAF) was 23.44 % (95 % CI: 14.69 %, 31.55 %). Each IQR μg/m3 increase in PM2.5 exposure was also related to increases of systolic blood pressure (SBP) by 2.54 mmHg (95 % CI:1.99, 3.10), and of diastolic blood pressure (DBP) by 1.36 mmHg (95 % CI: 1.04, 1.68). Additionally, the chemical components of SO42-, NO3-, NH4+, OM, and BC were also positively associated with an increased risk of hypertension incidence and elevated blood pressure.

CONCLUSIONS

These results indicate that long-term exposure to PM2.5 mass and its specific components may be major drivers of escalation in hypertension diseases.

Short-term effects of exposure to ambient PM2.5 and its components on hospital admissions for threatened and spontaneous abortions: A multicity case-crossover study in China

BACKGROUND

The adverse effects of short-term exposure to PM2.5 and its components on hospital admissions for threatened and spontaneous abortions (TSAB) are still controversial.

METHODS

Data on daily hospitalizations for TSAB and PM2.5 and its components, including sulfate (SO42-), nitrate (NO3-), ammonium salt (NH4+), organic matter (OM), and black carbon (BC), were collected from January 2015 to December 2021 (total 2,557 days) in five cities in China. Case-crossover analyses were conducted to investigate the short-term associations between PM2.5 and its components and TSAB. Additionally, the modification effects by age (<35 and ≥35 years), season (cold and warm seasons), and the "Three-Year Action Plan to Win the Blue Sky Defense War" (before and after implementation) on the above associations were further conducted.

RESULTS

For each 10 μg/m3 (1 μg/m3 for BC) increase, the strongest relative risks (95% confidence intervals) of hospitalization for TSAB were 1.011 (1.001-1.021) for PM2.5 in lag02, 1.060 (1.003-1.120) for SO42- in lag02, 1.035 (1.000-1.070) for NO3- in lag02, 1.065 (1.009-1.124) for NH4+ in lag02, 1.047 (1.008-1.088) for OM in lag01 and 1.029 (1.005-1.054) for BC in lag02 (all P <0.05). Furthermore, significant modifying effects of age and the Action Plan were found. The effects of NO3- (lag2), NH4+ (lag2), and BC (lag2) were more pronounced in mothers aged ≥35 years and the effects of PM2.5 (lag4), NO3- (lag4), NH4+ (lag4), OM (lag4), and BC (lag4) was more pronounced in the period before the Action Plan was implemented (all P modification <0.05).

CONCLUSION

Short-term exposure to ambient PM2.5 and its components (SO42-, NO3-, NH4+, OM, and BC) was related to increased risks of hospitalization for TSAB. The effects were more pronounced in mothers aged ≥35 years and the period before the Action Plan.

Long-term influence of air pollutants on morbidity and all-cause mortality of cardiometabolic multi-morbidity: A cohort analysis of the UK Biobank participants

BACKGROUND

The effects of air pollutants on cardiometabolic diseases (CMDs) have been widely explored, whereas their influences on cardiometabolic multi-morbidity (CMM) were not clear.

METHODS

We employed the UK Biobank cohort (N = 317,160) to study the association between six air pollutants (PM2.5, PM10, PM2.5-10, PM2.5abs, NO2, and NOx) and four CMDs including type II diabetes (T2D), coronary artery disease (CAD), stroke and hypertension. CMM was defined as occurrence of two or more of the four diseases. Multi-state Cox models were performed to estimate hazard ratio (HR) and its 95% confidence interval (95%CI).

RESULTS

During a median follow-up of 12.8 years, 52,211 participants developed only one CMD, 15,446 further developed CMM, and 16,861 ultimately died. It was demonstrated that per interquartile range increase (IQR) increases in PM2.5, PM10, PM2.5-10, PM2.5abs, NO2, and NOx would increase 12% (9%-15%), 4% (1%-7%), 3% (1%-6%), 7% (4%-10%), 11% (8%-15%) and 10% (7%-13%) higher risk of developing one CMD from health baseline; 7% (2%-12%), 8% (3%-13%), 6% (2%-11%), 10% (5%-15%), 13% (7%-18%) and 10% (5%-15%) greater risk of occurring CMM from one CMD baseline; and 11% (-2%∼26%), 22% (7%-38%), 17% (3%-32%), 31% (16%-49%), 33% (17%-51%) and 32% (17%-50%) larger risk of causing death from CMM baseline, respectively.

CONCLUSIONS

We revealed that people living in areas with high air pollution suffered from higher hazard of CMD, CMM and all-cause mortality; our findings implied keeping clean air was an effective approach to prevent or mitigate initiation, progression, and death from healthy to CMDs and from CMDs to CMM.

Effect of body mass index trajectory on hypertension among children and adolescents aged 5-18 years: a retrospective cohort study

BACKGROUND

Hypertension has become increasingly prevalent in Chinese children and adolescents in recent decades, which affects growth and development of children, leads to cognitive decline and multiple target organ damage. Here, we assessed the impact of different body mass index (BMI) trajectories on the occurrence of hypertension in children and adolescents using a cohort study in Northeast China.

MATERIALS AND METHODS

Children and adolescents aged 5-18 years was extracted for physical examination in Fuxin City, Liaoning Province, China during the 2009-2015 period. A latent category growth mixed model (LCGMM) was used to classify BMI changes and analyze the effect of different BMI trajectories on the risk of occurrence of hypertension in these participants within 5 years.

RESULTS

All participates were divided into five BMI trajectories by LCGMM method: slow increasing group (n = 2616, 30.8%), overweight and obesity (OW/OB) group (n = 1141, 13.4%), normal decreasing group (n = 232, 2.7%), stable normal group (n = 4383, 51.6%), and fast-increasing group (n = 120, 1.4%). Compared with the stable normal group, the slow increasing group [adjusted odds ratio (AOR): 1.610, 95% confidence interval (CI): 1.304-1.989], the OW/OB group (AOR: 3.172, 95% CI: 2.500-4.023) and the fast-increasing group (AOR: 2.708, 95% CI: 1.445-5.074) all increased the risk of developing hypertension in children and adolescents.

CONCLUSION

The potential of developing hypertension varies among groups of children aged 5-18 with different BMI trajectories. Children and adolescents in the normal BMI range (the slow growth group) still need to be aware of the change in BMI trajectory to stop or slow down the progression of BP abnormalities.

Ambient PM2.5 and its components associated with 10-year atherosclerotic cardiovascular disease risk in Chinese adults

BACKGROUND

Exposure to particulate matter with aerodynamic diameters less than 2.5 µm (PM2.5) may increase the risk of 10-year atherosclerotic cardiovascular disease (ASCVD) risk. While PM2.5 is comprised of various components, the evidence on the correlation of its components with 10-year ASCVD risk and which component contributes most remains limited.

METHODS

Data were derived from the baseline assessments of China Multi-Ethnic Cohort (CMEC). In total, 69,722 individuals aged 35-74 years were included into this study. The annual average concentration of PM2.5 and its components (black carbon, ammonium, nitrate, sulfate, organic matter, soil particles, and sea salt) were estimated by satellite remote sensing and chemical transport models. The ASCVD risk of individuals was calculated by the equations from the China-PAR Project (prediction for ASCVD risk in China). The relationship between single exposure to PM2.5 and its components and predicted 10-year ASCVD risk was assessed using the logistic regression model. The effect of joint exposure was estimated, and the most significant contributor was identified using the weighted quantile sum approach.

RESULTS

Totally 69,722 participants were included, of which 95.8 % and 4.2 % had low and high 10-year ASCVD risk, respectively. Per standard deviation increases in the 3-year average concentration of PM2.5 mass (odds ratio [OR] 1.23, 95 % confidence interval [CI]: 1.12-1.35), black carbon (1.21, 1.11-1.33), ammonium (1.21, 1.10-1.32), nitrate (1.25, 1.14-1.38), organic matter (1.29, 1.18-1.42), sulfate (1.17, 1.07-1.28), and soil particles (1.15, 1.04-1.26) were related to high 10-year ASCVD risk. The overall effect (1.19, 1.11-1.28) of the PM2.5 components was positively associated with 10-year ASCVD risk, and organic matter had the most contribution to this relationship. Female participants were more significantly impacted by PM2.5, black carbon, ammonium, nitrate, organic matter, sulfate, and soil particles compared to others.

CONCLUSION

Long-term exposure to PM2.5 mass, black carbon, ammonium, nitrate, organic matter, sulfate, and soil particles were positively associated with high 10-year ASCVD risk, while sea salt exhibited a protective effect. Moreover, the organic matter might take primary responsibility for the relationship between PM2.5 and 10-year ASCVD risk. Females were more susceptible to the adverse effect.

Long-term exposure to ambient PM2.5 constituents is associated with dyslipidemia in Chinese adults

BACKGROUND

Ambient particulate matter with aerodynamic diameter ≤ 2.5 µm (PM2.5) consists of various toxic constituents. However, the health effect of PM2.5 may differ depending on its constituents, but the joint effect of PM2.5 constituents remains incompletely understood.

OBJECTIVE

Our goal was to evaluate the joint effect of long-term PM2.5 constituent exposures on dyslipidemia and identify the most hazardous chemical constituent.

METHODS

This study included 67,015 participants from the China Multi-Ethnic Cohort study. The average yearly levels of PM2.5 constituents for all individuals at their residences were assessed through satellite remote sensing and chemical transport modeling. Dyslipidemia was defined as one or more following abnormal blood lipid concentrations: total cholesterol (TC) ≥ 6.22 mmol/L, triglycerides (TG) ≥ 2.26 mmol/L, high-density lipoprotein cholesterol (HDL-C) < 1.04 mmol/L, and low-density lipoprotein cholesterol (LDL-C) ≥ 4.14 mmol/L. The logistic regression model was utilized to examine the single effect of PM2.5 constituents on dyslipidemia, while the weighted quantile sum regression model for the joint effect.

RESULTS

The odds ratio with a 95 % confidence interval for dyslipidemia positively related to per-SD increase in the three-year average was 1.29 (1.20-1.38) for PM2.5 mass, 1.25 (1.17-1.34) for black carbon, 1.24 (1.16-1.33) for ammonium, 1.33 (1.24-1.43) for nitrate, 1.34 (1.25-1.44) for organic matter, 1.15 (1.08-1.23) for sulfate, 1.30 (1.22-1.38) for soil particles, and 1.12 (1.05-1.92) for sea salt. Stronger associations were observed in individuals < 65 years of age, males, and those with low physical activity. Joint exposure to PM2.5 constituents was positively related to dyslipidemia (OR: 1.09, 95 %CI: 1.05-1.14). Nitrate was identified as the constituent with the largest weight (weighted at 0.387).

CONCLUSIONS

Long-term exposure to PM2.5 constituents poses a significant risk to dyslipidemia and nitrate might be the most responsible for the risk. These findings indicate that reducing PM2.5 constituent exposures, especially nitrate, could be beneficial to alleviate the burden of disease attributed to PM2.5-related dyslipidemia.

PM2.5 and its respiratory tract depositions on blood pressure, anxiety, depression and health risk assessment: A mechanistic study based on urinary metabolome

Effects of fine particulate matter (PM2.5) and regional respiratory tract depositions on blood pressure (BP), anxiety, depression, health risk and the underlying mechanisms need further investigations. A repeated-measures panel investigation among 40 healthy young adults in Hefei, China was performed to explore the acute impacts of PM2.5 exposure and its deposition doses in 3 regions of respiratory tract over diverse lag times on BP, anxiety, depression, health risk, and the potential mechanisms. We collected PM2.5 concentrations, its deposition doses, BP, the Self-Rating Anxiety Scale (SAS) score and the Self-Rating Depression Scale (SDS) score. An untargeted metabolomics approach was used to detect significant urine metabolites, and the health risk assessment model was used to evaluate the non-carcinogenic risks associated with PM2.5. We applied linear mixed-effects models to assess the relationships of PM2.5 with the aforementioned health indicators We further evaluate the non-carcinogenic risks associated with PM2.5. We found deposited PM2.5 dose in the head accounted for a large proportion. PM2.5 and its three depositions exposures at a specific lag day was significantly related to increased BP levels and higher SAS and SDS scores. Metabolomics analysis showed significant alterations in urinary metabolites (i.e., glucoses, lipids and amino acids) after PM2.5 exposure, simultaneously accompanied by activation of the cAMP signaling pathway. Health risk assessment presented that the risk values for the residents in Hefei were greater than the lower limits of non-cancer risk guidelines. This real-world investigation suggested that acute PM2.5 and its depositions exposures may increase health risks by elevating BP, inducing anxiety and depression, and altering urinary metabolomic profile via activating the cAMP signaling pathway. And the further health risk assessment indicated that there are potential non-carcinogenic risks of PM2.5 via the inhalation route in this area.

Anemia is associated with long-term exposure to PM2.5 and its components: a large population-based study in Southwest China

Background

Anemia is linked to PM2.5 (particulate matter with aerodynamic diameters of ⩽2.5 μm) exposure, which can increase the risk of various negative health outcomes. It remains unclear which PM2.5 components are associated with anemia and the respective contribution of each component to this association.

Objective

This study aimed at investigating the association between PM2.5 and anemia in the general population and to identify the most critical PM2.5 toxic components in this association.

Design

Cross-sectional study.

Methods

Our study involved a large cohort of 73,511 individuals aged 30-79 from China's multi-ethnic population. We employed satellite observations and the chemical transport model (GEOS-Chem)to estimate the long-term exposure to PM2.5 and its components. Anemia was defined, according to WHO guidelines, as Hb levels below 130 g/L for men and below 120 g/L for women. Through logistic regression, we investigated the association between PM2.5 components and anemia. By utilizing weighted quantile sum (WQS) analysis, we identified key components and gained insights into their combined impact on anemia. Overall, our study sheds light on the relationship between PM2.5 exposure, its constituents, and the risk of anemia in a large cohort.

Results

PM2.5 and three components, nitrate (NIT), organic matter (OM), and soil particles (SOIL), were associated with anemia. Per-standard deviation increase in the 3-year average concentrations of PM2.5 [odds ratio (OR): 1.14, 95% confidence interval (CI): 1.01, 1.28], NIT (1.20, 1.06, 1.35), OM (1.17, 1.04, 1.32), and SOIL (1.22, 1.11, 1.33) were associated with higher odds of anemia. In WQS regression analysis, the WQS index was associated with anemia (OR: 1.29, 95% CI: 1.13, 1.47). SOIL has the highest weight among all PM2.5 components.

Conclusions

Long-term exposure to PM2.5 and its constituents is associated with anemia. Moreover, SOIL might be the most critical component of the relationship between PM2.5 and anemia. Our research increases the evidence of the association between PM2.5 and anemia in the general population, and targeted emission control measures should be taken into consideration to mitigate the adverse effects of PM2.5-related anemia.

The association between chemical constituents of ambient fine particulate matter and obesity in adults: A large population-based cohort study

OBJECTIVES

Current evidence demonstrated that ambient fine particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) and its constituents may be obesogenic in children, but evidence from adults is lacking. Our aim was to characterize the association between PM2.5 and its constituents and obesity in adults.

METHODS

We included 68,914 participants from the China Multi-Ethnic Cohort (CMEC) baseline survey. Three-year average concentrations of PM2.5 and its constituents were evaluated by linking pollutant estimates to the geocoded residential addresses. Obesity was defined as body mass index (BMI) ≥ 28 kg/m2. Logistic regression was used to examine the relationship between PM2.5 and its constituents and obesity. We performed weighed quantile sum (WQS) regression to get the overall effect of PM2.5 and its constituents and the relative contribution of each constituent.

RESULTS

Per-SD increase in PM2.5 (odds ratio [OR] = 1.43, 95% confidence interval [CI]: 1.37-1.49), black carbon (BC) (1.42, 1.36-1.48), ammonium (1.43, 1.37-1.49), nitrate (1.44, 1.38-1.50), organic matter (OM) (1.45, 1.39-1.51), sulfate (1.42, 1.35-1.48), and soil particles (SOIL) (1.31, 1.27-1.36) were positively associated with obesity, and SS (0.60, 0.55-0.65) was negatively associated with obesity. The overall effect (OR = 1.34, 95% CI: 1.29-1.41) of the PM2.5 and its constituents was positively associated with obesity, and ammonium made the most contribution to this relationship. Participants who were older, female, never smoked, lived in urban areas, had lower income or higher levels of physical activity were more significantly adversely affected by PM2.5, BC, ammonium, nitrate, OM, sulfate and SOIL compared to other individuals.

CONCLUSION

Our study revealed that PM2.5 constituents except SS were positively associated with obesity, and ammonium played the most important role. These findings provided new evidence for public health interventions, especially the precise prevention and control of obesity.

Noise and Air Pollution as Risk Factors for Hypertension: Part I-Epidemiology

Traffic noise and air pollution are 2 major environmental health risk factors in urbanized societies that often occur together. Despite cooccurrence in urban settings, noise and air pollution have generally been studied independently, with many studies reporting a consistent effect on blood pressure for individual exposures. In the present reviews, we will discuss the epidemiology of air pollution and noise effects on arterial hypertension and cardiovascular disease (part I) and the underlying pathophysiology (part II). Both environmental stressors have been found to cause endothelial dysfunction, oxidative stress, vascular inflammation, circadian dysfunction, and activation of the autonomic nervous system, thereby facilitating the development of hypertension. We also discuss the effects of interventions, current gaps in knowledge, and future research tasks. From a societal and policy perspective, the health effects of both air pollution and traffic noise are observed well below the current guideline recommendations. To this end, an important goal for the future is to increase the acceptance of environmental risk factors as important modifiable cardiovascular risk factors, given their substantial impact on the burden of cardiovascular disease.

Air Pollution: A Silent Key Driver of Dementia

In 2017, the Lancet Commission on Dementia Prevention, Intervention, and Care included air pollution in its list of potential risk factors for dementia; in 2018, the Lancet Commission on Pollution concluded that the evidence for a causal relationship between fine particulate matter (PM) and dementia is encouraging. However, few interventions exist to delay or prevent the onset of dementia. Air quality data are becoming increasingly available, and the science underlying the associated health effects is also evolving rapidly. Recent interest in this area has led to the publication of population-based cohort studies, but these studies have used different approaches to identify cases of dementia. The purpose of this article is to review recent evidence describing the association between exposure to air pollution and dementia with special emphasis on fine particulate matter of 2.5 microns or less. We also summarize here the proposed detailed mechanisms by which air pollutants reach the brain and activate the innate immune response. In addition, the article also provides a short overview of existing limitations in the treatment of dementia.

Pre- and postnatal particulate matter exposure and blood pressure in children and adolescents: A systematic review and meta-analysis

BACKGROUND

Early life is a susceptible period of air pollution-related adverse health effects. Hypertension in children might be life-threatening without prevention or treatment. Nevertheless, the causative association between environmental factors and childhood hypertension was limited. In the light of particulate matter (PM) as an environmental risk factor for cardiovascular diseases, this study investigated the association of pre- and postnatal PM exposure with blood pressure (BP) and hypertension among children and adolescents.

METHOD

Four electronic databases were searched for related epidemiological studies published up to September 13, 2022. Stata 14.0 was applied to examine the heterogeneity among the studies and evaluate the combined effect sizes per 10 μg/m³ increase of PM by selecting the corresponding models. Besides, subgroup analysis, sensitivity analysis, and publication bias test were also conducted.

RESULTS

Prenatal PM_2.5 exposure was correlated with increased diastolic blood pressure (DBP) in offspring [1.14 mmHg (95% CI: 0.12, 2.17)]. For short-term postnatal exposure effects, PM_2.5 (7-day average) was significantly associated with systolic blood pressure (SBP) [0.20 mmHg (95% CI: 0.16, 0.23)] and DBP [0.49 mmHg (95% CI: 0.45, 0.53)]; and also, PM₁₀ (7-day average) was significantly associated with SBP [0.14 mmHg (95% CI: 0.12, 0.16)]. For long-term postnatal exposure effects, positive associations were manifested in SBP with PM_2.5 [β = 0.44, 95% CI: 0.40, 0.48] and PM₁₀ [β = 0.35, 95% CI: 0.19, 0.51]; DBP with PM₁ [β = 0.45, 95% CI: 0.42, 0.49], PM_2.5 [β = 0.31, 95% CI: 0.27, 0.35] and PM₁₀ [β = 0.32, 95% CI: 0.19, 0.45]; and hypertension with PM₁ [OR = 1.43, 95% CI: 1.40, 1.46], PM_2.5 [OR = 1.65, 95% CI: 1.29, 2.11] and PM₁₀ [OR = 1.26, 95% CI: 1.09, 1.45].

CONCLUSION

Both prenatal and postnatal exposure to PM can increase BP, contributing to a higher prevalence of hypertension in children and adolescents.

Exploring the effect of ecological land structure on PM2.5: A panel data study based on 277 prefecture-level cities in China

In the context of serious urban air pollution and limited land resources, it is important to understand the environmental value of ecological land. Previous studies focused mostly on the effectiveness of a particular type of green space or the total amount of ecological land on PM_2.5 and have rarely analyzed the association between ecological land structure and PM_2.5 systematically and quantitatively. Therefore, we took 277 cities in China as an example, comprehensively compared the results of different models, and selected a spatial Durbin model using time-fixed effects to dissect the degree of influence of ecological land and different land types within it on PM_2.5. The urban ecological land use structure was closely related to PM_2.5, and the higher the proportion of ecological land use was, the lower the PM_2.5. The degree and direction of influence of different types of land functions within ecological land on PM_2.5 differed, with forests, shrubs, and grasslands causing a weakening impact on PM_2.5, while wetlands and waters did not have a weakening role. The degree of reduction of PM_2.5 by a single type of ecological land was significantly smaller than that by a composite type of ecological land. Green space should be comprehensively considered, designed and adjusted in urban planning to continuously optimize the ecological spatial structure, increase landscape diversity and maximize ecological benefits. The findings of this study help with exploring the effects of land use structure under the goal-oriented control of air pollution and provide theoretical reference and decision-making support for formulating precise air pollution control policies and optimizing the spatial development of national land.

Long-term effects of PM2.5 components on hypertension: A national analysis in China

BACKGROUND

Evidence is less about the associations between fine particulate matter (PM2.5) components and hypertension. We aimed to examine the long-term effects of PM2.5 components on prevalence of hypertension, diastolic blood pressure (DBP) and systolic blood pressure (SBP).

METHODS

We included participants between March 1, and July 31, 2021, from 13 provinces in China. Geocoded residential address was used for exposure assignment. Mixed-effect regression was used to assess 3-year average concentrations of PM2.5 and its components (black carbon, organic matter, nitrate, ammonium, and sulfate) on prevalence of hypertension, DBP and SBP with covariate-adjusted. SHapley Additive exPlanation was used to compare the contribution of PM2.5 components to hypertension, DBP, and SBP. Sex and age subgroup were also analyzed.

RESULTS

We enrolled a total of 113,159 participants aged ≥18 years. Long-term exposure to PM2.5 and its components (black carbon, organic matter, nitrate, ammonium, and sulfate) had associations with prevalence of hypertension, with the Odds Ratios and 95% confidence interval (CI) of 1.06 (95%CI: 1.03-1.09), 1.07 (95%CI: 1.04-1.09), 1.07 (95%CI: 1.04-1.10), 1.05 (95%CI: 1.01-1.08), 1.03 (95%CI: 1.00-1.06), and 1.03 (95%CI: 1.00-1.04), respectively. Effects of that except for black carbon on DBP with per interquartile upticks of concentration were 0.23 (95%CI: 0.11-0.35), 0.17 (95%CI: 0.04-0.29), 0.35 (95%CI: 0.21-0.48), 0.40 (95%CI: 0.28-0.52), and 0.25 (95%CI: 0.13-0.26), respectively. Ammonium was associated with SBP, corresponding to an increase of 0.18 (95%CI: 0.01-0.35). Males had higher risks of DBP (Z = 2.54-6.08, P < 0.001). Older people were substantially more affected by PM2.5 and its components. Nitrate showed the highest contribution to hypertension, DBP and SBP compared with other components.

CONCLUSIONS

Long-term exposure to PM2.5 and its components had adverse consequences on prevalence of hypertension, DBP and SBP, especially for males and older people. Nitrate contributed the highest to hypertension, DBP and SBP. Findings may have implications for pollution and hypertension control.

Long-term effects of ambient PM2.5 constituents on metabolic syndrome in Chinese children and adolescents

Metabolic syndrome (MetS) is considered a main public health issue as it remarkably adds the risk of cardiovascular disease, leading to a heavy burden of disease. There is growing evidence linking fine particulate matter (PM_2.5) exposure to MetS. However, the influences of PM_2.5 constituents, especially in children and adolescents, remain unclear. Our study was according to a national analysis among Chinese children and adolescents to examine the associations between long-term exposure to PM_2.5 main constituents and MetS. A total of 10,066 children and adolescents aged 10-18 years were recruited in 7 provinces in China, with blood tests, health exams, and questionnaire surveys. We estimated long-term exposures to PM_2.5 mass and its five constituents, containing black carbon (BC), organic matter (OM), inorganic nitrate (NO₃^-), sulfate (SO₄^2-), and soil particles (SOIL) from multi-source data fusion models. Mixed-effects logistic regression models were used with the adjustment of a variety of covariates. In the surveyed populations, 2.9% were classified as MetS. From the single-pollutant models, we discovered that long-term exposures to PM_2.5 mass, BC, OM, NO₃^-, as well as SO₄^2-, were significantly associated with the prevalence of MetS, with odds ratios (ORs) per 1 μg/m³ that were 1.02 (95% confidence interval (CI): 1.01, 1.03) for PM_2.5 mass, 1.24 (95% CI: 1.14, 1.35) for BC, 1.07 (95% CI: 1.04, 1.11) for OM, 1.09 (95% CI: 1.04, 1.13) for NO₃^-, and 1.14 (95% CI:1.04, 1.24) for SO₄^2-. The influence of BC on the prevalence of MetS was robust in both the multi-pollutant model and the PM_2.5-constituent joint model. The paper indicates long-term exposure to PM_2.5 mass and specific PM_2.5 constituents, particularly for BC, was significantly associated with a higher MetS prevalence among children and adolescents in China. Our results highlight the significance of establishing further regulations on PM_2.5 constituents.

Association of long-term exposure to PM2.5 constituents with glucose metabolism in Chinese rural population

BACKGROUND

Evidence on the associations of fine particulate matter (PM2.5) constituents and glucose metabolism is limited in resource-limited areas. This study aimed to explore the associations of PM2.5 constituents with glucose metabolism in rural areas, and to further specify the most responsible constituent.

METHODS

A total of 38,442 adults were recruited from the Henan Rural Cohort Study during 2015-2017. Three-year averaged concentrations of PM2.5 mass and its constituents (black carbon (BC), ammonium (NH4+), nitrate (NO3-), organic matter (OM), inorganic sulfate (SO42-), soil particles (SOIL) and sea salt (SS)) were estimated by a hybrid satellite-based model. Generalized linear model was applied to explore the associations of PM2.5 mass and its constituents with type 2 diabetes mellitus (T2DM), fasting blood glucose (FBG), insulin, and HOMA-β. Proportion and residual analyses were employed to specify the most responsible constituent.

RESULTS

The adjusted odds ratio (OR) for T2DM associated with 1 μg/m3 increase was 1.02 for PM2.5 mass, 1.28 for BC, 1.15 for NH4+, 1.08 for NO3-, 1.10 for OM, 1.11 for SO42-, and 1.12 for SOIL. Significant associations of PM2.5 mass and its constituents with elevated FBG, decreased insulin and HOMA-β were also observed. Proportion and residual analyses indicated that BC was the most responsible constituent, in which 1 percentage increment in the proportion of BC in PM2.5 corresponded with 1.51-fold risk for T2DM, 0.17 mmol/L increase in FBG, 2.18 μU/mL decrease in insulin, and 38.26 % decrease in HOMA-β; and 1 μg/m3 increment in the PM2.5-adjusted BC corresponded with 1.59-fold risk for T2DM, 0.53 mmol/L increase in FBG, 4.79 μU/mL decrease in insulin, and 91.32 % decrease in HOMA-β.

CONCLUSIONS

PM2.5 mass and its constituents (BC, NH4+, NO3-, OM, SO42-, SOIL) were associated with T2DM, increased FBG, decreased insulin and HOMA-β, of which BC was most responsible for these associations.

TRIAL REGISTRATION

The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375.

Associations between air pollutants and blood pressure in an ethnically diverse cohort of adolescents in London, England

Longitudinal evidence on the association between air pollution and blood pressure (BP) in adolescence is scarce. We explored this association in an ethnically diverse cohort of schoolchildren. Sex-stratified, linear random-effects modelling was used to examine how modelled residential exposure to annual average nitrogen dioxide (NO2), particulate matter (PM2.5, PM10) and ozone (O3), measures in μg/m3, associated with blood pressure. Estimates were based on 3,284 adolescents; 80% from ethnic minority groups, recruited from 51 schools, and followed up from 11-13 to 14-16 years old. Ethnic minorities were exposed to higher modelled annual average concentrations of pollution at residential postcode level than their White UK peers. A two-pollutant model (NO2 & PM2.5), adjusted for ethnicity, age, anthropometry, and pubertal status, highlighted associations with systolic, but not diastolic BP. A μg/m3 increase in NO2 was associated with a 0.30 mmHg (95% CI 0.18 to 0.40) decrease in systolic BP for girls and 0.19 mmHg (95% CI 0.07 to 0.31) decrease in systolic BP for boys. In contrast, a 1 μg/m3 increase in PM2.5 was associated with 1.34 mmHg (95% CI 0.85 to 1.82) increase in systolic BP for girls and 0.57 mmHg (95% CI 0.04 to 1.03) increase in systolic BP for boys. Associations did not vary by ethnicity, body size or socio-economic advantage. Associations were robust to adjustments for noise levels and lung function at 11-13 years. In summary, higher ambient levels of NO2 were associated with lower and PM2.5 with higher systolic BP across adolescence, with stronger associations for girls.

Long-term exposure of PM2.5 components on the adults' depressive symptoms in China - Evidence from a representative longitudinal nationwide cohort

In recent years, there is growing evidence that long-term exposure to fine particulate matter (PM_2.5) is associated with depressive symptoms. However, little is known about the individual effects of PM_2.5 components, particularly in low-income and middle-income countries. We investigated the association between long-term exposure to major components of PM_2.5 and worsening depressive symptoms in Chinese adults based on a large, long-term, nationally representative, population-based prospective cohort. Our data were derived from China Family Panel Study (CFPS) wave 2012, 2016 and 2018 and a long-term (2010-2019) high-resolution PM_2.5 components dataset covering the whole China. We assessed respondents' depressive symptoms using standardized scales and applied advanced Fixed-effect ordered logit model (FE-ologit) to capture the ordinal nature of respondents' depressive symptoms and control for individual-specific and time-invariant effects to investigate their associations with PM_2.5 components. We included 9503 respondents and the FE-ologit model results indicated that the odds ratio of increase per standard unit was 1.118 (95 % CI: 1.020, 1.225) for black carbon, 1.134 (95 % CI: 1.028, 1.252) for organic matter, 1.127 for ammonium (95 % CI: 1.011, 1.255), 1.107 for nitrate (95 % CI: 0.981, 1.248), and 1.117 for sulfate (95 % CI: 1.020, 1.224). Our study suggests that long-term exposure to PM_2.5 components is significantly associated with worsening of depressive symptoms, and that different components may have different toxicity. Reducing PM_2.5 emissions, especially the major sources of organic matter and ammonium, may reduce the burden of depressive symptoms in Chinese adults.

Subclinical cardiovascular outcomes of acute exposure to fine particulate matter and its constituents: A glutathione S-transferase polymorphism-based longitudinal study

To explore the acute subclinical cardiovascular effects of fine particulate matter (PM2.5) and its constituents, a longitudinal study with 61 healthy young volunteers was conducted in Xinxiang, China. Linear mixed-effect models were used to analyze the association of PM2.5 and its constituents with cardiovascular outcomes, respectively, including blood pressure (BP), heart rate (HR), serum levels of high-sensitivity C-reactive protein (hs-CRP), 8-hydroxy-2'-deoxyguanosine (8-OHdG), tissue-type plasminogen activator (t-PA), and platelet-monocyte aggregation (PMA). Additionally, the modifying effects of glutathione S-transferase mu 1 (GSTM1) and glutathione S-transferase theta 1 (GSTT1) polymorphisms were examined. A 10 μg/m3 increase in PM2.5 was associated with -1.04 (95 % CI: -1.86 to -0.22) mmHg and -0.90 (95 % CI: -1.69 to -0.11) mmHg decreases in diastolic BP (DBP) and mean arterial BP (MABP) along with 1.83 % (95 % CI: 0.59-3.08 %), 5.93 % (95 % CI: 0.70-11.16 %) increases in 8-OHdG and hs-CRP, respectively. Ni content was positively associated with the 8-OHdG levels whereas several other metals presented negative association with 8-OHdG and HR. Intriguingly, GSTT1+/GSTTM1+ subjects showed higher susceptibility to PM2.5-induced alterations of DBP and PMA, and GSTT1-/GSTM1+ subjects showed higher alteration on t-PA. Taken together, our findings indicated that short-term PM2.5 exposure induced oxidative stress, systemic inflammation, autonomic alterations, and fibrinolysis in healthy young subjects. Among multiple examined metal components Ni appeared to positively associated with systematic oxidative stress. In addition, GST-sufficient subjects might be more prone to PM2.5-induced autonomic alterations.

Association of PM2.5 and Its Chemical Compositions with Metabolic Syndrome: A Nationwide Study in Middle-Aged and Older Chinese Adults

Studies on the association of PM_2.5 and its compositions with metabolic syndrome (MetS) were limited, and it was unclear which was the most hazardous composition. In this study, we aimed to investigate the association between PM_2.5 and its compositions with MetS and identified the most hazardous composition. In this study, we included 13,418 adults over 45 years across 446 communities from 150 counties of 28 provinces in nationwide China in 2015. MetS was defined based on the five indicators of the Joint Interim Societies, including: blood pressure (SBP (systolic blood pressure) and DBP (diastolic blood pressure)); fasting blood glucose (FBG); fasting triglyceride (FTG); high density lipoprotein cholesterol (HDL-C); and waist circumference (WC). We used chemical transport models to estimate the concentration of PM_2.5 and its compositions, including black carbon, ammonium, nitrate, organic matter, and sulfate. We used a generalized linear regression model to examine the association of PM_2.5 and its compositions with MetS. In this study, we observed that the average age was 61.40 (standard deviation (SD): 9.59). Each IQR (29.76 μg/m³) increase in PM_2.5 was associated with a 1.27 (95% CI: 1.17, 1.37) increase in the odds for MetS. We indicated that black carbon showed stronger associations than other compositions. The higher associations were observed among women, participants aged less than 60 years, who lived in urban areas and in the Northeast, smokers, drinkers, and the obese populations. In conclusion, our findings identified the most harmful composition and sensitive populations and regions that required attention, which would be helpful for policymakers.

Evaluating the Impact of Vehicular Aerosol Emissions on Particulate Matter (PM2.5) Formation Using Modeling Study

Automobile emissions in urban cities, such as Peru, are significant; however, there are no published studies of the effects of these emissions on PM2.5 (fine particulate matter) formation. This study aims to analyze the contributions of vehicle aerosol emissions to the surface mass concentration of PM2.5 in the Metropolitan Area of Lima and Callao (MALC), one of the most polluted cities in Latin America and the Caribbean (LAC) known to have high concentrations of PM2.5. In February 2018, we performed two numerical simulations (control and sensitivity) using the Weather Research and Forecasting model coupled with Chemistry (WRF-Chem). We considered both trace gasses and aerosol emissions from on-road traffic for the baseline simulation (hereinafter referred to as “control”); gasses without particulate emissions from vehicles were considered for the sensitivity simulation (hereinafter referred to as WithoutAerosol). For control, the model’s performance was evaluated using in situ on-ground PM2.5 observations. The results of the predicted PM2.5 concentration, temperature, and relative humidity at 2 m, with wind velocity at 10 m, indicated the accuracy of the model for the control scenario. The results for the WithoutAerosol scenario indicated that the contributions of vehicular trace gasses to secondary aerosols PM2.5 concentrations was 12.7%; aerosol emissions from road traffic contributed to the direct emissions of fine aerosol (31.7 ± 22.6 µg/m3).

The underlying mechanism of PM2.5-induced ischemic stroke

Under the background of global industrialization, PM_2.5 has become the fourth-leading risk factor for ischemic stroke worldwide, according to the 2019 GBD estimates. This highlights the hazards of PM_2.5 for ischemic stroke, but unfortunately, PM_2.5 has not received the attention that matches its harmfulness. This article is the first to systematically describe the molecular biological mechanism of PM_2.5-induced ischemic stroke, and also propose potential therapeutic and intervention strategies. We highlight the effect of PM_2.5 on traditional cerebrovascular risk factors (hypertension, hyperglycemia, dyslipidemia, atrial fibrillation), which were easily overlooked in previous studies. Additionally, the effects of PM_2.5 on platelet parameters, megakaryocytes activation, platelet methylation, and PM_2.5-induced oxidative stress, local RAS activation, and miRNA alterations in endothelial cells have also been described. Finally, PM_2.5-induced ischemic brain pathological injury and microglia-dominated neuroinflammation are discussed. Our ultimate goal is to raise the public awareness of the harm of PM_2.5 to ischemic stroke, and to provide a certain level of health guidance for stroke-susceptible populations, as well as point out some interesting ideas and directions for future clinical and basic research.

Secular trends in global burden of diabetes attributable to particulate matter pollution from 1990 to 2019

Increasing evidence suggests an association between fine particulate matter (PM2.5) exposure and type 2 diabetes mellitus. However, there is still a lack of comparative evaluation regarding diabetes burden due to ambient and indoor PM2.5 pollution at a global scale. This study attempts to provide a systematic and comprehensive profile for PM2.5-attributable burden of diabetes and its spatiotemporal trends, globally and regionally. Comparative estimates of diabetes attributable to ambient PM2.5 and household air pollution (HAP) from solid fuels for 204 countries and territories were derived from the Global Burden of Disease Study 2019. Globally, 292.5 (95% uncertainty interval: 207.1, 373.4) thousand deaths and 13.0 (9.1, 17.2) million disability-adjusted life years (DALYs) from diabetes were attributed to PM2.5 pollution in 2019, wherein more than two-thirds (67.3% deaths and 69.7% DALYs) were contributed by ambient PM2.5. Compared to 1990, age-standardized DALY rate (ASDR) in 2019 attributable to ambient PM2.5 increased by 85.9% (APC: 2.21% [2.15, 2.27]), while HAP-associated ASDR decreased by 37.9% (APC: - 1.66% [- 1.82, - 1.50]). We observed a negative correlation between SDI and APC in ASMR (rs =  - 0.5, p < 0.001) and ASDR (rs = -0.4, p < 0.001) among 204 countries and territories. HAP-related diabetes experienced a sharp decline during 1990-2019, while global burden of diabetes attributable to ambient PM2.5 was rising rapidly. The elderly and people in low-SDI countries suffered from the greatest burden of diabetes due to PM2.5 pollution. More targeted interventions should be taken by governments to reduce PM2.5 exposure and related diabetes burden.