Estimating health burden and economic loss attributable to short-term exposure to multiple air pollutants in China

Household air pollution and attributable burden of disease in rural China: A literature review and a modelling study

Household air pollution prevails in rural residences across China, yet a comprehensive nationwide comprehending of pollution levels and the attributable disease burdens remains lacking. This study conducted a systematic review focusing on elucidating the indoor concentrations of prevalent household air pollutants-specifically, PM2.5, PAHs, CO, SO2, and formaldehyde-in rural Chinese households. Subsequently, the premature deaths and economic losses attributable to household air pollution among the rural population of China were quantified through dose-response relationships and the value of statistical life. The findings reveal that rural indoor air pollution levels frequently exceed China's national standards, exhibiting notable spatial disparities. The estimated annual premature mortality attributable to household air pollution in rural China amounts to 966 thousand (95% CI: 714-1226) deaths between 2000 and 2022, representing approximately 22.2% (95% CI: 16.4%-28.1%) of total mortality among rural Chinese residents. Furthermore, the economic toll associated with these premature deaths is estimated at 486 billion CNY (95% CI: 358-616) per annum, constituting 0.92% (95% CI: 0.68%-1.16%) of China's GDP. The findings quantitatively demonstrate the substantial disease burden attributable to household air pollution in rural China, which highlights the pressing imperative for targeted, region-specific interventions to ameliorate this pressing public health concern.

Burden of cardiovascular disease attributed to air pollution: a systematic review

BACKGROUND

Cardiovascular diseases (CVDs) are estimated to be the leading cause of global death. Air pollution is the biggest environmental threat to public health worldwide. It is considered a potentially modifiable environmental risk factor for CVDs because it can be prevented by adopting the right national and international policies. The present study was conducted to synthesize the results of existing studies on the burden of CVDs attributed to air pollution, namely prevalence, hospitalization, disability, mortality, and cost characteristics.

METHODS

A systematic search was performed in the Scopus, PubMed, and Web of Science databases to identify studies, without time limitations, up to June 13, 2023. Exclusion criteria included prenatal exposure, exposure to indoor air pollution, review studies, conferences, books, letters to editors, and animal and laboratory studies. The quality of the articles was evaluated based on the Agency for Healthcare Research and Quality Assessment Form, the Newcastle-Ottawa Scale, and Drummond Criteria using a self-established scale. The articles that achieved categories A and B were included in the study.

RESULTS

Of the 566 studies obtained, based on the inclusion/exclusion criteria, 92 studies were defined as eligible in the present systematic review. The results of these investigations supported that chronic exposure to various concentrations of air pollutants, increased the prevalence, hospitalization, disability, mortality, and costs of CVDs attributed to air pollution, even at relatively low levels. According to the results, the main pollutant investigated closely associated with hypertension was PM2.5. Furthermore, the global DALY related to stroke during 2016-2019 has increased by 1.8 times and hospitalization related to CVDs in 2023 has increased by 8.5 times compared to 2014.

CONCLUSION

Ambient air pollution is an underestimated but significant and modifiable contributor to CVDs burden and public health costs. This should not only be considered an environmental problem but also as an important risk factor for a significant increase in CVD cases and mortality. The findings of the systematic review highlighted the opportunity to apply more preventive measures in the public health sector to reduce the footprint of CVDs in human society.

Association between short-term exposure to ambient air pollution and upper respiratory tract infection in Kunshan

The health effects of air pollution have become a major public health problem. Studies on the relationship between short-term exposure to air pollutants and upper respiratory tract infection (URTI) related clinic visits and expenditures were scarce. From January 1, 2019, to December 31, 2021, we included all the URTI cases that turned to 11 public hospitals in Kunshan, and summarized individual medical cost. Daily meteorological factors and 24-h mean concentrations of four common air pollutants, including particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) and 10 μm (PM10), sulfur dioxide (SO2), and nitrogen dioxide (NO2), were consecutively recorded. Generalized additive regression model was adopted to quantify the associations between each air pollutant and the daily clinic visits of URTI cases. We further calculated attributable number (AN) and attributable fraction, and performed sensitivity analysis by gender, age, and season. A total of 934,180 cases were retrieved during the study period. PM2.5, PM10, SO2, and NO2 showed significant associations with hospital visits and expenditures due to URTI. Relative risks for them were 1.065 (95% confidence interval [CI] 1.055, 1.076), 1.045 (95% CI 1.037, 1.052), 1.098 (95% CI 1.038, 1.163), and 1.098 (95% CI 1.085, 1.111) on lag 0-5 days, respectively. Thirty-one thousand four hundred fifty-five (95% CI 27,457, 35,436) cases could be ascribed to increased NO2 and accounted for 3.37% (95% CI 2.94%, 3.79%) of all clinic visits. Sensitivity analyses indicated that the effects of air pollution were generally consistent for male and female. PM2.5, PM10, and NO2 had stronger associations among people aged ≤ 18 years, followed by those aged 19-64 years and ≥ 65 years. The association strengths of air pollution varied seasonally. Short-term exposure to ambient air pollutants had significant associations with clinic visits and expenditures owing to URTI. Children and adolescents appeared to be more susceptible to adverse health effects of air pollution. NO2 may be a priority when formulating pollution control measures.

Long- and short-term health benefits attributable to PM2.5 constituents reductions from 2013 to 2021: A spatiotemporal analysis in China

Long- and short-term exposure to constituents of fine particulate matter (PM2.5) substantially affects human health. However, assessments of the health and economic benefits of reducing PM2.5 constituents are scarce. This study estimates the number of premature deaths from all-cause, cardiovascular (CVD), and respiratory diseases avoided due to reductions in daily and annual average concentrations of PM2.5 constituents. The Environmental Benefits Mapping and Analysis Program was used for two scenarios: we used yearly concentrations of PM2.5 constituents from 2013 to 2020 as the baseline concentration surface (Scenario I), and 2021 as the baseline year (Scenario II). With reductions in daily and annual average concentrations of PM2.5 constituents, 309,099 (95 % confidence interval [CI]: 37,265-571,485) and 195,297 (95 % CI: 178,192-211,914) premature deaths were avoided in Scenario I, respectively; meanwhile, 347,296 (95 % CI: 79,258-604,758) and 201,567 (95 % CI: 185,038-217,530) premature deaths were avoided in Scenario II, respectively. Moreover, economic benefits associated with the prevention of premature deaths were estimated using the willingness to pay (WTP) and modified human capital (AHC) methods. The total estimated economic benefits amounted to 563.32 billion RMB (WTP) and 322.03 billion RMB (AHC) in Scenario I. In Scenario II, the associated economic benefits were 751.48 billion RMB (WTP) and 427.56 billion RMB (AHC), accounting for 0.657 and 0.374 % of China's gross domestic product in 2021, respectively. Additionally, we analyzed the sensitivity of CVD-related premature deaths to the concentrations of PM2.5 constituents, and found that CVD-related premature deaths were more sensitive to black carbon.

Specific analysis of PM2.5-attributed disease burden in typical areas of Northwest China

Background

Frequent air pollution events in Northwest China pose a serious threat to human health. However, there is a lack of specific differences assessment in PM2.5-related disease burden. Therefore, we aimed to estimate the PM2.5-related premature deaths and health economic losses in this typical northwest region, taking into account disease-specific, age-specific, and region-specific factors.

Methods

We utilized the WRF-Chem model to simulate and analyze the characteristics and exposure levels of PM2.5 pollution in Gansu Province, a typical region of Northwest China. Subsequently, we estimated the premature mortality and health economic losses associated with PM2.5 by combining the Global Exposure Mortality Model (GEMM) and the Value of a Statistical Life (VSL).

Results

The results suggested that the PM2.5 concentrations in Gansu Province in 2019 varied spatially, with a decrease from north to south. The number of non-accidental deaths attributable to PM2.5 pollution was estimated to be 14,224 (95% CI: 11,716-16,689), accounting for 8.6% of the total number of deaths. The PM2.5-related health economic loss amounted to 28.66 (95% CI: 23.61-33.63) billion yuan, equivalent to 3.3% of the regional gross domestic product (GDP) in 2019. Ischemic heart disease (IHD) and stroke were the leading causes of PM2.5-attributed deaths, contributing to 50.6% of the total. Older adult individuals aged 60 and above accounted for over 80% of all age-related disease deaths. Lanzhou had a higher number of attributable deaths and health economic losses compared to other regions. Although the number of PM2.5-attributed deaths was lower in the Hexi Corridor region, the per capita health economic loss was higher.

Conclusion

Gansu Province exhibits distinct regional characteristics in terms of PM2.5 pollution as well as disease- and age-specific health burdens. This highlights the significance of implementing tailored measures that are specific to local conditions to mitigate the health risks and economic ramifications associated with PM2.5 pollution.

Middle-term nitrogen dioxide exposure and electrocardiogram abnormalities: A nationwide longitudinal study

BACKGROUND

Recently, professionals, such as those from the World Health Organization, have recommended a rigorous standard for nitrogen dioxide (NO2), a typical urban air pollutant affected by regular traffic emissions, based on its short-term and long-term cardiorespiratory effects. However, the association between middle-term NO2 exposure and cardiovascular disorders remains unknown.

OBJECTIVES

This study was conducted to examine the relationship between NO2 exposure and its middle-term cardiovascular risks indicated by electrocardiogram (ECG) abnormalities.

METHOD

We included 61,094 subjects (132,249 visits) with repeated ECG observations based on longitudinal data from the China National Stroke Screening Survey (CNSSS). The NO2 exposure concentration was derived from a predictive model, measured as the monthly average concentration in the 6 months of preceding the ECG measurement. We used the generalized estimation equation to assess the association between NO2 exposure and ECG abnormalities.

RESULT

For each 10 µg/m3 increase in monthly average NO2 concentration, the odds ratio of ECG abnormalities was 1.10 (95% confidence interval [CI] 1.09-1.12) after multiple adjustments. Stratified regression analyses of urban and rural residents showed associations between middle-term NO2 exposure and ECG abnormalities in urban (OR 1.09 [95% CI 1.08-1.11]) and rural residents (OR 1.14 [95% CI 1.10-1.19]). The association was robust within different subpopulations. Associations generally remained statistically significant (OR 1.03 [95% CI 1.02-1.05]) after extra adjustment for PM2.5. Exposure-response relationship analysis revealed a nearly linear relationship between NO2 exposure and the risk for ECG abnormalities.

CONCLUSION

Using the variation in ECG signals as a potentially reversible indicator for subclinical risk in cardiovascular systems, our study provides additional evidence on the increased risk posed by middle-term NO2 exposure. Our study showed that policies controlling for NO2 concentrations are beneficial to prevent cardiovascular diseases among Chinese adults.

Estimation of health risk and economic loss attributable to PM2.5 and O3 pollution in Jilin Province, China

Ambient pollutants, particularly fine particulate matter (PM2.5) and ozone (O3), pose significant risks to both public health and economic development. In recent years, PM2.5 concentration in China has decreased significantly, whereas that of O3 has increased rapidly, leading to considerable health risks. In this study, a generalized additive model was employed to establish the relationship of PM2.5 and O3 exposure with non-accidental mortality across 17 districts and counties in Jilin Province, China, over 2015-2016. The health burden and economic losses attributable to PM2.5 and O3 were assessed using high-resolution satellite and population data. According to the results, per 10 µg/m3 increase in PM2.5 and O3 concentrations related to an overall relative risk (95% confidence interval) of 1.004 (1.001-1.007) and 1.009 (1.005-1.012), respectively. In general, the spatial distribution of mortality and economic losses was uneven. Throughout the study period, a total of 23,051.274 mortalities and 27,825.015 million Chinese Yuan (CNY) in economic losses were attributed to O3 exposure, which considerably surpassing the 5,450.716 mortalities and 6,553,780 million CNY in economic losses attributed to PM2.5 exposure. The O3-related health risks and economic losses increased by 3.75% and 9.3% from 2015 to 2016, while those linked to PM2.5 decreased by 23.33% and 18.7%. Sensitivity analysis results indicated that changes in pollutant concentrations were the major factors affecting mortality rather than baseline mortality and population.

An assessment of O3-related health risks and economic losses in typical regions of China

Introduction

As one of the key areas for air pollution prevention and control in China, the Fenwei Plain is experiencing serious near-surface O3 pollution, which is a key issue that needs to be solved urgently.

Methods

Based on pollutant concentration monitoring data and meteorological and health data over the same period, this study analyzed the temporal and spatial characteristics, the relationships with meteorological factors of O3 pollution, and the health effects and economic losses caused by exposure to O3 pollution using environmental health risk and environmental value assessment methods in 11 cities on the Fenwei Plain in China from 2014 to 2020.

Results

The results showed that O3 pollution has become increasingly serious on the Fenwei Plain in recent years. The annual average concentration of O3_8h_max showed an overall upwards trend, with an increase of 32.39% in 2020 compared to 2014. The mean concentrations observed in summer were the highest, followed by spring and autumn, and the lowest was in winter. The O3 concentration had a significant positive correlation with air temperature and sunshine hours. The evaluation results of the impact of air pollution on population health showed that the number of premature deaths caused by O3 pollution fluctuated and increased during 2014-2020. In 2020, the numbers of total, cardiovascular and respiratory deaths attributable to O3 pollution on the Fenwei Plain were 6,867 (95% CI: 3,739-9,965), 3,652 (95% CI: 1,363-5,905), and 1,257 (95% CI: 747-2,365), respectively, and the total number of premature deaths related to O3 exposure increased by 48.05% compared with 2014. The health and economic losses attributed to O3 pollution on the Fenwei Plain during the study period were 44.22 (95% CI: 22.17-69.18), 47.16 (95% CI: 23.64-73.77), 68.28 (95% CI: 34.27-106.31), 114.44 (95% CI: 57.42-177.76), 110.85 (95% CI: 55.45-172.52), 116.41 (95% CI: 58.24-180.74), and 116.81 (95% CI: 58.00-180.88) billion yuan, respectively. In Linfen City, the increasing rate of the number of premature deaths reached 283.39% because the O3 concentration increased greatly.

Discussion

Due to high O3 concentrations and obvious population growth in Xi'an, the problems of premature death and health and economic losses attributed to O3 concentrations exceeding the standard value are prominent.

Regional joint PM2.5-O3 control policy benefits further air quality improvement and human health protection in Beijing-Tianjin-Hebei and its surrounding areas

Beijing-Tianjin-Hebei and its surrounding areas (hereinafter referred to as "2+26" cities) are one of the most severe air pollution areas in China. The fine particulate matter (PM_2.5) and surface ozone (O₃) pollution have aroused a significant concern on the national scale. In this study, we analyzed the pollution characteristics of PM_2.5 and O₃ in "2+26" cities, and then estimated the health burden and economic loss before and after the implementation of the joint PM_2.5-O₃ control policy. During 2017-2019, PM_2.5 concentration reduced by 19% while the maximum daily 8 hr average (MDA8) O₃ stayed stable in "2+26" cities. Spatially, PM_2.5 pollution in the south-central area and O₃ pollution in the central region were more severe than anywhere else. With the reduction in PM_2.5 concentration, premature deaths from PM_2.5 decreased by 18% from 2017 to 2019. In contrast, premature deaths from O₃ increased by 5%. Noticeably, the huge potential health benefits can be gained after the implementation of a joint PM_2.5-O₃ control policy. The premature deaths attributed to PM_2.5 and O₃ would be reduced by 91.6% and 89.1%, and the avoidable economic loss would be 60.8 billion Chinese Yuan (CNY), and 68.4 billion CNY in 2035 compared with that in 2019, respectively. Therefore, it is of significance to implement the joint PM_2.5-O₃ control policy for improving public health and economic development.

Substantial short- and long-term health effect due to PM2.5 and the constituents even under future emission reductions in China

Heavy pollution events of fine particulate matter (PM_2.5) frequently occur in China, seriously affecting the human health. However, how meteorological factors and anthropogenic emissions affect PM_2.5 and the major constituents, as well as the subsequent health effect, remains unclear. Here, based on regional climate and air quality models Weather Research and Forecasting (WRF) and Community Multiscale Air Quality (CMAQ), the PM_2.5 and major constituents in China at present and mid-century under the carbon neutral scenario Shared Socioeconomic Pathways (SSP)1-2.6 are simulated. Due to anthropogenic emission reduction, concentrations of PM_2.5 and the constituents decrease substantially in SSP1-2.6. The long-term exposure premature deaths at present are 2.23 million per year in mainland China, which is projected to increase by 76 % under SSP1-2.6 despite emission reduction, primarily attributable to aging which strikingly offsets the effect of air quality improvement. The number of annual premature deaths resulting from short-term exposure is 228,104 in mainland China at present, which is projected to decrease in the future. Using North China Plain as an example, we identify that among the major constituents of PM_2.5, organic carbon leads to the most short-term exposure deaths considering the largest exposure-response coefficient. Regarding the abnormally meteorological conditions, we find, relative to low relative humidity (RH) and non-stagnation, the compound events, defined as concurrence of high RH and atmospheric stagnation, exhibit an amplified role inducing larger premature deaths compared to the additive effect of the individual event of high RH and atmospheric stagnation. This nonlinear effect occurs at both present and future, but diminished in future due to emission reductions. Our study highlights the importance of considering both the long- and short-term premature deaths associated with PM_2.5 and the constituents, as well as the critical effect of extreme weather events.

How does air pollution affect the stock market performance? Evidence from China

Given its broad impact on human society, air pollution could become a non-economic factor affecting the stock market. But the impact of air pollution on the stock market performance has not received enough attention. This study examines the influence and potential mechanism of air pollution on stock market performance based on the panel data of 1344 A-share listed firms in China covering the period 2013-2019. The result shows that air pollution can negatively affect stock market performance. Second, heterogeneity analysis creatively points out that firms with less analysts, smaller size, stated-owned ownership, polluting related industry are more vulnerable to the negative effects of air pollution. Finally, the result also reveals a mechanism that air pollution could worsen the stock market by depressing investors' sentiments. The above findings enrich current research related to the impact of air pollution on stock market performance and also provide a new perspective for investors to make stock investment decisions.

Ambient nitrogen dioxide and cardiovascular diseases in rural regions: a time-series analyses using data from the new rural cooperative medical scheme in Fuyang, East China

Most of studies relating ambient nitrogen dioxide (NO₂) exposure to hospital admissions for cardiovascular diseases (CVDs) were conducted among urban population. Whether and to what extent these results could be generalizable to rural population remains unknown. We addressed this question using data from the New Rural Cooperative Medical Scheme (NRCMS) in Fuyang, Anhui, China. Daily hospital admissions for total CVDs, ischaemic heart disease, heart failure, heart rhythm disturbances, ischaemic stroke, and haemorrhagic stroke in rural regions of Fuyang, China, were extracted from NRCMS between January 2015 and June 2017. A two-stage time-series analysis method was used to assess the associations between NO₂ and CVD hospital admissions and the disease burden fractions attributable to NO₂. In our study period, the average number (standard deviation) of hospital admissions per day were 488.2 (117.1) for total CVDs, 179.8 (45.6) for ischaemic heart disease, 7.0 (3.3) for heart rhythm disturbances, 13.2 (7.2) for heart failure, 267.9 (67.7) for ischaemic stroke, and 20.2 (6.4) for haemorrhagic stroke. The 10-μg/m³ increase of NO₂ was related to an elevated risk of 1.9% (RR: 1.019, 95% CI: 1.005 to 1.032) for hospital admissions of total CVDs at lag0-2 days, 2.1% (1.021, 1.006 to 1.036) for ischaemic heart disease, and 2.1% (1.021, 1.006 to 1.035) for ischaemic stroke, respectively, while no significant association was observed between NO₂ and hospital admissions for heart rhythm disturbances, heart failure, and haemorrhagic stroke. The attributable fractions of total CVDs, ischaemic heart disease, and ischaemic stroke to NO₂ were 6.52% (1.87 to 10.94%), 7.31% (2.19 to 12.17%), and 7.12% (2.14 to 11.85%), respectively. Our findings suggest that CVD burdens in rural population are also partly attributed to short-term exposure to NO₂. More studies across rural regions are required to replicate our findings.

How to Evaluate Green Development Policy Based on the PMC Index Model: Evidence from China

Implementing green development is important to realizing a harmonious relationship between humans and nature, and has attracted the attention of governments all over the world. This paper uses the PMC (Policy Modeling Consistency) model to make a quantitative evaluation of 21 representative green development policies issued by the Chinese government. The research finds: firstly, the overall evaluation grade of green development is good and the average PMC index of China's 21 green development policies is 6.59. Second, the evaluation of 21 green development policies can be divided into four different grades. Most grades of the 21 policies are excellent and good; the values of five first-level indicators about policy nature, policy function, content evaluation, social welfare, and policy object are high, which indicates that the 21 green development policies in this paper are relatively comprehensive and complete. Third, most green development policies are feasible. In twenty-one green development policies, there are: one perfect-grade policy, eight excellent-grade policies, ten good-grade policies, and two bad-grade policies. Fourthly, this paper analyzes the advantages and disadvantages of policies in different evaluation grades by drawing four PMC surface graphs. Finally, based on the research findings, this paper puts forward suggestions to optimize the green development policy-making of China.

Air Pollution and Birth Outcomes: Health Impact and Economic Value Assessment in Spain

Air pollution is considered an ongoing major public health and environmental issue around the globe, affecting the most vulnerable, such as pregnant women and fetuses. The aim of this study is to estimate the health impact and economic value on birth outcomes, such as low birthweight (LBW), preterm birth (PTB), small for gestational age (SGA), attributable to a reduction of PM₁₀ levels in Spain. Reduction based on four scenarios was implemented: fulfillment of WHO guidelines and EU limits, and an attributable reduction of 15% and 50% in annual PM₁₀ levels. Retrospective study on 288,229 live-born singleton children born between 2009-2010, using data from Spain Birth Registry Statistics database, as well as mean PM₁₀ mass concentrations. Our finding showed that a decrease in annual exposure to PM₁₀ appears to be associated with a decrease in the annual cases of LBW, SGA and PTB, as well as a reduction in hospital cost attributed to been born with LBW. Improving pregnancy outcomes by reducing the number of LBW up to 5% per year, will result in an estimate associated monetary saving of 50,000 to 7,000,000 euros annually. This study agrees with previous literature and highlights the need to implement, and ensure compliance with, stricter policies that regulate the maximum exposure to outdoor PM permitted in Spain, contributing to decreased environmental health risk, especially negative birth outcomes.

Understanding and revealing the intrinsic impacts of the COVID-19 lockdown on air quality and public health in North China using machine learning

To avoid the spread of COVID-19, China implemented strict prevention and control measures, resulting in dramatic variations in urban and regional air quality. With the complex effect from long-term emission mitigation and meteorology variation, an accurate evaluation of the net effect from lockdown on air quality changes has not been fully quantified. Here, we combined machine learning algorithm and Theil-Sen regression technique to eliminate meteorological and long-term trends effects on air pollutant concentrations and precisely detect concentrations changes those ascribed to lockdown measures in North China. Our results showed that, compared to the same period in 2015-2019, the adverse meteorology during the lockdown period (January 25th to March 15th) in early 2020 increased PM_2.5 concentration in North China by 9.8 %, while the reduction of anthropogenic emissions led to a 32.2 % drop. Stagnant meteorological conditions have a more significant impact on the ground-level air quality in the Beijing-Tianjin-Hebei Region than that in Shanxi and Shandong provinces. After further striping out the effect of long-term emission reduction trend, the lockdown-derived NO₂, PM_2.5, and O₃ shown variety change trend, and at -30.8 %, -27.6 %, and +10.0 %, respectively. Air pollutant changes during the lockdown could be overestimated up to 2-fold without accounting for the influences of meteorology and long-term trends. Further, with pollution reduction during the lockdown period, it would avoid 15,807 premature deaths in 40 cities. If with no deteriorate meteorological condition, the total avoided premature should increase by 1146.

Association between ambient carbon monoxide levels and hospitalization costs of patients with myocardial infarction: Potential effect modification by ABO blood group

Previous researches have reported the association between air pollution and various diseases. However, few researches have investigated whether air pollutants are associated with the economic loss resulting from patients' hospitalization, especially the economic loss of hospitalization due to acute cardiovascular events. The purpose of our research was to explore the association between the levels of carbon monoxide (CO), taken as an index of pollution, and the hospitalization costs of myocardial infarction (MI), and the potential effect modification by the ABO blood group. A total of 3237 MI inpatients were included in this study. A multiple linear regression model was used to evaluate the association between ambient CO levels and hospitalization costs of MI patients. Moreover, we performed stratified analyses by age, gender, body mass index (BMI), season, hypertension, and ABO blood types. There was a positive association between the levels of CO in the air and the costs of hospitalization caused by MI. Furthermore, such association was stronger in males, BMI ≥25, <65 years, with hypertension, and non-O blood group. Interestingly, we found the association was particularly significant in patients with blood group B. Overall, our study first found that ambient CO levels could have an impact on the hospitalization costs for MI patients, and those with blood group B can be more sensitive.

Population Aging Driven Slowdown in the Reduction of Economic Cost-Attributed to PM2.5 Pollution after 2013 in China

Since seniors are more susceptible to ambient fine particulate matter (PM2.5), the high economic cost to protect the aged population from PM2.5 exposure is expected. Significant efforts have been made in China to mitigate PM2.5 since 2013 under the Air Pollution Prevention and Control Action (APPCA) Plan, which remarkably reduced PM2.5 contamination and its associated economic and health burdens. However, to what extent population aging could influence the economic benefits from the APPCA Plan is unclear. Here, we estimate five driving factors contributing to the economic cost of mortality attributable to PM2.5 pollution. The results show that the economic cost attributed to PM2.5 pollution increased from 1980 to 2013 and decreased from 2013 to 2019 in China, benefiting from the APPCA Plan. Since 2013, population aging becomes the most significant positive driver that almost offsets declining economic cost from significantly declining PM2.5. Rapid aging has become an enormous burden to PM2.5-associated health and economic loss. Our findings suggest that we should further improve air quality and enhance health care for the elderly population.

Assessing the Public Health Economic Loss from PM2.5 Pollution in '2 + 26' Cities

Due to the fast growth of China's economy, urban atmospheric pollution has become a serious problem affecting the public's physical and mental health. The '2 + 26' cities, as the Jing-Jin-Ji atmospheric pollution transmission channel, has attracted widespread concern. There were several previous studies on the economic loss of public health caused by PM_2.5 pollution in '2 + 26' cities. To assess the economic loss caused by PM_2.5 on human health in '2 + 26' cities, this paper used the exposure-response model, the health effect loss model and willingness to pay method to obtain the economic loss from PM_2.5 pollution with the latest available data in 2020. It was concluded that, in 2020, the economic loss of '2 + 26' cities from PM_2.5 was spatially distributed low in the east and high in the west. In addition, it was larger in the southern and northern part, which was smaller in the middle of the region. Based on the conclusions, policy recommendations were put forward.

A novel hybrid model for six main pollutant concentrations forecasting based on improved LSTM neural networks

In recent years, air pollution has become a factor that cannot be ignored, affecting human lives and health. The distribution of high-density populations and high-intensity development and construction have accentuated the problem of air pollution in China. To accelerate air pollution control and effectively improve environmental air quality, the target of our research was cities with serious air pollution problems to establish a model for air pollution prediction. We used the daily monitoring data of air pollution from January 2016 to December 2020 for the respective cities. We used the long short term memory networks (LSTM) algorithm model to solve the problem of gradient explosion in recurrent neural networks, then used the particle swarm optimization algorithm to determine the parameters of the CNN-LSTM model, and finally introduced the complete ensemble empirical mode decomposition of adaptive noise (CEEMDAN) decomposition to decompose air pollution and improve the accuracy of model prediction. The experimental results show that compared with a single LSTM model, the CEEMDAN-CNN-LSTM model has higher accuracy and lower prediction errors. The CEEMDAN-CNN-LSTM model enables a more precise prediction of air pollution, and may thus be useful for sustainable management and the control of air pollution.

Trends and characteristics of ozone and nitrogen dioxide related health impacts in Chinese cities

Ambient ozone pollution has been becoming severe and attributed to considerable health impacts in China. Nitrogen dioxide (NO₂) is involved in atmospheric ozone production while also affecting public health directly. Joint control ozone and NO₂ pollution would be of significance. This study quantitatively assessed the health impact attributed to ambient ozone and NO₂ pollution in 338 Chinese cities from 2015 to 2020. The results reveal the generally opposite trends of ozone- and NO₂-related health impacts in China. From 2015-2020, respiratory and chronic obstructive pulmonary disease (COPD) health impacts attributed to ozone in 338 cities increased by 65.30% and 63.98%. The NO₂-attributed health impacts decreased by 24.80% and 24.62%. In 2020, the ozone- and NO₂-related respiratory health impacts were 3.96 million DALYs (disability-adjusted life years) and 1.47 million DALYs. High health impacts are concentrated in big cities and city clusters. In 2020, the sum of ozone- and NO₂-related respiratory health impacts in the top 20 cities was 0.98 million DALYs and 0.44 million DALYs, accounting for 24.70% and 30.24% of the 338 cities. The population attribution fraction analysis identified the increasing distributional consistency of ozone and NO₂-related health impacts, emphasizing the necessity and possible efficiency of ozone-NO₂ joint control. Emission source analysis based on gridded data provided a reference for understanding health impacts and developing targeted strategies.

Short-term effects of main air pollutants exposure on LOS and costs of CVD hospital admissions from 30,959 cases among suburban farmers in Pingliang, Northwest China

BACKGROUND

Although cardiovascular disease (CVD) has been the major contributor to global mortality and disability especially in undeveloped and developing countries/areas with severer air pollutions, studies are quite limited and evidence is insufficient of short-term main air pollutants exposure on health burden of CVD hospital admissions in those regions particularly through direct costs.

METHOD

Based on an analysis of 30,959 CVD hospital admissions among suburban farmers from 2018 to 2019 through multiple linear regression (MLR), our study evaluated the impact of main air pollutants (PM_2.5, PM₁₀, SO₂, CO, NO₂ and O₃) exposure on number of cases, length of stay (LOS) and costs of CVD hospital admissions in Pingliang, China.

RESULTS

Concentration of SO₂ and O₃ rising from a low level was found to lower the costs, LOS and daily cases of CVD hospital admissions and PM_2.5, PM₁₀, CO and NO₂ were found to aggravate the burden. Besides, the NO₂ could put more economic stress on those CVD patients in Pingliang (China) which implies that some improvements could be done on public medical insurance policy and benefit local suburban farmers by strengthening the supports on specific drugs and therapies.

CONCLUSIONS

More efforts should be made to lower the concentration of air pollution by coordinated control managements even in a low-level scenario. Concentration levels and interactions between main air pollutants may play an important role in air pollution-induced CVD health burden. Future research is needed to explore more evidence in different areas, especially with low-level SO₂ effects.

Impact of Particulate Matter on Hospitalizations for Respiratory Diseases and Related Economic Losses in Wuhan, China

Background

Prior studies have reported the effects of particulate matter (PM) on respiratory disease (RD) hospitalizations, but few have quantified PM-related economic loss in the central region of China. This investigation aimed to assess the impacts of PM pollution on the risk burden and economic loss of patients admitted with RD.

Methods

Daily cases of RD admitted to the hospital from 1 January 2015 to 31 December 2020 were collected from two class-A tertiary hospitals in Wuhan, China. Time series analysis incorporated with a generalized additive model (GAM) was adopted to assess the impacts of fine particulate matter (PM_2.5) and inhalable particulate matter (PM₁₀) exposures on patients hospitalized with RD. Stratified analyses were performed to investigate underlying effect modification of RD risk by sex, age, and season. The cost of illness (COI) approach was applied to evaluate the related economic losses caused by PM.

Results

A total of 51,676 inpatients with a primary diagnosis of RD were included for the analysis. PM_2.5 and PM₁₀ exposures were associated with increased risks of hospitalizations for RD. Subgroup analysis demonstrated that men and children in the 0–14 years age group were more vulnerable to PM, and the adverse effects were promoted by low temperature in the cold season. A 152.4 million China Yuan (CNY) economic loss could be avoided if concentrations of PM_2.5 and PM₁₀ declined to 10 and 20 μg/m³, respectively.

Conclusions

PM_2.5 and PM₁₀ concentrations were positively associated with RD hospitalization. Men and children were more vulnerable to PM. Effective air pollution control measures can reduce hospitalizations significantly and save economic loss substantially.

Coordinated health effects attributable to particulate matter and other pollutants exposures in the North China Plain

Hebei Province, located in the North China Plain (NCP) and encircling Beijing and Tianjin, has been suffering from severe air pollution. The monthly average fine particulate matter (PM_2.5) concentration was up to 276 μg/m³ in Hebei Province, which adversely affects human health. However, few studies evaluated the coordinated health impact of exposure to PM (PM_2.5 and PM₁₀) and other key air pollutants (SO₂, NO₂, CO, and surface ozone (O₃)). In this study, we systematically analyzed the health risks (both mortality and morbidity) due to multiple air pollutants exposures in Hebei Province. The economic loss associated with these health consequences was estimated using the value of statistical life (VSL) and cost of illness (COI) methods. Our results show the health burden and economic loss attributable to multiple ambient air pollutants exposures in Hebei Province is substantial. In 2017, the total premature mortality from multiple air pollutants exposures in Hebei Province was 69,833 (95% CI: 55,549-83,028), which was 2.9 times higher than that of the Pearl River Delta region (PRD). Most of the potential economic loss (79.65%) was attributable to premature mortality from air pollution. The total economic loss due to the health consequences of multiple air pollutants exposures was 175.16 (95% CI: 134.61-224.61) billion Chinese Yuan (CNY), which was 4.92% of Hebei Province's annual gross domestic product (GDP). Thus, the adverse health effects and economic loss caused by exposure to multiple air pollutants should be seriously taken into consideration. To alleviate these damages, Hebei's government ought to establish more stringent measures and regulations to better control air pollution.

Health Endpoint of Exposure to Criteria Air Pollutants in Ambient Air of on a Populated in Ahvaz City, Iran

The presence of criteria air pollutants (CAP) in the ambient air of a populated inhalation region is one of the main serious public health concerns. The present study evaluated the number of cardiovascular mortalities (CM), hospital admissions with cardiovascular disease (HACD), and hospital admissions for respiratory disease (HARD) due to CAP exposure between 2010 and 2014. The study used the Air Q model and descriptive analysis to investigate the health endpoint attributed to the ground level of ozone (O₃), nitrogen dioxide (NO₂), sulfide dioxide (SO₂), and particle matter (PM₁₀). Baseline incidence (BI) and relative risk (RR) are the most important factors in the evaluation of health outcomes from exposure to CAP in the ambient air of a populated area according to EPA and the World Health Organization (WHO) guidelines. Our study showed that annual cases of cardiovascular mortality during the period 2010–2014 relating to particle mater were 478, 506, 469, 427, and 371; ozone was 19, 24, 43, 56, and 49; nitrogen dioxide was 18, 20, 23, 27, and 21; and sulfide dioxide was 26, 31, 37, 43 and 11, in the years 2010 to 2014, respectively. These results indicate that the number of hospital admissions for respiratory disease attributed to PM were 2054, 2277, 2675, 2042, and 1895; O₃ was 27, 35, 58, 73, and 63; NO₂ was 23, 24, 15, 25, and 18; and SO₂ was 23, 24, 25, 30, and 20, in the years from 2010 to 2014, respectively. The results also showed that the number of hospital admissions for cardiovascular disease related to particle mater was 560, 586, 529, 503, and 472; ozone was 22, 32, 38, 55, and 51; nitrogen dioxide was 19, 18, 13, 21, and 14; and sulfide dioxide was 12, 14, 16, 22, and 9, in the same period, respectively. Observations showed that most of the pollution was from outdoor air and in the human respiratory tract. Increased levels of sulfide dioxide, particle matter, nitrogen dioxide, and ozone can cause additional morbidity and mortality for exposed populations. According to the results, it is possible to help increase the level of public health. The use of these findings could also be of great help to health professionals and facilitators at regional and national levels.

Association between Particulate Matter Pollution Concentration and Hospital Admissions for Hypertension in Ganzhou, China

Fine particulate matter (PM_2.5) and respirable particulate matter (PM₁₀) are two major air pollutants with toxic effects on the cardiovascular system. Hypertension, as a chronic noncommunicable cardiovascular disease, is also a risk factor for several diseases. We applied generalized linear models with a quasi-Poisson link to assess the effect of air pollution exposure on the number of daily admissions for patients with hypertension. In addition, we established a two-pollutant model to evaluate PM_2.5 and PM₁₀ hazard effect stability by adjusting the other gaseous pollutants. Results showed that during the study period, 24 h mean concentrations of ambient PM_2.5 and PM₁₀ at 38.17 and 59.84 μg/m³, respectively, and a total of 2,611 hypertension hospital admissions were recorded. Air pollution concentrations significantly affected the number of hospitalizations for hypertension approximately 2 months after exposure. For each 10 μg/m³ increase in PM_2.5 and PM₁₀ in single-pollutant models, the number of hospitalizations for hypertension increased by 7.92% (95% CI: 5.48% to 10.42%) and 4.46% (95% CI: 2.86% to 5.65%), respectively, at the lag day with the strongest effect. NO₂, O₃, CO, and SO₂ had different significant effects on the number of hospitalizations over the same time period, and PM_2.5 and PM₁₀ still showed robust significant effects after adjustment of gas pollutants through a two-pollutant model. These findings may contribute to a better understanding of the health effects of ambient particulate matter.

Ambient sulfur dioxide and hospital expenditures and length of hospital stay for respiratory diseases: A multicity study in China

BACKGROUND

Ambient sulfur dioxide (SO2) has been associated with morbidity and mortality of respiratory diseases, however, its effect on length of hospital stays (LOS) and cost for these diagnoses remain unclear.

METHODS

We collected hospital admission information for respiratory diseases from all 11 cities in the Shanxi Province of China during 2017-2019. We assessed individual-level exposure by using an inverse distance weighting approach based on geocoded residential addresses. A generalized additive model was built to delineate city-specific effects of SO2 on hospitalization, hospital expenditure, and length of hospital stay for respiratory diseases. The overall effects were obtained by random-effects meta-analysis. We further estimated the respiratory burden attributable to SO2 by comparing different reference concentrations.

RESULTS

We observed significant effects of SO2 exposure on respiratory diseases. At the provincial level, each 10 μg/m3 increase in SO2 on lag03 was associated with a 0.63% (95% CI: 0.14-0.11) increase in hospital admission, an increase of 4.56 days (95% CI: 1.16-7.95) of hospital stay, and 3647.97 renminbi (RMB, Chinese money) (95% CI: 1091.05-6204.90) in hospital cost. We estimated about 6.13 (95% CI: 1.33-11.10) thousand hospital admissions, 65.77 million RMB (95% CI: 19.67-111.87) in hospital expenditure, and 82.13 (95% CI: 20.87-143.40) thousand days of hospital stay could have potentially been avoided had the daily SO2 concentrations been reduced to WHO's reference concentration (40 µg/m3). Variable values in correspondence with this reference concentration could reduce the hospital cost and LOS of each case by 52.67 RMB (95% CI: 15.75-89.59) and 0.07 days (95% CI: 0.02-0.117).

CONCLUSION

This study provides evidence that short-term ambient SO2 exposure is an important risk factor of respiratory diseases, indicating that continually tightening policies to reduce SO2 levels could effectively reduce respiratory disease burden in Shanxi Province.

Acute effect of fine particulate matter on blood pressure, heart rate and related inflammation biomarkers: A panel study in healthy adults

Epidemiological evidence of short-term fine particulate matter (PM2.5) exposure on blood pressure (BP), heart rate (HR) and related inflammation biomarkers has been inconsistent. We aimed to explore the acute effect of PM2.5 on BP, HR and the mediation effect of related inflammation biomarkers. A total of 32 healthy college students were recruited to perform 4 h of exposure at two sites with different PM2.5 concentrations in Wuhan between May 2019 and June 2019. The individual levels of PM2.5 concentration, BP and HR were measured hourly for each participant. Blood was drawn from each participant after each visit and we measured the levels of inflammation markers, including serum high-sensitivity C-reactive protein and plasma fibrinogen. Linear mixed-effect models were to explore the acute effect of PM2.5 exposure on BP, HR, and related inflammation biomarkers. In addition, we evaluated related inflammation biomarkers as the mediator in the association of PM2.5 and cardiovascular health indicators. The results showed that a 10 μg/m3 increment in PM2.5 concentration was associated with an increase of 0.84 (95% CI: 0.54, 1.15) beats/min (bpm) in HR and a 3.52% (95% CI: 1.60%, 5.48%) increase in fibrinogen. The lag effect model showed that the strongest effect on HR was observed at lag 3 h of PM2.5 exposure [1.96 bpm (95% CI: 1.19, 2.75)], but for fibrinogen, delayed exposure attenuated the association. Increased fibrinogen levels may account for 39.07% (P = 0.44) of the elevated HR by PM2.5. Null association was observed when it comes to short-term PM2.5 exposure and BP. Short-term exposure to PM2.5 was associated with elevated HR and increased fibrinogen levels. But our finding was not enough to suggest that exposure to PM2.5 might induce adverse cardiovascular effects by the pathway of inflammation.

Assessing a Fossil Fuels Externality with a New Neural Networks and Image Optimization Algorithm: The Case of Atmospheric Pollutants as Cofounders to COVID-19 Lethality

This paper demonstrates how the combustion of fossil fuels for transport purpose might cause health implications. Based on an original case study [i.e. the Hubei province in China, the epicentre of the coronavirus disease-2019 (COVID-19) pandemic], we collected data on atmospheric pollutants (PM_2.5, PM₁₀ and CO₂) and economic growth (GDP), along with daily series on COVID-19 indicators (cases, resuscitations and deaths). Then, we adopted an innovative Machine Learning approach, applying a new image Neural Networks model to investigate the causal relationships among economic, atmospheric and COVID-19 indicators. Empirical findings emphasise that any change in economic activity is found to substantially affect the dynamic levels of PM_2.5, PM₁₀ and CO₂ which, in turn, generates significant variations in the spread of the COVID-19 epidemic and its associated lethality. As a robustness check, the conduction of an optimisation algorithm further corroborates previous results.

Short-term exposure to nitrogen dioxide and mortality: A systematic review and meta-analysis

BACKGROUND

Ambient air pollution has been characterized as a leading cause of mortality worldwide and has been associated with cardiovascular and respiratory diseases. There is increasing evidence that short-term exposure to nitrogen dioxide (NO₂), is related to adverse health effects and mortality.

METHODS

We conducted a systematic review of short-term NO₂ and daily mortality, which were indexed in PubMed and Embase up to June 2021. We calculated random-effects estimates by different continents and globally, and tested for heterogeneity and publication bias.

RESULTS

We included 87 articles in our quantitative analysis. NO₂ and all-cause as well as cause-specific mortality were positively associated in the main analysis. For all-cause mortality, a 10 ppb increase in NO₂ was associated with a 1.58% (95%CI 1.28%-1.88%, I² = 96.3%, Eggers' test p < 0.01, N = 57) increase in the risk of death. For cause-specific mortality, a 10 ppb increase in NO₂ was associated with a 1.72% (95%CI 1.41%-2.04%, I² = 87.4%, Eggers' test p < 0.01, N = 42) increase in cardiovascular mortality and a 2.05% (95%CI 1.52%-2.59%, I² = 78.5%, Eggers' test p < 0.01, N = 38) increase in respiratory mortality. In the sensitivity analysis, the meta-estimates for all-cause mortality, cardiovascular and respiratory mortality were nearly identical. The heterogeneity would decline to varying degrees through regional and study-design stratification.

CONCLUSIONS

This study provides evidence of an association between short-term exposure to NO₂, a proxy for traffic-sourced air pollutants, and all-cause, cardiovascular and respiratory mortality.

Assessing the health impacts attributable to PM2.5 and ozone pollution in 338 Chinese cities from 2015 to 2020

China has effectively reduced the fine particulate (PM_2.5) pollution from 2015 to 2020. Ozone pollution and related health impacts have become severe contemporaneously. The coordinated control of PM_2.5 and ozone is becoming a new issue for China's air pollution control. This study quantitatively assessed the health impacts attributed to PM_2.5 and ozone pollution in 338 Chinese cities from 2015 to 2020 and estimated the possible health benefits from achieving dual concentration targets during 2021-2025. Results show PM_2.5 caused a total health impact of 2.45 × 10⁷ disability-adjusted life years (DALYs) in 2020. All-cause and respiratory ozone-related health impact in 2020 was 1.04 × 10⁷ DALYs and 1.56 × 10⁶ DALYs. Between 2015 and 2020, the PM_2.5-related health impacts decreased by 14.97%, while those ozone-related increased by 94.61% and 96.54% for all-cause and respiratory. Cities in the North China Plain have suffered higher health impacts attributable to PM_2.5 and ozone pollution, indicating that the two-pollutant coordinated control is primarily needed. By achieving aggressive concentration target (decreasing 10%) between 2020 and 2025, China will reduce the PM_2.5-related health impacts in 338 cities by 1.56 × 10⁶ DALYs (improving 6.37%). By achieving general target (decreasing 10% or within the Interim target-1 of World Health Organization), the PM_2.5-related health benefit will be 7.98 × 10⁵ DALYs (improving 3.25%). The deteriorating ozone health risks will also be improved. Controlling air pollution in large cities and regional center cities can achieve remarkable health benefits. Due to the inter-region, inter-province, and inter-city difference of health impacts, targeted and differentiated pollution prevention and control need to be implemented.

Short-Term Ambient Particulate Air Pollution and Hospitalization Expenditures of Cause-Specific Cardiorespiratory Diseases in China: A Multicity Analysis

Background

Ambient air pollution is leading risk factor for health burden in China. Few studies in China have investigated the economic loss related to short-term exposure to ambient PM_2.5, which could trigger acute onset of cardiorespiratory diseases within a few days.

Methods

Daily ambient air pollutants data are obtained for each city from the National Air Quality Monitoring System and daily hospitalization data are obtained from the urban employee-based basic medical insurance scheme database in 74 Chinese cities with an average coverage of 88.5 million urban employees during 2016-2017. A three-stage time-series analytic approach is used in this study to investigate the impact of short-term exposure to ambient fine particulate (PM_2.5) air pollution on hospital admissions, expenses and hospital stays of three cause-specific cardiorespiratory diseases, including lower respiratory infections (LRI), coronary heart disease (CHD) and stroke in the included cities.

Findings

Based on the time-series analysis using daily hospitalization data, 28,560 LRI cases, 54,600 CHD cases, and 23,989 stroke cases are attributable to ambient PM_2.5 in the 74 cities during the study period, and the related attributable expenses are 220 million CNY (US$ 32.9 million) for LRI, 458 million CNY (US$ 68.5 million) for CHD, and 410 million CNY (US$ 65.8 million) for stroke, respectively. These attributable numbers account for 1.45% to 2.05% of total hospital admissions and 1.10% to 1.51% of total expenses for the three diseases during 2016-2017, respectively. The attributable numbers for the three cause-specific cardiorespiratory diseases would increase to 362,007 hospital admission cases and 3.68 billion CNY expenses ($US550 million) in the entire urban employee population (299 million) in China during 2016-2017, and the related direct economic loss of absence from work would be 798 million CNY (US$ 119.3 million).

Interpretation

Our results support that short-term exposure to ambient PM_2.5 pollution could lead to significant health and economic impacts in China. Reducing levels of ambient PM_2.5 can avoid substantial health damage and expenditures, and generate appreciable economic benefits from decreasing absence from work.

Funding

Natural Science Foundation of China (82073509, 71903010, 71903011), and the National Key Research and Development Program of China (2017YFC0211600, 2017YFC0211601).

Review on pollution damage costs accounting

Although the concept of damage cost accounting is already well-studied and applied, its application to pollution still lacks of an integrated accounting framework, while the spatial-temporal variability of accounting results has not been fully discussed. To fill this gap, this review frames the existing models and their limitations into static and dynamic categories, outlining the characteristics of different methods, which consider both human and non-human damages caused by pollution. Existing data sources, that could be used for accounting purposes, are detailed. Finally, this work discusses the relevance of spatial scales for the computation process, in order to obtain a more detailed information support for environmental policies for future compensatory actions. Conclusions highlights the need to develop a more comprehensive database of exposure-response relationships and to incorporate system alternatives into models to achieve a more accurate damage assessment.

Significance between air pollutants, meteorological factors, and COVID-19 infections: probable evidences in India

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease represents the causative agent with a potentially fatal risk which is having great global human health concern. Earlier studies suggested that air pollutants and meteorological factors were considered as the risk factors for acute respiratory infection, which carries harmful pathogens and affects the immunity. The study intended to explore the correlation between air pollutants, meteorological factors, and the daily reported infected cases caused by novel coronavirus in India. The daily positive infected cases, concentrations of air pollutants, and meteorological factors in 288 districts were collected from January 30, 2020, to April 23, 2020, in India. Spearman's correlation and generalized additive model (GAM) were applied to investigate the correlations of four air pollutants (PM2.5, PM10, NO2, and SO2) and eight meteorological factors (Temp, DTR, RH, AH, AP, RF, WS, and WD) with COVID-19-infected cases. The study indicated that a 10 μg/m3 increase during (Lag0-14) in PM2.5, PM10, and NO2 resulted in 2.21% (95%CI: 1.13 to 3.29), 2.67% (95% CI: 0.33 to 5.01), and 4.56 (95% CI: 2.22 to 6.90) increase in daily counts of Coronavirus Disease 2019 (COVID 19)-infected cases respectively. However, only 1 unit increase in meteorological factor levels in case of daily mean temperature and DTR during (Lag0-14) associated with 3.78% (95%CI: 1.81 to 5.75) and 1.82% (95% CI: -1.74 to 5.38) rise of COVID-19-infected cases respectively. In addition, SO2 and relative humidity were negatively associated with COVID-19-infected cases at Lag0-14 with decrease of 7.23% (95% CI: -10.99 to -3.47) and 1.11% (95% CI: -3.45 to 1.23) for SO2 and for relative humidity respectively. The study recommended that there are significant correlations between air pollutants and meteorological factors with COVID-19-infected cases, which substantially explain the effect of national lockdown and suggested positive implications for control and prevention of the spread of SARS-CoV-2 disease.

Spatiotemporal assessment of health burden and economic losses attributable to short-term exposure to ground-level ozone during 2015-2018 in China

BACKGROUND

Ground-level ozone (O3) pollution is currently the one of the severe environmental problems in China. Although existing studies have quantified the O3-related health impact and economic loss, few have focused on the acute health effects of short-term exposure to O3 and have been limited to a single temporal and spatial dimension.

METHODS

Based on the O3 concentration obtained from ground monitoring networks in 334 Chinese cities in 2015-2018, this study used a two-stage exposure parameter weighted Log-linear exposure-response function to estimate the cause-specific mortality for short-term exposure to O3.

RESULTS

The value of statistical life (VSL) method that were used to calculate the economic loss at the city-level. Our results show that in China, the national all-cause mortality attributed to O3 was 0.27(95% CI: 0.14-0.55) to 0.39 (95% CI: 0.20-0.67) million across 2015-2018. The estimated economic loss caused by O3 was 387.76 (95% CI: 195.99-904.50) to 594.08 (95% CI: 303.34-1140.65) billion CNY, accounting for 0.52 to 0.69% of total reported GDP. Overall, the O3 attributed health and economic burden has begun to decline in China since 2017. However, highly polluted areas still face severe burden, and undeveloped areas suffer from high GDP losses.

CONCLUSIONS

There are substantial health impacts and economic losses related to short-term O3 exposure in China. The government should pay attention to the emerging ozone pollution, and continue to strengthen the intervention in traditional priority areas while solving the pollution problem in non-priority areas.

Transition in air pollution, disease burden and health cost in China: A comparative study of long-term and short-term exposure

Ambient air pollution is one of the leading environmental risk factors to human health, largely offsetting economic growth. This study evaluated health burden and cost associated with the short-term and long-term exposure of major air pollutants (fine particulate matter [PM_2.5] and ozone [O₃]) during 2013-2018. We developed a database of gridded daily and annual PM_2.5 and O₃ exposure in China at 15 km × 15 km resolution. Then, we estimated the age- and cause-specific premature deaths and quantified related health damage with an age-adjusted value of statistical life (VSL) measure. The health cost estimated in this study captured direct cost, indirect cost and intangible cost of the premature death attributable to ambient PM_2.5 and O₃. We found that the national premature deaths attributable to long-term and short-term exposure to PM_2.5 decreased by 15% and 59%, whereas the national premature deaths attributable to long-term and short-term exposure to O₃ increased by 36% and 94%. Despite a 15% reduction of attributable deaths, the health cost attributable to long-term exposure to PM_2.5 did not change significantly as a result of GDP growth and population aging. On the other hand, the long-term O₃ related health cost in 2018 doubled that in 2013. Our study suggests that while premature deaths fell as a result of China's clean air actions, the health costs of air pollution remained high. The growing trends of O₃ highlighted the needs for strategies to reduce both PM_2.5 and O₃ emissions, for the sake of public health and social well-being in China.

Changes in Air Quality Associated with Mobility Trends and Meteorological Conditions during COVID-19 Lockdown in Northern England, UK

The COVID-19 pandemic triggered catastrophic impacts on human life, but at the same time demonstrated positive impacts on air quality. In this study, the impact of COVID-19 lockdown interventions on five major air pollutants during the pre-lockdown, lockdown, and post-lockdown periods is analysed in three urban areas in Northern England: Leeds, Sheffield, and Manchester. A Generalised Additive Model (GAM) was implemented to eliminate the effects of meteorological factors from air quality to understand the variations in air pollutant levels exclusively caused by reductions in emissions. Comparison of lockdown with pre-lockdown period exhibited noticeable reductions in concentrations of NO (56.68–74.16%), NO2 (18.06–47.15%), and NOx (35.81–56.52%) for measured data. However, PM10 and PM2.5 levels demonstrated positive gain during lockdown ranging from 21.96–62.00% and 36.24–80.31%, respectively. Comparison of lockdown period with the equivalent period in 2019 also showed reductions in air pollutant concentrations, ranging 43.31–69.75% for NO, 41.52–62.99% for NOx, 37.13–55.54% for NO2, 2.36–19.02% for PM10, and 29.93–40.26% for PM2.5. Back trajectory analysis was performed to show the air mass origin during the pre-lockdown and lockdown periods. Further, the analysis showed a positive association of mobility data with gaseous pollutants and a negative correlation with particulate matter.

Policy-driven changes in the health risk of PM2.5 and O3 exposure in China during 2013-2018

China issued a series of control measures to mitigate PM_2.5 pollution, including long-term (i.e., Air Pollution Prevention and Control Action Plan, APPCAP) and short-term (emergency measures in autumn and winter) acts. However, the O₃ concentration increased significantly as PM_2.5 levels sharply decreased when these measures were implemented. Therefore, the policy-driven positive/negative health effects of PM_2.5/O₃ need to be comprehensively estimated. The health impact function (HIF) is applied to evaluate the health burden attributable to long- and short-term PM_2.5 and O₃ exposure. The results show that the PM_2.5 concentration decreased by 42.95% in 74 cities, whereas O₃ pollution is increased by 17.56% from 2013 to 2018. Compared with 2013, the number of premature deaths attributable to long- and short-term PM_2.5 exposure decreased by almost 5.31 × 10⁴ (95% confidence interval [CI]: 2.87 × 10⁴-4.71 × 10⁴) (10.13%) and 3.00 × 10⁴ (95% CI: 1.66 × 10⁴-4.39 × 10⁴) (72.49%), respectively, in 2018. In contrast, O₃-attributable deaths, increased by 1.98 × 10⁴ (95% CI: 0.31 × 10⁴-3.59 × 10⁴) (130.57%) and 0.91 × 10⁴ (95% CI: 0.50 × 10⁴-1.33 × 10⁴) (76.16%) for long- and short-term exposure, respectively. The number of avoidable deaths attributed to PM_2.5 reduction is larger than the level of premature deaths related to increasing O₃. Although annual mean PM_2.5 concentrations have fallen rapidly, the benefits of reducing long-term exposure are limited, whereas the deaths associated with acute exposure decrease more significantly due to the reduction of heavy-pollution days by implementing emergency measures. The results show appreciable effectiveness in protecting human health and illustrate that synchronous control of PM_2.5 and O₃ pollution should be emphasized.

Changes of air quality and its associated health and economic burden in 31 provincial capital cities in China during COVID-19 pandemic

With outbreak of the novel coronavirus disease (COVID-19), immediate prevention and control actions were imposed in China. Here, we conducted a timely investigation on the changes of air quality, associated health burden and economic loss during the COVID-19 pandemic (January 1 to May 2, 2020). We found an overall improvement of air quality by analyzing data from 31 provincial cities, due to varying degrees of NO2, PM2.5, PM10 and CO reductions outweighing the significant O3 increase. Such improvement corresponds to a total avoided premature mortality of 9410 (7273-11,144) in the 31 cities by comparing the health burdens between 2019 and 2020. NO2 reduction was the largest contributor (55%) to this health benefit, far exceeding PM2.5 (10.9%) and PM10 (23.9%). O3 instead was the only negative factor among six pollutants. The period with the largest daily avoided deaths was rather not the period with strict lockdown but that during February 25 to March 31, due to largest reduction of NO2 and smallest increase of O3. Southwest, Central and East China were regions with relatively high daily avoided deaths, while for some cities in Northeast China, the air pollution was even worse, therefore could cause more deaths than 2019. Correspondingly, the avoided health economic loss attributable to air quality improvement was 19.4 (15.0-23.0) billion. Its distribution was generally similar to results of health burden, except that due to regional differences in willingness to pay to reduce risks of premature deaths, East China became the region with largest daily avoided economic loss. Our results here quantitatively assess the effects of short-term control measures on changes of air quality as well as its associated health and economic burden, and such information is beneficial to future air pollution control.

Continuous increases of surface ozone and associated premature mortality growth in China during 2015-2019

Ambient ozone (O₃) pollution has become a big issue in China. Recent studies have linked long- and short-term O₃ exposure to several public health risks. In this study, we (1) characterize the long-term and short-term O₃-attributed health metric in China from 2015 to 2019; (2) estimate the surface O₃ trends; and (3) quantify the long-term and short-term health impacts (i.e. all-cause, cardiovascular and respiratory mortality) in 350 urban Chinese cities. In these 5-years, the national annual average of daily maximum 8 h average (AVGDMA8) O₃ concentrations and warm-season (April-September) 4th highest daily maximum 8 h average (4DMA8) O₃ concentrations increased from 74.0 ± 15.5 μg/m³ (mean ± standard deviation) to 82.3 ± 12.0 μg/m³ and 167 ± 37.0 μg/m³ to 174 ± 30.0 μg/m³ respectively. During this period, the DMA8 O₃ concentration increased by 1.9 ± 3.3 μg/m³/yr across China, with over 70% of the monitoring sites showing a positive upward trend and 19.4% with trends >5 μg/m³/yr. The estimated long-term all-cause, cardiovascular and respiratory premature mortalities attributable to AVGDMA8 O₃ exposure in 350 Chinese cities were 181,000 (95% CI: 91,500-352,000), 112,000 (95% CI: 38,100-214,000) and 33,800 (95% CI: 0-71,400) in 2019, showing increases of 52.5%, 52.9% and 54.6% respectively compared to 2015 levels. Similarly, short-term all-cause, cardiovascular and respiratory premature mortalities attributed to ambient 4DMA8 O₃ exposure were 156,000 (95% CI: 85,300-227,000), 73,500 (95% CI: 27,500-119,000) and 28,600 (95% CI: 14,500-42,800) in 2019, increases of 19.6%, 19.8% and 21.2% respectively compared to 2015. The results of this study are important in ascertaining the effectiveness of recent emission control measures and to identify the areas that require urgent attention.