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Jin T, Lee S, Seo J, Ye S, Kim S, Oh JK, Kim S, Kim B. Long-term ambient ozone exposure and lung cancer mortality: A nested case-control study in Korea. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2025; 375:126299. [PMID: 40280269 DOI: 10.1016/j.envpol.2025.126299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 04/02/2025] [Accepted: 04/22/2025] [Indexed: 04/29/2025]
Abstract
The link between long-term exposure to tropospheric ozone (O3) and risk of lung cancer mortality remains uncertain. We aimed to provide new insights into the association between long-term O3 exposure and lung cancer mortality in Korea. A nested case-control study was conducted within a cancer-free cohort of 1,731,513 individuals who underwent health screenings provided by the National Health Insurance Service in 2006-2007. A total of 7133 lung cancer deaths that occurred from January 1, 2012, to December 31, 2021, were matched to 28,532 controls at a 1:4 ratio based on propensity scores. Daily 24-h and 8-h maximum O3 concentrations, averaged year-round and during the warm season from 2006 to 2010, were estimated for participants based on their residential addresses using the Community Multiscale Air Quality model. O3 concentrations rise during the daytime, also exhibiting seasonal variations, with the highest levels occurring in the warm season. Elevated risk of lung cancer mortality was observed among participants in the highest quartile of O3 exposure compared with those in the lowest quartile, yielding odds ratios ranging from 1.15 to 1.27. However, when exposure to particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) was further adjusted for, the adverse risk of long-term O3 exposure was attenuated, even tending to be protective. Notably, participants with both high O3 and high PM2.5 exposures had an increased risk of lung cancer mortality. Furthermore, regional differences were observed, with a significantly higher risk in rural areas. Findings of this study suggest that long-term exposure to O3, especially in combination with PM2.5 exposure, is associated with an excess risk of lung cancer mortality, underscoring the importance of addressing the O3 and PM2.5 interaction in lung cancer prevention.
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Affiliation(s)
- Taiyue Jin
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Seulbi Lee
- Department of Big Data Strategy, National Health Insurance Service, Wonju, South Korea
| | - Juhee Seo
- Vital Statistics Division, Statistics Korea, Daejeon, South Korea
| | - Shinhee Ye
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, South Korea
| | - Soontae Kim
- Department of Environmental and Safety Engineering, Ajou University, Suwon, South Korea
| | - Jin-Kyoung Oh
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, Goyang, South Korea; Department of Public Health & AI, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Seyoung Kim
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Byungmi Kim
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, Goyang, South Korea; Department of Public Health & AI, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.
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Peng M, Yuan Y, Sun HZ, Wu J, Zhu L, Zeng Y, Zhang Y, Yao Y. Loss of life expectancy attributed to long-term ozone exposure in Chinese older adults: Cross-cohort analysis from 3 national cohorts. J Adv Res 2025:S2090-1232(25)00204-8. [PMID: 40169077 DOI: 10.1016/j.jare.2025.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Revised: 03/23/2025] [Accepted: 03/23/2025] [Indexed: 04/03/2025] Open
Abstract
BACKGROUND Cohort evidence linking ozone (O3) exposure with mortality was sparsely investigated among the elderly in low- and middle-income countries. This study aims to quantify mortality risk and burden attributed to chronic O3 exposure in Chinese older adults. METHODS A total of 30,874 older adults aged ≥65 years were recruited from 3 national dynamic cohorts across 29 provincial regions in China, 2005-2018. Annual warm-season (April-September) O3 and year-round PM2.5 concentrations were estimated through well-validated satellite-based spatiotemporal models and were assigned to participants for each survey year. Time-dependent Fragility Cox models with random intercept for study cohort were employed to quantify O3-mortality association, adjusting for demographic, behavioral, health, and environmental covariates. A counterfactual causal framework was used for assessment of O3-attributable premature deaths in older adults based on exposure-response relationship derived from multi-cohort two-pollutant analysis (+PM2.5). Years of life lost and loss of life expectancy were subsequently evaluated based on the burden estimation model by incorporating the comparative risk assessment method and reference life tables. RESULTS 16,939 death events occurred during 0.16 million person-years of follow-up surveys. Each 10-ppb increase in O3 exposure was linked with a hazard ratio of 1.076 (95% confidence interval [CI]: 1.050, 1.102) for all-cause mortality. By achieving the counterfactual target (WHO AQG 2021) of 60 μg/m3 for warm-season O3, 0.88 (95% CI: 0.60, 1.14) million premature deaths could be avoidable among Chinese older population in 2019, yielding an inconspicuous reduction of 0.11 million compared to the estimate in 2011 (0.99 million, 95% CI: 0.68, 1.28). O3-attributable deaths amounted to 9.05 (95% CI: 6.19, 11.70) million years of life lost in 2019, equivalent to a loss of life expectancy of 0.93 (95% CI: 0.63, 1.20) years for older population in China. CONCLUSIONS Our multi-cohort analysis suggested that reducing ambient O3 exposure could increase the life expectancy of Chinese older adults, which may contribute to the development of healthy aging strategies and national cleaning air policies.
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Affiliation(s)
- Minjin Peng
- Department of Outpatient, Hubei Provincial Clinical Research Center for Precision Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Yang Yuan
- Shenzhen Bao'an District Songgang People's Hospital, Shenzhen 518100, China; School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Haitong Zhe Sun
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117609 Singapore
| | - Jing Wu
- Center for Healthy Aging Transdisciplinary Sciences, China Center for Health Development Studies, Peking University, Beijing, China
| | - Lifeng Zhu
- School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yi Zeng
- Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China; Center for the Study of Aging and Human Development and Geriatrics Division, Medical School of Duke University, Durham, NC, USA
| | - Yunquan Zhang
- School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China.
| | - Yao Yao
- Center for Healthy Aging Transdisciplinary Sciences, China Center for Health Development Studies, Peking University, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodelling, Peking University, Beijing, China; Key Laboratory of Major Disease Epidemiology under the Ministry of Education of China (Peking University).
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Gao A, You X, Li Z, Liao C, Yin Z, Zhang B, Zhang H. Health effects associated with ozone in China: A systematic review. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2025; 367:125642. [PMID: 39761714 DOI: 10.1016/j.envpol.2025.125642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Revised: 12/24/2024] [Accepted: 01/03/2025] [Indexed: 01/21/2025]
Abstract
As the ozone (O3) pollution becomes severe in China, it poses a threat to human health. Currently, studies on the impacts of O3 on different regions and groups are limited. This review systematically summarizes the relationship between O3 pollution and mortality and morbidity across the nation, regions, and cities in China, with a focus on the regional and group-specific studies. Then, we clarify the overall limitations in the research data, methods, and subjects. In addition, we briefly discuss the mechanisms by which O3 exposure affects human health, analyzing the effects of O3 on human health under heatwaves (temperature) condition, multi-pollutant modeling, and future climate scenarios. Finally, we give some suggestions for future research directions. Studies found that increased risks of premature mortality and morbidity of respiratory and cardiovascular diseases are closely associated with high concentration O3 exposure. Besides, the old and children are sensitive groups, more studies are needed estimate the risk of their health associated with O3 pollution. Severe O3 pollution in Northern and Eastern China, has significantly increased premature mortality. O3 pollution has led to decreased lung function in the elderly in East China, and a higher asthma risk among young people in South China. Comparing with other regions, less research studied the relationship between O3 pollution and health of local people in Southwest, Central, Northeast, and Northwest Regions. Therefore, it is necessary to enhance research in these regions, with a particular emphasis on the distinctive health consequences of O3 pollution in these regions. Given the diversity of regions and research groups, comprehensive comparison is crucial for determining the impact of O3 pollution on human health in China.
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Affiliation(s)
- Aifang Gao
- School of Water Resources and Environment, Hebei GEO University, Hebei Province Collaborative Innovation Center for Sustainable Utilization of Water Resources and Optimization of Industrial Structure, Hebei Province Key Laboratory of Sustained Utilization and Development of Water Resources, Hebei Center for Ecological and Environmental Geology Research, Shijiazhuang, 050031, China
| | - Xi You
- School of Water Resources and Environment, Hebei GEO University, Hebei Province Collaborative Innovation Center for Sustainable Utilization of Water Resources and Optimization of Industrial Structure, Hebei Province Key Laboratory of Sustained Utilization and Development of Water Resources, Hebei Center for Ecological and Environmental Geology Research, Shijiazhuang, 050031, China
| | - Zhao Li
- School of Water Resources and Environment, Hebei GEO University, Hebei Province Collaborative Innovation Center for Sustainable Utilization of Water Resources and Optimization of Industrial Structure, Hebei Province Key Laboratory of Sustained Utilization and Development of Water Resources, Hebei Center for Ecological and Environmental Geology Research, Shijiazhuang, 050031, China
| | - Chenglong Liao
- School of Water Resources and Environment, Hebei GEO University, Hebei Province Collaborative Innovation Center for Sustainable Utilization of Water Resources and Optimization of Industrial Structure, Hebei Province Key Laboratory of Sustained Utilization and Development of Water Resources, Hebei Center for Ecological and Environmental Geology Research, Shijiazhuang, 050031, China
| | - Ze Yin
- School of Water Resources and Environment, Hebei GEO University, Hebei Province Collaborative Innovation Center for Sustainable Utilization of Water Resources and Optimization of Industrial Structure, Hebei Province Key Laboratory of Sustained Utilization and Development of Water Resources, Hebei Center for Ecological and Environmental Geology Research, Shijiazhuang, 050031, China.
| | - Baojun Zhang
- Tangshan Ecological Environment Publicity and Education Center, Tangshan, 063000, China
| | - Hongliang Zhang
- Department of Environmental Science and Engineering, Fudan University, Shanghai, 200438, China.
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Huang K, Zhang Z, Hu M, Zhao J, Li Z, Hu C, Bai S, Wu D, Wu Y, Hu X, Wang X, Yan X, Li R, Xu B, Zhang XJ. Association of specific PM 2.5 chemical constituents and ozone exposure with pregnancy outcomes in women undergoing assisted reproductive technology treatment in central China. Int J Hyg Environ Health 2025; 263:114474. [PMID: 39378554 DOI: 10.1016/j.ijheh.2024.114474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 09/11/2024] [Accepted: 09/28/2024] [Indexed: 10/10/2024]
Abstract
The associations of air pollutants exposure with assisted reproductive technology (ART) pregnancy outcomes are mixed, and the effects of specific components of fine particulate matter (PM2.5) and ozone (O3) are not well understood. We conducted a retrospective longitudinal study to explore the association of PM2.5 constituents and O3 exposure with three ART outcomes among women undergoing ART treatment. The exposure window was segmented into five periods corresponding to the cycle of ovarian stimulation and oocyte retrieval procedure. Generalized linear mixed model (GLMM) was applied to explore the relationships between PM2.5 constituents, O3, Normalized Vegetation Index (NDVI) exposure and three ART outcomes. The combined effect of PM2.5 constituents was evaluated by the quantile g (qg)-computation. We also explored the modifying effect of different covariate. Elevated exposure level of PM2.5 (OR = 0.915, 95% CI: 0.859, 0.974) and its constituents (BC: 0.905, 95% CI: 0.840, 0.975; OM: 0.910, 95% CI: 0.848, 0.976; NO3-: 0.909, 95% CI: 0.850, 0.972, SO42-: 0.905, 95% CI: 0.846, 0.968, and NH4+: 0.902, 95% CI: 0.842, 0.966) exposure throughout the year before oocyte retrieval (period 1) was correlated with a reduced odds ratio (OR) of live birth with statistical significance. Similarly, for each interquartile range (IQR) increase in O3 exposure during periods 2 (85 days prior to oocyte retrieval), 3 (30 days prior to oocyte retrieval), 4 (oocyte retrieval to embryo transfer) and 5 (embryo transfer to hCG test) was significantly related to a decreased OR of live birth. Especially, participants who underwent fresh embryo transfer cycles and received two cleavage-stage embryo transfer, and were younger than 30 years old, showed a higher susceptibility to particulate matter. Findings from this study suggest that PM2.5 constituents and O3 exposure may have adverse effects on the ART outcomes, highlighting the importance of identifying critical exposure periods for various air pollutants and the need for meticulous management of particulate matter.
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Affiliation(s)
- Kai Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China; The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Zeling Zhang
- Reproductive and Genetic Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Meihong Hu
- Reproductive and Genetic Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Jiawen Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Zhenhua Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Chengyang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Shun Bai
- Reproductive and Genetic Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Dequan Wu
- The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Yile Wu
- The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Xiaoqian Hu
- The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Xueping Wang
- The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Xiang Yan
- The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Ruojie Li
- The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Bo Xu
- Reproductive and Genetic Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China.
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, 81 Meishan Road, Hefei, 230032, China.
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Peng M, Li Y, Wu J, Zeng Y, Yao Y, Zhang Y. Exposure to submicron particulate matter and long-term survival: Cross-cohort analysis of 3 Chinese national surveys. Int J Hyg Environ Health 2025; 263:114472. [PMID: 39369489 DOI: 10.1016/j.ijheh.2024.114472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/10/2024] [Accepted: 09/24/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Cohort evidence linking increased mortality with airborne fine particulate matter (PM2.5, particulate matter [PM] with aerodynamic diameter ≤2.5 μm) exposure was extensively validated worldwide. Nevertheless, long-term survival associated with submicron particulate matter (PM1, PM with aerodynamic diameter ≤1 μm) exposure remained largely unstudied, particularly in highly exposed populations. METHODS We performed a population-based investigation involving 86844 adults aged 16+ years from 3 national dynamic cohorts spanning from 2005 to 2018. Residential annual exposure to PM1 and PM2.5 was assigned for each follow-up year using satellite-derived spatiotemporal estimates at a 1-km2 resolution. The concentration of PM1-2.5 (PM with aerodynamic diameter between 1 and 2.5 μm) was calculated by subtracting PM1 from PM2.5. Time-independent Cox proportional hazards regression models were applied to assess the associations of all-cause mortality with long-term exposure to size-specific particles. To investigate the effect of PM1 on PM2.5-mortality associations, we categorized participants into low, medium, and high groups based on PM1/PM2.5 ratio and examined the risk of PM2.5-associated mortality in each stratum. Effect modifications were checked via subgroup analyses. RESULTS A total of 18722 deaths occurred during 497069.2 person-years of follow-up (median 5.7 years). Participants were exposed to an average annual concentration of 31.8 μg/m³ (range: 7.6-66.8 μg/m³) for PM1, 56.3 μg/m³ (range: 19.8-127.2 μg/m³) for PM2.5, and 24.5 μg/m³ (range: 7.3-60.3 μg/m³) for PM1-2.5. PM1, PM2.5, and PM1-2.5 were consistently associated with elevated mortality risks, with a hazard ratio (HR) of 1.029 (95% confidence interval [CI]: 1.013-1.046), 1.014 (95% CI: 1.005-1.023), and 1.019 (95% CI: 1.001-1.038) for each 10-μg/m3 increase in exposure, respectively. Compared with low (HR = 0.986, 95% CI: 0.967-1.004) and medium (HR = 1.015, 95% CI: 1.002-1.029) PM1/PM2.5 ratio groups, PM2.5-related risk of mortality was more pronounced in high PM1/PM2.5 ratio stratum (HR = 1.041, 95% CI: 1.019-1.064). Greater risks of mortality associated with size-specific particles were found among the elderly (>80 years old), southeastern participants, and those living in warmer areas. CONCLUSIONS This study demonstrated that long-term exposure to PM1, PM2.5, and PM1-2.5 was associated with heightened mortality, and PM1 may play a predominant role in PM2.5-induced risk. Our results emphasized the population health implications of establishing ambient PM1 air quality guidelines to mitigate the burden of premature mortality stemming from particulate air pollution.
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Affiliation(s)
- Minjin Peng
- Department of Outpatient, Hubei Provincial Clinical Research Center for Precision Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China
| | - Yachen Li
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Jing Wu
- China Center for Health Development Studies, Peking University, Beijing 100871, China
| | - Yi Zeng
- China Center for Health Development Studies, Peking University, Beijing 100871, China
| | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing 100871, China.
| | - Yunquan Zhang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China.
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Heo S, Schuch D, Junger WL, Zhang Y, de Fatima Andrade M, Bell ML. The impact of exposure assessment on associations between air pollution and cardiovascular mortality risks in the city of Rio de Janeiro, Brazil. ENVIRONMENTAL RESEARCH 2024; 263:120150. [PMID: 39414104 DOI: 10.1016/j.envres.2024.120150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 09/13/2024] [Accepted: 10/13/2024] [Indexed: 10/18/2024]
Abstract
Despite a growing literature for complex air quality models, scientific evidence lacks of the influences of varying exposure assessments and air quality data sources on the estimated mortality risks. This case-crossover study estimated cardiovascular mortality risks from fine particulate matter (PM2.5) and ozone (O3) exposures, using varying exposure methods, to aid understanding of the impact of exposure methods in the health risk estimation. We used individual-level cardiovascular mortality data in the city of Rio de Janeiro, 2012-2016. PM2.5 and O3 exposure levels (from the date of death to seven prior days [lag0-7]) were estimated at the individual level or district level using either the WRF-Chem modeling data or monitoring data, resulting in a total of 10 exposure methods. The exposure-response relationships were estimated using multiple logistic regressions. The changes in cardiovascular mortality were represented as an odds ratio (OR) and 95% confidence intervals (CIs) for an interquartile range (IQR) increase in the exposures. Results showed that socioeconomically more advantaged populations had lower access to the stationary monitoring networks. Higher variance in the estimated exposure levels across the 10 exposure methods was found for PM2.5 than O3. PM2.5 exposure was not associated with mortality risk in any exposure methods. WRF-Chem-based O3 exposure estimated for each individual of the entire population found a significant mortality risk (OR = 1.06, 95% CI: 1.01, 1.11), but not the other exposure methods. Higher risks for females and older populations were suggested for O3 estimates estimated for each individual using the WRF-Chem data. Findings indicate that decisions on exposure methods and data sources can lead to substantially varying implications for air pollution risks and highlight the need for comprehensive exposure and health impact assessments to aid local decision-making for air pollution and public health.
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Affiliation(s)
- Seulkee Heo
- School of the Environment, Yale University, New Haven, CT, USA.
| | - Daniel Schuch
- College of Engineering, Northeastern University, Boston, MA, USA.
| | | | - Yang Zhang
- College of Engineering, Northeastern University, Boston, MA, USA.
| | - Maria de Fatima Andrade
- Departamento de Ciências Atmosféricas, Instituto de Astronomia, Geofísica e Ciências Atmosféricas, Universidade de São Paulo, São Paulo, Brazil.
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT, USA; Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea.
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Wang Y, Chang J, Hu P, Deng C, Luo Z, Zhao J, Zhang Z, Yi W, Zhu G, Zheng G, Wang S, He K, Liu J, Liu H. Key factors in epidemiological exposure and insights for environmental management: Evidence from meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 362:124991. [PMID: 39303936 PMCID: PMC7616677 DOI: 10.1016/j.envpol.2024.124991] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/14/2024] [Accepted: 09/17/2024] [Indexed: 09/22/2024]
Abstract
In recent years, the precision of exposure assessment methods has been rapidly improved and more widely adopted in epidemiological studies. However, such methodological advancement has introduced additional heterogeneity among studies. The precision of exposure assessment has become a potential confounding factors in meta-analyses, whose impacts on effect calculation remain unclear. To explore, we conducted a meta-analysis to integrate the long- and short-term exposure effects of PM2.5, NO2, and O3 on all-cause, cardiovascular, and respiratory mortality in the Chinese population. Literature was identified through Web of Science, PubMed, Scopus, and China National Knowledge Infrastructure before August 28, 2023. Sub-group analyses were performed to quantify the impact of exposure assessment precisions and pollution levels on the estimated risk. Studies achieving merely city-level resolution and population exposure are classified as using traditional assessment methods, while those achieving sub-kilometer simulations and individual exposure are considered finer assessment methods. Using finer assessment methods, the RR (under 10 μg/m3 increment, with 95% confidence intervals) for long-term NO2 exposure to all-cause mortality was 1.13 (1.05-1.23), significantly higher (p-value = 0.01) than the traditional assessment result of 1.02 (1.00-1.03). Similar trends were observed for long-term PM2.5 and short-term NO2 exposure. A decrease in short-term PM2.5 levels led to an increase in the RR for all-cause and cardiovascular mortality, from 1.0035 (1.0016-1.0053) and 1.0051 (1.0021-1.0081) to 1.0055 (1.0035-1.0075) and 1.0086 (1.0061-1.0111), with weak between-group significance (p-value = 0.13 and 0.09), respectively. Based on the quantitative analysis and literature information, we summarized four key factors influencing exposure assessment precision under a conceptualized framework: pollution simulation resolution, subject granularity, micro-environment classification, and pollution levels. Our meta-analysis highlighted the urgency to improve pollution simulation resolution, and we provide insights for researchers, policy-makers and the public. By integrating the most up-to-date epidemiological research, our study has the potential to provide systematic evidence and motivation for environmental management.
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Affiliation(s)
- Yongyue Wang
- State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, 100084, China
| | - Jie Chang
- National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100084, China; Centre for Clinical and Epidemiologic Research, Beijing an Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Piaopiao Hu
- Centre for Clinical and Epidemiologic Research, Beijing an Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Chun Deng
- State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, 100084, China
| | - Zhenyu Luo
- State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, 100084, China
| | - Junchao Zhao
- State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, 100084, China
| | - Zhining Zhang
- State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, 100084, China
| | - Wen Yi
- State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, 100084, China
| | - Guanlin Zhu
- State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, 100084, China
| | - Guangjie Zheng
- State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, 100084, China
| | - Shuxiao Wang
- State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, 100084, China
| | - Kebin He
- State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, 100084, China
| | - Jing Liu
- Centre for Clinical and Epidemiologic Research, Beijing an Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Huan Liu
- State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, 100084, China.
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Kasdagli MI, Orellano P, Pérez Velasco R, Samoli E. Long-Term Exposure to Nitrogen Dioxide and Ozone and Mortality: Update of the WHO Air Quality Guidelines Systematic Review and Meta-Analysis. Int J Public Health 2024; 69:1607676. [PMID: 39494092 PMCID: PMC11527649 DOI: 10.3389/ijph.2024.1607676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 09/26/2024] [Indexed: 11/05/2024] Open
Abstract
Objectives We performed a systematic review and meta-analysis on long-term exposure to nitrogen dioxide (NO2) and ozone (O3) with mortality, to expand evidence that informed 2021 the WHO Air Quality Guidelines and guide the Health Risks of Air Pollution in Europe project. Methods We included cohorts investigating NO2 and O3 mortality from all-causes, respiratory diseases, chronic obstructive pulmonary disease (COPD), acute lower respiratory infections (ALRI); and NO2 mortality from circulatory, ischemic heart, cerebrovascular diseases and lung cancer. We pooled estimates by random-effects models and investigated heterogeneity. We assessed the certainty of the evidence using the Grading of Recommendations Assessment Development approach and Evaluation (GRADE). Results We selected 83 studies for NO2 and 26 for O3 for the meta-analysis. NO2 was associated with all outcomes, except for cerebrovascular mortality. O3 was associated with respiratory mortality following annual exposure. There was high heterogeneity, partly explained by region and pollutant levels. Certainty was high for NO2 with COPD and ALRI, and annual O3 with respiratory mortality. Conclusion An increasing body of evidence, with new results from countrywide areas and the Western Pacific, supports certainty, including new outcomes.
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Affiliation(s)
- Maria-Iosifina Kasdagli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Pablo Orellano
- Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Universidad Tecnologica Nacional, Facultad Regional San Nicolas, San Nicolas, Argentina
| | - Román Pérez Velasco
- World Health Organization (WHO) Regional Office for Europe, European Centre for Environment and Health, Bonn, Germany
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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9
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Chen X, Jiang Z, Shen Y, Wang S, Shindell D, Zhang Y. Ozone Mortality Burden Changes Driven by Population Aging and Regional Inequity in China in 2013-2050. GEOHEALTH 2024; 8:e2024GH001058. [PMID: 39086930 PMCID: PMC11286545 DOI: 10.1029/2024gh001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 08/02/2024]
Abstract
Air pollution exposure is closely linked to population age and socioeconomic status. Population aging and imbalance in regional economy are thus anticipated to have important implications on ozone (O3)-related health impacts. Here we provide a driver analysis for O3 mortality burden due to respiratory disease in China over 2013-2050 driven by population aging and regional inequity. Unexpectedly, we find that population aging is estimated to result in dramatic rises in annual O3 mortality burden in China; by 56, 101-137, and 298-485 thousand over the periods 2013-2020, 2020-2030, and 2030-2050, respectively. This reflects the exponential rise in baseline mortality rates with increasing age. The aging-induced mortality burden rise in 2030-2050 is surprisingly large, as it is comparable to the net national mortality burden due to O3 exposure in 2030 (359-399 thousand yr-1). The health impacts of O3 pollution, shown as mortality burden per capita, are inequitably distributed, with more severe effects in less developed provinces than their developed counterparts by 23.1% and 21.5% in 2019 and 2030, respectively. However, the regional inequity in O3 mortality burden is expected to be mitigated in 2050. This temporal variation reflects evolving demographic dividend characterized by a larger proportion of younger individuals in developed regions. These findings are critical for targeted improvement of healthcare services to ensure the sustainability of social development.
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Affiliation(s)
- Xiaokang Chen
- School of Earth and Space SciencesUniversity of Science and Technology of ChinaHefeiChina
| | - Zhe Jiang
- School of Earth and Space SciencesUniversity of Science and Technology of ChinaHefeiChina
| | - Yanan Shen
- School of Earth and Space SciencesUniversity of Science and Technology of ChinaHefeiChina
| | - Shuxiao Wang
- State Key Joint Laboratory of Environmental Simulation and Pollution ControlSchool of EnvironmentTsinghua UniversityBeijingChina
- State Environmental Protection Key Laboratory of Sources and Control of Air Pollution ComplexBeijingChina
| | - Drew Shindell
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
| | - Yuqiang Zhang
- Big Data Research Center for Ecology and EnvironmentShandong UniversityQingdaoChina
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10
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Yu Y, Tang Z, Huang Y, Zhang J, Wang Y, Zhang Y, Wang Q. Assessing long-term effects of gaseous air pollution exposure on mortality in the United States using a variant of difference-in-differences analysis. Sci Rep 2024; 14:16220. [PMID: 39003417 PMCID: PMC11246484 DOI: 10.1038/s41598-024-66951-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/05/2024] [Indexed: 07/15/2024] Open
Abstract
Long-term mortality effects of particulate air pollution have been investigated in a causal analytic frame, while causal evidence for associations with gaseous air pollutants remains extensively lacking, especially for carbon monoxide (CO) and sulfur dioxide (SO2). In this study, we estimated the causal relationship of long-term exposure to nitrogen dioxide (NO2), CO, SO2, and ozone (O3) with mortality. Utilizing the data from National Morbidity, Mortality, and Air Pollution Study, we applied a variant of difference-in-differences (DID) method with conditional Poisson regression and generalized weighted quantile sum regression (gWQS) to investigate the independent and joint effects. Independent exposures to NO2, CO, and SO2 were causally associated with increased risks of total, nonaccidental, and cardiovascular mortality, while no evident associations with O3 were identified in the entire population. In gWQS analyses, an interquartile range-equivalent increase in mixture exposure was associated with a relative risk of 1.067 (95% confidence interval: 1.010-1.126) for total mortality, 1.067 (1.009-1.128) for nonaccidental mortality, and 1.125 (1.060-1.193) for cardiovascular mortality, where NO2 was identified as the most significant contributor to the overall effect. This nationwide DID analysis provided causal evidence for independent and combined effects of NO2, CO, SO2, and O3 on increased mortality risks among the US general population.
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Affiliation(s)
- Yong Yu
- Center of Health Administration and Development Studies, School of Public Health, Hubei University of Medicine, Shiyan, 442000, China
| | - Ziqing Tang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Yuqian Huang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Jingjing Zhang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Yixiang Wang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Yunquan Zhang
- Center of Health Administration and Development Studies, School of Public Health, Hubei University of Medicine, Shiyan, 442000, China.
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, 430065, China.
| | - Qun Wang
- Center of Health Administration and Development Studies, School of Public Health, Hubei University of Medicine, Shiyan, 442000, China.
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11
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Zhu C, Yao M. Real-Time Monitoring of Air Pollution Health Impacts Using Breath-Borne Gaseous Biomarkers from Rats. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:4522-4534. [PMID: 38411076 DOI: 10.1021/acs.est.3c08629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Offline techniques are adopted for studying air pollution health impacts, thus failing to provide in situ observations. Here, we have demonstrated their real-time monitoring by online analyzing an array of gaseous biomarkers from rats' exhaled breath using an integrated exhaled breath array sensor (IEBAS) developed. The biomarkers include total volatile organic compounds (TVOC), CO2, CO, NO, H2S, H2O2, O2, and NH3. Specific breath-borne VOCs were also analyzed by a gas chromatography-ion mobility spectrometer (GC-IMS). After real-life ambient air pollution exposures (2 h), the pollution levels of PM2.5 and O3 were both found to significantly affect the relative levels of multiple gaseous biomarkers in rats' breath. Eleven biomarkers, especially NO, H2S, and 1-propanol, were detected as significantly correlated with PM2.5 concentration, while heptanal was shown to be significantly correlated with O3. Likewise, significant changes were also detected in multiple breath-borne biomarkers from rats under lab-controlled O3 exposures with levels of 150, 300, and 1000 μg/m3 (2 h), compared to synthetic air exposure. Importantly, heptanal was experimentally confirmed as a reliable biomarker for O3 exposure, with a notable dose-response relationship. In contrast, conventional biomarkers of inflammation and oxidative stress in rat sera exhibited insignificant differences after the 2 h exposures. The results imply that breath-borne gaseous biomarkers can serve as an early and sensitive indicator for ambient pollutant exposure. This work pioneered a new research paradigm for online monitoring of air pollution health impacts while obtaining important candidate biomarker information for PM2.5 and O3 exposures.
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Affiliation(s)
- Chenyu Zhu
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing 100871, China
| | - Maosheng Yao
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing 100871, China
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12
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Liu L, Zeng Y, Ji JS. Real-World Evidence of Multiple Air Pollutants and Mortality: A Prospective Cohort Study in an Oldest-Old Population. ENVIRONMENT & HEALTH (WASHINGTON, D.C.) 2024; 2:23-33. [PMID: 38269260 PMCID: PMC10804360 DOI: 10.1021/envhealth.3c00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 01/26/2024]
Abstract
We aimed to report real-world longitudinal ambient air pollutants levels compared to WHO Air Quality Guidelines (AQG) and analyze multiple air pollutants' joint effect on longevity, and the modification and confounding from the climate and urbanization with a focus on the oldest-old. This study included 13,207 old participants with 73.3% aged 80 and beyond, followed up from 2008 to 2018 in 23 Chinese provinces. We used the Cox-proportional hazards model and quantile-based g-computation model to measure separate and joint effects of the multiple pollutants. We adjusted for climate and area economic factors based on a directed acyclic graph. In 2018, no participants met the WHO AQG for PM2.5 and O3, and about one-third met the AQG for NO2. The hazard ratio (HR) for mortality was 1.07 (95% confidence interval-CI: 1.05, 1.09) per decile increase in all three pollutants, with PM2.5 being the dominant contributor according to the quantile-based g-computation model. In the three-pollutant model, the HRs (95% CI) for PM2.5 and NO2 were 1.27 (1.25, 1.3) and 1.08 (1.05, 1.12) per 10 μg/m3 increase, respectively. The oldest-old experienced a much lower mortality risk from air pollution compared to the young-old. The mortality risk of PM2.5 was higher in areas with higher annual average temperatures. The adjustment of road density considerably intensified the association between NO2 and mortality. The ambient PM2.5 and O3 levels in China exceeded the WHO AQG target substantially. Multiple pollutants coexposure, confounding, and modification of the district economic and climate factors should not be ignored in the association between air pollution and mortality.
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Affiliation(s)
- Linxin Liu
- Vanke
School of Public Health, Tsinghua University, Beijing, China 100084
- School
of Medicine, Tsinghua University, Beijing, China 100084
| | - Yi Zeng
- Center
for the Study of Aging and Human Development, School of Medicine, Duke University, Durham, North Carolina 27710, United States
- Center
for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China 100091
| | - John S. Ji
- Vanke
School of Public Health, Tsinghua University, Beijing, China 100084
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13
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Peng M, Zhang F, Yuan Y, Yang Z, Wang K, Wang Y, Tang Z, Zhang Y. Long-term ozone exposure and all-cause mortality: Cohort evidence in China and global heterogeneity by region. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 270:115843. [PMID: 38141337 DOI: 10.1016/j.ecoenv.2023.115843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Cohort evidence linking long-term ozone (O3) exposure to mortality remained largely mixed worldwide and was extensively deficient in densely-populated Asia. This study aimed to assess the long-term effects of O3 exposure on all-cause mortality among Chinese adults, as well as to examine potential regional heterogeneity across the globe. METHODS A national dynamic cohort of 42153 adults aged 16+ years were recruited from 25 provinces across Chinese mainland and followed up during 2010-2018. Annual warm-season (April-September) O3 and year-round co-pollutants (i.e., nitrogen dioxide [NO2] and fine particulate matter [PM2.5]) were simulated through validated spatial-temporal prediction models and were assigned to each enrollee in each calendar year. Cox proportional hazards models with time-varying exposures were employed to assess the O3-mortality association. Concentration-response (C-R) curves were fitted by natural cubic spline function to investigate the potential nonlinear association. Both single-pollutant model and co-pollutant models additionally adjusting for PM2.5 and/or NO2 were employed to examine the robustness of the estimated association. The random-effect meta-analysis was adopted to pool effect estimates from the current and prior population-based cohorts (n = 29), and pooled C-R curves were fitted through the meta-smoothing approach by regions. RESULTS The study population comprised of 42153 participants who contributed 258921.5 person-years at risk (median 6.4 years), of whom 2382 death events occurred during study period. Participants were exposed to an annual average of 51.4 ppb (range: 22.7-74.4 ppb) of warm-season O3 concentration. In the single-pollutant model, a significantly increased hazard ratio (HR) of 1.098 (95% confidence interval [CI]: 1.023-1.179) was associated with a 10-ppb rise in O3 exposure. Associations remained robust to additional adjustments of co-pollutants, with HRs of 1.099 (95% CI: 1.023-1.180) in bi-pollutant model (+PM2.5) and 1.093 (95% CI: 1.018-1.174) in tri-pollutant model (+PM2.5+NO2), respectively. A J-shaped C-R relationship was identified among Chinese general population, suggesting significant excess mortality risk at high ozone exposure only. The combined C-R curves from Asia (n = 4) and North America (n = 17) demonstrated an overall increased risk of all-cause mortality with O3 exposure, with pooled HRs of 1.124 (95% CI: 0.966-1.307) and 1.023 (95% CI: 1.007-1.039) per 10-ppb rise, respectively. Conversely, an opposite association was observed in Europe (n = 8, HR: 0.914 [95% CI: 0.860-0.972]), suggesting significant heterogeneity across regions (P < 0.01). CONCLUSIONS This study provided national evidence that high O3 exposure may curtail long-term survival of Chinese general population. Great between-region heterogeneity of pooled O3-mortality was identified across North America, Europe, and Asia.
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Affiliation(s)
- Minjin Peng
- Department of Outpatient, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Faxue Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan 430072, China
| | - Yang Yuan
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China.
| | - Zhiming Yang
- School of Economics and Management, University of Science and Technology Beijing, Beijing 100083, China
| | - Kai Wang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yaqi Wang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Ziqing Tang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yunquan Zhang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China.
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14
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Zeng X, Zhan Y, Zhou W, Qiu Z, Wang T, Chen Q, Qu D, Huang Q, Cao J, Zhou N. The Influence of Airborne Particulate Matter on the Risk of Gestational Diabetes Mellitus: A Large Retrospective Study in Chongqing, China. TOXICS 2023; 12:19. [PMID: 38250975 PMCID: PMC10818620 DOI: 10.3390/toxics12010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
Emerging research findings suggest that airborne particulate matter might be a risk factor for gestational diabetes mellitus (GDM). However, the concentration-response relationships and the susceptible time windows for different types of particulate matter may vary. In this retrospective analysis, we employ a novel robust approach to assess the crucial time windows regarding the prevalence of GDM and to distinguish the susceptibility of three GDM subtypes to air pollution exposure. This study included 16,303 pregnant women who received routine antenatal care in 2018-2021 at the Maternal and Child Health Hospital in Chongqing, China. In total, 2482 women (15.2%) were diagnosed with GDM. We assessed the individual daily average exposure to air pollution, including PM2.5, PM10, O3, NO2, SO2, and CO based on the volunteers' addresses. We used high-accuracy gridded air pollution data generated by machine learning models to assess particulate matter per maternal exposure levels. We further analyzed the association of pre-pregnancy, early, and mid-pregnancy exposure to environmental pollutants using a generalized additive model (GAM) and distributed lag nonlinear models (DLNMs) to analyze the association between exposure at specific gestational weeks and the risk of GDM. We observed that, during the first trimester, per IQR increases for PM10 and PM2.5 exposure were associated with increased GDM risk (PM10: OR = 1.19, 95%CI: 1.07~1.33; PM2.5: OR = 1.32, 95%CI: 1.15~1.50) and isolated post-load hyperglycemia (GDM-IPH) risk (PM10: OR = 1.23, 95%CI: 1.09~1.39; PM2.5: OR = 1.38, 95%CI: 1.18~1.61). Second-trimester O3 exposure was positively correlated with the associated risk of GDM, while pre-pregnancy and first-trimester exposure was negatively associated with the risk of GDM-IPH. Exposure to SO2 in the second trimester was negatively associated with the risk of GDM-IPH. However, there were no observed associations between NO2 and CO exposure and the risk of GDM and its subgroups. Our results suggest that maternal exposure to particulate matter during early pregnancy and exposure to O3 in the second trimester might increase the risk of GDM, and GDM-IPH is the susceptible GDM subtype to airborne particulate matter exposure.
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Affiliation(s)
- Xiaoling Zeng
- Institute of Toxicology, Facutly of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China; (X.Z.); (T.W.); (Q.C.)
- School of Public Health, China Medical University, Shenyang 110122, China
| | - Yu Zhan
- Department of Environmental Science and Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (Z.Q.)
| | - Wei Zhou
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children’s Hospital of Chongqing Medical University), Chongqing 401147, China; (W.Z.); (Q.H.)
| | - Zhimei Qiu
- Department of Environmental Science and Engineering, Sichuan University, Chengdu 610065, China; (Y.Z.); (Z.Q.)
| | - Tong Wang
- Institute of Toxicology, Facutly of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China; (X.Z.); (T.W.); (Q.C.)
| | - Qing Chen
- Institute of Toxicology, Facutly of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China; (X.Z.); (T.W.); (Q.C.)
| | - Dandan Qu
- Clinical Research Centre, Women and Children’s Hospital of Chongqing Medical University, Chongqing 401147, China;
- Chongqing Research Centre for Prevention & Control of Maternal and Child Diseases and Public Health, Women and Children’s Hospital of Chongqing Medical University, Chongqing 401147, China
| | - Qiao Huang
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children’s Hospital of Chongqing Medical University), Chongqing 401147, China; (W.Z.); (Q.H.)
| | - Jia Cao
- Institute of Toxicology, Facutly of Military Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China; (X.Z.); (T.W.); (Q.C.)
| | - Niya Zhou
- Clinical Research Centre, Women and Children’s Hospital of Chongqing Medical University, Chongqing 401147, China;
- Chongqing Research Centre for Prevention & Control of Maternal and Child Diseases and Public Health, Women and Children’s Hospital of Chongqing Medical University, Chongqing 401147, China
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15
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Sun HZ, Zhao J, Liu X, Qiu M, Shen H, Guillas S, Giorio C, Staniaszek Z, Yu P, Wan MW, Chim MM, van Daalen KR, Li Y, Liu Z, Xia M, Ke S, Zhao H, Wang H, He K, Liu H, Guo Y, Archibald AT. Antagonism between ambient ozone increase and urbanization-oriented population migration on Chinese cardiopulmonary mortality. Innovation (N Y) 2023; 4:100517. [PMID: 37822762 PMCID: PMC10562756 DOI: 10.1016/j.xinn.2023.100517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/17/2023] [Indexed: 10/13/2023] Open
Abstract
Ever-increasing ambient ozone (O3) pollution in China has been exacerbating cardiopulmonary premature deaths. However, the urban-rural exposure inequity has seldom been explored. Here, we assess population-scale O3 exposure and mortality burdens between 1990 and 2019 based on integrated pollution tracking and epidemiological evidence. We find Chinese population have been suffering from climbing O3 exposure by 4.3 ± 2.8 ppb per decade as a result of rapid urbanization and growing prosperity of socioeconomic activities. Rural residents are broadly exposed to 9.8 ± 4.1 ppb higher ambient O3 than the adjacent urban citizens, and thus urbanization-oriented migration compromises the exposure-associated mortality on total population. Cardiopulmonary excess premature deaths attributable to long-term O3 exposure, 373,500 (95% uncertainty interval [UI]: 240,600-510,900) in 2019, is underestimated in previous studies due to ignorance of cardiovascular causes. Future O3 pollution policy should focus more on rural population who are facing an aggravating threat of mortality risks to ameliorate environmental health injustice.
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Affiliation(s)
- Haitong Zhe Sun
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
- Department of Earth Sciences, University of Cambridge, Cambridge CB2 3EQ, UK
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Junchao Zhao
- State Key Joint Laboratory of ESPC, State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, School of Environment, Tsinghua University, Beijing 100084, China
| | - Xiang Liu
- School of Atmospheric Sciences, Nanjing University, Nanjing 210023, China
| | - Minghao Qiu
- Department of Earth System Science, Stanford University, Stanford, CA 94305, USA
| | - Huizhong Shen
- School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Serge Guillas
- Department of Statistical Science, University College London, London WC1E 6BT, UK
- The Alan Turing Institute, London NW1 2DB, UK
| | - Chiara Giorio
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
| | - Zosia Staniaszek
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
| | - Pei Yu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Michelle W.L. Wan
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
| | - Man Mei Chim
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
| | - Kim Robin van Daalen
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Heart and Lung Research Institute, University of Cambridge, Cambridge CB2 0BD, UK
- Barcelona Supercomputing Center, Department of Earth Sciences, 08034 Barcelona, Spain
| | - Yilin Li
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
| | - Zhenze Liu
- School of Environmental Science and Engineering, Nanjing University of Information Science and Technology, Nanjing 210044, China
| | - Mingtao Xia
- Department of Mathematics, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Shengxian Ke
- State Key Laboratory of New Ceramics and Fine Processing, Key Laboratory of Advanced Materials of Ministry of Education, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Haifan Zhao
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
| | - Haikun Wang
- School of Atmospheric Sciences, Nanjing University, Nanjing 210023, China
| | - Kebin He
- State Key Joint Laboratory of ESPC, State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, School of Environment, Tsinghua University, Beijing 100084, China
| | - Huan Liu
- State Key Joint Laboratory of ESPC, State Environmental Protection Key Laboratory of Sources and Control of Air Pollution Complex, School of Environment, Tsinghua University, Beijing 100084, China
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Alexander T. Archibald
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK
- National Centre for Atmospheric Science, Cambridge CB2 1EW, UK
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16
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Huang K, Feng LF, Liu ZY, Li ZH, Mao YC, Wang XQ, Zhao JW, Zhang KD, Li YQ, Wang J, Yu WJ, Cheng X, Yang XY, Li J, Zhang XJ. The modification of meteorological factors on the relationship between air pollution and periodontal diseases: an exploration based on different interaction strategies. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:8187-8202. [PMID: 37552412 DOI: 10.1007/s10653-023-01705-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
We aimed to characterize the association between air pollutants exposure and periodontal diseases outpatient visits and to explore the interactions between ambient air pollutants and meteorological factors. The outpatient visits data of several large stomatological and general hospitals in Hefei during 2015-2020 were collected to explore the relationship between daily air pollutants exposure and periodontal diseases by combining Poisson's generalized linear model (GLMs) and distributed lag nonlinear model (DLNMs). Subgroup analysis was performed to identify the vulnerability of different populations to air pollutants exposure. The interaction between air pollutants and meteorological factors was verified in both multiplicative and additive interaction models. An interquartile range (IQR) increased in nitrogen dioxide (NO2) concentration was associated with the greatest lag-specific relative risk (RR) of gingivitis at lag 3 days (RR = 1.087, 95% CI 1.008-1.173). Fine particulate matter (PM2.5) exposure also increased the risk of periodontitis at the day of exposure (RR = 1.049, 95% CI 1.004-1.096). Elderly patients with gingivitis and periodontitis were both vulnerable to PM2.5 exposure. The interaction analyses showed that exposure to high levels of NO2 at low temperatures was related to an increased risk of gingivitis, while exposure to high levels of NO2 and PM2.5 may also increase the risk of gingivitis and periodontitis in the high-humidity environment, respectively. This study supported that NO2 and PM2.5 exposure increased the risk of gingivitis and periodontitis outpatient visits, respectively. Besides, the adverse effects of air pollutants exposure on periodontal diseases may vary depending on ambient temperature and humidity.
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Affiliation(s)
- Kai Huang
- The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230032, China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Lin-Fei Feng
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230032, China
| | - Zhe-Ye Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Zhen-Hua Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Yi-Cheng Mao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xin-Qiang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Jia-Wen Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Kang-Di Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Ying-Qing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Jie Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Wen-Jie Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xin Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xi-Yao Yang
- The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230032, China
| | - Jiong Li
- College and Hospital of Stomatology, Key Laboratory of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei, 230032, China
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
- College and Hospital of Stomatology, Key Laboratory of Oral Diseases Research of Anhui Province, Anhui Medical University, Hefei, 230032, China.
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Hu S, Xu X, Li C, Zhang L, Xing X, He J, Guo P, Zhang J, Niu Y, Chen S, Zhang R, Liu F, Ma S, Zhang M, Guo F, Zhang M. Long-term exposure to ambient ozone at workplace is positively and non-linearly associated with incident hypertension and blood pressure: longitudinal evidence from the Beijing-Tianjin-Hebei medical examination cohort. BMC Public Health 2023; 23:2011. [PMID: 37845647 PMCID: PMC10577958 DOI: 10.1186/s12889-023-16932-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/07/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND There is limited longitudinal evidence on the hypertensive effects of long-term exposure to ambient O3. We investigated the association between long-term O3 exposure at workplace and incident hypertension, diastolic blood pressure (DBP), systolic blood pressure (SBP), pulse pressure (PP), and mean arterial pressure (MAP) in general working adults. METHODS We conducted a cohort study by recruiting over 30,000 medical examination attendees through multistage stratified cluster sampling. Participants completed a standard questionnaire and comprehensive medical examination. Three-year ambient O3 concentrations at each employed participant's workplace were estimated using a two-stage machine learning model. Mixed-effects Cox proportional hazards models and linear mixed-effects models were used to examine the effect of O3 concentrations on incident hypertension and blood pressure parameters, respectively. Generalized additive mixed models were used to explore non-linear concentration-response relationships. RESULTS A total of 16,630 hypertension-free working participants at baseline finished the follow-up. The mean (SD) O3 exposure was 45.26 (2.70) ppb. The cumulative incidence of hypertension was 7.11 (95% CI: 6.76, 7.47) per 100 person-years. Long-term O3 exposure was independently, positively and non-linearly associated with incident hypertension (Hazard ratios (95% CI) for Q2, Q3, and Q4 were 1.77 (1.34, 2.36), 2.06 (1.42, 3.00) and 3.43 (2.46, 4.79), respectively, as compared with the first quartile (Q1)), DBP (β (95% CI) was 0.65 (0.01, 1.30) for Q2, as compared to Q1), SBP (β (95% CI) was 2.88 (2.00, 3.77), 2.49 (1.36, 3.61) and 2.61 (1.64, 3.58) for Q2, Q3, and Q4, respectively), PP (β (95% CI) was 2.12 (1.36, 2.87), 2.03 (1.18, 2.87) and 2.14 (1.38, 2.90) for Q2, Q3, and Q4, respectively), and MAP (β (95% CI) was 1.39 (0.76, 2.02), 1.04 (0.24, 1.84) and 1.12 (0.43, 1.82) for Q2, Q3, and Q4, respectively). The associations were robust across sex, age, BMI, and when considering PM2.5 and NO2. CONCLUSIONS To our knowledge, this is the first cohort study in the general population that demonstrates the non-linear hypertensive effects of long-term O3 exposure. The findings are particularly relevant for policymakers and researchers involved in ambient pollution and public health, supporting the integration of reduction of ambient O3 into public health interventions.
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Affiliation(s)
- Songhua Hu
- School of Statistics and Data Science, Nankai University, Tianjin, China
- Big Data Center for Children's Medical Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Ximing Xu
- Big Data Center for Children's Medical Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Chunjun Li
- Tianjin Union Medical Center, Tianjin, China
| | - Li Zhang
- Tianjin First Central Hospital, Tianjin, China
| | - Xiaolong Xing
- School of Medicine, Nankai University, Tianjin, China
| | - Jiangshan He
- School of Medicine, Nankai University, Tianjin, China
| | - Pei Guo
- School of Medicine, Nankai University, Tianjin, China
| | - Jingbo Zhang
- Beijing Physical Examination Center, Beijing, China
| | - Yujie Niu
- Hebei Key Laboratory of Environment and Human Health, Shijiazhuang, China
- Department of Occupational Health and Environmental Health, Hebei Medical University, Shijiazhuang, China
| | - Shuo Chen
- Beijing Physical Examination Center, Beijing, China
| | - Rong Zhang
- Hebei Key Laboratory of Environment and Human Health, Shijiazhuang, China
- Department of Occupational Health and Environmental Health, Hebei Medical University, Shijiazhuang, China
| | - Feng Liu
- Beijing Physical Examination Center, Beijing, China
| | - Shitao Ma
- Hebei Key Laboratory of Environment and Human Health, Shijiazhuang, China
- Department of Occupational Health and Environmental Health, Hebei Medical University, Shijiazhuang, China
| | - Mianzhi Zhang
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
- Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Fenghua Guo
- School of Medicine, Nankai University, Tianjin, China
| | - Minying Zhang
- School of Medicine, Nankai University, Tianjin, China.
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Zhang Y, Yin Z, Li S, Zhang JJ, Sun HZ, Liu K, Shirai K, Hu K, Qiu C, Liu X, Li Y, Zeng Y, Yao Y. Ambient PM 2.5, ozone and mortality in Chinese older adults: A nationwide cohort analysis (2005-2018). JOURNAL OF HAZARDOUS MATERIALS 2023; 454:131539. [PMID: 37149946 PMCID: PMC11758737 DOI: 10.1016/j.jhazmat.2023.131539] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/17/2023] [Accepted: 04/27/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Cohort evidence linking long-term survival with exposure to multiple air pollutants (e.g., fine particulate matter [PM2.5] and ozone) was extensively sparse in low- and middle-income countries, especially among older adults. This study aimed to investigate potential associations of long-term exposures to PM2.5 and ozone with all-cause mortality in Chinese older adults. METHODS A dynamic nationwide prospective cohort comprising 20,352 adults aged ≥65 years were enrolled from the Chinese Longitudinal Healthy Longevity Study and followed up through 2005-2018. Participants' annual exposures to warm-season ozone and year-round PM2.5 were assigned using satellite-derived spatiotemporal estimates. A directed acyclic graph (DAG) was developed to identify confounding variables. Associations of annual mean exposures to PM2.5 and ozone with mortality were evaluated using single- and two-pollutant Cox proportional hazards models, adjusting for time-dependent individual risk factors and ambient temperature. RESULTS During 100 thousand person-years of follow-up (median: 3.6 years), a total of 14,313 death events occurred. The participants were averagely aged 87.1 years at baseline and exposed to a wide range of annual average concentrations of warm-season maximum 8-hour ozone (mean, 54.4 ppb; range, 23.3-81.6 ppb) and year-round PM2.5 (mean, 65.5 μg/m3; range, 10.1-162.9 μg/m3). Approximately linear concentration-response relationship was identified for ozone, whereas significant increases in PM2.5-associated mortality risks were observed only when concentrations were above 60 μg/m3. Rises of 10 ppb in ozone and 10 µg/m3 in PM2.5 above 60 µg/m3 were associated with increases in all-cause mortality of 13.2% (95% confidence interval [CI]: 10.2-16.2%) and 6.2% (95% CI: 4.6-7.7%) in DAG-based single-pollutant model, and of 9.7% (95% CI: 6.6-13.0%) and 5.3% (95% CI: 3.7-6.9%) in DAG-based two-pollutant model, respectively. We detected significant effect modification by temperature in associations of mortality with ozone (P <0.001 for interaction), suggesting greater ozone-related risks among participants in warmer locations. CONCLUSIONS This study provided longitudinal evidence that long-term exposure to ambient PM2.5 and ozone significantly and independently contributed to elevated risks of all-cause mortality among older adults in China.
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Affiliation(s)
- Yunquan Zhang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Zhouxin Yin
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China; School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen 518055, China
| | - Shaojie Li
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Junfeng Jim Zhang
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Haitong Zhe Sun
- Centre for Atmospheric Science, Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, UK; Department of Earth Sciences, University of Cambridge, Cambridge CB2 3EQ, UK
| | - Keyang Liu
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita Shi, Osaka, Japan
| | - Kokoro Shirai
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita Shi, Osaka, Japan
| | - Kejia Hu
- Institute of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou 310058, China
| | - Chengxuan Qiu
- Aging Research Center, Karolinska Institutet, Widerströmska Huset, SE-171 65 Solna, Sweden
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yachen Li
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yi Zeng
- Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China; Center for the Study of Aging and Human Development and Geriatrics Division, Medical School of Duke University, Durham, NC, US.
| | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing, China; Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China.
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