Effect of PM2.5 air pollution on the global burden of lower respiratory infections, 1990-2019: A systematic analysis from the Global Burden of Disease Study 2019

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

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

Global trends in staphylococcus aureus-related lower respiratory infections from 1990 to 2021: findings from the 2021 global burden of disease report

BACKGROUND

Lower respiratory infections (LRIs) represent a significant global health issue, especially affecting low- and middle-income countries. In this study, we explored the mortality and disability-adjusted life years (DALYs) associated with Staphylococcus aureus-related LRIs from 1990 to 2021, highlighting trends by age, sex, and Socio-Demographic Index (SDI).

METHODS

Data were derived from the 2021 Global Burden of Disease (GBD) database. Temporal trends in age-standardized mortality rates (ASMR) and disability-adjusted life years (DALYs) rates (ASDR) for S. aureus-related LRIs were analyzed based on the average annual percent change (AAPC), in terms of sex, 20-age groups, 21 regions, 204 countries, and 5 SDI quintiles.

RESULTS

In 2021, S. aureus-related LRIs contributed to 423,837 deaths (95% UI: 382,183-458,926), a 67.56% increase since 1990. In comparison, the global ASMR was 5.43 per 100,000 (95% UI: 4.89-5.90), and the ASDR was 156.80 per 100,000 (95% UI: 139.44-176.08), both exhibiting a declining trend compared to 1990. Rates were higher in low SDI regions, with Central Sub-Saharan Africa reporting the highest ASMR, while Eastern Europe had the lowest. Among the 204 countries analyzed, Zimbabwe recorded high ASMR and ASDR, at 24.84 (95% UI: 19.44-30.16) and 754.34 (95% UI: 591.05-923.06), respectively.

CONCLUSIONS

Although the global ASMR and ASDR decreased in 2021, the number of deaths from S. aureus-related LRIs significantly increased driven by the growing population and proportion of aged individuals. Additionally, the emergence of multidrug-resistant strains has made treatment more complex, particularly in low SDI regions, highlighting the urgent need for more targeted strategies, therapies, and vaccines.

Global, regional, and national burden of cardiovascular disease attributable to high body mass index from 1990 to 2021 and projection to 2045

Background

High body mass index (HBMI) is strongly associated with cardiovascular disease (CVD), but the global burden of CVD attributable to HBMI remains poorly defined. This study aims to elucidate the current burden and temporal trends of CVD attributable to HBMI.

Methods

We used data from the Global Burden of Disease Study (GBD) 2021 to estimate CVD deaths and disability-adjusted life years (DALYs) attributable to HBMI. Our analysis examines trends in deaths and DALYs by age, gender, and Socio-demographic Index (SDI) across global, regional, and national levels from 1990 to 2021. We used health inequality and decomposition analyses to quantify the influencing factors of disease burden and a Bayesian age-period-cohort (BAPC) model to predict the potential trend of HBMI on CVD burden.

Results

In 2021, HBMI-related CVD resulted in approximately 1.9 million deaths and 45.43 million DALYs among urban and rural populations, with an age-standardized mortality rate (ASMR) of 22.77 (95% UI, 12.87-34.24) and an age-standardized disability rate (ASDR) of 529.00 (95% UI, 277.28-808.64) per 100,000 people. Over the study period, the overall CVD burden attributable to HBMI decreased significantly, while the burden of atrial fibrillation and flutter increased. The disease burden was closely tied to socioeconomic development and was unevenly distributed, with middle SDI regions experiencing a heavier burden. The highest burden was observed in individuals aged 84 and older, with a significant increase in the 20-44 age group. Decomposition analysis revealed that the increase in DALYs was driven by population growth. Projections from the BAPC model suggest that by 2045, global DALYs of CVD attributable to HBMI may continue to increase.

Conclusions

This study provides a comprehensive epidemiological assessment of the CVD burden attributable to HBMI across various regions and populations, offering valuable insights for guiding policy and research efforts.

Burden of non-COVID-19 lower respiratory infections in China (1990-2021): a global burden of disease study analysis

BACKGROUND

The assessment of lower respiratory infection (LRI) mortality, incidence, and responsible pathogens in China provides a scientific basis for the prevention and management of LRI, especially for evaluating the impact of coronavirus disease 2019 (COVID-19). We provide a national estimate of the non-COVID-19 LRI burden and trends on people from 1990 to 2021 based on Global Burden of Disease (GBD) study 2021.

METHODS

We estimated China's mortality, incidence, disability-adjusted life years (DALYs), risk factors and aetiology attribution for LRI without including COVID-19 by using the estimated data of GBD study 2021. Mortality, incidence, DALYs, risk factors and aetiology were stratified by sex and age. Trends were evaluated using estimated annual percentage change.

RESULTS

In 2021, it is estimated that there were 206930.22 deaths (95% uncertainty interval [UI]: 171260.88-251990.47), with all-age mortality rate of 14.54 deaths (95% UI: 12.04-17.71) per 100,000 population. Compared to 2019, the all-age mortality rate had a 3.60% increase. Analyzing risk factors from 1990 to 2021, we found that the percentage of DALYs attributed to tobacco increased from 7.44% (95% UI: 1.26-15.72%) to 22.14% (95% UI: 3.28-38.41%), and that attributable to ambient particulate matter pollution increased from 19.84% (95% UI: 8.79-30.20%) to 32.72% (95% UI: 22.78-41.77%). The leading cause of mortality from LRIs remains Streptococcus pneumoniae from 1990 to 2021. However, the proportions of viral infections decreased. Compared to 2019, the proportion of deaths in 2021 caused by Influenza decreased from 13.03 to 2.70%, and the proportion of deaths due to RSV decreased from 2.21 to 0.41%.

CONCLUSIONS

In China, substantial progress has been made in reducing LRI mortality, yet LRIs have remained a threat in China from 1990 to 2021. During the COVID-19 pandemic, the mortality attributable to Influenza and RSV declined. Effective vaccines and treatments targeted at the main pathogens of LRI are important.

CLINICAL TRIAL NUMBER

Not applicable.

The burden of acute respiratory infection in children under 5 attributable to economic inequality in low- and middle-income countries

BACKGROUND

Quantifying the disease burden among children that could potentially be reduced through improvements in individual economic status and regional economic equality can greatly benefit policy making and resource allocation. However, such quantification has rarely been done. This study aimed to assess the inequality-related burden of acute respiratory infection (ARI) (the leading cause of child mortality in low- and middle-income countries (LMICs)) among under five children.

METHODS

This study integrated the Demographic and Health Survey data from 53 countries and linked individual records to a novel proxy of economic development status, the satellite night-time light (NTL). We assessed the number of children affected by ARI attributable to within-country economic disparities (eg, NTL

RESULTS

The odds of experiencing ARI were decreased significantly (3.5% ((95% confidence interval (CI) 1.4% to 4.4%)) for every 10-digit number increase in NTL. The exposure-response function showed constant decreasing in the risk of ARI as NTL level increases. It is estimated that within-country economic disparities contributed to 11.0% (95% CI 6.1% to 15.6%) of all children affected by ARI in 2001, which was decreased to 8.1% (95% CI 4.2% to 11.8%) in 2019. In contrast, the inequality-related burden remained stable. In sub-Saharan Africa, it increased from 4.8% (95% CI 1.7% to 8.0%) in 2001 to 6.8% (95% CI 3.0%-9.8%) in 2019. Eliminating within-country inequality would have avoided 522 136 (95% CI 2 66 760 to 7 57 414) cases of ARI among children across the 133 LMICs in 2019.

CONCLUSION

Our study revealed a protective effect of economic status on preventing ARI in children under 5 years of age. The considerable burden of childhood ARI was attributable to the economic inequality in LMICs. Optimising the allocation of economic resources can safeguard child health.

Collapse

Key Words

• Child health
• Cross-sectional survey
• Epidemiology
• Global Health

Collapse

MESH Headings

• Humans
• Respiratory Tract Infections/epidemiology
• Child, Preschool
• Developing Countries/statistics & numerical data
• Infant
• Male
• Female
• Cost of Illness
• Acute Disease
• Socioeconomic Factors
• Health Status Disparities
• Health Surveys

Collapse

Grants

• Science & Technology Fundamental Resources Investigation Program
• National Natural Science Foundation of China
• young elite scientist sponsorship program by BAST

Collapse

Affiliation(s)

Hailu Zhu School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Ke Huang National Center for Respiratory Diseases; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
Xueyan Han School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Zhaoyang Pan School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Hanchao Cheng School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Qi Wang School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Yicong Wang School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Wei Sun School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Jiarun Mi School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Ting Yang National Center for Respiratory Diseases; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
Tianjia Guan School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Tao Xue Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics / Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, China Advanced Institute of Information Technology, Peking University, Hangzhou, China State Environmental Protection Key Laboratory of Atmospheric Exposure and Health Risk Management, Center for Environment and Health, Peking University, Beijing, China
Chen Wang National Center for Respiratory Diseases; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Collapse

Collaborators Collapse

Household air pollution and respiratory health in Africa: persistent risk and unchanged health burdens

PURPOSE OF REVIEW

Despite evidence emerging from the Global Burden of Disease studies that biomass use and household air pollution are declining globally, with important positive health impacts for households in low- and middle-income countries, these trends have not been equally documented in African countries. This review describes the state of household air pollution exposure and its relationship with respiratory disease in Africa.

RECENT FINDINGS

African studies on this topic are limited, and generally focus on respiratory infections. Most evidence emerge from models based on the Global Burden of Disease data, and from limited individual epidemiological studies across the continent. More than 80% of the African population is exposed to household air pollution. Women and children continue to bear the substantial burden of exposure. Evidence from limited exposure-response studies strongly points to household air pollution being the major driver of acute and chronic respiratory diseases on the continent.

SUMMARY

Respiratory infections, particularly in children, and other chronic respiratory diseases, are strongly attributable to household air pollution. Elimination of such exposures through interventions such as cleaner fuels and preferably, electricity, is critical to improving respiratory health on the continent.

Multiphase Radical Chemical Processes Induced by Air Pollutants and the Associated Health Effects

Air pollution is increasingly recognized as a significant health risk, yet our understanding of its underlying chemical and physiological mechanisms remains incomplete. Fine particulate matter (PM2.5) and ozone (O3) interact with biomolecules in intracellular and microenvironments, such as the epithelial lining fluid (ELF), leading to the generation of reactive oxygen species (ROS). These ROS trigger cellular inflammatory responses and oxidative stress, contributing to a spectrum of diseases affecting the respiratory, cardiovascular, and central nervous systems. Extensive epidemiological and toxicological research highlights the pivotal role of ROS in air pollution-related diseases. It is crucial to comprehend the intricate chemical processes and accompanying physiological effects of ROS from air pollutants. This review aims to systematically summarize ROS generation mechanisms in the ELF and measurement techniques of oxidative potential (OP), taking the kinetic reactions of ROS cycling in the ELF as an example, and discusses the general health implications of ROS in respiratory, cardiovascular, and central nervous systems. Understanding these processes through interdisciplinary research is essential to develop effective and precise strategies as well as air quality standards to mitigate the public health impacts of air pollution globally.

Long-term exposure to air pollution and lower respiratory infections in a large population-based adult cohort in Catalonia

BACKGROUND

Evidence is limited regarding the role of air pollution in acute lower respiratory infections among adults. We assessed the influence of long-term air pollution exposure on hospital admission for lower respiratory infections and whether there are vulnerable subgroups.

METHODS

We used a populational cohort in Catalonia, Spain, comprising 3,817,820 adults residing in Catalonia as of January 1, 2015. Air pollution exposure was assigned to individuaĺs residential address using locally-developed models. We characterized the concentration-response functions between long-term air pollution exposure and hospital admission for lower respiratory infections between 2015 and 2019. We assessed interaction between exposure and clinical and socio-economic factors on multiplicative and additive scales.

RESULTS

An interquartile range exposure increase was associated with an 8 % (95 % Confidence Interval: 5 %-11 %) for Nitrogen Dioxide, 10 % (95 % Confidence Interval: 8 %-13 %) for Particulate Matter with diameter equal to or smaller than 2.5 µm, 5 % (95 % Confidence Interval: 3 %-7%) for Particulate Matter with diameter equal to or smaller than 10 µm and 18 % (95 % Confidence Interval: 14 %-22%) for ozone (adjusted by Nitrogen Dioxide) increase in hospital admissions for respiratory infections. Concentration-response functions were non-linear, with steeper slopes at exposures below the median or at most extreme high values. Associations were consistently greater for individuals over 65 years or with hypertension diagnosis and males.

CONCLUSIONS

Long-term exposure to air pollution was positively associated with hospital admission for lower respiratory infections. Individuals who were older than 65 years, hypertensive or male were most vulnerable.

Epidemiological shifts in chronic kidney disease: a 30-year global and regional assessment

BACKGROUND

Chronic kidney disease (CKD) presents a growing global health challenge, with significant variability in disease burden across different regions and countries. This study aimed to analyze the trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for CKD from 1990 to 2019, utilizing data from the Global Burden of Disease Study.

METHODS

We conducted an in-depth study on the global and age-standardized incidence, prevalence, mortality, and DALYs of CKD, and assessed trends over a 30-year period. Additionally, we explored the associations between healthcare access and quality (HAQ), the Socio-Demographic Index (SDI), and CKD. Furthermore, we conducted a detailed analysis of six risk factors closely related to CKD, and based on these findings, provided strong evidence for enhancing the management of CKD.

RESULTS

In 2019, there were 18,986,903 cases of CKD, with an average annual percent change (AAPC) of 1.82 (95% CI = 1.8 to 1.82) in incidence since 1990. The age-standardized incidence rate increased from 192.45 per 100,000 in 1990 to 233.65 per 100,000 in 2019. Prevalence also rose, with a total of 69,729,430 cases in 2019 and an AAPC of 1.19 (95% CI = 1.19 to 1.2). Mortality and DALYs have increased correspondingly, with the mortality rate reaching 18.29 per 100,000 and total DALYs at 41,538,592 in 2019. The analysis showed that higher HAQ levels are associated with better outcomes in terms of lower mortality and DALY rates, whereas lower HAQ levels correlate with poorer outcomes. In addition, high fasting plasma glucose and high systolic blood pressure are the main contributors to CKD-related deaths, with their population attributable fraction (PAF) significantly decreasing as the SDI decreases.

CONCLUSION

The burden of CKD has significantly increased over the past three decades, influenced by demographic changes and variations in healthcare quality and access. Effective public health strategies and improvements in healthcare delivery are needed to address the disparities in CKD outcomes globally.

Long-term trends and comparison of the burden of lower respiratory tract infections in China and globally from 1990 to 2021: an analysis based on the Global Burden of Disease study 2021

Background

This study aimed to describe the temporal trends in the age and sex burdens of lower respiratory infections (LRIs) in China and globally from 1990 to 2021 and to analyze their epidemiological characteristics to formulate corresponding strategies to control LRIs.

Methods

This study utilized open data from the Global Burden of Disease (GBD) database from 1990 to 2021 to assess the burden of disease based on the prevalence, incidence, mortality, years lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of LRIs in China and globally. Moreover, a comprehensive comparative analysis of the epidemiological characteristics of LRIs in China and globally was conducted via the Joinpoint regression model, age-period-cohort model (APC model), and stratified analysis of the study method from multiple dimensions, such as age, sex, and period. Finally, we used an autoregressive integrated moving average (ARIMA) model to predict the disease burden in LRIs over the next 15 years.

Results

From 1990 to 2021, China's age-standardized incidence, deaths, and disability-adjusted life year (DALY) rates per 100,000 people decreased from 5,481.13 (95% CI: 5,149.05, 5,836.35) to 2,853.81 (95% CI: 2,663.94, 3,067.55), from 60.65 (95% CI. 52.96, 66.66) to 14.03 (95% CI: 11.68, 17) and from 3,128.39 (95% CI: 2,724.11, 3,579.57) to 347.67 (95% CI: 301.28, 402.94). The global age-standardized incidence, deaths, and DALY rates per 100,000 people, on the other hand, decreased from 6,373.17 (95% CI: 5,993.51, 6,746.04) to 4,283.61 (95% CI: 4,057.03, 4,524.89) and from 61.81 (95% CI: 56.66, 66.74) to 28.67 (95% CI: 25.92, 31.07) and from 3,472.9 (95% CI: 3,090.71, 3,872.11) to 1,168.8 (95% CI: 1,016.96, 1,336.95). The decline in the aforementioned indicators is greater in the female population than in the male population, and the decrease in China is more pronounced than the global trend. In China, the age-standardized incidence and mortality rates of LRIs showed an annual average percentage change (AAPC) of -2.12 (95% CI: -2.20, -2.03) and -4.77 (95% CI: -5.14, -4.39), respectively. Globally, the age-standardized incidence and mortality rates for LRIs decreased by -1.28 (95% CI: -1.37, -1.18) and -2.47 (95% CI: -2.61, -2.32). By 2036, the incidence of lower respiratory infections (LRI) among men and women in China is projected to decrease by 36.55 and 46.87%, respectively, while the mortality rates are expected to decline to 12.67% for men and increase by 71.85% for women. In comparison, the global decline in LRI incidence is lower than that observed in China, yet the reduction in mortality rates is greater globally than in China.

Conclusions

Age-standardized incidence, mortality and disability-adjusted life years (DALYs) decreased more in China than at the global level between 1990 and 2021. Compared with the previous period, the COVID-19 pandemic has led to a significant decrease in the disease burden of LRIs. As the population continues to age, the disease burden of LRIs in the old adult population will become a major new public health challenge.

Risk assessment of PM2.5 from fossil energy consumption on the respiratory health of the elderly

Air pollution mainly comes from fossil energy consumption (FEC), and it brings great threat to public health. The respiratory system of the elderly is highly susceptible to the effects of air pollution due to the decline in body functions. PM2.5 is a major component of air pollution, so the study of the impact of PM2.5 generated by FEC on the respiratory health of the elderly is of great significance. The existing studies have focused more on the effect of PM2.5 on mortality, and this paper is a useful addition to the existing studies by examining the effect of PM2.5 from FEC on the health of the elderly from the perspective of prevalence. In this paper, the binary Logistic regression model was used to calculate the exposure-response relationship coefficient for respiratory health in older adults using the data in 2018 from the Chinese Longitudinal Healthy Longevity Survey. And referring to the Dynamic Projection model for Emissions in China, the changes in the number of older persons suffering from respiratory diseases due to PM2.5 from FEC in the baseline scenario, the clean air scenario, and the on-time peak-clean air scenario were predicted. The results indicated that: (1) PM2.5 from FEC mainly came from coal; (2) PM2.5 from FEC was detrimental to the respiratory health of the elderly, and older seniors were more affected as they age; (3) In the on-time peak-clean air scenario, the number of elderly people suffering from respiratory diseases due to PM2.5 from FEC was growing at the slowest rate. Based on the above results, this paper raised recommendations for reducing the effect of PM2.5 from FEC on the health of the elderly.

A fingerprint of source-specific health risk of PM2.5-bound components over a coastal industrial city

The influence of specific local land-use activities (continuously redistributing elements across environments) and environmental conditions (altering the chemical composition of airborne particulate matter) on the intrinsic health risk of PM2.5 exposure is sparsely reported. To fill this gap, we employed a novel integrated approach to address the influence of short-term changes in source-specific PM2.5 composition on the exposure-response risk, while controlling for weather conditions. We combine receptor-based source apportionment with conditional logistic regression in a space-time-stratified case-crossover design. This approach is different from previous studies as it: i) controls the impact of spatiotemporal variations in air pollution and human mobility using multilocation-specific fixed and disjointed space-time strata ii) addresses the spatial heterogeneity of personal exposure separating its variable effect from other predictors by allowing different baseline hazards for each space-time stratum; iii) aligns case/control periods with strong/regular episodes of source-specific PM-multipollutant fingerprint contributions rather than health outcomes. This enabled comprehensive examination of the association between source-specific PM2.5-bound species and cardiorespiratory disease hospitalizations. The epidemiological findings were that primary anthropogenic emissions [industrial (ORs 2.5 - 4.8)] were associated with higher 1-day moving average PM-induced risks. Natural-related sources [fresh / aged sea salt aerosol, dust, soil resuspension] and secondary sulfate formation were consistently associated with higher health risks (ORs 1.0 - 1.54) after 1 to 5-days since exposure. The results emphasize the importance of source-specific air quality management in complex areas and our research provides an adaptable universal tool to support targeted place-based policy interventions to mitigate air pollution impacts on health.

Global air quality enhancement pathways to health benefits and environmental justice

Nowadays, air pollution has emerged as a critical global health and environmental justice issue, with a stark contrast in exposure and management between high-, middle-, and low-income countries. This study synthesizes satellite-derived data with Global Burden of Disease insights, examining the spatiotemporal trends of PM2.5 and O3 exposures and their health impacts from 1998 to 2019. Despite a reversal in the global upward trend of PM2.5 exposure post-2011, O3 levels persist, highlighting a geographical disparity in health benefits due to air quality policies. The study reveals that while a reduction in indoor PM2.5 pollution has led to significant health gains, the rise in outdoor PM2.5 and O3 pollution continues to escalate the global death toll. The research underscores the urgent need for tailored governance strategies to address the primary pollution conditions in various income-level regions, advocating for environmental justice and equality. The findings suggest that targeted air pollution management could not only mitigate the health risks but also enhance life expectancy, emphasizing the potential for substantial health benefits through improved air quality regulations.

Non-linear association between air pollutants and secondary sensitive skin in acne patients

BACKGROUND

There is a growing number of patients suffering from sensitive skin secondary to acne, but its prevalence and influencing factors are not yet well-understood.

OBJECTIVE

The aim of this study is to investigate the nonlinear relationship between air pollutants and secondary sensitive skin in acne patients.

METHODS

A cross-sectional study comprising 4325 acne outpatients in China was carried out between September 2021 and December 2022, employing a simple random sampling approach. Air pollutants data was derived from the nearest air quality monitoring station corresponding to the subjects' residential locations. Furthermore, socio-economic characteristics, biological attributes, and lifestyle data of patients were acquired via questionnaire surveys. The data were subsequently analyzed utilizing the XGBoost machine learning model.

RESULTS

A nonlinear relationship has been observed between secondary sensitive skin in acne patients and various factors, including particulate matter (PM2.5), inhalable particulate matter (PM10), ozone (O3), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), the severity of depression, different levels of exercise intensity, acne grading, frequency of sunscreen application, gender, and age.

CONCLUSION

The occurrence of secondary sensitive skin in acne patients be mitigated through the implementation of measures such as the control of air pollutant emissions, regulation of negative emotions, and improvement of personal lifestyle.

Effect of water and sanitation, PM pollution and climate change of COPD and LRIs under different sociodemographic transitions

OBJECTIVES

To estimate the burden of chronic obstructive pulmonary disease (COPD) and lower respiratory tract infections (LRIs) stratified by geographic location, and social-demographic status for 21 regions across the world from 1990 to 2019.

STUDY DESIGN

The analysis utilized data from the Global Burden of Disease (GBD) Study, focusing on mortality and disability-adjusted life years (DALYs) as measures of COPD and LRI burden. Trend analyses using the Joinpoint model were conducted across five socio-demographic index (SDI) quintiles.

METHODS

We investigated the burden of COPD and LRIs employing restricted cubic splines to flexibly identify relationships between DALY rates and SDI. This method allowed for detailed examination of trends over time across different regions and socio-demographic contexts.

RESULTS

From 1990 to 2019, the ASMR of COPD attributed to PM for global and five SDI quintiles decreased 61.80 %, 53.41 %, 63.04 %, 63.00 %, 40.98 %, 12.14 % respectively. In terms of PM Pollution, there was an inverted U-shaped association between the DALY and SDI for COPD, the DALY rate associated with LRIs due to PM pollution exhibited a progressive decline as SDI increased.

CONCLUSION

Even though the trend in mortality and DALY of COPD and LRIs decreased globally, the COPD and LRI burden attributed to PM pollution remains high, particularly in lower SDI quintiles.

Increased impacts of aircraft activities on PM2.5 concentration and human health in China

The rapid development of China's aviation industry has caused a rapid increase in airport PM2.5 emissions. This study uses the Global Exposure Mortality Model (GEMM) to evaluate the monthly deaths caused by aircraft activities at 164 airports in China from 2015 to 2023, based on the PM2.5 concentration of airport aircraft activities and the detection data of the China National Environmental Monitoring Center, including twenty age groups, six diseases, and gender. This paper presents three main conclusions. Firstly, aviation PM2.5 emissions significantly impact mortality, with notable variations by year and season. The highest cumulative deaths are recorded in 2023, particularly in the third quarter, which peaked at 8,305 deaths. Despite the comparatively modest total of 11,604 deaths in 2022, a mere 0.2965 μg/m3 increase in PM2.5 concentration would precipitate an additional 39,138 deaths, representing a 1.05-fold rise from 2015. Secondly, the 80-84 age bracket exhibited the highest death proportion (16.51 %-18.73 %), while the 5-9 and 10-14 age groups had the lowest (0 %-0.13 %). Males aged 80-84 are the most affected demographic, with each 1 μg/m3 increase in PM2.5 leading to an additional 87 male deaths monthly in 2023, primarily from stroke and ischemic heart disease. In contrast, females only experienced 67 additional deaths per month from the same concentration increase. Lastly, airports in the economically vibrant Beijing-Shanghai-Guangzhou-Shenzhen region showed the highest mortality rates due to PM2.5 emissions. Airports in eastern coastal areas are more severely impacted than those in central and western China, revealing a spatial clustering of high death tolls in developed regions.

Review of in vitro studies evaluating respiratory toxicity of aerosols: impact of cell types, chemical composition, and atmospheric processing

In recent decades, several cell-based and acellular methods have been developed to evaluate ambient particulate matter (PM) toxicity. Although cell-based methods provide a more comprehensive assessment of PM toxicity, their results are difficult to comprehend due to the diversity in cellular endpoints, cell types, and assays and the interference of PM chemical components with some of the assays' techniques. In this review, we attempt to clarify some of these issues. We first discuss the morphological and immunological differences among various macrophage and epithelial cells, belonging to the respiratory systems of human and murine species, used in the in vitro studies evaluating PM toxicity. Then, we review the current state of knowledge on the role of different PM chemical components and the relevance of atmospheric processing and aging of aerosols in the respiratory toxicity of PM. Our review demonstrates the need to adopt more physiologically relevant cellular models such as epithelial (or endothelial) cells instead of macrophages for oxidative stress measurement. We suggest limiting macrophages for investigating other cellular responses (e.g., phagocytosis, inflammation, and DNA damage). Unlike monocultures (of macrophages and epithelial cells), which are generally used to study the direct effects of PM on a given cell type, the use of co-culture systems should be encouraged to investigate a more comprehensive effect of PM in the presence of other cells. Our review has identified two major groups of toxic PM chemical species from the existing literature, i.e., metals (Fe, Cu, Mn, Cr, Ni, and Zn) and organic compounds (PAHs, ketones, aliphatic and chlorinated hydrocarbons, and quinones). However, the relative toxicities of these species are still a matter of debate. Finally, the results of the existing studies investigating the effect of aging on PM toxicity are ambiguous, with varying results due to different cell types, different aging conditions, and the presence/absence of specific oxidants. More systematic studies are necessary to understand the role of different SOA precursors, interactions between different PM components, and aging conditions in the overall toxicity of PM. We anticipate that our review will guide future investigations by helping researchers choose appropriate cell models, resulting in a more meaningful interpretation of cell-based assays and thus ultimately leading to a better understanding of the health effects of PM exposure.

Systematic analysis and prediction of the burden of lower respiratory tract infections attribute to non-optimal temperature, 1990-2019

Background

Lower respiratory infections (LRIs) remain one of the most deadly infectious diseases in the world, and non-optimal temperature is a risk factor for LRIs. The aim of this study was to analyze the global burden of LRI attribute to non-optimal temperature and its trends from 1990 to 2019, and to project long-term trends.

Methods

Excerpts from the release of the 2019 Global Burden of Disease (GBD) study, which analyses the burden of lower respiratory infections due to non-optimal temperatures from 1990 to 2019 using data on deaths and disability adjusted life years (DALYs); explores differences across regions, populations and seasons, and projects future trends in burden.

Results

Between 1990 and 2019, there is a significant downward trend in the global burden of deaths and DALYs, but it remains high in infants and young children, the older adult, African countries and LOW SDI regions. Differences in geographical risk factors and economic levels lead to heterogeneous disease burdens across regions. In 2019, low SDI regions will have the highest burden, but high SDI regions will have the highest number of deaths. In addition, increasing SDI values were associated with decreasing trends in age-standardized mortality rates and disability-adjusted life years. BAPC model projections suggest a downward trend in the future burden of death and DALYs from the disease, but the improvement in the burden of death for women was not significant.

Conclusion

Our study comprehensively elucidates the distribution and dynamic trends in the burden of lower respiratory tract infections due to non-optimal temperatures from 1990 to 2019 along multiple dimensions. The burden of deaths and DALYs showed an overall decreasing trend, but the improvement was uneven in different regions. In addition, the results suggest that efforts should be made to reduce lower respiratory health losses in infants, young children, and older adult populations. Effective public health policies and interventions to reduce the burden of lower respiratory tract infections should be sustained globally.

Effect of the lack of access to handwashing facilities on the global burden of lower respiratory infections, 1990-2019: A systematic analysis from the global burden of disease study 2019

A lack of access to handwashing facilities is a significant risk factor for lower respiratory infections(LRIs). However, no studies have reported epidemiologic changes in the burden of LRIs attributed to the lack of access to handwashing facilities. We conducted an integrated assessment of the burden of LRIs attributable to the lack of handwashing facilities from 1990 to 2019 using data from the Global Burden of Disease Study 2019. In 2019, 270,000 deaths were attributed to LRIs due to a lack of access to handwashing facilities, with DALYs reaching 14.02 million. The age-standardized mortality rate (ASMR) of LRIs caused by a lack of access to handwashing facilities was approximately 3.74, while the age-standardized DALY rate (ASDR) was reported to be 203.55 in 2019. Over the past 30 years, the burden of LRIs attributed to the lack of access to handwashing facilities has shown a global decline. In 2019, this burden was most pronounced in infants under 1 year of age and in those older than 95 years, reflecting the highest DALY (5591.83) and mortality rates (79.43), respectively. The burden of LRIs caused by the lack of access to handwashing facilities was found to be more severe in males and significantly more pronounced in regions with a low sociodemographic index (SDI), such as the Sahara African region. The development of targeted strategies to address the inadequate and unequal distribution of handwashing facilities holds important value in improving the disease burden of LRIs.

Associations between long-term ambient PM2.5 exposure and the incidence of cardiopulmonary diseases and diabetes, attributable years lived with disability, and policy implication

Long-term exposure to ambient PM2.5 is known associated with cardiovascular and respiratory health effects. However, the heterogeneous concentrationresponse function (CRF) between PM2.5 exposure across different concentration range and cardiopulmonary disease and diabetes mellitus (DM) incidence, and their implications on attributable years lived with disability (YLD) and regulation policy has not been well-studied. In this retrospective longitudinal cohort study, disease-free participants (approximately 170,000 individuals, aged ≥ 30 years) from the MJ Health Database were followed up (2007-2017) regarding incidents of coronary heart disease (CHD), ischemic stroke, chronic obstructive pulmonary disease (COPD), lower respiratory tract infections (LRIs), and DM. We used a time-dependent nonlinear weight-transformation Cox regression model for the CRF with an address-matched 3-year mean PM2.5 exposure estimate. Town/district-specific PM2.5-attributable YLD were calculated by multiplying the disease incidence rate, population attributable fraction, disability weight, and sex-age group specific subpopulation for each disease separately. The estimated CRFs for cardiopulmonary diseases were heterogeneously with the hazard ratios (HRs) increased rapidly for CHD and ischemic stroke at PM2.5 concentration lower than 10 μg/m3, whereas the HRs for DM (LRIs) increased with PM2.5 higher than 15 (20) μg/m3. Women had higher HRs for ischemic stroke and DM but not CHD. Relative to the lowest observed PM2.5 concentration of 6 μg/m3 of the study population, the PM2.5 level with an extra risk of 0.1 % (comparable to the disease incidence) for CHD, ischemic stroke, DM, and LRIs were 8.59, 11.85, 22.09, and 24.23 μg/m3, respectively. The associated attributable YLD decreased by 51.4 % with LRIs reduced most (83.6 %), followed by DM (63.7 %) as a result of PM2.5 concentration reduction from 26.10 to 16.82 μg/m3 during 2011-2019 in Taiwan. The proportion of YLD due to CHD and ischemic stroke remained dominant (56.4 %-69.9 %). The cost-benefit analysis for the tradeoff between avoidable YLD and mitigation cost suggested an optimal PM2.5 exposure level at 12 μg/m3. CRFs for cardiopulmonary diseases, attributable YLD, and regulation level, may vary depending on the national/regional background and spatial distribution of PM2.5 concentrations, as well as demographic characteristics.

Exploring the Relationship between Acute Coronary Syndrome, Lower Respiratory Tract Infections, and Atmospheric Pollution

Background: Respiratory infections were found to be connected with the incidence of acute coronary syndrome (ACS). The proposed pathway of this connection includes inflammation, oxidative stress, pro-coagulation, and atherosclerotic plaque destabilization. This can cause rapture and thrombus formation, leading to ACS. Our study aimed to assess the risk factors for coronary artery thrombosis as a manifestation of ACS and for lower respiratory tract infections (LRTIs) in patients with ACS. Methods: The study included 876 patients with ACS from January 2014 to December 2018. Both the clinical data and air pollution data were analyzed. Statistical tests used for analysis included Student's t-test, the Mann-Whitney U-test, the Chi-squared test, and the odds ratio Altman calculation. Results: LRTIs were found in 9.13% patients with ACS. The patients with LRTI had a higher risk of coronary artery thrombosis (OR: 2.4903; CI: 1.3483 to 4.5996). Moreover, they had increased values of inflammatory markers, were older, had a lower BMI, and a higher rate of atrial fibrillation. The average atmospheric aerosols with a maximum diameter of 2.5 μm (PM2.5 concentration) from three consecutive days before hospitalization for ACS were higher in patients with LRTI. Conclusions: The occurrence of coronary artery thrombosis was higher among the patients with LRTI during ACS. PM2.5 exposition was higher in the three consecutive days before hospitalization in patients with LRTI during ACS.

Global prevalence of diet low in calcium and the disease burden: results from the Global Burden of Disease Study 2019

BACKGROUND

Due to the essential role of calcium in vital biological functions, diet low in calcium (DLC) is associated with various diseases. However, there is a lack of study about the current prevalence and health burden due to DLC using reliable data sources.

METHODS

We used data from the Global Burden of Disease study 2019 (GBD 2019) to estimate the prevalence and health burden of DLC in 204 countries from 1990 to 2019, by age, sex, and sociodemographic index (SDI). The estimates were produced in DisMod-MR 2.1, a Bayesian meta-regression tool. Summary exposure value (SEV) was used to show the prevalence of DLC, while diseases adjusted life year (DALY) was used to represent the disease burden. The disease burden was estimated for DLC-induced colorectal cancer. Spearman Rank Order correlation was used for correlation analysis, and estimated annual percentage (EAPC) was used to reflect the temporal trends.

RESULTS

From 1990 to 2019, the global prevalence of DLC decreased (EAPC of SEV, -0.47; 95% CI, -0.5 to -0.43), but have increased in Oceania region and in many countries, such as United Arab Emirates, New Zealand, Japan, and France. The global DALYs associated with low in calcium were estimated to be 3.14 million (95% uncertainty interval (UI), 2.25-4.26 million) in 2019, with an age standardized rate of 38.2 (95% UI, 27.2-51.8) per 100,000. Unlike the prevalence, the global age standardized DALY rates has remained unchanged (EAPC, -0.03; 95% CI, -0.12 to 0.07), but has increased in over 80 of the 204 countries, located mainly in Asia, Africa, and South America. In all years and regions, the age standardized SEV and DALY rates were higher in male people than that in female people. The prevalence (rho = -0.823; P < 0.001) and disease burden (rho = -0.433; P < 0.001) associated with diet in low calcium were strongly correlated to SDI. The prevalence decreased with age, but the DALY rates increased with age and peaked at about 90 years. The prevalence of DLC has decreased worldwide and in most countries, but the disease burden of DLC induced colorectal cancer has increased in over 40% of countries worldwide.

CONCLUSION

Countries with low sociodemographic level and male people are more likely to experience the risk of DLC and related disease burden. Related measures in improve dietary calcium intake are in need to address diet in low calcium related health problems.

Toward Better and Healthier Air Quality: Global PM2.5 and O3 Pollution Status and Risk Assessment Based on the New WHO Air Quality Guidelines for 2021

To reduce the high burden of disease caused by air pollution, the World Health Organization (WHO) released new Air Quality Guidelines (AQG) on September 22, 2021. In this study, the daily fine particulate matter (PM2.5) and surface ozone (O3) data of 618 cities around the world is collected from 2019 to 2022. Based on the new AQG, the number of attainment days for daily average concentrations of PM2.5 (≤ 15 µg m-3) and O3 (≤ 100 µg m-3) is approximately 10% and 90%, respectively. China and India exhibit a decreasing trend in the number of highly polluted days (> 75 µg m-3) for PM. Every year over 68% and 27% of cities in the world are exposed to harmful PM2.5 (> 35 µg m-3) and O3 (> 100 µg m-3) pollution, respectively. Combined with the United Nations Sustainable Development Goals (SDGs), it is found that more than 35% of the world's cities face PM2.5-O3 compound pollution. Furthermore, the exposure risks in these cities (China, India, etc.) are mainly categorized as "High Risk", "Risk", and "Stabilization". In contrast, economically developed cities are mainly categorized as "High Safety", "Safety", and "Deep Stabilization." These findings indicate that global implementation of the WHO's new AQG will minimize the inequitable exposure risk from air pollution.

Causal association between air pollution and frailty: a Mendelian randomization study

Backgrounds

Frailty is a significant problem for older persons since it is linked to a number of unfavorable consequences. According to observational researches, air pollution may raise the risk of frailty. We investigated the causal association between frailty and air pollution (including PM2.5, PM2.5-10, PM10, nitrogen dioxide, and nitrogen oxides) using Mendelian randomization approach.

Methods

We conducted MR analysis using extensive publically accessible GWAS (genome-wide association studies) summary data. The inverse variance weighted (IVW) method was employed as the primary analysis method. The weighted median model, MR-Egger, simple model, and weighted model approaches were chosen for quality control. The Cochran's Q test was utilized to evaluate heterogeneity. Pleiotropy is found using the MR-Egger regression test. The MR-PRESSO method was used to recognize outliers. The leave-one-out strategy was used to conduct the sensitivity analysis.

Results

MR results suggested that PM2.5 was statistically significantly associated with frailty [odds ratio (OR) = 1.33; 95%confidence interval (CI) = 1.12-1.58, p = 0.001] in IVW method. We observed no statistical association between PM2.5-10(OR = 1.00, 95% CI = 0.79-1.28, p = 0.979), PM10(OR = 0.91, 95% CI = 0.75-1.11, p = 0.364), nitrogen dioxide (OR = 0.98, 95% CI = 0.85-1.12, p = 0.730), nitrogen oxides (OR = 1.15, 95% CI = 0.98-1.36, p = 0.086) and frailty. There was no pleiotropy in the results. The sensitivity analysis based on the leave-one-out method showed that the individual single nucleotide polymorphisms (SNPs) did not affect the robustness of the results.

Conclusion

The current MR investigation shows a causal association between PM2.5 and frailty. Frailty's detrimental progression may be slowed down with the help of air pollution prevention and control.