Age-dependent health risk from ambient air pollution: a modelling and data analysis of childhood mortality in middle-income and low-income countries

Health risks and sources of trace elements and black carbon in PM2.5 from 2019 to 2021 in Beijing

A comprehensive health risk assessment of PM2.5 is meaningful to understand the current status and directions regarding further improving air quality from the perspective of human health. In this study, we evaluated the health risks of PM2.5 as well as highly toxic inorganic components, including heavy metals (HMs) and black carbon (BC) based on long-term observations in Beijing from 2019 to 2021. Our results showed that the relative risks of chronic obstructive pulmonary disease, lung cancer, acute lower respiratory tract infection, ischemic heart disease, and stroke decreased by 4.07%-9.30% in 2020 and 2.12%-6.70% in 2021 compared with 2019. However, they were still at high levels ranging from 1.26 to 1.77, in particular, stroke showed the highest value in 2021. Mn had the highest hazard quotient (HQ, from 2.18 to 2.56) for adults from 2019 to 2021, while Ni, Cr, Pb, As, and BC showed high carcinogenic risks (CR > 1.0×10-6) for adults. The HQ values of Mn and As and the CR values of Pb and As showed constant or slight upwards trends during our observations, which is in contrast to the downward trends of other HMs and PM2.5. Mn, Cr, and BC are crucial toxicants in PM2.5. A significant shrink of southern region sourcesof HMs and BCshrank suggests the increased importance of local sources. Industry, dust, and biomass burning are the major contributors to the non-carcinogenic risks, while traffic emissions and industry are the dominant contributors to the carcinogenic risks in Beijing.

Interplay of Climate Change and Air Pollution- Projection of the under-5 mortality attributable to ambient particulate matter (PM2.5) in South Asia

Ambient fine particulate matter (PM2.5) pollution is a leading health risk factor for children under- 5 years, especially in developing countries. South Asia is a PM2.5 hotspot, where climate change, a potential factor affecting PM2.5 pollution, adds a major challenge. However, limited evidence is available on under-5 mortality attributable to PM2.5 under different climate change scenarios. This study aimed to project under-5 mortality attributable to long-term exposure to ambient PM2.5 under seven air pollution and climate change mitigation scenarios in South Asia. We used a concentration-risk function obtained from a previous review to project under-5 mortality attributable to ambient PM2.5. With a theoretical minimum risk exposure level of 2.4 μg/m3, this risk function was linked to gridded annual PM2.5 concentrations from atmospheric modeling to project under-5 mortality from 2010 to 2049 under different climate change mitigation scenarios. The scenarios were developed from the Aim/Endues global model based on end-of-pipe (removing the emission of air pollutants at the source, EoP) and 2 °C target measures. Our results showed that, in 2010-2014, about 306.8 thousand under-5 deaths attributable to PM2.5 occurred in South Asia under the Reference (business as usual) scenario. The number of deaths was projected to increase in 2045-2049 by 36.6% under the same scenario and 7.7% under the scenario where EoP measures would be partially implemented by developing countries (EoPmid), and was projected to decrease under other scenarios, with the most significant decrease (81.2%) under the scenario where EoP measures would be fully enhanced by all countries along with the measures to achieve 2 °C target (EoPmaxCCSBLD) across South Asia. Country-specific projections of under-5 mortality varied by country. The current emission control strategy would not be sufficient to reduce the number of deaths in South Asia. Robust climate change mitigation and air pollution control policy implementation is required.

Influence of aerosol acidity and organic ligands on transition metal solubility and oxidative potential of fine particulate matter in urban environments

The adverse health effects of air pollution around the world have been associated with the inhalation of fine particulate matter (PM2.5). Such outcomes are thought to be related to the induction of oxidative stress due to the excess formation of reactive oxygen species (ROS) in the respiratory and cardiovascular systems. The ability of airborne chemicals to deplete antioxidants and to form ROS is known as oxidative potential (OP). Here we studied the influence of aerosol acidity and organic ligands on the solubility of transition metals, in particular iron (Fe) and copper (Cu), and on the OP of PM2.5 from Canadian National Air Pollution Surveillance urban sites in Toronto, Vancouver, and Hamilton. Using chemical assays and model simulations of the lung redox chemistry, we quantified ROS formation in the lung lining fluid, targeting superoxide anion (O2•-), hydrogen peroxide (H2O2), and hydroxyl radical (•OH), as well as the PM2.5 redox potential (RP). Experimental •OH formation (OPOH) showed high correlations with RP and model-predicted ROS metrics. Both aerosol acidity and oxalate content enhanced the solubility of transition metals, with oxalate showing a stronger association. While experimental OP metrics were primarily associated with species of primary origin such as elemental carbon, Fe, and Cu, model-predicted ROS were associated with secondary processes including proton- and ligand-mediated dissolution of Fe. Model simulations showed that water-soluble Cu was the main contributor to O2•- formation, while water-soluble Fe dominated the formation of highly reactive •OH radical, particularly at study sites with highly acidic aerosol and elevated levels of oxalate. This study underscores the importance of reducing transition metal emissions in urban environments to improve population health.

Cumulative effect of PM2.5 components is larger than the effect of PM2.5 mass on child health in India

While studies on ambient fine particulate matter (PM2.5) exposure effect on child health are available, the differential effects, if any, of exposure to PM2.5 species are unexplored in lower and middle-income countries. Using multiple logistic regression, we showed that for every 10 μg m-3 increase in PM2.5 exposure, anaemia, acute respiratory infection, and low birth weight prevalence increase by 10% (95% uncertainty interval, UI: 9-11), 11% (8-13), and 5% (4-6), respectively, among children in India. NO3-, elemental carbon, and NH4+ were more associated with the three health outcomes than other PM2.5 species. We found that the total PM2.5 mass as a surrogate marker for air pollution exposure could substantially underestimate the true composite impact of different components of PM2.5. Our findings provide key indigenous evidence to prioritize control strategies for reducing exposure to more toxic species for greater child health benefits in India.

The contribution of the exposome to the burden of cardiovascular disease

Large epidemiological and health impact assessment studies at the global scale, such as the Global Burden of Disease project, indicate that chronic non-communicable diseases, such as atherosclerosis and diabetes mellitus, caused almost two-thirds of the annual global deaths in 2020. By 2030, 77% of all deaths are expected to be caused by non-communicable diseases. Although this increase is mainly due to the ageing of the general population in Western societies, other reasons include the increasing effects of soil, water, air and noise pollution on health, together with the effects of other environmental risk factors such as climate change, unhealthy city designs (including lack of green spaces), unhealthy lifestyle habits and psychosocial stress. The exposome concept was established in 2005 as a new strategy to study the effect of the environment on health. The exposome describes the harmful biochemical and metabolic changes that occur in our body owing to the totality of different environmental exposures throughout the life course, which ultimately lead to adverse health effects and premature deaths. In this Review, we describe the exposome concept with a focus on environmental physical and chemical exposures and their effects on the burden of cardiovascular disease. We discuss selected exposome studies and highlight the relevance of the exposome concept for future health research as well as preventive medicine. We also discuss the challenges and limitations of exposome studies.

Short-term exposure to some heavy metals carried with PM10 and cardiovascular system biomarkers during dust storm

This study aimed to evaluate the effect of short-term exposure to heavy metals (HM) extracted from PM₁₀ on CB in workers' population in an outdoor space located in southern Iran during a dust storm. At first, 44 healthy and non-smoking workers were selected. Then PM₁₀ and Blood samples were collected before and after the dust storm. Finally, HMs associated with PM₁₀ measured by ICP-MS and its effect on the CB, including fibrinogen, CRP, TNF-α, and BP were estimated by ANOVA, Pearson correlation, and Odd Ratio (OR) in SPSS23. Based on the results, the concentration of PM₁₀ and extracted HM such as Cr, As, and Cd was higher than the WHO/EPA standards in dust storms they increased the CB and BP remarkably. Moreover, the level of fibrinogen, blood pressure (BP) and TNF-α in dust storms were higher than in normal conditions (p < 0.05, OR > 3). In addition, As and Cd decreased fibrinogen concentration and systolic BP, respectively. Whereas, TNF-α was associated with concentration of Pb (R = - 0.85) on normal days. Consequently, the HM on PM₁₀ such as As, interferes with the level of investigated CB. These results considered a potential risk for the residents in the southern regions of Iran.

Evaluating major anthropogenic VOC emission sources in densely populated Vietnamese cities

Volatile organic compounds (VOCs) play an important role in urban air pollution, both as primary pollutants and through their contribution to the formation of secondary pollutants, such as tropospheric ozone and secondary organic aerosols. In this study, more than 30 VOC species were continuously monitored in the two most populous cities in Vietnam, namely Ho Chi Minh City (HCMC, September-October 2018 and March 2019) and Hanoi (March 2019). In parallel with ambient VOC sampling, grab sampling was used to target the most prevalent regional-specific emission sources and estimate their emission factors (EFs). Emission ratios (ERs) obtained from ambient sampling were compared between Vietnamese cities and other cities across the globe. No significant differences were observed between HCMC and Hanoi, suggesting the presence of similar sources. Moreover, a good global agreement was obtained in the spatial comparison within a factor of 2, with greater ER for aromatics and pentanes obtained in the Vietnamese cities. The detailed analysis of sources included the evaluation of EF from passenger cars, buses, trucks, motorcycles, 3-wheeled motorcycles, waste burning, and coal-burning emissions. Our comparisons between ambient and near-source concentration profiles show that road transport sources are the main contributors to VOC concentrations in Vietnamese cities. VOC emissions were calculated from measured EF and consumption data available in Hanoi and compared with those estimated by a global emission inventory (EDGAR v4.3.2). The total VOC emissions from the road transport sector estimated by the inventory do not agree with those calculated from our observations which showed higher total emissions by a factor of 3. Furthermore, the inventory misrepresented the VOCs speciation, mainly for isoprene, monoterpenes, aromatics, and oxygenated compounds. Accounting for these differences in regional air quality models would lead to improved predictions of their impacts and help to prioritise pollution reduction strategies in the region.

Associations between air pollutant and pneumonia and asthma requiring hospitalization among children aged under 5 years in Ningbo, 2015-2017

Introduction

Exposure to ambient air pollutants is associated with an increased incidence of respiratory diseases such as pneumonia and asthma, especially in younger children. We investigated the relationship between rates of hospitalization of children aged under 5 years for pneumonia and asthma and the concentration of air pollutants in Ningbo between January 1, 2015 and August 29, 2017.

Methods

Data were obtained from the Ningbo Air Quality Data Real-time Publishing System and the big data platform of the Ningbo Health Information Center. A generalized additive model was established via logarithmic link function and utilized to evaluate the effect of pollutant concentration on lag dimension and perform sensitivity analysis.

Results

A total of 10,301 cases of pneumonia and 115 cases of asthma were identified over the course of this study. Results revealed that PM2.5, PM10, SO2 and NO2 were significantly associated with hospitalization for pneumonia and asthma in children under 5 years of age. For every 10-unit increase in lag03 air pollutant concentration, hospitalization for pneumonia and asthma due to PM2.5, PM10, SO2 and NO2 increased by 2.22% (95%CI: 0.64%, 3.82%), 1.94% (95%CI: 0.85%, 3.04%), 11.21% (95%CI: 4.70%, 18.10%) and 5.42% (95%CI: 3.07%, 7.82%), respectively.

Discussion

Adverse effects of air pollutants were found to be more severe in children aged 1 to 5 years and adverse effects due to PM2.5, PM10 and SO2 were found to be more severe in girls. Our findings underscore the need for implementation of effective public health measures to urgently improve air quality and reduce pediatric hospitalizations due to respiratory illness.

Government health expenditures and health outcome nexus: a study on OECD countries

Introduction

The consistent increase in health expenditures is an integral part of health policy. The aim of this study was to investigate the impact of health expenditures on health outcomes in the OECD countries.

Method

We used the system generalized method of moments (GMM) for thirty eight OECD countries using panel data from 1996 to 2020.

Results and discussion

The findings show that health expenditures have a negative impact on infant mortality while positive on life expectancy. The results further verify that the income measured as GDP, number of doctors, and air pollution has a negative effect on infant mortality, while these variables have a positive effect on life expectancy in the studied countries. The outcome of the study suggests that health expenditures need to be properly utilized and improvements can be made in the health policies to increase the investment in health technology. The government should also focus on measures like economic and environmental to have long-lasting health outcomes.

Compositional Constraints are Vital for Atmospheric PM2.5 Source Attribution over India

India experiences some of the highest levels of ambient PM_2.5 aerosol pollution in the world. However, due to the historical dearth of in situ measurements, chemical transport models that are often used to estimate PM_2.5 exposure over the region are rarely evaluated. Here, we conduct a novel model comparison with speciated airborne measurements of fine aerosol, revealing large biases in the ammonium and nitrate simulations. To address this, we incorporate process-level changes to the model and use satellite observations from the Cross-track Infrared Sounder (CrIS) and the TROPOspheric Monitoring Instrument (TROPOMI) to constrain ammonia and nitrogen oxide emissions. The resulting simulation demonstrates significantly lower bias (NMB_Modified: 0.19; NMB_Base: 0.61) when validated against the airborne aerosol measurements, particularly for the nitrate (NMB_Modified: 0.08; NMB_Base: 1.64) and ammonium simulation (NMB_Modified: 0.49; NMB_Base: 0.90). We use this validated simulation to estimate a population-weighted annual PM_2.5 exposure of 61.4 μg m^-3, with the RCO (residential, commercial, and other) and energy sectors contributing 21% and 19%, respectively, resulting in an estimated 961,000 annual PM_2.5-attributable deaths. Regional exposure and sectoral source contributions differ meaningfully in the improved simulation (compared to the baseline simulation). Our work highlights the critical role of speciated observational constraints in developing accurate model-based PM_2.5 aerosol source attribution for health assessments and air quality management in India.

Postnatal exposure to PM2.5 and weight trajectories in early childhood

BACKGROUND

Inconsistent evidence has assessed the impact of air pollution exposure on children's growth trajectories. We investigated the role of 90-day average postnatal fine particulate matter (PM2.5) exposures by estimating the magnitude of effects at different ages, and the change in child weight trajectory by categories of exposure.

METHODS

We obtained weight values from electronic health records at each hospital visit (males = 1859, females = 1601) from birth to 6 years old children recruited into the Boston-based Children's HealthWatch cohort (2009-2014). We applied mixed models, adjusting for individual and maternal confounders using (1) varying-coefficient models allowing for smooth non-linear interaction between age and PM2.5, (2) factor-smooth interaction between age and PM2.5 quartiles. Additionally, we stratified by sex and low birthweight (LBW) status (≤2500 g).

RESULTS

Using varying-coefficient models, we found that PM2.5 significantly modified the association between age and weight in males, with a positive association in children younger than 3 years and a negative association afterwards. In boys, for each 10 µg/m3 increase in PM2.5 we found a 2.6% increase (95% confidence interval = 0.8, 4.6) in weight at 1 year of age and a -0.6% (95% confidence interval = -3.9, 2.9) at 5 years. We found similar but smaller changes in females, and no differences comparing growth trajectories across quartiles of PM2.5. Most of the effects were in LBW children and null for normal birthweight children.

CONCLUSIONS

This study suggests that medium-term postnatal PM2.5 may modify weight trajectories nonlinearly in young children, and that LBW babies are more susceptible than normal-weight infants.

Communicating respiratory health risk among children using a global air quality index

Air pollution poses a serious threat to children's respiratory health around the world. Satellite remote-sensing technology and air quality models can provide pollution data on a global scale, necessary for risk communication efforts in regions without ground-based monitoring networks. Several large centers, including NASA, produce global pollution forecasts that may be used alongside air quality indices to communicate local, daily risk information to the public. Here we present a health-based, globally applicable air quality index developed specifically to reflect the respiratory health risks among children exposed to elevated outdoor air pollution. Additive, excess-risk air quality indices were developed using 51 different coefficients derived from time-series health studies evaluating the impacts of ambient fine particulate matter, nitrogen dioxide, and ozone on children's respiratory morbidity outcomes. A total of four indices were created which varied based on whether or not the underlying studies controlled for co-pollutants and in the adjustment of excess risks of individual pollutants. Combined with historical estimates of air pollution provided globally at a 25 × 25 km² spatial resolution from the NASA's Goddard Earth Observing System composition forecast (GEOS-CF) model, each of these indices were examined in a global sample of 664 small and 140 large cities for study year 2017. Adjusted indices presented the most normal distributions of locally-scaled index values, which has been shown to improve associations with health risks, while indices based on coefficients controlling for co-pollutants had little effect on index performance. We provide the steps and resources need to apply our final adjusted index at the local level using freely-available forecasting data from the GEOS-CF model, which can provide risk communication information for cities around the world to better inform individual behavior modification to best protect children's respiratory health.

Ambient air pollution and acute respiratory infection in children aged under 5 years living in 35 developing countries

BACKGROUND

Evidence from developed countries suggests that fine particulate matter (≤2.5 µm [PM_2.5]) contributes to childhood respiratory morbidity and mortality. However, few analyses have focused on resource-limited settings, where much of this burden occurs. We aimed to investigate the cross-sectional associations between annual average exposure to ambient PM_2.5 and acute respiratory infection (ARI) in children aged <5 years living in low- and middle-income countries (LMICs).

METHODS

We combined Demographic and Health Survey (DHS) data from 35 countries with gridded global estimates of annual PM_2.5 mass concentrations. We analysed the association between PM_2.5 and maternal-reported ARI in the two weeks preceding the survey among children aged <5 years living in 35 LMICs. We used multivariable logistic regression models that adjusted for child, maternal, household and cluster-level factors. We also fitted multi-pollutant models (adjusted for nitrogen dioxide [NO₂] and surface-level ozone [O₃]), among other sensitivity analyses. We assessed whether the associations between PM_2.5 and ARI were modified by sex, age and place of residence.

RESULTS

The analysis comprised 573,950 children, among whom the prevalence of ARI was 22,506 (3.92%). The mean (±SD) estimated annual concentration of PM_2.5 to which children were exposed was 48.2 (±31.0) µg/m³. The 5th and 95th percentiles of PM_2.5 were 9.8 µg/m³ and 110.9 µg/m³, respectively. A 10 µg/m³ increase in PM_2.5 was associated with greater odds of having an ARI (OR: 1.06; 95% CI: 1.05-1.07). The association between PM_2.5 and ARI was robust to adjustment for NO₂ and O₃. We observed evidence of effect modification by sex, age and place of residence, suggesting greater effects of PM_2.5 on ARI in boys, in younger children, and in children living in rural areas.

CONCLUSIONS

Annual average ambient PM_2.5, as an indicator for long-term exposure, was associated with greater odds of maternal-reported ARI in children aged <5 years living in 35 LMICs. Longitudinal studies in LMICs are required to corroborate our cross-sectional findings, to further elucidate the extent to which lowering PM_2.5 may have a role in the global challenge of reducing ARI-related morbidity and mortality in children.

Fine particulate matter and depressive symptoms in children: A mediation model of physical activity and a moderation model of family poverty

Rationale

Exposure to fine particulate matter has adverse effects on mental health outcomes. However, no empirical study has yet been conducted on mechanisms of how and why exposure to fine particulate matter can affect mental health outcomes, especially focusing on children. In addition, children living in poverty may be more vulnerable to fine particulate matter.

Objective

This study aims to examine whether physical activity can explain the impact of ambient fine particulate matter on depressive symptoms among Korean children and whether family poverty moderates the associations between fine particulate matter, physical activity, and children’s depressive symptoms.

Methods

Children and their primary caregiver data were drawn from the Children’s Happiness Life Time Survey data collected by Child Fund Korea, and fine particulate matter data were derived from Air Korea, collected by the Korea Environment Corporation. Individual-level data were linked to a nationwide neighborhood-level data on air quality. Multilevel structural equation modeling was used to consider the hierarchical data structure. The analytical sample consisted of 4,161 children living in 79 neighborhoods.

Results

The findings suggest that living in neighborhoods with higher levels of fine particulate matter is associated with a decrease in physical activity, which in turn increases children’s depressive symptoms. Physical activity fully mediates the association between fine particulate matter and children’s depressive symptoms. However, family poverty does not have a significant moderating role for the associations between fine particulate matter, physical activity, and children’s depressive symptoms.

Conclusions

The results of this study indicate the importance of physical activity in relation to fine particulate matter and children’s depressive symptoms.

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First study investigating the mechanisms of fine particulate on children's depressive symptoms.

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Physical activity mediates the association between fine particulate and children's depressive symptoms.

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Encouraging physical activity is important to prevent children's depressive symptoms.

Estimating the health and economic burden of shipping related air pollution in the Iberian Peninsula

Air pollution is the leading cause of the global burden of disease from the environment, entailing substantial economic consequences. International shipping is a significant source of NO_x, SO₂, CO and PM, which can cause known negative health impacts. Thus, this study aimed to estimate the health impacts and the associated external costs of ship-related air pollution in the Iberian Peninsula for 2015. Moreover, the impact of CAP2020 regulations on 2015 emissions was studied. Log-linear functions based on WHO-HRAPIE relative risks for PM_2.5 and NO₂ all-cause mortality and morbidity health end-points, and integrated exposure-response functions for PM_2.5 cause-specific mortality, were used to calculate the excess burden of disease. The number of deaths and years of life lost (YLL) due to NO₂ ship-related emissions was similar to those of PM_2.5 ship-related emissions. Estimated all-cause premature deaths attributable to PM_2.5 ship-related emissions represented an average increase of 7.7% for the Iberian Peninsula when compared to the scenario without shipping contribution. Costs of around 9 100 million € yr-1 (for value of statistical life approach - VSL) and 1 825 million € yr^-1 (for value of life year approach - VOLY) were estimated for PM and NO₂ all-cause burden of disease. For PM_2.5 cause-specific mortality, a cost of around 3 475 million € yr^-1 (for VSL approach) and 851 million € yr^-1 (for VOLY approach) were estimated. Costs due to PM and NO₂ all-cause burden represented around 0.72% and 0.15% of the Iberian Peninsula gross domestic product in 2015, respectively for VSL and VOLY approaches. For PM_2.5 cause-specific mortality, costs represented around 0.28% and 0.06%, respectively, for VSL and VOLY approaches. If CAP2020 regulations had been applied in 2015, around 50% and 30% respectively of PM_2.5 and NO₂ ship-related mortality would been avoided. These results show that air pollution from ships has a considerable impact on health and associated costs affecting the Iberian Peninsula.

Air pollution control efficacy and health impacts: A global observational study from 2000 to 2016

Particulate matter with aerodynamic diameter ≤2.5 μm (PM_2.5) concentrations vary between countries with similar carbon dioxide (CO₂) emissions, which can be partially explained by differences in air pollution control efficacy. However, no indicator of air pollution control efficacy has yet been developed. We aimed to develop such an indicator, and to evaluate its global and temporal distribution and its association with country-level health metrics. A novel indicator, ambient population-weighted average PM_2.5 concentration per unit per capita CO₂ emission (PM_2.5/CO₂), was developed to assess country-specific air pollution control efficacy (abbreviated as APCI). We estimated and mapped the global average distribution of APCI and its changes during 2000-2016 across 196 countries. Pearson correlation coefficients and Generalized Additive Mixed Model (GAMM) were used to evaluate the relationship between APCI and health metrics. APCI varied by country with an inverse association with economic development. APCI showed an almost stable trend globally from 2000 to 2016, with the low-income groups increased and several countries (China, India, Bangladesh) decreased. The Pearson correlation coefficients between APCI and life expectancy at birth (LE), infant-mortality rate (IMR), under-five year of age mortality rate (U5MR) and logarithm of per capita GDP (LPGDP) were -0.57, 0.65, 0.66, -0.59 respectively (all P values < 0.001). APCI could explain international variation of LE, IMR and U5MR. The associations between APCI and LE, IMR, U5MR were independent of per capita GDP and climatic factors. We consider APCI to be a good indicator for air pollution control efficacy given its relation to important population health indicators. Our findings provide a new metric to interpret health inequity across the globe from the point of climate change and air pollution control efficacy.

Increasing mortality caused by chronic obstructive pulmonary disease (COPD) in relation with exposure to ambient fine particulate matters: an analysis in Southeastern China

The objective of this study was to investigate the association between ambient particulate matters (PMs) and chronic obstructive pulmonary disease (COPD) mortality. generalized additive mixed model was employed to investigate the effects of ambient fine and coarse PMs on COPD mortality using 13,066 deaths from 2014 to 2016 among six cities in Zhejiang Province in Southeastern China. The daily average death count due to COPD was 3, varying from 1 to 7 among six cities. The daily 24-h mean concentrations were diverse among cities, from 29.7 to 56.8 μg/m³ for PM_2.5, 16.7 to 30.3 μg/m³ for PM_2.5-10, and 50.3 to 87.1 μg/m³ for PM₁₀, respectively. The analysis showed that daily exposure to PM_2.5 and PM₁₀ was associated with increased mortality due to COPD and that weak effects were observed between PM_2.5-10 and COPD mortality. Our results provided solid evidence that the fine particles in air pollution have stronger functions on adverse health effects other than coarser particles in Southeastern China, which may be considered as a potential clinic target in PM-associated COPD.

Ambient air pollution and cardiovascular disease rate an ANN modeling: Yazd-Central of Iran

This study was aimed to investigate the air pollutants impact on heart patient's hospital admission rates in Yazd for the first time. Modeling was done by time series, multivariate linear regression, and artificial neural network (ANN). During 5 years, the mean concentrations of PM₁₀, SO₂, O₃, NO₂, and CO were 98.48 μg m^-3, 8.57 ppm, 19.66 ppm, 18.14 ppm, and 4.07 ppm, respectively. The total number of cardiovascular disease (CD) patients was 12,491, of which 57% and 43% were related to men and women, respectively. The maximum correlation of air pollutants was observed between CO and PM₁₀ (R = 0.62). The presence of SO₂ and NO₂ can be dependent on meteorological parameters (R = 0.48). Despite there was a positive correlation between age and CD (p = 0.001), the highest correlation was detected between SO₂ and CD (R = 0.4). The annual variation trend of SO₂, NO₂, and CO concentrations was more similar to the variations trend in meteorological parameters. Moreover, the temperature had also been an effective factor in the O₃ variation rate at lag = 0. On the other hand, SO₂ has been the most effective contaminant in CD patient admissions in hospitals (R = 0.45). In the monthly database classification, SO₂ and NO₂ were the most prominent factors in the CD (R = 0.5). The multivariate linear regression model also showed that CO and SO₂ were significant contaminants in the number of hospital admissions (R = 0.46, p = 0.001) that both pollutants were a function of air temperature (p = 0.002). In the ANN nonlinear model, the 14, 12, 10, and 13 neurons in the hidden layer were formed the best structure for PM, NO₂, O₃, and SO₂, respectively. Thus, the R_all rate for these structures was 0.78-0.83. In these structures, according to the autocorrelation of error in lag = 0, the series are stationary, which makes it possible to predict using this model. According to the results, the artificial neural network had a good ability to predict the relationship between the effect of air pollutants on the CD in a 5 years' time series.

Recent trends in premature mortality and health disparities attributable to ambient PM2.5 exposure in China: 2005-2017

In the past decade, particulate matter with aerodynamic diameter less than 2.5 μm (PM_2.5) has reached unprecedented levels in China and posed a significant threat to public health. Exploring the long-term trajectory of the PM_2.5 attributable health burden and corresponding disparities across populations in China yields insights for policymakers regarding the effectiveness of efforts to reduce air pollution exposure. Therefore, we examine how the magnitude and equity of the PM_2.5-related public health burden has changed nationally, and between provinces, as economic growth and pollution levels varied during 2005-2017. We derive long-term PM_2.5 exposures in China from satellite-based observations and chemical transport models, and estimate attributable premature mortality using the Global Exposure Mortality Model (GEMM). We characterize national and interprovincial inequality in health outcomes using environmental Lorenz curves and Gini coefficients over the study period. PM_2.5 exposure is linked to 1.8 (95% CI: 1.6, 2.0) million premature deaths over China in 2017, increasing by 31% from 2005. Approximately 70% of PM_2.5 attributable deaths were caused by stroke and IHD (ischemic heart disease), though COPD (chronic obstructive pulmonary disease) and LRI (lower respiratory infection) disproportionately affected poorer provinces. While most economic gains and PM_2.5-related deaths were concentrated in a few provinces, both gains and deaths became more equitably distributed across provinces over time. As a nation, however, trends toward equality were more recent and less clear cut across causes of death. The rise in premature mortality is due primarily to population growth and baseline risks of stroke and IHD. This rising health burden could be alleviated through policies to prevent pollution, exposure, and disease. More targeted programs may be warranted for poorer provinces with a disproportionate share of PM_2.5-related premature deaths due to COPD and LRI.

Impact of Air Pollution (PM2.5) on Child Mortality: Evidence from Sixteen Asian Countries

Air pollution in Asian countries represents one of the biggest health threats given the varied levels of economic and population growth in the recent past. The quantification of air pollution (PM_2.5) vis à vis health problems has important policy implications in tackling its health effects. This paper investigates the relationship between air pollution (PM_2.5) and child mortality in sixteen Asian countries using panel data from 2000 to 2017. We adopt a two-stage least squares approach that exploits variations in PM_2.5 attributable to economic growth in estimating the effect on child mortality. We find that a one-unit annual increase in PM_2.5 leads to a nearly 14.5% increase in the number of children dying before the age of five, suggesting the severity of the effects of particulate matter (PM_2.5) on health outcomes in sixteen Asian countries considered in this study. The results of this study suggest the need for strict policy interventions by governments in Asian countries to reduce PM_2.5 concentration alongside environment-friendly policies for economic growth.

In utero exposure to diesel exhaust particles, but not silica, alters post-natal immune development and function

Our understanding of the impact of in utero exposure to PM on post-natal immune function and the subsequent response to PM exposure is limited. Similarly, very few studies have considered the effect of exposure to PM from different sources. Thus, the aim of this study was to examine how in utero exposure to PM from different sources effects the post-natal response to pro-inflammatory and immune stimuli. C56BL/6J pregnant mice were exposed intranasally on gestational day (E)7.5, E12.5 and E17.5-50 μg of diesel exhaust particles (DEP), silica or saline. At 4-weeks post-natal age, sub-groups of male and female mice were exposed intranasally to 50 μg of DEP or saline. Lung inflammatory responses were assessed 6 h later by quantifying inflammatory cells and cytokine production (MCP-1, MIP-2, IL-6). In separate groups of mice, the spleen was harvested to quantify B and T cell populations. Splenocytes were isolated and exposed to lipopolysaccharide or poly I:C for assessment of cytokine production. Exposure to DEP in utero decreased %CD1d^highCD5+ B cells in female mice and IFN-γ production by splenocytes in both sexes. Male mice had elevations in macrophage and lymphocyte numbers in response to DEP whereas female mice only had elevated IL-6, MCP-1 and MIP-2 levels. In utero exposure to silica had no effect on these measures. These data suggest that in utero exposure to PM alters immune development and post-natal immune function. This response is dependent on the source of PM, which has implications for understanding the community health effects of exposure to air pollution.

Spatial patterns of lower respiratory tract infections and their association with fine particulate matter

This study aimed to identify the spatial patterns of lower respiratory tract infections (LRIs) and their association with fine particulate matter (PM_2.5). The disability-adjusted life year (DALY) database was used to represent the burden each country experiences as a result of LRIs. PM_2.5 data obtained from the Atmosphere Composition Analysis Group was assessed as the source for main exposure. Global Moran's I and Getis-Ord Gi* were applied to identify the spatial patterns and for hotspots analysis of LRIs. A generalized linear mixed model was coupled with a sensitivity test after controlling for covariates to estimate the association between LRIs and PM_2.5. Subgroup analyses were performed to determine whether LRIs and PM_2.5 are correlated for various ages and geographic regions. A significant spatial auto-correlated pattern was identified for global LRIs with Moran's Index 0.79, and the hotspots of LRIs were clustered in 35 African and 4 Eastern Mediterranean countries. A consistent significant positive association between LRIs and PM_2.5 with a coefficient of 0.21 (95% CI 0.06-0.36) was identified. Furthermore, subgroup analysis revealed a significant effect of PM_2.5 on LRI for children (0-14 years) and the elderly (≥ 70 years), and this effect was confirmed to be significant in all regions except for those comprised of Eastern Mediterranean countries.

The influence of chemical composition, aerosol acidity, and metal dissolution on the oxidative potential of fine particulate matter and redox potential of the lung lining fluid

Air pollution is a major environmental health risk and it contributes to respiratory and cardiovascular diseases and excess mortality worldwide. The adverse health effects have been associated with the inhalation of fine particulate matter (PM_2.5) and induction of respiratory oxidative stress. In this work, we quantified the oxidative potential (OP) of PM_2.5 from several Canadian cities (Toronto, Hamilton, Montreal, Vancouver) using a recently developed bioanalytical method which measures the oxidation of lung antioxidants, glutathione, cysteine, and ascorbic acid, the formation of glutathione disulfide and cystine, and the related redox potential (RP) in a simulated epithelial lining fluid (SELF). We evaluated the application of empirical SELF RP as a new metric for aerosol OP. We further investigated how PM_2.5 chemical composition and OP are related across various emission source sectors and whether these features are linked to specific properties of aerosol aqueous phase, such as pH and metal-ligand complexation. The OP indicators including SELF RP were strongly correlated among each other, indicating that the empirical RP could be used as a reliable metric in future studies. OP based on ascorbic acid showed dependency on the emission source sectors, most likely due to variation in the solubility of Fe. Traffic emissions resulted in the highest OP, followed by industrial emissions and resuspended crustal matter. OP presented low correlation with PM_2.5 concentrations, low-moderate correlation with the aerosol organic matter, and moderate-strong association with black carbon and transition metals across the sites. We did not find strong association between the concentration of biomass burning tracers and OP. Copper was the only metal that showed high association with OP across all sites, whereas the correlation with other metals, such as iron, manganese, and titanium, showed clear dependency on the source sectors. The aerosol pH correlated negatively with ambient temperature and positively with biomass burning tracers and the levels of nitrate, ammonium, and aerosol liquid water content. The solubility of Fe was associated with sulfate and aerosol pH at most sites, suggesting the involvement of proton-mediated dissolution pathway, while this was not visible at the site influenced by industrial emission, most likely due to the abundance of pyrogenic Fe. The effect of metal-ligand complexation on the solubility of transition metals, in particular Fe, was clearly observed at all sites, whereas a combined effect with aerosol pH, and a subsequent impact on OP, was only seen at the traffic site in Toronto. The enhanced solubility of Fe due to proton- and ligand-mediated dissolution pathways and subsequent formation of reactive oxygen species may in part explain the health effects of PM_2.5 seen in previous epidemiological studies.

Economic Value of Life in Iran: The Human Capital Approach

Background:

The human life value is among the most important challenges of the health economic evaluation. This limitation has reduced the feasibility of applying the cost-benefit method in evaluations of health interventions and policies. Using the human capital approach and discounted value of future earnings, the present study calculated the human capital of different age groups.

Methods:

The required data were obtained using “income and expenditures of Iranian households” data in 2015 from the Statistical Center of Iran, which included the information on 19380 urban households.

Results:

According to the calculation of human capital, the maximum value of a statistical life year in the high-income group was related to the age group of 30–34 yr old (223,286 US$ equals to 9378 million Iranian Rials). The lowest value in all three groups of high, medium and low income is related to the age group of 85 and older. In addition, the economic value of statistical life year for men has been calculated as higher than that of women, however, in older age groups, the human capital of both genders have been converging.

Conclusion:

The economic value of life for young people aged between 20 to 30 yr was higher than other demographic groups. The findings of the research help to provide a more accurate base for the cost-benefit analysis of health and social policies. Considering the economic value of the statistical life for different age groups may change policy priorities in areas related to health and life of human beings.

Environmental air pollution: respiratory effects

Environmental air pollution is a major risk factor for morbidity and mortality worldwide. Environmental air pollution has a direct impact on human health, being responsible for an increase in the incidence of and number of deaths due to cardiopulmonary, neoplastic, and metabolic diseases; it also contributes to global warming and the consequent climate change associated with extreme events and environmental imbalances. In this review, we present articles that show the impact that exposure to different sources and types of air pollutants has on the respiratory system; we present the acute effects-such as increases in symptoms and in the number of emergency room visits, hospitalizations, and deaths-and the chronic effects-such as increases in the incidence of asthma, COPD, and lung cancer, as well as a rapid decline in lung function. The effects of air pollution in more susceptible populations and the effects associated with physical exercise in polluted environments are also presented and discussed. Finally, we present the major studies on the subject conducted in Brazil. Health care and disease prevention services should be aware of this important risk factor in order to counsel more susceptible individuals about protective measures that can facilitate their treatment, as well as promoting the adoption of environmental measures that contribute to the reduction of such emissions.

Short and Long Term Exposure to Ambient Air Pollution and Impact on Health in India: A Systematic Review

Health effects attributable to short-term and long-term ambient air pollution (AAP) exposure in Indian population are less understood. This study evaluates the effect of short time and long-term exposure to AAP on respiratory morbidity, mortality and premature mortality for the exposed population. A total of 59 studies are reviewed to examine the effects of short-term exposure (n = 23); long-term exposure (n = 18) and premature mortality (n = 18). Short-term exposures to ambient pollutants have strong associations between COPD, respiratory illnesses and higher rates of hospital admission or visit. The long-term effects of AAP, associated with deficit lung function, asthma, heart attack, cardiovascular mortality and premature mortality have received much attention. Particulate matter (PM_2.5 and PM₁₀) is primarily responsible for respiratory health problems. Out of 18 literature reviewed on premature mortality, most (12 of 18) studies have statistically significant associations between AAP exposure and increased premature mortality risk.

The association between pneumothorax onset and meteorological parameters and air pollution

Background

The aim of this study was to investigate the possible relation of meteorological parameters and air pollutant particle concentrations with the incidence of spontaneous pneumothorax in the Bolu region of Turkey.

Methods

Between January 2015 and February 2019, a total of 200 patients (175 males, 25 females; mean age 42.5±19.9 years, range, 10 to 88 years) with spontaneous pneumothorax were retrospectively analyzed. For each day, standard weather parameters including daily average temperature, relative humidity, wind speed, actual pressure, and daily total precipitation and concentration of air pollutants (PM₁₀ and SO₂) were recorded.

Results

During the study period, there were 200 cases with spontaneous pneumothorax within 178 days. The number of days with spontaneous pneumothorax represented 11.8% of the total number of days (1,504 days). In the study, 76.9% of the days with spontaneous pneumothorax were clustered. All meteorological (temperature, humidity, pressure, wind speed, and precipitation) and air pollution parameters (PM10 a nd SO₂) were available for 1,438 days (95.61%) and 853 days (56.71%), respectively. There was a significant relationship between spontaneous pneumothorax and air temperature (r=-0.094, p=0.001), and air pollution (PM10, r=-0.080, p=0.020; SO₂, r=-0.067, p=0.045).

Conclusion

Our study results show a relationship between spontaneous pneumothorax and air temperature, and air pollution. Preventing air pollution, which is a public health problem, can lead to a reduction in spontaneous pneumothorax.

Short term effects of air pollutants on hospital admissions for respiratory diseases among children: A multi-city time-series study in China

Evidence concerning short-term acute association between air pollutants and hospital admissions for respiratory diseases among children in a multi-city setting was quite limited. We conducted a time-series analysis to evaluate the association of six common air pollutants with hospital admissions for respiratory diseases among children aged 0-14 years in 4 cities (Guangzhou, Shanghai, Wuhan and Xining), China during 2013-2018. We used generalized additive models incorporating penalized smoothing splines and random-effect meta-analysis to calculate city-specific and pooled estimates, respectively. The exposure-response relationship curves were fitted using the cubic spline regression. Subgroup analyses by gender, age, season and disease subtype were also performed. A total of 183,036 respiratory diseases hospitalizations were recorded during the study period, and 94.1% of the cases were acute respiratory infections. Overall, we observed that increased levels of air pollutants except O₃, were significantly associated with increased hospital admissions for respiratory disease. Each 10 μg/m³ increase in PM_2.5, SO₂ and NO₂ at lag 07, PM₁₀ at lag 03 and per 1 mg/m³ increase in CO at lag 01 corresponded to increments of 1.19%, 3.58%, 2.23%, 0.51% and 6.10% in total hospitalizations, respectively. Generally, exposure-response relationships of PM_2.5 and SO₂ in Guangzhou, SO₂, NO₂ and CO in Wuhan, as well as SO₂ and NO₂ in Xining with respiratory disease hospitalizations were also found. Moreover, the adverse effects of these pollutants apart from PM_2.5 in certain cities remained significant even at exposure levels below the current Chinese Ambient Air Quality Standards (CAAQS) Grade II. Children aged 4-14 years appeared to be more vulnerable to the adverse effects of PM_2.5, SO₂ and NO₂. Furthermore, with the exception of O₃, the associations were stronger in cold season than in warm season. Short-term exposure to PM_2.5, SO₂, NO₂ and CO were associated, in dose-responsive manners, with increased risks of hospitalizations for childhood respiratory diseases, and adverse effects of air pollutants except PM_2.5 held even at exposure levels below the current CAAQS Grade II in certain cities.

Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions

Aims

Ambient air pollution is a major health risk, leading to respiratory and cardiovascular mortality. A recent Global Exposure Mortality Model, based on an unmatched number of cohort studies in many countries, provides new hazard ratio functions, calling for re-evaluation of the disease burden. Accordingly, we estimated excess cardiovascular mortality attributed to air pollution in Europe.

Methods and results

The new hazard ratio functions have been combined with ambient air pollution exposure data to estimate the impacts in Europe and the 28 countries of the European Union (EU-28). The annual excess mortality rate from ambient air pollution in Europe is 790 000 [95% confidence interval (95% CI) 645 000–934 000], and 659 000 (95% CI 537 000–775 000) in the EU-28. Between 40% and 80% are due to cardiovascular events, which dominate health outcomes. The upper limit includes events attributed to other non-communicable diseases, which are currently not specified. These estimates exceed recent analyses, such as the Global Burden of Disease for 2015, by more than a factor of two. We estimate that air pollution reduces the mean life expectancy in Europe by about 2.2 years with an annual, attributable per capita mortality rate in Europe of 133/100 000 per year.

Conclusion

We provide new data based on novel hazard ratio functions suggesting that the health impacts attributable to ambient air pollution in Europe are substantially higher than previously assumed, though subject to considerable uncertainty. Our results imply that replacing fossil fuels by clean, renewable energy sources could substantially reduce the loss of life expectancy from air pollution.

Using a distributed air sensor network to investigate the spatiotemporal patterns of PM2.5 concentrations

Spatiotemporal variations in PM_2.5 are a key factor affecting personal pollution exposure levels in urban areas. However, fixed-site monitoring stations are so sparsely distributed that they hardly capture the dynamic and fine-scale variations in PM_2.5 in urban areas with complex geographical features and urban forms. Recently, a distributed air sensor network (DASN) was deployed in Dezhou city, China, to monitor fine-scale air pollution information and obtain deep insight into variations in PM_2.5. Based on the data collected by the DASN, this paper investigated the spatiotemporal patterns of PM_2.5 using the time-series clustering method. The results demonstrated that there were four stages of PM_2.5 daily variations, i.e., accumulation, continuous pollution, dispersion, and cleaning. Generally, the stage of dispersion occurred more rapidly than the stage of accumulation, and PM_2.5 accumulated easily in warm and humid weather with low wind speeds. However, the stage of dispersion was affected mainly by high wind speeds and precipitation. Additionally, the results suggested that four variation stages did not strictly correspond to seasonal divisions. The spatial distributions of PM_2.5 revealed that the main pollution source was located in a southeastern industrial park, which exhibited a significant impact throughout the four stages. Considering both the temporal and spatial characteristics of PM_2.5, this study successfully identified pollution hotspots and confirmed the effect of industrial parks. The study demonstrates that the DASN has high prospective applicability for assessing the fine-scale spatial distribution of PM_2.5, and the time-series clustering method can also assist environmental researchers in further exploring the spatiotemporal characteristics of urban air pollution.

Integrated dispersion-deposition modelling for air pollutant reduction via green infrastructure at an urban scale

Green infrastructure (GI) can reduce air pollutants concentrations via coupled effects of surface deposition and aerodynamic dispersion, yet their magnitudes and relative effectiveness in reducing pollutant concentration are less studied at the urban scale. Here, we develop and apply an integrated GI assessment approach to simulate the individual effects of GI along with their combined impact on pollutant concentration reduction under eight GI scenarios. These include current for year 2015 (2015-Base); business-as-usual for year 2039 (2039-BAU); three alternative future scenarios with maximum possible coniferous (2039-Max-Con), deciduous (2039-Max-Dec) trees, and grassland (2039-Max-Grl) over the available land; and another three alternative future scenarios by considering coniferous (2039-NR-Con), deciduous (2039-NR-Dec) trees, and grassland (2039-NR-Grl) around traffic lanes. A typical UK town, Guildford, is chosen as study area where we estimated current and future traffic emissions (NO_x, PM₁₀ and PM_2.5), annual deposited amount and pollutants concentration reductions and percentage shared by dispersion and deposition effect in concentration reduction under above scenarios. The annual pollutant deposition was found to vary from 0.27-2.77 t·yr^-1·km^-2 for NO_x, 0.46-1.03 t·yr^-1·km^-2 for PM₁₀ and 0.08-0.23 t·yr^-1·km^-2 for PM_2.5, depending on the percentage share of GI type and traffic emissions. The 2039-Max-Dec showed the aerodynamic effect of GI can reduce the annual pollutant concentration levels up to ~10% in NO_x, ~1% in PM₁₀ and ~0.8% in PM_2.5. Furthermore, the total reductions can be achieved, via GI's coupled effects of surface deposition and aerodynamic dispersion, up to ~35% in NO_x, ~21% in PM₁₀ and ~8% in PM_2.5 with ~75% GI cover in modelled domain under 2015-Base scenario. Coniferous trees (2039-Max-Con) were found to promote enhanced turbulence flow and offer more surface for deposition. Moreover, planting coniferous trees near traffic lanes (2039-NR-Con) was found to be a more effective solution to reduce annual pollutant concentration.

Patterned nanofiber air filters with high optical transparency, robust mechanical strength, and effective PM2.5 capture capability

PM_2.5, due to its small particle size, strong activity, ease of the attachment of toxic substances and long residence time in the atmosphere, has a great impact on human health and daily production. In this work, we have presented patterned nanofiber air filters with high optical transparency, robust mechanical strength and effective PM_2.5 capture capability. Here, to fabricate a transparency air filter by a facile electrospinning method, we chose three kinds of patterned wire meshes with micro-structures as negative receiver substrates and directly electrospun polymer fibers onto the supporting meshes. Compared with randomly oriented nanofibers (named “RO NFs” in this paper) and commercially available facemasks, the patterned air filters showed great mechanical properties, and the water contact angles on their surfaces were about 122–143° (the water contact angle for RO NFs was 81°). In addition, the patterned nanofibers exhibited high porosity (>80%), and their mean pore size was about 0.5838–0.8686 μm (the mean pore size of RO NFs was 0.4374 μm). The results indicate that the transparent patterned air filters have the best PM_2.5 filtration efficiency of 99.99% at a high transmittance of ∼69% under simulated haze pollution.

PM_2.5, due to its small particle size, strong activity, ease of the attachment of toxic substances and long residence time in the atmosphere, has a great impact on human health and daily production.

Acute Effects of Air Pollution on Hospital Admissions for Asthma, COPD, and Bronchiectasis in Ahvaz, Iran

Background and Aim

Although air pollution is a serious problem in Ahvaz, the association between air pollution and respiratory diseases has not been studied enough in this area. The aim of this study was to determine the relation between short-term exposure to air pollutants and the risk of hospital admissions due to asthma, COPD, and bronchiectasis in Ahvaz.

Methods

Hospital admissions data and air pollutants including O3, NO, NO2, SO2, CO, PM10, and PM2.5 were obtained from 2008 to 2018. Adjusted Quasi-Poisson regression with a distributed lag model, controlled for trend, seasonality, weather, weekdays, and holidays was used for data analysis.

Results

The results showed a significant increase in hospital admissions for asthma (RR=1.004, 95% CI: 1.002-1.007) and COPD (RR=1.003, 95% CI: 1.001-1.005) associated with PM2.5. PM10 was associated with increased hospital admissions due to bronchiectasis in both genders (Men: RR=1.003, 95% CI: 1.001-1.006) (Female: RR=1.003, 95% CI: 1.000-1.006). NO2 was also associated with an increased risk of hospital admissions for asthma (RR=1.040, 95% CI: 1.008-1.074) and COPD (RR=1.049, 95% CI: 1.010-1.090). SO2 was associated with the risk of hospital admissions of asthma (RR=1.069, 95% CI: 1.017-1.124) and bronchiectasis (RR=1.030, 95% CI: 1.005-1.056). Finally, CO was associated with COPD (RR=1.643, 95% CI: 1.233-2.191) and bronchiectasis (RR=1.542, 95% CI: 1.035-2.298) hospital admissions.

Conclusion

Short-term exposure to air pollutants significantly increases the risk of hospital admissions for asthma, COPD, and bronchiectasis in the adult and elderly population.

Loss of life expectancy from air pollution compared to other risk factors: a worldwide perspective

AIMS

Long-term exposure of humans to air pollution enhances the risk of cardiovascular and respiratory diseases. A novel Global Exposure Mortality Model (GEMM) has been derived from many cohort studies, providing much-improved coverage of the exposure to fine particulate matter (PM2.5). We applied the GEMM to assess excess mortality attributable to ambient air pollution on a global scale and compare to other risk factors.

METHODS AND RESULTS

We used a data-informed atmospheric model to calculate worldwide exposure to PM2.5 and ozone pollution, which was combined with the GEMM to estimate disease-specific excess mortality and loss of life expectancy (LLE) in 2015. Using this model, we investigated the effects of different pollution sources, distinguishing between natural (wildfires, aeolian dust) and anthropogenic emissions, including fossil fuel use. Global excess mortality from all ambient air pollution is estimated at 8.8 (7.11-10.41) million/year, with an LLE of 2.9 (2.3-3.5) years, being a factor of two higher than earlier estimates, and exceeding that of tobacco smoking. The global mean mortality rate of about 120 per 100 000 people/year is much exceeded in East Asia (196 per 100 000/year) and Europe (133 per 100 000/year). Without fossil fuel emissions, the global mean life expectancy would increase by 1.1 (0.9-1.2) years and 1.7 (1.4-2.0) years by removing all potentially controllable anthropogenic emissions. Because aeolian dust and wildfire emission control is impracticable, significant LLE is unavoidable.

CONCLUSION

Ambient air pollution is one of the main global health risks, causing significant excess mortality and LLE, especially through cardiovascular diseases. It causes an LLE that rivals that of tobacco smoking. The global mean LLE from air pollution strongly exceeds that by violence (all forms together), i.e. by an order of magnitude (LLE being 2.9 and 0.3 years, respectively).

Childhood pneumonia in low-and-middle-income countries: An update

OBJECTIVES

To review epidemiology, aetiology and management of childhood pneumonia in low-and-middle-income countries.

DESIGN

Review of published English literature between 2013 and 2019.

RESULTS

Pneumonia remains a major cause of morbidity and mortality. Risk factors include young age, malnutrition, immunosuppression, tobacco smoke or air pollution exposure. Better methods for specimen collection and molecular diagnostics have improved microbiological diagnosis, indicating that pneumonia results from several organisms interacting. Induced sputum increases microbiologic yield for Bordetella pertussis or Mycobacterium tuberculosis, which has been associated with pneumonia in high TB prevalence areas. The proportion of cases due to Streptococcus pneumoniae and Haemophilus influenzae b has declined with new conjugate vaccines; Staphylococcus aureus and H. influenzae non-type b are the commonest bacterial pathogens; viruses are the most common pathogens. Effective interventions comprise antibiotics, oxygen and non-invasive ventilation. New vaccines have reduced severity and incidence of disease, but disparities exist in uptake.

CONCLUSION

Morbidity and mortality from childhood pneumonia has decreased but a considerable preventable burden remains. Widespread implementation of available, effective interventions and development of novel strategies are needed.

Screening of antagonistic strains of respiratory origin and analysis of their bacteriostatic effects on pathogens

Objective

To find antagonistic strains in the respiratory tract having bacteriostatic properties against common pathogens.

Methods

The oropharyngeal microbiota of five healthy children aged 4–6 years were collected and α‐hemolytic bacteria screened on 15% sheep blood agar. Bacteriostatic effects of the isolated α‐hemolytic bacteria on Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Streptococcus pyogenes were evaluated by the Oxford cup method. Antagonistic strains were identified by mass spectrometry, and the16S rDNAs were sequenced, and their best bacteriostatic concentrations and antagonistic spectra for Klebsiella pneumoniae, Proteus vulgaris, Enterobacter cloacae, Acinetobacter Baumanii, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Streptococcus pyogenes were evaluated.

Results

Of 300 isolated α‐hemolytic bacterial clones, four exhibited bacteriostatic activity against Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Streptococcus pyogenes. Mass spectrometric analyses revealed that two of them were Streptococcus mitis and two others were Streptococcus parasanguinis strains. Further tests showed that all 4 antagonistic strains also had bacteriostatic effects on Klebsiella pneumoniae, Proteus vulgaris, Enterobacter cloacae, and Acinetobacter Baumanii, and the mode of action was not mediated by lactic acid production.

Conclusion

Four antagonistic Streptococcus strains derived from oropharyngeal microbiotas showed bacteriostatic effects on pathogens and may be involved in pharyngeal microbiome homeostasis.

Burden of disease at the same limit of exposure to airborne polycyclic aromatic hydrocarbons varies significantly across countries depending on the gap in longevity

Atmospheric polycyclic aromatic hydrocarbons (PAHs) disproportionately affect human health across the globe, and differential exposure is believed to drive the unequal health burden. Therefore, this study assessed and compared the burden of disease, in disability-adjusted life years (DALYs), at the same level (or limit) of exposure to atmospheric PAHs in nine countries. We calculated the DALYs per person-year per ng/m³ of benzo[a]pyrene from ten cancers and thirty-four non-cancer adverse outcomes using published toxicity information and country-specific disease severity. Exposure duration was averaged over 30 years and we adjusted for early-life vulnerability to cancer. The DALYs per person-year per ng/m³ of fifteen other individual PAHs was calculated using relative potency factors, and toxicity factors derived from quantitative structure-activity relationships. We found that even at the same level of exposure to PAHs, the incremental burdens of disease varied substantially across countries. For instance, they varied by about 2-3 folds between Nigeria and the USA. Countries having the lowest longevity had the highest DALYs per person-year per ng/m³ of each PAH. Kruskal-Wallis test (α = 0.05) showed that the variation across countries was significant. The post hoc tests detected a significant difference between two countries when the gap in longevity was >10 years. This suggests that countries having very low average life expectancy require more stringent PAH limit. Linear or exponential function of average longevity gave valid approximation of the DALYs per person-year per ng/m³ of benzo[a]pyrene or phenanthrene, respectively. Furthermore, we used global gridded surface benzo[a]pyrene concentrations and global population dataset for 2007, with spatial resolution of 0.1° × 0.1°, to calculate the contribution of differential exposures to the estimated DALYs per person-year. We found that in six out of nine countries, differential exposures to PAH contribute less to the estimated health loss than differential severities of the diseases. This indicates that the risk to health from PAHs may be underreported if the severities of the diseases in the countries are not considered.

Health impact and related cost of ambient air pollution in Tehran

Ambient air pollution represents one of the biggest environmental risks to health. In this study, we estimated the avoidable mortality burden attributable to ambient air pollution in Tehran, and derived the economic impact associated with these health effects. Using PM_2.5 data from ground-level air pollution measurements in Tehran, we estimated PM_2.5 exposure for 349 neighborhoods in Tehran, by the Environmental Benefits Mapping and Analysis Program (BenMAP-CE). We considered five scenarios related to PM_2.5 levels: an increase to 35 μg/m³; a reduction to 25 μg/m³; a reduction to 15 μg/m³; a reduction to 10 μg/m³ (the WHO's air quality guideline value); and a full roll-back, assuming a reduction to 2.4 μg/m³. All scenarios used 2017 p.m._2.5 levels as a starting point. Using the concentration response function of the Global Exposure Mortality Model (GEMM), we estimated a total of 7146 (95% CI: 6596-7513) adult (age ≥25 years) deaths attributable to PM_2.5 in 2017. The leading causes of death were ischemic heart disease (3437; 95% CI: 3315-3516), stroke (886; 95% CI: 693-1002), lower respiratory infections (531: 95% CI: 414-589), chronic obstructive pulmonary disease (364; 95% CI: 271-420), and lung cancer (274; 95% CI: 236-298). The estimated total annual economic benefit (2017) of reducing PM_2.5 concentration levels to 2.4 μg/m³ was USD 0.591 (95% CI: 0.447-0.624) billion per year, using the value of a life year (VOLY) approach, and USD 2.894 (95% CI: 2.671-3.043) billion per year, using the value of a statistical life (VSL) approach.

Associations between ambient air pollution and mortality from all causes, pneumonia, and congenital heart diseases among children aged under 5 years in Beijing, China: A population-based time series study

BACKGROUND

Previous studies have mainly focused on the associations between particulate matters and infant mortality. However, evidence regarding the associations between gaseous pollutants and mortality among children aged <5 years remains sparse.

OBJECTIVES

The aim of this study was to investigate the associations between ambient air pollution and death among children aged <5 years in Beijing, China, and explore the impact of age, gender and specific causes of death on these associations.

METHODS

Concentrations of ambient air pollution and the number of deaths among children aged <5 years in Beijing from January 2014 to September 2016 were extracted from authoritative electronic databases. The associations were estimated for a single-month lag from the current month up to the previous 5 months (lag0-lag5) and moving averages of the current and previous months (lag01-lag05) using generalized additive Poisson regression (adjusted for time trends, season, meteorological variables and holidays). Subgroup analyses related to age, gender and specific diseases were performed. Two-pollutant models were used to evaluate the possible role of single pollutants.

RESULTS

Sulfur dioxide (SO₂), nitrogen dioxide (NO₂) and carbon monoxide (CO) demonstrated the strongest associations with death among children aged <5 years at lag0, and the estimates decreased or even turned negative with the increasing lag periods. For an interquartile range increase in SO₂, NO₂ and CO at lag0, the odds ratios (OR) were 1.332 (95% CI 1.152-1.539), 1.383 (95% CI 1.113-1.718) and 1.273 (95% CI 1.028-1.575). However, CO lost significance after adjusting for SO₂ and NO₂, and PM_2.5 gained significance (OR 1.548, 95% CI 1.061-2.258) after adjusting for PM₁₀. The ORs for SO₂ and NO₂ remained the most stable across all two-pollutant models. The associations for children aged 1-5 years were stronger than those reported for infants at lag0 but lower at the other lag months. The pollutant associations were stronger for congenital heart disease-related death than overall and pneumonia-related death. We did not find significant differences in terms of gender.

CONCLUSION

Exposure to air pollution may increase the incidence of death among children aged <5 years. SO₂ and NO₂ may be the most stable pollutants reflecting associations between air pollution and death, deserving further attention. Children with congenital heart diseases are more susceptible to air pollution. Therefore, it is urgent to implement the clean air targets established by WHO and reduce the exposure of children to air pollution.

Exploring the economy-wide effects of agriculture on air quality and health: Evidence from Europe

Agricultural emissions strongly contribute to fine particulate matter pollution (PM2.5) and associated effects on human health. Environmentally-extended input-output models and a regional atmospheric chemistry model (WRF-Chem) were combined to conduct an economy-wide assessment of air pollution and pre-mature mortality in the European Union (EU), associated with a 20% increase in the final demand for the output of the agricultural sector. Model results revealed significant differences in air pollution originating from agricultural growth across the 28 EU countries (EU-28). The highest impact of agricultural growth on PM2.5 concentrations occur over the Northern Balkan countries (Bulgaria and Romania) and northern Italy. However, the highest excess mortality rates in the EU-28 due to changes in emissions and enhanced PM2.5 concentrations are observed in Malta, Greece, Spain and Cyprus. The least affected countries are mostly located in the northern part of Europe, with the exception of the Scandinavian Countries, which have relatively good air quality under current conditions. Our integrated modelling framework results highlight the importance of capturing both the direct and indirect air pollution emissions of economic sectors via upstream supply chains and underscore the non-linear response of surface PM2.5 levels and their health impacts to emission fluxes.

Using Ionic Liquids To Study the Migration of Semivolatile Organic Vapors in Smog Chamber Experiments

Atmospheric organic aerosols comprise complex mixtures of a myriad of compounds with a wide range of structures and volatilities. To understand the fate of atmospheric organic aerosols and their contribution to particulate matter pollution, we need to study the relative portion divided between semivolatile organic compounds (SVOCs) and low-volatility organic compounds (LVOCs). SVOCs can effectively migrate and exchange between aerosol populations and thus are more accessible for further reactions and removal processes, while LVOCs will essentially stay in the particle phase. Here, we introduce using ionic liquid droplets as novel sorbents for organic vapors in smog chamber experiments to study the transfer of constituents between aerosol populations and to separate SVOCs and LVOCs from chamber-produced secondary organic aerosols (SOAs). SOA was formed and condensed on the ammonium-sulfate seeds, and later ionic liquid droplets were introduced into the chamber. We show that there are considerable yields of both LVOCs and SVOCs produced from α-pinene ozonolysis, and the uptake of SVOCs into the ionic liquid increases as the amount of reacted α-pinene increases. We also show that the SVOCs absorbed into the ionic liquid re-evaporate more readily compared to SOA originally condensed on the ammonium-sulfate seeds. We are thus able to differentiate the semivolatile components that partition into the extremely polar ionic liquid aerosols from the demonstrably less volatile components also condensed on the ammonium-sulfate seeds. Combined with previous studies using other organic aerosols as solvents to probe SVOC transfer between aerosol populations, we provide a wide set of measurements to probe and constrain the physical and thermodynamic properties of chamber-produced SOA complex.

Transboundary and traffic influences on air pollution across two Caribbean islands

Exposure to ambient air pollution has been linked to adverse health outcomes ranging from asthma to premature mortality. However, little to no information exists on the exposure of residents and visitors in the Caribbean islands. While a few previous studies have quantified levels of PM₁₀ (particulate matter <10 μm) from Sahara dust in Trinidad, our study focussed on a local source of air pollution, traffic emissions. Mass concentrations of black carbon (BC) and PM_2.5 (PM <2.5 μm) were measured at ten locations across the islands of Trinidad and Tobago over a three-week period. PM_2.5 concentrations were observed to be heavily influenced by air masses showing origins from the Sahara Desert (31%), North America (26%) and Atlantic Ocean (42%), which resulted in similar average concentrations between the two islands. Average concentrations of BC were five times higher in Trinidad than Tobago (2.0 vs 0.43 μg/m³). In addition, BC in Trinidad was three times higher near than away from major roads (2.21 vs. 0.72 μg/m³), with concentrations reaching levels comparable to those near highways in large Metropolitan cities. The elevated BC concentrations observed in this study suggests that significant exposure to diesel exhaust is occurring in Trinidad, with significant contributions from traffic.