Emergency room visits associated with particulate concentration and Asian dust storms in metropolitan Taipei

Urban-rural disparity of the short-term association of PM2.5 with mortality and its attributable burden

Although studies have investigated the associations between PM_2.5 and mortality risk, evidence from rural areas is scarce. We aimed to compare the PM_2.5-mortality associations between urban cities and rural areas in China. Daily mortality and air pollution data were collected from 215 locations during 2014–2017 in China. A two-stage approach was employed to estimate the location-specific and combined cumulative associations between short-term exposure to PM_2.5 (lag 0–3 days) and mortality risks. The excess risks (ER) of all-cause, respiratory disease (RESP), cardiovascular disease (CVD), and cerebrovascular disease (CED) mortality for each 10 μg/m³ increment in PM_2.5 across all locations were 0.54% (95% confidence interval [CI]: 0.38%, 0.70%), 0.51% (0.10%, 0.93%), 0.74% (0.50%, 0.97%), and 0.52% (0.20%, 0.83%), respectively. Slightly stronger associations for CVD (0.80% versus 0.60%) and CED (0.61% versus 0.26%) mortality were observed in urban cities than in rural areas, and slightly greater associations for RESP mortality (0.51% versus 0.43%) were found in rural areas than in urban cities. A mean of 2.11% (attributable fraction [AF], 95% CI: 1.48%, 2.76%) of all-cause mortality was attributable to PM_2.5 exposure in China, with a larger AF in urban cities (2.89% [2.12%, 3.67%]) than in rural areas (0.61% [−0.60%, 1.84%]). Disparities in PM_2.5-mortality associations between urban cities and rural areas were also found in some subgroups classified by sex and age. This study provided robust evidence on the associations of PM_2.5 with mortality risks in China and demonstrated urban-rural disparities of PM_2.5-mortality associations for various causes of death.

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PM_2.5 had greater effects on CVD/CED mortality in urban cities than in rural areas

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PM_2.5 had stronger effects on RESP mortality in rural areas than in urban cities

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An annual mean of 16.5/100,000 deaths was attributable to PM_2.5 in urban cities

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An annual mean of 3.4//100,000 deaths was attributable to PM_2.5 in rural areas

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Spatially targeted measures are needed to reduce PM_2.5-related mortality in China

Global Health Impacts of Dust Storms: A Systematic Review

BACKGROUND

Dust storms and their impacts on health are becoming a major public health issue. The current study examines the health impacts of dust storms around the world to provide an overview of this issue.

METHOD

In this systematic review, 140 relevant and authoritative English articles on the impacts of dust storms on health (up to September 2019) were identified and extracted from 28 968 articles using valid keywords from various databases (PubMed, WOS, EMBASE, and Scopus) and multiple screening steps. Selected papers were then qualitatively examined and evaluated. Evaluation results were summarized using an Extraction Table.

RESULTS

The results of the study are divided into two parts: short and long-term impacts of dust storms. Short-term impacts include mortality, visitation, emergency medical dispatch, hospitalization, increased symptoms, and decreased pulmonary function. Long-term impacts include pregnancy, cognitive difficulties, and birth problems. Additionally, this study shows that dust storms have devastating impacts on health, affecting cardiovascular and respiratory health in particular.

CONCLUSION

The findings of this study show that dust storms have significant public health impacts. More attention should be paid to these natural hazards to prepare for, respond to, and mitigate these hazardous events to reduce their negative health impacts.Registration: PROSPERO registration number CRD42018093325.

Predicting carbonaceous aerosols and identifying their source contribution with advanced approaches

Organic carbon (OC) and elemental carbon (EC) play important roles in various atmospheric processes and health effects. Predicting carbonaceous aerosols and identifying source contributions are important steps for further epidemiological study and formulating effective emission control policies. However, we are not aware of any study that examined predictions of OC and EC, and this work is also the first study that attempted to use machine learning and hyperparameter optimization method to predict concentrations of specific aerosol contaminants. This paper describes an investigation of the characteristics and sources of OC and EC in fine particulate matter (PM_2.5) from 2005 to 2010 in the City of Taipei. Respective hourly average concentrations of OC and EC were 5.2 μg/m³ and 1.6 μg/m³. We observed obvious seasonal variation in OC but not in EC. Hourly and daily OC and EC concentrations were predicted using generalized additive model and grey wolf optimized multilayer perceptron model, which could explain up to about 80% of the total variation. Subsequent clustering suggests that traffic emission was the major contribution to OC, accounting for about 80% in the spring, 65% in the summer, and 90% in the fall and winter. In the Taipei area, local emissions were the dominant sources of OC and EC in all seasons, and long-range transport had a significant contribution to OC and in PM_2.5 in spring.

Assessing the effects of meteorological factors on daily children's respiratory disease hospitalizations: A retrospective study

Respiratory disease symptoms in children are aggravated by frequent changes in meteorological conditions. The net effective temperature (NET) integrates temperature, relative humidity, and wind speed as a cooling indicator. This study aims to assess the effect of daily changes in meteorological factors and corresponding NET data on children's hospitalizations for different ages, genders and subtypes of respiratory infections in Baotou, China. Distributed lag non-linear models were constructed to simultaneously assess the exposure–response associations between daily admission counts of children with respiratory diseases and daily NET and other meteorological factors, as well as their lag dependencies. As air pollution significantly affects the respiratory tract, it was considered as confounding factor. In general, the cumulative meteorological factors had greater effects on lower respiratory tract infections than upper respiratory tract infections (RR: temperature [5.21 vs. 2.33], wind speed [4.89 vs. 3.12], and humidity [1.77 vs. 0.97]). The effects of cumulative meteorological factors on female children were greater than those on male children (RR: temperature [2.14 vs. 1.82], wind speed [5.46 vs. 1.90], and humidity [1.60 vs. 1.55]). Temperature and wind speed showed an influence on 4–7-year-old children, but these factors had no influence on other age groups; humidity only showed an influence on the 0–3-year-old group. The NET value had a large effect on lower respiratory infections, in the 4–7-year-old group and female children. In conclusion, a complex non-linear relationship exists between climate variability and children's respiratory diseases. The results of the study can be used to support the development of important meteorological information tools for early warnings of respiratory disease events in children. Concurrently, the NET values can be used for comprehensive assessments of climate change in the future, which will help the government and health authorities better minimize the impacts of children's respiratory diseases.

Comparative assessments of mortality from and morbidity of circulatory diseases in association with extreme temperatures

BACKGROUND

This study evaluated vulnerable subpopulation on mortality, emergency room visits (ERVs) and outpatient visits associated with ambient daily temperature from 2000 to 2014 using vital statistics and insurance claims of Taiwan.

METHODS

We used the distributed lag non-linear model to assess circulatory disease-specific deaths, ERVs, and outpatient visits by mean temperature after controlling particulate matter (PM₁₀) and other covariates. Lag effect of temperature changes on health risks accumulated for 0-10 days associated with low temperature and for 0-5 days for high temperature were evaluated. Cause-specific pooled relative risk (RR) and 95% confidence intervals (CI) were estimated for the whole population of Taiwan using random-effects meta-analysis.

RESULTS

We used reference temperatures of 60th percentiles for mortality from circulatory diseases, 99th percentile for ERVs of circulatory diseases, 2nd percentile for ERVs of heart diseases and ischemic heart disease, 53th percentile for ERVs of cerebrovascular disease, and 12-16th percentiles for outpatient visits of circulatory diseases. The lag effects peaked at lag 4-5 day for low temperature exposure and at lag 0 for high temperature exposure. Pooled cold related health risk was the highest for mortality from and ERV of circulatory diseases with RR of 1.41 (95% CI: 1.34, 1.49) and 1.41 (95% CI: 1.35, 1.48), respectively, as daily mean temperatures was at 1st percentile (12.8 °C). Heat related health risk was significant for mortality from heart diseases [RR = 1.12 (95% CI: 1.07, 1.18)] and ischemic heart diseases [RR = 1.13 (95% CI: 1.06, 1.20)] as daily mean temperatures was at 99th percentile (29.9 °C).

CONCLUSIONS

Health authority should evaluate the effectiveness of adaptive policy, strategy, and actions responding to extreme temperatures to prevent mortality from circulatory diseases.

Health Effects of Asian Dust: A Systematic Review and Meta-Analysis

BACKGROUND

Potential adverse health effects of Asian dust exposure have been reported, but systematic reviews and quantitative syntheses are lacking.

OBJECTIVE

We reviewed epidemiologic studies that assessed the risk of mortality, hospital admissions, and symptoms/dysfunction associated with exposure to Asian dust.

METHODS

We performed a systematic search of PubMed and Web of Science to identify studies that reported the association between Asian dust exposure and human health outcomes. We conducted separate meta-analyses using a random-effects model for mortality and hospital admissions for a specific health outcome and assessed pooled estimates for each lag when at least three studies were available for a specific lag.

RESULTS

We identified 89 studies that met our inclusion criteria for the systematic review, and 21 studies were included in the meta-analysis. The pooled estimates (percentage changes) of mortality from circulatory and respiratory causes for Asian dust days vs. non-Asian dust days were 2.33% [95% confidence interval (CI): 0.76, 3.93] increase at lag 0 and 3.99% (95% CI: 0.08, 8.06) increase at lag 3, respectively. The increased risk for hospital admissions for respiratory disease, asthma, and pneumonia peaked at lag 3 by 8.85% (95% CI: 0.80, 17.55), 14.55% (95% CI: 6.74, 22.94), and 8.51% (95% CI: 2.89, 14.44), respectively. Seven of 12 studies reported reduced peak expiratory flow, and 16 of 21 studies reported increased respiratory symptoms associated with Asian dust exposure. There were substantial variations between the studies in definitions of Asian dust, study designs, model specifications, and confounder controls.

DISCUSSION

We found evidence of increased mortality and hospital admissions for circulatory and respiratory events. However, the number of studies included in the meta-analysis was not large and further evidences are merited to strengthen our conclusions. Standardized protocols for epidemiological studies would facilitate interstudy comparisons. https://doi.org/10.1289/EHP5312.

[Health Effects of Asian Dust Events: A Literature Review Update of Epidemiological Evidence]

Asian dust is a phenomenon involving the long-range transport of atmospheric pollutants originating from the desert areas of China and Mongolia. In recent years, the health effects of Asian dust have raised public concerns. Numerous studies on the health effects of Asian dust have been published since the last review in 2010. Thus, a literature review was conducted to shed light on the latest epidemiologic findings. PubMed and Science Direct databases were used for the review of epidemiologic studies published between June 2009 and April 2018. We identified 53 epidemiologic studies. Mortality, ambulance transportation, hospitalization/medical examination, changes in symptomatic, functional, and examination findings, as well as birth outcomes have been reported as outcomes. When the outcomes were categorized by disease, the effects of Asian dust on respiratory, cardiovascular, and allergic diseases raised concerns. The common evidences of causation between Asian dust and these diseases were the consistency of findings and temporal sequence of association. As results of research on dose-response relationships have become available, and the possibility that the health effects of Asian dust may vary depending on its chemical composition has been pointed out, further research using the exposure level indicators of Asian dust or its chemical composition should be conducted. Furthermore, with focus on the crucial issue of reducing exposure, research related to prevention and raising awareness should be further promoted.

Ambient Particulate Matter Exposure and Under-Five and Maternal Deaths in Asia

The Asian region is one of the major emission sources of air pollution. Although ambient PM_2.5 has been linked to several health risks in high-, low-, and middle-income countries, the further analysis of type impact is still rare but significant. The PM_2.5 distribution retrieved from MODIS (Moderate Resolution Imaging Spectroradiometer) aerosol optical depth products within 16 years thus explored the associations between under-five and maternal mortality for 45 countries in Asia. Both the nonparametric (Generalized Additive Mixed-Effect) and parametric (Generalized Linear Mixed-Effect) models were employed to analyze the collected datasets. The results show that the levels of PM_2.5 in Asian sub-regions were higher than the Global Air Quality Standards. Biomass PM_2.5 concentrations was associated with increased the rate of under-five (Incidence Rate Ratio, IRR = 1.29, 95% CI, 1.13–1.47) and maternal (IRR = 1.09, 95% CI: 1.08–1.10) deaths in Asia. Anthropogenic PM_2.5 was associated with increased rate of under-five deaths in Asia by 12%. The nonparametric method revealed that dust PM_2.5 was positively associated with the under-five (β = 0.04, p < 0.001) and maternal (β = 0.07, p < 0.001) deaths in Asia. The rate of maternal deaths was increased by biomass/dust (IRR = 1.64, 95% CI: 1.63–1.65) and anthropogenic/dust (IRR = 1.22, 95% CI: 1.19–1.26) mixture types. In summary, long-term exposure to different types of ambient PM_2.5 in high concentration increased the rate of under-five and maternal deaths, suggesting that policies focusing on preventive and control measures is imperative for developing an improved maternal, newborn, and child health in Asia.

Extreme desert dust storms and COPD morbidity on the island of Crete

Introduction and objectives

Short-term extreme increases in desert-derived particulate-matter with aerodynamic diameter below 10 μm (PM₁₀) may affect emergency department (ED) visits due to COPD exacerbations.

Research question

Our aim was to identify the effect of extreme increases in desert-derived PM₁₀ on ED visits for dyspnea and COPD exacerbations and on the related hospital admissions.

Methods

We performed a retrospective analysis of dyspnea-related ED visits and hospital admissions in Heraklion, Crete, during four consecutive storms of desert-derived PM₁₀ that happened during March 2018. We collected data from over 17,000 ED visits and recorded patients with atopic symptoms, COPD exacerbations, and dyspnea, as well as admissions to the departments of pulmonary medicine, internal medicine, and cardiology. PM₁₀ data were collected from a monitoring station in the same geographic area.

Results

Four desert dust storms were recorded during the study period with 238, 203, 1138, and 310 μg/m³ average-daily PM₁₀ and 652, 308, 4262, and 778 μg/m³ hourly mean day-peak PM_10, respectively. There was no clinically important increase in total ED visits, total admissions or admissions to the departments of cardiology, pulmonary medicine, or internal medicine, during PM₁₀ peaks. However, during the desert dust storm with daily-average PM₁₀ above 500 μg/m³, there was a striking increase in dyspnea-related ED visits (including COPD exacerbations, 3.6-fold increase), while there was no clinically important increase in non-asthma allergy-related ED visits.

Conclusion

Extreme desert dust storm episodes may cause meaningful increases in ED visits for dyspnea and COPD exacerbations/admissions.

Spatial Analysis of Ambient PM2.5 Exposure and Bladder Cancer Mortality in Taiwan

Fine particulate matter (PM_2.5) is an air pollutant that is receiving intense regulatory attention in Taiwan. In previous studies, the effect of air pollution on bladder cancer has been explored. This study was conducted to elucidate the effect of atmospheric PM_2.5 and other local risk factors on bladder cancer mortality based on available 13-year mortality data. Geographically weighted regression (GWR) was applied to estimate and interpret the spatial variability of the relationships between bladder cancer mortality and ambient PM_2.5 concentrations, and other variables were covariates used to adjust for the effect of PM_2.5. After applying a GWR model, the concentration of ambient PM_2.5 showed a positive correlation with bladder cancer mortality in males in northern Taiwan and females in most of the townships in Taiwan. This is the first time PM_2.5 has been identified as a risk factor for bladder cancer based on the statistical evidence provided by GWR analysis.

Mortality and emergency room visits associated with ambient particulate matter constituents in metropolitan Taipei

OBJECTIVE

To evaluate the elderly mortality and all population emergency room visits (ERV) associated with exposing to particulate matter (PM) ≤10μm in aerodynamic diameter (PM10), PM2.5, and PM constituents in Taipei, Taiwan.

METHODS

This study used a distributed lag nonlinear model with Poisson distribution to estimate cumulative 6-day (lags 0-5) relative risks (RRs) and confidence intervals (CIs) of mortality and ERV of all causes, circulatory diseases, and respiratory diseases associated with daily concentrations of PM10, PM2.5 and PM constituents (organic carbon (OC), elemental carbon (EC), nitrate and sulfate).

RESULTS

Mortality and ERVs were associated with PM concentrations and its constituents. The elderly all-cause mortality was significantly associated with nitrate concentrations (RR=1.12 (95% CI: 1.02, 1.23) at 1μg/m(3)) and OC higher than 15μg/m(3); and mortality from circulatory diseases was significantly associated with PM10 (RR=1.13 (95% CI: 1.02, 1.25) at 50μg/m(3)), PM2.5 (RR=1.16 (95% CI: 1.01, 1.34) at 30μg/m(3)), nitrate higher than 8μg/m(3), and sulfate (RR=1.31 (95% CI: 1.12, 1.54) at 7μg/m(3)). An increase in PM2.5 from 5μg/m(3) to 30μg/m(3) was associated with increased ERV risk of all causes and respiratory diseases with cumulative 6-day RRs of 1.12 (95% CI: 1.06, 1.18) and 1.27 (95% CI: 1.10, 1.46), respectively. All-cause ERV was significantly associated with concentrations of OC (RR=1.03 (95% CI: 1.00, 1.06) at 4μg/m(3)), EC (RR=1.08 (95% CI: 1.05, 1.12) at 2μg/m(3)), nitrate higher than 6μg/m(3), and sulfate higher than 8μg/m(3).

CONCLUSIONS

Ambient air quality management should regularly evaluate PM constituents and related health effects.

Effect of Dust Storms on the Atmospheric Microbiome in the Eastern Mediterranean

We evaluated the impact of Saharan dust storms on the local airborne microbiome in a city in the Eastern Mediterranean area. Samples of particles with diameter less than 10 μm were collected during two spring seasons on both dusty and nondusty days. DNA was extracted, and partial 16S rRNA gene amplicons were sequenced using the Illumina platform. Bioinformatic analysis showed the effect of dust events on the diversity of the atmospheric microbiome. The relative abundance of desert soil-associated bacteria increased during dust events, while the relative abundance of anthropogenic-influenced taxa decreased. Quantitative polymerase chain reaction measurements of selected clinically significant antibiotic resistance genes (ARGs) showed that their relative abundance decreased during dust events. The ARG profiles on dust-free days were similar to those in aerosol collected in a poultry house, suggesting a strong agricultural influence on the local ambient profiles. We conclude that dust storms enrich the ambient airborne microbiome with new soil-derived bacteria that disappear as the dust settles, suggesting that the bacteria are transported attached to the dust particles. Dust storms do not seem to be an important vector for transport of probed ARGs.