Exposure to Environmental Toxins: Potential Implications for Stroke Risk via the Gut- and Lung-Brain Axis

Recent evidence indicates that exposure to environmental toxins, both short-term and long-term, can increase the risk of developing neurological disorders, including neurodegenerative diseases (i.e., Alzheimer's disease and other dementias) and acute brain injury (i.e., stroke). For stroke, the latest systematic analysis revealed that exposure to ambient particulate matter is the second most frequent stroke risk after high blood pressure. However, preclinical and clinical stroke investigations on the deleterious consequences of environmental pollutants are scarce. This review examines recent evidence of how environmental toxins, absorbed along the digestive tract or inhaled through the lungs, affect the host cellular response. We particularly address the consequences of environmental toxins on the immune response and the microbiome at the gut and lung barrier sites. Additionally, this review highlights findings showing the potential contribution of environmental toxins to an increased risk of stroke. A better understanding of the biological mechanisms underlying exposure to environmental toxins has the potential to mitigate stroke risk and other neurological disorders.

Mechanistic insights into cardiovascular effects of ultrafine particle exposure: A longitudinal panel study

BACKGROUND

Ultrafine particle (UFP) has been linked with higher risks of cardiovascular diseases; however, the biological mechanisms remain to be fully elucidated.

OBJECTIVES

This study aims to investigate the cardiovascular responses to short-term UFP exposure and the biological pathways involved.

METHODS

A longitudinal panel study was conducted among 32 healthy, non-smoking young adults in Shanghai, China, who were engaged in five rounds of follow-ups between December 2020 and November 2021. Individual exposures were calculated based on the indoor and outdoor real-time measurements. Blood pressure, arterial stiffness, targeted biomarkers, and untargeted proteomics and metabolomics were examined during each follow-up. Linear mixed-effect models were applied to analyze the exposure and health data. The differential proteins and metabolites were used for pathway enrichment analyses.

RESULTS

Short-term UFP exposure was associated with significant increases in blood pressure and arterial stiffness. For example, systolic blood pressure increased by 2.10 % (95 % confidence interval: 0.63 %, 3.59 %) corresponding to each interquartile increase in UFP concentrations at lag 0-3 h, while pulse wave velocity increased by 2.26 % (95 % confidence interval: 0.52 %, 4.04 %) at lag 7-12 h. In addition, dozens of molecular biomarkers altered significantly. These effects were generally present within 24 h after UFP exposure, and were robust to the adjustment of co-pollutants. Molecular changes detected in proteomics and metabolomics analyses were mainly involved in systemic inflammation, oxidative stress, endothelial dysfunction, coagulation, and disturbance in lipid transport and metabolism.

DISCUSSION

This study provides novel and compelling evidence on the detrimental subclinical cardiovascular effects in response to short-term UFP exposure. The multi-omics profiling further offers holistic insights into the underlying biological pathways.

Harnessing AI to unmask Copenhagen's invisible air pollutants: A study on three ultrafine particle metrics

Ultrafine particles (UFPs) are airborne particles with a diameter of less than 100 nm. They are emitted from various sources, such as traffic, combustion, and industrial processes, and can have adverse effects on human health. Long-term mean ambient average particle size (APS) in the UFP range varies over space within cities, with locations near UFP sources having typically smaller APS. Spatial models for lung deposited surface area (LDSA) within urban areas are limited and currently there is no model for APS in any European city. We collected particle number concentration (PNC), LDSA, and APS data over one-year monitoring campaign from May 2021 to May 2022 across 27 locations and estimated annual mean in Copenhagen, Denmark, and obtained additionally annual mean PNC data from 6 state-owned continuous monitors. We developed 94 predictor variables, and machine learning models (random forest and bagged tree) were developed for PNC, LDSA, and APS. The annual mean PNC, LDSA, and APS were, respectively, 5523 pt/cm3, 12.0 μm2/cm3, and 46.1 nm. The final R2 values by random forest (RF) model were 0.93 for PNC, 0.88 for LDSA, and 0.85 for APS. The 10-fold, repeated 10-times cross-validation R2 values were 0.65, 0.67, and 0.60 for PNC, LDSA, and APS, respectively. The root mean square error for final RF models were 296 pt/cm3, 0.48 μm2/cm3, and 1.60 nm for PNC, LDSA, and APS, respectively. Traffic-related variables, such as length of major roads within buffers 100-150 m and distance to streets with various speed limits were amongst the highly-ranked predictors for our models. Overall, our ML models achieved high R2 values and low errors, providing insights into UFP exposure in a European city where average PNC is quite low. These hyperlocal predictions can be used to study health effects of UFPs in the Danish Capital.

Erythrocyte Vulnerability to Airborne Nanopollutants

The toxicological impact of airborne polluting ultrafine particles (UFPs, also classified as nanoparticles with average sizes of less than 100 nm) is an emerging area of research pursuing a better understanding of the health hazards they pose to humans and other organisms. Hemolytic activity is a toxicity parameter that can be assessed quickly and easily to establish part of a nanoparticle's behavior once it reaches our circulatory system. However, it is exceedingly difficult to determine to what extent each of the nanoparticles present in the air is responsible for the detrimental effects exhibited. At the same time, current hemolytic assessment methodologies pose a series of limitations for the interpretation of results. An alternative is to synthesize nanoparticles that model selected typical types of UFPs in air pollution and evaluate their individual contributions to adverse health effects under a clinical assay of osmotic fragility. Here, we discuss evidence pointing out that the absence of hemolysis is not always a synonym for safety; exposure to model nanopollutants, even at low concentrations, is enough to increase erythrocyte susceptibility and dysfunction. A modified osmotic fragility assay in combination with a morphological inspection of the nanopollutant-erythrocyte interaction allows a richer interpretation of the exposure outcomes. Membrane-nanoparticle interplay has a leading role in the vulnerability observed. Therefore, future research in this line of work should pay special attention to the evaluation of the mechanisms that cause membrane damage.

Investigating environmentally persistent free radicals (EPFRs) emissions of 3D printing process

In recent years, the emission of particles and gaseous pollutants from 3D printing has attracted much attention due to potential health risks. This study investigated the generation of environmentally persistent free radicals (EPFRs, organic free radicals stabilized on or inside particles) in total particulate matter (TPM) released during the 3D printing process. Commercially available 3D printer filaments, made of acrylonitrile-butadiene-styrene (ABS) in two different colors and metal content, ABS-blue (19.66 μg/g Cu) and ABS-black (3.69 μg/g Fe), were used for printing. We hypothesized that the metal content/composition of the filaments contributes not only to the type and number of EPFRs in TPM emissions, but also impacts the overall yield of TPM emissions. TPM emissions during printing with ABS-blue (11.28 μg/g of printed material) were higher than with ABS-black (7.29 μg/g). Electron paramagnetic resonance (EPR) spectroscopy, employed to measure EPFRs in TPM emissions of both filaments, revealed higher EPFR concentrations in ABS-blue TPM (6.23 × 1017 spins/g) than in ABS-black TPM (9.72 × 1016 spins/g). The presence of copper in the ABS-blue contributed to the formation of mostly oxygen-centered EPFR species with a g-factor of ~2.0041 and a lifetime of 98 days. The ABS-black EPFR signal had a lower g-factor of ~2.0011, reflecting the formation of superoxide radicals during the printing process, which were shown to have an "estimated tentative" lifetime of 26 days. Both radical species (EPFRs and superoxides) translate to a potential health risk through inhalation of emitted particles.

Adverse effects of exposure to fine particles and ultrafine particles in the environment on different organs of organisms

Particulate pollution is a global risk factor that seriously threatens human health. Fine particles (FPs) and ultrafine particles (UFPs) have small particle diameters and large specific surface areas, which can easily adsorb metals, microorganisms and other pollutants. FPs and UFPs can enter the human body in multiple ways and can be easily and quickly absorbed by the cells, tissues and organs. In the body, the particles can induce oxidative stress, inflammatory response and apoptosis, furthermore causing great adverse effects. Epidemiological studies mainly take the population as the research object to study the distribution of diseases and health conditions in a specific population and to focus on the identification of influencing factors. However, the mechanism by which a substance harms the health of organisms is mainly demonstrated through toxicological studies. Combining epidemiological studies with toxicological studies will provide a more systematic and comprehensive understanding of the impact of PM on the health of organisms. In this review, the sources, compositions, and morphologies of FPs and UFPs are briefly introduced in the first part. The effects and action mechanisms of exposure to FPs and UFPs on the heart, lungs, brain, liver, spleen, kidneys, pancreas, gastrointestinal tract, joints and reproductive system are systematically summarized. In addition, challenges are further pointed out at the end of the paper. This work provides useful theoretical guidance and a strong experimental foundation for investigating and preventing the adverse effects of FPs and UFPs on human health.

Air Pollution and Temperature: a Systematic Review of Ubiquitous Environmental Exposures and Sudden Cardiac Death

PURPOSE OF REVIEW

Environmental exposures have been associated with increased risk of cardiovascular mortality and acute coronary events, but their relationship with out-of-hospital cardiac arrest (OHCA) and sudden cardiac death (SCD) remains unclear. SCD is an important contributor to the global burden of cardiovascular disease worldwide.

RECENT FINDINGS

Current literature suggests a relationship between environmental exposures and cardiovascular disease, but their relationship with OHCA/SCD remains unclear. A literature search was conducted in PubMed, Embase, Web of Science, and Global Health. Of 5138 studies identified by our literature search, this review included 30 studies on air pollution, 42 studies on temperature, 6 studies on both air pollution and temperature, and 1 study on altitude exposure and OHCA/SCD. Particulate matter air pollution, ozone, and both hot and cold temperatures are associated with increased risk of OHCA/SCD. Pollution and other exposures related to climate change play an important role in OHCA/SCD incidence.

Short-term exposure to ultrafine particles and mortality and hospital admissions due to respiratory and cardiovascular diseases in Copenhagen, Denmark

Ultrafine particles (UFP; particulate matter <0.1 μm in diameter) may be more harmful to human health than larger particles, but epidemiological evidence on their health effects is still limited. In this study, we examined the association between short-term exposure to UFP and mortality and hospital admissions in Copenhagen, Denmark. Daily concentrations of UFP (measured as particle number concentration in a size range 11-700 nm) and meteorological variables were monitored at an urban background station in central Copenhagen during 2002-2018. Daily counts of deaths from all non-accidental causes, as well as deaths and hospital admissions from cardiovascular and respiratory diseases were obtained from Danish registers. Mortality and hospital admissions associated with an interquartile range (IQR) increase in UFP exposure on a concurrent day and up to six preceding days prior to the death or admission were examined in a case-crossover study design. Odds ratios (OR) with 95% confidence intervals (CI) per one IQR increase in UFP were estimated after adjusting for temperature and relative humidity. We observed 140,079 deaths in total, 236,003 respiratory and 342,074 cardiovascular hospital admissions between 2002 and 2018. Hospital admissions due to respiratory and cardiovascular diseases were significantly positively associated with one IQR increase in UFP (OR: 1.04 [95% CI: 1.01, 1.07], lag 0-4, and 1.02 [1.00, 1.04], lag 0-1, respectively). Among the specific causes, the strongest associations were found for chronic obstructive pulmonary disease (COPD) mortality and asthma hospital admissions and two-day means (lag 0-1) of UFP (OR: 1.13 [1.01, 1.26] and 1.08 [1.00, 1.16], respectively, per one IQR increase in UFP). Based on 17 years of UFP monitoring data, we present novel findings showing that short-term exposure to UFP can trigger respiratory and cardiovascular diseases mortality and morbidity in Copenhagen, Denmark. The strongest associations with UFP were observed with COPD mortality and asthma hospital admissions.

Short-term environmental triggers of hemorrhagic stroke

Hemorrhagic stroke (HS) is associated with severe morbidity and high mortality. Identifying the trigger factors for HS is critical for disease prevention. This study aimed to assess the associations between short-term environmental triggers (STETs) and HS risk. We systematically searched six databases for articles published up to September 9, 2022. Pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using random-effect models to evaluate the associations between STETs and the risk of HS. Heterogeneity was assessed using Cochran Q and I2 tests. A total of 63 studies were included for analysis. Of these, 40 focused on air pollutants and 23 on meteorological factors. Pooling results showed that exposure to particulate matter 2.5 (PM2.5; OR, 1.003 per 10 μg/m3; 95% CI, 1.001-1.007), sulfur dioxide (SO2; OR, 1.022 per 10 ppb; 95% CI, 1.005-1.040), and nitrogen dioxide (NO2; OR, 1.026 per 10 ppb; 95% CI, 1.004-1.047) was associated with an increase in HS risk. Moreover, exposure to PM2.5 (OR, 1.018 per 10 μg/m3; 95% CI, 1.009-1.027) and SO2 (OR, 1.102 per 10 ppb; 95% CI, 1.010-1.204) was positively associated with the risk of intracerebral hemorrhage. In addition, extreme temperature, high pressures, high and low relative humidity were potentially associated with HS risk. Targeted preventive measures to limit the effect of these air pollutants and extreme meteorological factors should be taken to reduce the HS disease burden. Further studies are warranted to verify these findings.

Effect of Air Pollution Particulate Matter on Ischemic and Hemorrhagic Stroke: A Scoping Review

Air pollution particulate matter (PM) exposure has been established as a risk factor for stroke. However, few studies have investigated the effects of PM exposure on stroke subtypes (ischemic and hemorrhagic stroke). Ischemic (IS) and hemorrhagic strokes (HS) involve distinctive pathophysiological pathways and may be differentially influenced by PM exposure. This review aims to characterize the effects of PM exposure on ischemic and hemorrhagic strokes. It also identifies subpopulations that may be uniquely vulnerable to PM toxicity. Pubmed was queried from 2000 to 2023 to identify clinical and epidemiological studies examining the association between PM exposure and stroke subtypes (ischemic and hemorrhagic stroke). Inclusion criteria were: 1) articles written in English 2) clinical and epidemiological studies 3) studies with a clear definition of stroke, IS, HS, and air pollution 4) studies reporting the effects of PM and 5) studies that included distinct analyses per stroke subtype. Two independent reviewers screened the literature for applicable studies. A total of 50 articles were included in this review. Overall, PM exposure increases ischemic stroke risk in both lightly and heavily polluted countries. The association between PM exposure and hemorrhagic stroke is variable and may be influenced by a country's ambient air pollution levels. A stronger association between PM exposure and stroke is demonstrated in older individuals and those with pre-existing diabetes. There is no clear effect of sex or hypertension on PM-associated stroke risk. Current literature suggests PM exposure increases ischemic stroke risk, with an unclear effect on hemorrhagic stroke risk. Older patients and those with pre-existing diabetes may be the most vulnerable to PM toxicity. Future investigations are needed to characterize the influence of sex and hypertension on PM-associated stroke risk.

The bio-distribution, clearance pathways, and toxicity mechanisms of ambient ultrafine particles

Ambient particles severely threaten human health worldwide. Compared to larger particles, ultrafine particles (UFPs) are highly concentrated in ambient environments, have a larger specific surface area, and are retained for a longer time in the lung. Recent studies have found that they can be transported into various extra-pulmonary organs by crossing the air-blood barrier (ABB). Therefore, to understand the adverse effects of UFPs, it is crucial to thoroughly investigate their bio-distribution and clearance pathways in vivo after inhalation, as well as their toxicological mechanisms. This review highlights emerging evidence on the bio-distribution of UFPs in pulmonary and extra-pulmonary organs. It explores how UFPs penetrate the ABB, the blood-brain barrier (BBB), and the placental barrier (PB) and subsequently undergo clearance by the liver, kidney, or intestine. In addition, the potential underlying toxicological mechanisms of UFPs are summarized, providing fundamental insights into how UFPs induce adverse health effects.

Shared Lifestyle-Related Risk Factors of Cardiovascular Disease and Cancer: Evidence for Joint Prevention

Cardiovascular disease (CVD) and cancer are leading causes of mortality and morbidity worldwide and are the major focus of the World Health Organization's joint prevention programs. While, diverse diseases, CVD and cancer, have many similarities. These include common lifestyle-related risk factors and shared environmental, metabolic, cellular, inflammatory, and genetic pathways. In this review, we will discuss the shared lifestyle-related and environmental risk factors central to both diseases and how the strategies commonly used to prevent atherosclerotic vascular disease can be applied to cancer prevention.

Hydrocarbons in the atmospheric gas phase of a coastal city in Tunisia: Levels, gas-particle partitioning, and health risk assessment

Many studies have focused on aliphatic hydrocarbons and polycyclic aromatic hydrocarbons (AHs and PAHs) in different environmental compartments, especially atmospheric particles (aerosols), due to their adverse effects on the environment and human health. However, much less information is currently available on the content of AHs and PAHs in the atmospheric gas phase, which is a major reservoir of volatile and photoreactive compounds. Here, for the first time, we assessed the levels, gas-particle partitioning, human health risks and seasonal variations of AHs and PAHs in the atmospheric gas-phase of Bizerte city (Tunisia, North Africa) over a one-year period (March 2015-January 2016). Σ₃₄PAH concentration in the gas phase over the period ranged from 6.7 to 90.6 ng m^-3 and on average was 2.5 times higher in the cold season than in the warm season. Σ₂₈AH concentration in the gas phase over the period ranged from 14.0 to 35.9 ng m^-3, with no clear seasonal variations. In the gas phase, hydrocarbons were dominated by low-molecular-weight (LMW) compounds, i.e. 3- and 4-ring for PAHs and < n-C₂₄ for AHs. Gas-phase concentrations of PAHs and AHs accounted for up to 80 % of the total (gas + particle phases) atmospheric concentrations of PAHs and AHs. Further analysis of gas-particle partitioning showed that LMW hydrocarbons preferential accumulated in the gas phase, and that gas-particle partitioning was not in equilibrium but dominated by absorption processes into the aerosol organic matter. Benzo[a]pyrene toxic equivalency quotient (BaP-TEQ) in the gas phase represented on average 37 % of the total atmospheric BaP-TEQ concentration, which was always higher in the cold season. Atmospheric gas is a significant factor in the risks of cancer associated with inhalation of ambient air. The Monte Carlo simulation-based exposure assessment model predicted that outdoor air exposure to PAHs does not pose a cancer risk to infants, but the children, adolescent, and adult populations may face a lower cancer risk during the warm season and a higher risk in the cold season.

Source-Specific Air Pollution Including Ultrafine Particles and Risk of Myocardial Infarction: A Nationwide Cohort Study from Denmark

BACKGROUND

Air pollution is negatively associated with cardiovascular health. Impediments to efficient regulation include lack of knowledge about which sources of air pollution contributes most to health burden and few studies on effects of the potentially more potent ultrafine particles (UFP).

OBJECTIVE

The authors aimed to investigate myocardial infarction (MI) morbidity and specific types and sources of air pollution.

METHODS

We identified all persons living in Denmark in the period 2005-2017, age >50 y and never diagnosed with MI. We quantified 5-y running time-weighted mean concentrations of air pollution at residencies, both total and apportioned to traffic and nontraffic sources. We evaluated particulate matter (PM) with aerodynamic diameter ≤2.5μm (PM2.5), <0.1μm (UFP), elemental carbon (EC), and nitrogen dioxide (NO2). We used Cox proportional hazards models, with adjustment for time-varying exposures, and personal and area-level demographic and socioeconomic covariates from high-quality administrative registers.

RESULTS

In this nationwide cohort of 1,964,702 persons (with 18 million person-years of follow-up and 71,285 cases of MI), UFP and PM2.5 were associated with increased risk of MI with hazard ratios (HRs) per interquartile range (IQR) of 1.040 [95% confidence interval (CI): 1.025, 1.055] and 1.053 (95% CI: 1.035, 1.071), respectively. HRs per IQR of UFP and PM2.5 from nontraffic sources were similar to the total (1.034 and 1.051), whereas HRs for UFP and PM2.5 from traffic sources were smaller (1.011 and 1.011). The HR for EC from traffic sources was 1.013 (95% CI: 1.003, 1.023). NO2 from nontraffic sources was associated with MI (HR=1.048; 95% CI: 1.034, 1.062) but not from traffic sources. In general, nontraffic sources contributed more to total air pollution levels than national traffic sources.

CONCLUSIONS

PM2.5 and UFP from traffic and nontraffic sources were associated with increased risk of MI, with nontraffic sources being the dominant source of exposure and morbidity. https://doi.org/10.1289/EHP10556.

Assessment of Low-Level Air Pollution and Cardiovascular Incidence in Gdansk, Poland: Time-Series Cross-Sectional Analysis

(1) Background: More than 1.8 million people in the European Union die every year as a result of CVD, accounting for 36% of all deaths with a large proportion being premature (before the age of 65). There are more than 300 different risk factors of CVD, known and air pollution is one of them. The aim of this study was to investigate whether daily cardiovascular mortality was associated with air pollutants and meteorological conditions in an urban environment with a low level of air pollution. (2) Methods: Data on daily incidence of strokes and myocardial infarctions in the city of Gdansk were obtained from the National Health Fund (NHF) and covered the period from 1 January 2014 to 31 December 2018. Data on the level of pollution, i.e., SO2, NO, NO2, NOx, CO, PM10, PM2.5, CO2, O3 and meteorological conditions came from the foundation: Agency of Regional Air Quality Monitoring in the Gdańsk metropolitan area (ARMAG). Using these data, we calculated mean values with standard deviation (SD) and derived the minimum and maximum values and interquartile range (IQR). Time series regression with Poisson distribution was used in statistical analysis. (4) Results: Stroke incidence is significantly affected by an increase in concentrations of NO, NO2 and NOx with RRs equal to 1.019 (95%CI: 1.001–1.036), 1.036 (95%CI: 1.008–1.064) and 1.017 (95%CI: 1.000–1.034) for every increase in IQR by 14.12, 14.62 and 22.62 μg/m3, respectively. Similarly, myocardial infarction incidence is significantly affected by an increase in concentrations of NO, NO2 and NOx with RRs equal to 1.030 (95%CI: 1.011–1.048), 1.053 (95%CI: 1.024–1.082) and 1.027 (95%CI: 1.010–1.045) for every increase in IQR by 14.12, 14.62 and 22.62 μg/m3, respectively. Both PM10 and PM2.5 were positively associated with myocardial infarction incidence. (5) Conclusions: In this time-series cross-sectional study, we found strong evidence that support the hypothesis that transient elevations in ambient PM2.5, PM10, NO2, SO2 and CO are associated with higher relative risk of ischemic stroke and myocardial infarction incidents.

Associations between short-term PM2.5 exposure and daily hospital admissions for circulatory system diseases in Ganzhou, China: A time series study

Objective

Previous epidemiological studies have shown that both long-term and short-term exposure to fine particulate matters (PM2.5) were associated with the morbidity and mortality of circulatory system diseases (CSD). However, the impact of PM2.5 on CSD remains inconclusive. This study aimed to investigate the associations between PM2.5 and circulatory system diseases in Ganzhou.

Methods

We conducted this time series study to explore the association between ambient PM2.5 exposure and daily hospital admissions for CSD from 2016 to 2020 in Ganzhou by using generalized additive models (GAMs). Stratified analyses were also performed by gender, age, and season.

Results

Based on 201,799 hospitalized cases, significant and positive associations were found between short-term PM2.5 exposure and hospital admissions for CSD, including total CSD, hypertension, coronary heart disease (CHD), cerebrovascular disease (CEVD), heart failure (HF), and arrhythmia. Each 10 μg/m3 increase in PM2.5 concentrations was associated with a 2.588% (95% confidence interval [CI], 1.161%–4.035%), 2.773% (95% CI, 1.246%–4.324%), 2.865% (95% CI, 0.786%–4.893%), 1.691% (95% CI, 0.239%–3.165%), 4.173% (95% CI, 1.988%–6.404%) and 1.496% (95% CI, 0.030%–2.983%) increment in hospitalizations for total CSD, hypertension, CHD, CEVD, HF, and arrhythmia, respectively. As PM2.5 concentrations rise, the hospitalizations for arrhythmia showed a slow upward trend, while other CSD increased sharply at high PM2.5 levels. In subgroup analyses, the impacts of PM2.5 on hospitalizations for CSD were not materially changed, although the females had higher risks of hypertension, HF, and arrhythmia. The relationships between PM2.5 exposure and hospitalizations for CSD were more significant among individuals aged ≤65 years, except for arrhythmia. PM2.5 had stronger effects on total CSD, hypertension, CEVD, HF, and arrhythmia during cold seasons.

Conclusion

PM2.5 exposure was positively associated with daily hospital admissions for CSD, which might provide informative insight on adverse effects of PM2.5.

Short-term effect of PM2.5 on stroke in susceptible populations: A case-crossover study

BACKGROUND

Fine particulate matter (PM2.5) is a risk factor for stroke, and patients with pre-existing diseases appear to be particularly susceptible. We conducted a case-crossover study to examine the association between short-term exposure to fine particulate matter (PM2.5) and hospital admission for stroke in individuals with atrial fibrillation (AF), hypertension, diabetes, or hyperlipidemia.

METHODS

Patients diagnosed with acute ischemic stroke (AIS) were recruited from 2015 to 2017 in Chinese Stroke Center Alliances. We estimated daily PM2.5 average exposures with a spatial resolution of 0.1° using a data assimilation approach combining satellite measurements, air model simulations, and monitoring values. Conditional logistic regression was used to assess PM2.5-related stroke risk in patients with pre-existing medical co-morbidities.

RESULTS

A total of 155,616 patients diagnosed with AIS were admitted. Patients with a history of AF (n = 15,430), hypertension (n = 138,220), diabetes (n = 43,737), or hyperlipidemia (n = 16,855) were assessed separately. A 10 µg/m³ increase in daily PM2.5 was associated with a significant increase in AIS for individuals with AF at lag 4 (odds ratio (OR), 1.008; 95% confidence interval (CI), 1.002-1.014), and with hypertension (OR, 1.008; 95% CI, 1.006-1.010), diabetes (OR, 1.006; 95% CI, 1.003-1.010), and hyperlipidemia (OR, 1.007; 95% CI, 1.001-1.012) at lags 0-7. Elderly (⩾ 65 years old) and female patients with AF had significantly higher associations at lag 5 (OR, 1.009; 95% CI, 1.002-1.015) and lag 5 (OR, 1.010; 95% CI, 1.002-1.018), respectively.

CONCLUSION

Short-term exposure to PM2.5 is significantly associated with hospital admission for stroke in individuals with pre-existing medical histories, especially in older or female patients with AF. Preventive measures to reduce PM2.5 concentrations are particularly important in individuals with other medical co-morbidities.

Associations between short-term exposure to ambient PM2.5 and incident cases of cerebrovascular disease in Yantai, China

There are limited studies examining the association between PM_2.5 exposure and incident cerebrovascular disease (CD) cases in China. In this study, daily counts of incident CD cases and daily PM_2.5 concentrations were obtained in Yantai, Shandong Province, China from 2014 to 2019. We used a combination of the Poisson-distribution generalized linear model (GLM) and a distributed lag nonlinear model (DLNM) to examine the association of short-term exposure to ambient PM_2.5 and incident cases of CD. The results revealed that for every 10 μg/m³ increment of PM_2.5 would increase the incident CD cases by 0.216% (RR:1.00216, 95%CI:1.0016-1.0028) at lag4. The stratified analysis demonstrated that the females and residents aged 65 years or above presented higher short-term PM_2.5-associated CD risks than the males and aged below 65 years. Targeted prevention strategies should be adopted to reduce the PM_2.5-related CD burden, especially for the susceptible population in China.

PM2.5-Associated Hospitalization Risk of Cardiovascular Diseases in Wuhan: Cases Alleviated by Residential Greenness

PM_2.5, a type of particulate matter with an aerodynamic diameter of less than 2.5 μm, is associated with the occurrence of cardiovascular diseases (CVDs), while greenness seems to be associated with better cardiovascular health. We identified 499,336 CVD cases in Wuhan's 74 municipal hospitals between 2017 and 2019. A high-resolution PM_2.5 model and a normalized difference vegetation index (NDVI) map were established to estimate individual exposures. The time-stratified case-crossover design and conditional logistic regression models were applied to explore the associations between PM_2.5 and CVDs under different levels of environmental factors. Greenness could alleviate PM_2.5-induced hospitalization risks of cardiovascular diseases. Compared with patients in the low-greenness group (ER = 0.99%; 95% CI: 0.71%, 1.28%), patients in the high-greenness group (ER = 0.45%; 95% CI: 0.13%, 0.77%) showed a lower increase in total CVD hospitalizations. After dividing the greenness into quartiles and adding long-term PM_2.5 exposure as a control factor, no significant PM_2.5-associated hospitalization risks of CVD were identified in the greenest areas (quartile 4), whether the long-term PM_2.5 exposure level was high or low. Intriguingly, in the least green areas (quartile 1), the PM_2.5-induced excess risk of CVD hospitalization was 0.58% (95% CI: 0.04%, 1.11%) in the long-term high-level PM_2.5 exposure group, and increased to 1.61% (95% CI: 0.95%, 2.27%) in the long-term low-level PM_2.5 exposure group. In the subgroup analysis, males and participants aged 55-64 years showed more significant increases in the PM_2.5-induced risk of contracting CVDs with a reduction in greenness and fine particle exposure conditions. High residential greenness can greatly alleviate the PM_2.5-induced risk of cardiovascular admission. Living in the areas with long-term low-level PM_2.5 may make people more sensitive to short-term increases in PM_2.5, leading to CVD hospitalization.

Particle surface area, ultrafine particle number concentration, and cardiovascular hospitalizations

While the health impacts of larger particulate matter, such as PM₁₀ and PM_2.5, have been studied extensively, research regarding ultrafine particles (UFPs or PM_0.1) and particle surface area concentration (PSC) is lacking. This case-crossover study assessed the associations between exposure to PSC and UFP number concentration (UFPnc) and hospital admissions for cardiovascular diseases (CVDs) in New York State (NYS), 2013-2018. We used a time-stratified case-crossover design to compare the PSC and UFPnc levels between hospitalization days and control days (similar days without admissions) for each CVD case. We utilized NYS hospital discharge data to identify all CVD cases who resided in NYS. UFP simulation data from GEOS-Chem-APM, a state-of-the-art chemical transport model, was used to define PSC and UFPnc. Using a multi-pollutant model and conditional logistic regression, we assessed excess risk (ER)% per inter-quartile change of PSC and UFPnc after controlling for meteorological factors, co-pollutants, and time-varying variables. We found immediate and lasting associations between PSC and overall CVDs (lag0-lag0-6: ERs% (95% CI%) ranges: 0.4 (0.1,0.7) - 0.9 (0.7-1.2), and delayed and prolonged ERs%: 0.1-0.3 (95% CIs: 0.1-0.5) between UFPnc and CVDs (lag0-3-lag0-6). Exposure to larger PSC was associated with immediate ER increases in stroke, hypertension, and ischemic heart diseases (1.1%, 0.7%, 0.8%, respectively, all p < 0.05). The adverse effects of PSC on CVDs were highest among children (5-17 years old), in the fall and winter, and during cold temperatures. In conclusion, we found an immediate, lasting effects of PSC on overall CVDs and a delayed, prolonged impact of UFPnc. PSC was a more sensitive indicator than UFPnc. The PSC effects were higher among certain CVD subtypes, in children, in certain seasons, and during cold days. Further studies are needed to validate our findings and evaluate the long-term effects.

Exposure characteristics of ultrafine particles on urban streets and its impact on pedestrians

In order to investigate the pedestrian exposure characteristics of ultrafine particles (UFPs) on urban streets, both mobile and fixed-point monitoring experiments were conducted. A generalized additive model and a respiratory deposition dose model were used to quantify the influencing factors and potential harm of UFPs, respectively. The results showed that UFPs' hotspots were more likely to manifest at places where vehicles tend to cluster, namely at road intersections and bus stops. The pedestrian bridge had the lowest number concentration of UFPs in comparison with the pedestrian crossing and underground passage at the same intersection. Aboveground, a "weekend effect" acting upon urban streets and evidence for periodicity at the intersections were found. The UFPs' number concentration was comprehensively explained-about 62.7% of its variation-by traffic volume, wind speed, temperature, and relative humidity. The UFPs were mainly deposited in the alveolar region of the respiratory system, but the deposition doses of males exceeded those of females under the same conditions. Based on these findings, the study also provides appropriate suggestions for better managing traffic pollution sources, traffic infrastructure, and traffic organization.

Short-term effects of exposure to ambient PM1, PM2.5, and PM10 on ischemic and hemorrhagic stroke incidence in Shandong Province, China

BACKGROUND

Short-term exposure to ambient PM_2.5 and PM₁₀ is associated with increased risk of mortality and hospital admissions for stroke. However, there is less evidence regarding the effect of exposure to PM₁ on stroke incidence. We estimated the incidence risk of stroke and the attributable fractions related to short-term exposure to ambient PM₁, PM_2.5 and PM₁₀ in China.

METHODS

County-specific incidence of stroke was obtained from health statistics in years 2014-2019. We linked county-level mean daily concentrations of PM₁, PM_2.5 and PM₁₀ with stroke incidence. We used the time stratified case-crossover design to estimate the associations between stroke incidence and exposure to PM₁, PM_2.5 and PM₁₀. We also estimated the disease burden fractions attributable to PM₁, PM_2.5, and PM₁₀.

RESULTS

The study included a total of 2,193,954 stroke, from which 1,861,331 were ischemic and 332,623 were hemorrhagic stroke. PM₁, PM_2.5, and PM₁₀ levels were associated with increased risks of total stroke and ischemic stroke at when assessing the associations in exposure at lag0-4 days. The increase of 10 μg/m³ in PM₁, PM_2.5, and PM₁₀ was associated with total stroke, and the relative risks were 1.012 (95% confidence interval: 1.008, 1.015), 1.006 (1.004, 1.007) and 1.003 (1.002, 1.004), while the associations with ischemic stroke were 1.013 (1.010, 1.017), 1.006 (1.005, 1.008) and 1.003 (1.002, 1.004), respectively. There was no significant association between PM and risk of hemorrhagic stroke. The attributable fractions of total stroke were 6.9% (5.1%, 8.5%), 5.6% (4.2%, 6.8%) and 5.6% (3.9%, 7.1%) for PM₁, PM_2.5, and PM₁₀, respectively.

CONCLUSIONS

PM₁ showed a stronger association with stroke, with a larger attributable fraction of outcomes, than PM_2.5 and PM₁₀. Clean air policies should target the whole scope of PM, including PM₁.

Indirect mediators of systemic health outcomes following nanoparticle inhalation exposure

The growing field of nanoscience has shed light on the wide diversity of natural and anthropogenic sources of nano-scale particulates, raising concern as to their impacts on human health. Inhalation is the most robust route of entry, with nanoparticles (NPs) evading mucociliary clearance and depositing deep into the alveolar region. Yet, impacts from inhaled NPs are evident far outside the lung, particularly on the cardiovascular system and highly vascularized organs like the brain. Peripheral effects are partly explained by the translocation of some NPs from the lung into the circulation; however, other NPs largely confined to the lung are still accompanied by systemic outcomes. Omic research has only just begun to inform on the complex myriad of molecules released from the lung to the blood as byproducts of pulmonary pathology. These indirect mediators are diverse in their molecular make-up and activity in the periphery. The present review examines systemic outcomes attributed to pulmonary NP exposure and what is known about indirect pathological mediators released from the lung into the circulation. Further focus was directed to outcomes in the brain, a highly vascularized region susceptible to acute and longer-term outcomes. Findings here support the need for big-data toxicological studies to understand what drives these health outcomes and better predict, circumvent, and treat the potential health impacts arising from NP exposure scenarios.

New Homogeneous Spatial Areas Identified Using Case-Crossover Spatial Lag Grid Differences between Aerosol Optical Depth-PM2.5 and Respiratory-Cardiovascular Emergency Department Visits and Hospitalizations

Optimal use of Hierarchical Bayesian Model (HBM)-assembled aerosol optical depth (AOD)-PM2.5 fused surfaces in epidemiologic studies requires homogeneous temporal and spatial fused surfaces. No analytical method is available to evaluate spatial heterogeneity. The temporal case-crossover design was modified to assess the spatial association between four experimental AOD-PM2.5 fused surfaces and four respiratory–cardiovascular hospital events in 12 km2 grids. The maximum number of adjacent lag grids with significant odds ratios (ORs) identified homogeneous spatial areas (HOSAs). The largest HOSA included five grids (lag grids 04; 720 km2) and the smallest HOSA contained two grids (lag grids 01; 288 km2). Emergency department asthma and inpatient asthma, myocardial infarction, and heart failure ORs were significantly higher in rural grids without air monitors than in urban grids with air monitors at lag grids 0, 1, and 01. Rural grids had higher AOD-PM2.5 concentration levels, population density, and poverty percentages than urban grids. Warm season ORs were significantly higher than cold season ORs for all health outcomes at lag grids 0, 1, 01, and 04. The possibility of elevated fine and ultrafine PM and other demographic and environmental risk factors synergistically contributing to elevated respiratory–cardiovascular chronic diseases in persons residing in rural areas was discussed.

Environmental risk factors and cardiovascular diseases: a comprehensive review

Noncommunicable diseases (NCDs) are fatal for more than 38 million people each year and are thus the main contributors to the global burden of disease accounting for 70% of mortality. The majority of these deaths are caused by cardiovascular disease. The risk of NCDs is strongly associated with exposure to environmental stressors such as pollutants in the air, noise exposure, artificial light at night and climate change, including heat extremes, desert storms and wildfires. In addition to the traditional risk factors for cardiovascular disease such as diabetes, arterial hypertension, smoking, hypercholesterolemia and genetic predisposition, there is a growing body of evidence showing that physicochemical factors in the environment contribute significantly to the high NCD numbers. Furthermore, urbanization is associated with accumulation and intensification of these stressors. This comprehensive expert review will summarize the epidemiology and pathophysiology of environmental stressors with a focus on cardiovascular NCDs. We will also discuss solutions and mitigation measures to lower the impact of environmental risk factors with focus on cardiovascular disease.

Short- and long-term exposure to air pollution increases the risk of stroke

OBJECTIVE

Many epidemiological studies have observed the association of air pollutant exposure with the onset, progression, and mortality of stroke. The aim of this study was to investigate the associations of air pollutants, including SO₂, NO₂, O₃, CO, and PM₁₀, with stroke according to exposure duration.

METHODS

Data from the Korean National Health Insurance Service-Health Screening Cohort from 2002 to 2015 were obtained. The 21,240 patients who were admitted for or died due to stroke were 1:4 matched for age, sex, income, and region of residence with 84,960 control participants. The meteorological factors of mean, highest, and lowest temperatures; relative humidity; ambient atmospheric pressure; and air pollutant concentrations (SO₂, NO₂, O₃, CO, and PM₁₀) were analyzed to determine their associations with stroke. The odds ratios for stroke after exposure to each meteorological factor and air pollutant at 7 and 30 days were calculated in the stroke and control groups. Subgroup analyses were conducted according to age, sex, income, and region of residence.

RESULTS

The odds ratio associated with seven days of exposure to CO was 1.16 (95% CI = 1.04-1.31) in stroke patients. For 30 days of exposure, the odds ratio associated with CO was 1.16 (95% CI = 1.02-1.32) in stroke patients. Seven and 30 days of NO₂ exposure were inversely associated with stroke. The odds ratio associated with seven days of exposure to O₃ was 1.16 (95% CI = 1.01-1.32) in ischemic stroke patients. Both ischemic and hemorrhagic stroke had negative associations with 7 and 30 days of NO₂ exposure.

CONCLUSION

Both short- and long-term exposure to CO were related to stroke.

Long-term exposure to ambient air pollution is associated with coronary artery calcification among asymptomatic adults

AIMS

We investigated the effects of exposure to very low levels of particulate matter <2.5 µm (PM2.5) and nitrogen dioxide (NO2) on coronary calcium score (CCS) in asymptomatic adults who are free of coronary artery disease (CAD).

METHODS AND RESULTS

This study included 606 asymptomatic adults (49% men, aged 56±7 years) recruited from communities in three states of Australia during 2017-2018. CCS was measured using coronary computed tomography scan at recruitment. Annual PM2.5 and NO2 concentrations were estimated on the year before recruitment using statistical exposure models and assigned to each participant's residential address. Medical history, physical measurements, biochemistry, and sociodemographic and socioeconomic status were also recorded. Median concentrations of PM2.5 and NO2 were 6.9 µg/m3 [interquartile range (IQR) 6.0-7.7)] and 3.1 ppb [IQR 2.2-4.5], respectively. Of the 606 participants, 16% had high CCS (≥100) and 4% had very high CCS (≥400). Exposure to higher PM2.5 (per µg/m3) was significantly associated with greater odds of having high CCS (OR 1.20, 95% CI 1.02-1.43) and very high CCS (OR 1.55, 95% CI 1.05-2.29). Similar associations were observed for NO2 and high CCS (OR 1.14, 95% CI 1.02-1.27) and very high CCS (OR 1.23, 95% CI 1.07-1.51). These findings were robust to adjustment for sociodemographic factors, traditional cardiovascular risk factors, renal function, education, and socio-economic status.

CONCLUSIONS

Ambient air pollution even at low concentration was associated with degree of coronary artery calcification among asymptomatic low cardiovascular risk adults, independent of other risk factors. These findings suggest that air pollution is one of the residual risk factors of CAD.

High-Spatial-Resolution Estimates of Ultrafine Particle Concentrations across the Continental United States

There is growing evidence that ultrafine particles (UFP; particles smaller than 100 nm) are likely more toxic than larger particles. However, the health effects of UFP remain uncertain due in part to the lack of large-scale population-based exposure assessment. We develop a national-scale empirical model of particle number concentration (PNC; a measure of UFP) using data from mobile monitoring and fixed sites across the United States and a land-use regression (LUR) modeling framework. Traffic, commercial land use, and urbanicity-related variables explain much of the spatial variability of PNC (base model R² = 0.77, RMSE = 2400 cm^-3). Model predictions are robust across a diverse set of evaluations [random 10-fold holdout cross-validation (HCV): R² = 0.72, RMSE = 2700 cm^-3; spatially defined HCV: R² = 0.66, RMSE = 3000 cm^-3; evaluation against an independent data set: R² = 0.54, RMSE = 2600 cm^-3]. We apply our model to predict PNC at ∼6 million residential census blocks in the contiguous United States. Our estimates are annual average concentrations for 2016-2017. The predicted national census-block-level mean PNC ranges between 1800 and 26 600 cm^-3 (population-weighted average: 6500 cm^-3), with hotspots in cities and near highways. Our national PNC model predicts large urban-rural, intra-, and inter-city contrasts. PNC and PM_2.5 are moderately correlated at the city scale, but uncorrelated at the regional/national scale. Our high-spatial-resolution national PNC estimates are useful for analyzing population exposure (socioeconomic disparity, epidemiological health impact) and environmental policy and regulation.

Ambient air pollution and the risk of ischaemic and haemorrhagic stroke

Stroke is a leading cause of disability and the second most common cause of death worldwide. Increasing evidence suggests that air pollution is an emerging risk factor for stroke. Over the past decades, air pollution levels have continuously increased and are now estimated to be responsible for 14% of all stroke-associated deaths. Interpretation of previous literature is difficult because stroke was usually not distinguished as ischaemic or haemorrhagic, nor by cause. This Review summarises the evidence on the association between air pollution and the different causes of ischaemic stroke and haemorrhagic stroke, to clarify which people are most at risk. The risk for ischaemic stroke is increased after short-term or long-term exposure to air pollution. This effect is most pronounced in people with cardiovascular burden and stroke due to large artery disease or small vessel disease. Short-term exposure to air pollution increases the risk of intracerebral haemorrhage, a subtype of haemorrhagic stroke, whereas the effects of long-term exposure are less clear. Limitations of the current evidence are that studies are prone to misclassification of exposure, often rely on administrative data, and have insufficient clinical detail. In this Review, we provide an outlook on new research opportunities, such as those provided by the decreased levels of air pollution due to the current COVID-19 pandemic.

Effect of ambient fine particulates (PM2.5) on hospital admissions for respiratory and cardiovascular diseases in Wuhan, China

Background

Positive associations between ambient PM_2.5 and cardiorespiratory disease have been well demonstrated during the past decade. However, few studies have examined the adverse effects of PM_2.5 based on an entire population of a megalopolis. In addition, most studies in China have used averaged data, which results in variations between monitoring and personal exposure values, creating an inherent and unavoidable type of measurement error.

Methods

This study was conducted in Wuhan, a megacity in central China with about 10.9 million people. Daily hospital admission records, from October 2016 to December 2018, were obtained from the Wuhan Information center of Health and Family Planning, which administrates all hospitals in Wuhan. Daily air pollution concentrations and weather variables in Wuhan during the study period were collected. We developed a land use regression model (LUR) to assess individual PM_2.5 exposure. Time-stratified case-crossover design and conditional logistic regression models were adopted to estimate cardiorespiratory hospitalization risks associated with short-term exposure to PM_2.5. We also conducted stratification analyses by age, sex, and season.

Results

A total of 2,806,115 hospital admissions records were collected during the study period, from which we identified 332,090 cardiovascular disease admissions and 159,365 respiratory disease admissions. Short-term exposure to PM_2.5 was associated with an increased risk of a cardiorespiratory hospital admission. A 10 μg/m³ increase in PM_2.5 (lag0–2 days) was associated with an increase in hospital admissions of 1.23% (95% CI 1.01–1.45%) and 1.95% (95% CI 1.63–2.27%) for cardiovascular and respiratory diseases, respectively. The elderly were at higher PM-induced risk. The associations appeared to be more evident in the cold season than in the warm season.

Conclusions

This study contributes evidence of short-term effects of PM_2.5 on cardiorespiratory hospital admissions, which may be helpful for air pollution control and disease prevention in Wuhan.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12931-021-01731-x.

Neurological disorders vis-à-vis climate change

Climate change is one of the biggest challenges humanity is facing in the 21st century. Two recognized sequelae of climate change are global warming and air pollution. The gradual increase in ambient temperature, coupled with elevated pollution levels have a devastating effect on our health, potentially contributing to the increased rate and severity of numerous neurological disorders. The main aim of this review paper is to shed some light on the association between the phenomena of global warming and air pollution, and two of the most common and debilitating neurological conditions: stroke and neurodegenerative disorders. Extreme ambient temperatures induce neurological impairment and increase stroke incidence and mortality. Global warming does not participate in the etiology of neurodegenerative disorders, but it exacerbates symptoms of dementia, Alzheimer's disease (AD) and Parkinson's Disease (PD). A very close link exists between accumulated levels of air pollutants (principally particulate matter), and the incidence of ischemic rather than hemorrhagic strokes. People exposed to air pollutants have a higher risk of developing dementia and AD, but not PD. Oxidative stress, changes in cardiovascular and cerebrovascular haemodynamics, excitotoxicity, microglial activation, and cellular apoptosis, all play a central role in the overlap of the effect of climate change on neurological disorders. The complex interactions between global warming and air pollution, and their intricate effect on the nervous system, imply that future policies aimed to mitigate climate change must address these two challenges in unison.

Association of outdoor air pollution with the medical expense of ischemic stroke: The case study of an industrial city in western China

Ischemic stroke, the most frequent cause of severe disability, imposes a significant mental and economic burden on patients and their families. There is increasing evidence to indicate that air pollution contributes to the risk of ischemic stroke. This study aimed to examine the correlation between air pollution and the expense imposed by an ischemic stroke. Data were obtained from hospitals and environmental monitoring stations in an industry city, Longspring, in western China. We used a generalized additive model to estimate the associations between the two factors, measured during 2015-2017. Counter-intuitively, the medical expenses arising from ischemia were negatively associated with the level of air pollution. The corresponding ER for per interquartile range increase of PM2.5, PM10, SO₂ , and NO₂ in lag10 was -0.17% (95% confidence interval (95% CI -0.31%, -0.03%), -0.11% (95% CI -0.2%, -0.02%), -1.04% (95% CI -1.92%, -0.17%) and -0.44% (95% CI -0.66%, -0.22%), respectively (p < 0.05). Subgroups based on gender, age, and season were considered in the analysis. The results indicated that pollutants had significant effects on ischaemia's medical expenses, which were stronger for older people, patients who survived, and warm seasons. This study is the first step in optimizing medical resources, which are essential for policymaking and service planning.

Integrated QSAR and Adverse Outcome Pathway Analysis of Chemicals Released on 3D Printing Using Acrylonitrile Butadiene Styrene

Additive manufacturing commonly known as 3D printing has numerous applications in several domains including material and biomedical technologies and has emerged as a tool of capabilities by providing fast, highly customized, and cost-effective solutions. However, the impact of the printing materials and chemicals present in the printing fumes has raised concerns about their adverse potential affecting humans and the environment. Thus, it is necessary to understand the properties of the chemicals emitted during additive manufacturing for developing safe and biocompatible fibers having controlled emission of fumes including its sustainable usage. Therefore, in this study, we have developed a computational predictive risk-assessment framework on the comprehensive list of chemicals released during 3D printing using the acrylonitrile butadiene styrene (ABS) filament. Our results showed that the chemicals present in the fumes of the ABS-based fiber used in additive manufacturing have the potential to lead to various toxicity end points such as inhalation toxicity, oral toxicity, carcinogenicity, hepatotoxicity, and teratogenicity. Moreover, because of their absorption, distribution in the body, metabolism, and excretion properties, most of the chemicals exhibited a high absorption level in the intestine and the potential to cross the blood-brain barrier. Furthermore, pathway analysis revealed that signaling like alpha-adrenergic receptor signaling, heterotrimeric G-protein signaling, and Alzheimer's disease-amyloid secretase pathway are significantly overrepresented given the identified target proteins of these chemicals. These findings signify the adversities associated with 3D printing fumes and the necessity for the development of biodegradable and considerably safer fibers for 3D printing technology.

Association of exhaled carbon monoxide with risk of cardio-cerebral-vascular disease in the China Kadoorie Biobank cohort study

Exhaled carbon monoxide (COex) level has been proposed as a noninvasive and easily-obtainable cardiovascular risk marker, however, with limited prospective evidence, and its association with stroke risk has been rarely explored. Measurements of COex were performed during 2004-2008 baseline examinations in the China Kadoorie Biobank study among 512,891 adults aged 30-79 years from 10 diverse study areas. After excluding participants with baseline cardiopulmonary diseases, stroke and cancer, 178,485 men and 267,202 women remained. Cox regression yielded hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of cardio-cerebral-vascular disease (CCVD) associated with COex levels, with sequential addition of adjustment for proxy variables for CO exposure, including study area indexing ambient CO variations at large, and smoking and solid fuel use, apart from adjusting for traditional cardiovascular risk factors. During 7-year follow-up, we documented 1744 and 1430 major coronary events (myocardial infarction plus fatal ischemic heart disease), 8849 and 10,922 ischemic strokes, and 2492 and 2363 hemorrhagic strokes among men and women, respectively. The HRs with 95% CIs comparing the highest with lowest COex quintile were 2.15 [1.72, 2.69] for major coronary events, 1.65 [1.50, 1.80] for ischemic stroke, and 1.35 [1.13, 1.61] for hemorrhagic stroke among men, while among women higher associated risk was only observed for major coronary events (1.64 [1.35, 2.00]) and ischemic stroke (1.87 [1.73, 2.01]). The elevated risks were consistent when COex level was over 3 ppm. However, these associations were all attenuated until null by sequential addition of stratification by study areas, and adjustments of smoking and solid fuel use. Nevertheless, the association with ischemic stroke was maintained among the subgroup of male smokers even with adjustment for the depth and amount of cigarette smoking (HR [95% CI]: 1.37 [1.06, 1.77]), while a negative association with hemorrhagic stroke also appeared within this subgroup. Higher COex level (over 3 ppm) was associated with elevated risk of ischemic CCVD, but not independently of CO exposure. Our finding suggests that, though not an independent risk factor, COex could potentially provide a cost-effective biomarker for ischemic cardio-cerebral-vascular risk, given that CO exposure is ubiquitous.

Association of Fine Particulate Matter and Risk of Stroke in Patients With Atrial Fibrillation

IMPORTANCE

Air pollution is associated with cardiovascular outcomes. Specifically, fine particulate matter measuring 2.5 μm or less (PM2.5) is associated with thrombosis, stroke, and myocardial infarction. Few studies have examined particulate matter and stroke risk in individuals with atrial fibrillation (AF).

OBJECTIVE

To assess the association of residential-level pollution exposure in 1 year and ischemic stroke in individuals with AF.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study included 31 414 individuals with AF from a large regional health care system in an area with historically high industrial pollution. All participants had valid residential addresses for geocoding and ascertainment of neighborhood-level income and educational level. Participants were studied from January 1, 2007, through September 30, 2015, with prospective follow-up through December 1, 2017. Data analysis was performed from March 14, 2018, to October 9, 2019.

EXPOSURES

Exposure to PM2.5 ascertained using geocoding of addresses and fine-scale air pollution exposure surfaces derived from a spatial saturation monitoring campaign and land-use regression modeling. Exposure to PM2.5 was estimated annually across the study period at the residence level.

MAIN OUTCOMES AND MEASURES

Multivariable-adjusted stroke risk by quartile of residence-level and annual PM2.5 exposure.

RESULTS

The cohort included 31 414 individuals (15 813 [50.3%] female; mean [SD] age, 74.4 [13.5] years), with a median follow-up of 3.5 years (interquartile range, 1.6-5.8 years). The mean (SD) annual PM2.5 exposure was 10.6 (0.7) μg/m3. A 1-SD increase in PM2.5 was associated with a greater risk of stroke after both adjustment for demographic and clinical variables (hazard ratio [HR], 1.08; 95% CI, 1.03-1.14) and multivariable adjustment that included neighborhood-level income and educational level (HR, 1.07; 95% CI, 1.00-1.14). The highest quartile of PM2.5 exposure had an increased risk of stroke relative to the first quartile (HR, 1.36; 95% CI, 1.18-1.58). After adjustment for clinical covariates, income, and educational level, risk of stroke remained greater for the highest quartile of exposure relative to the first quartile (HR, 1.21; 95% CI, 1.01-1.45).

CONCLUSIONS AND RELEVANCE

This large cohort study of individuals with AF identified associations between PM2.5 and risk of ischemic stroke. The results suggest an association between fine particulate air pollution and cardiovascular disease and outcomes.

Spatial Correlation of Ultrafine Particle Number and Fine Particle Mass at Urban Scales: Implications for Health Assessment

The epidemiological evidence for ultrafine particles (UFP; particles with diameter <100 nm) causing chronic health effects independent of fine particulate matter (PM_2.5) mass is inconclusive. A prevailing view is that urban UFP and PM_2.5 mass have different spatial patterns, which should allow epidemiological studies to distinguish their independent, chronic health effects. We investigate intraurban spatial correlation of PM_2.5 and UFP exposures in Pittsburgh, Pennsylvania. Measurements and predictions of a land-use regression model indicate moderate spatial correlation between particle number concentrations (PNC; a proxy for UFP) and PM_2.5 (R² of 0.38 and 0.41, respectively). High-resolution (1-km) chemical transport model simulations predict stronger spatial correlation (R² ≈ 0.8). The finding of moderate to strong spatial correlation was initially surprising because secondary aerosol contributes the vast majority of PM_2.5 mass. However, intraurban spatial patterns of both PNC and PM_2.5 are driven by local emissions and both pollutants largely behave as passive tracers at time scales of 1 day or less required for transport across most urban environments. Although previous research has shown little temporal correlation between PNC and PM_2.5, our finding of moderate to strong spatial correlation may complicate epidemiological analyses to separate the chronic health effects of PNC from PM_2.5 mass.

Ambient fine particulate matter and hospital admissions for ischemic and hemorrhagic strokes and transient ischemic attack in 248 Chinese cities

Few studies have investigated the acute effects of fine particulate matter (PM_2.5) on the risk of stroke subtypes and transient ischemic attack (TIA) in low- and middle-income countries. The primary aim of this study was to assess the associations between short-term exposure to PM_2.5 and daily hospital admissions for total cerebrovascular disease, ischemic and hemorrhagic strokes, and TIA in China. A total of 8,359,162 hospital admissions in 248 Chinese cities from 2013 to 2017 were identified from the Hospital Quality Monitoring System of China. Generalized additive models with quasi-Poisson regression were used to estimate the associations in each city, and random-effect meta-analyses were conducted to combine the city-specific estimates. We found that a 10 μg/m³ increase in PM_2.5 concentration was significantly associated with a 0.19% (95% CI, 0.13% to 0.25%), 0.26% (95% CI, 0.17% to 0.35%), and 0.26% (95% CI, 0.13% to 0.38%) increase in same-day hospital admissions for total cerebrovascular disease, ischemic stroke, and TIA, respectively. In contrast, a non-significant negative association with PM_2.5 was observed for hemorrhagic stroke in the main analyses (lag 0 day), which became statistically significant when using other single-day exposures (lag 1 or 2 days) or moving average exposures (lag 0-1, 0-2, or 0-3 days) as exposure metric. These associations were robust to adjustment for other criteria air pollutants in two-pollutant models. For ischemic stroke, the effect estimates were significantly larger in people aged 65-74 years, in cool season, and in cities with lower annual average PM_2.5 concentrations. The exposure-response curves were nonlinear with a leveling off at high concentrations. These results contribute to the relatively limited literature on the PM_2.5-related risks of cerebrovascular events in low- and middle-income countries.

The health effects of ultrafine particles

Ultrafine particles (PM_0.1), which are present in the air in large numbers, pose a health risk. They generally enter the body through the lungs but translocate to essentially all organs. Compared to fine particles (PM_2.5), they cause more pulmonary inflammation and are retained longer in the lung. Their toxicity is increased with smaller size, larger surface area, adsorbed surface material, and the physical characteristics of the particles. Exposure to PM_0.1 induces cough and worsens asthma. Metal fume fever is a systemic disease of lung inflammation most likely caused by PM_0.1. The disease is manifested by systemic symptoms hours after exposure to metal fumes, usually through welding. PM_0.1 cause systemic inflammation, endothelial dysfunction, and coagulation changes that predispose individuals to ischemic cardiovascular disease and hypertension. PM_0.1 are also linked to diabetes and cancer. PM_0.1 can travel up the olfactory nerves to the brain and cause cerebral and autonomic dysfunction. Moreover, in utero exposure increases the risk of low birthweight. Although exposure is commonly attributed to traffic exhaust, monitored students in Ghana showed the highest exposures in a home near a trash burning site, in a bedroom with burning coils employed to abate mosquitos, in a home of an adult smoker, and in home kitchens during domestic cooking. The high point-source production and rapid redistribution make incidental exposure common, confound general population studies and are compounded by the lack of global standards and national reporting. The potential for PM_0.1 to cause harm to health is great, but their precise role in many illnesses is still unknown and calls for more research.

Tiny particles found in air pollution enter the body usually through the lungs and disperse to other organs, causing more inflammation and cellular toxicity than larger particles. Dean Schraufnagel from the University of Illinois at Chicago, USA, reviews the way by which nano-sized air pollutants threaten human health. He describes how ultrafine particles measuring less than 100 nanometres in diameter elicit greater inflammatory responses and stay in the lungs longer than larger particles. Repeated contact with extremely small particulate matter can trigger heart disease, diabetes, cancer, neurological disorders and respiratory ailments, especially among children and people with long-term occupational exposure. Much remains to be learned about the disease-causing properties of these nanoparticles and their long-term effects. Further developments in understanding remain handicapped by the lack of international standards and reporting measures.

Association between air pollution exposure and diabetic retinopathy among diabetics

BACKGROUND

Exposure to air pollution has been linked to adverse effects on vascular diseases. However, the effects of air pollution exposure on diabetic retinopathy (DR), a vascular disease, have not been studied.

OBJECTIVE

To determine the association of ambient air pollution exposure with DR risk.

METHODS

Patients newly diagnosed as having diabetes mellitus (DM) during 2003-2012 from Longitudinal Health Insurance Database 2005), a subset of National Health Insurance Research Database, were included as the study cohort. Newly diagnosed DR patients one year or later after DM diagnosis were identified as cases. Kriging was used to interpolate yearly concentrations of air pollutants at township levels and linked with every individual's residence in each year; average concentrations during the follow-up period were then calculated as personal exposure. Conditional logistic regressions with adjustments for age at DM diagnosis and comorbidities were applied.

RESULTS

Of newly diagnosed DM cases during 2003-2012, 579 were newly diagnosed as having DR over a mean follow-up period of 5.6 years. The Odds ratio (95% confidence interval) of DR occurrence for every 10-μg/m³ increase in particulate matter with ≤2.5 and 2.5-10-μm diameter was 1.29 (1.11-1.50) and 1.37 (1.17-1.61), respectively.

CONCLUSION

In patients with DM, the higher particulate matter exposure, the higher is the DR risk.

Association between short-term exposure to air pollution and ischemic stroke onset: a time-stratified case-crossover analysis using a distributed lag nonlinear model in Shenzhen, China

BACKGROUND

Stroke, especially ischemic stroke (IS), has been a severe public health problem around the world. However, the association between air pollution and ischemic stroke remains ambiguous.

METHODS

A total of 63, 997 IS cases aged 18 years or above in Shenzhen were collected from 2008 to 2014. We used the time-stratified case-crossover design combining with distributed lag nonlinear model (DLNM) to estimate the association between air pollution and IS onset. Furthermore, this study explored the variability across gender and age groups.

RESULTS

The cumulative exposure-response curves were J-shaped for SO₂, NO₂ and PM₁₀, and V-shaped for O₃, and crossed over the relative risk (RR) of one. The 99th, 50th (median) and 1st percentiles of concentration (μg/m³) respectively were 37.86, 10.06, 3.71 for SO₂, 116.26, 41.29, 18.51 for NO₂, 145.94, 48.29, 16.14 for PM₁₀, and 111.57, 49.82, 16.00 for O₃. Extreme high-SO₂, high-NO₂, high-PM₁₀, high-O₃, and low-O₃ concentration increased the risk of IS, with the maximum RR values and 95% CIs: 1.50(1.22, 1.84) (99th vs median) at 0-12 lag days, 1.37(1.13, 1.67) (99th vs median) at 0-10 lag days, 1.26(1.04, 1.53) (99th vs median) at 0-12 lag days, 1.25(1.04, 1.49) (99th vs median) at 0-14 lag days, and 1.29(1.03, 1.61) (1st vs median) at 0-14 lag days, respectively. The statistically significant minimal RR value and 95% CI was 0.79(0.66,0.94) at 0-10 lag days for extreme low-PM₁₀. The elderly aged over 65 years were susceptible to extreme pollution conditions. Difference from the vulnerability of males to extreme high-SO₂, high-NO₂ and low-O₃, females were vulnerable to extreme high-PM₁₀ and high-O₃. Comparing with the elderly, adults aged 18-64 year were immune to extreme low-NO₂ and low-PM₁₀. However, no association between CO and IS onset was found.

CONCLUSIONS

SO₂, NO₂, PM₁₀ and O₃ exerted non-linear and delayed influence on IS, and such influence varied with gender and age. These findings may have significant public health implications for the prevention of IS.

Particulate air pollution and ischemic stroke hospitalization: How the associations vary by constituents in Shanghai, China

BACKGROUND

The identification of constituents of fine particulate matter (PM_2.5) air pollution that had key impacts of ischemic stroke (the predominant subtype of stroke) is important to understand the underlying biological mechanisms and develop air pollution control policies.

OBJECTIVES

To explore the associations between PM_2.5 constituents and hospitalization for ischemic stroke in Shanghai, China.

METHODS

We conducted a time-series study to explore the associations between 27 constituents of PM_2.5 and hospitalization for ischemic stroke in Shanghai, China from 2014 to 2016. The over-dispersed generalized additive models with adjustment for time, day of week, holidays, and weather conditions were used to estimate the associations. We also evaluated the robustness of the effect estimates for each constituent after adjusting for the confounding effects of PM_2.5 total mass and gaseous pollutants and the collinearity (the residual) between this constituent and PM_2.5 total mass. We also compared the associations between seasons.

RESULTS

In total, we identified 4186 ischemic stroke hospitalizations during the study period. The associations of ischemic stroke were consistently significant with elemental carbon and several elemental constituents (Chromium, Iron, Copper, Zinc, Arsenic, Selenium, and Lead) at lag 1 day in single-constituent models, models adjusting for PM_2.5 total mass or gaseous pollutants and models adjusting for collinearity. The associations were much stronger in cool season than in warm season.

CONCLUSIONS

The current study provides suggestive evidence that elemental carbon and some metallic elements may be mainly responsible for the risks of ischemic stroke hospitalization induced by short-term PM_2.5 exposure.

Association of residential air pollution, noise, and greenspace with initial ischemic stroke severity

BACKGROUND AND PURPOSE

A number of environmental risk factors of acute ischemic stroke have been identified, but few studies have evaluated the influence of the outdoor environment on stroke severity. We assessed the association of residential ambient fine particulate matter air pollution (PM_2.5), noise, and surrounding greenspace with initial stroke severity.

METHODS

We obtained data on patients hospitalized with acute ischemic stroke from a hospital-based prospective stroke register (2005-2014) in Barcelona. We estimated residential PM_2.5 based on an established land use regression model, greenspace as the average satellite-based Normalized Difference Vegetation Index (NDVI) within a 300 m buffer of the residence, and daily (Lday), evening (Levening), night (Lnight) and average noise (Lden) level at the street nearest to the residential address using municipal noise models. Stroke severity was assessed at the time of hospital presentation using the National Institute of Health Stroke Scale (NIHSS).We used logistic regression and binomial models to evaluate the associations of PM_2.5, greenspace, and noise with initial stroke severity adjusting for potential confounders.

RESULTS

Among 2761 patients, higher residential surrounding greenspace was associated with lower risk of severe stroke (OR for NIHSS>5, 0.75; 95% CI: 0.60-0.95), while, living in areas with higher Lden was associated with a higher risk of severe stroke (OR, 1.30; 95% CI: 1.02-1.65). PM_2.5 was not associated with initial stroke severity.

CONCLUSIONS

In an urban setting, surrounding greenspace and traffic noise at home are associated with initial stroke severity, suggesting an important influence of the built environment on the global burden of ischemic stroke.

Short-term exposure to air pollution and incidence of stroke in the Women's Health Initiative

BACKGROUND

Evidence of the association between daily variation in air pollution and risk of stroke is inconsistent, potentially due to the heterogeneity in stroke etiology.

OBJECTIVES

To estimate the associations between daily variation in ambient air pollution and risk of stroke and its subtypes among participants of the Women's Health Initiative, a large prospective cohort study in the United States.

METHODS

We used national-scale, log-normal ordinary kriging models to estimate daily concentrations of fine particulate matter (PM_2.5), respirable particulate matter (PM₁₀), nitrogen dioxide (NO₂), nitrogen oxides (NOx), sulphur dioxide, and ozone at participant addresses. Stroke was adjudicated by trained neurologists and classified as ischemic or hemorrhagic. Ischemic strokes were further classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. We used a time-stratified case-crossover approach to estimate the odds ratio (OR) of the risk of stroke associated with an interquartile range (IQR) increase in concentrations of each air pollutant. We performed stratified analysis to examine whether associations varied across subgroups defined by age at stroke onset, US census region, smoking status, body mass index, and prior history of diabetes mellitus, hypertension, heart or circulation problems, or arterial fibrillation at enrollment.

RESULTS

Among 5417 confirmed strokes between 1993 and 2012, 4300 (79.4%) were classified as ischemic and 924 (17.1%) as hemorrhagic. No association was observed between day-to-day variation in any pollutant and risk of total stroke, ischemic stroke, or specific etiologies of ischemic stroke. We observed a positive association between risk of hemorrhagic stroke and NO₂ and NO_x in the 3 days prior to stroke with OR of 1.24 (95% CI: 1.01, 1.52) and 1.18 (95% CI: 1.03, 1.34) per IQR increase, respectively. The observed associations with hemorrhagic stroke were more pronounced among non-obese participants.

CONCLUSIONS

In this large cohort of post-menopausal US women, daily NO₂ and NOx were associated with higher risk of hemorrhagic stroke, but ambient levels of four other air pollutants were not associated with higher risk of total stroke, ischemic stroke, or ischemic stroke subtypes.

Novel evidence for a greater burden of ambient air pollution on cardiovascular disease

Ambient and household air pollution is a major health problem worldwide, contributing annually to approximately seven million of all-cause avoidable deaths, shorter life expectancy, and significant direct and indirect costs for the community. Air pollution is a complex mixture of gaseous and particulate materials that vary depending on their source and physicochemical features. Each material has detrimental effects on human health, but a number of experimental and clinical studies have shown a strong impact for fine particulate matter (PM_2.5). In particular, there is more and more evidence that PM_2.5 exerts adverse effects particularly on the cardiovascular system, contributing substantially (mainly through mechanisms of atherosclerosis, thrombosis and inflammation) to coronary artery and cerebrovascular disease, but also to heart failure, hypertension, diabetes and cardiac arrhythmias. In this review, we summarize knowledge on the mechanisms and magnitude of the cardiovascular adverse effects of short-and long-term exposure to ambient air pollution, particularly for the PM_2.5 size fraction. We also emphasize that very recent data indicate that the global mortality and morbidity burden of cardiovascular disease associated with this air pollutant is dramatically greater than what has been thought up to now.

Cardiovascular disease and long-term occupational exposure to ultrafine particles: A cohort study of airport workers

AIM

To investigate if ischemic heart disease (IHD) and cerebrovascular disease is associated with long-term occupational exposure to ultrafine particles (UFP) outdoors at an airport.

METHODS AND RESULTS

This is a register-based follow-up study based on a cohort comprising an exposed group of 6515 men employed in unskilled work at Copenhagen Airport and a reference group of 61,617 men in unskilled work in other firms in greater Copenhagen during 1990-2012. The exposure was assessed from information on proportion of time spent on the airport apron for each calendar year (apron-years) and the primary exposure measure was cumulated apron-years. The cohort was merged to the National Patient Register that includes data on all contacts to public and private hospitals in Denmark and the Register of Causes of Death. Risk estimates were provided by Poisson regression and adjusted for age, calendar year and educational level. We found no associations between cumulative apron-years and IHD (IRR, 1.00; 95%CI, 0.97-1.03) or cerebrovascular disease (IRR, 1.00; 0.98-1.02) when adjusted for confounders.

CONCLUSION

In this large cohort study, we found no association between outdoor occupational exposure to UFP and IHD and cerebrovascular disease.

Fine and ultrafine particle removal efficiency of new residential HVAC filters

Particle air filters used in central residential forced-air systems are most commonly evaluated for their size-resolved removal efficiency for particles 0.3-10 µm using laboratory tests. Little information exists on the removal efficiency of commercially available residential filters for particles smaller than 0.3 µm or for integral measures of mass-based aerosol concentrations (eg, PM_2.5 ) or total number concentrations (eg, ultrafine particles, or UFPs) that are commonly used in regulatory monitoring and building measurements. Here, we measure the size-resolved removal efficiency of 50 new commercially available residential HVAC filters installed in a recirculating central air-handling unit in an unoccupied apartment unit using alternating upstream/downstream measurements with incense and NaCl as particle sources. Size-resolved removal efficiencies are then used to estimate integral measures of PM_2.5 and total UFP removal efficiency for the filters assuming they are challenged by 201 residential indoor particle size distributions (PSDs) gathered from the literature. Total UFP and PM_2.5 removal efficiencies generally increased with manufacturer-reported filter ratings and with filter thickness, albeit with numerous exceptions. PM_2.5 removal efficiencies were more influenced by the assumption for indoor PSD than total UFP removal efficiencies. Filters with the same ratings but from different manufacturers often had different removal efficiencies for PM_2.5 and total UFPs.

Association between incidence of fatal intracerebral hemorrhagic stroke and fine particulate air pollution

Objective

Few studies investigating associations between fine particulate air pollution and hemorrhagic stroke have considered subtypes. Additionally, less is known about the modification of such association by factors measured at the individual level. We aimed to investigate the risk of fatal intracerebral hemorrhage (ICH) incidence in case of PM_2.5 (particles ≤ 2.5 μm in aerodynamic diameter) exposure.

Methods

Data on incidence of fatal ICH from 1 June 2012 to 31 May 2014 were extracted from the acute stroke mortality database in Shanghai Municipal Center for Disease Control and Prevention (SCDC). We used the time-stratified case-crossover approach to assess the association between daily concentrations of PM_2.5 and fatal ICH incidence in Shanghai, China.

Results

A total of 5286 fatal ICH cases occurred during our study period. The averaged concentration of PM_2.5 was 77.45 μg/m³. The incidence of fatal ICH was significantly associated with PM_2.5 concentration. Substantial differences were observed among subjects with diabetes compared with those without; following the increase of PM_2.5 in lag2, the OR (95% CI) for subjects with diabetes was 1.26 (1.09–1.46) versus 1.05 (0.98–1.12) for those without. We did not find evidence of effect modification by hypertension and cigarette smoking.

Conclusions

Fatal ICH incidence was associated with PM_2.5 exposure. Our results also suggested that diabetes may increase the risk for ICH incidence in relation to PM_2.5.

Electronic supplementary material

The online version of this article (10.1186/s12199-019-0793-9) contains supplementary material, which is available to authorized users.

The effect of air pollution on hospitalization of individuals with respiratory and cardiovascular diseases in Jinan, China

To analyze the short-term effects of air pollution on the hospitalization rates of individuals with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), stroke, and myocardial infarction (MI) after adjusting for confounding factors including weather, day of the week, holidays, and long-term trends in Jinan, China.Hospitalization information was extracted based on data from the primary class 3-A hospitals in Jinan from 2013 to 2015. The concentrations of PM2.5, PM10, SO2, NO2, and O3 were obtained from Jinan Environment Monitoring Center. The relative risk and 95% confidence intervals of AECOPD, stroke, and MI were estimated using generalized additive models with quasi-Poisson distribution in the mgcv package, using R software, version 1.0.136.The incremental increased concentrations of particulate pollutants including PM2.5 and PM10 were significantly associated with increased risk of hospitalization of AECOPD, stroke, and MI, and the adverse influences of PM2.5 on these diseases were generally stronger than that of PM10. The incremental increased concentrations of gaseous pollutants including SO2, NO2, and O3 were significantly associated with increased risk of hospitalization of stroke and MI in this population.Air pollution has significant adverse effects on hospitalization rates of individuals with AECOPD, stroke, and MI in Jinan, China.

A comprehensive evaluation of the association between ambient air pollution and adverse health outcomes of major organ systems: a systematic review with a worldwide approach

Ambient air pollution is nowadays one of the most crucial contributors to deteriorating health status worldwide. The components of air pollution include PM_2.5 and PM₁₀, NO₂, SO₂, CO, O₃, and organic compounds. They are attributed to several health outcomes, for instance, cardiovascular diseases (CVD), respiratory diseases, birth outcomes, neurologic diseases, and psychiatric diseases. The objective of this study is to evaluate the association between different ambient air pollutants and the above-mentioned health outcomes. In this systematic review, a total of 76 articles was ultimately selected from 2653 articles, through multiple screening steps by the aid of a set of exclusion criteria as non-English articles, indoor air pollution assessment, work-related, occupational and home-attributed pollution, animal studies, tobacco smoking effects, letters to editors, commentaries, animal experiments, reviews, case reports and case series, out of 19,862 published articles through a systematic search in PubMed, Web of Science, and Scopus. Then, the associations between air pollution and different health outcomes were measured as relative risks and odds ratios. The association between air pollutants, PM_2.5 and PM₁₀, NO₂, SO₂, CO, O₃, and VOC with major organ systems health was investigated through the gathered studies. Relative risks and/or odds ratios attributed to each air pollutant/outcome were ultimately reported. In this study, a thorough and comprehensive discussion of all aspects of the contribution of ambient air pollutants in health outcomes was proposed. To our knowledge up to now, there is no such comprehensive outlook on this issue. Growing concerns in concert with air pollution-induced health risks impose a great danger on the life of billions of people worldwide. Should we propose ideas and schemes to reduce ambient air pollutant, there will be dramatic reductions in the prevalence and occurrence of health-threatening conditions.