Air Pollution in the Asia-Pacific Region. A Joint Asian Pacific Society of Respirology/American Thoracic Society Perspective

Children's exposure to air pollution in a natural gas industrial area and their risk of hospital admission for respiratory diseases

The rapid expansion of the natural gas industry to meet the global demand have raised environmental health concerns. Few studies have found that areas with natural gas industrial activity have poor air quality. However, the negative health impacts of ambient air pollution in a natural gas industrial area remain unclear. This study aimed to explore the relationship between short-term exposure to air pollution and hospital admissions for respiratory diseases among children in a natural gas industrial area in Bintulu, Malaysia. Daily hospital admissions for respiratory diseases among children were collected from a hospital in Bintulu from 2010 to 2019. Data on six air pollutants (PM₁₀, PM_2.5, SO₂, NO₂, O₃, and CO) in the study area were obtained from the Department of Environment Malaysia. Quasi-Poisson time series regressions with distributed lag non-linear models (DLNM) were applied to explore the associations between ambient air pollution and childhood hospitalisations for respiratory diseases. Stratification analyses were performed by gender and age group to identify the vulnerable populations. A 10 μg/m³ increased PM_2.5 and SO₂ was associated with hospital admissions for respiratory diseases among children with the greatest relative risk of RR 1.089 (95% CI 1.001-1.183) at cumulative lag 0-2 days and RR 1.229 (95% CI 1.073-1.409) at cumulative lag 0-6 days, respectively. There was no significant association between short-term exposure of PM₁₀, NO₂, CO, and O₃ with childhood respiratory hospitalisation. The association between PM_2.5 and SO₂ exposure and hospital admissions for childhood respiratory diseases in the two pollutants model remained statistically significant. There were stronger associations in younger children aged 0-4 years and girls. This study reveals that short-term exposure to SO₂ was associated with a higher risk of respiratory hospitalisations among children in Bintulu than PM_2.5. Better air quality control is necessary for children's health living in the natural gas industrial area.

Thoracic Society of Australia and New Zealand Position Statement: Respiratory nursing

The Thoracic Society of Australia and New Zealand's (TSANZ) Position Statement recognizes the pivotal role respiratory nurses play in the lung health of Australians and New Zealanders. The national and international lung health strategies are evidence based to ensure optimal professional clinical support for patients. Respiratory nurses are essential to the success of these strategies as a professional workforce, irrespective of healthcare setting, as they are at the forefront of the delivery of world-class evidence-based respiratory care. Respiratory nursing, as an entity, does not have the status as a nursing specialist area despite its range of professional practice across the life span and diverse settings, including disease prevention, public health, occupational health, symptom management, health education, surgery, rehabilitation, non-invasive ventilation, support for a life-limiting illness and adjustments to living with a chronic disease. Recognition of the specialized nature of work and specialist nursing practice status has been conferred by nurse registration boards upon cancer, emergency, cardiac, critical care, midwifery, mental health and palliative care nurses. It is time to confer this speciality practice recognition upon respiratory nurses of Australia and New Zealand. Through this position statement, the TSANZ advocates for respiratory nursing as a speciality area of professional nursing practice, thus supporting registered nurses in respiratory practice as well as the development of future generations of respiratory nurses. Furthermore, this statement validates the strong partnerships between all professions within the society for the advancement of lung health.

A comparative study of the disease burden attributable to PM2.5 in China, Japan and South Korea from 1990 to 2017

BACKGROUND

Exposure to fine particulate matter (PM_2.5) is one of the leading contributors to disease burden. However, little is known about the spatial and temporal trends of the disease burden attributable to PM_2.5 in the three major economies in East Asia. We aimed to estimate the patterns and temporal variations of the disease burden attributable to PM_2.5 in China, Japan, and South Korea from 1990 to 2017.

METHODS

We obtained data on disease burden attributable to PM_2.5 from the Global Burden of Disease Study (GBD) 2017. We retrieved the numbers and age-standardized mortality rate (ASMR) and disability-adjusted life years (DALYs) rate (ASDR) of disease attributable to PM_2.5 by age, sex, socio-demographic index (SDI), and country. We used percentage change and estimated annual percentage change (EAPC) to assess the trends of ASMR and ASDR attributable to PM_2.5 between 1990 and 2017. We further calculated the contribution of population growth, population aging, and changes in mortality or DALYs rate to the net changes in total deaths and DALYs associated with PM_2.5.

RESULTS

We found considerable differences in the disease burden attributable to PM_2.5 in China, Japan, and South Korea. In 2017, the ASMR and ASDR of disease attributable to PM_2.5 in China were 49.37 (95% UI: 41.18, 57.5) per 100,000 population and 1065.9 (95% UI: 891.28, 1237.38) per 100,000 population, respectively, which was about four times higher than that of Japan and twice higher than that of South Korea. Regardless of country, the ASMR and ASDR were more pronounced among elders and males. From 1990 to 2017, the declines in ASMR and ASDR were more pronounced in Japan and South Korea than in China. The changes in PM_2.5 associated total deaths and DALYs between 1990 and 2017 were the combined effects of population aging, population growth, and changes in mortality or DALY rate, resulting in a net increase in total deaths and DALYs in China but little changes in Japan and South Korea.

CONCLUSIONS

PM_2.5 still contributed to significant disease burdens in 2017, although age-standardized disease burden has declined from 1990 to 2017. There has been an increasing trend in total deaths and DALYs in China, which was primarily driven by population aging.

Ambient air pollution and cause-specific risk of hospital admission in China: A nationwide time-series study

BACKGROUND

The impacts of air pollution on circulatory and respiratory systems have been extensively studied. However, the associations between air pollution exposure and the risk of noncommunicable diseases of other organ systems, including diseases of the digestive, musculoskeletal, and genitourinary systems, remain unclear or inconclusive. We aimed to systematically assess the associations between short-term exposure to main air pollutants (fine particulate matter [PM2.5] and ozone) and cause-specific risk of hospital admission in China over a wide spectrum of human diseases.

METHODS AND FINDINGS

Daily data on hospital admissions for primary diagnosis of 14 major and 188 minor disease categories in 252 Chinese cities (107 cities in North China and 145 cities in South China) from January 1, 2013, to December 31, 2017, were obtained from the Hospital Quality Monitoring System of China (covering 387 hospitals in North China and 614 hospitals in South China). We applied a 2-stage analytic approach to assess the associations between air pollution and daily hospital admissions. City-specific associations were estimated with quasi-Poisson regression models and then pooled by random-effects meta-analyses. Each disease category was analyzed separately, and the P values were adjusted for multiple comparisons. A total of 117,338,867 hospital admissions were recorded in the study period. Overall, 51.7% of the hospitalized cases were male, and 71.3% were aged <65 years. Robust positive associations were found between short-term PM2.5 exposure and hospital admissions for 7 major disease categories: (1) endocrine, nutritional, and metabolic diseases; (2) nervous diseases; (3) circulatory diseases; (4) respiratory diseases; (5) digestive diseases; (6) musculoskeletal and connective tissue diseases; and (7) genitourinary diseases. For example, a 10-μg/m3 increase in PM2.5 was associated with a 0.21% (95% CI 0.15% to 0.27%; adjusted P < 0.001) increase in hospital admissions for diseases of the digestive system on the same day in 2-pollutant models (adjusting for ozone). There were 35 minor disease categories significantly positively associated with same-day PM2.5 in both single- and 2-pollutant models, including diabetes mellitus, anemia, intestinal infection, liver diseases, gastrointestinal hemorrhage, renal failure, urinary tract calculus, chronic ulcer of skin, and back problems. The association between short-term ozone exposure and respiratory diseases was robust. No safety threshold in the exposure-response relationships between PM2.5 and hospital admissions was observed. The main limitations of the present study included the unavailability of data on personal air pollution exposures.

CONCLUSIONS

In the Chinese population during 2013-2017, short-term exposure to air pollution, especially PM2.5, was associated with increased risk of hospitalization for diseases of multiple organ systems, including certain diseases of the digestive, musculoskeletal, and genitourinary systems; many of these associations are important but still not fully recognized. The effect estimates and exposure-response relationships can inform policy making aimed at protecting public health from air pollution in China.

Blood lead levels in relation to smoking and chronic obstructive pulmonary disease (COPD): a study from Korean National Health and Nutrition Examination Survey (KNHANES)

Background

Lead exposure is a resurgent environmental issue globally. Smoking can be a source of lead exposure, although the majority of lead poisonings originate from workplace exposures. However, no study has been undertaken concerning the blood lead levels based on the chronic obstructive pulmonary disease (COPD), smoking status, and other risk factors of COPD. This cross-sectional study was conducted to investigate the blood lead levels according to COPD and clinical variables associated with COPD.

Methods

Data (total number =53,829) were collected from the Korean National Health and Nutrition Examination Survey (IV in 2008 and 2009, V in 2010–2012, and VI in 2013). Multivariable linear regression analyses were performed to determine variables associated with elevated blood lead levels.

Results

Univariate regression analysis showed that male sex, older age, smoking, occupation level, income level, education level, and presence of COPD were related to higher blood lead levels, whereas the other co-morbidities including diabetes, hypertension, cerebral stroke, osteoporosis, asthma, and depression were not related (P<0.05). Multivariable regression analysis demonstrated that older age, male sex, smoking, occupation, and education level were independently associated with higher blood lead levels (P<0.05).

Conclusions

Smoking status, occupation, and education level along with old age and male sex were independently associated with higher blood lead levels; however, COPD was not after adjustment of all confounding factors.

Multi-city study on air pollution and hospital outpatient visits for asthma in China

BACKGROUND

The proportion of asthma patients with mild to moderate exacerbations is far greater than the number who experience episodes that are severe enough to require emergency room visits or hospital admission. However the routinely collected data from hospitals is absent in the past.

OBJECTIVE

To evaluate associations between short-term exposures to air pollutants and hospital outpatient visits for asthma in China.

METHODS

We obtained data for 143,057 asthma outpatient visits from the largest hospitals in 17 Chinese cities, between Jan 01 2013 and Dec 31 2015. We used daily concentrations of air pollutants measured by the China National Environmental Monitoring Centre. We used a time-stratified case-crossover design, and fitted conditional logistic regression models to determine the associations.

RESULTS

Particulate matter ≤10μm in diameter (PM10) and nitrogen dioxide (NO2) were associated with increased risks of hospital outpatient visits for asthma on the same day, while the effects were delayed for particulate matter ≤2.5μm in diameter (PM2.5) and sulphur dioxide (SO2). For the cumulative effect model at lag05 days, 10 μg/m3 increase in air pollutants concentrations were correlated with hospital outpatient visits for asthma with odds ratios (ORs) and 95% confidence intervals 1.004 (1.000-1.008) for PM2.5, 1.005 (1.002-1.008) for PM10, 1.030 (1.021-1.040) for NO2, and 1.015 (1.008-1.021) for SO2. Almost one in nine (10.9%; 7.7, 13.9%) hospital outpatient visits for asthma were attributable to NO2.

CONCLUSION

Short-term exposures to PM2.5, PM10, NO2 and SO2 were associated with hospital outpatient visits for asthma in China.

Associations between ambient air pollution and cancer incidence in Taiwan: an ecological study of geographical variations

BACKGROUND

Air pollution is a global public health concern. The World Health Organization has recently set up a goal of saving 7 million people globally by 2030 from air pollution related death. We conducted an ecological study of geographical variation to explore the association between air pollution (specifically, particulate matter <2.5 μm in aerodynamic diameter [PM2.5], particulate matter <10 μm in aerodynamic diameter, sulfur dioxide, nitrogen dioxide, nitric oxide, and ozone) and cancer incidence in Taiwan, from 2012 to 2016.

METHODS

In this study, the yearly average concentrations of each air pollutant at 75 air quality monitoring stations were calculated, and using the kriging method, the concentrations were extrapolated to each and every geographical central point of 349 local administrative areas of Taiwan. Spearman rank correlation coefficients between the age-adjusted cancer incidence rates and various air pollutants were calculated by stratifying genders and urbanization degrees of the local administrative areas. A total of 70 correlation coefficients were calculated.

RESULTS

In total, 17 correlation coefficients were significantly positive at an alpha level of 0.05. Among these, four correlation coefficients between the age-adjusted cancer incidence rates and PM2.5 levels remained significant after Bonferroni correction. For men in developing towns, general towns, and aged towns and for women in aged towns, the age-adjusted cancer incidence rates increased 13.1 (95% confidence interval [CI], 8.8-17.6), 11 (95% CI, 5.6-16.4), 16.7 (95% CI, 6.9-26.4), and 11.9 (95% CI, 5.6-18.2) per 100,000 populations, respectively, for every 1 μg/m3 increment in PM2.5 concentrations.

CONCLUSIONS

A significantly positive correlation was observed between the PM2.5 level and cancer incidence rate after multiple testing correction.