Air pollution and public health in Latin America and the Caribbean (LAC): a systematic review with meta-analysis

Long-term exposure to PM2.5 and cardiorespiratory mortality: an ecological small-area study in five cities in Colombia

Long-term exposure to the fine particulate matter (PM2.5) is a risk factor for cardiorespiratory mortality. However, little is known about its distribution and health impact in large cities in low-middle-income countries where population exposure has increased during the last decades. This ecological study evaluated the association between PM2.5 concentration and adult cardiorespiratory mortality at the intraurban census sector (CS) level of Colombia's five most populated cities (2015-2019). We estimated incidence rate ratios (IRR; per 5µg/m3) by fitting negative binomial regressions to smoothed Bayesian mortality rates (BMR) on PM2.5 predicted from land use regression (LUR) models, adjusting for CS demographic structure, multidimensional poverty index, and spatial autocorrelation. CS median PM2.5 ranged from 8.1µg/m3 in Bucaramanga to 18.7µg/m3 in Medellín, whereas Bogotá had the highest variability (IQR = 29.5µg/m3) and cardiorespiratory mortality (BMR = 2,560 per 100,000). Long-term exposure to PM2.5 increased cardiorespiratory mortality in Bucaramanga (IRR = 1.15; 95%CI: 1.02; 1.31), without evidence of spatial clustering, and cardiovascular (IRR = 1.06; 95%CI: 1.01; 1.12) and respiratory (IRR = 1.07; 95%CI: 1.02; 1.13) mortality in Medellín. Cardiorespiratory mortality spatially clustered in some Colombian cities and was associated with long-term exposure to PM2.5 in urban areas where the LUR models had the highest predictive accuracy. These findings highlight the need to incorporate high-quality, high-resolution exposure assessments to better understand the health impact of air pollution and inform public health interventions in urban environments.

Global, regional, and national burden of young COPD, 1990-2021, with forecasts to 2050: a systematic analysis for the global burden of disease study 2021

BACKGROUND

Young chronic obstructive pulmonary disease (COPD) refers to people with COPD between the ages of 20 and 50 years. Current epidemiological studies focus on local geography, and there is a lack of global-level analysis. This study provides in-depth analyses of the disease burden of young COPD at global, regional, and national levels.

METHODS

This study used the Global Burden of Disease Study 2021 (GBD). The age-standardised prevalence rate (ASPR), age-standardised incidence rate (ASIR), age-standardised death rate (ASDR), and age-standardised disability-adjusted life years (DALYs) rate were used to describe the disease burden. The estimated annual percentage change (EAPC) during the study period was calculated. Joinpoint regression analysis examined the time trend from 1990 to 2021. Annual percentage change (APC) and average annual percentage change (AAPC) were calculated. Risk factors were reported by region and sex.

RESULTS

In 2021, the global number of young COPD cases was 30,384,539, and the ASPR, ASIR, ASDR, and age-standardised DALYs rates fell slightly. Oceania reported the highest ASPR, ASDR, and age-standardised DALYs rate. High-income North America has the highest ASIR. In 2021, the prevalence, incidence, death, and DALYs rates exhibited similar trends, increasing with age. From 1990 to 2021, both the prevalence and death rates showed a consistent downward trend across all age groups. Joinpoint regression analysis indicated a slight increase in both the ASPR (APC: 0.13; 95% CI: 0.06 to 0.19) and the ASIR (APC: 0.17; 95% CI: 0.10 to 0.24) during the period from 1990 to 1994. The leading DALYs attributable to risk factors for young COPD are household air pollution from solid fuels (20.4%), ambient particulate matter pollution (17.9%), and smoking (13.5%).

CONCLUSIONS

The global burden of ASPR, ASIR, ASDR, and age-standardised DALYs rates in young COPD has decreased, however, the absolute number of patients has increased. The global burden shows noticeable regional differences, with particularly high burdens observed in Oceania. Improving air quality, promoting smoking cessation, and increasing access to lung function tests, raising awareness of young COPD are key strategies for alleviating the burden of young COPD.

Cardiovascular disease burden linked to particulate matter pollution in Latin America and the Caribbean: Insights from GBD 2021 and socio-demographic index analysis

OBJECTIVES

This study aimed to analyze the burden of cardiovascular disease (CVD) attributable to particulate matter (PM) pollution in Latin American and Caribbean (LAC) countries and territories, and its relationship with the Socio-Demographic Index (SDI).

STUDY DESIGN

A cross-sectional analysis was conducted.

METHODS

The disability-adjusted life years (DALYs) and the SDI data were obtained from the Global Burden of Disease Study 2021. Spearman's regression coefficients (rho) and 95 % confidence intervals (CI) were used to evaluate the relationship of interest.

RESULTS

We computed a total of 22,231,164 disability-adjusted life years DALYs due to CVD in 2021, with an age-standardized rate of 3742 DALYs per 100,000 population. Ischemic heart disease and ischemic stroke were predominant. PM pollution was responsible for 2,974,358 DALYs (12.1 % of total CVD DALYs), varying widely across regions, with the highest attributable fractions observed in Haiti, Honduras, and Guatemala. A negative linear relationship (rho = -0.73, 95 % CI -0.95 to -0.51) was observed between PM pollution-attributable CVD burden and SDI, indicating a higher burden in regions with lower SDI. Public health interventions targeting PM pollution could substantially mitigate the burden of CVD, particularly in vulnerable populations identified in this study.

CONCLUSSIONS

These findings underscore the critical importance of environmental policies and interventions aimed at reducing PM pollution, and underlying socio-economic disparities, to alleviate the health impact of CVD in LAC countries and territories.

Variations in air pollution before, during and after the COVID-19 lockdown in Peruvian cities

The high concentrations of air pollutants in Peru remain a persistent problem, significantly impacting public health. Understanding the extent to which the COVID-19 lockdown affected these contaminants is crucial. To determine variations in NO2, O3, CO, and SO2 concentrations in 10 Peruvian cities before, during, and after lockdown. A comparative ecological study was conducted in urban areas of 10 major Peruvian cities using the Google Earth Engine (GEE) platform. Data on atmospheric pollutant concentrations were extracted from the Sentinel-5P/TROPOMI satellite images for the period between March 16 and June 30, across the years 2019, 2020, 2021, and 2022, for comparative analysis. The Wilcoxon test was used to evaluate changes between the study periods. We included 10 urban cities located across three geographic regions of Peru. Most urban cities experienced a decrease in NO2 concentrations and an increase in O3 and CO levels during the lockdown, while SO2 concentrations remained relatively constant. The lockdown has caused variations in NO2, O3 and CO concentrations. Future studies with accurate data on air pollutant concentrations are needed to ensure targeted and effective interventions.

Air quality self-management in asthmatic patients with COPD: An integrative review for developing nursing interventions to prevent exacerbations

OBJECTIVES

Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) patients experience a lower quality of life, frequent exacerbations, and worse pulmonary function. Environmental management is essential in a complex chronic condition, as pollutant exposure can worsen symptoms and increase morbidity and mortality. We aimed to identify evidence that informs nursing interventions in promoting self-management of air quality in asthmatic people with COPD.

METHODS

We conducted an integrative review in March of 2023. We searched the databases CINAHL, MEDLINE, Academic Search Complete, Cochrane Database of Systematic Reviews (CDSR), Scopus, Web of Science, Joanna Briggs Institute (JBI) Evidence-Based Practice Database, and Google Scholar. We included articles whose participants were adults with asthma, COPD, or both; the intervention was air quality management and the outcome of any exacerbations. We excluded editorials, letters, commentaries, opinion papers, position papers, study protocols, conference abstracts, and reviews. Data extraction and synthesis were performed, categorizing interventions according to nursing actions. Methodological quality assessment was conducted using the JBI Critical Appraisal Checklist tools. The review protocol was registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/5Y4KW).

RESULTS

We included five articles from different countries. The interventions promoting air quality self-management for individuals with asthma and COPD included vigilance interventions (health professional regular visits, assessment of symptoms), monitoring interventions (measurement of indoor and outdoor trigger factors), and educational interventions (air quality alerts, allergen avoidance). Policy interventions such as smoke-free policies and comprehensive strategies to improve air quality were also identified. These areas of focus represent critical components of nurses' interventions and can integrate the fundamental patterns of knowing in nursing. Although the studies reveal heterogeneous interventions and the methodological quality is variable, these interventions showed potential for preventing exacerbations, reducing emergency department visits, and minimizing hospitalizations.

CONCLUSIONS

The study emphasizes the need for a comprehensive approach involving nurses in multidisciplinary teams to air quality self-management. They can use these results to inform their interventions and ways of knowing, benefiting individuals with asthma and COPD. Further research is needed to expand the evidence base and refine these interventions.

Methodological and reporting quality of systematic reviews on health effects of air pollutants were higher than extreme temperatures: a comparative study

BACKGROUND

An increasing number of systematic reviews (SRs) in the environmental field have been published in recent years as a result of the global concern about the health impacts of air pollution and temperature. However, no study has assessed and compared the methodological and reporting quality of SRs on the health effects of air pollutants and extreme temperatures. This study aims to assess and compare the methodological and reporting quality of SRs on the health effects of ambient air pollutants and extreme temperatures.

METHODS

PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Web of Science, and Epistemonikos databases were searched. Two researchers screened the literature and extracted information independently. The methodological quality of the SRs was assessed through A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The reporting quality was assessed through Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA).

RESULTS

We identified 405 SRs (286 for air pollution, 108 for temperature, and 11 for the synergistic effects). The methodological and reporting quality of the included SRs were suboptimal, with major deficiencies in protocol registration. The methodological quality of SRs of air pollutants was better than that of temperature, especially in terms of satisfactory explanations for any heterogeneity (69.6% v. 45.4%). The reporting quality of SRs of air pollution was better than temperature, however, adherence to the reporting of the assessment results of risk of bias in all SRs (53.5% v. 34.3%) was inadequate.

CONCLUSIONS

Methodological and reporting quality of SRs on the health effect of air pollutants were higher than those of temperatures. However, deficiencies in protocol registration and the assessment of risk of bias remain an issue for both pollutants and temperatures. In addition, developing a risk-of-bias assessment tool applicable to the temperature field may improve the quality of SRs.

2030 Agenda: discussion on Brazilian priorities facing air pollution and climate change challenges

The advance of human activities in a disorderly way has accelerated in recent decades, intensifying the environmental impacts directly linked to these practices. The atmosphere, essential for the maintenance of life, is increasingly saturated with pollutants, offering risks to practically all the inhabitants of the planet, a process that, in addition to causing illness and early mortality, is related to serious financial losses (including in the production of goods), dangerous temperature increase and severe natural disasters. Although this perception is not recent, the global initiative to control the different mechanisms that trigger the commitment of biodiversity and irreversible climate changes arising from pollution is still very incipient, given that global initiatives on the subject emerged just over 50 years ago. Brazil is a territory that centralizes many of these discussions, as it still faces both political and economic obstacles in achieving a sustainable growth model as it was agreed through the United Nations 2030 Agenda. Even though there is little time left for the completion of these goals, much remains to be done, and despite the fulfillment of this deadline, the works will certainly need to be extended for much longer until an effective reorientation of consciousness occurs. Scientific researches and discussions are fundamental tools to the understanding of issues still little explored in this field.