Ambient PM2.5, O₃, and NO₂ Exposures and Associations with Mortality over 16 Years of Follow-Up in the Canadian Census Health and Environment Cohort (CanCHEC)

Interactive effects of atmospheric oxidising pollutants and heat waves on the risk of residential mortality

BACKGROUND

The impact of heat waves and atmospheric oxidising pollutants on residential mortality within the framework of global climate change has become increasingly important.

OBJECTIVE

In this research, the interactive effects of heat waves and oxidising pollutants on the risk of residential mortality in Fuzhou were examined. Methods We collected environmental, meteorological, and residential mortality data in Fuzhou from 1 January 2016, to 31 December 2021. We then applied a generalised additive model, distributed lagged nonlinear model, and bivariate three-dimensional model to investigate the effects and interactions of various atmospheric oxidising pollutants and heat waves on the risk of residential mortality.

RESULTS

Atmospheric oxidising pollutants increased the risk of residential mortality at lower concentrations, and O3 and Ox were positively associated with a maximum risk of 2.19% (95% CI: 0.74-3.66) and 1.29% (95% CI: 0.51-2.08). The risk of residential mortality increased with increasing temperature, with a strong and long-lasting effect and a maximum cumulative lagged effect of 1.11% (95% CI: 1.01, 1.23). Furthermore, an interaction between atmospheric oxidising pollutants and heat waves may have occurred: the larger effects in the longest cumulative lag time on residential mortality per 10 µg/m3 increase in O3, NO2 and Ox during heat waves compared to non-heat waves were [-3.81% (95% CI: -14.82, 8.63)]; [-0.45% (95% CI: -2.67, 1.81)]; [67.90% (95% CI: 11.55, 152.71)]; 16.37% (95% CI: 2.43, 32.20)]; [-3.00% (95% CI: -20.80, 18.79)]; [-0.30% (95% CI: -3.53, 3.04)]. The risk on heat wave days was significantly higher than that on non-heat wave days and higher than the separate effects of oxidising pollutants and heat waves.

CONCLUSIONS

Overall, we found some evidence suggesting that heat waves increase the impact of oxidising atmospheric pollutants on residential mortality to some extent.

Association of ambient ozone exposure and greenness exposure with hemorrhagic stroke mortality at different times: A cohort study in Shandong Province, China

Evidence on the association between long-term ozone exposure and greenness exposure and hemorrhagic stroke (HS) is limited, with mixed results. One potential source of this inconsistency is the difference in exposure time metrics. This study aimed to investigate the association between long-term exposure to ambient ozone, greenness, and mortality from HS using exposure metrics at different times. We also examined whether greenness exposure modified the relationship between ozone exposure and mortality due to HS. The study population consisted of 45771 participants aged ≥40 y residing in 20 counties in Shandong Province who were followed up from 2013 to 2019. Ozone exposure metrics (annual mean and warm season) and the normalized difference a measure of greenness exposure, were calculated. The relationship between environmental exposures (ozone and greenness exposures) and mortality from HS was assessed using time-dependent Cox proportional hazards models, and the modification of greenness exposure was examined using stratified analysis with interaction terms. The person-years at the end of follow-up were 90,663. With full adjustments, the risk of death from hemorrhagic stroke increased by 5% per interquartile range increase in warm season ozone [hazard ratio =1.05; 95 % confidence interval: 1.01-1.08]. No clear association was observed between annual ozone and mortality HS. Both the annual and summer NDVI were found to reduce the risk of HS mortality. The relationships were influenced by age, sex, and residence (urban or rural). Furthermore, greenness exposure was shown to have a modifying effect on the relationship between ozone exposure and the occurrence of HS mortality (P for interaction = 0.001). Long-term exposure to warm season O3 was positively associated with HS mortality, while greenness exposure was inversely associated with HS mortality. Greenness exposure may mitigate the negative effects of warm season ozone exposure on HS mortality.

Model misspecification, measurement error, and apparent supralinearity in the concentration-response relationship between PM2.5 and mortality

A growing number of studies have produced results that suggest the shape of the concentration-response (C-R) relationship between PM2.5 exposure and mortality is "supralinear" such that incremental risk is higher at the lowest exposure levels than at the highest exposure levels. If the C-R function is in fact supralinear, then there may be significant health benefits associated with reductions in PM2.5 below the current US National Ambient Air Quality Standards (NAAQS), as each incremental tightening of the PM2.5 NAAQS would be expected to produce ever-greater reductions in mortality risk. In this paper we undertake a series of tests with simulated cohort data to examine whether there are alternative explanations for apparent supralinearity in PM2.5 C-R functions. Our results show that a linear C-R function for PM2.5 can falsely appear to be supralinear in a statistical estimation process for a variety of reasons, such as spatial variation in the composition of total PM2.5 mass, the presence of confounders that are correlated with PM2.5 exposure, and some types of measurement error in estimates of PM2.5 exposure. To the best of our knowledge, this is the first simulation-based study to examine alternative explanations for apparent supralinearity in C-R functions.

Association of Environmental Injustice and Cardiovascular Diseases and Risk Factors in the United States

BACKGROUND

While the impacts of social and environmental exposure on cardiovascular risks are often reported individually, the combined effect is poorly understood.

METHODS AND RESULTS

Using the 2022 Environmental Justice Index, socio-environmental justice index and environmental burden module ranks of census tracts were divided into quartiles (quartile 1, the least vulnerable census tracts; quartile 4, the most vulnerable census tracts). Age-adjusted rate ratios (RRs) of coronary artery disease, strokes, and various health measures reported in the Prevention Population-Level Analysis and Community Estimates data were compared between quartiles using multivariable Poisson regression. The quartile 4 Environmental Justice Index was associated with a higher rate of coronary artery disease (RR, 1.684 [95% CI, 1.660-1.708]) and stroke (RR, 2.112 [95% CI, 2.078-2.147]) compared with the quartile 1 Environmental Justice Index. Similarly, coronary artery disease 1.057 [95% CI,1.043-1.0716] and stroke (RR, 1.118 [95% CI, 1.102-1.135]) were significantly higher in the quartile 4 than in the quartile 1 environmental burden module. Similar results were observed for chronic kidney disease, hypertension, diabetes, obesity, high cholesterol, lack of health insurance, sleep <7 hours per night, no leisure time physical activity, and impaired mental and physical health >14 days.

CONCLUSIONS

The prevalence of CVD and its risk factors is highly associated with increased social and environmental adversities, and environmental exposure plays an important role independent of social factors.

Interactions between aerosols and surface ozone in arid and semi-arid regions of China

Atmospheric aerosols affect surface ozone concentrations by influencing radiation, but the mechanism and dominant factors are unclear. Therefore, this paper analyses the changes in aerosol-radiative-surface ozone in China's arid and semi-arid regions with the help of the Atmospheric Radiative Transfer (SBDART) model. The results suggest that Aerosol Optical Depth (AOD) and coarse Particulate Matter (PM10) have the same trend, with high values in spring and winter and low values in summer and autumn. Surface ozone is high in spring and summer and low in autumn and winter. Surface ozone is higher in spring and summer and lower in autumn and winter. In winter, mainly secondary pollutants are dominated by high pollution levels. In the rest of the seasons, a mixture of dust, motor vehicle exhaust, and soot is dominated by low pollution levels. Surface ozone is positively correlated with fine particles and negatively correlated with coarse particles. Temperature is positively correlated with surface ozone in all seasons and negatively correlated with PM10 in summer, autumn, and winter. Precipitation negatively correlates with PM10 each season and surface ozone in winter and spring. Analysis of surface ozone and PM10 sources in the more polluted city of Hohhot based on the back-line trajectory model showed that airflow trajectories mainly transported surface ozone and PM10 pollution from northwestern Inner Mongolia and western Mongolia. During dusty solid weather, the decrease in radiation reaching the Earth's surface and the cooling effect of aerosols lead to lower temperatures, which slows down the rate of chemical reactions of precursors of surface ozone, resulting in lower ozone concentrations at the surface. This study can provide a theoretical reference for aerosol and surface ozone control in arid and semi-arid areas of China.

Particulate matters 2.5 induce tumor progression in lung cancer by increasing the activity of hnRNPA2B1 resulting in retarding mRNA decay of oxidative phosphorylation

Particulate matter 2.5 (PM2.5) has been implicated in lung injury and various cancers, yet its precise mechanistic role remains elusive. To elucidate the key signaling pathways underpinning PM2.5-induced lung cancer progression, we embarked on a study examining the impact of PM2.5 both in vitro and in vivo. Lung cancer cell lines, A549 and H157, were employed for the in vitro investigations. Overexpression or knockdown techniques targeting the hnRNPA2B1 protein were implemented. Lung cancer cells were treated with a medium containing PM2.5 and subsequently prepared for in vitro evaluations. Cell growth, invasion, and migration were gauged using transwell and CCK-8 assays. Apoptosis was ascertained through flow cytometry and western blotting of pertinent proteins. Seahorse analyses probed the influence of PM2.5 on lung cancer energy metabolism. The RNA stability assay was employed to discern the impact of PM2.5 on the stability of oxidative phosphorylation-related genes in lung cancer. Our findings revealed that PM2.5 augmented cell proliferation, migration, and invasion rates. Similarly, a diminished apoptosis rate was observed in PM2.5-treated cells. Elevated expression of hnRNPA2B1 was detected in lung cancer cells exposed to PM2.5. Moreover, in cells treated with PM2.5, hnRNPA2B1 knockdown markedly curtailed cell proliferation by inducing G1-S cell cycle arrest and bolstered lung cancer cell apoptosis in vitro; it also curbed xenograft tumor growth. Mechanistically, our data suggest that PM2.5 undermines the stability of mRNA transcripts associated with oxidative phosphorylation (OXPHOS) and augments the formation of processing bodies (P-bodies), leading to an upsurge in OXPHOS levels. In conclusion, PM2.5 appears to drive lung cancer progression and migration by modulating the energy metabolism of lung cancer in a hnRNPA2B1-dependent manner.

Risk Factors and Inequities in Transportation Injury and Mortality in the Canadian Census Health and Environment Cohorts (CanCHECs)

BACKGROUND

Road traffic injury contributes substantially to morbidity and mortality. Canada stands out among developed countries in not conducting a national household travel survey, leading to a dearth of national transportation mode data and risk calculations that have appropriate denominators. Since traffic injuries are specific to the mode of travel used, these risk calculations should consider travel mode.

METHODS

Census data on mode of commute is one of the few sources of these data for persons aged 15 and over. This study leveraged a national data linkage cohort, the Canadian Census Health and Environment Cohorts, that connects census sociodemographic and commute mode data with records of deaths and hospitalizations, enabling assessment of road traffic injury associations by indicators of mode of travel (commuter mode). We examined longitudinal (1996-2019) bicyclist, pedestrian, and motor vehicle occupant injury and fatality risk in the Canadian Census Health and Environment Cohorts by commuter mode and sociodemographic characteristics using Cox proportional hazards models within the working adult population.

RESULTS

We estimated positive associations between commute mode and same mode injury and fatality, particularly for bicycle commuters (hazard ratios for bicycling injury was 9.1 and for bicycling fatality was 11). Low-income populations and Indigenous people had increased injury risk across all modes.

CONCLUSIONS

This study shows inequities in transportation injury risk in Canada and underscores the importance of adjusting for mode of travel when examining differences between population groups.

Long-term ozone exposure and mortality in patients with chronic kidney disease: a large cohort study

BACKGROUND

Epidemiologic studies on the effects of long-term exposure to ozone (O3) have shown inconclusive results. It is unclear whether to O3 has an effect on chronic kidney disease (CKD). We investigated the effects of O3 on mortality and renal outcome in CKD.

METHODS

We included 61,073 participants and applied Cox proportional hazards models to examine the effects of ozone on the risk of end-stage renal disease (ESRD) and mortality in a two-pollutants model adjusted for socioeconomic status. We calculated the concentration of ozone exposure one year before enrollment and used inverse distance weighting (IDW) for interpolation, where the exposure was evenly distributed.

RESULTS

In the single pollutant model, O3 was significantly associated with an increased risk of ESRD and all-cause mortality. Based on the O3 concentration from IDW interpolation, this moving O3 average was significantly associated with an increased risk of ESRD and all-cause mortality. In a two-pollutants model, even after we adjusted for other measured pollutants, nitrogen dioxide did not attenuate the result for O3. The hazard ratio (HR) value for the district-level assessment is 1.025 with a 95% confidence interval (CI) of 1.014-1.035, while for the point-level assessment, the HR value is 1.04 with a 95% CI of 1.035-1.045. The impact of ozone on ESRD, hazard ratio (HR) values are, 1.049(95%CI: 1.044-1.054) at the district unit and 1.04 (95%CI: 1.031-1.05) at the individual address of the exposure assessment. The ozone hazard ratio for all-cause mortality was 1.012 (95% confidence interval: 1.008-1.017) for administrative districts and 1.04 (95% confidence interval: 1.031-1.05) for individual addresses.

CONCLUSIONS

This study suggests that long-term ambient O3 increases the risk of ESRD and mortality in CKD. The strategy to decrease O3 emissions will substantially benefit health and the environment.

Disentangling associations between multiple environmental exposures and all-cause mortality: an analysis of European administrative and traditional cohorts

Background

We evaluated the independent and joint effects of air pollution, land/built environment characteristics, and ambient temperature on all-cause mortality as part of the EXPANSE project.

Methods

We collected data from six administrative cohorts covering Catalonia, Greece, the Netherlands, Rome, Sweden, and Switzerland and three traditional cohorts in Sweden, the Netherlands, and Germany. Participants were linked to spatial exposure estimates derived from hybrid land use regression models and satellite data for: air pollution [fine particulate matter (PM2.5), nitrogen dioxide (NO₂), black carbon (BC), warm season ozone (O3)], land/built environment [normalized difference vegetation index (NDVI), distance to water, impervious surfaces], and ambient temperature (the mean and standard deviation of warm and cool season temperature). We applied Cox proportional hazard models accounting for several cohort-specific individual and area-level variables. We evaluated the associations through single and multiexposure models, and interactions between exposures. The joint effects were estimated using the cumulative risk index (CRI). Cohort-specific hazard ratios (HR) were combined using random-effects meta-analyses.

Results

We observed over 3.1 million deaths out of approximately 204 million person-years. In administrative cohorts, increased exposure to PM2.5, NO2, and BC was significantly associated with all-cause mortality (pooled HRs: 1.054, 1.033, and 1.032, respectively). We observed an adverse effect of increased impervious surface and mean season-specific temperature, and a protective effect of increased O3, NDVI, distance to water, and temperature variation on all-cause mortality. The effects of PM2.5 were higher in areas with lower (10th percentile) compared to higher (90th percentile) NDVI levels [pooled HRs: 1.054 (95% confidence interval (CI) 1.030-1.079) vs. 1.038 (95% CI 0.964-1.118)]. A similar pattern was observed for NO2. The CRI of air pollutants (PM2.5 or NO2) plus NDVI and mean warm season temperature resulted in a stronger effect compared to single-exposure HRs: [PM2.5 pooled HR: 1.061 (95% CI 1.021-1.102); NO2 pooled HR: 1.041 (95% CI 1.025-1.057)]. Non-significant effects of similar patterns were observed in traditional cohorts.

Discussion

The findings of our study not only support the independent effects of long-term exposure to air pollution and greenness, but also highlight the increased effect when interplaying with other environmental exposures.

Concomitant exposure to air pollution, green space and noise, and risk of myocardial infarction: a cohort study from Denmark

AIMS

The three correlated environmental exposures (air pollution, road traffic noise, and green space) have all been associated with the risk of myocardial infarction (MI). The present study aimed to analyse their independent and cumulative association with MI.

METHODS AND RESULTS

In a cohort of all Danes aged 50 or older in the period 2005-17, 5-year time-weighted average exposure to fine particles (PM2.5), ultrafine particles, elemental carbon, nitrogen dioxide (NO2), and road traffic noise at the most and least exposed façades of residence was estimated. Green space around residences was estimated from land use maps. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI), and cumulative risk indices (CRIs) were calculated. All expressed per interquartile range. Models were adjusted for both individual and neighbourhood-level socio-demographic covariates. The cohort included 1 964 702 persons. During follow-up, 71 285 developed MI. In single-exposure models, all exposures were associated with an increased risk of MI. In multi-pollutant analyses, an independent association with risk of MI was observed for PM2.5 (HR: 1.026; 95% CI: 1.002-1.050), noise at most exposed façade (HR: 1.024; 95% CI: 1.012-1.035), and lack of green space within 150 m of residence (HR: 1.018; 95% CI: 1.010-1.027). All three factors contributed significantly to the CRI (1.089; 95% CI: 1.076-1.101).

CONCLUSION

In a nationwide cohort study, air pollution, noise, and lack of green space were all independently associated with an increased risk of MI. The air pollutant PM2.5 was closest associated with MI risk.

PM2.5 constituents associated with childhood obesity and larger BMI growth trajectory: A 14-year longitudinal study

BACKGROUND

The association of specific PM2.5 chemical constituents with childhood overweight or obesity (OWOB) remain unclear. Furthermore, the long-term impacts of PM2.5 exposure on the trajectory of children's body mass index (BMI) have not been explored.

METHODS

We conducted a longitudinal study among 1,450,830 Chinese children aged 6-19 years from Beijing and Zhongshan in China during 2005-2018 to examine the associations of PM2.5 and its chemical constituents with incident OWOB risk. We extracted PM2.5 mass and five main component exposure from Tracking Air Pollution in China (TAP) dataset. Cox proportional hazards models were applied to quantify exposure-response associations. We further performed principal component analysis (PCA) to handle the multi-collinearity and used quantile g-computation (QGC) approach to analyze the impacts of exposure mixtures. Additionally, we selected 125,863 children with at least 8 physical examination measurements and combined group-based trajectory models (GBTM) with multinomial logistic regression models to explore the impacts of exposure to PM2.5 mass and five constituents on BMI and BMI Z-score trajectories during 6-19 years.

RESULTS

We observed each interquartile range increment in PM2.5 exposure was significantly associated with a 5.1 % increase in the risk of incident OWOB (95 % confidence Interval [CI]: 1.036-1.066). We also found black carbon, sulfate, organic matter, often linked to fossil combustion, had comparable or larger estimates of the effect (HR = 1.139-1.153) than PM2.5. Furthermore, Exposure to PM2.5 mass, sulfate, nitrate, ammonium, organic matter and black carbon was significantly associated with an increased odds of being in a larger BMI trajectory and being assigned to persistent OWOB trajectory.

CONCLUSIONS

Our findings provide evidence that the constituents mainly from fossil fuel combustion may have a perceptible influence on increased OWOB risk associated with PM2.5 exposure in China. Moreover, long-term exposure to PM2.5 contributes to an increased odds of being in a lager BMI and a persistent OWOB trajectories.

Ultra-high-resolution mapping of ambient fine particulate matter to estimate human exposure in Beijing

With the decreasing regional-transported levels, the health risk assessment derived from fine particulate matter (PM2.5) has become insufficient to reflect the contribution of local source heterogeneity to the exposure differences. Here, we combined the both ultra-high-resolution PM2.5 concentration with population distribution to provide the personal daily PM2.5 internal dose considering the indoor/outdoor exposure difference. A 30-m PM2.5 assimilating method was developed fusing multiple auxiliary predictors, achieving higher accuracy (R2 = 0.78-0.82) than the chemical transport model outputs without any post-simulation data-oriented enhancement (R2 = 0.31-0.64). Weekly difference was identified from hourly mobile signaling data in 30-m resolution population distribution. The population-weighted ambient PM2.5 concentrations range among districts but fail to reflect exposure differences. Derived from the indoor/outdoor ratio, the average indoor PM2.5 concentration was 26.5 μg/m3. The internal dose based on the assimilated indoor/outdoor PM2.5 concentration shows high exposure diversity among sub-groups, and the attributed mortality increased by 24.0% than the coarser unassimilated model.

Long-term exposure to air pollution and mortality in Scotland: A register-based individual-level longitudinal study

BACKGROUND

Air pollution is associated with several adverse health outcomes. However, heterogeneity in the size of effect estimates between cohort studies for long-term exposures exist and pollutants like SO2 and mental/behavioural health outcomes are little studied. This study examines the association between long-term exposure to multiple ambient air pollutants and all-cause and cause-specific mortality from both physical and mental illnesses.

METHODS

We used individual-level administrative data from the Scottish-Longitudinal-Study (SLS) on 202,237 individuals aged 17 and older, followed between 2002 and 2017. The SLS dataset was linked to annual concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) pollution at 1 km2 spatial resolution using the individuals' residential postcode. We applied survival analysis to assess the association between air pollution and all-cause, cardiovascular, respiratory, cancer, mental/behavioural disorders/suicides, and other-causes mortality.

RESULTS

Higher all-cause mortality was associated with increasing concentrations of PM2.5, PM10, NO2, and SO2 pollutants. NO2, PM10, and PM2.5 were also associated with cardiovascular, respiratory, cancer and other-causes mortality. For example, the mortality hazard from respiratory diseases was 1.062 (95%CI = 1.028-1.096), 1.025 (95%CI = 1.005-1.045), and 1.013 (95%CI = 1.007-1.020) per 1 μg/m3 increase in PM2.5, PM10 and NO2 pollutants, respectively. In contrast, mortality from mental and behavioural disorders was associated with 1 μg/m3 higher exposure to SO2 pollutant (HR = 1.042; 95%CI = 1.015-1.069).

CONCLUSION

This study revealed an association between long-term (16-years) exposure to ambient air pollution and all-cause and cause-specific mortality. The results suggest that policies and interventions to enhance air quality would reduce the mortality hazard from cardio-respiratory, cancer, and mental/behavioural disorders in the long-term.

Assessing the effect of COVID-19 pandemic on air quality change and human health outcomes in a capital city, southwestern Iran

The aimsof this study were to assess the spatial variation of PM2.5, NO2, and O3 between 2019 (before) and 2020 (during COVID-19 pandemic); and calculation the health outcomes of exposure to these pollutants. The daily PM2.5, NO2, and O3 concentrations were applied to assess health effects by relative risk, and baseline incidence. The annual PM2.5 and NO2 mean concentrations exceeded the WHO guideline values, while O3 did not exceed. The restrictive measures associated to COVID-19 led to reduction at the annual means of PM2.5 and NO2 by -25.5% and -23.1%, respectively, while the annual mean of O3 increased by +7.9%. The number of M-CVD and M-RD (-25.6%, -26.1%) related to PM2.5 exposure, and HA-COPD and HA-RD >65 years old (-21% and -3.84%) related to NO2 exposure were reduced in 2020, and O3 exposure-related M-CVD (+30.1%) and HA-RD >65 years old (+23.4%) increased compared to the previous year 2019.

Long-Term Exposure to Low-Level PM2.5 and Mortality: Investigation of Heterogeneity by Harmonizing Analyses in Large Cohort Studies in Canada, United States, and Europe

BACKGROUND

Studies across the globe generally reported increased mortality risks associated with particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ) exposure with large heterogeneity in the magnitude of reported associations and the shape of concentration-response functions (CRFs). We aimed to evaluate the impact of key study design factors (including confounders, applied exposure model, population age, and outcome definition) on PM 2.5 effect estimates by harmonizing analyses on three previously published large studies in Canada [Mortality-Air Pollution Associations in Low Exposure Environments (MAPLE), 1991-2016], the United States (Medicare, 2000-2016), and Europe [Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), 2000-2016] as much as possible.

METHODS

We harmonized the study populations to individuals 65 + years of age, applied the same satellite-derived PM 2.5 exposure estimates, and selected the same sets of potential confounders and the same outcome. We evaluated whether differences in previously published effect estimates across cohorts were reduced after harmonization among these factors. Additional analyses were conducted to assess the influence of key design features on estimated risks, including adjusted covariates and exposure assessment method. A combined CRF was assessed with meta-analysis based on the extended shape-constrained health impact function (eSCHIF).

RESULTS

More than 81 million participants were included, contributing 692 million person-years of follow-up. Hazard ratios and 95% confidence intervals (CIs) for all-cause mortality associated with a 5 - μ g / m 3 increase in PM 2.5 were 1.039 (1.032, 1.046) in MAPLE, 1.025 (1.021, 1.029) in Medicare, and 1.041 (1.014, 1.069) in ELAPSE. Applying a harmonized analytical approach marginally reduced difference in the observed associations across the three studies. Magnitude of the association was affected by the adjusted covariates, exposure assessment methodology, age of the population, and marginally by outcome definition. Shape of the CRFs differed across cohorts but generally showed associations down to the lowest observed PM 2.5 levels. A common CRF suggested a monotonically increased risk down to the lowest exposure level. https://doi.org/10.1289/EHP12141.

Antagonism between ambient ozone increase and urbanization-oriented population migration on Chinese cardiopulmonary mortality

Ever-increasing ambient ozone (O3) pollution in China has been exacerbating cardiopulmonary premature deaths. However, the urban-rural exposure inequity has seldom been explored. Here, we assess population-scale O3 exposure and mortality burdens between 1990 and 2019 based on integrated pollution tracking and epidemiological evidence. We find Chinese population have been suffering from climbing O3 exposure by 4.3 ± 2.8 ppb per decade as a result of rapid urbanization and growing prosperity of socioeconomic activities. Rural residents are broadly exposed to 9.8 ± 4.1 ppb higher ambient O3 than the adjacent urban citizens, and thus urbanization-oriented migration compromises the exposure-associated mortality on total population. Cardiopulmonary excess premature deaths attributable to long-term O3 exposure, 373,500 (95% uncertainty interval [UI]: 240,600-510,900) in 2019, is underestimated in previous studies due to ignorance of cardiovascular causes. Future O3 pollution policy should focus more on rural population who are facing an aggravating threat of mortality risks to ameliorate environmental health injustice.

Long-term exposure to air pollution and incidence of mental disorders. A large longitudinal cohort study of adults within an urban area

BACKGROUND

Recent epidemiological evidence suggests associations between air pollution exposure and major depressive disorders, but the literature is inconsistent for other mental illnesses. We investigated the associations of several air pollutants and road traffic noise with the incidence of different categories of mental disorders in a large population-based cohort.

METHODS

We enrolled 1,739,277 individuals 30 + years from the 2011 census in Rome, Italy, and followed them up until 2019. In detail, we analyzed 1,733,331 participants (mean age 56.43 +/- 15.85 years; 54.96 % female) with complete information on covariates of interest. We excluded subjects with prevalent mental disorders at baseline to evaluate the incidence (first hospitalization or co-pay exemption) of schizophrenia spectrum disorders, bipolar, anxiety, personality, or substance use disorders. In addition, we studied subjects with first prescriptions of antipsychotics, antidepressants, and mood stabilizers. Annual average concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO₂), Black Carbon (BC), ultrafine particles (UFP), and road traffic noise were assigned to baseline residential addresses. We applied Cox regression models adjusted for individual and area-level covariates.

RESULTS

Each interquartile range (1.13 µg/m3) increase in PM2.5 was associated with a hazard ratio (HR) of 1.070 (95 % confidence interval [CI]: 1.017, 1.127) for schizophrenia spectrum disorder, 1.135 (CI: 1.086, 1.186) for depression, 1.097 (CI: 1.030, 1.168) for anxiety disorders. Positive associations were also detected for BC and UFP, and with the three categories of drug prescriptions. Bipolar, personality, and substance use disorders did not show clear associations. The effects were highest in the age group 30-64 years, except for depression.

CONCLUSIONS

Long-term exposure to ambient air pollution, especially fine and ultrafine particles, was associated with increased risks of schizophrenia spectrum disorder, depression, and anxiety disorders. The association of the pollutants with the prescriptions of specific drugs increases the credibility of the results.

Drivers of ozone-related premature mortality in China: Implications for historical and future scenarios

Long-term exposure to ambient ozone (O3) poses a severe public health threat in China. However, the drivers of premature mortality caused by O3 pollution are still poorly constrained, despite being prerequisites for addressing the threat. Here, we demonstrate the contributions of historical and future changes in peak-season O3, population size, age structure, and baseline mortality to China's O3-related mortality using decomposition analysis. From 2013 to 2021, O3-related mortality decreased dramatically from 78.8 (40.8-124.6) to 68.7 (36.0-107.2) thousand, especially in densely populated areas with high pollution. Variations in peak-season O3, population size, age structure, and baseline mortality led to changes in O3-related mortality of +27.3 (14.8-41.3), +2.6 (1.4-4.1), +22.3 (11.5-35.2), and -40.3 (20.9-63.7) thousand, respectively. The influence of peak-season O3 on O3-related mortality shifted from positive during 2013-2019 (+8.4% per year) to negative during 2019-2021 (-8.8% per year), which highly regulated the interannual trend of mortality. From 2021 to 2035, O3-related mortality is expected to increase by 31% in the current context of peak-season O3 levels, primarily caused by increased aging. Even reducing peak-season O3 to the WHO interim target 1 (IT-1) would only reduce O3-related mortality by 3.9%, while a more rigorous standard (IT-2) would prevent 83.7% of mortality. These findings suggest that improving ambient O3 can lead to significant health benefits, but substantial mitigation strategies are merited given the future trend of population aging.

Air Pollution and Cardiac Diseases: A Review of Experimental Studies

Air pollution is associated with around 6.5 million premature deaths annually, which are directly related to cardiovascular diseases, and the most dangerous atmospheric pollutants to health are as follows: NO2, SO2, CO, and PM. The mechanisms underlying the observed effects have not yet been clearly defined. This work aims to conduct a narrative review of experimental studies to provide a more comprehensive and multiperspective assessment of how the effect of atmospheric pollutants on cardiac activity can result in the development of cardiac diseases. For this purpose, a review was carried out in databases of experimental studies, excluding clinical trials, and epidemiological and simulation studies. After analyzing the available information, the existence of pathophysiological effects of the different pollutants on cardiac activity from exposure during both short-term and long-term is evident. This narrative review based on experimental studies is a basis for the development of recommendations for public health.

Exposure to low-level ambient air pollution and the relationship with lung and bladder cancer in older men, in Perth, Western Australia

BACKGROUND

Air pollution is a cause of lung cancer and is associated with bladder cancer. However, the relationship between air pollution and these cancers in regions of low pollution is unclear. We investigated associations between fine particulate matter (PM2.5), nitrogen dioxide, and black carbon (BC), and both these cancers in a low-pollution city.

METHODS

A cohort of 11,679 men ≥65 years old in Perth (Western Australia) were followed from 1996-1999 until 2018. Pollutant concentrations, as a time-varying variable, were estimated at participants' residential addresses using land use regression models. Incident lung and bladder cancer were identified through the Western Australian Cancer Registry. Risks were estimated using Cox proportional-hazard models (age as the timescale), adjusting for smoking, socioeconomic status, and co-pollutants.

RESULTS

Lung cancer was associated with PM2.5 and BC in the adjusted single-pollutant models. A weak positive association was observed between ambient air pollution and squamous cell lung carcinoma but not lung adenocarcinoma. Positive associations were observed with bladder cancer, although these were not statistically significant. Associations were attenuated in two-pollutant models.

CONCLUSION

Low-level ambient air pollution is associated with lung, and possibly bladder, cancer among older men, suggesting there is no known safe level for air pollution as a carcinogen.

Exposure to Neighborhood Walkability and Residential Greenness and Incident Fracture

Importance

Emerging studies have suggested that environmental factors are associated with fracture. However, little is known about the association of neighborhood walkability and residential greenness with fracture.

Objective

To investigate the association of long-term exposure to walkability and greenness with incident fracture and explore the potential interaction effect.

Design, Setting, and Participants

This cohort study recruited participants aged 40 years or older in Ningbo, China from June 2015 to January 2018. Participants were observed for outcomes through February 2023, with data analysis conducted in March 2023.

Exposures

Neighborhood walkability was measured by a modified walkability calculation method according to a walk score tool. Residential greenness was assessed by satellite-derived normalized difference vegetation index (NDVI) within a 1000-m buffer.

Main Outcomes and Measures

Incident fracture was ascertained according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes via the Yinzhou Health Information System. Cox proportional hazards models were fit, with age as time scale to estimate the associations of walkability and greenness with fracture. Potential effect modification was explored by covariates, as well as the interactive effect of walkability and greenness.

Results

A total of 23 940 participants were included in this study with 13 735 being female (57.4%). The mean (SD) age at baseline was 63.4 (9.4) years. During a follow-up period of 134 638 person-years, 3322 incident fractures were documented. In the full adjusted model, every IQR increment in neighborhood walkability and residential greenness was associated with a hazard ratio (HR) of 0.88 (95% CI, 0.83-0.92) and 0.84 (95% CI, 0.80-0.89), respectively, for fracture. Furthermore, the association of greenness and fracture was greater with an increase in walkability. The HR (Q4 vs Q1) for greenness was 0.62 (95% CI, 0.46-0.82) in neighborhoods with the highest quartile of walkability.

Conclusions and Relevance

This population cohort study suggested that long-term exposure to neighborhood walkability and residential greenness were both associated with lower risk of incident fracture. The benefits of greenness increased in more walkable areas.

Effects of low-level air pollution exposures on hospital admission for myocardial infarction using multiple causal models

Myocardial infarctions have been associated with PM2.5, and more recently with NO2 and O3, however counterfactual designs have been lacking and argument continues over the extent of confounding control. Here we introduce a doubly robust, counterfactual-based approach that deals with nonlinearity and interactions in associations between confounders and both outcome and exposure, as well as a double negative controls approach that capture omitted confounders. We used data from over 4 million admissions for myocardial infarction in the US Medicare population between 2000 and 2016 and linked them by ZIP code of residence to high resolution predictions of annual PM2.5, NO2, and O3. We computed the counts of admissions for each ZIP code-year. In the doubly robust approach, we divided each pollutant into deciles, and for each decile, we fitted a gradient boosting machine model to estimate the effects of covariates, including the co-pollutants, on the counts. We used these models to predict, for all ZIP code-years, the expected counts had everyone be exposed in that decile. We also estimated the probability of being in that decile given all covariates, again with a gradient boosting machine, and used inverse probability weights to compute the weighted average rate of MI admission in each decile. In the negative control approach, for each pollutant, we fitted a quasi-Poisson model to estimate the exposure effect, adjusting for covariates including the co-pollutants, and negative exposure and outcome controls to control for unmeasured confounding. Each 1-μg/m3 increase in annual PM2.5 increased the admission for MI by 1.37 cases per 10,000 person-years (95% CI: 1.20, 1.54) in the doubly robust approach, and by 0.69 cases (95% CI 0.60, 0.78) using the negative control approach. Elevated risks were seen even below annual PM2.5 level of 8 μg/m3. Results for NO2 and O3 were inconsistent.

Toward a Cardio-Environmental Risk Model: Environmental Determinants of Cardiovascular Disease

It is increasingly recognized that strong geographic variations in cardiovascular risk cannot be explained using traditional cardiovascular risk factors alone. Indeed, it is highly unlikely that heredity and classic risk factors such as hypertension, diabetes, dyslipidemia, and tobacco use can explain the tenfold variation observed in cardiovascular mortality among men in Russia and those in Switzerland. Since the advent of industrialization and resultant changes to our climate, it is now clear that environmental stressors also influence cardiovascular health and our thinking around cardiovascular risk prediction is in need of a paradigm shift. Herein, we review the basis for this shift in our understanding of the interplay of environmental factors with cardiovascular health. We illustrate how air pollution, hyperprocessed foods, the amount of green space, and population activity levels are now considered the 4 major environmental determinants of cardiovascular health and provide a framework for how these considerations might be incorporated into clinical risk assessment. We also outline the clinical and socioeconomic effects of the environment on cardiovascular health and review key recommendations from major medical societies.

Inequality in the Distribution of Air Pollution Attributable Mortality Within Canadian Cities

Recent studies have identified inequality in the distribution of air pollution attributable health impacts, but to our knowledge this has not been examined in Canadian cities. We evaluated the extent and sources of inequality in air pollution attributable mortality at the census tract (CT) level in seven of Canada's largest cities. We first regressed fine particulate matter (PM2.5) and nitrogen dioxide (NO2) attributable mortality against the neighborhood (CT) level prevalence of age 65 and older, low income, low educational attainment, and identification as an Indigenous (First Nations, Métis, Inuit) or Black person, accounting for spatial autocorrelation. We next examined the distribution of baseline mortality rates, PM2.5 and NO2 concentrations, and attributable mortality by neighborhood (CT) level prevalence of these characteristics, calculating the concentration index, Atkinson index, and Gini coefficient. Finally, we conducted a counterfactual analysis of the impact of reducing baseline mortality rates and air pollution concentrations on inequality in air pollution attributable mortality. Regression results indicated that CTs with a higher prevalence of low income and Indigenous identity had significantly higher air pollution attributable mortality. Concentration index, Atkinson index, and Gini coefficient values revealed different degrees of inequality among the cities. Counterfactual analysis indicated that inequality in air pollution attributable mortality tended to be driven more by baseline mortality inequalities than exposure inequalities. Reducing inequality in air pollution attributable mortality requires reducing disparities in both baseline mortality and air pollution exposure.

Long-Term Exposure to PM2.5 and Mortality: A Cohort Study in China

We investigated the association of long-term exposure to atmospheric PM2.5 with non-accidental and cause-specific mortality in Yinzhou, China. From July 2015 to January 2018, a total of 29,564 individuals aged ≥ 40 years in Yinzhou were recruited for a prospective cohort study. We used the Cox proportional-hazards model to analyze the relationship of the 2-year average concentration of PM2.5 prior to the baseline with non-accidental and cause-specific mortality. The median PM2.5 concentration was 36.51 μg/m3 (range: 25.57-45.40 μg/m3). In model 4, the hazard ratios per 10 μg/m3 increment in PM2.5 were 1.25 (95%CI: 1.04-1.50) for non-accidental mortality and 1.38 (95%CI:1.02-1.86) for cardiovascular disease mortality. We observed no associations between PM2.5 and deaths from respiratory disease or cancer. In the subgroup analysis, interactions were observed between PM2.5 and age, as well as preventive measures on hazy days. The observed association between long-term exposure to atmospheric PM2.5 at a relatively moderate concentration and the risk of non-accidental and cardiovascular disease mortality among middle-aged and elderly Chinese adults could provide evidence for government decision-makers to revise environmental policies towards a more stringent standard.

Within-city spatial variations in long-term average outdoor oxidant gas concentrations and cardiovascular mortality: Effect modification by oxidative potential in the Canadian Census Health and Environment Cohort

Health effects of oxidant gases may be enhanced by components of particulate air pollution that contribute to oxidative stress. Our aim was to examine if within-city spatial variations in the oxidative potential of outdoor fine particulate air pollution (PM2.5) modify relationships between oxidant gases and cardiovascular mortality.

Methods

We conducted a retrospective cohort study of participants in the Canadian Census Health and Environment Cohort who lived in Toronto or Montreal, Canada, from 2002 to 2015. Cox proportional hazards models were used to estimate associations between outdoor concentrations of oxidant gases (Ox, a redox-weighted average of nitrogen dioxide and ozone) and cardiovascular deaths. Analyses were performed across strata of two measures of PM2.5 oxidative potential and reactive oxygen species concentrations (ROS) adjusting for relevant confounding factors.

Results

PM2.5 mass concentration showed little within-city variability, but PM2.5 oxidative potential and ROS were more variable. Spatial variations in outdoor Ox were associated with an increased risk of cardiovascular mortality [HR per 5 ppb = 1.028, 95% confidence interval (CI): 1.001, 1.055]. The effect of Ox on cardiovascular mortality was stronger above the median of each measure of PM2.5 oxidative potential and ROS (e.g., above the median of glutathione-based oxidative potential: HR = 1.045, 95% CI: 1.009, 1.081; below median: HR = 1.000, 95% CI: 0.960, 1.043).

Conclusion

Within-city spatial variations in PM2.5 oxidative potential may modify long-term cardiovascular health impacts of Ox. Regions with elevated Ox and PM2.5 oxidative potential may be priority areas for interventions to decrease the population health impacts of outdoor air pollution.

Regional joint PM2.5-O3 control policy benefits further air quality improvement and human health protection in Beijing-Tianjin-Hebei and its surrounding areas

Beijing-Tianjin-Hebei and its surrounding areas (hereinafter referred to as "2+26" cities) are one of the most severe air pollution areas in China. The fine particulate matter (PM_2.5) and surface ozone (O₃) pollution have aroused a significant concern on the national scale. In this study, we analyzed the pollution characteristics of PM_2.5 and O₃ in "2+26" cities, and then estimated the health burden and economic loss before and after the implementation of the joint PM_2.5-O₃ control policy. During 2017-2019, PM_2.5 concentration reduced by 19% while the maximum daily 8 hr average (MDA8) O₃ stayed stable in "2+26" cities. Spatially, PM_2.5 pollution in the south-central area and O₃ pollution in the central region were more severe than anywhere else. With the reduction in PM_2.5 concentration, premature deaths from PM_2.5 decreased by 18% from 2017 to 2019. In contrast, premature deaths from O₃ increased by 5%. Noticeably, the huge potential health benefits can be gained after the implementation of a joint PM_2.5-O₃ control policy. The premature deaths attributed to PM_2.5 and O₃ would be reduced by 91.6% and 89.1%, and the avoidable economic loss would be 60.8 billion Chinese Yuan (CNY), and 68.4 billion CNY in 2035 compared with that in 2019, respectively. Therefore, it is of significance to implement the joint PM_2.5-O₃ control policy for improving public health and economic development.

Concomitant exposure to air pollution, green space, and noise and risk of stroke: a cohort study from Denmark

Background

Air pollution, road traffic noise, and green space are correlated factors, associated with risk of stroke. We investigated their independent relationship with stroke in multi-exposure analyses and estimated their cumulative stroke burden.

Methods

For all persons, ≥50 years of age and living in Denmark from 2005 to 2017, we established complete address histories and estimated running 5-year mean exposure to fine particles (PM_2.5), ultrafine particles, elemental carbon, nitrogen dioxide (NO₂), and road traffic noise at the most, and least exposed façade. For air pollutants, we estimated total, and non-traffic contributions. Green space around the residence was estimated from land use maps. Hazard ratios (HR) and 95% confidence limits (CL) were estimated with Cox proportional hazards models and used to calculate cumulative risk indices (CRI). We adjusted for the individual and sociodemographic covariates available in our dataset (which did not include information about individual life styles and medical conditions).

Findings

The cohort accumulated 18,344,976 years of follow-up and 94,256 cases of stroke. All exposures were associated with risk of stroke in single pollutant models. In multi-pollutant analyses, only PM_2.5 (HR: 1.058, 95% CI: 1.040-1.075) and noise at most exposed façade (HR: 1.033, 95% CI: 1.024-1.042) were independently associated with a higher risk of stroke. Both noise and air pollution contributed substantially to the CRI (1.103, 95% CI: 1.092-1.114) in the model with noise, green space, and total PM_2.5 concentrations.

Interpretation

Environmental exposure to air pollution and noise were both independently associated with risk of stroke.

Funding

Health Effects Institute (HEI) (Assistance Award No. R-82811201).

Long-term air pollution exposure and markers of cardiometabolic health in the National Longitudinal Study of Adolescent to Adult Health (Add Health)

BACKGROUND

Air pollution exposure is associated with cardiovascular morbidity and mortality. Although exposure to air pollution early in life may represent a critical window for development of cardiovascular disease risk factors, few studies have examined associations of long-term air pollution exposure with markers of cardiovascular and metabolic health in young adults.

OBJECTIVES

By combining health data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) with air pollution data from the Fused Air Quality Surface using Downscaling (FAQSD) archive, we: (1) calculated multi-year estimates of exposure to ozone (O3) and particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5) for Add Health participants; and (2) estimated associations between air pollution exposures and multiple markers of cardiometabolic health.

METHODS

Add Health is a nationally representative longitudinal cohort study of over 20,000 adolescents aged 12-19 in the United States (US) in 1994-95 (Wave I). Participants have been followed through adolescence and into adulthood with five in-home interviews. Estimated daily concentrations of O3 and PM2.5 at census tracts were obtained from the FAQSD archive and used to generate tract-level annual averages of O3 and PM2.5 concentrations. We estimated associations between average O3 and PM2.5 exposures from 2002 to 2007 and markers of cardiometabolic health measured at Wave IV (2008-09), including hypertension, hyperlipidemia, body mass index (BMI), diabetes, C-reactive protein, and metabolic syndrome.

RESULTS

The final sample size was 11,259 individual participants. The average age of participants at Wave IV was 28.4 years (range: 24-34 years). In models adjusting for age, race/ethnicity, and sex, long-term O3 exposure (2002-07) was associated with elevated odds of hypertension, with an odds ratio (OR) of 1.015 (95% confidence interval [CI]: 1.011, 1.029); obesity (1.022 [1.004, 1.040]); diabetes (1.032 [1.009,1.054]); and metabolic syndrome (1.028 [1.014, 1.041]); PM2.5 exposure (2002-07) was associated with elevated odds of hypertension (1.022 [1.001, 1.045]).

CONCLUSION

Findings suggest that long-term ambient air pollution exposure, particularly O3 exposure, is associated with cardiometabolic health in early adulthood.

Excess mortality associated with high ozone exposure: A national cohort study in China

Emerging epidemiological studies suggest that long-term ozone (O₃) exposure may increase the risk of mortality, while pre-existing evidence is mixed and has been generated predominantly in North America and Europe. In this study, we investigated the impact of long-term O₃ exposure on all-cause mortality in a national cohort in China. A dynamic cohort of 20882 participants aged ≥40 years was recruited between 2011 and 2018 from four waves of the China Health and Retirement Longitudinal Study. A Cox proportional hazard regression model with time-varying exposures on an annual scale was used to estimate the mortality risk associated with warm-season (April-September) O₃ exposure. The annual average level of participant exposure to warm-season O₃ concentrations was 100 μg m^-3 (range: 61-142 μg m^-3). An increase of 10 μg m^-3 in O₃ was associated with a hazard ratio (HR) of 1.18 (95% confidence interval [CI]: 1.13-1.23) for all-cause mortality. Compared with the first exposure quartile of O₃, HRs of mortality associated with the second, third, and highest exposure quartiles were 1.09 (95% CI: 0.95-1.25), 1.02 (95% CI: 0.88-1.19), and 1.56 (95% CI: 1.34-1.82), respectively. A J-shaped concentration-response association was observed, revealing a non-significant increase in risk below a concentration of approximately 110 μg m^-3. Low-temperature-exposure residents had a higher risk of mortality associated with long-term O₃ exposure. This study expands current epidemiological evidence from China and reveals that high-concentration O₃ exposure curtails the long-term survival of middle-aged and older adults.

Potential causal links between long-term ambient particulate matter exposure and cerebrovascular mortality: Insights from a large cohort in southern China

Cohort studies conducted in North America and Europe have linked cerebrovascular mortality to long-term exposure to particulate matter (PM). However, limited evidence from large cohorts in high-exposure areas and the traditional approach of association assessment may cause residual confounding issues. In this study, we aimed to investigate the causal links between cerebrovascular mortality and long-term exposure to PM_2.5, PM₁₀, and PM_2.5-10 in an ongoing cohort study with 580,757 participants in southern China. Using satellite-based estimates of PM concentration at a 1-km² spatial resolution, we assigned exposure levels to each participant and used the marginal structural Cox model to assess the association between PM exposure and cerebrovascular mortality while accounting for time-varying covariates. We also explored the potential modification effects of sociodemographic and behavioral factors on the PM-health associations. Adjusted hazard ratios (HR) for overall cerebrovascular mortality were 1.041 (95% confidence interval (CI): 1.034-1.049) and 1.032 (95% CI: 1.026-1.038) for each 1 μg/m³ increase in PM_2.5, and PM₁₀, respectively. Similar trends were observed in the mortality risk from stroke and ischemic stroke, with HRs ranging from 1.040 to 1.069 and 1.025 to 1.052, respectively, across 2 p.m. exposures. The impact of PM exposure was generally more apparent among women, participants with primary school diplomas and below, and the subgroup under low-exposure. Multiple sensitivity analyses confirmed the robustness of the results. In conclusion, this sizable prospective cohort study hypothesizes causal links between long-term PM exposure and cerebrovascular mortality, particularly among vulnerable participants, supporting the rationale for reducing PM concentration in China to reduce cerebrovascular mortality.

Ambient Air Pollution and Risk of Enterotomy, Gastrointestinal Cancer, and All-Cause Mortality among 4,708 Individuals with Inflammatory Bowel Disease: A Prospective Cohort Study

BACKGROUND

Previous studies indicated that air pollution plausibly increases the risk of adverse outcomes in inflammatory bowel disease (IBD) via proinflammatory mechanisms. However, there is scant epidemiological data and insufficient prospective evidence assessing associations between ambient air pollution and clinical outcomes of IBD.

OBJECTIVES

We aimed to investigate the associations between ambient air pollution and clinical outcomes among individuals with IBD.

METHODS

Leveraging data from the UK Biobank, we included 4,708 individuals with IBD recruited in the period 2006-2010 in this study. A land use regression model was used to assess annual mean concentrations of ambient air pollutants nitrogen including oxides (NO x ), nitrogen dioxide (NO 2 ), and particulate matter (PM) with aerodynamic diameter ≤ 10 μ m (PM 10 ) and PM with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ). Individuals with IBD were followed up for incident clinical outcomes of enterotomy, gastrointestinal cancer, and all-cause mortality, ascertained via death registry, inpatient, primary care, and cancer registry data. Cox proportional hazard model was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the magnitude of the associations.

RESULTS

During a mean follow-up of 12.0 y, 265 enterotomy events, 124 incident gastrointestinal cancer, and 420 death events were documented among individuals with IBD. We found that each interquartile range (IQR) increase in exposure to PM 2.5 was associated with increased risk of enterotomy (HR = 1.16 ; 95% CI: 1.00, 1.34, p = 0.043 ), whereas an IQR increase in exposure to NO x (HR = 1.10 ; 95% CI: 1.01, 1.20, p = 0.016 ), NO 2 (HR = 1.16 ; 95% CI: 1.03, 1.29, p = 0.010 ), PM 10 (HR = 1.15 ; 95% CI: 1.03, 1.30, p = 0.015 ), and PM 2.5 (HR = 1.14 ; 95% CI: 1.02, 1.28, p = 0.019 ) was associated with increased risk of all-cause mortality among individuals with IBD. We did not observe any significant associations between air pollutants and gastrointestinal cancer in the primary analyses. Consistent results were observed in subgroup and sensitivity analyses.

CONCLUSIONS

Ambient pollution exposure was associated with an increased risk of enterotomy and all-cause mortality among individuals with IBD, highlighting the important role of environmental health in improving the prognosis of IBD. https://doi.org/10.1289/EHP12215.

Assessing the health impacts of PM2.5 and ozone pollution and their comprehensive correlation in Chinese cities based on extended correlation coefficient

The coordinated control of PM_2.5 and ozone pollution is becoming more and more important in the current and next stage of Chinese environmental pollution control. Existing studies are unable to provide sufficient quantitative assessments of the correlation of PM_2.5 and ozone pollution to support the coordinated control of the two air pollutants. This study develops a systematic method to comprehensively assess the correlation between PM_2.5 and ozone pollution, including the evaluation of the impact of two air pollutants on human health and the extended correlation coefficient (ECC) for assessing the bivariate correlation index of PM_2.5-ozone pollution in Chinese cities. According to the latest studies on epidemiology conducted in China, we take cardiovascular and cerebrovascular diseases and respiratory diseases as the ozone pollution's health burden when evaluating the health impact of ozone pollution. The results show that the health impact of PM_2.5 in China decreases by 25.9 % from 2015 to 2021, while the health impact of ozone increases by 11.8 %. The ECC of 335 cities in China shows an increasing-decreasing trend but has generally increased from 2015 to 2021. The study provides important support for an in-depth understanding of the correlation and development trend of Chinese PM_2.5 and ozone pollution by classifying the comprehensive PM_2.5-ozone correlation performances of Chinese cities into four types. China or other countries will get better environmental benefits by implementing different coordinated management approaches for different correlative types of regions based on the assessment method in this study.

Evaluation of the health risk using multi-pollutant air quality health index: case study in Tianjin, China

Introduction

Air pollution imposes a significant burden on public health. Compared with the popular air quality index (AQI), the air quality health index (AQHI) provides a more comprehensive approach to measuring mixtures of air pollutants and is suitable for overall assessments of the short-term health effects of such mixtures.

Methods

We established an AQHI and cumulative risk index (CRI)-AQHI for Tianjin using single-and multi-pollutant models, respectively, as well as environmental, meteorological, and daily mortality data of residents in Tianjin between 2018 and 2020.

Results and discussion

Compared with the AQI, the AQHI and CRI-AQHI established herein correlated more closely with the exposure-response relationships of the total mortality effects on residents. For each increase in the interquartile range of the AQHI, CRI-AQHI and AQI, the total daily mortality rates increased by 2.06, 1.69 and 0.62%, respectively. The AQHI and CRI-AQHI predicted daily mortality rate of residents more effectively than the AQI, and the correlations of AQHI and CRI-AQHI with health were similar. Our AQHI of Tianjin was used to establish specific (S)-AQHIs for different disease groups. The results showed that all measured air pollutants had the greatest impact on the health of persons with chronic respiratory diseases, followed by lung cancer, and cardiovascular and cerebrovascular diseases. The AQHI of Tianjin established in this study was accurate and dependable for assessing short-term health risks of air pollution in Tianjin, and the established S-AQHI can be used to separately assess health risks among different disease groups.

Characterization, risk assessment, and source estimation of PM10-bound polycyclic aromatic hydrocarbons during wintertime in the ambient air of Basrah City, Iraq

In this study, the concentration and structure of polycyclic aromatic hydrocarbons (PAHs) associated with the ambient PM₁₀ in Basrah City, Iraq have been investigated for the first time. From December 2021 to February 2022, PM₁₀ samples were collected on quartz fiber filters, extracted using an optimized extraction protocol, and analyzed for the sixteen US EPA priority PAHs. The results indicated that 4- and 5-ring PAHs represent 52% of the total detected PAHs. The most abundant PAHs over the study period were chrysene (1.2 ± 1.5 ng m^-3), fluorene (0.9 ± 1.4 ng m^-3), and benzo[b]fluoranthene (0.7 ± 0.9 ng m^-3). Source identification suggested that PM₁₀-bound PAHs primarily originated from pyrogenic and petrogenic activities in Basrah City. In addition, the cancer risk associated to PAH exposure was assessed based on benzo[a]pyrene equivalent concentration and was found ranging from 0.07 to 6.32 ng m^-3; hence, it exceeded the threshold limit of 1.0 ng m^-3 established by the European legislation (EU, 2014). Benzo[a]pyrene was determined to be main contributor to total carcinogenic power of the detected PAHs, accounting for 50.3%, followed by dibenz[a,h]anthracene (22.3%). Similarly, benzo[a]pyrene represented a major contributor to PAH associated mutagenicity, accounting for 43.5% of the total.

Cardiovascular, respiratory and all-cause (natural) health endpoint estimation using a spatial approach in Malaysia

In 2016, the World Health Organization (WHO) estimated that approximately 4.2 million premature deaths worldwide were attributable to exposure to particulate matter 2.5 μm (PM_2.5). This study assessed the environmental burden of disease attributable to PM_2.5 at the national level in Malaysia. We estimated the population-weighted exposure level (PWEL) of PM10 concentrations in Malaysia for 2000, 2008, and 2013 using aerosol optical density (AOD) data from publicly available remote sensing satellite data (MODIS Terra). The PWEL was then converted to PM_2.5 using Malaysia's WHO ambient air conversion factor. We used AirQ+ 2.0 software to calculate all-cause (natural), ischemic heart disease (IHD), stroke, chronic obstructive pulmonary disease (COPD), lung cancer (LC), and acute lower respiratory infection (ALRI) excess deaths from the National Burden of Disease data for 2000, 2008 and 2013. The average PWELs for annual PM_2.5 for 2000, 2008, and 2013 were 22 μg m-3, 18 μg m-3 and 24 μg m-3, respectively. Using the WHO 2005 Air Quality Guideline cut-off point of PM_2.5 of 10 μg m-3, the estimated excess deaths for 2000, 2008, and 2013 from all-cause (natural) mortality were between 5893 and 9781 (95 % CI: 3347-12,791), COPD was between 164 and 957 (95 % CI: 95-1411), lung cancer was between 109 and 307 (95 % CI: 63-437), IHD was between 3 and 163 deaths, according to age groups (95 % CI: 2-394) and stroke was between 6 and 155 deaths, according to age groups (95 % CI: 3-261). An increase in estimated health endpoints was associated with increased estimated PWEL PM_2.5 for 2013 compared to 2000 and 2008. Adhering the ambient PM_2.5 level to the Malaysian Air Quality Standard IT-2 would reduce the national health endpoints mortality.

Machine learning-based country-level annual air pollutants exploration using Sentinel-5P and Google Earth Engine

Climatic condition is triggering human health emergencies and earth's surface changes. Anthropogenic activities, such as built-up expansion, transportation development, industrial works, and some extreme phases, are the main reason for climate change and global warming. Air pollutants are increased gradually due to anthropogenic activities and triggering the earth's health. Nitrogen Dioxide (NO₂), Carbon Monoxide (CO), and Aerosol Optical Depth (AOD) are truthfully important for air quality measurement because those air pollutants are more harmful to the environment and human's health. Earth observational Sentinel-5P is applied for monitoring the air pollutant and chemical conditions in the atmosphere from 2018 to 2021. The cloud computing-based Google Earth Engine (GEE) platform is applied for monitoring those air pollutants and chemical components in the atmosphere. The NO₂ variation indicates high during the time because of the anthropogenic activities. Carbon Monoxide (CO) is also located high between two 1-month different maps. The 2020 and 2021 results indicate AQI change is high where 2018 and 2019 indicates low AQI throughout the year. The Kolkata have seven AQI monitoring station where high nitrogen dioxide recorded 102 (2018), 48 (2019), 26 (2020) and 98 (2021), where Delhi AQI stations recorded 99 (2018), 49 (2019), 37 (2020), and 107 (2021). Delhi, Kolkata, Mumbai, Pune, and Chennai recorded huge fluctuations of air pollutants during the study periods, where ~ 50-60% NO₂ was recorded as high in the recent time. The AOD was noticed high in Uttar Pradesh in 2020. These results indicate that air pollutant investigation is much necessary for future planning and management otherwise; our planet earth is mostly affected by the anthropogenic and climatic conditions where maybe life does not exist.

Associations Between Gender Gaps in Life Expectancy, Air Pollution, and Urbanization: A Global Assessment With Bayesian Spatiotemporal Modeling

Objectives: It's evident that women have a longer life expectancy than men. This study investigates the spatiotemporal trends of gender gaps in life expectancy (GGLE). It demonstrates the spatiotemporal difference of the influence factors of population-weighted air pollution (pwPM_2.5) and urbanization on GGLE. Methods: Panel data on GGLE and influencing factors from 134 countries from 1960 to 2018 are collected. The Bayesian spatiotemporal model is performed. Results: The results show an obvious spatial heterogeneity worldwide with a continuously increasing trend of GGLE. Bayesian spatiotemporal regression reveals a significant positive relationship between pwPM_2.5, urbanization, and GGLE with the spatial random effects. Further, the regression coefficients present obvious geographic disparities across space worldwide. Conclusion: In sum, social-economic development and air quality improvement should be considered comprehensively in global policy to make a fair chance for both genders to maximize their health gains.

Long-term exposure to elemental components of fine particulate matter and all-natural and cause-specific mortality in a Danish nationwide administrative cohort study

BACKGROUND

Fine particulate matter (PM_2.5) is a well-recognized risk factor for premature death. However, evidence on which PM_2.5 components are most relevant is unclear.

METHODS

We evaluated the associations between mortality and long-term exposure to eight PM_2.5 elemental components [copper (Cu), iron (Fe), zinc (Zn), sulfur (S), nickel (Ni), vanadium (V), silicon (Si), and potassium (K)]. Studied outcomes included death from diabetes, chronic kidney disease (CKD), dementia, and psychiatric disorders as well as all-natural causes, cardiovascular disease (CVD), respiratory diseases (RD), and lung cancer. We followed all residents in Denmark (aged ≥30 years) from January 1, 2000 to December 31, 2017. We used European-wide land-use regression models at a 100 × 100 m scale to estimate the residential annual mean levels of exposure to PM_2.5 components. The models were developed with supervised linear regression (SLR) and random forest (RF). The associations were evaluated by Cox proportional hazard models adjusting for individual- and area-level socioeconomic factors and total PM_2.5 mass.

RESULTS

Of 3,081,244 individuals, we observed 803,373 death from natural causes during follow-up. We found significant positive associations between all-natural mortality with Si and K from both exposure modeling approaches (hazard ratios; 95% confidence intervals per interquartile range increase): SLR-Si (1.04; 1.03-1.05), RF-Si (1.01; 1.00-1.02), SLR-K (1.03; 1.02-1.04), and RF-K (1.06; 1.05-1.07). Strong associations of K and Si were detected with most causes of mortality except CKD and K, and diabetes and Si (the strongest associations for psychiatric disorders mortality). In addition, Fe was relevant for mortality from RD, lung cancer, CKD, and psychiatric disorders; Zn with mortality from CKD, RD, and lung cancer, and; Ni and V with lung cancer mortality.

CONCLUSIONS

We present novel results of the relevance of different PM_2.5 components for different causes of death, with K and Si seeming to be most consistently associated with mortality in Denmark.

Neighborhood Deprivation and Rurality Associated With Patient-Reported Outcomes and Survival in Men With Prostate Cancer in NRG Oncology RTOG 0415

PURPOSE

Rurality and neighborhood deprivation can contribute to poor patient-reported outcomes, which have not been systematically evaluated in patients with specific cancers in national trials. Our objective was to examine the effect of rurality and neighborhood socioeconomic and environmental deprivation on patient-reported outcomes and survival in men with prostate cancer in NRG Oncology RTOG 0415.

METHODS AND MATERIALS

Data from men with prostate cancer in trial NRG Oncology RTOG 0415 were analyzed; 1,092 men were randomized to receive conventional radiation therapy or hypofractionated radiation therapy. Rurality was categorized as urban or rural. Neighborhood deprivation was assessed using the area deprivation index and air pollution indicators (nitrogen dioxide and particulate matter with a diameter less than 2.5 micrometers) via patient ZIP codes. Expanded Prostate Cancer Index Composite measured cancer-specific quality of life. The Hopkins symptom checklist measured anxiety and depression. EuroQoL-5 Dimension assessed general health.

RESULTS

We analyzed 751 patients in trial NRG Oncology RTOG 0415. At baseline, patients from the most deprived neighborhoods had worse bowel (P = .011), worse sexual (P = .042), and worse hormonal (P = .015) scores; patients from the most deprived areas had worse self-care (P = .04) and more pain (P = .047); and patients from rural areas had worse urinary (P = .03) and sexual (P = .003) scores versus patients from urban areas. Longitudinal analyses showed that the 25% most deprived areas (P = .004) and rural areas (P = .002) were associated with worse EuroQoL-5 Dimension visual analog scale score. Patients from urban areas (hazard ratio, 1.81; P = .033) and the 75% less-deprived neighborhoods (hazard ratio, 0.68; P = .053) showed relative decrease in risk of recurrence or death (disease-free survival).

CONCLUSIONS

Patients with prostate cancer from the most deprived neighborhoods and rural areas had low quality of life at baseline, poor general health longitudinally, and worse disease-free survival. Interventions should screen populations from deprived neighborhoods and rural areas to improve patient access to supportive care services.

Ambient PM2.5, ozone and mortality in Chinese older adults: A nationwide cohort analysis (2005-2018)

BACKGROUND

Cohort evidence linking long-term survival with exposure to multiple air pollutants (e.g., fine particulate matter [PM_2.5] and ozone) was extensively sparse in low- and middle-income countries, especially among older adults. This study aimed to investigate potential associations of long-term exposures to PM_2.5 and ozone with all-cause mortality in Chinese older adults.

METHODS

A dynamic nationwide prospective cohort comprising 20,352 adults aged ≥65 years were enrolled from the Chinese Longitudinal Healthy Longevity Study and followed up through 2005-2018. Participants' annual exposures to warm-season ozone and year-round PM_2.5 were assigned using satellite-derived spatiotemporal estimates. A directed acyclic graph (DAG) was developed to identify confounding variables. Associations of annual mean exposures to PM_2.5 and ozone with mortality were evaluated using single- and two-pollutant Cox proportional hazards models, adjusting for time-dependent individual risk factors and ambient temperature.

RESULTS

During 100 thousand person-years of follow-up (median: 3.6 years), a total of 14,313 death events occurred. The participants were averagely aged 87.1 years at baseline and exposed to a wide range of annual average concentrations of warm-season maximum 8-hour ozone (mean, 54.4 ppb; range, 23.3-81.6 ppb) and year-round PM_2.5 (mean, 65.5 μg/m³; range, 10.1-162.9 μg/m³). Approximately linear concentration-response relationship was identified for ozone, whereas significant increases in PM_2.5-associated mortality risks were observed only when concentrations were above 60 μg/m³. Rises of 10 ppb in ozone and 10 µg/m³ in PM_2.5 above 60 µg/m³ were associated with increases in all-cause mortality of 13.2% (95% confidence interval [CI]: 10.2-16.2%) and 6.2% (95% CI: 4.6-7.7%) in DAG-based single-pollutant model, and of 9.7% (95% CI: 6.6-13.0%) and 5.3% (95% CI: 3.7-6.9%) in DAG-based two-pollutant model, respectively. We detected significant effect modification by temperature in associations of mortality with ozone (P <0.001 for interaction), suggesting greater ozone-related risks among participants in warmer locations.

CONCLUSIONS

This study provided longitudinal evidence that long-term exposure to ambient PM_2.5 and ozone significantly and independently contributed to elevated risks of all-cause mortality among older adults in China.

Impacts of emissions policies on future UK mortality burdens associated with air pollution

Air pollution is the greatest environmental risk to public health. Future air pollution concentrations are primarily determined by precursor emissions, which are driven by environmental policies relating to climate and air pollution. Detailed health impact assessments (HIA) are necessary to provide quantitative estimates of the impacts of future air pollution to support decision-makers developing environmental policy and targets. In this study we use high spatial resolution atmospheric chemistry modelling to simulate future air pollution concentrations across the UK for 2030, 2040 and 2050 based on current UK and European policy projections. We combine UK regional population-weighted concentrations with the latest epidemiological relationships to quantify mortality associated with changes in PM_2.5 and NO₂ air pollution. Our HIA suggests that by 2050, population-weighted exposure to PM_2.5 will reduce by 28% to 36%, and for NO₂ by 35% to 49%, depending on region. The HIA shows that for present day (2018), annual mortality attributable to the effects of long-term exposure to PM_2.5 and NO₂ is in the range 26,287 - 42,442, and that mortality burdens in future will be substantially reduced, being lower by 31%, 35%, and 37% in 2030, 2040 and 2050 respectively (relative to 2018) assuming no population changes. Including population projections (increases in all regions for 30+ years age group) slightly offsets these health benefits, resulting in reductions of 25%, 27%, and 26% in mortality burdens for 2030, 2040, 2050 respectively. Significant reductions in future mortality burdens are estimated and, importantly for public health, the majority of benefits are achieved early on in the future timeline simulated, though further efforts are likely needed to reduce impacts of air pollution to health.

Uncovering the cytotoxic effects of air pollution with multi-modal imaging of in vitro respiratory models

Annually, an estimated seven million deaths are linked to exposure to airborne pollutants. Despite extensive epidemiological evidence supporting clear associations between poor air quality and a range of short- and long-term health effects, there are considerable gaps in our understanding of the specific mechanisms by which pollutant exposure induces adverse biological responses at the cellular and tissue levels. The development of more complex, predictive, in vitro respiratory models, including two- and three-dimensional cell cultures, spheroids, organoids and tissue cultures, along with more realistic aerosol exposure systems, offers new opportunities to investigate the cytotoxic effects of airborne particulates under controlled laboratory conditions. Parallel advances in high-resolution microscopy have resulted in a range of in vitro imaging tools capable of visualizing and analysing biological systems across unprecedented scales of length, time and complexity. This article considers state-of-the-art in vitro respiratory models and aerosol exposure systems and how they can be interrogated using high-resolution microscopy techniques to investigate cell-pollutant interactions, from the uptake and trafficking of particles to structural and functional modification of subcellular organelles and cells. These data can provide a mechanistic basis from which to advance our understanding of the health effects of airborne particulate pollution and develop improved mitigation measures.

Long-term exposure to fine particulate matter and site-specific cancer mortality: A difference-in-differences analysis in Jiangsu province, China

BACKGROUND

Accumulating studies have reported that chronic exposure to ambient fine particulate matter (PM_2.5) can lead to adverse effects on lung cancer mortality; however, such chronic effects are less clear for mortality from other site-specific cancers.

OBJECTIVE

To explore the causal effect of long-term PM_2.5 exposure on mortality from all-site and a variety of site-specific cancers in Jiangsu province, China during 2015-2020 using a difference-in-differences analysis.

METHODS

For each of 53 county-based spatial units in Jiangsu province, we calculated annual death counts for all-site cancer and 23 site-specific cancers. Using a validated high-resolution PM_2.5 grid dataset, long-term PM_2.5 exposure of a spatial unit within a given year was evaluated as the average of population-weighted annual concentrations during recent 10 years. Conditional Poisson regression models were employed to evaluate exposure-response associations adjusting for spatial and temporal variables, seasonal temperatures, relative humidity, and gross domestic product (GDP).

RESULTS

During the study period, we identified 947,337 adult cancer deaths in Jiangsu province. Each 1 μg/m³ increment in PM_2.5 exposure was significantly associated with a 2.7% increase in the risk of all-site cancer mortality. PM_2.5-mortality associations were also observed in cancer of lip, oral cavity and pharynx, stomach, colorectum, pancreas, lung, bone and joints, ovary, prostate, and lymphoma (all adjusted P < 0.05), with the relative risks ranging from 1.028 (95% confidence interval [CI]: 1.011, 1.046) for stomach cancer to 1.201 (95% CI: 1.120, 1.308) for bone and joints cancers. Exposure-response curves showed that these associations were close to linearity, though most of them had increasing slopes at high exposure levels. Overall, women and subjects in low GDP regions were more vulnerable to PM_2.5 exposures.

CONCLUSIONS

Long-term exposure to ambient PM_2.5 contributes to a higher risk of mortality from multiple site-specific cancers.

Association between exposure to multiple air pollutants, transportation noise and cause-specific mortality in adults in Switzerland

BACKGROUND

Long-term exposure to air pollution and noise is detrimental to health; but studies that evaluated both remain limited. This study explores associations with natural and cause-specific mortality for a range of air pollutants and transportation noise.

METHODS

Over 4 million adults in Switzerland were followed from 2000 to 2014. Exposure to PM_2.5, PM_2.5 components (Cu, Fe, S and Zn), NO₂, black carbon (BC) and ozone (O₃) from European models, and transportation noise from source-specific Swiss models, were assigned at baseline home addresses. Cox proportional hazards models, adjusted for individual and area-level covariates, were used to evaluate associations with each exposure and death from natural, cardiovascular (CVD) or non-malignant respiratory disease. Analyses included single and two exposure models, and subset analysis to study lower exposure ranges.

RESULTS

During follow-up, 661,534 individuals died of natural causes (36.6% CVD, 6.6% respiratory). All exposures including the PM_2.5 components were associated with natural mortality, with hazard ratios (95% confidence intervals) of 1.026 (1.015, 1.038) per 5 µg/m³ PM_2.5, 1.050 (1.041, 1.059) per 10 µg/m³ NO₂, 1.057 (1.048, 1.067) per 0.5 × 10^-5/m BC and 1.045 (1.040, 1.049) per 10 dB Lden total transportation noise. NO₂, BC, Cu, Fe and noise were consistently associated with CVD and respiratory mortality, whereas PM_2.5 was only associated with CVD mortality. Natural mortality associations persisted < 20 µg/m³ for PM_2.5 and NO₂, < 1.5 10^-5/m BC and < 53 dB Lden total transportation noise. The O₃ association was inverse for all outcomes. Including noise attenuated all outcome associations, though many remained significant. Across outcomes, noise was robust to adjustment to air pollutants (e.g. natural mortality 1.037 (1.033, 1.042) per 10 dB Lden total transportation noise, after including BC).

CONCLUSION

Long-term exposure to air pollution and transportation noise in Switzerland contribute to premature mortality. Considering co-exposures revealed the importance of local traffic-related pollutants such as NO₂, BC and transportation noise.

Future air quality and premature mortality in Korea

We simulate air quality in Korea for the present, the near-term, and the long-term future conditions under the Shared Socioeconomic Pathways (SSP1: most sustainable pathway with strong emissions control, SSP3: most challenging pathway with mild emissions control) using a chemical transport model. Simulated future concentrations of NO₂, SO₂, and fine particulate matter (PM_2.5), show, in general, lower values compared to the present with varying degrees depending on SSP scenarios. Significant reductions in precursor emissions result in a decrease in O₃ concentrations under a NO_x-limited environment in the long-term future under SSP1. Under SSP3, O₃ increases in the future under a VOC-limited regime, driven by increased CH₄ levels and biogenic VOC emissions under the warming climate. Concentrations of PM_2.5 and its components, including sulfate, nitrate, ammonium, and organic aerosols (OA), generally decrease in the long-term future under both scenarios. However, the contribution of biogenic secondary OA (BSOA) to PM_2.5 will increase in the future. Simulated results are used to estimate cardiorespiratory mortality changes with concentration-response factors from epidemiologic studies in Korea based on national health surveys and Korean cohorts, using projected population structures from the SSP database. The cardiorespiratory health burden of long-term exposure to O₃, NO₂, SO₂, and PM_2.5 is estimated to be 10,419 (95 % confidence interval: 1271-17,142), 8630 (0-18,713), 3958 (0-9272), and 10,431 (1411-20,643) deaths in 2019. We find that the total cardiorespiratory excess mortality due to air pollutants under SSP1 decreases by 8 % and 95 % in 2045 and 2095, respectively. Under SSP3, excess mortality increases by 80 % in 2045, and decreases by 22 % in 2095, resulting in a substantial difference in the health outcomes depending on the emission scenario. We also find that the BSOA contribution to total PM_2.5 will differ by region, emphasizing the potential health impact of BSOA on a local scale in the future.

Long-term exposure to particulate matter and COPD mortality: Insights from causal inference methods based on a large population cohort in southern China

BACKGROUND

Evidence of the association between long-term exposure to particulate matter (PM) and chronic obstructive pulmonary disease (COPD) mortality from large population-based cohort study is limited and often suffers from residual confounding issues with traditional statistical methods. We hereby assessed the casual relationship between long-term PM (PM_2.5, PM₁₀ and PM_10-2.5) exposure and COPD mortality in a large cohort of Chinese adults using state-of-the-art causal inference approaches.

METHODS

A total of 580,757 participants in southern China were enrolled in a prospective cohort study from 2009 to 2015 and followed up until December 2020. Exposures to PM at each residential address were obtained from the Long-term Gap-free High-resolution Air Pollutant Concentration dataset. Marginal structural Cox models were used to investigate the association between COPD mortality and annual average exposure levels of PM exposure.

RESULTS

During an average follow-up of 8.0 years, 2250 COPD-related deaths occurred. Under a set of causal inference assumptions, the hazard ratio (HR) for COPD mortality was estimated to be 1.046 (95 % confidence interval: 1.034-1057), 1.037 (1.028-1.047), and 1.032 (1.006-1.058) for each 1-μg/m³ increase in annual average concentrations of PM_2.5, PM₁₀, and PM_10-2.5 respectively. Additionally, the detrimental effects appeared to be more pronounced among the elderly (age ≥ 65) and inactive participants. The effect estimates of PM_2.5, PM₁₀, and PM_10-2.5 tend to be greater among participants who were generally exposed to PM₁₀ concentrations below 70 μg/m³ than that among the general population.

CONCLUSION

Our results support causal links between long-term PM exposure and COPD mortality, highlighting the urgency for more effective strategies to reduce PM exposure, with particular attention on protecting potentially vulnerable groups.

Air pollution and traffic noise interact to affect cognitive health in older Mexican Americans

BACKGROUND

Both air pollution and noise exposures have separately been shown to affect cognitive impairment. Here, we examine how air pollution and noise exposures interact to influence the development of incident dementia or cognitive impairment without dementia (CIND).

METHODS

We used 1,612 Mexican American participants from the Sacramento Area Latino Study on Aging conducted from 1998 to 2007. Air pollution (nitrogen dioxides, particulate matter, ozone) and noise exposure levels were modeled with a land-use regression and via the SoundPLAN software package implemented with the Traffic Noise Model applied to the greater Sacramento area, respectively. Using Cox proportional hazard models, we estimated the hazard of incident dementia or CIND from air pollution exposure at the residence up to 5-years prior to diagnosis for the members of each risk set at event time. Further, we investigated whether noise exposure modified the association between air pollution exposure and dementia or CIND.

RESULTS

In total, 104 incident dementia and 159 incident dementia/CIND cases were identified during the 10 years of follow-up. For each ∼2 µg/m3 increase in time-varying 1- and 5-year average PM2.5 exposure, the hazard of dementia increased 33% (HR = 1.33, 95%CI: 1.00, 1.76). The hazard ratios for NO2-related dementia/CIND and PM2.5-related dementia were stronger in high-noise (≥65 dB) exposed than low-noise (<65 dB) exposed participants.

CONCLUSION

Our study indicates that PM2.5 and NO2 air pollution adversely affect cognition in elderly Mexican Americans. Our findings also suggest that air pollutants may interact with traffic-related noise exposure to affect cognitive function in vulnerable populations.

Predicting hourly PM2.5 concentrations in wildfire-prone areas using a SpatioTemporal Transformer model

Globally, wildfires are becoming more frequent and destructive, generating a significant amount of smoke that can transport thousands of miles. Therefore, improving air pollution forecasts from wildfires is essential and informing citizens of more frequent, accurate, and interpretable updates related to localized air pollution events. This research proposes a multi-head attention-based deep learning architecture, SpatioTemporal (ST)-Transformer, to improve spatiotemporal predictions of PM_2.5 concentrations in wildfire-prone areas. The ST-Transformer model employed a sparse attention mechanism that concentrates on the most useful contextual information across spatial, temporal, and variable-wise dimensions. The model includes critical driving factors of PM_2.5 concentrations as predicting factors, including wildfire perimeter and intensity, meteorological factors, road traffic, PM_2.5, and temporal indicators from the past 24 h. The model is trained to conduct time series forecasting on PM_2.5 concentrations at EPA's air quality stations in the greater Los Angeles area. Prediction results were compared with other existing time series forecasting methods and exhibited better performance, especially in capturing abrupt changes or spikes in PM_2.5 concentrations during wildfire situations. The attention matrix learned by the proposed model enabled interpretation of the complex spatial, temporal, and variable-wise dependencies, indicating that the model can differentiate between wildfires and non-wildfires. The ST-Transformer model's accurate predictability and interpretation capacity can help effectively monitor and predict the impacts of wildfire smoke and be applicable to other complex spatiotemporal prediction problems.

Long-term fine particular exposure and incidence of frailty in older adults: findings from the Chinese Longitudinal Healthy Longevity Survey

BACKGROUND

The association between fine particular matter (PM2.5) and frailty is less studied, and the national burden of PM2.5-related frailty in China is unknown.

OBJECTIVE

To explore the association between PM2.5 exposure and incident frailty in older adults, and estimate the corresponding disease burden.

DESIGN

Chinese Longitudinal Healthy Longevity Survey from 1998 to 2014.

SETTING

Twenty-three provinces in China.

SUBJECTS

A total of 25,047 participants aged ≥65-year-old.

METHODS

Cox proportional hazards models were performed to evaluate the association between PM2.5 and frailty in older adults. A method adapted from the Global Burden of Disease Study was used to calculate the PM2.5-related frailty disease burden.

RESULTS

A total of 5,733 incidents of frailty were observed during 107,814.8 person-years follow-up. A 10 μg/m3 increment of PM2.5 was associated with a 5.0% increase in the risk of frailty (Hazard Ratio = 1.05, 95% confidence interval = [1.03-1.07]). Monotonic, but non-linear exposure-response, relationships of PM2.5 with risk of frailty were observed, and slopes were steeper at concentrations >50 μg/m³. Considering the interaction between population ageing and mitigation of PM2.5, the PM2.5-related frailty cases were almost unchanged in 2010, 2020 and 2030, with estimations of 664,097, 730,858 and 665,169, respectively.

CONCLUSIONS

This nation-wide prospective cohort study showed a positive association between long-term PM2.5 exposure and frailty incidence. The estimated disease burden indicated that implementing clean air actions may prevent frailty and substantially offset the burden of population ageing worldwide.