Mortality due to Vegetation Fire-Originated PM2.5 Exposure in Europe-Assessment for the Years 2005 and 2008

Wildfire risk management in the era of climate change

The August 8, 2023R Lahaina fire refocused attention on wildfires, public alerts, and emergency management. Wildfire risk is on the rise, precipitated through a combination of climate change, increased development in the wildland-urban interface (WUI), decades of unmitigated biomass accumulation in forests, and a long history of emphasis on fire suppression over hazard mitigation. Stemming the tide of wildfire death and destruction will involve bringing together diverse scientific disciplines into policy. Renewed emphasis is needed on emergency alerts and community evacuations. Land management strategies need to account for the impact of climate change and hazard mitigation on forest ecosystems. Here, we propose a long-term strategy consisting of integrating wildfire risk management in wider-scope forest land management policies and strategies, and we discuss new technologies and possible scientific breakthroughs.

Fires as a source of annual ambient PM2.5 exposure and chronic health impacts in Europe

Chronic exposure to ambient PM2.5 is the largest environmental health risk in Europe. We used a chemical transport model and recent exposure response functions to simulate ambient PM2.5, contribution from fires and related health impacts over Europe from 1990 to 2019. Our estimation indicates that the excess death burden from exposure to ambient PM2.5 declined across Europe at a rate of 10,000 deaths per year, from 0.57 million (95 % confidence intervals: 0.44-0.75 million) in 1990 to 0.28 million (0.19-0.42 million) in the specified period. Among these excess deaths, approximately 99 % were among adults, while only around 1 % occurred among children. Our findings reveal a steady increase in fire mortality fractions (excess deaths from fires per 1000 deaths from ambient PM2.5) from 2 in 1990 to 13 in 2019. Notably, countries in Eastern Europe exhibited significantly higher fire mortality fractions and experienced more pronounced increases compared to those in Western and Central Europe. We performed sensitivity analyses by considering fire PM2.5 to be more toxic as compared to other sources, as indicated by recent studies. By considering fire PM2.5 to be more toxic than other PM2.5 sources results in an increased relative contribution of fires to excess deaths, reaching 2.5-13 % in 2019. Our results indicate the requirement of larger mitigation and adaptation efforts and more sustainable forest management policies to avert the rising health burden from fires.

Associations between landscape fires and child morbidity in southern Mozambique: a time-series study

BACKGROUND

Epidemiological evidence linking exposure to landscape fires to child health remains scarce. We assessed the association between daily landscape fire smoke and child hospital visits and admissions in the Manhiça district, Mozambique, an area characterised by frequent forest and cropland fires.

METHODS

In this time-series analysis (2012-20), our primary metric for exposure to landscape fires was fire-originated PM2·5 from smoke dispersion hindcasts. We also assessed total and upwind fire exposure using daily satellite-derived fire density data. Daily numbers of hospital visits and admissions were extracted from an ongoing paediatric morbidity surveillance system (children aged ≤15 years). We applied quasi-Poisson regression models controlling for season, long-term trend, day of the week, temperature, and rainfall, and offsetting by annual population-time at risk to examine lag-specific association of fires on morbidity.

FINDINGS

A 10 μg/m3 increase in fire-originated PM2·5 was associated with a 6·12% (95% CI 0·37-12·21) increase in all-cause and a 12·43% (5·07-20·31) increase in respiratory-linked hospital visits on the following day. Positive associations were also observed for lag 0 and the cumulative lag of 0-1 days. Null associations were observed for hospital admissions. Landscape fires mostly occurred in forested areas; however, associations with child morbidity were stronger for cropland than for forest fires.

INTERPRETATION

Landscape fire smoke was associated with all-cause and respiratory-linked morbidity in children. Improved exposure assessment is needed to better quantify the contribution of landscape fire smoke to child health in regions with scarce air pollution monitoring.

FUNDING

H2020 project EXHAUSTION, Academy of Finland, Spanish Ministry of Science and Innovation, Generalitat de Catalunya, and Government of Mozambique and Spanish Agency for International Cooperation and Development.

Continent-based systematic review of the short-term health impacts of wildfire emissions

This review systematically gathers and provides an analysis of pollutants levels emitted from wildfire (WF) and their impact on short-term health effects of affected populations. The available literature was searched according to Population, Exposure, Comparator, Outcome, and Study design (PECOS) database defined by the World Health Organization (WHO) and a meta-analysis was conducted whenever possible. Data obtained through PECOS characterized information from the USA, Europe, Australia, and some Asian countries; South American countries were seldom characterized, and no data were available for Africa and Russia. Extremely high levels of pollutants, mostly of fine fraction of particulate matter (PM) and ozone, were associated with intense WF emissions in North America, Oceania, and Asia and reported to exceed several-fold the WHO guidelines. Adverse health outcomes include emergency department visits and hospital admissions for cardiorespiratory diseases as well as mortality. Despite the heterogeneity among exposure and health assessment methods, all-cause mortality, and specific-cause mortality were significantly associated with WF emissions in most of the reports. Globally, a significant association was found for all-cause respiratory outcomes including asthma, but mixed results were noted for cardiovascular-related effects. For the latter, estimates were only significant several days after WF emissions, suggesting a more delayed impact on the heart. Different research gaps are presented, including the need for the application of standardized protocols for assessment of both exposure and adverse health risks. Mitigation actions also need to be strengthened, including dedicated efforts to communicate with the affected populations, to engage them for adoption of protective behaviors and measures.

Global population exposure to landscape fire air pollution from 2000 to 2019

Wildfires are thought to be increasing in severity and frequency as a result of climate change1-5. Air pollution from landscape fires can negatively affect human health4-6, but human exposure to landscape fire-sourced (LFS) air pollution has not been well characterized at the global scale7-23. Here, we estimate global daily LFS outdoor fine particulate matter (PM2.5) and surface ozone concentrations at 0.25° × 0.25° resolution during the period 2000-2019 with the help of machine learning and chemical transport models. We found that overall population-weighted average LFS PM2.5 and ozone concentrations were 2.5 µg m-3 (6.1% of all-source PM2.5) and 3.2 µg m-3 (3.6% of all-source ozone), respectively, in 2010-2019, with a slight increase for PM2.5, but not for ozone, compared with 2000-2009. Central Africa, Southeast Asia, South America and Siberia experienced the highest LFS PM2.5 and ozone concentrations. The concentrations of LFS PM2.5 and ozone were about four times higher in low-income countries than in high-income countries. During the period 2010-2019, 2.18 billion people were exposed to at least 1 day of substantial LFS air pollution per year, with each person in the world having, on average, 9.9 days of exposure per year. These two metrics increased by 6.8% and 2.1%, respectively, compared with 2000-2009. Overall, we find that the global population is increasingly exposed to LFS air pollution, with socioeconomic disparities.

Health impacts of extreme weather events - Cascading risks in a changing climate

Background

Extreme weather events represent one of the most tangible impacts of anthropogenic climate change. They have increased in number and severity and a further increase is expected. This is accompanied by direct and indirect negative consequences for human health.

Methods

Flooding events, storms and droughts are analysed here for Germany from a systemic perspective on the basis of a comprehensive literature review. Cascading risks beyond the initial event are also taken into account in order to depict downstream consequences.

Results

In addition to the immediate health burdens caused by extreme weather events such as injuries, long-term consequences such as stress-related mental disorders occur. These stresses particularly affect certain vulnerable groups, e.g. older persons, children, pregnant women or first responders.

Conclusions

A look at the cascading risks described in the international literature allows us to develop precautionary measures for adaptation to the consequences of climate change. Many adaptation measures protect against different risks at the same time. In addition to planning measures, these include, above all, increasing the population's ability to protect itself through knowledge and strengthening of social networks.

Particulate Matter and Its Components Induce Alteration on the T-Cell Response: A Population Biomarker Study

Compared with the T-cell potential of particulate matter (PM) in animal studies, comprehensive evaluation on the impairments of T-cell response and exposure-response from PM and its components in human population is limited. There were 768 participants in this study. We measured environmental PM and its polycyclic aromatic hydrocarbons (PAHs) and metals and urinary metabolite levels of PAHs and metals among population. T lymphocyte and its subpopulation (CD4⁺ T cells and CD8⁺ T cells) and the expressions of T-bet, GATA3, RORγt, and FoxP3 were measured. We explored the exposure-response of PM compositions by principal component analysis and mode of action by mediation analysis. There was a significant decreasing trend for T lymphocytes and the levels of T-bet and GATA3 with increased PM levels. Generally, there was a negative correlation between PM, urinary 1-hydroxypyrene, urinary metals, and the levels of T-bet and GATA3 expression. Additionally, CD4⁺ T lymphocytes were found to mediate the associations of PM_2.5 with T-bet expression. PM and its bound PAHs and metals could induce immune impairments by altering the T lymphocytes and genes of T-bet and GATA3.

Estimation of hospital visits for respiratory diseases attributable to PM10 from vegetation fire smoke and health impacts of regulatory intervention in Upper Northern Thailand

The air quality in Upper Northern Thailand (UNT) deteriorates during seasonal vegetation fire events, causing adverse effects especially on respiratory health outcomes. This study aimed to quantitatively estimate respiratory morbidity from vegetation fire smoke exposure, and to assess the impact of a burning ban enforced in 2016 on morbidity burden in UNT. We computed daily population exposure to fire-originated PM10 and estimated its health burden during a 5-year period from 2014 to 2018 using daily fire-originated PM10 concentration and the concentration-response function for short-term exposure to PM10 from vegetation fire smoke and respiratory morbidity. In subgroups classified as children and older adults, the health burden of respiratory morbidity was estimated using specific effect coefficients from previous studies conducted in UNT. Finally, we compared the health burden of respiratory morbidity before and after burning ban enforcement. Approximately 130,000 hospital visits for respiratory diseases were estimated to be attributable to fire-originated PM10 in UNT from 2014 to 2018. This estimation accounted for 1.3% of total hospital visits for respiratory diseases during the 5-year period, and 20% of those during burning events. Age-specific estimates revealed a larger impact of PM10 in the older adult group. The number of hospital visits for respiratory diseases attributable to fire-originated PM10 decreased from 1.8% to 0.5% after the burning ban policy was implemented in the area. Our findings suggest that PM10 released from vegetation fires is a health burden in UNT. The prohibition of the burning using regulatory measure had a positive impact on respiratory morbidity in this area.

Public Health Measures to Address the Impact of Climate Change on Population Health-Proceedings from a Stakeholder Workshop

BACKGROUND

The World Health Organization identified climate change as the 21st century's biggest health threat. This study aimed to identify the current knowledge base, evidence gaps, and implications for climate action and health policymaking to address the health impact of climate change, including in the most underserved groups.

METHODS

The Horizon-funded project ENBEL ('Enhancing Belmont Research Action to support EU policy making on climate change and health') organised a workshop at the 2021-European Public Health conference. Following presentations of mitigation and adaptation strategies, seven international researchers and public health experts participated in a panel discussion linking climate change and health. Two researchers transcribed and thematically analysed the panel discussion recording.

RESULTS

Four themes were identified: (1) 'Evidence is key' in leading the climate debate, (2) the need for 'messaging about health for policymaking and behaviour change' including health co-benefits of climate action, (3) existing 'inequalities between and within countries', and (4) 'insufficient resources and funding' to implement national health adaptation plans and facilitate evidence generation and climate action, particularly in vulnerable populations.

CONCLUSION

More capacity is needed to monitor health effects and inequities, evaluate adaptation and mitigation interventions, address current under-representations of low- or middle-income countries, and translate research into effective policymaking.

Effect of a vegetation fire event ban on hospital visits for respiratory diseases in Upper Northern Thailand

BACKGROUND

Upper Northern Thailand (UNT) has been episodically affected by air pollution from vegetation burning, which causes adverse respiratory health effects. However, no study has evaluated the effect of regulatory actions to prohibit vegetation burning on respiratory morbidity. We examined the effect of a burning ban enforced in May 2016 on hospital visits for respiratory diseases in UNT.

METHODS

This study used data from eight provinces in UNT. Analyses were conducted for January to April of 2014-2016 (before ban enforcement) and January to April of 2017-2018 (after ban enforcement). Particulate matter of 10 microns in diameter or smaller (PM10) concentrations, numbers of satellite fire hotspots and age-standardized rates of hospital visits for respiratory diseases before and after ban enforcement were compared. The effect of the ban on hospital visits for respiratory diseases was evaluated using an interrupted time-series analysis controlled for season-specific temporal trends, day of week, public holiday, temperature, relative humidity, number of hospitals and offset population, with gastrointestinal diseases as a negative control. A meta-analysis was performed to pool province-specific effect estimates.

RESULTS

The daily average PM10 concentration and the number of fire hotspots decreased after ban enforcement in all provinces in UNT, with percent changes ranging from 5.3 to 34.3% and 14.3 to 81.5%, respectively. The adjusted pooled effect estimates of hospital visits for respiratory diseases decreased by 9.1% (95% CI: 5.1, 12.9), whereas a null association was observed for gastrointestinal diseases.

CONCLUSION

The burning ban had a positive impact on both air pollution levels and rates of hospital visits for respiratory diseases in UNT.

Fine particulate matter exposure in four transport modes of Greater Cairo

The number of daily commuters in Greater Cairo has exceeded 15 million nevertheless personal exposure studies in transport microenvironments are limited. The aim of this study is to quantify PM_2.5 exposure during peak hours in four transport modes of Greater Cairo - car (windows-open, windows-closed with recirculation and AC-on), microbus (windows-open), cycling and walking - and understand its underlying drivers. Data was collected using a pDR-1500 monitor and analysed to capture concentration variations, spatial variability, exposure doses, commuting costs versus inhaled doses, health burden and economic losses. Car with recirculation resulted in the least average PM_2.5 concentrations (32 ± 6 μg/m³), followed by walking (77 ± 35 μg/m³), car with windows-open (82 ± 32 μg/m³), microbus with windows-open (96 ± 29 μg/m³) and cycling (100 ± 28 μg/m³). Evening hours observed average PM_2.5 concentrations by 26-58% lesser than morning. Spatial variability analysis showed that 75th-90th percentile PM_2.5 concentrations coincided with congested spots. Cycling and walking lanes are rare hence commuters are exposed to surges in PM_2.5 concentrations when passing near construction and solid waste burning sites. Cycling and walking also resulted in inhaling 40-times and 32-times higher PM_2.5 dose per kilometre than for car with recirculation. Commuting by microbus cost (with windows-open) ~45% of car cost (with recirculation) but it resulted in 4-times higher inhaled PM_2.5 dose. As expected due to the lowest PM_2.5 exposure concentrations, health burden resulting from car travel (with recirculation) caused the least death rates of 0.07 (95% CI 0.07-0.08) prematures deaths per 100,000 commuters/year while microbus with windows-open resulted in the highest death rates; 0.52 (95% CI 0.49-0.56). Microbus deaths represent 57% of national economic losses due to PM_2.5 exposure amongst the four transport modes. This study provides real-time exposure data and analyses its implications on commuter health as a first step in informed decision-making and better urban planning.

Mortality risk attributable to wildfire-related PM2·5 pollution: a global time series study in 749 locations

BACKGROUND

Many regions of the world are now facing more frequent and unprecedentedly large wildfires. However, the association between wildfire-related PM2·5 and mortality has not been well characterised. We aimed to comprehensively assess the association between short-term exposure to wildfire-related PM2·5 and mortality across various regions of the world.

METHODS

For this time series study, data on daily counts of deaths for all causes, cardiovascular causes, and respiratory causes were collected from 749 cities in 43 countries and regions during 2000-16. Daily concentrations of wildfire-related PM2·5 were estimated using the three-dimensional chemical transport model GEOS-Chem at a 0·25° × 0·25° resolution. The association between wildfire-related PM2·5 exposure and mortality was examined using a quasi-Poisson time series model in each city considering both the current-day and lag effects, and the effect estimates were then pooled using a random-effects meta-analysis. Based on these pooled effect estimates, the population attributable fraction and relative risk (RR) of annual mortality due to acute wildfire-related PM2·5 exposure was calculated.

FINDINGS

65·6 million all-cause deaths, 15·1 million cardiovascular deaths, and 6·8 million respiratory deaths were included in our analyses. The pooled RRs of mortality associated with each 10 μg/m3 increase in the 3-day moving average (lag 0-2 days) of wildfire-related PM2·5 exposure were 1·019 (95% CI 1·016-1·022) for all-cause mortality, 1·017 (1·012-1·021) for cardiovascular mortality, and 1·019 (1·013-1·025) for respiratory mortality. Overall, 0·62% (95% CI 0·48-0·75) of all-cause deaths, 0·55% (0·43-0·67) of cardiovascular deaths, and 0·64% (0·50-0·78) of respiratory deaths were annually attributable to the acute impacts of wildfire-related PM2·5 exposure during the study period.

INTERPRETATION

Short-term exposure to wildfire-related PM2·5 was associated with increased risk of mortality. Urgent action is needed to reduce health risks from the increasing wildfires.

FUNDING

Australian Research Council, Australian National Health & Medical Research Council.

Associations between exposure to landscape fire smoke and child mortality in low-income and middle-income countries: a matched case-control study

BACKGROUND

The prevalence of landscape fires has increased, particularly in low-income and middle-income countries (LMICs). We aimed to assess the impact of exposure to landscape fire smoke (LFS) on the health of children.

METHODS

We conducted a sibling-matched case-control study and selected 552 155 children (aged <18 years) from Demographic and Health Surveys in 55 LMICs from 2000 to 2014. Each deceased child was matched with their sibling(s). The exposure indicators were fire-sourced PM_2·5 and dry-matter emissions. We associated these exposure indicators with child mortality using conditional regressions, and derived an exposure-response function using a non-linear model. Based on the association, we quantified the global burden of fire-attributable child deaths in LMICs from 2000 to 2014.

FINDINGS

Each 1 μg/m³ increment of fire-sourced PM_2·5 was associated with a 2·31% (95% CI 1·50-3·13) increased risk of child mortality. The association was robust to different models. The exposure-response function was superlinear and suggested per-unit exposure to larger fires was more toxic. Based on our non-linear exposure-response function, we estimated that between 2000 and 2014, the five countries with the largest number of child deaths associated with fire-sourced PM_2·5 were Nigeria (164 000 [126 000 to 209 000] annual deaths), Democratic Republic of the Congo (126 000 [95% CI 114 000 to 139 000] annual deaths), India (65 900 [-22 200 to 147 000] annual deaths), Uganda (30 200 [24 500 to 36 300] annual deaths), and Indonesia (28 900 [19 100 to 38 400]).

INTERPRETATION

Exposure to landscape fire smoke contributes substantially to the global burden of child mortality.

FUNDING

National Natural Science Foundation of China, Ministry of Science and Technology of China, Peking University, UK National Institute for Health Research Health Protection Research Unit, Leverhulme Center for Wildfires, Environment and Society, and National Environment Research Council National Capability funding to National Centre for Earth Observation and Energy Foundation.

Sub-Clinical Effects of Outdoor Smoke in Affected Communities

Many Australians are intermittently exposed to landscape fire smoke from wildfires or planned (prescribed) burns. This study aimed to investigate effects of outdoor smoke from planned burns, wildfires and a coal mine fire by assessing biomarkers of inflammation in an exposed and predominantly older population. Participants were recruited from three communities in south-eastern Australia. Concentrations of fine particulate matter (PM_2.5) were continuously measured within these communities, with participants performing a range of health measures during and without a smoke event. Changes in biomarkers were examined in response to PM_2.5 concentrations from outdoor smoke. Increased levels of FeNO (fractional exhaled nitric oxide) (β = 0.500 [95%CI 0.192 to 0.808] p < 0.001) at a 4 h lag were associated with a 10 µg/m³ increase in PM_2.5 levels from outdoor smoke, with effects also shown for wildfire smoke at 4, 12, 24 and 48-h lag periods and coal mine fire smoke at a 4 h lag. Total white cell (β = −0.088 [−0.171 to −0.006] p = 0.036) and neutrophil counts (β = −0.077 [−0.144 to −0.010] p = 0.024) declined in response to a 10 µg/m³ increase in PM_2.5. However, exposure to outdoor smoke resulting from wildfires, planned burns and a coal mine fire was not found to affect other blood biomarkers.

In-car particulate matter exposure across ten global cities

Cars are a commuting lifeline worldwide, despite contributing significantly to air pollution. This is the first global assessment on air pollution exposure in cars across ten cities: Dhaka (Bangladesh); Chennai (India); Guangzhou (China); Medellín (Colombia); São Paulo (Brazil); Cairo (Egypt); Sulaymaniyah (Iraq); Addis Ababa (Ethiopia); Blantyre (Malawi); and Dar-es-Salaam (Tanzania). Portable laser particle counters were used to develop a proxy of car-user exposure profiles and analyse the factors affecting particulate matter ≤2.5 μm (PM_2.5; fine fraction) and ≤10 μm (PM_2.5-10; coarse fraction). Measurements were carried out during morning, off- and evening-peak hours under windows-open and windows-closed (fan-on and recirculation) conditions on predefined routes. For all cities, PM_2.5 and PM₁₀ concentrations were highest during windows-open, followed by fan-on and recirculation. Compared with recirculation, PM_2.5 and PM₁₀ were higher by up to 589% (Blantyre) and 1020% (São Paulo), during windows-open and higher by up to 385% (São Paulo) and 390% (São Paulo) during fan-on, respectively. Coarse particles dominated the PM fraction during windows-open while fine particles dominated during fan-on and recirculation, indicating filter effectiveness in removing coarse particles and a need for filters that limit the ingress of fine particles. Spatial variation analysis during windows-open showed that pollution hotspots make up to a third of the total route-length. PM_2.5 exposure for windows-open during off-peak hours was 91% and 40% less than morning and evening peak hours, respectively. Across cities, determinants of relatively high personal exposure doses included lower car speeds, temporally longer journeys, and higher in-car concentrations. It was also concluded that car-users in the least affluent cities experienced disproportionately higher in-car PM_2.5 exposures. Cities were classified into three groups according to low, intermediate and high levels of PM exposure to car commuters, allowing to draw similarities and highlight best practices.

A Scoping Review of Nurses' Contributions to Health-Related, Wildfire Research

Exposure to unprecedented levels of wildfire smoke is increasing cardiopulmonary mortality and is especially catastrophic to people with preexisting respiratory conditions such as asthma. Wildfire smoke is a mixture of hazardous air pollutants and airborne particulate matter and wildfires are burning larger areas of land and lasting longer, extending the smoke season. The wildfire season is also expected to lengthen as a result of the changing climate. This scoping review examines publications related to wildfires and health in order to explore the ways in which nursing science contributes to research on the health effects of wildfires and strategies to decrease exposure to wildfires and/or wildfire smoke. Nursing's contribution to wildfire research needs to increase to meet the demands of this rapidly growing, international problem. Nurses have an opportunity to protect the public's health through interventional research focused on preventing exposure and applying what is learned to practice.

Premature Deaths in Brazil Associated With Long-Term Exposure to PM2.5 From Amazon Fires Between 2016 and 2019

Amazonian deforestation from slash-and-burn practices is a significant contributor to biomass burning within Brazil. Fires emit carbonaceous aerosols that negatively impact human health by increasing fine particulate matter (PM2.5) exposure. These negative effects on health compound the already detrimental climatological and ecological impacts. Despite high biomass burning emissions in Brazil and the international attention drawn by the relaxation of Amazon protections in 2019, little is known about the health impacts from PM2.5 exposure attributable to these fires. We estimate PM2.5-related premature deaths in Brazil associated with biomass burning, focusing on temporal, interannual, and spatial trends. We find that during the fire season of 2019, 4,966 (2,427, 8,340) premature deaths were attributable to fire emissions making up 10% (5, 17) of all PM2.5-related premature deaths in Brazil. Between the 2019 and 2018 seasons, fire emissions increased by 1.37 Tg (1.00, 2.18) or 115% (60, 201), which was responsible for an increase in health impacts of 2,109 (965, 3,623) premature deaths or 74% (54, 98). Biomass burning emissions throughout Brazil contribute significantly to premature deaths, with the largest burning events occurring in northwestern Brazil. The impact of fires on PM2.5-related premature deaths is highest in heavily populated regions despite their fires being 1 to 2 orders of magnitude smaller than the largest burning events. Results from this study characterize the extent to which elevated PM2.5 exposure levels owing to fires affect public health in Brazil and present an additional, public health-focused, support for increased Amazon protections.

Health Impact Assessment of Volcanic Ash Inhalation: A Comparison With Outdoor Air Pollution Methods

This paper critically appraises the extrapolation of concentration-response functions (CRFs) for fine and coarse particulate matter, PM2.5 and PM10, respectively, used in outdoor air pollution health impact assessment (HIA) studies to assess the extent of health impacts in communities exposed to volcanic emissions. Treating volcanic ash as PM, we (1) consider existing models for HIA for general outdoor PM, (2) identify documented health effects from exposure to ash in volcanic eruptions, (3) discuss potential issues of applying CRFs based on the composition and concentration of ash-related PM, and (4) critically review available case studies of volcanic exposure scenarios utilizing HIA for outdoor air pollution. We identify a number of small-scale studies focusing on populations exposed to volcanic ash; exposure is rarely quantified, and there is limited evidence concerning the health effects of PM from volcanic eruptions. That limited evidence is, however, consistent with the CRFs typically used for outdoor air pollution HIA. Two health assessments of exposure to volcanic emissions have been published using population- and occupational-based CRFs, though each application entails distinct assumptions and limitations. We conclude that the best available strategy, at present, is to apply outdoor air pollution risk estimates to scenarios involving volcanic ash emissions for the purposes of HIA. However, due to the knowledge gaps on, for example, the health effects from exposure to volcanic ash and differences in ash composition, there is inherent uncertainty in this application. To conclude, we suggest actions to enable better prediction and assessment of health impacts of volcanic emissions.

Mortality associated with wildfire smoke exposure in Washington state, 2006-2017: a case-crossover study

BACKGROUND

Wildfire events are increasing in prevalence in the western United States. Research has found mixed results on the degree to which exposure to wildfire smoke is associated with an increased risk of mortality.

METHODS

We tested for an association between exposure to wildfire smoke and non-traumatic mortality in Washington State, USA. We characterized wildfire smoke days as binary for grid cells based on daily average PM2.5 concentrations, from June 1 through September 30, 2006-2017. Wildfire smoke days were defined as all days with assigned monitor concentration above a PM2.5 value of 20.4 μg/m3, with an additional set of criteria applied to days between 9 and 20.4 μg/m3. We employed a case-crossover study design using conditional logistic regression and time-stratified referent sampling, controlling for humidex.

RESULTS

The odds of all-ages non-traumatic mortality with same-day exposure was 1.0% (95% CI: - 1.0 - 4.0%) greater on wildfire smoke days compared to non-wildfire smoke days, and the previous day's exposure was associated with a 2.0% (95% CI: 0.0-5.0%) increase. When stratified by cause of mortality, odds of same-day respiratory mortality increased by 9.0% (95% CI: 0.0-18.0%), while the odds of same-day COPD mortality increased by 14.0% (95% CI: 2.0-26.0%). In subgroup analyses, we observed a 35.0% (95% CI: 9.0-67.0%) increase in the odds of same-day respiratory mortality for adults ages 45-64.

CONCLUSIONS

This study suggests increased odds of mortality in the first few days following wildfire smoke exposure. It is the first to examine this relationship in Washington State and will help inform local and state risk communication efforts and decision-making during future wildfire smoke events.

Interactions Between Air Pollution and Pollen Season for Rhinitis Using Mobile Technology: A MASK-POLLAR Study

BACKGROUND

Several studies have suggested an interaction between air pollution and pollen exposure with an impact on allergy symptoms. However, large studies with real-life data are not available.

OBJECTIVE

To investigate associations between major air pollutants (ozone and particulate matter with a diameter of <2.5 μm) and allergic rhinitis (AR) control during grass and birch pollen seasons as well as outside the pollen season.

METHODS

The daily impact of allergic symptoms was recorded by the Allergy Diary (Mobile Airways Sentinel NetworK [MASK-air]) app (a validated mHealth tool for rhinitis management) using visual analog scales (VASs) in Northern and Central Europe users in 2017 and 2018. Uncontrolled AR was defined using symptoms and medications. Pollutant levels were assessed using the System for Integrated modeLing of Atmospheric coMposition database. Pollen seasons were assessed by regions using Google Trends. Generalized estimating equation models were used to account for repeated measures per user, adjusting for sex, age, treatment, and country. Analyses were stratified by pollen seasons to investigate interactions between air pollutants and pollen exposure.

RESULTS

A total of 3323 geolocated individuals (36,440 VAS-days) were studied. Associations between uncontrolled rhinitis and pollutants were stronger during the grass pollen season. Days with uncontrolled AR increased by 25% for an interquartile range increase in ozone levels during the grass pollen season (odds ratio of 1.25 [95% CI, 1.11-1.41] in 2017 and of 1.14 [95% CI, 1.04-1.25] in 2018). A similar trend was found for particulate matter with a diameter of less than 2.5 μm, especially in 2017.

CONCLUSIONS

These results suggest that the relationship between uncontrolled AR and air pollution is modified by the presence of grass pollens. This study confirms the impact of pollutants in the grass pollen season but not in the birch pollen season.

Modeling Wildland Fire-Specific PM2.5 Concentrations for Uncertainty-Aware Health Impact Assessments

Wildland fire is a major emission source of fine particulate matter (PM_2.5), which has serious adverse health effects. Most fire-related health studies have estimated human exposures to PM_2.5 using ground observations, which have limited spatial/temporal coverage and could not separate PM_2.5 emanating from wildland fires from other sources. The Community Multiscale Air Quality (CMAQ) model has the potential to fill the gaps left by ground observations and estimate wildland fire-specific PM_2.5 concentrations, although the issues around systematic bias in CMAQ models remain to be resolved. To address these problems, we developed a two-step calibration strategy under the consideration of prediction uncertainties. In a case study of the eastern U.S. in 2014, we evaluated the calibration performance using three cross-validation methods, which consistently indicated that the prediction accuracy was improved with an R² of 0.47-0.64. In a health impact study based on the wildland fire-specific PM_2.5 predictions, we identified regions with excess respiratory hospital admissions due to wildland fire events and quantified the estimation uncertainty propagated from multiple components in health impact function. We concluded that the proposed calibration strategy could provide reliable wildland fire-specific PM_2.5 predictions and health burden estimates to support policy development for reducing fire-related risks.

Influence of Meteorological Variables and Forest Fires Events on Air Quality in an Urban Area (Córdoba, Argentina)

Extreme environmental events, such as forest fires, are a major emission source of aerosols into the atmosphere. Thus, to investigate the contribution of local forest fires to urban particulate matter, we selected several forest fire indicators, such as number of heat sources, fire events, and burnt area, and collected particles smaller than 2.5 µm (PM_2.5) during a 2.5-year period in Cordoba City (Argentina). Temporal variation of PM_2.5 concentration and composition was described considering fire and nonfire periods, and the influence of meteorological variables was estimated as well. On average, PM_2.5 levels registered in Córdoba city during the study period were lower than values reported for other similar cities in Latin America, despite the fact that during wintertime an increase in PM_2.5 levels was observed due to the occurrence of thermal inversions. Several fire events taking place in the nearby hills around the city during winter and spring 2013 suggest that biomass burning was a strong contribution to urban particles levels, which is consistent with the significant correlation between PM_2.5 concentration and heat sources number. During fire periods, levels of Fe, Ca, and K, were significantly higher than in the nonfire periods, suggesting that these elements can be reliable forest fire markers.

PM2.5 aggravates the lipid accumulation, mitochondrial damage and apoptosis in macrophage foam cells

Epidemiological evidence showed that the particulate matter exposure is associated with atherosclerotic plaque progression, which may be related to foam cell formation, but the mechanism is still unknown. The study was aimed to investigate the toxic effects and possible mechanism of PM_2.5 on the formation of macrophage foam cells induced by oxidized low density lipoprotein (ox-LDL). Results showed that PM_2.5 induced cytotoxicity by decreasing the cell viability and increasing the LDH level in macrophage foam cells. PM_2.5 aggravated the lipid accumulation in ox-LDL-stimulated macrophage RAW264.7 within markedly increasing level of intracellular lipid by Oil red O staining. The level of ROS increased obivously after co-exposure to PM_2.5 and ox-LDL than single exposure group. In addition, serious mitochondrial damage such as the mitochondrial swelling, cristae rupturing and disappearance were observed in macrophage foam cells. The loss of the mitochondrial membrane potential (MMP) further exacerbated the mitochondrial damage in PM_2.5-induced macrophage foam cells. The apoptotic rate increased more severely via up-regulated protein level of Bax, Cyt C, Caspase-9, Caspase-3, and down-regulated that of Bcl-2, indicating that PM_2.5 activated the mitochondrial-mediated apoptosis pathway. In summary, our results demonstrated that PM_2.5 aggravated the lipid accumulation, mitochondrial damage and apoptosis in macrophage foam cells, suggesting that PM_2.5 was a risk factor of atherosclerosis progression.

Wildland fire smoke and human health

The natural cycle of landscape fire maintains the ecological health of the land, yet adverse health effects associated with exposure to emissions from wildfire produce public health and clinical challenges. Systematic reviews conclude that a positive association exists between exposure to wildfire smoke or wildfire particulate matter (PM2.5) and all-cause mortality and respiratory morbidity. Respiratory morbidity includes asthma, chronic obstructive pulmonary disease (COPD), bronchitis and pneumonia. The epidemiological data linking wildfire smoke exposure to cardiovascular mortality and morbidity is mixed, and inconclusive. More studies are needed to define the risk for common and costly clinical cardiovascular outcomes. Susceptible populations include people with respiratory and possibly cardiovascular diseases, middle-aged and older adults, children, pregnant women and the fetus. The increasing frequency of large wildland fires, the expansion of the wildland-urban interface, the area between unoccupied land and human development; and an increasing and aging U.S. population are increasing the number of people at-risk from wildfire smoke, thus highlighting the necessity for broadening stakeholder cooperation to address the health effects of wildfire. While much is known, many questions remain and require further population-based, clinical and occupational health research. Health effects measured over much wider geographical areas and for longer periods time will better define the risk for adverse health outcomes, identify the sensitive populations and assess the influence of social factors on the relationship between exposure and health outcomes. Improving exposure models and access to large clinical databases foreshadow improved risk analysis facilitating more effective risk management. Fuel and smoke management remains an important component for protecting population health. Improved smoke forecasting and translation of environmental health science into communication of actionable information for use by public health officials, healthcare professionals and the public is needed to motivate behaviors that lower exposure and protect public health, particularly among those at high risk.

Cleaner fuels for ships provide public health benefits with climate tradeoffs

We evaluate public health and climate impacts of low-sulphur fuels in global shipping. Using high-resolution emissions inventories, integrated atmospheric models, and health risk functions, we assess ship-related PM_2.5 pollution impacts in 2020 with and without the use of low-sulphur fuels. Cleaner marine fuels will reduce ship-related premature mortality and morbidity by 34 and 54%, respectively, representing a ~ 2.6% global reduction in PM_2.5 cardiovascular and lung cancer deaths and a ~3.6% global reduction in childhood asthma. Despite these reductions, low-sulphur marine fuels will still account for ~250k deaths and ~6.4 M childhood asthma cases annually, and more stringent standards beyond 2020 may provide additional health benefits. Lower sulphur fuels also reduce radiative cooling from ship aerosols by ~80%, equating to a ~3% increase in current estimates of total anthropogenic forcing. Therefore, stronger international shipping policies may need to achieve climate and health targets by jointly reducing greenhouse gases and air pollution.

Cleaner fuels for ships provide public health benefits with climate tradeoffs

We evaluate public health and climate impacts of low-sulphur fuels in global shipping. Using high-resolution emissions inventories, integrated atmospheric models, and health risk functions, we assess ship-related PM2.5 pollution impacts in 2020 with and without the use of low-sulphur fuels. Cleaner marine fuels will reduce ship-related premature mortality and morbidity by 34 and 54%, respectively, representing a ~ 2.6% global reduction in PM2.5 cardiovascular and lung cancer deaths and a ~3.6% global reduction in childhood asthma. Despite these reductions, low-sulphur marine fuels will still account for ~250k deaths and ~6.4 M childhood asthma cases annually, and more stringent standards beyond 2020 may provide additional health benefits. Lower sulphur fuels also reduce radiative cooling from ship aerosols by ~80%, equating to a ~3% increase in current estimates of total anthropogenic forcing. Therefore, stronger international shipping policies may need to achieve climate and health targets by jointly reducing greenhouse gases and air pollution.

Investigating the contribution of shipping emissions to atmospheric PM2.5 using a combined source apportionment approach

Many studies have been conducted focusing on the contribution of land emission sources to PM_2.5 in China; however, little attention had been paid to other contributions, especially the secondary contributions from shipping emissions to atmospheric PM_2.5. In this study, a combined source apportionment approach, including principle component analysis (PCA) and WRF-CMAQ simulation, was applied to identify both primary and secondary contributions from ships to atmospheric PM_2.5. An intensive PM_2.5 observation was conducted from April 2014 to January 2015 in Qinhuangdao, which was close to the largest energy output port of China. The chemical components analysis results showed that the primary component was the major contributor to PM_2.5, with proportions of 48.3%, 48.9%, 55.1% and 55.4% in spring, summer, autumn and winter, respectively. The secondary component contributed higher fractions in summer (48.2%) and winter (36.8%), but had lower percentages in spring (30.1%) and autumn (32.7%). The hybrid source apportionment results indicated that the secondary contribution (SC) of shipping emissions to PM_2.5 could not be ignored. The annual average SC was 2.7%, which was comparable to the primary contribution (2.9%). The SC was higher in summer (5.3%), but lower in winter (1.1%). The primary contributions to atmospheric PM_2.5 were 3.0%, 2.5%, 3.4% and 2.7% in spring, summer, autumn and winter, respectively. As for the detailed chemical components, the contributions of shipping emissions were 2.3%, 0.5%, 0.1%, 1.0%, 1.7% and 0.1% to elements & sea salt, primary organic aerosol (POA), element carbon (EC), nitrate, sulfate and secondary organic carbon (SOA), respectively. The results of this study will further the understanding of the implications of shipping emissions in PM_2.5 pollution.

Wildfire smoke exposure and human health: Significant gaps in research for a growing public health issue

Understanding the effect of wildfire smoke exposure on human health represents a unique interdisciplinary challenge to the scientific community. Population health studies indicate that wildfire smoke is a risk to human health and increases the healthcare burden of smoke-impacted areas. However, wildfire smoke composition is complex and dynamic, making characterization and modeling difficult. Furthermore, current efforts to study the effect of wildfire smoke are limited by availability of air quality measures and inconsistent air quality reporting among researchers. To help address these issues, we conducted a substantive review of wildfire smoke effects on population health, wildfire smoke exposure in occupational health, and experimental wood smoke exposure. Our goal was to evaluate the current literature on wildfire smoke and highlight important gaps in research. In particular we emphasize long-term health effects of wildfire smoke, recovery following wildfire smoke exposure, and health consequences of exposure in children.

iRhom2 deficiency relieves TNF-α associated hepatic dyslipidemia in long-term PM2.5-exposed mice

Accumulating researches reported that particulate matter (PM2.5) is a risk factor for developing various diseases, including metabolic syndrome. Recently, inactive rhomboid protein 2 (iRhom2) was considered as a necessary modulator for shedding of tumor necrosis factor-α (TNF-α) in immune cells. TNF-α, a major pro-inflammatory cytokine, was linked to various pathogenesis of diseases, including dyslipidemia. Here, wild type (WT) and iRhom2-knockout (iRhom2^-/-) mice were used to investigate the effects of iRhom2 on PM2.5-induced hepatic dyslipidemia. The hepatic histology, inflammatory response, glucose tolerance, serum parameters and gene expressions were analyzed. We found that long-term inhalation of PM2.5 resulted in hepatic steatosis. And a significant up-regulation of iRhom2 in liver tissues was observed, accompanied with elevated TNF-α, TNF-α converting enzyme (TACE), TNFα receptor (TNFR)2 and various inflammatory cytokines expressions. Additionally, PM2.5 treatment caused TG and TC accumulation in serum and liver, probably attributed to changes of genes modulating lipid metabolism. Intriguingly, hepatic injury and dyslipidemia were attenuated by iRhom2^-/- in mice with PM2.5 challenge. In vitro, iRhom2-knockdwon reduced TNF-α expressions and its associated inflammatory cytokines in Kupffer cells, implying that liver-resident macrophages played an important role in regulating hepatic inflammation and lipid metabolism in cells treated with PM2.5. The findings indicated that long-term PM2.5 exposure caused hepatic steatosis and dyslipidemia through triggering inflammation, which was, at least partly, dependent on iRhom2/TNF-α pathway in liver-resident macrophages.