Spatiotemporal Changes in Fine Particulate Matter Pollution and the Associated Mortality Burden in China between 2015 and 2016

Changes of PM2.5 and O3 and their impact on human health in the Guangdong-Hong Kong-Macao Greater Bay Area

In recent years, the combined pollution of PM2.5 and O3 in China, particularly in economically developed regions such as the Guangdong-Hong Kong-Macao Greater Bay Area (GBA), has garnered significant attention due to its potential implications. This study systematically investigated the changes of PM2.5 and O3 and their associated human health effects in the GBA, utilizing observational data spanning from 2015 to 2019. The findings revealed a spatial trend indicating a gradual decrease in PM2.5 levels from the northwest to the southeast, while the spatial distribution of MDA8 O3 demonstrated an opposing pattern to that of PM2.5. The monthly fluctuations of PM2.5 and MDA8 O3 exhibited V-shaped and M-shaped patterns, respectively. Higher MDA8 O3 concentrations were observed in autumn, followed by summer and spring. Over the five-year period, PM2.5 concentrations exhibited a general decline, with an annual reduction rate of 1.7 μg m-3/year, while MDA8 O3 concentrations displayed an annual increase of 3.2 μg m-3. Among the GBA regions, Macao, Foshan, Guangzhou, and Jiangmen demonstrated notable decreases in PM2.5, whereas Jiangmen, Zhongshan, and Guangzhou experienced substantial increases in MDA8 O3 levels. Long-term exposure to PM2.5 in 2019 was associated with 21,113 (95% CI 4968-31,048) all-cause deaths (AD), 1333 (95% CI 762-1714) cardiovascular deaths (CD), and 1424 (95% CI 0-2848) respiratory deaths (RD), respectively, reflecting declines of 27.6%, 28.0%, and 28.4%, respectively, compared to 2015. Conversely, in 2019, estimated AD, CD, and RD attributable to O3 were 16,286 (95% CI 8143-32,572), 7321 (95% CI 2440-14,155), and 6314 (95% CI 0-13,576), respectively, representing increases of 45.9%, 46.2%, and 44.2% over 2015, respectively. Taken together, these findings underscored a shifting focus in air pollution control in the GBA, emphasizing the imperative for coordinated control strategies targeting both PM2.5 and O3.

Associations between Different Ozone Indicators and Cardiovascular Hospital Admission: A Time-Stratified Case-Crossover Analysis in Guangzhou, China

Epidemiological studies reported that ozone (O₃) is associated with cardiovascular diseases. However, only few of these studies examined the impact of multiple O₃ indicators on cardiovascular hospital admissions. This study aimed to explore and compare the impacts of different O₃ indicators on cardiovascular hospital admissions in Guangzhou, China. Based upon the data on daily cardiovascular hospital admissions, air pollution, and meteorological factors in Guangzhou from 2014 to 2018, a time-stratified case-crossover design model was used to analyze the associations between different O₃ indicators and cardiovascular hospital admissions. Moreover, the sensitivities of different age and gender groups were analyzed for the whole year and different seasons (i.e., warm and cold). During the warm season, for the single-pollutant model, the odds ratio (OR) value of cardiovascular hospital admissions was 1.0067 (95% confidence interval (CI): 1.0037, 1.0098) for every IQR increase in MDA8 O₃ at a lag of five days. The effect of O₃ on people over 60 year was stronger than that on the 15-60 years age group. Females were more sensitive than males to O₃ exposure. These results provided valuable references for further scientific research and environmental improvement in Guangzhou. Given that short-term O₃ exposure poses a threat to human health, the government should therefore pay attention to prevention and control policies to reduce and eliminate O₃ pollution and protect human health.

Mathematical modeling in the health risk assessment of air pollution-related disease burden in China: A review

This review paper covers an overview of air pollution-related disease burden in China and a literature review on the previous studies which have recently adopted a mathematical modeling approach to demonstrate the relative risk (RR) of air pollution-related disease burden. The associations between air pollution and disease burden have been explored in the previous studies. Therefore, it is necessary to quantify the impact of long-term exposure to ambient air pollution by using a suitable mathematical model. The most common way of estimating the health risk attributable to air pollution exposure in a population is by employing a concentration-response function, which is often based on the estimation of a RR model. As most of the regions in China are experiencing rapid urbanization and industrialization, the resulting high ambient air pollution is influencing more residents, which also increases the disease burden in the population. The existing RR models, including the integrated exposure-response (IER) model and the global exposure mortality model (GEMM), are critically reviewed to provide an understanding of the current status of mathematical modeling in the air pollution-related health risk assessment. The performances of different RR models in the mortality estimation of disease are also studied and compared in this paper. Furthermore, the limitations of the existing RR models are pointed out and discussed. Consequently, there is a need to develop a more suitable RR model to accurately estimate the disease burden attributable to air pollution in China, which contributes to one of the key steps in the health risk assessment. By using an updated RR model in the health risk assessment, the estimated mortality risk due to the impacts of environment such as air pollution and seasonal temperature variation could provide a more realistic and reliable information regarding the mortality data of the region, which would help the regional and national policymakers for intensifying their efforts on the improvement of air quality and the management of air pollution-related disease burden.

How the Air Clean Plan and carbon mitigation measures co-benefited China in PM2.5 reduction and health from 2014 to 2020

China implemented a stringent Air Clean Plan (ACP) since 2013 to address environmental and health risks caused by ambient fine particulate matter (PM_2.5). However, the policy effectiveness of ACP and co-benefits of carbon mitigation measures to environment and health are still largely unknown. Using satellite-based PM_2.5 products produced in our previous study, concentration-response functions, and the logarithmic mean Divisia index (LMDI) method, we analyzed the spatiotemporal dynamics of premature deaths attributable to PM_2.5 exposure, and quantitatively estimated the policy benefits of ACP and carbon mitigation measures. We found the annual PM_2.5 concentrations in China decreased by 33.65 % (13.41 μg m^-3) from 2014 to 2020, accompanied by a decrease in PM_2.5-attributable premature deaths of 0.23 million (95 % confidence interval (CI): 0.22-0.27), indicating the huge benefits of China ACP for human health and environment. However, there were still 1.12 million (95 % CI: 0.79-1.56) premature deaths caused by the exposure of PM_2.5 in mainland China in 2020. Among all ACP measures, clean production (contributed 55.98 % and 51.14 % to decrease in PM_2.5 and premature deaths attributable to PM_2.5) and energy consumption control (contributed 32.58 % and 29.54 % to decrease in PM_2.5 and premature deaths attributable to PM_2.5) made the largest contribution during the past seven years. Nevertheless, the environmental and health benefits of ACP are not fully synergistic in different regions, and the effectiveness of ACP measures reduced from 2018 to 2020. The co-effects of CO₂ and PM_2.5 has become one of the major drivers for PM_2.5 and premature deaths reduction since 2018, confirming the clear environment and health co-benefits of carbon mitigation measures. Our study suggests, with the saturation of clean production and source control, more targeted region-specific strategies and synergistic air pollution-carbon mitigation measures are critical to achieving the WHO's Air Quality Guideline target and the UN's Sustainable Development Goal Target in China.

Long-term trends of atmospheric hot-and-polluted episodes (HPE) and the public health implications in the Pearl River Delta region of China

Air pollution and extreme heat have been responsible for more than a million deaths in China every year, especially in densely urbanized regions. While previous studies intensively evaluated air pollution episodes and extreme heat events, a limited number of studies comprehensively assessed atmospheric hot-and-polluted-episodes (HPE) - an episode with simultaneously high levels of air pollution and temperature - which have potential adverse synergic impacts on human health. This study focused on the Pearl River Delta (PRD) region of China due to its high temperature in summer and poor air quality throughout a year. We employed geostatistical downscaling to model meteorology at a spatial resolution of 1 km, and applied a machine learning algorithm (XGBoost) to estimate a high-resolution (1 km) daily concentration of particulate matter with an aerodynamic diameter ≤2.5 μm (PM_2.5) and ozone (O₃) for June to October over 20 years (2000-2019). Our results indicate an increasing trend (∼50%) in the frequency of HPE occurrence in the first decade (2000-2010). Conversely, the annual frequency of HPE occurrence reduced (16.7%), but its intensity increased during the second decade (2010-2019). The northern cities in the PRD region had higher levels of PM_2.5 and O₃ than their southern counterparts. During HPEs, regional daily PM_2.5 exceeded the World Health Organization (WHO) and Chinese guideline levels by 75% and 25%, respectively, while the O₃ exceeded the WHO O₃ standard by up to 69%. Overall, 567,063 (95% confidence interval (CI): 510,357-623,770) and 52,231 (95%CI: 26,116-78,346) excessive deaths were respectively attributable to exposure to PM_2.5 and O₃ in the PRD region. Our findings imply the necessity and urgency to formulate co-benefit policies to mitigate the region's air pollution and heat problems.

Evaluating the real changes of air quality due to clean air actions using a machine learning technique: Results from 12 Chinese mega-cities during 2013-2020

China has implemented two national clean air actions in 2013-2017 and 2018-2020, respectively, with the aim of reducing primary emissions and hence improving air quality at a national level. It is important to examine the effectiveness of such emission reductions and assess the resulting changes in air quality. However, such evaluation is difficult as meteorological factors can amplify, or obscure the changes of air pollutants, in addition to the emission reduction. In this study, we applied the random forest machine learning technique to decouple meteorological influences from emissions changes, and examined the deweathered trends of air pollutants in 12 Chinese mega-cities during 2013-2020. The observed concentrations of all criteria pollutants except O₃ showed significant declines from 2013 to 2020, with PM_2.5 annual decline rates of 6-9% in most cities. In contrast, O₃ concentrations increased with annual growth rates of 1-9%. Compared with the observed results, all the pollutants showed smoothed but similar variation in trend and annual rate-of-change after weather normalization. The response of O₃ to NO₂ concentrations indicated significant regional differences in photochemical regimes, and the differences between observed and deweathered results provided implications for volatile organic compound emission reductions in O₃ pollution mitigation. We further evaluated the effectiveness of first and second clean air actions by removing the meteorological influence. We found that the meteorology can make negative or positive contribution in reducing pollutant concentrations from emission reduction, depending on type of pollutants, locations, and time period. Among the 12 mega-cities, only Beijing showed a positive meteorological contribution in amplifying reductions in main pollutants except O₃ during both clean air action periods. Considering the large and variable impact of meteorological effects in changing air quality, we suggest that similar deweathered analysis is needed as a routine policy evaluation tool on a regional basis.

Association between atmospheric particulate matter and emergency room visits for cerebrovascular disease in Beijing, China

PURPOSE

The association between atmospheric particulate matter and emergency room visits for cerebrovascular disease were evaluated in Beijing.

METHODS

A generalized additive model was used to evaluate the associations between particulate matter and cerebrovascular disease, based on the daily data of meteorological elements, PM concentrations, and emergency room (ER) visits for cerebrovascular disease in Beijing from 2009 to 2012. Long-term trends and the effects of holidays, the day of the week, and confounding factors were controlled to determine the lag effect at 0-6 days. Single- and double-pollutant models were employed for different age and sex groups.

RESULTS

The effect of PM_2.5 concentration on the number of daily ER visits for cerebrovascular disease was much stronger than that of PM₁₀ concentration. PM_2.5 and PM₁₀ had maximum RR values of 1.096 and 1.054 at lag 6 for patients aged 61-75 years. For each inter-quartile range (IQR) increase in PM₁₀ concentration, the maximum RR values for the total, males, females, aged 15-60 years, aged 61-75 years, and aged > 75 years were 1.024, 1.044, 1.043, 1.038, 1.054, and 1.032, respectively. For each IQR increase in PM_2.5 concentration, the maximum RR values for the total, males, females, aged 15-60 years, aged 61-75 years, and aged > 75 years were 1.038, 1.064, 1.076, 1.054, 1.096, and 1.049, respectively. The RR values of the double-pollutant models were lower than those of the single-pollutant models.

CONCLUSION

This study showed that the effects of PM pollution on cerebrovascular disease were different among different gender and age groups, and aged 61-75 years were mostly sensitive to particulate matters. The effects of PM_2.5 on cerebrovascular disease were stronger than those of PM₁₀. Our results can provide scientific evidence for the local government to take effective measures to improve air quality and the health of residents.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40201-021-00776-w.

Modeling the Determinants of PM2.5 in China Considering the Localized Spatiotemporal Effects: A Multiscale Geographically Weighted Regression Method

Many studies have identified the influences of PM2.5. However, very little research has addressed the spatiotemporal dependence and heterogeneity in the relationships between impact factors and PM2.5. This study firstly utilizes spatial statistics and time series analysis to investigate the spatial and temporal dependence of PM2.5 at the city level in China using a three-year (2015–2017) dataset. Then, a new local regression model, multiscale geographically weighted regression (MGWR), is introduced, based on which we measure the influence of PM2.5. A spatiotemporal lag is constructed and included in MGWR to account for spatiotemporal dependence and spatial heterogeneity simultaneously. Results of MGWR are comprehensively compared with those of ordinary least square (OLS) and geographically weighted regression (GWR). Experimental results show that PM2.5 is autocorrelated in both space and time. Compared with existing approaches, MGWR with a spatiotemporal lag (MGWRL) achieves a higher goodness-of-fit and a more significant effect on eliminating residual spatial autocorrelation. Parameter estimates from MGWR demonstrate significant spatial heterogeneity, which traditional global models fail to detect. Results also indicate the use of MGWR for generating local spatiotemporal dependence evaluations which are conditioned on various covariates rather than being simple descriptions of a pattern. This study offers a more accurate method to model geographic events.

Is prosocial behaviour a missing link between green space quality and child health-related outcomes?

BACKGROUND

This study aimed to investigate prosocial behaviour-those behaviours that benefit others or enhance relationships with others-as a mediator of the associations between green space quality and child health-related outcomes (physical activity, mental health, and health-related quality of life (HRQOL)).

METHODS

This study involved data from 4983 children with 10-year follow-up (2004-2014) retrieved from the Longitudinal Study of Australian Children. Green space quality (the exposure), prosocial behaviour (the candidate mediator), and child health-related outcomes were assessed biennially based on caregiver reports. Causal mediation analysis was used, with four mediation models developed for each outcome.

RESULTS

Mediation by prosocial behaviour appeared in the late childhood mediation model with higher mediation proportions reported compared to models of earlier and middle childhood. Prosocial behaviour had moderate mediation consistency for the association between green space quality and physical activity enjoyment, but no mediation was evident for other physical activity variables. Prosocial behaviour had low mediation consistency for child mental health (internalising and externalising subscales). Similarly, low mediation consistency of prosocial behaviour was also evident for all HRQOL variables, such as physical, emotional, social, school functioning, psychosocial health, and total quality of life (QOL).

CONCLUSION

Prosocial behaviour partially mediated the association between green space quality and child health-related outcomes (physical activity enjoyment, mental health, and HRQOL). Improving the quality of neighbourhood green space that supports the development of prosocial behaviour may result in better child health-related outcomes. Other physical activity variables might not specifically relate to social interactions, and therefore, no mediation by prosocial behaviour was apparent.

Health Impact Attributable to Improvement of PM2.5 Pollution from 2014–2018 and Its Potential Benefits by 2030 in China

With the advancement of urbanization and industrialization, air pollution has become one of the biggest challenges for sustainable development. In recent years, ambient PM2.5 concentrations in China have declined substantially due to the combined effect of PM2.5 control and meteorological conditions. To this end, it is critical to assess the health impact attributable to PM2.5 pollution improvement and to explore the potential benefits which may be obtained through the achievement of future PM2.5 control targets. Based on PM2.5 and population data with a 1 km resolution, premature mortality caused by exposure to PM2.5 in China from 2014 to 2018 was estimated using the Global Exposure Mortality Model (GEMM). Then, the potential benefits of achieving PM2.5 control targets were estimated for 2030. The results show that premature mortality caused by PM2.5 pollution decreased by 22.41%, from 2,361,880 in 2014 to 1,832,470 in 2018. Moreover, the reduction of premature mortality in six major regions of China accounted for 52.82% of the national total reduction. If the PM2.5 control target can be achieved by 2030, PM2.5-related premature deaths will further decrease by 403,050, accounting for 21.99% of those in 2018. Among them, 87.02% of cities exhibited decreases in premature deaths. According to the potential benefits in 2030, all cities were divided into three types, of which type III cities should set stricter PM2.5 control targets and further strengthen the associated monitoring and governance. The results of this study provide a reference for the formulation of air pollution control policies based on regional differences.

Coordinated control of PM2.5 and O3 is urgently needed in China after implementation of the "Air pollution prevention and control action plan"

To improve air quality, China formulated the Air Pollution Prevention and Control Action Plan (APPCAP) in 2013. In the present study, the changes in the concentration of air pollutants after the implementation of APPCAP were investigated based on nationwide monitoring data. From the results, it is evident that the annual mean concentrations of PM_2.5, PM₁₀, SO₂, and CO show a significant downward trend over 2015-2018, with decreasing rates of 3.4, 4.1, 3.8, and 70 μg m^-3/year, respectively. However, no significant change was found in NO₂ while maximum daily 8 h average O₃ concentration (MDA8 O₃) was increased by 3.4 μg m^-3/year during the four years. Spatially, the highest decrease in PM_2.5 was found in Beijing-Tianjin-Hebei (BTH), followed by central China and northeast China, while the Pearl River Delta (PRD), Yungui Plateau, and northwest China showed less decreases. MDA8 O₃ had a higher increase in BTH, central China, Yangtze River Delta (YRD), and PRD. With the decrease in PM_2.5 in recent years, cumulative population exposure to PM_2.5 gradually decreased, whereas there was still more than 65% of the population exposing to annual PM_2.5 higher than the standard of 35 μg m^-3 in 2018. In contrast, the health effects of O₃ gradually increased with 13.1%, 14.3%, 20.4%, and 21.7% of the population exposed to unhealthy O₃ levels in summer from 2015 to 2018. O₃ pollution is causing severe health risks with estimated nationwide mortality of 70,024 (95% CI: 55,510-84,501), 79,159 (95% CI: 62,750-95,525), 105,150 (95% CI: 83,378-126,852), and 104,404 (95% CI: 82,784-125,956) in the four years, respectively. This clearly shows that the target of air pollution control in China shifts and coordinated control of PM_2.5 and O₃ is urgently needed after the successful implementation of APPCAP.

Influence of air pollution on human comfort in five typical Chinese cities

It is known that air pollution is harmful to creatures, though until now most of the human thermal comfort indices that existed were calculated only with meteorological conditions. Therefore, a new index - meteorology and environment comfort (MEC) - was given out in this paper that considers both meteorology and air pollution conditions and presents the comprehensive and synergistic effects of meteorological and air pollution. The meteorology and air pollution data were used to establish the influence function of the five air pollutants (PM2.5, PM10, O3, NO2, and SO2) according to Fechner's law; then, we calculated the somatosensory temperature (ST, a class of human thermal comfort indices) and MEC values of five typical cities (Beijing, Xining, Nanjing, Kunming, and Guangzhou). The results showed average improvements of five cities on MEC as a new comprehensive human comfort index to new ST. In spring, the MEC comfort proportion fell by 29.25%. Besides, the extreme heat discomfort ratio in Nanjing and Kunming has increased over 20%. In summer, the comfort proportion fell 12.54%; the extreme heat discomfort proportion of Beijing increased 37.86% and Kunming increased 24.09%. Air pollution significantly raised discomfort stress in Beijing. In fall, the comfort proportion fell by 20.87%; and the extreme heat discomfort of Nanjing increased 23.67% caused by poor air quality. About winter, the comfort ratio decreased 12.72%, and the cold discomfort proportion of Nanjing increased 30.30%, signifying awful air quality in winter. Air pollution levels significantly affect the comfort levels in all seasons, which is more evident with good weather patterns. MEC can offer early warnings of extreme weather events and provide a basis for the better prevention and control of air pollution to protect human health basing on the predictions of meteorological and environmental impact factors.

Substantial changes in PM2.5 pollution and corresponding premature deaths across China during 2015-2019: A model prospective

Long-term exposure to the ambient fine particulate matter (PM_2.5) is the major public health risk factor in China. Several past studies have assessed premature mortalities associated with PM_2.5 in China at varying levels of temporal and spatial scales using different methodological approaches. However, recently developed global exposure mortality model [GEMM NCD + LRI and GEMM 5-COD] provides a much more sophisticated methodology in capturing mortality due to PM_2.5-exposure than the commonly accepted integrated exposure-response (IER) model, which this study applied to China. This study provides a comparative assessment of the excess long-term PM_2.5-attributed nonaccidental deaths as well as cause-specific deaths for 349 cities in mainland China during five years (from 2015 to 2019) and compares the results with the spatial resolution scale of 0.1° × 0.1° across overall China. The results demonstrate that the national annual average PM_2.5 concentration declined from 51.9 ± 18.2 μg/m³ in 2015 to 39.0 ± 13.2 μg/m³ in 2019, and the overall annual negative trend was around -3.1 ± 2.2 μg/m³/year [-5.6 ± 3.4%/year] across China. Consequently, the number of PM_2.5-related deaths decreased by 383 thousand [95% CI: 331-429] to 1755 thousand [95% Confidence Interval: 1470-2025; GEMM NCD + LRI]; 315 thousand [95% CI: 227-370] to 1380 thousand [95% CI: 948-1740; GEMM 5-COD] and 125 thousand [95% CI: 64-140] to 876 thousand [95% CI: 394-1262; IER] in 2019, derived from the pre-established models (GEMM and IER). The estimate PM_2.5-attributed death with a spatial resolution of 0.1° × 0.1° was 2419 thousand [95% CI: 2041-2771; GEMM NCD + LRI], 1918 thousand [95% CI: 1333-2377; GEMM 5-COD] and 1162 thousand [95% CI: 534-1611; IER] in 2015, which is about 11-16% higher value than the city-level health risk assessment study. The estimated deaths by GEMM NCD + LRI and GEMM 5-COD were 104% and 61% higher than the estimated by IER, highlighting that total premature mortalities associated with PM_2.5 were substantially left behind based on the pre-existing model. The "other noncommunicable diseases" mortality, which IER method doesn't account for, was 375 thousand in 2019, 68 thousand less than in 2015. Such significant mortality was previously overlooked in estimation methods, which should now be considered for the air pollution-related policy development in China. The high number of premature deaths in central and northern parts of China, calls for the need for the Government to quickly impose even more stringent and effective pollution control measures.

Age- and season-specific effects of ambient particles (PM1, PM2.5, and PM10) on daily emergency department visits among two Chinese metropolitan populations

BACKGROUND

Ambient PM_2.5 has been identified as the top leading cause of risk-attributable deaths worldwide, particularly in China. Evidence suggested that PM₁ contributed the most majority of PM_2.5 concentrations in Chinese cities. However, epidemiologic knowledge to date is of wide lack regarding PM₁-associated health effects.

METHODS

We collected daily records of all-cause emergency department visits (EDVs) and ground measurements of ambient air pollutants and meteorological factors in Guangzhou and Shenzhen, China, 2015-2016. Case-crossover design and conditional logistic regression models were used to comparatively assess the short-term effects of ambient PM₁, PM_2.5, and PM₁₀ on EDVs. Stratified analyses by gender, age and season were performed to identify vulnerable groups and periods.

RESULTS

PM₁, PM_2.5 and PM₁₀ were all significantly associated with increased EDVs in both cities. Population risks for EDVs increased by 2.2% [95% confidence interval, 1.8 to 2.6] in Guangzhou and 1.7% [1.0 to 2.4] in Shenzhen, for a 10 μg/m³ rise in PM₁ at lag 0-1 days and lag 0-4 days, respectively. Relatively lower risks were found to be associated with PM_2.5 and PM₁₀. PM-EDVs associations exhibited no gender differences, but varied across age groups. Compared with adults and the elderly, children under 14 years-of-age suffered higher PM-induced risks. Results from both cities suggested greatly significant effect modification by season, with consistently stronger PM-EDVs associations during cold months.

CONCLUSIONS

Our study added comparative evidence for increased EDVs risks associated with short-term exposures to ambient PM₁, PM_2.5 and PM₁₀. Besides, PM-associated effects were significantly stronger among children and during cold months.

Analyses of air pollution control measures and co-benefits in the heavily air-polluted Jinan city of China, 2013-2017

China has made great efforts in air pollution control since 2013. However, there is a lack of evaluation of environmental, health and economic co-benefits associated with the national and local air pollution control measures at a city level. We analyzed local air pollution control policies and implementation in Jinan, one of the most heavily air-polluted cities in China between 2013 and 2017. We assessed the changes in exhaust emissions, air quality, mortality and morbidity of associated specific-diseases, and related economic benefits. We also projected the future scenarios of PM_2.5 concentration dropped to 15 μg/m³. There were significant decreases in exhaust emissions of SO₂ and NO_x in Jinan during the study period. Annual reductions in ambient air pollution were 72.6% for SO₂, 43.1% for PM_2.5, and 34.2% for PM₁₀. A total of 2,317 (95%CI: 1,533-2,842) premature deaths and 15,822 (95%CI: 8,734-23,990) related morbidity cases had been avoided in 2017, leading to a total of US$ 317.7 million (95%CI: 227.5-458.1) in economic benefits. Decreasing PM_2.5 concentrations to 15 μg/m³ would result in reductions of 70% in total PM_2.5-related non-accidental mortality and 95% in total PM_2.5-related morbidity, which translates into US$ 1,289.5 million (95%CI: 825.8-1,673.6) in economic benefits. The national and local air pollution control measures have brought significant environmental, health and economic benefits to a previously heavy polluted Chinese city.

Evaluating the effects of surface O3 on three main food crops across China during 2015-2018

In order to tackle China's severe air pollution issue, the government has released the "Air Pollution Prevention and Control Action Plan" (known simply as the "Action Plan") since 2013. A recent study reported a decreased trend in PM_2.5 concentrations over 2013-2017, but O₃ pollution has become more serious. However, the effects of surface O₃ on crops are unclear after the implementation of the "Action Plan". Here, we evaluated the potential negative effects of surface O₃ on three main food crops (winter wheat, maize and rice) across China during 2015-2018 using nationwide O₃ monitoring data and AOT40-yield response functions. Results suggested that mean O₃ concentration, AOT40 and relative yield loss in China showed an overall upward trend from 2015 to 2018. During winter wheat, maize, single rice, double-early rice, and double-late rice growing seasons, mean O₃ concentration in recent years ranged from 38.6 to 46.9 ppb, 40.2-43.9 ppb, 39.3-42.2 ppb, 33.8-40.0 ppb, and 35.9-39.1 ppb, respectively, and AOT40 mean values ranged from 8.5 to 14.3 ppm h, 10.5-13.4 ppm h, 9.8-11.9 ppm h, 5.2-9.2 ppm h, and 8.0-9.5 ppm h, respectively. O₃-induced yield reductions were estimated to range from 20.1 to 33.3% for winter wheat, 5.0-6.3% for maize, 7.3-8.8% for single rice, 3.9-6.8% for double-early rice and 5.9-7.1% for double-late rice. O₃-induced production losses for winter wheat, maize, single rice, double-early rice, and double-late rice totaled 39.5-88.2 million metric tons, 12.6-21.0 million metric tons, 9.5-11.3 million metric tons, 1.2-1.8 million metric tons, and 2.2-2.7 million metric tons, respectively, and the corresponding economic losses totaled 14.3-32.0 billion US$, 3.9-6.5 billion US$, 3.9-4.6 billion US$, 0.5-0.7 billion US$, and 0.9-1.1 billion US$, respectively. Our results suggested that the government should take effective measures to reduce O₃ pollution and its effects on agricultural production.

Lung Cancer in Never-Smokers: A Multicenter Case-Control Study in North China

This study aimed at estimating the effects of epidemiological risk factors for lung cancer in never-smokers. A multicenter and matched case-control study was conducted in the cities of Shijiazhuang, Xingtai, Qinhuangdao, Baoding, and Chengde in North China. It comprised 1,086 cases and 2,172 healthy subjects as controls, all of whom had smoked fewer than 100 cigarettes in their lifetimes. Patients were newly diagnosed with lung cancer between January 2015 and December 2017. Each patient was matched to two control participants for sex and age (±5 years). Both univariate analysis and multivariate conditional logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval (95% CI). Subsequently, data were stratified by participant sex and different air quality conditions for analysis. Type of job, exposure to environmental tobacco smoke in the workplace or at home, above-average exposure to cooking oil fumes, depression, poor sleep quality, occupational exposure, cardiovascular diseases, and family history of cancer were revealed as significant risk factors for lung cancer in never-smokers. However, higher educational level, frequent use of a PM_2.5 mask, cooking using clean fuels, and consumption of dietary supplements and tea reduced the risk of lung cancer. Risk factors varied between males and females. In areas with air pollution, the number of risk factors was greater than elsewhere, and the magnitudes of their effects were different. Hence, focusing on these risk factors is important for the prevention and control of lung cancer in never-smokers.

Trends of outdoor air pollution and the impact on premature mortality in the Pearl River Delta region of southern China during 2006-2015

Severe air pollution in the Pearl River Delta (PRD) region of southern China has increased attention of both the scientific community and policy makers. Air quality data collected at the PRD Regional Air Quality Monitoring Network during 2006-2015 were analyzed for assessing the effectiveness of pollution control measures and for estimating the trends of premature mortality attributable to ambient PM_2.5 and O₃. Statistically significant decreasing trends were detected for PM_2.5 (-1.74 to -1.83 μg m^-3 yr^-1), PM₁₀ (-2.70 to -2.78 μg m^-3 yr^-1), NO (-0.61 to -0.74 μg m^-3 yr^-1), NO₂ (-1.20 to -1.22 μg m^-3 yr^-1), and SO₂ (-3.46 to -4.01 μg m^-3 yr^-1), while an increasing trend was found for O₃ (0.70-0.86 μg m^-3 yr^-1) during the study period. The findings demonstrate the effectiveness of control measures implemented in the last decade for primary pollutants and also indicate the challenges for controlling secondary pollutants. The PM_2.5-related premature deaths varied little, e.g., from 40.6 thousand deaths in 2006 to 40.4 thousand deaths in 2015, due to the two contrasting factors, i.e., the decreased PM_2.5 concentration and increased population. The increases in both O₃ concentration and exposed population resulted in a significant rising trend for the O₃-related premature deaths, which increased from 2.7 thousand deaths in 2006 to 4.5 thousand deaths in 2015, at a rate of 165 deaths yr^-1. Consistent with the spatial distribution of air pollution and population density, high levels of premature deaths from PM_2.5 and O₃ were located in the central PRD including Guangzhou, Foshan, Dongguan, and Shenzhen. Decreasing PM_2.5 concentration is the most effective way in reducing the regional mortality burden from air pollution in the near future. Besides controlling primary emissions of PM_2.5, reducing VOCs emissions is also important for limiting atmospheric oxidizing capacity and associated secondary PM_2.5 formation.

Short-Term Effects of Carbonaceous Components in PM2.5 on Pulmonary Function: A Panel Study of 37 Chinese Healthy Adults

OBJECTIVES

To explore the health effects of indoor/outdoor carbonaceous compositions in PM_2.5 on pulmonary function among healthy students living in the local university campus.

METHODS

Daily peak expiratory flow (PEF) and forced expiratory volume in 1 second (FEV₁) were measured among 37 healthy students in the morning and evening for four two-week periods. Concurrent concentrations of indoor and outdoor PM_2.5 (particulate matter with an aerodynamic diameter ≤ 2.5μm), carbonaceous components in PM_2.5, ambient temperature, and relative humidity in the study area were also obtained. Mixed-effects model was applied to evaluate the associations between carbonaceous components and lung function. Different lags for the carbonaceous components were investigated.

RESULTS

In single-pollutant model, a 10 μg/m³ increase of indoor and outdoor EC (elemental carbon) associated with -3.93 (95%CI: -6.89, -0.97) L/min and -3.21 (95%CI: -5.67, -0.75) L/min change in evening PEF at lag 0 day, respectively. Also, a 10 μg/m³ increase of indoor and outdoor POC (primary organic carbon) concentration was significantly associated with -5.82 (95%CI: -10.82, -0.81) L/min and -7.32 (95%CI: -12.93, -1.71) L/min change of evening PEF at lag 0 day. After adjusting total mass of PM_2.5, indoor EC consistently had a significant adverse impact on evening PEF and FEV₁ at lag3 day and a cumulative effect at lag0-3 day.

CONCLUSIONS

This study suggests that carbonaceous components in PM_2.5 indeed have impacts on pulmonary function among healthy young adults especially on evening PEF. Thus, the local mitigation strategies on pollution are needed.

Air pollution intervention and life-saving effect in China

As a critical air pollutant, PM_2.5 is proved to be associated with numerous adverse health impacts and pose serious challenges to human life. This situation is especially important for China as the most populous and one of the heaviest PM_2.5 polluted country in the world. However, health burden estimations reported for China in previous studies may be biased due to the usage of PM_2.5 concentrations at a coarsely spatial resolution, as well as the ignorance of the spatial discrepancies of parameters (e.g. respiratory rate) employed in the exposure-response function. This study therefore utilized a hybrid remote sensing-geostatistical approach to refine PM_2.5 concentrations at 1 km resolution across mainland China from 2013 to 2017. Meanwhile, nationwide exposure parameters were for the first time introduced to weight the integrated exposure response (IER) function to calculate and spatially reallocate the corresponding PM_2.5-attributable premature deaths at 1 km resolution. Results showed that annually averaged PM_2.5 concentrations in mainland China decreased by 39.5%, from 59.1 μg/m³ in 2013 to 35.8 μg/m³ in 2017. Subsequently, PM_2.5 attributable premature deaths reduced 12.6%, from 1.20 million (95% CI: 0.57; 1.71) in 2013 to 1.05 million (95% CI: 0.44; 1.44) in 2017. This declining trend was found in most parts of China except some areas in Xinjiang, Jilin, and Heilongjiang provinces. As a result, 214,821 (95% CI: 96,675; 302,897) life were saved with an estimated monetary value of US$ 210.14 billion (2011 values). However, it has to be acknowledged that, the central and northern China within priority areas of air pollution control were still experiencing high numbers of premature deaths due to the severe PM_2.5 pollution and high-density population. But more worrying than these priority areas are those Harbin-Changchun Metropolitan Region, City Belt in Central Henan and Yangtze-Huaihe City Belt in non-priority areas, which also have been seriously suffering PM_2.5 attributable premature deaths over 28, 000 cases per year. In conclusion, despite the huge gain in life-saving effects in China over the past five years with the help of air pollution intervention policy, future work on cleaner air and better human health is still strongly needed, especially in non-priority areas of air pollution control.

PM2.5-related health and economic loss assessment for 338 Chinese cities

China is in a critical stage of ambient air quality management after global attention on pollution in its cities. Industrial development and urbanization have led to alarming levels of air pollution with serious health hazards in densely populated cities. The quantification of cause-specific PM_2.5-related health impacts and corresponding economic loss estimation is crucial for control policies on ambient PM_2.5 levels. Based on ground-level direct measurements of PM_2.5 concentrations in 338 Chinese cities for the year 2016, this study estimates cause-specific mortality using integrated exposure-response (IER) model, non-linear power law (NLP) model and log-linear (LL) model followed by morbidity assessment using log-linear model. The willingness to pay (WTP) and cost of illness (COI) methods have been used for PM_2.5-attributed economic loss assessment. In 2016 in China, the annual PM_2.5 concentration ranged between 10 and 157 μg/m³ and 78.79% of the total population was exposed to >35 μg/m³ PM_2.5 concentration. Subsequently, the national PM_2.5-attributable mortality was 0.964 (95% CI: 0.447, 1.355) million (LL: 1.258 million and NPL: 0.770 million), about 9.98% of total reported deaths in China. Additionally, the total respiratory disease and cardiovascular disease-specific hospital admission morbidity were 0.605 million and 0.364 million. Estimated chronic bronchitis, asthma and emergency hospital admission morbidity were 0.986, 1.0 and 0.117 million respectively. Simultaneously, the PM_2.5 exposure caused the economic loss of 101.39 billion US$, which is 0.91% of the national GDP in 2016. This study, for the first time, highlights the discrepancies associated with the three commonly used methodologies applied for cause-specific mortality assessment. Mortality and morbidity results of this study would provide a measurable assessment of 338 cities to the provincial and national policymakers of China for intensifying their efforts on air quality improvement.

Spatial Distribution of Secondary Organic Aerosol Formation Potential in China Derived from Speciated Anthropogenic Volatile Organic Compound Emissions

Fine particulate matter (PM_2.5), largely composed of secondary organic aerosol (SOA), is currently one of the most intractable environmental problems in China. As crucial precursors for SOA, understanding the formation propensity of various volatile organic compound (VOC) species and sources is useful for pollution control. In this work, we estimated the SOA formation potential (SOAP) of anthropogenic VOC emissions based on an improved speciated VOC emission inventory and investigated its distribution in China. According to our estimates, toluene had the largest SOAP, followed by n-dodecane, m-/p-xylene, styrene, n-decane, and n-undecane, while passenger cars, chemical fiber manufacturing, asphalt paving, and building coating were the top five SOAP-contributing sources nationwide. The spatial distribution of SOAP in China shows a distinct pattern of high values in the southeast and low values in the northwest. Beijing-Tianjin-Hebei and surroundings, the Yangtze River Delta, Pearl River Delta, and Sichuan-Chongqing District were found to have the highest SOAP, particularly in urban areas. The major SOAP-contributing species and sources differed among these regions, which was attributed to local industrial and energy structures. Our results suggest that to mitigate PM_2.5 pollution in China, more efficient SOAP-based control measures should be implemented instead of current emissions-based policies, and VOC control strategies should be adapted to local conditions.

Ambient air pollution of particles and gas pollutants, and the predicted health risks from long-term exposure to PM2.5 in Zhejiang province, China

In recent years, ambient air has been severely contaminated by particulate matters (PMs) and some gas pollutants (nitrogen dioxide (NO₂) and sulfur dioxide (SO₂)) in China, and many studies have demonstrated that exposure to these pollutants can induce great adverse impacts on human health. The concentrations of the pollutants were much higher in winter than those in summer, and the average concentrations in this studied area were lower than those in northern China. In the comparison between high-resolution emission inventory and spatial distribution of PM_2.5, significant positive linear correlation was found. Though the pollutants had similar trends, NO₂ and SO₂ delayed with 1 h to PM_2.5. Besides, PM_2.5 had a lag time of 1 h to temperature and relative humidity. Significant linear correlation was found among pollutants and meteorological conditions, suggesting the impact of meteorological conditions on ambient air pollution other than emission. For the 24-h trend, lowest concentrations of PM_2.5, NO₂, and SO₂ were found around 15:00-18:00. In 2015, the population attributable fractions (PAFs) for ischemic heart disease (IHD), cerebrovascular disease (stroke), chronic obstructive pulmonary disease (COPD), lung cancer (LC), and acute lower respiratory infection (ALRI) due to the exposure to PM_2.5 in Zhejiang province were 25.82, 38.94, 17.73, 22.32, and 31.14%, respectively. The population-weighted mortality due to PM_2.5 exposure in Zhejiang province was lower than the average level of the whole country-China.

Spatiotemporal Assessment of PM2.5-Related Economic Losses from Health Impacts during 2014⁻2016 in China

Background: Particulate air pollution, especially PM_2.5, is highly correlated with various adverse health impacts and, ultimately, economic losses for society, however, few studies have undertaken a spatiotemporal assessment of PM_2.5-related economic losses from health impacts covering all of the main cities in China. Methods: PM_2.5 concentration data were retrieved for 190 Chinese cities for the period 2014–2016. We used a log-linear exposure–response model and monetary valuation methods, such as value of a statistical life (VSL), amended human capital (AHC), and cost of illness to evaluate PM_2.5-related economic losses from health impacts at the city level. In addition, Monte Carlo simulation was used to analyze uncertainty. Results: The average economic loss was 0.3% (AHC) to 1% (VSL) of the total gross domestic product (GDP) of 190 Chinese cities from 2014 to 2016. Overall, China experienced a downward trend in total economic losses over the three-year period, but the Beijing–Tianjin–Hebei, Shandong Peninsula, Yangtze River Delta, and Chengdu-Chongqing regions experienced greater annual economic losses. Conclusions: Exploration of spatiotemporal variations in PM_2.5-related economic losses from long-term health impacts could provide new information for policymakers regarding priority areas for PM_2.5 pollution prevention and control in China.

Fine particulate matter associated mortality burden of lung cancer in Hebei Province, China

BACKGROUND

The association between fine particulate matter (PM_2.5 ) and lung cancer (LC) mortality in China is limited. The Beijing-Tianjin-Hebei region is infamous for serious air pollution. Seven of the top 10 cities with the worst air quality are located in Hebei Province. Thus, we explored the effect of 10 years of PM_2.5 on the LC mortality rate in Hebei Province.

METHODS

We quantified associations between LC mortality and PM_2.5 and estimated the LC mortality burden attributed to PM_2.5 with predicted county level LC deaths in 2014.

RESULTS

The 10-year PM_2.5 LC mortality associations were non-linear, with thresholds of 63 μg/m³ overall, 69 μg/m³ for men, 68 μg/m³ for women, 66 μg/m³ for those aged 30-64 years, and 62 μg/m³ for those aged ≥ 65 years. The relative risks for these groups were 1.09 (95% confidence interval [CI] 1.08-1.10), 1.06 (95% CI 1.03-1.10), 1.20 (95% CI 1.10-1.26), 1.07 (95% CI 1.05-1.11), and 1.10 (95% CI: 1.07-1.13), respectively. There were 2525 (95% CI 2265-2780) LC deaths attributed to 10-year PM_2.5 in 2014, at fractions of 8.3% (95% CI 7.4-9.1%) overall, 5.7% (95% CI 2.8-9.4%) for men, 16.7% (95% CI: 8.3-21.6%) for women, 6.5% (95% CI 4.7-10.3%) for those aged 30-64 years, and 9.1% (95% CI 6.4-11.5%) for those aged ≥ 65 years.

CONCLUSION

Our results suggest that a reduction in the PM_2.5 exposure levels below thresholds would prevent a substantial number of LC deaths in Hebei Province.

Estimation of PM2.5 Concentration Efficiency and Potential Public Mortality Reduction in Urban China

The particulate matter 2.5 (PM_2.5) is a serious air-pollutant emission in China, which has caused serious risks to public health. To reduce the pollution and corresponding public mortality, this paper proposes a method by incorporating slacks-based data envelopment analysis (DEA) and an integrated exposure risk (IER) model. By identifying the relationship between the PM_2.5 concentration and mortality, the potential PM_2.5 concentration efficiency and mortality reduction were measured. The proposed method has been applied to China’s 243 cities in 2015. Some implications are achieved. (1) There are urban disparities in estimated results around China. The geographic distribution of urban mortality reduction is consistent with that of the PM_2.5 concentration efficiency, but some inconsistency also exists. (2) The pollution reduction and public health improvement should be addressed among China’s cities, especially for those in northern coastal, eastern coastal, and middle Yellow River areas. The reduction experience of PM_2.5 concentration in cities of the southern coastal area could be advocated in China. (3) Environmental consideration should be part of the production adjustment of urban central China. The updating of technology is suggested for specific cities and should be considered by the policymaker.