Construction of air quality health index for respiratory diseases in Urumqi / 环境与职业医学

Background Air quality health index (AQHI) is derived from exposure-response coefficients calculated from air pollution and morbidity/mortality time series, which helps to understand the overall short-term health impacts of air pollution. Objective To study the effects of common air pollutants on respiratory diseases in Urumqi and to develop an AQHI for the risk of respiratory diseases in the city. Methods The daily outpatient volume data of respiratory diseases from The First Affiliated Hospital of Xinjiang Medical University, meteorological data (daily mean temperature and daily mean relative humidity), and air pollutants [fine particulate matter (PM2.5), inhalable particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon dioxide (CO), and ozone (O3)] in Urumqi City, Xinjiang, China were collected from January 1, 2017 to December 31, 2021. A distributed lag nonlinear model based on quasi-Poisson distribution was constructed by time-stratified case crossover design. Adopting zero concentration of air pollutants as reference, the exposure-response coefficient (β value) was used to quantify the impact of included air pollutants on the risk of seeking medical treatment for respiratory diseases, and the AQHI was established. The association of between AQHI and the incidence of respiratory diseases and between air quality index (AQI) and the incidence of respiratory diseases was compared to evaluate the prediction effect of AQHI. Results Each 10 µg·m−3 increase in PM10, SO2, NO2, and O3 concentrations presented the highest excess risk of seeking outpatient services at 3 d cumulative lag (Lag03) and 2d cumulative lag (Lag02), with increased risks of morbidity of 0.687% (95%CI: 0.101%, 1.276%), 17.609% (95%CI: 3.253%, 33.961%), 13.344% (95%CI: 8.619%, 18.275%), and 4.921% (95%CI: 1.401%, 8.502%), respectively. There was no statistically significant PM2.5 or CO lag effect. An AQHI was constructed based on a model containing PM10, SO2, NO2, and O3, and the results showed that the excess risk of respiratory disease consultation for the whole population, different genders, ages, or seasons for each inter-quartile range increase in the AQHI was higher than the corresponding value of AQI. Conclusion PM10, SO2, NO2, and O3 impact the number of outpatient visits for respiratory diseases in Urumqi, and the constructed AQHI for the risk of respiratory diseases in Urumqi outperforms the AQI in predicting the effect of air pollution on respiratory health.

Effects of Residential Proximity to Industrial Zone on Respiratory Symptoms among Residents in Parit Raja, Batu Pahat

@#Introduction: The industrial park in the district of Parit Raja, Batu Pahat resulted in rapid growth of the town during the last 20 years and has been a reason of concern that this park also has contributed greatly to the problem of air pollution. The aim of this study was to evaluate the association between industrial air pollution and respiratory symptoms in adults living in the Parit Raja. Methods: A comparative cross-sectional study was undertaken among residents in the district of Parit Raja, Batu Pahat, Johor, Malaysia. A total of 110 residents aged between 19 and 65 years were randomly selected and information on personal characteristics and respiratory symptoms was obtained through a validated questionnaire. The prevalence of respiratory symptoms was compared between residents recruited from the areas situated about 5km radius of the industrial park (exposed) and >5km radius from the industrial park (comparative). Results: A total of 34.5% and 25.5% of adults from the exposed group reported experiencing coughing for the last 3 months and chest tightness for the last 3 years. The logistic regression models showed that symptoms of coughing was associated with the exposed group (aOR=6.34, 95% CI=2.08-19.35), male respondents (aOR=3.18, 95% CI=1.10-9.16) and who stay in Part Raja for more than 14 years (aOR=3.16, 95% CI=1.14-8.79). Conclusion: This study demonstrated that long-term air pollution exposures are consistently associated with respiratory symptoms in residents living in the proximity of industrial parks. Therefore, public health initiatives that aim to provide more conducive environment are needed, especially for residents living near industrial parks.

Airborne PM2.5 and Parkinson's disease: An updated meta-analysis / 环境与职业医学

Background An association between atmospheric fine particulate matter (PM2.5) exposure and Parkinson's disease (PD) has been suggested by previous studies, but the results of current epidemiological studies are still inconclusive. Objective To systematically evaluate the relationship between exposure to ambient PM2.5 and the risk of PD, as well as to explore potential influencing factors, aiming to provide scientific evidence for formulating early prevention strategies for PD. Methods Cochrane Library, PubMed, Web of Science, Medline, Embase, China National Know-ledge Infrastructure (CNKI), Wanfang Database, and VIP Chinese Science and Technology Journal Database were queried. The search terms included Parkinson's disease, particulate matter 2.5, and PM2.5 in both Chinese and English. Cohort studies examining the association between atmospheric PM2.5 exposure and the risk of PD were collected and searched from the inception of each database to June 26, 2023. The identified literature was screened, and the basic information of the included studies and their research subjects, outcome indicators, quantitative results of each study, as well as the information required by bias risk assessment were extracted. The Newcastle-Ottawa Scale was employed to assess the risk of literature bias. Meta-analysis, subgroup analysis, sensitivity analysis, and publication bias analysis were conducted in Stata 15.0 software. Results Twelve cohort studies were identified. A total of 17443136 participants with follow-up periods ranging from 3.5 to 22 years were included in the analysis. The meta-analysis, utilizing a random-effects model, revealed that PD risk was elevated by 6% after exposure to PM2.5 [HR=1.06 (95%CI: 1.02, 1.11), P=0.006]. The subgroup analysis demonstrated that exposure to PM2.5 increased PD risk by 6% in North America [HR=1.06 (95%CI: 1.00, 1.12), P=0.033] and by 17% in East Asia [HR=1.17 (95%CI: 1.02, 1.33), P=0.020]. However, the effect was not statistically significant in Europe. PD risk exhibited a 7% rise [HR=1.07 (95%CI: 1.02, 1.14), P=0.011] in individuals aged 60 years and older, which was different from that in individuals younger than 60 years. Exposure to various concentrations of PM2.5 was observed to associate with an elevated risk of PD. The inclusion of adjustments for PD-related comorbidities did not alter the conclusion that ambient PM2.5 exposure might elevate the risk of PD. The studies with a follow-up duration exceeding 5 years and reporting more than 1000 PD cases suggested a significant increase in the risk of PD due to ambient PM2.5 exposure [HR=1.06 (95%CI: 1.01, 1.12), P=0.012; HR=1.06 (95%CI: 1.01, 1.11), P=0.027, respectively]. Conversely, no significant association was identified between ambient PM2.5 exposure and the risk of PD within the cohorts with a follow-up duration of less than 5 years and reporting fewer than 1000 PD cases [HR=1.09 (95%CI: 0.95, 1.26), P=0.214; HR=1.12 (95%CI: 0.98, 1.02), P=0.092, respectively]. The sensitivity analysis showed that the results were stable. The publication bias analysis and the combined trim-and-fill method showed that the results were robust. Conclusion The risk of PD could be increased by ambient PM2.5 exposure and influenced by age and area. The research results might be affected by the duration of follow-up and the quantity of PD cases reported.

Research progress on effects of air pollution on pollinosis and its mechanisms / 环境与职业医学

Pollinosis is one of the common allergic diseases, and its morbidity continues to increase. Studies have demonstrated that air pollution is a key environmental factor that leads to the increased prevalence of pollinosis. Air pollutants and pollen allergens exert synergistic effects in stimulating allergic responses in susceptible individuals. In this article, we analyzed the relationship between air pollution and pollinosis based on the latest studies, and elaborated potential mechanisms on how air pollution increases the incidence of pollinosis and aggravates allergic reactions. Air pollutants can increase both pollen production and the levels of allergenic proteins, and enhance allergenicity of pollen allergens through structural alterations or chemical modifications. The potential mechanisms of air pollutants exacerbating pollen allergies are as follows: Air pollutants may disrupt the barrier function of the respiratory epithelium and facilitate the penetration of pollen allergens into deeper tissues. Additionally, they may accelerate the process of the release of pollen allergy-related cytokines, promoting T helper 2 (Th2) cell differentiation and exacerbating inflammatory responses in the airways. Given the limitations of existing research, future prospective studies are needed to explore the effects of mixed pollutants and different types of pollutants on pollen, and the response mechanisms of allergy-related cells and cytokines to different pollutant categories. The findings would provide a comprehensive understanding of the impacts of air pollution on pollen allergies and scientific evidence for effective protection of the heath of pollinosis patients.

Effects of land cover and air pollution on the risk of preterm births / Efeitos da cobertura de solo e poluição do ar no risco de nascimentos prematuros

ABSTRACT OBJECTIVE To evaluate the association between gestational age and green areas, urban built areas, and the concentration of particulate matter 2.5 (PM2.5) in the city of São Paulo, analyzing the irregular distribution of these areas and pollution levels above the recommended level. METHODS The study population consisted of a cohort of live births from 2012, and data from the Live Birth Information System (Sinasc) of the city of São Paulo were used. Using satellite images and supervised classification, the distribution and quantity of green areas and built areas in the city of São Paulo was obtained, as well as the concentrations of PM2.5. Logistic regressions were used to obtain possible associations. RESULTS The results of the study show that a lower percentage of green areas is significantly associated with a higher chance of preterm births. A higher building density was positively associated with the odds ratio for preterm birth. We did not find any significant associations between air pollution (PM2.5) and preterm births. CONCLUSIONS The results of this study show that greener areas are less associated with preterm births when compared with less green areas.

RESUMO OBJETIVO Avaliar a associação entre a idade gestacional e as áreas verdes, áreas construídas urbanas e a concentração de material particulado 2,5 (MP2,5) em São Paulo, analisando a distribuição irregular dessas áreas e os níveis de poluição acima do recomendado. MÉTODOS A população utilizada no estudo foi a dos nascidos vivos no ano de 2012, com os dados do Sistema de Informações sobre Nascidos Vivo (Sinasc) na cidade de São Paulo. Por meio de imagens de satélites e realizando a classificação supervisionada, obtivemos a distribuição e quantidade de áreas verdes e de áreas construídas, na cidade de São Paulo, assim como as concentrações de MP2,5. Regressões logísticas foram utilizadas para obter possíveis associações. RESULTADOS Os resultados do estudo mostram que menor percentual de áreas verdes está associado significativamente com maior chance de prematuridade. Maior densidade de construção foi associada positivamente com a razão de chance de nascimento prematuro. Não encontramos resultados significativos entre a poluição do ar (MP2,5) e prematuridade. CONCLUSÕES Os resultados deste estudo demostraram que áreas mais verdes em relação às áreas menos verdes são menos associadas a nascimentos prematuros.

Biomonitoring of air quality in the Bodoquena microregion, Mato Grosso Do Sul: mutagenic and morphoanatomical alterations in Tradescantia pallida (rose) D.R. Hunt var. purpurea

Abstract The objective of this study was to assess air quality in relation to vehicular traffic flow in cities located at different elevations in the Bodoquena microregion, state of Mato Grosso do Sul, Brazil. To do so, a micronucleus test was carried out using the TRAD-MCN bioassay on young Tradescantia buds collected from February to November 2018 in seven cities of the microregion with different traffic flow intensities. Meteorological parameters were evaluated, and vehicular traffic was counted to determine traffic flow in each city. With data from the Shuttle Radar Topography Mission (SRTM) and processing in Esri ArcGIS® software version 10.5.1, the regions was mapped based on an Elevation Model. Morphoanatomical analyses were performed according to standard methodology. Measurements were taken of thickness, length and width of tissues and structures, including the upper and lower cuticle, upper and lower epidermis, hypodermis and mesophyll. The greatest traffic flow was found in the cities of Bodoquena, Guia Lopes da Laguna, Jardim, and Porto Murtinho, with the period from 5:00 to 6:00 p.m. showing the highest traffic flow. The greatest frequency of mutagenic alterations was found in the city of Guia Lopes da Laguna, although the results did not differ significantly from Bonito, Caracol, and Jardim. Throughout the biomonitoring, the summer and autumn seasons showed the greatest micronuclei frequencies in all evaluated cities. Variations in the tissue/structure thickness was observed across cities and seasons, but with a decrease in thickness during autumn. In general, the tissues/structures were smaller for the cities of Nioaque and Porto Murtinho, while the anatomical and morphological characteristics of leaf length and thickness showed no differences among cities. We found limited correlation between micronuclei frequency and traffic flow, supporting the hypothesis that although mutagenic alterations are observed in T. pallida, in this microregion the changes are numerically lower when compared to other regions of the state. In light of the genotoxic and morphoanatomical factors assessed herein, the Bodoquena microregion appears to be well preserved in terms of air quality, presenting low micronuclei frequency and a limited reduction in tissues and leaf structures, regardless of the season.

Resumo O objetivo deste trabalho foi avaliar a qualidade do ar com base no fluxo veicular das cidades localizadas em diferentes altitudes na microrregião da Bodoquena, no estado de Mato Grosso do Sul, Brasil. Para tal, foi realizado o teste de micronúcleo, por meio do bioensaio TRAD-MCN em botões jovens de Tradescantia coletadas no período entre fevereiro a novembro de 2018 em sete cidades da microrregião da Bodoquena, com diferentes intensidades de fluxo veicular. Foram avaliados os parâmetros meteorológicos, os veículos foram contados para determinar o tráfego de veículos em cada cidade e altitude. A partir da topografia Shuttle Radar (SRTM) e processamento no software Esri ArcGIS® versão 10.5.1 foi possível mapear a área com base no Modelo de Elevação. As análises morfoanatômicos foram realizadas conforme metodologia padrão. As mensurações de espessura, comprimento, largura dos tecidos e estruturas como a cutícula superior, cutícula inferior, face superior e face inferior da epiderme, hipoderme e mesófilo foram avaliadas. O maior fluxo veicular foi encontrado nas cidades de Bodoquena, Guia Lopes da Laguna, Jardim e Porto Murtinho. O horário das 17:00 às 18:00h foi o que apresentou maiores fluxo de veículos. A maior frequência de alterações mutagênicas foi encontrada na cidade de Guia Lopes, não diferindo de Bonito, Caracol e Jardim. Ao longo do biomonitoramento observou-se que as estações de verão e outono foram as que apresentaram maiores frequências de micronúcleo independente da cidade avaliada. Observou-se que a correlação entre a frequência de micronúcleos e o fluxo veicular foi baixa, apoiando a tese de que essa microrregião, embora apresente alterações mutagênicas em T. pallida, as alterações numericamente são pequenas quando comparadas a outras regiões do estado de Mato Grosso do Sul. Observou-se uma variação na espessura dos tecidos/estruturas que é variável entre as diferentes cidades e estações do ano. De forma geral os tecidos/estrutura apresentaram redução na espessura para as cidades de Nioaque e Porto Murtinho quanto aos aspectos anatômicos e morfológicos, sendo que, para o comprimento e espessura foliar não foi observado diferenças entre as cidades. Em relação as estações do ano, observou-se que no outono a espessura dos tecidos/estruturas são menores. Diante dos fatores genotóxicos e morfoanatômicos aqui avaliados, a microrregião da Bodoquena parece estar bem preservada em termos de qualidade do ar, apresentando baixa frequência de micronúcleos e redução limitada de tecidos e estruturas foliares, independentemente da estação do ano.

Defectos congénitos y exposición prenatal a material particulado en una población colombiana

Objetivo. Determinar la existencia de asociación entre defectos congénitos y la exposición prenatal de mujeres gestantes a PM10 en una población colombiana. Métodos. Estudio retrospectivo de casos y controles. Se incluyeron casos de madres de recién nacidos con defectos congénitos confirmados posnatalmente y controles sin defectos congénitos. La exposición a emisiones se determinó mediante disgregación temporo-espacial mediante ArcGIS® y georreferenciación mediante gvSIG, Google Earth y Google Street View®, usando estimaciones previamente publicadas y validadas para la ciudad. El análisis estadístico se realizó utilizando Jamovi-Stats Open now. Resultados . Se incluyeron un total de 101 pacientes, correspondiendo a 31 casos y 70 controles. Existió un aumento del riesgo de desarrollar defectos congénitos tras la exposición a emisiones de PM10 superiores a 2,23 Ton/año/250 m2 (OR: 8,17; IC 95%: 1.61 a 41.46; p = 0,011). Conclusiones. Existió relación entre la exposición a niveles elevados de PM10 y aumento en el riesgo de defectos congénitos en la población estudiada. Se sugiere la realización de futuras investigaciones sobre la relación entre contaminación medioambiental y eventos obstétricos adversos.

Objective: To determine the existence of an association between birth defects and prenatal exposure of pregnant women to PM10 in a Colombian population. Methods: Retrospective case-control study. Cases of mothers of newborns with postnatally confirmed congenital defects and controls without congenital defects were included. Emission exposure was determined by temporo-spatial disaggregation using ArcGIS® and georeferencing using gvSIG®, Google Earth® and Google Street View®, using previously published and validated estimates for the city. Statistical analysis was performed using Jamovi-Stats Open now®. Results: A total of 101 patients were included, corresponding to 31 cases and 70 controls. There was an increased risk of developing birth defects after exposure to PM10 emissions above 2.23 Ton/year/250m2 (OR: 8.17; 95% CI: 1.61 - 41.46; p = 0.011). Conclusions: There was a relationship between exposure to high levels of PM10 and increased risk of birth defects in the population studied. Future research on the relationship between environmental contamination and adverse obstetric events is suggested.

The effect of social determinants of health on severity of microbial keratitis presentation at a tertiary eye care hospital in Southern India

Purpose: Understanding the association between social determinants of health (SDoHs) and microbial keratitis (MK) can inform underlying risk for patients and identify risk factors associated with worse disease, such as presenting visual acuity (VA) and time to initial presentation. Methods: This was a cross?sectional study was conducted with patients presenting with MK to the cornea clinic at a tertiary care hospital in Madurai, India. Patient demographics, SDoH survey responses, geographic pollution, and clinical features at presentation were collected. Descriptive statistics, univariate analysis, multi?variable linear regression models, and Poisson regression models were utilized. Results: There were 51 patients evaluated. The mean age was 51.2 years (SD = 13.3); 33.3% were female and 55% did not visit a vision center (VC) prior to presenting to the clinic. The median presenting logarithm of the minimum angle of resolution (logMAR) VA was 1.1 [Snellen 20/240, inter?quartile range (IQR) = 20/80 to 20/4000]. The median time to presentation was 7 days (IQR = 4.5 to 10). The average particulate matter 2.5 (PM2.5) concentration, a measure of air pollution, for the districts from which the patients traveled was 24.3 ?g/m3 (SD = 1.6). Age? and sex?adjusted linear regression and Poisson regression results showed that higher levels of PM2.5 were associated with 0.28 worse presenting logMAR VA (Snellen 2.8 lines, P = 0.002). Patients who did not visit a VC had a 100% longer time to presentation compared to those who did (incidence rate ratio = 2.0, 95% confidence interval = 1.3–3.0, P = 0.001). Conclusion: Patient SDoH and environmental exposures can impact MK presentation. Understanding SDoH is important for public health and policy implications to mitigate eye health disparities in India.

To Study the Effect of Interventions to Reduce the Indoor Air Pollution in Asthmatic Children of Rural India

Background: Around 2.6 billion people cook their food using biomass fuel (BMF), kerosene oil, and coal fuel, by which each year, 4 million people die prematurely from household air pollution or by this inefficient cooking practices. So, this study was planned to measure the effect of interventions of cooking fuel (BMF to LPG) to reduce the indoor air pollution in asthmatic children of rural India. Methods: Prospective observational study was done by door-to-door survey, among school-age children. Households of asthmatic children were encouraged to change their cooking fuel to more secure and were followed up for a period of 9 months. The intervention was in the form of a change of cooking fuel (from BMF to LPG) and proper education. The levels of indoor pollutants (PM10, PM2.5, and PM1) were measured before and after 3 months of follow-up. Result: A total of 56 asthmatic children from 42 households were followed-up for the following 9 months at every 3 months visit. The mean age was 9.27 ± 3.94 years with an equivalent sex ratio. There was at least one smoker in 73.81% of households of asthmatic children. Nearly, 45% of children were living in 101–500 square yard area and 67.86% with the inhabitation of ? 3/room. The level of all particulate matter decreased significantly at 3 months (p < 0.05). At 3, 6, 9 months of follow-up, respiratory symptoms and morbidity significantly diminished. Conclusion: The change in cooking fuel to more secure was found to be one of the factors decreasing indoor pollutants and respiratory symptoms/morbidity among asthmatic children in rural areas.

Effect of Household Air Pollution on Blood Pressure – A Review.

High blood pressure (BP) remains a public health issue of concern in low- and middle-income countries (LMICs). Cooking with solid biomass fuel is common in LMICs, producing hazardous levels of household air pollution (HAP), and exposure to which results in significant morbidity and mortality. The primary victims are women, who are the immediate users. Therefore, a potential relationship between these factors would have massive public health reverberations. Our objective was thus to perform a literature review of the studies investigating the association between HAP and BP in women. We searched the PubMed, CORE, and Semantic Scholar databases from inception through March 2022 to identify reports investigating the relationship between BP and HAP from solid fuel use. The studies included in this report point to an increased risk of high BP from HAP generated as a consequence of using solid fuels for cooking. Conversely, few studies have reported a negative association between HAP and BP. Notably, this inconsistency and the limited evidence base necessitate confirmation of the association by more extensive and robust studies. Further, this report identifies a need to introduce and implement effective clean cooking solutions for public health benefits.

Effect of air pollution on mortality among residents in Hangzhou City / 预防医学

Objective@#To examine the effects of air pollution on overall mortality, mortality of respiratory diseases, and mortality of circulatory diseases among residents in Hangzhou City.@*Methods@#Residents' mortality data in Hangzhou City from 2014 to 2016 were captured from Zhejiang Provincial Chronic Disease Surveillance Information Management System, and the ambient air quality in Hangzhou City from 2014 to 2016 were collected from Hangzhou Environmental Monitoring Center, while the meteorological monitoring data during the study period were collected from Hangzhou Meteorological Bureau. The effects of PM2.5, PM10, NO2 and SO2 on overall mortality, morality of respiratory diseases and mortality of circulatory diseases were evaluated a generalized additive model (GAM) based on Poisson distribution, and the risk of mortality was described with excess risk (ER) and its 95%CI.@*Results@#The daily M (QR) overall deaths, deaths from respiratory diseases and deaths from circulatory diseases were 111 (30), 16 (9) and 37 (14) persons in Hangzhou City from 2014 to 2016, respectively. A 10 μg/m3 increase in PM2.5, PM10, NO2 and SO2 resulted in 0.47% (95%CI: 0.23%-0.70%), 0.37% (95%CI: 0.21%-0.53%), 1.06% (95%CI: 0.50%-1.61%) and 3.08% (95%CI: 2.18%-3.99%) rises in the risk of overall mortality, 0.60% (95%CI: 0.04%-1.16%), 0.45% (95%CI: 0.06%-0.83%), 2.01% (95%CI: 0.84%-3.20%) and 6.06% (95%CI: 3.80%-8.37%) rises in the risk of mortality of respiratory diseases, and 0.45% (95%CI: 0.08%-0.83%), 0.44% (95%CI: 0.17%-0.71%), 1.43% (95%CI: 0.49%-2.37%) and 3.66% (95%CI: 2.13%-5.22%) rises in the risk of mortality of circulatory diseases, and the greatest effect was observed at a 2-day lag. Multi-pollutant model analysis showed that, after adjustment for PM2.5, NO2 and PM2.5+NO2+SO2, a 10 μg/m3 increase in SO2 resulted in an elevated risk of mortality of respiratory diseases than a single-pollutant model.@*Conclusions@#The air pollutants PM10, PM2.5, NO2, and SO2 correlated positively with the risk of overall mortality, mortality of respiratory diseases and mortality of circulatory diseases in Hangzhou City from 2014 to 2016, and the co-existence of multiple pollutants enhanced the effect of SO2 on mortality of respiratory diseases.

Role of interleukin-6 signaling pathway in adverse health effects induced by air pollution / 环境与职业医学

Air pollution is one of the most important environmental issues in China and worldwide, as well as a critical public health problem affecting human health. With the implementation of emission reduction and other programs, the air quality in China has been improved dramatically in recent years, but is still worse than the WHO guideline recommended levels. Numerous epidemiological and toxicological studies have shown that short-term or long-term exposure to air pollution is strongly associated with respiratory diseases, cardiovascular diseases, diabetes, and so forth, in which interleukin-6 (IL-6), a well-known inflammatory factor, may play an important role. Studies have found that IL-6 can bind to interleukin-6 receptor (IL-6R) , which leads to the recruiting and activation of glycoprotein 130, and then the formed IL-6/IL-6R/gp130 complex triggers the janus kinase/signal transducer and activator of transcription, Src homology-2 domain-containing protein tyrosine phosphatase-2/mitogen-activated protein kinase, and phosphatidylinositol 3-kinase/protein kinase B signaling pathways. All of these signaling pathways are found to be involved in a variety of physiopathological processes. In the present review, information about the IL-6 signaling pathway and its role in air pollution-induced adverse health effects was systematically reviewed, hoping to provide insights for the future prevention and control policies.

Association between time-weighted individual exposure to ambient pollutants and carotid intima-media thickness / 环境与职业医学

Background Evidence about the association between air pollution and carotid intima-media thickness (CIMT) is inconsistent, and limited studies have explored the relationship between gaseous pollutants and CIMT. Additionally, personal activity patterns and infiltrated ambient pollution are not comprehensively considered to estimate individual exposure to air pollutants. Objective To investigate the relationship between long-term time-weighted individual exposure to ambient pollutants [fine particulate matter (PM2.5), inhalable particulate matter (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO)] and the progression of CIMT. Methods This study was performed among 554 participants in the Beijing Health Management Cohort who were free of atherosclerotic lesions on carotid artery at baseline. Daily concentrations of pollutants were predicted at both residential and work addresses based on land-use regression model. With additional consideration of personal indoor and outdoor activity patterns at both addresses and exposure to ambient pollutants from traffic transportation, individual time-weighted concentration was calculated. Indoor exposure was estimated by infiltrated ambient pollutants (based on infiltration factors and land-use regression model). Personal activity patterns included type, time, location, and frequency. Exposure to ambient pollutants from different traffic transportations was estimated by the average outdoor pollutant concentrations at both residential and work addresses combined within filtration factors and time spent on commuting. Multiple linear regression was conducted to assess the association of time-weighted individual pollutant exposure and the central position of CIMT progression. Quantile regression was applied to explore the relationship between time-weighted individual pollutant exposure and the progression of CIMT on different percentiles. Results The median value of CIMT progression was 369.49 μm·year−1. PM2.5, PM10, SO2, and O3 were associated with CIMT progression in the multiple linear regression model. The largest effect sizes of PM2.5, PM10, and SO2 were obtained for one-year exposure (regression coefficient: 66.910, 64.077, and 191.070, respectively), and two-year exposure for O3 (regression coefficient: 62.197). The results of quantile regression demonstrated different effect sizes for pollutants among different percentiles on CIMT progression. Significant associations between CIMT progression and PM2.5 from P30 to P50, CO from P10 to P40, and PM10 from P30 to P60 were observed. Two-year and three-year exposures to NO2 (P10, P20 and P40) were also associated with CIMT progression. The association between SO2 and the progression of CIMT was proved on all percentiles, and larger effect sizes of one-year and two-year exposures to SO2 (except P90) were demonstrated with increasing percentiles. The upward trend for the coefficients was clearly presented from P50 to P80. Specifically, the coefficient of two-year exposure to SO2 ranged from 136.583 (P50) to 277.330 (P80). No statistically significant association was observed between O3 and CIMT progression on any percentile (P>0.05), and the results were inconsistent with those of the multiple linear regression. Conclusion Individual time-weighted exposures to PM2.5, PM10, SO2, NO2, and CO have the potential to promote the progression of CIMT, and the adverse effect of ambient pollution on atherosclerotic lesion is identified.

Construction of AQHI based on joint effects of multi-pollutants in 5 provinces of China / 环境与职业医学

Background Air pollution is a major public health concern. Air Quality Health Index (AQHI) is a very important air quality risk communication tool. However, AQHI is usually constructed by single-pollutant model, which has obvious disadvantages. Objective To construct an AQHI based on the joint effects of multiple air pollutants (J-AQHI), and to provide a scientific tool for health risk warning and risk communication of air pollution. Methods Data on non-accidental deaths in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces from January 1, 2013 to December 31, 2018 were obtained from the corresponding provincial disease surveillance points systems (DSPS), including date of death, age, gender, and cause of death. Daily meteorological (temperature and relative humidity) and air pollution data (SO2, NO2, CO, PM2.5, PM10, and maximum 8 h O3 concentrations) at the same period were respectively derived from China Meteorological Data Sharing Service System and National Urban Air Quality Real-time Publishing Platform. Lasso regression was first applied to select air pollutants, then a time-stratified case-crossover design was applied. Each case was matched to 3 or 4 control days which were selected on the same days of the week in the same calendar month. Then a distributed lag nonlinear model (DLNM) was used to estimate the exposure-response relationship between selected air pollutants and mortality, which was used to construct the AQHI. Finally, AQHI was classified into four levels according to the air pollutant guidance limit values from World Health Organization Global Air Quality Guidelines (AQG 2021), and the excess risks (ERs) were calculated to compare the AQHI based on single-pollutant model and the J-AQHI based on multi-pollutant model. Results PM2.5, NO2, SO2, and O3 were selected by Lasso regression to establish DLNM model. The ERs for an interquartile range (IQR) increase and 95% confidence intervals (CI) for PM2.5, NO2, SO2 and O3 were 0.71% (0.34%–1.09%), 2.46% (1.78%–3.15%), 1.25% (0.9%–1.6%), and 0.27% (−0.11%–0.65%) respectively. The distribution of J-AQHI was right-skewed, and it was divided into four levels, with ranges of 0-1 for low risk, 2-3 for moderate risk, 4-5 for high health risk, and ≥6 for severe risk, and the corresponding proportions were 11.25%, 64.61%, 19.33%, and 4.81%, respectively. The ER (95%CI) of mortality risk increased by 3.61% (2.93–4.29) for each IQR increase of the multi-pollutant based J-AQHI , while it was 3.39% (2.68–4.11) for the single-pollutant based AQHI . Conclusion The J-AQHI generated by multi-pollutant model demonstrates the actual exposure health risk of air pollution in the population and provides new ideas for further improvement of AQHI calculation methods.

Correlation between atmospheric nitrogen oxides and nitrogen dioxide acute exposure and outpatient visits of pediatric respiratory diseases / 预防医学

Objective @#To examine the association between acute exposure to traffic-related air pollutants (TRAP) NOX and NO2 and outpatient visits of pediatric respiratory diseases. @*Methods @#Data regarding outpatient visits to Department of Respiratory Diseases of Beijing Children's Hospital from 2015 to 2020 were collected, and the concentrations of nitrogen oxides (NOX), nitrogen dioxide (NO2) and other TRAP were collected from the surveillance sites assigned by the Peking University Health Science Center. A time-stratified case-crossover design was employed, and a conditional logistic regression model was created to examine the association between NOX and NO2 acute exposure and outpatient visits of pediatric respiratory diseases. @*Results @#The daily mean outpatient visits of pediatric respiratory diseases were 571 (interquartile range, 554) person-times among children at ages of 0 to 14 years in Beijing Children's Hospital from 2015 to 2020, and the daily mean outpatient visits for upper respiratory tract infections (URI), bronchitis, and pneumonia were 265 (interquartile range, 282), 143 (interquartile range, 178) and 128 (interquartile range, 120) person-times, respectively. The daily mean concentrations of atmospheric NOX and NO2 were 67.8 (interquartile range, 50.7) and 49.3 (interquartile range, 30.7) μg/m3, respectively. Conditional logistic regression analysis showed the largest lagged effect of NOX and NO2 on pediatric respiratory diseases at cumulative lags of 0 to 7 days. An increase in NOX concentrations by an interquartile range resulted in the excess risks of URI, bronchitis and pneumonia by 6.87% (95%CI: 6.37%-7.38%), 7.25% (95%CI: 6.51%-7.99%), and 5.51% (95%CI: 4.69%-6.33%), and an increase in NO2 concentrations by an interquartile range resulted in excess risks of URI, bronchitis and pneumonia by 5.71% (95%CI: 5.12%-6.31%), 5.32% (95%CI: 4.51%-6.14%), and 4.83% (95%CI: 3.91%-5.75%), respectively. NOX and NO2 presented a more remarkable effect on outpatient visits of pediatric respiratory diseases among children at ages of over 5 years. @*Conclusion @#NOx and NO2 acute exposure may increase the outpatient visits of pediatric respiratory diseases.

Tonstruction of AHI based on the integrating health risks of exposure to air pollution and ambient temperature in Tianjin / 公共卫生与预防医学

Objective To construct an air health index (AHI) based on the exposure-response relationships of air pollution and ambient temperature with the years of life lost (YLL) in Tianjin. Methods The time series database of air pollution, meteorological factors, and non-accidental YLL from 2014-2019 in six urban areas of Tianjin were established. The data from 2014 to 2017 were used as the construction set to establish the exposure-response relationships of air pollution and ambient temperature with non-accidental YLL and establish the AHI model. The data from 2018 to 2019 were used as the validation set for verifying AHI. The generalized additive model (GAM) and weighted quantile sum (WQS) model were used to establish the exposure-response relationship between air pollution mixtures and non-accidental YLL. The distributed lag nonlinear model (DLNM) was fitted to assess the exposure-response relationship between ambient temperature and non-accidental YLL. Based on these obtained coefficients, the AHI and air quality health index (AQHI) were built. By comparing the associations between AHI, air quality health index (AQHI), and air quality index (AQI) with daily mortality and YLL and model goodness of fit to evaluate the validity of AHI. Results The formula for AHIt=EYLLt,air pollution+ambient temperature/475.11*10. The validation results showed that each IQR increase in AHI was associated with a higher increase in non-accidental mortality and YLL (10.61% and 353.37 person-year) compared with the corresponding values of AQHI and AQI. In addition, the model goodness of AHI was better than AQHI and AQI model. Conclusion Compared with AQHI and AQI, the AHI based on the integrating health effects of air pollution and ambient temperature has a better health risk prediction ability.

Research progress on cardiovascular effects of traffic-related air pollution and noise: Evidence from population-based and mechanism studies / 环境与职业医学

Traffic-related air pollution and noise are becoming increasingly prominent issues in the context of urbanization, both of which are modifiable environmental risk factors for cardiovascular diseases. Those two kinds of traffic-related pollution may have combined effects on the cardiovascular system of human beings, but the biological mechanisms by which they may interact have not been elucidated yet. Thus, we reviewed the research progress based on published population-based and mechanism studies from five aspects, including oxidative stress, inflammatory response, nervous system activation and stress hormones, coagulation dysfunction, and endothelial dysfunction, providing indications for possible common biological pathways. Future studies can construct co-exposure scenarios for traffic-related air pollution and noise to explore their common biological mechanisms in the cardiovascular system by examining the reviewed pathways to provide a scientific basis for the protection of susceptible populations. In addition, the effect modification by individual characteristics and underlying diseases may merit further exploration.

Meta-analysis on correlations between short-term exposures to 6 common air pollutants and incidence of ischemic stroke / 环境与职业医学

Background Previous studies using meta-analysis to explore the relationship between air pollution exposure and ischemic stroke (IS) mostly focus on particulate matter-related themes, few include gaseous pollutants in the study, and subgroup analyses of factors such as different lag days, seasons, and genders are rarely been reported. Objective To quantitatively evaluate the relationships between short-term exposures to 6 common air pollutants, including fine particulate matter (PM2.5), inhalable particulate matter (PM10), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3), and the incidence of IS. Methods A systematic search was conducted to collect literature studying the 6 common air pollutants and IS published up to May 1, 2022 in 6 databases (China Journal Full-text Database, China Biology Medicine Disc, PubMed, Cochrane Library, Web of Science, and Embase). Literature quality evaluation was performed using the Newcastle-Ottawa Scale. Stata 16.0 software was used to conduct meta-analysis including heterogeneity test, combined effect size, meta-regression, subgroup analysis, sensitivity analysis, and publication bias test. Results A total of 33 articles were qualified for inclusion. The total number of samples included in the literature was 7195631. The meta-analysis results showed that short-term exposures to PM2.5 (OR=1.0082, 95%CI: 1.0049−1.0116), PM10 (OR=1.0017, 95%CI: 1.0008−1.0026), CO (OR=1.0328, 95%CI: 1.0231−1.0426), NO2 (OR=1.0150, 95%CI: 1.0079−1.0222), SO2 (OR=1.0158, 95%CI: 1.0078-1.0238), and O3 (OR=1.0017, 95%CI: 1.0003−1.0032) were associated with an increased risk of IS. PM10 and O3 increased the risk of IS in both lag0 and lag1, while PM2.5, CO, NO2, and SO2 all showed an associated increased risk of IS only in lag0. The results of sensitivity analysis showed stable results for all pollutants studied, and there was no publication bias in the literature on the association of the remaining five pollutants with IS incidence except for the PM2.5-related literature. Conclusion Short-term exposures to PM2.5, PM10, CO, NO2, SO2, and O3 may increase the incidence of IS, with this risk showing the most significant level on the day of IS onset.

Relationship between reduction of urban PM2.5 and mental health of middle-aged and elderly people after China's Air Pollution Prevention and Control Action Plan / 环境与职业医学

Background Epidemiological evidence indicates an association of particulate matter with depression and cognitive performance. From 2013 to 2017, China implemented the Air Pollution Prevention and Control Action Plan to reduce particulate matter concentration. There are few studies on the relationship between the decrease of particulate matter concentration and the improvement of mental health in middle-aged and elderly people. Objective To analyze the relationship between the decrease of city-level particulate matter concentration and the improvement of depression and cognitive function in the middle-aged and elderly population after the implementation of the Air Pollution Prevention and Control Action Plan. Methods Using the China Health and Retirement Longitudinal Study (CHARLS) data in 2011 and 2018, this study applied longitudinal data clustering technology to group cities based on the actual response of each city to the policy (the dynamic change trajectory of PM2.5 in each city during the study period); the higher the degree of response, the greater the reduction of PM2.5 concentration in the city. We assigned participants to three groups with different degrees of response to the policy, including low-response group A as the control group, medium-response intervention group B, and high-response intervention group C. A difference-in-differences (DID) model was used to estimate the influence of PM2.5 decline on the depression and cognitive function among middle-aged and elderly people in China by considering potential individual and city-level time-varying confounders. Depression was measured using the 10-item Center for the Epidemiological Studies of Depression Scale (CES-D10) (10 questions, total score range 0-30) with higher score representing higher severity of depression. Cognitive function was evaluated with reference to the international cognitive function test questionnaire for the middle-aged and the elderly which was further categorized into two dimensions of memory and cognitive status and included 31 questions with a score range of 0-31; the higher the score, the better the cognitive function. Samples with relatively complete outcomes were selected for analysis, including 10729 people in depression analysis and 4510 people in cognitive analysis. Results The longitudinal clustering results indicated that the urban groups with the highest decline of PM2.5 concentrations (high-response group C) had the highest baseline PM2.5 concentrations, mainly in Beijing-Tianjin-Hebei region, Chengdu-Chongqing metropolitan area, and Wuhan metropolitan area. In 2011, no significant differences were observed in depression and cognitive function among the three groups of middle-aged and elderly populations (Kruskal Wallis test: Pdepression=0.864, Pcognition=0.239). Significant differences were found in depression and cognitive function in both low-response group A and medium-response group B in 2018 compared to 2011 (paired Wilcox test, all P<0.001). However, in the high-response group C, there was no significant difference in depression in 2018 compared to 2011 (P=0.195), while a significant difference was detected in cognitive function (P=0.006). As PM2.5 concentrations decreased, the DID model showed that the depression of the middle-aged and elderly people in the high-response group C decreased by 7.55% (95%CI: 2.83%-12.03%), and the cognitive function improved by 2.70% (95%CI: 0.25%-5.22%) compared with the low-response group A. However, no intervention effect was observed in group B with moderate response level compared with group A with low response level. Conclusion After the implementation of the Air Pollution Prevention and Control Action Plan policy, the decrease of PM2.5 concentration has an ameliorative effect on the depression and cognitive function of middle-aged and elderly people in China. Given the aging population and the increasing burden of mental-related diseases in China, the promotion of environmental air pollution control has important public health implications.

Time-series analysis of association between air pollution and hospital outpatient visits in a district of Shanghai from 2015 to 2019 / 上海预防医学

ObjectiveTo explore the association between air pollutants and hospital outpatient visits in a district of Shanghai. MethodsDaily meteorological data， environmental data， data of outpatient visits to two secondary hospitals and two tertiary hospitals in this district from January 1， 2015 to December 31， 2019 were collected. A Poisson regression generalized linear model was used to analyze the exposure-response relationship between the air pollutants and hospital outpatient visits in this area. ResultsDuring the study period， the total number of outpatient visits in the included hospitals was 17 802 634， with an average daily total of （9 750±4 191） outpatient visits，and an average daily of （761±341） respiratory outpatient visits. In the lag effect of single pollutant model， when the concentration of air pollutant increased by 10 μg·m-3， PM2.5， SO2， NO2 had the maximum lag effect on the number of outpatient visits in the department of internal medicine for respiratory diseases on lag day 4， day 5 and day 7， respectively. And the RR values and 95%CI were 1.002 0（1.001 3‒1.002 6）， 1.0154（1.012 3‒1.018 5）， and 1.006 1（1.005 3‒1.006 9）， respectively. ConclusionThere is a exposure-response relationship between air pollutants and the number of outpatient visits in each department of the hospitals， and different pollutants have different degrees of lag effects.