The association between fine particulate air pollution and hospital emergency room visits for cardiovascular diseases in Beijing, China

Background

Because epidemiological studies have yielded different results, the association between exposure to fine particulate matter less than 2.5 μm in aerodynamic diameter (PM_2.5) and acute events of cardiovascular diseases (CVD) is unknown. Additionally, no research has been conducted to explore the association between PM_2.5 and hospital emergency room (ER) visits of cardiovascular diseases in Beijing, China.

Objective

To explore the association between PM_2.5 and the hospital ER visits in Beijing, China for CVD {(International Classification of Diseases, 10th vision (ICD-10): I00~I99)}.

Methods

We collected data for daily hospital ER visits for CVD from the Peking University Third Hospital, daily ambient PM_2.5 data from a fixed monitor site at Peking University, and data on the daily level of gaseous air pollutants {sulfur dioxide (SO₂) and nitrogen dioxide (NO₂)} from the Beijing Municipal Environmental Monitoring Center between June 1, 2004 and December 31, 2006. A time-stratified case-crossover design was used to evaluate associations between CVD health outcomes and ambient air pollutants.

Results

8377 hospital ER visits of CVD were collected in our study. After adjusting the temperature and the relative humidity, the associations for 10 μg/m³ increases in levels of PM_2.5, SO₂, or NO₂ and hospital ER visits for cardiovascular diseases were statistically significant with odds ratios (ORs) of 1.005{95% confidence interval (CI): 1.001-1.009}, 1.014(95% CI: 1.004-1.024), and 1.016(95% CI: 1.003-1.029), respectively.

Conclusion

These findings suggest that elevated levels of ambient air pollutants are associated with the increase in hospital ER visits for CVD in Beijing, China.     

Air quality and outpatient visits for asthma in adults during the 2008 Summer Olympic Games in Beijing

To fulfill its commitment to a successful 2008 Olympic and Paralympic Games, the Chinese government made unprecedented efforts to improve the air quality in Beijing. We report findings on air quality and outpatient visits for asthma among adults in Beijing during the 2008 Summer Olympic Games. Three study periods were defined: summer baseline (June 1-June 30: before any air pollution controls), pre-Olympics (July 1-August 7: transportation restrictions in effect), and Olympics (August 8-September 20: further restrictions on industrial emissions). Daily data on outpatient asthma visits were obtained from the asthma registry of Beijing Chaoyang Hospital. We used time-series Poisson regression models to estimate the relative risk (RR) for asthma visits associated with pollution levels. The average numbers of outpatient visit for asthma were 12.5 per day at baseline and 7.3 per day during the Olympics. Compared with baseline, the Games were associated with a significant reduction in asthma visits (RR 0.54, 95%CI: 0.39-0.75). Our analysis showed that even in a heavily-polluted city, decreased concentrations of small particles were associated with some reduction in asthma visits in adults.     

Low-carbon energy policy and ambient air pollution in Shanghai, China: a health-based economic assessment

Energy and related health issues are of growing concern worldwide today. To investigate the potential public health and economic impact of ambient air pollution under various low-carbon energy scenarios in Shanghai, we estimated the exposure level of Shanghai residents to air pollution under various planned scenarios, and assessed the public health impact using concentration-response functions derived from available epidemiologic studies. We then estimated the corresponding economic values of the health effects based on unit values for each health outcome. Our results show that ambient air pollution in relation to low-carbon energy scenarios could have a significant impact on the future health status of Shanghai residents, both in physical and monetary terms. Compared with the base case scenario, implementation of various low-carbon energy scenarios could prevent 2804-8249 and 9870-23,100 PM10-related avoidable deaths (mid-value) in 2010 and 2020, respectively. It could also decrease incidence of several relevant diseases. The corresponding economic benefits could reach 507.31-1492.33 and 2642.45-6192.11 million U.S. dollars (mid-value) in 2010 and 2020, respectively. These findings illustrate that a low-carbon energy policy will not only decrease the emission of greenhouse gases, but also play an active role in the reduction of air pollutant emissions, improvement of air quality, and promotion of public health. Our estimates can provide useful information to local decision-makers for further cost-benefit analysis.     

Time-series studies on air pollution and daily outpatient visits for allergic rhinitis in Beijing, China

To investigate the effects of urban air quality change on health, we carried out a time-series analysis of daily general practitioner consultations for allergic rhinitis (AR) in Beijing, China. Non-parametric generalized additive model (GAM) was used to analyze the highly non-linear or non-monotonic exposure-response relationship between three air pollutants (namely PM₁₀, SO₂ and NO₂) and daily outpatient visits for AR, after controlling for long term trends, the ‘day of the week’ effect and confounding meteorological factors. The objective of this study was to assess the possible effects of air pollutants on outpatient visits caused by AR in Beijing during the period 2009-2010. Our work indicates that strong associations exist between daily concentration of the three air pollutants and the daily number of outpatients for AR.     

The relationship between particulate air pollution and emergency hospital visits for hypertension in Beijing, China

Background

A number of epidemiological studies have examined the adverse effect of air pollution on mortality and morbidity. Also, several studies have investigated the associations between air pollution and specific-cause diseases including arrhythmia, myocardial infarction, and heart failure. However, little is known about the relationship between air pollution and the onset of hypertension.

Objective

To explore the risk effect of particulate matter air pollution on the emergency hospital visits (EHVs) for hypertension in Beijing, China.

Methods

We gathered data on daily EHVs for hypertension, fine particulate matter less than 2.5 μm in aerodynamic diameter (PM_2.5), particulate matter less than 10 μm in aerodynamic diameter (PM₁₀), sulfur dioxide, and nitrogen dioxide in Beijing, China during 2007. A time-stratified case-crossover design with distributed lag model was used to evaluate associations between ambient air pollutants and hypertension. Daily mean temperature and relative humidity were controlled in all models.

Results

There were 1,491 EHVs for hypertension during the study period. In single pollutant models, an increase in 10 μg/m³ in PM_2.5 and PM₁₀ was associated with EHVs for hypertension with odds ratios (overall effect of five days) of 1.084 (95% confidence interval (CI): 1.028, 1.139) and 1.060% (95% CI: 1.020, 1.101), respectively.

Conclusion

Elevated levels of ambient particulate matters are associated with an increase in EHVs for hypertension in Beijing, China.     

Ambient air pollution and daily mortality in Anshan, China: a time-stratified case-crossover analysis

Few case-crossover studies were conducted in China to investigate the acute health effects of air pollution. We conducted a time-stratified case-crossover analysis to examine the association between air pollution and daily mortality in Anshan, a heavily-polluted industrial city in northeastern China. Daily mortality, air pollution, and weather data in 2004-2006 in Anshan were collected. Time-stratified case-crossover approach was used to estimate the effect of air pollutants (PM₁₀, SO₂, NO₂ and CO) on total and cardiopulmonary mortality. Controls were selected as matched days of the week in the same month. Potential effect modifiers, such as gender and age, were also examined. We found significant associations between air pollution and daily mortality from cardiovascular diseases in Anshan. A 10 μg/m³ elevation of 2-day moving average (lag 01) concentration in PM₁₀, SO₂, NO₂ and CO corresponded to 0.67% (95% CI: 0.29%, 1.04%), 0.38% (95% CI: −0.06%, 0.83%), 2.11% (95% CI: 0.22%, 4.00%) and 0.04% (95% CI: 0.01%, 0.07%) increase of cardiovascular mortality. The associations for total and respiratory mortality were generally positive but statistically insignificant. The air pollution health effects were significantly modified by age, but not by gender. Conclusively, our study showed that short-term exposure to air pollution was associated with increased cardiovascular mortality in Anshan. These findings may have implications for local environmental and social policies.     

Simulation-based feasibility study of improved air conditioning systems for hospital operating room

The goal of the air distribution inside a hospital operating room (OR) is to protect the patient and staff from cross-infection while maintaining occupant comfort and not affecting the facilitation of surgical tasks. In ORs, HEPA-filtered air and vertical (downward) laminar airflow are often used to achieve a unidirectional flow of fresh air from ceiling, washing over the patient and flowing out of exhaust vents on the side walls, near the floor. However, previous research has shown that this method does not necessarily achieve the desired unidirectional flow pattern or adequately achieve optimal air asepsis. The results from this study show that maximizing the area of the laminar flow diffusers remedies this issue and provides very low contamination levels. The use of air curtains as specified by manufacturers of commercial products may not provide satisfactory results, with noticeable contamination levels at the wound site.     

Assessing air quality in Hong Kong: A proposed,revised air pollution index (API)

The Environment Protection Department of Hong Kong has been using an air pollution index (API) to report the status of ambient air quality since 1995. Such an index system was first developed by the USA Environmental Protection Authority. The API compares five main air pollutants, i.e. sulfur dioxide (SO₂), respirable suspended particulates (RSP), nitrogen dioxide (NO₂), carbon monoxide (CO) and Ozone (O₃) as sub-indexes, which are calculated separately from a segmented linear function that transforms ambient pollutants concentrations into a normalized scale extending from 0 to 500. The resultant pollution level is described by the maximal value of these five sub-indexes. The limitation of this API system is that it considers only one pollutant with the maximum value at a time but reflects other pollutants concurrently. In this study, a revised air quality index (RAPI) is proposed based on the entropy function, which combines the effect of all pollutants on public health. The design of the revised index is based on database of air pollutants collected at two air quality monitoring stations in Hong Kong, i.e. a roadside station in Mong Kok and a general station in Sha Tin. Compared with the existing API, values of RAPI (calculated from data collected for API) at both stations are at higher levels and provide more information of levels of all pollutants. Therefore, RAPI should be representatively and widely used to provide the public with a better indicator of air quality. In addition, variations and oscillations of pollutants concentrations were also examined and the results show that RSP and NO₂ contribute more to the overall pollution level than other components. It is suggested that more abatement strategies be focused on these pollutants to improve air quality in the future.     

A distance-decay variable selection strategy for land use regression modeling of ambient air pollution exposures

Land use regression (LUR) has emerged as an effective and economical means of estimating air pollution exposures for epidemiological studies. To date, no systematic method has been developed for optimizing the variable selection process. Traditionally, a limited number of buffer distances assumed having the highest correlations with measured pollutant concentrations are used in the manual stepwise selection process or a model transferred from another urban area.In this paper we propose a novel and systematic way of modeling long-term average air pollutant concentrations through “A Distance Decay REgression Selection Strategy” (ADDRESS). The selection process includes multiple steps and, at each step, a full spectrum of correlation coefficients and buffer distance decay curves are used to select a spatial covariate of the highest correlation (compared to other variables) at its optimized buffer distance. At the first step, the series of distance decay curves is constructed using the measured concentrations against the chosen spatial covariates. A variable with the highest correlation to pollutant levels at its optimized buffer distance is chosen as the first predictor of the LUR model from all the distance decay curves. Starting from the second step, the prediction residuals are used to construct new series of distance decay curves and the variable of the highest correlation at its optimized buffer distance is chosen to be added to the model. This process continues until a variable being added does not contribute significantly (p > 0.10) to the model performance. The distance decay curve yields a visualization of change and trend of correlation between the spatial covariates and air pollution concentrations or their prediction residuals, providing a transparent and efficient means of selecting optimized buffer distances. Empirical comparisons suggested that the ADDRESS method produced better results than a manual stepwise selection process of limited buffer distances. The method also enables researchers to understand the likely scale of variables that influence pollution levels, which has potentially important ramifications for planning and epidemiological studies.     

The short-term effect of air pollution on cardiovascular mortality in Tianjin, China: comparison of time series and case-crossover analyses

Background

Many studies have illustrated that ambient air pollution negatively impacts on health. However, little evidence is available for the effects of air pollution on cardiovascular mortality (CVM) in Tianjin, China. Also, no study has examined which strata length for the time-stratified case-crossover analysis gives estimates that most closely match the estimates from time series analysis.

Objectives

The purpose of this study was to estimate the effects of air pollutants on CVM in Tianjin, China, and compare time-stratified case-crossover and time series analyses.

Method

A time-stratified case-crossover and generalized additive model (time series) were applied to examine the impact of air pollution on CVM from 2005 to 2007. Four time-stratified case-crossover analyses were used by varying the stratum length (Calendar month, 28, 21 or 14 days). Jackknifing was used to compare the methods. Residual analysis was used to check whether the models fitted well.

Results

Both case-crossover and time series analyses show that air pollutants (PM₁₀, SO₂ and NO₂) were positively associated with CVM. The estimates from the time-stratified case-crossover varied greatly with changing strata length. The estimates from the time series analyses varied slightly with changing degrees of freedom per year for time. The residuals from the time series analyses had less autocorrelation than those from the case-crossover analyses indicating a better fit.

Conclusion

Air pollution was associated with an increased risk of CVM in Tianjin, China. Time series analyses performed better than the time-stratified case-crossover analyses in terms of residual checking.     

Urinary 1-hydroxypyrene, air pollution exposure and associated life style factors in pregnant women

1-hydroxypyrene (1-OHP) is a biomarker of exposure to polycyclic aromatic hydrocarbons (PAHs). PAHs are pollutants produced by the combustion of organic material, and could be found both indoors and outdoors. Prenatal exposure to these compounds has been associated with retarded intrauterine growth and respiratory problems in children. The objective of this study is to describe the 1-OHP levels in urine in pregnant women in the INMA cohort in Valencia, and to study the association with socio-demographic and lifestyle variables, as well as with indicators of air pollution. The study population is a sub-sample (n: 204) of a cohort of pregnant women in the multicentre INMA project in Valencia (Spain). Urine samples were taken in week 12 of gestation, and 1-OHP was analyzed, and adjusted for creatinine. Socio-demographic and lifestyle information was collected using a questionnaire. Data from the monitoring stations in Valencia were used to assign levels of exposure to nitrogen dioxide (NO2), sulphur dioxide (SO2), total suspended particulates (TSP) and carbon monoxide (CO). The median 1-OHP level was 0.061 muicrool/mol of creatinine. Women who smoked had higher 1-OHP levels (0.095 micromol/mol of creatinine) than non-smokers (0.050 micromol/mol of creatinine). The variables predicting 1-OHP levels on linear multivariate analysis were: tobacco consumption, consumption of fried and smoked foods. There was also a significant association with NO2 levels 4 and 5 days before the samples were taken. The 1-OHP levels found in pregnant women in Valencia were higher than those found among women in reports in USA. 1-hydroxypyrene could be a good marker of exposure to PAHs from tobacco and diet, and also a useful marker of short term exposure to air pollution.     

Coarse particles and mortality in three Chinese cities: the China Air Pollution and Health Effects Study (CAPES)

Evidence concerning the health risks of coarse particles (PM_10-2.5) is limited. There have been no multi-city epidemiologic studies of PM_10-2.5 in developing Asian countries. We examine the short-term association between PM_10-2.5 and daily mortality in three Chinese cities: Beijing, Shanghai, and Shenyang. PM_10-2.5 concentrations were estimated by subtracting PM_2.5 from PM₁₀ measurements. Data were analyzed using the over-dispersed generalized linear Poisson models. The average daily concentrations of PM_10-2.5 were 101 μg/m³ for Beijing (2007-2008), 50 μg/m³ for Shanghai (2004-2008), and 49 μg/m³ for Shenyang (2006-2008). In the single-pollutant models, the three-city combined analysis showed significant associations between PM_10-2.5 and daily mortality from both total non-accidental causes and from cardiopulmonary diseases. A 10-μg/m³ increase in 1-day lagged PM_10-2.5 was associated with a 0.25% (95% CI: 0.08 to 0.42) increase in total mortality, 0.25% (95% CI: 0.10 to 0.40) increase in cardiovascular mortality, and 0.48% (95% CI: 0.20 to 0.76) increase in respiratory mortality. However, these associations became statistically insignificant after adjustment for PM_2.5. PM_2.5 was significantly associated with mortality both before and after adjustment for PM_10-2.5. In conclusion, there were no statistically significant associations between PM_10-2.5 and daily mortality after adjustment for PM_2.5 in the three Chinese cities.     

The effects of changes in cadmium and lead air pollution on cancer incidence in children

This article presents the results of research on the effects of air pollution on cancer incidence in children in the region of Silesia (Poland), which has undergone one of the most profound anthropogenic transformations in Europe. The main objective of the research was to specify the impact of changes in cadmium and lead pollution in the years 1990-2005 on the incidence of cancers reported in children. Lead concentration ranged from 0 to 1490 · 10^-9 G m⁻²/year, and cadmium concentration ranged from 0 to 33.7 · 10^-9 G  m⁻²/year. There was no strong significant correlation (max 0.3) between air pollution and incidence rate (IR) in the general population of children in any particular year. Alongside the cartographic presentation of dependences, correlation coefficients between the variables in question were calculated. This made it possible to determine the relationship between the pollution levels and incidence rates in the area. There was a significant reduction in the level of pollution during the investigated period. The study of the relationship between the number of cancers reported and the condition of the natural environment revealed increased sensitivity to toxins in boys (correlation coefficient 0.3). In addition, the spatial distribution of the number of cases reported in boys suggests a correlation with the spatial distribution of the coefficients for the entire group of children included in the study. The yearly average IR of childhood cancer in specific districts ranged from 0 to 61.48/100,000 children under 18 years of age during the 1995-2004 period.     

Ambient carbon monoxide and daily mortality in three Chinese cities: the China Air Pollution and Health Effects Study (CAPES)

Ambient carbon monoxide (CO) is an air pollutant primarily generated by traffic. CO has been associated with increased mortality and morbidity in developed countries, but few studies have been conducted in Asian developing countries. In the China Air Pollution and Health Effects Study (CAPES), the short-term associations between ambient CO and daily mortality were examined in three Chinese cities: Shanghai, Anshan and Taiyuan. Poisson regression models incorporating natural spline smoothing functions were used to adjust for long-term and seasonal trend of mortality, as well as other time-varying covariates. Effect estimates were obtained for each city and then for the cities combined. In both individual-city and combined analysis, significant associations of CO with both total non-accidental and cardiovascular mortality were observed. In the combined analysis, a 1 mg/m³ increase of 2-day moving average concentrations of CO corresponded to 2.89% (95%CI: 1.68, 4.11) and 4.17% (95%CI: 2.66, 5.68) increase of total and cardiovascular mortality, respectively. CO was not significantly associated with respiratory mortality. Sensitivity analyses showed that our findings were generally insensitive to alternative model specifications. In conclusion, ambient CO was associated with increased risk of daily mortality in these three cities. Our findings suggest that the role of exposure to CO and other traffic-related air pollutants should be further investigated in China.     

中国大气污染现状及防治对策

分别介绍了大气污染产生的严重危害和当前我国大气污染现状及特征,针对造成大气污染的各类因素进行了分析,在此基础上提出了相应的防治措施并作了具体阐述,以期指导人们加强环境保护意识。     

Effect of air and noise pollution on species diversity and population density of forest birds at Lalpahari, West Bengal, India

The Rajmahal-type quality stones for building purposes are found abundantly in Birbhum district, West Bengal, India, where stone mining and crushing have become the main industrial activity. Although crusher dust is injurious to health, demand for crushed stone is ever-increasing as a result of rapid infrastructural growth in the country. Most of the crusher units at Rampurhat are situated along the roadways adjacent to forest under Tumboni Beat of Rampurhat Range of Birbhum Forest Division. Excessive load of air pollution in this area has led to degradation of this forest. The status of the ambient air and noise level was evaluated. The effect of air and noise pollution on abundance and variability of birds in this forest have been compared to an almost non-polluted forest of the same bio-geographic zone. Both species diversity and population density of birds were found to decrease in the polluted forest, especially in the areas adjacent to crushers. For comparing the pollution status of two different forest sites and for establishing whether the density of birds have any correlation between the sites, the Student's t-test and the chi-square test were applied respectively. Most of the results proved to be significant.     

Cell type specificity of lung cancer associated with air pollution

The aim of this study is to explore whether lung cancer associated with air pollution has cell type specificity. The air quality data (SO(2), CO, O(3), NOx) from the Taiwan EPA's air quality monitoring stations were collected between 1995 and 1998. Patients with lung cancer were identified through the National Cancer Registration Program operated by the Taiwanese government. Two major pathological types (adenocarcinoma (AC) and squamous cell carcinoma (SCC)) were considered. The Pearson correlation coefficients between the air quality index and age-standardized incidence rate per 100,000 person years (ASR) of AC and SCC were calculated for both genders for three township categories characterized by different levels of air pollution. The traffic-related NOx and CO showed significant correlations with female lung cancer incidence rate, with Pearson's correlation 0.33 (P=0.03) and 0.40 (P=0.01) respectively. However, the correlation between air pollution and lung cancer was not significant for males. Significant correlation coefficients were also found between the ratio of AC/SCC and the mean concentrations of NOx (r=0.41, P=0.04) and CO (r=0.47, P=0.02) in females. Our results show that the worse the air pollution was in the area, the higher the AC rate, regardless of gender. On the other hand, SCC incidence rates did not increase with increasing air pollution. Our results show that a correlation exists between air pollution and lung adenocarcinoma incidence.     

Spatiotemporal relationship between particle air pollution and respiratory emergency hospital admissions in Brisbane, Australia

The nature of spatial variation in the relationship between air pollution and health outcomes within a city remains an open and important question. This study investigated the spatial variability of particle matter air pollution and its association with respiratory emergency hospital admissions across six geographic areas in Brisbane, Australia. Data on particles of 10 microm or less in aerodynamic diameter per cubic metre (PM10), meteorological conditions, and daily respiratory emergency hospital admissions were obtained for the period of 1 January 1998 to 31 December 2001. A Poisson generalised linear model was used to estimate the specific effects of PM10 on respiratory emergency hospital admissions for each geographic area. A pooled effect of PM10 was then estimated using a meta-analysis approach for the whole city. The results of this study indicate that the magnitude of the association between particulate matter and respiratory emergency hospital admissions varied across different geographic areas in Brisbane. This relationship appeared to be stronger in areas with heavy traffic. We found an overall increase of 4.0% (95% confidence interval [CI]: 1.1-6.9%) in respiratory emergency hospital admissions associated with an increase of 10 microg /m3 in PM10 in the single pollutant model. The association was weaker but still statistically significant (an increase of 2.6%; 95% CI: 1.0-5.5%) after adjusting for O3, but did not appear to be affected by NO2. The effect estimates of PM10 were generally consistent for three spatial methods used in this study, but appeared to be underestimated if the spatial nature of the data was ignored. Therefore, the spatial variation in the relationship between PM10 and health outcomes needs to be considered when the health impact of air pollution is assessed, particularly for big cities.     

我国房间空调器材料资源消耗状况分析

调查分析了我国房间空调器材料的组成情况和材料资源的消耗状况。结果表明,按成品用材量计算,2005年我国房间空调器生产的材料消耗量约为:钢铁231万t、铜材55万t、铝材27万t、塑料45万t,其中铜材消耗量约占当年全国矿山铜总产量的85%。认为空调节材与空调节能具有同样重要的意义。     

High temperature effects on out-patient visits and hospital admissions in Chiang Mai, Thailand

Objectives

This study investigated the short-term effects of temperature on out-patient visits and hospital admissions in Chiang Mai, Thailand. While mortality outcomes in the literature have been reported, there is less evidence of morbidity effects with very few studies conducted in developing countries with subtropical or tropical climate.

Methods

Time-series regression analysis was employed using generalized negative binomial regression to model the short-term relationships between temperature and morbidity after controlling for seasonal patterns and other potential confounders. Lag effects up to 13 days and effect modification by age (0-14 years, 15-64 years, ≥ 65 years) were examined.

Results

Temperature effects with wide confidence intervals were found, with an increase in diabetic visits of 26.3% (95% CI: 7.1%-49.0%), and circulatory visits of 19.2% (95% CI: 7.0%-32.8%) per 1 °C increase in temperature above an identified threshold of 29 °C. Additionally, there was a rise of both visits (3.7% increase, 95% CI: 1.5%-5.9%) and admissions (5.8% increase, 95% CI: 2.3%-9.3%) due to intestinal infectious disease in association with each 1 °C increase across the whole temperature range. The effects of temperature were stronger in the elderly though not statistically significant.

Conclusions

Daily morbidity in Chiang Mai was positively associated with temperature with a lag effect of up to 2 weeks, which was longer than lag effects previously reported. Public health preparedness and interventions should be considered to minimise possible increased hospital visits and admissions during hot weather.