Spatial analysis of annual air pollution exposure and mortality

The aim of this study was to relate ambient air pollution levels to mortality in Auckland, New Zealand. We used urban airshed modelling and GIS-based techniques to quantify long-term exposure to ambient air pollution levels and associated mortality. After adjusting for age, sex, ethnicity, socio-economic status, and urban/rural domicile there was a 1.3% (95%CI: 1-1.5%) increase in non-external cause mortality, and 1.8% (95%CI: 1.5-2.1%) increase in circulatory and respiratory causes per 1 microg/m(3) increase in annual average NO(2). Based on these exposure-response relationships and applying an annual average threshold of 13 microg/m(3), the average annual (for 1996-1999) number of people estimated to die from non-external causes and circulatory and respiratory causes attributable to air pollution in Auckland is 268 (95% range: 227-310) (3.9% of total all cause deaths) and 203 (95% range: 169-237) (5.9% of total circulatory and respiratory deaths) per year, respectively. The number of attributable deaths found in this study are consistent with a previous New Zealand risk assessment using a different methodology, and is approximately twice the number of people dying from motor vehicle accidents in the region, which is on average (1996-1999) 103 per year. The GIS-based exposure maps identify high exposure areas for policy developers and planners in a simple and realistic manner. Taken together with overseas studies the study provides additional evidence that long-term exposure to poor air quality, even at levels below current standards, is a hazard to the public health.     

Burden of disease attributable to air pollutants from municipal solid waste incinerators in Seoul, Korea: a source-specific approach for environmental burden of disease

Few studies have attempted to quantify the integrated health burden, incorporating both mortality and morbidity as these factors pertain to air pollutants, on the population in the vicinity of the incinerators. The aims of this study are to estimate the attributable burden of disease caused by incinerators in Seoul, Korea and to present an approach based on source-specific exposure for the estimation of the environmental burden of disease (EBD). With particular attention on the development of a measurement means of the source-specific, exposure-based population attributable fraction (PAF), we integrated air dispersion modeling, Geographic Information Systems (GIS), the population distribution of exposure, and the exposure-response relationship. We then estimated the PAFs caused by additional concentrations of four air pollutants (PM₁₀, NO_2, SO₂, and CO) emitted from four municipal solid waste incinerators (MSWIs) in Seoul in 2007. We, finally, estimated the attributable burden of disease, using the estimated PAF and the disability-adjusted life years (DALY) method developed by the Global Burden of Disease Group of the World Health Organization (WHO).The PAF for NO₂ to all-cause mortality was assessed at approximately 0.02% (95% CI: 0.003-0.036%), which was the highest among all air pollutants. The PAFs for respiratory and cardiovascular disease were 0.12% (95% CI: 0.01-0.16%) and 0.10% (95% CI: 0.04-0.16%), respectively. The sum of the attributable burden of disease for four pollutants was about 297 person-years (PYs) (95% CI: 121-472 PYs) when the incinerators observed to the emission standards. The attributable burdens of respiratory disease and cardiovascular disease were about 0.2% and 0.1%, respectively, of the total burden of respiratory disease and cardiovascular disease of Seoul citizens for the year 2007. Although the air emissions from one risk factor, an incinerator, are small, the burden of disease can be significant to the public health when population exposure is considered.     

Health benefits of improving air quality in the rapidly aging Korean society

Korea is experiencing an extraordinarily rapid demographic transition. We investigated the short-term association between air pollution and mortality and assessed the impact of improved air quality on mortality in a rapidly aging city, Seoul, Korea.The generalized additive model (GAM) was used to estimate the relative risks (RR) of mortality associated with changes in air pollution. The time trends, seasonal variations, day of the week effects, and weather effects were controlled in the models. To estimate the health benefits, we used the US Environmental Protection Agency's BenMAP.For people 0–64 years of age, elderly people (65+ years), and all age groups, an increase of 10 μg/m³ in PM₁₀ was associated with increases in daily death counts of 0.27% (95% CI: 0.04–0.50), 0.45% (95% CI: 0.27–0.64), and 0.37% (95% CI: 0.23–0.52), respectively. For ages 0–64 years, elderly people, and all age groups, a 10 ppb increase in 1-hour maximum ozone concentration resulted in an increased risk of daily death counts of 0.28% (95% CI: − 0.19–0.74), 0.96% (95% CI: 0.46–1.47), and 0.81% (95% CI: 0.35–1.26), respectively.For elderly people, it was estimated that the health benefits of attaining the World Health Organization's (WHO) air quality guidelines (AQGs) for PM₁₀ (24-hour average 50 μg/m³) would suggest an annual reduction of 964 (95% CI: 564–1366) premature deaths, and 329 (95% CI: 159–500) premature deaths could be prevented annually in 2015 from attaining the WHO's guidelines for ozone (8-hour average 100 μg/m³).The rapid increase of the elderly population has major consequences and implications for society and public health. This study showed that elderly people are at higher risk for the acute mortality effects of air pollution. Therefore, cleaner air will substantially contribute to improved public health in Seoul, given the growing concern about the adverse effects of air pollution for elderly people.     

Exposure to household air pollution from biomass‐burning cookstoves and HbA1c and diabetic status among Honduran women

Household air pollution from biomass cookstoves is estimated to be responsible for more than two and a half million premature deaths annually, primarily in low and middle‐income countries where cardiometabolic disorders, such as Type II Diabetes, are increasing. Growing evidence supports a link between ambient air pollution and diabetes, but evidence for household air pollution is limited. This cross‐sectional study of 142 women (72 with traditional stoves and 70 with cleaner‐burning Justa stoves) in rural Honduras evaluated the association of exposure to household air pollution (stove type, 24‐hour average kitchen and personal fine particulate matter [PM_2.5] mass and black carbon) with glycated hemoglobin (HbA1c) levels and diabetic status based on HbA1c levels. The prevalence ratio (PR) per interquartile range increase in pollution concentration indicated higher prevalence of prediabetes/diabetes (vs normal HbA1c) for all pollutant measures (eg, PR per 84 μg/m³ increase in personal PM_2.5, 1.49; 95% confidence interval [CI], 1.11‐2.01). Results for HbA1c as a continuous variable were generally in the hypothesized direction. These results provide some evidence linking household air pollution with the prevalence of prediabetes/diabetes, and, if confirmed, suggest that the global public health impact of household air pollution may be broader than currently estimated.     

A review on reducing indoor particulate matter concentrations from personal-level air filtration intervention under real-world exposure situations

Improving air quality in indoor environments where people live is of importance to protect human health. In this systematic review, we assessed the effectiveness of personal-level use of air filtration units in reducing indoor particulate matters (PM) concentrations under real-world situations following systematic review guidelines. A total of 54 articles were included in the review, in which 20 randomized controlled/crossover trials that reported the changes in indoor fine PM (PM_2.5) concentrations were quantitatively assessed in meta-analysis. Standardized mean differences (SMDs) were calculated for changes in indoor PM concentrations following air filtration interventions. Moderate-to-large reductions of 11%–82% in indoor PM_2.5 concentrations were observed with SMD of −1.19 (95% CI: −1.50, −0.88). The reductions in indoor PM concentrations varied by geographical locations, filtration technology employed, indoor environmental characteristics, and air pollution sources. Most studies were graded with low-to-moderate risk of bias; however, the overall certainty of evidence for indoor PM concentration reductions was graded at very low level. Considering the effectiveness of indoor air filtration under practical uses, socio-economic disparities across study populations, and costs of air filter replacement over time, our results highlight the importance of reducing air pollution exposure at the sources.     

Health benefit evaluation of the energy use scenarios in Beijing, China

Air pollution is one of the important causal factors for excess cardiorespiratory deaths and diseases. However, little information is available on health gains from clean energy usage in developing countries. In this study the expected population exposed to air pollutants was estimated under the different energy use scenarios by the year 2010, 2020 and 2030, respectively, in the urban area of Beijing, China. The concentration-response functions between air pollutants and the health endpoints were established using meta-analysis and regression models. The decreased cardiorespiratory deaths and diseases of the exposed population were predicted as the health benefits from air pollution reduction. We used daily measurements of particulate matter less than 10 mum in aerodynamic diameter (PM(10)) and sulphate dioxide (SO(2)) as air pollution indicators. The percentage of population exposed to higher level of PM(10) will be decreased significantly under the clean energy use scenario than that under the Baseline Scenario (i.e., business-as-usual scenario). Compared with the Baseline Scenario there will be, by 2010, 2020, and 2030, respectively, a decrease of 29-152, 30-212 and 39-287 acute excess deaths; and 340-1811, 356-2529 and 462-3424 chronic excess deaths associated with the reduction of PM(10) level; also a decrease of 237-331, 285-371 and 400-554 short-term excess deaths associated with the decrease of SO(2) level. Meanwhile, the number of respiratory and cardiovascular hospital admissions, outpatient visits to internal and paediatrics departments, total emergency room visits and asthma attacks will be remarkably reduced with the reduction of air pollution. Energy structure improvement could reduce ambient air pollution and produce substantial health benefits to the population in Beijing. These findings may have significant implications for other metropolitan cities, particularly in developing countries.     

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.     

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.     

Patterns and predictors of personal exposure to indoor air pollution from biomass combustion among women and children in rural China

Indoor air pollution (IAP) from domestic biomass combustion is an important health risk factor, yet direct measurements of personal IAP exposure are scarce. We measured 24-h integrated gravimetric exposure to particles < 2.5 μm in aerodynamic diameter (particulate matter, PM?.?) in 280 adult women and 240 children in rural Yunnan, China. We also measured indoor PM?.? concentrations in a random sample of 44 kitchens. The geometric mean winter PM?.? exposure among adult women was twice that of summer exposure [117 μg/m3 (95% CI: 107, 128) vs. 55 μg/m3 (95% CI: 49, 62)]. Children's geometric mean exposure in summer was 53 μg/m3 (95% CI: 46, 61). Indoor PM?.? concentrations were moderately correlated with women's personal exposure (r=0.58), but not for children. Ventilation during cooking, cookstove maintenance, and kitchen structure were significant predictors of personal PM?.? exposure among women primarily cooking with biomass. These findings can be used to develop exposure assessment models for future epidemiologic research and inform interventions and policies aimed at reducing IAP exposure. PRACTICAL IMPLICATIONS: Our results suggest that reducing overall PM pollution exposure in this population may be best achieved by reducing winter exposure. Behavioral interventions such as increasing ventilation during cooking or encouraging stove cleaning and maintenance may help achieve these reductions.     

Ozone in urban China: Impact on mortalities and approaches for establishing indoor guideline concentrations

Reducing indoor ozone levels may be an effective strategy to reduce total exposure and associated mortality. Here we estimate (a) premature mortalities attributable to ozone for China's urban population ≥25 years of age; (b) the fraction of total exposure occurring indoors; and (c) mortalities that can be potentially avoided through meeting current and more stringent indoor ozone standards/guidelines based on 1‐hour daily maxima. To estimate ozone‐attributable premature mortalities, we used hourly outdoor ozone concentrations measured at 1497 monitoring stations located in 339 Chinese cities and a published concentration‐response model. We proceeded to estimate province‐specific infiltration factors and co‐occurring hourly indoor ozone concentrations. For the year 2015, we estimated that indoor exposures accounted for 59% (95% confidence interval (CI): 26%‐79%) of the total ozone exposure that resulted in 70800 (95% CI: 35 900‐137 700) premature all‐cause mortalities in urban China. If the current Chinese indoor ozone standards (80 ppbv (160 µg/m³); 56 ppbv (112 µg/m³)) were met, the mean estimates of reduction in mortalities would be indistinguishable from zero. With stricter 1‐hour indoor ozone guidelines, the expected mortality reductions increase exponentially per unit decrease in indoor ozone. The analysis in this paper should help facilitate formulating present and future indoor ozone guidelines.     

Can one use ambient air concentration data to estimate personal and population exposures to particles? An approach within the European EXPOLIS study

The objective of this paper is to devise a way to facilitate the use of fixed air monitors data in order to assess population exposure. A weighting scheme that uses the data from different monitoring sites and takes into account the time-activity patterns of the study population is proposed. PM2.5 personal monitoring data were obtained within the European EXPOLIS study, in Grenoble, France (40 adult non-smoking volunteers, winter 1997). Volunteers carried PM2.5 personal monitors during 48 h and filled in time-activity diaries. Workplaces and places of residence were classified into two categories using a Geographic Information System (GIS): some volunteers' life environments are seen as best represented by PM10 ambient air monitors located in urban background sites; others by monitors situated close to high traffic density sites (proximity sites). Measurements from the Grenoble fixed monitoring network using a TEOM PM10 sampler were available across the same period for these two types of sites (PM10block and PM10prox). These data were used to compute a translator parameter deltai that forces the measured PM2.5 personal exposures (PM2.5persoi) to equate the average PM10 urban ambient air concentrations ([PM10back + PM10prox]/2) measured the same days. Average deltai was 4.2 microg/m3 (CI95%[-3.4; 11.9]), with true average PM2.5 personal exposure being 36.2 microg/m3 (28.2; 44.1). PM10 ambient levels at the proximity site and at the background site were respectively PM10prox = 43.8 microg/m3 (37.1; 50.6) and PM10back = 37.0 microg/m3 (31.8; 42.3). In order to assess the consistency of this approach, six scenarios of 'proximity' and 'background' environments were accommodated, according to traffic intensity and road distance. Deltai was estimated for the entire EXPOLIS population and for subgroups, using terciles based on the percentage of time spent in proximity by each subject. Other similar studies need to be conducted in different urban settings, and with other pollutants, in order to assess the generalizability of this simple approach to estimate population exposures from air quality surveillance data.     

A randomized double‐blind crossover study of indoor air filtration and acute changes in cardiorespiratory health in a First Nations community

Few studies have examined indoor air quality in First Nations communities and its impact on cardiorespiratory health. To address this need, we conducted a crossover study on a First Nations reserve in Manitoba, Canada, including 37 residents in 20 homes. Each home received an electrostatic air filter and a placebo filter for 1 week in random order, and lung function, blood pressure, and endothelial function measures were collected at the beginning and end of each week. Indoor air pollutants were monitored throughout the study period. Indoor PM_2.5 decreased substantially during air filter weeks relative to placebo (mean difference: 37 μg/m³, 95% CI: 10, 64) but remained approximately five times greater than outdoor concentrations owing to a high prevalence of indoor smoking. On average, air filter use was associated with a 217‐ml (95% CI: 23, 410) increase in forced expiratory volume in 1 s, a 7.9‐mm Hg (95% CI: ?17, 0.82) decrease in systolic blood pressure, and a 4.5‐mm Hg (95% CI: ?11, 2.4) decrease in diastolic blood pressure. Consistent inverse associations were also observed between indoor PM_2.5 and lung function. In general, our findings suggest that reducing indoor PM_2.5 may contribute to improved lung function in First Nations communities.     

Numerical investigation on the ingress of particulate matter from ambient air into the inlet of a building air handling unit

The transportation of ambient particulate matter (PM) from outdoor air into the inlet of a mechanical building ventilation system is poorly understood. No studies have examined the effect commonly used commercial air handling unit (AHU) inlet designs have upon the migration of PM from the ambient environment into the building ventilation system, and implications of this on energy consumption and indoor air quality (IAQ). Through the numerical analysis of commercial AHU inlets, the differences in concentration of PM in ambient air and that within AHUs were determined, more commonly referred to as Aspiration Efficiency (AE %). A 20–50% difference in particle concentrations between ambient air and the in-AHU concentration was observed between forward and rear-facing AHUs relative to ambient wind direction and speed, and at the maximum ventilation flow rate. Furthermore, a decrease in the ventilation flow rates resulted in a significant reduction in PM concentrations entering the rear-facing AHU. Increasing the Stoke number led to lower AE as a continuous decrease was observed for both rear-facing inlets. The findings of this paper show that AHU inlet design has significant implications on IAQ and building energy consumption, and scope exists to design these inlets to impact both aspects positively.     

Respiratory health, effects of ambient air pollution and its modification by air humidity in Drobeta-Turnu Severin, Romania

Background

Associations between ambient air pollution and respiratory health have been mainly reported for Western Europe and Northern America.

Objectives

Our goal was to investigate such associations among the population of Drobeta-Turnu Severin, Romania, a city in Central Eastern Europe (CEE), and to quantify their modification by air humidity. The latter is of increased interest for the current discussion about the potential effects of climate change on human health.

Methods

We investigated (study period: 23.01.2001-31.08.2002) the associations between chronic obstructive pulmonary disease (COPD), asthma and chronic bronchitis (CB) and total suspended particles (TSP), sulphur dioxide (SO₂) and nitrogen dioxide (NO₂). Generalized additive models (GAM) controlling for time patterns and weather effects were applied. Delayed effects up to seven days were analysed in single lag and polynomial distributed lag models (PDLMs).

Results

An increase of 10 µg/m³ TSP was related to a 3.3% (95% CI: 0.3%-6.4%) and a 2.8% (95% CI: 0.1%-5.7%) increase for hospital admissions for chronic bronchitis with a lag of one and four days, respectively. The adverse effect of TSP on chronic bronchitis was reduced by higher humidity. An increase of 10 µg/m³ SO₂ was related to a 6% (95% CI: 7%-25%) increase, with a two days lag, for hospital admissions for chronic bronchitis. We have not been able to identify a threshold, below which ambient TSP and SO₂ concentrations have no effect on hospital admissions for chronic bronchitis. We found adverse but nonsignificant influences of TSP, SO₂ and NO₂ on total respiratory hospital admissions, COPD and asthma and NO₂ on chronic bronchitis.

Conclusions

We conclude that in Drobeta-Turnu Severin CB is associated with TSP and mainly SO₂. Dry air aggravates the adverse effect of TSP.     

Cooking‐related PM2.5 and acrolein measured in grocery stores and comparison with other retail types

We measured particulate matter (PM), acrolein, and other indoor air contaminants in eight visits to grocery stores in California. Retail stores of other types (hardware, furniture, and apparel) were also sampled on additional visits. Based on tracer gas decay data, most stores had adequate ventilation according to minimum ventilation rate standards. Grocery stores had significantly higher concentrations of acrolein, fine and ultrafine PM, compared to other retail stores, likely attributable to cooking. Indoor concentrations of PM_2.5 and acrolein exceeded health guidelines in all tested grocery stores. Acrolein emission rates to indoors in grocery stores had a mean estimate about 30 times higher than in other retail store types. About 80% of the indoor PM_2.5 measured in grocery stores was emitted indoors, compared to only 20% for the other retail store types. Calculations suggest a substantial increase in outdoor air ventilation rate by a factor of three from current level is needed to reduce indoor acrolein concentrations. Alternatively, acrolein emission to indoors needs to be reduced 70% by better capturing of cooking exhaust. To maintain indoor PM_2.5 below the California annual ambient standard of 12 μg/m³, grocery stores need to use air filters with an efficiency rating higher than the MERV 8 air filters commonly used today.     

Reduction potential of urban PM2.5 mortality risk using modern ventilation systems in buildings

Urban PM2.5 (particulate matter with aerodynamic diameter smaller than 2.5 microm) is associated with excess mortality and other health effects. Stationary sources are regulated and considerable effort is being put into developing low-pollution vehicles and environment-friendly transportation systems. While waiting for technological breakthroughs in emission controls, the current work assesses the exposure reductions achievable by a complementary means: efficient filtration of supply air in buildings. For this purpose infiltration factors for buildings of different ages are quantified using Exposures of Adult Urban Populations in Europe Study (EXPOLIS) measurements of indoor and outdoor concentrations in a population-based probability sample of residential and occupational buildings in Helsinki, Finland. These are entered as inputs into an evaluated simulation model to compare exposures in the current scenario with an alternative scenario, where the distribution of ambient PM2.5 infiltration factors in all residential and occupational buildings are assumed to be similar to the subset of existing occupational buildings using supply air filters. In the alternative scenario exposures to ambient PM2.5 were reduced by 27%. Compared with source controls, a significant additional benefit is that infiltration affects particles from all outdoor sources. The large fraction of time spent indoors makes the reduction larger than what probably can be achieved by local transport policies or other emission controls in the near future. PRACTICAL IMPLICATIONS: It has been suggested that indoor concentrations of ambient particles and the associated health risks can be reduced by using mechanical ventilation systems with supply air filtering in buildings. The current work quantifies the effects of these concentration reductions on population exposures using population-based data from Helsinki and an exposure model. The estimated exposure reductions suggest that correctly defined building codes may reduce annual premature mortality by hundreds in Finland and by tens of thousands in the developed world altogether.     

Global burden of disease as a result of indoor air pollution in Shaanxi, Hubei and Zhejiang, China

Indoor air pollution in developing countries is a major global health problem, yet estimates of the global burden of disease vary widely and are associated with large uncertainty. The World Health Organization uses the fuel based approach to estimate 1.6 million premature deaths globally each year associated with exposure to indoor air pollution, of which 420 000 are in China. The fuel based approach uses a ventilation factor to account for differences in indoor air concentrations and exposures in different parts of the world based on regional differences in stove technology. In China this approach assumes that flues eliminate the majority of indoor air pollution, with a ventilation factor of 0.25. To account for historic exposure leading to current disease patterns the ventilation factor was adjusted to 0.5 for adult health endpoints. Measurements in three Chinese provinces, Shaanxi, Hubei and Zhejiang, however, show that high PM₄ concentrations are present in kitchens and living rooms even with stoves with flues as a result of multiple stove and flue use. Comparison of Indian and Chinese indoor air concentrations suggests more appropriate ventilation factors in the range 0.76-1.0 for women and children, and 1.0 for men. Premature mortality in the three provinces using these estimates would be closer to 60 600, rather than current estimates of 46 000. With the addition of cardiovascular diseases these estimates would increase by 92 000. Pollutant based estimates using measured indoor air concentrations and combined with dose-response estimates would imply a burden of disease of 157 800 premature deaths including cardiovascular diseases, a tripling of current estimates.     

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.     

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.     

The adverse effects of fine particle air pollution on respiratory function in the elderly

There is increasing concern that airborne particles are critical risk factors for adverse health conditions in susceptible populations. The objective of this panel study is to investigate an association between particulate matter and the peak expiratory flow rate (PEFR) in the elderly and to compare estimated risks using PM10 or PM2.5 levels as a measure of exposure. During a 2-year longitudinal follow-up study, we contacted subjects living in an asylum for the elderly, provided them with a mini-Wright peak flow meter, and instructed to record all the flow readings, any respiratory symptoms, passive smoking activity, and hours spent outdoors for that given day. Daily levels of particulate matter were measured by two separate mini-volume air samplers (for PM10 and PM2.5) placed on the rooftop of the two-story residence asylum building. In our statistical models, we assumed that the expected response varied linearly for each participant with a slope and intercept that depended on fixed or time-varying covariates using a mixed linear model. The daily mean levels of PM10 and PM2.5 were 78 microg/m3 and 56 microg/m3, respectively. For every 10 microg/m3 increase in PM10 and PM2.5 levels, there was an estimated PEFR change of -0.39 l/min (95% CI, -0.63, -0.14) and -0.54 l/min (95% CI, -0.89, -0.19), respectively. These data also suggest that fine particles have a more adverse respiratory health impact for sensitive individuals such as the elderly and that more research and control strategies should focus on the smaller particles associated with air pollution.