Air pollution and stroke mortality in Arak, Iran: Short-term and long- term exposure effects analyzed using zero-inflated negative binomial

Long-term air pollution exposure is associated with increased mortality, but the association with incidence of fatal and nonfatal coronary heart disease is less certain. Moreover, it is unknown how chronic exposure to air pollution affects prognosis among survivors of a first coronary event. This study evaluated the association between long-term traffic-related air pollution exposure and incidence of nonfatal and fatal coronary events, as well as subsequent hospital readmission and mortality among myocardial infarction survivors. The study population comprised all residents of Rome aged 35-84 years during the period 1998-2000. Residential nitrogen dioxide (NO2) exposure as a marker of traffic pollution was assessed by a land-use regression model in 1995-1996 (R = 0.69). A total of 11,167 incident coronary events were observed (4654 fatal, including 3598 out-of-hospital coronary deaths, and 6513 nonfatal). The cohort of 6513 survivors was followed 4.0-7.5 years for readmission or mortality, starting 28 days from the date of first event. Relative risks per 10 mug/m of NO2 exposure, adjusted for age, sex, and socioeconomic status, were calculated by Poisson regression (population-based incidence) and Cox regression (cohort analysis). The relative risk for incidence in coronary events per 10 mug/m of NO2 was 1.03 (95% confidence interval = 1.00-1.07). Stronger associations were found for fatal cases (1.07; 1.02-1.12) and out-of-hospital deaths (1.08; 1.02-1.13). Using NO2 exposure at the time of the first event, there was no association of air pollution exposure with either subsequent hospital readmission or mortality among survivors of the first coronary event. Long-term air pollution exposure increases the risk of coronary heart disease, particularly fatal events. Hospital readmission or subsequent mortality among survivors was not associated with traffic air pollution.

Outdoor air pollution and lung cancer: recent epidemiologic evidence.

Associations of air pollution, obesity and cardiometabolic health in young adults: The Meta-AIR study

BackgroundA growing body of evidence suggests that air pollution exposure is associated with an increased risk for cardiovascular diseases. Data regarding the impact of long-term air pollution exposure on ischemic stroke mortality are sparse. MethodsThe German nationwide inpatient sample was used to analyse all cases of hospitalized patients with ischemic stroke in Germany 2015–2019, which were stratified according to their residency. Data of the German Federal Environmental Agency regarding average values of air pollutants were assessed from 2015 to 2019 at district-level. Data were combined and the impact of different air pollution parameters on in-hospital case-fatality was analyzed. ResultsOverall, 1,505,496 hospitalizations of patients with ischemic stroke (47.7% females; 67.4 % ≥70 years old) were counted in Germany 2015–2019, of whom 8.2 % died during hospitalization. When comparing patients with residency in federal districts with high vs. low long-term air pollution, enhanced levels of benzene (OR 1.082 [95%CI 1.034–1.132],P = 0.001), ozone (O3, OR 1.123 [95%CI 1.070–1.178],P < 0.001), nitric oxide (NO, OR 1.076 [95%CI 1.027–1.127],P = 0.002) and PM2.5 fine particulate matter concentrations (OR 1.126 [95%CI 1.074–1.180],P < 0.001) were significantly associated with increased case-fatality independent from age, sex, cardiovascular risk-factors, comorbidities, and revascularization treatments. Conversely, enhanced carbon monoxide, nitrogen dioxide, PM10, and sulphur dioxide (SO2) concentrations were not significantly associated with stroke mortality. However, SO2−concentrations were significantly associated with stroke-case-fatality rate of >8 % independent of residence area-type and area use (OR 1.518 [95%CI 1.012–2.278],P = 0.044). ConclusionElevated long-term air pollution levels in residential areas in Germany, notably of benzene, O3, NO, SO2, and PM2.5, were associated with increased stroke mortality of patients. Research in contextEvidence before this study:Besides typical, established risk factors, increasing evidence suggests that air pollution is an important and growing risk factor for stroke events, estimated to be responsible for approximately 14 % of all stroke-associated deaths. However, real-world data regarding the impact of long-term exposure to air pollution on stroke mortality are sparse.Added value of this study:The present study demonstrates that the long-term exposure to the air pollutants benzene, O3, NO, SO2 and PM2.5 are independently associated with increased case-fatality of hospitalized patients with ischemic stroke in Germany.Implications of all the available evidence:The results of our study support the urgent need to reduce the exposure to air pollution by tightening emission controls to reduce the stroke burden and stroke mortality.

Diabetes is a growing epidemic, and it has become arguably one of the biggest health challenges of our time. Currently, more than 23 million Americans have diabetes, and the Centers for Disease Control and Prevention estimate that in the last 15 years, the number of people in the United States with diabetes has more than doubled. Diabetes is increasing at an alarming rate in Europe as well, and it is fast becoming a major health threat in developing countries such as India and China. Despite its high prevalence, however, diabetes remains somewhat of a mystery. Although type 1 diabetes mellitus could be attributed to insufficient insulin release by the β-cells of the pancreas, the origins of type 2 diabetes mellitus (which accounts for >90% of the cases of diabetes) remain obscure. Insulin resistance is a cardinal feature of type 2 diabetes mellitus; however, it is not clear how whole-body insulin resistance develops, which specific tissues are affected first and which ones later, and how metabolic changes in individual tissues contribute to the overall development of the disease and its many secondary complications. Article p 538 The origin of diabetes is equally complex. Although diabetes develops in genetically susceptible individuals, it is a complex trait and does not show simple mendelian inheritance. Because the rates of diabetes change with the environment in several population groups, it has been suggested that modifiable environmental factors and lifestyle choices account for more than 90% of adult-onset diabetes.1 Nevertheless, our understanding of the environmental causes of diabetes has remained rather rudimentary, being limited mostly to the impact of physical inactivity or unhealthy dietary choices. In this context, the study by Sun and coworkers published in the present issue of Circulation 2 is interesting because it provides new evidence showing that exposure to particulate air …

Epidemiological studies suggest an association between stroke incidence and stroke mortality and long-term exposure to particulate matter (PM) air pollution. However, the magnitude of the association is still unclear. We searched the Pubmed citation database for epidemiological studies and reviews on stroke and PM exposure. Then, we carried out a meta-analysis to quantify the pooled association between stroke incidence and mortality and long-term exposure to PM. Meta-analyses were performed for stroke events and stroke mortality and for PM10 and PM2.5 separately and jointly. We identified 20 studies, including a total of >10 million people, on long-term PM exposure and stroke event or stroke mortality. For exposure to PM10 (including estimated exposure to PM10 from studies using PM2.5), the pooled hazard ratio for each 10-μg/m3 increment in PM10 was 1.061 (95% confidence interval, 1.018-1.105) and 1.080 (0.992-1.177) for overall stroke events and stroke mortality, respectively. A stratified analysis by continent revealed that the association between stroke and long-term PM10 exposure was positive in North America (1.062 [1.015-1.110]) and Europe (1.057 [0.973-1.148]), but studies in Asia (1.010 [0.885-1.153]) showed a high degree of heterogeneity. Considering exposure to PM2.5 (Europe and North America combined), the hazard ratios for a 5-μg/m3 increment were 1.064 (1.021-1.109) and 1.125 (1.007-1.256) for stroke events and mortality, respectively. The scientific evidence of the past decade identifies long-term exposure to PM, and PM2.5 in particular, as a risk factor for stroke. However, we found some currently unexplained geographical variability in this association.

The effects of long-term ambient air pollutant mixture exposure on incident diabetes: A prospective cohort study in China.

Independent associations of short- and long-term air pollution exposure with COVID-19 mortality among Californians.

Roles of pollution in the prevalence and exacerbations of allergic diseases in Asia

Background:The impact of nitrogen dioxide () and particulate matter with an aerodynamic diameter of less than or equal to 2.5. microns () exposures on lung function has been investigated mainly in children and less in adults. Furthermore, it is unclear whether short-term deviations of air pollutant concentration need to be considered in long-term exposure models.Objectives:The aims of this study were to investigate the association between short-term air pollution exposure and lung function and to assess whether short-term deviations of air pollutant concentration should be integrated into long-term exposure models.Methods:Short-term (daily averages 0–7 d prior) and long-term (1- and 4-y means) and concentrations were modeled using satellite, land use, and meteorological data calibrated on ground measurements. Forced expiratory volume within the first second (FEV1) of forced exhalation and forced vital capacity (FVC) were measured during a LuftiBus assessment (2003–2012) and linked to exposure information from the Swiss National Cohort for 36,085 adults (ages 18–95 y). We used multiple linear regression to estimate adjusted associations, and additionally adjusted models of long-term exposures for short-term deviations in air pollutant concentrations.Results:A increase in and on the day of the pulmonary function test was associated with lower FEV1 and FVC (: FEV1 [95% confidence interval: , ], FVC [, ]; : FEV1 [, ], FVC [, ]). A increase in 1-y mean was also associated with lower FEV1 (; , 0.5) and FVC (; , ), as was a increase in 1-y mean (FEV1: ; , ; FVC: ; , ). These associations were robust to adjustment for short-term deviations in the concentration of each air pollutant.Conclusions:Short- and long-term air pollution exposures were negatively associated with lung function, in particular long-term exposure with FVC. Our findings contribute substantially to the evidence of adverse associations between air pollution and lung function in adults. https://doi.org/10.1289/EHP7529

Assessment of long-term exposure to outdoor air pollution remains a major challenge for epidemiological studies. One of these challenges is characterizing fine-scale spatial variation of the ambient concentrations of key traffic-related air pollutants - including ultrafine particles (UFPs), black carbon (BC), and nitrogen dioxide (NO2). Epidemiological studies have used widely different approaches to address these challenges, including empirical land use regression (LUR) models based on fixed-site routine or targeted monitoring, low-cost sensor networks, mobile monitoring, and deterministic dispersion models. Little information is available about the relative performance of these different approaches for assessing long-term exposure to traffic-related air pollution. Different methods may result in heterogeneity in health effect estimates from epidemiological studies applying different exposure-assessment approaches. We evaluated annual average air pollution concentrations across the Netherlands using a suite of different exposure models, which differed in modeling approach (empirical LUR, deterministic dispersion models) and monitoring data used (low-cost sensors, mobile monitoring, nationwide and Europewide routine monitoring, and study-specific targeted monitoring). For empirical models, we tested three model development algorithms: supervised linear regression (SLR), Random Forest, and least absolute shrinkage and selection operator (LASSO). The predictions of the models were compared at 20,000 addresses across the Netherlands. The performance was also tested on external validation data, which were obtained from a new campaign (2021-2023) and existing data from different years, allowing assessment of how well recent models predict past air pollution exposure. Epidemiological analyses in three cohort studies were conducted to compare health effect estimates of the different exposure models. We assessed associations of air pollution in a national administrative cohort with natural-cause and cause-specific mortality, in a cohort study that had detailed lifestyle data with natural-cause mortality and incidence of stroke and coronary events, and in a mature birth cohort with lung function and asthma incidence. Exposure predictions at residential sites from the dispersion model and the Europewide hybrid LUR models were available for multiple years in the period 2010-2019. For these models, exposure predictions of different years in the period 2010-2019 were highly correlated for BC, NO2, and PM2.5 (Correlation coefficient R > 0.9). Consistently, the year of the exposure model did not affect the presence of an association with mortality and morbidity. Small differences in hazard ratios (HR) were related to exposure contrast for different years. The HR for the association of NO2 with natural-cause mortality was 1.026 (95% confidence interval [CI]: 1.022-1.031) for the 2010 exposure estimate and 1.030 (1.024-1.035) for the 2019 exposure estimate of the Europewide LUR model, expressed per 10 µg/m3. The main conclusions of the project.

Introduction: Air quality is a major environmental determinant of health, especially among adults living in areas with high levels of air pollution. Given our world’s aging population and increasingly dynamic climate, better understanding the relationship between ambient air quality and cerebrovascular disease outcomes among older adult is increasingly important. Objective: To document the relationship between air quality, as measured by particulate matter (PM 2.5) and cerebrovascular disease outcomes, measured by stroke death rates among older adults in the United States. Methods: The CDC Wonder database was used to retrieve Environmental Protection Agency's Air Quality System annual average ambient concentrations of PM2.5 and National Center for Health Statistics (NCHS) stroke death and total cardiovascular death rates by county across the United States. Spearman correlation was used to analyze the relationship between these variables. Results: Nationally, average ambient concentration of PM2.5 ranged from 3 to 19.7 μg/m3 with a mean of 9 μg/m3 ± 1.9 μg/m3 among 3,108 counties reporting data. Particular matter concentrations had a moderately positive relationship with stroke death rates (0.44, p&lt;0.01) and total cardiovascular death rates (0.45, p&lt;0.01) among adults over age 65. Conclusions: Our analysis of ambient air quality and cerebrovascular as well as total cardiovascular death rates demonstrates a moderate correlation between fine particulate matter and poor outcomes. Our data further demonstrates a number of US counties exceed World Health Organization fine particulate matter guidelines. These findings provide compelling evidence for both increased efforts towards improvement of air quality and mitigation strategies to prevent associated negative health outcomes.

This study investigated whether exposure to air pollution remains a significant factor contributing to childhood asthma in China. Short-term exposure to air pollutants was assessed using daily average concentrations of pollutants at current and lag intervals (0-6 days) from 2015 to 2018. Long-term individual exposure in 2016 was estimated using land-use regression (LUR) models. The effects of short- and long-term exposure on childhood asthma hospitalizations were evaluated using generalized additive models and multiple time-dependent Cox regression models, respectively. Hospitalizations for childhood asthma typically peaked in late spring and fall, with a higher prevalence of wheezing or asthma observed in male individuals than in female individuals. Hospital admissions were most frequent among children aged 0-3 years. However, no significant positive associations were observed between short- or long-term air pollutant exposure and daily childhood asthma hospitalizations, based on the applied statistical models and the levels of air pollution exposure measured during the study period. In this study, variability in air pollution exposure was not associated with variability in hospitalizations of children with asthma. Instead, asthma onset exhibited unique seasonal and demographic patterns.

Several studies on long-term air pollution exposure and sleep have reported inconsistent results. Large-scale studies on short-term air pollution exposures and sleep have not been conducted. We investigated the associations of long- and short-term exposure to ambient air pollutants with sleep in a Chinese population based on over 1 million nights of sleep data from consumer wearable devices. Air pollution data including particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) were collected from the Ministry of Ecology and Environment. Short-term exposure was defined as a moving average of the exposure level for different lag days from Lag0 to Lag0-6. A 365-day moving average of air pollution was regarded as long-term exposure. Sleep data were recorded using wearable devices from 2017 to 2019. The mixed-effects model was used to evaluate the associations. We observed that sleep parameters were associated with long-term exposure to all air pollutants. Higher levels of air pollutant concentrations were associated with longer total sleep and light sleep duration, shorter deep sleep duration, and decreases in wake after sleep onset (WASO), with stronger associations of exposures to NO2 and CO [a 1-interquartile range (IQR) increased NO2 (10.3 μg/m3) was associated with 8.7 min (95% CI: 8.08 to 9.32) longer sleep duration, a 1-IQR increased CO (0.3 mg/m3) was associated with 5.0 min (95% CI: − 5.13 to − 4.89) shorter deep sleep duration, 7.7 min (95% CI: 7.46 to 7.85) longer light sleep duration, and 0.5% (95% CI: − 0.5 to − 0.4%) lower proportion of WASO duration to total sleep]. The cumulative effect of short-term exposure on Lag0-6 is similar to long-term exposure but relatively less. Subgroup analyses indicated generally greater effects on individuals who were female, younger (< 45 years), slept longer (≥ 7 h), and during cold seasons, but the pattern of effects was mixed. We supplemented two additional types of stratified analyses to reduce repeated measures of outcomes and exposures while accounting for individual variation. The results were consistent with the overall results, proving the robustness of the overall results. In summary, both short- and long-term exposure to air pollution affect sleep, and the effects are comparable. Although people tend to have prolonged total sleep duration with increasing air pollutant concentrations, their sleep quality might remain poor because of the reduction in deep sleep.

For industrial cities, quantifying the influence of a given emission source on air quality is very important for making a detailed control strategy to the emissions. By taking use of the mobile observations and WRF-STILT model simulations, this study analyzes the air pollution characteristics and air quality influences from an industrial emission source in Xinji, China. During the study period, the hourly average concentrations of smoke, SO2, and NOx emitted from the industrial source are 1.01, 22.04, and 26.22 mg/m3, respectively. The mobile observations show that with the increase of distance from the emission source, the concentration of air pollutants increases first and then decreases. The peak values of PM2.5, SO2, and NOx appear at the distance of around 0–3 km away from the emission source, among which PM2.5 and SO2 increase first and then decrease before stabilizing, while NOx is interfered by emissions from the traffic along the roads. Within the distance of 3 km, the emission source has obvious influence on the air quality with contribution rate 10–48% at night time and 3–23% at day time. The simulation results of WRF-STILT also support the observed gradient change characteristics of air pollutants, suggesting that this industrial emission source is an important pollution source for regions around it. Our results further show that the meteorological conditions play an important role on the transport capacity of industrial emissions. The results of this study provide support for quantifying the scope of influence of fixed emission sources, especially in industrial cities.