Mortality impacts of air pollution and greenness: real-world and counterfactual exposure scenarios in seven Northern European cities.

Estimating ambient air pollution mortality and disease burden and its economic cost in Barcelona

Chronic obstructive pulmonary disease (COPD) is an epidemic in China. Ozone is a possible risk factor of COPD, with ozone concentrations increasing in China, despite air pollution mitigation measures that reduced particulate matter. The WHO Air Quality Guidelines (AQG) recommendations in 2021 are a turning point that formally recognizes the crucial role of indoor air pollution. We aimed to investigate the premature COPD deaths attributable to ozone in 2019, taking the WHO AQG 2021 level into account to determine the gap to bridge ozone control in China. First, we assessed ozone exposures initiated from indoor and outdoor sources by gender and age groups in 344 cities under four scenarios: 2019 as a baseline, and outdoor ozone at WHO AQG 2021 level in 2019, 2030, and 2050, respectively. Subsequently, we estimated COPD deaths attributable to ozone. The results show that the COPD deaths attributable to ozone are 77,737 in 2019, and 527, 872, 1355 if the outdoor ozone concentration is reduced to the WHO AQG 2021 level in 2019 (counterfactual scenario), 2030, and 2050, respectively in urban China. The indoor ozone sources only contribute to less than 5% of COPD deaths. A gap of 68.5 μg/m3 for the highest seasonal ozone concentration should be bridged to meet the WHO AQG 2021 and avoid over 76 thousand (98%) COPD deaths in 2019 in urban China.

Modeling air pollution around major dumpsites in Lagos State using geospatial methods with solutions

Achieving WHO air pollution guidelines is critical to reduce the health burden of air pollution, which disproportionately affects socioeconomically disadvantaged populations and varies by sector, spatial distribution, and seasonal trends. This study explores the implications of sectorial and spatial-seasonal air pollution patterns, socio-economic disparities, and 15-minute communities to achieve (2021) WHO air quality guidelines for PM2.5 and NO2. The study analyses spatial-temporal patterns of air pollution in Belgium. Seasonal air pollution exposure is assessed through summer-to-winter ratios, stratified by land cover, urbanisation, and proximity to roads, and linked to socio-economic disparities using LOESS regression. A case study evaluates the mitigation potential of 15-minute communities for traffic-related air pollution, leveraging the Mobiscore tool to explore the relationship between accessibility and car ownership, a proxy for traffic-related emissions. NO2 and PM2.5 show marked seasonal and spatial variations, with higher concentration ratios in summer near busy roads and urban centres, especially for NO2. In general the NO2 spatial-seasonal pattern is more heterogenous compared to the PM2.5 pattern. Winter pollution exposure significantly hampers meeting WHO health targets, although summer levels of NO2 remain high around major traffic routes. The observed disparities in exposure to NO₂ highlight significant socio-economic inequalities, with the most deprived populations disproportionately burdened by traffic-related air pollution. The results from our case-study to mitigate traffic-related air pollution demonstrate that, up to a Mobiscore of 8.0, car ownership remains constant with increasing availability of services and public transport. From a turning point Mobiscore of 8.0, car ownerships starts to drop significantly, indicating that improving Mobiscores to very high scores ( > = 8.0) may lead to reduced car ownership and lower NO2 and PM2.5 emissions and exposure. Our study highlights important spatial-seasonal patterns in air pollution and their health implications, emphasizing the need for season-specific and structural traffic interventions to meet WHO guidelines for PM2.5 and NO2 exposure. A case study on mitigating traffic-related air pollution identifies a threshold where sufficient public transport and service accessibility lead to a reduction in car ownership. Addressing socio-economic disparities is crucial, as these areas often face greater challenges in meeting WHO air pollution guidelines, particularly for NO₂.

India's air pollution: a new government and global plan

This article describes the WHO Air Quality Guidelines and highlights two projects that were initiated to update the risk assessment of the main air pollutants: “Systematic Review of Health Aspects of Air Quality in Europe” and the “Global Update of WHO Air Quality Guidelines.” The report of the Systematic Review emphasizes that the accumulated evidence is sufficient to require actions reducing the health impacts of air pollution in Europe. The global update of the air quality guidelines focuses on particulate matter (PM), ozone, NO2, and SO2 and addresses issues associated with the practical feasibility of attaining the guidelines in developing countries. The article illustrates WHO's activities toward gathering the best available international scientific evidence to support air quality policy development in all regions of the world.

Background Air pollution, specifically particulate matter with a diameter of 2.5 micrometers (PM2.5), is the primary environmental health risk in Europe. Exposure to PM2.5 increases the risk of cardiovascular diseases, including AMI, resulting in high direct costs associated with in-patient treatment. This study aims to estimate the avoidable and attributable disease and economic burden of AMI due to ambient PM2.5 exposure in Portugal between 2011 and 2021. Methods National databases were used to assess the annual number of hospitalisations and deaths due to AMI between 2011 and 2021. The annual mean costs were calculated using a direct cost analysis (bottom-up micro-costing) to assess the direct economic burden of AMI. In turn, these cases and associated costs were multiplied by the respective morbidity and mortality population attributable fraction (PAF) to estimate the number of hospital admissions and deaths, and their associated costs attributable to ambient PM2.5 exposure. For 2019 and 2021, an alternative scenario of exposure was considered (2021 WHO Air Quality Guidelines), and the avoidable morbidity and mortality costs were determined using the potential impact fraction (PIF). Results Between 2011 and 2021, there were 130,447 hospitalisations and 47,968 deaths due to AMI, with 4.79% and 28.90%, respectively, attributable to ambient PM2.5 exposure. This translates to a direct economic burden of morbidity of more than 44 million euros and mortality of almost 195 million euros. If the proposed scenario guidelines were met, 279 cases and 448 deaths would have been avoided in 2019, resulting in a savings of almost 9.7 million euros. In 2021, 93 cases and 355 deaths would have been avoided, with approximately 4 million euros saved. Conclusions Exposure to ambient PM2.5 significantly contributes to AMI cases and deaths in Portugal, imposing a significant economic burden. These findings highlight the urgent need for measures to improve air quality. Key messages • PM2.5 pollution in Portugal drives AMI cases and fatalities, entailing significant economic costs. • Adhering to WHO air quality guidelines promises substantial reductions in AMI incidence and save millions annually in healthcare expenditure.

BACKGROUND AND AIM: Several existing studies have shown that long-term exposure to air pollution is associated with reduced kidney function. However, less is known about the effects of short-term exposure to air pollution on kidney disease aggravation and resultant emergency department burden. This study aimed to estimate the excess emergency room (ER) visits attributable to the short-term air pollution and to suggest evidence on better air pollution standards to protect kidney patients. METHODS: We conducted a time-series study using the National Health Insurance data covering all persons in South Korea (2003-2013). We collected daily data for air pollutants (particulate matter 10µm [PM10], ozone [O3], carbon monoxide [CO], and sulfur dioxide [SO2]) and ER visits for total kidney disease, acute kidney injury (AKI), and chronic kidney disease (CKD), respectively. We performed a distributed lag model analyses to estimate excess ER visits attributable to air pollution. RESULTS:For all kidney disease, excess ER visits attributable to air pollution were statistically significant for all air pollutants. While, for AKI, O3 showed the highest impacts on excess ER visits compared to other pollutants. On the other hand, the impacts of CO and SO2 were the highest for CKD compared to O3 and PM10. We also found that the positive association between air pollution and kidney ER visits existed for days with air pollution concentrations below the current WHO air quality guidelines. CONCLUSIONS:This study provides estimates of excess ER burdens attributable to air pollution and suggests that stricter air quality standards would benefit kidney disease patients. KEYWORDS: Kidney disease, Emergency Room Burden, Short term exposure, Air pollution, WHO air quality guideline

New WHO global air quality guidelines: more pressure on nations to reduce air pollution levels

Sex differences in associations of environmental exposure with respiratory health have been observed, but results are not conclusive. This study investigated the associations of exposure to air pollution and greenness with natural-cause mortality in men and women in Northern Europe. We studied 10,011 participants in the third Respiratory Health in Northern Europe (RHINE III) study in 2010 (age 40-65 years), with exposure to air pollution and greenness in the 20 years before (1990-2010), and with mortality (n = 368) follow-up until 2021. Cox proportional hazard models were used to estimate the associations of long-term particulate matter (PM_2.5 and PM₁₀), black carbon (BC), nitrogen dioxide (NO₂), ozone (O₃) and greenness (normalized difference vegetation index (NDVI)) with mortality, adjusting for body mass index, smoking, education, marital status and serious respiratory infection before 5 years old. The analyses were done separately for men and women. The overall mean levels of air pollutants were far below the European Union (EU) standards. In single pollutant models, for women, the adjusted hazard ratios (HRs) of natural-cause mortality were 1.10 (95% confidence interval (CI): 1.06, 1.15), 1.04 (95% CI: 1.01, 1.07), 2.99 (95% CI: 1.87, 4.77), 1.03 (95% CI: 1.01, 1.05) and 0.95 (95% CI: 0.93, 0.98) per 1 µg/m³ increase in PM_2.5, PM₁₀, BC, NO₂ and O₃, respectively. No significant associations were observed between the air pollutants and mortality in men. Greenness was not associated with mortality in men or women. Long-term exposure to low-level air pollution is associated with female mortality. Women might be more susceptible to air pollution than men.

Long-term exposure to ambient air pollution, genetic susceptibility, and the incidence of bipolar disorder: A prospective cohort study

Ambient air pollution remains the major environmental cause of disease. Accurate assessment of population exposure and small-scale spatial exposure variations over long time periods is essential for epidemiological studies. We estimated annual exposure to fine and coarse particulate matter (PM2.5, PM10), and nitrogen oxides (NOx, NO2) with high spatial resolution to examine time trends 2000‒2018, compliance with the WHO Air Quality Guidelines, and assess the health impact. The modelling area covered six metropolitan areas in Sweden with a combined population of 5.5 million. Long-range transported air pollutants were modelled using a chemical transport model with bias correction, and locally emitted air pollutants using source-specific Gaussian-type dispersion models at resolutions up to 50 × 50 m. The modelled concentrations were validated using quality-controlled monitoring data. Lastly, we estimated the reduction in mortality associated with the decrease in population exposure. The validity of modelled air pollutant concentrations was good (R2 for PM2.5 0.84, PM10 0.61, and NOx 0.87). Air pollution exposure decreased substantially, from a population weighted mean exposure to PM2.5 of 12.2 µg m−3 in 2000 to 5.4 µg m−3 in 2018. We estimated that the decreased exposure was associated with a reduction of 2719 (95% CI 2046–3055) premature deaths annually. However, in 2018, 65%, 8%, and 42% of residents in the modelled areas were still exposed to PM2.5, PM10, or NO2 levels, respectively, that exceeded the current WHO Air Quality Guidelines for annual average exposure. This emphasises the potential public health benefits of reductions in air pollution emissions.

Background The adverse health impact of air pollution on non-communicable diseases (NCDs) is well documented, yet methodological tools for assessing the potential health benefits of interventions are lacking. This study uses a parametric g-computation approach to evaluate the impact of hypothetical interventions targeting long-term air pollution exposure on reducing NCDs prevalence in Belgium, using data from three national Health Interview Surveys (BHIS 2008-2013-2018). Methods BHIS data (n = 27,536) were linked to environmental data at participants’ residential addresses. A g-computation approach was used to calculate the potential impact fractions of air quality interventions on several NCDs. Regression models were adjusted for socio-economic, environmental and lifestyle factors. The scenarios involved reducing individual long-term air pollution exposure to WHO air quality guideline levels, followed by investigating dose-response functions through various percentage reductions in air pollution exposure. Results Significant associations were found between air pollution and asthma, stroke, and multimorbidity. Adhering to WHO air quality guidelines would substantially reduce stroke risk in Belgium by 0.87% (95% CI:0.38; 1.35) for PM2.5 and 0.32% (95% CI:-0.05; 0.70) for NO2, preventing 63% and 22% of cases, respectively. For asthma, risk reduction was 1.43% (95% CI:-0.53; 3.4) for PM2.5 and 0.83% (95% CI: 0.01; 1.63) for NO2, preventing 27% and 16% of cases, respectively. For multimorbidity, risk reduction was 3.20 % (95% CI: -1.75; 8.16) for PM2.5 and 0.43% (95% CI:-2.03; 2.90) for NO2, preventing 7% and 0.4% of cases, respectively. Results revealed a clear dose-response association between air pollution reduction and the prevalence of stroke, asthma, and multimorbidity in Belgium. Conclusions This study demonstrates that air pollution reduction interventions could effectively decrease the prevalence of asthma, stroke, and multimorbidity in Belgium. Key messages • Air pollution reduction interventions could effectively decrease the prevalence of asthma, stroke, and multimorbidity in Belgium. • The g-computation approach to assess PIF of interventions represents a straightforward approach for drawing causal inferences from observational data.

BACKGROUND AND AIM: Literature has linked air pollution and cerebrovascular diseases including stroke. However, evidence is limited for the simultaneous effects of multiple air pollutants on stroke incidence. METHODS: A nationwide population-based open cohort study was used to estimate the association between long-term exposure to PM2.5, NO2, ozone, and stroke incidence. The study population included all free-for-service Medicare enrollees (aged ≥65 years) in the contiguous United States from 2000-2017. We estimated the hazard ratios (HRs) for the first diagnosis with stroke using single-, bi-, and tri-pollutant Cox proportional hazards models that controlled for demographic characteristics, Medicaid eligibility, and area-level covariates. We further looked at this relationship in two sub-cohorts of enrollees who were always exposed to pollutant levels below the US EPA National Ambient Air Quality Standards [NAAQS] (annual PM2.5 ≤12 μg/m³, annual NO2 ≤53 ppb, and warm-season ozone ≤50 ppb) and the WHO air quality guideline (annual PM2.5 ≤10 μg/m³, annual NO2 ≤20 ppb, and warm-season ozone ≤40 ppb). RESULTS:Increases of 10 μg/m³ in PM2.5, 10 ppb in NO2, and 10 ppb in ozone were associated with increased risk of first diagnosis with stroke, with HRs of 1.063 (95% CI, 1.048-1.077), 1.048 (1.043-1.052), and 1.031 (1.026-1.037), respectively. Among the below EPA low-exposure sub-cohort, the corresponding HRs were 1.041 (95% CI, 1.008-1.075), 1.067 (1.056-1.077), and 1.123 (1.108-1.138), respectively. When restricting analyses to levels below the WHO air quality guidelines, increasing pollution levels were consistently associated with a greater hazard estimate. CONCLUSIONS:Long-term exposure to air pollution, even at concentrations below NAAQS or international standards, was significantly associated with increased stroke incidence among the US elderly population. KEYWORDS: Air pollution, Multi-pollutant, Stroke

A European perspective on hazardous air pollutants