Combined Effects Of Air Pollution Research Articles

Air pollution exposure, chemical compositions, and risk of expiratory airflow limitation in youth in Northeast China

BackgroundExpiratory airflow limitation (EAL) is closely associated with respiratory health in youth and adulthood. Owing to limited evidence, we aim to estimate the association between air pollutants, both individually and in combination, along with their chemical compositions, and the risk of EAL in youth based on data obtained from Northeast China Biobank. MethodsPulmonary function was evaluated using a medical-grade pulmonary function analyzer, with EAL defined as a forced expiratory flow in 1 s/ forced vital capacity ratio of < 0.8. Land use regression models were used to predict exposure to six air pollutants. Air pollution score (APS) for each participant was constructed as combined exposure. The chemical composition of particulate matter with an aerodynamic diameter of ≤ 2.5 µm (PM2.5) was determined using a validated machine-learning algorithm. Logistic regression models were employed to estimate effect sizes, and odds ratio (OR) and 95 % confidence intervals (CI) were calculated. ResultsIn total, 905 EAL cases were identified among the 4301 participants, with a prevalence of 21.04 %. Each inter-quartile range increase in APS was associated with a 25 % higher risk of EAL (OR = 1.25, 95 % CI: 1.12, 1.39). Among the pollutants analyzed, PM2.5 exposure had the strongest association with the risk of EAL (OR = 1.33, 95 % CI: 1.18, 1.52). Out of the five chemical components, sulfate (SO2-4) (OR = 1.39, 95 % CI: 1.24, 1.57) and ammonium (NH+4) (OR = 1.39, 95 % CI: 1.23, 1.57) exhibited the strongest associations with the risk of EAL. ConclusionsOverall, combined effects of air pollution increased the risk of EAL in youth, with SO2-4 and NH+4 emerging as the predominant contributing chemical components in Northeast China.

Health effect of multiple air pollutant mixture on sarcopenia among middle-aged and older adults in China

BackgroundAs the global aging process accelerates, the health challenges posed by sarcopenia among middle-aged and older adults are becoming increasingly prominent. However, the available evidence on the adverse effects of air pollution on sarcopenia is limited, particularly in the Western Pacific region. This study aimed to explore relationships of multiple air pollutants with sarcopenia and related biomarkers using the nationally representative database. MethodsTotally, 6585 participants aged over 45 years were enrolled from the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 3443 of them were followed up until 2015. Air pollutants were estimated from high-resolution satellite-based spatial-temporal models. In the cross-sectional analysis, we used generalized linear regression, unconditional logistic regression analytical and restricted cubic spline (RCS) methods to assess the single-exposure and non-linear effects of multiple air pollutants on sarcopenia and related surrogate biomarkers (serum creatinine and cystatin C). Several popular mixture analysis techniques such as Bayesian kernel machine regression (BKMR), weighted quantile sum (WQS) regression, and quantile-based g-computation (Qgcomp) were further used to examinate the combined effects of multiple air pollutants. Logistic regression was used to further analyze the longitudinal association between air pollution and sarcopenia. ResultsEach interquartile range increase in PM2.5, PM10 and NO2 was significantly associated with an increased risk of sarcopenia, with adjusted odds ratios (aORs) of 1.09 [95 % confidence interval (CI): 1.01, 1.20], 1.24 (95 % CI: 1.14, 1.35) and 1.18 (95 % CI: 1.08, 1.28), respectively. Our findings also showed that five air pollutants were significantly associated with the sarcopenia index. In addition, employing a mixture analysis approach, we confirmed significant combined effects of air pollution mixtures on sarcopenia risk and associated biomarkers, with PM10 and PM2.5 identified as major contributors to the combined effect. The results of the exposure-response (E-R) relationships, subgroup analysis, longitudinal analysis and sensitivity analysis all showed the unfavorable impact of air pollution on sarcopenia risk and related vulnerable populations. ConclusionsSingle-exposure and co-exposure to multiple air pollutants were positively associated with sarcopenia among middle-aged and older adults in China. Our study provided new evidence that air pollution mixture was significantly associated with sarcopenia related biomarkers.

Escaping Environmental Hazards? Human Mobility in Response to Air Pollution and Extreme Cold Events

Understanding the patterns of human mobility and how they relate to different environmental risks is key to developing effective adaptation strategies. To this end, this study applied large-scale mobile phone data to examine the differential mobility responses to and interaction between air pollution and extreme cold events and attempted to identify nonlinearities in the relationship between short-term movements and the two environmental hazards. The results revealed that extreme cold events had a strong influence on the mobility decisions of residents in the city of Chengdu, China. Residents were more likely to react to climate-related hazards in their daily mobility than air pollution, which is often characterized as a slow-onset, small-impact, and frequent concern. The findings from the estimation of an interaction term indicated an antagonistic effect; that is, the combined effect of air pollution and extreme cold events on short-term movements was significantly lower than expected from the sum of their individual effects. Using a piecewise regression approach, this study uncovered nonlinearities in mobility as a response to air pollution and cold events as the number of trips from hazardous places to less hazardous places increased more than proportional to the differentials in air quality and magnitude of cold events.

Independent and interaction effects of prenatal exposure to high AQI and extreme Humidex on the risk of preterm birth: A large sample population study in northern China

The combined effects of air pollution and extreme temperature on PTB remain unclear. To evaluate the independent effect and interaction effect of prenatal extreme exposure to air quality index (AQI) and Humidex, on PTB. Based on the National Health Care Data Platform of Shandong University, women who gave birth in 2019–2020 were selected for the study. First, the independent effects of AQI and Humidex on PTB were assessed by logistic regression model. Subsequently, the interaction effects of AQI and Humidex on PTB were estimated separately by calculation of the relative excess risk of interaction (RERI). A total of 34365 pregnant women were included and 1975 subjects were diagnosed with PTB. We observed a significant increase in the odds of PTB associated with maternal high AQI exposure, with an OR of 1.70 (95% CI: 1.59, 1.81). Similarly, extreme exposure to Humidex also demonstrated an elevated PTB odds, with a low Humidex OR of 2.48 (95% CI: 2.23, 2.76) and a high Humidex OR of 1.48 (95% CI: 1.31, 1.67). Finally, we observed an interaction between high AQI and extreme Humidex during the 1st trimester. Interaction effects were noted between high AQI and low Humidex throughout the entire trimester and the 2nd trimester. This study suggests that prenatal exposure to high AQI and extreme Humidex could increase the odds of PTB, with effects exhibiting the sensitivity window and a cumulative trend. Additionally, there is an interaction between AQI and Humidex.

The combined effect of air pollution and non-optimal temperature on mortality in Shandong Province, China: establishment of air health index.

The air health index (AHI) captures the combined effects of air pollution and non-optimal temperatures and helps assess the atmospheric environment's overall health risk. Shandong Province is a crucial industrial base in China, and the health effects of air pollution and non-optimal temperature cannot be ignored. To construct an AHI for Shandong Province and assess the district-level mortality burden due to AHI in the study area. Daily district-specific mortality, meteorological, and air pollution data over 2013-2018 were collected in Shandong Province, China. The AHI construction eventually incorporated PM2.5 and NO2, O3, and non-optimal temperatures. Attributable fraction (AF) and attributable number (AN) were used to estimate the district-specific mortality burden attributable to AHI. The average AHI value observed in Shandong Province was 6. Our research revealed a positive association between the total AHI and total mortality, with an overall trend of a slow increase followed by a rapid increase. The exposure-response curves, when stratified by gender, age, and cause of death, were approximately consistent with the overall trend. The provincial attributable fraction (AF) was 5.31% (95% CI 4.58%, 5.91%), and the attributable number (AN) was 188,246 (95% CI 162,396, 209,533). Overall, higher ANs mainly appeared in the southwestern area, while higher values of AF were observed in the central-eastern and central-northern areas. The air health index performs well in predicting death burden and can convey health risks related to exposure to the ambient environment to the public.

Joint effects of prenatal exposure to air pollution and pregnancy-related anxiety on birth weight: A prospective birth cohort study in Ma’anshan, China

BackgroundA growing number of studies have shown that prenatal exposure to chemical and non-chemical stressors has effects on fetal growth. The co-exposure of both better reflects real-life exposure patterns. However, no studies have included air pollutants and pregnancy-related anxiety (PrA) as mixtures in the analysis. MethodUsing the birth cohort study method, 576 mother-child pairs were included in the Ma'anshan Maternal and Child Health Hospital. Evaluate the exposure levels of six air pollutants during pregnancy using inverse distance weighting (IDW) based on the pregnant woman's residential address and air pollution data from monitoring stations. Prenatal anxiety levels were assessed using the PrA Questionnaire. Generalized linear regression (GLR), quantile g-computation (QgC) and bayesian kernel machine regression (BKMR) were used to assess the independent or combined effects of air pollutants and PrA on birth weight for gestational age z-score (BWz). ResultThe results of GLR indicate that the correlation between the six air pollutants and PrA with BWz varies depending on the different stages of pregnancy and pollutants. The QgC shows that during trimester 1, when air pollutants and PrA are considered as a whole exposure, an increase of one quartile is significantly negatively correlated with BWz. The BKMR similarly indicates that during trimester 1, the combined exposure of air pollutants and PrA is moderately correlated with a decrease in BWz. ConclusionUsing the method of analyzing mixed exposures, we found that during pregnancy, the combined exposure of air pollutants and PrA, particularly during trimester 1, is associated with BWz decrease. This supports the view that prenatal exposure to chemical and non-chemical stressors has an impact on fetal growth.

The effects of heatwave on cognitive impairment among older adults: Exploring the combined effects of air pollution and green space

The association between heatwaves and cognitive impairment in older adults, especially the joint effect of air pollution and green space on this association, remains unknown. The present cohort study used data from waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. Heatwaves were defined as having daily maximum temperature ≥ 92.5th, 95th and 97.5th percentile that continued at least two, three and four days, measured as the one-year heatwave days prior to the participants' incident cognitive impairment. Data on the annual average air pollutant concentrations of fine particulate matter (PM2.5) and ozone (O3) as well as green space exposure (according to the Normalized Difference Vegetation Index (NDVI)) were collected. Time-varying Cox proportional hazards models were constructed to examine the independent effect of heatwaves on cognitive impairment and the combined effect of heatwaves, air pollution, and green space on cognitive impairment. Potential multiplicative interactions were examined by adding a product term of air pollutants and NDVI with heatwaves in the models. The relative excess risk due to interaction (RERI) was calculated to reflect additive interactions. We found that heatwave exposure was associated with higher risks of cognitive impairment, with hazard ratios (HRs) and 95 % confidence intervals (CIs) ranging from 1.035 (95 % CI: 1.016–1.055) to 1.058 (95 % CI: 1.040–1.075). We observed a positive interaction of PM2.5 concentrations, O3 concentrations, lack of green space, and heatwave exposure on a multiplicative scale (HRs for product terms >1). Furthermore, we found a synergistic interaction of PM2.5 concentrations, O3, lack of green space, and heatwave exposure on an additive scale, with RERIs >0. These results suggest that extreme heat exposure may be a potential risk factor for cognitive impairment in older adults. Additionally, coexposure to air pollution and lack of green space exacerbated the adverse effects of heatwaves on cognitive function.

Associations of air pollution with all-cause dementia, Alzheimer's disease, and vascular dementia: a prospective cohort study based on 437,932 participants from the UK biobank.

To prospectively assess whether air pollution, including PM2.5, PM10, and NOx, is associated with the risk of all-cause dementia, Alzheimer's disease (AD), and vascular dementia, and to investigate the potential relationship between air pollution and genetic susceptibility in the development of AD. Our study included 437,932 participants from the UK Biobank with a median follow-up period of over 10 years. Using a Cox proportional hazards model, we found that participants exposed to PM2.5 levels of ≥10 μg/m3 had a higher risk of developing all-cause dementia (HR = 1.1; 95% CI: 1.05-1.28; p < 0.05) compared to the group exposed to PM2.5 levels of <10 μg/m3. However, there was no significant association between PM10 levels of ≥15 μg/m3 and the risk of all-cause dementia, AD, or vascular dementia when compared to the group exposed to PM10 levels of <15 μg/m3. On the other hand, participants exposed to NOx levels of ≥50 μg/m3 had a significantly higher risk of all-cause dementia (HR = 1.14; 95% CI: 1.02-1.26; p < 0.05) and AD (HR = 1.26; 95% CI: 1.08-1.48; p < 0.05) compared to the group exposed to NOx levels of <50 μg/m3. Furthermore, we examined the combined effect of air pollution (PM2.5, PM10, and NOx) and Alzheimer's disease genetic risk score (AD-GRS) on the development of AD using a Cox proportional hazards model. Among participants with a high AD-GRS, those exposed to NOx levels of ≥50 μg/m3 had a significantly higher risk of AD compared to those in the group exposed to NOx levels of <50 μg/m3 (HR = 1.36; 95% CI: 1.03-1.18; p < 0.05). Regardless of air pollutant levels (PM2.5, PM10, or NOx), participants with a high AD-GRS had a significantly increased risk of developing AD. Similar results were obtained when assessing multiple variables using inverse probability of treatment weighting (IPTW). Our findings indicate that individuals living in areas with PM2.5 levels of ≥10 μg/m3 or NOx levels of ≥50 μg/m3 are at a higher risk of developing all-cause dementia. Moreover, individuals with a high AD-GRS demonstrated an increased risk of developing AD, particularly in the presence of NOx ≥ 50 μg/m3.

Combined effects of ambient air pollution and PM2.5 components on renal function and the potential mediation effects of metabolic risk factors in China

Growing evidence links long-term air pollution exposure with renal function. However, little research has been conducted on the combined effects of air pollutant mixture on renal function and multiple mediation effects of metabolic risk factors. This study enrolled 8996 adults without chronic kidney disease (CKD) at baseline from the CHCN-BTH cohort study. Three-year exposure to air pollutants [particulate matter ≤ 2.5 µm (PM2.5), PM10, PM1, ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2) and carbon monoxide (CO)] and PM2.5 components [black carbon (BC), ammonium (NH4+), nitrate (NO3-), sulfate (SO42-) and organic matter (OM)] were assessed using well-validated machine learning methods. Linear mixed models were applied to investigate the associations between air pollutants and estimated glomerular filtration rate (eGFR). Quantile G-computation was used to assess the combined effects of pollutant mixtures. Causal mediation analysis and Bayesian mediation analysis were employed to estimate the mediation effects of metabolic risk factors. An interquartile range increases in BC (−0.256, 95 %CI: −0.331, −0.180) and OM (−0.603, 95 %CI: −0.810, −0.397) were significantly associated with eGFR decline; while O3 (1.151, 95 %CI: 0.813, 1.489), PM10 (0.721, 95 %CI: 0.309, 1.133), NH4+ (0.990, 95 %CI: 0.638, 1.342), and NO3- (0.610, 95 %CI: 0.405, 0.815) were associated with higher eGFR. The combined effect of the PM2.5 component mixture was found to be associated with lower eGFR (−1.147, 95 % CI: −1.456, −0.839), with OM contributing 72.4 % of the negative effect. Univariate mediation analyses showed that high-density lipoprotein (HDL) mediated 7.1 %, 6.9 %, and 6.1 % effects of O3, BC, and OM, respectively. However, these mediation effects were not significant in Bayesian mediation analysis. These findings suggest the effect of the PM2.5 component mixture on eGFR decline and the strong contribution of OM. Metabolic risk factors may not mediate the effects of air pollutants. Further study is warranted to clarify the potential mechanisms involved.

Air quality health index (AQHI) based on multiple air pollutants and mortality risks in Taiwan: Construction and validation

The currently used air quality index (AQI) is not able to capture the additive effects of air pollution on health risks and reflect non-threshold concentration-response relationships, which has been criticized. We proposed the air quality health index (AQHI) based on daily air pollution-mortality associations, and compared its validity in predicting daily mortality and morbidity risks with the existing AQI. We examined the excess risk (ER) of daily elderly (≥65-year-old) mortality associated with 6 air pollutants (PM2.5, PM10, SO2, CO, NO2, and O3) in 72 townships across Taiwan from 2006 to 2014 by performing a time-series analysis using a Poisson regression model. Random effect meta-analysis was used to pool the township-specified ER for each air pollutant in the overall and seasonal scenarios. The integrated ERs for mortality were calculated and used to construct the AQHI. The association of the AQHI with daily mortality and morbidity were compared by calculating the percentage change per interquartile range (IQR) increase in the indices. The magnitude of the ER on the concentration-response curve was used to evaluate the performance of the AQHI and AQI, regarding specific health outcomes. Sensitivity analysis was conducted using coefficients from the single- and two-pollutant models. The coefficients of PM2.5, NO2, SO2, and O3 associated with mortality were included to form the overall and season-specific AQHI. An IQR increase in the overall AQHI at lag 0 was associated with 1.90%, 2.96%, and 2.68% increases in mortality, asthma, and respiratory outpatient visits, respectively. The AQHI had higher ERs for mortality and morbidity on the validity examinations than the current AQI. The AQHI, which captures the combined effects of air pollution, can serve as a health risk communication tool to the public.

Association of long-term exposure to air pollutant mixture and incident cardiovascular disease in a highly polluted region of China

Despite growing evidence that links long-term air pollution exposure to cardiovascular disease (CVD), the combined effects of air pollutants and particulate matter with an aerodynamic diameter of less than 2.5 μm (PM2.5) components are still limited. A prospective cohort study was performed based on the Cohort Study on Chronic Disease of the Community Natural Population in the Beijing-Tianjin-Hebei Region (CHCN-BTH) to assess the association of long-term air pollutants with incident CVD and the combined effect of the air pollutants mixture among 26,851 adults. Three-year residential exposure to air pollutants (PM2.5, O3, PM10, PM1, NO2, SO2 and CO) and PM2.5 components [black carbon (BC), NH4+, SO42-, NO3− and organic matter (OM)] were calculated based on well-validated models. Proportional hazard models were applied to assess the association of air pollutants with incident CVD. Quantile g-Computation was used to examine the combined effect of the pollutant mixture. During the 56,090 person-years follow-up, 629 participants reported incident CVD. Adjusted hazard ratios with 95% confidence intervals (CIs) of CVD per interquartile range increase in O3, PM2.5, PM1, NO2, BC, and OM concentrations were 4.52 (95%CI: 2.61, 7.83), 2.39 (95%CI: 1.83, 3.13), 2.37 (95%CI: 1.20, 4.70), 1.36 (95%CI: 1.19, 1.56), 3.84 (95%CI: 2.38, 6.18), and 3.07 (95%CI: 2.01, 4.69), respectively. In multi-pollutant models, the combined effect of air pollutant mixture on incident CVD was 2.37 (95%CI: 2.30, 2.44). PM2.5 and O3 contributed 54.3% and 44.5% of the combined effect of the air pollutant mixture, respectively. After using PM2.5 components instead of PM2.5 as part of the mixture, OM drove 55.2% of the combined effect. The findings indicated associations of air pollutant mixtures with CVD incidence. PM2.5 (especially OM) and O3 might strongly contribute to air pollutant mixtures that lead to incident CVD.

A novel mathematical model for estimating the relative risk of mortality attributable to the combined effect of ambient fine particulate matter (PM2.5) and cold ambient temperature

Exposures to ambient fine particulate matter (PM2.5) and cold ambient temperatures have been identified as important risk factors in contributing towards the global mortality from chronic obstructive pulmonary disease (COPD). Despite China currently being the country with the largest population in the world, previous relative risk (RR) models have considered little or no information from the ambient air pollution related cohort studies in the country. This likely provides a less accurate picture of the trend in air pollution attributable mortality in the country over time. A novel relative risk model called pollutant-temperature exposure (PTE) model is proposed to estimate the RR attributable to the combined effect of air pollution and ambient temperature in a population. In this paper, the pollutant concentration-response curve was extrapolated from the cohort studies in China, whereas the temperature response curve was extracted from a study in Yangtze River Delta (YRD) region. The performance of the PTE model was compared with the integrated exposure-response (IER) model using the data of YRD region, which revealed that the estimated relative risks of the PTE model were noticeably higher than the IER model during the winter season. Furthermore, the predictive ability of the PTE model was validated using actual data of Ningbo city, which showed that the estimated RR using the PTE model with 1-month moving average data showed a good result with the trend of actual COPD mortality, indicated by a lower root mean square error (RMSE = 0.956). By considering the combined effect of ambient air pollutant and ambient temperature, the PTE model is expected to provide more accurate relative risk estimates for the regions with high levels of ambient PM2.5 and seasonal variation of ambient temperature.

Combined effects of air pollution and neighborhood violence on epilepsy and seizures in children

Combined effects of air pollution and neighborhood violence on epilepsy and seizures in children

Effects of short-term exposure to air pollution on hospital admissions for autism spectrum disorder in Korean school-aged children: a nationwide time-series study

ObjectivesThis study explored the effects of short-term exposure to air pollution on hospital admissions for autism spectrum disorder (ASD), a proxy for symptom aggravation, among Korean children aged 5–14 years.DesignTime-series...

Indicators of Local and Systemic Immunity of Adolescents under Combined Exposure to Air Pollution and Cigarette Smoke

Introduction: Chemical compounds polluting the environment and contained in cigarette smoke affect the immune system and the respiratory tract contributing to the development of diseases. Given the sexual dimorphism of innate and acquired immunity, the objective of the study was to identify characteristics of the local and systemic immunity in adolescent girls and boys exposed to harmful environmental and cigarette smoke chemicals. Materials and methods: During two years of the study, we examined 546 active and passive teenage smokers of both sexes living in industrial cities with high ambient air pollution. Levels of interleukins-2 and -10, alpha- and gamma-interferons, immunoglobulin A in blood serum, nasal and oral washings of high school students were tested. Results: We established sex-specific differences in local and systemic immune responses of adolescents to effects of the combined air pollution and cigarette smoke exposure. Significant differences in the content of cytokines and immunoglobulin A were found only for males. The levels of alpha and gamma interferons in the oral lavage fluid of smoking boys were lower while the level of interleukin-2 was higher than those in non-smokers. Blood levels of alpha interferon and immunoglobulin A in male smokers were higher than in non-smokers. Conclusion: Sex-specific differences in the response to the combined effect of air pollution and cigarette smoke necessitate a differentiated approach to elaborating preventive and therapeutic measures aimed at preventing immunological and upper respiratory disorders in adolescent boys and girls.

Physical Exercise in the Context of Air Pollution: An Emerging Research Topic.

Physical exercise (PE) brings physiological benefits to human health; paradoxically, exposure to air pollution (AP) is harmful. Hence, the combined effects of AP and PE are interesting issues worth exploring. The objective of this study is to review literature involved in AP-PE fields to perform a knowledge-map analysis and explore the collaborations, current hotspots, physiological applications, and future perspectives. Herein, cluster, co-citation, and co-occurrence analysis were applied using CiteSpace and VOSviewer software. The results demonstrated that AP-PE domains have been springing up and in rapid growth since the 21st century. Subsequently, active countries and institutions were identified, and the productive institutions were mainly located in USA, China, UK, Spain, and Canada. Developed countries seemed to be the major promoters. Additionally, subject analysis found that environmental science, public health, and sports medicine were the core subjects, and multidimensional communications were forming. Thereafter, a holistic presentation of reference co-citation clusters was conducted to discover the research topics and trace the development focuses. Youth, elite athletes, and rural population were regarded as the noteworthy subjects. Commuter exposure and moderate aerobic exercise represented the common research context and exercise strategy, respectively. Simultaneously, the research hotspots and application fields were elaborated by keyword co-occurrence distribution. It was noted that physiological adaptations including respiratory, cardiovascular, metabolic, and mental health were the major themes; oxidative stress and inflammatory response were the mostly referred mechanisms. Finally, several challenges were proposed, which are beneficial to promote the development of the research field. Molecular mechanisms and specific pathways are still unknown and the equilibrium points and dose-effect relationships remain to be further explored. We are highly confident that this study provides a unique perspective to systematically and comprehensively review the pieces of AP-PE research and its related physiological mechanisms for future investigations.

Combined effects of air pollution in adulthood and famine exposure in early life on type 2 diabetes.

Famine exposure or air pollution is linked to type 2 diabetes mellitus (T2DM). However, their combined effects on T2DM remain largely unknown. A total of 11,640 individuals were obtained from the Henan Rural Cohort Study. According to their birthdate, participants were divided into three famine exposure subgroups: fetal exposed, childhood exposed, and unexposed groups. The air pollutants (particles with aerodynamics diameters ≤ 1.0µm (PM1), ≤ 2.5µm, and ≤ 10µm, and nitrogen dioxide) concentrations of each individual were estimated by a spatiotemporal model. Participants were divided into low or high air pollution exposure groups taking the 1st quartile value of air pollutants as the cut-off point. Logistic regression model was used to analyze independent and joint associations between air pollution exposure, famine exposure, and T2DM. Positive associations of air pollution and famine exposure with T2DM were found. Participants who experienced fetal or childhood famine and also were exposed to high concentrations of any kind of the air pollutants had a much higher risk for T2DM than those with no famine and low air pollutants exposure (taking PM1.0 for example, the odds ratio [OR]: 1.76, 95% confidence interval [CI]: 1.25, 2.47 for fetal famine, and OR: 1.64, 95%CI: 1.13, 2.40 for childhood famine). After stratified analysis, similar results were observed in women. The results indicated that both famine exposure in early life and air pollution exposure in adulthood are related to increased risk for prevalent T2DM, and they have combined effects on T2DM.

Airborne particles and cardiovascular morbidity in severe inherited hypercholesterolemia: Vulnerable endothelium under multiple attacks.

Despite recent advances in the research related to air pollution and associated adverse cardiovascular events, the combined effects of air pollution, climate change, and SARS-CoV-2 infection on cardiovascular health need to be researched further. This Commentary addresses their impacts on cardiovascular health in the approximately 25 million people with a severe form of inherited hypercholesterolemia, called familial hypercholesterolemia (FH). The arterial endothelium in these individuals is potentially under multiple attacks caused by particles of both endogenous and exogenous origin. Thus, they have a lifelong highly elevated level of circulating low density lipoprotein (LDL) cholesterol which drives premature atherosclerosis. The high levels of LDL particles, often associated with an elevated level of circulating lipoprotein(a) particles, are both capable of inducing and maintaining endothelial dysfunction. Such pre-existing endothelial dysfunction can be exacerbated by exposure to SARS-CoV-2 viral particles, by exposure to fine particulate matter generated by climate change-associated wildfires, and by dehydration during deadly heatwaves linked to the globally rising temperatures. The external factors can severely worsen the pre-existing endothelial dysfunction, and thereby significantly increase the risk of a cardiovascular event in the exposed FH patients.

Combined effects of air pollution and extreme heat events among ESKD patients within the Northeastern United States

BackgroundIncreasing number of studies have linked air pollution exposure with renal function decline and disease. However, there is a lack of data on its impact among end-stage kidney disease (ESKD) patients and its potential modifying effect from extreme heat events (EHE). MethodsFresenius Kidney Care records from 28 selected northeastern US counties were used to pool daily all-cause mortality (ACM) and all-cause hospital admissions (ACHA) counts. County-level daily ambient PM2.5 and ozone (O3) were estimated using a high-resolution spatiotemporal coupled climate-air quality model and matched to ESKD patients based on ZIP codes of treatment sites. We used time-stratified case-crossover analyses to characterize acute exposures using individual and cumulative lag exposures for up to 3 days (Lag 0–3) by using a distributed lag nonlinear model framework. We used a nested model comparison hypothesis test to evaluate for interaction effects between air pollutants and EHE and stratification analyses to estimate effect measures modified by EHE days. ResultsFrom 2001 to 2016, the sample population consisted of 43,338 ESKD patients. We recorded 5217 deaths and 78,433 hospital admissions. A 10-unit increase in PM2.5 concentration was associated with a 5% increase in ACM (rate ratio [RRLag0–3]: 1.05, 95% CI: 1.00–1.10) and same-day O3 (RRLag0: 1.02, 95% CI: 1.01–1.03) after adjusting for extreme heat exposures. Mortality models suggest evidence of interaction and effect measure modification, though not always simultaneously. ACM risk increased up to 8% when daily ozone concentrations exceeded National Ambient Air Quality Standards established by the United States, but the increases in risk were considerably higher during EHE days across lag periods. ConclusionOur findings suggest interdependent effects of EHE and air pollution among ESKD patients for all-cause mortality risks. National level assessments are needed to consider the ESKD population as a sensitive population and inform treatment protocols during extreme heat and degraded pollution episodes.

Combined effects of air pollutants on gestational diabetes mellitus: A prospective cohort study

Exposures to multiple air pollutants during pregnancy have been associated with the risk of gestational diabetes mellitus (GDM). However, their combined effects are unclear. We aimed to evaluate the combined associations of five air pollutants from pre-pregnancy to the 2nd trimester with GDM. This study included 20,113 participants from the Born in Guangzhou Cohort Study (BIGCS). The inverse distance-weighted models were used to estimate individual air pollutant exposure, namely ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), particulate matter less than 10 μm in diameter (PM10), and less than 2.5 μm in diameter (PM2.5). We estimated stage-specific associations of air pollutants with GDM using generalized estimating equation, and departures from additive joint effects were assessed using the relative excess risk (RERI) and the joint relative risk (JRR). Of the 20,113 participants, 3440 women (17.1%) were diagnosed with GDM. In the adjusted model, increased concentrations of O3 and SO2 3–6 months before pregnancy were associated with GDM occurrence, as well as O3 and PM10 in the 1st trimester, the adjusted relative risk (95% confident intervals) [RRs (95%CI)] ranged from 1.05 (1.00, 1.09) to 1.21 (1.04, 1.40). The largest JRR for GDM was the combination of SO2, NO2, and PM10 in the 1st trimester (JRR = 1.32, 95% CI: 1.10, 1.59). The JRR for O3 and SO2 was less than their additive joint effects [RERI = -0.25 (−0.47, −0.04), P for interaction = 0.048]. Associations of air pollutants with GDM differed somewhat by pre-pregnancy BMI and season. This study added new evidence to the current understanding of the combined effects of multiple air pollutants on GDM. Public health strategies were needed to reduce the adverse effects of air pollution exposure on pregnant women.