Concentration-response Functions Research Articles

The Health Impact and External Cost of Electricity Production

The use of fossil fuels, which still dominate global primary energy consumption, results not only in emissions of greenhouse gas but also in emissions of pollutants such as SO2, NOx, and PM. Damage caused by air pollution can be expressed in monetary terms in the form of external costs to society. The goal of this paper is to answer the following questions: How much will the energy sector’s emissions change as a result of decarbonization? What is the estimated level of external costs related to human health in future energy scenarios? How large are the estimated external costs compared to the planned investments in this sector? The study conducted for the period 2018–2050 used the impact pathway approach and covered the centralized power and heat generation sector in Poland. The reported values of the concentration–response functions that relate human exposure to air pollution with health impact were reviewed. The results show that external costs decrease from an estimated annual level in the range of EUR 782–1911 million in 2018 to EUR 36–876 million in 2050. The cumulative value of avoided external costs between 2018 and 2050 is significantly lower than the planned capital expenditures in the energy sector in Poland.

Mortality Risk from : A Comparison of Modeling Approaches to Identify Disparities across Racial/Ethnic Groups in Policy Outcomes.

Background:Regulatory analyses of air pollution policies require the use of concentration–response functions and underlying health data to estimate the mortality and morbidity effects, as well as the resulting benefits, associated with policy-related changes in fine particulate matter ()]. Common practice by U.S. federal agencies involves using underlying health data and concentration–response functions that are not differentiated by racial/ethnic group.Objectives:We aim to explore the policy implications of using race/ethnicity-specific concentration–response functions and mortality data in comparison to standard approaches when estimating the impact of air pollution on non-White racial/ethnic subgroups.Methods:Using new estimates from the epidemiological literature on race/ethnicity-specific concentration–response functions paired with race/ethnicity-specific mortality rates, we estimated the mortality impacts of air pollution from all sources from a uniform increase in concentrations and from the regulations imposed by the Mercury Air Toxics Standards.Results:Use of race/ethnicity-specific information increased premature mortality estimates in older populations by 9% and among older Black Americans by 150% for all-source pollution exposure. Under a uniform degradation of air quality and race/ethnicity-specific information, older Black Americans were found to have approximately 3 times higher mortality relative to White Americans, which is obscured under a non–race/ethnicity-specific modeling approach. Standard approaches of using non–racial/ethnic specific information underestimate the benefits of the Mercury Air Toxics Standards to older Black Americans by almost 60% and overestimate the benefits to older White Americans by 14% relative to using a race/ethnicity-specific modeling approach.Discussion:Policy analyses incorporating race/ethnicity-specific concentration–response functions and mortality data relative to nondifferentiated inputs underestimate the overall magnitude of mortality burden and the disparity in impacts on older Black American populations. Based on our results, we recommend that the best available race/ethnicity-specific inputs are used in regulatory assessments to understand and reduce environmental injustices. https://doi.org/10.1289/EHP9001

Excess Morbidity and Mortality Associated with Air Pollution above American Thoracic Society Recommended Standards, 2017-2019.

Rationale: Over the past year, the American Thoracic Society (ATS), led by its Environmental Health Policy Committee, has reviewed the most current air quality scientific evidence and has revised their recommendations to 8 μg/m3 and 25 μg/m3 for long- and short-term fine particulate matter (PM2.5) and reaffirmed the recommendation of 60 ppb for ozone to protect the American public from the known adverse health effects of air pollution. The current U.S. Environmental Protection Agency (EPA) standards, in contrast, expose the American public to pollution levels that are known to result in significant morbidity and mortality. Objectives: To provide county-level estimates of annual air pollution-related health outcomes across the United States using the most recent federal air quality data, and to support the ATS's recent update to the long-term PM2.5 recommended standard. This study is presented as part of the annual ATS/Marron Institute "Health of the Air" report. Methods: Daily air pollution values were obtained from the EPA's air quality system for monitored counties in the United States from 2017-2019. Concentration-response functions used in the EPA's regulatory review process were applied to pollution increments corresponding to differences between the rolling 3-year design values and ATS-recommended levels for long-term PM2.5 (8 μg/m3), short-term PM2.5 (25 μg/m3), and ground-level ozone (O3; 60 ppb). Health impacts were estimated at the county level in locations with valid monitoring data. Results: Meeting ATS recommendations throughout the country prevents an estimated 14,650 (95% confidence interval [CI], 8,660-22,610) deaths; 2,950 (95% CI, 1,530-4,330) lung cancer incidence events; 33,100 (95% CI, 7,300-71,000) morbidities, and 39.8 million (95% CI, 14.6-63.3 million) impacted days annually. This prevents 11,850 more deaths; 2,580 more lung cancer incidence events; 25,400 more morbidities; and 27.2 million more impacted days than meeting EPA standards alone. Conclusions: Significant health benefits to be gained by U.S. communities that work to meet ATS-recommended air quality standards have now been identified under scenarios meeting the new ATS recommendation for long-term PM2.5 (8 μg/m3). The "Health of the Air" report presents an opportunity for air quality managers to quantify local health burdens and EPA officials to update their standards to reflect the latest science.

Ozone Effects on Douro Vineyards under Climate Change

Tropospheric ozone (O3) levels in southern Europe have an increasing tendency, in close relation with the higher incidence of hot summers and heatwaves. Given that O3 is one of the most damaging pollutants for vegetation, known to affect productivity and quality of crops, it is necessary to develop more rigorous and consistent methods of risk assessment that consider climate change conditions. Studying the O3 deposition over the Douro Demarcated Region (DDR), which is one of the most productive wine areas in Portugal, and assessing its potential effects under a climate change scenario, was the purpose of this study. To that end, the chemical transport model CHIMERE, with a spatial resolution of 1 km2, fed by meteorological data from the WRF model, was applied for a recent past climate (2003 to 2005) and future mid-term (2049 and 2064) and long-term (2096 and 2097) scenarios. Simulations for future climate were performed considering: (i) only the climate change effect, and (ii) the effect of climate change together with future air pollutant emissions. The assessment of the potential damage in terms of wine productivity and quality (sugar content) was performed through analysis of O3 deposition and the application of concentration–response functions, based on AOT40 values. Modeling results show that a reduction in emission of O3 precursors can successfully decrease AOT40 levels in the DDR, but it is not enough to accomplish the European Commission target value for the protection of vegetation. If the emissions remain constant, the exposure–response functions indicate that, in the long-term, AOT40 levels could worsen wine productivity and quality.

Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project

Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O3) with the incidence of stroke and acute coronary heart disease. We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992-2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011-15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants' baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values. From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17·2 years (IQR 13·8-19·5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2·5 (hazard ratio 1·10 [95% CI 1·01-1·21] per 5 μg/m3 increase), NO2 (1·08 [1·04-1·12] per 10 μg/m3 increase), and black carbon (1·06 [1·02-1·10] per 0·5 10-5/m increase), whereas coronary heart disease incidence was only associated with NO2 (1·04 [1·01-1·07]). Warm-season O3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2·5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 μg/m3 for PM2·5 and 40 μg/m3 for NO2. Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values. Health Effects Institute.

Quantifying the short-term effects of air pollution on health in the presence of exposure measurement error: a simulation study of multi-pollutant model results

BackgroundMost epidemiological studies estimate associations without considering exposure measurement error. While some studies have estimated the impact of error in single-exposure models we aimed to quantify the effect of measurement error in multi-exposure models, specifically in time-series analysis of PM2.5, NO2, and mortality using simulations, under various plausible scenarios for exposure errors. Measurement error in multi-exposure models can lead to effect transfer where the effect estimate is overestimated for the pollutant estimated with more error to the one estimated with less error. This complicates interpretation of the independent effects of different pollutants and thus the relative importance of reducing their concentrations in air pollution policy.MethodsMeasurement error was defined as the difference between ambient concentrations and personal exposure from outdoor sources. Simulation inputs for error magnitude and variability were informed by the literature. Error-free exposures with their consequent health outcome and error-prone exposures of various error types (classical/Berkson) were generated. Bias was quantified as the relative difference in effect estimates of the error-free and error-prone exposures.ResultsMortality effect estimates were generally underestimated with greater bias observed when low ratios of the true exposure variance over the error variance were assumed (27.4% underestimation for NO2). Higher ratios resulted in smaller, but still substantial bias (up to 19% for both pollutants). Effect transfer was observed indicating that less precise measurements for one pollutant (NO2) yield more bias, while the co-pollutant (PM2.5) associations were found closer to the true. Interestingly, the sum of single-pollutant model effect estimates was found closer to the summed true associations than those from multi-pollutant models, due to cancelling out of confounding and measurement error bias.ConclusionsOur simulation study indicated an underestimation of true independent health effects of multiple exposures due to measurement error. Using error parameter information in future epidemiological studies should provide more accurate concentration-response functions.

Health Impact Assessment of PM2.5 control legislation in Korea

BACKGROUND AND AIM: Exposure to PM2.5 has been associated with increased all-cause mortality. The metropolitan area particulate matter reduction policy is enacted to reduce PM2.5 concentration in 2008. The policy selected substances subject to particulate matter management, implemented total emission regulations in Seoul and Incheon, strengthened standards for allowing emissions for production vehicles, and promoted reduction of diesel car emissions. The aim of the present analysis is to evaluate the effectiveness of the policy on health. METHODS: The policy was applied to Seoul and Incheon, and other metropolitan cities in Korea were selected as control groups. We conducted interrupted time series analyses to examine changes in PM2.5 concentration and concentration-response function after the enactment of the policy. Based on the calculated change, we estimated the health benefit in terms of reduced mortality. RESULTS:We observed a decrease in the slope of concentration-response function of all-cause mortality after intervention in Seoul and Incheon. PM2.5 concentrations also decreased. The interaction coefficient about intervention was -0.537 (p value=0.001) in Seoul and -0.0276 (p value=0.64) in Incheon. We calculated the number of excess deaths when there was no intervention effect, when only PM2.5 concentrations were decreased, when only concentration-response function was decreased, when both concentration-response function and PM2.5 were reduced. The number of excess death in Seoul was 684.1 (221-1112.3), 654 (230.1-1149.1), 450.9 (0-883.1), and 432.2 (0-919.1), respectively. We observed 137.1 (0-673.4), 113.8 (0-560.7), 82 (0-236.2), and 68.7 (0-196.7), in Incheon, respectively. CONCLUSIONS:The all-cause mortality caused by PM2.5 in Seoul and Incheon decreased after intervention. KEYWORDS: All-cause mortality, Health impact assessment, Legislation, PM2.5 concentration, Excess death

Annual dementia incidence and socioeconomic costs attributable to fine particulate matter (PM2.5) exposure in Sweden

BACKGROUND AND AIM: Alzheimer’s disease (AD) and other dementias currently represent the fifth most common cause of death in the world, according to the World Health Organization, with a projected future increase as the proportion of the elderly in the population is growing. Air pollution has emerged as a plausible risk factor for AD, but studies estimating dementia cases attributable to exposure to fine particulate matter (PM2.5) air pollution and resulting socioeconomic costs are lacking. METHODS: We used data on average population-weighted exposure to ambient PM2.5 for the entire population of Sweden above 30 years of age. To estimate the annual number of dementia cases in Sweden attributable to air pollution we used the latest concentration response functions (CRF) between PM2.5 exposure and dementia incidence, based on ten longitudinal cohort studies. To estimate the socioeconomic costs of dementia, we calculated average life-time costs related to dementia, including formal health care costs, informal care, indirect costs, and intangible costs by including quality-adjusted life years (QALYs) lost. Two applied monetary valuations of QALYs in Sweden decision-making process was used to estimate the monetary value of reduced quality-of-life. RESULTS:The annual number of dementia cases attributable to PM2.5 exposure was estimated to be 820, which represents 5% of the annual dementia cases in Sweden. Formal life-time average cost per incidence of dementia was calculated to correspond € 213,000. From a societal perspective, this corresponds to monetarized annual dementia burden of €215 per individual at risk. Reducing PM2.5 by 1 µg/m3 would correspond to 0.6% of Swedish GDP in opportunity costs due to reduced incident of dementia. CONCLUSIONS:This study estimated that 5% of annual dementia cases could be attributed to PM2.5 exposure, and that the resulting socioeconomic costs were substantial. These findings suggest the need to consider airborne toxic pollutants associated with dementia incidence in public health policy decisions. KEYWORDS: Air pollution, Policy, particulate matter,

Daily particulate matter and temperature from satellite-hybrid models and 1.5 million deaths: A time-stratified case-crossover analysis in Central Mexico

BACKGROUND AND AIM: Highly spatio-temporally resolved (daily 1x1-Km) fine particulate matter (PM₂.₅) and air temperature (Ta) models are being used to advance exposure science and refine health effect estimates in developed countries. Limited evidence exists about their use in densely populated areas from middle-income regions, and different exposure conditions. METHODS: We use a time-stratified case-crossover study design, matching cases to control days on day of week, month and year, for 1,516,442 non-external deaths (≥18 years-old) from 586 sub-county areas in Central Mexico (including Mexico City) from 2004-2019. Daily 1x1-Km PM₂.₅ (median=23.4μm³; IQR=17–30.6μm³) and Ta estimates from our new satellite-based models for the region were employed for exposure assessment at the sub-county level using population-weighted centroids. Acute associations of PM₂.₅ and Ta with mortality were estimated with distributed lag conditional logistic models. RESULTS:Mortality was significantly associated with 10μm³ PM₂.₅ increase with stronger effects for lag0 [1.44% (95% CI:1.37–1.50%)] and lag1 [0.67% (0.60–0.75%)], with a 1-week cumulative effect (lag06) of 3.52% (3.41–3.63%). The minimum mortality temperature (MMT) was estimated at 18.4°C (18.3–18.4°C), and used as reference to estimate effects from cold (p5=12°C) and heat (p95=20.6°C) from the daily Ta distribution. Heat effects peaked at lag0 [4.64% (4.40–4.89%)] and persisted for 2-days with a cumulative lag02 effect of 7.07% (6.83–7.32%). CONCLUSIONS:We performed the largest case-crossover study of PM₂.₅ and Ta with mortality in Mexico. Our linked datasets utilizing highly spatio-temporally resolved exposure models will enable inference for developing new concentration-response functions in the Central Mexico region. Additional analyses will investigate effect modification by individual characteristics (e.g., occupational classes, sex, and age) and heterogeneity of associations for specific causes of death. KEYWORDS: Mortality, Particulate matter, Temperature, Short-term exposure

Global urban temporal trends in fine particulate matter (PM2.5) and attributable health burdens

BACKGROUND AND AIM: With much of the world’s population residing in urban areas, an understanding of city-level air pollution exposures can inform mitigation approaches. Prior studies of global urban air pollution have not considered trends in air pollutant concentrations nor corresponding attributable health burdens. METHODS: We use high-resolution annual average PM2.5 concentrations, epidemiologically derived concentration response functions, and country-level baseline disease rates from the Global Burden of Disease Injuries and Risk Factors (GBD) 2019 Study to estimate population-weighted PM2.5 concentrations and attributable cause-specific mortality in ~13,000 urban centers between 2000 and 2018. RESULTS:We estimate that the mean urban population-weighted annual average PM2.5 was 42 µg/m3 (range=1-150 µg/m3) in 2018, relatively unchanged compared to 2000 (40 µg/m3, range=1-154 µg/m3), though four times the World Health Organization’s (WHO) guideline for annual average PM2.5 (10 µg/m3). Approximately 86% of urban inhabitants (2.5 billion) people live in urban areas exceeding the WHO guideline in 2018, with only 15% (1,994) of cities meeting the WHO annual average guideline concentration at any point during the study period. While regional averages of urban PM2.5 concentrations decreased, we find considerable heterogeneity between urban areas. We find demographic changes drove PM2.5-attributable health burdens, resulting in an increase in PM2.5-attributable deaths in cities on average in all regions except Europe. CONCLUSIONS:We found the majority of the world’s urban population lived in areas with unhealthy levels of PM2.5 between 2000 and 2018. While global averages in urban areas were relatively unchanged during this period, there is considerable heterogeneity between urban areas both for PM2.5 exposures and attributable health burdens. We found increasing PM2.5-attributable health burdens despite decreases in PM2.5 concentrations, speaking to the need for much more dramatic improvements to air quality in order to reduce health burden as a result of the other public health levers contributing to non-communicable disease rates. KEYWORDS: Air pollution, risk assessment, urban trends

Assessment of Respiratory morbidity burden from exposure to vegetation fire-PM2.5 in Upper Northern Thailand for the year 2018

BACKGROUND AND AIM: The seasonal occurrence of vegetation fire in the Mainland Southeast Asia (MSEA) has deteriorated air quality, which can increase respiratory diseases. Nevertheless, no study has assessed the health burden from exposure to vegetation-fire smoke in the MSEA. We aimed to estimate the number of hospital visits from respiratory diseases attributable to vegetation-fire PM2.5 in the Upper northern Thailand (UNT). METHODS: The modelled vegetation fire-PM2.5 were obtained from System for Integrated modeLling of Atmosheric coMposition (SILAM) model, which is a global-to-meso-scale air pollution dispersion model. Vegetation fire-PM2.5 were simulated based on fire radiative power data of Moderate Resolution Imaging Spectroradiometer (MODIS) satellite data. We averaged the extracted grid-cell of fire-PM2.5 within district boundaries. The number of respiratory disease-related hospital visits attributable to fire-PM2.5 was estimated for the whole year and burning period (January to April) of the year 2018 by using the modelled daily fire-PM2.5, population data, and concentration-response function derived from the previous epidemiological study. RESULTS:In 2018, we estimated 17,817 hospital visits for respiratory diseases attributable to vegetation fire-PM2.5 in the UNT. Our estimation was accounted approximately 1% of the total hospital visits for respiratory diseases throughout the year and 3 % during the burning season. CONCLUSIONS:This study suggests that PM2.5 emitted from vegetation fire events poses a health burden across the UNT. KEYWORDS: Health burden estimation, Vegetation fires, Hospital visits, Respiratory diseases

Health Impacts of Climate Change as Contained in Economic Models Estimating the Social Cost of Carbon Dioxide.

The health impacts of climate change are substantial and represent a primary motivating factor to mitigate climate change. However, the health impacts in economic models that estimate the social cost of carbon dioxide (SC‐CO2) have generally been made in isolation from health experts and have never been rigorously evaluated. Version 3.10 of the Framework for Uncertainty, Negotiation and Distribution (FUND) model was used to estimate the health‐based portion of current SC‐CO2 estimates across low‐, middle‐, and high‐income regions. In addition to the base model, three additional experiments assessed the sensitivity of these estimates to changes in the socio‐economic assumptions in the model. Economic impacts from adverse health outcomes represent ∼8.7% of current SC‐CO2 estimates. The majority of these health impacts (74%) were attributable to diarrhea mortality (from both low‐ and high‐income regions) followed by diarrhea morbidity (12%) and malaria mortality (11%); no other health impact makes a meaningful contribution to SC‐CO2 estimates in current economic models. The results of the socio‐economic experiments show that the health‐based portion of SC‐CO2 estimates are highly sensitive to assumptions regarding income elasticity of health effects, income growth, and use of equity weights. Improving the health‐based portion of SC‐CO2 estimates could have substantial impacts on magnitude of the SC‐CO2. Incorporating additional health impacts not previously included in estimates of SC‐CO2 will be a critical component of model updates. This effort will be most successful through coordination between economists and health researchers and should focus on updating the form and function of concentration‐response functions.

Contribution of AOD-PM2.5 surfaces to respiratory-cardiovascular hospital events in urban and rural areas in Baltimore, Maryland, USA: New analytical method correctly identified true positive cases and true negative controls

Epidemiologic studies have used aerosol optical depth (AOD)-PM2.5 as a proxy for ambient PM2.5 in urban and rural areas, even though its validation with air monitors has only occurred in urban areas. The contribution of elevated AOD-PM2.5 on respiratory-cardiovascular true positive (TP) cases, exposed to high PM2.5, and true negative (TN) controls, not exposed to elevated PM2.5, was evaluated in 72 Community Multiscale Air Quality (CMAQ) grids with (urban) and without (rural) air monitors. The odds ratio (OR) algorithm and the newly developed beta (ẞ) algorithm were used to evaluate the reliability and validity of TP cases, and TN controls in grids with and without air monitors. Four experimental AOD-PM2.5 fused surfaces and four health outcomes were evaluated. Only the linear predictor (ẞ) algorithm reliably and correctly identified TP cases and TN controls, with probabilities ~1.00. The OR algorithm only identified TN controls, with probabilities ~1.00, and significantly overestimated the percentage of TP cases. Regression analyses demonstrated that the OR algorithm's accuracy could be improved if the number of cases for all health outcomes was increased 50.8% in all grids and 73.9% in grids without monitors. Since the number and percentage of TP cases and TN controls were similar in grids with and without air monitors, this outcome suggests that the AOD-PM2.5 and health outcome concentration-response function evaluated in grids with monitors also holds in grids without air monitors. The possible use of AOD-PM2.5 fused surfaces, as another epidemiologic tool, to assess elevated ambient PM2.5 concentration levels to respiratory-cardiovascular hospital events in rural areas is discussed.

Estimating the Acute Health Impacts of Fire-Originated PM2.5 Exposure During the 2017 California Wildfires: Sensitivity to Choices of Inputs.

Exposure to wildfire smoke increases the risk of respiratory and cardiovascular hospital admissions. Health impact assessments, used to inform decision‐making processes, characterize the health impacts of environmental exposures by combining preexisting epidemiological concentration–response functions (CRFs) with estimates of exposure. These two key inputs influence the magnitude and uncertainty of the health impacts estimated, but for wildfire‐related impact assessments the extent of their impact is largely unknown. We first estimated the number of respiratory, cardiovascular, and asthma hospital admissions attributable to fire‐originated PM2.5 exposure in central California during the October 2017 wildfires, using Monte Carlo simulations to quantify uncertainty with respect to the exposure and epidemiological inputs. We next conducted sensitivity analyses, comparing four estimates of fire‐originated PM2.5 and two CRFs, wildfire and nonwildfire specific, to understand their impact on the estimation of excess admissions and sources of uncertainty. We estimate the fires accounted for an excess 240 (95% CI: 114, 404) respiratory, 68 (95% CI: −10, 159) cardiovascular, and 45 (95% CI: 18, 81) asthma hospital admissions, with 56% of admissions occurring in the Bay Area. Although differences between impact assessment methods are not statistically significant, the admissions estimates' magnitude is particularly sensitive to the CRF specified while the uncertainty is most sensitive to estimates of fire‐originated PM2.5. Not accounting for the exposure surface's uncertainty leads to an underestimation of the uncertainty of the health impacts estimated. Employing context‐specific CRFs and using accurate exposure estimates that combine multiple data sets generates more certain estimates of the acute health impacts of wildfires.

Linking air quality, health, and economic effect models for use in air pollution epidemiology studies with uncertain factors

Epidemiological studies have shown that premature mortality, hospital admission, and outpatient visits are closely related to particulate matter (PM) pollution. The modelling of air quality, assessment of human health impact, and estimation of health impact models are useful tools for assessing the impact of air pollution on health. This study proposes a model framework for assessing air pollution damage, including air quality simulation for PM10, assessment of human health impacts, and estimation of health impact models that meet the requirements of actual monitoring data. The novel contribution of this study is a proposal for the application of the Weather Research and Forecasting (WRF)/Community Multiscale Air Quality Modeling System (CMAQ) model and the epidemiological coefficient β of concentration–response functions (CRFs), which were determined from epidemiological studies and selected in accordance with the study area conditions under limited conditions related to the field measurement data, to calculate the health impacts and economic losses caused by PM10. Calculation results for a typical month in 2017 showed that economic losses were approximately 125.119 million Vietnamese Dong (95% CI: −26.841, 272.633), in which the highest number of mortality and morbidity due to PM10 dust pollution exposure was identified on October 24, 2017. The WRF/CMAQ simulation results were calibrated and validated to improve the efficiency of the estimation. These validated results were mainly based on the measured data, which played a significant role in enhancing the accuracy of the quantification of air pollution effects.

Population ageing and deaths attributable to ambient PM2·5 pollution: a global analysis of economic cost

The health impacts of ambient air pollution impose large costs on society. Although all people are exposed to air pollution, the older population (ie, those aged ≥60 years) tends to be disproportionally affected. As a result, there is growing concern about the health impacts of air pollution as many countries undergo rapid population ageing. We investigated the spatial and temporal variation in the economic cost of deaths attributable to ambient air pollution and its interaction with population ageing from 2000 to 2016 at global and regional levels. In this global analysis, we developed an age-adjusted measure of the value of a statistical life-year (VSLY) to estimate the economic cost of deaths attributable to ambient PM2·5 pollution using Global Burden of Diseases, Injuries, and Risk Factors Study 2017 data and country-level socioeconomic information. First, we estimated the global age-specific and cause-specific mortality and years of life lost (YLLs) attributable to PM2·5 pollution using the global exposure mortality model and global estimates of exposure at 0·1° × 0·1° (about 11 km × 11 km at the equator) resolution. Second, for each year between 2000 and 2016, we translated the YLLs within each age group into a health-related cost using a country-specific, age-adjusted measure of VSLY. Third, we decomposed the major driving factors that contributed to the temporal change in health costs related to PM2·5. Finally, we did a sensitivity test to analyse the variability of the estimated health costs to four alternative valuation measures. We identified the uncertainty intervals (UIs) from 1000 draws of the parameters and concentration-response functions by age, cause, country, and year. All economic values are reported in 2011 purchasing power parity-adjusted US dollars. All simulations were done with R, version 3.6.0. Globally, in 2016, PM2·5 was estimated to have caused 8·42 million (95% UI 6·50-10·52) attributable deaths, which was associated with 163·68 million (116·03-219·44) YLLs. In 2016, the global economic cost of deaths attributable to ambient PM2·5 pollution for the older population was US$2·40 trillion (1·89-2·93) accounting for 59% (59-60) of the cost for the total population ($4·09 trillion [3·19-5·05]). The economic cost per capita for the older population was $2739 (2160-3345) in 2016, which was 10 times that of the younger population (ie, those aged <60 years). By assessing the factors that contributed to economic costs, we found that increases in these factors changed the total economic cost by 77% for gross domestic product (GDP) per capita, 21% for population ageing, 16% for population growth, -41% for age-specific mortality, and -0·4% for PM2·5 exposure. The economic cost of ambient PM2·5 borne by the older population almost doubled between 2000 and 2016, driven primarily by GDP growth, population ageing, and population growth. Compared with younger people, air pollution leads to disproportionately higher health costs among older people, even after accounting for their relatively shorter life expectancy and increased disability. As the world's population is ageing, the disproportionate health cost attributable to ambient PM2·5 pollution potentially widens the health inequities for older people. Countries with severe air pollution and rapid ageing rates need to take immediate actions to improve air quality. In addition, strategies aimed at enhancing health-care services, especially targeting the older population, could be beneficial for reducing the health costs of ambient air pollution. National Natural Science Foundation of China, China Postdoctoral Science Foundation, and Qiushi Foundation.

Annual dementia incidence and monetary burden attributable to fine particulate matter (PM2.5) exposure in Sweden

BackgroundAlzheimer’s disease (AD) and other dementias currently represent the fifth most common cause of death in the world, according to the World Health Organization, with a projected future increase as the proportion of the elderly in the population is growing. Air pollution has emerged as a plausible risk factor for AD, but studies estimating dementia cases attributable to exposure to fine particulate matter (PM2.5) air pollution and resulting monetary estimates are lacking.MethodsWe used data on average population-weighted exposure to ambient PM2.5 for the entire population of Sweden above 30 years of age. To estimate the annual number of dementia cases attributable to air pollution in the Swedish population above 60 years of age, we used the latest concentration response functions (CRF) between PM2.5 exposure and dementia incidence, based on ten longitudinal cohort studies, for the population above 60 years of age. To estimate the monetary burden of attributable cases, we calculated total costs related to dementia, including direct and indirect lifetime costs and intangible costs by including quality-adjusted life years (QALYs) lost. Two different monetary valuations of QALYs in Sweden were used to estimate the monetary value of reduced quality-of-life from two different payer perspectives.ResultsThe annual number of dementia cases attributable to PM2.5 exposure was estimated to be 820, which represents 5% of the annual dementia cases in Sweden. Direct and indirect lifetime average cost per dementia case was estimated to correspond € 213,000. A reduction of PM2.5 by 1 μg/m3 was estimated to yield 101 fewer cases of dementia incidences annually, resulting in an estimated monetary benefit ranging up to 0.01% of the Swedish GDP in 2019.ConclusionThis study estimated that 5% of annual dementia cases could be attributed to PM2.5 exposure, and that the resulting monetary burden is substantial. These findings suggest the need to consider airborne toxic pollutants associated with dementia incidence in public health policy decisions.

Physico-Chemical and Biological Characteristics of Faecal Sludge in Pit Latrines with Depth

There is limited information about the characteristics of faecal sludges in ordinary pit latrines. Knowledge of the physico-chemical and biological characteristics of pit sludge from different layers of the pit apart from providing an indication of the nature of pit contents endeavoured to provide information and decision support for managing pit latrines during their normal lifespan. Therefore, this paper was aimed at investigating the physico-chemical and biological characteristics of pit sludge samples to equip latrine owners with environmental and health implications of this sludge. Legislation that establishes regulations specifically for the treatment and discharge, enduse, or disposal of faecal sludge is therefore essential. Thus, faecal sludges sampled from ten (10) pit latrines were subjected to laboratory analyses with particular reference to selected parameters. From the study, biochemical oxygen demand (BOD), chemical oxygen demand (COD), total solids (TS), moisture content, suspended solids (SS) and volatile solids (VS) showed decreasing trend throughout as the pit depth increased. Temperature presented double scenarios, increasing initially and decreasing afterwards with the highest values within 0.4m to 0.6m pit depth in all the pit latrines. Efforts to understand and mitigate the health effects of particulate matter (PM) air pollution have a rich and interesting history. This review focuses on six substantial lines of research that have been pursued since 1997 that have helped elucidate our understanding about the effects of PM on human health. There has been substantial progress in the evaluation of PM health effects at different time-scales of exposure and in the exploration of the shape of the concentration-response function. There has also been emerging evidence of PM-related cardiovascular health effects and growing knowledge regarding interconnected general pathophysiological pathways that link PM exposure with cardiopulmonary morbidity and mortality. Despite important gaps in scientific knowledge and continued reasons for some skepticism, a comprehensive evaluation of the research findings provides persuasive evidence that exposure to fine particulate air pollution has adverse effects on cardiopulmonary health. Although much of this research has been motivated by environmental public health policy, these results have important scientific, medical, and public health implications that are broader than debates over legally mandated air quality standards.

Physico-Chemical and Biological Characteristics of Faecal Sludge in Pit Latrines with Depth

There is limited information about the characteristics of faecal sludges in ordinary pit latrines. Knowledge of the physico-chemical and biological characteristics of pit sludge from different layers of the pit apart from providing an indication of the nature of pit contents endeavoured to provide information and decision support for managing pit latrines during their normal lifespan. Therefore, this paper was aimed at investigating the physico-chemical and biological characteristics of pit sludge samples to equip latrine owners with environmental and health implications of this sludge. Legislation that establishes regulations specifically for the treatment and discharge, enduse, or disposal of faecal sludge is therefore essential. Thus, faecal sludges sampled from ten (10) pit latrines were subjected to laboratory analyses with particular reference to selected parameters. From the study, biochemical oxygen demand (BOD), chemical oxygen demand (COD), total solids (TS), moisture content, suspended solids (SS) and volatile solids (VS) showed decreasing trend throughout as the pit depth increased. Temperature presented double scenarios, increasing initially and decreasing afterwards with the highest values within 0.4m to 0.6m pit depth in all the pit latrines. Efforts to understand and mitigate the health effects of particulate matter (PM) air pollution have a rich and interesting history. This review focuses on six substantial lines of research that have been pursued since 1997 that have helped elucidate our understanding about the effects of PM on human health. There has been substantial progress in the evaluation of PM health effects at different time-scales of exposure and in the exploration of the shape of the concentration-response function. There has also been emerging evidence of PM-related cardiovascular health effects and growing knowledge regarding interconnected general pathophysiological pathways that link PM exposure with cardiopulmonary morbidity and mortality. Despite important gaps in scientific knowledge and continued reasons for some skepticism, a comprehensive evaluation of the research findings provides persuasive evidence that exposure to fine particulate air pollution has adverse effects on cardiopulmonary health. Although much of this research has been motivated by environmental public health policy, these results have important scientific, medical, and public health implications that are broader than debates over legally mandated air quality standards.

Health Impact Assessment of the 2020 Washington State Wildfire Smoke Episode: Excess Health Burden Attributable to Increased PM2.5 Exposures and Potential Exposure Reductions.

Major wildfires starting in the summer of 2020 along the west coast of the United States made PM2.5 concentrations in this region rank among the highest in the world. Washington was impacted both by active wildfires in the state and aged wood smoke transported from fires in Oregon and California. This study aims to estimate the magnitude and disproportionate spatial impacts of increased PM2.5 concentrations attributable to these wildfires on population health. Daily PM2.5 concentrations for each county before and during the 2020 Washington wildfire episode (September 7–19) were obtained from regulatory air monitors. Utilizing previously established concentration‐response function (CRF) of PM2.5 (CRF of total PM2.5) and odds ratio (OR) of wildfire smoke days (OR of wildfire smoke days) for mortality, we estimated excess mortality attributable to the increased PM2.5 concentrations in Washington. On average, daily PM2.5 concentrations increased 97.1 μg/m3 during the wildfire smoke episode. With CRF of total PM2.5, the 13‐day exposure to wildfire smoke was estimated to lead to 92.2 (95% CI: 0.0, 178.7) more all‐cause mortality cases; with OR of wildfire smoke days, 38.4 (95% CI: 0.0, 93.3) increased all‐cause mortality cases and 15.1 (95% CI: 0.0, 27.9) increased respiratory mortality cases were attributable to the wildfire smoke episode. The potential impact of avoiding elevated PM2.5 exposures during wildfire events significantly reduced the mortality burden. Because wildfire smoke episodes are likely to impact the Pacific Northwest in future years, continued preparedness and mitigations to reduce exposures to wildfire smoke are necessary to avoid excess health burden.