Multi-city Study Research Articles

Short-Term Exposure to Ambient Air Pollution and Influenza: A Multicity Study in China

Short-Term Exposure to Ambient Air Pollution and Influenza: A Multicity Study in China

A multi-city study of indoor air quality in green vs non-green low-income housing

ObjectivesThe condition of the home is a strong predictor of exposure to environmental contaminants, with low-income households being particularly vulnerable. Therefore, improving housing standards is a priority. Housing built to “green” standards, with improved building methods and materials, has been suggested to reduce contaminants. However, evidence is limited as to which contaminants are reduced. The Green Housing Study was conducted to address this issue. The study hypothesis was that housing built using green components has lower concentrations of environmental contaminants compared to conventional housing. MethodsA repeated-measures, 12-month cohort study was performed in three U.S. cities. Data were collected in the home at three time points throughout a year. The level of contaminants were estimated using air samples for particulate matter and black carbon, dust samples for aeroallergens and pesticides, and resident or study staff reporting evidence of mold. To investigate source(s) of PM2.5 and black carbon, multivariable models using stepwise variable selection were developed. ResultsIn adjusted generalized estimating equations (GEE) models, black carbon concentration (μg/m3) (β = −0.22, 95% CI = −0.38 to −0.06, p = 0.01), permethrin (OR = 0.28, 95% CI = 0.15–0.49, p < 0.0001), and reported mold (OR = 0.29, 95% CI = 0.13–0.68, p = 0.003) were significantly lower in green homes. Cockroach antigen was also lower in green homes (OR = 0.59, 95% CI = 0.33–1.08, p = 0.09), although not statistically significant. We found that 68% of PM2.5 was explained by dwelling type and smoking and 42% of black carbon was explained by venting while cooking and use of a gas stove. ConclusionsThis study provides quantitative data suggesting benefits of incorporating green building practices on the level of numerous environmental contaminants known to be associated with health. Occupant behavior, particularly smoking, is an important contributor to indoor air pollution.

Development of Normative Data for the Mini Mental State Examination (MMSE) in the Elderly Population of Chile: A Multi-City Study

The Mini-Mental State Examination (MMSE) is one of the most widely used tests to assess the global cognitive deterioration of older adults. There are many versions of this Test in Spanish. A validation study was previously conducted in Chile, but to date, no standards computed from a large population sample are available. to develop normative scores according to age and educational level for older people living in Chile. Data were collected from a sample of 1199 subjects between 50 and 91 years of age from various research centers. We present the normative scores in percentiles calculated according to age (50-64, 65-74, 75-91 years of age) and educational level (1-12 years and more than 13 years of formal schooling). This article provides normative scores for the MMSE that should be useful in clinical practice as they may help better interpret the performances of Chilean older adults who seek consultation for cognitive impairment.

Effects of environmental conditions on COVID-19 morbidity as an example of multicausality: a multi-city case study in Italy.

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), broke out in December 2019 in Wuhan city, in the Hubei province of China. Since then, it has spread practically all over the world, disrupting many human activities. In temperate climates overwhelming evidence indicates that its incidence increases significantly during the cold season. Italy was one of the first nations, in which COVID-19 reached epidemic proportions, already at the beginning of 2020. There is therefore enough data to perform a systematic investigation of the correlation between the spread of the virus and the environmental conditions. The objective of this study is the investigation of the relationship between the virus diffusion and the weather, including temperature, wind, humidity and air quality, before the rollout of any vaccine and including rapid variation of the pollutants (not only their long term effects as reported in the literature). Regarding them methodology, given the complexity of the problem and the sparse data, robust statistical tools based on ranking (Spearman and Kendall correlation coefficients) and innovative dynamical system analysis techniques (recurrence plots) have been deployed to disentangle the different influences. In terms of results, the evidence indicates that, even if temperature plays a fundamental role, the morbidity of COVID-19 depends also on other factors. At the aggregate level of major cities, air pollution and the environmental quantities affecting it, particularly the wind intensity, have no negligible effect. This evidence should motivate a rethinking of the public policies related to the containment of this type of airborne infectious diseases, particularly information gathering and traffic management.

Impacts of exposure to humidex on cardiovascular mortality: a multi-city study in Southwest China

BackgroundMany studies have reported the association between ambient temperature and mortality from cardiovascular disease (CVD). However, the health effects of humidity are still unclear, much less the combined effects of temperature and humidity. In this study, we used humidex to quantify the effect of temperature and humidity combined on CVD mortality.MethodsDaily meteorological, air pollution, and CVD mortality data were collected in four cities in southwest China. We used a distributed lag non-linear model (DLNM) in the first stage to assess the exposure–response association between humidex and city-specific CVD mortality. A multivariate meta-analysis was conducted in the second stage to pool these effects at the overall level. To evaluate the mortality burden of high and low humidex, we determined the attributable fraction (AF). According to the abovementioned processes, stratified analyses were conducted based on various demographic factors.ResultsHumidex and the CVD exposure–response curve showed an inverted “J” shape, the minimum mortality humidex (MMH) was 31.7 (77th percentile), and the cumulative relative risk (CRR) was 2.27 (95% confidence interval [CI], 1.76–2.91). At extremely high and low humidex, CRRs were 1.19 (95% CI, 0.98–1.44) and 2.52 (95% CI, 1.88–3.38), respectively. The burden of CVD mortality attributed to non-optimal humidex was 21.59% (95% empirical CI [eCI], 18.12–24.59%), most of which was due to low humidex, with an AF of 20.16% (95% eCI, 16.72–23.23%).ConclusionsLow humidex could significantly increase the risk of CVD mortality, and vulnerability to humidex differed across populations with different demographic characteristics. The elderly (> 64 years old), unmarried people, and those with a limited level of education (1–9 years) were especially susceptible to low humidex. Therefore, humidex is appropriate as a predictor in a CVD early-warning system.

Roles of urbanization on heat-related mortality and their spatial heterogeneities: a multi-city multi-country study

Roles of urbanization on heat-related mortality and their spatial heterogeneities: a multi-city multi-country study

Ambient temperature and suicide: a multi-city multi-country study across 26 countries

Ambient temperature and suicide: a multi-city multi-country study across 26 countries

Roles of urbanization on heat-related mortality and their spatial heterogeneities: a multi-city multi-country study

Roles of urbanization on heat-related mortality and their spatial heterogeneities: a multi-city multi-country study

Total and cause-specific mortality attributable to cold spells in China: A multicity and multicounty study

Climate change has resulted in an increase in the frequency and intensity of extreme cold weather events, but few multicity or multicounty researches have explored the association between cold spells and mortality risk and burden. We collected daily data on climate, sociodemographic factors and mortality in 18 cities/counties across 11 geographical regions for the period of November to March 2014–2018. A distributed lag nonlinear model was used to examine the association between cold spells and mortality after adjustment for confounding factors. Twelve definitions of cold spells were used. Multi-meta regression analysis was applied to pool the impacts over different regions. Cold spells were significantly associated with all-cause mortality at lag 0–21 (CRR:1.38, 95%CI:1.21,1.57). In addition to respiratory diseases and circulatory system diseases, digestive, endocrine and nervous system diseases and injury were also affected by cold spells. The magnitude of the impacts of cold spells on mortality varied among the diseases investigated, with the highest risk estimate found for influenza and pneumonia (CRR: 2.00, 95%CI: 1.45, 2.76) and the lowest estimate found for injury (CRR: 1.26, 95%CI: 1.09,1.46). The fraction of all-cause mortality attributable to cold spells was 2.31% (95%CI: 0.90%, 3.46%). Among the regional differences, the attributable burden of all-cause mortality was higher in rural areas and subtropical monsoon climate zone, with attributable fractions of 2.85% (95%CI: 1.23%, 4.11%) and 3.36% (95%CI: 0.55%, 5.35%), respectively. Cold spells increased mortality from a range of diseases. Women, older adults and residents of rural areas and subtropical monsoon climate zone were more vulnerable to cold spells impacts. The findings may help to formulate preventive strategies and early warning response plans to reduce mortality burden of extreme cold events.

General air temperature and humidity features of local climate zones: A multi-city observational study in eastern China

The local climate zone (LCZ) scheme has been widely applied in urban climate studies. However, most field observations were conducted in individual cities and focused solely on air temperature. Few investigations have focused on the general climatic features of LCZs. This study aimed to obtain a reliable understanding of the air temperature and humidity features of LCZs by conducting multi-city observations. Towards this goal, fixed stations were established using temperature/humidity loggers deployed at 17 pairs of urban and rural sites in 15 cities of eastern China for one year. All the rural reference sites were LCZ D (low plants). Differences in air temperature (ΔT) and humidity ratio (ΔW) between the urban and rural sites (LCZ X − LCZ D) were analyzed on multiple time scales (diurnal, seasonal, and annual). In addition, we assessed urban-rural differences in the frequency and duration of heat and cold waves and the effects of local urban climates on building energy demands and human thermal stress. The results showed that: (1) the nocturnal ΔT values for ‘ideal’ days (calm and clear days) exhibited distinguishable differences among different LCZ types, but approximately similar magnitudes for urban sites belonging to the same LCZ type; (2) the analysis of ΔW revealed that moisture deficits and excesses were common occurrences in urban sites across cities; and there was no discernible pattern in ΔW among LCZs; (3) compared to their rural counterparts, all urban sites exhibited remarkable increases in heat-wave incidence, cooling energy demand, and heat exposure risk. These findings will help better understand the general climatic features of LCZs and develop adaption strategies.

Short-term ambient air pollution risk for ischemic stroke hospitalization and related economic burden: A multi-city time-series study in southwest China

Short-term exposure to air pollution is associated with hospitalization for ischemic stroke (IS); however, evidence of the impact of the exposure on IS in highly polluted developing regions is limited. This study aimed to assess the relationships between air pollutants and IS hospitalization, as well as economic burden attributable to the hospitalization in Sichuan, China. Records from 160,555 IS hospitalizations were collected from medical institutions in nine cities in Sichuan from 2017 to 2019, along with simultaneous meteorological and air pollution data. Generalized additive model (GAM) was used to analyze the relationship between air pollutants and IS hospitalizations. The economic burden due to air pollutants exposure were further assessed using a cost-of-illness (COI) method. All p values were corrected for multiple comparisons. The single pollutant model showed that the effects of each interquartile range (IQR) increase in PM2.5, PM10, O3, and CO, on IS hospitalization peaked on lag 07, with relative risk values of 1.057(95% CI: 1.030–1.085), 1.060(95% CI:1.032–1.090), 1.110(95% CI:1.043–1.181), and 1.096 (95% CI:1.060–1.132), respectively. Stratified analysis shows that older people are more susceptible to the impact of air pollutants, and compared to the warm season, IS hospitalization in the cold season is more susceptible to exposure to O3 and CO. It has been determined that during the study period, the number of IS hospitalizations attributable to PM2.5 pollution was 5,157 and to PM10 pollution was 3,650, with an economic cost of CNY 67, 966, 100 and 48, 107, 900, respectively. In this study, we found that short-term exposure to PM2.5, PM10, O3, and CO can lead to increased hospitalizations for stroke and a quantifiably greater economic burden.

An integrated One Health framework for holistic evaluation of risks from antifungal agents in a large-scale multi-city study

A new framework for retrospective mass spectral data mining for antifungal agents (AFs) and Wastewater-Based Epidemiology (WBE) was developed as part of One Health framework to tackle risks from AFs. A large scale, multi-city study was undertaken in South-West England. Key drivers of AFs in the catchment were identified with communal wastewater discharges being the main driver for human AFs (fluconazole, ketoconazole) and agricultural runoff being the main driver for pesticide AFs (prochloraz, prothioconazole and tebuconazole). Average WBE-estimated human used fluconazole and ketoconazole PNDIs (population normalised daily intake) exceeded 300 mg day−1 1000 inh−1 and 2000 mg day−1 1000 inh−1. This is much higher than PNDPs (population normalised daily prescriptions <40 mg day−1 1000 inh−1 and <80 mg day−1 1000 inh−1 for fluconazole and ketoconazole respectively). This was expected due to both prescription and over-the-counter usage, and both oral and topical applications. Pesticide AF, prothioconazole had PNDIs <40,000 mg day−1 1000 inh −1, which gave intake: 0.43, 0.26, 0.07 mg kg−1 in City A, B, and C, likely due to accounting for external/non-human sources. This is higher than the acceptable daily intake (ADI) of 0.01 mg kg−1bw day−1, which warrants further study. Intake per kg of body weight estimated using tebuconazole was 0.86, 1.39, 0.12, 0.13, and 2.7 mg kg−1 in City A-E respectively and is likely due to external/non-human sources. Intake calculated using its metabolite was 0.02 and 0.01 mg kg−1 in City B and C respectively, which aligned with ADI (0.03 mg kg−1bw day−1). The environmental risk assessment of AFs indicated low/medium risk from fluconazole, prochloraz, and tebuconazole, medium risk from epoxiconazole, prothioconazole's metabolite, and tebuconazole, and high risk for prothioconazole in river water. High risk was estimated from fluconazole, epoxiconazole, prothioconazole and its metabolite, tebuconazole, ketoconazole in wastewater samples, which is important during raw sewage discharge events via sewer overflows.

Attitudes and demands on medical statistical education during the COVID-19 pandemic among undergraduates-postgraduates-teachers: A cross-sectional study in eastern China.

Global coronavirus disease 2019 pandemic leads to the soaring demand for medical statistical applications, bringing a great challenge to medical education at universities worldwide. The purpose of our study is to investigate medical students and teachers attitudes and demands on statistical software education. A multi-city cross-sectional study was conducted in 2021 at medical universities in eastern China. Students and teachers were surveyed through online electronic questionnaires. We collected information on each participant attitudes and demands on medical statistical software usage experience. A total of 895 responses were collected using a validated questionnaire. Most students showed great interest in learning medical statistical software (undergraduates 91.9% vs post-graduates 97.8%, P < .01), thought that statistical software was important (undergraduates 99.2% vs post-graduates 94.7%, P < .01), highly relied on using the SPSS (undergraduates 52.9 % vs post-graduates 77.6%, P < .01) and R package, and felt difficulty in learning statistical software (undergraduates 82.7% vs post-graduates 98.4%, P < .01). Among teachers, the most commonly used statistical software was SPSS (91.2%), followed by the R package. Notably, very few students and teachers thought "Statistical software met needs" (from 21.8% of undergraduates to 8.8% of teachers). There were 75.4% of post-graduates and 96.5% of teachers who thought it was necessary for a university to offer an advanced statistical software curriculum such as the R package in the preferred teaching format of offline class as well as the combination of theory and software practice teaching. This study for the first time demonstrated that most medical undergraduates, post-graduates, and teachers in Anhui Province of eastern China were not satisfied with statistical software usage experience, calling for prompt adjustments to statistical software education in medical universities.

Association between ambient BTEX mixture and neurological hospitalizations: A multicity time-series study in Taiwan

BackgroundBenzene, toluene, ethylbenzene, and xylenes, collectively known as BTEX, are hazardous chemical mixtures, and their neurological health effects have not been thoroughly evaluated. We examined the association between BTEX exposure and neurological hospital admissions. MethodsThis was a multicity time-series study conducted in five major Taiwanese cities. Daily hospital admission records for diseases of the nervous system from January 1, 2016, to December 31, 2017, were collected from the National Health Insurance Research Database. Ambient BTEX and criteria pollutant concentrations and weather factors were collected from Photochemical Assessment Monitoring Stations. We applied a Poisson generalized additive model (GAM) and weighted quantile sum regression to calculate city-specific effect estimates for BTEX and conducted a random-effects meta-analysis to pool estimates. ResultsWe recorded 68 neurological hospitalizations per day during the study period. The daily mean BTEX mixture concentrations were 22.5 µg/m3, ranging from 18.3 µg/m3 in Kaohsiung to 27.0 µg/m3 in Taichung, and toluene (13.6 µg/m3) and xylene (5.8 µg/m3) were the dominant chemicals. Neurological hospitalizations increased by an average of 1.6 % (95 % CI: 0.6–2.6 %) for every interquartile range (15.8 µg/m3) increase in BTEX at lag 0 estimated using a GAM model. A quartile increase in the weighted sum of BTEX exposure was associated with a 1.7 % (95 % CI: 0.6–2.8 %) increase in daily neurological hospitalizations. ConclusionWe found consistent acute adverse effects of BTEX on neurological hospitalizations in Taiwan, with toluene and xylene as the dominant chemicals. These findings aid the development of more targeted public health interventions.

The association between long-term exposure to outdoor artificial light at night and poor sleep quality among Chinese veterans: A multi-city study.

A handful of previous studies have reported the association between exposure to outdoor artificial light at night (ALAN) and sleep problems. However, evidence for such association is limited in low- and middle-income countries. This study aimed to examine the association between outdoor ALAN exposure and sleep quality in veterans across different regions of China. Within the network of the Chinese Veteran Clinical Research Platform, we selected 7258 participants from 277 veteran communities in 18 cities across China during December 2009 and December 2011, using a multi-stage stratified cluster sampling strategy. Face-to-face interviews with the participants were conducted by trained investigators. We used the Pittsburgh Sleep Quality Index (PSQI) to assess participants' sleep quality. We defined poor sleep quality as a PSQI global score >7. The 3-year average exposure to outdoor ALAN prior to the baseline interview was calculated using satellite imagery data, according to participants' geolocation information. The association of ALAN exposure with sleep quality was examined using the mixed-effects logistic regression models with natural cubic splines. The exposure-response curve for sleep quality associated with ALAN exposure was nonlinear, with a threshold value of 49.20nW/cm2/sr for the 3-year average exposure to outdoor ALAN prior to the baseline interview. Higher ALAN exposure above the threshold was associated with increased risk of poor sleep quality. After adjusting for potential confounders, the odds ratios (and 95%CI, 95% confidence intervals) were 1.15 (0.97, 1.36) and 1.45 (1.17, 1.78) at the 75th and 95th percentiles of ALAN against the threshold. The association of ALAN exposure with poor sleep quality was more pronounced in veterans with depression than those without. Higher OR of poor sleep quality at the 75th percentile of ALAN against the threshold was observed in veterans with depression than those without [2.09 (1.16, 3.76) vs. 1.09 (0.92, 1.30)]. Long-term exposure to outdoor ALAN was associated with higher risk of poor sleep quality in Chinese veterans. Effective outdoor ALAN management may help to reduce the burden of sleep disorders in Chinese veterans.

A multi-city study on structural characteristics of bicycle networks

Bicycle networks are made up of different types of infrastructure for cars, bikes and mixed use, which has resulted in various definitions being used to describe them. However, it’s crucial to bring these definitions together to understand the structural differences among them and the impact of choices and investments in bike infrastructure. This study examines different definitions of bicycle networks in 47 cities, analysing scaling effects and various network metrics for four different definitions. Understanding structural characteristics of different bicycle networks definitions contributes to the body of knowledge necessary for design interventions by policymakers.

Hepatitis B Prevalence among Men Who Have Sex with Men in Brazil.

Hepatitis B virus (HBV) is a global public health problem and requires specific prevention actions, particularly focusing on the key populations, such as men who have sex with men (MSM). We aimed at assessing the prevalence of HBV infection, among MSM, in a multicity study in Brazil. In 2016, we conducted a survey using a respondent-driven sampling methodology in 12 Brazilian cities. Rapid tests (RT) were performed on 3178 samples from those MSM. Positive results were tested for HBV DNA and sequenced. If negative for HBV DNA, samples were tested for serological markers. The prevalence rate of HBV exposure and clearance was 10.1% (95% CI: 8.1-12.6), and 1.1% (95%; CI: 0.6-2.1) were confirmed to be HBsAg-positive. Of those samples tested for anti-HBs (n = 1033), only 74.4% presented a serological profile analogous to that elicited by hepatitis B vaccination. Among HBsAg-positive samples (n = 29), 72.4% were HBV DNA-positive, and from these, 18 were sequenced. HBV genotypes A, F, and G were found in 55.5%, 38.9%, and 5.6%, respectively. This study indicates high prevalence rates of MSM HBV exposure and a low positivity index for the serological marker of HBV vaccine immunity. These findings may contribute to the discussion of strategies to prevent hepatitis B and reinforce the importance of promoting HBV vaccination in this key population.

Techno-economic appraisal of electric vehicle charging stations integrated with on-grid photovoltaics on existing fuel stations: A multicity study framework

The affordable transportation industry has been severely compromised in 2022 as a consequence of the unexpected surge in the price of fossil fuels. By 2050, the transportation industry is forecasted to expand twice, leading to a variety of issues, such as fossil fuel depletion and environmental emissions. As a result, worldwide trend toward electrifying transport, with energy production originating from both traditional and carbon-free sources. Therefore, consumers of electric vehicles require convenient access to the services of charging stations around the country. This research investigates existing fuel station rooftops for the deployment of the grid-connected photovoltaic (GCPV) system electric vehicle charging stations (EVCS), design, and performance analysis of Pakistan's cities. A mathematical model of the GCPV EVCS under consideration has been described. Three cities in Pakistan: Multan, Lahore, and Islamabad-EVCS powered by photovoltaics and the utility grid have been designed and their comparison of the techno-economic performance indicators have been done through System Advisor Model (SAM) software. To comprehend the impact of uncertainty on the functionality of the GCPV EVCS, sensitivity analyses were conducted at all three designated cities in Pakistan. With this strategy, Pakistan will be able to reduce its greenhouse gas emissions to the level required by the Paris Agreement.

The association between adverse ergonomic factors and work-related musculoskeletal symptoms among medical staff in China: a cross-sectional study

We investigated the prevalence of work-related musculoskeletal symptoms (WMSs) among medical staff and evaluated the associations of different levels of adverse ergonomic factors with WMSs. A total of 6099 Chinese medical staff were asked to complete a self-reported questionnaire to assess the prevalence and risk factors of WMSs from June 2018 to December 2020. A prevalence rate of 57.5% was observed for WMSs among overall medical staffs, which mainly affected the neck (41.7%) and shoulder (33.5%). “Keeping sitting for long hours very frequently” (OR = 1.26, 95% CI: 1.04, 1.53) was positively associated with WMSs in doctors, while “keeping sitting for long hours occasionally” (OR = 0.91, 95% CI: 0.85, 0.97) was identified as a protective factor of WMSs in nurses. The associations of adverse ergonomic factors, organizational factors, and environmental factors with WMSs were different among medical staff in different positions.

Ozone pollution and hospital admissions for cardiovascular events.

The available literature on morbidity risk of cardiovascular diseases associated with ambient ozone pollution is still limited. This study examined the potential acute effects of exposure to ambient ozone pollution on hospital admissions of cardiovascular events in China. A two-stage multi-city time-series study approach was used to explore the associations of exposure to ambient ozone with daily hospital admissions (n = 6 444 441) for cardiovascular events in 70 Chinese cities of prefecture-level or above during 2015-17. A 10 μg/m3 increment in 2-day average daily 8 h maximum ozone concentrations was associated with admission risk increases of 0.46% [95% confidence interval (CI): 0.28%, 0.64%] in coronary heart disease, 0.45% (95% CI: 0.13%, 0.77%) in angina pectoris, 0.75% (95% CI: 0.38%, 1.13%) in acute myocardial infarction (AMI), 0.70% (95% CI: 0.41%, 1.00%) in acute coronary syndrome, 0.50% (95% CI: 0.24%, 0.77%) in heart failure, 0.40% (95% CI: 0.23%, 0.58%) in stroke and 0.41% (95% CI: 0.22%, 0.60%) in ischemic stroke, respectively. The excess admission risks for these cardiovascular events associated with high ozone pollution days (with 2-day average 8-h maximum concentrations ≥100 µg/m3 vs. < 70 µg/m3) ranged from 3.38% (95% CI: 1.73%, 5.06%) for stroke to 6.52% (95% CI: 2.92%, 10.24%) for AMI. Ambient ozone was associated with increased hospital admission risk for cardiovascular events. Greater admission risks for cardiovascular events were observed under high ozone pollution days. These results provide evidence for the harmful cardiovascular effects of ambient ozone and call for special attention on the control of high ozone pollution.