Non-accidental Causes Research Articles

Impacts of PM2.5 exposure near cement facilities on human health and years of life lost: A case study in Brazil

Cement factories significantly contribute to atmospheric pollution by generating fine particulate matter (PM2.5), which can potentially increase the mortality risk. The lack of information on the health impacts of PM2.5 pollution from cement operations in Brazil prompted this investigation. We used corrected PM2.5 measurements from low-cost sensors from March 2021 to October 2022 in Rio Branco do Sul, city in the southern region of the country and home to Latin America's largest cement plant, to assess exposure data. Disability-adjusted life years (DALY) method was applied to estimate the years of life lost (YLL) and cost estimate due to deaths from non-accidental causes, cardiovascular and respiratory diseases. The total YLL attributable to PM2.5 concentration was estimated by calculating the attributable fraction (AF) through relative risk. We also collected PM2.5 using a Harvard impactor to evaluate health risks from toxic metals components. During the study period, the analysis of chemical characterization of PM2.5 showed enrichment factors for most elements and the possible influence of the calcination process facilities on the PM2.5 levels. The mean concentration of PM2.5 exceeded the annual WHO air quality guideline (AQG) level, accounted for 3.5%, 4.7%, and 4.3% of total YLL from all causes, cardiovascular, and respiratory diseases, which corresponded to 0.23 (95% CI: 0.17–0.26), 0.06 (95% CI: 0.05–0.07) and 0.03 (95% CI: 0.01–0.06) years loss in life expectancy, respectively. An indirect health cost attributable to PM2.5 resulted in US$ 1.4 million, equivalent to about 3.5% of the total local annual health costs in Rio Branco do Sul, underscoring the significant financial burden of PM2.5 exposures. The greatest economic loss was found in the male age group of 40–69 years and among those with cardiovascular disease, rather than those with respiratory disease. Despite this, the carcinogenic and non-carcinogenic risks from inhalation of hazardous elements were within safe ranges. This work demonstrated PurpleAir's potential for air quality and public health applications. Our findings indicate health and economic benefits from reducing PM2.5 levels by adopting WHO air pollution standards. The results can guide policies toward delivering more effective health care.

Developing and validating intracity spatiotemporal air quality health index in eastern China

BackgroundRecently pilot published city-level air quality health index (AQHI) provides a useful tool for communicating short-term health risks of ambient air pollution, but fails to account for intracity spatial heterogeneity in exposure and associated population health impacts. This study aims to develop the intracity spatiotemporal AQHI (ST-AQHI) via refined air pollution-related health risk assessments. MethodsA three-stage analysis was conducted through integrating province-wide death surveillance data and high-resolution gridded estimates of air pollution and climate factors spanning 2016–2019 in Jiangsu Province, eastern China. First, an individual-level case-crossover design was employed to quantify the short-term risk of nonaccidental mortality associated with residential exposure to individual pollutant (i.e., PM2.5, NO2, O3, and SO2). Second, we accumulated and scaled the excess risks arising from multiple pollutants to formulate daily gridded ST-AQHI estimates at 0.1° × 0.1°, dividing exposure-related risks into low (0–3), moderate (4–6), high (7–9), and extreme high (10+) levels. Finally, the effectiveness of ST-AQHI as composite risk communication was validated through checking the dose-response associations of individual ST-AQHI exposure with deaths from nonaccidental and major cardiopulmonary causes via repeating case-crossover analyses. ResultsWe analyzed a total of 1,905,209 nonaccidental death cases, comprising 785,567 from circulatory diseases and 247,336 from respiratory diseases. In the first-stage analysis, for each 10-μg/m3 rise in PM2.5, NO2, O3, and SO2 exposure at lag-01 day, population risk of nonaccidental death was increased by 0.8% (95% confidence interval: 0.7%, 0.9%), 1.9% (1.7%, 2.0%), 0.4% (0.3%, 0.5%), and 4.1% (3.7%, 4.5%), respectively. Spatiotemporal distribution of ST-AQHI exhibited a consistent declining trend throughout the study period (2016–2019), with annual average ST-AQHI decreasing from 5.2 ± 1.3 to 4.0 ± 1.0 and high-risk days dropping from 15.8% (58 days) to 1.6% (6 days). Exposure associated health risks showed great intracity- and between-city heterogeneities. In the validation analysis, ST-AQHI demonstrated approximately linear, threshold-free associations with multiple death events from nonaccidental and major cardiopulmonary causes, suggesting excellent performance in predicting exposure-related health risks. Specifically, each 1-unit rise in ST-AQHI was significantly associated with an excess risk of 2.0% (1.8%, 2.1%) for nonaccidental mortality, 2.3% (2.1%, 2.6%) for overall circulatory mortality, and 2.7% (2.3%, 3.1%) for overall respiratory mortality, as well as 1.7%–3.0% for major cardiopulmonary sub-causes. ConclusionsST-AQHI developed in this study performed well in predicting intracity spatiotemporal heterogeneity of death risks related to multiple air pollutants, and may hold significant practical importance in communicating air pollution-related health risks to the public at the community scales.

Assessing the role of socio-economic factors in shaping the temperature-mortality exposure-response relationship in China

Non-optimal temperatures significantly influence public health. However, the role of socio-economic factors in modulating health risks associated with non-optimal temperatures varies geographically and among different populations. Thus, the meteorological, air quality, health data, and socio-economic indicators were obtained from 23 districts in North and 48 districts in East China, respectively. Employing a two-stage meta-analysis, the exposure-response relationship was constructed for temperature against mortality from non-accidental causes, cardiovascular and cerebrovascular diseases, and respiratory illnesses. Furthermore, a non-linear spline regression was applied to assess the impact of socio-economic indicators on the exposure-response relationship and predicted future risks under various Shared Socioeconomic Pathways. The results revealed that the influence of socio-economic factors on the exposure-response curve showed heterogeneity in East China and North China. In North China, the shape of the exposure-response curve changed greatly under different socio-economic levels, while it remained similar in East China. In East China, the relative risk of heat and cold exposure was reduced in regions with high GDP, high levels of public finance, good medical services, and a low proportion of the elderly population. Specifically, the risk of non-accidental deaths due to heat shows a nearly linear negative correlation with per capita GDP in East China, with a decrease of the relative risk by 0.075 for every 10 thousand yuan increase in per capita GDP. Future projections indicate that population aging plays a decisive role in shaping the exposure-response curves. Although economic growth can reduce the risk of heat-related mortality, the combined effect of population aging and economic increase results in steeper exposure-response curves in both hot and cold temperature ranges in the future. In conclusion, although spatial variations in relative risk changes still exist, enhancing the adaptive capacity of populations can mitigate health risks associated with future climate change.

The impacts of extreme heat events on non-accidental, cardiovascular, and respiratory mortality: An analysis of 12 Canadian cities from 2000 to 2020.

Extreme heat has significant impacts on mortality. In Canada, past research has analyzed the degree to which non-accidental mortality increases during single extreme heat events; however, few studies have considered multiple causes of death and the impacts of extreme heat events on mortality over longer time periods. Daily death counts attributable to non-accidental, cardiovascular, and respiratory causes were retrieved for the 12 most populous cities in Canada from 2000 to 2020. Generalized additive models were applied to quantify daily mortality risks for people aged younger than 65 years and for those aged 65 years and older in each city and for each cause of death. Model results were used to calculate the change in mortality risks and the number of excess deaths attributable to extreme heat during extreme heat events. Elevated mortality risks were observed during extreme heat events in most cities for non-accidental and respiratory causes. The impacts of extreme heat on non-accidental mortality were typically greater for people aged 65 and older than for those aged younger than 65. Significantly higher non-accidental mortality risks were observed during extreme heat events for people aged 65 and older in Montréal, the city of Québec, Surrey, and Toronto. For cardiovascular and respiratory causes, people aged 65 and older had significantly higher mortality risks during extreme heat events in Montréal, and both Montréal and Toronto, respectively. In the 12 cities, approximately 670 excess non-accidental deaths, 115 excess cardiovascular deaths, and 115 excess respiratory deaths were attributable to extreme heat events during the study period. Mortality risks during extreme heat events were generally higher in cities with larger proportions of renter households and fewer extreme heat events. This study estimates the longer-term impacts of extreme heat events on three mortality outcomes in a set of large Canadian cities. As climate change causes more frequent and intense extreme heat events, and as policy makers aim to reduce the health impacts of heat, it is important to understand how and where extreme heat affects health.

Association between Long-Term Exposure to PM2.5 Inorganic Chemical Compositions and Cardiopulmonary Mortality: A 22-Year Cohort Study in Northern China.

Particulate matter with diameters ≤2.5 μm (PM2.5) has been identified as a significant air pollutant contributing to premature mortality. Nevertheless, the specific compositions within PM2.5 that play the most crucial role remain unclear, especially in areas with high pollution concentrations. This study aims to investigate the individual and joint mortality risks associated with PM2.5 inorganic chemical compositions and identify primary contributors. In 1998, we conducted a prospective cohort study in four northern Chinese cities (Tianjin, Shenyang, Taiyuan, and Rizhao). Satellite-based machine learning models calculated PM2.5 inorganic chemical compositions, including sulfate (SO4 2-), nitrate (NO3 -), ammonium (NH4 +), and chloride (Cl-). A time-varying Cox proportional hazards model was applied to analyze associations between these compositions and cardiorespiratory mortality, encompassing nonaccidental causes, cardiovascular diseases (CVDs), nonmalignant respiratory diseases (RDs), and lung cancer. The quantile-based g-computation model evaluated joint exposure effects and relative contributions of the compositions. Stratified analysis was used to identify vulnerable subpopulations. During 785,807 person-years of follow-up, 5812 (15.5%) deaths occurred from nonaccidental causes, including 2932 (7.8%) from all CVDs, 479 (1.3%) from nonmalignant RDs, and 552 (1.4%) from lung cancer. Every interquartile range (IQR) increase in SO4 2- was associated with mortality from nonaccidental causes (hazard ratio: 1.860; 95% confidence interval: 1.809, 1.911), CVDs (1.909; 1.836, 1.985), nonmalignant RDs (2.178; 1.975, 2.403), and lung cancer (1.773; 1.624, 1.937). In the joint exposure model, a simultaneous rise of one IQR in all four compositions increased the risk of cardiorespiratory mortality by at least 36.3%, with long-term exposure to SO4 2- contributing the most to nonaccidental and cardiopulmonary deaths. Individuals with higher incomes and lower education levels were found to be more vulnerable. Long-term exposure to higher levels of PM2.5 inorganic compositions was associated with significantly increased cardiopulmonary mortality, with SO4 2- potentially being the primary contributor. These findings offer insights into how PM2.5 sources impact health, aiding the development of more effective governance measures.

Ambient air pollution and mortality: The role of socioeconomic conditions.

There is a vast body of literature covering the association between air pollution exposure and nonaccidental mortality. However, the role of socioeconomic status (SES) in this relationship is still not fully understood. We investigated if individual and contextual SES modified the relationship between short-term exposure to ozone (O3), nitrogen dioxide (NO2), and particulate matter with aerodynamic diameter <10 µm (PM10) on cardiovascular, respiratory, and all nonaccidental mortality. We conducted a time-stratified case-crossover study. Analyses were based on information on 280,685 deaths from 2011 to 2015 in the city of São Paulo. Education was used as an individual SES, and information on the district of residence was used to build a contextual SES. Exposure to PM10, NO2, and O3 was accessed from monitoring stations and linked to each case based on the date of death. Conditional logistic regression models were used to estimate the effects of air pollutants, and interaction terms were added to access the effect modification of SES. Individuals with lower education had an increased chance of dying for all nonaccidental outcomes (1.54% [0.91%, 2.14%]) associated with exposure to PM10. Individuals living in lower SES areas had an increased chance of dying for nonaccidental (0.52% [0.16%, 0.88%]), cardiovascular (1.17% [0.88%, 1.46%]), and respiratory (1.70% [0.47%, 2.93%]) causes owing to NO2 exposure. Exposure to air pollutants increases the chance of dying by nonaccidental, cardiovascular, and respiratory causes. Lower educational levels and living on lower contextual SES increased the risk of mortality associated with air pollution exposure.

Abstract 836: Long-term particulate matter and mortality in cancer patients and survivors compared to general population

Abstract Background and Aim Exposure to particulate matter (PM) has been reported as a major environmental hazard to human health. Although many studies found the associations with mortality and its susceptibility in patients with diabetes and heart diseases, few studies paid attention to cancer. In addition, there were no studies that compared these associations in cancer patients and survivors with those in healthy people from the same population. The aim of this study is to compare the association between long-term exposure to PM with all-cause and cause-specific mortality between the general population and cancer patients and survivors both of which were selected from the same cohort in the Seoul Metropolitan Area (SMA), South Korea. Methods Using the National Health Insurance Services-National Sample cohort, we selected the subjects who received health screening during 2005-2007, had full address information, and were aged 30-80 without severe disability. We defined cause-specific mortality based on the International Classification of Disease, 10th reversion from 2007 to 2015. Using a previously-validated prediction model, we estimated annual-average PM concentrations at participants’ district-level addresses and assessed individual long-term exposure as the average concentrations in the previous 5 years on each year during the follow-up. Then, we performed time-varying Cox proportional hazards model to estimate hazard ratios (HRs) and 95% confidence intervals (95%CI) per 10 ug/m3 increase in PM2.5 and PM10 adjusting for sociodemographic characteristics, family history of cancer, and health behaviors. Results Our study population of 98,493 adults include 94,494 (95.9%) general population and 3,999 (4.1%) cancer patients and survivors in the SMA at baseline. In the general population, we observed the associations with deaths from all causes (PM2.5: HR=1.31, 95% CI: 1.10-1.55; PM10: 1.07, 1.00-1.15), non-accidental causes (PM2.5: 1.51, 1.24-1.84; PM10: 1.10, 1.02-1.20), and cardiopulmonary diseases (PM2.5: 1.57, 1.07-2.31); PM10: 1.22, 1.04-1.43). In contrast, although all HRs of all-cause and cause-specific mortality were not statistically significant, cancer patients and survivors showed much higher HRs for all-cancer and lung-cancer mortality (PM2.5: 1.57 and 1.99; PM10: 1.01 and 1.33) than those for all or other cause-specific mortality as well as those of cancer-related mortality in the general population. Conclusions Our findings provided suggestive evidence of the different causes of deaths associated with long-term exposure to air pollution between the general population and cancer patients and survivors. While PM could behave as a risk factor of cardiopulmonary deaths in the general population, after diagnosed with cancer, exposure to PM may increase the risk of dying of cancer. Citation Format: Miyoun Shin, Ok-Jin Kim, Seung-Ah Choe, Yoon-Jung Choi, Ho Kim, Woojoo Lee, Ho Lee, Sun-Young Kim. Long-term particulate matter and mortality in cancer patients and survivors compared to general population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 836.

Association Between Nitrogen Dioxide Pollution and Cause-Specific Mortality in China: Cross-Sectional Time Series Study.

Nitrogen dioxide (NO2) has been frequently linked to a range of diseases and associated with high rates of mortality and morbidity worldwide. However, there is limited evidence regarding the risk of NO2 on a spectrum of causes of mortality. Moreover, adjustment for potential confounders in NO2 analysis has been insufficient, and the spatial resolution of exposure assessment has been limited. This study aimed to quantitatively assess the relationship between short-term NO2 exposure and death from a range of causes by adjusting for potential confounders in Guangzhou, China, and determine the modifying effect of gender and age. A time series study was conducted on 413,703 deaths that occurred in Guangzhou during the period of 2010 to 2018. The causes of death were classified into 10 categories and 26 subcategories. We utilized a generalized additive model with quasi-Poisson regression analysis using a natural cubic splines function with lag structure of 0 to 4 days to estimate the potential lag effect of NO2 on cause-specific mortality. We estimated the percentage change in cause-specific mortality rates per 10 μg/m3 increase in NO2 levels. We stratified meteorological factors such as temperature, humidity, wind speed, and air pressure into high and low levels with the median as the critical value and analyzed the effects of NO2 on various death-causing diseases at those high and low levels. To further identify potentially vulnerable subpopulations, we analyzed groups stratified by gender and age. A significant association existed between NO2 exposure and deaths from multiple causes. Each 10 μg/m3 increment in NO2 density at a lag of 0 to 4 days increased the risks of all-cause mortality by 1.73% (95% CI 1.36%-2.09%) and mortality due to nonaccidental causes, cardiovascular disease, respiratory disease, endocrine disease, and neoplasms by 1.75% (95% CI 1.38%-2.12%), 2.06% (95% CI 1.54%-2.59%), 2.32% (95% CI 1.51%-3.13%), 2.40% (95% CI 0.84%-3.98%), and 1.18% (95% CI 0.59%-1.78%), respectively. Among the 26 subcategories, mortality risk was associated with 16, including intentional self-harm, hypertensive disease, and ischemic stroke disease. Relatively higher effect estimates of NO2 on mortality existed for low levels of temperature, relative humidity, wind speed, and air pressure than with high levels, except a relatively higher effect estimate was present for endocrine disease at a high air pressure level. Most of the differences between subgroups were not statistically significant. The effect estimates for NO2 were similar by gender. There were significant differences between the age groups for mortality due to all causes, nonaccidental causes, and cardiovascular disease. Short-term NO2 exposure may increase the risk of mortality due to a spectrum of causes, especially in potentially vulnerable populations. These findings may be important for predicting and modifying guidelines for NO2 exposure in China.

Mortality burden attributable to exceptional PM2.5 air pollution events in Australian cities: A health impact assessment

BackgroundPeople living in Australian cities face increased mortality risks from exposure to extreme air pollution events due to bushfires and dust storms. However, the burden of mortality attributable to exceptional PM2.5 levels has not been well characterised. We assessed the burden of mortality due to PM2.5 pollution events in Australian capital cities between 2001 and 2020. MethodsFor this health impact assessment, we obtained data on daily counts of deaths for all non-accidental causes and ages from the Australian National Vital Statistics Register. Daily concentrations of PM2.5 were estimated at a 5 km grid cell, using a Random Forest statistical model of data from air pollution monitoring sites combined with a range of satellite and land use-related data. We calculated the exceptional PM2.5 levels for each extreme pollution exposure day using the deviation from a seasonal and trend loess decomposition model. The burden of mortality was examined using a relative risk concentration-response function suggested in the literature. FindingsOver the 20-year study period, we estimated 1454 (95 % CI 987, 1920) deaths in the major Australian cities attributable to exceptional PM2.5 exposure levels. The mortality burden due to PM2.5 exposure on extreme pollution days was considerable. Variations were observed across Australia. Despite relatively low daily PM2.5 levels compared to global averages, all Australian cities have extreme pollution exposure days, with PM2.5 concentrations exceeding the World Health Organisation Air Quality Guideline standard for 24-h exposure. Our analysis results indicate that nearly one-third of deaths from extreme air pollution exposure can be prevented with a 5 % reduction in PM2.5 levels on days with exceptional pollution. InterpretationExposure to exceptional PM2.5 events was associated with an increased mortality burden in Australia's cities. Policies and coordinated action are needed to manage the health risks of extreme air pollution events due to bushfires and dust storms under climate change.

Particulate pollution at construction sites of Kolkata and associated health burden for exposed construction workers

The present study assesses the construction dust pollution scenario and associated health burden for construction sites at Kolkata metropolis. The generated PM levels well exceeded 24 h and annual air quality guideline levels prescribed by World Health Organization (599.52–27,238.41% and 1998.56–81,915.22% respectively for PM10 and 1028.78–23,691.68% and 3286.34–71,275.03% respectively for PM2.5). Health burden in terms of population attributable fraction (PAF) attributed to associated mortality risks are estimated. The PAF ranged between 0.28 and 1.00 for elevated PM10 exposure. For PM2.5 exposure the PAF ranged between 0.70 and 1.00. When compared with the average Kolkata city residents, the health burden of the exposed construction workers is found to be alarmingly higher. Considering the mortality risks for all non-accidental causes, 57–99% (for PM10 exposure) and 62–100% (for PM2.5 exposure) of the construction workers are found to be susceptible compared to only 32% and 22% of the average Kolkata city residents respectively. Similar kind of health burden could be observed for different cause-specific mortality risks also. The stochastic nature of the influencing variables while calculating health risks are handled through Monte Carlo's Simulation (MCS). The situation demands for immediate control and mitigation measures.

Mortality Risk and Burden From a Spectrum of Causes in Relation to Size-Fractionated Particulate Matters: Time Series Analysis.

There is limited evidence regarding the adverse impact of particulate matters (PMs) on multiple body systems from both epidemiological and mechanistic studies. The association between size-fractionated PMs and mortality risk, as well as the burden of a whole spectrum of causes of death, remains poorly characterized. We aimed to examine the wide range of susceptible diseases affected by different sizes of PMs. We also assessed the association between PMs with an aerodynamic diameter less than 1 µm (PM1), 2.5 µm (PM2.5), and 10 µm (PM10) and deaths from 36 causes in Guangzhou, China. Daily data were obtained on cause-specific mortality, PMs, and meteorology from 2014 to 2016. A time-stratified case-crossover approach was applied to estimate the risk and burden of cause-specific mortality attributable to PMs after adjusting for potential confounding variables, such as long-term trend and seasonality, relative humidity, temperature, air pressure, and public holidays. Stratification analyses were further conducted to explore the potential modification effects of season and demographic characteristics (eg, gender and age). We also assessed the reduction in mortality achieved by meeting the new air quality guidelines set by the World Health Organization (WHO). Positive and monotonic associations were generally observed between PMs and mortality. For every 10 μg/m3 increase in 4-day moving average concentrations of PM1, PM2.5, and PM10, the risk of all-cause mortality increased by 2.00% (95% CI 1.08%-2.92%), 1.54% (95% CI 0.93%-2.16%), and 1.38% (95% CI 0.95%-1.82%), respectively. Significant effects of size-fractionated PMs were observed for deaths attributed to nonaccidental causes, cardiovascular disease, respiratory disease, neoplasms, chronic rheumatic heart diseases, hypertensive diseases, cerebrovascular diseases, stroke, influenza, and pneumonia. If daily concentrations of PM1, PM2.5, and PM10 reached the WHO target levels of 10, 15, and 45 μg/m3, 7921 (95% empirical CI [eCI] 4454-11,206), 8303 (95% eCI 5063-11,248), and 8326 (95% eCI 5980-10690) deaths could be prevented, respectively. The effect estimates of PMs were relatively higher during hot months, among female individuals, and among those aged 85 years and older, although the differences between subgroups were not statistically significant. We observed positive and monotonical exposure-response curves between PMs and deaths from several diseases. The effect of PM1 was stronger on mortality than that of PM2.5 and PM10. A substantial number of premature deaths could be preventable by adhering to the WHO's new guidelines for PMs. Our findings highlight the importance of a size-based strategy in controlling PMs and managing their health impact.

Increased ground-level O3 during the COVID-19 pandemic in China aggravates human health risks but has little effect on winter wheat yield

In January 2020, the novel coronavirus (COVID-19) outbreak emerged in China, prompting the enforcement of stringent lockdown measures nationwide to contain its spread. Multiple studies have demonstrated that these measures successfully reduced the levels of air pollutants except for ozone (O3). However, the potential risks of nationwide O3 changes during this period remain uncertain. To address this gap, we evaluated the ecological and health effects of O3 using hourly O3 data from 1 January to 17 June in both 2020 and 2019. Our results indicated that all health and ecological indicators, except SUM06 (sum of all hourly O3 over 60 ppb), during the COVID-19 pandemic in 2020 increased most obviously in Stages 2 and 3 with the strictest control measures, compared to the same period in 2019. The national premature deaths due to short-term O3 exposure during Stages 2–3 in 2020 totaled 146,558 (95% CI: 79,386–213,730) for all non-accidental causes and 82,408 (95% CI: 30,522–134,295) for cardiovascular diseases, increasing by 18.78% and 18.76% in 2019, respectively. The most significant increase in health risks occurred in Hubei, followed by Jiangxi, Zhejiang, Hunan, and Shaanxi. In addition, the estimated national winter wheat production losses (WWPL) attributable to O3 amounted to 50.6 and 51.1 million metric tons for 2019 and 2020, respectively. Among the major winter wheat-producing provinces, Anhui and Jiangsu experienced a larger increase in WWPL, while Shandong and Hebei suffered a greater decrease in 2020 compared to 2019, resulting in little overall change in WWPL between the two years. These findings provided direct evidence of the harmful effects of O3 during the COVID-19 pandemic and serve as a valuable reference for future air pollution control.

Short-term exposure to ultrafine particles and mortality and hospital admissions due to respiratory and cardiovascular diseases in Copenhagen, Denmark

Ultrafine particles (UFP; particulate matter <0.1 μm in diameter) may be more harmful to human health than larger particles, but epidemiological evidence on their health effects is still limited. In this study, we examined the association between short-term exposure to UFP and mortality and hospital admissions in Copenhagen, Denmark. Daily concentrations of UFP (measured as particle number concentration in a size range 11–700 nm) and meteorological variables were monitored at an urban background station in central Copenhagen during 2002–2018. Daily counts of deaths from all non-accidental causes, as well as deaths and hospital admissions from cardiovascular and respiratory diseases were obtained from Danish registers. Mortality and hospital admissions associated with an interquartile range (IQR) increase in UFP exposure on a concurrent day and up to six preceding days prior to the death or admission were examined in a case-crossover study design. Odds ratios (OR) with 95% confidence intervals (CI) per one IQR increase in UFP were estimated after adjusting for temperature and relative humidity. We observed 140,079 deaths in total, 236,003 respiratory and 342,074 cardiovascular hospital admissions between 2002 and 2018. Hospital admissions due to respiratory and cardiovascular diseases were significantly positively associated with one IQR increase in UFP (OR: 1.04 [95% CI: 1.01, 1.07], lag 0–4, and 1.02 [1.00, 1.04], lag 0–1, respectively). Among the specific causes, the strongest associations were found for chronic obstructive pulmonary disease (COPD) mortality and asthma hospital admissions and two-day means (lag 0–1) of UFP (OR: 1.13 [1.01, 1.26] and 1.08 [1.00, 1.16], respectively, per one IQR increase in UFP). Based on 17 years of UFP monitoring data, we present novel findings showing that short-term exposure to UFP can trigger respiratory and cardiovascular diseases mortality and morbidity in Copenhagen, Denmark. The strongest associations with UFP were observed with COPD mortality and asthma hospital admissions.

Sector of Employment and Mortality: A Cohort Based on Different Administrative Archives.

Administrative data can be precious in connecting information from different sectors. For the first time, we used data from the National Social Insurance Agency (INPS) to investigate the association between the occupational sectors and both non-accidental and accidental mortality. We retrieved information on occupational sectors from 1974 to 2011 for private sector workers included in the 2011 census cohort of Rome. We classified the occupational sectors into 25 categories and analyzed occupational exposure as ever/never have been employed in a sector or as the lifetime prevalent sector. We followed the subjects from the census reference day (9 October 2011) to 31 December 2019. We calculated age-standardized mortality rates for each occupational sector, separately in men and women. We used Cox regression to investigate the association between the occupational sectors and mortality, producing hazard ratios (HRs) and 95% confidence intervals (95%CI). We analyzed 910,559 30+-year-olds (53% males) followed for 7 million person-years. During the follow-up, 59,200 and 2560 died for non-accidental and accidental causes, respectively. Several occupational sectors showed high mortality risks in men in age-adjusted models: food and tobacco production with HR = 1.16 (95%CI: 1.09-8.22), metal processing (HR = 1.66, 95%CI: 1.21-11.8), footwear and wood (HR = 1.19, 95%CI: 1.11-1.28), construction (HR = 1.15, 95%CI: 1.12-1.18), hotels, camping, bars, and restaurants (HR = 1.16, 95%CI: 1.11-1.21) and cleaning (HR = 1.42, 95%CI: 1.33-1.52). In women, the sectors that showed higher mortality than the others were hotels, camping, bars, and restaurants (HR = 1.17, 95%CI: 1.10-1.25) and cleaning services (HR = 1.23, 95%CI: 1.17-1.30). Metal processing and construction sectors showed elevated accidental mortality risks in men. Social Insurance Agency data have the potential to characterize high-risk sectors and identify susceptible groups in the population.

Individual and joint associations of long-term exposure to air pollutants and cardiopulmonary mortality: a 22-year cohort study in Northern China

Evidence on the associations between long-term exposure to multiple air pollutants and cardiopulmonary mortality is limited, especially for developing regions with higher pollutant levels. We aimed to characterise the individual and joint (multi-pollutant) associations of long-term exposure to air pollutants with cardiopulmonary mortality, and to identify air pollutant that primarily contributes to the mortality risk. We followed 37,442 participants with a mean age of 43.5 years in four cities in northern China (Tianjin, Shenyang, Taiyuan, and Rizhao) from January 1998 to December 2019. Annual particulate matter (PM) with diameters ≤2.5μm (PM2.5), ≤10μm (PM10), sulfur dioxide (SO2) and nitrogen dioxide (NO2) were estimated using daily average values from satellite-derived machine learning models and monitoring stations. Time-varying Cox proportional hazards model was used to evaluate the individual association between air pollutants and mortality from non-accidental causes, cardiovascular diseases (CVDs), non-malignant respiratory diseases (RDs) and lung cancer, accounting for demographic and socioeconomic factors. Effect modifications by age, sex, income and education level were also examined. Quantile-based g-Computation integrated with time-to-event data was additionally applied to evaluate the co-effects and the relative weight of contributions for air pollutants. During 785,807 person-years of follow-up, 5812 (15.5%) died from non-accidental causes, among which 2932 (7.8%) were from all CVDs, 479 (1.3%) from non-malignant RDs, and 552 (1.4%) from lung cancer. Long-term exposure to PM10 (mean [baseline]: 136.5μg/m3), PM2.5 (mean [baseline]: 70.2μg/m3), SO2 (mean [baseline]: 113.0μg/m3) and NO2 (mean [baseline]: 39.2μg/m3) were adversely and consistently associated with all mortality outcomes. A 10μg/m3 increase in PM2.5 was associated with higher mortality from non-accidental causes (hazard ratio 1.20; 95% confidence interval 1.17-1.23), CVDs (1.23; 1.19-1.28), non-malignant RDs (1.37; 1.25-1.49) and lung cancer (1.14; 1.05-1.23). A monotonically increasing curve with linear or supra-linear shape with no evidence of a threshold was observed for the exposure-response relationship of mortality with individual or joint exposure to air pollutants. PM2.5 consistently contributed most to the elevated mortality risks related to air pollutant mixture, followed by SO2 or PM10. There was a strong and positive association of long-term individual and joint exposure to PM10, PM2.5, SO2, and NO2 with mortalities from non-accidental causes, CVDs, non-malignant RDs and lung cancer in high-exposure settings, with PM2.5 potentially being the main contributor. The shapes of associations were consistent with a linear or supra-linear exposure-response relationship, with no lower threshold observed within the range of concentrations in this study. National Key Research and Development Program of China, the China Scholarship Council, the National Natural Science Foundation of China, Natural Science Foundation of Guangdong Province.

Sudden unexpected death in epilepsy is prevented by blocking postictal hypoxia

Epilepsy is at times a fatal disease. Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related mortality in people with intractable epilepsy and is defined by exclusion; non-accidental, non-toxicologic, and non-anatomic causes of death. While SUDEP often follows a bilateral tonic-clonic seizure, the mechanisms that ultimately lead to terminal apnea and then asystole remain elusive and there is a lack of preventative treatments. Based on the observation that discrete seizures lead to local and postictal vasoconstriction, resulting in hypoperfusion, hypoxia and behavioural disturbances in the forebrain we reasoned those similar mechanisms may play a role in SUDEP when seizures invade the brainstem. Here we tested this neurovascular-based hypothesis of SUDEP in awake non-anesthetized mice by pharmacologically preventing seizure-induced vasoconstriction, with cyclooxygenase-2 or L-type calcium channel antagonists. In both acute and chronic mouse models of seizure-induced premature mortality, ibuprofen and nicardipine extended life while systemic drug levels remained high enough to be effective. We also examined the potential role of spreading depolarization in the acute model of seizure-induced premature mortality. These data provide a proof-of-principle for the neurovascular hypothesis of SUDEP rather than spreading depolarization and the use of currently available drugs to prevent it.

Premature deaths related to urban air pollution in Poland

In the present study, we conducted a risk assessment of urban population exposure to ambient particles (PM2.5, PM10), nitrogen dioxides (NO2), and tropospheric ozone (O3) in six Polish urban areas over the period 2015–2020. The main goals were to: i) evaluate the number of premature deaths attributed to ambient air pollutants, and to ii) assess the effectiveness of emissions control policies in reducing urban population exposure to air pollution, and thus related health effects. For that, we used air quality data from 15 urban monitoring stations and city-specific health data (relative risk values and baseline incidence). For all cities, the annual PM2.5, PM10, and NO2 mean concentrations exceeded the 2021 World Health Organization Air Quality Guidelines in 2015–2020. In all cities, the annual PM2.5 (- 0.5% to - 6.1% year−1), PM10 (- 1.6 to - 8.1% year−1), and NO2 (- 1.3% to - 4.5% year−1) mean concentrations declined over time, while O3 levels rose (+1.0% to + 4.2% year−1). Exposure to ambient PM2.5, PM10, NO2, and O3 has substantially contributed to mortality in the six studied cities: a total of 6700 deaths for non-accidental causes, 2310 deaths for cardiovascular diseases, and 500 deaths for respiratory diseases were reported. Between 2015 and 2020, the number of annual PM2.5-, PM10-, and NO2-related premature deaths decreased (respectively, by - 8.4, - 6.7, and - 2.1 deaths per 106 inhabitants) in line with cleaner air. The rising O3 levels led to an increase in annual O3-related premature deaths (+1.3 deaths per 106 inhabitants) over time. A major concern is related to the overrun of exposure metrics compared to the target values for human health. To date, human health is mainly threatened by PM2.5 and O3, particularly in Southern Poland.

SENTIERI Project: air pollution and health impact of population living in industrial areas in Italy

to estimate the impact of PM2.5 and PM10 in the Italian industrial areas included in the SENTIERI project characterized by industrial plants with combustion processes deriving from point emissions. using satellite data, the Population Weighted Exposure (PWE) to PM2.5 and PM10 for 2011 and 2015 was estimated. The concentration-response functions available were used to estimate the number of premature deaths attributable to exposure to industrial emissions. The counterfactual levels recommended by the new WHO Air Quality Guidelines were used. for the selection of industrial plants, the European database on emissions of the European Pollutant Release and Transfer Register was used. Residents in areas of 1 km x 1 km and 4 km x 4 km around the selected industrial plants were considered. the number of premature deaths from non-accidental causes, cardiovascular and respiratory diseases, and lung cancer was estimated. residents were exposed to PM2.5 values of 17.3 µg/m3 (Northern Italy: 23.3) and to 24.3 µg/m3 (Northern Italy: 30.3) of PM10. PWE for both pollutants tends to increase as the size of the area under study is reduced and it is generally higher everywhere in 2011 than in 2015, with values that are always higher than the average (overall) in the Norther Italy. In 2011, 1,709 (IC95% 1,309-1,903) and 1,611 (IC95% 1,225-2,353) non accidental premature deaths were estimated attributable to PM2.5 and PM10, respectively, in residents close to the industrial plants (1 km x 1 km). Deaths attributable to exposure to PM2.5 and PM10 tend to follow a North-Central-South&Islands gradient for all observed causes and for both years of analysis. although exposure assessment of the population by using random-forest model does not allow to disentangle the contribution of the industrial component, the results of the study are suggestive of an impact on health from PM exposure in the industrial areas considered, with a greater impact in the vicinity of the plants, recommending the implementation of urgent impact reduction actions.

BIGEPI project: environmental and health data

the BIGEPI project, co-funded by INAIL, has used big data to identify the health risks associated with short and long-term exposure to air pollution, extreme temperatures and occupational exposures. the project consists of 5 specific work packages (WP) aimed at assessing: 1. the acute effects of environmental exposures over the national territory; 2. the acute effects of environmental exposures in contaminated areas, such as Sites of National Interest (SIN) and industrial sites; 3. the chronic effects of environmental exposures in 6 Italian longitudinal metropolitan studies; 4. the acute and chronic effects of environmental exposures in 7 epidemiological surveys on population samples; 5. the chronic effects of occupational exposures in the longitudinal metropolitan studies of Rome and Turin. BIGEPI analyzed environmental and health data at different levels of detail: the whole Italian population (WP1); populations living in areas contaminated by pollutants of industrial origin (WP2); the entire longitudinal cohorts of the metropolitan areas of Bologna, Brindisi, Rome, Syracuse, Taranto and Turin (WP3 and WP5); population samples participating in the epidemiological surveys of Ancona, Palermo, Pavia, Pisa, Sassari, Turin and Verona (WP4). environmental exposure: PM10, PM2,5, NO2 and O3 concentrations and air temperature at 1 Km2 resolution at national level. Occupational exposures: employment history of subjects working in at least one of 25 sectors with similar occupational exposures to chemicals/carcinogens; self-reported exposure to dust/fumes/gas in the workplace. Health data: cause-specific mortality/hospitalisation; symptoms/diagnosis of respiratory/allergic diseases; respiratory function and bronchial inflammation. BIGEPI analyzed data at the level of the entire Italian population, data on 2.8 million adults (>=30 yrs) in longitudinal metropolitan studies and on about 14,500 individuals (>=18 yrs) in epidemiological surveys on population samples. The population investigated in the longitudinal metropolitan studies had an average age of approximately 55 years and that of the epidemiological surveys was about 48 years; in both cases, 53% of the population was female. As regards environmental exposure, in the period 2013-2015, at national level average values for PM10, PM2.5, NO2 and summer O3 were: 21.1±13.6, 15.1±10.9, 14.7±9.1 and 80.3±17.3 µg/m3, for the temperature the average value was 13.9±7.2 °C. Data were analyzed for a total of 1,769,660 deaths from non-accidental causes as well as 74,392 incident cases of acute coronary event and 45,513 of stroke. Epidemiological investigations showed a high prevalence of symptoms/diagnoses of rhinitis (range: 14.2-40.5%), COPD (range: 4.7-19.3%) and asthma (range: 3.2-13.2%). The availability of these large datasets has made it possible to implement advanced statistical models for estimating the health effects of short- and long-term exposures to pollutants. The details are reported in the BIGEPI papers already published in other international journals and in those published in this volume of E&P. BIGEPI has confirmed the great potential of using big data in studies of the health effects of environmental and occupational factors, stimulating new directions of scientific research and confirming the need for preventive action on air quality and climate change for the health of the general population and the workers.

Impacts of urbanization on air quality and the related health risks in a city with complex terrain

Abstract. Urbanization affects air pollutants via urban expansion and emission growth, thereby inevitably changing the health risks involved with air pollutants. However, the health risks related to urbanization are rarely estimated, especially for cities with complex terrain. In this study, a highly urbanized city with severe air pollution and complex terrain (Chengdu) is selected to explore this issue. The effects of urban expansion are further compared with emission growth because air quality management is usually achieved by regulating anthropogenic emissions. Air pollution in Chengdu was mainly caused by PM2.5 and O3 from 2015 to 2021. PM2.5 pollution tended to appear in cold months (November to February) owing to the blocking of air and the stable atmospheric layer, whereas O3 pollution was likely to occur in warm months (April to August) that experience high-temperature and strong-sunlight conditions and are dominated by high-pressure systems. From 2015 to 2021, the 7-year annual average of premature mortality from all non-accidental causes (ANACs) due to PM2.5 and O3 was 9386 (95 % confidence interval (CI) of 6542–11 726) and 8506 (95 % CI of 4817–11 882), respectively. Based on the characteristics of PM2.5 and O3, six numerical experiments were conducted to investigate the impacts of urban expansion and emission growth on the health risks related to air pollutants. The results show that urban land use led to an increase in the air temperature and boundary layer height compared with cropland, which was conducive to the diffusion of PM2.5. Thus, the monthly average surface PM2.5 concentrations decreased by 10.8 µg m−3 (7.6 %) in January. However, the monthly average daily maximum 8 h average (MDA8) O3 concentrations increased by 10.6 µg m−3 (6.0 %) in July owing to the stronger photochemical production and better vertical mixing during daytime. In this case, premature mortality from ANACs due to PM2.5 decreased by 171 (95 % CI of 129–200, or about 6.9 %) in January, and that due to O3 increased by 203 (95 % CI of 122–268, or about 9.5 %) in July. As for the effects of emission growth, the monthly average PM2.5 and MDA8 O3 concentrations increased by 23.9 (16.8 %) and 4.8 µg m−3 (2.7 %), respectively, when anthropogenic emissions were taken into account. Premature mortality from ANACs due to PM2.5 and O3 then increased by 388 (95 % CI of 291–456, or about 15.7 %) and 87 (95 % CI of 54–112, or about 4.1 %), respectively. From a health risk perspective, the effects of urban land use on the health risks related to PM2.5 are about half that of anthropogenic emissions, whereas the effects of urban land use on the health risks related to O3 can be 2 times that of anthropogenic emissions. This emphasizes that, in addition to regulating anthropogenic emissions, urban planning is also important for urban air quality, especially for secondary pollutants like O3.