Physical activity, long-term fine particulate matter exposure and type 2 diabetes incidence: A prospective cohort study.

Background: Despite the adverse effects of ambient fine particulate matter (PM2.5) on type 2 diabetes and the beneficial role of physical activity (PA), the influence of PM2.5 on the relationship between PA and type 2 diabetes remains unclear. Methods: In this prospective study with 71,689 participants, PA was assessed by a questionnaire and was categorized into quartiles for volume and three groups for intensity. Long-term PM2.5 exposure was calculated using 1-km resolution satellite-based PM2.5 estimates. PM2.5 exposure and PA's effect on type 2 diabetes were assessed by cohort-stratified Cox proportional hazards models, individually and in combination. Results: In 488,166 person-years of follow-up, 5487 incident type 2 diabetes cases were observed. The association between PA and type 2 diabetes was modified by PM2.5. Compared with the lowest quartile of PA volume, the highest quartile was associated with reduced type 2 diabetes risk in low PM2.5 stratification (≤65.02 µg/m3) other than in high PM2.5 stratification (>65.02 µg/m3), with the hazard ratio (HR) of 0.75 (95% confidence interval [CI]: 0.66-0.85) and 1.10 (95% CI: 0.99-1.22), respectively. Similar results were observed for PA intensity. High PM2.5 exposure combined with the highest PA levels increased the risk of type 2 diabetes the most (HR = 1.79, 95% CI: 1.59-2.01 for PA volume; HR = 1.82, 95% CI: 1.64-2.02 for PA intensity). Conclusion: PA could reduce type 2 diabetes risk in low-pollution areas, but high PM2.5 exposure may weaken or even reverse the protective effects of PA. Safety and health benefits of PA should be thoroughly assessed for long-term polluted residents.

Dietary intake changes the associations between long-term exposure to fine particulate matter and the surrogate indicators of insulin resistance.

The relationship of fine particulate matter (PM2.5) exposure and insulin resistance remains inclusive. Our study aimed to investigate this association in the project of Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR). Specifically, we examined the associations between long-term PM2.5 exposure and three surrogate indicators of insulin resistance: the triglyceride-glucose index (TyG), TyG with waist circumference (TyG-WC) and metabolic score for insulin resistance (METS-IR). Additionally, we explored potential effect modification of dietary intake and components. Generalized estimating equations were used to evaluate the associations between PM2.5 and the indicators with an unbalanced repeated measurement design. Our analysis incorporated a total of 162,060 observations from 99,329 participants. Each 10 µg/m3 increment of PM2.5 was associated with an increase of 0.22 % [95 % confidence interval (CI): 0.20 %, 0.25 %], 1.60 % (95 % CI: 1.53 %, 1.67 %), and 2.05 % (95 % CI: 1.96 %, 2.14 %) in TyG, TyG-WC, and METS-IR, respectively. These associations were attenuated among participants with a healthy diet, particularly those with sufficient intake of fruit and vegetable, fish or tea (pinteraction < 0.0028). For instance, among participants with a healthy diet, TyG increased by 0.11 % (95 % CI: 0.08 %, 0.15 %) per 10 µg/m3 PM2.5 increment, significantly lower than the association observed in those with an unhealthy diet. The findings of this study emphasize the potential of a healthy diet to mitigate these associations, highlighting the urgency for improving air quality and implementing dietary interventions among susceptible populations in China.

Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen, China.

BACKGROUND: The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease (CHD) is insufficient. We aimed to assess the association and population-attributable fractions (PAFs) between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen, China. METHODS: We conducted a retrospective cohort study of older Chinese patients (aged ≥ 65 years) who were diagnosed with CHD. Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease (CVD) mortality. We also calculated the PAFs. RESULTS: The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1, 2016, and August 31, 2022. Among them, 70,217 (91.9%) had multimorbidity, defined as the presence of at least one of the predefined 14 chronic conditions. Those with cancer, hemorrhagic stroke and chronic liver disease had the worst overall death risk, with adjusted HRs (95% CIs) of 4.05 (3.77, 4.38), 2.22 (1.94, 2.53), and 1.85 (1.63, 2.11), respectively. For CVD mortality, the highest risk was observed for hemorrhagic stroke, ischemic stroke, and chronic kidney disease; the corresponding adjusted HRs (95% CIs) were 3.24 (2.77, 3.79), 1.91 (1.79, 2.04), and 1.81 (1.64, 1.99), respectively. All-cause mortality was mostly attributable to cancer, heart failure and ischemic stroke, with PAFs of 11.8, 10.2, and 9.1, respectively. As for CVD mortality, the leading PAFs were heart failure, ischemic stroke and diabetes; the corresponding PAFs were 18.0, 15.7, and 6.1, respectively. CONCLUSIONS: Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen, China. Cancer, heart failure, ischemic stroke and diabetes are the primary contributors to PAFs. Therefore, prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.

Applications of digital health approaches for cardiometabolic diseases prevention and management in the Western Pacific region.

Cardiometabolic diseases (CMDs) are the major types of non-communicable diseases, contributing to huge disease burdens in the Western Pacific region (WPR). The use of digital health (dHealth) technologies, such as wearable gadgets, mobile apps, and artificial intelligence (AI), facilitates interventions for CMDs prevention and treatment. Currently, most studies on dHealth and CMDs in WPR were conducted in a few high- and middle-income countries like Australia, China, Japan, the Republic of Korea, and New Zealand. Evidence indicated that dHealth services promoted early prevention by behavior interventions, and AI-based innovation brought automated diagnosis and clinical decision-support. dHealth brought facilitators for the doctor-patient interplay in the effectiveness, experience, and communication skills during healthcare services, with rapidly development during the pandemic of coronavirus disease 2019. In the future, the improvement of dHealth services in WPR needs to gain more policy support, enhance technology innovation and privacy protection, and perform cost-effectiveness research.

Outdoor fine particulate matter exposure and telomere length in humans: A systematic review and meta-analysis.

Although the association between changes in human telomere length (TL) and ambient fine particulate matter (PM2.5) has been documented, there remains disagreement among the related literature. Our study conducted a systematic review and meta-analysis of epidemiological studies to investigate the health effects of outdoor PM2.5 exposure on human TL after a thorough database search. To quantify the overall effect estimates of TL changes associated with every 10 µg/m3 increase in PM2.5 exposure, we focused on two main topics, which were outdoor long-term exposure and prenatal exposure of PM2.5. Additionally, we included a summary of short-term PM2.5 exposure and its impact on TL due to limited data availability. Our qualitative analysis included 20 studies with 483,600 participants. The meta-analysis showed a statistically significant association between outdoor PM2.5 exposure and shorter human TL, with pooled impact estimates (ß) of -0.12 (95% CI: -0.20, -0.03, I2= 95.4%) for general long-term exposure and -0.07 (95% CI: -0.15, 0.00, I2= 74.3%) for prenatal exposure. In conclusion, our findings suggest that outdoor PM2.5 exposure may contribute to TL shortening, and noteworthy associations were observed in specific subgroups, suggesting the impact of various research variables. Larger, high-quality studies using standardized methodologies are necessary to strengthen these conclusions further.

Fine Particulate Matter Exposure, Genetic Susceptibility, and the Risk of Incident Stroke: A Prospective Cohort Study.

BACKGROUND: Both genetic factors and environmental air pollution contribute to the risk of stroke. However, it is unknown whether the association between air pollution and stroke risk is influenced by the genetic susceptibilities of stroke and its risk factors. METHODS: This prospective cohort study included 40 827 Chinese adults without stroke history. Satellite-based monthly fine particulate matter (PM2.5) estimation at 1-km resolution was used for exposure assessment. Based on 534 identified genetic variants from genome-wide association studies in East Asians, we constructed 6 polygenic risk scores for stroke and its risk factors, including atrial fibrillation, blood pressure, type 2 diabetes, body mass index, and triglyceride. The Cox proportional hazards model was applied to evaluate the hazard ratios and 95% CIs for the associations of PM2.5 and polygenic risk score with incident stroke and the potential effect modifications. RESULTS: Over a median follow-up of 12.06 years, 3147 incident stroke cases were documented. Compared with the lowest quartile of PM2.5 exposure, the hazard ratio (95% CI) for stroke in the highest quartile group was 2.72 (2.42-3.06). Among individuals at high genetic risk, the relative risk of stroke was 57% (1.57; 1.40-1.76) higher than those at low genetic risk. Although no statistically significant interaction was found, participants with both the highest PM2.5 and high genetic risk showed the highest risk of stroke, with ≈4× that of the lowest PM2.5 and low genetic risk group (hazard ratio, 3.55 [95% CI, 2.84-4.44]). Similar upward gradients were observed in the risk of stroke when assessing the joint effects of PM2.5 and genetic risks of blood pressure, type 2 diabetes, body mass index, atrial fibrillation, and triglyceride. CONCLUSIONS: Long-term exposure to PM2.5 was associated with a higher risk of incident stroke across different genetic susceptibilities. Our findings highlighted the great importance of comprehensive assessment of air pollution and genetic risk in the prevention of stroke.

Urinary Albumin-to-Creatinine Ratio in Normal Range, Cardiovascular Health, and All-Cause Mortality.

Importance: Although cumulative evidence suggests that elevated urinary albumin-to-creatinine ratio (UACR) in the normal range (<30 mg/g) may be associated with an increased risk of mortality, few studies have investigated whether cardiovascular health (CVH) modifies the harmful outcomes of high-normal UACR. Objective: To investigate associations of traditionally normal UACR and CVH with all-cause mortality. Design, Setting, and Participants: This cohort study used National Health and Nutrition Examination Survey data from 2005 through 2018 and linked mortality information until 2019. Data were analyzed from March 1 through October 31, 2023. The study included adult participants aged 20 to 79 years with a normal UACR (<30 mg/g) based on Kidney Disease: Improving Global Outcomes criteria. Exposures: The UACR was treated as a continuous variable and categorized into tertiles delineated as low (<4.67 mg/g), medium (4.67-7.67 mg/g), and high (7.68 to <30 mg/g). Cardiovascular health was assessed using Life's Essential 8 scores and grouped as poor (0-49 points), moderate (50-79 points), and ideal (80-100 points). Main Outcomes and Measures: Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for associations of UACR with all-cause mortality in total participants and as stratified by CVH groups. Results: The study included 23 697 participants (mean [SD] age, 45.58 [15.44] years; 11 806 women [49.7%] and 11 891 men [50.3%]). During the median 7.8 years (range, 4.5-11.1 years) of follow-up, 1403 deaths were recorded. Near-linear associations were observed for continuous UACR and CVH with all-cause mortality. Compared with the low UACR group, high UACR in the normal range showed an increased mortality risk in the moderate and poor CVH groups (CVH [50-79]: HR, 1.54 [95% CI, 1.26-1.89]; CVH [0-49]: HR, 1.56 [95% CI, 1.10-2.20]), with a significant multiplicative interaction of UACR and CVH (P < .001). Conclusions and Relevance: The findings suggest that high UACR within the normal range is associated with a significantly increased risk of all-cause mortality, with the association more pronounced in adults with poor CVH status. These findings highlight the importance of risk management for early kidney dysfunction, particularly among individuals with poor CVH.

Impact of some antiviral drugs on health care utilization for patients with COVID-19: a systematic review and meta-analysis.

BACKGROUND: We aimed to assess the impact of antiviral drugs (fluvoxamine,remdesivir, lopinavir/ritonavir (LPV/r), molnupiravir, andnirmatrelvir/ritonavir (NRV/r)) on health care utilization (HCU) inCOVID-19 patients. We summarized findings from randomized controlledtrials (RCTs) and observational studies. METHODS: We systematically searched four medical databases (PubMed, Web of Science, Embase, Cochrane Library) for COVID-19 studies up to February 15, 2023. A comprehensive review, meta-analysis, sensitivity analysis, and subgroup analysis were conducted. Pooled effects with 95% confidence intervals (CIs) were calculated for antiviral drugs' impact on hospitalization, mechanical ventilation (MV), and intensive care unit (ICU) outcomes. RESULTS: Our analysis included 34 studies (584,978 patients). Meta-analysisindicated potential benefits: remdesivir and molnupiravir potentiallyreduced MV risk, and NRV/r correlated with lower hospitalizationrates. However, LPV/r did not notably curb HCU. Remdesivir waspreferable for high-risk COVID-19 patients, while molnupiravir andNRV/r were recommended for those aged 60 and above. CONCLUSION: Remdesivir, molnupiravir, and NRV/r may reduce HCU during the COVID-19 pandemic. However, due to limited study details and significant heterogeneity in effect estimates, further precise evidence is crucial, especially concerning emerging variants.

Shift work and risk of incident gastroesophageal reflux disease: the association and mediation.

Introduction: Shift work has become an increasingly common work mode globally. This study aimed to investigate the association between shift work and the risk of incident gastroesophageal reflux disease (GORD), an upward gastrointestinal disorder disease worldwide, and to explore the mediating factors. Method: A total of 262,722 participants from the UK Biobank free of GORD and related gastrointestinal diseases were included to investigate the association and potential mediators between shift work and incident GORD. Multivariate-adjusted Cox models were used to evaluate the association between shift work status and GORD incidence. Results: Compared to non-shift workers, shift workers had a 1.10-fold greater risk of incident GORD [95% confidence intervals (CIs): 1.03, 1.18], after adjusting for a range of potential confounders. However, the excess risk of GORD attenuated to the null after further adjusting for selected mediators. Specifically, the association was mediated by sleep patterns (25.7%), healthy behaviors (16.8%), depressive symptoms (20.2%), chronic conditions (13.3%), and biological factors (17.6%). After adjustment for all the mediators together, the association was attenuated by 71.5%. Discussion: Our findings indicated that long-term shift workers may have a higher risk of incident GORD, yet the excess risk may be explained by poor sleep quality, unhealthy behaviors, depressive symptoms, etc. This has positive implications for protecting the health of shift workers.

Association of Long-Term Exposure to Ambient Fine Particulate Matter with Atherosclerotic Cardiovascular Disease Incidence Varies across Populations with Different Predicted Risks: The China-PAR Project.

Previous studies have established a significant link between ambient fine particulate matter (PM2.5) exposure and atherosclerotic cardiovascular disease (ASCVD) incidence, but whether this association varies across populations with different predicted ASCVD risks was uncertain previously. We included 109,374 Chinese adults without ASCVD at baseline from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project. We obtained PM2.5 data of participants' residential address from 2000 to 2015 using a satellite-based spatiotemporal model. Participants were classified into low-to-medium and high-risk groups according to the ASCVD 10-year and lifetime risk prediction scores. Hazard ratios (HRs) and 95% confidence intervals (CIs) for PM2.5 exposure-related incident ASCVD, as well as the multiplication and additive interaction, were calculated using stratified Cox proportional hazard models. The additive interaction between risk stratification and PM2.5 exposure was estimated by the synergy index (SI), the attributable proportion due to the interaction (API), and the relative excess risk due to interaction (RERI). Over the follow-up of 833,067 person-years, a total of 4230 incident ASCVD cases were identified. Each 10 µg/m3 increment of PM2.5 concentration was associated with 18% (HR: 1.18; 95% CI: 1.14-1.23) increased risk of ASCVD in the total population, and the association was more pronounced among individuals having a high predicted ASCVD risk than those having a low-to-medium risk, with the HR (95% CI) of 1.24 (1.19-1.30) and 1.11 (1.02-1.20) per 10 µg/m3 increment in PM2.5 concentration, respectively. The RERI, API, and SI were 1.22 (95% CI: 0.62-1.81), 0.22 (95% CI: 0.12-0.32), and 1.37 (95% CI: 1.16-1.63), respectively. Our findings demonstrate a significant synergistic effect on ASCVD between ASCVD risk stratification and PM2.5 exposure and highlight the potential health benefits of reducing PM2.5 exposure in Chinese, especially among those with high ASCVD risk.

The policy implemented by the government and the protection effect of PM2.5 decreasing on blood pressure in adolescents: From a quasi-experimental study.

Background: High particulate matter with an aerodynamic diameter of 2.5 µm or less (PM2.5) exposure levels posed a great risk to human health, but the protection effects of environmental protection on cardiovascular disease have not been systematically evaluated. This study aims to illustrate the effect of the decreased concentration of PM2.5 on blood pressure level in adolescents after enacting the protection measures of environment from a cohort study. Methods: A quasi-experimental study including 2415 children from the Chongqing Children's Health Cohort, aged 7.32 ± 0.60 years with normal blood pressure at baseline, with 53.94% males, were analysed. Both the generalised linear regression model (GLM) and Poisson regression model were used to calculate the impact of the declining exposure level of PM2.5 on blood pressure and the incidence of prehypertension and hypertension. Results: The annual mean PM2.5 concentration in 2014 and in 2019 were 65.01 ± 6.46 µgmes per cubic metre (µg / m3), 42.08 ± 2.04 µg / m3 respectively, and the decreased PM2.5 concentration between 2014 and 2019 was 22.92 ± 4.51 µg / m3. The effect of decreased PM2.5 concentration by 1µg / m3 on systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and the difference of blood pressure (BP) indexes between 2014 and 2019 were all significant (P < 0.001). The absolute differences of SBP (-3.598 mmHg; 95% confidence interval (CI) = -4.47,-2.72 mm Hg), DBP (-2.052 mmHg; 95% CI = -2.80,-1.31 mm Hg) and MAP (-2.568 mmHg; 95% CI = -3.27,-1.87 mm Hg) in the group with a decreased level of ≥25.56 µg / m3 were more significant than those in a decreased concentration of PM2.5 for <25.56 µg / m3 (P < 0.001). And the incidence of prehypertension and hypertension for three occasions blood pressure diagnose was 2.21% (95% CI = 1.37%-3.05%, P = 0.001) in children with PM2.5 decreased level ≤25.56 µg / m3 (50%), which was significant higher than its' counterparts 0.89% (95% CI = 0.37%-1.42%, P = 0.001). Conclusions: Our study found the etiological relationship between the declining PM2.5 concentration and the BP values and the incidence of prehypertension and hypertension in children and adolescents, suggesting continuous environmental protection measures in China have achieved remarkable health benefits.

Spatial Accessibility Evaluation and Location Optimization of Primary Healthcare in China: A Case Study of Shenzhen.

The unbalanced allocation of healthcare resources is a major challenge that hinders access to healthcare. Taking Shenzhen as an example, this study aimed to enhance equity in obtaining healthcare services, through measuring and visualizing the spatial accessibility of community healthcare centers (CHC), and optimizing CHC geospatial allocation. We used the number of health technicians per 10,000 to represent the CHC's service capacity, combined with resident points and census data to calculate the population the CHC needs to carry, and then analyzed the accessibility based on the Gaussian two-step floating catchment area method. In 2020, five regions in Shenzhen had better spatial accessibility scores: Nanshan (0.250), Luohu (0.246), Futian (0.244), Dapeng (0.226), and Yantian (0.196). The spatial accessibility of CHCs shows a gradual decrease from the city center to the edge, which is affected by economic and topographic factors. With the support of the maximal covering location problem model, we selected up to 567 candidate locations for the new CHC, which could improve Shenzhen's accessibility score from 0.189 to 0.361 and increase the coverage population by 63.46% within a 15-min impedance. By introducing spatial techniques and maps, this study provides (a) new evidence for promoting equitable access to primary healthcare services in Shenzhen and (b) a foundation for improving the accessibility of public service facilities in other areas.

Spatiotemporal and Seasonal Trends of Class A and B Notifiable Infectious Diseases in China: Retrospective Analysis.

BACKGROUND: China is the most populous country globally and has made significant achievements in the control of infectious diseases over the last decades. The 2003 SARS epidemic triggered the initiation of the China Information System for Disease Control and Prevention (CISDCP). Since then, numerous studies have investigated the epidemiological features and trends of individual infectious diseases in China; however, few considered the changing spatiotemporal trends and seasonality of these infectious diseases over time. OBJECTIVE: This study aims to systematically review the spatiotemporal trends and seasonal characteristics of class A and class B notifiable infectious diseases in China during 2005-2020. METHODS: We extracted the incidence and mortality data of 8 types (27 diseases) of notifiable infectious diseases from the CISDCP. We used the Mann-Kendall and Sen's methods to investigate the diseases' temporal trends, Moran I statistic for their geographical distribution, and circular distribution analysis for their seasonality. RESULTS: Between January 2005 and December 2020, 51,028,733 incident cases and 261,851 attributable deaths were recorded. Pertussis (P=.03), dengue fever (P=.01), brucellosis (P=.001), scarlet fever (P=.02), AIDS (P<.001), syphilis (P<.001), hepatitis C (P<.001) and hepatitis E (P=.04) exhibited significant upward trends. Furthermore, measles (P<.001), bacillary and amebic dysentery (P<.001), malaria (P=.04), dengue fever (P=.006), brucellosis (P=.03), and tuberculosis (P=.003) exhibited significant seasonal patterns. We observed marked disease burden-related geographic disparities and heterogeneities. Notably, high-risk areas for various infectious diseases have remained relatively unchanged since 2005. In particular, hemorrhagic fever and brucellosis were largely concentrated in Northeast China; neonatal tetanus, typhoid and paratyphoid, Japanese encephalitis, leptospirosis, and AIDS in Southwest China; BAD in North China; schistosomiasis in Central China; anthrax, tuberculosis, and hepatitis A in Northwest China; rabies in South China; and gonorrhea in East China. However, the geographical distribution of syphilis, scarlet fever, and hepatitis E drifted from coastal to inland provinces during 2005-2020. CONCLUSIONS: The overall infectious disease burden in China is declining; however, hepatitis C and E, bacterial infections, and sexually transmitted infections continue to multiply, many of which have spread from coastal to inland provinces.

Associations between Household Solid Fuel Use, Obesity, and Cardiometabolic Health in China: A Cohort Study from 2011 to 2018.

This study aims to explore the longitudinal relationship between solid fuel use and CMD incidence based on a nationally representative follow-up cohort study. A total of 6038 participants of the China Health and Retirement Longitudinal Study (CHARLS) were enrolled in the study. CMD is a cluster of diseases that include heart disease, stroke, and type 2 diabetes. Cox proportional-hazards regression models were used to examine the association between solid fuel use and the incidence or multimorbidity of CMD. The interactions between overweight or obesity and household air pollution on CMD incidence were also investigated. In the present study, solid fuel use from cooking or heating, separately or simultaneously, was positively associated with CMD incidence. Elevated solid fuel use was significantly associated with a higher risk of CMD incidence (HR = 1.25, 95% CI: 1.09, 1.43 for cooking; HR = 1.27, 95% CI: 1.11, 1.45 for heating). A statistically significant interaction between household solid fuel and OW/OB on the incidence of CMD and Cardiometabolic multimorbidity was also observed (p < 0.05). Our findings show that household solid fuel is a risk factor for the incidence of CMD. Therefore, reducing household solid fuel use and promoting clean energy may have great public health value for the prevention of CMD.

Impacts of heatwaves and cold spells on glaucoma in rural China: a national cross-sectional study.

China faces increasing health risks from climate change. The structure and function of the eye and vision were affected by extreme heat and cold. The study aimed to evaluate the impacts of heatwaves and cold spells on glaucoma. A national cross-sectional study of the Rural Epidemiology for Glaucoma (REG-China) was conducted in ten provinces of China, and 36,081 adults aged 40 years or more were included. Glaucoma signs were assessed via a standard examination. A total of 15 heatwave definitions, based on intensity (95th to 99th percentiles of temperature distribution) and duration (≥2 days, 3 days, and 4 days), were used to quantify heatwave effects, and 6 cold spell definitions were defined based on threshold temperature percentile (5th and 10th) and duration (3 days, 5 days, and 9 days). Multivariable-adjusted logistic regression models paired with interaction analysis were performed to investigate the impacts of heatwaves and cold spells on glaucoma, and the dose-response relationships were assessed using a restricted cubic spline (RCS) model. Subgroup analysis was conducted stratified by gender, age, smoking status, occupation, and family history of glaucoma. The overall prevalence of glaucoma was 2.1% (95% CI 1.94-2.25%). Higher heatwaves were significantly correlated with higher OR of glaucoma, with the OR (95% CI) ranging from 1.014 (1.009, 1.018) to 1.090 (1.065, 1.115) by different definitions. Glaucoma was affected by heatwaves more strongly than by cold spells. The effects of both heatwaves and cold spells were higher in males than females and in smokers than nonsmokers. These results of the present study evoked the attention of prospective research to elucidate the relationship between extreme temperatures and eye diseases.

Life's Essential 8 and 10-Year and Lifetime Risk of Atherosclerotic Cardiovascular Disease in China.

INTRODUCTION: Cardiovascular health level according to the American Heart Association's Life's Essential 8 (LE8) in China and its effectiveness on the 10-year and lifetime risk of atherosclerotic cardiovascular diseases is unclear. METHODS: This prospective study included 88,665 participants in the China-PAR cohort (data from 1998 to 2020) and 88,995 in the Kailuan cohort (data from 2006 to 2019). Analyses were conducted by November 2022. LE8 was measured according to the American Heart Association's LE8 algorithm, and a high cardiovascular health status was defined as a LE8 score ≥80 points. Participants were followed for the primary composite outcomes, including fatal and nonfatal acute myocardial infarction, ischemic stroke, and hemorrhagic stroke. The lifetime risk was estimated from the cumulative risk of atherosclerotic cardiovascular diseases through ages 20-85 years, the association of LE8 and LE8 change with atherosclerotic cardiovascular diseases was assessed with the Cox proportional-hazards model, and partial population-attributable risks evaluated the proportion of atherosclerotic cardiovascular diseases that could be averted. RESULTS: The mean LE8 score was 70.0 in the China-PAR cohort and 64.6 in the Kailuan cohort, with 23.3% and 8.0% of participants having a high cardiovascular health status, respectively. Participants in the highest quintile had about 60% lower 10-year and lifetime risk of atherosclerotic cardiovascular diseases in the China-PAR and Kailuan cohorts than participants with the lowest quintile LE8 score. If everyone maintained the highest quintile of LE8 score, approximately half of the atherosclerotic cardiovascular diseases could be prevented. The participant with LE8 score that increased from the lowest to the highest tertile during 2006-2012 had a 44% (hazard ratio=0.56; 95% CI=0.45, 0.69) lower observed risk and a 43% (hazard ratio=0.57; 95% CI=0.46, 0.70) lower lifetime risk of atherosclerotic cardiovascular diseases than those remaining in the lowest tertile in the Kailuan cohort. CONCLUSIONS: The LE8 score was below optimal levels in Chinese adults. A high baseline LE8 score and an improving LE8 score were associated with decreased 10-year and lifetime risk of atherosclerotic cardiovascular diseases.

Maternal Exposure to PM2.5 and the Risk of Congenital Heart Defects in 1.4 Million Births: A Nationwide Surveillance-Based Study.

BACKGROUND: Evidence remains limited about the association of maternal exposure to ambient fine particulate matter (airborne particles with an aerodynamic diameter ≤2.5 µm [PM2.5]) with fetal congenital heart defects (CHDs) in highly polluted regions, and few studies have focused on preconception exposure. METHODS: Using a nationwide surveillance-based case-control design in China, we examined the association between maternal exposure to PM2.5 during periconception (defined as 3 months before conception until 3 months into pregnancy) and risk of CHD in offspring. The study included 1 434 998 births involving 7335 CHDs from 2014 through 2017 on the basis of the National Population-Based Birth Defects Surveillance System, covering 30 provinces, municipalities, or municipal districts in China. We assigned maternal PM2.5 exposure during the periconception period to each participant using satellite-based PM2.5 concentrations at 1-km spatial resolution. Multilevel logistic regression models were used to calculate the multivariable-adjusted odds ratio and 95% CI for CHDs in offspring associated with maternal PM2.5 exposure, and the exposure-response association was investigated using restricted cubic spline analysis. Subgroup or sensitivity analyses were conducted to identify factors that may modify the association. RESULTS: The average maternal exposure to PM2.5 levels across all participants was 56.51 µg/m3 (range, 10.95 to 182.13 µg/m3). For each 10 µg/m³ increase in maternal PM2.5 exposure, the risk of CHDs in offspring was increased by 2% (odds ratio, 1.02 [95% CI, 1.00 to 1.05]), and septal defect was the most influenced subtype (odds ratio, 1.04 [95% CI, 1.01 to 1.08]). The effect of PM2.5 on CHD risk was more pronounced during the preconception period. Mothers <35 years of age, those living in northern China, and those living in low-income areas were more susceptible to PM2.5 exposure than their counterparts (all P<0.05). PM2.5 exposure showed a linear association with total CHDs or specific CHD types. CONCLUSIONS: High maternal PM2.5 exposure, especially during the preconception period, increases risk of certain types of CHD in offspring. These findings are useful for CHD prevention and highlight the public health benefits of improving air quality in China and other highly polluted regions.

Joint effects of meteorological factors and PM2.5 on age-related macular degeneration: a national cross-sectional study in China.

BACKGROUND: Weather conditions are a possible contributing factor to age-related macular degeneration (AMD), a leading cause of irreversible loss of vision. The present study evaluated the joint effects of meteorological factors and fine particulate matter (PM2.5) on AMD. METHODS: Data was extracted from a national cross-sectional survey conducted across 10 provinces in rural China. A total of 36,081 participants aged 40 and older were recruited. AMD was diagnosed clinically by slit-lamp ophthalmoscopy, fundus photography, and spectral domain optical coherence tomography (OCT). Meteorological data were calculated by European Centre for Medium-Range Weather Forecasts (ECMWF) reanalysis and were matched to participants' home addresses by latitude and longitude. Participants' individual PM2.5 exposure concentrations were calculated by a satellite-based model at a 1-km resolution level. Multivariable-adjusted logistic regression models paired with interaction analysis were performed to investigate the joint effects of meteorological factors and PM2.5 on AMD. RESULTS: The prevalence of AMD in the study population was 2.6% (95% CI 2.42-2.76%). The average annual PM2.5 level during the study period was 63.1 ± 15.3 µg/m3. A significant positive association was detected between AMD and PM2.5 level, temperature (T), and relative humidity (RH), in both the independent and the combined effect models. For PM2.5, compared with the lowest quartile, the odds ratios (ORs) with 95% confidence intervals (CIs) across increasing quartiles were 0.828 (0.674,1.018), 1.105 (0.799,1.528), and 2.602 (1.516,4.468). Positive associations were observed between AMD and temperature, with ORs (95% CI) of 1.625 (1.059,2.494), 1.619 (1.026,2.553), and 3.276 (1.841,5.830), across increasing quartiles. In the interaction analysis, the estimated relative excess risk due to interaction (RERI) and the attributable proportion (AP) for combined atmospheric pressure and PM2.5 was 0.864 (0.586,1.141) and 1.180 (0.768,1.592), respectively, indicating a synergistic effect between PM2.5 and atmospheric pressure. CONCLUSIONS: This study is among the first to characterize the coordinated effects of meteorological factors and PM2.5 on AMD. The findings warrant further investigation to elucidate the relationship between ambient environment and AMD.

A satellite-driven model to estimate long-term particulate sulfate levels and attributable mortality burden in China.

Ambient fine particulate matter (PM2.5) pollution is a major environmental and public health challenge in China. In the recent decade, the PM2.5 level has decreased mainly driven by reductions in particulate sulfate as a result of large-scale desulfurization efforts in coal-fired power plants and industrial facilities. Emerging evidence also points to the differential toxicity of particulate sulfate affecting human health. However, estimating the long-term spatiotemporal trend of sulfate is difficult because a ground monitoring network of PM2.5 constituents has not been established in China. Spaceborne sensors such as the Multi-angle Imaging SpectroRadiometer (MISR) instrument can provide complementary information on aerosol size and type. With the help of state-of-the-art machine learning techniques, we developed a sulfate prediction model under support from available ground measurements, MISR-retrieved aerosol microphysical properties, and atmospheric reanalysis data at a spatial resolution of 0.1°. Our sulfate model performed well with an out-of-bag cross-validationR2 of 0.68 at the daily level and 0.93 at the monthly level. We found that the national mean population-weighted sulfate concentration was relatively stable before the Air Pollution Prevention and Control Action Plan was enforced in 2013, ranging from 10.4 to 11.5 µg m-3. But the sulfate level dramatically decreased to 7.7 µg m-3 in 2018, with a change rate of -28.7 % from 2013 to 2018. Correspondingly, the annual mean total non-accidental and cardiopulmonary deaths attributed to sulfate decreased by 40.7 % and 42.3 %, respectively. The long-term, full-coverage sulfate level estimates will support future studies on evaluating air quality policies and understanding the adverse health effect of particulate sulfate.

Air pollution exposure and vascular endothelial function: a systematic review and meta-analysis.

Vascular endothelial dysfunction is an early stage to cardiovascular diseases (CVDs), but whether air pollution exposure has an effect on it remains unknown. We conducted a systematic review and meta-analysis to summarize epidemiological evidence between air pollution and endothelial dysfunction. We searched the database of PubMed, EMBASE, the Cochrane Library, and Web of Science up to November 10, 2022. Fixed and random effect models were used to pool the effect change or percent change (% change) and 95% confidence interval (95% CI) of vascular function associated with particulate matter (PM) and gaseous pollutants. I2 statistics, funnel plot, and Egger's test were used to evaluate heterogeneity and publication bias. There were 34 articles included in systematic review, and 25 studies included in meta-analysis. For each 10 µg/m3 increment in short-term PM2.5 exposure, augmentation index (AIx) and pulse wave velocity (PWV) increased by 2.73% (95% CI: 1.89%, 3.57%) and 0.56% (95% CI: 0.22%, 0.89%), and flow-mediated dilation (FMD) decreased by 0.17% (95% CI: - 0.33%, - 0.00%). For each 10 µg/m3 increment in long-term PM2.5 exposure, FMD decreased by 0.99% (95% CI: - 1.41%, - 0.57%). The associations between remaining pollutants and outcomes were not statistically significant. The effect of short-term PM2.5 exposure on FMD change was stronger in population with younger age, lower female proportion, higher mean body mass index and higher PM2.5 exposure. Cardiac or vasoactive medication might attenuate this effect. Our study provides evidence that PM2.5 exposure had adverse impact on vascular endothelial function, indicating the importance of air quality improvement for early CVD prevention.