Association between Ambient Volatile Organic Compounds Exposome and Emergency Hospital Admissions for Cardiovascular Disease.

The limited research on volatile organic compounds (VOCs) has not taken into account the interactions between constituents. We used the weighted quantile sum (WQS) model and generalized linear model (GLM) to quantify the joint effects of ambient VOCs exposome and identify the substances that play key roles. For a 0 day lag, a quartile increase of WQS index for n-alkanes, iso/anti-alkanes, aromatic, halogenated aromatic hydrocarbons, halogenated saturated chain hydrocarbons, and halogenated unsaturated chain hydrocarbons were associated with 1.09% (95% CI: 0.13, 2.06%), 0.98% (95% CI: 0.22, 1.74%), 0.92% (95% CI: 0.14, 1.69%), 1.03% (95% CI: 0.14, 1.93%), 1.69% (95% CI: 0.48, 2.91%), and 1.85% (95% CI: 0.93, 2.79%) increase in cardiovascular disease (CVD) emergency hospital admissions, respectively. Independent effects of key substances on CVD-related emergency hospital admissions were also reported. In particular, an interquartile range increase in 1,1,1-trichloroethane, methylene chloride, styrene, and methylcyclohexane is associated with a greater risk of CVD-associated emergency hospital admissions [3.30% (95% CI: 1.93, 4.69%), 3.84% (95% CI: 1.21, 6.53%), 5.62% (95% CI: 1.35, 10.06%), 8.68% (95% CI: 3.74, 13.86%), respectively]. We found that even if ambient VOCs are present at a considerably low concentration, they can cause cardiovascular damage. This should prompt governments to establish and improve concentration standards for VOCs and their sources. At the same time, policies should be introduced to limit VOCs emission to protect public health.

Chronic maternal hepatitis B virus infection and pregnancy outcome- a single center study in Kunming, China.

BACKGROUND: Chinese population has a high prevalence of chronic hepatitis B virus (HBV) infection, the impact of which on pregnancy outcome remains controversial. A single-center retrospective cohort study was performed in Kunming, a multi-ethnic city in south-western China to examine this issue. METHODS: The singleton pregnancies delivering at ≥28 weeks gestation under our care in 2005-2017 constituted the study cohort. Maternal characteristics and pregnancy outcome were compared between mothers with and without seropositivity for hepatitis B surface antigen (HBsAg) determined at routine antenatal screening. RESULTS: Among the 49,479 gravidae in the cohort, the 1624 (3.3%) HBsAg seropositive gravidae had a lower incidence of nulliparity (RR 0.963, 95% CI 0.935-0.992) and having received tertiary education (RR 0.829, 95% CI 0.784-0.827). There was no significant difference in the medical history, pregnancy complications, or labor or perinatal outcome, except that HBV carriers had significantly lower incidence of labor induction (RR 0.827, 95% CI 0.714-0.958) and of small-for-gestational age (SGA) infants (RR 0.854, 95% CI 0.734-0.994). On regression analysis, maternal HBV carriage was independently associated with spontaneous labor (aRR 1.231, 95% CI 1.044-1.451) and reduced SGA infants (aRR 0.842, 95% CI 0.712-0.997). CONCLUSIONS: Our 3.3% prevalence of maternal HBV infection was around the lower range determined in the Chinese population. The association with spontaneous labor and reduced SGA infants could have helped to promote the perpetuation of the infection through enhanced survival of the offspring infected at birth, thus explaining the high prevalence in the Chinese population.

Impact of childbirth policy changes on obstetric workload over a 13-year period in a regional referral center in China - implications on service provision planning.

BACKGROUND: We aimed to appraise the impact of the changing national childbirth policy since 2002, currently allowing two children per family, on obstetric workload in a regional referral center in China. METHODS: In a retrospective cohort study, temporal changes were examined in relation with maternal demographics, incidence of women with high risk pregnancies and resource statistics in our hospital in managing singleton viable pregnancies (birth from 28 weeks gestational age onwards) for the period 2005-2017. RESULTS: During this 13-year period, the number of singleton livebirths from 28 weeks gestational age onwards was 49,479. Annual numbers of births increased from 1,941 to 2005 to 5,777 in 2017. There were concomitant and significant increases in the incidence of multiparous women (10.6-50.8 %), of age ≥35 years (6.5-24.3 %), with prior caesarean Sec. (2.6-23.6 %), with ≥3 previous pregnancy terminations (1.0-4.9 %), with pre-gestational diabetes (0.2-0.9 %), and with chronic hypertension (0.2-1.2 %). There were associated increases in beds and staff complement and reduced average hospital stay. Nevertheless, while the workload of medical staff remained stable with increasing staff complement, that of midwives increased significantly as reflected by the total births: midwife ratio which increased from 194.1:1 to 320.9:1 (p < 0.001). CONCLUSIONS: In our hospital, progressively increasing numbers of annual births in combination with an increased incidence of women with high risk pregnancies took place following the revised national childbirth policy. Only the increase in medical and nursing, but not midwifery, staff was commensurate with workload. Remedial measures are urgently required before the anticipated progressive increase in care demand would overwhelm maternity care with potentially disastrous consequences.

Prospective evaluation of screening performance of first-trimester prediction models for preterm preeclampsia in an Asian population.

BACKGROUND: The administration of aspirin <16 weeks gestation to women who are at high risk for preeclampsia has been shown to reduce the rate of preterm preeclampsia by 65%. The traditional approach to identify such women who are at risk is based on risk factors from maternal characteristics, obstetrics, and medical history as recommended by the American College of Obstetricians and Gynecologists and the National Institute for Health and Care Excellence. An alternative approach to screening for preeclampsia has been developed by the Fetal Medicine Foundation. This approach allows the estimation of patient-specific risks of preeclampsia that requires delivery before a specified gestational age with the use of Bayes theorem-based model. OBJECTIVE: The purpose of this study was to examine the diagnostic accuracy of the Fetal Medicine Foundation Bayes theorem-based model, the American College of Obstetricians and Gynecologists, and the National Institute for Health and Care Excellence recommendations for the prediction of preterm preeclampsia at 11-13+6 weeks gestation in a large Asian population STUDY DESIGN: This was a prospective, nonintervention, multicenter study in 10,935 singleton pregnancies at 11-13+6 weeks gestation in 11 recruiting centers across 7 regions in Asia between December 2016 and June 2018. Maternal characteristics and medical, obstetric, and drug history were recorded. Mean arterial pressure and uterine artery pulsatility indices were measured according to standardized protocols. Maternal serum placental growth factor concentrations were measured by automated analyzers. The measured values of mean arterial pressure, uterine artery pulsatility index, and placental growth factor were converted into multiples of the median. The Fetal Medicine Foundation Bayes theorem-based model was used for the calculation of patient-specific risk of preeclampsia at <37 weeks gestation (preterm preeclampsia) and at any gestation (all preeclampsia) in each participant. The performance of screening for preterm preeclampsia and all preeclampsia by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index, and placental growth factor (triple test) was evaluated with the adjustment of aspirin use. We examined the predictive performance of the model by the use of receiver operating characteristic curve and calibration by measurements of calibration slope and calibration in the large. The detection rate of screening by the Fetal Medicine Foundation Bayes theorem-based model was compared with the model that was derived from the application of American College of Obstetricians and Gynecologists and National Institute for Health and Care Excellence recommendations. RESULTS: There were 224 women (2.05%) who experienced preeclampsia, which included 73 cases (0.67%) of preterm preeclampsia. In pregnancies with preterm preeclampsia, the mean multiples of the median values of mean arterial pressure and uterine artery pulsatility index were significantly higher (mean arterial pressure, 1.099 vs 1.008 [P<.001]; uterine artery pulsatility index, 1.188 vs 1.063[P=.006]), and the mean placental growth factor multiples of the median was significantly lower (0.760 vs 1.100 [P<.001]) than in women without preeclampsia. The Fetal Medicine Foundation triple test achieved detection rates of 48.2%, 64.0%, 71.8%, and 75.8% at 5%, 10%, 15%, and 20% fixed false-positive rates, respectively, for the prediction of preterm preeclampsia. These were comparable with those of previously published data from the Fetal Medicine Foundation study. Screening that used the American College of Obstetricians and Gynecologists recommendations achieved detection rate of 54.6% at 20.4% false-positive rate. The detection rate with the use of National Institute for Health and Care Excellence guideline was 26.3% at 5.5% false-positive rate. CONCLUSION: Based on a large number of women, this study has demonstrated that the Fetal Medicine Foundation Bayes theorem-based model is effective in the prediction of preterm preeclampsia in an Asian population and that this method of screening is superior to the approach recommended by American College of Obstetricians and Gynecologists and the National Institute for Health and Care Excellence. We have also shown that the Fetal Medicine Foundation prediction model can be implemented as part of routine prenatal care through the use of the existing infrastructure of routine prenatal care.

Risk for Cesarean section in women of advanced maternal age under the changed reproductive policy in China: A cohort study in a tertiary hospital in southwestern China.

AIM: To describe changed epidemiological features of advanced maternal age (AMA) and to examine the effect of AMA on the risk for Cesarean section (CS) in a Chinese pregnant population. METHODS: This retrospective single-center cohort study investigated the changes of epidemiological features of AMA parturients with respect to the revised reproductive policy in China in 43 702 singleton deliveries with live birth at ≥28 weeks managed from January 2005 to December 2016. We also evaluated the pregnancy outcomes in different age groups and risk factors of CS with multivariate analysis. RESULTS: In this 12-year study period, the average maternal age increased from 28.5 to 30.2 years, and the proportion of AMA raised from 6.5% to 17.2%. AMA was significantly associated with increased risk of adverse pregnancy outcomes, and after adjustment for confounding factors, AMA remained a significant independent risk factor for CS. Furthermore, the effect of AMA in nulliparous women on the risk of CS was more significant than in multiparous women, while the history of previous CS (adjusted odds ratio 39.85) and interdelivery interval ≥10 years (adjusted odds ratio 1.52) also increased the risk of CS in multiparous women. CONCLUSION: AMA increased the risk of a number of adverse pregnancy outcomes, and was independently associated with increased risk for CS. The increasing number of AMA parturients with risk factors is likely to increase CS rate in China in the near future, thus it is imperative to reduce the rate of primary CS as a matter of policy.

Related health burden with the improvement of air quality across China.

BACKGROUND: Substantial progress in air pollution control has brought considerable health benefits in China, but little is known about the spatio-temporal trends of economic burden from air pollution. This study aimed to explore their spatio-temporal features of disease burden from air pollution in China to provide policy recommendations for efficiently reducing the air pollution and related disease burden in an era of a growing economy. METHODS: Using the Global Burden of Disease method and willingness to pay method, we estimated fine particulate matter (PM2.5) and/or ozone (O3) related premature mortality and its economic burden across China, and explored their spatio-temporal trends between 2005 and 2017. RESULTS: In 2017, we estimated that the premature mortality and economic burden related to the two pollutants were RMB 0.94 million (68.49 per 100,000) and 1170.31 billion yuan (1.41% of the national gross domestic product [GDP]), respectively. From 2005 to 2017, the total premature mortality was decreasing with the air quality improvement, but the economic burden was increasing along with the economic growth. And the economic growth has contributed more to the growth of economic costs than the economic burden decrease brought by the air quality improvement. The premature mortality and economic burden from O3 in the total loss from the two pollutants was substantially lower than that of PM2.5, but it was rapidly growing. The O3-contribution was highest in the Yangtze River Delta region, the Fen-Wei Plain region, and some western regions. The proportion of economic burden from PM2.5 and O3 to GDP significantly declined from 2005 to 2017 and showed a decreasing trend pattern from northeast to southwest. CONCLUSION: The disease burden from O3 is lower than that of PM2.5, the O3-contribution has a significantly increasing trend with the growth of economy and O3 concentration.

Dust particulate matter increases pulmonary embolism onset: A nationwide time-stratified case-crossover study in China.

BACKGROUND: Particulate matter (PM) has been found to elevate the risk of pulmonary embolism (PE) onset. Among the contributors to PM, dust PM stands as the second natural source, and its emissions are escalating due to climate change. Despite this, information on the effect of dust PM on PE onset is scarce. Hence, this study aims to investigate the impacts of dust PM10, dust PM2.5-10, and dust PM2.5 on PE onset. METHODS: A nationwide time-stratified case-crossover study was conducted between 2015 and 2020, using data from 18,616 PE onset cases across 1,921 hospitals in China. The analysis employed a conditional logistic regression model to quantify the associations between dust PM10, dust PM2.5-10, and dust PM2.5 and PE onset. Furthermore, the study explored the time-distributed lag pattern of the effect of dust PM on PE development. Stratified analyses were performed based on sex, age, region, and season. RESULTS: Dust PM10, dust PM2.5-10, and dust PM2.5 exhibited significant health effects on PE onset, particularly concerning exposure on the same day. The peak estimates were observed at lag 01 day, with the odds ratio being 1.011 [95 % confidence interval (CI): 1.003, 1.019], 1.014 (95 % CI: 1.003, 1.026), and 1.039 (95 % CI: 1.011, 1.068), for a 10 µg/m3 increase in the concentration of dust PM10, dust PM2.5-10, and dust PM2.5, respectively. In addition, the study identified a higher risk of PE onset associated with dust PM exposure during the warm season than that in cool season, particularly for dust PM2.5. CONCLUSIONS: The findings from this study suggest that short-term exposure to dust PM, particularly dust PM2.5, may trigger PE onset, posing a significant health threat. Implementing measures to mitigate dust PM emissions and protect patients with PE from dust PM exposure is imperative.

Validation of the first-trimester machine learning model for predicting pre-eclampsia in an Asian population.

OBJECTIVES: To evaluate the performance of an artificial intelligence (AI) and machine learning (ML) model for first-trimester screening for pre-eclampsia in a large Asian population. METHODS: This was a secondary analysis of a multicenter prospective cohort study in 10 935 participants with singleton pregnancies attending for routine pregnancy care at 11-13+6 weeks of gestation in seven regions in Asia between December 2016 and June 2018. We applied the AI+ML model for the first-trimester prediction of preterm pre-eclampsia (<37 weeks), term pre-eclampsia (≥37 weeks), and any pre-eclampsia, which was derived and tested in a cohort of pregnant participants in the UK (Model 1). This model comprises maternal factors with measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor (PlGF). The model was further retrained with adjustments for analyzers used for biochemical testing (Model 2). Discrimination was assessed by area under the receiver operating characteristic curve (AUC). The Delong test was used to compare the AUC of Model 1, Model 2, and the Fetal Medicine Foundation (FMF) competing risk model. RESULTS: The predictive performance of Model 1 was significantly lower than that of the FMF competing risk model in the prediction of preterm pre-eclampsia (0.82, 95% confidence interval [CI] 0.77-0.87 vs. 0.86, 95% CI 0.811-0.91, P = 0.019), term pre-eclampsia (0.75, 95% CI 0.71-0.80 vs. 0.79, 95% CI 0.75-0.83, P = 0.006), and any pre-eclampsia (0.78, 95% CI 0.74-0.81 vs. 0.82, 95% CI 0.79-0.84, P < 0.001). Following the retraining of the data with adjustments for the PlGF analyzers, the performance of Model 2 for predicting preterm pre-eclampsia, term pre-eclampsia, and any pre-eclampsia was improved with the AUC values increased to 0.84 (95% CI 0.80-0.89), 0.77 (95% CI 0.73-0.81), and 0.80 (95% CI 0.76-0.83), respectively. There were no differences in AUCs between Model 2 and the FMF competing risk model in the prediction of preterm pre-eclampsia (P = 0.135) and term pre-eclampsia (P = 0.084). However, Model 2 was inferior to the FMF competing risk model in predicting any pre-eclampsia (P = 0.024). CONCLUSION: This study has demonstrated that following adjustment for the biochemical marker analyzers, the predictive performance of the AI+ML prediction model for pre-eclampsia in the first trimester was comparable to that of the FMF competing risk model in an Asian population.

[Effects of hyperglycaemia in pregnancy and relevant factors on neonatal body composition].

OBJECTIVE: To compare body composition at birth in the appropriate-for-gestational-age infants of women with gestational diabetes mellitus (GDM) and normal glucose tolerance and determine the influencing factors of body composition in infants of women with GDM and normal glucose tolerance. METHODS: A study was conducted on 160 appropriate-for-gestational-age infants (90 males and 70 females) of women with gestational diabetes mellitus (GDM group) and 284 appropriate-for-gestational-age infants (139 males and 145 females) of women with normal glucose tolerance (control group). Anthropometric measurements were obtained within 24 to 48 hours of birth. Multiple stepwise regression was used to determine the correlating factors of fat mass, percent of body fat and fat free mass mass. RESULTS: There were no significant difference in gestational age, birth weight, length, body mass index, circumferences of head, chest and upper arm, biceps, abdominal superficial skin fold between two groups (all P > 0.05), but GDM group was characterized by higher skin folds of triceps and subscapular and flank versus control group(all P = 0.000). GDM group had greater fat mass but decreased fat free mass versus control group ((585 ± 59) vs (480 ± 74) g, 17.8% ± 0.8% vs 14.7% ± 1.9%, (2685 ± 127) vs (2784 ± 109) g, all P = 0.000). Stepwise regression showed that maternal fasting glucose level of oral glucose tolerance test and pre-gravid body mass index correlated with fat mass and percent of body fat. Fasting glucose level had the strongest correlation with fat mass and percent of body fat (P = 0.004, 0.006). Gestational age and maternal height correlated with fat free mass in GDM group (P = 0.040, 0.013). On the other hand, maternal weight gain correlated with fat mass (P = 0.015), fasting glucose level and maternal prepartal weight were correlated with percent of body fat (P = 0.002, 0.043) and pre-gravid body mass index had correlation with fat free mass in control group (P = 0.004). CONCLUSIONS: The appropriate-for-gestational-age infants of women with GDM have increased fat mass and percent of body fat, but decreased fat free mass. Maternal fasting glucose level of oral glucose tolerance test, pre-gravid body mass index, weight gain and maternal prepartal weight are influencing factors of body composition in neonates.

[Effect of breastfeeding on childhood overweight in the offspring of mothers with gestational diabetes mellitus].

OBJECTIVE: To investigate whether breastfeeding can reduce the risk of childhood overweight in the offspring of mothers with gestational diabetes mellitus (GDM). METHODS: Follow-up was performed on 1189 offspring of mothers with GDM between January 2003 and December 2009. The influence of the manner and duration of breastfeeding between 0 to 3 months after birth on the risk of childhood overweight in the offspring of mothers with GDM was analyzed by logistic regression. RESULTS: After correcting confounding factors such as pre-pregnancy BMI, gestational weight gain, gestational blood sugar, sex, birth weight, age and farther's body weight, it was found that the risk of childhood overweight in the offspring who received exclusive breastfeeding during the first 3 months after birth was lower than in the artificial feeding group (OR: 0.479, 95%CI: 0.256-0.897). Offspring who were breastfed for 0 to 3 months, 4 to 6 months and over 6 months had a lower risk of childhood overweight than the artificial feeding group (OR: 0.456, 95%CI: 0.233-0.827; OR: 0.29, 95%CI: 0.103-0.817; OR: 0.534, 95%CI: 0.280-0.970), offspring who were breastfed for 4 to 6 months had a lower risk of childhood overweight than those who were breastfed for 0 to 3 months (OR: 0.372, 95%CI: 0.129-0.874), and offspring who were breastfed for more than 6 months did not show significantly lower risk of overweight than those who were breastfed for less than 6 months (OR: 0.769, 95%CI: 0.470-1.258). CONCLUSIONS: Within 3 months of birth, breastfeeding, especially exclusively, may reduce the risk of childhood overweight in the offspring of mothers with GDM. Within 6 months of birth, the risk of childhood overweight decreases as the duration of breastfeeding increases, but prolonging the duration of breastfeeding cannot necessarily reduce the risk of childhood overweight after postnatal six months.

Associations of long-term fine particulate matter exposure with all-cause and cause-specific mortality: results from the ChinaHEART project.

Background: The chronic effects of fine particulate matter (PM2.5) at high concentrations remains uncertain. We aimed to examine the relationship of long-term PM2.5 exposure with all-cause and the top three causes of death (cardiovascular disease [CVD], cancer, and respiratory disease), and to analyze their concentration-response functions over a wide range of concentrations. Methods: We enrolled community residents aged 35-75 years from 2014 to 2017 from all 31 provinces of the Chinese Mainland, and followed them up until 2021. We used a long-term estimation dataset for both PM2.5 and O3 concentrations with a high spatiotemporal resolution to assess the individual exposure, and used Cox proportional hazards models to estimate the associations between PM2.5 and mortalities. Findings: We included 1,910,923 participants, whose mean age was 55.6 ± 9.8 years and 59.4% were female. A 10 µg/m3 increment in PM2.5 exposure was associated with increased risk for all-cause death (hazard ratio 1.02 [95% confidence interval 1.012-1.028]), CVD death (1.024 [1.011-1.037]), cancer death (1.037 [1.023-1.052]), and respiratory disease death (1.083 [1.049-1.117]), respectively. Long-term PM2.5 exposure nonlinearly related with all-cause, CVD, and cancer mortalities, while linearly related with respiratory disease mortality. Interpretation: The overall effects of long-term PM2.5 exposure on mortality in the high concentration settings are weaker than previous reports from settings of PM2.5 concentrations < 35 µg/m³. The distinct concentration-response relationships of CVD, cancer, and respiratory disease mortalities could facilitate targeted public health efforts to prevent death caused by air pollution. Funding: The Chinese Academy of Medical Sciences Innovation Fund for Medical Science, the National High Level Hospital Clinical Research Funding, the Ministry of Finance of China and National Health Commission of China, the 111 Project from the Ministry of Education of China.

[Distribution and normal reference range of fetal nuchal translucency thickness in Kunming pregnant women in the first trimester].

OBJECTIVE: To establish the normal reference range of fetal nuchal translucency (NT) thickness in Kunming Chinese pregnant women in the first trimester. METHODS: The study samples comprised of 1790 Kunming pregnant women who attended antenatal visit in the first trimester in the First Affiliated Hospital of Kunming Medical University. The general information including maternal date of birth, past pregnant history and other related conditions were recorded. The crown rump length (CRL) and NT thickness at 11 - 13(+6) gestational weeks were measured according to guidelines from Fetal Medicine Foundation (FMF). RESULTS: The total 1790 of normal fetuses was recruited for final analysis. The mean and median values of CRL were (59.6 ± 9.2) mm and 58.3 mm, respectively. The mean and median values of NT thickness were (1.7 ± 0.5) mm and 1.7 mm, respectively. While the CRL were at between 45.0 - 54.9 mm, 55.0 - 64.9 mm, 65.0 - 74.9 mm and 75.0 - 84.0 mm, the corresponding values of NT thickness were 1.0 mm, 1.3 mm, 1.5 mm, 1.5 mm at the 5(th) percentile and 2.0 mm, 2.5 mm, 2.7 mm, 2.9 mm at the 95(th) percentile, respectively, and the corresponding medial values of NT thickness were 1.4 mm, 1.7 mm, 2.0 mm, 2.0 mm, respectively. The NT thickness had no relationship with maternal age (P > 0.05). The mean value of NT thickness was (1.8 ± 1.1) mm in male fetuses. The mean value of NT thickness was (1.7 ± 0.6) mm in female fetuses. The NT thickness in male fetuses was significantly thicker than that of females (P = 0.001). CONCLUSION: The present study established a reference range of normal fetal NT thickness corresponding with CRL in early pregnancy with reliable FMF quality control.

The relationship between particulate matter and lung function of children: A systematic review and meta-analysis.

There have been many studies on the relationship between fine particulate matter (PM2.5) and lung function. However, the impact of short-term or long-term PM2.5 exposures on lung function in children is still inconsistent globally, and the reasons for the inconsistency of the research results are not clear. Therefore, we searched the PubMed, Embase and Web of Science databases up to May 2022, and a total of 653 studies about PM2.5 exposures on children's lung function were identified. Random effects meta-analysis was used to estimate the combined effects of the 25 articles included. PM2.5 concentrations in short-term exposure studies mainly come from individual and site monitoring. And for every 10 µg/m3 increase, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and peak expiratory flow (PEF) decreased by 21.39 ml (95% CI: 13.87, 28.92), 25.66 ml (95% CI: 14.85, 36.47) and 1.76 L/min (95% CI: 1.04, 2.49), respectively. The effect of PM2.5 on lung function has a lag effect. For every 10 µg/m3 increase in the 1-day moving average PM2.5 concentration, FEV1, FVC and PEF decreased by 14.81 ml, 15.40 ml and 1.18 L/min, respectively. PM2.5 concentrations in long-term exposure studies mainly obtained via ground monitoring stations. And for every 10 µg/m3 increase, FEV1, FVC and PEF decreased by 61.00 ml (95% CI: 25.80, 96.21), 54.47 ml (95% CI: 7.29, 101.64) and 10.02 L/min (95% CI: 7.07, 12.98), respectively. The sex, body mass index (BMI), relative humidity (RH), temperature (Temp) and the average PM2.5 exposure level modify the relationship between short-term PM2.5 exposure and lung function. Our study provides further scientific evidence for the deleterious effects of PM2.5 exposures on children's lung function, suggesting that exposure to PM2.5 is detrimental to children's respiratory health. Appropriate protective measures should be taken to reduce the adverse impact of air pollution on children's health.

Long-term exposure to ozone and cardiovascular mortality in a large Chinese cohort.

BACKGROUND: Evidence for the association between long-term exposure to ozone (O3) and cause-specific cardiovascular disease (CVD) mortality is inconclusive, and this association has rarely been evaluated at high O3 concentrations. OBJECTIVES: We aim to evaluate the associations between long-term O3 exposure and cause-specific CVD mortality in a Chinese population. METHODS: From 2009 to 2018, 744,882 subjects (median follow-up of 7.72 years) were included in the CHinese Electronic health Records Research in Yinzhou (CHERRY) study. The annual average concentrations of O3 and fine particulate matter (PM2.5), which were estimated using grids with a resolution up to 1 × 1 km, were assigned to the community address for each subject. The outcomes were deaths from CVD, ischemic heart disease (IHD), myocardial infarction (MI), stroke, and hemorrhagic/ischemic stroke. Time-varying Cox model adjusted for PM2.5 and individual-level covariates was used. RESULTS: The mean of annual average O3 concentrations was 68.05 µg/m3. The adjusted hazard ratio per 10 µg/m3 O3 increase was 1.22 (95% confidence interval [CI]: 1.13-1.33) for overall CVD mortality, 1.08 (0.91-1.29) for IHD, 1.21 (0.90-1.63) for MI, 1.28 (1.15-1.43) for overall stroke, 1.39 (1.16-1.67) for hemorrhagic stroke and 1.22 (1.00-1.49) for ischemic stroke, respectively. The study showed that subjects without hypertension had a higher risk for CVD mortality associated with long-term O3 exposure (1.66 vs. 1.15, p = 0.01). CONCLUSIONS: We observed the association between long-term exposure to high O3 concentrations and cause-specific CVD mortality in China, independent of PM2.5 and other CVD risk factors. This suggested an urgent need to control O3 pollution, especially in developing countries.

Prospective Evaluation of International Prediction of Pregnancy Complications Collaborative Network Models for Prediction of Preeclampsia: Role of Serum sFlt-1 at 11-13 Weeks' Gestation.

The study aimed to investigate whether serum sFlt-1 (soluble fms-like tyrosine kinase-1) at 11-13 weeks' gestation in pregnancies that subsequently developed preeclampsia was different from those without preeclampsia and compare screening performance of the International Prediction of Pregnancy Complications (IPPIC) reported models, which include various combinations of maternal factors, systolic blood pressure, diastolic blood pressure, PlGF (placental growth factor) and sFlt-1 and the competing risk (CR) models, which include various combinations of maternal factors, mean arterial pressure (MAP) and PlGF for predicting any-onset, early-onset, and late-onset preeclampsia. This was a prospective multicenter study in 7877 singleton pregnancies. The differences of the predictive performance between the IPPIC and CR models were compared. There were 141 women (1.79%) who developed preeclampsia, including 13 cases (0.17%) of early-onset preeclampsia and 128 cases (1.62%) of late-onset preeclampsia. In pregnancies that developed preeclampsia compared to unaffected pregnancies, median serum sFlt-1 levels and its MoMs were not significantly different (p>0.05). There was no significant association between gestational age at delivery and log10 sFlt-1 and log10 sFlt-1 MoM (p>0.05). The areas under the curve of CR models were significantly higher than the IPPIC models for the prediction of any-onset and late-onset preeclampsia but not for early-onset preeclampsia. In conclusion, there are no significant differences in the maternal serum sFlt-1 levels at 11-13 weeks' gestation between women who subsequently develop preeclampsia and those who do not. Moreover, the CR models for the prediction of any-onset and late-onset preeclampsia perform better than the IPPIC reported model.

PM2.5-associated risk for cardiovascular hospital admission and related economic burdens in Beijing, China.

BACKGROUND: The study of ambient air particulate matter (PM2.5)-associated health and economic burdens of cardiovascular disease are crucial for air pollution control and disease prevention strategies. Quantified evidence remains inadequate. OBJECTIVES: This study aimed to estimate the PM2.5 associated risk in cardiovascular hospital admission as well as attributable health burdens and economic costs. METHODS: A total of 2,202,244 hospital admission records of cardiovascular disease and six common clinical subtypes in Beijing were included. A time-stratified case-crossover design was applied to estimate the associations and the concentration-response curve. Then, the annual average additional hospital admissions, days of hospital stay, and hospital expenditures were evaluated from 2013 to 2017 and compared between 2017 and 2013. RESULTS: The results showed that each 10 µg/m3 increase in previous-day PM2.5 concentration was associated with a risk increase of 0.44% (95%CI: 0.40%, 0.47%) for cardiovascular disease, 0.66% (95%CI: 0.58%, 0.73%) for angina pectoris, 0.53% (95%CI: 0.39%, 0.66%) for chronic ischemic heart disease, 0.48% (95%CI: 0.34%, 0.63%) for myocardial infarction, 0.44% (95%CI: 0.29%, 0.60%) for hypertensive heart disease and 0.40% (95%CI: 0.27%, 0.52%) for ischemic stroke. There were 1938 PM2.5 attributed additional hospital admissions, resulting in 21,668 additional days in hospital, along with 5527.12 and 1947.04 ten-thousand of additional total hospital cost and self-afforded cost, respectively. Compared with 2013, the above-mentioned four burdens decreased by 18.17%, 28.80%, 18.90% and 13.72% in 2017, respectively. CONCLUSION: PM2.5 exposure was significantly associated with substantial burdens of cardiovascular hospital admission and economic expenditures. The results highlight the necessity of continuous PM2.5 control from the perspective of healthy and sustainable city development in urban China.

Risk of Cardiovascular Hospital Admission After Exposure to Fine Particulate Pollution.

BACKGROUND: Heavy fine particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5) pollution events continue to occur frequently in developing countries. OBJECTIVES: The authors conducted a case-crossover study aimed at exploring the association between heavy PM2.5 pollution events and hospital admission for cardiovascular diseases. METHODS: Hospital admissions for cardiovascular diseases were observed by Beijing Municipal Commission of Health and Family Planning Information Center from 2013 to 2017. Air pollution data were collected from the Beijing Municipal Environmental Monitoring Center. Distinct definitions were used to identify heavy and extremely heavy fine particulate pollution events. A conditional logistic regression model was used. The hospital admission burdens for cardiovascular disease were also estimated. RESULTS: A total of 2,202,244 hospital admissions for cardiovascular diseases and 222 days of extremely heavy PM2.5 pollution events (PM2.5 concentration ≥150 µg/m3) were observed. The ORs associated with extremely heavy PM2.5 pollution events lasting for 3 days or more for total cardiovascular disease, angina, myocardial infarction, ischemic stroke, and heart failure were 1.085 (95% CI: 1.077-1.093), 1.112 (95% CI: 1.095-1.130), 1.068 (95% CI: 1.037-1.100), 1.071 (95% CI: 1.053-1.090), and 1.060 (95% CI: 1.021-1.101), respectively. The numbers and days of cardiovascular disease hospital admission annually related to extremely heavy PM2.5 pollution events lasting for 1 day or more were 3,311 (95% CI: 2,969-3,655) and 37,020 (95% CI: 33,196-40,866), respectively. CONCLUSIONS: Heavy and extremely heavy PM2.5 pollution events resulted in substantial increased hospital admission risk for cardiovascular disease. With higher PM2.5 concentration and longer duration of heavy PM2.5 pollution events, a greater risk of cardiovascular hospital admission was observed.

Random forest model based fine scale spatiotemporal O3 trends in the Beijing-Tianjin-Hebei region in China, 2010 to 2017.

Ambient ozone (O3) concentrations have shown an upward trend in China and its health hazards have also been recognized in recent years. High-resolution exposure data based on statistical models are needed. Our study aimed to build high-performance random forest (RF) models based on training data from 2013 to 2017 in the Beijing-Tianjin-Hebei (BTH) region in China at a 0.01 ° × 0.01 ° resolution, and estimated daily maximum 8h average O3 (O3-8hmax) concentration, daily average O3 (O3-mean) concentration, and daily maximum 1h O3 (O3-1hmax) concentration from 2010 to 2017. Model features included meteorological variables, chemical transport model output variables, geographic variables, and population data. The test-R2 of sample-based O3-8hmax, O3-mean and O3-1hmax models were all greater than 0.80, while the R2 of site-based and date-based model were 0.68-0.87. From 2010 to 2017, O3-8hmax, O3-mean, and O3-1hmax concentrations in the BTH region increased by 4.18 µg/m3, 0.11 µg/m3, and 4.71 µg/m3, especially in more developed regions. Due to the influence of weather conditions, which showed high contribution to the model, the long-term spatial distribution of O3 concentrations indicated a similar pattern as altitude, where high concentration levels were distributed in regions with higher altitude.

Associations between short-term exposure to PM2.5 and stroke incidence and mortality in China: A case-crossover study and estimation of the burden.

Stroke and fine particulate matter (PM2.5) are two important public health concerns worldwide. Although numerous studies have reported the associations between PM2.5 and stroke, scientific evidence in China is incomplete, particularly the effect of PM2.5 on the acute incidence and national acute health burdens of stroke attributed to PM2.5 pollution. This study identified about 131,947 registered patients and 23,018 deaths due to stroke in 10 counties located in various regions from 2013 to 2017. Using a time-stratified case-crossover design, this study evaluated the associations between short-term exposure to PM2.5 and the risks of acute incidence and mortality for different types of stroke on the same spatiotemporal scale. With a 10 µg/m3 increase in the PM2.5 concentration, the acute incidence risk increased by 0.37% (0.15%, 0.60%) for stroke, 0.46% (0.21%, 0.72%) for ischemic stroke, and -0.13% (-0.73%, 0.48%) for hemorrhagic stroke. The corresponding values for the mortality risk were 0.71% (0.08%, 1.33%), 1.09% (0.05%, 2.14%), and 0.43% (-0.44%, 1.31%) for stroke, ischemic stroke and hemorrhagic stroke, respectively. Compared with the other groups, females and patients aged over 64 years presented higher incidence and mortality risks, while the group aged >75 years may exhibit a greater risk of mortality. Based on the estimated effects, we evaluated 43,300 excess deaths and 48,800 acute incidences attributed to short-term PM2.5 exposure across China in 2015. This study provided robust estimates of PM2.5-induced stroke incidence and mortality risks, and susceptible populations were identified. Excess mortality and morbidity attributed to short-term PM2.5 exposure indicate the necessity to implement health care and prevention strategies, as well as medical resource allocation for noncommunicable diseases in regions with high levels of air pollution.