Improved morbidity-based air quality health index development using Bayesian multi-pollutant weighted model.

BACKGROUND: The widely used Air Quality Index (AQI) has been criticized due to its inaccuracy, leading to the development of the air quality health index (AQHI), an improvement on the AQI. However, there is currently no consensus on the most appropriate construction strategy for the AQHI. OBJECTIVES: In this study, we aimed to evaluate the utility of AQHIs constructed by different models and health outcomes, and determine a better strategy. METHODS: Based on the daily time-series outpatient visits and hospital admissions from 299 hospitals (January 2016-December 2018), and mortality (January 2017-December 2019) in Guangzhou, China, we utilized cumulative risk index (CRI) method, Bayesian multi-pollutant weighted (BMW) model and standard method to construct AQHIs for different health outcomes. The effectiveness of AQHIs constructed by different strategies was evaluated by a two-stage validation analysis and examined their exposure-response relationships with the cause-specific morbidity and mortality. RESULTS: Validation by different models showed that AQHI constructed with the BMW model (BMW-AQHI) had the strongest association with the health outcome either in the total population or subpopulation among air quality indexes, followed by AQHI constructed with the CRI method (CRI-AQHI), then common AQHI and AQI. Further validation by different health outcomes showed that AQHI constructed with the risk of outpatient visits generally exhibited the highest utility in presenting mortality and morbidity, followed by AQHI constructed with the risk of hospitalizations, then mortality-based AQHI and AQI. The contributions of NO2 and O3 to the final AQHI were prominent, while the contribution of SO2 and PM2.5 were relatively small. CONCLUSIONS: The BMW model is likely to be more effective for AQHI construction than CRI and standard methods. Based on the BMW model, the AQHI constructed with the outpatient data may be more effective in presenting short-term health risks associated with the co-exposure to air pollutants than the mortality-based AQHI and existing AQIs.

Association between residential greenness and overweight/obesity among rural adults in northwestern China.

BACKGROUND: Living in greener areas may reduce adiposity, but epidemiological evidence on this topic is still inconsistence and limited, especially in rural areas. METHODS: We performed a cross-sectional study among 4651 Uyghur adults in rural areas in Xinjiang province, northwestern China, from May to September 2016. We measured residential greenness levels using satellite-derived Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI) in 100 m, 300 m, 500 m, and 1000 m buffers around each home address. Body height, weight, and waist circumference were assessed according to recommended guidelines. Data on baseline characteristics and confounders were collected using a questionnaire. We used generalized linear mixed models to estimate the associations of residential greenness with overweight/obesity prevalence and obesity-related anthropometric indices. RESULTS: Higher residential greenness levels were associated with lower waist circumference and body mass index levels, as well as with a lower odds ratio of peripheral overweight/obesity prevalence. No significant association was found for greenness and central obesity prevalence. The associations persisted in magnitude and direction across several sensitivity analyses we performed. Stratified analysis suggested that the associations were generally stronger in older adults than those in younger adults. Additionally, neither air pollutants nor physical activity significantly mediated the associations between greenness and obesity. CONCLUSIONS: Our results suggest that higher residential greenness were associated with lower odds of overweight/obesity and lower obesity-related anthropometric indices among rural Uyghur adults in China, especially for older adults.

Co-exposure and health risks of parabens, bisphenols, triclosan, phthalate metabolites and hydroxyl polycyclic aromatic hydrocarbons based on simultaneous detection in urine samples from guangzhou, south China.

Polycyclic aromatic hydrocarbons (PAHs) and certain ingredients in personal care products, such as parabens, bisphenols, triclosan and phthalate metabolites, have become ubiquitous in the world. Concerns of human exposure to these pollutants have increased during recent years because of various adverse health effects of these chemicals. Multiple compounds including parabens, bisphenols, triclosan, phthalate metabolites (mPAEs) and hydroxyl PAHs (OH-PAHs) in urine samples from Guangzhou were determined simultaneously to identify the human exposure pathways without external exposure data combined with data analysis, and the toxicants posed the highest risk to human health were screened in the present study. The detection frequencies for the chemicals exceeded 90%. Among the contaminants, mPAEs showed the highest concentrations, followed by OH-PAHs, with triclosan present at the lowest concentrations. Mono-n-butyl phthalate, methylparaben, bisphenol A, and hydroxynaphthalene represented the most abundant mPAE, parabens, bisphenol, and OH-PAH compounds, respectively. The present PAHs are mainly exposed to human through inhalation, while the chemicals added to personal care products are mainly exposed to human through oral intake and dermal contact. The urine samples from suburban subjects showed significantly higher OH-PAH levels than the urine samples from urban subjects, and females had lower OH-PAH levels than males. Urinary concentrations of the analyzed contaminants were significantly correlated with age, body mass index, residence time, as well as the frequencies of alcohol consumption and swimming. Risk assessments based on Monte Carlo simulation indicated that approximately 30% of the subjects suffered non-carcinogenic risks from mPAEs and OH-PAHs, with mPAEs accounting for 89% of the total risk.

The Central Role of Nondisclosed Men Who Have Sex With Men in Human Immunodeficiency Virus-1 Transmission Networks in Guangzhou, China.

BACKGROUND: Men who have sex with men (MSM) are vulnerable risk group for human immunodeficiency virus (HIV)-1 infection. However, some MSM do not disclose their same-sex behavior and could impact the transmission and prevention of HIV-1 infection. Here, we evaluated the role of nondisclosed MSM in HIV-1 transmission in Guangzhou, China. METHODS: The HIV-1 pol sequences were obtained from HIV-infected subjects from 2008 to 2015. A transmission network was constructed using HIV TRAnsmission Cluster Engine (HIV-TRACE) at a pairwise genetic distance of 0.5%. The position of nondisclosed MSM in the network was determined by centrality analysis. RESULTS: Nondisclosed MSM were inferred in 9.92% (61 of 615) of slightly older, self-reported non-MSM (P = .006). They were more likely to be married (P = .002) and less educated (P < .001) than the MSM with whom they clustered. Closeness centrality was bigger for nondisclosed MSM than for MSM (P < .001), indicating the central position of nondisclosed MSM in the networks. The average shortest path length was smaller for nondisclosed MSM than for MSM (P < .001), whereas radiality was bigger for nondisclosed MSM than for MSM, suggesting a relatively greater contribution of nondisclosed MSM in transmitting HIV-1 than MSM. Assortativity analysis indicated that nondisclosed MSM were more likely to link each other with coefficient of 0.025. CONCLUSIONS: Nondisclosed MSM are a specific group, and they play an important role in HIV-1 transmission. They could be bisexual and might increase the risk of HIV-1 infection to their sex partners. Therefore, specific prevention and intervention targeting nondisclosed MSM are urgently needed.

Interactions between ambient air pollutants and temperature on emergency department visits: Analysis of varying-coefficient model in Guangzhou, China.

BACKGROUND: At present, there are few studies on the effect of short-term interactions between ambient air pollutants and temperature on cause-specific emergency department visits in China. This study aimed to explore their short-term interactions on cause-specific emergency department visits using data collected from a total of 65 public hospitals in Guangzhou city, south China. MATERIAL AND METHODS: We included a total of 226,443 emergency department visits which were diagnosed as neurological, respiratory and circulatory disease in Guangzhou from January 1, 2014 to December 31, 2017. Average daily concentrations of air pollutants including carbon monoxide (CO), particulate matter having a median diameter of 2.5 µm or less (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3) were collected from the Guangzhou Environmental Protection Bureau. We employed quasi-Poisson varying coefficient regression models to assess the interaction effects between air pollutants and daily temperature levels (DTLs) on emergency department visits for neurological, respiratory and circulatory diseases, respectively. RESULTS: Average number of emergency department visits for neurological, respiratory and circulatory diseases were 92, 26 and 38, respectively. After controlling for other pollutants, meteorological factors and other time-varying confounders, we found the interactions between NO2 and the 1st DTL (3.4-17.1 °C), NO2 and the 2nd DTL (17.1-23.5 °C) for neurological emergency department visits were statistically significant, displaying a nonlinear relationship. Additionally, we found that the interactions between SO2 and the 4th DTL (27.4-31.1 °C) also had a significantly adverse effect on respiratory emergency department visits. CONCLUSIONS: Our findings provide novel evidence on SO2-by-temperature interactions, and NO2-by-temperature interactions for emergency department visits of cause-specific diseases.