Communicating air pollution-related health risks to the public: an application of the Air Quality Health Index in Shanghai, China.

The Air Quality Health Index (AQHI) was originally developed in Canada. However, little is known about its validity in communicating morbidity risks. We aimed to establish the AQHI in Shanghai, China, and to compare the associations of AQHI and existing Air Pollution Index (API) with daily mortality and morbidity. We constructed the AQHI as the sum of excess total mortality associated with individual air pollutants, and then adjusted it to an arbitrary scale (0-10), according to a time-series analysis of air pollution and mortality in Shanghai from 2001 to 2008. We examined the associations of AQHI with daily mortality and morbidity, and compared these associations with API from 2005 to 2008. The coefficients of short-term associations of total mortality with particulate matter with an aerodynamic diameter less than 10 µm (PM(10)), PM(2.5) and nitrogen dioxide (NO(2)) were used in the establishment of AQHI. During 2005-2008, the AQHI showed linear non-threshold positive associations with daily mortality and morbidity. A unit increase of the PM(10)-AQHI was associated with a 0.90% [95% (confidence interval, CI), 0.43 to 1.37], 1.04% (95%CI, 0.04 to 2.04), 1.62% (95%CI, 0.39 to 2.85) and 0.51% (95%CI, 0.09 to 0.93) increase of current-day total mortality, hospital admissions, outpatient visits and emergency room visits, respectively. The PM(2.5)-AQHI showed quite similar effect estimates with the PM(10)-AQHI. In contrast, the associations for API were much weaker and generally statistically insignificant. The AQHI, compared with the existing API, provided a more effective tool to communicate the air pollution-related health risks to the public.

Exposure assessment of phthalates in non-occupational populations in China.

Phthalates have been used worldwide and are ubiquitous in environmental media and human bodies. Based on existing data on phthalate concentrations, distributions of phthalates in the environment and their exposure assessment to non-occupational populations in China can be evaluated. Fifty-three studies, published from January 2000 to October 2010, were reviewed and their data were analyzed in this study. Geographic information system (GIS) was used in mapping the published data of phthalate concentrations and their distributions in environmental media, while scatter diagrams were applied to show the time trends for phthalate concentrations in various environmental media. Results showed that there was a time-dependent increase in ∑phthalates (total phthalates) and DEHP concentrations in air during the past 10 years; phthalate concentrations varied in different areas, among which Guangdong and northeast China were the most polluted. Using Clark's equations, daily intake of ∑phthalates and DEHP in the Pearl River Delta and the Yangtze River Delta was estimated from consumption of contaminated food, water and air. Results showed that daily intake of ∑phthalates and DEHP was 128.63 and 61.29 µg/kg BW/d for adults in the Pearl River Delta, which is significantly higher than those residing in the Yangtze River Delta (33.87 and 24.68 µg/kg BW/d).

Association of particulate air pollution with daily mortality: the China Air Pollution and Health Effects Study.

China is one of the few countries with some of the highest particulate matter levels in the world. However, only a small number of particulate matter health studies have been conducted in China. The study objective was to examine the association of particulate matter with an aerodynamic diameter of less than 10 µm (PM(10)) with daily mortality in 16 Chinese cities between 1996 and 2008. Two-stage Bayesian hierarchical models were applied to obtain city-specific and national average estimates. Poisson regression models incorporating natural spline smoothing functions were used to adjust for long-term and seasonal trends of mortality, as well as other time-varying covariates. The averaged daily concentrations of PM(10) in the 16 Chinese cities ranged from 52 µg/m(3) to 156 µg/m(3). The 16-city combined analysis showed significant associations of PM(10) with mortality: A 10-µg/m(3) increase in 2-day moving-average PM(10) was associated with a 0.35% (95% posterior interval (PI): 0.18, 0.52) increase of total mortality, 0.44% (95% PI: 0.23, 0.64) increase of cardiovascular mortality, and 0.56% (95% PI: 0.31, 0.81) increase of respiratory mortality. Females, older people, and residents with low educational attainment appeared to be more vulnerable to PM(10) exposure. Conclusively, this largest epidemiologic study of particulate air pollution in China suggests that short-term exposure to PM(10) is associated with increased mortality risk.

Air pollution and health studies in China--policy implications.

During the rapid economic development in China, ambient air pollutants in major cities, including PM10 (particulate matter with aerodynamic diameter < or =10 microm) and SO2 have been reduced due to various measures taken to reduce or control sources of emissions, whereas NO2 is stable or slightly increased. However, air pollution levels in China are still at the higher end of the world level. Less information is available regarding changes in national levels of other pollutants such as PM2.5 and ozone. The Chinese Ministry of Environmental Protection (MOEP) set an index for "controlling/reducing total SO2 emissions" to evaluate the efficacy of air pollution control strategy in the country. Total SO2 emissions declined for the first time in 2007. Chinese epidemiologic studies evidenced adverse health effects of ambient air pollution similar to those reported from developed countries, though risk estimates on mortality/morbidity per unit increase of air pollutant are somewhat smaller than those reported in developed countries. Disease burden on health attributable to air pollution is relatively greater in China because of higher pollution levels. Improving ambient air quality has substantial and measurable public health benefits in China. It is recommended that the current Chinese air quality standards be updated/revised and the target for "controlling/reducing total SO2 emissions" be maintained and another target for "reducing total NO2 emissions" be added in view of rapid increase in motor vehicles. Continuous and persistent efforts should be taken to improve ambient air quality.

Air pollution and population health: a global challenge.

"Air pollution and population health" is one of the most important environmental and public health issues. Economic development, urbanization, energy consumption, transportation/motorization, and rapid population growth are major driving forces of air pollution in large cities, especially in megacities. Air pollution levels in developed countries have been decreasing dramatically in recent decades. However, in developing countries and in countries in transition, air pollution levels are still at relatively high levels, though the levels have been gradually decreasing or have remained stable during rapid economic development. In recent years, several hundred epidemiological studies have emerged showing adverse health effects associated with short-term and long-term exposure to air pollutants. Time-series studies conducted in Asian cities also showed similar health effects on mortality associated with exposure to particulate matter (PM), sulfur dioxide (SO(2)), nitrogen dioxide (NO(2)) and ozone (O(3)) to those explored in Europe and North America. The World Health Organization (WHO) published the "WHO Air Quality Guidelines (AQGs), Global Update" in 2006. These updated AQGs provide much stricter guidelines for PM, NO(2), SO(2) and O(3). Considering that current air pollution levels are much higher than the WHO-recommended AQGs, interim targets for these four air pollutants are also recommended for member states, especially for developing countries in setting their country-specific air quality standards. In conclusion, ambient air pollution is a health hazard. It is more important in Asian developing countries within the context of pollution level and population density. Improving air quality has substantial, measurable and important public health benefits.

Low-carbon energy policy and ambient air pollution in Shanghai, China: a health-based economic assessment.

Energy and related health issues are of growing concern worldwide today. To investigate the potential public health and economic impact of ambient air pollution under various low-carbon energy scenarios in Shanghai, we estimated the exposure level of Shanghai residents to air pollution under various planned scenarios, and assessed the public health impact using concentration-response functions derived from available epidemiologic studies. We then estimated the corresponding economic values of the health effects based on unit values for each health outcome. Our results show that ambient air pollution in relation to low-carbon energy scenarios could have a significant impact on the future health status of Shanghai residents, both in physical and monetary terms. Compared with the base case scenario, implementation of various low-carbon energy scenarios could prevent 2804-8249 and 9870-23,100 PM10-related avoidable deaths (mid-value) in 2010 and 2020, respectively. It could also decrease incidence of several relevant diseases. The corresponding economic benefits could reach 507.31-1492.33 and 2642.45-6192.11 million U.S. dollars (mid-value) in 2010 and 2020, respectively. These findings illustrate that a low-carbon energy policy will not only decrease the emission of greenhouse gases, but also play an active role in the reduction of air pollutant emissions, improvement of air quality, and promotion of public health. Our estimates can provide useful information to local decision-makers for further cost-benefit analysis.

Exposures and health outcomes from outdoor air pollutants in China.

China's economy has developed rapidly in the recent two decades. Economic development is usually linked with increase in energy consumption and consumption emissions, which in turn leads to worsening of air quality. Due to the adoption of various control measures, the ambient air quality in a number of large cities in China has actually improved. The ambient air TSP and SO(2) levels in China have been decreasing in the last decade. However, ambient air NO(x) level has been increasing due to the increased number of motor vehicles. Coal has been and is still the major source of energy in China. Ambient air pollution in large cities has changed from the conventional coal combustion type to the mixed coal combustion/motor vehicle emission type. A series of epidemiological studies on air pollution and health effects ranging from mortality, morbidity to functional changes have been conducted in China. The results showed that ambient air pollution had acute and chronic effects on mortality, morbidity, hospital admissions, clinical symptoms, lung function changes, etc. The exposure-response relationship between air pollutants and daily mortality, morbidity, hospital admissions, and lung function has been established accordingly.

Particulate air pollution in urban areas of Shanghai, China: health-based economic assessment.

Urban air quality is becoming a serious public health concern in China. To obtain the quantitative result of the impact of particulate air pollution on human health and the subsequent economic costs in Shanghai, we used epidemiology-based exposure-response functions to calculate the attributable number of cases due to particulate air pollution in urban areas of Shanghai in 2001, and then we estimated the corresponding economic costs of the health damage based on unit values of the health outcomes. It was estimated that the total economic cost of health impacts due to particulate air pollution in urban areas of Shanghai in 2001 was approximately 625.40 million US dollars, accounting for 1.03% of gross domestic product of the city. The results suggest that the impact of particulate air pollution on human health could be substantial in urban Shanghai, whether in physical and economic terms.