Socioeconomic status, lifestyle and risk of incident dementia: a prospective cohort study of 276730 participants.

Healthy lifestyle might alleviate the socioeconomic inequities in health, but the extent of the joint and interactive effects of these two factors on dementia are unclear. This study aimed to detect the joint and interactive associations of socioeconomic status (SES) and lifestyle factors with incident dementia risk, and the underlying brain imaging alterations. Cox proportional hazards analysis was performed to test the joint and interactive associations. Partial correlation analysis was performed to reflect the brain imaging alterations. A total of 276,730 participants with a mean age of 55.9 (±8.0) years old from UK biobank were included. Over 8.5 (±2.6) years of follow-up, 3013 participants were diagnosed with dementia. Participants with high SES and most healthy lifestyle had a significantly lower risk of incident dementia (HR=0.19, 95% CI=0.14 to 0.26, P<2×10-16), Alzheimer's disease (AD, HR=0.19, 95% CI=0.13 to 0.29, P=8.94×10-15), and vascular dementia (HR=0.24, 95% CI=0.12 to 0.48, P=7.57×10-05) compared with participants with low SES and an unhealthy lifestyle. Significant interactions were found between SES and lifestyle on dementia (P=0.002) and AD (P=0.001) risks; the association between lifestyle and dementia was stronger among those of high SES. The combination of high SES and healthy lifestyle was positively associated with higher volumes in brain regions vulnerable to dementia-related atrophy. These findings suggest that SES and lifestyle significantly interact and influence dementia with its related brain structure phenotypes.

Association between light at night and the risk of child death in sub-saharan Africa: a cross-sectional analysis based on DHS data.

BACKGROUND: The high under-five mortality rate (U5MR) in Africa is a significant public health concern. Previous studies have found that satellite retrieved light at night (LAN) data with long-term and global coverage can be used as a proxy for socio-economic development and urbanization. Currently, few studies on the effects of LAN on child mortality have been conducted in Africa, a region with varying levels of urbanization between countries. OBJECTIVE: To quantify the correlation between risk of child mortality and LAN as an indicator of urbanization and economic development in Africa. METHODS: Using data from the Demographic and Health Survey (DHS) database conducted in 15 African countries out of 46 countries from 2005 to 2013, this study estimated LAN levels for children based on their year of birth and residential addresses. This study used Cox proportional hazards models to assess the association between LAN and the risk of child mortality in Africa. RESULTS: The mean U5MR was 95 per 1,000 livebirths among the 15 African countries during 2005-2013. After adjusting for covariates, each 10-unit increment in LAN was associated with a 5.3% reduction in the risk of U5MR. The effect estimates were more pronounced in areas with lower LAN. CONCLUSION: In Africa, the risk of U5MR decreased with increasing LAN, especially in areas with lower LAN. The results suggest that the development of urbanization and socio-economic conditions may be beneficial to child health, especially in regions with low LAN. The use of LAN as a proxy may offer an intriguing approach for identifying areas requiring targeted development in urbanization and socio-economic conditions.

Global warming may significantly increase childhood anemia burden in sub-Saharan Africa.

Childhood anemia constitutes a global public health problem, especially in low- and middle-income countries (LMICs). However, it remains unknown whether global warming has an impact on childhood anemia. Here, we examined the association between annual temperatures and childhood anemia prevalence in sub-Saharan Africa and then projected childhood anemia burden attributable to climate change. Each 1°C increment in annual temperature was associated with increased odds of childhood anemia (odd ratio = 1.138, 95% confidence interval: 1.134-1.142). Compared with the baseline period (1985-2014), the attributable childhood anemia cases would increase by 7,597 per 100,000 person-years under a high-emission scenario in the 2090s, which would be almost 2-fold and over 3-fold more than those projected in moderate- and low-emission scenarios. Our results reveal the vulnerabilities and inequalities of children for the excess burden of anemia due to climate warming and highlight the importance of climate mitigation and adaptation strategies in LMICs.

Association of Ambient Temperature With the Prevalence of Intimate Partner Violence Among Partnered Women in Low- and Middle-Income South Asian Countries.

Importance: Intimate partner violence (IPV), including physical, sexual, and emotional violence, constitutes a critical public health problem, particularly in low- and middle-income countries. While climate change could escalate violent events, data quantifying its possible association with IPV are scant. Objective: To evaluate the association of ambient temperature with the prevalence of IPV among partnered women in low- and middle-income countries in South Asia, and to estimate the association of future climate warming with IPV. Design, Setting, and Participants: This cross-sectional study used data from the Demographic and Health Survey and included 194 871 ever-partnered women aged 15 to 49 years from 3 South Asian countries (India, Nepal, and Pakistan). The study applied the mixed-effect multivariable logistic regression model to investigate the association of ambient temperature with IPV prevalence. The study further modeled the change in IPV prevalence under various future climate change scenarios. The data included in the analyses were collected from October 1, 2010, to April 30, 2018, and the current analyses were performed from January 2, 2022, to July 11, 2022. Exposure: Annual ambient temperature exposure for each woman, estimated based on an atmospheric reanalysis model of the global climate. Main Outcomes and Measures: The prevalence of IPV and its types (physical, sexual, and emotional violence) were assessed based on self-reported questionnaires from October 1, 2010, to April 30, 2018, and the changes in the prevalence with climate changes were estimated through the 2090s. Results: The study included 194 871 ever-partnered women aged 15 to 49 years (mean [SD] age, 35.4 [7.6] years; overall IPV prevalence, 27.0%) from 3 South Asian countries. The prevalence of physical violence was highest (23.0%), followed by emotional (12.5%), and sexual violence (9.5%). The annual temperature ranges were mostly between 20 °C and 30 °C. A significant association was found between high ambient temperature and the prevalence of IPV against women, with each 1 °C increase in the annual mean temperature associated with a mean increase in IPV prevalence of 4.49% (95% CI, 4.20%-4.78%). According to the study's projections under the unlimited emissions scenarios (SSPs [shared socioeconomic pathways], as defined by the Intergovernmental Panel on Climate Change] 5-8.5), IPV prevalence would increase by 21.0% by the end of the 21st century, while it would only moderately increase under increasingly stricter scenarios (SSP2-4.5 [9.8%] and SSP1-2.6 [5.8%]). In addition, the projected increases in the prevalence of physical (28.3%) and sexual (26.1%) violence were greater than that of emotional violence (8.9%). In the 2090s, India was estimated to experience the highest IPV prevalence increase (23.5%) among the 3 countries, compared with Nepal (14.8%) and Pakistan (5.9%). Conclusions and Relevance: This cross-sectional, multicountry study provides ample epidemiological evidence to support that high ambient temperature may be associated with the risk of IPV against women. These findings highlight the vulnerabilities and inequalities of women experiencing IPV in low- and middle-income countries in the context of global climate warming.

Evolution in disparity of PM2.5 pollution in China.

The spatial disparity of air pollutants is one of the key influential factors for environmental inequality. We quantitatively evaluated the evolution of PM2.5 spatial disparity in China during 2013-2020, and investigated the associations between PM2.5 spatial disparity and economic indicators. Differences in PM2.5 between more- and less-polluted cities declined over time, suggesting decreased absolute disparity. However, the more polluted cities in 2013 remained so in 2017 and 2020, and vice versa, indicating persistent relative disparity. PM2.5 pollution levels increased with higher GDP per capita in less-developed areas of China, but such negative effects weakened over time, while economic development tended to promote cleaner air in developed areas of China. Therefore, policies to improve air quality and promote economic development simultaneously are needed in China to reduce the disparity of air pollution and promote all people to enjoy environmental equality.

The inequality labor loss risk from future urban warming and adaptation strategies.

Heat-induced labor loss is a major economic cost related to climate change. Here, we use hourly heat stress data modeled with a regional climate model to investigate the heat-induced labor loss in 231 Chinese cities. Results indicate that future urban heat stress is projected to cause an increase in labor losses exceeding 0.20% of the total account gross domestic product (GDP) per year by the 2050s relative to the 2010s. In this process, certain lower-paid sectors could be disproportionately impacted. The implementation of various urban adaptation strategies could offset 10% of the additional economic loss per year and help reduce the inequality-related impact on lower-paid sectors. So future urban warming can not only damage cities as a whole but can also contribute to income inequality. The implication of adaptation strategies should be considered in regard to not only cooling requirements but also environmental justice.

Life-cycle assessment of two sewage sludge-to-energy systems based on different sewage sludge characteristics: Energy balance and greenhouse gas-emission footprint analysis.

Anaerobic digestion and incineration are widely used sewage sludge (SS) treatment and disposal approaches to recovering energy from SS, but it is difficult to select a suitable technical process from the various technologies. In this study, life-cycle assessments were adopted to compare the energy- and greenhouse gas- (GHG) emission footprints of two sludge-to-energy systems. One system uses a combination of AD with incineration (the AI system), whereas the other was simplified by direct incineration (the DI system). Comparison between three SS feedstocks (VS/TS: 57.61 -73.1 ds.%) revealed that the AI system consistently outperformed the DI system. The results of sensitivity analyses showed that the energy and GHG emission performances were mainly affected by VS content of the SS, AD conversion efficiency, and the energy consumption of sludge drying. Furthermore, the energy and GHG emission credit of the two systems increased remarkably with the increase in the VS content of the SS. For the high-organic-content sludge (VS/TS: 55%-80%), the energy and GHG emission credit of the AI system increase with the increase of AD conversion efficiency. However, for the low organic content sludge (VS/TS: 30%-55%), it has the opposite effect. In terms of energy efficiency and GHG performance, the AI system is a good choice for the treatment of high-organic-content sludge (VS/TS>55%), but DI shows superiority over AI when dealing with low organic content sludge (VS/TS<55%).

Necessity of personal sampling for exposure assessment on specific constituents of PM2.5: Results of a panel study in Shanghai, China.

Many epidemiological studies have evaluated the health risks of ambient fine particulate matter (PM2.5). However, few studies have investigated the potential exposure misclassification caused by using ambient PM2.5 concentrations as proxy for individual exposure to PM2.5 in regions with high-level of air pollution. This study aimed to compare the differences between personal and ambient PM2.5 constituent concentrations, and to predict the personal exposure of sixteen PM2.5 constituents. We collected 141 72-h personal exposure filter samples from a panel of 36 healthy non-smoking college students in Shanghai, China. We then used the liner mixed effects models to predict personal constituent-specific exposure using ambient observations and several possible influencing factors including time-activity patterns, temporal variables, and meteorological conditions. The final model of each component was further evaluated by determination coefficient (R2) and root mean square error (RMSE) from leave-one-out-cross-validation (LOOCV). We observed ambient concentrations were higher than personal concentrations for all PM2.5 components except for Mn, Fe, Ca, and V. Especially, ambient NH4+, As, and NO3- concentrations were 3.65, 5.65 and 7.33-fold higher than their corresponding personal concentrations, respectively. The ambient level was the strongest predictor of their corresponding personal PM2.5 components with the highest marginal R2 (RM2: 0.081 ~ 0.901), meteorological conditions (RM2: 0.000 ~ 0.357), time-activity pattern (RM2: 0.000 ~ 0.083) and temporal indicators (RM2: 0.031 ~ 0.562) were also important predictors. Our final models predicted at least 50% of the variance of all personal PM2.5 constituents and even over 90% for K, Pb, and SO42-. LOOCV analysis showed that R2 and RMSE ranged from 0.251 to 0.907 and 0.000 to 0.092 µg/m3, respectively. Our results showed that ambient concentration of most PM2.5 constituents along with time-activity patterns, temporal variables, and meteorological conditions, could adequately predict personal exposure concentration. Prediction models of individual PM2.5 constituent may help to improve the accuracy of exposure measurement in future epidemiological studies.

The Impact of Ambient Air Pollution on Daily Hospital Visits for Various Respiratory Diseases and the Relevant Medical Expenditures in Shanghai, China.

The evidence concerning the acute effects of ambient air pollution on various respiratory diseases was limited in China, and the attributable medical expenditures were largely unknown. From 2013 to 2015, we collected data on the daily visits to the emergency- and outpatient-department for five main respiratory diseases and their medical expenditures in Shanghai, China. We used the overdispersed generalized additive model together with distributed lag models to fit the associations of criteria air pollutants with hospital visits, and used the linear models to fit the associations with medical expenditures. Generally, we observed significant increments in emergency visits (8.81-17.26%) and corresponding expenditures (0.33-25.81%) for pediatric respiratory diseases, upper respiratory infection (URI), and chronic obstructive pulmonary disease (COPD) for an interquartile range increase of air pollutant concentrations over four lag days. As a comparison, there were significant but smaller increments in outpatient visits (1.36-4.52%) and expenditures (1.38-3.18%) for pediatric respiratory diseases and upper respiratory infection (URI). No meaningful changes were observed for asthma and lower respiratory infection. Our study suggested that short-term exposure to outdoor air pollution may induce the occurrences or exacerbation of pediatric respiratory diseases, URI, and COPD, leading to considerable medical expenditures upon the patients.

Air Pollution, Disease Burden, and Health Economic Loss in China.

As the largest developing country in the world, China is now facing one of the severest air pollution problems. The objective of this section is to evaluate the disease burden and corresponding economic loss attributable to ambient air pollution in China. We reviewed a series of studies by Chinese or foreign investigators focusing on the disease burden and economic loss in China. These studies showed both the general air pollution and haze episodes have resulted in substantial disease burden in terms of excess number of premature deaths, disability-adjusted life-year loss, and years of life lost. The corresponding economic loss has accounted for an appreciable proportion of China's national economy. Overall, the disease burden and health economic loss due to ambient air pollution in China is greater than in the remaining parts of the world, for one of the highest levels of air pollution and the largest size of exposed population. Consideration of both health and economic impacts of air pollution can facilitate the Chinese government to develop environmental policies to reduce the emissions of various air pollutants and protect the public health.

Analysis of residents' willingness to pay to reduce air pollution to improve children's health in community and hospital settings in Shanghai, China.

BACKGROUND: Shanghai, along with many major cities in China, faces deterioration of air quality and increases in air pollution-related respiratory diseases (RDs) in children due to rapid industrialization and urbanization. The Contingent Valuation Method (CVM) was used to qualitatively and quantitatively measure the willingness to pay (WTP) for reducing children's RDs through air quality improvement. METHODS: Between April and May, 2014, 975 face-to-face interviews were collected from parents in a community-based and a hospital-setting in Shanghai. Multiple imputation and the Probit model were used to determine the relationship between the WTP and the related environmental factors, child health factors and the socio-economic status. RESULTS: Most respondents reported being willing to make a financial contribution to improve air quality in both the community (52.6%) and hospital (70.2%) samples. Those in the hospital setting were willing to pay significantly more ¥504 (USD$80.7) compared to the community sample ¥428 ($68.5) as expected. Reasons for those not being willing to pay included lack of disposable income and believing that responsibility of the air quality was a community issue. These did not differ by sample. Annual household income and education were related to WTP. CONCLUSION: This study indicated that parents in Shanghai would be willing to pay for improved air quality. Children's health can be the incentive for the citizens' participation and support in the air quality improvement, therefore, hospital settings may present unique places to improve education about air quality and enhance advocacy efforts. This study also suggested that future environmental policies be addressed more rigorously for targeted populations.

Multifunctional AlPO4 coating for improving electrochemical properties of low-cost Li[Li0.2Fe0.1Ni0.15Mn0.55]O2 cathode materials for lithium-ion batteries.

Layered Li-rich, Fe- and Mn-based cathode material, Li[Li0.2Fe0.1Ni0.15Mn0.55]O2, has been successfully synthesized by a coprecipitation method and further modified with different coating amounts of AlPO4 (3, 5, and 7 wt %). The effects of AlPO4 coating on the structure, morphology and electrochemical properties of these materials are investigated systematically. XRD results show that the pristine sample is obtained with typical Li-rich layered structure and trace amount of Li3PO4 phase are observed for the coated samples. The morphology observations reveal that all the samples show spherical particles (3-4 µm in diameter) with hierarchical structure, composed of nanoplates and nanoparticles. XPS analysis confirms the existence of AlPO4 and Li3PO4 phases at the surface. The electrochemical performance results indicate that the sample coated with 5 wt % AlPO4 exhibits the highest reversible capacity (220.4 mA h g(-1) after 50 cycles at 0.1C), best cycling performance (capacity retention of 74.4% after 50 cycles at 0.1C) and rate capability (175.3 mA h g(-1) at 1C, and 120.2 mA h g(-1) at 10C after 100 cycles) among all the samples. Cycle voltammograms show good reversibility of the coated samples. EIS analysis reveals that charge transfer resistance after coating is much lower than that of the pristine sample. The excellent electrochemical performances can be attributed to the effects of multifunctional AlPO4 coating layer, including the suppression of surface side reaction and oxygen vacancies diffusion, the acceleration of lithium ions transport as well as the lower electrochemical resistance. Our research provides a new insight of surface modification on low-cost Li-rich material to achieve high energy as the next-generation cathode of lithium-ion batteries.

The positive roles of integrated layered-spinel structures combined with nanocoating in low-cost Li-rich cathode Li[Li0.2Fe0.1Ni0.15Mn0.55]O2 for lithium-ion batteries.

As the most promising cathodes of lithium-ion batteries, lithium-rich manganese-based layered oxides with high capacity suffer from poor cycle stability, poor rate capability, and fast voltage fading. Here we introduced AlF3 into the surface of layered lithium-rich cathode (Li[Li0.2Fe0.1Ni0.15Mn0.55]O2) as an artificial protective layer as well as an inducer of integrated layered-spinel structures to achieve both low cost and high capacity. The reduced irreversible capacity loss, improved cycling stability, and superior high-rate capability were ascribed to the combination of AlF3 nanocoating and the unique structures as well as the low charge transfer resistance. Besides, the intractable issue, fast voltage fading of the layered lithium-rich cathode was also alleviated. Such materials with both low cost and high capacity are considered to be promising candidate cathodes to achieve lithium-ion batteries with high energy and high power.

Organic-acid-assisted fabrication of low-cost Li-rich cathode material (Li[Li1/6Fe1/6Ni1/6Mn1/2]O2) for lithium-ion battery.

A novel Li-rich cathode Li[Li1/6Fe1/6Ni1/6Mn1/2]O2 (0.4Li2MnO3-0.6LiFe1/3Ni1/3Mn1/3O2) was synthesized by a sol-gel method, which uses citric acid (SC), tartaric acid (ST), or adipic acid (SA) as a chelating agent. The structural, morphological, and electrochemical properties of the prepared samples were characterized by various methods. X-ray diffraction showed that single-phase materials are formed mainly with typical α-NaFeO2 layered structure (R3̅m), and the SC sample has the lowest Li/Ni cation disorder. The morphological study indicated homogeneous primary particles in good distribution size (100 nm) with small aggregates. The Fe, Ni, and Mn valences were determined by X-ray absorption near-edge structure analysis. In coin cell tests, the initial reversible discharge capacity of an SA electrode was 289.7 mAh g(-1) at the 0.1C rate in the 1.5-4.8 V voltage range, while an SC electrode showed a better cycling stability with relatively high capacity retention. At the 2C rate, the SC electrode can deliver a discharge capacity of 150 mAh g(-1) after 50 cycles. Differential capacity vs voltage curves were employed to further investigate the electrochemical reactions and the structural change process during cycling. This low-cost, Fe-based compound prepared by the sol-gel method has the potential to be used as the high capacity cathode material for Li-ion batteries.

Stock volatility and stroke mortality in a Chinese population.

AIM: This work was done to study the relationship between stock volatility and stroke mortality in Shanghai, China. METHODS: Daily stroke death numbers and stock performance data from 1 January 2006 to 31 December 2008 in Shanghai were collected from the Shanghai Center for Disease Control and Prevention and Shanghai Stock Exchange (SSE), respectively. Data were analysed with overdispersed generalized linear Poisson models, controlling for long-term and seasonal trends of stroke mortality and weather conditions with natural smooth functions, as well as Index closing value, air pollution levels and day of the week. RESULTS: We observed a U-shaped relationship between the Index change and stroke deaths: both rising and falling of the Index were associated with more deaths, and the fewest deaths coincided with little or no change of the Index. We also examined the absolute daily change of the Index in relation to stroke deaths: each 100-point Index change corresponded to 3.22% [95% confidence interval (CI) 0.45-5.49] increase of stroke deaths. CONCLUSION: We found that stroke deaths fluctuated with daily stock changes in Shanghai, suggesting that stock volatility may adversely affect cerebrovascular health.

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.

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.