Air Pollutants and Mortality Risk in Patients with Aortic Dissection: Evidence from a Clinical Cohort, Single-Cell Sequencing, and Proteomics.

We aimed to evaluate the association between air pollutants and mortality risk in patients with acute aortic dissection (AAD) in a longitudinal cohort and to explore the potential mechanisms of adverse prognosis induced by fine particulate matter (PM2.5). Air pollutants data, including PM2.5, PM10.0, nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), and ozone (O3), were collected from official monitoring stations, and multivariable Cox regression models were applied. Single-cell sequencing and proteomics of aortic tissue were conducted to explore the potential mechanisms. In total, 1,267 patients with AAD were included. Exposure to higher concentrations of air pollutants was independently associated with an increased mortality risk. The high-PM2.5 group carried approximately 2 times increased mortality risk. There were linear associations of PM10, NO2, CO, and SO2 exposures with long-term mortality risk. Single-cell sequencing revealed an increase in mast cells in aortic tissue in the high-PM2.5 exposure group. Enrichment analysis of the differentially expressed genes identified the inflammatory response as one of the main pathways, with IL-17 and TNF signaling pathways being among the top pathways. Analysis of proteomics also identified these pathways. This study suggests that exposure to higher PM2.5, PM10, NO2, CO, and SO2 are associated with increased mortality risk in patients with AAD. PM2.5-related activation and degranulation of mast cells may be involved in this process.

Toxic Potencies of Particulate Matter from Typical Industrial Plants Mediated with Acidity via Metal Dissolution.

Acidity is an important property of particulate matter (PM) in the atmosphere, but its association with PM toxicity remains unclear. Here, this study quantitively reports the effect of the acidity level on PM toxicity via pH-control experiments and cellular analysis. Oxidative stress and cytotoxicity potencies of acidified PM samples at pH of 1-2 were up to 2.8-5.2 and 2.1-13.2 times higher than those at pH of 8-11, respectively. The toxic potencies of PM samples from real-world smoke plumes at the pH of 2.3 were 9.1-18.2 times greater than those at the pH of 5.6, demonstrating a trend similar to that of acidified PM samples. Furthermore, the impact of acidity on PM toxicity was manifested by promoting metal dissolution. The dramatic increase by 2-3 orders of magnitude in water-soluble metal content dominated the variation in PM toxicity. The significant correlation between sulfate, the pH value, water-soluble Fe, IC20, and EC1.5 (p < 0.05) suggested that acidic sulfate could enhance toxic potencies by dissolving insoluble metals. The findings uncover the superficial association between sulfate and adverse health outcomes in epidemiological research and highlight the control of wet smoke plume emissions to mitigate the toxicity effects of acidity.

Unaddressed Uncertainties When Scaling Regional Aircraft Emission Surveys to Basin Emission Estimates.

Wide-area aerial methods provide comprehensive screening of methane emissions from oil and gas (O & G) facilities in production basins. Emission detections ("plumes") from these studies are also frequently scaled to the basin level, but little is known regarding the uncertainties during scaling. This study analyzed an aircraft field study in the Denver-Julesburg basin to quantify how often plumes identified maintenance events, using a geospatial inventory of 12,629 O & G facilities. Study partners (7 midstream and production operators) provided the timing and location of 5910 maintenance events during the 6 week study period. Results indicated three substantial uncertainties with potential bias that were unaddressed in prior studies. First, plumes often detect maintenance events, which are large, short-duration, and poorly estimated by aircraft methods: 9.2 to 46% (38 to 52%) of plumes on production were likely known maintenance events. Second, plumes on midstream facilities were both infrequent and unpredictable, calling into question whether these estimates were representative of midstream emissions. Finally, 4 plumes attributed to O & G (19% of emissions detected by aircraft) were not aligned with any O & G location, indicating that the emissions had drifted downwind of some source. It is unclear how accurately aircraft methods estimate this type of plume; in this study, it had material impact on emission estimates. While aircraft surveys remain a powerful tool for identifying methane emissions on O & G facilities, this study indicates that additional data inputs, e.g., detailed GIS data, a more nuanced analysis of emission persistence and frequency, and improved sampling strategies are required to accurately scale plume estimates to basin emissions.

Sustained Reductions of Bay Area CO2 Emissions 2018-2022.

Cities represent a significant and growing portion of global carbon dioxide (CO2) emissions. Quantifying urban emissions and trends over time is needed to evaluate the efficacy of policy targeting emission reductions as well as to understand more fundamental questions about the urban biosphere. A number of approaches have been proposed to measure, report, and verify (MRV) changes in urban CO2 emissions. Here we show that a modest capital cost, spatially dense network of sensors, the Berkeley Environmental Air Quality and CO2 Network (BEACO2N), in combination with Bayesian inversions, result in a synthesis of measured CO2 concentrations and meteorology to yield an improved estimate of CO2 emissions and provide a cost-effective and accurate assessment of CO2 emissions trends over time. We describe nearly 5 years of continuous CO2 observations (2018-2022) in a midsized urban region (the San Francisco Bay Area). These observed concentrations constrain a Bayesian inversion that indicates the interannual trend in urban CO2 emissions in the region has been a modest decrease at a rate of 1.8 ± 0.3%/year. We interpret this decrease as primarily due to passenger vehicle electrification, reducing on-road emissions at a rate of 2.6 ± 0.7%/year.

Seasonal extreme temperatures and short-term fine particulate matter increases pediatric respiratory healthcare encounters in a sparsely populated region of the intermountain western United States.

BACKGROUND: Western Montana, USA, experiences complex air pollution patterns with predominant exposure sources from summer wildfire smoke and winter wood smoke. In addition, climate change related temperatures events are becoming more extreme and expected to contribute to increases in hospital admissions for a range of health outcomes. Evaluating while accounting for these exposures (air pollution and temperature) that often occur simultaneously and may act synergistically on health is becoming more important. METHODS: We explored short-term exposure to air pollution on children's respiratory health outcomes and how extreme temperature or seasonal period modify the risk of air pollution-associated healthcare events. The main outcome measure included individual-based address located respiratory-related healthcare visits for three categories: asthma, lower respiratory tract infections (LRTI), and upper respiratory tract infections (URTI) across western Montana for ages 0-17 from 2017-2020. We used a time-stratified, case-crossover analysis with distributed lag models to identify sensitive exposure windows of fine particulate matter (PM2.5) lagged from 0 (same-day) to 14 prior-days modified by temperature or season. RESULTS: For asthma, increases of 1 µg/m3 in PM2.5 exposure 7-13 days prior a healthcare visit date was associated with increased odds that were magnified during median to colder temperatures and winter periods. For LRTIs, 1 µg/m3 increases during 12 days of cumulative PM2.5 with peak exposure periods between 6-12 days before healthcare visit date was associated with elevated LRTI events, also heightened in median to colder temperatures but no seasonal effect was observed. For URTIs, 1 unit increases during 13 days of cumulative PM2.5 with peak exposure periods between 4-10 days prior event date was associated with greater risk for URTIs visits that were intensified during median to hotter temperatures and spring to summer periods. CONCLUSIONS: Delayed, short-term exposure increases of PM2.5 were associated with elevated odds of all three pediatric respiratory healthcare visit categories in a sparsely population area of the inter-Rocky Mountains, USA. PM2.5 in colder temperatures tended to increase instances of asthma and LRTIs, while PM2.5 during hotter periods increased URTIs.

A novel framework for high resolution air quality index prediction with interpretable artificial intelligence and uncertainties estimation.

Accurate air quality index (AQI) prediction is essential in environmental monitoring and management. Given that previous studies neglect the importance of uncertainty estimation and the necessity of constraining the output during prediction, we proposed a new hybrid model, namely TMSSICX, to forecast the AQI of multiple cities. Firstly, time-varying filtered based empirical mode decomposition (TVFEMD) was adopted to decompose the AQI sequence into multiple internal mode functions (IMF) components. Secondly, multi-scale fuzzy entropy (MFE) was applied to evaluate the complexity of each IMF component and clustered them into high and low-frequency portions. In addition, the high-frequency portion was secondarily decomposed by successive variational mode decomposition (SVMD) to reduce volatility. Then, six air pollutant concentrations, namely CO, SO2, PM2.5, PM10, O3, and NO2, were used as inputs. The secondary decomposition and preliminary portion were employed as the outputs for the bidirectional long short-term memory network optimized by the snake optimization algorithm (SOABiLSTM) and improved Catboost (ICatboost), respectively. Furthermore, extreme gradient boosting (XGBoost) was applied to ensemble each predicted sub-model to acquire the consequence. Ultimately, we introduced adaptive kernel density estimation (AKDE) for interval estimation. The empirical outcome indicated the TMSSICX model achieved the best performance among the other 23 models across all datasets. Moreover, implementing the XGBoost to ensemble each predicted sub-model led to an 8.73%, 8.94%, and 0.19% reduction in RMSE, compared to SVM. Additionally, by utilizing SHapley Additive exPlanations (SHAP) to assess the impact of the six pollutant concentrations on AQI, the results reveal that PM2.5 and PM10 had the most notable positive effects on the long-term trend of AQI. We hope this model can provide guidance for air quality management.

[Pollution Characteristics, Source, and Health Risk Assessment of Metal Elements in PM2.5 Between Winter and Spring in Zhengzhou].

A total of 18 metal elements in ambient PM2.5 in Zhengzhou were continuously determined using an online heavy metal observation instrument in January and April, 2021, and the changes in element concentrations were analyzed. Metal elements were traced via enrichment factors, positive matrix factorization (PMF), and a characteristic radar chart. The US EPA health risk assessment model was used to assess the health risks of heavy metals, and the backward trajectory method and the concentration-weighted trajectory (CWT) method were used to evaluate the potential source regions of health risks. The results showed that the element concentrations were higher in spring, and the sum of Fe, Ca, Si, and Al concentrations accounted for 89.8% and 87.5% of the total element concentrations in winter and spring, respectively. Cd was enriched significantly, which was related to human activities. The concentrations of Pb, Se, Zn, Ni, Sb, and K in winter and Cr, Ni, Fe, Mn, V, Ba, Ca, K, Si, and Al in spring increased with the increasing pollution level. The results of PMF and the characteristic radar chart showed that the main sources of metal elements in winter and spring were industry, crust, motor vehicles, and mixed combustion, with industry and mixed combustion pollution occurring more often in winter and crust pollution occurring more often in spring. Significant non-carcinogenic risks existed in both winter and spring with more severe health risks in winter, and Mn caused significant non-carcinogenic risks. The health risks in winter were mainly influenced by Zhengzhou and surrounding cities and long-distance transport in the northwest, and the health risks in spring were mainly influenced by Zhengzhou and surrounding cities.

[Characteristics, Sources Apportionment, and Health Risks of PM2.5-bound PAHs and Their Derivatives Before and After Heating in Zibo City].

Atmospheric polycyclic aromatic hydrocarbons (PAHs) and their derivatives are a global problem that influences the environment and threatens human health. To investigate the characteristics, sources, and health risk assessment of PM2.5-bound PAHs and their derivatives, PM2.5 were collected at an urban site in Zibo from November 5 to December 26, 2020, and the concentrations of 16 conventional PAHs, nine NPAHs, and five OPAHs in PM2.5 were analyzed using gas chromatography-mass spectrometry. Source apportionment of PAHs and their derivatives was conducted using diagnostic ratios and a PMF model, and the health risks of PAHs and their derivatives to adult men and women were evaluated using the source-dependent incremental lifetime cancer risk (ILCR) model. The results showed that the average concentrations of ∑16pPAHs, ∑9NPAHs, and ∑5OPAHs in PM2.5 of Zibo City during the sampling period were (41.61 ± 13.40), (6.38 ± 5.70), and (53.20 ± 53.47) ng·m-3, respectively. The concentrations of the three PAHs increased significantly after heating, which were 1.31, 2.04, and 5.24 times larger than those before heating. During the sampling period, Chr, BaP, and BaA were the dominant components of pPAHs; 9N-Ant and 2N-Flt + 3N-Flt were the dominant components of NPAHs; and ATQ and BZO were the dominant components of OPAHs. Source apportionment results showed that motor vehicles were the main source of PAHs and their derivatives in PM2.5 before heating, whereas after heating, the main sources were the mixed source of coal and biomass combustion and secondary formation. The total BaP equivalent (TEQ) was 14.5 ng·m-3 during the sampling period, and the TEQ increased significantly after heating, which was approximately 1.2 times of that before heating. Assisted by the individual PAH source apportionment results, the ILCR of PM2.5-boundPAHs and NPAHs in Zibo City had a certain potential carcinogenic risk for adult males (1.06 × 10-5) and females (9.32 × 10-6). Among them, the health risks of PAHs from gasoline vehicles, diesel vehicles, and coal/biomass combustion were significantly higher than those from other emission sources.

[Spatial and Temporal Distribution Characteristics of Ozone Concentration and Health Benefit Assessment in the Beijing-Tianjin-Hebei Region from 2015 to 2020].

To evaluate the spatial and temporal distribution characteristics of ambient ozone (O3) in the Beijing-Tianjin-Hebei (BTH) Region, the land use regression (LUR) model and random forest (RF) model were used to simulate the ambient O3 concentration from 2015 to 2020. Meanwhile, all-cause, cardiovascular, and respiratory mortalities as well as economic losses attributed to O3 were also estimated. The results showed that upward trends with fluctuation were observed for ambient O3 concentration, mortalities, and economic losses attributable to O3 exposure in the BTH Region from 2015 to 2020. The areas with high O3 concentration and great changes were concentrated in the central and southwestern regions, whereas the concentration in the northern region was low, and the change degree was small. The spatial distribution of the mortalities was also consistent with the spatial distribution of O3 concentration. From 2015 to 2020, the economic losses regarding all-cause mortality and cardiovascular mortality increased in 13 cities of the BTH Region, whereas the economic losses of respiratory mortality decreased in 4 cities in the BTH Region. The results indicated that the priority areas for O3 control were not uniform. Specifically, Beijing, Tianjin, Hengshui, and Xingtai were vital areas for O3 pollution control in the BTH Region. Differentiated control measures should be adopted based on the characteristics of these target areas to decline O3 concentration and reduce health impacts and economic losses associated with O3 exposure.

Microalgal biochar assisted simultaneous removal of particulate matter, formaldehyde, and total volatile organic compounds (TVOC's) from indoor air.

Biochar-based materials for air treatment have gained significant attention for removing health-detrimental volatile organic compounds (VOCs) and particulate matter (PM) in indoor air settings. However, high turnaround time, multiple pretreatment processes involved, and high pore size and low surface area (>10 µm, <100 m2 g-1) of lignocellulosic feedstocks demand alternative biochar feedstock material. Considering this, we designed a simple first-of-its-kind indoor air scrubbing material using diatoms-enriched microalgae biochar. In the present study, the microalgae were cultivated on waste anaerobic digestate (biogas slurry) and were pyrolyzed at three different temperatures: 300 °C (BC300), 500 °C (BC500), and 700 °C (BC700). The BC500 and BC700 showed the highest removal efficiencies (99 %) for total volatile organic carbons (TVOCs) and formaldehyde (HCHO) at concentrations of 1.22 mg m-3 HCHO and 8.57 mg m-3 TVOC compared to 50% efficiency obtained with commercially available surgical, cloth, and N95 masks. The biochar obtained showed a high Brunauer-Emmett-Teller (BET) surface area of 238 m2 g-1 (BC500) and 480 m2 g-1 (BC700) and an average pore size of 9-11 nm due to the mesoporous characteristic of diatom frustules. The comparatively poor performance of BC300 was due to lower surface area (150 m2 g-1) arising from incomplete organic removal, as evidenced by FESEM-EDX and FTIR. The high removal efficiencies in BC500 and BC700 were also attributed to the presence of reactive functional groups such as -OH and R-NH2. Concurrently, the average particulate matter (PM10, PM2.5, and PM1) removal efficiency for BC500 and BC 700 ranged between 66 and 82.69 %. The PM removal performance of BC500 and BC700 was lower (15-20%) than commercially available masks. Overall, the present study highlights the importance of diatoms (reactive Si) present inside the pores of microalgal biochar for enhanced removal of PM, TVOCs, and HCHO at temperatures above 500 °C. This complete approach signifies a step towards establishing a self-sustainable and circular process characterized by minimal waste generation for indoor air treatment.

Emission characteristics of condensable particulate matter during the production of solid waste-based sulfoaluminate cement: Compositions, heavy metals, and preparation impacts.

Recycling solid waste for preparing sulfoaluminate cementitious materials (SACM) represents a promising approach for low-carbon development. There are drastic physical-chemical reactions during SACM calcination. However, there is a lack of research on the flue gas pollutants emissions from this process. Condensable particulate matter (CPM) has been found to constitute the majority of the primary PM emitted from various fuel combustion. In this study, the emission characteristics of CPM during the calcination of SACM were determined using tests in both a real-operated kiln and laboratory experiments. The mass concentration of CPM reached 96.6 mg/Nm3 and occupied 87% of total PM emission from the SACM kiln. Additionally, the mass proportion of SO42- in the CPM reached 93.8%, thus indicating that large quantities of sulfuric acid mist or SO3 were emitted. CaSO4 was one key component for the formation of main mineral ye'elimite (3CaO·3Al2O3·CaSO4), and its decomposition probably led to the high SO42- emission. Furthermore, the use of CaSO4 as a calcium source led to SO42- emission factor much higher than conventional calcium sources. Higher calcination temperature and more residence time also increased SO42- emission. The most abundant heavy metal in kiln flue gas and CPM was Zn. However, the total condensation ratio of heavy metals detected was only 40.5%. CPM particles with diameters below 2.5 µm and 4-20 µm were both clearly observed, and components such as Na2SO4 and NaCl were conformed. This work contributes to the understanding of CPM emissions and the establishment of pollutant reduction strategies for waste collaborative disposal in cement industry.

Assessing the health burden from air pollution.

A broader approach to assessing the burden of disease from air pollution is required.

Up-bottom assessments of nutrient supply and gaseous pollutant from Chinese wheat straw field management.

To achieve resource efficiency, and carbon neutrality, it is vital to evaluate nutrient supply and gaseous pollutant emissions associated with field management of bio-straw resources. Previous straw yield estimates have typically relied on a constant grain-to-straw yield ratio without accounting for grain yield levels in a given region. Addressing this high-resolution data gap, our study introduces a novel empirical model for quantifying grain-to-straw yield, which has been used to gauge wheat straw field management practices at the city level during 2011-2015. Utilizing both statistical review and GIS-based methods, average nitrogen (N), phosphorus (P), and potassium (K) supplies from straw field management stood at 1510, 1229, and 61700 tons, respectively. Average emissions of PM2.5, SO2, NOx, NH3, CH4, and CO2 due to straw burning were 367, 41, 160, 18, 165, and 70,644 tons, respectively. We also reported uncertainty from Monte Carlo model as the 5th-95th percentiles of estimated nutrient supply and gaseous pollutant. These insights will provide foundational support for the sustainable and environmentally friendly management of wheat straw in China.

Ozone pollution contributes to the yield gap for beans in Uganda, East Africa, and is co-located with other agricultural stresses.

Air quality negatively impacts agriculture, reducing the yield of staple food crops. While measured data on African ground-level ozone levels are scarce, experimental studies demonstrate the damaging impact of ozone on crops. Common beans (Phaseolus vulgaris), an ozone-sensitive crop, are widely grown in Uganda. Using modelled ozone flux, agricultural surveys, and a flux-effect relationship, this study estimates yield and production losses due to ozone for Ugandan beans in 2015. Analysis at this scale allows the use of localised data, and results can be presented at a sub-regional level. Soil nutrient stress, drought, flood risk, temperature and deprivation were also mapped to investigate where stresses may coincide. Average bean yield losses due to ozone were 17% and 14% (first and second growing season respectively), equating to 184 thousand tonnes production loss. However, for some sub-regions, losses were up to 27.5% and other crop stresses also coincided in these areas. This methodology could be applied widely, allowing estimates of ozone impact for countries lacking air quality and/or experimental data. As crop productivity is below its potential in many areas of the world, changing agricultural practices to mitigate against losses due to ozone could help to reduce the crop yield gap.

Mortality Burden Due to Short-term Exposure to Fine Particulate Matter in Korea.

OBJECTIVES: Excess mortality associated with long-term exposure to fine particulate matter (PM2.5) has been documented. However, research on the disease burden following short-term exposure is scarce. We investigated the cause-specific mortality burden of short-term exposure to PM2.5 by considering the potential non-linear concentration-response relationship in Korea. METHODS: Daily cause-specific mortality rates and PM2.5 exposure levels from 2010 to 2019 were collected for 8 Korean cities and 9 provinces. A generalized additive mixed model was employed to estimate the non-linear relationship between PM2.5 exposure and cause-specific mortality levels. We assumed no detrimental health effects of PM2.5 concentrations below 15 µg/m3. Overall deaths attributable to short-term PM2.5 exposure were estimated by summing the daily numbers of excess deaths associated with ambient PM2.5 exposure. RESULTS: Of the 2 749 704 recorded deaths, 2 453 686 (89.2%) were non-accidental, 591 267 (21.5%) were cardiovascular, and 141 066 (5.1%) were respiratory in nature. A non-linear relationship was observed between all-cause mortality and exposure to PM2.5 at lag0, whereas linear associations were evident for cause-specific mortalities. Overall, 10 814 all-cause, 7855 non-accidental, 1642 cardiovascular, and 708 respiratory deaths were attributed to short-term exposure to PM2.5. The estimated number of all-cause excess deaths due to short-term PM2.5 exposure in 2019 was 1039 (95% confidence interval, 604 to 1472). CONCLUSIONS: Our findings indicate an association between short-term PM2.5 exposure and various mortality rates (all-cause, non-accidental, cardiovascular, and respiratory) in Korea over the period from 2010 to 2019. Consequently, action plans should be developed to reduce deaths attributable to short-term exposure to PM2.5.

Exploring the adverse effect of fine particulate matter (PM2.5) on wildland firefighters' pulmonary function and DNA damage.

Chiang Mai encounters severe pollution during the wildfire season. Wildland firefighters encounter various hazards while engaged in fire suppression operations, which encompass significant exposure to elevated concentrations of air pollutants resulting from combustion, especially particulate matter. The adverse effects of wildfire smoke on respiratory health are a significant concern. The objective of this study was to examine the potential adverse effects of PM2.5 exposure on the respiratory function and DNA damage of wildland firefighters. This prospective cohort study conducted in Chiang Mai from January to May 2022 planned to evaluate the health status of wildland firefighters during the pre-peak, peak, and post-peak ambient air pollution seasons. The measurement of PM2.5 was done at every forest fire station, as well as utilizing data from the Pollution Control Department. Participants received general health examinations, spirometry evaluations, and blood tests for DNA damage analysis. Pair t-tests and multiple regression models were used to examine the connection between pulmonary function parameters (FVC, FEV1) and PM2.5 concentration, with a significance level of P < 0.05. Thirty-three peak-season and twenty-one post-peak-season participants were enrolled. Four pre-peak-season wildland firefighters had FVC and FEV1 declines of > 15%. Multiple regression analysis showed a negative association between PM2.5 exposure and FVC% predicted (- 2.81%, 95% CI - 5.27 to - 0.34%, P = 0.027) and a marginally significant negative correlation with FVC (- 114.38 ml, 95% CI - 230.36 to 1.59 ml, P = 0.053). The remaining pulmonary measures showed a statistically insignificant decline. There were no significant changes in DNA damage detected. Wildland firefighters suffered a significant decline in pulmonary function associated with PM2.5 exposure. Spirometry is crucial for monitoring and promptly identifying respiratory issues that occur during wildfire seasons. Further research is recommended to explore DNA damage alterations and their potential association with PM2.5.

Exposure to ambient air pollution and cognitive function: an analysis of the English Longitudinal Study of Ageing cohort.

BACKGROUND: An increasing number of studies suggest adverse effects of exposure to ambient air pollution on cognitive function, but the evidence is still limited. We investigated the associations between long-term exposure to air pollutants and cognitive function in the English Longitudinal Study of Ageing (ELSA) cohort of older adults. METHODS: Our sample included 8,883 individuals from ELSA, based on a nationally representative study of people aged ≥ 50 years, followed-up from 2002 until 2017. Exposure to air pollutants was modelled by the CMAQ-urban dispersion model and assigned to the participants' residential postcodes. Cognitive test scores of memory and executive function were collected biennially. The associations between these cognitive measures and exposure to ambient concentrations of NO2, PM10, PM2.5 and ozone were investigated using mixed-effects models adjusted for time-varying age, physical activity and smoking status, as well as baseline gender and level of education. RESULTS: Increasing long-term exposure per interquartile range (IQR) of NO2 (IQR: 13.05 µg/m3), PM10 (IQR: 3.35 µg/m3) and PM2.5 (IQR: 2.7 µg/m3) were associated with decreases in test scores of composite memory by -0.10 (95% confidence interval [CI]: -0.14, -0.07), -0.02 [-0.04, -0.01] and -0.08 [-0.11, -0.05], respectively. The same increases in NO2, PM10 and PM2.5 were associated with decreases in executive function score of -0.31 [-0.38, -0.23], -0.05 [-0.08, -0.02] and -0.16 [-0.22, -0.10], respectively. The association with ozone was inverse across both tests. Similar results were reported for the London-dwelling sub-sample of participants. CONCLUSIONS: The present study was based on a long follow-up with several repeated measurements per cohort participant and long-term air pollution exposure assessment at a fine spatial scale. Increasing long-term exposure to NO2, PM10 and PM2.5 was associated with a decrease in cognitive function in older adults in England. This evidence can inform policies related to modifiable environmental exposures linked to cognitive decline.

Cooking with liquefied petroleum gas or biomass and fetal growth outcomes: a multi-country randomised controlled trial.

BACKGROUND: Household air pollution might lead to fetal growth restriction during pregnancy. We aimed to investigate whether a liquefied petroleum gas (LPG) intervention to reduce personal exposures to household air pollution during pregnancy would alter fetal growth. METHODS: The Household Air Pollution Intervention Network (HAPIN) trial was an open-label randomised controlled trial conducted in ten resource-limited settings across Guatemala, India, Peru, and Rwanda. Pregnant women aged 18-34 years (9-19 weeks of gestation) were randomly assigned in a 1:1 ratio to receive an LPG stove, continuous fuel delivery, and behavioural messaging or to continue usual cooking with biomass for 18 months. We conducted ultrasound assessments at baseline, 24-28 weeks of gestation (the first pregnancy visit), and 32-36 weeks of gestation (the second pregnancy visit), to measure fetal size; we monitored 24 h personal exposures to household air pollutants during these visits; and we weighed children at birth. We conducted intention-to-treat analyses to estimate differences in fetal size between the intervention and control group, and exposure-response analyses to identify associations between household air pollutants and fetal size. This trial is registered with ClinicalTrials.gov (NCT02944682). FINDINGS: Between May 7, 2018, and Feb 29, 2020, we randomly assigned 3200 pregnant women (1593 to the intervention group and 1607 to the control group). The mean gestational age was 14·5 (SD 3·0) weeks and mean maternal age was 25·6 (4·5) years. We obtained ultrasound assessments in 3147 (98·3%) women at baseline, 3052 (95·4%) women at the first pregnancy visit, and 2962 (92·6%) at the second pregnancy visit, through to Aug 25, 2020. Intervention adherence was high (the median proportion of days with biomass stove use was 0·0%, IQR 0·0-1·6) and pregnant women in the intervention group had lower mean exposures to particulate matter with a diameter less than 2·5 µm (PM2·5; 35·0 [SD 37·2] µg/m3vs 103·3 [97·9] µg/m3) than did women in the control group. We did not find differences in averaged post-randomisation Z scores for head circumference (0·30 vs 0·39; p=0·04), abdominal circumference (0·38 vs 0·39; p=0·99), femur length (0·44 vs 0·45; p=0·73), and estimated fetal weight or birthweight (-0·13 vs -0·12; p=0·70) between the intervention and control groups. Personal exposures to household air pollutants were not associated with fetal size. INTERPRETATION: Although an LPG cooking intervention successfully reduced personal exposure to air pollution during pregnancy, it did not affect fetal size. Our findings do not support the use of unvented liquefied petroleum gas stoves as a strategy to increase fetal growth in settings were biomass fuels are used predominantly for cooking. FUNDING: US National Institutes of Health and Bill & Melinda Gates Foundation. TRANSLATIONS: For the Kinyarwanda, Spanish and Tamil translations of the abstract see Supplementary Materials section.

COVID-19 fatality and DALYs, and associated metabolic disorders and ambient air pollutants in pre-Omicron era of the pandemic: an international comparative study.

BACKGROUND: Air pollution and a number of metabolic disorders have been reported to increase the risk of severe COVID-19 outcomes. This study explored the association between severe COVID-19 outcomes, metabolic disorders and environmental air pollutants, at regional level, across 38 countries. METHODS: We conducted an ecological study using COVID-19 data related to countries of the Organization for Economic Cooperation and Development (OECD), with an estimated population of 1.4 billion. They were divided into 3 regions: 1. Europe & Middle east; 2. Americas (north, central & south America); 3. East-Asia & West Pacific. The outcome variables were: COVID-19 case-fatality rate (CFR) and disability-adjusted life years (DALYs) at regional level. Freely accessible datasets related to regional DALYs, demographics and other environmental pollutants were obtained from OECD, WHO and the World in Data websites. Generalized linear model (GLM) was performed to determine the regional determinants of COVID-19 CFR and DALYs using the aggregate epidemiologic data (Dec. 2019-Dec. 2021). RESULTS: Overall cumulative deaths were 65,000 per million, for mean CFR and DALYs of 1.31 (1.2)% and 17.35 (2.3) years, respectively. Globally, GLM analysis with adjustment for elderly population rate, showed that COVID-19 CFR was positively associated with atmospheric PM2.5 level (beta = 0.64(0.0), 95%CI: 0.06-1.35; p < 0.05), diabetes prevalence (beta = 0.26(0.1), 95%CI: 0.12-0.41; p < 0.001). For COVID-19 DALYs, positive associations were observed with atmospheric NOx level (beta = 0.06(0.0), 95%CI: 0.02-0.82; p < 0.05) and diabetes prevalence (beta = 0.32(0.2), 95%CI: 0.04-0.69; p < 0.05). At regional level, adjusted GLM analysis showed that COVID-19 CFR was associated with atmospheric PM2.5 level in the Americas and East-Asia & Western Pacific region; it was associated with diabetes prevalence for countries of Europe & Middle east and East-Asia & Western Pacific region. Furthermore, COVID-19 DALYs were positively associated with atmospheric PM2.5 and diabetes prevalence for countries of the Americas only. CONCLUSION: These findings confirm that diabetes and air pollution increase the risk of disability and fatality due to COVID-19, with disparities in terms of their impact. They suggest that efficient preventive and management programs for diabetes and air pollution countermeasures would have curtailed severe COVID-19 outcome rates.