Progress and future perspective of epidemiological research of air pollution and climate change in the context of achieving carbon peaking and carbon neutrality goals / 中华流行病学杂志

Climate change is the great health challenge for human beings in the 21st century. Air pollution is also an important public health problem worldwide. China announced the climate commitment to achieve carbon peaking by 2030 and carbon neutrality by 2060. Achieving these goals would not only have far-reaching effects on air pollution control and climate change, but also improve the population health in China. Air pollution and climate change epidemiology are important aspects of environmental epidemiology. In this paper, we discuss the current status and future development of epidemiological research of air pollution and climate change in the context of achieving carbon peaking and carbon neutrality goals to provide ideas and suggestions for environmental and health studies in the future.

A panel study on the acute respiratory effects of ambient particles of different sizes on children in Shanghai / 中华预防医学杂志

Objective: To explore the association between size-fractionated particle number concentrations (PNC) and respiratory health in children. Methods: From November 2018 to June 2019, there were 65 children aged 6-9 years from an elementary school in shanghai recruited in this panel study with three rounds of follow-up. The forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and exhaled nitric oxide (FeNO) levels were measured and buccal mucosa samples of children were collected at each follow-up visit. The level of PNC, temperature and humidity of the elementary school was monitored from 3 days before each physical examination to the end of the physical examination. The linear mixed effects model was used to analyze the association between PNC and indicators of respiratory health in children. Results: Linear mixed effects model analysis revealed that, at lag 2 day, an interquartile range increase in PNC for particles measuring 0.25-0.40 μm was associated with the absolute changes in FVC, FEV1 and abundance-based coverage estimator (ACE) about -60.15 ml (95%CI:-88.97 ml, -31.32 ml), -34.26 ml (95%CI:-63.22 ml, -5.31 ml), -6.00 (95%CI:-9.15, -2.84) and percentage change in FeNO about 12.10% (95%CI: 3.05%, 21.95%), respectively. These adverse health effects increased with the decrease of particle size. Conclusion: The short-term exposure to particulate matter is associated with reduced lung function, buccal microbe diversity and higher airway inflammation level among children. These adverse health effects may increase with the decrease of particle size.

Advances in research of effects of ambient ultrafine particles on human health / 上海预防医学

Particulate matters are primary pollutants and ubiquitous in most urban areas of China and prove to be an acknowledged risk to human health, whose degree of harm is realated to the particle size.Ultrafine particles (UFPs) with its diameter less than 0.1 μm may have greater adverse health effects compared with larger ones as fine particulate matters(PM10)and (PM2.5).However, there have been fewer studies and insuffient evidence in this regard.In this review, we analyze recent population-based studies on UFPs exposure and its health impacts and elucidate associations of UFPs exposure with subclinical endpoints changes so as to promote the awreness of UFPs and provide reference for its further research.

Impact of short-term exposure to ambient nitrogen dioxide on daily outpatient visits in 3 cities of China / 上海预防医学

Objective To explore associations between short-term exposure to ambient nitrogen dioxide (NO2) and hospital outpatient visits. Methods Daily outpatient visit data were obtained from 5 hospitals in Beijing, Shanghai, and Guangzhou, the three major cities in China.The study period was from 2013 to 2015.The causes of disease were determined in accordance to the International Classification of Disease 10th version, with the codes A00-R99.Daily air pollution data were from the nearest state-controlled environmental monitoring stations.City-level environmental factors were acquired, including temperature and relative humidity.A time-series generalized additive model (GAM) was adopted to explore the effect of daily NO2 exposure on hospital outpatient visits, after controlling the time trends, day of week (DOW), holiday, and environmental factors.Then a random-effect meta-analysis was used to pool the results across cities.We also explored the lag structure, two-pollutant models, and potential seasonal effect. Results During the study period, the average daily outpatient visits were 3 949.The average NO2 exposure level was 55.3 μg/m3.The lag analysis showed that NO2 exposure had the greatest effect on outpatient visits every day. For a 10 μg/m3 increase in NO2, outpatient visits remarkably increased by 0.85% (95%CI:0.51%-1.19%).The associations of NO2 remained robust after controlling co-pollutants, including fine particulate matter, ozone, sulfur dioxide and carbon monoxide.The effects of NO2 were more in cool seasons, and the exposure-response curves between NO2 and outpatient visits were nearly linear. Conclusions Short-term exposure to NO2 increases the risk of hospital outpatient visits in major cities, suggesting a need to further lower exposure levels of NO2 in China.

A Genetic Susceptibility Study of Lung Cancer Risk Potentially Associated with Polycyclic Aromatic Hydrocarbon Inhalation Exposure / 生物医学与环境科学（英文）

To establish a genetic susceptibility assessment model of lung cancer risk potentially associated with polycyclic aromatic hydrocarbon (PAH) inhalation exposure among non-smokers in China, a total of 143 patients with lung adenocarcinoma and 143 cancer-free individuals were recruited. Sixty-eight genetic polymorphisms in 10 pathways related to PAH metabolism and tumorigenesis were selected and examined. It was observed that 3 genetic polymorphisms, along with 10 additional genetic polymorphisms via gene-gene interactions, significantly influenced lung cancer risk potentially associated with PAH inhalation exposure. Most polymorphisms were associated with PAH metabolism. According to the established genetic susceptibility score (GSS), lung cancer risk increased with a rise in the GSS level, thereby indicating a positive dose-response relationship.

Ambient temperature and outpatient visits for acute exacerbation of chronic bronchitis in Shanghai: a time series analysis / 生物医学与环境科学（英文）

The association between ambient temperature and acute exacerbation of chronic bronchitis (AECB) was still unknown. Therefore, we performed an epidemiological study in a large hospital of Shanghai to explore the relationship about temperature and outpatient visit for AECB. We adopted a quasi-Poisson generalized additive models and distributed lag nonlinear models to estimate the accumulative effects of temperature on AECB across multiple days. We found significant non-linear effects of cold temperature on hospital visits for AECB, and the potential effect of cold temperature might last more than 2 weeks. The relative risks of extreme cold (first percentiles of temperature throughout the study period) and cold (10th percentile of temperature) temperature over lags 0-14 d were 2.98 [95% confidence intervals (CI): 1.77, 5.04] and 1.63 (95% CI: 1.21, 2.19), compared with the 25th percentile of temperature. However, we found no positive association between hospital visits and hot weather. This study showed that exposure to both extreme cold and cold temperatures were associated with increased outpatient visits for AECB in a large hospital of Shanghai.

Impact of temperature on mortality in three major Chinese cities / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To study the relation between temperature and mortality by estimating the temperature-related mortality in Beijing, Shanghai, and Guangzhou.</p><p><b>METHODS</b>Data of daily mortality, weather and air pollution in the three cities were collected. A distributed lag nonlinear model was established and used in analyzing the effects of temperature on mortality. Current and future net temperature-related mortality was estimated.</p><p><b>RESULTS</b>The association between temperature and mortality was J-shaped, with an increased death risk of both hot and cold temperature in these cities. The effects of cold temperature on health lasted longer than those of hot temperature. The projected temperature-related mortality increased with the decreased cold-related mortality. The mortality was higher in Guangzhou than in Beijing and Shanghai.</p><p><b>CONCLUSION</b>The impact of temperature on health varies in the 3 cities of China, which may have implications for climate policy making in China.</p>

Association between Ambient Air Pollution and Outpatient Visits for Acute Bronchitis in a Chinese City / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the short-term association between outdoor air pollution and outpatient visits for acute bronchitis, which is a rare subject of research in the mainland of China.</p><p><b>METHODS</b>A time-series analysis was conducted to examine the association of outdoor air pollutants with hospital outpatient visits in Shanghai by using two-year daily data (2010-2011).</p><p><b>RESULTS</b>Outdoor air pollution was found to be associated with an increased risk of outpatient visits for acute bronchitis in Shanghai. The effect estimates of air pollutants varied with the lag structures of the concentrations of the pollutants. For lag06, a 10 μg/m(3) increase in the concentrations of PM10, SO(2), and NO(2) corresponded to 0.94% (95% CI: 0.83%, 1.05%), 11.12% (95% CI: 10.76%, 11.48%), and 4.84% (95% CI: 4.49%, 5.18%) increases in hospital visits for acute bronchitis, respectively. These associations appeared to be stronger in females (P<0.05). Between-age differences were significant for SO(2) (P<0.05), and between-season differences were also significant for SO(2) (P<0.05).</p><p><b>CONCLUSION</b>Our analyses have provided the first evidence that the current air pollution level in China has an effect on acute bronchitis and that the rationale for further limiting air pollution levels in Shanghai should be strengthened.</p>

Ambient air pollution and human health in China: The past and future / 第二军医大学学报

Outdoor air pollution is one of the major environmental problems for China, and it has drawn wide concerns. This paper descsibed the current status of air pollution in China and reviewed the research on air pollution and human heaith in China from the followmg perspectives: the acute heaith effects, chronic heaith effects, and interventional research; finally the authors discussed the prospect of future related researches.

Association between diurnal temperature range and respiratory tract infections / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>This study aimed to assess the association between emergency-room visits for respiratory tract infection (RTI) with diurnal temperature range (DTR), a weather parameter closely associated with urbanization and global climate change.</p><p><b>METHODS</b>We conducted a semiparametric time-series analysis to estimate the percentage increase in emergency-room visits for RTI associated with changes in DTR after adjustment for daily weather conditions (temperature and relative humidity) and outdoor air pollution.</p><p><b>RESULTS</b>DTR was significantly associated with daily emergency-room visits for RTI. An increase of 1 °C in the current-day (L0) and in the 2-day moving average (L01) DTR corresponded to a 0.94% [95% confidence interval (CI), 0.34%-1.55%] and 2.08% (95% CI, 1.24%-2.93%) increase in emergency-room visits for RTI, respectively.</p><p><b>CONCLUSION</b>DTR was associated with increased risk of RTI. More studies are needed to understand the impact of DTR on respiratory health.</p>

Application of statistical distribution of PM10 concentration in air quality management in 5 representative cities of China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To estimate the frequency of daily average PM10 concentrations exceeding the air quality standard (AQS) and the reduction of particulate matter emission to meet the AQS from the statistical properties (probability density functions) of air pollutant concentration.</p><p><b>METHODS</b>The daily PM10 average concentration in Beijing, Shanghai, Guangzhou, Wuhan, and Xi'an was measured from 1 January 2004 to 31 December 2008. The PM10 concentration distribution was simulated by using the lognormal, Weibull and Gamma distributions and the best statistical distribution of PM10 concentration in the 5 cities was detected using to the maximum likelihood method.</p><p><b>RESULTS</b>The daily PM10 average concentration in the 5 cities was fitted using the lognormal distribution. The exceeding duration was predicted, and the estimated PM10 emission source reductions in the 5 cities need to be 56.58%, 93.40%, 80.17%, 82.40%, and 79.80%, respectively to meet the AQS.</p><p><b>CONCLUSION</b>Air pollutant concentration can be predicted by using the PM10 concentration distribution, which can be further applied in air quality management and related policy making.</p>

The establishment and application of Shanghai air quality health index / 中华预防医学杂志

<p><b>OBJECTIVE</b>This work aimed to construct Shanghai air quality health index (SAQHI) and to grade the air quality in Shanghai.</p><p><b>METHODS</b>Daily average concentrations of particulate matter with aerodynamic diameter less than 10 micrometer (PM(10)), SO(2) and NO(2) from 2001 to 2008 in the central urban areas of Shanghai were collected from Shanghai Environmental Monitoring Center. Contemporaneous data of daily average temperature and relative humidity were obtained from Shanghai Meteorological Bureau. Contemporaneous daily non-accidental mortality of registered residents in central urban areas of Shanghai were obtained from Shanghai Municipal CDC, respectively. Time-series analysis was conducted to estimate the association between air pollution and daily non-accidental mortality in the central urban areas of Shanghai. SAQHI was then established and applied to grade the air quality in Shanghai.</p><p><b>RESULTS</b>On average, there were 122 non-accidental daily deaths in the central urban areas of Shanghai from 2001 to 2008. The contemporaneous daily average concentrations of PM(10), SO(2) and NO(2) for the same period were (97.3 ± 59.5), (50.1 ± 27.8) and (64.7 ± 23.9) µg/m(3), respectively. Daily average temperature was (17.7 ± 8.8)°C, and daily average relative humidity was (71.4 ± 11.8)%. Based on results of time series analysis, formula for SAQHI was SAQHI = 10/17× (exp (0.000 153×PM(10))-1+exp (0.000 662×NO(2))-1)×100. Air quality in Shanghai was graded according to SAQHI values as low health risk (SAQHI: 0 ∼ 3), moderate health risk (SAQHI: 4-6), high health risk (SAQHI: 7-10) and very high health risk (SAQHI: > 10).</p><p><b>CONCLUSION</b>SAQHI could be applied in grading air quality in Shanghai, and reflect the effects of the overall air quality on health.</p>

Distributed lag effects in the relationship between daily mean temperature and mortality in Shanghai / 中华流行病学杂志

Objective To study the impact of daily mean temperature on mortality in Shanghai.Methods With data on daily mortality,meteorological and air pollution,we used a distributed lag nonlinear model (DLNM) to assess the effects of daily mean temperature on deaths (caused by non-accidental,cardiovascular and respiratory) adjusted for both secular,seasonal trends and other confounders.Results A J-shaped relationship was found consistently between daily mean temperature and non-accidental,cardiovascular and respiratory deaths in Shanghai.Cold effects were delayed by 1 day to 4 days and persisted for 14-30 days.Hot effects appeared acute and the highest at the first day,but lasted for 2 days and followed by mortality displacement.Conclusion In Shanghai,both cold and hot temperatures increased the risk of mortality with delayed effects.Cold effects seemed last longer than heat did.

Application of disability adjusted life years in evaluating health effects due to particulate air pollution in Chinese cities / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the loss of disability adjusted life years (DALYs) due to particulate air pollution in Chinese urban residents.</p><p><b>METHODS</b>DALYs was applied to evaluate the health effects due to particulate air pollution in the residents of 656 Chinese cities, and the data of annual average concentrations of inhalable particle (PM(10)) in 2006 were collected from the state-owned air quality monitoring network.</p><p><b>RESULTS</b>Particulate air pollution in Chinese urban areas in 2006, could cause (506.6 +/- 95.2) thousand premature deaths, (156.6 +/- 41.2) thousand new cases of chronic bronchitis, (12.6 +/- 5.2) million outpatient visits for internal medicine, (99.9 +/- 50.4) thousand and (72.0 +/- 8.2) thousand hospital admissions for cardiovascular diseases and respiratory diseases respectively. The attributable DALYs loss in urban residents amounted up to (5.26 +/- 0.99) million person years in 2006, of which, 96.26% (506.55/526.22) were caused by premature deaths. The attributable loss of DALYs increased with more seriously PM-polluted atmosphere and larger urban population.</p><p><b>CONCLUSION</b>Substantial adverse health effects due to outdoor particulate air pollution were observed in China urban areas, thus strengthening air pollution control still remains an imperative and urgent matter in public health perspective.</p>

Impact of ambient air pollution on public health under various traffic policies in Shanghai, China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the potential impact of ambient air pollution on public health under various traffic policies in Shanghai.</p><p><b>METHODS</b>The exposure level of Shanghai residents to air pollution under various planned traffic scenarios was estimated, and the public health impact was assessed using concentration-response functions derived from available epidemiological studies.</p><p><b>RESULTS</b>Our results showed that ambient air pollution in relation to traffic scenarios had a significant impact on the future health status of Shanghai residents. Compared with the base case scenario, implementation of various traffic scenarios could prevent 759-1574, 1885-2420, and 2277-2650 PM10-related avoidable deaths (mean-value) in 2010, 2015, and 2020, respectively. It could also decrease the incidence of several relevant diseases.</p><p><b>CONCLUSION</b>Our findings emphasize the need to consider air pollution-related health effects as an important impact of traffic policy in Shanghai.</p>

A time series analysis of outdoor air pollution and preterm birth in Shanghai, China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the relation between air pollution exposure and preterm birth in Shanghai, China.</p><p><b>METHODS</b>We examined the effect of ambient air pollution on preterm birth using time-series approach in Shanghai in 2004. This method can eliminate potential confounding by individual risk factors that do not change over a short period of time. Daily numbers of preterm births were obtained from the live birth database maintained by Shanghai Municipal Center of Disease Control and Prevention. We used the generalized additive model (GAM) with penalized splines to analyze the relation between preterm birth, air pollution, and covariates.</p><p><b>RESULTS</b>We observed a significant effect of outdoor air pollution only with 8-week exposure before preterm births. An increase of 10 microg/m3 of 8-week average PM10, SO2, NO2, and O3 corresponded to 4.42% (95%CI 1.60%, 7.25%), 11.89% (95%CI 6.69%, 17.09%), 5.43% (95%CI 1.78%, 9.08%), and 4.63% (95%CI 0.35%, 8.91%) increase of preterm birth. We did not find any significant acute effect of outdoor air pollution on preterm birth in the week before birth.</p><p><b>CONCLUSION</b>Ambient air pollution may contribute to the risk of preterm birth in Shanghai. Our analyses also strengthen the rationale for further limiting air pollution level in the city.</p>

Interaction between ambient particles and ozone and its effect on daily mortality / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To examine the effect of particulate matter (PM) less than 10 microns in diameter (PM10) and ozone (O3) on daily mortality in Shanghai, China.</p><p><b>METHODS</b>A generalized additive model with penalized spline function was used to observe the acute effect of PM10 and O3 on daily mortality.</p><p><b>RESULTS</b>Higher PM10 significantly increased the effect of O3 on total mortality, and O3 also increased the effect of PM10 although the estimated increment was statistically insignificant.</p><p><b>CONCLUSION</b>Our findings provide further evidence for the effect of PM10 and O3 on daily mortality.</p>

Application of DALYs in measuring health effect of ambient air pollution: a case study in Shanghai, China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the effect of ambient air pollution on human health and the subsequent disability-adjusted life years (DALYs) lost in Shanghai.</p><p><b>METHODS</b>We used epidemiology-based exposure-response functions to calculate the attributable number of cases due to air pollution in Shanghai in 2000, and then we estimated the corresponding DALYs lost in Shanghai based on unit DALYs values of the health consequences.</p><p><b>RESULTS</b>Ambient air pollution caused 103,064 DALYs lost in Shanghai in 2000. Among all the health endpoints, premature deaths and chronic bronchitis predominated in the value of total DALYs lost.</p><p><b>CONCLUSION</b>The air pollution levels have an adverse effect on the general population health and strengthen the rationale for limiting the levels of air pollution in outdoor air in Shanghai.</p>

Relationship between ambient air pollution and daily mortality of SARS in Beijing / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To study the relationship between ambient air pollution and daily mortality of SARS in Beijing.</p><p><b>METHODS</b>The approach of time-series Poisson regression was used to assess the relationship between daily SARS mortality, ambient air pollution, and other factors from April 25 to May 31, 2003 in Beijing.</p><p><b>RESULTS</b>An increase of each 10 microg/m3 over a 5-day moving average of PM10, SO2 and NO2 corresponded to 1.06 (1.00-1.12), 0.74 (0.48-1.13) and 1.22 (1.01-1.48) relative risks (RRs) of daily SARS mortality, respectively. The relative risks (RRs) values depended largely on the selection of lag days.</p><p><b>CONCLUSION</b>The daily mortality of SARS might be associated with certain air pollutants in Beijing.</p>

Establishment of exposure-response functions of air particulate matter and adverse health outcomes in China and worldwide / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To obtain the exposure-response functions that could be used in health-based risk assessment of particulate air pollution in China.</p><p><b>METHODS</b>Meta analysis was conducted on the literatures on air particulate matter and its adverse health outcomes in China and worldwide.</p><p><b>RESULTS</b>For each health outcome from morbidity to mortality changes, the relative risks were estimated when the concentration of air particulate matter increased to some certain units.</p><p><b>CONCLUSION</b>The exposure-response functions recommended here can be further applied to health risk assessment of air particulate matter in China.</p>