Global, regional, and national burden of ischemic heart disease attributable to ambient PM2.5 from 1990 to 2019: An analysis for the global burden of disease study 2019.

Information on the spatio-temporal patterns of the burden of ischemic heart disease (IHD) caused by ambient ambient fine particulate matter (PM2.5) in the global level is needed to prioritize the control of ambient air pollution and prevent the burden of IHD. The Global Burden of Disease Study (GBD) 2019 provides data on IHD attributable to ambient PM2.5. The IHD burden and mortality attributable to ambient PM2.5 were analyzed by year, age, gender, socio-demographic index (SDI) level, geographical region and country. Estimated annual percentage change (EAPC) was calculated to estimate the temporal trends of age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years rate (ASDR) from 1990 to 2019. Globally, the ASMR and ASDR for ambient PM2.5-related IHD tended to level off generally, with EAPC of -0.03 (95% CI: -0.06, 0.12) and 0.3 (95% CI: 0.22, 0.37), respectively. In the past 30 years, there were obvious differences in the trend of burden change among different regions. A highest increased burden was estimated in low-middle SDI region (EAPC of ASMR: 3.73 [95% CI: 3.56, 3.9], EAPC of ASDR: 3.83 [95% CI: 3.64, 4.02]). In contrast, the burden in high SDI region (EAPC of ASMR: -4.48 [95% CI: -4.6, -4.35], EAPC of ASDR: -3.98 [95% CI: -4.12, -3.85]) has declined most significantly. Moreover, this burden was higher among men and older populations. EAPCs of the ASMR (R = -0.776, p < 0.001) and ASDR (R = -0.781, p < 0.001) of this burden had significant negative correlations with the countries' SDI level. In summary, although trends in the global burden of IHD attributable to ambient PM2.5 are stabilizing, but this burden has shifted from high SDI countries to middle and low SDI countries, especially among men and elderly populations. To reduce this burden, the air pollution management prevention need to be further strengthened, especially among males, older populations, and middle and low SDI countries.

Influence of Air Pollution Exposures on Cardiometabolic Risk Factors: a Review.

PURPOSE OF REVIEW: The increasing prevalence of cardiometabolic risk factors (CRFs) contributes to the rise in cardiovascular disease. Previous research has established a connection between air pollution and both the development and severity of CRFs. Given the ongoing impact of air pollution on human health, this review aims to summarize the latest research findings and provide an overview of the relationship between different types of air pollutants and CRFs. RECENT FINDINGS: CRFs include health conditions like diabetes, obesity, hypertension etc. Air pollution poses significant health risks and encompasses a wide range of pollutant types, air pollutants, such as particulate matter (PM), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O2). More and more population epidemiological studies have shown a positive correlation between air pollution and CRFs. Although various pollutants have diverse effects on specific cellular molecular pathways, their main influence is on oxidative stress, inflammation response, and impairment of endothelial function. More and more studies have proved that air pollution can promote the occurrence and development of cardiovascular and metabolic risk factors, and the research on the relationship between air pollution and CRFs has grown intensively. An increasing number of studies are using new biological monitoring indicators to assess the occurrence and development of CRFs resulting from exposure to air pollution. Abnormalities in some important biomarkers in the population (such as homocysteine, uric acid, and C-reactive protein) caused by air pollution deserve more attention. Further research is warranted to more fully understand the link between air pollution and novel CRF biomarkers and to investigate potential prevention and interventions that leverage the mechanistic link between air pollution and CRFs.

The association between childhood adiposity in northeast China and anthropogenic heat flux: A new insight into the comprehensive impact of human activities.

Anthropogenic heat has been reported to have significant health impacts, but research on its association with childhood adiposity is still lacking. In this study, we matched the 2008-2012 average anthropogenic heat flux, as simulated by a grid estimation model using inventory methods, with questionnaire and measurement data of 49,938 children randomly recruited from seven cities in Northeast China in 2012. After adjusting for social demographic and behavioral factors, we used generalized linear mixed-effect models to assess the association between anthropogenic heat flux and adiposity among children. We also examined the effect modification of various social demographic and behavioral confounders. We found that each 10 W/m2 increase in total anthropogenic heat flux and that from the industry source was associated with an increase of 5.82% (95% CI = 0.84%-11.05%) and 6.62% (95% CI = 0.87%-12.70%) in the odds of childhood adiposity. Similarly, the excess rate of adiposity among children were 5.26% (95% CI = -1.33%-12.29%) and 8.51% (95% CI = 2.24%-15.17%) per 1 W/m2 increase in the anthropogenic heat flux from transportation and buildings, and was 7.94% (95% CI = 2.28%-13.91%) per 0.001 W/m2 increase in the anthropogenic heat flux from human metabolism. We also found generally greater effect estimates among female children and children who were exposed to passive smoking during pregnancy, born by caesarean section, non-breastfed/mixed-fed, or lived within 20 m adjacent to the main road. The potential deleterious effect of anthropogenic heat exposure on adiposity among children may make it a new but major threat to be targeted by future mitigation strategies.

Outdoor light at night, overweight, and obesity in school-aged children and adolescents.

Previous studies have indicated that outdoor light at night (LAN) is associated with a higher prevalence of overweight or obesity in adults. However, the association of LAN levels with overweight or obesity in children is still unknown. This study utilized data from the Seven Northeastern Cities study, which included 47,990 school-aged children and adolescents (ages 6-18 years). Outdoor LAN levels were measured using satellite imaging data. Weight and height were used to calculate age-sex-specific body mass index (BMI) Z-scores based on the World Health Organization (WHO) growth standards. Overweight status and obesity were defined using the Chinese standard. Information regarding socioeconomic status, sleep-related characteristics, and obesogenic factors were obtained using a questionnaire. A generalized linear mixed model examined the associations of outdoor LAN levels (in quartiles) with the outcomes of interest. Compared to children in the lowest quartile of outdoor LAN levels, children exposed to higher outdoor LAN levels had larger BMI Z-scores and higher odds of being overweight (including obesity) or obese, with the largest estimates in the third quartile [BMI Z-score: ß = 0.26, 95% CI: 0.18-0.33; overweight (including obesity): OR = 1.40, 95% CI: 1.25-1.56; obesity: OR = 1.46, 95% CI: 1.29-1.65]. There was a significant sex difference (Pinteraction<0.001) in the association of outdoor LAN levels with BMI Z-scores, and the association was stronger in males. Results remained robust following multiple sensitivity analyses and the adjustment of sleep-related characteristics, obesogenic factors, and environmental exposures. Our findings suggest that higher outdoor LAN levels are associated with larger BMI Z-scores and greater odds of overweight (including obesity) and obesity in school-aged children and adolescents. Further, the association between outdoor LAN levels and BMI Z-scores is stronger in males. Future studies with exposure assessments that consider both outdoor and indoor LAN exposures are needed.

The association between anthropogenic heat and adult hypertension in Northeast China.

OBJECTIVES: Although the potential serious threat of anthropogenic heat on human health was receiving considerable attention worldwide, its long-term health effect on blood pressure (BP) remained unknown. We aimed to evaluate the associations of long-term anthropogenic heat exposure with different components of BP and hypertension. METHODS: In this cross-sectional study (Liaoning province, China) conducted in 2009, we included a total of 24,845 Chinese adults (18-74 years). We estimated the anthropogenic heat exposure in 2008 using multisource remote sensing images and ancillary data. We measured systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP), and defined hypertension. We used generalized linear mixed model to examine the associations. RESULTS: In the adjusted model, the estimates indicated that the difference in SBP, MAP and PP for those in highest quartiles of total anthropogenic heat exposure was greater compared with the lowest quartile (highest quartile: ß = 1.11 [95% CI: 0.28-1.94], 0.60 [95% CI: 0.04-1.17], 0.76 [95% CI: 0.17-1.35]). Compared with the lowest quartile, the odds of hypertension were higher among those in higher quartiles (second quartile: OR = 1.17 [95% CI: 1.05-1.30]; third quartile:1.10 [95% CI: 1.1.01-1.21]; highest quartile: 1.17 [95% CI: 1.06-1.28]). These associations were stronger in female participants. CONCLUSION: Our study showed that long-term exposure to anthropogenic heat was associated with elevated BP and higher odds of hypertension. These findings suggest that mitigation strategies to reduce anthropogenic heat should be considered.

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

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

Exposure to second-hand smoke during early life and subsequent sleep problems in children: a population-based cross-sectional study.

BACKGROUND: Previous studies have revealed that current secondhand smoke exposure showed highly suggestive evidence for increased risk of simultaneous sleep problems in children. Data on the associations between early-life exposure to SHS with subsequent sleep problems in children were scarce. We aimed to evaluate the associations of early-life SHS exposure with sleep problems in children. METHODS: In this cross-sectional study, children were recruited from elementary and middle schools in Liaoning Province, China between April 2012 and January 2013. We assessed early-life SHS exposure (pregnancy and the first 2 years of life) via questionnaires. Sleep problems and different types of sleep-related symptoms were measured based on the validated tool of the Sleep Disturbance Scale for Children (SDSC). Generalized linear mixed models were applied to estimate the associations of early-life SHS exposure with sleep problems. RESULTS: We included a total of 45,562 children (22,657 [49.7%] males; mean [SD] age, 11.0 [2.6] years) and 6167 of them (13.5%) were exposed to early-life SHS during both pregnancy and the first 2 years of life. Compared with unexposed counterparts, children exposed to early-life SHS had higher total T-scores of SDSC (ß = 4.32; 95%CI: 4.06, 4.58) and higher odds of increased sleep problems (OR = 2.14; 95%CI: 1.89, 2.42). When considering different sleep-related symptoms, the associations between early-life SHS exposure and symptom of sleep-wake transition disorders (i.e., bruxism) were the strongest in all analyses. CONCLUSIONS: Early-life SHS exposure was associated with higher odds of global sleep problems and different sleep-related symptoms in children aged 6-18 years. Our findings highlight the importance to strengthen efforts to support the critical importance of maintaining a smoke-free environment especially in early life.

Association of Prenatal, Early Postnatal, or Current Exposure to Secondhand Smoke With Attention-Deficit/Hyperactivity Disorder Symptoms in Children.

Importance: Few studies have investigated the association between the exposure window (prenatal, early postnatal, and current period) of secondhand smoke (SHS) and attention-deficit/hyperactivity disorder (ADHD) symptoms and subtypes in children. Objective: To evaluate the associations of prenatal, early postnatal, or current SHS exposure with ADHD symptoms and subtypes among school-aged children. Design, Setting, and Participants: In this cross-sectional study, 48 612 children aged 6 to 18 years from elementary and middle schools in Liaoning province, China, between April 2012 and January 2013 were eligible for participation. Data on SHS exposure and ADHD symptoms and subtypes for each child were collected via questionnaires administered to parents or guardians by school teachers. Data were analyzed from September 14 to December 2, 2020. Main Outcomes and Measures: The ADHD symptoms and subtypes (inattention, hyperactivity-impulsivity, and combined) were measured based on a validated tool developed from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Generalized linear mixed models were evaluated to estimate the association of SHS exposure with ADHD symptoms and subtypes. Results: A total of 45 562 participants completed the questionnaires and were included in this study (22 905 girls [50.3%]; mean [SD] age, 11.0 [2.6] years; 2170 [4.8%] with ADHD symptoms). Compared with their unexposed counterparts, children who were ever exposed (odds ratio [OR], 1.50; 95% CI, 1.36-1.66) or always exposed to SHS (OR, 2.88; 95% CI, 2.55-3.25) from pregnancy to childhood had higher odds of having ADHD symptoms and subtypes (ORs ranged from 1.46 [95% CI, 1.31-1.62] to 2.94 [95% CI, 2.09-4.13]). Compared with their unexposed counterparts, children with SHS exposure had higher odds of having ADHD symptoms when exposed in the prenatal period (OR, 2.28; 95% CI, 2.07-2.51), early postnatal period (OR, 1.47; 95% CI, 1.29-1.68), or current period (OR, 1.20; 95% CI, 1.09-1.31). Compared with their unexposed counterparts, children whose fathers smoked 10 or more cigarettes/d on both weekdays and weekends had higher odds of having ADHD symptoms and subtypes (ORs ranged from 1.48 [95% CI, 1.28-1.70] to 2.25 [95% CI, 1.29-3.93]). Conclusions and Relevance: Being exposed to SHS from pregnancy to childhood was associated with higher odds of having ADHD symptoms and subtypes among school-aged children, and the associations were somewhat stronger for SHS exposure during prenatal and early postnatal periods. Our findings highlight the important public health implications of reducing SHS exposure, which may decrease the health and economic burdens of individuals with ADHD.

Association Between Residential Greenness, Cardiometabolic Disorders, and Cardiovascular Disease Among Adults in China.

Importance: Living in areas with more vegetation (referred to as residential greenness) may be associated with cardiovascular disease (CVD), but little data are available from low- and middle-income countries. In addition, it remains unclear whether the presence of cardiometabolic disorders modifies or mediates the association between residential greenness and CVD. Objective: To evaluate the associations between residential greenness, cardiometabolic disorders, and CVD prevalence among adults in China. Design, Setting, and Participants: This analysis was performed as part of the 33 Communities Chinese Health Study, a large population-based cross-sectional study that was conducted in 33 communities (ranging from 0.25-0.64 km2) in 3 cities within the Liaoning province of northeastern China between April 1 and December 31, 2009. Participants included adults aged 18 to 74 years who had resided in the study area for 5 years or more. Greenness levels surrounding each participant's residential community were assessed using the normalized difference vegetation index and the soil-adjusted vegetation index from 2010. Lifetime CVD status (including myocardial infarction, heart failure, coronary heart disease, cerebral thrombosis, cerebral hemorrhage, cerebral embolism, and subarachnoid hemorrhage) was defined as a self-report of a physician diagnosis of CVD at the time of the survey. Cardiometabolic disorders, including hypertension, diabetes, dyslipidemia, and overweight or obese status, were measured and defined clinically. Generalized linear mixed models were used to evaluate the association between residential greenness levels and CVD prevalence. A 3-way decomposition method was used to explore whether the presence of cardiometabolic disorders mediated or modified the association between residential greenness and CVD. Data were analyzed from October 10 to May 30, 2020. Main Outcomes and Measures: Lifetime CVD status, the presence of cardiometabolic disorders, and residential greenness level. Results: Among 24 845 participants, the mean (SD) age was 45.6 (13.3) years, and 12 661 participants (51.0%) were men. A total of 1006 participants (4.1%) reported having a diagnosis of CVD. An interquartile range (1-IQR) increase in the normalized difference vegetation index within 500 m of a community was associated with a 27% lower likelihood (odds ratio [OR], 0.73; 95% CI, 0.65-0.83; P < .001) of CVD prevalence, and an IQR increase in the soil-adjusted vegetation index within 500 m of a community was associated with a 26% lower likelihood (OR, 0.74; 95% CI, 0.66-0.84; P < .001) of CVD prevalence. The presence of cardiometabolic disorders was found to mediate the association between residential greenness and CVD, with mediation effects of 4.5% for hypertension, 4.1% for type 2 diabetes, 3.1% for overweight or obese status, 12.7% for hypercholesterolemia, 8.7% for hypertriglyceridemia, and 11.1% for high low-density lipoprotein cholesterol levels. Conclusions and Relevance: In this cross-sectional study, higher residential greenness levels were associated with lower CVD prevalence, and this association may be partially mediated by the presence of cardiometabolic disorders. Further studies, preferably longitudinal, are warranted to confirm these findings.

[Impact of Differents in the Concentrations of Ozone on the Chemical Composition of Single Particles].

To investigate the effect of high concentration of ozone (O3) on the aerosol formation and aging process, this study made observations using a single-particle aerosol mass spectrometer (SPAMS) at Heshan Atmospheric Environment Supervision Station in Guangdong Province in October 2018. During the observation period, a high ozone concentration period (PH) and a low ozone concentration period (PL) were defined according to the level of O3 concentration. The average O3 concentration during PH was 117 µg·m-3, and that of PL was 25 µg·m-3. According to the difference in chemical composition, single particles mainly included aging element carbon particles (EC-aged), secondary particles (Sec), and aging organic carbon particles (OC-aged) during the observation period. The total number of single particles in PH (348085) was higher than in PL (224797), and the proportion of Sec particles (37.1%) in PH was significantly higher than in PL (27.8%), whereas the proportion of EC-aged particles in PH (32.1%) was lower than in PL (44.1%). The proportion of OC-aged particles in PH (13.5%) was slightly higher than in PL (10.4%). The concentration of particles containing nitrate and sulfate showed significant diurnal changes during PH, but no diurnal changes during PL. The peak area of nitrate and sulfate in the Sec particles and EC-aged particles in PH was higher than in PL, which indicates that the amount of nitrate and sulfate produced by the secondary reaction process in PH was more than in PL. In addition, the peak areas of nitrate and sulfate in the Sec particles were significantly higher than those in the EC-aged particles, indicating that the age of the Sec particles was greater. In this study, acetate (59CH3CO2-) and glyoxal (73C2HO3-) were selected to represent the changing characteristics of aldehyde and ketone compounds in single-particle aerosols. The number concentration and peak area of 59CH3CO2- and 73C2HO3- in Sec and OC-aged particles in PH were significantly higher than those in PL, and showed significant diurnal variation characteristic during PH. The peak appeared 2 h after the peak of O3 concentration. In PL, the peak value was significantly reduced, and the change trend was the same as that of the number concentration of Sec and OC-aged particles, indicating that high concentration of O3 is beneficial to the oxidation of VOCs to 59CH3CO2- and 73C2HO3-. In summary, high concentration of O3 and enhancement of secondary species in single particles were due to the strong photochemical reactions during PH.

Association of Breastfeeding and Air Pollution Exposure With Lung Function in Chinese Children.

Importance: Breastfeeding and exposure to ambient air pollutants have been found to be independently associated with respiratory health in children; however, previous studies have not examined the association of breastfeeding as a potential moderator of the association. Objective: To assess associations of breastfeeding and air pollution with lung function in children. Design, Setting, and Participants: Using a cross-sectional study design, children were recruited from 62 elementary and middle schools located in 7 Chinese cities from April 1, 2012, to October 31, 2013. Data analyses were conducted from November 1, 2018, to March 31, 2019. Exposures: Long-term concentrations of airborne particulate matter with a diameter of 1 µm or less (PM1), airborne particulate matter with a diameter of 2.5 µm or less (PM2.5), airborne particulate matter with a diameter of 10 µm or less (PM10), and nitrogen dioxide were estimated using a spatial statistical model matched to children's geocoded home addresses, and concentrations of PM10, sulfur dioxide, nitrogen dioxide, and ozone were measured by local air monitoring stations. Main Outcomes and Measures: Breastfeeding was defined as maternal report of having mainly breastfed for longer than 3 months. Lung function was measured using portable electronic spirometers. Using previously published predicted spirometric values for children in Northeast China as the reference, lung impairment was defined as forced vital capacity (FVC) less than 85%, forced expiratory volume in the first second of expiration less than 85%, peak expiratory flow less than 75%, or maximum midexpiratory flow less than 75%. Results: Participants included 6740 children (mean [SD] age, 11.6 [2.1] years; 3382 boys [50.2%]). There were 4751 children (70.5%) who were breastfed. Mean (SD) particulate matter concentrations ranged from 46.8 (6.5) µg/m3 for PM1 to 95.6 (9.8) µg/m3 for PM10. The prevalence of lung function impairment ranged from 6.8% for peak expiratory flow to 11.3% for FVC. After controlling for age, sex, and other covariates, 1-interquartile range greater concentration of pollutants was associated with higher adjusted odds ratios (AORs) for lung function impairment by FVC among children who were not breastfed compared with those who were (PM1: AOR, 2.71 [95% CI, 2.02-3.63] vs 1.20 [95% CI, 0.97-1.48]; PM2.5: AOR, 2.27 [95% CI, 1.79-2.88] vs 1.26 [95% CI, 1.04-1.51]; and PM10: AOR, 1.93 [95% CI, 1.58-2.37] vs 1.46 [95% CI, 1.23-1.73]). Younger age (<12 years) was associated with lower lung function impairment among the children who had been breastfed. In children from elementary schools, 1-interquartile range greater concentration of pollutants was associated with higher AORs for lung function impairment by FVC among children who had not been breastfed compared with those who had (PM1: AOR, 6.43 [95% CI, 3.97-10.44] vs 1.89 [95% CI, 1.28-2.80]; PM2.5: AOR, 3.83 [95% CI, 2.63-5.58] vs 1.50 [95% CI, 1.12-2.01]; and PM10: AOR, 2.61 [95% CI, 1.90-3.57] vs 1.52 [95% CI, 1.19-1.95]). Results from linear regression models also showed associations of air pollution with worse lung function among children who were not breastfed compared with their counterparts who were breastfed, especially for FVC (PM1: ß, -240.46 [95% CI, -288.71 to -192.21] vs -38.21 [95% CI, -69.27 to -7.16] mL) and forced expiratory volume in the first second of expiration (PM1: ß, -201.37 [95% CI, -242.08 to -160.65] vs -30.30 [95% CI, -57.66 to -2.94] mL). Conclusions and Relevance: In this study, breastfeeding was associated with lower risk of lung function impairment among children in China exposed to air pollution, particularly among younger children.

Ambient PM1 air pollution, blood pressure, and hypertension: Insights from the 33 Communities Chinese Health Study.

No evidence exists concerning the association between blood pressure and ambient particles with aerodynamic diameter ≤ 1.0 µm (PM1), a major component of PM2.5 (≤ 2.5 µm) particles, and potentially causing more hazardous health effects than PM2.5. We aimed to examine the associations of blood pressure in adults with both PM1 and PM2.5 in China. In 2009, we randomly selected 24,845 participants aged 18-74 years from 33 communities in China. Using a standardized mercuric-column sphygmomanometer, we measured blood pressure. Long-term exposure (2006-08) to PM1 and PM2.5 were estimated using a spatial statistical model. Generalized linear mixed models were used to evaluate the associations between air pollutants and blood pressure and hypertension prevalence, controlling for multiple covariates. A 10-µg/m3 increase in PM1 was significantly associated with an increase of 0.57 (95% CI 0.31-0.83) mmHg in systolic blood pressure (SBP), 0.19 (95% CI 0.03-0.35) mmHg increase in diastolic blood pressure (DBP), and a 5% (OR=1.05; 95% CI 1.01-1.10) increase in odds for hypertension. Similar associations were detected for PM2.5. Furthermore, PM1-2.5 showed no association with blood pressure or hypertension. In summary, both PM1 and PM2.5 exposures were associated with elevated blood pressure levels and hypertension prevalence in Chinese adults. In addition, most of the pro-hypertensive effects of PM2.5 may come from PM1. Further longitudinal designed studies are warranted to validate our findings.

Associations of greenness with diabetes mellitus and glucose-homeostasis markers: The 33 Communities Chinese Health Study.

BACKGROUND: Residing in greener places may be protective against diabetes mellitus (DM) but evidence is scarce and comes mainly from developed countries. OBJECTIVES: To investigate associations of residential greenness with DM prevalence and glucose-homeostasis markers in Chinese adults and whether these associations were mediated by air pollution, physical activity, and body mass index. METHODS: In 2009, a total of 15,477 adults from the cross-sectional 33 Communities Chinese Health Study provided blood samples and completed a questionnaire. We considered fasting and 2-h glucose and insulin concentrations, as well as the homoeostasis model assessment of insulin resistance and ß-cell function, as glucose-homeostasis markers. DM was defined according to the American Diabetes Association's recommendations. Residential greenness was estimated by two satellite-derived vegetation indexes - Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI). Nitrogen dioxide and particulate matter ≤2.5 µm were used as air pollution proxies. Associations were assessed by two-level adjusted logistic and linear regression models. RESULTS: A 0.1-unit increase in NDVI500 m and SAVI500 m was significantly associated with lower odds of DM by factors of 0.88 (95% Confidence Interval 0.82-0.94) and 0.80 (0.72-0.90), respectively. Higher greenness was also significantly associated with lower fasting and 2-h glucose levels, 2-h insulin level, as well as lower insulin resistance and higher ß-cell function. Air pollution and body mass index significantly mediated 6.9-51.1% and 8.6-78.7% these associations, respectively, while no mediation role was observed for physical activity. CONCLUSIONS: Higher residential greenness appears to be associated with a lower prevalence of DM. This association might be due to glucose and insulin metabolism and pancreatic ß-cell function. Lower levels of air pollution and body mass index can be pathways linking greenspace to diabetes.

Association between long-term exposure to air pollution and sleep disorder in Chinese children: the Seven Northeastern Cities study.

Study Objectives: There is limited knowledge regarding the effects of air pollution on sleep disorders, particularly in children. The aim of this study is to investigate this association in Chinese children. Methods: During 2012-2013, 59754 children aged 2-17 years were randomly selected from 27 districts in seven northeastern Chinese cities. All participants' sleep was evaluated with the Sleep Disturbance Scale for Children. Four year average concentrations of pollutants were calculated for particles with an aerodynamic diameter of ≤1 µm (PM1), ≤2.5 µm (PM2.5) from a spatial statistical model, and ≤10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) from monitoring stations. To examine the effects, two-level regression analysis was used, controlling for covariates. Results: We observed that sleep disorder was generally associated with all air pollutants, with the highest odds among PM1 exposure for male (odds ratio [OR] 1.55; 95% confidence interval [95% CI] 1.36-1.76) and female (OR 1.50; 95% CI 1.30-1.72) children. The overall strongest association with sleep disorder symptom was exposure to PM1 and Disorders of Excessive Somnolence (OR 1.43; 95% CI 1.30-1.58). PM1 and PM2.5 were strongly associated with all sleep disorder symptoms in females (ORs ranged for PM1 from 1.19 to 1.49; and PM2.5 1.18 to 1.44). The association between air pollutants and total sleep score was generally greater in female than in male children. Conclusions: Our findings suggest that exposure to air pollutants increases the odds of sleep disorder in children and point to the need to make reducing exposure to air pollutants a public health priority.

Overweight modifies the association between long-term ambient air pollution and prehypertension in Chinese adults: the 33 Communities Chinese Health Study.

BACKGROUND: Research regarding the interaction of ambient air pollution and overweight on prehypertension is scarce. We aimed to test whether overweight modifies the association between long-term exposure to ambient air pollution and prehypertension in Chinese adults. METHODS: A total of 16,188 Chinese adults, aged 18-74 years old, from 33 communities in 3 Northeastern Chinese cities were evaluated. Three-year average levels of particles with an aerodynamic diameter ≤ 10 µm (PM10), sulfur dioxides (SO2), nitrogen dioxides (NO2), and ozone (O3) were calculated at monitoring stations. Generalized additive models and 2-level regression analyses were applied. RESULTS: We observed significant interactions between air pollutants and overweight on prehypertension and blood pressure. The associations of PM10, SO2, NO2, and O3 with prehypertension were significant among overweight participants (Prevalence Rate Ratios (PRRs) per interquartile range (IQR) of air pollutants: 1.14-1.20), but not among normal weight participants (PRRs: 0.98-1.04). PM10, SO2, and O3 were significantly associated with systolic blood pressure (SBP), and the magnitudes of these associations were higher among overweight adults (increases in SBP per IQR of air pollutants: 1.82-4.53 mmHg) than those among normal weight adults (increases in SBP: 0.42-0.61 mmHg). For diastolic blood pressure (DBP), significant associations were mainly observed in overweight participants (increases in DBP: 0.80-1.63 mmHg). Further stratified analyses showed that all these interactions were stronger in women, the older, and participants living in areas with lower income levels or higher population density. CONCLUSIONS: Being overweight may enhance the effects of ambient air pollution on prehypertension and blood pressure in Chinese adults.

Ambient air pollution in relation to diabetes and glucose-homoeostasis markers in China: a cross-sectional study with findings from the 33 Communities Chinese Health Study.

BACKGROUND: Health effects of air pollution on diabetes have been scarcely studied in developing countries. We aimed to explore the associations of long-term exposure to ambient particulate matter (PM) and gaseous pollutants with diabetes prevalence and glucose-homoeostasis markers in China. METHODS: Between April 1 and Dec 31, 2009, we recruited a total of 15 477 participants aged 18-74 years using a random number generator and a four-staged, stratified and cluster sampling strategy from a large cross-sectional study (the 33 Communities Chinese Health Study) from three cities in Liaoning province, northeastern China. Fasting and 2 h insulin and glucose concentrations and the homoeostasis model assessment of insulin resistance index and ß-cell function were used as glucose-homoeostasis markers. Diabetes was defined according to the American Diabetes Association's recommendations. We calculated exposure to air pollutants using data from monitoring stations (PM with an aerodynamic diameter of 10 µm or less [PM10], sulphur dioxide, nitrogen dioxide, and ozone) and a spatial statistical model (PM with an aerodynamic diameter of 1 µm or less [PM1] and 2·5 µm or less [PM2·5]). We used two-level logistic regression and linear regression analyses to assess associations between exposure and outcomes, controlling for confounders. FINDINGS: All the studied pollutants were significantly associated with increased diabetes prevalence (eg, the adjusted odds ratios associated with an increase in IQR for PM1, PM2·5, and PM10 were 1·13, 95% CI 1·04-1·22; 1·14, 1·03-1·25; and 1·20, 1·12-1·28, respectively). These air pollutants were also associated with higher concentrations of fasting glucose (0·04-0·09 mmol/L), 2 h glucose (0·10-0·19 mmol/L), and 2 h insulin (0·70-2·74 µU/L). No association was observed for the remaining biomarkers. Stratified analyses indicated greater effects on the individuals who were younger (<50 years) or overweight or obese. INTERPRETATION: Long-term exposure to air pollution was associated with increased risk of diabetes in a Chinese population, particularly in individuals who were younger or overweight or obese. FUNDING: The National Key Research and Development Program of China, the National Natural Science Foundation of China, the Fundamental Research Funds for the Central Universities, the Guangdong Province Natural Science Foundation, the Career Development Fellowship of Australian National Health and Medical Research Council, and the Early Career Fellowship of Australian National Health and Medical Research Council.

Pet exposure in utero and postnatal decreases the effects of air pollutants on hypertension in children: A large population based cohort study.

The effect of ambient air pollution exposure on childhood hypertension has emerged as a concern in China, and previous studies suggested pet ownership is associated with lower blood pressure (BP). However, limited information exists on the interactive effects pet ownership and air pollution exposure has on hypertension. We investigated the interactions between exposure to pet ownership and air pollutants on hypertension in Chinese children. 9354 students in twenty-four elementary and middle schools (aged 5-17 years) in Northeastern China were evaluated during 2012-2013. Four-year average concentrations of particulate matter with aerodynamic diameter of ≤10 µm (PM10), SO2, NO2, and O3, were collected in the 24 districts from 2009 to 2012. Hypertension was defined as average diastolic or systolic BP (three time measurements) in the 95th percentile or higher based on height, age, and sex. To examine effects, two-level regression analysis was used, controlling covariates. Consistent interactions between exposure to pet and air pollutants were observed. Compared to children exposed to pet, those not exposed exhibited consistently stronger effects of air pollution. The highest odds ratios (ORs) per 30.6 µg/m3 increase in PM10 were 1.79 (95%confidence interval [95%CI]: 1.29-2.50) in children without current pet exposure compared to 1.24 (95%CI: 0.85-1.82) in children with current pet exposure. As for BP, only O3 had an interaction for all exposure to pet ownership types, and showed lower BP in children exposed to pet. The increases in mean diastolic BP per 46.3 µg/m3 increase in O3 were 0.60  mmHg (95%CI: 0.21, 0.48) in children without pet exposure in utero compared with 0.34  mmHg (95%CI: 0.21, 0.48) in their counterparts. When stratified by age, pet exposure was more protective among younger children. In conclusion, in this large population-based cohort, pet ownership is associated with smaller associations between air pollution and hypertension in children, suggesting pet ownership reduces susceptibility to the health effects of pollutants.

Long-term exposure to ambient air pollution (including PM1) and metabolic syndrome: The 33 Communities Chinese Health Study (33CCHS).

Little evidence exists about the effects of long-term exposure to ambient air pollution on metabolic syndrome (MetS). This study aimed to determine the association between long-term ambient air pollution and MetS in China. A total of 15,477 adults who participated in the 33 Communities Chinese Health Study (33CCHS) in 2009 were evaluated. MetS was defined based on the recommendation by the Joint Interim Societies. Exposure to air pollutants was assessed using data from monitoring stations and a spatial statistical model (including particles with diameters ≤ 1.0 µm (PM1), ≤ 2.5 µm (PM2.5), and ≤ 10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3)). Two-level logistic regression analyses were utilized to assess the associations between air pollutants and MetS. The prevalence of MetS was 30.37%. The adjusted odds ratio of MetS per 10 µg/m3 increase in PM1, PM2.5, PM10, SO2, NO2, and O3 were 1.12 (95% CI = 1.00-1.24), 1.09 (95% CI = 1.00-1.18), 1.13 (95% CI = 1.08-1.19), 1.10 (95% CI = 1.02-1.18), 1.33 (95% CI = 1.12-1.57), and 1.10 (95% CI = 1.01-1.18), respectively. Stratified analyses indicated that the above associations were stronger in participants with the demographic variables of males, < 50 years of age, and higher income, as well as with the behavioral characteristics of smoking, drinking, and consuming sugar-sweetened soft drinks frequently. This study indicates that long-term exposure to ambient air pollutants may increase the risk of MetS, especially among males, the young to middle aged, those of low income, and those with unhealthy lifestyles.

Is prehypertension more strongly associated with long-term ambient air pollution exposure than hypertension? Findings from the 33 Communities Chinese Health Study.

Numerous studies have evaluated the effects of long-term exposure to ambient air pollution on hypertension. However, little information exists regarding its effects on prehypertension, a very common, but understudied cardiovascular indicator. We evaluated data from 24,845 adults (ages 18-74 years) living in three Northeastern Chinese cities in 2009. Blood pressure (BP) was measured by trained observers using a standardized mercuric-column sphygmomanometer. Three-year (from 2006 to 2008) average concentrations of particles with an aerodynamic diameter ≤10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxides (NO2), and ozone (O3) were calculated using data from monitoring stations. Effects were analyzed using generalized additive models and two-level regression analyses, controlling for covariates. We found positive associations of all pollutants with prehypertension (e.g. odds ratio (OR) was 1.17 (95% confidence interval (CI), 1.09-1.25) per interquartile range (IQR) of PM10) in a fully adjusted model, as compared to normotensive participants. These associations were stronger than associations with hypertension (e.g. OR was 1.03 (95% CI, 1.00, 1.07) per IQR of PM10). We have also found positive associations of all studied pollutants with systolic and diastolic BP: e.g., associations with PM10 per IQR were 1.24 mmHg (95% CI, 1.03-1.45) for systolic BP and 0.47 mmHg (95% CI, 0.33-0.61) for diastolic BP. Further, we observed that associations with BP were stronger in women and in older participants (systolic BP only). In conclusion, long-term exposure to ambient air pollution was more strongly associated with prehypertension than with hypertension, especially among females and the elderly. Thus, interventions to reduce air pollution are of great significance for preventing future cardiovascular events, particularly among individuals with prehypertension.