Air Pollution Health Impact Monitoring and Health Risk Assessment Technology and Its Application - China, 2006-2019.

Air pollution is a significant risk factor contributing to the burden of disease in China. Health risk assessment and management are important to reduce the impact of air pollution on public health. To help formulate standardized health risk assessment techniques, a series of studies were conducted from 2006 to 2019. Through systematic review, study of molecular mechanisms, epidemiological investigation, and health effect monitoring, the overall project established a monitoring and evaluation indicator system, a comprehensive information platform, software for automatic data cleaning, and standardized health risk assessment techniques. Technical specifications have been issued by the National Health Commission for promoting health risk assessments across China. This paper introduces the project, the research approach, its main research accomplishments, innovations, and public health significance, and describes directions for further research.

The impacts of continuous improvements in air quality on mortality in Beijing: A longitudinal comparative study.

There has been increasing concern about the health effects of air pollution in China, and many measures have been implemented to control air pollution. To investigate the impacts of air quality improvement on mortality from non-accidental causes (NAD), cardiovascular disease (CD), and respiratory disease (RD), a longitudinal comparative study was conducted in Beijing. This study investigated the effects of air pollutants on outcomes across five periods (stages 1-5). Health effect data from stage1-5 (1990-2013) were obtained through a systematic literature search of studies published before 2021. Daily atmospheric pollutant, meteorological, and cause-specific death data were collected to determine the effects in stage 5 (2015-2017). Poisson generalized additive models were used to analyze the associations between short-term exposure to air pollutants and mortality. Random-effects meta-analysis models were used to estimate the pooled effects at each stage. The effects of changes in air quality were analyzed through a difference-in-differences approach. Our results indicate that the absolute change of concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2), and particulate matter with aerodynamic diameter≤ 10 µm (PM10) and≤ 2.5 µm (PM2.5) decreased by up to 42%, 10%, 33%, and 15% (stage 5), respectively. The effects of SO2 on deaths from CD and RD decreased by up to 2.76% and 1.43% (stage 3). The effects of NO2 on mortality from NAD, CD, and RD decreased by up to 0.39%, 0.74%, and 0.37% (stage 5). The effects of PM10 on death decreased by up to 0.11% (stage 3). The effects of PM2.5 on deaths from CD and RD decreased by up to 0.33% and 0.13% (stage 5). The results indicate that continued improvements in air quality have reduced the acute impact of air pollutants on population health.

[Risk assessment of excess mortality attribute to PM_(2.5) exposure in 5 cities in China in 2018].

OBJECTIVE: To assess the risk of excess mortality caused by exposure to PM_(2.5) in 5 cities in China. METHODS: Surveillance data on daily concentration of PM_(2.5), meteorology and death-causes were collected from 2015 to 2018 in Harbin, Xi& apos; an, Nanjing, Chengdu and Guangzhou cities. Generalized additive model(GAM) was used to analyze acute exposure-response coefficients of PM_(2.5) exposure on the mortality. Using daily 24-hour average concentration of PM_(2.5) in 2018 to estimate the exposure levels of the population, with PM_(2.5) 24-hour average concentration limit of the ambient air quality standard(GB 3095-2012) for reference concentration(75 µg/m~3), and applicating the health risk assessment model, the excess deaths attribute to PM_(2.5) exposure in the 5 cities in 2018 was estimated. RESULTS: Attribute to PM_(2.5) exposure, the excess cases of death caused by circulatory system diseases in Harbin and Guangzhou were 35 and 92, the excess cases caused by respiratory diseases in Xi& apos; an was 70, the excess cases of caused by non-accident in Nanjing was 69, and the excess cases caused by non-accidental, respiratory and circulatory diseases in Chengdu were 588, 210 and 134 in 2018. CONCLUSION: PM_(2.5) exposure could increase the excess mortality risk, which varies among different cities.

An association between PM2.5 and pediatric respiratory outpatient visits in four Chinese cities.

BACKGROUND: The effects of exposure to particulate matter with aerodynamic diameter less than 2.5 µm (PM2.5) on children's respiratory system were investigated in numerous epidemiological literatures. However, studies on the association between PM2.5 and pediatric outpatient visits for respiratory diseases, especially considering the multicenter studies were limited in China. OBJECTIVES: To study the association between the short-term exposure to PM2.5 and the number of children's outpatient visits for respiratory diseases in four Chinese cities as well as the pooled health effects. METHODS: Data of pediatric outpatient visits for respiratory diseases (RD, ICD: J00-J99) from representative hospitals in Shijiazhuang (SJZ), Xi'an (XA), Nanjing (NJ) and Guangzhou (GZ) in China from 2015 to 2018 were collected and the air quality data for the same period were collected from environmental protection departments. Generalized additive model (GAM) with quasi-Poisson regression was conducted to analyze the effects of PM2.5 on the number of pediatric outpatient visits in each city. Single-day lag model (lag0 to lag7) and moving average lag model (lag01 and lag07) were used to examine the lag effects and cumulative effects. Random-effects meta-analysis was used to pool the estimated risks of four cities. The interactions between PM2.5 and temperature were also explored. RESULTS: The average daily/total outpatient visits for RD, in SJZ, XA, NJ and GZ from 2015 to 2018 were 854.2/1,245,384, 2353.9/3,439,025, 1267.2/1,851,438 and 1399.5/2,044,740 respectively. The percentages of acute upper respiratory infections (URD, ICD: J00-J06) and other acute lower respiratory infections (LRD, ICD: J20-J22) in RD were 33%, 13% (SJZ), 43%, 32% (XA), 26%, 21% (NJ) and 54%, 26% (GZ). The largest pooled estimates of single-day lag effects for RD, URD, and LRD were at lag0, lag0 and lag1. Every 10 µg/m3 increase in PM2.5 concentration was associated with a 0.46% (95%CI: 0.21%-0.70%), 0.50% (95%CI: 0.19%-0.81%) and 0.42% (95%CI: 0.06%-0.79%) increased number of outpatient visits significantly. While max cumulative effects which were all at lag 07 were 1.10% (95%CI: 0.46%-1.74%), 0.96% (95%CI: 0.20%-1.73%) and 1.06% (95%CI: 0.12%-2.00%). Less polluted cities (GZ and NJ) showed greater city-specific excess risks, but the excess risks significantly decreased after adjusting for NO2 in two-pollutant models. Generally, PM2.5 showed larger health hazards on lower temperature days. CONCLUSIONS: Our study showed that exposure to the ambient PM2.5 was associated with the increase of the number of outpatient visits with pediatric respiratory diseases in four Chinese cities. The health effects of PM2.5 may not be independent of other air pollutants and could be modified by temperature.

Risk factors and on-site simulation of environmental transmission of SARS-CoV-2 in the largest wholesale market of Beijing, China.

From June 11, 2020, a surge in new cases of coronavirus disease 2019 (COVID-19) in the largest wholesale market of Beijing, the Xinfadi Market, leading to a second wave of COVID-19 in Beijing, China. Understanding the transmission modes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the personal behaviors and environmental factors contributing to viral transmission is of utmost important to curb COVID-19 rise. However, currently these are largely unknown in food markets. To this end, we completed field investigations and on-site simulations in areas with relatively high infection rates of COVID-19 at Xinfadi Market. We found that if goods were tainted or personnel in market was infected, normal transaction behaviors between sellers and customers, daily physiological activities, and marketing activities could lead to viral contamination and spread to the surroundings via fomite, droplet or aerosol routes. Environmental factors such as low temperature and high humidity, poor ventilation, and insufficient hygiene facilities and disinfection practices may contribute to viral transmission in Xinfadi Market. In addition, precautionary control strategies were also proposed to effectively reduce the clustering cases of COVID-19 in large-scale wholesale markets.

[Application of AirQ+ software in air pollution acute health risk assessment in China].

OBJECTIVE: To promote the application of software AirQ +developed by WHO in the air pollution health risk assessment in China. METHODS: Introduced the calculation principle, scope of application, required data, results output and application examples of the model. Meta-analysis result of exposure-response relationship coefficients of acute health risks of air pollution in China are also provided in this paper. RESULTS: The air quality and other related parameters of the study area in China can be input into AirQ+ software to obtain the attributable risk value of the health outcome of the exposed population compared with the reference concentration. CONCLUSION: The AirQ + software can be used for quantitative assessment of acute health risks of air pollution in China.

[Application of COBRA tool in health risk and comprehensive benefits assessment].

OBJECTIVE: To introduce the application of COBRA in health risk assessment of air pollution, and provide reference for the development of similar tools in China. METHODS: The software overview, scope of application and application literature, data requirements and software operation, calculation principles, model construction was introduced, and put forward the reference significance to China. RESULTS: Health and economic benefits can be quickly obtained by entering the type and value of change in pollutant concentration into the software. CONCLUSION: COBRA can be used to quickly evaluate the health effects and economic benefits of pollutant changes, and provide reference for the development of relevant tools in China, applied in many ways, such as rapid assessment of health benefits of pollution prevention and control programs in different cities, regions or nationwide, and screening the policies and measures with lower costs and greater benefits.

[Application of BenMAP-CE software in health risk assessment of air pollution in China].

OBJECTIVE: To promote the application of air pollution health risk assessment software BenMAP-CE developed by the US Environmental Protection Agency in China's air pollution health risk assessment. METHODS: According to China's air quality and health impact monitoring data characteristics, the software's operational analysis process and principle, scope of application, required data, export and import settings and application examples are systematically introduced. RESULTS: Through the software, the parameters of the research area of China can be input into the module, and the health benefit analysis can be carried out according to the change of air quality. CONCLUSION: The software is suitable for China's air pollution health risk assessment, and has guiding significance and reference value for the formulation of environmental policies.

[Effects of ambient air pollution on acute respiratory diseases and symptoms among adults in three cities in the Yangtze River Delta in 2015].

OBJECTIVE: To understand the effects of ambient air pollution on the prevalence of acute respiratory diseases and symptoms among adults in three cities in the Yangtze River Delta. METHODS: During September to November 2015, 4144 permanent residents aged 18 years and above from four investigation sites in three cities in the Yangtze River Delta were randomly surveyed by questionnaire. Daily concentrations of air pollutants, including PM_(2. 5), NO_2、O_3、CO and SO_2 nearest to the investigation sites were collected from the department of environmental protection. Logistic regression was used to analyze the association between air pollution and acute respiratory diseases and symptoms after other risk factors were adjusted. RESULTS: The prevalence of acute respiratory diseases and symptoms in two weeks among adults were 0. 99% and 3. 88%, respectively. Chemicals related to air pollution(OR=2. 339, 95%CI 1. 156-4. 734) and allergy(OR=4. 857, 95%CI 2. 279-10. 350) were the risk factors of acute respiratory diseases in two weeks among adults while occupational hazards such as toxic chemicals and high temperature(OR=1. 796, 95%CI 1. 220-2. 644), family history of respiratory diseases(OR=2. 670, 95%CI 1. 865-3. 823) and allergy(OR=3. 703, 95%CI 2. 395-5. 725) were the risk factor of respiratory symptoms in two weeks among adults. In addition, the average exposure level of PM_(2. 5)in two weeks was associated with acute respiratory diseases(OR=1. 014, 95%CI 1. 000-1. 028) and symptoms(OR=1. 025, 95%CI 1. 018-1. 033) in two weeks among adults. CONCLUSION: The increases of the prevalence of acute respiratory diseases and symptoms among adults are associated with ambient air pollution in three cities in the Yangtze River Delta.

Short-term effects of ambient air pollution exposure on lung function: A longitudinal study among healthy primary school children in China.

BACKGROUND: Short-term exposure to ambient air pollution has been associated with reduced lung function among asthmatic children. However, there is little information about the effects among healthy children, especially in areas with relatively high exposure background. OBJECTIVE: To examine the association between short-term effects of ambient air pollutants and lung function among healthy primary school-aged children in China. METHODS: A total of 334 healthy children (7-11 years) from four cities (Chengdu (Southwest China), Guangzhou (Southern China), Wuhan (Central China), and Xi'an (Northwest China)) in China with repeated lung function measurement in 2014-2016 were included. Daily ambient concentrations of PM2.5, PM10, NO2, SO2, mean temperature, and relative humidity data were obtained. Linear mixed model was used to estimate the percent change in lung function associated with per inter-quartile range (IQR) exposure (up to 3 days) increase after adjusting for confounders. RESULTS: Ambient PM2.5 and PM10 exposure were associated with decrements in lung function measurements. The moving average exposures generally showed stronger effect estimates than the single lag day exposures. An IQR increase in two-day average (lag01 day) PM10 exposure (IQR, 144 µg/m3) was significantly associated with 2.56% decrease in FVC, 5.46% in FEV1, 4.23% in PEF, and 7.35% in FEF25%, respectively. The effect estimates were stronger after adjusting for gaseous pollutants in particulate matter (PM) models. The strengths of these associations were stronger in girls than those in boys. CONCLUSION: Short-term exposure to PM was associated with reduced lung function in healthy children. The estimated adverse effects were greater in girls than in boys.

[Determination of lead and isotope ratios in whole blood by inductively coupled plasma mass spectrometry].

OBJECTIVE: To establish a method to determine lead and Isotope Ratios in whole blood by inductively coupled plasma mass spectrometry (ICP-MS). METHODS: The whole blood samples was removed protein by 5% nitric acid , Online join thallium (Tl) as internal standard substance, used lyophilized bovine blood lead and cadmium standard material (GBW09139h and GBW09140h) for quality control of blood lead concentrations. Lead isotope standard substances (GBW04426) is used to determine the correction factor, lead isotope ratios will lead isotope standard reference material NIST SRM981 by icp-ms with samples for testing. RESULTS: Optimize the detection method, detection of blood lead and lead isotope, and the method of linear range r >0.9999, GBW09139h and GBW09140h test results are within the scope of quality control. NIST SRM981 isotope determination precision RSD<1%, NIST SRM981 test results and the certificate of value close to. CONCLUSION: The method is simple and convenient data is reliable, can meet the total lead (pb) in blood and former isotope simultaneous determination.

[Evaluation of the capacity of personal protection on poison emergency items in Chinese disease control and prevention institutes].

OBJECTIVE: To analyze the capacity of personal protection on poison emergency items in Chinese disease control and prevention institutes. METHODS: Evaluation analysis based on data obtained from investigating personal protection equipments and professional knowledge quizzing about personal protection in poisoning control of 57 different level centers for disease control and prevention selected from China by a multi-stage stratified sampling. RESULTS: All 80.70% of the institutes possessed the protection equipments, provincial, municipal, county level institutes were 100.00%, 95.24%, 66.67%, respectively, with significant statistical difference (H = 7.94, P < 0.05). The average level of the type of individual protective equipments in disease control and prevention institutes was (5.42 +/- 4.00) kinds, the average points in category of provincial, municipal, county level institutes were (11.33 +/- 3.67), (6.52 +/- 3.16), (3.47 +/- 3.10) kinds, being statistically significant (F = 17.30, P < 0.05); type difference counts of disease control and prevention institutes in economic development, secondary, less-developed regions were (6.41 +/- 4.03), (3.55 +/- 3.35), (6.45 +/- 4.07) kinds, with statistical significance (F = 3.70, P < 0.05). Protection equipments chiefly possessed were latex gloves, gauze masks and C-protective clothing. Protective clothing and respiratory protective equipments were insufficient evidently. The average points in testing personal protection basic knowledge were (71.39 +/- 12.52) points; there were no differences between different institutes with different economic regions, levels, technical posts and title degrees. CONCLUSION: Certain advances have been achieved in recent years in personal protection capacity of institutes for disease control and prevention, but far from the actual demands, and maybe no enough effective response on emergency occurred.

[Experimental study on therapeutic efficacy of tetrandrine on lung injury induced by acute of paraquat poisoning].

OBJECTIVE: To investigate the antagonistic efficacy of tetrandrine (TET) on lung injury induced by acute paraquat poisoning. METHODS: Male Wistar rats were randomly divided into three groups (control group, non-treatment group and treatment group). The tetrandrine of 30 mg/kg was given by gastric lavage six hours after 32 rats were intraperitoneally injected with paraquat 15 mg/kg (treatment group). Then the same dose of tetrandrine was given once a day. Normal saline of the same volume was given by gastric lavage in another 32 rats intraperitoneally injected with paraquat 15 mg/kg (non-treatment group). Seven rats were intraperitoneally injected by normal saline as the control group. Levels of maleic dialdehyde (MDA), activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in plasma and the lung homogenate of three groups were determined at 3 d, 7 d, 14 d and 21 d after exposure to paraquat. Histological changes of the lungs were observed. RESULTS: The levels of MDA at 3 d both in plasma [(3.65 +/- 0.44) nmol/ml] and the lung homogenate [(9.54 +/- 0.92) nmol/mg pro] of the non-treatment group significantly increased compared with the control group (P < 0.01), the activities of GSH-Px and SOD in plasma at 3 d were significantly less than the control group (P < 0.05 or P < 0.01), the activities of GSH-Px (3 d, 7 d) and SOD (7 d, 14 d) in the lung homogenate were significantly less than the control group (P < 0.05). There were no significant difference in the levels of MDA both in plasma and the lung homogenate between the treatment group and the non-treatment group (P > 0.05). The SOD activities of treatment group on the third day was significantly increased compared with the non-treatment group (P < 0.01 or P < 0.05). Although the activities of GSH-Px in plasma and the lung homogenate of the treatment group on the third day were increased, there was no significantly difference compared with the non-treatment group (P > 0.05). The integral score of pulmonary fibrosis in the treatment group were significantly lower than in the non-treatment group (P < 0.01). CONCLUSION: TET has antagonistic effect against acute toxicity of paraquat through significant reduction of pulmonary fibrosis.