Respiratory medication sales and urban air pollution in Brussels (2005 to 2011)

BackgroundWe investigated the associations between daily sales of respiratory medication and air pollutants in the Brussels-Capital Region between 2005 and 2011.MethodsWe used over-dispersed Poisson Generalized Linear Models to regress daily individual reimbursement data of prescribed asthma and COPD medication from the social security database against each subject's residential exposure to outdoor particulate matter (PM₁₀) or NO₂ estimated, by interpolation from monitoring stations. We calculated cumulative risk ratios (RR) and their 95% confidence intervals (CI) for interquartile ranges (IQR) of exposure for different windows of past exposure for the entire population and for seven age groups.ResultsMedian daily concentrations of PM₁₀ and NO₂ were 25 μg/m³ (IQR = 17.1) and 38 μg/m³ (IQR = 20.5), respectively. PM₁₀ was associated with daily medication sales among individuals aged 13 to 64 y. For NO₂, significant associations were observed among all age groups except > 84 y. The highest RR were observed for NO₂, among adolescents, including three weeks lags (RR = 1.187 95%CI: 1.097–1.285).ConclusionThe associations found between temporal changes in exposure to air pollutants and daily sales of respiratory medication in Brussels indicate that urban air pollution contributes to asthma and COPD morbidity in the general population.     

Long-term air pollution exposure and diabetes in a population-based Swiss cohort

Air pollution is an important risk factor for global burden of disease. There has been recent interest in its possible role in the etiology of diabetes mellitus. Experimental evidence is suggestive, but epidemiological evidence is limited and mixed. We therefore explored the association between air pollution and prevalent diabetes, in a population-based Swiss cohort.We did cross-sectional analyses of 6392 participants of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults [SAPALDIA], aged between 29 and 73 years. We used estimates of average individual home outdoor PM₁₀ [particulate matter <10 μm in diameter] and NO₂ [nitrogen dioxide] exposure over the 10 years preceding the survey. Their association with diabetes was modeled using mixed logistic regression models, including participants' study area as random effect, with incremental adjustment for confounders.There were 315 cases of diabetes (prevalence: 5.5% [95% confidence interval (CI): 2.8, 7.2%]). Both PM₁₀ and NO₂ were associated with prevalent diabetes with respective odds ratios of 1.40 [95% CI: 1.17, 1.67] and 1.19 [95% CI: 1.03, 1.38] per 10 μg/m³ increase in the average home outdoor level. Associations with PM₁₀ were generally stronger than with NO₂, even in the two-pollutant model. There was some indication that beta blockers mitigated the effect of PM₁₀. The associations remained stable across different sensitivity analyses.Our study adds to the evidence that long term air pollution exposure is associated with diabetes mellitus. PM₁₀ appears to be a useful marker of aspects of air pollution relevant for diabetes. This association can be observed at concentrations below air quality guidelines.     

Exposure to coarse particulate matter during gestation and birth weight in the U.S.

Few studies have explored the relationship between coarse particles (PM_10-2.5) and adverse birth outcomes. We examined associations between gestational exposure of PM_10-2.5 and birth weight. U.S. birth certificates data (1999–2007) were acquired for 8,017,865 births. Gestational and trimester exposures of PM_10-2.5 were estimated using co-located PM₁₀ and PM_2.5 monitors ≤ 35 km from the population-weighted centroid of mothers' residential counties. A linear regression model was applied, adjusted by potential confounders. As sensitivity analyses, we explored alternative PM_10-2.5 estimations, adjustment for PM_2.5, and stratification by regions. Gestational exposure to PM_10-2.5 was associated with 6.6 g (95% Confidence Interval: 5.9, 7.2) lower birth weight per interquartile range increase (7.8 μg/m³) in PM_10-2.5 exposures. All three trimesters showed associations. Under different exposure methods for PM_10-2.5, associations remained consistent but with different magnitudes. Results were robust after adjusting for PM_2.5, and regional analyses showed associations in all four regions with larger estimates in the South. Our results suggest that PM_10-2.5 is associated with birth weight in addition to PM_2.5. Regional heterogeneity may reflect differences in population, measurement error, region-specific emission pattern, or different chemical composition within PM_10-2.5. Most countries do not set health-based standards for PM_10-2.5, but our findings indicate potentially important health effects of PM_10-2.5.     

Associations between ultrafine and fine particles and mortality in five central European cities — Results from the UFIREG study

BackgroundEvidence on health effects of ultrafine particles (UFP) is still limited as they are usually not monitored routinely. The few epidemiological studies on UFP and (cause-specific) mortality so far have reported inconsistent results.ObjectivesThe main objective of the UFIREG project was to investigate the short-term associations between UFP and fine particulate matter (PM) < 2.5 μm (PM_2.5) and daily (cause-specific) mortality in five European Cities. We also examined the effects of PM < 10 μm (PM₁₀) and coarse particles (PM_2.5–10).MethodsUFP (20–100 nm), PM and meteorological data were measured in Dresden and Augsburg (Germany), Prague (Czech Republic), Ljubljana (Slovenia) and Chernivtsi (Ukraine). Daily counts of natural and cardio-respiratory mortality were collected for all five cities. Depending on data availability, the following study periods were chosen: Augsburg and Dresden 2011–2012, Ljubljana and Prague 2012–2013, Chernivtsi 2013–March 2014. The associations between air pollutants and health outcomes were assessed using confounder-adjusted Poisson regression models examining single (lag 0–lag 5) and cumulative lags (lag 0–1, lag 2–5, and lag 0–5). City-specific estimates were pooled using meta-analyses methods.ResultsResults indicated a delayed and prolonged association between UFP and respiratory mortality (9.9% [95%-confidence interval: − 6.3%; 28.8%] increase in association with a 6-day average increase of 2750 particles/cm³ (average interquartile range across all cities)). Cardiovascular mortality increased by 3.0% [− 2.7%; 9.1%] and 4.1% [0.4%; 8.0%] in association with a 12.4 μg/m³ and 4.7 μg/m³ increase in the PM_2.5- and PM_2.5–10-averages of lag 2–5.ConclusionsWe observed positive but not statistically significant associations between prolonged exposures to UFP and respiratory mortality, which were independent of particle mass exposures. Further multi-centre studies are needed investigating several years to produce more precise estimates on health effects of UFP.     

Association between long-term exposure to air pollution and mortality in France: A 25-year follow-up study

IntroductionLong-term exposure to air pollution (AP) has been shown to have an impact on mortality in numerous countries, but since 2005 no data exists for France.ObjectivesWe analyzed the association between long-term exposure to air pollution and mortality at the individual level in a large French cohort followed from 1989 to 2013.MethodsThe study sample consisted of 20,327 adults working at the French national electricity and gas company EDF-GDF. Annual exposure to PM₁₀, PM_10–2.5, PM_2.5, NO₂, O₃, SO₂, and benzene was assessed for the place of residence of participants using a chemistry-transport model and taking residential history into account. Hazard ratios were estimated using a Cox proportional-hazards regression model, adjusted for selected individual and contextual risk factors. Hazard ratios were computed for an interquartile range (IQR) increase in air pollutant concentrations.ResultsThe cohort recorded 1967 non-accidental deaths. Long-term exposures to baseline PM_2.5, PM_10-25, NO₂ and benzene were associated with an increase in non-accidental mortality (Hazard Ratio, HR = 1.09; 95% CI: 0.99, 1.20 per 5.9 μg/m³, PM_10-25; HR = 1.09;95% CI: 1.04, 1.15 per 2.2 μg/m³, NO₂: HR = 1.14; 95% CI: 0.99, 1.31 per 19.3 μg/m³ and benzene: HR = 1.10; 95% CI: 1.00, 1.22 per 1.7 μg/m³).The strongest association was found for PM₁₀: HR = 1.14; 95% CI: 1.05, 1.25 per 7.8 μg/m³. PM₁₀, PM_10-25 and SO₂ were associated with non-accidental mortality when using time varying exposure. No significant associations were observed between air pollution and cardiovascular and respiratory mortality.ConclusionLong-term exposure to fine particles, nitrogen dioxide, sulfur dioxide and benzene is associated with an increased risk of non-accidental mortality in France. Our results strengthen existing evidence that outdoor air pollution is a significant environmental risk factor for mortality. Due to the limited sample size and the nature of our study (occupational), further investigations are needed in France with a larger representative population sample.     

Short-term effects of particulate matter constituents on daily hospitalizations and mortality in five South-European cities: Results from the MED-PARTICLES project

BackgroundFew recent studies examined acute effects on health of individual chemical species in the particulate matter (PM) mixture, and most of them have been conducted in North America. Studies in Southern Europe are scarce. The aim of this study is to examine the relationship between particulate matter constituents and daily hospital admissions and mortality in five cities in Southern Europe.MethodsThe study included five cities in Southern Europe, three cities in Spain: Barcelona (2003–2010), Madrid (2007–2008) and Huelva (2003–2010); and two cities in Italy: Rome (2005–2007) and Bologna (2011–2013). A case-crossover design was used to link cardiovascular and respiratory hospital admissions and total, cardiovascular and respiratory mortality with a pre-defined list of 16 PM₁₀ and PM_2.5 constituents. Lags 0 to 2 were examined. City-specific results were combined by random-effects meta-analysis.ResultsMost of the elements studied, namely EC, SO₄^2 −, SiO_2, Ca, Fe, Zn, Cu, Ti, Mn, V and Ni, showed increased percent changes in cardiovascular and/or respiratory hospitalizations, mainly at lags 0 and 1. The percent increase by one interquartile range (IQR) change ranged from 0.69% to 3.29%. After adjustment for total PM levels, only associations for Mn, Zn and Ni remained significant. For mortality, although positive associations were identified (Fe and Ti for total mortality; EC and Mg for cardiovascular mortality; and NO₃⁻ for respiratory mortality) the patterns were less clear.ConclusionsThe associations found in this study reflect that several PM constituents, originating from different sources, may drive previously reported results between PM and hospital admissions in the Mediterranean area.     

Saharan dust,particulate matter and cause-specific mortality: A case–crossover study in Barcelona (Spain)

BackgroundStudies measuring health effects of Saharan dust based on large particulate matter (PM) fraction groups may be masking some effects. Long distant transport reduces the amount of heavier and larger particles in the Saharan air masses increasing the relative contribution of smaller particles that may be more innocuous. This study investigates the association between different PM fractions and daily mortality during Saharan and non-Saharan days in Barcelona, Spain.MethodsWe collected daily PM₁, PM_2.5–1 and PM_10–2.5 fractions, and cause-specific mortality (cardiovascular, respiratory and cerebrovascular) between March 2003 and December 2007. Changes of effects between Saharan and non-Saharan dust days were assessed using a time-stratified case–crossover design.ResultsDuring non-Saharan dust days we found statistically significant (p < 0.05) effects of PM_10–2.5 for cardiovascular (odds ratio for increase of an interquartile range, OR = 1.033, 95% confidence interval: 1.006–1.060) and respiratory mortality (OR = 1.044, 95% CI: 1.001–1.089). During Saharan dust days strongest cardiovascular effects were found for the same fraction (OR = 1.085, 95% CI: 1.017–1.158) with an indication of effect modification (p = 0.111). Effects of PM_2.5–1 during Saharan dust days were about the double than in non-dust days for cardiovascular and respiratory mortality, but these differences were not statistically significant.ConclusionOur results using independent fractions of PMs provide further evidence that the effects of short-term exposure to PM during Saharan dust days are associated with both cardiovascular and respiratory mortality. A better understanding of which of the different PM size fractions brought by Saharan dust is more likely to accelerate adverse effects may help better understand mechanisms of toxicity.     

The impact of summer temperatures and heatwaves on mortality and morbidity in Perth,Australia 1994–2008

Climate change projections have drawn attention to the risks of extreme heat and the importance of public health interventions to minimise the impact. The city of Perth, Western Australia, frequently experiences hot summer conditions, with recent summers showing above average temperatures. Daily maximum and minimum temperatures, mortality, emergency department (ED) presentations and hospital admissions data were acquired for Perth for the period 1994 to 2008. Using an observed/expected analysis, the temperature thresholds for mortality were estimated at 34–36 °C (maximum) and 20 °C (minimum). Generalised estimating equations (GEEs) were used to estimate the percentage increase in mortality and morbidity outcomes with a 10 °C increment in temperature, with adjustment for air pollutants. Effect estimates are reported as incidence rate ratios (IRRs). The health impact of heatwave days (three or more days of ≥ 35 °C) was also investigated. A 9.8% increase in daily mortality (IRR 1.098; 95%CI: 1.007–1.196) was associated with a 10 °C increase in maximum temperature above threshold. Total ED presentations increased by 4.4% (IRR 1.044; 95%CI: 1.033–1.054) and renal-related ED presentations by 10.2% (IRR 1.102; 95%CI: 1.071–1.135) per 10 °C increase in maximum temperature. Heatwave days were associated with increases in daily mortality and ED presentations, while total hospital admissions were decreased on heatwave days. Public health interventions will be increasingly important to minimise the adverse health impacts of hot weather in Perth, particularly if the recent trend of rising average temperatures and more hot days continues as projected.     

Air pollution exposure and telomere length in highly exposed subjects in Beijing,China: A repeated-measure study

BackgroundAmbient particulate matter (PM) exposure has been associated with short- and long-term effects on cardiovascular disease (CVD). Telomere length (TL) is a biomarker of CVD risk that is modified by inflammation and oxidative stress, two key pathways for PM effects. Whether PM exposure modifies TL is largely unexplored.ObjectivesTo investigate effects of PM on blood TL in a highly-exposed population.MethodsWe measured blood TL in 120 blood samples from truck drivers and 120 blood samples from office workers in Beijing, China. We measured personal PM_2.5 and Elemental Carbon (EC, a tracer of traffic particles) using light-weight monitors. Ambient PM₁₀ was obtained from local monitoring stations. We used covariate-adjusted regression models to estimate percent changes in TL per an interquartile-range increase in exposure.ResultsCovariate-adjusted TL was higher in drivers (mean = 0.87, 95%CI: 0.74; 1.03) than in office workers (mean = 0.79, 95%CI: 0.67; 0.93; p = 0.001). In all participants combined, TL increased in association with personal PM_2.5 (+ 5.2%, 95%CI: 1.5; 9.1; p = 0.007), personal EC (+ 4.9%, 95%CI: 1.2; 8.8; p = 0.01), and ambient PM₁₀ (+ 7.7%, 95%CI: 3.7; 11.9; p < 0.001) on examination days. In contrast, average ambient PM₁₀ over the 14 days before the examinations was significantly associated with shorter TL (− 9.9%, 95%CI: − 17.6; − 1.5; p = 0.02).ConclusionsShort-term exposure to ambient PM is associated with increased blood TL, consistent with TL roles during acute inflammatory responses. Longer exposures may shorten TL as expected after prolonged pro-oxidant exposures. The observed TL alterations may participate in the biological pathways of short- and long-term PM effects.     

Air pollution,ethnicity and telomere length in east London schoolchildren: An observational study

BackgroundShort telomeres are associated with chronic disease and early mortality. Recent studies in adults suggest an association between telomere length and exposure to particulate matter, and that ethnicity may modify the relationship. However associations in children are unknown.ObjectivesWe examined associations between air pollution and telomere length in an ethnically diverse group of children exposed to high levels of traffic derived pollutants, particularly diesel exhaust, and to environmental tobacco smoke.MethodsOral DNA from 333 children (8–9 years) participating in a study on air quality and respiratory health in 23 inner city London schools was analysed for relative telomere length using monochrome multiplex qPCR. Annual, weekly and daily exposures to nitrogen oxides and particulate matter were obtained from urban dispersion models (2008–10) and tobacco smoke by urinary cotinine. Ethnicity was assessed by self-report and continental ancestry by analysis of 28 random genomic markers. We used linear mixed effects models to examine associations with telomere length.ResultsTelomere length increased with increasing annual exposure to NO_x (model coefficient 0.003, [0.001, 0.005], p < 0.001), NO₂ (0.009 [0.004, 0.015], p < 0.001), PM_2.5 (0.041, [0.020, 0.063], p < 0.001) and PM₁₀ (0.096, [0.044, 0.149], p < 0.001). There was no association with environmental tobacco smoke. Telomere length was increased in children reporting black ethnicity (22% [95% CI 10%, 36%], p < 0.001)ConclusionsPollution exposure is associated with longer telomeres in children and genetic ancestry is an important determinant of telomere length. Further studies should investigate both short and long-term associations between pollutant exposure and telomeres in childhood and assess underlying mechanisms.     

High resolution exposure modelling of heat and air pollution and the impact on mortality

BackgroundElevated temperature and air pollution have been associated with increased mortality. Exposure to heat and air pollution, as well as the density of vulnerable groups varies within cities. The objective was to investigate the extent of neighbourhood differences in mortality risk due to heat and air pollution in a city with a temperate maritime climate.MethodsA case-crossover design was used to study associations between heat, air pollution and mortality. Different thermal indicators and air pollutants (PM₁₀, NO₂, O₃) were reconstructed at high spatial resolution to improve exposure classification. Daily exposures were linked to individual mortality cases over a 15 year period.ResultsSignificant interaction between maximum air temperature (Ta_max) and PM₁₀ was observed. During “summer smog” days (Ta_max > 25 °C and PM₁₀ > 50 μg/m³), the mortality risk at lag 2 was 7% higher compared to the reference (Ta_max 15 °C and PM₁₀ 15 μg/m³). Persons above age 85 living alone were at highest risk.ConclusionWe found significant synergistic effects of high temperatures and air pollution on mortality. Single living elderly were the most vulnerable group. Due to spatial differences in temperature and air pollution, mortality risks varied substantially between neighbourhoods, with a difference up to 7%.     

Chronic disease prevalence in women and air pollution — A 30-year longitudinal cohort study

BackgroundAir pollution, such as fine particulate matter (PM_2.5), can increase risk of adverse health events among people with heart disease, diabetes, asthma and chronic obstructive pulmonary disease (COPD) by aggravating these conditions. Identifying the influence of PM_2.5 on prevalence of these conditions may help target interventions to reduce disease morbidity among high-risk populations.ObjectivesThe objective of this study is to measure the association of exposure of PM_2.5 with prevalence risk of various chronic diseases among a longitudinal cohort of women.MethodsWomen from Ontario who enrolled in the Canadian National Breast Screening Study (CNBSS) from 1980 to 1985 (n = 29,549) were linked to provincial health administrative data from April 1, 1992 to March 31, 2013 to determine the prevalence of major chronic disease and conditions (heart disease, diabetes, asthma, COPD, acute myocardial infarction, angina, stroke and cancers). Exposure to PM_2.5 was measured using satellite data collected from January 1, 1998 to December 31, 2006 and assigned to resident postal-code at time of entry into study. Poisson regression models were used to describe the relationship between exposure to ambient PM_2.5 and chronic disease prevalence. Prevalence rate ratios (PRs) were estimated while adjusting for potential confounders: baseline age, smoking, BMI, marital status, education and occupation. Separate models were run for each chronic disease and condition.ResultsCongestive heart failure (PR = 1.31, 95% CI: 1.13, 1.51), diabetes (PR = 1.28, 95% CI: 1.16, 1.41), ischemic heart disease (PR = 1.22, 95% CI: 1.14, 1.30), and stroke (PR = 1.21, 95% CI: 1.09, 1.35) showed over a 20% increase in PRs per 10 μg/m³ increase in PM_2.5 after adjusting for risk factors. Risks were elevated in smokers and those with BMI greater than 30.ConclusionsThis study estimated significant elevated prevalent rate ratios per unit increase in PM_2.5 in nine of the ten chronic diseases studied.     

Spatial variations in the associations of term birth weight with ambient air pollution in Georgia,USA

Birth weight is an important indicator of overall infant health and a strong predictor of infant morbidity and mortality, and low birth weight (LBW) is a leading cause of infant mortality in the United States. Numerous studies have examined the associations of birth weight with ambient air pollution, but the results were inconsistent. In this study, a spatial statistical technique, geographically weighted regression (GWR) is applied to explore the spatial variations in the associations of birth weight with concentrations of ozone (O₃) and fine particulate matter (PM_2.5) in the State of Georgia, USA adjusted for gestational age, parity, and six other socioeconomic, behavioral, and land use factors. The results show considerable spatial variations in the associations of birth weight with both pollutants. Significant positive, non-significant, and significant negative relationships between birth weight and concentrations of each air pollutant are all found in different parts of the study area, and the different types of the relationships are affected by the socioeconomic and urban characteristics of the communities where the births are located. The significant negative relationships between birth weight and O₃ indicate that O₃ is a significant risk factor of LBW and these associations are primarily located in less-urbanized communities. On the other hand, PM_2.5 is a significant risk factor of LBW in the more-urbanized communities with higher family income and education attainment. These findings suggest that environmental and health policies should be adjusted to address the different effects of air pollutants on birth outcomes across different types of communities to more effectively and efficiently improve birth outcomes.     

DNA hypomethylation and its mediation in the effects of fine particulate air pollution on cardiovascular biomarkers: A randomized crossover trial

BackgroundShort-term exposure to fine particulate matter (PM_2.5) air pollution has been associated with altered DNA methylation in observational studies, but it remains unclear whether this change mediates the effects on cardiovascular biomarkers.ObjectiveTo examine the impact of ambient PM_2.5 on gene-specific DNA methylation and its potential mediation in the acute effects of PM_2.5 on cardiovascular biomarkers.MethodsWe designed a randomized, double-blind crossover trial using true or sham air purifiers for 48 h among 35 healthy college students in Shanghai, China, in 2014. We measured blood global methylation estimated in long interspersed nucleotide element-1 (LINE‑1) and Alu repetitive elements, methylation in ten specific genes, and ten cardiovascular biomarkers. We used linear mixed-effect models to examine the associations between PM_2.5 and methylation. We also performed causal mediation analyses to evaluate the potential mediation of methylation in the associations between PM_2.5 and biomarkers.ResultsAir purification increased DNA methylation in repetitive elements and all candidate genes. An IQR increase (64 μg/m³) in PM_2.5 was significantly associated with reduction of methylation in LINE-1 (1.44%), one pro-inflammatory gene (CD40LG, 9.13%), two pro-coagulant genes (F3, 15.20%; SERPINE1, 3.69%), and two pro-vasoconstriction genes (ACE, 4.64%; EDN1, 9.74%). There was a significant mediated effect (17.82%, P = 0.03) of PM_2.5 on sCD40L protein through CD40LG hypomethylation. Hypomethylation in other candidate genes generally showed positive but non-significant mediation.ConclusionsThis intervention study provided robust human evidence that ambient PM_2.5 could induce rapid decreases in DNA methylation and consequently partly mediate its effects on cardiovascular biomarkers.     

Heat and air pollution exposure as triggers of delivery: A survival analysis of population-based pregnancy cohorts in Rome and Barcelona

IntroductionEnvironmental exposures have been linked to length of gestation but the question as to during which weeks of gestation pregnancies are most susceptible still remains little explored.We estimated the effect of maximum apparent temperature and air pollution levels on risk of birth by week of gestation.MethodsWe analyzed two cohorts of singleton live births in Rome (2001–2010) and Barcelona (2007–2012). Maximum apparent temperature (MAT), PM₁₀, O₃ and NO₂ were analyzed in the warm period (1st April–31st October).Gestational week-specific hazard ratios of giving birth associated to a 1-unit increase in exposure were estimated fitting Cox regression models adjusted for seasonality, and demographic and clinical characteristics of the mother.ResultsWe observed 78,633 births (5.5% preterm) in Rome and 27,255 (4.5% preterm) in Barcelona. The highest hazard ratios for 1 °C increase in MAT were in the 22nd–26th weeks of gestation, 1.071, (95% CI 1.052–1.091) in Rome and 1.071 (95% CI 1.036–1.106) in Barcelona, and decreased to 1.032 (95% CI 1.026–1.038) and 1.033 (95% CI 1.020–1.045) at the 36th week of gestation, respectively. Similar associations and trends were observed for PM₁₀ and NO₂ after adjusting for MAT. O₃ showed similar trends but weaker associations.ConclusionsWe found, consistently in Rome and Barcelona, an increased risk of delivery for a unit increase in MAT, PM₁₀, NO₂ and O₃, especially in the second half of the second trimester, thus effectively increasing the risk of preterm and particularly early preterm birth. Results may help to increase awareness of these risks among public-health regulators and clinicians, leading to better preventive strategies.     

Health effects from Sahara dust episodes in Europe: Literature review and research gaps

The adverse consequences of particulate matter (PM) on human health have been well documented. Recently, special attention has been given to mineral dust particles, which may be a serious health threat. The main global source of atmospheric mineral dust is the Sahara desert, which produces about half of the annual mineral dust. Sahara dust transport can lead to PM levels that substantially exceed the established limit values. A review was undertaken using the ISI web of knowledge database with the objective to identify all studies presenting results on the potential health impact from Sahara dust particles. The review of the literature shows that the association of fine particles, PM_2.5, with total or cause‐specific daily mortality is not significant during Saharan dust intrusions. However, regarding coarser fractions PM₁₀ and PM_2.5–10 an explicit answer cannot be given. Some of the published studies state that they increase mortality during Sahara dust days while other studies find no association between mortality and PM₁₀ or PM_2.5–10. The main conclusion of this review is that health impact of Saharan dust outbreaks needs to be further explored. Considering the diverse outcomes for PM₁₀ and PM_2.5–10, future studies should focus on the chemical characterization and potential toxicity of coarse particles transported from Sahara desert mixed or not with anthropogenic pollutants. The results of this review may be considered to establish the objectives and strategies of a new European directive on ambient air quality. An implication for public policy in Europe is that to protect public health, anthropogenic sources of particulate pollution need to be more rigorously controlled in areas highly impacted by the Sahara dust.     

The mortality effect of ship-related fine particulate matter in the Sydney greater metropolitan region of NSW,Australia

This study investigates the mortality effect of primary and secondary PM_2.5 related to ship exhaust in the Sydney greater metropolitan region of Australia. A detailed inventory of ship exhaust emissions was used to model a) the 2010/11 concentration of ship-related PM_2.5 across the region, and b) the reduction in PM_2.5 concentration that would occur if ships used distillate fuel with a 0.1% sulfur content at berth or within 300 km of Sydney. The annual loss of life attributable to 2010/11 levels of ship-related PM_2.5 and the improvement in survival associated with use of low-sulfur fuel were estimated from the modelled concentrations.In 2010/11, approximately 1.9% of the region-wide annual average population weighted-mean concentration of all natural and human-made PM_2.5 was attributable to ship exhaust, and up to 9.4% at suburbs close to ports. An estimated 220 years of life were lost by people who died in 2010/11 as a result of ship exhaust-related exposure (95% CI_β: 140–290, where CI_β is the uncertainty in the concentration-response coefficient only). Use of 0.1% sulfur fuel at berth would reduce the population weighted-mean concentration of PM_2.5 related to ship exhaust by 25% and result in a gain of 390 life-years over a twenty year period (95% CI_β: 260–520). Use of 0.1% sulfur fuel within 300 km of Sydney would reduce the concentration by 56% and result in a gain of 920 life-years over twenty years (95% CI_β: 600–1200).Ship exhaust is an important source of human exposure to PM_2.5 in the Sydney greater metropolitan region. This assessment supports intervention to reduce ship emissions in the GMR. Local strategies to limit the sulfur content of fuel would reduce exposure and will become increasingly beneficial as the shipping industry expands. A requirement for use of 0.1% sulfur fuel by ships within 300 km of Sydney would provide more than twice the mortality benefit of a requirement for ships to use 0.1% sulfur fuel at berth.     

Using the Community Multiscale Air Quality (CMAQ) model to estimate public health impacts of PM2.5 from individual power plants

We estimated PM_2.5-related public health impacts/ton emitted of primary PM_2.5, SO₂, and NO_x for a set of power plants in the Mid-Atlantic and Lower Great Lakes regions of the United States, selected to include varying emission profiles and broad geographic representation. We then developed a regression model explaining variability in impacts per ton emitted using the population distributions around each plant. We linked outputs from the Community Multiscale Air Quality (CMAQ) model v 4.7.1 with census data and concentration–response functions for PM_2.5-related mortality, and monetized health estimates using the value-of-statistical-life. The median impacts for the final set of plants were $130,000/ton for primary PM_2.5 (range: $22,000–230,000), $28,000/ton for SO₂ (range: $19,000–33,000), and $16,000/ton for NOx (range: $7100–26,000). Impacts of NO_x were a median of 34% (range: 20%–75%) from ammonium nitrate and 66% (range: 25%–79%) from ammonium sulfate. The latter pathway is likely from NO_x enhancing atmospheric oxidative capacity and amplifying sulfate formation, and is often excluded. Our regression models explained most of the variation in impact/ton estimates using basic population covariates, and can aid in estimating impacts averted from interventions such as pollution controls, alternative energy installations, or demand-side management.     

Associations of gestational and early life exposures to ambient air pollution with childhood respiratory diseases in Shanghai,China: A retrospective cohort study

BackgroundAssociations of ambient air pollutants with respiratory health are inconsistent.ObjectivesWe analyzed the associations of gestational and early life exposures to air pollutants with doctor-diagnosed asthma, allergic rhinitis, and pneumonia in children.MethodsWe selected 3358 preschool children who did not alter residences after birth from a cross-sectional study in 2011–2012 in Shanghai, China. Parents reported children's respiratory health history, home environment, and family lifestyle behaviors. We collected daily concentrations of sulphur dioxide (SO₂), nitrogen dioxide (NO₂), and particulate matter with an aerodynamic diameter ≤ 10 μm (PM₁₀) during the child's total lifetime (2006–2012) for each district where the children lived. We analyzed the associations using logistic regression models.ResultsAfter adjusting for covariates and the other studied pollutants, we found that exposure to NO₂ (increment of 20 μg/m³) during the first year of life was significantly associated with asthma [odds ratio (OR) = 1.77; 95% confidence interval (CI): 1.29–2.43] and allergic rhinitis (OR = 1.67; 95% CI: 1.07–2.61). Exposure to NO₂ during gestation, the first two and three years, and over total lifetimewas all consistently associated with increased odds of allergic rhinitis. Quartiles of NO₂ concentration during different exposure periods showed a slight dose–response relationship with the studied diseases. These diseases had significant associations with pollutant mixtures that included NO₂, but had no significant association with exposures to SO₂ and PM₁₀ individually or in mixtures.ConclusionsGestational and early life exposures to ambient NO₂ are risk factors for childhood respiratory diseases.     

Acute health impacts of airborne particles estimated from satellite remote sensing

Satellite-based remote sensing provides a unique opportunity to monitor air quality from space at global, continental, national and regional scales. Most current research focused on developing empirical models using ground measurements of the ambient particulate. However, the application of satellite-based exposure assessment in environmental health is still limited, especially for acute effects, because the development of satellite PM_2.5 model depends on the availability of ground measurements. We tested the hypothesis that MODIS AOD (aerosol optical depth) exposure estimates, obtained from NASA satellites, are directly associated with daily health outcomes. Three independent healthcare databases were used: unscheduled outpatient visits, hospital admissions, and mortality collected in Beijing metropolitan area, China during 2006. We use generalized linear models to compare the short-term effects of air pollution assessed by ground monitoring (PM₁₀) with adjustment of absolute humidity (AH) and AH-calibrated AOD. Across all databases we found that both AH-calibrated AOD and PM₁₀ (adjusted by AH) were consistently associated with elevated daily events on the current day and/or lag days for cardiovascular diseases, ischemic heart diseases, and COPD. The relative risks estimated by AH-calibrated AOD and PM₁₀ (adjusted by AH) were similar. Additionally, compared to ground PM₁₀, we found that AH-calibrated AOD had narrower confidence intervals for all models and was more robust in estimating the current day and lag day effects. Our preliminary findings suggested that, with proper adjustment of meteorological factors, satellite AOD can be used directly to estimate the acute health impacts of ambient particles without prior calibrating to the sparse ground monitoring networks.