Previous studies demonstrated that short-term exposure to gaseous pollutants (nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3)) had a greater adverse effect on cardiovascular disease. However, little evidence exists regarding the synergy between gaseous pollutants and cardiovascular disease (CVD). Therefore, we aimed to estimate the effect of individual gaseous pollutants on hospital admissions for CVD and to explore the possible synergistic effects between gaseous pollutants. Daily hospitalization counts for CVD were collected from January 1, 2014, to December 31, 2015. We also collected daily time series on gaseous pollutants from the Environment of the People’s Republic of China, including NO2, SO2, and O3. We used distributed lag nonlinear models (DLNMs) to assess the association of individual gaseous pollutants on CVD hospitalization, after controlling for seasonality, day of the week, public holidays, and weather variables. Then, we explored the variability across age and sex groups. In addition, we analyzed the synergistic effects between gaseous pollutants on CVD. Extremely low NO2 and SO2 increase the risk of CVD in all subgroup at lag 7 days. The greatest effect of high concentration of SO2 was observed in male and the elderly (≥ 65 years) at lag 3 days. Greater effects of high concentration of O3 were more pronounced in the young (< 65 years) and female at lag 3 days, while the effect of low concentration of O3 was greater in male and the young (< 65 years) at lag 0 day. We found a synergistic effect between NO2 and SO2 for CVD, as well as between SO2 and O3. The synergistic effects of NO2 and SO2 on CVD were stronger in the elderly (≥ 65) and female. The female was sensitive to synergistic effects of SO2-O3 and NO2-O3. Interestingly, we found that there was a risk of CVD in the susceptible population even for gaseous pollutant concentrations below the National Environmental Quality Standard. The synergy between NO2 and SO2 was significantly associated with cardiovascular disease hospitalization in the elderly (≥ 65). This study provides evidence for the synergistic effect of gaseous pollutants on hospital admissions for cardiovascular disease.
Environmental sustainability is the foundation and of great significance for the sustainable development of urban agglomerations. Taking the Beijing-Tianjin-Hebei urban agglomeration as an example, we developed a method to effectively assess long-term regional environmental sustainability based on the Google Earth Engine (GEE) platform. We used the GEE to obtain 5206 Landsat remote sensing images in the region from 1983 to 2016 and developed the comprehensive environmental index (CEI) to assess regional environmental sustainability based on the theme-oriented framework proposed by the United Nations Commission on Sustainable Development. We found that the environmental sustainability of the urban agglomeration showed a trend of first rising, then falling, and then rising again in the past 30 years. The average CEI increased from 0.621 to 0.631 from 1985 to 1990, dropped to the lowest value of 0.618 in 2000, and then rose to the highest value of 0.672 in 2015. In particular, the extent of areas in which environmental sustainability improved (56% of the region) was greater than the extent of areas in which environmental deterioration occurred. The environmental sustainability of Hengshui, Xingtai, and Cangzhou in the southeast of the region has been significantly improved. The method proposed in this study provides an automatic, rapid, and extensible way to assess regional environmental sustainability and provides a scientific reference for improving the sustainability of the regional environment.
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