Long term exposure to ambient air pollution and hospital admission burden in Scotland: 16 year prospective population cohort study.

Air pollution is considered a major threat for global health and is associated with various health outcomes. Previous research on long term exposure to ambient air pollution and health placed more emphasis on mortality rather than hospital admission outcomes and was characterised by heterogeneities in the size of effect estimates between studies, with less focus on mental/behavioural or infectious diseases outcomes. In this study, we investigated the association between long term exposure to ambient air pollution and all cause and cause specific hospital admissions. This was a prospective cohort study. Individual level data from the Scottish Longitudinal Study (SLS) were linked to yearly concentrations of four pollutants (nitrogen dioxide (NO2), sulphur dioxide (SO2), particulate matter diameter ≤10 µm (PM10) and particulate matter diameter ≤2.5 µm (PM2.5)) at 1 km2 spatial resolution using the individual's residential postcode for each year between 2002 and 2017. The study included 202 237 adult individuals aged ≥17 years. The associations between air pollution and all cause, cardiovascular, respiratory, infectious, mental/behavioural disorders and other cause hospital admissions were examined using multi-level, mixed effects, negative binomial regression. Higher exposure to NO2, PM10 and PM2.5 was associated with a higher incidence of all cause, cardiovascular, respiratory and infectious hospital admissions before adjusting for the area of residence, and in fully adjusted models when considering cumulative exposure across time. In fully adjusted models, the incidence rate for respiratory hospital admissions increased by 4.2% (95% CI 2.1% to 6.3%) and 1.2% (95% CI 0.8% to 1.7%) per 1 µg/m3 increase in PM2.5 and NO2 pollutants, respectively. SO2 was mainly associated with respiratory hospital admissions (incidence rate ratio (IRR)=1.016; 95% CI 1.004 to 1.027) and NO2 was related to a higher incidence of hospital admissions for mental/behavioural disorders (IRR=1.021; 95% CI 1.011 to 1.031). Average cumulative exposure to air pollution showed stronger positive associations with higher rates of hospital admissions. The results of this study support an association between long term (16 years) exposure to ambient air pollution and increased all cause and cause specific hospital admissions for both physical and mental/behavioural illnesses. The results suggest that interventions on air pollution through stricter environmental regulations could help ease the hospital care burden in Scotland in the long term.

Abed Al Ahad M ，Demšar U ，Sullivan F ，Kulu H ... -  《BMJ Open》

Short-term effects of air pollutants on hospitalization for childhood respiratory diseases in Suzhou City: a time-stratified case-crossover study.

Short-term exposure to air pollution has been demonstrated in previous studies to correlate with respiratory disease (RD) in children. Due to regional heterogeneity, our objective was to explore the correlation between short-term exposure to ambient air pollution and hospital admissions for respiratory ailments in children in Suzhou City from January 1, 2017, to December 31, 2022, alongside assessing the influence of the COVID-19 pandemic on this relationship. We collected data on air pollutant levels and hospital admissions for childhood respiratory disease (RD) in Suzhou, China, from 2017 to 2022. We utilized a time-stratified case-crossover design along with a conditional logistic regression model to assess the short-term impacts of air pollutants on RD in children through stratified analysis and sensitivity analysis. A total of 13,408 children with respiratory diseases were included in the study. The findings revealed significant associations between hospitalization for respiratory diseases in children and exposure to PM2.5, PM10, SO2, NO2, and CO. The maximum effect values (95%CI, best lag days) for each 10 µg/m3 increase in the concentrations of PM2.5, PM10, SO2, and NO2 were as follows: 1.017 (1.003-1.031, lag0-2), 1.015 (1.004-1.026, lag0-2), 1.117 (1.001-1.247, lag0-1), and 1.036 (1.009-1.064, lag0-7). Additionally, the maximum effect value (95%CI, best lag days) for each 1 mg/m3 increase in CO concentration was found to be 1.267 1.017-1.579, lag0-7). Stratified analysis indicated that sex, season of admission, and stage of admission did not modify these correlations significantly; however, differential effects on various age groups and sexes were primarily observed among school-age and older children as well as boys. The short-term exposure to PM2.5, PM10, SO2, NO2, and CO in Suzhou, China, exhibited a positive correlation with RD hospitalization. Prior to the COVID-19 pandemic, the adverse impacts of air pollutants on hospitalizations for childhood respiratory disease were mitigated compared to the period following the pandemic. Local governments should continue promoting decisions and measures for air pollution prevention and control to reduce further pollutant concentration, which is crucial for public health in reducing the burden of childhood respiratory diseases.

Zhang R ，Chen J ，Wang M ，Chen Z ，Sun H ... -  《-》

Ambient air pollution exposure and adult asthma incidence: a systematic review and meta-analysis.

Ambient (outdoor) air pollutant exposures have emerged as a plausible risk factor for incident childhood asthma. However, the effect of ambient air pollutant exposures on risk of incident adult asthma is unclear. We aimed to investigate associations between specific ambient air pollutants and the risk of incident adult asthma. In this systematic review and meta-analysis, we searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science from inception to Nov 27, 2023. We included observational studies with the outcome of new-onset asthma during adulthood (onset at ≥18 years), and metric of exposure of ambient air pollutants (particulate matter [PM]2·5, nitrogen dioxide [NO2], ozone [O3], and sulphur dioxide [SO2]). Study data were extracted independently by two reviewers and study quality was assessed using the Newcastle-Ottawa scale. When four or more eligible studies were available for a given pollutant, we applied meta-analysis using inverse variance weighting in a random effects model to estimate pooled relative risk (RR), and used meta-regression to explore sources of heterogeneity. The protocol was registered with PROSPERO, CRD42023420139. Our search identified 1891 references. After excluding 651 (34%) duplicates and ineligible studies, we included 25 studies in the systematic review. After excluding studies with overlapping populations or reporting effect estimates that could not be pooled, we performed meta-analysis for PM2·5 (nine studies), NO2 (nine studies), and O3 (four studies). Pooled random effects RRs for incident adult asthma per 5 μg/m3 increase in PM2·5 were 1·07 (95% CI 1·01 to 1·13) and per 10 μg/m3 in NO2 were 1·11 (1·03 to 1·20). We found no significant association between increasing O3 concentration and incident adult asthma (per 60-μg/m3 increase in O3, pooled RR 1·04 [0·79 to 1·36]). We found substantial heterogeneity across studies (I2=88% for all analyses). In exploratory meta-regression, average exposure level was a significant source of heterogeneity for the pooled NO2 estimate (95% CI -0·0077 to -0·0025 per μg/m3). Exposure to increased ambient PM2·5 or NO2 might present an additional risk factor for incident adult asthma, although high heterogeneity among included studies warrants caution in interpretation. Evidence was inconsistent for O3 and insufficient for SO2. To increase confidence and population representation in pooled estimates, further primary investigations are necessary, ideally with aligned methodology and reporting. None.

Lee S ，Tian D ，He R ，Cragg JJ ，Carlsten C ，Giang A ，Gill PK ，Johnson KM ，Brigham E ... -  《The Lancet Planetary Health》

The association between different timeframes of air pollution exposure and COVID-19 incidence, morbidity and mortality in German counties in 2020.

Ambient air pollution is a known risk factor for several chronic health conditions, including pulmonary dysfunction. In recent years, studies have shown a positive association between exposure to air pollutants and the incidence, morbidity, and mortality of a COVID-19 infection, however the time period for which air pollution exposure is most relevant for the COVID-19 outcome is still not defined. The aim of this study was to analyze the difference in association when varying the time period of air pollution exposure considered on COVID-19 infection within the same cohort during the first wave of the pandemic in 2020. We conducted a cross-sectional study analyzing the association between long- (10- and 2-years) and short-term (28 days, 7 days, and 2 days) exposure to NO2 and PM2.5 on SARS-CoV-2 incidence, morbidity, and mortality at the level of county during the first outbreak of the pandemic in spring 2020. Health data were extracted from the German national public health institute (Robert-Koch-Institute) and from the German Interdisciplinary Association for Intensive Care and Emergency Medicine. Air pollution data were taken from the APExpose dataset (version 2.0). We used negative binomial models, including adjustment for risk factors (age, sex, days since first COVID-19 case, population density, socio-economic and health parameters). We found that PM2.5 and NO2 exposure 28 days before COVID-19 infection had the highest association with infection, morbidity as well as mortality, as compared to long-term or short-term (2 or 7 days) air pollutant exposure. A 1 μg/m3 increase in PM2.5 was associated with a 31.7% increase in incidence, a 20.6% need for ICU treatment, a 23.1% need for mechanical ventilation, and a 55.3% increase in mortality; an increase of 1 μg/m3 of NO2 was associated with an increase for all outcomes by 25.2 - 29.4%. Our findings show a positive association between PM2.5 and NO2 exposure and the clinical course of a SARS-CoV2 infection, with the strongest association to 28 days of exposure to air pollution. This finding provides an indication as to the primary underlying pathophysiology, and can therefore help to improve the resilience of societies by implementing adequate measures to reduce the air pollutant impact on health outcomes. Not applicable.

Hermanns S ，von Schneidemesser E ，Caseiro A ，Koch S ... -  《Environmental Health》

Long-term ambient air pollution exposure and cardio-respiratory disease in China: findings from a prospective cohort study.

Existing evidence on long-term ambient air pollution (AAP) exposure and risk of cardio-respiratory diseases in China is mainly on mortality, and based on area average concentrations from fixed-site monitors for individual exposures. Substantial uncertainty persists, therefore, about the shape and strength of the relationship when assessed using more personalised individual exposure data. We aimed to examine the relationships between AAP exposure and risk of cardio-respiratory diseases using predicted local levels of AAP. A prospective study included 50,407 participants aged 30-79 years from Suzhou, China, with concentrations of nitrogen dioxide (NO2), sulphur dioxide (SO2), fine (PM2.5), and inhalable (PM10) particulate matter, ozone (O3) and carbon monoxide (CO) and incident cases of cardiovascular disease (CVD) (n = 2,563) and respiratory disease (n = 1,764) recorded during 2013-2015. Cox regression models with time-dependent covariates were used to estimate adjusted hazard ratios (HRs) for diseases associated with local-level concentrations of AAP exposure, estimated using Bayesian spatio-temporal modelling. The study period of 2013-2015 included a total of 135,199 person-years of follow-up for CVD. There was a positive association of AAP, particularly SO2 and O3, with risk of major cardiovascular and respiratory diseases. Each 10 µg/m3 increase in SO2 was associated with adjusted hazard ratios (HRs) of 1.07 (95% CI: 1.02, 1.12) for CVD, 1.25 (1.08, 1.44) for COPD and 1.12 (1.02, 1.23) for pneumonia. Similarly, each 10 µg/m3 increase in O3 was associated with adjusted HR of 1.02 (1.01, 1.03) for CVD, 1.03 (1.02, 1.05) for all stroke, and 1.04 (1.02, 1.06) for pneumonia. Among adults in urban China, long-term exposure to ambient air pollution is associated with a higher risk of cardio-respiratory disease.

Wright N ，Newell K ，Chan KH ，Gilbert S ，Hacker A ，Lu Y ，Guo Y ，Pei P ，Yu C ，Lv J ，Chen J ，Li L ，Kurmi O ，Chen Z ，Lam KBH ，Kartsonaki C ... -  《Environmental Health》