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      Ambient air pollution, smog episodes and mortality in Jinan, China

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          Abstract

          We aimed to assess the acute effects of ambient air pollution and weather conditions on mortality in the context of Chinese smog episodes. A total of 209,321 deaths were recorded in Jinan, a large city in eastern China, during 2011–15. The mean concentrations of daily particulate matter ≤10 μm (PM 10), fine particulate matter (PM 2.5), sulfur dioxide (SO 2) and nitrogen dioxide (NO 2) were 169 μg/m 3, 100 μg/m 3, 77 μg/m 3, and 54 μg/m 3, respectively. Increases of 10 μg/m 3 in PM 10, PM 2.5, SO 2 and NO 2 were associated with 1.11% (95% CI 0.96–1.26%), 0.71% (95% CI 0.60–0.82%), 1.69% (95% CI 1.56–1.83%), and 3.12% (95% CI 2.72–3.53%) increases in daily non-accidental mortality rates, respectively. Moreover, the risk estimates for these 4 pollutants were higher in association with respiratory and cardiovascular mortality. The effects of all the evaluated pollutants on mortality were greater in winter than in summer. Smog episodes were associated with a 5.87% (95% CI 0.16–11.58%) increase in the rate of overall mortality. This study highlights the effect of exposure to air pollution on the rate of mortality in China.

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          Particulate matter air pollution and cardiovascular disease: An update to the scientific statement from the American Heart Association.

          Robert D Brook, Sanjay Rajagopalan, C. Pope … (2010)
          In 2004, the first American Heart Association scientific statement on "Air Pollution and Cardiovascular Disease" concluded that exposure to particulate matter (PM) air pollution contributes to cardiovascular morbidity and mortality. In the interim, numerous studies have expanded our understanding of this association and further elucidated the physiological and molecular mechanisms involved. The main objective of this updated American Heart Association scientific statement is to provide a comprehensive review of the new evidence linking PM exposure with cardiovascular disease, with a specific focus on highlighting the clinical implications for researchers and healthcare providers. The writing group also sought to provide expert consensus opinions on many aspects of the current state of science and updated suggestions for areas of future research. On the basis of the findings of this review, several new conclusions were reached, including the following: Exposure to PM <2.5 microm in diameter (PM(2.5)) over a few hours to weeks can trigger cardiovascular disease-related mortality and nonfatal events; longer-term exposure (eg, a few years) increases the risk for cardiovascular mortality to an even greater extent than exposures over a few days and reduces life expectancy within more highly exposed segments of the population by several months to a few years; reductions in PM levels are associated with decreases in cardiovascular mortality within a time frame as short as a few years; and many credible pathological mechanisms have been elucidated that lend biological plausibility to these findings. It is the opinion of the writing group that the overall evidence is consistent with a causal relationship between PM(2.5) exposure and cardiovascular morbidity and mortality. This body of evidence has grown and been strengthened substantially since the first American Heart Association scientific statement was published. Finally, PM(2.5) exposure is deemed a modifiable factor that contributes to cardiovascular morbidity and mortality.
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            Factor analysis and AIC

            Hirotugu Akaike (1987)
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              Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis

              R Atkinson, S S Kang, H R Anderson … (2014)
              Background Short-term exposure to outdoor fine particulate matter (particles with a median aerodynamic diameter <2.5 μm (PM2.5)) air pollution has been associated with adverse health effects. Existing literature reviews have been limited in size and scope. Methods We conducted a comprehensive, systematic review and meta-analysis of 110 peer-reviewed time series studies indexed in medical databases to May 2011 to assess the evidence for associations between PM2.5 and daily mortality and hospital admissions for a range of diseases and ages. We stratified our analyses by geographical region to determine the consistency of the evidence worldwide and investigated small study bias. Results Based upon 23 estimates for all-cause mortality, a 10 µg/m3 increment in PM2.5 was associated with a 1.04% (95% CI 0.52% to 1.56%) increase in the risk of death. Worldwide, there was substantial regional variation (0.25% to 2.08%). Associations for respiratory causes of death were larger than for cardiovascular causes, 1.51% (1.01% to 2.01%) vs 0.84% (0.41% to 1.28%). Positive associations with mortality for most other causes of death and for cardiovascular and respiratory hospital admissions were also observed. We found evidence for small study bias in single-city mortality studies and in multicity studies of cardiovascular disease. Conclusions The consistency of the evidence for adverse health effects of short-term exposure to PM2.5 across a range of important health outcomes and diseases supports policy measures to control PM2.5 concentrations. However, reasons for heterogeneity in effect estimates in different regions of the world require further investigation. Small study bias should also be considered in assessing and quantifying health risks from PM2.5.
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                Author and article information

                Contributors
                Huai-chen Li: lihuaichen@163.com
                Journal
                Journal ID (nlm-ta): Sci Rep
                Journal ID (iso-abbrev): Sci Rep
                Title: Scientific Reports
                Publisher: Nature Publishing Group UK (London )
                ISSN (Electronic): 2045-2322
                Publication date (Electronic): 11 September 2017
                Publication date PMC-release: 11 September 2017
                Publication date Collection: 2017
                Volume: 7
                Electronic Location Identifier: 11209
                Affiliations
                [1 ]Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong 250021 China
                [2 ]ISNI 0000 0004 1769 9639, GRID grid.460018.b, Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, ; Jinan, Shandong 250021 China
                [3 ]Jinan Research Academy of Environmental Sciences, Jinan, Shandong 250000 China
                Article
                Publisher ID: 11338
                DOI: 10.1038/s41598-017-11338-2
                PMC ID: 5593894
                PubMed ID: 28894179
                SO-VID: 95b24eb6-ed44-4f30-8575-3ca1667210f5
                Copyright © © The Author(s) 2017
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 22 December 2016
                Date accepted : 22 August 2017
                Categories
                Subject: Article
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                issue-copyright-statement © The Author(s) 2017

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