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Short-term health effects of ambient PM2.5 have been established with numerous studies, but evidence in Asian countries is limited. This study aimed to investigate the short-term effects of PM2.5 on acute health outcomes, particularly all-cause, cardiovascular, respiratory, cerebrovascular and neuropsychological outcomes. We utilized daily emergenc...
Citations
... These studies have suggested associations between increases in PM 2:5 levels and ED presentations [80][81][82] as well as emergency ambulance dispatches. 83 However, they were all looking at short-term associations (lags from several hours to 14 d) and conducted in major Asian cities where PM 2:5 averages were substantially higher than Australian ambient levels, which makes direct comparison to our results difficult. However, our findings were corroborated by those of a large birth cohort in New Zealand that found that residing in areas with higher proportion of houses heating with wood and/or coal was correlated with nonaccidental ED presentations in the first 3 years of life. ...
Background:
Episodic spikes in air pollution due to landscape fires are increasing, and their potential for longer term health impacts is uncertain.
Objective:
Our objective is to evaluate associations between exposure in utero and in infancy to severe pollution from a mine fire, background ambient air pollution, and subsequent hospital care.
Methods:
We linked health records of births, emergency department (ED) visits, and hospitalizations of children born in the Latrobe Valley, Australia, 2012-2015, which included a severe pollution episode from a mine fire (9 February 2014 to 25 March 2014). We assigned modeled exposure estimates for fire-related and ambient particulate matter with an aerodynamic diameter of 2.5μm (PM2.5) to residential address. We used logistic regression to estimate associations with hospital visits for any cause and groupings of infectious, allergic, and respiratory conditions. Outcomes were assessed for the first year of life in the in utero cohort and the year following the fire in the infant cohort. We estimated exposure-response for both fire-related and ambient PM2.5 and also employed inverse probability weighting using the propensity score to compare exposed and not/minimally exposed children.
Results:
Prenatal exposure to fire-related PM2.5 was associated with ED presentations for allergies/skin rash [odds ratio (OR)=1.34, 95% confidence interval (CI): 1.01, 1.76 per 240 μg/m3 increase]. Exposure in utero to ambient PM2.5 was associated with overall presentations (OR=1.18, 95% CI: 1.05, 1.33 per 1.4 μg/m3) and visits for infections (ED: OR=1.13, 95% CI: 0.98, 1.29; hospitalizations: OR=1.23, 95% CI: 1.00, 1.52). Exposure in infancy to fire-related PM2.5 compared to no/minimal exposure, was associated with ED presentations for respiratory (OR=1.37, 95% CI: 1.05, 1.80) and infectious conditions (any: OR=1.21, 95% CI: 0.98, 1.49; respiratory-related: OR=1.39, 95% CI: 1.05, 1.83). Early life exposure to ambient PM2.5 was associated with overall ED visits (OR=1.17, 95% CI: 1.05, 1.30 per 1.4 μg/m3 increase).
Discussion:
Higher episodic and lower ambient concentrations of PM2.5 in early life were associated with visits for allergic, respiratory, and infectious conditions. Our findings also indicated differences in associations at the two developmental stages. https://doi.org/10.1289/EHP12238.
... We also conducted a funnel plot analysis and used Egger's test to assess asymmetry in the estimates. Throughout this study, pre-hospitalization exposure to PM 2.5 was assessed by the daily PM 2.5 on the hospitalization day (lag 0), following previous results (Bell et al., 2015;Phung et al., 2018). We investigated temporal changes by examining the single-day exposure of the prior day (lag 1) to 6 days before (lag 6), as well as the moving average lags of the same day to one day before (lag 01), three days before (lag 03), and six days before (lag 06). ...
There have been few studies in non-western countries on the relationship between low levels of daily fine particulate matter (PM2.5) exposure and morbidity or mortality, and the impact of PM2.5 concentrations below 15 μg/m3, which is the latest World Health Organization Air Quality Guideline (WHO AQG) value for the 24-h mean, is not yet clear. We assessed the associations between low-level PM2.5 exposure and cardiorespiratory admissions in Japan. We collected the daily hospital admission count data, air pollutant data, and meteorological condition data recorded from April 2016 to March 2019 in 139 Japanese cities. City-specific estimates were obtained from conditional logistic regression models in a time-stratified case-crossover design and pooled by random-effect models. We estimated that every 10-μg/m3 increase in the concurrent-day PM2.5 concentration was related to a 0.52% increase in cardiovascular admissions (95% CI: 0.13-0.92%) and a 1.74% increase in respiratory admissions (95% CI: 1.41-2.07%). These values were nearly the same when the datasets were filtered to contain only daily PM2.5 concentrations <15 μg/m3. The exposure-response curves showed approximately sublinear-to-linear curves with no indication of thresholds. These associations with cardiovascular diseases weakened after adjusting for nitrogen dioxide or sulfur dioxide, but associations with respiratory diseases were almost unchanged when additionally adjusted for other pollutants. This study demonstrated that associations between daily PM2.5 and daily cardiorespiratory hospitalizations might persist at low concentrations, including those below the latest WHO AQG value. Our findings suggest that the updated guideline value may still be insufficient from the perspective of public health.
... Health effects of exposure to PM 2.5 can be expressed as the strength of associations between PM 2.5 constituents and health outcomes via time-series analyses using various statistical models. Previous studies have revealed the effects of PM 2.5 on health-related outcomes including mortality and morbidity using generalized linear model (GLM), generalized additive model (GAM), and other statistical models (Pascal et al. 2014;Phung et al. 2018;Cai et al. 2019). ...
Ambient PM2.5 is one of the major risk factors for human health, and is not fully explained solely by mass concentration. We examined the short-term associations of cause-specific mortality (i.e., all-cause, cardiovascular, and respiratory mortality) with the 15 chemical constituents and sources of PM2.5 in four metropolitan cities of South Korea during 2014–2018. We found transition metals consistently showed significant associations with all-cause mortality, while the effects of other constituents varied across the cities and for cause of death. Carbonaceous components strongly affected the all-cause, cardiovascular, and respiratory mortality in Daejeon. Secondary inorganic aerosols, SO4²⁻ and NH4⁺, showed significant associations with respiratory mortality in Gwangju. We also found the sources from which species closely linked to mortality generally increased the relative mortality risks. Heavy metal markers from soil or industrial sources were significantly associated with mortality in all cities. However, several sources influenced mortality despite their marker species not being significantly associated with it. Secondary nitrate and secondary sulfate sources were linked to mortality in DJ. This could be attributed to the deep inland location, which might have facilitated formation of secondary inorganic aerosols. In addition, primary sources including mobile and coal combustion seemed to have acute impacts on respiratory mortality in Gwangju. Our findings suggest the necessity of positive matrix factorization (PMF)-based approaches for evaluating health effects of PM2.5 while considering the spatial heterogeneity in the compositions and source contributions of PM2.5.
... per 8.6 μg/m 3 increase in total PM 2.5 at lag0−1 (1.4% (1.0−1.8) per 10 μg/ m 3 increase) was slightly higher than that in an eight-city study of Japan between 2007 and 2011, which revealed that a pooled estimate of all-cause ambulance dispatches was 0.64% (95% CI = 0.23−1.06%) per 10 μg/m 3 increase in total PM 2.5 at lag0− 1. 11 However, this multicity study did not include data of ambulance dispatches in Tokyo, and the city-specific point Environmental Science & Technology pubs.acs.org/est Article estimates showed variation among cities. ...
... In past Japanese studies as well, the effect estimates of the association between short-term exposure to particulate matter and emergency ambulance dispatches among children and adults tended to be higher than those among older adults. 11,36 Given that the vast majority of ambulance dispatches were in response to nonsevere conditions, children and adults who were surprised by mild but well-defined PM 2.5 -related symptoms might have the tendency to call the emergency service. Although there is weak evidence that the strength of the association between PM 2.5 and mortality and morbidity is higher for women than for men, 37,38 the present study showed no effect modification by sex. ...
A limited number of studies have investigated the association between short-term exposure to PM2.5 components and morbidity. The present case-crossover study explored the association between exposure to total PM2.5 and its components and emergency ambulance dispatches, which is one of the indicators of morbidity, in the 23 Tokyo wards. Between 2016 and 2018 (mean mass concentrations of total PM2.5 13.5 μg/m3), we obtained data, from the Tokyo Fire Department, on the daily cases of ambulance dispatches. Fine particles were collected at a fixed monitoring site and were analyzed to estimate the daily mean concentrations of carbons and ions. We analyzed 1038301 cases of health-based all-cause ambulance dispatches by using a conditional logistic regression model. The average concentrations of total PM2.5 over one and the previous day were positively associated with the number of ambulance dispatches. In terms of PM2.5 components, the percentage increase per interquartile range (IQR) increase was 0.8% for elemental carbon (IQR = 0.8 μg/m3; 95% CI = 0.3-1.3%), 0.9% for sulfate (2.1 μg/m3; 0.5-1.4%), and 1.1% for ammonium (1.3 μg/m3; 0.4-1.8%) in the PM2.5-adjusted models. This is the first study to find an association between some specific components in PM2.5 and ambulance dispatches.
... depression increased by 36% (95%CI: 3%-79%). These increases in ambulance attendances and ED presentations are well above estimates from previous large scale ambient pollution studies, where similar 10 μg/m 3 increases in PM 2.5 were associated with more modest increases of 1.5% for ambulance attendances (Phung et al., 2018) and 0.13% for ED presentations (Liu et al., 2019) for mental health conditions. It is evident that a severe pollution event involving a sudden, steep, and protracted increase in PM 2.5 concentrations has considerably greater repercussions for mental health and the level of demand for ambulance attendances and ED presentations among those exposed, than the same 10 μg/m 3 increase in exposure resulting from changes in ambient pollution. ...
Climate change and an increase in the number of major fire events occurring around the world have drawn attention to the importance of understanding the association between air pollution events and mental health. In 2014, the Morwell open-cut brown coal mine adjacent to the Hazelwood power station in the Latrobe Valley region of Victoria, Australia, caught fire as a result of nearby wildfires, and exposed the local community to a prolonged period of deteriorated air quality. The aim of this study was to examine how exposure to coal mine fire-related fine particulate matter (PM2.5) during the event affected the utilisation of local health services (ambulance attendances; emergency department (ED) presentations; hospital admissions) for mental health conditions. A time-series analysis indicated that mine fire-related PM2.5 exposure was associated with short-term increases in ambulance attendances and ED presentations but not hospital admissions. To allow for delays between exposure and changes in service utilisation, different lag periods were assessed. The most prominent effects were observed over a 5-day lag period where, for each 10 μg/m³ increase in daily mean mine fire-related PM2.5, the risk of an ambulance attendance for anxiety increased by 38% (95%CI: 13%–69%) and the risk of an ED presentation for depression increased by 36% (95%CI: 3%–79%). Accordingly, ambulance and hospital services should expect to encounter an increase in the number of people seeking assistance for mental health conditions during extreme air pollution events and mechanisms need to be in place to ensure that surges in demand for mental health care during these circumstances can be accommodated.
... The adjusted time-series regression analysis indicated that, over a 5-day lag period, for every 10µg/m 3 increase in mean mine fire-related PM2.5 the risk of an ambulance attendance for anxiety increased by 34% (95%CI: 8% to 67%) and the risk of an ED presentation for depression increased by 36% (95%CI: 3% to 79%). These increases in ambulance attendances and ED presentations are well above estimates from previous large scale ambient pollution studies, where similar 10µg/m 3 increases in PM2.5 were associated with more modest increases of 1.5% for ambulance attendances (Phung et al., 2018) and 0.13% for ED presentations (Liu et al., 2019) for mental health conditions. It is evident that a severe pollution event involving a sudden, steep, and protracted increase in PM2.5 concentrations has considerably greater repercussions for mental health and the level of demand for ambulance attendances and ED presentations among those exposed, than the same 10µg/m 3 increase in exposure resulting from changes in ambient pollution. ...
Climate change and an increase in the number of major fire events occurring around the world have drawn attention to the importance of understanding the association between air pollution events and mental health. In 2014, the Morwell open-cut brown coal mine adjacent to the Hazelwood power station in the Latrobe Valley region of Victoria, Australia, caught fire as a result of nearby wildfires, and exposed the local community to a prolonged period of deteriorated air quality. The aim of this study was to examine how exposure to coal mine fire-related fine particulate matter (PM2.5) during the event affected the utilisation of local health services for mental health conditions (ambulance attendances; emergency department (ED) presentations; hospital admissions). A time-series analysis indicated that mine fire-related PM2.5 exposure was associated with short-term increases in ambulance attendances and ED presentations but not hospital admissions. To allow for delays between exposure and changes in service utilisation, different lag periods were assessed. The most prominent effects were observed over a 5-day lag period where, for each 10µg/m3 increase in daily mean mine fire-related PM2.5, the risk of an ambulance attendance for anxiety increased by 34% (95%CI: 8% to 67%) and the risk of an ED presentation for depression increased by 36% (95%CI: 3% to 79%). Accordingly, ambulance and hospital services should expect to encounter an increase in the number of people seeking assistance for mental health conditions during extreme air pollution events and mechanisms need to be in place to ensure that surges in demand for mental health care during these circumstances can be accommodated.
... The relative risk for total emergency ambulance dispatches per 10 μg/m 3 rise in PM 2.5 was 1.05% for lag1 and 1.07% for lag2. Although our study did not find a significant effect on ambulance dispatches on the current day of PM 2.5 increment, the overall effect trend is consistent with previous findings (Michikawa et al. 2015a;Phung et al. 2018). The relative risk for total emergency ambulance dispatches per 10 μg/m 3 rise in PM 10 was 1.13% Fig. 6 The effects of NO 2 for different causes of emergency ambulance dispatches. ...
Objective
Air pollutants play a crucial role in human health and disease. Emergency ambulance dispatch data have excellent potential for public and environmental health research. This study aimed at investigating the impact of short-term exposure to air pollutants on the emergency ambulance dispatches.Methods
We used data on emergency ambulance dispatches in Shanghai Municipality, China, from April 1, 2016 to December 31, 2017. The association of the daily emergency ambulance dispatches with air pollutants including PM2.5 (particles ≤ 2.5 μm in aerodynamic diameter), PM10, O3, NO2 and SO2 was analyzed with the use of time-series analyses.ResultsA total of 310,825 emergency ambulance dispatches for acute illness occurred in Shanghai during the study period. An increase in PM2.5 by 10 μg/m3 at lag1 and lag2 was shown to increase the risk of emergency ambulance dispatches (RR for lag1 = 1.05, 95% CI 1.00–1.11, RR for lag2 = 1.07, 95% CI 1.01–1.12). PM10, NO2, and SO2 also showed significant associations with emergency ambulance dispatches in single-pollutant models. Cause-specific analyses showed an elevation in PM2.5 by 10 μg/m3 was associated with an increased risk of emergency ambulance dispatches related to respiratory diseases on the current day (lag0, RR 1.17, 95% CI 1.01–1.33), while the impact on emergency ambulance dispatches related to other diseases presented 1–3 days later. The other pollutants have the similar trend.Conclusions
Our findings show a strong relationship between ambient air pollutants and emergency ambulance dispatches. Our study contributes to the growing body of evidence describing the adverse health effects of ambient air pollution and will benefit ambulance services for early warning and effective ambulatory planning.
... Salimi et al. (2017) demonstrated that an increase in PM 2.5 exposure from bushfire smoke was positively associated with ambulance attendances for breathing problems on the same day. Phung et al. (2018) showed that ambient PM 2.5 exposure was associated with respiratory-related ambulance attendances up to five days after exposure. A recent meta-analysis by Sangkharat and colleagues suggested that short-term PM 2.5 exposure increases the risk of respiratory-related ambulance dispatches and respiratory-related dispatches with subsequent physician diagnosis (Sangkharat et al., 2019). ...
Background
Little is known about the long-term health effects of coalmine fire smoke exposure. The 2014 Hazelwood coalmine fire event in southeast Australia released smoke into surrounding areas for 6 weeks.
Objectives
We aimed to investigate whether individual-level exposure to coalmine fire-related PM2.5 was associated with a long-term increase in ambulance attendances following a coalmine fire event.
Methods
A total of 2223 residents from the most exposed town of Morwell were assessed for ambulance attendances after the Hazelwood event from April 1, 2014 to December 31, 2017. PM2.5 exposure was estimated for each individual using participant self-reported location diary data during the event and modelled PM2.5 concentrations. Recurrent event survival analysis was used to evaluate the relationship between PM2.5 exposure and ambulance attendances.
Results
For each 10 μg/m³ increase in mean coalmine fire-related PM2.5 exposure, there was a 10% (adjusted hazard ratio [HR]:1.10, 95%CI:1.03–1.17) increase in the overall risk of ambulance attendances within 3.5 years after the coalmine fire. Exposure to PM2.5 was also associated with increased risk of respiratory (HR: 1.21, 95%CI: 1.02–1.44) and cardiovascular (HR: 1.13, 95%CI: 1.01–1.28) related ambulance attendances.
Conclusion
These results demonstrate that exposure to coalmine fire smoke during the Hazelwood event was associated with a long-term health risk post the fire event, specifically for respiratory and cardiovascular conditions. These findings are important for effective implementation of health care services following future extended coalmine fire PM2.5 events.
... The concentrationresponse curves in the form of non-linear parametric functions were also estimated (Szyszkowicz 2018). At least two other studies investigating the broad associations between air pollution and health emergencies were previously performed (Phung et al. 2018;Wei et al. 2019), where the impact of only fine particulate matter (PM 2.5 ) on all ICD-9 chapters was considered. PM 2.5 (lag 0-2) linked to a wide variety of hospital admissions in US Medicare population. ...
To investigate the acute impact of various air pollutants on various disease groups in the urban area of the city of Toronto, Canada. Statistical models were developed to estimate the relative risk of an emergency department visit associated with ambient air pollution concentration levels. These models were generated for 8 air pollutants (lagged from 0 to 14 days) and for 18 strata (based on sex, age group, and season). Twelve disease groups extracted from the International Classification of Diseases 10th Revision (ICD-10) were used as health classifications in the models. The qualitative results were collected in matrices composed of 18 rows (strata) and 15 columns (lags) for each air pollutant and the 12 health classifications. The matrix cells were assigned a value of 1 if the association was positively statistically significant; otherwise, they were assigned to a value of 0. The constructed matrices were totalized separately for each air pollutant. The resulting matrices show qualitative associations for grouped diseases, air pollutants, and their corresponding lagged concentrations and indicate the frequency of statistically significant positive associations. The results are presented in colour-gradient matrices with the number of associations for every combination of patient strata, pollutant, and lag in corresponding cells. The highest number of the associations was 8 (of 12 possible) obtained for the same day exposure to carbon monoxide, nitrogen dioxide, and days with elevated air quality health index (AQHI) values. For carbon monoxide, the number of the associations decreases with the increasing lags. For this air pollutant, there were almost no associations after 8 days of lag. In the case of nitrogen dioxide, the associations persist even for longer lags. The numerical values obtained from the models are provided for every pollutant. The constructed matrices are a useful tool to analyze the impact of ambient air pollution concentrations on public health.
... 23 24 Research on PM 2.5 air pollution-related mortality, suggests that PM 2.5 is positively correlated to both mortality and morbidity of NCDs, particularly on chronic obstructive pulmonary disease (COPD), lung cancer, stroke and heart diseases at all age groups. 1 2 6 7 9 25 From the number of cause-specific deaths at a global level, 26% of ischaemic heart disease (IHD) deaths were attributed to PM 2.5 , 23% of stroke, 51% COPD and 43% of lung cancer deaths. 1 For example, there were positive relationships between PM 2.5 and all-cause mortality, as well as to respiratory, cerebrovascular and neuropsychology in Japanese cities from 2007 to 2011. 26 Similarly, in the Nanjing district in China, premature mortality achieved 50% reductions in COPD, IHD, lung cancer and stroke when PM 2.5 concentration decreased by 64%-80%. 27 PM 2.5 is able to shorten life expectancy by augmenting premature deaths. ...
Objectives
To investigate the effect that particulate matter with a diameter of 2.5 μg (PM 2.5 ) had on mortality in Asian populations in years 2000–2015.
Setting
Mortality and level of PM 2.5 data from the United Nations, Global Burden of Disease and University of Chicago were used.
Outcome measures
Age pattern of mortality and the number of life-years lost (LYL) attributable to PM 2.5 in years 2000–2015. LYL were further separated into causes of death to quantify the contribution of each cause.
Results
Ischaemic heart disease (IHD) mortality increased to represent over 31% of the LYL attributable to PM 2.5 between 2005–2010 and 2010–2015 in Asia (females 31% and males 35%). However, great diversity in LYL attributable to PM 2.5 by causes-of-death were found across the region, with IHD proportions of LYL ranging from 25% to 63% for males from Eastern and Central Asia, respectively. Similar diversity was observed for mortality attributable to PM 2.5 for other causes of death across Asia: chronic obstructive pulmonary disease (LYL ranging from 6% to 28%), lung cancer (4% to 20%) and stroke (11% to 22%).
Conclusion
PM 2.5 is a crucial component in the rising health effects in Asia. The diverse trends in cause-specific mortality attributable to PM 2.5 creates a further challenge for health systems in the region. These findings highlight that immediate interventions are needed to mitigate the increasing levels of air pollution and with that reduce its detrimental effect on the health and mortality of Asian populations.
