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Exposure to residential greenness might affect population health through increasing physical activity and social engagement, improving mental health, and reducing harmful environmental exposure. However, evidence on the association of greenness with risk of diabetes is still controversial. In this study, we recruited a total of 22,535 participants aged ≥18 years from Yinzhou District, Ningbo, Zhejiang Province, China to investigate the associations between residential greenness and risk of diabetes incidence. Residential greenness was estimated using Normalized Difference Vegetation Index (NDVI), Enhanced Vegetation Index (EVI), and Vegetation Continuous Field (VCF). We also calculated cumulative average NDVI, EVI and VCF values, and changes in NDVI, EVI and VCF during the follow-up period. We used Cox proportional hazards models controlling for demographic characteristics, lifestyles, individual socioeconomic status, history of diseases and particulate matter with an aerodynamic diameter ≤2.5 μm (PM 2.5 ) to examine hazard ratios (HRs) and 95% confidence intervals (95% CIs) and assessed physical activity, body mass index (BMI) or PM 2.5 as potential mediators. During 84,992.64 person-years of follow-up, a total of 1,154 incident cases of diabetes occurred. In multivariable models, living in the highest quartile of cumulative average NDVI, EVI and VCF within 250-m buffer was associated with 57% (HR = 0.43, 95% CI: 0.36, 0.52), 62% (HR = 0.38, 95% CI: 0.32, 0.45), and 55% (HR = 0.45, 95% CI: 0.38, 0.54) reduction in diabetes risk compared with the lowest quartile, respectively. Results remained similar for NDVI, EVI, and VCF within 500-m and 1000-m buffers. Stratified analyses showed stronger association for residential greenness and diabetes among older people. The association between greenness and diabetes did not appear to be mediated by physical activity, PM 2.5 or BMI. Our findings suggested that higher residential greenness was significantly associated with lower risk of diabetes., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Growing evidence has linked residential greenness to depression, the results from prospective cohort study are still limited. And it remains unclear whether particulate matter (PM) modify, mediate, or interact the greenness-depression relationship., Methods: We collected data from Yinzhou Cohort(N = 47,516) which was recruited between June 2015 and December 2017. Depression cases before April 2020 were ascertained from local Health Information System covered all residents' health care records. Residential greenness (the Normalized Difference Vegetation Index, NDVI, and the Enhanced Vegetation Index, EVI) and PM (particulate matters with diameters≤2.5 μm, PM 2.5 and particulate matters with diameters≤10 μm, PM 10 ) were estimated based on participants' residential coordinates. We conducted Cox models employing age as timescale to estimate the association between residential greenness within different buffers and incident depression. Furthermore, we explored the potential confounding, mediation and interaction relationship between greenness and PM., Results: During the 99,556 person-years of follow-up, 1043 incident depression cases occurred. In single exposure models, residential greenness was inversely associated with depression incidence (e.g. Hazard Ratio (HR) = 0.86, 95% confidence interval (CI): 0.79, 0.94 for per interquartile range (IQR) increase NDVI 250 m). The protective association between greenness was attenuated after introducing PM 2.5 and PM 10 into the models. We identified multiplicative interactions between greenness and PM exposure for depression (e.g. HR interaction  = 0.91, 95%CI: 0.85, 0.98 for per IQR decrease NDVI 250 m and per IQR increase PM 2.5 ). Besides, we found the protective association of greenness was partly mediated by PM (e.g. mediation proportion = 52.9% between NDVI 250 m and PM 2.5 )., Conclusions: In this longitudinal cohort study, residents living in greener neighborhoods had a lower risk of depression incidence and the benefits were interacted and partly mediated by PM. Improvement in residential greenness could be an actionable and planning intervention to prevent depression., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Fine particulate matter (PM 2.5 ) is a mixture of multiple components, which is associated with several chronic diseases, including respiratory and cardiovascular diseases. We evaluated the association between daily PM 2.5 and PM 2.5-10 exposure and hospital visits for respiratory diseases. Hospital visits for respiratory diseases were collected from Yinzhou Health Information System database. We used generalized additive models to examine the excess relative risk (ERR) and 95% confidence interval for hospital visits for respiratory diseases associated with each 10-μg/m 3 increase in PM 2.5 and PM 2.5-10 concentration. Non-linear exposure-response relationship between PM exposure and hospital visits for respiratory diseases was evaluated by a smooth spline. The ERRs for hospital visits for respiratory diseases associated with a 10-μg/m 3 increase in the 6-day cumulative average concentration of PM 2.5 and PM 2.5-10 were 5.40 (95% CI 2.32, 8.57) and 6.37% (95% CI 1.84, 11.10), respectively. The findings remained stable when we adjusted other gaseous air pollution. PM 2.5 and PM 2.5-10 were associated with the increased visits for the acute upper respiratory infection, pneumonia, asthma, and COPD. In this time-series study, we found a positive association between daily particulate matter exposure and hospital visits for respiratory diseases.

Recently, air pollution has attracted a substantial amount of attention in China, which can be influenced by a variety of factors, but the association between air pollution and human activity is not quite clear. Based on real-time online data (January 1, 2014, to December 31, 2014) of air pollution and meteorology reported by official sites, and demographic, economic, and environmental reform data in a statistical yearbook, the influences of meteorological factors (temperature, relative humidity, precipitation intensity, and wind force) and human activities on PM 2.5 pollution were explored. After correlation analysis, logistic regression analysis, and a nonparametric test, weak negative correlations between temperature and PM 2.5 pollution were found. In most cases, festival and morning peak hours were protection and risk factors of PM 2.5 pollution, respectively. In addition, government actions, such as an afforestation project and increasing financial expenditure for energy saving and environmental protection, could greatly contribute to alleviating pollution of PM 2.5 . The findings could help officials formulate effective laws and regulations, and then PM 2.5 pollution related to the pattern of human activity would be ameliorated., Implications: Most of the time, festival and morning peak hours are protection and risk factors for PM 2.5 pollution, respectively. Increasing the percentage of afforestation area and financial expenditure for energy saving and environmental protection could significantly reduce PM 2.5 pollution. The findings can help officials formulate effective laws and regulations, and then PM 2.5 pollution related to the pattern of human activity, especially government action, will be ameliorated.

Objective: To explore the association between particulate matter (PM) and daily hospital visits of coronary heart diseases in Ningbo. Methods: Daily data of hospital visits from January 2014 to June 2015 (516 days in total) were obtained from the Yinzhou Health Information System in Ningbo. Daily air pollution data for PM and meteorological data were collected from the database of Ningbo Environmental Monitoring Center and Ningbo Meteorological Bureau. Time-series analysis by quasi-Poisson generalized additive model was used to examine the association between air pollution and hospital visits for coronary heart diseases by adjustment of long-term trends, seasonal patterns and meteorological variables (temperature, humidity), and day of week. Results: An increase of an IQR of PM 2.5 accounted for 1.98% (95% CI :-0.59%-4.63%) increase of hospital visits for coronary heart diseases. The associations between PM 2.5 and hospital visits for coronary heart diseases among female and the elderly (≥75 years) were stronger ( ER =2.70%,95% CI :0.01%-5.47%; ER =3.35%, 95% CI: 0.12%-6.69%). The effects of PM 2.5~10 attenuated after adjustment for PM 2.5. Conclusion: PM 2.5 had short-term effects on daily hospital visits for coronary heart diseases in Ningbo, and such association was stronger among female and the elderly.

Abstract Background Air pollution epidemiological studies increasingly rely on high-resolution exposure prediction models. However, to date, few models of this type exist for use in China. Objectives We produced a national land-use regression model (LUR) to estimate monthly average PM 2.5 , PM 10 and NO 2 from 2014 to 2016 in China. Methods We developed a spatiotemporal semi-parametric model using generalized additive mixed models. A variety of predictor variables were included in model: time varying meteorological data, high resolution land cover data from Globaland30, satellite measures of aerosol optical depth, and Geographic Information System (GIS)-derived predictors. We assessed model performance with two cross-validation (CV) approaches, including hold-out CV, and 10-fold CV. Results Over 22,000 monthly observations at 1382 monitoring locations were included to estimate the air pollution exposure. The time-varying spatial terms explained 87%, 71%, and 69% of variability with a hold-out cross-validated R2 of 0.85, 0.62, and 0.62 for PM 2.5 , PM 10 and NO 2 models, respectively. Models show that meteorological variables, population density, elevation, distance to road, and land cover types were important predictors for air pollution exposure. Conclusions we have developed a new nationwide model to estimate residence-level air pollution exposures, which can be used in studies of the chronic adverse effects of air pollution. Highlights • We developed national scale spatiotemporal land use models to estimate monthly PM 2.5 , PM 10 and NO 2 concentrations in China. • For the PM 2.5 , PM 10 and NO 2 models, predictors explained 87%, 71%, and 69% of variability of the pollutant distributions. • Meteorological, AOD, and GIS-derived covariates were important predictors for air pollution exposure. [ABSTRACT FROM AUTHOR]

Living in walkable neighborhoods has been reported to be associated with a lower risk of cardiovascular disease. Features of walkable neighborhoods, however, may be related to particulate matter with an aerodynamic diameter ≤2.5 μm (PM 2.5), which could increase risk of cardiovascular disease. The interaction effect between walkability and PM 2.5 on risk of ischemic stroke remains to be elucidated. In this study, we recruited a total of 27,375 participants aged ≥40 years from Yinzhou District, Ningbo, Zhejiang Province, China to investigate the associations of walkability and PM 2.5 with risk of ischemic stroke. We used amenity categories and decay functions to evaluate walkability and high-spatiotemporal-resolution land-use regression models to assess PM 2.5 concentrations. We used Cox proportional hazards regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During a median follow-up of 4.08 years, we identified a total of 637 incident cases of ischemic stroke in the entire cohort. Higher walkability was associated with a lower risk of ischemic stroke (quartile, Q4 vs. Q1 walkability: HR = 0.59, 95% CI: 0.47–0.75), whereas PM 2.5 was positively associated with risk of ischemic stroke (Q4 vs. Q1 PM 2.5 : HR = 1.70, 95% CI: 1.29–2.25). Furthermore, we observed a significant interaction between walkability and PM 2.5 on risk of ischemic stroke. Walkability was inversely associated with risk of ischemic stroke at lower PM 2.5 concentrations, but this association was attenuated with increasing PM 2.5 concentrations. Although walkable neighborhoods appear to decrease the risk of ischemic stroke, benefits may be offset by adverse effects of PM 2.5 exposure in the most polluted areas. These findings are meaningful for future neighborhood design, air pollution control, and stroke prevention. [Display omitted] • Linking walkability and PM 2.5 with ischemic stroke using a prospective design. • Walkability was inversely associated with risk of ischemic stroke. • Exposure to PM 2.5 was positively associated with risk of ischemic stroke. • Exposure to PM 2.5 attenuated the beneficial effects of walkability. [ABSTRACT FROM AUTHOR]

Sleep disorders have been verified to be associated with adverse health outcomes. Recent studies have linked ambient air pollution to sleep disorders. However, evidence with large sample size and especially prospective studies is very limited. We used data from a prospective cohort study established from 2015 to 2018 in Ningbo, China. Participants were followed-up after baseline survey through linkage to the regional Health Information System (HIS). Sleep disorders were defined based on International Classification of Disease 10 (ICD-10). Spatial-temporal land-use regression (LUR) models were used to estimate the annual exposure to particulate matter with diameter ≤ 2.5 µm (PM 2.5), ≤ 10 µm (PM 10) and nitrogen dioxides (NO 2). The associations between long-term exposure to air pollutants and prevalence of sleep disorders were examined using logistic regression models, and Cox regression models for the effects of air pollution on the incidence of sleep disorders. A generalized weighted quantile sum (gWQS) regression was used in the multipollutant analysis. A total of 38,775 participants were included in the final analysis. Based on baseline data, we observed significant positive associations between air pollution exposure and increased odds of prevalent sleep disorders (Odds Ratio (OR) = 1.48, 95% confidence interval (CI): 1.41–1.55 for PM 2.5 ; OR = 1.47,95%CI:1.38–1.57 for PM 10 ; OR = 1.38, 95%CI:1.31–1.46 for NO 2). In the longitudinal analysis, hazard ratios for incident sleep disorders associated with per interquartile range (IQR) increase in PM 2.5 , PM 10 and NO 2 were 1.14 (1.03, 1.25), 1.13 (1.01, 1.27) and 1.13 (1.04, 1.23), respectively. A gWQS regression analysis showed significant association between air pollution mixture and incident sleep disorders (OR = 1.11, 95%CI: 1.03–1.20). Long-term exposure to PM 2.5 , PM 10 and NO 2 were associated with increased risk of sleep disorders in a Chinese population. Our findings could provide evidence for a more general role in the adverse health impact of air pollution. ga1 • Positive associations between air pollution and incident sleep disorder were found. • PM 2.5 , PM 10 and NO 2 contributed similarly to sleep disorders in multipollutant analysis. • Reducing the ambient air pollution level would benefit sleep health. [ABSTRACT FROM AUTHOR]

The coronavirus disease (COVID-19) has become a global public health threaten. A series of strict prevention and control measures were implemented in China, contributing to the improvement of air quality. In this study, we described the trend of air pollutant concentrations and the incidence of COVID-19 during the epidemic and applied generalized additive models (GAMs) to assess the association between short-term exposure to air pollution and daily confirmed cases of COVID-19 in 235 Chinese cities. Disease progression based on both onset and report dates as well as control measures as potential confounding were considered in the analyses. We found that stringent prevention and control measures intending to mitigate the spread of COVID-19, contributed to a significant decline in the concentrations of air pollutants except ozone (O 3). Significant positive associations of short-term exposure to air pollutants, including particulate matter with diameters ≤2.5 μm (PM 2.5), particulate matter with diameters ≤10 μm (PM 10), and nitrogen dioxide (NO 2) with daily new confirmed cases were observed during the epidemic. Per interquartile range (IQR) increase in PM 2.5 (lag0-15), PM 10 (lag0-15), and NO 2 (lag0-20) were associated with a 7% [95% confidence interval (CI): (4–9)], 6% [95% CI: (3–8)], and 19% [95% CI: (13–24)] increase in the counts of daily onset cases, respectively. Our results suggest that there is a statistically significant association between ambient air pollution and the spread of COVID-19. Thus, the quarantine measures can not only cut off the transmission of virus, but also retard the spread by improving ambient air quality, which might provide implications for the prevention and control of COVID-19. Image 1 • There is a statistically significant association between ambient air pollution and the spread of COVID-19. • The lag days from onset date to report date of COVID-19 were taken into account. • Quarantine measures can not only cut off the transmission of virus, but also retard the spread by improving air quality. Short-term exposure to air pollutants, including PM 2.5 , PM 10 , NO 2 , may contribute to an increase in the counts of daily onset cases. Stringent prevention and control measures can not only cut off the transmission of virus, but also retard the virus spread by reducing air pollution, which might provide implications for the prevention and control of COVID-19. [ABSTRACT FROM AUTHOR]

To examine the association between short-term exposure to air pollution and ischemic stroke (IS) onset and the role of lifestyles on the association. We performed a time-stratified case-crossover study to estimate the association between short-term exposure to air pollution and IS onset in Yinzhou, China from July 1st, 2015 to May 31st, 2020. Conditional logistic regression models were used to assess the effect of air pollution on IS onset. Furthermore, we explored whether these effects were modified by lifestyle factors by using stratified analyses. A total of 700 subjects were included in analyses. We found that positive associations between exposure to O 3 and IS onset with the OR IQRs of 1.23 (95% CI: 1.01–1.49) at lag04 and 1.28 (95% CI: 1.03–1.59) at lag06, respectively. Stronger associations were observed between NO 2 at lag04 and lag06 and IS onset after adjusting for other air pollutants, and the corresponding OR IQRs were 2.08 (95% CI: 1.37–3.15) and 2.04 (95% CI: 1.27–3.27), respectively. However, no association was observed for exposure to particulate matters and IS onset. Stronger associations were observed for NO 2 and risk of IS onset among abnormal weight subjects, alcohol drinkers, smokers, and subjects who exercised 1–4 times per week or barely exercised every week. We also observed stronger associations of SO 2 , CO, PM 2.5 and PM 10 with IS onset among subjects who exercised 1–4 times per week. In this case-crossover study, we found positive associations between short-term exposure to air pollution, especially for NO 2 , and risk of IS onset. Moreover, our study highlighted that lifestyle factors, such as alcohol consumption and physical activity, had significant impacts on the association of ambient air pollution with risk of IS onset. • New evidence on the association between short-term exposure to air pollution and ischemic stroke from China. • O 3 and NO 2 were positively associated with risk of ischemic stroke onset. • Lifestyle factors could affect the association of short-term exposure to air pollution with risk of ischemic stroke onset. [ABSTRACT FROM AUTHOR]

Background: Peptic ulcer disease (PUD) continued to be a source of significant morbidity and mortality worldwide. Recently, it has been reported that exposure to air pollution is a potential risk factor for PUD, but evidence on the association still remains inconsistent. Methods: We performed an ecological study to examine the association between short-term exposure to air pollution and daily hospital visits for PUD in Yinzhou, China from January 1st, 2017 to December 31st, 2019. Distributed lag nonlinear models were used to estimate the nonlinear and lag-response effects of air pollutants. Subgroup analyses stratified by sex, age and season were conducted to examine the effect modifications. Results: Overall, we found that short-term exposure to air pollution including SO 2 , NO 2 , CO, O 3 and PM 2.5 was significantly associated with hospital visits for PUD among all subjects. The lag-response effects of SO 2 , NO 2 and O 3 varied at different concentrations and lag days. The cumulative risk ratios of CO and PM 2.5 showed nearly linear adverse effects and increased to maxima of 2.68 (95% CI: 1.49–4.78) and 2.40 (95% CI: 1.36–4.24) with their ranges from the references to the maximum concentrations, respectively. Moreover, the cumulative risks of particulate matters on hospital visits for PUD increased significantly in cold seasons, but not in warm seasons. Conclusions: Our findings could provide growing evidence regarding the adverse health effects of air pollution on PUD, thereby strengthening the hypothesis that air pollutants have harmful impacts on digestive system. [Display omitted] • Air pollution has adverse health effects on respiratory and cardiovascular systems. • This study suggested short-term air pollution had nonlinear and lag-response effects on peptic ulcer disease. • Air pollution may also have adverse health effects on digestive system. [ABSTRACT FROM AUTHOR]

Ambient fine particulate matter (particle diameter < 2.5 μm, or PM 2.5) is a major public health concern in China. Exposure to PM 2.5 has been associated with a wide range of adverse health outcomes. The current study aimed to estimate the association between exposure to PM 2.5 and the risk of peptic ulcer diseases (PUDs). We conducted a hospital-based cross-sectional study of seven major cities in Zhejiang Province, China (combined population > 57 million people), which included a total of 647,092 subjects who underwent gastroscopy examination (86,852 subjects were diagnosed with PUDs) recorded in 13 large hospitals from 2014 to 2018. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the relationship between PM 2.5 and PUDs, including duodenal ulcers (DUs) and gastric ulcers (GUs). The overall estimated OR (95% CI) associated with every 10-μg/m3 increase in the 1-month average PM 2.5 before the detection of PUDs was 1.050 (95% CI: 1.038, 1.063). The association between PM 2.5 concentration and the prevalence of PUDs tended to be attenuated but remained significant when considering different exposure periods (OR = 1.030, 95% CI = 1.018–1.043 for the 3-month moving average; OR = 1.020, 95% CI = 1.005–1.037 for the 6-month moving average). Stronger associations were observed for DUs than GUs. The observed positive association of PM 2.5 exposure with PUDs remained significant in the two-pollutant models after adjusting for other air pollutants. Our findings could provide scientific evidence for a more general adverse role of air pollution on PUDs. • Association of exposure to PM 2.5 and peptic ulcer disease was investigated in China. • Increased recent exposure to PM2.5 was associated with higher odds for peptic ulcer. • The effect of PM2.5 persists when adjusting for other air pollutants. • The adverse effect of PM 2.5 was stronger on duodenal ulcer than gastric ulcer. [ABSTRACT FROM AUTHOR]