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The study used the AirQ + software developed by the World Health Organization (WHO) to evaluate the health impacts associated with long-term exposure to PM2.5 in Mashhad, Iran. For this purpose, we analyzed the daily average concentrations of PM2.5 (with a diameter of 2.5 micrometers or less) registered by the air quality monitoring stations from 2016 to 2021. The levels of PM2.5 surpassed the Air Quality Guidelines (AQG) limit value of 5 µg/m3 (annual value) established by WHO. The findings revealed that the burden of mortality (from all-natural causes) at people above 30 years old associated with PM2.5 exposures was 2093 [95% confidence interval [CI]: 1627–2314] deaths in 2016 and 2750 [95% CI: 2139–3038] deaths in 2021. In general, the attributable mortality from specific causes of deaths (e.g., COPD (chronic obstructive pulmonary diseases), IHD (ischemic heart diseases) and stroke) in people above 25 years old increased between the years, but the mortality from lung cancer was stable at 46 [95% CI: 33–59] deaths in 2016 and 48 [95% CI: 34–61] deaths in 2021. The attributable mortality from ALRI (Acute Lower Respiratory Infection) in children below 5 years old increased between the years. We also found differences in mortality cases from IHD and stroke among the age groups and between the years 2016 and 2021. It was concluded that burden of disease methodologies are suitable tools for regional and national policymakers, who must take decisions to prevent and to control air pollution and to analyze the cost-effectiveness of interventions. [ABSTRACT FROM AUTHOR]

Abstract The study used the AirQ + software developed by the World Health Organization (WHO) to evaluate the health impacts associated with long-term exposure to PM2.5 in Mashhad, Iran. For this purpose, we analyzed the daily average concentrations of PM2.5 (with a diameter of 2.5 micrometers or less) registered by the air quality monitoring stations from 2016 to 2021. The levels of PM2.5 surpassed the Air Quality Guidelines (AQG) limit value of 5 µg/m3 (annual value) established by WHO. The findings revealed that the burden of mortality (from all-natural causes) at people above 30 years old associated with PM2.5 exposures was 2093 [95% confidence interval [CI]: 1627–2314] deaths in 2016 and 2750 [95% CI: 2139–3038] deaths in 2021. In general, the attributable mortality from specific causes of deaths (e.g., COPD (chronic obstructive pulmonary diseases), IHD (ischemic heart diseases) and stroke) in people above 25 years old increased between the years, but the mortality from lung cancer was stable at 46 [95% CI: 33–59] deaths in 2016 and 48 [95% CI: 34–61] deaths in 2021. The attributable mortality from ALRI (Acute Lower Respiratory Infection) in children below 5 years old increased between the years. We also found differences in mortality cases from IHD and stroke among the age groups and between the years 2016 and 2021. It was concluded that burden of disease methodologies are suitable tools for regional and national policymakers, who must take decisions to prevent and to control air pollution and to analyze the cost-effectiveness of interventions.

Air pollution exposure is closely linked to population age and socioeconomic status. Population aging and imbalance in regional economy are thus anticipated to have important implications on ozone (O3)‐related health impacts. Here we provide a driver analysis for O3 mortality burden due to respiratory disease in China over 2013–2050 driven by population aging and regional inequity. Unexpectedly, we find that population aging is estimated to result in dramatic rises in annual O3 mortality burden in China; by 56, 101–137, and 298–485 thousand over the periods 2013–2020, 2020–2030, and 2030–2050, respectively. This reflects the exponential rise in baseline mortality rates with increasing age. The aging‐induced mortality burden rise in 2030–2050 is surprisingly large, as it is comparable to the net national mortality burden due to O3 exposure in 2030 (359–399 thousand yr−1). The health impacts of O3 pollution, shown as mortality burden per capita, are inequitably distributed, with more severe effects in less developed provinces than their developed counterparts by 23.1% and 21.5% in 2019 and 2030, respectively. However, the regional inequity in O3 mortality burden is expected to be mitigated in 2050. This temporal variation reflects evolving demographic dividend characterized by a larger proportion of younger individuals in developed regions. These findings are critical for targeted improvement of healthcare services to ensure the sustainability of social development. Plain Language Summary: Air pollution exposure is closely linked to the age distribution and socioeconomic status of the population. The ongoing process of population aging and the pronounced disparities in regional economic growth across China are thus anticipated to have substantial implications for the health effects stemming from ozone (O3) exposure. Our finding reveals that population aging is projected to lead to a significant upsurge in annual O3 mortality burden; the health impacts of O3 pollution, measured in terms of mortality burden per capita, exhibit significant disparities, with more severe effects in less developed provinces than their developed counterparts. These results hold critical implications for the targeted improvement of healthcare services, ensuring the sustainable development of society in China over the coming decades. Key Points: Ozone‐related mortality burden are increasing in the future except for the SSP1 scenarioThe mortality burden increases were mainly driven by the population aging in ChinaThe O3 mortality burden per capita, are inequitably distributed, with more severe effects in developed regions [ABSTRACT FROM AUTHOR]

This article examines the impact of on-road vehicle emissions on mortality rates in Perth, Australia. Using a particle modeling framework, the study found that long-term exposure to vehicle pollution is responsible for 66 premature deaths annually in Perth, costing an estimated AUD 150 million each year. The study emphasizes the need for reducing air pollution from traffic to improve public health, but acknowledges the limitations of current emissions inventories and calls for further research to accurately assess emissions factors in an Australian context. The article also discusses the importance of public health policies promoting lower emission vehicles and the potential health benefits for Australian city dwellers. It references other studies on the mortality burden of vehicle emissions and the effects of wood heater pollution. Overall, the article provides valuable information on the current state of vehicle emissions and their implications for public health. [Extracted from the article]

Air pollution is one of the major global public health challenges. Using annual fine particulate matter (PM2.5) concentration data from 2016 to 2021, along with the global exposure mortality model (GEMM), we estimated the multi-year PM2.5-pollution-related deaths divided by different age groups and diseases. Then, using the VSL (value of statistical life) method, we assessed corresponding economic losses and values. The number of deaths attributed to PM2.5 in Beijing in 2021 fell by 33.74 percent from 2016, while health economic losses would increase by USD 4.4 billion as per capita disposable income increases year by year. In 2021, the average annual concentration of PM2.5 in half of Beijing's municipal administrative districts is less than China's secondary ambient air quality standard (35 μg/m3), but it can still cause 48,969 deaths and corresponding health and economic losses of USD 16.31 billion, equivalent to 7.9 percent of Beijing's GDP. Therefore, it is suggested that more stringent local air quality standards should be designated to protect public health in Beijing. [ABSTRACT FROM AUTHOR]

Abstract Air pollution exposure is closely linked to population age and socioeconomic status. Population aging and imbalance in regional economy are thus anticipated to have important implications on ozone (O3)‐related health impacts. Here we provide a driver analysis for O3 mortality burden due to respiratory disease in China over 2013–2050 driven by population aging and regional inequity. Unexpectedly, we find that population aging is estimated to result in dramatic rises in annual O3 mortality burden in China; by 56, 101–137, and 298–485 thousand over the periods 2013–2020, 2020–2030, and 2030–2050, respectively. This reflects the exponential rise in baseline mortality rates with increasing age. The aging‐induced mortality burden rise in 2030–2050 is surprisingly large, as it is comparable to the net national mortality burden due to O3 exposure in 2030 (359–399 thousand yr−1). The health impacts of O3 pollution, shown as mortality burden per capita, are inequitably distributed, with more severe effects in less developed provinces than their developed counterparts by 23.1% and 21.5% in 2019 and 2030, respectively. However, the regional inequity in O3 mortality burden is expected to be mitigated in 2050. This temporal variation reflects evolving demographic dividend characterized by a larger proportion of younger individuals in developed regions. These findings are critical for targeted improvement of healthcare services to ensure the sustainability of social development.

Background: Low temperatures are adverse contributors to cardiovascular diseases, but the associations between short-term exposure to cold and the risk of death from aortic dissection and aneurysm remain unclear, particularly in tropical regions. Objective: This study was conducted based on 123,951 records of deaths caused by aortic dissection and aneurysms extracted from the national Mortality Information System in Brazil between 2000 and 2019. Methods: Relative risks and 95 % confidence intervals (CI) for the aortic-related deaths associated with low ambient temperatures were estimated using the conditional logistic model combined with the distributed lag nonlinear model. Subgroup analyses were performed by age group, sex, race, education level, and residential region. Furthermore, this study calculated the number and fraction of aortic-related deaths attributed to temperatures below the temperature threshold to quantify the cold-related mortality burden of aortic diseases. Results: During the study period, aortic-related deaths and mortality rates in Brazil exhibited a steady increase, rising from 4419 (2.66/100,000) in 2000 to 8152 (3.88/100,000) in 2019. Under the identified temperature threshold (26 °C), per 1 °C decrease in daily mean temperature was associated with a 4.77 % (95 % CI: 4.35, 5.19) increase in mortality risk of aortic-related diseases over lag 0–3 days. Females, individuals aged 50 years or older, Asian and Black race, and northern residents were more susceptible to low temperatures. Low temperatures were responsible for 19.10 % (95 % CI: 17.71, 20.45) of aortic-related deaths in Brazil. Conclusion: This study highlights that low temperatures were associated with an increased risk of aortic-related deaths, with a remarkable burden even in this predominantly tropical country.

Air pollution is one of the major global public health challenges. Using annual fine particulate matter (PM2.5) concentration data from 2016 to 2021, along with the global exposure mortality model (GEMM), we estimated the multi-year PM2.5-pollution-related deaths divided by different age groups and diseases. Then, using the VSL (value of statistical life) method, we assessed corresponding economic losses and values. The number of deaths attributed to PM2.5 in Beijing in 2021 fell by 33.74 percent from 2016, while health economic losses would increase by USD 4.4 billion as per capita disposable income increases year by year. In 2021, the average annual concentration of PM2.5 in half of Beijing’s municipal administrative districts is less than China’s secondary ambient air quality standard (35 μg/m3), but it can still cause 48,969 deaths and corresponding health and economic losses of USD 16.31 billion, equivalent to 7.9 percent of Beijing’s GDP. Therefore, it is suggested that more stringent local air quality standards should be designated to protect public health in Beijing.

Although studies have estimated the associations of PM2.5 with total mortality or cardiopulmonary mortality, few have comprehensively examined cause-specific mortality risk and burden caused by ambient PM2.5. Thus, this study investigated the association of short-term exposure to PM2.5 with cause-specific mortality using a death-spectrum wide association study (DWAS). Individual information of 5,450,764 deaths during 2013–2018 were collected from six provinces in China. Daily PM2.5 concentration in the case and control days were estimated by a random forest model. A time-stratified case-crossover study design was applied to estimate the associations (access risk, ER) of PM2.5 with cause-specific mortality, which was then used to calculate the population-attributable fraction (PAF) of mortality and the corresponding mortality burden caused by PM2.5. Each 10 μg/m3 increase in PM2.5 concentration (lag03) was associated with a 0.80 % [95 % confidence interval (CI): 0.73 %, 0.86 %] rise in total mortality. We found greater mortality effect at PM2.5 concentrations

Background: A large gap exists between the latest Global Air Quality Guidelines (AQG 2021) and Chinese air quality standards for NO2. Assessing whether and to what extent air quality standards for NO2 should be tightened in China requires a comprehensive understanding of the spatiotemporal characteristics of population exposure to ambient NO2 and related health risks, which have not been studied to date. Objective: We predicted ground NO2 concentrations with high resolution in mainland China, explored exposure characteristics to NO2 pollution, and assessed the mortality burden attributable to NO2 exposure. Methods: Daily NO2 concentrations in 2019 were predicted at 1-km spatial resolution in mainland China using random forest models incorporating multiple predictors. From these high-resolution predictions, we explored the spatiotemporal distribution of NO2, population and area percentages with NO2 exposure exceeding criterion levels, and premature deaths attributable to long- and short-term NO2 exposure in China. Results: The cross-validation R2 and root mean squared error of the NO2 predicting model were 0.80 and 7.78 μg/m3, respectively, at the daily level in 2019. The percentage of people (population number) with annual NO2 exposure over 40 μg/m3 in mainland China in 2019 was 10.40 % (145,605,200), and it reached 99.68 % (1,395,569,840) with the AQG guideline value of 10 μg/m3. NO2 levels and population exposure risk were elevated in urban areas than in rural. Long- and short-term exposures to NO2 were associated with 285,036 and 121,263 non-accidental deaths, respectively, in China in 2019. Tightening standards in steps gradually would increase the potential health benefit. Conclusion: In China, NO2 pollution is associated with significant mortality burden. Spatial disparities exist in NO2 pollution and exposure risks. China’s current air quality standards may no longer objectively reflect the severity of NO2 pollution and exposure risk. Tightening the national standards for NO2 is needed and will lead to significant health benefits.

In this study, the AirQ+ software proposed by the World Health Organization (WHO) was applied in order to assess the health endpoints associated with the long-term exposure to PM2.5 in Attica Region, Greece. For this purpose, we analyzed the daily average concentrations of PM2.5 registered by the air quality monitoring stations in the region, from 1 January 2007 to 31 December 2018. Although there was a decreasing trend in PM2.5 concentrations levels, the levels of PM2.5 exceeded the AQG (Air Quality Guidelines) limit value (annual value: 5 μg/m3) established by the WHO. The findings revealed that the burden of mortality (from all-natural causes) at people above 30 years old associated with PM2.5 exposure was 4752 [3179–6152] deaths in 2007 and 2424 [1598–3179] deaths in 2018. In general, the attributable mortality from specific causes of deaths (e.g., lung cancer, IHD (ischemic heart diseases) and stroke) in people above 25 years old decreased between the years, but the mortality from COPD (chronic obstructive pulmonary diseases) was stable at 146 [79–220] deaths in 2007 and 147 [63–244] deaths in 2018. We also found differences in mortality cases from IHD and stroke among the age groups and between the years 2007 and 2018. [ABSTRACT FROM AUTHOR]

Background: We quantify the mortality burden and economic loss attributable to nonoptimal temperatures for cold and heat in the Central and South American countries in the Multi-City Multi-Country (MCC) Collaborative Research Network., Methods: We collected data for 66 locations from 13 countries in Central and South America to estimate location-specific temperature-mortality associations using time-series regression with distributed lag nonlinear models. We calculated the attributable deaths for cold and heat as the 2.5th and 97.5th temperature percentiles, above and below the minimum mortality temperature, and used the value of a life year to estimate the economic loss of delayed deaths., Results: The mortality impact of cold varied widely by country, from 9.64% in Uruguay to 0.22% in Costa Rica. The heat-attributable fraction for mortality ranged from 1.41% in Paraguay to 0.01% in Ecuador. Locations in arid and temperate climatic zones showed higher cold-related mortality (5.10% and 5.29%, respectively) than those in tropical climates (1.71%). Arid and temperate climatic zones saw lower heat-attributable fractions (0.69% and 0.58%) than arid climatic zones (0.92%). Exposure to cold led to an annual economic loss of $0.6 million in Costa Rica to $472.2 million in Argentina. In comparison, heat resulted in economic losses of $0.05 million in Ecuador to $90.6 million in Brazil., Conclusion: Most of the mortality burden for Central and South American countries is caused by cold compared to heat, generating annual economic losses of $2.1 billion and $290.7 million, respectively. Public health policies and adaptation measures in the region should account for the health effects associated with nonoptimal temperatures., Competing Interests: A.T. was supported by the JSPS KAKENHI Grant Number 24K13527. The other authors declare that they have no conflicts of interest with regard to the content of this report., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Environmental Epidemiology. All rights reserved.)

The distribution of temperature and temperature-health association varied largely across different regions in China, a region-specific definition for heatwave was therefore needed. We collected the data on daily mortality, meteorological factors and air pollution in 84 Chinese cities during 2013–2016, which was divided into seven regions. Based on the association between daily maximum temperature and mortality in each city in a threshold distributed lag non-linear model, where the threshold was defined as the temperature corresponding to the lowest mortality risk, we calculated the number of deaths that could be avoided for 1 °C decrease in maximum temperature under different thresholds, then a random-effect meta-analysis was used to generate regional results, in which the temperature with the highest avoidable mortality number for 1 °C decrease was considered as the most appropriate heatwave definition. We observed an immediate detrimental effect of high temperature within three lag days. Our analysis suggested to use 29.5 °C, 31.5 °C, 29.0 °C, 31.5 °C, 30.0 °C, and 28.5 °C as the heatwave standard for east, north, northeast, central, south, and southwest region, with the avoidable mortality number of 1.54 (95 % Confidence interval (CI): 0.88, 2.19), 0.55 (95 % CI: 0.16, 0.94), 0.59 (95 % CI: 0.32, 0.86), 1.14 (95 % CI: 0.68, 1.59), 1.22 (95 % CI: 0.54, 1.90), and 0.78 (95 % CI: 0.01, 1.55), respectively, while the estimated number 0.19 (95 % CI: −0.02, 0.40) in northwest region was not statistically significant. The concept of ‘avoidable mortality for 1 °C decrease’ was proposed to define the heatwave event, and varied maximum temperature between 28.5 and 31.5 °C was suggested for region-specific heatwave definition in China.

Introduction and objectivesStudies assessing the health benefits of air pollution reduction in Vietnam are scarce. This study quantified the annual mortality burden due to PM2.5 pollution in Vietnam above the World Health Organization recommendation for community health (AQG: 5 μg/m3) and the proposed National Technical Regulation on Ambient Air Quality (proposed QCVN: 15 μg/m3).MethodologyThis study applied a health impact assessment methodology with the hazard risk function for non-communicable diseases (NCDs) and lower respiratory infections (LRIs) in the Global Exposure Mortality Model (GEMM) to calculate attributable deaths, Years of Life lost, and Loss of Life expectancy at birth due to air pollution in the Vietnamese population above 25 years of age in 11 provinces. We obtained annual average PM2.5 concentrations for Vietnam in 2019 at a 3x3 km grid modeled using Mixed Linear regression and multi-data sources. Population and baseline mortality data were obtained from administrative data system in Vietnam. We reported the findings at both the provincial and smaller district levels.ResultsAnnual PM2.5 concentrations in all studied provinces exceeded both the AQG and the proposed QCVN. The maximum annual number of attributable deaths in the studied provinces if they had complied with WHO air quality guidelines was in Ha Noi City, with 5,090 (95%CI: 4,253–5,888) attributable deaths. At the district level, the highest annual rate of attributable deaths if the WHO recommendation for community health had been met was 104.6 (95%CI: 87.0–121.5) attributable deaths per 100,000 population in Ly Nhan (Ha Nam province).ConclusionA much larger number of premature deaths in Vietnam could potentially be avoided by lowering the recommended air quality standard. These results highlight the need for effective clean air action plans by local authorities to reduce air pollution and improve community health.

[Display omitted] • Aortic-related deaths in Brazil exhibited a steady increase during 2000–2019. • Low temperatures were associated with an immediately increased risk of aortic death. • Per 1 °C drop under 26 °C was associated with a 4.77 % rise in aortic mortality risk. • Low temperatures were responsible for 19.10 % of aortic-related deaths even in Brazil. Low temperatures are adverse contributors to cardiovascular diseases, but the associations between short-term exposure to cold and the risk of death from aortic dissection and aneurysm remain unclear, particularly in tropical regions. This study was conducted based on 123,951 records of deaths caused by aortic dissection and aneurysms extracted from the national Mortality Information System in Brazil between 2000 and 2019. Relative risks and 95 % confidence intervals (CI) for the aortic-related deaths associated with low ambient temperatures were estimated using the conditional logistic model combined with the distributed lag nonlinear model. Subgroup analyses were performed by age group, sex, race, education level, and residential region. Furthermore, this study calculated the number and fraction of aortic-related deaths attributed to temperatures below the temperature threshold to quantify the cold-related mortality burden of aortic diseases. During the study period, aortic-related deaths and mortality rates in Brazil exhibited a steady increase, rising from 4419 (2.66/100,000) in 2000 to 8152 (3.88/100,000) in 2019. Under the identified temperature threshold (26 °C), per 1 °C decrease in daily mean temperature was associated with a 4.77 % (95 % CI: 4.35, 5.19) increase in mortality risk of aortic-related diseases over lag 0–3 days. Females, individuals aged 50 years or older, Asian and Black race, and northern residents were more susceptible to low temperatures. Low temperatures were responsible for 19.10 % (95 % CI: 17.71, 20.45) of aortic-related deaths in Brazil. This study highlights that low temperatures were associated with an increased risk of aortic-related deaths, with a remarkable burden even in this predominantly tropical country. [ABSTRACT FROM AUTHOR]

Objective: This study reports the mortality burden due to PM2.5 exposure among adults (age >25) living in Hanoi in 2017.Methods: We applied a health impact assessment methodology with the global exposure mortality model and a PM2.5 map with 3 × 3 km resolution derived from multiple data sources.Results: The annual average PM2.5 concentration for each grid ranged from 22.1 to 37.2 µg/m³. The district average concentration values ranged from 26.9 to 37.2 µg/m³, which means that none of the 30 districts had annual average values below the Vietnam Ambient National Standard of 25 µg/m3. Using the Vietnam Ambient National Standard as the reference standard, we estimated that 2,696 deaths (95% CI: 2,225 to 3,158) per year were attributable to exposure to elevated PM2.5 concentrations in Hanoi. Using the Interim Target 4 value of 10 µg/m3 as the reference standard, the number of excess deaths attributable to elevated PM2.5 exposure was 4,760 (95% CI: 3,958–5,534).Conclusion: A significant proportion of deaths in Hanoi could be avoided by reducing air pollution concentrations to a level consistent with the Vietnam Ambient National Standard.

Abstract Background Several studies have investigated the associations between ambient temperature and years of life lost (YLLs), but few focused on the difference of life loss attributable to temperature among different socioeconomic development levels. Objectives We investigated the disparity in temperature-YLL rate relationships and life loss per death attributable to nonoptimal temperature in regions with various development levels. Methods Three hundred sixty-four Chinese counties or districts were classified into 92 high-development regions (HDRs) and 272 low-development regions (LDRs) according to socioeconomic factors of each location using K-means clustering approach. We used distributed lag non-linear models (DLNM) and multivariate meta-analysis to estimate the temperature-YLL rate relationships. We calculated attributable fraction (AF) of YLL and temperature-related average life loss per death to compare mortality burden of temperature between HDRs and LDRs. Stratified analyses were conducted by region, age, sex and cause of death. Results We found that non-optimal temperatures increased YLL rates in both HDRs and LDRs, but all subgroups in LDRs were more vulnerable. The disparity of cold effects between HDRs and LDRs was significant, while the difference in heat effect was insignificant. The overall AF of non-optimal temperature in LDRs [AF = 12.2, 95% empirical confidence interval (eCI):11.0–13.5%] was higher than that in HDRs (AF = 8.9, 95% eCI: 8.3–9.5%). Subgroups analyses found that most groups in LDRs had greater AFs than that in HDRs. The average life loss per death due to non-optimal temperature in LDRs (1.91 years, 95% eCI: 1.72–2.10) was also higher than that in HDRs (1.32 years, 95% eCI: 1.23–1.41). Most of AFs and life loss per death were caused by moderate cold in both HDRs and LDRs. Conclusions Mortality burden caused by temperature was more significant in LDRs than that in HDRs, which means that more attention should be paid to vulnerable populations in LDRs in planning adaptive strategies.

In their recent analysis, Hanlon et al. estimated the years of life lost (YLL) in people who have died with COVID-19 by following and expanding on the WHO standard approach. We welcome this research as an attempt to draw a more accurate picture of the mortality burden of this disease which has been involved in the deaths of more than 300,000 people worldwide as of May 2020. However, we argue that obtained YLL estimates (13 years for men and 11 years for women) are interpreted in a misleading way. Even with the presented efforts to control for the role of multimorbidity in COVID-19 deaths, these estimates cannot be interpreted to imply “how long someone who died from COVID-19 might otherwise have been expected to live”. By example we analyze the underlying problem which renders such an interpretation of YLL estimates impossible, and outline potential approaches to control for the problem.

Previous studies have reported that atmospheric elemental carbon (EC) may pose potentially elevated toxicity when compared to total ambient fine particulate matter (PM _2.5 ). However, most research on EC has been conducted in the US and Europe, whereas China experiences significantly higher EC pollution levels. Investigating the health impact of EC exposure in China presents considerable challenges due to the absence of a monitoring network to document long-term EC levels. Despite extensive studies on total PM _2.5 in China over the past decade and a significant decrease in its concentration, changes in EC levels and the associated mortality burden remain largely unknown. In our study, we employed a combination of satellite remote sensing, available ground observations, machine learning techniques, and atmospheric big data to predict ground EC concentrations across China for the period 2005–2018, achieving a spatial resolution of 10 km. Our findings reveal that the national average annual mean EC concentration has remained relatively stable since 2005, even as total PM _2.5 levels have substantially decreased. Furthermore, we calculated the all-cause non-accidental deaths attributed to long-term EC exposure in China using baseline mortality data and pooled mortality risk from a cohort study. This analysis unveiled significant regional disparities in the mortality burden resulting from long-term EC exposure in China. These variations can be attributed to varying levels of effectiveness in EC regulations across different regions. Specifically, our study highlights that these regulations have been effective in mitigating EC-related health risks in first-tier cities. However, in regions characterized by a highconcentration of coal-power plants and industrial facilities, additional efforts are necessary to control emissions. This observation underscores the importance of tailoring environmental policies and interventions to address the specific challenges posed by varying emission sources and regional contexts.

Background: The relation between climate change and human health has become one of the major worldwide public health issues. However, the evidence for low-latitude plateau regions is limited, where the climate is unique and diverse with a complex geography and topography., Objectives: This study aimed to evaluate the effect of ambient temperature on the mortality burden of nonaccidental deaths in Yunnan Province and to further explore its spatial heterogeneity among different regions., Methods: We collected mortality and meteorological data from all 129 counties in Yunnan Province from 2014 to 2020, and 16 prefecture-level cities were analyzed as units. A distributed lagged nonlinear model was used to estimate the effect of temperature exposure on years of life lost (YLL) for nonaccidental deaths in each prefecture-level city. The attributable fraction of YLL due to ambient temperature was calculated. A multivariate meta-analysis was used to obtain an overall aggregated estimate of effects, and spatial heterogeneity among 16 prefecture-level cities was evaluated by adjusting the city-specific geographical characteristics, demographic characteristics, economic factors, and health resources factors., Results: The temperature-YLL association was nonlinear and followed slide-shaped curves in all regions. The cumulative cold and heat effect estimates along lag 0-21 days on YLL for nonaccidental deaths were 403.16 (95% empirical confidence interval [eCI] 148.14-615.18) and 247.83 (95% eCI 45.73-418.85), respectively. The attributable fraction for nonaccidental mortality due to daily mean temperature was 7.45% (95% eCI 3.73%-10.38%). Cold temperature was responsible for most of the mortality burden (4.61%, 95% eCI 1.70-7.04), whereas the burden due to heat was 2.84% (95% eCI 0.58-4.83). The vulnerable subpopulations include male individuals, people aged <75 years, people with education below junior college level, farmers, nonmarried individuals, and ethnic minorities. In the cause-specific subgroup analysis, the total attributable fraction (%) for mean temperature was 13.97% (95% eCI 6.70-14.02) for heart disease, 11.12% (95% eCI 2.52-16.82) for respiratory disease, 10.85% (95% eCI 6.70-14.02) for cardiovascular disease, and 10.13% (95% eCI 6.03-13.18) for stroke. The attributable risk of cold effect for cardiovascular disease was higher than that for respiratory disease cause of death (9.71% vs 4.54%). Furthermore, we found 48.2% heterogeneity in the effect of mean temperature on YLL after considering the inherent characteristics of the 16 prefecture-level cities, with urbanization rate accounting for the highest proportion of heterogeneity (15.7%) among urban characteristics., Conclusions: This study suggests that the cold effect dominated the total effect of temperature on mortality burden in Yunnan Province, and its effect was heterogeneous among different regions, which provides a basis for spatial planning and health policy formulation for disease prevention., (© Yang Chen, Lidan Zhou, Yuanyi Zha, Yujin Wang, Kai Wang, Lvliang Lu, Pi Guo, Qingying Zhang. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

In this study, the AirQ+ software proposed by the World Health Organization (WHO) was applied in order to assess the health endpoints associated with the long-term exposure to PM2.5 in Attica Region, Greece. For this purpose, we analyzed the daily average concentrations of PM2.5 registered by the air quality monitoring stations in the region, from 1 January 2007 to 31 December 2018. Although there was a decreasing trend in PM2.5 concentrations levels, the levels of PM2.5 exceeded the AQG (Air Quality Guidelines) limit value (annual value: 5 μg/m3) established by the WHO. The findings revealed that the burden of mortality (from all-natural causes) at people above 30 years old associated with PM2.5 exposure was 4752 [3179–6152] deaths in 2007 and 2424 [1598–3179] deaths in 2018. In general, the attributable mortality from specific causes of deaths (e.g., lung cancer, IHD (ischemic heart diseases) and stroke) in people above 25 years old decreased between the years, but the mortality from COPD (chronic obstructive pulmonary diseases) was stable at 146 [79–220] deaths in 2007 and 147 [63–244] deaths in 2018. We also found differences in mortality cases from IHD and stroke among the age groups and between the years 2007 and 2018.

Summary: Although numerous studies have investigated premature deaths attributable to temperature, effects of temperature on years of life lost (YLL) remain unclear. We estimated the relationship between temperatures and YLL, and quantified the YLL per death caused by temperature in China. We collected daily meteorological and mortality data, and calculated the daily YLL values for 364 locations (2013–2017 in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces, and 2006–2011 in other locations) in China. A time-series design with a distributed lag nonlinear model was first employed to estimate the location-specific associations between temperature and YLL rates (YLL/100,000 population), and a multivariate meta-analysis model was used to pool location-specific associations. Then, YLL per death caused by temperatures was calculated. The temperature and YLL rates consistently showed U-shaped associations. A mean of 1.02 (95% confidence interval: 0.67, 1.37) YLL per death was attributable to temperature. Cold temperature caused 0.98 YLL per death with most from moderate cold (0.84). The mean YLL per death was higher in those with cardiovascular diseases (1.14), males (1.15), younger age categories (1.31 in people aged 65–74 years), and in central China (1.34) than in those with respiratory diseases (0.47), females (0.87), older people (0.85 in people ≥75 years old), and northern China (0.64) or southern China (1.19). The mortality burden was modified by annual temperature and temperature variability, relative humidity, latitude, longitude, altitude, education attainment, and central heating use. Temperatures caused substantial YLL per death in China, which was modified by demographic and regional characteristics.

Background: Both inhalable particles (PM10) and fine particles (PM2.5) are regulated in various countries mainly due to their adverse health effects. However, there is increasing evidence that PM2.5 might be responsible for these effects and coarse particles (PMc) plays little role in adverse health effects, if so, it might be not necessary to monitor PM10. Methods: In this study, we conducted a time-series analysis using a generalized additive model to explore the effects of PM2.5, PMc, and PM10 on mortality from ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) in 96 Chinese cities during 2013–2016. The mortality number and attributable fraction were further estimated using the national air quality standard and WHO’s guideline as the reference. Results: We observed significant effects of PM2.5 on IHD and COPD mortality; each 10 ug/m3 increase in lag01 PM2.5 was associated with a 0.26% (95% CI: 0.17%, 0.34%) increase in IHD mortality and a 0.19% (95% CI: 0.09%, 0.29%) increase in COPD mortality. We also found significant effects of PMc and PM10 on mortality from IHD and COPD, but the magnitudes of effects were weaker than those of PM2.5. The results were robust when adjusting for co-pollutants and altering model parameters. We further estimated that about 1.27% (95% CI: 0.29%, 2.30%) of IHD mortality and 1.25% (95% CI: 0.08%, 2.46%) of COPD mortality could be attributable to PM2.5 exposure using WHO’s guideline (25 ug/m3) as a reference, corresponding to 15,337 (95% CI: 3,375, 27,842) mortalities from IHD and 5,653 (95% CI: 379, 11,152) COPD mortalities in the 96 cities. Across all of China, almost fifty thousand cases of IHD mortality and twenty thousand cases of COPD mortality might be avoidable if the PM2.5 concentration declined to the WHO guideline. Conclusions: Our study indicates that short-term exposure to PM2.5 could be an important risk factor of mortality from IHD and COPD, and substantial cardiopulmonary mortality could be avoidable by reducing daily PM2.5 concentrations. It is nonnegligible to consider the role of PMc in triggering in cardiopulmonary mortality. And it could be necessary to continue monitoring PM10 in the study regions due to the adverse effects of PMc.

The updated climate models provide projections at a fine scale, allowing us to estimate health risks due to future warming after accounting for spatial heterogeneity. Here, we utilized an ensemble of high-resolution (25 km) climate simulations and nationwide mortality data from 306 Chinese cities to estimate death anomalies attributable to future warming. Historical estimation (1986-2014) reveals that about 15.5% [95% empirical confidence interval (eCI):13.1%, 17.6%] of deaths are attributable to nonoptimal temperature, of which heat and cold corresponded to attributable fractions of 4.1% (eCI:2.4%, 5.5%) and 11.4% (eCI:10.7%, 12.1%), respectively. Under three climate scenarios (SSP126, SSP245, and SSP585), the national average temperature was projected to increase by 1.45, 2.57, and 4.98 °C by the 2090s, respectively. The corresponding mortality fractions attributable to heat would be 6.5% (eCI:5.2%, 7.7%), 7.9% (eCI:6.3%, 9.4%), and 11.4% (eCI:9.2%, 13.3%). More than half of the attributable deaths due to future warming would occur in north China and cardiovascular mortality would increase more drastically than respiratory mortality. Our study shows that the increased heat-attributable mortality burden would outweigh the decreased cold-attributable burden even under a moderate climate change scenario across China. The results are helpful for national or local policymakers to better address the challenges of future warming.

This paper focuses on the use of results of epidemiological studies to quantify the effects on health, particularly on mortality, of long-term exposure to air pollutants. It introduces health impact assessment methods, used to predict the benefits that can be expected from implementation of interventions to reduce emissions of pollutants. It also explains the estimation of annual mortality burdens attributable to current levels of pollution. Burden estimates are intended to meet the need to communicate the size of the effect of air pollution on public health to policy makers and others. The implications, for the interpretation of the estimates, of the assumptions and approximations underlying the methods are discussed. The paper starts with quantification based on results obtained from studies of the association of mortality risk with long-term average concentrations of particulate air pollution. It then tackles the additional methodological considerations that need to be addressed when also considering the mortality effects of other pollutants such as nitrogen dioxide (NO2). Finally, approaches that could be used to integrate morbidity and mortality endpoints in the same assessment are touched upon. This article is part of a discussion meeting issue 'Air quality, past present and future'. [ABSTRACT FROM AUTHOR]

Investigations on the chronic health effects of fine particulate matter (PM2.5) exposure in China are limited due to the lack of long-term exposure data. Using satellite-driven models to generate spatiotemporally resolved PM2.5 levels, we aimed to estimate high-resolution, long-term PM2.5 and associated mortality burden in China. The multiangle implementation of atmospheric correction (MAIAC) aerosol optical depth (AOD) at 1-km resolution was employed as a primary predictor to estimate PM2.5 concentrations. Imputation techniques were adopted to fill in the missing AOD retrievals and provide accurate long-term AOD aggregations. Monthly PM2.5 concentrations in China from 2000 to 2016 were estimated using machine-learning approaches and used to analyze spatiotemporal trends of adult mortality attributable to PM2.5 exposure. Mean coverage of AOD increased from 56 to 100% over the 17-y period, with the accuracy of long-term averages enhanced after gap filling. Machine-learning models performed well with a random cross-validation R² of 0.93 at the monthly level. For the time period outside the model training window, prediction R² values were estimated to be 0.67 and 0.80 at the monthly and annual levels. Across the adult population in China, long-term PM2.5 exposures accounted for a total number of 30.8 (95% confidence interval [CI]: 28.6, 33.2) million premature deaths over the 17-y period, with an annual burden ranging from 1.5 (95% CI: 1.3, 1.6) to 2.2 (95% CI: 2.1, 2.4) million. Our satellite-based techniques provide reliable long-term PM2.5 estimates at a high spatial resolution, enhancing the assessment of adverse health effects and disease burden in China. [ABSTRACT FROM AUTHOR]

Background: Several studies have investigated the associations between ambient temperature and years of life lost (YLLs), but few focused on the difference of life loss attributable to temperature among different socioeconomic development levels.Objectives: We investigated the disparity in temperature-YLL rate relationships and life loss per death attributable to nonoptimal temperature in regions with various development levels.Methods: Three hundred sixty-four Chinese counties or districts were classified into 92 high-development regions (HDRs) and 272 low-development regions (LDRs) according to socioeconomic factors of each location using K-means clustering approach. We used distributed lag non-linear models (DLNM) and multivariate meta-analysis to estimate the temperature-YLL rate relationships. We calculated attributable fraction (AF) of YLL and temperature-related average life loss per death to compare mortality burden of temperature between HDRs and LDRs. Stratified analyses were conducted by region, age, sex and cause of death.Results: We found that non-optimal temperatures increased YLL rates in both HDRs and LDRs, but all subgroups in LDRs were more vulnerable. The disparity of cold effects between HDRs and LDRs was significant, while the difference in heat effect was insignificant. The overall AF of non-optimal temperature in LDRs [AF = 12.2, 95% empirical confidence interval (eCI):11.0-13.5%] was higher than that in HDRs (AF = 8.9, 95% eCI: 8.3-9.5%). Subgroups analyses found that most groups in LDRs had greater AFs than that in HDRs. The average life loss per death due to non-optimal temperature in LDRs (1.91 years, 95% eCI: 1.72-2.10) was also higher than that in HDRs (1.32 years, 95% eCI: 1.23-1.41). Most of AFs and life loss per death were caused by moderate cold in both HDRs and LDRs.Conclusions: Mortality burden caused by temperature was more significant in LDRs than that in HDRs, which means that more attention should be paid to vulnerable populations in LDRs in planning adaptive strategies. [ABSTRACT FROM AUTHOR]

Previous studies have reported that atmospheric elemental carbon (EC) may pose potentially elevated toxicity when compared to total ambient fine particulate matter (PM 2.5 ). However, most research on EC has been conducted in the US and Europe, whereas China experiences significantly higher EC pollution levels. Investigating the health impact of EC exposure in China presents considerable challenges due to the absence of a monitoring network to document long-term EC levels. Despite extensive studies on total PM 2.5 in China over the past decade and a significant decrease in its concentration, changes in EC levels and the associated mortality burden remain largely unknown. In our study, we employed a combination of satellite remote sensing, available ground observations, machine learning techniques, and atmospheric big data to predict ground EC concentrations across China for the period 2005-2018, achieving a spatial resolution of 10 km. Our findings reveal that the national average annual mean EC concentration has remained relatively stable since 2005, even as total PM 2.5 levels have substantially decreased. Furthermore, we calculated the all-cause non-accidental deaths attributed to long-term EC exposure in China using baseline mortality data and pooled mortality risk from a cohort study. This analysis unveiled significant regional disparities in the mortality burden resulting from long-term EC exposure in China. These variations can be attributed to varying levels of effectiveness in EC regulations across different regions. Specifically, our study highlights that these regulations have been effective in mitigating EC-related health risks in first-tier cities. However, in regions characterized by a high concentration of coal-power plants and industrial facilities, additional efforts are necessary to control emissions. This observation underscores the importance of tailoring environmental policies and interventions to address the specific challenges posed by varying emission sources and regional contexts., Competing Interests: Conflict of interests The authors declare no competing interests.

Abstract Numerous epidemiologic studies on adverse health effects of air pollution have been well documented; however, assessment on health benefits of air quality improvement from air pollution control measures has been limited in developing countries. We assessed the mortality benefits associated with air pollution improvement over 11 years in Guangzhou, China (2006–2016). A time series analysis with Generalized additive Poisson models was used to estimate mortality effects of ozone (O 3) and nitrogen dioxide (NO 2), adjusting for time trend, day of week, public holiday, temperature and relative humidity. We further estimated the changes in mortality burden of O 3 and NO 2 , including attributable fraction (AF, in %) and attributable mortality (AM, in number of death) during study period. We lastly estimated mortality effects during the 2010 Asian Games (November 12 to December 18, 2010) compared to a baseline period consisting of 4-week before and 4-week after the game. During the study period, average annual concentrations of NO 2 decreased from 42.3 μg/m3 in 2006 to 33.8 μg/m3 in 2016; while O 3 levels remained stable over time. We observed significant increases in mortality of O 3 and NO 2 , with approximately linear exposure-response relationships. In specific, each increase of 10 μg/m3 in O 3 and NO 2 at 2 prior days was associated with increases of 0.60% (95% confidence interval (CI): 0.47, 0.74) and 1.89% (95%CI: 1.49, 2.29) in total mortality, respectively. We further estimated that AF on total mortality attributed to NO 2 decreased from 1.38% (95%CI: 1.09, 1.68) in 2006–2010 to 0.43% (95%CI: 0.34, 0.52) in 2011–2016, corresponding to AM on total mortality of 2496 deaths (95%CI: 1964, 3033) to 1073 deaths (95%CI: 846, 1301). During the 2010 Asian Games, we observed decrease in total mortality of 9.3% (95%CI: −15.0, −3.2) in comparison with that observed in the baseline period. Similar mortality benefits in cardiovascular diseases were also observed. Our results showed reduced mortality burden from air pollution improvement in Guangzhou in recent years, which provide strong rationale for continuing to reduce air pollution through comprehensive and rigorous air quality management in the area. Highlights • Exposures to O 3 and NO 2 were significantly associated with mortality in Guangzhou, China. • Reductions in mortality burden of NO 2 following improved air quality during 2006–2016 • Health benefits of improved air quality were observed during the 2010 Asian Games. [ABSTRACT FROM AUTHOR]

Abstract Studies worldwide have estimated the number of deaths attributable to long-term exposure to fine airborne particles (PM 2.5), but limited information is available on short-term exposure, particularly in China. In addition, most existing studies have assumed that short-term PM 2.5 -mortality associations were linear. For this reason, the use of linear exposure-response functions for calculating disease burden of short-term exposure to PM 2.5 in China may not be appropriate. There is an urgent need for a comprehensive, evidence-based assessment of the disease burden related to short-term PM 2.5 exposure in China. Here, we explored the non-linear association between short-term PM 2.5 exposure and all-cause mortality in 104 counties in China; estimated county-specific mortality burdens attributable to short-term PM 2.5 exposure for all counties in the country and analyzed spatial characteristics of the mortality burden due to short-term PM 2.5 exposure in China. The pooled PM 2.5 -mortality association was non-linear, with a reversed J-shape. We found an approximately linear increased risk of mortality from 0 to 62 μg/m3 and decreased risk from 62 to 250 μg/m3. We estimated a total of 169,862 additional deaths from short-term PM 2.5 exposure throughout China in 2015. Models using linear exposure-response functions for the PM 2.5 -mortality association estimated 32,186 deaths attributable to PM 2.5 exposure, which is 5.3 times lower than estimates from the non-linear effect model. Short-term PM 2.5 exposure contributed greatly to the death burden in China, approximately one seventh of the estimates from the chronic effect. It is essential and crucial to incorporate short-term PM 2.5 -related mortality estimations when considering the disease burden attributable to PM 2.5 in developing countries such as China. Traditional linear effect models likely underestimated the mortality burden due to short-term exposure to PM 2.5. Highlights • The first county-level assessment of short-term PM 2.5 related mortality in China. • The association between short-term PM 2.5 exposure and mortality was non-linear. • A total of 169,862 additional deaths from short-term PM 2.5 exposure in China in 2015. • Previous linear models might have largely underestimated the burden of mortality. [ABSTRACT FROM AUTHOR]

Abstract The estimation of PM 2.5 -related mortality is becoming increasingly important. The accuracy of results is largely dependent on the selection of methods for PM 2.5 exposure assessment and Concentration-Response (C-R) function. In this study, PM 2.5 observed data from the China National Environmental Monitoring Center, satellite-derived estimation, widely collected geographic and socioeconomic information variables were applied to develop a national satellite-based Land Use Regression model and evaluate PM 2.5 exposure concentrations within 2013–2015 with the resolution of 1 km × 1 km. Population weighted concentration declined from 72.52 μg/m3 in 2013 to 57.18 μg/m3 in 2015. C-R function is another important section of health effect assessment, but most previous studies used the Integrated Exposure Regression (IER) function which may currently underestimate the excess relative risk of exceeding the exposure range in China. A new Shape Constrained Health Impact Function (SCHIF) method, which was developed from a national cohort of 189,793 Chinese men, was adopted to estimate the PM 2.5 -related premature deaths in China. Results showed that 2.19 million (2013), 1.94 million (2014), 1.65 million (2015) premature deaths were attributed to PM 2.5 long-term exposure, different from previous understanding around 1.1–1.7 million. The top three provinces of the highest premature deaths were Henan, Shandong, Sichuan, while the least ones were Tibet, Hainan, Qinghai. The proportions of premature deaths caused by specific diseases were 53.2% for stroke, 20.5% for ischemic heart disease, 16.8% for chronic obstructive pulmonary disease and 9.5% for lung cancer. IER function was also used to calculate PM 2.5 -related premature deaths with the same exposed level used in SCHIF method, and the comparison of results indicated that IER had made a much lower estimation with less annual amounts around 0.15–0.5 million premature deaths within 2013–2015. Graphical abstract Image 1 Highlights • Developing LUR model for PM 2.5 combined satellite and surface observation. • The spatial resolution of our study is 1 km × 1 km, more elaborate than previous studies. • Updating PM 2.5 -related premature deaths using local concentration–response function. • Our estimation of premature deaths shows higher results than previous understanding. [ABSTRACT FROM AUTHOR]

Abstract Background Limited evidence is available on the health effects of particulate matter with an aerodynamic diameter of <1 μm (PM 1), mainly due to the lack of its ground measurement worldwide. Objectives To identify and examine the mortality risks and mortality burdens associated with PM 1 , PM 2.5 , and PM 10 in Zhejiang province, China. Methods We collected daily data regarding all-cause (stratified by age and gender), cardiovascular, stroke, respiratory, and chronic obstructive pulmonary disease (COPD) mortality, and PM 1 , PM 2.5 , and PM 10 , from 11 cities in Zhejiang province, China during 2013 and 2017. We used a quasi-Poisson regression model to estimate city-specific associations between mortality and PM concentrations. Then we used a random-effect meta-analysis to pool the provincial estimates. To show the mortality burdens of PM 1 , PM 2.5 , and PM 10 , we calculated the mortality fractions and deaths attributable to these PMs. Results Daily concentrations of PM 1 , PM 2.5 , and PM 10 ranged between 0–199 μg/m3, 0–218 μg/m3, and 0–254 μg/m3, respectively; Mortality effects were significant in lag 0–2 days. The relative risks for all-cause mortality were 1.0064 (95% CI: 1.0034, 1.0094), 1.0061 (95% CI: 1.0034, 1.0089), and 1.0060 (95% CI: 1.0038, 1.0083) associated with a 10 μg/m3 increase in PM 1 , PM 2.5, and PM 10 , respectively. Age- and gender-stratified analysis shows that elderly people (aged 65+) and females are more sensitive to PMs. The mortality fractions of all-cause mortality were estimated to be 2.39% (95% CI: 1.28, 3.48) attributable to PM 1 , 2.53% (95% CI: 1.42, 3.63) attributable to PM 2.5 , and 3.08% (95% CI: 1.95, 4.19) attributable to PM 10. The ratios of attributable cause-specific deaths for PM 1 /PM 2.5 , PM 1 /PM 10 , and PM 2.5 /PM 10 were higher than the ratios of their respective concentrations. Conclusions PM 1 , PM 2.5 and PM 10 are risk factors of all-cause, cardiovascular, stroke, respiratory, and COPD mortality. PM 1 accounts for the vast majority of short-term PM 2.5 - and PM 10 -induced mortality. Our analyses support the notion that smaller size fractions of PM have a more toxic mortality impacts, which suggests to develop strategies to prevent and control PM 1 in China, such as to foster strict regulations for automobile and industrial emissions. Highlights • PM 1 , PM 2.5 and PM 10 are risk factors of all-cause, cardiovascular, stroke, respiratory, and COPD mortality. • PM 1 accounts for the vast majority of short-term PM 2.5 - and PM 10 -induced mortality. • Smaller size fractions of PM have a more toxic mortality impacts. • PM 1 has stronger effects on all-cause, cardiovascular, and stroke mortality in the warm season than in the cold season. [ABSTRACT FROM AUTHOR]

The evidence is limited for the mortality burden of temperature variability between neighboring days. This study developed a novel indicator to measure temperature variability between neighboring days and quantify its mortality burden. Daily mortality and meteorological data during 2006–2017 from 364 locations across China were collected. We first employed a distributed lag non-linear model and multivariable meta-analysis to investigate the association between the diurnal temperature range (DTR) with the years of life lost (YLL) rate and the association between the nocturnal temperature range (NTR) with the YLL rate. Then, we calculated the weight temperature variability between neighboring days (weight-TVN) based on the attributable YLL rate of the DTR and NTR. The relationship between the weight-TVN and YLL rate was analyzed, and the attributable fraction (AF) of the YLL and weight-TVN related life loss per death was calculated to quantify the mortality burden. Stratified analyses were conducted by region, season, gender, age group and cause of death. The DTR-YLL rate curve and NTR-YLL rate curve were both J-shaped and a higher YLL rate attributable to DTR was observed than NTR. There was a significant association between the weight-TVN and YLL rate. An estimated AF of the weight-TVN was 6.02% (95%CI: 3.71%–8.33%). The average life loss per death due to weight-TVN was 0.93 year (95%CI: 0.57–1.29). Stratification analyses showed that the AFs of weight-TVN were relatively larger in southern China, in the cold season, in the elderly, females and patients with respiratory illnesses. Although the AF of weight-TVN among the young group (AF = 4.74%, 95%CI: 1.79%–7.69%) was lower than for the elderly (AF = 6.06%, 95%CI: 3.72%–8.41%), weight-TVN related life loss per death among the young population (1.51, 95%CI: 0.57–2.45) was much higher than in the elderly (0.59, 95%CI: 0.36–0.82). A novel indicator to measure temperature variability between neighboring days was developed, and temperature fluctuation between adjacent days significantly increased the mortality burden. Our results indicate that more attention should be paid to short-term temperature fluctuation.

The flow of the Earth’s atmosphere not only largely determines its temperature status, but also profoundly affects aerosol concentrations. Therefore, exploring how to evaluate the synthetical effects of temperature and aerosol pollution on human health is an important topic. Regarding the atmosphere as a whole, we quantified the mortality burden attributable to short-term exposure to abnormal temperatures and PM _2.5 in Beijing from the perspective of atmospheric flow. We first divided the atmospheric stability into three levels (including disturbed, normal, and stable conditions) according to the variations in meteorological conditions and PM _2.5 concentrations across the stable weather index levels. We then applied a generalized additive model to separately evaluate the short-term effects of temperature and PM _2.5 on mortality under each level of atmospheric stability. We further estimate the associated mortality burden using two indicators, namely attributable fraction and attributable number of deaths. Abnormal temperatures were responsible for most of the mortality burden. Cold temperatures accounted for a substantially higher mortality burden than hot temperatures. The synthetical mortality effects of temperature and PM _2.5 varied for different atmospheric stabilities. A stable atmosphere poses the strongest synthetical effects of temperature and PM _2.5 , while a normal atmosphere provides comparatively beneficial conditions for human health. Our results indicated that the synthetical health impacts of temperature and PM _2.5 driven by atmospheric flow need to be considered in the further promulgation of public health policies and air pollution abatement strategies, particularly in the context of climate change.

Background: People in daily life are usually exposed to multiple environmental factors, but few studies have evaluated the joint health impacts of ambient air pollutants and weather factors., Objectives: To investigate the joint associations of short-term exposures to ambient air pollutants and weather factors with mortality and estimate the mortality burden attributable to these multiple environmental exposures in China., Methods: We collected individual death information from six provinces (Guangdong, Yunnan, Hunan, Zhejiang, Tibet and Jilin) in China during 2013 to 2018, and applied a time-stratified case-crossover study design to estimate the joint associations of air pollutants [PM 2.5 (particulate matter with an aerodynamic diameter ≤2.5 μm), O 3 (ozone), NO 2 (nitrogen dioxide), SO 2 (sulfur dioxide), and CO (carbon monoxide)] and weather factors (temperature and relative humidity) with mortality. Air pollutant concentrations on the case day and control days were assessed using a random forest model, and the corresponding temperature and relative humidity data were assessed using a thin plate smoothing model. Excess risks (ER) of exposure to air pollutants and weather factors were estimated using Cox proportional regression models and the attributable fraction (AF) was calculated., Results: A total of 6,685,146 deaths were enrolled in this study. The overall AF of total mortality attributed to air pollutants (lag03 days) and weather factors (lag021 days) was 16.65 % (95%CI: 16.43 %, 16.87 %), in which the joint AFs attributable to air pollutants and weather factors were 5.31 % (95%CI: 5.08 %, 5.53 %) and 11.34 % (95%CI: 11.12 %, 11.56 %) respectively, and temperature contributed 56 % in the joint effects. Stratified analyses showed greater AFs in females (21.32 %) than in males (14.61 %), and in the elderly (>100 years, 42.34 %) than in young people (21-30 years, 7.67 %). The AFs of mortality from cardiovascular diseases, respiratory diseases, and pneumonia attributed to the joint exposures were 22.72 %, 24.82 % and 33.03 %, respectively., Discussion: This study provides the joint associations of short-term exposures to both air pollutants and weather factors with mortality risk in China, which has important implications in comprehensively assessing the health impacts of environmental exposures, and taking actions to protect human health., (Copyright © 2023. Published by Elsevier B.V.)

Investigating how well people adapt to heat waves and cold spells has been an important issue under climate change. Also, most of previous studies focused only on the mortality risks for heat waves or cold spells for certain time period not considering its temporal changes and increasing frequencies. This study investigated the change in risks of mortality from heat waves and cold spells over time, and estimated the temporal changes in mortality burden attributed to heat waves and cold spells in Korea and Japan. We collected time-series data covering mortality and weather variables from 53 communities in the two countries from 1992 to 2015. Two-stage time-series regression with a time-varying distributed lag model and meta-analysis was used to assess the impacts of heat waves and cold spells by period (1990s, 2000s, and 2010s). In total population, the risks of heat waves have decreased over time; however their mortality burden increased in the 2010s compared to the 2000s with increasing frequency. On the other hand, the risk and health burden of cold spells have increased over the decades. Our findings showed that the future mortality burden of heat waves and cold spells might not decrease, when considering their changes in risks and frequencies. [ABSTRACT FROM AUTHOR]

Background Sudden temperature change may elevate short-term mortality and remains an important global health threat in the context of climate change. To date, however, little available temperature-mortality evidence has taken into account both intra- and inter-day temperature variability (TV), thus largely limiting the comprehensive understanding of mortality burden due to unstable weather. Moreover, seasonal and temporal patterns in TV-mortality associations were sparsely discussed, nationally and regionally. Objectives We aimed to assess the nationwide association of all-cause mortality with hourly temperature variability (HTV), quantify HTV-attributable mortality, and further explore the temporal and seasonal variations of mortality burden due to HTV in United Kingdom. Methods Fourteen-year time-series data on temperature and mortality were collected from 10 regions in England and Wales during 1993–2006, totally including 7,573,716 all-cause deaths. HTV was calculated from the standard deviation of hourly temperature records within two neighboring days. A three-stage analytic approach was adopted to assess HTV-associated mortality burden. We first applied a time-series quasi-Poisson regression to estimate region-specific HTV-mortality associations, then pooled these associations at the national level using a multivariate meta-analysis, and finally estimated the HTV-attributable mortality fraction and illustrated its seasonal and temporal variations by conducting season- and period-specific analyses based on time-varying distributed lag models. Results We found strong evidence that large HTV exposure elevated short-term mortality risk in England and Wales, with a pooled estimate of 1.13% (95% confidence interval (CI): 0.88, 1.39) associated with a 1-°C increase in HTV. During the whole study period, HTV accounted for a national average attributable fraction of 2.52% (95% empirical confidence interval (eCI): 2.27, 2.76) of the total deaths. This HTV-attributable mortality estimate showed a significant temporal decrease (p < 0.001) from 2.72% (95% eCI: 2.58, 2.87) in 1993–99 to 2.28% (95% eCI: 2.13, 2.43) in 2000–06. Additionally, clear seasonal variations were observed for HTV-attributable mortality burden, with the largest estimate of 3.08% (95% eCI: 2.80, 3.38) in summer, followed by 2.71% (95% eCI: 2.44, 2.98) in spring, 2.40% (95% eCI: 2.16, 2.63) in autumn, and 2.00% (95% eCI: 1.81, 2.20) in winter. Conclusions Despite clear evidence observed for the reduction, mortality burden caused by temperature variability remained a great public health threat, especially in warm seasons. It highlighted the importance of specific interventions targeted to unstable weather as well as temperature extremes, so as to reduce climate-related mortality burden. [ABSTRACT FROM AUTHOR]

Recent studies have reported that heat-related mortality decreased by adaptation during decades. However, since the frequency of extreme heat events is increasing, it is difficult to conclude with certainty that the heat mortality burden is decreasing. To examine temporal changes in mortality attributed to heat extremes in Northeast Asia, we collected temperature and mortality data covering the years 1972–2012 from 57 cities of 3 countries (Taiwan, Korea, and Japan) in Northeast Asia. Poisson regression curves were fitted to the data from each city. The temporal changes in heat-mortality association were estimated with a time-varying distributed lag non-linear model. Heat extremes were defined as temperatures greater than the 97.5th percentiles of city-specific average temperatures. Attributable deaths were calculated considering temporal variations in exposure and relative risk. The estimates were then pooled through meta-analysis. The results show that the mortality risk on extreme heat days declined during the study period in all countries. However, as summer temperatures in Japan have shown more heat extremes over time, the mortality risk attributed to heat increased during 2003–2012 (0.32%) compared with 1972–1981 (0.19%). Thus, to assess the total health burden due to heat extremes related to climate change, public health strategies should focus on the temporal variation in heat-mortality association as well as changes in the distribution of heat extremes overtime. [ABSTRACT FROM AUTHOR]

Although studies have estimated the associations of PM 2.5 with total mortality or cardiopulmonary mortality, few have comprehensively examined cause-specific mortality risk and burden caused by ambient PM 2.5. Thus, this study investigated the association of short-term exposure to PM 2.5 with cause-specific mortality using a death-spectrum wide association study (DWAS). Individual information of 5,450,764 deaths during 2013–2018 were collected from six provinces in China. Daily PM 2.5 concentration in the case and control days were estimated by a random forest model. A time-stratified case-crossover study design was applied to estimate the associations (access risk, ER) of PM 2.5 with cause-specific mortality, which was then used to calculate the population-attributable fraction (PAF) of mortality and the corresponding mortality burden caused by PM 2.5. Each 10 μg/m3 increase in PM 2.5 concentration (lag03) was associated with a 0.80 % [95 % confidence interval (CI): 0.73 %, 0.86 %] rise in total mortality. We found greater mortality effect at PM 2.5 concentrations < 50 μg/m3. Stratified analyses showed greater ERs in females (1.01 %, 95 %CI: 0.91 %, 1.11 %), children ≤ 5 years (2.17 %, 95 %CI: 0.85 %, 3.51 %), and old people ≥ 70 years. We identified 33 specific causes (level 2) of death which had significant associations with PM 2.5 , including 16 circulatory diseases, 9 respiratory diseases, and 8 other causes. The PAF estimated based on the overall association between PM 2.5 and total mortality was 3.16 % (95 %CI: 2.89 %, 3.40 %). However, the PAF was reduced to 2.88 % (95 %CI: 1.88 %, 3.81 %) using the associations of PM 2.5 with 33 level 2 causes of death, based on which 250.15 (95 %CI: 163.29, 330.93) thousand deaths were attributable to short-term PM 2.5 exposure across China in 2019. Overall, this study provided a comprehensive picture on the death-spectrum wide association between PM 2.5 and morality in China. We observed robust positive cause-specific associations of PM 2.5 with mortality risk, which may provide more precise basis in assessing the mortality burden of air pollution. [Display omitted] • We estimate association of short-term exposure to PM 2.5 with cause-specific mortality. • A time-stratified case-crossover study design was used in 5.4 million deaths in China. • Short-term exposure to PM 2.5 is associated with mortality from 33 specific causes. • Mortality burden of PM 2.5 using associations with total mortality was overestimated. • The results provide more precise basis in assessing mortality burden of air pollution. [ABSTRACT FROM AUTHOR]

A large gap exists between the latest Global Air Quality Guidelines (AQG 2021) and Chinese air quality standards for NO 2. Assessing whether and to what extent air quality standards for NO 2 should be tightened in China requires a comprehensive understanding of the spatiotemporal characteristics of population exposure to ambient NO 2 and related health risks, which have not been studied to date. We predicted ground NO 2 concentrations with high resolution in mainland China, explored exposure characteristics to NO 2 pollution, and assessed the mortality burden attributable to NO 2 exposure. Daily NO 2 concentrations in 2019 were predicted at 1-km spatial resolution in mainland China using random forest models incorporating multiple predictors. From these high-resolution predictions, we explored the spatiotemporal distribution of NO 2 , population and area percentages with NO 2 exposure exceeding criterion levels, and premature deaths attributable to long- and short-term NO 2 exposure in China. The cross-validation R2 and root mean squared error of the NO 2 predicting model were 0.80 and 7.78 μg/m3, respectively, at the daily level in 2019. The percentage of people (population number) with annual NO 2 exposure over 40 μg/m3 in mainland China in 2019 was 10.40 % (145,605,200), and it reached 99.68 % (1,395,569,840) with the AQG guideline value of 10 μg/m3. NO 2 levels and population exposure risk were elevated in urban areas than in rural. Long- and short-term exposures to NO 2 were associated with 285,036 and 121,263 non-accidental deaths, respectively, in China in 2019. Tightening standards in steps gradually would increase the potential health benefit. In China, NO 2 pollution is associated with significant mortality burden. Spatial disparities exist in NO 2 pollution and exposure risks. China's current air quality standards may no longer objectively reflect the severity of NO 2 pollution and exposure risk. Tightening the national standards for NO 2 is needed and will lead to significant health benefits. [ABSTRACT FROM AUTHOR]

Ambient exposure to fine particulate matter (PM _2.5 ) is one of the top global health concerns. We estimate the PM _2.5 -related health benefits of emission reduction over New York State (NYS) from 2002 to 2012 using seven publicly available PM _2.5 products that include information from ground-based observations, remote sensing and chemical transport models. While these PM _2.5 products differ in spatial patterns, they show consistent decreases in PM _2.5 by 28%–37% from 2002 to 2012. We evaluate these products using two sets of independent ground-based observations from the New York City Community Air Quality Survey (NYCCAS) Program for an urban area, and the Saint Regis Mohawk Tribe Air Quality Program for a remote area. Inclusion of satellite remote sensing improves the representativeness of surface PM _2.5 in the remote area. Of the satellite-based products, only the statistical land use regression approach captures some of the spatial variability across New York City measured by NYCCAS. We estimate the PM _2.5 -related mortality burden by applying an integrated exposure-response function to the different PM _2.5 products. The multi-product mean PM _2.5 -related mortality burden over NYS decreased by 5660 deaths (67%) from 8410 (95% confidence interval (CI): 4570–12 400) deaths in 2002 to 2750 (CI: 700–5790) deaths in 2012. We estimate a 28% uncertainty in the state-level PM _2.5 mortality burden due to the choice of PM _2.5 products, but such uncertainty is much smaller than the uncertainty (130%) associated with the exposure-response function.

We developed a novel indicator, daily excessive concentration hours (DECH), to explore the acute mortality impacts of ambient fine particulate matter pollution (PM 2.5 ) in Hong Kong. The DECH of PM 2.5 was calculated as daily concentration-hours >25 μg/m 3 . We applied a generalized additive models to quantify the association between DECH and mortality with adjustment for potential confounders. The results showed that the DECH was significantly associated with mortality. The excess mortality risk for an interquartile range (565 μg/m 3 *hours) increase in DECH of PM 2.5 was 1.65% (95% CI: 1.05%, 2.26%) for all natural mortality at lag 02 day, 2.01% (95% CI: 0.82%, 3.21%) for cardiovascular mortality at lag 03 days, and 1.41% (95% CI: 0.34%, 2.49%) for respiratory mortality at lag 2 day. The associations remained consistent after adjustment for gaseous air pollutants (daily mean concentration of SO 2 , NO 2 and O 3 ) and in alternative model specifications. When compared to the mortality burden of daily mean PM 2.5 , DECH was found to be a relatively conservative indicator. This study adds to the evidence by showing that daily excessive concentration hours of PM 2.5 might be a new predictor of mortality in Hong Kong. [ABSTRACT FROM AUTHOR]