Although health effects of air pollutants are well documented in many countries especially in North America and Western Europe, few studies have been conducted in Thailand where pollution mix, ...weather conditions, and demographic characteristics are different. The present study aimed to investigate the effects of ambient air pollution on hospital admissions for cardiovascular and respiratory diseases in Bangkok, Thailand.
We obtained daily air pollution concentration (O3, NO2, SO2, PM10, and CO) and weather variable monitored in Bangkok from January 2006 to December 2014. Daily hospital admissions for cardiovascular and respiratory diseases were obtained from the National Health Security Office during the study period. A time-series analysis with generalized linear model was used to examine the effects of air pollution on hospital admissions by controlling for long-term trend and other potential confounders. The effect modification by age (0–14 years, 15–64 years, ≥65 years) and gender was also examined.
An increase of 10 μg/m3 in O3, NO2, SO2, PM10, and 1 mg/m3 in CO at lag 0–1 day was associated with a 0.14% (95% CI: −0.34 to 0.63), 1.28% (0.87 to 1.69), 8.42% (6.16 to 10.74), 1.04% (0.68 to 1.41) and 6.69% (4.33 to 9.11) increase in cardiovascular admission, respectively; and 0.69% (95% CI: 0.18 to 1.21), 1.42% (0.98 to 1.85), 4.49% (2.22 to 6.80), 1.18% (0.79 to 1.57) and 7.69% (5.20 to 10.23) increase in respiratory admission, respectively. The elderly (≥65 years) seemed to be the most susceptible group to the effect of air pollution, whereas the effect estimate for male and female was not significantly different.
Results from this study contributed the evidence to support the effects of air pollution (O3, NO2, SO2, PM10, and CO) on hospital admissions for cardiovascular and respiratory diseases, which might be useful for public health intervention in Thailand.
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•Ambient air pollution was associated with increased risk of hospital admission in Bangkok.•Effect of air pollution on pneumonia, COPD, asthma, IHD, and MI admission was found.•Elderly is the most susceptible group to the effect of air pollution on respiratory admission.•First study to examine the effects of CO and NO2 on hospital admission in Thailand•NO2 had consistent effects on cardiovascular and respiratory hospital admission in Bangkok.
Epidemiological studies based on mortality and crime data have indicated that short-term exposure to higher temperature increases the risk of suicide and violent crimes. However, there are few ...studies on non-fatal intentional injury, especially on non-fatal self-harm which is much more common than suicide.
We aimed to clarify how short-term exposure to temperature is associated with emergency ambulance transport caused by intentional injuries including acts of self-harm and assault.
We applied a time-stratified case-crossover design using a conditional quasi-Poisson regression model for each of the 46 prefectures. All temperatures were converted to percentile value for each prefecture, to account for the varied climate across Japan. A Distributed Lag Non-Linear Model was used to explore the temperature percentile and lag pattern. The prefecture-specific results were combined using a meta-analysis with the random effects model.
Between 2012 and 2015, the number of acts of self-harm and assault across all 46 prefectures totaled 151,801 and 95,861, respectively. We found that as the temperature increased, the relative risk (RRs) for both self-harm and assault behaviors increased in a nearly linear manner. The pooled relative risk at the 99th percentile temperature for self-harm behavior was 1.11 (95% CI: 1.07, 1.15) compared with the risk at the 1st percentile temperature, and that for assault was 1.12 (95% CI: 1.08, 1.16) at lag 0. The RRs were highest at lag0 and less than 1 at lag7–20.
The present study found that short-term exposure to higher temperature promotes the risk of emergency ambulance transport due to acts of self-harm and assault. The lag pattern indicates a possible “displacement” effect. These results suggest that exposure to high temperatures may potentially function as a trigger for intentional injuries.
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•Elevated temperature may increase intentional injuries.•The association was strongest on the same day.•There may be morbidity displacement in exposure-response lag patterns.
Several studies have noted that the existence of comorbidities lead to an increase in the risk of premature mortality and morbidity. Most of the studies examining the effects of air pollution on ...comorbidity visits were from Northern American countries, with scarce literature from Asia. This study contributes to existing, yet limited understanding of air pollution-comorbidity by examining the effects of daily air pollutants on outpatient single morbidity and comorbid cardiorespiratory visits in Japan.
A total of 1,452,505 outpatient cardiorespiratory visits were recorded among the 21 Japanese cities from 2013 to 2016. Daily outpatient cardiorespiratory visit data were obtained from a health insurance claims database managed by the Japan Medical Data Center Co., Ltd. (JMDC). A time-stratified case crossover analysis coupled with Generalized Additive Mixed Model was used to analyze the association of daily air pollutants (particulate matter 2.5 μm or less in diameter, ozone and nitrogen dioxide) on daily single (respiratory and cardiovascular) and comorbidity health outcomes. We further examined single and cumulative effects for 0–3 and 0–14 lag periods.
Ozone, NO2, and PM2.5 were positively associated with cardiorespiratory visits in either shorter or longer lags, with more apparent comorbidity associations with NO2 exposure. A 10-unit increase in NO2, after adjusting for ozone, was associated with a 2.24% (95% CI: 1.34–3.15) and 6.49% (95% CI: 5.00–8.01) increase in comorbidity visit at Lag 0 (of Lag 0–3) and cumulative lag 0–3, respectively. Our results contribute to existing evidence suggesting that short-term and extended exposure to air pollution elicit health risks on cardiovascular, respiratory and comorbid clinic visits. Exposure to NO2, in particular, was associated with increase in the risk of single and comorbidity cardiorespiratory visits. Results can be potentially utilized for both individual health (e.g. risk population health management) and health facility management (e.g. health visit influx determination).
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•NO2 exposure leads to greater risks for comorbid visit than single morbidity visit.•Ozone and NO2 exhibited immediate and delayed effects on morbidity visits.•PM2.5 showed delayed association for single- and comorbid cardiorespiratory visits.
Poor air quality is globally the largest environmental health risk. Epidemiological studies have uncovered clear relationships of gaseous pollutants and particulate matter (PM) with adverse health ...outcomes, including mortality by cardiovascular and respiratory diseases. Studies of health impacts by aerosols are highly multidisciplinary with a broad range of scales in space and time. We assess recent advances and future challenges regarding aerosol effects on health from molecular to global scales through epidemiological studies, field measurements, health-related properties of PM, and multiphase interactions of oxidants and PM upon respiratory deposition. Global modeling combined with epidemiological exposure-response functions indicates that ambient air pollution causes more than four million premature deaths per year. Epidemiological studies usually refer to PM mass concentrations, but some health effects may relate to specific constituents such as bioaerosols, polycyclic aromatic compounds, and transition metals. Various analytical techniques and cellular and molecular assays are applied to assess the redox activity of PM and the formation of reactive oxygen species. Multiphase chemical interactions of lung antioxidants with atmospheric pollutants are crucial to the mechanistic and molecular understanding of oxidative stress upon respiratory deposition. The role of distinct PM components in health impacts and mortality needs to be clarified by integrated research on various spatiotemporal scales for better evaluation and mitigation of aerosol effects on public health in the Anthropocene.
Seasonal variation and regional heterogeneity have been observed in the estimated effect of fine particulate matter (PM2.5) mass on mortality. Differences in the chemical compositions of PM2.5 may ...cause this variation. We investigated the association of the daily concentration of PM2.5 components with mortality in Nagoya, Japan.
We combined daily mortality counts for all residents aged 65 years and older with concentration data for PM2.5 mass and components in Nagoya from April 2003 to December 2007. A time-stratified case-crossover design was used to examine the association of daily mortality with PM2.5 mass and each component (chloride, nitrate, sulfate, sodium, potassium, calcium, magnesium, ammonium, elemental carbon EC, and organic carbon OC).
We found a stronger association between mortality and PM2.5 mass in transitional seasons. In analysis for each PM2.5 component, sulfate, nitrate, chloride, ammonium, potassium, EC, and OC were significantly associated with mortality in a single-pollutant model. In a multi-pollutant model, an interquartile range increase in the concentration of sulfate was marginally associated with an increase in all-cause mortality of 2.1% (95% confidence interval, -0.1 to 4.4).
These findings suggest that some specific PM components have a more hazardous effect than others and contribute to seasonal variation in the health effects of PM2.5.
From around 2012, the use of automated equipment for fine particulate matter (PM
) measurement with equivalence to a reference method has become popular nationwide in Japan. This enabled us to ...perform a national health effect assessment employing PM
concentrations based on the standardized measurement method. We evaluated the association between non-accidental mortality and short-term exposure to PM
and coarse particulate matter (PM), with the latter estimated as the difference between suspended particulate matter and PM
, for the fiscal years 2012-2014.
This was a time-stratified case-crossover study in 100 highly-populated Japanese cities. Mortality data was obtained from the Ministry of Health, Labour and Welfare. City-specific estimates of PM-mortality association were calculated by applying a conditional logistic regression analysis, and combined with a random-effects meta-analysis.
The respective averages of daily mean concentration were 14.6 µg/m
for PM
and 6.4 µg/m
for coarse PM. A 10 µg/m
increase in PM
concentrations for the average of the day of death and the previous day was associated with an increase of 1.3% (95% confidence interval (CI), 0.9-1.6%) in total non-accidental mortality. For cause-specific mortality, PM
was positively associated with cardiovascular and respiratory mortality. After adjustment for PM
, we observed a 1.4% (95% CI, 0.2-2.6%) increase in total mortality with a 10 µg/m
increase in coarse PM.
The study revealed that short-term exposure to PM
had adverse effects on total non-accidental, cardiovascular, and respiratory mortality in Japan. Coarse PM exposure also increased the risk of total mortality.
Abstract
Background
Upper Northern Thailand (UNT) has been episodically affected by air pollution from vegetation burning, which causes adverse respiratory health effects. However, no study has ...evaluated the effect of regulatory actions to prohibit vegetation burning on respiratory morbidity. We examined the effect of a burning ban enforced in May 2016 on hospital visits for respiratory diseases in UNT.
Methods
This study used data from eight provinces in UNT. Analyses were conducted for January to April of 2014–2016 (before ban enforcement) and January to April of 2017–2018 (after ban enforcement). Particulate matter of 10 microns in diameter or smaller (PM10) concentrations, numbers of satellite fire hotspots and age-standardized rates of hospital visits for respiratory diseases before and after ban enforcement were compared. The effect of the ban on hospital visits for respiratory diseases was evaluated using an interrupted time-series analysis controlled for season-specific temporal trends, day of week, public holiday, temperature, relative humidity, number of hospitals and offset population, with gastrointestinal diseases as a negative control. A meta-analysis was performed to pool province-specific effect estimates.
Results
The daily average PM10 concentration and the number of fire hotspots decreased after ban enforcement in all provinces in UNT, with percent changes ranging from 5.3 to 34.3% and 14.3 to 81.5%, respectively. The adjusted pooled effect estimates of hospital visits for respiratory diseases decreased by 9.1% (95% CI: 5.1, 12.9), whereas a null association was observed for gastrointestinal diseases.
Conclusion
The burning ban had a positive impact on both air pollution levels and rates of hospital visits for respiratory diseases in UNT.
Exposure to fine particulate matter (PM2.5) is a potential aggravating factor for respiratory and allergic diseases. However, which PM2.5 sources are associated with such diseases remains unclear. ...This study aimed to investigate the association of PM2.5 sources with allergic and respiratory symptoms in schoolchildren. PM2.5 samples were collected in Fukuoka during the spring in 2014 and 2015. Asian dust was observed in 2014. Ion components, elemental components, and organic components were analyzed. Positive matrix factorization (PMF) was conducted to calculate PM2.5 concentrations from each source. Mixed logistic regression analysis with a random intercept for each schoolchild was performed to evaluate the association of components and sources with symptoms. Among 2317 schoolchildren, the mean prevalence was 28.9%, 23.6%, 11.2%, and 11.4% for lower respiratory, nasal, ocular, and skin symptoms, respectively. PMF identified the following six PM2.5 sources “Secondary sulfate and coal combustion”, “Secondary nitrate”, “Heavy oil combustion”, “Sea salt”, “Soil” and “Traffic emission”. An interquartile range of PM2.5 mass was associated with nasal (Odds ratios 1.08, 95% confidence interval 1.03, 1.13), ocular (1.10, 1.04, 1.16), and skin symptoms (1.13, 1.06, 1.20). Among the source factors, “Heavy oil combustion” was significantly associated with nasal symptom (1.11, 1.05, 1.18) while “Sea salt” was associated with nasal (1.06, 1.02, 1.11) and skin (1.073, 1.01, 1.14) symptoms. We found “Soil”, which might be affected by Asian dust, was associated with ocular (1.07, 1.03, 1.10) and skin (1.05, 1.01, 1.08) symptoms. Further studies in other seasons or places are needed to clarify the influence of PM2.5 sources on children's health.
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•PM2.5 in Fukuoka is affected both by local emission and transported particles.•PM2.5 mass increased allergic but not lower respiratory symptoms for children.•Soil influenced by Asian dust may cause ocular and skin symptom.•Heavy oil combustion from ship emission/aged sea salt linked with nasal symptoms.
Fine particulate matter (PM2.5) is composed of a variety of chemical components, and the dependency of the health effects of total PM2.5 on specific components is still under discussion. We ...hypothesised that specific PM2.5 components are responsible for the health effects, and investigated the association between PM2.5 components and mortality in 23 Tokyo wards. We obtained mortality data from the Ministry of Health, Labour and Welfare for the period from April 2013 to March 2017. At a monitoring site within the study area, we collected daily samples of PM2.5 on a filter, and determined the daily mean concentrations of total carbon (organic carbon and elemental carbon) and ions such as nitrate and sulphate. A case-crossover design was employed, and a conditional logistic regression model was used to estimate the strength of the association. Over the study period, we identified 280,460 total non-accidental deaths, and the average daily mean concentration of total PM2.5 was 16.0 (standard deviation = 8.9) μg/m3. We observed a positive association of total PM2.5 with total, cardiovascular, and respiratory mortality. After adjustment for total PM2.5 and its components associated with mortality in the single-component models, the percentage increase per interquartile range (2.3 μg/m3) increase in the average total carbon concentration of the case- and previous-day was 2.1% (95% confidence interval = 1.0 to 3.1%) for total mortality. Carbon elements were associated with respiratory but not cardiovascular mortality. Our results suggest that specific components of PM2.5 account for its adverse health effects.
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•It is still unclear the health effects of PM2.5 depend on specific components.•We performed a case-crossover study in 23 Tokyo wards, capital city of Japan.•Exposure to carbon elements were associated with total and respiratory mortality.•Local combustion sources were a major contributor of PM2.5 toxicity in urban area.
Smoke haze due to vegetation and peatland fires in Southeast Asia is a serious public health concern. Several approaches have been applied in previous studies; however, the concepts and ...interpretations of these approaches are poorly understood. In this scoping review, we addressed issues related to the application of epidemiology (EPI), health burden estimation (HBE), and health risk assessment (HRA) approaches, and discussed the interpretation of findings, and current research gaps. Most studies reported an air quality index exceeding the ‘unhealthy’ level, especially during smoke haze periods. Although smoke haze is a regional issue in Southeast Asia, studies on its related health effects have only been reported from several countries in the region. Each approach revealed increased health effects in a distinct manner: EPI studies reported excess mortality and morbidity during smoke haze compared to non-smoke haze periods; HBE studies estimated approximately 100,000 deaths attributable to smoke haze in the entire Southeast Asia considering all-cause mortality and all age groups, which ranged from 1,064–260,000 for specified mortality cause, age group, study area, and study period; HRA studies quantified potential lifetime cancer and non-cancer risks due to exposure to smoke-related chemicals. Currently, there is a lack of interconnection between these three approaches. The EPI approach requires extensive effort to investigate lifetime health effects, whereas the HRA approach needs to clarify the assumptions in exposure assessments to estimate lifetime health risks. The HBE approach allows the presentation of health impact in different scenarios, however, the risk functions used are derived from EPI studies from other regions. Two recent studies applied a combination of the EPI and HBE approaches to address uncertainty issues due to the selection of risk functions. In conclusion, all approaches revealed potential health risks due to smoke haze. Nonetheless, future studies should consider comparable exposure assessments to allow the integration of the three approaches.
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