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PDF file - 15KB, Characteristics of CRC and advanced adenoma patients in initial microRNA profiling.

Purpose: Detecting microRNA (miRNA) in stool is a novel approach for colorectal cancer (CRC) screening. This study aimed to identify stool-based miRNA as noninvasive biomarkers for detection of CRC and adenoma.Experimental Design: A miRNA expression array covering 667 human miRNAs was performed on five pairs of CRC and two pairs of advanced adenoma tissues. The most upregulated miRNAs were validated in 40 pairs of CRC tissues, 16 pairs of advanced adenoma tissues, and 424 stool samples, including 104 CRCs, 169 adenomas, 42 inflammatory bowel diseases (IBD), and 109 healthy controls. miRNA levels were followed-up after removal of lesions.Results: In an array analysis, miR-31 and miR-135b were the most upregulated miRNAs in CRC and advanced adenoma as compared with their adjacent normal tissues (>13-fold increase). In stool samples, level of miR-135b was significantly higher in subjects with CRC (P < 0.0001) or adenomas (P < 0.0001), but not in patients with IBD compared with controls. miR-135b showed a significant increasing trend across the adenoma to cancer sequence (P < 0.0001). Levels of miR-31 were not significantly different among groups. The sensitivity of stool mR-135b was 78% for CRC, 73% for advanced adenoma, and 65% for any adenoma, respectively, with a specificity of 68%. No significant difference in the miR-135b level was found between proximal and distal colorectal lesions. Stool miR-135b dropped significantly upon removal of CRC or advanced adenoma (P < 0.0001).Conclusion: Stool-based miR-135b can be used as a noninvasive biomarker for the detection of CRC and advanced adenoma. Clin Cancer Res; 20(11); 2994–3002. ©2014 AACR.

XLSX file - 33KB, The characteristics of CRC and advancent adenoma patients in tissue miRNA assay.

PDF file - 141KB, Flow-chart of exclusion of subjects in the study.

XLSX file - 585KB, miRNA microarray data from 5 pairs of CRCs and 2 pairs of adenomas.

PDF file - 16KB, Sensitivity and specificity of miRNA markers.

BACKGROUND: Previous studies have demonstrated the seasonal variations of non-variceal upper gastrointestinal bleeding (UGIB), but there is scanty data on lower gastrointestinal bleeding (LGIB) and the association with other meteorological parameters.METHODS: We included all patients hospitalized for UGIB and LGIB between 2009 and 2018 in Hong Kong. The monthly age-standardized and sex-standardized GIB incidences were fitted to meteorological data including average temperature (AT), maximum temperature (MaxT), minimum temperature (MinT), temperature range (TR), average precipitation, average atmospheric pressure (AtomP), and average relative humidity after adjusting for prescriptions of aspirin, proton pump inhibitors, and Helicobacter pylori eradication therapy using the autoregressive integrated moving average model.RESULTS: Despite a gradual decline in UGIB incidences, the incidences of UGIB were still higher in winter months. The incidence and fluctuation of both UGIB and LGIB were higher in the older age groups, especially those ≥80 years. The seasonality was only identified in those ≥60 years for UGIB, and only in those ≥80 years for LGIB. UGIB incidence was inversely associated with AT, MaxT, and MinT, but positively associated with TR and AtomP. LGIB was also significantly associated with AT, MaxT, MinT, and AtomP.CONCLUSION: Despite the changes in GIB incidences, the seasonal patterns of GIB were still marked in the elderly. With the aging population, the impacts of seasonal variations on GIB incidences could be considerable.

The fast-spreading Omicron variant of SARS-CoV-2 overwhelmed Hong Kong, causing the fifth wave of COVID-19. It remains to be determined what mitigation measures might have played a role in reversing the rising trend of confirmed cases in this major outbreak. The government of Hong Kong has launched the mass rapid antigen tests (RAT) in the population and the StayHomeSafe scheme since February 2022. In this study, we examined the impact of the mass RAT on disease transmission and the case fatality ratio. It was suggested that the implementation of RAT plausibly played a role in the steady decrease of the effective reproduction number, leading to diminished SARS-CoV-2 transmission. In addition, we projected the disease burden of the outbreak in a scenario analysis to highlight the necessity of the StayHomeSafe scheme in Hong Kong. The Omicron outbreak experience in Hong Kong may provide actionable insights for navigating the challenges of COVID-19 surges in other regions and countries.

Funding Information: Funding: Supported by AIR@InnoHK programme from The Innovation and Technology Commission of the Hong Kong Special Administrative Region, National Natural Science Foundation of China (72104208), JSPS KAKENHI (JP21H04595), National Nature Science Foundation of China (72025405, 91846301, 72088101, and 71790615). Publisher Copyright: © 2022, Chinese Center for Disease Control and Prevention. All rights reserved. Introduction: Minimizing the importation and exportation risks of coronavirus disease 2019 (COVID-19) is a primary concern for sustaining the “Dynamic COVID-zero” strategy in China. Risk estimation is essential for cities to conduct before relaxing border control measures. Methods: Informed by the daily number of passengers traveling between 367 prefectures (cities) in China, this study used a stochastic metapopulation model parameterized with COVID-19 epidemic characteristics to estimate the importation and exportation risks. Results: Under the transmission scenario (R0=5.49), this study estimated the cumulative case incidence of Changchun City, Jilin Province as 3,233 (95% confidence interval: 1,480, 4,986) before a lockdown on March 14, 2022, which is close to the 3,168 cases reported in real life by March 16, 2022. In a total of 367 prefectures (cities), 127 (35%) had high exportation risks according to the simulation and could transmit the disease to 50% of all other regions within a period from 17 to 94days. The average time until a new infection arrives in a location in 1 of the 367 prefectures (cities) ranged from 26 to 101 days. Conclusions: Estimating COVID-19 importation and exportation risks is necessary for preparedness, prevention, and control measures of COVID-19 — especially when new variants emerge.

Aims We estimated the association between outdoor light at night at the residence and risk of coronary heart disease (CHD) within a prospective cohort of older adults in Hong Kong. Methods and results Over a median of 11 years of follow-up, we identified 3772 incident CHD hospitalizations and 1695 CHD deaths. Annual levels of outdoor light at night at participants’ residential addresses were estimated using time-varying satellite data for a composite of persistent night-time illumination at ∼1 km2 scale. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the association between outdoor light at night at the residence and risk of CHD. The association between light at night and incident CHD hospitalization and mortality exhibited a monotonic exposure-response function. An interquartile range (IQR) (60.0 nW/cm2/sr) increase in outdoor light at night was associated with an HR of 1.11 (95% CI: 1.03, 1.18) for CHD hospitalizations and 1.10 (95% CI: 1.00, 1.22) for CHD deaths after adjusting for both individual and area-level risk factors. The association did not vary across strata of hypothesized risk factors. Conclusion Among older adults, outdoor light at night at the residence was associated with a higher risk of CHD hospitalizations and deaths. We caution against causal interpretation of these novel findings. Future studies with more detailed information on exposure, individual adaptive behaviours, and potential mediators are warranted to further examine the relationship between light at night and CHD risk.

Numerous studies have indicated that ambient particulate matter is closely associated with increased risk of cardiovascular disease, yet the evidence for its association with renal disease remains underrecognized. We aimed to estimate the association between long-term exposure to fine particulate matter, defined as particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5), and mortality from renal failure (RF) among participants in the Elderly Health Service Cohort in Hong Kong, China, from 1998 to 2010. PM2.5 concentration at the residential address of each participant was estimated based on a satellite-based spatiotemporal model. We used Cox proportional hazards regression to estimate risks of overall RF and cause-specific mortality associated with PM2.5. After excluding 5,373 subjects without information on residential address or relevant covariates, we included 61,447 participants in data analyses. We identified 443 RF deaths during the 10 years of follow-up. For an interquartile-range increase in PM2.5 concentration (3.22 μg/m3), hazard ratios for RF mortality were 1.23 (95% confidence interval: 1.06, 1.43) among all cohort participants and 1.42 (95% confidence interval: 1.16, 1.74) among patients with chronic kidney disease. Long-term exposure to atmospheric PM2.5 might be an important risk factor for RF mortality in the elderly, especially among persons with existing renal diseases.

Particulate matter with aerodynamic diameter not larger than 2.5 μm (PM

Summer-spring predominance of tuberculosis (TB) has been widely reported. The relative contributions of exogenous recent infection versus endogenous reactivation to such seasonality remains poorly understood. Monthly TB notifications data between 2005 and 2017 in Hong Kong involving 64,386 cases (41% aged ≥ 65; male-to-female ratio 1.74:1) were examined for the timing, amplitude, and predictability of variation of seasonality. The observed seasonal variabilities were correlated with demographics and clinical presentations, using wavelet analysis coupled with dynamic generalised linear regression models. Overall, TB notifications peaked annually in June and July. No significant annual seasonality was demonstrated for children aged ≤ 14 irrespective of gender. The strongest seasonality was detected in the elderly (≥ 65) among males, while seasonal pattern was more prominent in the middle-aged (45–64) and adults (30–44) among females. The stronger TB seasonality among older adults in Hong Kong suggested that the pattern has been contributed largely by reactivation diseases precipitated by defective immunity whereas seasonal variation of recent infection was uncommon.

BACKGROUND The health benefits of urban green space have been widely reported in the literature; however, the biological mechanisms remain unexplored, and a causal relationship cannot be established between green space exposure and cardiorespiratory health. OBJECTIVE Our aim was to conduct a panel study using personal tracking devices to continuously collect individual exposure data from healthy Chinese adults aged 50 to 64 years living in Hong Kong. METHODS A panel of cardiorespiratory biomarkers was tested each week for a period of 5 consecutive weeks. Data on weekly exposure to green space, air pollution, and the physical activities of individual participants were collected by personal tracking devices. The effects of green space exposure measured by the normalized difference vegetation index (NDVI) at buffer zones of 100, 250, and 500 meters on a panel of cardiorespiratory biomarkers were estimated by a generalized linear mixed-effects model, with adjustment for confounding variables of sociodemographic characteristics, exposure to air pollutants and noise, exercise, and nutrient intake. RESULTS A total of 39 participants (mean age 56.4 years, range 50-63 years) were recruited and followed up for 5 consecutive weeks. After adjustment for sex, income, occupation, physical activities, dietary intake, noise, and air pollution, significant negative associations with the NDVI for the 250-meter buffer zone were found in total cholesterol (–21.6% per IQR increase in NDVI, 95% CI –32.7% to –10.6%), low-density lipoprotein (–14.9%, 95% CI –23.4% to –6.4%), glucose (–11.2%, 95% CI –21.9% to –0.5%), and high-sensitivity C-reactive protein (–41.3%, 95% CI –81.7% to –0.9%). Similar effect estimates were found for the 100-meter and 250-meter buffer zones. After adjustment for multiple testing, the effect estimates of glucose and high-sensitivity C-reactive protein were no longer significant. CONCLUSIONS The health benefits of green space can be found in some metabolic and inflammatory biomarkers. Further studies are warranted to establish the causal relationship between green space and cardiorespiratory health. CLINICALTRIAL

BackgroundOn December 30th, 2013, the Hong Kong government implemented the Air Quality Health Index (AQHI) to reduce short-term impacts of air pollution on the population. However, whether air quality alert programs, such as the AQHI, reduce morbidity is still questionable. Using a quasi-experimental design, we conducted the first evaluation of the AQHI in Hong Kong focusing on respiratory morbidity.MethodInterrupted time series with Poisson segmented regression from 2010 to 2016 were used to detect any sudden or gradual changes in emergency respiratory hospital admissions, adjusted for air pollutants (NO2, SO2, PM10, O3), temperature and humidity, when the AQHI policy was implemented. Findings were validated using three false policy periods. We also assessed changes by specific respiratory diseases (respiratory tract infections (RTI), asthma, chronic obstructive pulmonary disease and pneumonia) and by age.ResultsFrom January 1st, 2010-December 31st, 2016, 10576.98 deseasonalized, age- and sex-standardized hospital admissions for respiratory diseases occurred in Hong Kong. On implementation of the AQHI, RTI admissions immediately dropped by 14% (relative risk (RR) 0.86 95% confidence interval (CI) 0.76-0.98). In age specific analysis, immediate reductions in hospital admissions, were only apparent in children for RTI (RR 0.84, 95% CI 0.74-0.96) and pneumonia (RR 0.88, 95% CI 0.60-0.96).ConclusionHong Kong’s AQHI helped reduced hospital admissions in children, particularly for RTI and pneumonia. To maximize the health benefits of the policy, at risk groups need to be able to follow the behavioral changes recommended by the AQHI index.

Background On July 1st, 2015, Hong Kong became the first city in Asia to implement a policy regulating sulfur dioxide (SO2) in shipping emissions. We conducted an accountability study assessing the improvement in ambient air quality and estimating the effect on health outcomes of the policy.MethodWe used interrupted time series (ITS) with segmented regression to identify any change in ambient concentrations of SO2 in contrast to other ambient pollutants (particulate matter

Background Fine particulate matter (Particulate matter with diameter ≤ 2.5 μm) is associated with multiple health outcomes, with varying effects across seasons and locations. It remains largely unknown that which components of PM2.5 are most harmful to human health. Methods We systematically searched all the relevent studies published before August 1, 2018, on the associations of fine particulate matter constituents with mortality and morbidity, using Web of Science, MEDLINE, PubMed and EMBASE. Studies were included if they explored the associations between short term or long term exposure of fine particulate matter constituents and natural, cardiovascular or respiratory health endpoints. The criteria for the risk of bias was adapted from OHAT and New Castle Ottawa. We applied a random-effects model to derive the risk estimates for each constituent. We performed main analyses restricted to studies which adjusted the PM2.5 mass in their models. Results Significant associations were observed between several PM2.5 constituents and different health endpoints. Among them, black carbon and organic carbon were most robustly and consistently associated with all natural, cardiovascular mortality and morbidity. Other potential toxic constituents including nitrate, sulfate, Zinc, silicon, iron, nickel, vanadium, and potassium were associated with adverse cardiovascular health, while nitrate, sulfate and vanadium were relevant for adverse respiratory health outcomes. Conclusions Our analysis suggests that black carbon and organic carbon are important detrimental components of PM2.5, while other constituents are probably hazardous to human health. However, more studies are needed to further confirm our results.

Ambient PM

While many studies have focused on identifying the association between meteorological factors and the activity of COVID-19, we argue that the contribution of meteorological factors to a reduction of the risk of COVID-19 was minimal when the effects of control measures were taken into account. In this study, we assessed how much variability in COVID-19 activity is attributable to city-level socio-demographic characteristics, meteorological factors, and the control measures imposed. We obtained the daily incidence of COVID-19, city-level characteristics, and meteorological data from a total of 102 cities situated in 27 provinces/municipalities outside Hubei province in China from 1 January 2020 to 8 March 2020, which largely covers almost the first wave of the epidemic. Generalized linear mixed effect models were employed to examine the variance in the incidence of COVID-19 explained by different combinations of variables. According to the results, including the control measure effects in a model substantially raised the explained variance to 45%, which increased by >40% compared to the null model that did not include any covariates. On top of that, including temperature and relative humidity in the model could only result in < 1% increase in the explained variance even though the meteorological factors showed a statistically significant association with the incidence rate of COVID-19. In conclusion, we showed that very limited variability of the COVID-19 incidence was attributable to meteorological factors. Instead, the control measures could explain a larger proportion of variance., Author summary COVID-19 has a great impact worldwide, especially in some rural settings where healthcare resources are not sufficient. While control measures in these area may be limited, scholars have been discussing the potential effects of meteorological factors on mitigating COVID-19 transmission. Unfortunately, the majority of literatures only looked at the association between COVID-19 and environmental factors in which their findings could mislead readers that certain environmental conditions could be ‘protective’. In this study, we argue that the impact of the meteorological factors was very limited by using the incidence data from 102 Chinese cities in the first epidemic period when control measures have been taken into account. As what we expected, once the control measures have been incorporated in the modelling analysis, the meteorological factors could only explain < 1% increase in variability of COVID-19 while control measure explained the variance for more than 40% in total. Because of it, we suggest stringent control measures are necessary to control COVID-19 regardless the meteorological conditions of an area. Given that no vaccine is available to date, our investigation provides an additional evidence, as advocated by World Meteorological Organization rather than relying on changes in the natural environment for mitigation, active non-pharmaceutical interventions are necessary to curb the COVID-19 pandemic.

The Xuanwei area of Yunnan Province, China, is one of the regions suffering from the highest occurrence and mortality rate of lung cancer in the world. Local residents tend to use bituminous coal as domestic fuel, which causes serious indoor air pollution and is established as the main carcinogen. After the local government carried out furnace and stove reform work, lung cancer rate including incidence and mortality among residents remains high. We herein wonder if there are specific mechanisms at protein level for the development of non‐small‐cell lung cancer (NSCLC) in this area. We investigated the changes of protein profiling in tumour of the patients from Xuanwei area. Tandem mass tag (TMT) was employed to screen the differential proteins between carcinoma and para‐carcinoma tissues. We identified a total of 422 differentially expressed proteins, among which 162 proteins were significantly up‐regulated and 260 were downregulated compared to para‐carcinoma tissues. Many of the differentially expressed proteins were related to extracellular matrix (ECM)‐receptor interaction, focal adhesion, PI3K/AKT pathway and ferroptosis. Further experiments on the two differential proteins, thioredoxin 2 (TXN2) and haptoglobin (HP), showed that the change of their expressions could make the lung cancer cell lines more resistant to erastin or RSL‐induced ferroptosis in vitro, and promote the growth of tumour in nude mice. In conclusion, this study revealed that aberrant regulation of ferroptosis may involve in the development of lung cancer in Xuanwei area.

Background Influenza epidemics occur during winter in temperate zones, but have less regular seasonality in the subtropics and tropics. Here we quantified the role of environmental drivers of influenza seasonality in temperate and subtropical China. Methods We used weekly surveillance data on influenza virus activity in mainland China and Hong Kong from 2005 through 2016. We estimated the transmissibility via the instantaneous reproduction number (Rt), a real-time measure of transmissibility, and examined its relationship with different climactic drivers and allowed for the timing of school holidays and the decline in susceptibility in the population as an epidemic progressed. We developed a multivariable regression model for Rt to quantify the contribution of various potential environmental drivers of transmission. Findings We found that absolute humidity is a potential driver of influenza seasonality and had a U-shaped association with transmissibility and hence can predict the pattern of influenza virus transmission across different climate zones. Absolute humidity was able to explain up to 15% of the variance in Rt, and was a stronger predictor of Rt across the latitudes. Other climatic drivers including mean daily temperature explained up to 13% of variance in Rt and limited to the locations where the indoor measures of these factors have better indicators of outdoor measures. The non-climatic driver, holiday-related school closures could explain up to 7% of variance in Rt. Interpretation A U-shaped association of absolute humidity with influenza transmissibility was able to predict seasonal patterns of influenza virus epidemics in temperate and subtropical locations.

Background The Xuanwei area of Yunnan Province, China is one of the regions with the highest incidence of lung cancer in the world. Local residents use bituminous coal as fuel for cooking and heating, which causes serious indoor air pollution. After the local government carried out furnace and stove reform work, the high incidence of lung cancer in residents continued. We herein wonder if there are specific mechanisms at protein level for the development of lung cancer in the area. Methods We investigated the changes of protein profiling in tumor of the patients from Xuanwei area. Tandem Mass Tag (TMT) were employed to screen the differential proteins between carcinoma and para-carcinoma tissues. Results We identified a total of 422 differentially-expressed proteins, among which 162 proteins were significantly upregulated and 260 were downregulated compared to para-carcinoma tissues. Many of the differentially-expressed proteins were related to ECM-receptor interaction, focal adhesion, PI3K/AKT pathway and ferroptosis. Further experiments on the two differential proteins, TXN2 and HP, showed that the change of their expressions could make the lung cancer cell lines more resistant to erastin or RSL-induced ferroptosis in vitro, and promote the growth of tumor in nude mice. Conclusion This study revealed that aberrant regulation of ferroptosis may involve in the development of lung cancer in Xuanwei area.

Knowledge gaps remain regarding the cardiorespiratory impacts of ambient volatile organic compounds (VOCs) for the general population. This study identified contributing sources to ambient VOCs and estimated the short-term effects of VOC apportioned sources on daily emergency hospital admissions for cardiorespiratory diseases in Hong Kong from 2011 to 2014. We estimated VOC source contributions using fourteen organic chemicals by positive matrix factorization. Then, we examined the associations between the short-term exposure to VOC apportioned sources and emergency hospital admissions for cause-specific cardiorespiratory diseases using generalized additive models with polynomial distributed lag models while controlling for meteorological and co-pollutant confounders. We identified six VOC sources: gasoline emissions, liquefied petroleum gas (LPG) usage, aged VOCs, architectural paints, household products, and biogenic emissions. We found that increased emergency hospital admissions for chronic obstructive pulmonary disease were positively linked to ambient VOCs from gasoline emissions (excess risk (ER%): 2.1%, 95% CI: 0.9% to 3.4%), architectural paints (ER%: 1.5%, 95% CI: 0.2% to 2.9%), and household products (ER%: 1.5%, 95% CI: 0.2% to 2.8%), but negatively associated with biogenic VOCs (ER%: &minus, 6.6%, 95% CI: &minus, 10.4% to &minus, 2.5%). Increased congestive heart failure admissions were positively related to VOCs from architectural paints and household products in cold seasons. This study suggested that source-specific VOCs might trigger the exacerbation of cardiorespiratory diseases.

Direct evidence about associations between fine particles (PM

Background: Air quality alert programs have been introduced around the world to reduce the short term effects of air pollution on health. Hong Kong, a densely populated city in southern China with high levels of air pollution, introduced its first air quality health index (AQHI) on December 30th 2013. However, whether air quality alert program warnings, such as the AQHI, reduces morbidity is uncertain. Using a quasi-experimental design, we conducted the first evaluation of the AQHI in Hong Kong, focusing on cardiovascular morbidity in Hong Kong’s elderly population. Method: Interrupted time series with Poisson segmented regression from 2010 to 2016 was used to detect any sudden or gradual changes in emergency hospital admissions for cardiovascular diseases (CVD), after the AQHI policy was implemented. To account for potential confounders, models were adjusted for air pollutants (NO2, SO2, PM10, O3), temperature and humidity. The findings were validated using a negative control and three false policy periods. We also assessed effects on specific subtypes of CVD (hypertensive disease (HPD), acute myocardial infarction (AMI), heart failure, stroke and other CVD) and by sex. Results: From January 1st 2010 to December 31st, 2016, 375,672 hospital admissions for CVD occurred in Hong Kong’s elderly population. Immediately after the policy HPD and AMI dropped by16% (relative risk (RR) 0.84, 95% confidence interval (CI): 0.78–0.91) and 15% (RR 0.85, 95% CI: (0.76–0.97)) respectively. There was no significant change for all CVD or other sub-types and no differences by sex. Conclusion: Hong Kong’s AQHI helped reduced hospital admissions in the elderly for HPD and AMI but had no effect on overall emergency hospitalization for CVD. To maximize health benefits of the policy, at risk groups need to be able to follow the behavioral changes recommended by the AQHI warnings. Keywords: AQHI, Cardiovascular diseases, Elderly, Interrupted time series, Segmented regression

Background Although residing in lower surrounding greenness and transient exposure to air pollution are independently associated with higher risk of adverse health outcomes, little is known about their interactions. Objectives We examine whether residential neighborhood greenness modifies the short-term association between air pollution and respiratory mortality among the participants of Chinese Elderly Health Service Cohort in Hong Kong. Methods We estimated residential surrounding greenness by measuring satellite-derived normalized difference vegetation index (NDVI) from Landsat within catchments of residential addresses of participants who died of respiratory diseases between 1998 and 2011. We first dichotomized NDVI into low and high greenness and used a time-stratified case-crossover approach to estimate the percent excess risk of respiratory mortality associated with fine particulate matter (PM2.5), respirable particulate matter (PM10), nitrogen dioxide (NO2), and ozone (O3). We further classified NDVI into greenness quartiles and introduced an interaction term between air pollution and the assigned median values of the NDVI quartiles into the models to assess the trend of greenness modification on the air pollution and respiratory mortality associations. Results Among 3159 respiratory deaths during the follow-up, 2058 were from pneumonia and 947 from chronic obstructive pulmonary disease. Elders living in the low greenness areas were associated with a higher risk of pneumonia mortality attributed to NO2 (p = 0.049) and O3 (p = 0.025). The mortality risk of pneumonia showed a decreasing trend for NO2 (p for trend = 0.041), O3 (p for trend = 0.006), and PM2.5 (p for trend = 0.034) with greenness quartiles increasing from Quartile 1 (lowest) to Quartile 4 (highest). Conclusions Our findings suggest that elders living in higher greenness areas are less susceptible to pneumonia mortality associated with air pollution, which provides evidence for optimizing allocation, siting, and quality of urban green space to minimize detrimental health effects of air pollution.

Background While numerous studies worldwide have evaluated the short-term associations of fine and coarse particulate matter (PM) air pollution with mortality and morbidity, these studies may be susceptible to short-term harvesting effect. We aimed to investigate the short-term association between mortality and PM with aerodynamic diameter less than 2.5 μm (PM2.5) and those between 2.5 and 10 μm (PMc) within a month prior to death, and assess the mortality displacement by PM2.5 and PMc among elderly population in Hong Kong. Methods We obtained air pollution data from January 2011 to December 2015 from Environmental Protection Department, and daily cause-specific mortality data from Census and Statistical Department of Hong Kong. We performed generalized additive distributed lag model to examine the acute, delayed and long-lasting effects of PM2.5 and PMc within one month on mortality. Results We observed a statistically significant association of PM2.5 and PMc exposure over lags 0–6 days with all natural mortality and cardio-respiratory mortality. The overall cumulative effect of PM2.5 over 0–30 lag days was 3.44% (95% CI: 0.30–6.67%) increase in all natural mortality and 6.90% (95% CI: 0.58–13.61%) increase of circulatory mortality, which suggested the absence of mortality displacement by PM2.5. On the other hand, no significant cumulative association with mortality was found for PMc over 0–30 lag exposure window, and thus mortality displacement by PMc cannot be ruled out. Findings remained robust in various sensitivity analyses. Conclusions We found adverse effect of both PM2.5 and PMc exposure within one week prior to death. While there was no evidence of mortality displacement in the association of PM2.5 exposure over one month prior with all natural and circulatory mortality, mortality displacement by PMc cannot be ruled out. PM2.5 may contribute more to the longer term effect of particulate matter than PMc.

Background Little information exists on the lipidemic effects of air pollution, particularly in developing countries. We aimed to investigate the associations of long-term exposure to ambient air pollutants with lipid levels and dyslipidemias in China. Methods In 2009, a total of 15,477 participants aged 18–74 years were recruited from the 33 Communities Chinese Health Study conducted in three Northeastern China cities. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured in participants' blood specimens. Three year (2006–08) average air pollution concentrations were assessed using data from 33 communities (particles with diameters ≤1.0 μm (PM 1 ) and ≤2.5 μm (PM 2.5 ) were predicted using a spatial statistical model) or 11 air monitoring stations (particles with diameters ≤10 μm (PM 10 ), sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), and ozone (O 3 )). Associations were evaluated by two-level logistic and generalized linear regression models. Results We detected many significant associations between exposure to air pollutants (especially for PM 1 and PM 2.5 ) and blood lipid levels. Most of the associations suggested deleterious effects on blood lipid markers (e.g., a 10 μg/m 3 increase in PM 1 was associated with 1.6% (95% confidence interval (CI): 1.1, 2.0), 2.9% (95% CI: −3.3, 9.3), and 3.2% (95% CI: 2.6, 3.9) higher levels of TC, TG, and LDL-C, respectively, but 1.4% (95% CI: −1.8, −0.9) lower HDL-C levels), although beneficial associations were found for O 3 . In analysis with dyslipidemias, all the observed associations suggested deleterious lipidemic effects of air pollutants, and no significant beneficial association was observed for O 3 . Stratified analyses showed that the associations were stronger in overweight or obese participants; sex and age modified the associations, but the pattern of effects was mixed. Conclusions Long-term ambient air pollution was associated with both altered lipid profiles and dyslipidemias, especially among overweight or obese participants.

Background: Several studies have reported associations between long term exposure to air pollutants and cause-specific mortality. However, since the concentrations of air pollutants in Asia are much higher compared to those reported in North American and European cohort studies, cohort studies on long term effects of air pollutants in Asia are needed for disease burden assessment and to inform policy. Objectives: To assess the effects of long-term exposure to particulate matter with aerodynamic diameter