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Background: High-level exposure to indoor air pollutants (IAPs) and their corresponding adverse health effects have become a public concern in China in the past 10 years. However, neither national nor provincial level burden of disease attributable to multiple IAPs has been reported for China. This is the first study to estimate and rank the annual burden of disease and the financial costs attributable to targeted residential IAPs at the national and provincial level in China from 2000 to 2017., Methods: We first did a systematic review and meta-analysis of 117 articles from 37 231 articles identified in major databases, and obtained exposure-response relationships for the candidate IAPs. The exposure levels to these IAPs were then collected by another systematic review of 1864 articles selected from 52 351 articles. After the systematic review, ten IAPs with significant and robust exposure-response relationships and sufficient exposure data were finally targeted: PM 2·5 , nitrogen dioxide, sulphur dioxide, ozone, carbon monoxide, radon, formaldehyde, benzene, toluene, and p-dichlorobenzene. The annual exposure levels in residences were then evaluated in all 31 provinces in mainland China continuously from 2000 to 2017, using the spatiotemporal Gaussian process regression model to analyse indoor originating IAPs, and the infiltration factor method to analyse outdoor originating IAPs. The disability-adjusted life-years (DALYs) attributable to the targeted IAPs were estimated at both national and provincial levels in China, using the population attributable fraction method. Financial costs were estimated by an adapted human capital approach., Findings: From 2000 to 2017, annual DALYs attributable to the ten IAPs in mainland China decreased from 4620 (95% CI 4070-5040) to 3700 (3210-4090) per 100 000. Nevertheless, in 2017, IAPs still ranked third among all risk factors, and their DALYs and financial costs accounted for 14·1% (95% CI 12·3-15·6) of total DALYs and 3·45% (3·01-3·82) of the gross domestic product. Specifically, the rank of ten targeted IAPs in order of their contribution to DALYs in 2017 was PM 2·5 , carbon monoxide, radon, benzene, nitrogen dioxide, ozone, sulphur dioxide, formaldehyde, toluene, and p-dichlorobenzene. The DALYs attributable to IAPs were 9·50% higher than those attributable to outdoor air pollution in 2017. For the leading IAP, PM 2·5 , the DALYs attributable to indoor origins are 18·3% higher than those of outdoor origins., Interpretation: DALYs attributed to IAPs in China have decreased by 20·0% over the past two decades. Even so, they are still much higher than those in the USA and European countries. This study can provide a basis for determining which IAPs to target in various indoor air quality standards and for estimating the health and economic benefits of various indoor air quality control approaches, which will help to reduce the adverse health effects of IAPs in China., Funding: The National Key Research and Development Program of China and the National Natural Science Foundation of China., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Indoor ammonia (NH 3 ) pollution has been paid more and more attention in view of its health risk. However, few studies have investigated the exposure level in the non-occupational environment in China. This study systematically reviewed the indoor ammonia exposure level in different regions, the equivalent exposure concentration of different populations, and the factors that influence indoor air ammonia in residences, offices, and schools in China. The literature published in 1980-2019 from main databases was searched and detailed screened, and finally, 56 related studies were selected. The results illustrated that the median concentration of indoor air ammonia in residences, offices, and school buildings was 0.21 mg/m 3 , 0.26 mg/m 3 , and 0.15 mg/m 3 . There were 46.4%, 71.4%, and 40% of these samples exceeding the NH 3  standard, respectively. The national concentrations and the equivalent exposure levels of adults and children were calculated and found to be higher than 0.20 mg/m 3 . The concentration of ammonia varied greatly in different climate zones and economic development regions. Higher concentrations were found in the severe cold zone and the regions with higher economic level. This review reveals a high exposure risk of indoor air ammonia and the crucial impact of human emission, indoor air temperature, new concrete, and economic level, suggesting further investigation on indoor air ammonia evaluation and health effects., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Findings for impacts of outdoor air pollutants on birth outcomes were controversial. We performed a retrospective observational study in 2527 preschoolers of Shanghai, China and investigated associations of duration-averaged concentrations of outdoor sulphur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), and particulate matter with an aerodynamic diameter ≤ 10 μm (PM 10 ) in different months and trimesters of gestation, with preterm birth (PB), low birth weight (LBW), term low birth weight (T-LBW), and small for gestational age (SGA). Daily concentrations of outdoor air pollutants were collected in each residence-located district. Parents reported health information. In the multivariate logistic regression analyses, exposures to outdoor NO 2 were consistently associated with the higher odds of LBW and T-LBW. These associations were generally stronger for early months than for later months of the gestation. Adjusted odds ratios generally were larger in multi-pollutant model than in single-pollutant model. Exposure to NO 2 in the first month of the gestation was significantly associated with T-LBW (adjusted OR, 95%CI: 1.91, 1.02-3.58 for increment of interquartile range (18.5 μg/m 3 ); p-value = 0.044) in multi-pollutant model. This association was stronger in girls, renters, and children whose mothers ≥30 years-old, with household dampness-related exposures, and with parental smoking during pregnancy. Our results indicate that exposure to NO 2 during gestation perhaps is a risk factor for LBW and T-LBW, and effects of NO 2 exposures could be greater during early periods than during later periods of gestation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

It's inconsistent about associations of early exposures to outdoor air pollutants with allergies and airway diseases in childhood. Here, we investigated associations of prenatal and postnatal exposures to outdoor nitrogen dioxide (NO 2 ), sulphur dioxide (SO 2 ), and PM 10 (particulate matter with an aerodynamic diameter ≤ 10 μm) with asthma, wheeze, hay fever, rhinitis, pneumonia, and eczema in childhood. We surveyed 3,177 preschoolers who never change residences since birth in Shanghai, China. Parents reported information regarding children's health status. Daily-averaged concentrations of these pollutants in the children's gestation and in the first year of lifetime for district where children lived were collected by Shanghai Environmental Monitoring Center. After adjusting for covariates, exposures to higher level of NO 2 during different trimesters of gestation and of the first year of lifetime had significant associations with the increased odds of asthma, hay fever, rhinitis, pneumonia, and eczema in childhood. Associations of NO 2 exposures in the early trimesters of gestation and of the first year of lifetime with pneumonia were stronger than in the later trimesters, whereas associations of NO 2 exposures in the early trimesters with hay fever and eczema were weaker than in the later trimesters. Our results indicated that prenatal and postnatal exposures to outdoor NO 2 could be risk factors for allergies and airway diseases in childhood. Both dose and duration were related with the influence degree of early NO 2 exposure on childhood allergies and airway diseases., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Findings are inconsistent in studies for impacts of outdoor air pollutants on airway health in childhood. In this paper, we collected data regarding airway and allergic symptoms in the past year before a survey in 13,335 preschoolers from a cross-sectional study. Daily averaged concentrations of ambient sulphur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), and particulate matter with an aerodynamic diameter ≤10 μm (PM 10 ) in the past year before the survey were collected in the kindergarten-located district. We investigated associations of 12-month average concentrations of these pollutants with childhood airway and allergic symptoms. In the two-level (district-child) logistic regression analyses, exposure to higher level of NO 2 and of PM 10 increased odds of wheeze symptoms (adjusted OR, 95%CI: 1.03, 1.01-1.05 for per 3.0 μg/m 3 increase in NO 2 ; 1.22, 1.09-1.39 for per 7.6 μg/m 3 increase in PM 10 ), wheeze with a cold (1.03, 1.01-1.06; 1.22, 1.08-1.39), dry cough during night (1.05, 1.03-1.08; 1.23, 1.09-1.40), rhinitis symptoms (1.11, 1.08-1.13; 1.32, 1.07-1.63), rhinitis on pet (1.11, 1.05-1.18; 1.37, 0.95-1.98) and pollen (1.12, 1.03-1.21; 1.23, 0.84-1.82) exposure, eczema symptoms (1.09, 1.05-1.12; 1.22, 0.98-1.52), and lack of sleep due to eczema (1.12, 1.07-1.18; 1.58, 1.25-1.98). Exposures to NO 2 and PM 10 were also significantly and positively associated with the accumulative score of airway symptoms. Similar positive associations were found of NO 2 and of PM 10 with the individual symptoms and symptom scores among preschoolers from different kindergarten-located district. These results indicate that ambient NO 2 and PM 10 likely are risk factors for airway and allergic symptoms in childhood in Shanghai, China., Competing Interests: Declaration of competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The urbanization and industrialization in China is accompanied by bad air quality, and the prevalence of asthma in Chinese children has been increasing in recent years. To investigate the associations between ambient PM 2.5 levels and asthmatic and allergic diseases or symptoms in preschool children in China, we assigned PM 2.5 exposure data from the Global Burden of Disease (GBD) project to 205 kindergartens at a spatial resolution of 0.1° × 0.1° in six cities in China (Shanghai, Nanjing, Chongqing, Changsha, Urumqi, and Taiyuan). A hierarchical multiple logistical regression model was applied to analyze the associations between kindergarten-level PM 2.5 exposure and individual-level outcomes of asthmatic and allergic symptoms. The individual-level variables, including gender, age, family history of asthma and allergic diseases, breastfeeding, parental smoking, indoor dampness, interior decoration pollution, household annual income, and city-level variable-annual temperature were adjusted. A total of 30,759 children (average age 4.6 years, 51.7% boys) were enrolled in this study. Apart from family history, indoor dampness, and decoration as predominant risk factors, we found that an increase of 10 μg/m 3 of the annual PM 2.5 was positively associated with the prevalence of allergic rhinitis by an odds ratio (OR) of 1.20 (95% confidence interval [CI] 1.11, 1.29) and diagnosed asthma by OR of 1.10 (95% CI 1.03, 1.18). Those who lived in non-urban (vs. urban) areas were exposed to more severe indoor air pollution arising from biomass combustion and had significantly higher ORs between PM 2.5 and allergic rhinitis and current rhinitis. Our study suggested that long-term exposure to PM 2.5 might increase the risks of asthmatic and allergic diseases or symptoms in preschool children in China. Compared to those living in urban areas, children living in suburban or rural areas had a higher risk of PM 2.5 exposure., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Whether ambient air pollution is associated with childhood atopic eczema is controversial. In this paper, we selected 3358 preschool children who had not altered residences since pregnancy from a cross-sectional study during 2011-2012 in Shanghai, China, and obtained parent-reported data regarding childhood atopic eczema using an improved ISAAC questionnaire. We recorded daily concentrations of SO 2 , NO 2 , and PM 10 throughout the child's lifetime (2006-2012), and calculated period-averaged concentrations for each district where the child lived to represent the child's exposure levels of these pollutants during different periods. In the multiple logistic regression analyses adjusted for potential confounders as well as for the other pollutants in the same periods, childhood atopic eczema was significantly associated with increments of NO 2 in the approximate interquartile range (20μg/m 3 ) during gestational period (adjusted OR, 95% CI for eczema lifetime-ever: 1.80, 1.29-2.49; for eczema in the year prior to the survey: 2.32, 1.57-3.43) and during the first year of life (2.00, 1.40-2.84; 2.16, 1.43-3.28). Exposure to elevated NO 2 in the first two years, three years and total lifetime, as well as exposure to mixtures containing NO 2 in each of these periods, were consistently associated with increased likelihood of childhood eczema. The highest odds ratios were found between exposure to a mixture of SO 2 and NO 2 during total lifetime (increment: 35μg/m 3 ) and childhood eczema (adjusted OR, 95% CI: 2.80, 1.75-4.48; 3.50, 1.98-6.19). No significant associations were found between childhood eczema and ambient SO 2 and PM 10 individually or in mixtures. This study indicates that gestational and lifetime exposures to ambient NO 2 are risk factors for atopic eczema in childhood. Exposure to ambient SO 2 and PM 10 may enhance the effect of NO 2 exposure on childhood eczema., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Associations of ambient air pollutants with respiratory health are inconsistent., Objectives: We analyzed the associations of gestational and early life exposures to air pollutants with doctor-diagnosed asthma, allergic rhinitis, and pneumonia in children., Methods: We selected 3358 preschool children who did not alter residences after birth from a cross-sectional study in 2011-2012 in Shanghai, China. Parents reported children's respiratory health history, home environment, and family lifestyle behaviors. We collected daily concentrations of sulphur dioxide (SO2), nitrogen dioxide (NO2), and particulate matter with an aerodynamic diameter ≤10μm (PM10) during the child's total lifetime (2006-2012) for each district where the children lived. We analyzed the associations using logistic regression models., Results: After adjusting for covariates and the other studied pollutants, we found that exposure to NO2 (increment of 20μg/m(3)) during the first year of life was significantly associated with asthma [odds ratio (OR)=1.77; 95% confidence interval (CI): 1.29-2.43] and allergic rhinitis (OR=1.67; 95% CI: 1.07-2.61). Exposure to NO2 during gestation, the first two and three years, and over total lifetimewas all consistently associated with increased odds of allergic rhinitis. Quartiles of NO2 concentration during different exposure periods showed a slight dose-response relationship with the studied diseases. These diseases had significant associations with pollutant mixtures that included NO2, but had no significant association with exposures to SO2 and PM10 individually or in mixtures., Conclusions: Gestational and early life exposures to ambient NO2 are risk factors for childhood respiratory diseases., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

With on-site measurements, this paper analyzed the current status of airborne fungi in the child's bedroom of the residences in Shanghai and its associations with the characteristics of residences. The average concentration of airborne fungi in the 446 children's bedrooms was 310 CFU/m 3 (range: 6 to 3184 CFU/m 3 ). Only one bedroom had higher concentration of airborne fungi than the standard concentration of 2500 CFU/m 3 with 3180 CFU/m 3 . Compared to the residences with building areas ≤ 75 m 2 , those residences > 100 m 2 had significant higher average concentrations (mean ± standard deviation: 270 ± 183 vs. 354 ± 409). The children's bedrooms at the ground floor or the attic floor of the residential building had higher average concentration of airborne fungi than others. The results indicate that building characteristics of residences may be associated with the concentrations of airborne fungi in the child's bedroom. [ABSTRACT FROM AUTHOR]

In order to investigate the relationship between outdoor air pollution and sick building syndrome (SBS) symptoms, the CCHH (China, Children, Home, Health) group in Shanghai conducted a cross-sectional survey on the current incidence of SBS symptoms among residents in five districts of Shanghai during April 2011–April 2012. It also collected the related outdoor air pollutants data from Shanghai environmental monitoring center (SEMC), including nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ) and particles with aerodynamic diameter less than 10 µm (PM 10 ). The logistic regression models were used in this paper to study the associations between air pollutants and SBS symptoms. Results were found that the daily mean concentrations of NO 2 and SO 2 met standard requirement, but that of PM 10 exceeded the limit values of the standard in China during this survey. The significant differences were found between the pollutants concentration in urban and suburban area. In addition, the incidences of three categories of SBS symptoms among residents were 79.1% for general symptoms (GS), 65.2% for mucous membrane symptoms (MS) and 35.7% for skin symptoms (SS), respectively. Multiple logistic regression analysis by two case studies illustrated that three outdoor air pollutants, both their concentration quartiles and equal increment, were all associated to and taken as the risk factors for SBS symptoms, for GS OR NO2  = 1.62 (1.18–2.22), MS OR NO2  = 1.58 (1.21–2.06) and SS OR PM10  = 1.21 (1.09–1.35). Furthermore, the new pollutants expressed as the mixtures of their combination were also significantly associated with part of the SBS symptoms. The synthetic air quality indexes of all surveyed residents were calculated as III-level, which represented mild pollution. Therefore, it would be an effective way to decrease the incidence of SBS symptoms in residence to reduce the outdoor air pollution and control the penetration from outdoor to indoor environment. [ABSTRACT FROM AUTHOR]