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Background: Previous research has shown that lack of leisure activities, either outdoor or social activities, impedes cognitive function. However, the interrelationship between poor cognition and deficient activities is understudied. In addition, whether exposure to air pollution, such as PM 2.5 , can accelerate the detrimental 'inactivity-poor cognition' cycle, is worthy of investigation., Methods: We used data from the 2008, 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We assessed the frequency of outdoor or social activities at each wave. The cognitive function was examined using a China-Modified Mini-mental State Examination. We estimated the residential exposure to fine particular matter (PM 2.5 ) via a satellite-based model. We applied cross-lagged panel (CLP) model to examine the bi-directional relationship between outdoor or social activities and cognitive function. We then examined the effect of PM 2.5 exposure with sequent cognitive function and activities using generalized estimation equation (GEE) model., Findings: Overall, we observed significant bi-directional associations between outdoor or social activities and cognitive function. Participants with better cognitive function in the last wave were more likely to engage in outdoor or social activities in the following wave (outdoor activities: β = 0.37, 95% CI [0.27,0.48], P < 0.01; social activities: β = 0.05, 95% CI [0.02,0.09] P < 0.01). Meanwhile, higher engagement in outdoor or social activities in the last wave was associated with more favorable cognitive function in the following wave (outdoor activities: β = 0.06, 95% CI [0.03,0.09], P < 0.01; social activities: β = 0.10, 95% CI [0.03,0.18], P < 0.01). Notably, an increase in PM 2.5 exposure during the preceding year was significantly associated with a declining cognitive function (β = -0.05, 95% CI [-0.08,-0.03], P < 0.01), outdoor activities (β = -0.02, 95% CI [-0.04, -0.01], P < 0.01) and social activities (β = -0.02, 95% CI [-0.02, -0.01], P < 0.01) in the current year; the lagged effects of the PM 2.5 exposure in the past year of the last wave on activities and cognitive function of the following wave were also observed., Interpretation: Our findings not only indicate the bi-directional links between the frequency of outdoor or social activities and cognitive function, but also report that PM 2.5 exposure plays a role in catalyzing the detrimental inactivity-poor cognition cycle. Future research should investigate whether the policy-driven interventions, such as clean air policies, can break the unfavorable activity-cognition cycle, and thereby promoting health from the dual gains in leisure activities and cognition., 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 © 2024 Elsevier Inc. All rights reserved.)

Complicated associations between multiplexed environmental factors and aging are poorly understood. We manipulated aging using multidimensional metrics such as phenotypic age, brain age, and brain volumes in the UK Biobank. Weighted quantile sum regression was used to examine the relative individual contributions of multiplexed environmental factors to aging, and self-organizing maps (SOMs) were used to examine joint effects. Air pollution presented a relatively large contribution in most cases. We also found fair heterogeneities in which the same environmental factor contributed inconsistently to different aging metrics. Particulate matter contributed the most to variance in aging, while noise and green space showed considerable contribution to brain volumes. SOM identified five subpopulations with distinct environmental exposure patterns and the air pollution subpopulation had the worst aging status. This study reveals the heterogeneous associations of multiplexed environmental factors with multidimensional aging metrics and serves as a proof of concept when analyzing multifactors and multiple outcomes., (© 2024. The Author(s).)

Background: Although growing evidence has shown independent links of long-term exposure to fine particulate matter (PM 2.5 ) with cognitive impairment, the effects of its constituents remain unclear. This study aims to explore the associations of long-term exposure to ambient PM 2.5 constituents' mixture with cognitive impairment in Chinese older adults, and to further identify the main contributor., Methods: 15,274 adults ≥ 65 years old were recruited by the Chinese Longitudinal Healthy Longevity Study (CLHLS) and followed up through 7 waves during 2000-2018. Concentrations of ambient PM 2.5 and its constituents (i.e., black carbon [BC], organic matter [OM], ammonium [NH 4 + ], sulfate [SO 4 2- ], and nitrate [NO 3 - ]) were estimated by satellite retrievals and machine learning models. Quantile-based g-computation model was employed to assess the joint effects of a mixture of 5 PM 2.5 constituents and their relative contributions to cognitive impairment. Analyses stratified by age group, sex, residence (urban vs. rural), and region (north vs. south) were performed to identify vulnerable populations., Results: During the average 3.03 follow-up visits (89,296.9 person-years), 4294 (28.1%) participants had developed cognitive impairment. The adjusted hazard ratio [HR] (95% confidence interval [CI]) for cognitive impairment for every quartile increase in mixture exposure to 5 PM 2.5 constituents was 1.08 (1.05-1.11). BC held the largest index weight (0.69) in the positive direction in the qg-computation model, followed by OM (0.31). Subgroup analyses suggested stronger associations in younger old adults and rural residents., Conclusion: Long-term exposure to ambient PM 2.5 , particularly its constituents BC and OM, is associated with an elevated risk of cognitive impairment onset among Chinese older adults., 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 © 2024 Elsevier B.V. All rights reserved.)

Purpose: The air health index (AHI) captures the combined effects of air pollution and non-optimal temperatures and helps assess the atmospheric environment's overall health risk. Shandong Province is a crucial industrial base in China, and the health effects of air pollution and non-optimal temperature cannot be ignored. To construct an AHI for Shandong Province and assess the district-level mortality burden due to AHI in the study area., Methods: Daily district-specific mortality, meteorological, and air pollution data over 2013-2018 were collected in Shandong Province, China. The AHI construction eventually incorporated PM 2.5 and NO 2 , O 3 , and non-optimal temperatures. Attributable fraction (AF) and attributable number (AN) were used to estimate the district-specific mortality burden attributable to AHI., Results: The average AHI value observed in Shandong Province was 6. Our research revealed a positive association between the total AHI and total mortality, with an overall trend of a slow increase followed by a rapid increase. The exposure-response curves, when stratified by gender, age, and cause of death, were approximately consistent with the overall trend. The provincial attributable fraction (AF) was 5.31% (95% CI 4.58%, 5.91%), and the attributable number (AN) was 188,246 (95% CI 162,396, 209,533). Overall, higher ANs mainly appeared in the southwestern area, while higher values of AF were observed in the central-eastern and central-northern areas., Conclusions: The air health index performs well in predicting death burden and can convey health risks related to exposure to the ambient environment to the public., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Evidence linking mortality and short-term exposure to particulate matter (PM 2.5 ) constituents was sparse. The mortality displacement was often unconsidered and may induce incorrect risk estimation., Objectives: To assess the short-term effects of PM 2.5 constituents on all-cause mortality considering the mortality displacement., Methods: Daily data on all-cause mortality and PM 2.5 constituents, including sulfate (SO 4 2- ), nitrate (NO 3 - ), ammonium (NH 4 + ), organic matters (OM), and black carbon (BC), were collected from 2009 to 2020. The mortality effect of PM 2.5 and its constituents was estimated using a distributed lag non-linear model. Stratified analyses were performed by age, sex, and season., Results: Per interquartile range increases in SO 4 2- , NO 3 - , NH 4 + , OM, and BC were associated with the 1.42% (95%CI: 0.98, 1.87), 3.76% (3.34, 4.16), 2.26% (1.70, 2.83), 2.36% (2.02, 2.70), and 1.26% (0.91, 1.61) increases in all-cause mortality, respectively. Mortality displacements were observed for PM 2.5 , SO 4 2- , NH 4 + , OM, and BC, with their overall effects lasting for 7-15 days. Stratified analyses revealed a higher risk for old adults (>65 years) and females, with stronger effects in the cold season., Conclusions: Short-term exposures to PM 2.5 constituents were positively associated with increased risks of mortality. The mortality displacement should be considered in future epidemiological studies on PM constituents., Data Availability: Data will be made available on request., 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 © 2023 Elsevier B.V. All rights reserved.)

Background: Sex difference in the association between ambient air pollution and cognitive aging remained unclear. This current study aimed to assess the impacts of long-term exposure to major air pollutants on cognitive performance among Chinese middle-aged and older adults, and explore whether these associations could be modified by sex., Methods: By deriving longitudinal data from four waves of the China Health and Retirement Longitudinal Study, we included 13,507 participants aged 45+ years who had at least two cognitive tests recorded from 2011 to 2018. We used a standardized questionnaire consisting of five domain-specific functions to measure global cognitive score. Based on well-validated spatiotemporal datasets, annual average concentrations of ambient fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ), and ozone (O 3 ) were assigned to each enrollee at prefectural city level and at the simulated residential addresses through Monte Carlo simulation approach. Linear mixed-effects models were applied to assess the impacts of major air pollutants on cognitive function with multiple adjustments. Sex-stratified analyses were performed to examine the potential effect modification on these associations. To enhance the interpretability of our results, we also compared the estimated effects of air pollutants with the effect of aging on cognitive function., Results: We evaluated 38,950 records of cognitive function tests, of which 44.0% were from women. An increase of 10-μg/m 3 in PM 2.5 , NO 2 and O 3 exposure were associated with 0.36 (95% confidence interval: -0.40, -0.31), 0.51 (-0.60, -0.43) and 0.26 (-0.47, -0.06) points decline in global cognitive score, respectively, equivalent to the effect of aging by 2.8-5.0 years. Sex-stratified analyses suggested significantly greater cognitive impairment associated with air pollutants in women than men. We found reversely J-shaped concentration-response relationships between ambient air pollutants and cognitive decline in both sexes. Main findings on sex-specific associations were robust to the adjustments for covariates, inclusion criteria, and co-pollutant analyses, as well as sensitivity analyses based on simulation-based exposure for PM 2.5 and NO 2 ., Conclusions: Later-life exposure to ambient air pollution may accelerate cognitive aging of middle-aged and older adults, suggesting significant sex disparity with higher vulnerability in women., 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 © 2023. Published by Elsevier B.V.)

Background: Cohort evidence linking long-term survival with exposure to multiple air pollutants (e.g., fine particulate matter [PM 2.5 ] and ozone) was extensively sparse in low- and middle-income countries, especially among older adults. This study aimed to investigate potential associations of long-term exposures to PM 2.5 and ozone with all-cause mortality in Chinese older adults., Methods: A dynamic nationwide prospective cohort comprising 20,352 adults aged ≥65 years were enrolled from the Chinese Longitudinal Healthy Longevity Study and followed up through 2005-2018. Participants' annual exposures to warm-season ozone and year-round PM 2.5 were assigned using satellite-derived spatiotemporal estimates. A directed acyclic graph (DAG) was developed to identify confounding variables. Associations of annual mean exposures to PM 2.5 and ozone with mortality were evaluated using single- and two-pollutant Cox proportional hazards models, adjusting for time-dependent individual risk factors and ambient temperature., Results: During 100 thousand person-years of follow-up (median: 3.6 years), a total of 14,313 death events occurred. The participants were averagely aged 87.1 years at baseline and exposed to a wide range of annual average concentrations of warm-season maximum 8-hour ozone (mean, 54.4 ppb; range, 23.3-81.6 ppb) and year-round PM 2.5 (mean, 65.5 μg/m 3 ; range, 10.1-162.9 μg/m 3 ). Approximately linear concentration-response relationship was identified for ozone, whereas significant increases in PM 2.5 -associated mortality risks were observed only when concentrations were above 60 μg/m 3 . Rises of 10 ppb in ozone and 10 µg/m 3 in PM 2.5 above 60 µg/m 3 were associated with increases in all-cause mortality of 13.2% (95% confidence interval [CI]: 10.2-16.2%) and 6.2% (95% CI: 4.6-7.7%) in DAG-based single-pollutant model, and of 9.7% (95% CI: 6.6-13.0%) and 5.3% (95% CI: 3.7-6.9%) in DAG-based two-pollutant model, respectively. We detected significant effect modification by temperature in associations of mortality with ozone (P <0.001 for interaction), suggesting greater ozone-related risks among participants in warmer locations., Conclusions: This study provided longitudinal evidence that long-term exposure to ambient PM 2.5 and ozone significantly and independently contributed to elevated risks of all-cause mortality among older adults in China., 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 © 2023 Elsevier B.V. All rights reserved.)

Introduction: Emerging research suggested a nexus between air pollution exposure and risks of overweight and obesity, while existing longitudinal evidence was extensively sparse, particularly in densely populated regions. This study aimed to quantify concentration-response associations of changes in weight and waist circumference (WC) related to air pollution in Chinese adults., Methods: We conceived a nationally representative longitudinal study from 2011 to 2015, by collecting 34,854 observations from 13,757 middle-aged and older adults in 28 provincial regions of China. Participants' height, weight and WC were measured by interviewers using standardized devices. Concentrations of major air pollutants including fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ) and ozone (O 3 ) predicted by well-validated spatiotemporal models were assigned to participants according to their residential cities. Possible exposure biases were checked through 1000 random simulated exposure at individual level, using a Monte Carlo simulation approach. Linear mixed-effects models were applied to estimate the relationships of air pollution with weight and WC changes, and restricted cubic spline functions were adopted to smooth concentration-response (C-R) curves., Results: Each 10-μg/m 3 rise in PM 2.5 , NO 2 and O 3 was associated with an increase of 0.825 (95% confidence interval: 0.740, 0.910), 0.921 (0.811, 1.032) and 1.379 (1.141, 1.616) kg in weight, respectively, corresponding to WC gains of 0.688 (0.592, 0.784), 1.189 (1.040, 1.337) and 0.740 (0.478, 1.002) cm. Non-significant violation for linear C-R relationships was observed with exception of NO 2 -weight and PM 2.5 /NO 2 -WC associations. Sex-stratified analyses revealed elevated vulnerability in women to gain of weight in exposure to PM 2.5 and NO 2 . Sensitive analyses largely supported our primary findings via assessing exposure estimates from 1000 random simulations, and performing reanalysis based on non-imputed covariates and non-obese participants, as well as alternative indicators (i.e., body mass index and waist-to-height ratio)., Conclusions: We found positively robust associations of later-life exposure to air pollutants with gains in weight and WC based on a national sample of Chinese adult men and women. Our findings suggested that mitigation of air pollution may be an efficient intervention to relieve obesity burden., 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 © 2023 Elsevier B.V. All rights reserved.)

Introduction: Serval longitudinal investigations have reported relationships between long-term nitrogen dioxide (NO 2 ) exposure and mortality. In developing countries such as China, however, the cohort evidence was extremely rare. In this study, we aimed to establish the concentration-response relationship between long-term exposure to NO 2 and mortality in Chinese adults., Methods: We conducted a prospective cohort study followed up from 2011 to 2018, by enrolling 15,440 participants aged ≥45 years from 28 provincial regions of China. NO 2 concentration estimates were derived from high-quality spatiotemporal datasets developed by machine learning methods and were assigned for each participant according to their residential cities. We applied Cox proportional hazard models with time-varying exposures to assess the association of all-cause death with long-term NO 2 exposure. Subgroup analyses were performed to identify effect modifications., Results: A total of 1646 death events occurred during 105,478.5 person-years' follow-up (median 7.1 years). No evident violation for linear NO 2 -mortality relationship (P nonlinear = 0.332) was observed at a range of 7.4-45.0 μg/m 3 . Per 10-μg/m 3 rise in NO 2 was associated with an hazard ratio of 1.220 (95% confidence interval: 1.103-1.350) for all-cause mortality. The association between NO 2 and mortality was generally robust after adjusting for co-pollutants including fine particulate matter or/and ozone. Only participants aged 65 and over (1.351 [1.193-1.531]) suffered from increased risks of death associated with NO 2 exposure, and an evident effect modification by age (P = 0.008) was identified. The elevated risk of death induced by NO 2 was also observed in participants living in rural areas and those with elementary school education or below, though effect modifications were non-significant in these subgroups., Conclusions: This study provided novel evidence that long-term NO 2 exposure could be an independent risk for mortality among Chinese middle-aged and older adults. Our findings highlighted the importance of controlling air pollution induced by vehicle emissions., 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 © 2022 Elsevier B.V. All rights reserved.)

Introduction: Numerous studies have reported the modification of particulate matters (PMs) on the association between cold temperature and health. However, it remains uncertain whether the modification effect may vary by size of PMs, especially in Shandong Province, China where the disease burdens associated with cold temperature and PMs are both substantial. This study aimed to examine various interactive effects of cold exposure and ambient PMs with diameters ≤1/2.5 μm (PM1 and PM2.5) on premature deaths in Shandong Province, China., Methods: In the 2013-2018 cold seasons, data on daily mortality, PM1 and PM2.5, and weather conditions were collected from the 1822 sub-districts of Shandong Province. A time-stratified case-crossover study design was performed to quantify the cumulative association between ambient cold and mortality over lag 0-12 days, with a linear interactive term between temperature and PM1 and PM2.5 additionally added into the model., Results: The mortality risk increased with temperature decline, with the cumulative OR of extreme cold (-16.9°C, the 1st percentile of temperature range) being 1.83 (95% CI: 1.66, 2.02), compared with the minimum mortality temperature. The cold-related mortality risk was 2.20 (95%CI: 1.83, 2.64) and 2.24 (95%CI: 1.78, 2.81) on high PM1 and PM2.5 days, which dropped to 1.60 (95%CI: 1.39, 1.84) and 1.60 (95%CI: 1.37, 1.88) on low PM1 and PM2.5 days. PM1 showed greater modification effect for per unit concentration increase than PM2.5. For example, for each 10?g/m3 increase in PM1 and PM2.5, the mortality risk associated with extreme cold temperature increased by 7.6% (95% CI: 1.3%, 14.2%) and 2.6% (95% CI: -0.7%, 5.9%), respectively., Discussion: The increment of smaller PMs' modification effect varied by population subgroups, which was particularly strong in the elderly aged over 75 years and individuals with middle school education and below. Specific health promotion strategies should be developed towards the greater modification effect of smaller PMs on cold effect., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zhao, Chu, Xu, Cao, Schikowski, Geng, Chen, Bai, Hu, Xia, Ma, Liu, Lu, Guo and Zhao.)

Background: A growing number of studies have reported an increased risk of cardiovascular disease (CVD) and respiratory disease (RD) within hours after exposure to ambient air pollution or temperature. We assemble published evidence on the sub-daily associations of CVD and RD with ambient air pollution and temperature., Methods: Databases of PubMed and Web of Science were searched for original case-crossover and time-series designs of English articles examining the intra-day effects of ambient air pollution [particulate matter with aerodynamic diameter ≤2.5 μm (PM 2.5 ), ≤10 μm (PM 10 ), 2.5-10μm (PM 10-2.5 ), and < 7 μm (SPM), O 3 , SO 2 , NO 2 , CO, and NO] and temperatures (heat and cold) on cardiorespiratory diseases within 24 h after exposure in the general population by comparing with exposure at different exposure levels or periods. Meta-analyses were conducted to pool excess risks (ERs, absolute percentage increase in risk) of CVD and RD morbidities associated with an increase of 10 μg/m 3 in particulate matters, 0.1 ppm in CO, and 10 ppb in other gaseous pollutants., Findings: Final analysis included thirty-three papers from North America, Europe, Oceania, and Asia. Meta-analysis found an increased risk of total CVD morbidity within 3 h after exposure to PM 2.5 [ER%: 2.65% (95% CI: 1.00% to 4.34%)], PM 10-2.5 [0.31% (0.02% to 0.59%)], O 3 [1.42% (0.14% to 2.73%)], and CO [0.41% (0.01% to 0.81%)]. The risk of total RD morbidity elevated at lag 7-12 h after exposure to PM 2.5 [0.69% (0.14% to 1.24%)] and PM 10 [0.38% (0.02% to 0.73%)] and at lag 12-24 h after exposure to SO 2 [2.68% (0.94% to 4.44%)]. Cause-specific CVD analysis observed an increased risk of myocardial infarction morbidity within 6 h after exposure to PM 2.5 , PM 10 , and NO 2 , and an increased risk of out-of-hospital cardiac arrest morbidity within 12 h after exposure to CO. Risk of total CVD also increased within 24 h after exposure to heat., Interpretation: This study supports a sudden risk increase of cardiorespiratory diseases within a few hours after exposure to air pollution or heat, and some acute and highly lethal diseases such as myocardial infarction and cardiac arrest could be affected within a shorter time., Funding: The National Natural Science Foundation of China (Grant No. 42105165; 81773518), the High-level Scientific Research Foundation of Anhui Medical University (Grant No. 0305044201), and the Discipline Construction of Anhui Medical University (Grant No. 0301001836)., Competing Interests: Declaration of interests All the authors declared no conflict of interests., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Previous studies have indicated the associations between fine particulate matter (PM 2.5 ) exposure and diabetes or glucose levels. However, evidence linking PM 2.5 constituents and diabetes or glucose levels was extensively scarce, particularly in developing countries. This study aimed to investigate the associations of exposure to PM 2.5 and its five constituents (black carbon [BC], organic matter [OM], nitrate [NO 3 - ], sulfate [SO 4 2- ], and ammonium [NH 4 + ]) with diabetes and glucose levels among the middle-aged and elderly Chinese populations., Methods: A national cross-sectional sample of participants aged 45+ years was enrolled from 28 provinces across China's mainland. Health examination and questionnaire survey for each respondent were performed during 2011-2012. Diabetes was determined by alternative definitions, and the main definition (MD) was self-report diabetes or antidiabetic medicine use or HbA 1c ≥6.5 or fasting glucose ≥7 mmol/L or random glucose ≥11.1 mmol/L. Monthly exposure to PM 2.5 mass and its five constituents (BC, OM, NO 3 - , SO 4 2- , and NH 4 + ) for each participant at residence were estimated using satellite-based spatiotemporal prediction models. Generalized linear models and linear mixed-effects models were used to assess the effects of exposure to PM 2.5 and its constituents on diabetes or glucose levels, respectively. Stratification analyses were done by sex and age., Results: We included a total of 17,326 adults over 45 years in this study. The 3-year mean (interquartile range [IQR]) concentrations of PM 2.5 , BC, OM, NO 3 - , SO 4 2- , and NH 4 + were 47.9 (27.4) µg/m 3 , 2.9 (2.2) µg/m 3 , 9.2 (6.6) µg/m 3 , 10.2 (9.4) µg/m 3 , 11.0 (5.2) µg/m 3 , and 7.1 (4.4) µg/m 3 , respectively. Per IQR rise in exposure to PM 2.5 was significantly associated with an increase of 0.133 mmol/L (95% confidence interval, 0.048-0.219) in glucose concentrations. Similar positive associations were observed for BC (0.097 mmol/L [0.012-0.181]), OM (0.160 mmol/L [0.065-0.256]), NO 3 - (0.145 mmol/L [0.039-0.251]), SO 4 2- (0.111 mmol/L [0.026-0.196]), and NH 4 + (0.135 mmol/L [0.041-0.230]). Under different diabetes definitions, PM 2.5 mass and selected constituents with the exception of SO 4 2- were all associated with a higher risk of prevalent diabetes. In MD-based analysis, similar positive associations were observed for four constituents, with corresponding odds ratios of 1.180 (1.097-1.270) for PM 2.5 , 1.154 (1.079-1.235) for BC, 1.170 (1.079-1.270) for OM, 1.200 (1.098-1.312) for NO 3 - , and 1.123 (1.037-1.215) for NH 4 + . Stratified analyses showed a significantly higher risk of diabetes in males (1.225 [1.064-1.411]) than females (1.024 [0.923-1.136]) when exposed to PM 2.5 . Participants under 65 years were generally more vulnerable to diabetes hazards related to PM 2.5 constituents exposure., Conclusions: Exposures to PM 2.5 and its constituents (i.e., BC, OM, NO 3 - , and NH 4 + ) were positively associated with increased risks of prevalent diabetes and elevated glucose levels in middle-aged and older adults., 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 © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Fine particulate matter pollution (PM 2.5 ) is widely considered to be a top-ranked risk factor for premature mortality and years of life lost (YLL). However, evidence regarding the effect of daily air quality improvement on life expectancy is scarce, especially in the Middle East such as Iran. This study aimed to investigate the potential benefits in life expectancy at concentrations meeting the daily PM 2.5 standards during 2012-2016 in Tehran, Iran., Methods: We collected daily non-accidental mortality and data on air pollutants and weather conditions from Tehran, Iran, 2012-2016. A quasi-Poisson or Gaussian time-series regression was employed to fit the associations between ambient PM 2.5 and mortality or YLL. Potential gains in life expectancy (PGLE) and attributable fraction (AF) were estimated by assuming that daily PM 2.5 concentrations attained the World Health Organization air quality guidelines (WHO AQG) 2005 (25 μg/m 3 ) and 2021 (15 μg/m 3 )., Results: During the study period, a total of 221,231 non-accidental deaths were recorded in Tehran, resulting in 3.6 million YLL. The mean concentration of ambient PM 2.5 was 34.7 μg/m 3 (standard deviation: 15.3 μg/m 3 ). For a 10-μg/m 3 rise in 4-day moving average (lag 03-day) in PM 2.5 concentration, non-accidental mortality and YLL increased by 1.12% (95% confidence interval: 0.60, 1.65) and 20.73 (7.08, 34.39) person years, respectively. A relatively higher effect was observed in males and young adults aged 18-64 years. We estimated that 39830 [AF = 1.1%] and 74284 [AF = 2.1%] YLL could potentially be avoided if daily PM 2.5 concentrations attained the WHO AQG 2005 and 2021, respectively, which corresponded to potential gains in life expectancy of 0.18 (0.06, 0.30) and 0.34 (0.11, 0.56) years for each deceased person. PM 2.5 -associated PGLE estimates were largely robust when performing sensitivity analyses., Conclusions: Our findings indicated that short-term exposure to PM 2.5 is associated with increased non-accidental YLL and mortality. Prolonged life expectancy could be achieved if the particulate matter air pollution level were kept under a stricter standard., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Many studies have illustrated adverse effects of short-term exposure to air pollution on human health, which usually assumes a linear exposure-response (E-R) function in the delineation of health effects due to air pollution. However, nonlinearity may exist in the association between air pollutant concentrations and health outcomes such as adult pneumonia hospital visits, and there is a research gap in understanding the nonlinearity. Here, we utilized both the distributed lag model (DLM) and nonlinear model (DLNM) to compare the linear and nonlinear impacts of air pollution on adult pneumonia hospital visits in the coastal city of Qingdao, China. While both models show adverse effects of air pollutants on adult pneumonia hospital visits, the DLNM shows an attenuation of E-R curves at high concentrations. Moreover, the DLNM may reveal delayed health effects that may be missed in the DLM, e.g., ozone exposure and pneumonia hospital visits. With the stratified analysis of air pollutants on adult pneumonia hospital visits, both models consistently reveal that the influence of air pollutants is higher during the cold season than during the warm season. Nevertheless, they may behave differently in terms of other subgroups, such as age, gender and visit types. For instance, while no significant impact due to PM 2.5 in any of the subgroups abovementioned emerges based on DLM, the results from DLNM indicate statistically significant impacts for the subgroups of elderly, female and emergency department (ED) visits. With respect to adjustment by two-pollutants, PM 10 effect estimates for pneumonia hospital visits were the most robust in both DLM and DLNM, followed by NO 2 and SO 2 based on the DLNM. Considering the estimated health effects of air pollution relying on the assumed E-R functions, our results demonstrate that the traditional linear association assumptions may overlook some potential health risks., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: To our knowledge, no study has assessed the association between heatwaves and risk of hospitalization and how it may change over time in Brazil. We quantified the heatwave-hospitalization association in Brazil during 2000-2015., Methods and Findings: Daily data on hospitalization and temperature were collected from 1,814 cities (>78% of the national population) in the hottest five consecutive months during 2000-2015. Twelve types of heatwaves were defined with daily mean temperatures of ≥90th, 92.5th, 95th, or 97.5th percentiles of year-round temperature and durations of ≥2, 3, or 4 consecutive days. The city-specific association was estimated using a quasi-Poisson regression with constrained distributed lag model and then pooled at the national level using random-effect meta-analysis. Stratified analyses were performed by five regions, sex, 10 age groups, and nine cause categories. The temporal change in the heatwave-hospitalization association was assessed using a time-varying constrained distributed lag model. Of the 58,400,682 hospitalizations (59% women), 24%, 34%, 21%, and 19% of cases were aged <20, 20-39, 40-59, and ≥60 years, respectively. The city-specific year-round daily mean temperatures were 23.5 ± 2.8 °C on average, varying from 26.8 ± 1.8 °C for the 90th percentile to 28.0 ± 1.6 °C for the 97.5th percentile. We observed that the risk of hospitalization was most pronounced for heatwaves characterized by high daily temperatures and long durations across Brazil, except for the minimal association in the north (the hottest region). After controlling for temperature, the association remained for severe heatwaves in the south and southeast (cold regions). Children 0-9 years, the elderly ≥70 years, and admissions for perinatal conditions were most strongly associated with heatwaves. Over the study period, the strength of the heatwave-hospitalization association declined substantially in the south, while an apparent increase was observed in the southeast. The main limitations of this study included the lack of data on individual temperature exposure and measured air pollution., Conclusions: There are geographic, demographic, cause-specific, and temporal variations in the heatwave-hospitalization associations across the Brazilian population. Considering the projected increase in frequency, duration, and intensity of heatwaves, future strategies should be developed, such as building early warning systems, to reduce the health risk associated with heatwaves in Brazil., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: MJA has received investigator initiated grants for unrelated research from Pfizer and Boehringer-Ingelheim. He has also undertaken an unrelated consultancy for Sanofi. The other authors have declared that no competing interests exist.

Background: The occurrence of compound hot extreme (CHE) events in China is increasingly frequent. This study aimed to investigate the association between CHEs and all-cause mortality in Shandong Province and to estimate the attributable excess deaths. Methods: We collected daily data on weather, air pollution, and all-cause mortality at the subdistrict level in Shandong Province from 2013 to 2018. A CHE was defined as both daily maximum and minimum temperatures being higher than their historical 90th percentiles during 2013–2018 hot seasons. A case time-series analysis with a distributed lagged non-linear model was applied to analyze the subdistrict-specific association between different hot extremes and mortality risk, which were then pooled at the province level using meta-analysis. Results: Hot nights (RR = 1.44, 95%CI: 1.35–1.53) and CHEs (RR = 1.77, 95%CI: 1.64–1.90) were significantly associated with an increased mortality risk. CHEs had a greater effect for females (RR = 1.99, 95%CI: 1.81–2.19) and the elderly (>74 years) (RR = 2.14, 95%CI: 1.93–2.38) than their counterparts, respectively. Cardiovascular and respiratory deaths were more susceptible to CHEs than other deaths. Each year, 4888 (95%CI: 4133–5811) excess deaths in Shandong Province were attributable to CHEs, accounting for 2.60% (95%CI: 2.20–3.10%) of all-cause deaths and equating to 50 (95%CI: 42–58) deaths per 1,000,000 residents. The CHE-related mortality burden varied across subdistricts, with the highest occurring in the southeastern area and the lowest occurring in the northeastern and southwestern regions. Conclusion: CHEs and hot nights were substantially associated with excess deaths in Shandong Province, especially for females, the elderly, and residents living in the southeastern area. Our findings may facilitate the development of a heat alert warning system and preventive measures for vulnerable populations. [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]