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Background: In 2015, the Chinese Government launched the coal to clean heating policy (CHP), designed to improve air quality and health in China. The CHP banned household coal burning and provided subsidies for clean electric or gas-powered heating for millions of peri-urban and rural households. We aimed to investigate whether the CHP affected the incidence of acute myocardial infarction in Beijing townships., Methods: In this quasi-experimental study, we obtained township data on acute myocardial infarction hospital admissions and deaths, exposure to the CHP (yes vs no), and a range of covariates for periods before (Jan 1, 2013, to Dec 31, 2014) and after the CHP began (Jan 1, 2016, to Dec 31, 2017; and Jan 1, 2018, to Dec 31, 2019). The policy was gradually rolled out across villages, and townships in our study were considered exposed to the policy in periods when more than 50% of their villages were assigned into the CHP. We estimated the effect of the CHP on township incidence of acute myocardial infarction for all adults (aged ≥35 years) and separately for sex and older adults (aged ≥65 years) using a difference-in-differences approach that accommodates the progressive roll-out of the policy., Findings: Of 307 townships in Beijing, we excluded 156 (51%) urban townships where most villages had central heating and were thus ineligible for the CHP. Of the 151 peri-urban and rural Beijing townships considered eligible for the CHP, 75 (50%) townships were exposed to the CHP by the end of 2017 and 92 (61%) by the end of 2019. We estimated an overall reduction of 6·6% (95% CI -12·3 to -0·8) in the incidence of acute myocardial infarction from before to after roll-out of the CHP in exposed townships relative to those not exposed to the policy, with some evidence of larger effects in women (-11·7% [-19·0 to -4·1%]), older adults (-10·7% [-17·4 to -3·6%]), and in townships exposed for longer (-3·5% [-9·5 to 2·8%] after <2 years and -9·7% [-18·3 to -0·5%] after 2-4 years)., Interpretation: Our results provide among the first empirical evidence of possible cardiovascular benefits from a household clean energy policy, and support efforts to implement and assess such policies in China and globally., Funding: Wellcome Trust, the Canadian Institutes for Health Research, and the National Natural Science Foundation of China., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 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.)

The coronavirus (COVID-19) lockdown in China is thought to have reduced air pollution emissions due to reduced human mobility and economic activities. Few studies have assessed the impacts of COVID-19 on community and indoor air quality in environments with diverse socioeconomic and household energy use patterns. The main goal of this study was to evaluate whether indoor and community air pollution differed before, during, and after the COVID-19 lockdown in homes with different energy use patterns. Using calibrated real-time PM 2.5 sensors, we measured indoor and community air quality in 147 homes from 30 villages in Beijing over 4 months including periods before, during, and after the COVID-19 lockdown. Community pollution was higher during the lockdown (61 ± 47 μg/m 3 ) compared with before (45 ± 35 μg/m 3 , p < 0.001) and after (47 ± 37 μg/m 3 , p < 0.001) the lockdown. However, we did not observe significantly increased indoor PM 2.5 during the COVID-19 lockdown. Indoor-generated PM 2.5 in homes using clean energy for heating without smokers was the lowest compared with those using solid fuel with/without smokers, implying air pollutant emissions are reduced in homes using clean energy. Indoor air quality may not have been impacted by the COVID-19 lockdown in rural settings in China and appeared to be more impacted by the household energy choice and indoor smoking than the COVID-19 lockdown. As clean energy transitions occurred in rural households in northern China, our work highlights the importance of understanding multiple possible indoor sources to interpret the impacts of interventions, intended or otherwise., (© 2022 The Authors. Indoor Air published by John Wiley & Sons Ltd.)

The Chinese government implemented a national household energy transition program that replaced residential coal heating stoves with electricity-powered heat pumps for space heating in northern China. As part of a baseline assessment of the program, this study investigated variability in personal air pollution exposures within villages and between villages and evaluated exposure patterns by sociodemographic factors. We randomly recruited 446 participants in 50 villages in four districts in rural Beijing and measured 24 h personal exposures to fine particulate matter (PM 2.5 ) and black carbon (BC). The geometric mean personal exposure to PM 2.5 and BC was 72 and 2.5 μg/m 3 , respectively. The variability in PM 2.5 and BC exposures was greater within villages than between villages. Study participants who used traditional stoves as their dominant source of space heating were exposed to the highest levels of PM 2.5 and BC. Wealthier households tended to burn more coal for space heating, whereas less wealthy households used more biomass. PM 2.5 and BC exposures were almost uniformly distributed by socioeconomic status. Future work that combines these results with PM 2.5 chemical composition analysis will shed light on whether air pollution source contributors (e.g., industrial, traffic, and household solid fuel burning) follow similar distributions.

Acute myocardial infarction (AMI) poses a serious disease burden in China, but studies on small-area characteristics of AMI incidence are lacking. We therefore examined temporal trends and geographic variations in AMI incidence at the township level in Beijing. In this cross-sectional analysis, 259,830 AMI events during 2007-2018 from the Beijing Cardiovascular Disease Surveillance System were included. We estimated AMI incidence for 307 consistent townships during consecutive 3-year periods with a Bayesian spatial model. From 2007 to 2018, the median AMI incidence in townships increased from 216.3 to 231.6 per 100,000, with a greater relative increase in young and middle-aged males (35-49 years: 54.2%; 50-64 years: 33.2%). The most pronounced increases in the relative inequalities was observed among young residents (2.1 to 2.8 for males and 2.8 to 3.4 for females). Townships with high rates and larger relative increases were primarily located in Beijing's northeastern and southwestern peri-urban areas. However, large increases among young and middle-aged males were observed throughout peri-urban areas. AMI incidence and their changes over time varied substantially at the township level in Beijing, especially among young adults. Targeted mitigation strategies are required for high-risk populations and areas to reduce health disparities across Beijing.

Exposure to air pollution is a leading health risk factor. The variance components and contributions of indoor versus outdoor source determinants of personal exposure to air pollution are poorly understood, especially in settings of household solid fuel use. We conducted a panel study with up to 4 days of repeated measures of integrated gravimetric personal exposure to PM 2.5 and black carbon in 787 men and women (ages 40-79) living in peri-urban villages in northern (Beijing and Shanxi) and southern (Guangxi) China. We simultaneously measured outdoor PM 2.5 and collected questionnaire data on sociodemographic characteristics and indoor pollution sources including tobacco smoking and solid fuel stove use. We obtained over 2000 days of personal exposure monitoring which showed higher exposures in the heating season (geometric mean (GM): 108 versus 65 μg/m 3 in the non-heating season for PM 2.5 ) and among northern participants (GM: 90 versus 59 μg/m 3 in southern China in the non-heating season for PM 2.5 ). We used mixed-effects models to estimate within- and between-participant variance components and to assess the determinants of exposures. Within-participant variance in exposure dominated the total variability (68-95%). Outdoor PM 2.5 was the dominant variable for explaining within-participant variance in exposure to PM 2.5 (16%). Household fuel use (PM 2.5 : 8%; black carbon: 10%) and smoking status (PM 2.5 : 27%; black carbon: 5%) explained the most between-participant variance. Indoor sources (solid fuel stoves, tobacco smoking) were associated with 13-30% higher exposures to air pollution and each 10 μg/m 3 increase in outdoor PM 2.5 was associated with 6-8% higher exposure. Our findings indicate that repeated measurements of daily exposure are likely needed to capture longer-term exposures in settings of household solid fuel use, even within a single season, and that reducing air pollution from both outdoor and indoor sources is likely needed to achieve measurable reductions in exposures to air pollution., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Identifying the key chemical compounds and source contributions in ambient particles associated with the burden of cardiopulmonary disease is important to develop cost-effective air pollution mitigating strategies that maximize the protection of public health. To help address this need, we examined 109 daily ambient fine particulate matter samples (PM 2.5 ) that were collected in Beijing in one year. The samples were analyzed for chemical composition including organic and elemental carbons, metals, ions, as well as organic molecular markers. In addition, the secretion of pro-inflammatory cytokines, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were measured by exposing lung epithelial cells (A549) to water extracts of PM 2.5 samples. Single pollutant and constituent-PM 2.5 joint linear models were used to estimate the associations. Higher PM 2.5 mass and measured chemical components were found in cold seasons than in warm seasons due to the greater contributions of secondary inorganic sources, biomass burning, and coal combustion. Water-soluble organic nitrogen (WSON) had the strongest associations with levels of pro-inflammatory cytokines compared to PM 2.5 mass and other chemical species in both the one and constituent-PM 2.5 joint linear models. Our study is the first to highlight that ambient WSON from diverse sources dominates the inflammatory potential of lung epithelial cells.