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Background: The potential impacts of daily ambient fine particulate pollution (PM 2.5 ) exposure on year of life lost (YLL) due to ischemic heart diseases (IHD) remain uncertain. We aimed to estimate the improvement in IHD-related life expectancy by attaining the daily air quality standards of ambient PM 2.5 in China., Methods and Results: This study was based on daily mortality data covering 96 Chinese cities from 2013 to 2016. Regional- and national-associations between IHD-related YLLs and daily PM 2.5 were estimated by generalized additive models. We further evaluated the IHD-related avoidable YLLs with an assumption that the daily PM 2.5 was below the ambient air quality standards of World Health Organization (WHO) and China, and calculated the improvement of life expectancy by dividing the avoidable YLLs by the overall number of IHD mortality. We totally recorded 1,485,140 IHD deaths from 2013 to 2016. At the national level, we found a positive association between IHD-related YLLs and daily PM 2.5 . Per 10 μg/m 3 increment of four-day averaged ambient PM 2.5 related to an increase of 0.40 IHD-related YLLs (95% CI: 0.28, 0.51). By achieving the WHO's air quality guideline, we estimated that an averaged number of 1346.94 (95% CI: 932.61, 1761.27) YLLs can be avoided for the IHD deaths in each city. On average, the life expectancy can be improved by 0.15 years (95% CI: 0.11, 0.19) for each death., Conclusions: Our study provides a nationwide picture of the life expectancy improvements by reaching the daily PM 2.5 standards in China, indicating that people can live longer in an environment with higher air quality., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Both inhalable particles (PM 10 ) and fine particles (PM 2.5 ) are regulated in various countries mainly due to their adverse health effects. However, there is increasing evidence that PM 2.5 might be responsible for these effects and coarse particles (PM c ) plays little role in adverse health effects, if so, it might be not necessary to monitor PM 10 ., Methods: In this study, we conducted a time-series analysis using a generalized additive model to explore the effects of PM 2.5 , PM c , and PM 10 on mortality from ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) in 96 Chinese cities during 2013-2016. The mortality number and attributable fraction were further estimated using the national air quality standard and WHO's guideline as the reference., Results: We observed significant effects of PM 2.5 on IHD and COPD mortality; each 10 ug/m 3 increase in lag 01 PM 2.5 was associated with a 0.26% (95% CI: 0.17%, 0.34%) increase in IHD mortality and a 0.19% (95% CI: 0.09%, 0.29%) increase in COPD mortality. We also found significant effects of PM c and PM 10 on mortality from IHD and COPD, but the magnitudes of effects were weaker than those of PM 2.5 . The results were robust when adjusting for co-pollutants and altering model parameters. We further estimated that about 1.27% (95% CI: 0.29%, 2.30%) of IHD mortality and 1.25% (95% CI: 0.08%, 2.46%) of COPD mortality could be attributable to PM 2.5 exposure using WHO's guideline (25 ug/m 3 ) as a reference, corresponding to 15,337 (95% CI: 3,375, 27,842) mortalities from IHD and 5,653 (95% CI: 379, 11,152) COPD mortalities in the 96 cities. Across all of China, almost fifty thousand cases of IHD mortality and twenty thousand cases of COPD mortality might be avoidable if the PM 2.5 concentration declined to the WHO guideline., Conclusions: Our study indicates that short-term exposure to PM 2.5 could be an important risk factor of mortality from IHD and COPD, and substantial cardiopulmonary mortality could be avoidable by reducing daily PM 2.5 concentrations. It is nonnegligible to consider the role of PM c in triggering in cardiopulmonary mortality. And it could be necessary to continue monitoring PM 10 in the study regions due to the adverse effects of PM c ., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Ozone is one of the dominant air pollutants due to its impact on disease burden and increasing trend in concentration. However, evidence regarding short-term effect of ozone on years of life lost (YLL) is scarce., Methods: A national time-series study was conducted in 48 large Chinese cities from 2013 to 2017. Generalized additive model coupled with random effects model were used to estimate national-average associations of ozone with YLL. Potential modifiers and additional life gain due to avoidable YLL under certain scenario were also evaluated., Results: The average annual mean ozone concentration of these cities was 86.9 μg/m 3 . For 10 μg/m 3 increase in 3-day moving average ozone concentration, we estimated 0.37% [95% confidence interval (CI): 0.29%, 0.46%] increase in YLL from nonaccidental causes, 0.38% (95% CI: 0.30%, 0.46%) increase in YLL from cardiovascular diseases, and 0.36% (95% CI: 0.16%, 0.56%) increase in YLL from respiratory diseases. Moreover, the associations were more evident in people with less education and in cities with lower carbon monoxide concentration or those located at north region with lower mean temperature. Finally, an estimated life of 0.055 (95% CI: 0.043, 0.068) years would be gained per deceased people if ozone concentration could fall to 100 μg/m 3 ., Conclusions: Our findings indicated robust associations between short-term exposure to ozone and YLL from nonaccidental causes and cardiopulmonary diseases. Relevant intervention design should take the heterogeneity of both individual- and city-level characteristics into account. Implementation of more stringent standard is beneficial for alleviating YLL caused by ozone., 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.)

Background: Coarse particulate matter with aerodynamic diameter between 2.5 and [Formula: see text] ([Formula: see text]) air pollution is a severe environmental problem in developing countries, but its challenges to public health were rarely evaluated., Objective: We aimed to investigate the associations between day-to-day changes in [Formula: see text] and cause-specific mortality in China., Methods: We conducted a nationwide daily time-series analysis in 272 main Chinese cities from 2013 to 2015. The associations between [Formula: see text] concentrations and mortality were analyzed in each city using overdispersed generalized additive models. Two-stage Bayesian hierarchical models were used to estimate national and regional average associations, and random-effect models were used to pool city-specific concentration-response curves. Two-pollutant models were adjusted for fine particles with aerodynamic diameter [Formula: see text] ([Formula: see text]) or gaseous pollutants., Results: Overall, we observed positive and approximately linear concentration-response associations between [Formula: see text] and daily mortality. A [Formula: see text] increase in [Formula: see text] was associated with higher mortality due to nonaccidental causes [0.23%; 95% posterior interval (PI): 0.13, 0.33], cardiovascular diseases (CVDs; 0.25%; 95% PI: 0.13, 0.37), coronary heart disease (CHD; 0.21%; 95% PI: 0.05, 0.36), stroke (0.21%; 95% PI: 0.08, 0.35), respiratory diseases (0.26%; 95% PI: 0.07, 0.46), and chronic obstructive pulmonary disease (COPD; 0.34%; 95% PI: 0.12, 0.57). Associations were stronger for cities in southern vs. northern China, with significant differences for total and cardiovascular mortality. Associations with [Formula: see text] were of similar magnitude to those for [Formula: see text] in both single- and two-pollutant models with mutual adjustment. Associations were robust to adjustment for gaseous pollutants other than nitrogen dioxide and sulfur dioxide. Meta-regression indicated that a larger positive correlation between [Formula: see text] and [Formula: see text] predicted stronger city-specific associations between [Formula: see text] and total mortality., Conclusions: This analysis showed significant associations between short-term [Formula: see text] exposure and daily nonaccidental and cardiopulmonary mortality based on data from 272 cities located throughout China. Associations appeared to be independent of exposure to [Formula: see text], carbon monoxide, and ozone. https://doi.org/10.1289/EHP2711.

Background: The evidence was limited and inconclusive about the added effects of heatwaves, especially in developing countries., Objective: To evaluate the added effects of heatwaves on cause-specific mortality in China., Methods: We designed a nationwide time-series analysis based on daily data from 272 main Chinese cities to from 2013 to 2015. We adopted 12 definitions by combining 4 heat thresholds (90th, 92.5th, 95th, 97.5th percentile of city-specific daily mean temperature) and duration of ≥2, 3 and 4 days. We applied overdispersed generalized additive models with distributed lag models to estimate the city-specific cumulative effects of heatwaves over lags of 0-10 days after controlling for daily temperature. We then, used a meta-regression model to pool the effect estimates at national and regional levels., Results: Heatwaves could significantly increase risk for mortality from total and cardiopulmonary diseases, including coronary heart disease, ischemic stroke (rather than hemorrhagic stroke) and chronic obstructive pulmonary disease. The effects increased with higher thresholds, but were not appreciably influenced by the duration of heat. The risks generally occurred immediately and lasted for 3 to 5 days. The risks were much larger in the temperate continental zone and the temperate monsoon zones than in the subtropical monsoon zone where there was an evident mortality displacement. The elderly, females and less-educated people were more vulnerable., Conclusions: This analysis provided ample evidence for the added mortality risk associated with heatwaves, which had important implications for designing heatwave-warning systems and predicting the disease burden of future heatwaves., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Stroke is the second leading cause of death in the world. It has multiple risk factors of which some, such as ambient temperature, are less well documented., Objective: We aimed to examine the association between diurnal temperature range (DTR) and stroke mortality, and to test the possible effect modification of this association according to gender, age and educational level., Methods: Daily data on weather and stroke mortality from 16 provincial capital cities in China for the years 2007-2013 were obtained, with a total of 788,783 deaths from stroke. A quasi-Poisson generalized linear regression combined with a distributed lag non-linear model was used to examine the city-specific DTR effect on stroke mortality. The pooled effects of DTR on stroke mortality were then obtained using a meta-analysis, which was based on restricted maximum likelihood estimation., Results: The DTR impacts were generally limited to a period of eight days, while significant effects during lag 0-8 days were only found in the cities of Beijing, Zhengzhou, Nanjing, Hefei, Chongqing and Changsha. The DTR effects were significantly and negatively associated with latitudes at lag 0-10 days (r s = - 0.640, P = 0.008). An increase of 1 °C in DTR was associated with pooled estimate of 0.66% (95%CI: 0.28-1.05%), 0.12% (- 0.26% to 0.51%) and 0.67% (0.26-1.07%) increases in stroke mortality at lag 0-10 days during the total, hot and cold days, respectively. The impact of DTR was much higher in southern China than in northern China [1.02% (0.62% to 1.43%) versus 0.10% (-0.27% to 0.47%) ]. For the individual characteristics, only females, the elderly aged ≥ 65 years, and those with lower educational attainment were vulnerable to DTR., Conclusions: DTR has considerable effects on risk of mortality from stroke in various cities in China, especially among the elderly, females, those with low educational level, and people living in southern China. The results can inform decisions on developing programs to protect vulnerable subpopulations from adverse impacts of DTR., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: There has been a long history of debate regarding whether ambient nitrogen dioxide (NO2) directly affects human health., Methods: We conducted a nationwide time-series analysis in 272 major Chinese cities (2013-2015) to evaluate the associations between short-term exposure to NO2 and cause-specific mortality. We used the overdispersed generalized linear model together with the Bayesian hierarchical model to estimate the associations between NO2 and mortality at the national and regional levels. We examined two-pollutant models with adjustment of fine particles, sulfur dioxide, carbon monoxide, and ozone to evaluate robustness for the effects of NO2., Results: At the national-average level, we observed linear and positive associations between NO2 and mortality from all causes and main cardiorespiratory diseases. A 10 μg/m increase in 2-day average concentrations of NO2 would lead to increments of 0.9% (95% posterial interval [PI], 0.7%, 1.1%) in mortality from total nonaccidental causes, 0.9% (95% PI, 0.7%, 1.2%) from total cardiovascular disease, 1.4% (95% PI, 0.8%, 2.0%) from hypertension, 0.9% (95% PI, 0.6%, 1.2%) from coronary heart disease, 0.9% (95% PI, 0.5%, 1.2%) from stroke, 1.2% (95% PI, 0.9%, 1.5%) from total respiratory diseases, and 1.6% (95% PI, 1.1%, 2.0%) from chronic obstructive pulmonary disease. There were no appreciable differences in estimates from single-pollutant and two-pollutant models. The associations were stronger in the south of China, in the elderly, and in females., Conclusions: The present study provided robust epidemiologic evidence of associations between day-to-day NO2 and mortality from total natural causes and main cardiorespiratory diseases that might be independent of other criteria air pollutants.

Background: Evidence of the acute health effects of ambient carbon monoxide air pollution in developing countries is scarce and mixed. We aimed to evaluate short-term associations between carbon monoxide and daily cardiovascular disease mortality in China., Methods: We did a nationwide time-series analysis in 272 major cities in China from January, 2013, to December, 2015. We extracted daily cardiovascular disease mortality data from China's Disease Surveillance Points system. Data on daily carbon monoxide concentrations for each city were obtained from the National Urban Air Quality Real-time Publishing Platform. City-specific associations between carbon monoxide concentrations and daily mortality from cardiovascular disease, coronary heart disease, and stroke were estimated with over-dispersed generalised linear models. Bayesian hierarchical models were used to obtain national and regional average associations. Exposure-response association curves and potential effect modifiers were evaluated. Two-pollutant models were fit to evaluate the robustness of the effects of carbon monoxide on cardiovascular mortality., Findings: The average annual mean carbon monoxide concentration in these cities from 2013 to 2015 was 1·20 mg/m 3 , ranging from 0·43 mg/m 3 to 2·45 mg/m 3 . For a 1 mg/m 3 increase in average carbon monoxide concentrations on the present day and previous day (lag 0-1), we observed significant increments in mortality of 1·12% (95% posterior interval [PI] 0·42-1·83) from cardiovascular disease, 1·75% (0·85-2·66) from coronary heart disease, and 0·88% (0·07-1·69) from stroke. These associations did not vary substantially by city, region, and demographic characteristics (age, sex, and level of education), and the associations for cardiovascular disease and coronary heart disease were robust to the adjustment of criteria co-pollutants. We did not find a threshold below which carbon monoxide exposure had no effect on cardiovascular disease mortality., Interpretation: This analysis is, to our knowledge, the largest study done in a developing country, and provides robust evidence of the association between short-term exposure to ambient carbon monoxide and increased cardiovascular disease mortality, especially coronary heart disease mortality., Funding: Public Welfare Research Program., (Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)