Poor indoor air quality can have adverse effects on human health, especially in susceptible populations; however, few studies have measured multiple pollutants in facilities for susceptible populations at a national scale in South Korea. Therefore, we measured the concentrations of indoor pollutants (fine particulate matter (PM₁₀), CO₂, airborne bacteria (AB), total volatile organic compounds (TVOCs), and formaldehyde) to determine their possible relation to other indoor environmental factors and characteristics of facilities with susceptible populations, such as hospitals, geriatric hospitals, elderly care facilities, and postnatal care centers throughout South Korea. Indoor pollutants were sampled at 82 indoor facilities, including 62 facilities for susceptible populations. Spearman's correlation, Kruskal–Wallis, and Mann–Whitney analyses were used to examine the relationship among and differences between pollutants at indoor facilities and indoor/outdoor differences in PM₁₀ concentration. There were significant correlations between indoor temperature and AB concentration (r = 0.37, p < 0.01), TVOCs, and formaldehyde (r = 0.264, p < 0.01). Indoor PM₁₀ concentrations were higher than outdoor concentrations at all facilities for susceptible populations (p < 0.01). CO₂ might be a good indicator for predicting indoor pollutants when categorized into two levels (≤750 ppm and >750 ppm). The hazard quotient of formaldehyde was higher than the acceptable level of 1 for children under the age of eight in postnatal care centers, indicative of unsafe levels. Therefore, more depth study for exposure characteristics of formaldehyde and indoor air quality (IAQ) in postnatal care facilities as a national scale is needed for finding the children exposure levels.

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.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.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.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.

Studies differentiating the cardiorespiratory morbidity effects of PM₂.₅, PM₁₀, and PM₂.₅∼₁₀ (i.e. coarse PM or PMc) are still limited and inconsistent.To estimate the acute, cumulative, and harvesting effects of exposure to the three size-specific PM on cardiorespiratory morbidity, and their concentration-response relations.A total of 6,727,439 emergency department (ED) visits were collected from 16 public teaching hospitals in Guangzhou, from January 1st 2012 to December 31st 2015, among which over 2.1 million were asthma, COPD, pneumonia, respiratory tract infection (RTI), hypertension, stroke, and coronary heart disease (CHD). Distributed lag non-linear models (DLNM) was used to estimate the associations between the three size-specific PM and ED visits for the cardiovascular diseases. Long-term trends, seasonality, influenza epidemics, meteorological factors, and other gas pollutants, including SO2, NO₂, and O₃, were adjusted. We stratified the analyses by gender and age.Elevated PM₂.₅ and PM₁₀ were significantly associated with increased ED visits for pneumonia, RTI, and CHD at both lag₀ and lag₀₋₃. A 10 μg/m³ increment of PMc (at lag₀₋₁₄) was estimated to increase ED visits for pneumonia by 6.32% (95% CI, 4.19, 8.49) and for RTI by 4.72% (95% CI, 3.81, 5.63), respectively. PMc showed stronger cumulative effects on asthma in children than elderly. We observed significant harvesting effects (i.e. morbidity displacements) of the three size-specific PM on respiratory but very little on cardiovascular ED visits. The concentration-response curves suggested non-linear relations between exposures to the three different sizes of PM and respiratory morbidity.Overall, the three size-specific PM demonstrated distinct acute and cumulative effects on the cardiorespiratory diseases. PM₂.₅ and PMc would have significant effects on pneumonia and RTI. Strategies should be considered to further reduce levels of ambient PM₂.₅ and PMc.

This study investigated ambient volatile organic compounds (VOCs) and assessed excess health risks for child, adult and elderly populations in a residential area near a large-scale petrochemical complex in central Taiwan. A total of 155 daily VOC samples were collected in canisters from nine sites in spring, summer and winter during 2013–2014. We used a positive matrix factorization (PMF) model incorporating a conditional probability function (CPF) to quantify the potential sources of VOCs with the influences of local source directions. We then evaluated the non-cancer and cancer risks of specific VOCs with probabilistic distributions by performing a Monte-Carlo simulation for the child, adult, and elderly populations. Most of the VOCs were higher in summer than in winter or spring for the sampling sites. The presence of vinyl acetate, chloroethene, and 1,2-dichloroethane were significantly high within a 5-km radius of the petrochemical complex. Four potential sources of ambient VOCs, industrial emission (49.2%–63.6%), traffic-related emission (13.9%–19.1%), fuel evaporation (12.3%–16.9%), and aged emission (10.2%–14.8%), were identified. The cancer risk of ambient VOC exposure was mainly attributed to the industrial source in the study area, while the non-cancer risk was of less concern. Benzene associated with fuel evaporation resulted in the highest cancer risk (4.1 × 10−5−5.5 × 10−5) as compared to that of the other toxic VOCs.

The occurrence of five groups of semivolatile organic compounds (SVOCs) (total of ∼120 distinct chemicals) was investigated in senior care facilities in the United States and in Portugal. Indoor settled dust samples were collected from fourteen facilities, and the concentrations of organophosphate esters (OPEs), brominated flame retardants (BFRs), polycyclic aromatic hydrocarbons (PAHs), organochlorine pesticides (OCPs), and polychlorinated biphenyls (PCBs) were measured in these samples. Overall, OPEs, PAHs, and BFRs were the most abundant, and OCPs and PCBs were the least abundant SVOC groups in dust collected from both U.S. and Portuguese facilities. ∑OPE, ∑PAH, and ∑BFR concentrations were significantly higher in U.S. facilities than those in Portuguese facilities (P < 0.001), while ∑OCP and ∑PCB concentrations were not different between the two countries (P < 0.05). The samples were collected from three different microenvironments, including bedrooms, living rooms, and corridors. ∑OPE, ∑PAH, and ∑BFR concentrations were up to five times higher in corridors compared to bedrooms and living rooms. ∑OCP and ∑PCB concentrations were overall higher in bedrooms and in living rooms and lower in corridors.

There have been few large multicity studies to evaluate the acute health effects of ambient air pollution on morbidity risk in developing counties. In this study, we examined the short-term associations of air pollution with daily hospital admissions in China. We conducted a nationwide time-series study in 218 Chinese cities between 2014 and 2016. Data on daily hospital admissions counts were obtained from the National Health Insurance Database for Urban Employees covering 0.28 billion enrollees. We used generalized additive model with Poisson regression to estimate the associations in each city, and we performed random-effects meta-analysis to pool the city-specific estimates. More than 60 million hospital admissions were analyzed in this study. At the national-average level, each 10 μg/m³ increase in PM₁₀, SO₂, and NO₂, and 1 mg/m³ increase in CO at lag 0 day was associated with a 0.29% (95% CI, 0.23%–0.36%), 1.16% (95% CI, 0.92%–1.40%), 1.68% (95% CI, 1.40%–1.95%), and 2.59% (95% CI, 1.69%–3.50%) higher daily hospital admissions, respectively. The associations of air pollution with hospital admissions remained statistically significant at levels below the current Chinese Ambient Air Quality Standards. The effect estimates were larger in cities with lower air pollutants levels or higher air temperatures and relative humidity, as well as in the elderly. In conclusion, our findings provide robust evidence of increased hospital admissions in association with short-term exposure to ambient air pollution in China.

The associations of air pollution with chronic kidney disease (CKD) have not yet been fully studied. We enrolled 8,497 Taipei City residents older than 65 years and calculated the estimated glomerular filtration rate (eGFR) using the Taiwanese Chronic Kidney Disease Epidemiology Collaboration equation. Proteinuria was assessed via dipstick on voided urine. CKD prevalence and risk of progression were defined according to the KDIGO 2012 guidelines. Land-use regression models were used to estimate the participants’ one-year exposures to PM of different sizes and traffic-related exhaust, PM₂.₅ absorbance, nitrogen dioxide (NO₂), and NOₓ. Generalized linear regressions and logistic regressions were used to examine the associations of one-year air pollution exposures with eGFR, proteinuria, CKD prevalence and risk of progression. The results showed that the interquartile range (IQR) increments of PM₂.₅ absorbance (0.4 × 10⁻⁵/m) and NO₂ (7.0 μg/m³) were associated with a 1.07% [95% confidence interval (CI): 0.54–1.57] and 0.84% (95% CI: 0.37–1.32) lower eGFR, respectively; such relationships were magnified in subjects who had an eGFR >60 ml/min/1.73 m² or who were non-diabetic. Similar associations were also observed for PM₁₀ and PM₂.₅₋₁₀. Two-pollutant models showed that PM₁₀ and PM₂.₅ absorbance were associated with a lower eGFR. The odd ratios (ORs) of CKD prevalence and risk of progression also increased with exposures to PM₂.₅ absorbance and NO₂. In summary, one-year exposures to traffic-related air pollution were associated with lower eGFR, higher CKD prevalence, and increased risk of CKD progression among the elderly population. Air pollution-related impaired renal function was stronger in non-CKD and non-diabetic subjects.

Ambient ozone is one of the most important air pollutants with respect to its impacts on human health and its increasing concentrations globally. However, studies which explored the burden of ozone pollution on chronic obstructive pulmonary disease (COPD) and estimated the relevant economic loss were rare.We explored the relationships between ambient ozone exposure and years of life lost (YLL) from COPD mortality and estimated the relevant economic loss in Ningbo, in the Yangtze River Delta of China, 2011–2015.A time-series study was conducted to explore the effects of ozone on YLL from COPD. Seasonal stratified analyses were performed, and the effect modification of demographic factors was estimated. In addition, the related economic loss was calculated using the method of the value per statistical life year (VSLY).Averaged daily mean maximum 8-h average ozone concentration was 40.90 ppb in Ningbo, China, 2011–2015. The effect of short term ambient ozone exposure on COPD YLL was more pronounced in the cool season than in the warm season, with 10 ppb increment of ozone corresponding to 7.09(95%CI: 3.41, 10.78) years increase in the cool season and 0.31 (95%CI: −2.15, 2.77) years change in the warm season. The effect was higher in the elderly than the young. Economic loss due to excess COPD YLL related to ozone exposure accounted for 7.30% of the total economic loss due to COPD YLL in Ningbo during the study period.Our findings highlight that ozone exposure was related to tremendous disease burden of COPD in Ningbo, China. The effects were more pronounced in the cool season, and the elderly were more susceptible populations.

The effects of ambient temperature on stroke death in China have been well addressed. However, few studies are focused on the attributable burden for the incident of different types of stroke due to ambient temperature, especially in Beijing, China. We purpose to assess the influence of ambient temperature on hospital stroke admissions in Beijing, China. Data on daily temperature, air pollution, and relative humidity measurements and stroke admissions in Beijing were obtained between 2013 and 2014. Distributed lag non-linear model was employed to determine the association between daily ambient temperature and stroke admissions. Relative risk (RR) with 95% confidence interval (CI) and Attribution fraction (AF) with 95% CI were calculated based on stroke subtype, gender and age group. A total number of 147, 624 stroke admitted cases (including hemorrhagic and ischemic types of stroke) were documented. A non-linear acute effect of cold temperature on ischemic and hemorrhagic stroke hospital admissions was evaluated. Compared with the 25th percentile of temperature (1.2 °C), the cumulative RR of extreme cold temperature (first percentile of temperature, −9.6 °C) was 1.51 (95% CI: 1.08–2.10) over lag 0–14 days for ischemic type and 1.28 (95% CI: 1.03–1.59) for hemorrhagic stroke over lag 0–3 days. Overall, 1.57% (95% CI: 0.06%–2.88%) of ischemic stroke and 1.90% (95% CI: 0.40%–3.41%) of hemorrhagic stroke was attributed to the extreme cold temperature over lag 0–7 days and lag 0–3 days, respectively. The cold temperature's impact on stroke admissions was found to be more obvious in male gender and the youth compared to female gender and the elderly. Exposure to extreme cold temperature is associated with increasing both ischemic and hemorrhagic stroke admissions in Beijing, China.

Reduced physical performance is an important feature of aging, and walking speed is a valid measure of physical performance and mobility in older adults. Previous epidemiological studies suggest that cadmium exposure, even at low environmental levels, may contribute to vascular, musculoskeletal, and cognitive dysfunction, which may all be associated with reductions in physical performance. To this end, we investigated the associations of blood and urine cadmium concentrations with walking speed in middle-aged and older adults in the U.S. general population. We studied U.S. adults from the National Health and Nutrition Examination Survey 1999 to 2002 who were ≥50 years of age, who had determinations of cadmium in blood or in urine, and who had measurements of the time taken to walk 20 feet. Walking speed (ft/sec) was computed as walked distance (20 ft) divided by measured time to walk (in seconds). The weighted geometric means of blood and urine cadmium were 0.49 [95% confidence interval (CI): 0.47, 0.52] μg/L and 0.37 (95% CI: 0.34, 0.42) ng/mL, respectively. After adjusting for sociodemographic, anthropometric, health-related behavioral, and clinical risk factors and inflammation markers, the highest (vs. lowest) quintile of blood cadmium was associated with a 0.18 (95% CI: 0.10, 0.25) ft/sec reduction in walking speed (p-Trend <0.001). No association was observed for urine cadmium levels with walking speed. Cadmium concentrations in blood, but not in urine, were associated with slower gait speed. Our findings add to the growing volume of evidence supporting cadmium's toxicity even at low levels of exposure.