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.

While increasing evidence suggested that PM₂.₅ is the most harmful fraction of the particle pollutants, the health effects of coarse particles (PM₁₀–₂.₅) have been inconclusive, especially on cerebrovascular diseases, we thus evaluated the effects of PM₁₀, PM₂.₅, and PM₁₀–₂.₅ on stroke mortality in six Chinese subtropical cities using generalized additive models. We also conducted random-effects meta-analyses to estimate the overall effects across the six cities. We found that PM₁₀, PM₂.₅, and PM₁₀₋₂.₅ were significantly associated with stroke mortality. Each 10 μg/m³ increase of PM₁₀, PM₂.₅ and PM₁₀₋₂.₅ (lag03) was associated with an increase of 1.88% (95% CI: 1.37%, 2.39%), 3.07% (95% CI: 2.35%, 3.79%), and 5.72% (95% CI: 3.82%, 7.65%) in overall stroke mortality. Using the World Health Organization's guideline as reference concentration, we estimated that 3.21% (95% CI: 1.65%, 3.01%) of stroke mortality (corresponding to 1743 stroke mortalities, 95% CI: 896, 1633) were attributed to PM₁₀, 5.57% (95% CI: 0.50%, 1.23%) stroke mortality (3019, 95% CI: 2286, 3777) were attributed to PM₂.₅, and 2.02% (95% CI: 1.85%, 3.08%) of stroke mortality (1097, 95% CI: 1005, 1673) could be attributed to PM₁₀₋₂.₅. Our analysis indicates that both PM₂.₅ and PM₁₀₋₂.₅ are important risk factors of stroke mortality and should be considered in the prevention and control of stroke in the study area.

Few studies have analyzed the health effects of temperature variability (TV) accounting for both interday and intraday variations in ambient temperature. In this study, TV was defined as the standard deviations of the daily minimum and maximum temperature during different exposure days. Distributed lag non-linear Poisson regression model was used to examine the city-specific effect of TV on mortality in 31 Chinese municipalities and provincial capital cities. The national estimate was pooled through a meta-analysis based on the restricted maximum likelihood estimation. To assess effect modification on TV-mortality association by individual characteristics, stratified analyses were further fitted. Potential effect modification by city characteristics was performed through a meta-regression analysis. In total, 259 million permanent residents and 4,481,090 non-accidental deaths were covered in this study. The effect estimates of TV on mortality were generally increased by longer exposure days. A 1 °C increase in TV at 0–7 days' exposure was associated with a 0.60% (95% CI: 0.25–0.94%), 0.65% (0.24–1.05%), 0.82% (0.29–1.36%), 0.86% (0.42–1.31%), 0.98% (0.57–1.39%) and 0.54% (−0.11-1.20%) increase in non-accidental, cardiovascular, IHD, stroke, respiratory and COPD mortalities, respectively. Those with lower levels of educational attainment were significantly susceptible to TV. Cities with dense population, higher mean temperatures, and relative humidity and lower diurnal temperature ranges also had higher mortality risks caused by TV. This study demonstrated that TV had considerable health effects. An early warning system to alert residents about large temperature variations is recommended, which may have a significant impact on the community awareness and public health.

Previous studies reported triggering of acute cardiovascular events by short-term increasedPM₂.₅ concentrations. From 2007 to 2013, national and New York state air quality policies and economic influences resulted in reduced concentrations of PM₂.₅ and other pollutants across the state. We estimated the rate of cardiovascular hospital admissions associated with increased PM₂.₅ concentrations in the previous 1–7 days, and evaluated whether they differed before (2005–2007), during (2008–2013), and after these concentration changes (2014–2016).Using the Statewide Planning and Research Cooperative System (SPARCS) database, we retained all hospital admissions with a primary diagnosis of nine cardiovascular disease (CVD) subtypes, for residents living within 15 miles of PM₂.₅ monitoring sites in Buffalo, Rochester, Albany, Queens, Bronx, and Manhattan from 2005 to 2016 (N = 1,922,918). We used a case-crossover design and conditional logistic regression to estimate the admission rate for total CVD, and nine specific subtypes, associated with increased PM₂.₅ concentrations.Interquartile range (IQR) increases in PM₂.₅ on the same and previous 6 days were associated with 0.6%–1.2% increases in CVD admission rate (2005–2016). There were similar patterns for cardiac arrhythmia, ischemic stroke, congestive heart failure, ischemic heart disease (IHD), and myocardial infarction (MI). Ambient PM₂.₅ concentrations and annual total CVD admission rates decreased across the period. However, the excess rate of IHD admissions associated with each IQR increase in PM₂.₅ in previous 2 days was larger in the after period (2.8%; 95%CI = 1.5%–4.0%) than in the during (0.6%; 95%CI = 0.0%–1.2%) or before periods (0.8%; 95%CI = 0.2%–1.3%), with similar patterns for total CVD and MI, but not other subtypes.While pollutant concentrations and CVD admission rates decreased after emission changes, the same PM₂.₅ mass was associated with a higher rate of ischemic heart disease events. Future work should confirm these findings in another population, and investigate whether specific PM components and/or sources trigger IHD events.

Knowledge of environmental risk factors for stroke and their role are limited. We performed a case-cohort study to evaluate the association between serum persistent organic pollutants (POPs) level and stroke risk.526 subcohort members and 111 stroke incidence cases were identified from the Korean Cancer Prevention Study-II. Serum levels of POPs were measured using gas chromatography/high-resolution mass spectrometry. The hazard ratios (HRs) for stroke (ischemic, hemorrhagic, and all stroke types) were estimated using the weighted Cox regression model. Age, sex, body mass index, smoking status, physical activity, family history of cardiovascular disease, and hypertension were adjusted in the weighted Cox regression model.After adjusting for potential confounding factors, increased risk for stroke was observed among participants with serum concentration of p,p'-DDE in the highest tertile compared to those in the lowest tertile (HR = 4.10, 95% CI: 1.58, 10.59). A similar association was estimated for PCB118 (HR = 2.33, 95% CI: 1.04, 5.22), PCB156 (HR = 3.42, 95% CI: 1.42, 8.23), and PCB138 (HR = 3.80, 95% CI: 1.48, 9.76). For TEQ, stroke was three times as likely to occur among subjects with TEQ in the highest tertile compared to those in the lowest tertile (HR = 3.12, 95% CI: 1.27, 7.65). PCBs were positively associated with ischemic stroke, but not with hemorrhagic stroke.Elevated serum POPs levels were associated with an increased risk of stroke, especially ischemic stroke.

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.

The estimation of PM₂.₅-related mortality is becoming increasingly important. The accuracy of results is largely dependent on the selection of methods for PM₂.₅ exposure assessment and Concentration-Response (C-R) function. In this study, PM₂.₅ observed data from the China National Environmental Monitoring Center, satellite-derived estimation, widely collected geographic and socioeconomic information variables were applied to develop a national satellite-based Land Use Regression model and evaluate PM₂.₅ exposure concentrations within 2013–2015 with the resolution of 1 km × 1 km. Population weighted concentration declined from 72.52 μg/m³ in 2013 to 57.18 μg/m³ in 2015. C-R function is another important section of health effect assessment, but most previous studies used the Integrated Exposure Regression (IER) function which may currently underestimate the excess relative risk of exceeding the exposure range in China. A new Shape Constrained Health Impact Function (SCHIF) method, which was developed from a national cohort of 189,793 Chinese men, was adopted to estimate the PM₂.₅-related premature deaths in China. Results showed that 2.19 million (2013), 1.94 million (2014), 1.65 million (2015) premature deaths were attributed to PM₂.₅ long-term exposure, different from previous understanding around 1.1–1.7 million. The top three provinces of the highest premature deaths were Henan, Shandong, Sichuan, while the least ones were Tibet, Hainan, Qinghai. The proportions of premature deaths caused by specific diseases were 53.2% for stroke, 20.5% for ischemic heart disease, 16.8% for chronic obstructive pulmonary disease and 9.5% for lung cancer. IER function was also used to calculate PM₂.₅-related premature deaths with the same exposed level used in SCHIF method, and the comparison of results indicated that IER had made a much lower estimation with less annual amounts around 0.15–0.5 million premature deaths within 2013–2015.

In recent years, ambient air has been severely contaminated by particulate matters (PMs) and some gas pollutants (nitrogen dioxide (NO₂) and sulfur dioxide (SO₂)) in China, and many studies have demonstrated that exposure to these pollutants can induce great adverse impacts on human health. The concentrations of the pollutants were much higher in winter than those in summer, and the average concentrations in this studied area were lower than those in northern China. In the comparison between high-resolution emission inventory and spatial distribution of PM₂.₅, significant positive linear correlation was found. Though the pollutants had similar trends, NO₂ and SO₂ delayed with 1 h to PM₂.₅. Besides, PM₂.₅ had a lag time of 1 h to temperature and relative humidity. Significant linear correlation was found among pollutants and meteorological conditions, suggesting the impact of meteorological conditions on ambient air pollution other than emission. For the 24-h trend, lowest concentrations of PM₂.₅, NO₂, and SO₂ were found around 15:00–18:00. In 2015, the population attributable fractions (PAFs) for ischemic heart disease (IHD), cerebrovascular disease (stroke), chronic obstructive pulmonary disease (COPD), lung cancer (LC), and acute lower respiratory infection (ALRI) due to the exposure to PM₂.₅ in Zhejiang province were 25.82, 38.94, 17.73, 22.32, and 31.14%, respectively. The population-weighted mortality due to PM₂.₅ exposure in Zhejiang province was lower than the average level of the whole country—China.