A Prospective Cohort Study of Antimony Exposure and Cognitive Impairment in Older Adults—China,2017–2021

What is already known about this topic?Antimony(Sb)has been identified as a new neurotoxicant that impacts neurological functions in animal studies.However,its effects on the human population remain unknown.What is added by this report?The study reveals that there is an association between exposure to Sb and a higher incidence of cognitive impairment in older adults.The dose-response curve demonstrates that the risk of cognitive impairment consistently increased with higher levels of Sb exposure without a discernible threshold.What are the implications for public health practice?Reducing exposure to Sb may have a beneficial effect in delaying or preventing the onset of cognitive impairment.This intervention has the potential to significantly decrease the disease burden associated with cognitive impairment,ultimately contributing to social development.

Association between Long-Term Exposure to PM_(2.5) Inorganic Chemical Compositions and Cardiopulmonary Mortality: A 22-Year Cohort Study in Northern China

Particulate matter with diameters≤2.5μm(PM_(2.5))has been identified as a significant air pollutant contributing to premature mortality.Nevertheless,the specific compositions within PM_(2.5) that play the most crucial role remain unclear,especially in areas with high pollution concentrations.This study aims to investigate the individual and joint mortality risks associated with PM_(2.5) inorganic chemical compositions and identify primary contributors.In 1998,we conducted a prospective cohort study in four northern Chinese cities(Tianjin,Shenyang,Taiyuan,and Rizhao).Satellite-based machine learning models calculated PM_(2.5) inorganic chemical compositions,including sulfate(SO_(4)^(2–)),nitrate(NO_(3)^(–)),ammonium(NH_(4)^(+)),and chloride(Cl^(-)).A time-varying Cox proportional hazards model was applied to analyze associations between these compositions and cardiorespiratory mortality,encompassing nonaccidental causes,cardiovascular diseases(CVDs),nonmalignant respiratory diseases(RDs),and lung cancer.The quantile-based g-computation model evaluated joint exposure effects and relative contributions of the compositions.Stratified analysis was used to identify vulnerable subpopulations.During 785,807 person-years of follow-up,5812(15.5%)deaths occurred from nonaccidental causes,including 2932(7.8%)from all CVDs,479(1.3%)from nonmalignant RDs,and 552(1.4%)from lung cancer.Every interquartile range(IQR)increase in SO_(4)^(2–)was associated with mortality from nonaccidental causes(hazard ratio:1.860;95%confidence interval:1.809,1.911),CVDs(1.909;1.836,1.985),nonmalignant RDs(2.178;1.975,2.403),and lung cancer(1.773;1.624,1.937).In the joint exposure model,a simultaneous rise of one IQR in all four compositions increased the risk of cardiorespiratory mortality by at least 36.3%,with long-term exposure to SO_(4)^(2–)contributing the most to nonaccidental and cardiopulmonary deaths.Individuals with higher incomes and lower education levels were found to be more vulnerable.Long-term exposure to higher levels of PM_(2.5) inorganic compositions was associated with significantly increased cardiopulmonary mortality,with SO_(4)^(2–)potentially being the primary contributor.These findings offer insights into how PM_(2.5) sources impact health,aiding the development of more effective governance measures.

Poverty and malaria in the Yunnan province, China

Poverty and malaria appear to have an intertwined link.This paper aims to define the relationship between poverty and malaria in Yunnan,China,and to make recommendations for future research in this important area.Data on malaria prevalence and the population’s income in each county between 2005 and 2010 were obtained from the Yunnan Center for Disease Control and Prevention and the Yunnan Bureau of Statistics,respectively.Geographic mapping shows an apparent spatial convergence of poverty and the incidence of malaria at a county level,and suggests that poverty may be one of the drivers of malaria transmission in Yunnan.Future research should focus on:1.measuring and quantifying the relationship between poverty and the malaria burden at the individual,community,county and regional level in Yunnan;and 2.developing the GIS-based spatial decision support system(SDSS)framework in malaria endemic areas,particularly along the border areas in Yunnan.

Economic burden of premature deaths attributable to different heatwaves in China: A multi-site study, 2014-2019

It has been well documented that heatwaves are linked to elevated mortality and morbidity.However,the selection of optimal heatwave definitions for subsequent risk assessment has been inconsistent and there is no full picture of the effects of heatwaves with different intensities on economic losses due to mortality,which can provide important insights for public health considerations.Hence,we used a two-stage time series analysis,combined with values of statistical life(VsL)based on the value of a statistical life year to assess the economic burden of deaths associated with heatwaves of different intensities and durations and to identify the vulnerable populations and regions.We further conducted stratified analyses by age,sex,and region.We found 2.9%(95%CI:0.0%,6.5%)-20.0%(95%CI:2.9%,34.2%)of VsL were attributable to heatwaves,corresponding to attributable economic losses(AELs)of 2.20(95%CI:0.32,3.77)-4.77(95%CI:1.53,7.63)billion CNY.The economic burden of death was most sensitive to heatwave H99P_2D(99th percentile,at last 2 consecutive days),while H97.5P_2D(97.5th percentile,at last 2 consecutive days)caused the highest attributable economic losses.Females and elderly people aged≥65 years were more sensitive.The AELs in the temperate zone and northern regions were larger than those in subtropical zone and southern regions during relatively low-intensity heatwaves,respectively.By contrast,the AELs in subtropical zone and southern regions were relatively higher than those in temperate zone and northern regions during relatively high-intensity heatwaves,respectively.The AELs were larger in urban areas than in rural areas.Tailored intervention strategies,primarily focusing on vulnerable populations and regions,should be formulated to reduce the economic loss due to heatwaves in the context of climate change.

Air pollution and liver cancer: A systematic review

Air pollution has previously been linked to several adverse health outcomes, but the potential association between air pollution and liver cancer remains unclear. We searched Pub Med, EMBASE, and Web of Science from inception to 10 October 2021, and manually reviewed the references of relevant papers to further identify any related literature investigating possible associations between air pollution and liver cancer. Risk estimates values were represented by statistical associations based on quantitative analyses. A total of 13cohort studies obtained from 11 articles were included, with 10,961,717 participants. PM_(2.5)was the most frequently examined pollutant(included in 11 studies), followed by NO_(2)and NOx(included in 6 studies), and fewer studies focused on other pollutants(PM_(2.5)absorbance,PM_(10), PM_(2.5–10), O_(3), and BC). In all the 16 associations for liver cancer mortality, 14 associations reported the effect of PM_(2.5)on liver cancer mortality. Eight associations on PM_(2.5)were significant, showing a suggestive association between PM_(2.5)and liver cancer mortality. Among24 associations shown by risk estimates for liver cancer incidence, most associations were not statistically significant. For other air pollutants, no positive associations were presented in these studies. PM_(2.5)was the most frequently examined pollutant, followed by NO_(2)and NOx, and fewer studies focused on other pollutants. PM_(2.5)was associated with liver cancer mortality, but there was no association for other air pollutants. Future research should use advanced statistical methods to further assess the impact of multiple air pollutants on liver cancer in the changing socio-environmental context.

Temperature change between neighboring days and hospital admissions in China

The short-term temperature fluctuation caused by global climate change is one of the risk factors affecting public health.Exploring the association between temperature fluctuation and diseases,which has received relatively limited research attention,can contribute to enhancing awareness of health risks and taking timely measures for health risk alert and management.Therefore,this study aims to investigate the relationship between temperature change between neighboring days(TCN)and hospitalizations,identify diseases sensitive to extreme TCN,and evaluate the related disease burden.We collected meteorological and hospitalization data from 2014 to 2019 in 23 sites of China to explore the impact of TCN on hospitalizations.We first quantified site-specific associations between TCN and hospitalizations and then conducted meta-analysis to pool the results,to assess the relative risk of extreme TCN for susceptible diseases,and to estimate the related disease burden attributed to TCN.Stratified analyses were undertaken by age,sex,and disease type.Results showed that all-cause hospital admission was significantly linked to TCN.A negative TCN(below-1.9℃)in the cool season and a positive TCN(above 1.0℃)in the warm season increased the risk of hospitalization.People aged 15-64 years,men,and patients with musculoskeletal system or connective tissue diseases were more sensitive to extremely negative TCN during the cool season.People aged over 65 years,men,and patients with respiratory diseases were more sensitive to extremely positive TCN during the warm season.The attributable fraction to all-cause hospitalization from negative TCN in the cool season was 2.05%(95%CI:-0.90%,4.53%)and from positive TCN in the warm season was 5.79%(95%CI:2.98%,8.31%).Circulatory diseases in the cool season and respiratory diseases in the warm season had the highest disease burden.Our findings indicate that awareness of TCN and its health risks should be promoted and evidence-informed policies are needed to reduce the risk of TCN.

Evaluating modified effects of family factors on intervention to protect primary school students from the impact of heatwave

Identifying the factors that may impact intervention effectiveness of primary students is crucial for developing targeted intervention strategies on heatwave adaption.The purpose of the study was to assess how the family factors could affect the intervention effects of primary school students to adapt heatwave,using the data from a previously conducted primary school-based intervention study.The study recruited 648 students(9-13 years old)and their parents from two primary schools in Dongtai of Jiangsu province,China.From May to September 2017,a 5-mon intervention for enhancing knowledge,attitude and practice(KAP)was implemented at the intervention school.The students'KAP scores and the family-related information were measured by designed self-administered questionnaires at intervention school and control school separately before and after intervention.The effects of the intervention were explored through the propensity score matching and difference-in-difference method(PSM-DID),and stratifed analysis were conducted by family factors.The overall KAP score increased by 2.391(95%CI:1.881,2.902)after intervention,which shows that the intervention was effective.The students whose parents with higher school educational attainment,parents with employment,and household number≤3 achieved significantly higher increment of KAP scores than their counterparts.Although students whose parents in marriage achieved higher score increasing than parents not in marriage,the difference was non-significant.Our findings indicated that parental education status,working status and the household size were the influence factors of heatwave adaption interventions for primary school students.Future interventions should take parental education status,working status and household size into account to improve the effectiveness of heatwave adaption intervention for primary school students.

Health risks from non-optimal temperatures in different populations and regions in China:Tailored intervention strategies are needed

Identifying temperature-sensitive diseases,vulnerable populations and attributable disease burden is crucial for the development and implementation of tailored climate change adaptation strategies in the context of climate change,especially through both mortality and morbidity analysis by using the data from same regions and populations.We re-analyzed and outlined the whole picture of the impacts of extreme temperatures on both mortality and morbidity among various populations and regions,based on the researches from a well-planned national project of Scientific Survey of Regional Meteorological Sensitive Diseases(SRMSD)with consistent methodology in China.The twenty-four representative regions of the SRMSD project cover all eleven geographical meteorological divisions in the country,including urban and rural areas.In addition to circulatory and respiratory diseases,we found that neurological diseases,injuries,digestive diseases,endocrine diseases,genitourinary diseases,skin and subcutaneous tissue diseases were sensitive to extreme heat,while digestive diseases were sensitive to extreme cold.The extreme temperature-sensitive diseases and the attributable disease burden varied by region.Females and the elderly people(65 years old and above)were more vulnerable to extreme heat when using mortality as a health outcome,whereas males and the young and middle-aged adults were more vulnerable to morbidity risk from heat.Our findings provide important scientific evidence for regional distribution of temperature-sensitive diseases and identification of vulnerable populations in China.It provides evidence and implications of developing regional heat/cold-exposure intervention policies,especially for hospital emergency departments and ambulance services during hot seasons.

Total and cause-specific mortality attributable to cold spells in China:A multicity and multicounty study

Climate change has resulted in an increase in the frequency and intensity of extreme cold weather events,but few multicity or multicounty researches have explored the association between cold spells and mortality risk and burden.We collected daily data on climate,sociodemo-graphic factors and mortality in 18 cities/counties across 11 geographical regions for the period of November to March 2014-2018.A distributed lag nonlinear model was used to examine the association between cold spells and mortality after adjustment for confounding factors.Twelve definitions of cold spells were used.Multi-meta regression analysis was applied to pool the impacts over different regions.Cold spells were significantly associated with all-cause mortality at lag 0-21(CRR:1.38,95%CI:1.21,1.57).In addition to respiratory diseases and cir-culatory system diseases,digestive,endocrine and nervous system diseases and injury were also affected by cold spells.The magnitude of the impacts of cold spells on mortality varied among the diseases investigated,with the highest risk estimate found for influenza and pneumonia(CRR:2.00,95%CI:1.45,2.76)and the lowest estimate found for injury(CRR:1.26,95%CI:1.09,1.46).The fraction of all-cause mortality attributable to cold spells was 2.31%(95%CI:0.90%,3.46%).Among the regional differences,the attributable burden of all-cause mortality was higher in rural areas and subtropical monsoon climate zone,with attributable fractions of 2.85%(95%CI:1.23%,4.11%)and 3.36%(95%CI:0.55%,5.35%),respectively.Cold spells increased mortality from a range of diseases.Women,older adults and residents of rural areas and subtropical monsoon climate zone were more vulnerable to cold spells impacts.The findings may help to formulate preventive strategies and early warning response plans to reduce mortality burden of extreme cold events.

Association of heat exposure and emergency ambulance calls: A multi-city study

Evidence of the impact of ambient temperatures on emergency ambulance calls (EACs) in developing countries contributes to the improvement and complete understanding of the acute health effects of temperatures. This study aimed to examine the impacts and burden of heat on EACs in China, quantify the contributions of regional modifiers, and identify the vulnerable populations. A semi-parametric generalized additive model with a Poisson distribution was used to analyze the city-specific impacts of the daily maximum temperature (Tmax) on EACs in June–August in 2014–2017. Stratified analyses by sex and age were performed to identify the vulnerable sub-populations. Meta-analysis was undertaken to illustrate the pooled associations. Further subgroup analysis, stratified by climate, latitude, and per capita disposable income (PCDI), and meta-regression analysis were conducted to explore the regional heterogeneity and quantify the contributions of possible modifiers. The city- and region-specific attributable fractions of EACs attributable to heat were calculated. Strong associations were observed between the daily Tmax and total EACs in all cities. A total of 11.7% (95% confidence interval (CI): 11.2%–12.3%) of EACs were attributed to high temperatures in ten Chinese cities, and the central region with a low level of PCDI had the highest attributable fraction of 17.8% (95% CI: 17.2%–18.4%). People living in the central region with lower PCDI, and those aged 18–44 and 0–6 years were more vulnerable to heat than the others. The combined effects of PCDI, temperature, and latitude contributed 88.6% of the regional heterogeneity. The results complemented the understanding of the burden of EACs attributable to heat in developing countries and the quantitative contribution of regional modifiers.

Exploring atmospheric environmental drivers of asthma among children in Shanghai, China: Evidence-informed policies are required

It is important to identify atmospheric environmental drivers of childhood asthma because asthma is the most common chronic disease in children globally.We provided an overview of the impacts of exposure to atmospheric environmental factors(e.g.,meteorological factors and air pollutants)on childhood asthma,based on a series of studies with the cutting-edge environmental epidemiological methodology in Shanghai,China.Overall,we found that the prevalence of asthma among the children aged 3–7 years had increased by approximately 7 fold,from 2.1%in 1990 to 14.6%in 2019.Most meteorological factors(i.e.daily mean temperature,temperature difference,air pressure,air pressure difference,precipitation,relative humidity,sunshine and wind speed)and air pollutants(PM10,PM2.5,NO2,SO2 and O3)were significantly associated with childhood asthma(p<0.05),but meteorological factors appeared to play more important roles than air pollutants in the occurrence of asthma exacerbations.We also found that temperature variability was significantly associated with the elevated relative risk of daily outpatient visits for childhood asthma(p<0.05).Furthermore,we conducted a systematic review on climate change adaptation measures and childhood asthma and found that there were a number of adaptation measures proposed for childhood asthma in response to climate change,including vulnerability assessment,improving ventilation and heating,enhancing community education,developing forecast models,and early warning systems.However,the effectiveness of most adaptation measures,except for improving ventilation and heating in winter,have not been explored and quantified.Since asthma is sensitive to the variation of atmospheric environmental conditions,it is critical to develop and implement appropriate climate change mitigation and adaptation strategies as global heating becomes apparent.

Addressing Environmental Health Challenges for Sustainable Development in China

On May 5,2023,the World Health Organization(WHO)declared that the coronavirus disease 2019(COVID-19)no longer posed a public health emergency of international concern(1).As restrictions associated with the epidemic are relaxed and a fresh policy cycle commences,China’s economy is expected to serve as a key driver of global economic postpandemic recovery.

Fluctuating temperature modifies heat-mortality association around the globe

Studies have investigated the effects of heat and temperature variability(TV)on mortality.However,few assessed whether TV modifies the heat-mortality association.Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries.TV was calculated as the standard deviation of the average of the same and previous days’minimum and maximum temperatures.

An indisputable link between climate emergency and human health

Climate change is one of the greatest health challenges that humanity faces.The Intergovernmental Panel on Climate Change estimates that 3.3 billion people worldwide are highly vulnerable to climate change and confront greater health risks as a consequence(IPCC,2023).The fact that climate change is a health issue is finally being widely recognised.

Weather Variability,Socioeconomic Factors,and Pneumonia in Children Under Five-Years Old——Bangladesh,2012−2016

Summary What is already known on this topic?Different socioecological factors were associated with childhood pneumonia in Bangladesh.However,previous studies did not assess spatial patterns,and socioecological factors and spatial variation have the potential to improve the accuracy and predictive ability of existing models.What is added by this report?

Healthy Environment Promotion Campaign in Healthy China Initiative

On July 15,2019,the State Council of China issued new guidelines for the implementation of the country’s Healthy China Initiative(2019–2030)and for the promotion of population health across the nation.This article interprets Healthy Environment Promotion Campaign(HEPC)in the Healthy China Initiative from four main aspects—background,major indices,strategies,and features.Two outcome indices and four advocacy indices are proposed by the HEPC,and the strategies are mainly embodied at three levels:individual/family,society and government.The strategies have the following features:1)the strategies are developed on the basis of scientific evidence;2)the strategies advocate that citizens must be responsible for their own health;3)the administrative impetus provided by the Chinese government to integrate health into all policies is an important driver for developing and implementing the HEPC;and 4)HEPC is not an isolated campaign,so it is necessary to coordinate all 15 campaigns in order to proactively and properly implement HEPC.