This study aimed to evaluate the long-term trends in lung cancer (LC) and chronic obstructive pulmonary disease (COPD) mortality attributable to particulate matter (PM2.5) in China and to identify the contributions of population aging and other risk factors to changes in mortality rates.

Using data from 1991 to 2021, we assessed trends in LC and COPD deaths attributable to PM2.5 through linear regression. Decomposition analysis was conducted to determine the extent to which changes in mortality rates were driven by demographic and non-demographic factors.

The crude mortality rates attributable to PM2.5 increased significantly for LC (500.40%) and COPD (85.26%). From 1990 to 2021, LC mortality attributable to PM2.5 increased annually by 4.11% (95% CI: 3.64%, 4.59%), while COPD mortality decreased annually by 1.23% (95% CI: -0.82%, -1.65%). Decomposition analysis revealed that 43.0% of the increase in LC mortality was due to population aging, and 57.0% was attributed to changes in other risk factors. For COPD, population aging contributed to an 18.547/100,000 increase, whereas other risk factors reduced mortality by 10.628/100,000.

The findings highlight the critical roles of population aging and risk factor modification in LC and COPD mortality trends. Interventions to address aging-related vulnerabilities and air pollution control are essential to mitigate future health burdens.

Few studies have examined the associations between long-term exposure to ultrafine particles (UFP) and type 2 diabetes (T2DM). This study aimed to investigate the impact of long-term UFP exposure on diabetes prevalence and stages, as well as glycemic markers, using data from a large multi-center cohort collected from 2017 to 2021. The health outcomes assessed included diabetes prevalence and stages (normoglycemia, prediabetes, and diabetes), as well as glycemic markers, i.e., fasting blood glucose (FPG) and glycated hemoglobin (HbA1c). The three-year average UFP concentration prior to baseline was used as the long-term UFP exposure level. This cross-sectional study included 93,990 participants, with a diabetes prevalence of 10.97 %. An interquartile range increase in UFP was significantly associated with diabetes prevalence and stages, with ORs of 1.20 (95 % CI: 1.14, 1.26) and 1.11 (95 % CI: 1.07, 1.44), respectively. Specifically, for comparison between normoglycemia and prediabetes, and between prediabetes and diabetes, the corresponding ORs were 1.01 (95 % CI: 0.96, 1.04) and 1.24 (95 % CI: 1.17, 1.31), respectively. UFP exposure was also significantly associated with elevated levels of FPG and HbA1c. These findings suggest that long-term UFP exposure may be a potential risk factor for diabetes with larger risks in the prediabetes population.

Accumulating evidence suggests a strong correlation between air pollution and neurological disorders; however, appropriate models and methodologies are currently lacking. In this study, a human nasal RPMI 2650 cell model based on air-liquid interface culture was discovered to possess olfactory epithelial cells. Two short-chain per- and polyfluoroalkyl substances (PFAS), PFBA and PFHxA, were used to validate the performance of the model. RNA sequencing initially revealed the adverse effects of two PFAS at environmentally relevant concentrations. Their effects on key nasal epithelial cell functions, including barrier protection, solute transport, and neuronal activity, were separately investigated. Both PFBA and PFHxA disrupted membrane integrity and increased cellular transport capacity, as indicated by the upregulation of ABC transporters. Additionally, they inhibited tight junction proteins, including ZO-1, claudin-3, and occludin, while increasing mucin expression and mucus secretion. PFHxA exhibited stronger effects in most assays and uniquely induced a significant upregulation of NOTCH1 expression (p < 0.05), highlighting its potential hazards on olfactory neurons. This study proposed a novel in vitro test model with the matched respiratory epithelial and neuronal end points, which was expected to improve toxicological research and risk assessment of air pollutants.

Air fine particulate matter and tobacco smoke exposure are primary risk factors for lung cancer. However, their recent global exposure levels, attributable burden, and patterns of inequalities remain insufficiently quantified.

Utilizing the Global Burden of Disease 2021 study, we analyzed exposure levels of air fine particulate matter (ambient and household) and tobacco smoke (active and secondhand) by age-standardized summary exposure value (ASEV). Age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years rate (ASDR) were used to assess their attributable lung cancer burden globally. Temporal patterns were examined using weighted average annual percentage change (WAPC). Cross-national health inequalities were evaluated with the concentration index (CI) for ASMR and slope index of inequality (SII) for ASDR.

In 2021, air fine particulate (PM2.5) exposure peaked in low socio-demographic index (SDI) countries, while tobacco exposure was highest in high-middle SDI regions. Globally, air PM2.5 contributed to 374.21 thousand (95% uncertainty interval [UI]: 236.36, 520.26) lung cancer deaths [ambient: 297.60 thousand (95% UI: 183.71, 414.74); household: 76.48 thousand (95% UI: 28.6, 187.34)], whereas tobacco exposure caused 1,238.65 thousand (95% UI: 1,075.69, 1,423.12) deaths [active smoking: 1,195.80 thousand (95% UI: 1,054.67, 1,359.22); secondhand smoke: 97.91 thousand (95% UI: 11.96, 184.91)]. High-middle SDI countries and the Southeast Asia, East Asia, and Oceania regions bore the greatest burden. The attributable burden for males exceeded that for females by approximately twofold for air PM2.5 and fivefold for tobacco exposure. The 55 + age group showed disproportionately high impacts despite lower exposure. From 1990 to 2021, the ASMR attributable to air PM2.5 and tobacco exposure changed annually by -1.32% (95% confidence interval [CI]: -1.48, -1.16) and - 0.95% (95% CI: -1.03, -0.88), respectively. The attributable ASDR also showed declining trends. Regarding translational health inequality, the air PM2.5 attributable lung cancer burden shifted from high to low SDI countries (CI: 0.05 to -0.10, SII: 31.00 to -35.50), while the tobacco-attributable burden persisted in higher SDI countries, albeit with diminishing inequalities (CI: 0.34 to 0.25, SII: 572.20 to 304.60).

This up-to-date study provides a comprehensive perspective on air fine particulate matter and tobacco smoke exposure's impact on lung cancer burden, highlighting its widespread nature, substantial impact, unequal distribution, and preventability. The findings call for targeted interventions and global cooperation across socioeconomic levels to reduce the overall lung cancer burden in the post-pandemic era.

Lung cancer is the most common cancer worldwide, yet the current epidemiological profile of lung-cancer incidence by histological subtype is only partly understood. We aimed to assess geographical variation in incidence of lung cancer by subtype worldwide in 2022, geographical variation in adenocarcinoma incidence attributable to ambient particulate matter (PM) pollution worldwide in 2022, temporal trends in lung-cancer incidence by subtype from 1988 to 2017 in 19 countries, and generational changes.

For this population-based study, we used data from the Global Cancer Observatory (GLOBOCAN) 2022, Cancer Incidence in Five Continents Volumes VII-XII, and members of the African Cancer Registry Network. To obtain national estimates of lung cancer in 2022 for the four main histological subtypes (ie, adenocarcinoma, squamous cell carcinoma [SCC], small-cell carcinoma, and large-cell carcinoma) by year, sex, and age group, we combined national estimates with representative, subsite-specific incidence proportions of lung cancer on the basis of recorded incidence data compiled in Cancer Incidence in Five Continents Volume XII and from members of the African Cancer Registry Network. We calculated country-specific, sex-specific, and age-specific proportions of and sex-specific and age-specific incidence rates per 100 000 people for all four histological subtypes. To account for differences in age composition between populations by country, we calculated age-standardised incidence rates (ASRs) per 100 000 people for lung cancer by subtype and sex at national and regional levels. We also quantified the burden of adenocarcinoma incidence attributable to ambient PM pollution for 179 countries in 2022. We conducted joinpoint regression and age-period-cohort analysis to assess temporal trends in ASRs in 19 countries by sex.

In 2022, we estimated that there were 1 572 045 new cases of lung cancer worldwide among male individuals, of which 717 211 (45·6%) were adenocarcinoma, 461 171 (29·4%) were SCC, 180 063 (11·5%) were small-cell carcinoma, and 101 861 (6·5%) were large-cell carcinoma. In 2022, we estimated that there were 908 630 new cases of lung cancer worldwide among female individuals, of which 541 971 (59·7%) were adenocarcinoma, 155 598 (17·1%) were SCC, 87 902 (9·7%) were small-cell carcinoma, and 59 271 (6·5%) were large-cell carcinoma. Among male individuals, the highest ASRs were in east Asia for adenocarcinoma (27·12 [95% CI 27·04-27·21] per 100 000 people), east Europe for SCC (21·70 [21·51-21·89] per 100 000 people) and small-cell carcinoma (9·85 [9·72-9·98] per 100 000 people), and north Africa for large-cell carcinoma (4·33 [4·20-4·45] per 100 000 people). Among female individuals, the highest ASRs were in east Asia for adenocarcinoma (19·04 [18·97-19·11] per 100 000 people), north America for SCC (5·28 [5·21-5·35] per 100 000 people) and small-cell carcinoma (4·28 [4·21-4·35] per 100 000 people), and north Europe for large-cell carcinoma (2·87 [2·78-2·96] per 100 000 people). We estimated that 114 486 adenocarcinoma cases among male individuals and 80 378 adenocarcinoma cases among female individuals were attributable to ambient PM pollution worldwide in 2022, with ASRs of 2·35 (95% CI 2·33-2·36) per 100 000 male individuals and 1·46 (1·45-1·47) per 100 000 female individuals. Temporal trends in lung-cancer incidence by subtype and sex during 1988-2017 varied considerably across the 19 countries.

Estimated geographical and temporal distribution of lung-cancer incidence varied across the four main subtypes worldwide. Our study highlights the need for future studies that identify possible causal factors that contribute to the changing risk patterns of lung cancer.

Natural Science Foundation of China Young Scientist Fund, Medical Scientific Research Foundation of Guangdong Province in China, and Young Innovative Talents Project of General Universities in Guangdong Province in China.

Both air pollution and low socioeconomic status (SES) are associated with worse cognitive function. The extent to which low SES may compound the adverse effect of air pollution on cognitive function remains unclear.

7,087 older adults aged 65 and above were included from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and followed up in 4 waves during 2008-2018. Cognitive function was measured repeatedly at each wave using the modified Chinese Mini-Mental State Examination (MMSE). Concentrations of particulate matter (PM1, PM2.5, and PM10) were evaluated using satellite-based spatiotemporal models. SES was measured based on five components and categorized into three levels (low, middle, and high). Generalized estimating equation models were used to estimate the association of PM and SES with cognitive function. Stratified analyses and effect modification by SES levels were further conducted.

Each 10 µg/m3 increase in PM1, PM2.5, and PM10 was associated with a 0.43 (95 % CI: -0.58, -0.27), 0.29 (95% CI: -0.37, -0.20), and 0.17 (95 % CI: -0.22, -0.13) unit decrease in MMSE scores, respectively. Lower SES was associated with worse cognitive function. Significant effect modifications were observed by SES, with the corresponding association of PM exposure being more pronounced among participants with a lower SES (p-interaction = 0.006, 0.001, and 0.006 for PM1, PM2.5, and PM10, respectively).

SES is an important effect modifier, and lower SES may compound the detrimental effect of PM on cognitive health. This finding may have implications for identifying vulnerable populations and targeted interventions against air pollution.

Air pollution remains a significant threat to human health and economic development. Most previous studies have examined the health effects of individual pollutants, which often overlook the combined impacts of multiple pollutants. The traditional composite indicator air quality index (AQI) only focuses on the major pollutants, whereas the health risk-based air quality index (HAQI) could offer a more comprehensive evaluation of the health effects of various pollutants on populations. Currently, research on HAQI to evaluate the influence of multiple air pollutants on life expectancy losses is limited. In this study, we employed HAQIto estimate years of life lost (YLL) caused by exposure to air pollution for total deaths and sub-groups by sex, age, and cause-specific disease in Ningbo from 2014 to 2018. Results reveal that significant improvement in air quality during the study period. Based on the AQI-classified air quality risk category, the HAQI estimated a more severe level, which suggests that the commonly used AQI significantly underestimates the hazards of multiple air pollutants. The YLL attributable to exposure above threshold concentrations of the Chinese Ambient Air Quality Standards (CAAQS) 24-hour Grade II standards was 1.375 years (95% CI, 1.044-1.707) per death based on the HAQI, while the YLL estimated using AQI was 1.047 years (95% CI, 0.809-1.286) per death. Females and elderly people over 65 years were vulnerable subgroups, with YLL of 1.232 and 1.480 years per death, respectively. Among deaths of cause-specific disease, the YLL attributed to polluted air was highest for patients with respiratory diseases (0.866 years, 95% CI: 0.668-1.064), followed by patients with circulatory diseases (0.490 years) and endocrine diseases (0.478 years), respectively. Improving the standards of air quality could promote the management of air quality and reduce the disease burden and economic losses caused by polluted air to populations, especially for vulnerable populations. Our study provides a basis for the formulation of policies and upgrade of air quality standards.

The cancer burden continues to escalate in China. This study was designed to quantify the burden of deaths attributable to modifiable risk factors for major cancers in China from 2012 to 2035, and to provide evidence-based recommendations for cancer management. Using nationally representative data on risk factors and cancer mortality, a comparative risk assessment approach was employed to calculate the temporal trend of population-attributable fractions (PAFs) for 15 modifiable risk factors associated with major cancers in China. The PAF for modifiable risk factors decreased from 64.5% (95% uncertainty interval [UI]: 46.2%-75.3%) in 2012 to 59.3% (95% UI: 40.6%-71.2%) in 2035. Attributable deaths increased from 1,309,990 (95% UI: 938,217-1,529,170) in 2012 to 1,313,418 (95% UI: 898,411-1,577,189) in 2035, while attributable disability-adjusted life years (DALYs) rose from 28,488,120 (95% UI: 20,471,859-33,308,237) to 33,017,705 (95% UI: 22,730,814-39,564,735). Between 2012 and 2035, the top three risk factors contributing to cancer burden shifted from smoking, insufficient fruit intake and particulate matter <2.5 μm in diameter (PM2.5) exposure to smoking, physical inactivity, and inadequate fruit intake. Controlling modifiable risk factors at recommended levels by 2020 could have prevented around 890,000 deaths and 2.2 million DALYs by 2035. The proportion of cancer burden due to modifiable risk factors is projected to decrease, but the absolute number continues to rise. Adhering to an optimal lifestyle could prevent ~40% of cancer deaths by 2035. Key modifiable risk factors including smoking, physical inactivity, and insufficient intake of fruits require high attention.

Cohort evidence linking ozone (O3) exposure with mortality was sparsely investigated among the elderly in low- and middle-income countries. This study aims to quantify mortality risk and burden attributed to chronic O3 exposure in Chinese older adults.

A total of 30,874 older adults aged ≥ 65 years were recruited from 3 national dynamic cohorts across 29 provincial regions in China, 2005-2018. Annual warm-season (April-September) O3 and year-round PM2.5 concentrations were estimated through well-validated satellite-based spatiotemporal models and were assigned to participants for each survey year. Time-dependent Fragility Cox models with random intercept for study cohort were employed to quantify O3-mortality association, adjusting for demographic, behavioral, health, and environmental covariates. A counterfactual causal framework was used for assessment of O3-attributable premature deaths in older adults based on exposure-response relationship derived from multi-cohort two-pollutant analysis (+PM2.5). Years of life lost and loss of life expectancy were subsequently evaluated based on the burden estimation model by incorporating the comparative risk assessment method and reference life tables.

16,939 death events occurred during 0.16 million person-years of follow-up surveys. Each 10-ppb increase in O3 exposure was linked with a hazard ratio of 1.076 (95 % confidence interval [CI]: 1.050, 1.102) for all-cause mortality. By achieving the counterfactual target (WHO AQG 2021) of 60 μg/m3 for warm-season O3, 0.88 (95 % CI: 0.60, 1.14) million premature deaths could be avoidable among Chinese older population in 2019, yielding an inconspicuous reduction of 0.11 million compared to the estimate in 2011 (0.99 million, 95 % CI: 0.68, 1.28). O3-attributable deaths amounted to 9.05 (95 % CI: 6.19, 11.70) million years of life lost in 2019, equivalent to a loss of life expectancy of 0.93 (95 % CI: 0.63, 1.20) years for older population in China.

Our multi-cohort analysis suggested that reducing ambient O3 exposure could effectively increase the life expectancy of Chinese older adults, which may contribute to the development of healthy aging strategies and national cleaning air policies.

In 1993, the World Bank released a global report on the efficacy of health promotion, introducing the disability-adjusted life years (DALY) as a novel indicator. The DALY, a composite metric incorporating temporal and qualitative data, is grounded in preferences regarding disability status. This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application. In contrast to the quality-adjusted life years approach, derived from multi-attribute utility theory, the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights. Claiming to rely on no mathematical or economic theory, DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators, notably content validity, reliability, specificity, and sensitivity. The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative, leading to numerous publications in international literature. Despite widespread adoption, the DALY synthetic indicator has prompted significant methodological concerns since its inception, manifesting in inconsistent and non-reproducible results. Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments, a reassessment is warranted. This reconsideration is imperative for enhancing the robustness and reliability of public health decision-making processes.

While the correlation between cancer and air pollutants is well-established, research on the delayed effects of NO2 on oral cancer remains limited.

We collected data on nitrogen dioxide (NO2) along with diagnosed cases of oral cancer in Guangxi, China, and analyzed the correlation between exposure to NO2 and the prevalence of oral cancer.

The study included 1,841 participants diagnosed with oral malignancies, consisting of 1,179 males (64.0%) and 662 females (36.0%), with a mean age of 55.9 ± 14.0 years. The NO2 concentration is 20.2 ± 10.4 μg/m3. The highest cumulative effects of NO2 exposure were observed at a 3-year cumulative lag, with a relative risk (RR) of 1.115 (95% CI: 1.102-1.128). For males, the most pronounced effect of NO2 also occurred at a 3-year lag (RR = 1.110, 95% CI: 1.094-1.127). Similarly, among females, the significant cumulative impact of NO2 was found at a 3-year lag (RR = 1.123, 95% CI: 1.101-1.145). For individuals under 60 years of age, the cumulative impact of NO2 peaked at the same 3-year lag (RR = 1.102, 95% CI: 1.085-1.120). For individuals aged 60 and above, the highest cumulative impact of NO2 was also detected at a 3-year lag (RR = 1.132, 95% CI: 1.112-1.152). For the group with normal BMI, the highest cumulative effect of NO2 exposure was also observed at the 3-year lag period (RR = 1.289, 95% CI: 1.217-1.365), consistent with the findings for other groups.

These findings suggest a significant lagged effect of long-term NO2 exposure on oral cancer, with varying associations between NO2 and oral cancer across different ages and genders.

This study investigated the relationship between long-term low-level ozone (O3) exposure, type 2 diabetes mellitus (T2DM) incidence, and glycemic levels within a prospective cohort in Southwest China, especially in regions with relatively low air pollution levels.

Between 2010 and 2020, the Guizhou Population Health Cohort Study (GPHCS) enrolled 9280 participants, who were followed up from 2016 to 2020. A total of 7317 participants (aged 18-95 years, mean 43.70 ± 14.89 years) were included in the final analysis. Time-dependent Cox regression models were used to evaluate the hazard ratios (HRs) between O3 exposure and T2DM incidence and its 95 % confidence intervals (CIs). Generalized linear model (GLM) assessed the association between O3 exposure and fasting blood glucose (FBG) levels.

During a median follow-up period of 6.58 (6.25, 8.42) years, 763 participants were diagnosed with T2DM. For every 1 standard deviation (SD) increase in O3 exposure (Mean ± SD: 67.23 ± 2.16 μg/m³) during the 6 years before baseline, the incidence of T2DM increased by 32.4 % (HR = 1.324, 95 % CI: 1.216, 1.442), while FBG levels rose by 0.081 mmol/L (β = 0.081, 95 % CI: 0.035,0.126). These associations persisted after adjusting for potential confounders, including PM2.5 and temperature. Stratified analyses revealed stronger associations in Han Chinese and urban populations.

This study provides robust evidence that even long-term exposure to low-level O3, below the World Health Organization (WHO) guideline value, is significantly associated with increased T2DM incidence and elevated FBG levels. These findings stress the need for stricter air pollution control measures to reduce the incident T2DM caused by long-term low-level O3 exposure and enhance public health protections.

Since 2013, China has implemented a series of strict Air Pollution Control Strategies (APCS) to mitigate environmental and health risks associated with ambient fine particulate matter (PM2.5). However, while APCS sets clear targets for PM2.5 concentration, it lacks quantitative control over O3 levels. Most existing studies have focused on nation-wide health assessments. Therefore, by conducting a coupled framework using health assessment and decomposition method, the spatiotemporal variation in deaths attributable to PM2.5 pollution, as well as the role of APCS and the synergies between PM2.5 and O3 on PM2.5 concentration and health impacts in the Beijing-Tianjin-Hebei (BTH) region have been explored. The result showed that: (1) PM2.5 concentration in the BTH region decreased by 68.2%, with a reduction of 45,833 (95% Confidence Interval [CI]: 33,808, 50,069) deaths over the period. However, both concentrations and mortality remained high, indicating a need for faster reductions. (2) End-of-pipe control contributed the most to reducing PM2.5 concentrations and deaths, though the gaps between source control and end-of-pipe control is narrowing. (3) The synergistic effects of O3 and PM2.5 in reducing concentration and mortality have increased, becoming a significant driver of PM2.5-related health impacts. Our study emphasizes the future importance of implementing refined, diverse emission reduction measures and coordinating efforts to reduce both O3 and PM2.5 emissions, which are crucial for achieving the Sustainable Development Goals (SDGs) and advancing the "Beautiful China" and "Healthy China" initiatives.

Although the adverse health effects of PM2.5 exposure has been well documented, evidence of its adverse effect on overall outpatient visits was still limited. Besides, the adverse health effects of PM2.5 exposure get complicated due to various components within the particles. So far, little is known about the relationship between PM2.5 components and overall outpatient visits.

This study aims to evaluate the causal relationships between long-term exposure to primary chemical components of PM2.5 and outpatient visits, while estimating the mixture effect and relative contribution of the components.

Based on nationwide provincial-level surveillance data of outpatient visits in China and well-validated simulations of PM2.5 components concentration, we employed the Difference-In-Differences (DID) approach to evaluate the causal relationships between long-term exposure to primary chemical components of PM2.5 and outpatient visits, and used a Bayesian Weighted Quantile Sum (BWQS) regression to assess the mixture effect of the components.

We found a 20.44% increase in the risk (IR%) of outpatient visits following each InterQuartile Range (IQR) increment in PM2.5 concentration. Our estimation further suggested a 17.07%, 15.91%, and 14.04% increase in the risk of outpatient visits for organic matter, sulfate, and nitrate, but non-significant increases for other components. However, when considering the inter-components correlation, sulfate and black carbon contributed most (42.3% and 28.1%, respectively) to the overall mixture effect of PM2.5 which was indicated by a 4.84% increase (95%CI: 1.92%, 7.83%) in the risk of outpatient visits following every unit increase in the overall BWQS index. Additionally, stratified analyses showed a stronger association among aged provinces and provinces with lower education rates.

Our findings would improve understanding of the individual and mixture impact of major chemical components of PM2.5 and may contribute to more targeted and optimized environmental programs for pollution control.

China, home to over 250 million children, has witnessed remarkable economic development in recent decades, successfully addressing many issues related to basic hygiene and sanitation in children, thereby altering the childhood disease spectrum. However, the emergence of environment-related disorders among children has become a significant concern. Despite the rapid accumulation of scientific knowledge on the adverse effects of environmental pollution on child health, the availability of children-specific protective strategies and actions remains alarmingly low. This commentary synthesizes the information and viewpoints presented and discussed by experts at the International Forum on Children's Environmental Health in China. It summarizes the strategies and actions proposed to reduce adverse environmental exposure and protect children's short- and long-term health and a call for more children-centered evidence-action transformation. The following four specific actions were proposed: (1) strengthen health education in parents, caregivers, and children, and personal protection for children; (2) monitor child exposure and environment-related health status; (3) set up child-specific interventions and regulations; and (4) conduct more research on environment exposures and child health.

As global aging intensifies, urological cancers pose increasing health and economic burdens. In China, home to one-fifth of the world's population, monitoring the distribution and determinants of these cancers and simulating the effects of health interventions are crucial for global and national health.

With Global Burden of Disease (GBD) China database, the present study analyzed age-sex-specific patterns of incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) in China and its 34 provinces as well as the association between gross domestic product per capita (GDPPC) and these patterns. Importantly, a multi-attentive deep learning pipeline (iTransformer) was pioneered to model the spatiotemporal patterns of urological cancers, risk factors, GDPPC, and population, to provide age-sex-location-specific long-term forecasts of urological cancer burdens, and to investigate the impacts of risk-factor-directed interventions on their future burdens.

From 1990 to 2021, the incidence and prevalence of urological cancers in China has increased, leading to 266,887 new cases (95% confidence interval: 205,304-346,033) and 159,506,067 (12,236,0000-207,447,070) cases in 2021, driven primarily by males aged 55+ years. In 2021, Taiwan, Beijing, and Zhejiang had the highest age-standardized incidence rate (ASIR) and age-standardized prevalence rates of urological cancer in China, highlighting significant regional disparities in the disease burden. Conversely, the national age-standardized mortality rate (ASMR) has declined from 6.5 (5.1-7.8) per 100,000 population in 1990 to 5.6 (4.4-7.2) in 2021, notably in Jilin [-166.7% (-237 to -64.6)], Tibet [-135.4% (-229.1 to 4.4)], and Heilongjiang [-118.5% (-206.5 to -4.6)]. Specifically, the national ASMR for bladder and testicular cancers reduced by -32.1% (-47.9 to 1.9) and -31.1% (-50.2 to 7.2), respectively, whereas prostate and kidney cancers rose by 7.9% (-18.4 to 43.6) and 9.2% (-12.2 to 36.5). Age-standardized DALYs, YLDs, and YLLs for urological cancers were consistent with ASMR. Males suffered higher burdens of urological cancers than females in all populations, except those aged <5 years. Regionally and provincially, high GDPPC provinces have the highest burden of prostate cancer, while the main burden in other provinces is bladder cancer. The main risk factors for urological cancers in 2021 are smoking [accounting for 55.1% (42.7-67.4)], high body mass index [13.9% (5.3-22.4)], and high fasting glycemic index [5.9% (-0.8 to 13.4)] for both males and females, with smoking remarkably affecting males and high body mass index affecting females. Between 2022 and 2040, the ASIR of urological cancers increased from 10.09 (9.19-10.99) to 14.42 (14.30-14.54), despite their ASMR decreasing. Notably, prostate cancer surpassed bladder cancer as the primary subcategory, with those aged 55+ years showing the highest increase in ASIR, highlighting the aging-related transformation of the urological cancer burden. Following the implementation of targeted interventions, smoking control achieved the greatest reduction in urological cancer burden, mainly affecting male bladder cancer (-45.8% decline). In females, controlling smoking and high fasting plasma glucose reduced by 5.3% and 5.8% ASMR in urological cancers. Finally, the averaged mean-square-Percentage-Error, absolute-Percentage-Error, and root-mean-square Logarithmic-Error of the forecasting model are 0.54 ± 0.22, 1.51 ± 1.26, and 0.15 ± 0.07, respectively, indicating that the model performs well.

Urological cancers exhibit an aging trend, with increased incidence rates among the population aged 55+ years, making prostate cancer the most burdensome subcategory. Moreover, urological cancer burden is imbalanced by age, sex, and province. Based on our findings, authorities and policymakers could refine or tailor population-specific health strategies, including promoting smoking cessation, weight reduction, and blood sugar control.

Bill & Melinda Gates Foundation.

Fine particulate matter (PM2·5) is the leading environmental risk factor for mortality and disability worldwide. We aimed to evaluate the temporal trend in, and spatial distribution of, the disease burden attributable to PM2·5 in China from 1990 to 2021.

Based on the methodology framework and general analytical strategies applied in the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we calculated the numbers, age-standardised rates, and percentage of deaths and disability-adjusted life-years (DALYs) attributable to PM2·5 air pollution from 1990 to 2021 at the national and provincial level in China, by disease, sex, and age groups. Exposure to PM2·5, including ambient PM2·5 pollution and household PM2·5 pollution from solid fuels, was evaluated across 33 provincial administrative units in China.

In 2021, 2·3 million (95% uncertainty interval [UI] 1·8-2·9) deaths and 46·7 million (36·6-59·7) DALYs could be attributable to PM2·5 pollution in China, accounting for 19·4% (16·0-23·6) of total deaths and 11·6% (9·4-14·1) of total DALYs. Of these, 1·9 million (95% UI 1·3-2·3) deaths and 37·8 million (26·3-46·5) DALYs resulted from ambient exposure, while 0·4 million (0·1-1·3) deaths and 8·9 million (1·5-27·8) DALYs were due to household exposure from solid fuel use. Stroke, ischaemic heart disease, and chronic obstructive pulmonary disease were the leading three causes. Two peaks in the burden were observed: in children aged younger than 5 years, and in people aged 70 years and older. The percentage of deaths and DALYs due to ambient PM2·5 was higher in men, while that due to household PM2·5 was higher in women. Geographically, the disease burden from ambient PM2·5 was higher in north and northwest China, while that from household PM2·5 was higher in southwest China. From 1990 to 2021, age-standardised death rates attributable to total PM2·5 decreased by 66·0% (95% UI 57·7-73·1) and those attributable to household PM2·5 decreased by 92·2% (76·6-98·7), with larger reductions observed in east and south China. By contrast, the disease burden related to ambient PM2·5 continued to increase and only began to decline in the past decade.

Despite the decline in the disease burden attributable to total PM2·5 in China during 1990-2021, ambient PM2·5 remains a major contributor to mortality and disability. This study highlights considerable spatial heterogeneity across different provinces and provides valuable insights for developing geographically tailored strategies for PM2·5 control and public health promotion in China. Stricter control of ambient air pollution is needed in northern and northwestern regions, while promoting clean cooking energy is more urgently warranted in southwestern areas.

National Natural Science Foundation of China, National Key Research and Development Program of China, Shanghai Municipal Science and Technology Major Project, China Postdoctoral Science Foundation.

Ambient air pollution poses a significant yet manageable threat to human health. The growing consensus on the impact of ambient air pollutants on allergic rhinitis (AR) emphasizes the importance of prevention, control, and treatment strategies. A multidisciplinary consensus development group was established to further standardize management strategies for AR in the presence of exposure to ambient air pollutants. The quality of the evidence and the strength of the recommendations were evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) system based on domestic and international relevant medical evidence. This consensus evaluates the effects of key air pollutants on public health in relation to AR, including the synergistic effects of air pollutants with meteorological conditions and aeroallergens. At the same time, the consensus provides recommendations for targeted therapeutic and preventive measures for AR under conditions of ambient air pollution, aiming to improve AR-related health outcomes. These recommendations aim to increase public and clinical awareness of the contribution of environmental factors to AR, and offer evidence-based insights for policymakers and regulators to establish informed ambient air quality standards.

Schizophrenia may be exacerbated by ambient air pollution. In this study, we aim to explore the association of air pollution with hospital admission for schizophrenia in Liuzhou, China.

The daily concentration of air pollutants was gathered from an average of seven fixed monitoring sites in Liuzhou, while the daily admission data for schizophrenia was received from The Guangxi Zhuang Autonomous Region Brain Hospital. A Poisson generalized linear regression model in conjunction with a distributed lag nonlinear model was utilized to quantify the exposure-lag-response connection between ambient air pollution and schizophrenia hospitalization. The stratification analysis was then carried out by age, gender, and season.

PM2.5, PM10, and SO2 was significantly associated with elevated number of schizophrenia hospitalization. We observed the largest single-day effects of PM2.5 at lag 17 day, PM10 at lag 17 day, and SO2 at lag 28 day, with the corresponding RRs being 1.01611 (95% CI:1.00652-1.02579), 1.01648 (95% CI:1.00603-1.02704), and 1.02001 (95% CI: 1.00001-1.04041), respectively. Stratification analysis revealed that patients who were < 45 years old and female were more vulnerable to hospitalization due to exposure to PM2.5 and PM10. The effects of PM2.5 and PM10 were more noticeable during the cooler seasons than during the warmer one.

This study reveals that being exposed to PM2.5, PM10, and SO2 may increase the chance of schizophrenia hospitalization.

Respiratory infections and tuberculosis ranked as the second leading global causes of mortality in 2021. Following the methodology from the Global Burden of Disease Study (GBD) 2021, we aimed to estimate the attributable burden and risk factors of respiratory infections and tuberculosis among China's population under 20 from 1990 to 2021. In 2021, there were 652 million new cases and 12 699 deaths of respiratory infections and tuberculosis among people under 20 years old in China. We estimated 9054 (71.2%) deaths and 818 498 (54.6%) disability-adjusted life years (DALYs) from respiratory infections attributed to all evaluated risk factors. Mortality rates were the highest in Xizang, Xinjiang, and Qinghai in 2021, while they constantly decreased since 1990. Ambient particulate matter pollution was the second leading cause of death among males and first among females, accounting for nearly 1/5 of deaths from respiratory infections and tuberculosis in 2021. In 23 of 33 provinces, ambient particulate matter pollution was the first leading cause of death and DALY, while in Xizang and Gansu, it was not the major contributor to the burden. From 1990 to 2021, the burden from household air pollution declined remarkably in all 33 provinces except for Xizang and Gansu, while the population attributable fraction (PAF) of ambient particulate matter pollution continuously increased. The overall burden of respiratory infections and tuberculosis showed a declining trend, while it remained a fatal threat to infants in relatively less developed regions. The raised hazard of ambient particulate matter pollution underscored the necessity of the shift into the formulation of prevention and intervention strategies.

The short-term effects of exposure to fine particulate matter (PM2.5) and its five components (sulfate, nitrate, ammonium salt, organic matter, and black carbon) on hospitalizations for hypertensive disorders of pregnancy (HDP) remain unclear.

This study enrolled mothers with HDP from January 1, 2015, to December 31, 2021, in 5 cities in Henan Province, China. Daily data on PM2.5 were obtained from the Tracking Air Pollution in China, an online public dataset. The time-stratified case-crossover method was usd to assess the short-term single-day (lag0-1) and multi-day (lag01-07) lag effects of PM2.5 and its components on hospitalizations for HDP and further explored the modification effects of maternal age (<35 years and ≥35 years), season (cold and warm seasons), and the Three-Year Action Plan to Win the Blue Sky Defense War (before and after June 27, 2018) on the short-term effects.

A total of 8,007 mothers with HDP were enrolled. An IQR increased in exposure to PM2.5, organic matter, and black carbon, was associated with 5.7% (RR=1.057; 95% CI=1.002, 1.112) (lag01), 6.4% (1.064; 1.003, 1.126) (lag01), and 6.8% (1.068; 1.001, 1.135) (lag05) increases in the risk of HDP, respectively (all p<0.05). The effects of exposure to PM2.5 and its components were stronger in mothers aged ≥35 years, in the cold season, and in the period before the Action Plan was implemented (pmodification<0.05).

Short-term exposure to PM2.5 and its components was positively associated with hospitalization for HDP, particularly among mothers aged ≥35 years, during the cold season and before the implementation of the Action Plan.

Despite the growing evidence pointing to the detrimental effects of air pollution on diabetes mellitus (DM), the relationship remains poorly explored, especially in desert-adjacent areas characterized by high aridity and pollution.

We conducted a cross-sectional study with health examination data from more than 2.9 million adults in 2 regions situated in the southern part of the Taklamakan Desert, China.

We assessed 3-year average concentrations (2018-2020) of particulate matter (PM1, PM2.5, and PM10), carbon monoxide (CO), nitrogen dioxide (NO2), and sulfur dioxide (SO2) through a space-time extra-trees model. After adjusting for various covariates, we employed generalized linear mixed models to evaluate the association between exposure to air pollutants and DM.

The odds ratios for DM associated with a 10 µg/m3 increase in PM1, PM2.5, PM10, CO, and NO2 were 1.898 (95% CI, 1.741-2.070), 1.07 (95% CI, 1.053-1.086), 1.013 (95% CI, 1.008-1.018), 1.009 (95% CI, 1.007-1.011), and 1.337 (95% CI, 1.234-1.449), respectively. Notably, men, individuals aged 50 years or older, those with lower educational attainment, nonsmokers, and those not engaging in physical exercise appeared to be more susceptible to the adverse effects of air pollution. Multiple sensitivity analyses confirmed the stability of these findings.

Our study provides robust evidence of a correlation between prolonged exposure to air pollution and the prevalence of DM among individuals living in desert-adjacent areas. This research contributes to the expanding knowledge on the relationship between air pollution exposure and DM prevalence in desert-adjacent areas.

As the ozone (O3) pollution becomes severe in China, it poses a threat to human health. Currently, studies on the impacts of O3 on different regions and groups are limited. This review systematically summarizes the relationship between O3 pollution and mortality and morbidity across the nation, regions, and cities in China, with a focus on the regional and group-specific studies. Then, we clarify the overall limitations in the research data, methods, and subjects. In addition, we briefly discuss the mechanisms by which O3 exposure affects human health, analyzing the effects of O3 on human health under heatwaves (temperature) condition, multi-pollutant modeling, and future climate scenarios. Finally, we give some suggestions for future research directions. Studies found that increased risks of premature mortality and morbidity of respiratory and cardiovascular diseases are closely associated with high concentration O3 exposure. Besides, the old and children are sensitive groups, more studies are needed estimate the risk of their health associated with O3 pollution. Severe O3 pollution in Northern and Eastern China, has significantly increased premature mortality. O3 pollution has led to decreased lung function in the elderly in East China, and a higher asthma risk among young people in South China. Comparing with other regions, less research studied the relationship between O3 pollution and health of local people in Southwest, Central, Northeast, and Northwest Regions. Therefore, it is necessary to enhance research in these regions, with a particular emphasis on the distinctive health consequences of O3 pollution in these regions. Given the diversity of regions and research groups, comprehensive comparison is crucial for determining the impact of O3 pollution on human health in China.

The identification of different air pollution sources is essential to effectively control atmospheric pollution, particularly in megacities of emerging countries with rapid economic development, such as the Metropolitan Area of Lima-Callao (MALC). The objective of this research was to identify the main sources of particulate matter pollution by applying bivariate polar plots and the k-means clustering algorithm. These statistical techniques were applied to hourly in situ data of four variables collected over a 5-year period (2015-2019) by the Automatic Air Quality Monitoring Network of the MALC: wind direction, wind speed, PM10, and PM2.5 concentrations. Average PM10 concentrations ranged from 34 μg m-3 (CDM station) to 126.7 μg m-3 (VMT station), while average PM2.5 concentrations ranged from 16.8 μg m-3 (CDM station) to 41.2 μg m-3 (ATE station). The diurnal variation of PM presented two peaks, one in the morning (from 0800 to 1000 h) and the other at night (from 1900 to 2300 h), with the highest concentrations of PM10 recorded at the ATE (0800 h: 155.8 μg m-3) and VMT (2100 h: 154.6 μg m-3) stations, and PM2.5 at the ATE station (0800 h: 60.3 μg m-3 and 2300 h: 37.5 μg m-3). The results showed that the contributions of PM10 are directly related to emissions from industrial activities, automotive fleet, construction, demolition, wind erosion, and the suspension and resuspension of particulates from unpaved roads. Meanwhile, high concentrations of PM2.5 are mainly attributed to vehicle exhaust emissions, industrial emissions, secondary particulate formation, and drag by the action of the winds. The major source of particulate matter contamination is the vehicle fleet, and within this, automobiles, station wagons, combi vans, and 2 and 3-wheel motorcycles are those that have the greatest contribution. These results were supported by non-parametric statistical tests such as Kruskal-Wallis and Mann-Whitney U and validated by the conditional bivariate probability function. The findings of this work may help to implement pollution prevention and control strategies in the future within this South American megacity.

Exposure to fine particulate matter, particularly PM2.5, has been associated with increased platelet activation and cardiovascular risks. However, its effect on platelet recovery after transfusion remains unclear.

This study aims to assess the influence of PM2.5 exposure on platelet recovery in patients with hematologic malignancies receiving prophylactic platelet transfusions.

We conducted a cross-sectional study involving 66 patients with hematologic malignancies who developed chemotherapy-induced thrombocytopenia and received prophylactic platelet transfusions between January and December 2021. A total of 191 transfusion events were analyzed. Platelet increment and corrected count increment (CCI) were measured one hour post-transfusion. Transfusions were categorized based on mean PM2.5 levels one day prior to platelet collection: the control group (< 37.5 μg/m³) and the case group (≥ 37.5 μg/m³). Multivariate analyses were used to adjust for potential confounders.

No significant differences were observed in platelet increment (p = 0.128) or CCI (p = 0.828) between the PM2.5 exposure groups. Correlation analyses showed no significant association between PM2.5 levels and platelet increment (r = 0.0565, p = 0.437) or CCI (r = 0.0370, p = 0.614). These findings suggest that exposure to elevated PM2.5 levels one day before donation does not significantly impair platelet recovery.

Short-term exposure to elevated PM2.5 levels does not significantly affect platelet recovery in patients receiving prophylactic platelet transfusions. These results provide important reassurance regarding the immediate effects of air pollution on transfusion outcomes, while highlighting the need for further research into potential long-term impacts.

Air pollution, especially particulate matter (PM), is one of the most common risk factors for global burden of disease. However, its effect on the risk of digestive diseases is unclear. Herein, we attempt to explore this issue by reviewing the existing evidence from published meta-analyses. We conducted a systematic literature search to identify all relevant meta-analyses regarding the association of air pollution with digestive diseases, and summarize their major findings. We assessed the methodological quality and evidence quality of the included meta-analyses using the AMSTAR-2 and GRADE tools, respectively, and the overlap of primary studies was assessed by the GROOVE tool. Nine meta-analyses were included in our analysis, containing 43 primary studies with high overlap. In the included meta-analyses, the methodological quality was from critically low to moderate, and the evidence quality was from very low to moderate. The exposure was primarily PM2.5. Seven, four, and one meta-analysis investigated the effect of air pollution on liver diseases, gastrointestinal diseases, and pancreatic diseases, respectively. PM2.5 exposure was significantly associated with liver dysfunction, chronic liver diseases, liver cancer, and colorectal cancer, but not oesophagus cancer, gastric cancer, or pancreatic cancer. Based on very low to moderate quality evidence from meta-analyses, PM2.5 exposure may contribute to the development of some digestive diseases, especially liver diseases.

Previous studies have suggested that neighborhoods characterized by higher walkability are related to a reduced risk of ischemic heart disease (IHD), whereas exposure to PM2.5 is positively associated with risk of IHD. Nevertheless, their joint impact on IHD warrants further investigation.

This prospective cohort study was performed in Yinzhou, Ningbo, China, comprising 47,516 participants. Individual-level walkability and PM2.5 were evaluated using a commercial walkability database and a land use regression (LUR) model, respectively. Hazard ratios (HRs) and 95 % confidence intervals (95 % CIs) were calculated using two Cox proportional hazards models: one based on two-year average PM2.5 levels prior to baseline, and the other incorporating time-varying PM2.5 assessed on a monthly scale. Dose-response relationships were explored using restricted cubic spline (RCS) functions. Interactions on both additive and multiplicative scales were assessed via relative excess risk due to interaction (RERI) and likelihood-ratio tests. Joint effects were explored and visualized using a 3D wireframe plot.

Over a median follow-up of 5.14 years, 1735 incident cases of IHD were identified. Adjusted HRs (95 % CIs) were 1.56 (1.34-1.81) per 10 μg/m3 increase in PM2.5 and 0.96 (0.94-0.98) per 10-unit increase in walkability, with both exposures exhibiting non-linear dose-response relationships. Walkability and PM2.5 were positively correlated (rs = 0.12, P < 0.001), and a multiplicative interaction was detected (Pinteraction = 0.019).

Walkability was inversely associated with risk of IHD, whereas exposure to PM2.5 was positively associated with IHD. Notably, the pernicious effects of PM2.5 could be attenuated in areas with higher levels of walkability. Our findings underscore the significance of walkable urban design, air quality improvement, as preventive strategies for IHD.

To assess the co-occurrence of incidental CT lung findings (emphysema, bronchiectasis, and airway wall thickening) as well as associated risk factors in low-dose CT (LDCT) lung cancer screening in a Chinese urban population.

Data from 978 participants aged 40-74 years from the Chinese NELCIN-B3 urban population study who underwent LDCT screening were selected. CT scans were reviewed for incidental lung findings: emphysema, bronchiectasis and airway wall thickness. Emphysema was defined in three ways (≥ trace, ≥ mild, or ≥ moderate) depending on severity. Participants were described and stratified by presence or absence of incidental lung findings. Logistic regression analyses were performed to examine the relationship between participant characteristics and CT findings.

Mean age was 61.3 years ± 6.8 and 533 (54.6%) were female. 48% of participants had incidental lung findings: 19.9% had emphysema (≥ mild), 9.2% had bronchiectasis, and 35.7% had airway wall thickening. Among 978 participants, 2.1% showed all three findings. Multivariable analysis showed that higher age (OR: 1.06; 95% CI: 1.04-1.08; p < 0.001), male sex (OR: 1.68; 95% CI: 1.14-2.47; p = 0.008) smoking history (OR: 1.76; 95% CI: 1.02-3.03; p = 0.04 for former smokers; OR: 2.45; 95% CI: 1.59-3.78; p < 0.001 for current smokers), and the presence of respiratory symptoms (OR: 1.42; 95% CI: 1.01-2.00; p = 0.04) were associated with the risk of having at least one incidental lung findings. When different definitions of emphysema were used, the results remained consistent.

In a Chinese urban population undergoing LDCT lung cancer screening, 48% had at least one incidental CT lung finding, which was associated with higher age, male sex, questionnaire-based respiratory symptoms and smoking history.

Question Reporting of incidental lung findings that indicate lung disease risk lacks consensus in the cancer screening setting and needs evidence of co-occurrence in general populations. Findings Almost half of the 978 participants had at least one incidental lung CT finding; these were associated with older age, male sex, respiratory symptoms, and smoking history. Clinical relevance Incidental lung findings and related risk factors are often observed in low-dose CT lung cancer screening, and careful consideration of their relevance should be given to their inclusion in future screenings.

Cohort evidence linking increased mortality with airborne fine particulate matter (PM2.5, particulate matter [PM] with aerodynamic diameter ≤2.5 μm) exposure was extensively validated worldwide. Nevertheless, long-term survival associated with submicron particulate matter (PM1, PM with aerodynamic diameter ≤1 μm) exposure remained largely unstudied, particularly in highly exposed populations.

We performed a population-based investigation involving 86844 adults aged 16+ years from 3 national dynamic cohorts spanning from 2005 to 2018. Residential annual exposure to PM1 and PM2.5 was assigned for each follow-up year using satellite-derived spatiotemporal estimates at a 1-km2 resolution. The concentration of PM1-2.5 (PM with aerodynamic diameter between 1 and 2.5 μm) was calculated by subtracting PM1 from PM2.5. Time-independent Cox proportional hazards regression models were applied to assess the associations of all-cause mortality with long-term exposure to size-specific particles. To investigate the effect of PM1 on PM2.5-mortality associations, we categorized participants into low, medium, and high groups based on PM1/PM2.5 ratio and examined the risk of PM2.5-associated mortality in each stratum. Effect modifications were checked via subgroup analyses.

A total of 18722 deaths occurred during 497069.2 person-years of follow-up (median 5.7 years). Participants were exposed to an average annual concentration of 31.8 μg/m³ (range: 7.6-66.8 μg/m³) for PM1, 56.3 μg/m³ (range: 19.8-127.2 μg/m³) for PM2.5, and 24.5 μg/m³ (range: 7.3-60.3 μg/m³) for PM1-2.5. PM1, PM2.5, and PM1-2.5 were consistently associated with elevated mortality risks, with a hazard ratio (HR) of 1.029 (95% confidence interval [CI]: 1.013-1.046), 1.014 (95% CI: 1.005-1.023), and 1.019 (95% CI: 1.001-1.038) for each 10-μg/m3 increase in exposure, respectively. Compared with low (HR = 0.986, 95% CI: 0.967-1.004) and medium (HR = 1.015, 95% CI: 1.002-1.029) PM1/PM2.5 ratio groups, PM2.5-related risk of mortality was more pronounced in high PM1/PM2.5 ratio stratum (HR = 1.041, 95% CI: 1.019-1.064). Greater risks of mortality associated with size-specific particles were found among the elderly (>80 years old), southeastern participants, and those living in warmer areas.

This study demonstrated that long-term exposure to PM1, PM2.5, and PM1-2.5 was associated with heightened mortality, and PM1 may play a predominant role in PM2.5-induced risk. Our results emphasized the population health implications of establishing ambient PM1 air quality guidelines to mitigate the burden of premature mortality stemming from particulate air pollution.

Fine particulate matter (PM2.5) pollution poses a serious threat to public health, and there has been a recent resurgence in PM2.5 pollution levels in China. Inter-provincial trade has further complicated the allocation of responsibility for PM2.5 emissions. An in-depth analysis of the Air Pollution Prevention and Control Action Plan (APPCAP), a highly effective environmental policy, offers new perspectives and avenues for reflection. Using the multi-regional input-output model and structural decomposition analysis model, this study provides insights into the interlinkages of PM2.5 emissions, and their influencing mechanisms among different regions from the perspective of source emissions by quantifying the dynamics of production-related PM2.5 emissions (PEp) associated with energy consumption and the key driving socio-economic factors in the pre-and post-APPCAP phases. The results indicate that PEp initially increased and then decreased over the study period. In the pre-policy stage, only five provinces exhibited a decrease in PEp, and this number increased to 21 provinces post-policy. Manufacturing and energy utilities consistently account for significant PEp contributions, particularly in Shanghai, Inner Mongolia, and Shanxi. This study finds that pre-policy, the industrial structure effect, the demographic effect, and the level of affluence effect primarily drove PEp increases. The post-policy decrease was influenced by industrial structure and consumption pattern effects. Although China's PEp remains higher than the consumption-based PM2.5 emissions (PEc), significant provincial variations exist. Notably, while changes in PEp do not always align with PM2.5 concentration changes, simultaneous reductions following policy implementation signal positive progress in pollution control. This underscores the necessity of continuously optimizing policy strategies to accommodate regional characteristics.

Air Quality Standards (AQSs) worldwide have continued to employ concentration-based approaches since their first implementation under the 1970 Clean Air Act in the United States. The primary objective of establishing these AQSs is widely recognized as protecting public health. With the significantly improved understanding of the health risks associated with air pollutants today, it is an opportune time to reassess air pollution management from a fundamental risk perspective. This study applied a risk-based AQS system to assess the overall mortality risks associated with both long- and short-term exposure to air pollution in China between 2015 and 2022. The analyses revealed that the health benefits resulting from reductions in concentrations of non-ozone (O3) pollutants exceeded the health risks associated with increasing O3 concentrations. As a result, the overall mortality risk across China showed a significant descending trend. During the initial phase of decarbonization, emission reductions may unintentionally lead to increased O3 concentrations in China due to the non-linear response of O3 to its precursors. Nevertheless, the overall health benefits derived from emission controls incentivize governments to implement stringent measures toward achieving carbon neutrality. These findings highlight the substantial benefits of applying the risk-based AQS system for synergistic health and carbon management.

Epidemiological studies have demonstrated a causal relationship between ambient ozone (O 3 ) and mortality from chronic obstructive pulmonary disease (COPD), which is the only outcome considered in the Global Burden of Disease Study 2021 for O 3 . This study aims to evaluate the temporal trend and spatial distribution of the COPD burden attributable to O 3 across China from 1990 to 2021.

The ambient O 3 concentrations in China were estimated. Based on the methodology framework and standard analytical methods applied in the Global Burden of Disease Study 2021, we estimated the annual number, age-standardized rate, and percentage of deaths and disability-adjusted life-years (DALYs) from COPD attributable to O 3 pollution during 1990-2021 at the national and provincial levels in China.

In 2021, a total of 125.7 (95% uncertainty interval [UI], 26.4-228.3) thousand deaths and 1917.5 (95% UI, 398.7-3504.6) thousand DALYs from COPD were attributable to ambient O 3 pollution in China, accounting for 9.8% (95% UI, 2.1-17.0%) and 8.1% (95% UI, 1.8-14.1%) of the total COPD deaths and DALYs, respectively. Generally, a higher burden was observed among males, the elderly, and the population residing in regions with worse health conditions. The age-standardized rates of COPD deaths and DALYs per 100,000 populations ranged from 0.5 (95% UI, 0-1.4) and 8.1 (95% UI, 0.7-20.9) in Hong Kong to 22.8 (95% UI, 3.9-43.5) and 396.6 (95% UI, 68.9-763.7) in Xizang. From 1990 to 2021, there was a notable decrease in the age-standardized rates of COPD-related deaths (68.2%, 95% UI, 60.1-74.9%) and DALYs (71.5%, 95% UI, 63.7-77.6%), especially in regions with poor health conditions. However, the attributable numbers and percentages changed relatively marginally.

Ambient O 3 pollution is a major contributor to the COPD burden in China. Our findings highlight the significant spatial heterogeneity across different provinces and underscore the implementation of geographically tailored policies to effectively reduce O 3 pollution and alleviate the associated disease burden.

Growing evidence links air pollution, a ubiquitous environmental stressor, to a higher risk of developing mental disorders, raising significant public health concerns. Mental disorders represent a significant global public health challenge which can have a profound impact on individual lives. In this study, we used Mendelian randomization (MR) to investigate the causal relationship between ambient air pollution and four common mental disorders. Genome-wide association study (GWAS) data for ambient air pollution and summary-level GWAS data for four representative mental disorders were obtained from open-access database. Inverse variance weighted (IVW) method with multiplicative random-effects model was the main analysis. Sensitivity analyses were conducted to validate the results. Bayesian colocalization analysis was conducted to explore the potential shared genetic causal variants between specific air pollutants and mental disorders. A suggestive association was observed between political matter (PM) 2.5 and anxiety disorders (OR 2.96, 95%CI 1.29-6.81, p = 0.010). Exposure to nitrogen dioxide (NO2) was significantly linked to an elevated risk of schizophrenia (OR 1.95, 95% CI 1.45-2.63, p = 1.13E-05) and showed a nominal association with an increased risk of bipolar disorder (OR 1.43, 95% CI 1.09-1.86, p = 0.009). A suggestive causal association was detected between nitrogen oxides (NOx) and anxiety disorder (OR 2.90, 95%CI 1.21-6.97, p = 0.017). No significant association was detected between exposure to PM2.5-10, PM10 and mental disorders. No significant horizonal pleiotropy and heterogeneity was found. The colocalization analysis revealed robust evidence supporting the colocalization of NO2 with schizophrenia at SNP rs12203592. Our findings support causal associations between exposure to ambient air pollution, particularly PM2.5, NO2, and NOx, and an increased risk of specific mental disorders.

Background: Early-onset type 2 diabetes (T2D) is an increasingly serious public health issue, particularly in China. This study aimed to analyze the characteristics of disease burden, secular trend, and attributable risk factors of early-onset T2D in China. Methods: Using data from the Global Burden of Disease (GBD) 2021, we analyzed the age-standardized rate (ASR) of incidence, disability-adjusted life years (DALYs), and mortality rates of T2D among individuals aged 15 to 39 years in China from 1990 to 2021. Joinpoint regression analysis was employed to analyze secular trend, calculating the average annual percent change (AAPC). We also examined changes in the proportion of early-onset T2D within the total T2D burden and its attributable risk factors. Results: From 1990 to 2021, the ASR of incidence of early-onset T2D in China increased from 140.20 [95% uncertainty interval (UI): 89.14 to 204.74] to 315.97 (95% UI: 226.75 to 417.55) per 100,000, with an AAPC of 2.67% (95% CI: 2.60% to 2.75%, P < 0.001). DALYs rose from 116.29 (95% UI: 78.51 to 167.05) to 267.47 (95% UI: 171.08 to 387.38) per 100,000, with an AAPC of 2.75% (95% CI: 2.64% to 2.87%, P < 0.001). Mortality rates slightly decreased from 0.30 (95% UI: 0.24 to 0.38) to 0.28 (95% UI: 0.23 to 0.34) per 100,000, with an AAPC of -0.22% (95% CI: -0.33% to -0.11%, P < 0.001). The 15 to 19 years age group showed the fastest increase in incidence (AAPC: 4.08%, 95% CI: 3.93% to 4.29%, P < 0.001). The burden was consistently higher and increased more rapidly among males compared to females. The proportion of early-onset T2D within the total T2D burden fluctuated but remained higher than global levels. In 2021, high body mass index (BMI) was the primary attributable risk factor for DALYs of early-onset T2D (59.85%, 95% UI: 33.54% to 76.65%), and its contribution increased substantially from 40.08% (95% UI: 20.71% to 55.79%) in 1990, followed by ambient particulate matter pollution (14.77%, 95% UI: 8.24% to 21.24%) and diet high in red meat (9.33%, 95% UI: -1.42% to 20.06%). Conclusion: The disease burden of early-onset T2D in China is rapidly increasing, particularly among younger populations and males. Despite a slight decrease in mortality rates, the continued rapid increase in incidence and DALYs indicates a need for strengthened prevention and management strategies, especially interventions targeting younger age groups. High BMI and environmental pollution emerge as primary risk factors and should be prioritized in future interventions.

The heightened vulnerability of individuals with HIV to environmental stressors is well-recognized, yet the role of air pollution in exacerbating HIV-related mortality remains underexplored. In this nationwide, individual-level case-crossover study conducted from 2013 to 2019, we investigated the association between short-term exposure to criteria air pollutants and HIV-related mortality. Our analysis of 38,510 HIV-related deaths revealed significant associations between exposure to PM2.5, PM10, NO2, and CO and increased mortality risk. The effects of PM2.5 and PM10 persisted for two days, whereas NO2 and CO had immediate, same-day impacts. Vulnerability was heightened in individuals under 65 years, males, those with lower educational attainment, and unmarried individuals. Among causes of death, HIV-related malignant neoplasms exhibited the highest sensitivity to particulate matter. Our findings provide novel insights into the relationship between short-term air pollution exposure and HIV-related mortality, emphasizing the increased susceptibility of this immunocompromised population. The results underscore the need for targeted public health interventions to reduce pollution exposure, particularly for the most at-risk demographic groups. This study contributes to a deeper understanding of environmental health risks faced by individuals living with HIV and informs evidence-based policy recommendations.