Exposure to ambient fine particulate matter (PM2.5) is a major global health concern. Quantitative estimates of attributable mortality are based on disease-specific hazard ratio models that incorporate risk information from multiple PM2.5 sources (outdoor and indoor air pollution from use of solid fuels and secondhand and active smoking), requiring assumptions about equivalent exposure and toxicity. We relax these contentious assumptions by constructing a PM2.5-mortality hazard ratio function based only on cohort studies of outdoor air pollution that covers the global exposure range. We modeled the shape of the association between PM2.5 and nonaccidental mortality using data from 41 cohorts from 16 countries-the Global Exposure Mortality Model (GEMM). We then constructed GEMMs for five specific causes of death examined by the global burden of disease (GBD). The GEMM predicts 8.9 million [95% confidence interval (CI): 7.5-10.3] deaths in 2015, a figure 30% larger than that predicted by the sum of deaths among the five specific causes (6.9; 95% CI: 4.9-8.5) and 120% larger than the risk function used in the GBD (4.0; 95% CI: 3.3-4.8). Differences between the GEMM and GBD risk functions are larger for a 20% reduction in concentrations, with the GEMM predicting 220% higher excess deaths. These results suggest that PM2.5 exposure may be related to additional causes of death than the five considered by the GBD and that incorporation of risk information from other, nonoutdoor, particle sources leads to underestimation of disease burden, especially at higher concentrations.

https://www.pnas.org/content/pnas/115/38/9592.full.pdf

Global estimates of mortality associated with long-term exposure to outdoor fine particulate matter

Air Pollution and Cardiovascular Disease: JACC State-of-the-Art Review

The impact of air pollution on deaths, disease burden, and life expectancy across the states of India: the Global Burden of Disease Study 2017

Long-term exposure to PM and all-cause and cause-specific mortality: A systematic review and meta-analysis.

Outdoor air pollution is a major contributor to the burden of disease worldwide. Most of the global population resides in places where air pollution levels, because of emissions from industry, power generation, transportation, and domestic burning, considerably exceed the World Health Organization's health-based air-quality guidelines. Outdoor air pollution poses an urgent worldwide public health challenge because it is ubiquitous and has numerous serious adverse human health effects, including cancer. Currently, there is substantial evidence from studies of humans and experimental animals as well as mechanistic evidence to support a causal link between outdoor (ambient) air pollution, and especially particulate matter (PM) in outdoor air, with lung cancer incidence and mortality. It is estimated that hundreds of thousands of lung cancer deaths annually worldwide are attributable to PM air pollution. Epidemiological evidence on outdoor air pollution and the risk of other types of cancer, such as bladder cancer or breast cancer, is more limited. Outdoor air pollution may also be associated with poorer cancer survival, although further research is needed. This report presents an overview of outdoor air pollutants, sources, and global levels, as well as a description of epidemiological evidence linking outdoor air pollution with cancer incidence and mortality. Biological mechanisms of air pollution-derived carcinogenesis are also described. This report concludes by summarizing public health/policy recommendations, including multilevel interventions aimed at individual, community, and regional scales. Specific roles for medical and health care communities with regard to prevention and advocacy and recommendations for further research are also described.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21632

Outdoor air pollution and cancer: An overview of the current evidence and public health recommendations.

Background: Cohort studies in North America and western Europe have reported increased risk of mortality associated with long-term exposure to fine particles (PM2.5), but to date, no such studies h...

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Long-term Fine Particulate Matter Exposure and Nonaccidental and Cause-specific Mortality in a Large National Cohort of Chinese Men.

Background: To examine the joint effects of smoking and blood pressure on the risk of mortality from cardiovascular disease (CVD) in a cohort of Chinese men. Methods: This study followed a cohort of 213,221 men over 40 years of age who were recruited from 45 district/counties across China between 1990–1991, and whose cause-specific mortality was examined for 15 years, up to 31 December 2005. We calculated hazard ratios for all-cause mortality and CVD, ischemic heart disease (IHD), and stroke mortality for the combined sets of smoking status and blood pressure levels using the Cox proportional hazard model, adjusting for potential individual-level and contextual-level risk factors. Results: During the 15 years of follow-up, 52,795 deaths occurred, including 18,833 deaths from CVD, 3744 deaths from IHD, and 11,288 deaths from stroke. The risk of mortality from CVD, IHD, and stroke increased significantly, with increased systolic blood pressure (SBP), diastolic blood pressure (DBP), and with more pack years of smoking. Compared with never-smokers with normal blood pressure, the hazard ratios and 95% CI of CVD, IHD, and stroke mortality for those who smoked over 20 pack years with hypertension were remarkably increased to 2.30 (95% CI: 2.12–2.50), 1.78 (95% CI: 1.48–2.14), and 2.74 (95% CI: 2.45–3.07), respectively. Conclusion: There was a combined effect on the risk of CVD, IHD, and stroke mortality between smoking and hypertension. The joint efforts on smoking cessation and lowered blood pressure should be made to prevent cardiovascular disease mortality in Chinese men.

https://www.mdpi.com/1660-4601/15/5/1026/pdf

Smoking, Blood Pressure, and Cardiovascular Disease Mortality in a Large Cohort of Chinese Men with 15 Years Follow-up.

To investigate trends in the prevalence, awareness, treatment and control of hypertension and their demographic determinants in Shaanxi Province. Six successive cross-sectional surveys on non-communicable chronic diseases and their risk factors were conducted between 2004 and 2018 in Shaanxi. Complex multistage stratified sampling was adopted to select participants. The information was collected through face-to-face interviews and on-site health examinations. Changes in hypertension prevalence and its management across survey years were estimated. Demographics associated with hypertension prevalence and its management was explored by multivariable logistic regression using pooled data from 2004 to 2018. The prevalence of hypertension increased from 16.71% in 2004 to 31.96% in 2018 with an estimated increase of 1.09% (95% CI 0.31-1.87) per year. However, the rate of awareness, treatment and control among these with hypertension was unexpectedly low and there were no significant change from 2004 to 2018. The corresponding changes were - 0.08% (95% CI - 0.85-0.69) per year for awareness, - 0.06% (95% CI - 1.11-1.00) per year for treatment, and - 0.23% (95% CI - 0.53-0.07) per year for control, respectively. Sensitivity analysis showed the same trend. Adults who were old, male, divorced/Widowed/Separated, retired were more likely to develop hypertension. Among these with hypertension, those who were more educated and retired were more likely to manage their hypertension compared with their counterparts. The overall hypertension prevalence from 2004 to 2018 increased rapidly, while awareness, treatment and control of hypertension remained unexpectedly low. This suggested urgent intervention should be implemented to improve hypertension control in Shaanxi Province. 

/pdf/prevalence-awareness-treatment-and-control-of-hypertension-285hco46.pdf

Prevalence, awareness, treatment, and control of hypertension and their risk factors in Shaanxi Province in 2004–18

/pdf/analysis-of-adult-residents-blood-pressure-measurement-jjldslnc.pdf

Weihua Wang

Papers

Long-term Fine Particulate Matter Exposure and Nonaccidental and Cause-specific Mortality in a Large National Cohort of Chinese Men.

Smoking, Blood Pressure, and Cardiovascular Disease Mortality in a Large Cohort of Chinese Men with 15 Years Follow-up.

Prevalence, awareness, treatment, and control of hypertension and their risk factors in Shaanxi Province in 2004–18

Analysis of Adult Residents’ Blood Pressure Measurement Behavior and Its Influencing Factors in Shaanxi Province