Outdoor Air Pollution and Population Health in Mainland China

Transcription

1 Outdoor Air Pollution and Population Health in Mainland China Haidong Kan, MD Fudan University International Symposium of Environmental Medicine Oct 24, 2015

2 Outline Background Disease burden of air pollution in China Air pollution epidemiologic studies in China Summary

3 Pollution in China by LU Guang

4 In terms of health, air pollution is most significant among various environmental risks in China Cost of environmental pollution in China in 2003 Urban air pollution Disease burden 400,000 premature deaths Health economic loss Other economic loss Water pollution 52,000 cancer deaths 519,9 Billion 9.5 Billion 36,7 Billion 158,0 Billion Source: World Bank, Cost of Pollution in China, 2007

5 Satellite Global PM 2.5 concentrations Donkelaar et al, EHP, 2015

6 Dust- and sea salt-free PM 2.5 concentrations Donkelaar et al, EHP, 2015

7 Heavy fog in Beijing January, 2013

8 PM 2.5 ( ):China and US Source: Aaron Cohen, HEI

9 Beijng Marathon,2014

10 APEC Blue, 2014

11 2014:Beijing Marathon vs. APEC Blue

12 Environmental Kuznet Curve

13 Globalisation and air pollution in China 36% of SO 2, 27% of NO 2, 22% of CO, and 33% of CO 2 emitted in China were associated with production of goods for overseas markets Kan, Lancet, 2014

14 Outline Ambient air pollution levels in China Disease burden of air pollution in China Air pollution epidemiologic studies in China Summary

15 Global Burden of Disease (2010) Global China 4 8 Lim et al, Lancet, 2012

16 Global Burden of Disease (2013) -China Ambient PM 916,100 Household air pollution 807,236 Ambient ozone 67,485

17 Cause-specific deaths due to ambient PM 2.5 in China Total estimate: 916,100 premature deaths Lung cancer, LRI, COPD, Caridova scular disease,

18 Premature mortality due to various outdoor air pollution sources in China Total estimate: 1.35 million premature deaths Natural, 9% Power generation, 18% Agriculture, 29% Lelieveld et al, Nature, 2015 Residential energy, 32% Industry, 8% Biomass burning, 1% Land traffic, 3%

19 Economic analysis 1.2% of GDP 3.8% of GDP World Bank, Cost of Pollution in China, 2007

20 Outline Ambient air pollution levels in China Health burden of air pollution in China Air pollution epidemiologic studies in China Summary

21 Air pollution and health studies in China

22 A summary of air pollution epidemiologic studies in China Short-term exposure studies Time-series/case crossover studies Single-city analysis: Beijing, Hong Kong, Shanghai, Shenyang, Taiyuan, Wuhan, etc. Multi-city analysis: PAPA, CAPES Panel study: Long-term exposure study Cross-sectional study: several Cohort study: CNHS-Air Intervention study Beijing Olympics Air purifiers

23 Short-term exposure: PAPA Public Health and Air Pollution in Asia (PAPA) Wuhan Shanghai Hong Kong Bangkok

24 Short-term exposure: CAPES CAPES China Air Pollution and Health Effects Study A new multi-city time-series study in China Supported by China Ministry of Environmental Protection AJE, 2012; EHP, 2012, 2013; Stroke, 2012; Neurology, 2013

25 CAPES cities

26 CAPES Health and Exposure Data Health outcomes Total and cause-specific mortality (for every city) Hospital visits (Shanghai) Air pollution PM 10, SO 2, NO 2 (for every city) PM 2.5 (Beijing, Shanghai, Shenyang, Xi an, Guangzhou) PNC (Shenyang, Shanghai) PM 2.5 components (Xi an) PM (Beijing, Shanghai, Shenyang) BC (Shanghai) O 3 (Shanghai, Suzhou) CO (Shanghai, Anshan, Taiyuan) Visibility (Shanghai)

27 CAPES CAPES study: what will it contribute to policy making in China? Robustness of time-series study risk estimates New evidence of the national C-R function Comparison of risk estimates gained from China and developed countries Regional/city variability in results: source apportionment Does threshold exist

28 CAPES Anshan Beijing Fuzhou Guangzhou Hangzhou Hong Kong Lanzhou Shanghai Shenyang Suzhou Taiyuan Tangshan Tianjin Urumqi Wuhan Xi an National average Effects of PM 10 in the CAPES cities Increase % Total mortality Anshan Beijing Fuzhou Guangzhou Hangzhou Hong Kong Shanghai Shenyang Suzhou Taiyuan Tangshan Tianjin Urumqi Wuhan Xi an National average Increase % Cardiovascular mortality Anshan Beijing Fuzhou Guangzhou Hangzhou Hong Kong Shanghai Shenyang Suzhou Taiyuan Tangshan Tianjin Urumqi Wuhan Xi an National average Increase % Respiratory mortality Chen et al, AJE, 2012

29 CAPES Gender, age, and SES might modify PM 10 s health effect Chen et al, AJE, 2012

30 logrr CAPES Combined E-R curve of PM 2.5 总死亡 China AQS for PM PM2.5 30

31 CAPES Regional pattern of PM s health effect 31

32 CAPES Potential reasons for regional pattern SO2 NOx PM O3 Air pollution mixture Concentrations Components, sources Exposure pattern (people 90% time indoors) Residents characteristics

33 PM composition in various Chinese cities

34 CAPES Regional pattern of PM 10 health impact: a potential role of indoor exposure to outdoor PM 10 PM 10 exposure coefficient R = ( toutδcpm 10 out 2 = tinδcpm 10 in ) / ( 24hourΔCPM 10 out ) Zhou et al, AE,

35 CAPES 35

36 CAPES PNCs and daily mortality 4 % 0.5µm < µm Meng et al, EHP, 2013

37 Deposition of particles in the respiratory system 可入肺颗粒物 PM2.5 总沉积量 扩散沉积 撞击沉积 鼻腔沉积 肺泡沉积 支气管沉积 37

38 CAPES PM 2.5 components and daily mortality in Xi an Cao et al, EHP, 2012

39 CAPES BC might be an important component Gen et al, Environ Res, 2013

40 CAPES PM 2.5 components and emergencyroom visits in Shanghai Qiao et al, EST, 2014

41 PM components PM 2.5 components and emergencyroom visits in Shanghai Without adjustment for PM 2.5 : significant for most components adjustment for PM 2.5 : OC, EC, NO 3-, Ca 2+, Cl -, Na + Residuals with adjustment for PM 2.5 : :OC, EC Qiao et al, EST, 2014

42 PM components PM 2.5 components OC, EC > Ni, SO 4 2-,NO 3 -

43 Panel study Panel study 1 Size-fractionated PM and Circulating Biomarkers Particles <0.4μm had strongest associations Apparent acute effect on circulating biomarkers, even 2 hours after exposure PM PM <0.4μm Effects on inflammation occurred more quickly than on coagulation and vasoconstriction Chen et al, Epidemiology, 2015

44 Panel study Panel study 2 PM 2.5 constituents, and NOS2A DNA methylation Six repeated tests on FeNO among a panel of COPD patients Real-time measurements of PM 2.5 and its constituents Chen R, et al, ES&T,2015

45 Panel study PM 2.5 constituents and NOS2A (encoding nitric oxide synthase) DNA methylation Concomitant measuremen ts of the methylation of NOS2A, extracted from buccal samples Chen R, et al, ES&T,2015

46 Panel study Time course for the effects of PM 2.5 on methylation and FeNO Chen R, et al, ES&T,2015

47 Long-term exposure: cohort CNHS-Air Study China National Hypertension Survey (CNHS) Baseline survey in 1991 Follow-up visit in ,666 participants in 17 provinces of China (including both urban and rural areas) CNHS-Air: a retrospective cohort analysis of outdoor air pollution and mortality in China 90,167 urban participants in 41 Chinese cities

48 Long-term exposure: cohort CNHS-Air cities Outdoor air pollution levels (in , μg/m 3 ) Mean Range TSP SO NO X

49 Long-term exposure: cohort CNHS-Air Results Each 10 μg/m 3 increase in TSP was associated with increased risk of death *: 0.2% for total mortality (p=0.222) 0.8% for cardiovascular mortality (p=0.003) 0.4% for respiratory mortality (p=0.448) 1.0% for lung cancer mortality (p=0.095) * After adjustment for age, gender, smoking (smoking status, age at starting smoking, years smoked, and cigarettes per day), alcohol intake, physical activity, education, hypertension

50 Long-term exposure: cohort Comparison with the ACS study CNHS*: 10 μg/m 3 increase of PM 2.5 was associated with - 0.6% of total mortality - 2.5% of cardiovascular mortality - 1.2% of respiratory mortality - 3.1% of lung cancer mortality ACS:10 μg/m 3 increase of PM 2.5 was associated with - 4% of total mortality - 6% of cardiopulmonary mortality - 8% of lung cancer mortality *: assuming PM 2.5 /PM and PM 10 /TSP 0.5 Chen et al, JHM, 2011 Pope et al, JAMA, 2002

51 China Western Countries Acute effects Chronic effects Kan et al, Biomed Environ Sci, 2005

52 Possible reasons for the smaller effects in Chinese cities China Developed countries Pope et al, Circulation, 2009

53 Intervention study Health benefits gained from environmental intervention Hong Kong Dublin Atlanta Beijing Olympics Air purifiers

54 Intervention study Typical air pollution in Beijing Good air quality during the Beijing Olympics

55 Intervention study 2008 Beijing Olympic Games

56 Intervention study 2008 Beijing Olympic Games

57 Intervention study HEART Study Rich et al, JAMA, 2012

58 Li et al, Sci Total Environ, 2010

59 Cardiopulmonary Benefits of Reducing Indoor Particles of Outdoor Origin: A Randomized, Double-Blind Crossover Trial of Air Purifiers Chen et al, JACC, 2015

60 Time-Varying PM 2.5 Concentration in Outdoor Air, Sham-Purified Indoor Air, and True-Purified Indoor Air Chen et al, JACC, 2015

61 Air Purifiers and Cardiopulmonary Benefits PM 2.5 Chen et al, JACC, 2015

62 Summary Strong evidence that ambient air pollution is associated with adverse health effects in Chinese populations Increased risks observed among Chinese population are somewhat lower in magnitude, per amount of pollution, than the risks found in developed countries. Current air quality standard in China can not fully protect population health Indoor air purification may have cardiopulmonary benefits in developing countries with high air pollution levels

63 Acknowledgement Sponsors: Ministry of Environmental Protection, China; 973 Programme, MOST, China; China Medical Board. Fudan University: Bingheng Chen, Weimin Song, Renjie Chen, Wenjuan Ma, Chunxue Yang, Xia Meng

64 Thank you! Q?