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Exposure to traffic-related air pollutants is an important public health issue. Here, we present a systematic review and meta-analysis of research examining the relationship of measures of nitrogen oxides (NOx) and of various measures of traffic-related air pollution exposure with lung cancer. We conducted random-effects meta-analyses of studies examining exposure to nitrogen dioxide (NO2) and NOx and its association with lung cancer. We identified 20 studies that met inclusion criteria and provided information necessary to estimate the change in lung cancer per 10-μg/m3 increase in exposure to measured NO2. Further, we qualitatively assessed the evidence of association between distance to roadways and traffic volume associated with lung cancer. The meta-estimate for the change in lung cancer associated with a 10-μg/m3 increase in exposure to NO2 was 4% (95% CI: 1%, 8%). The meta-estimate for change in lung cancer associated with a 10-μg/m3 increase in NOx was similar and slightly more precise, 3% (95% CI: 1%, 5%). The NO2 meta-estimate was robust to different confounding adjustment sets as well as the exposure assessment techniques used. Trim-and-fill analyses suggest that if publication bias exists, the overall meta-estimate is biased away from the null. Forest plots for measures of traffic volume and distance to roadways largely suggest a modest increase in lung cancer risk. We found consistent evidence of a relationship between NO2, as a proxy for traffic-sourced air pollution exposure, with lung cancer. Studies of lung cancer related to residential proximity to roadways and NOx also suggest increased risk, which may be attributable partly to air pollution exposure. The International Agency for Research on Cancer recently classified outdoor air pollution and particulate matter as carcinogenic (Group 1). These meta-analyses support this conclusion, drawing particular attention to traffic-sourced air pollution. Hamra GB, Laden F, Cohen AJ, Raaschou-Nielsen O, Brauer M, Loomis D. 2015. Lung cancer and exposure to nitrogen dioxide and traffic: a systematic review and meta-analysis. Environ Health Perspect 123:1107-1112; http://dx.doi.org/10.1289/ehp.1408882.

Ambient fine particulate matter (PM 2.5 ) is the world’s leading environmental health risk factor. Quantification is needed of regional contributions to changes in global PM 2.5 exposure. Here we interpret satellite-derived PM 2.5 estimates over 1998-2019 and find a reversal of previous growth in global PM 2.5 air pollution, which is quantitatively attributed to contributions from 13 regions. Global population-weighted (PW) PM 2.5 exposure, related to both pollution levels and population size, increased from 1998 (28.3 μg/m 3 ) to a peak in 2011 (38.9 μg/m 3 ) and decreased steadily afterwards (34.7 μg/m 3 in 2019). Post-2011 change was related to exposure reduction in China and slowed exposure growth in other regions (especially South Asia, the Middle East and Africa). The post-2011 exposure reduction contributes to stagnation of growth in global PM 2.5 -attributable mortality and increasing health benefits per µg/m 3 marginal reduction in exposure, implying increasing urgency and benefits of PM 2.5 mitigation with aging population and cleaner air. Global fine particulate matter air pollution recently pivots from increase to decrease as inferred from satellite observations, driven by unprecedented exposure reduction in China and slowed exposure growth in South Asia, the Middle East and Africa.

We estimated mortality and economic loss attributable to PM 2·5 air pollution exposure in 429 counties of Iran in 2018. Ambient PM 2.5 -related deaths were estimated using the Global Exposure Mortality Model (GEMM). According to the ground-monitored and satellite-based PM 2.5 data, the annual mean population-weighted PM 2·5 concentrations for Iran were 30.1 and 38.6 μg m −3 , respectively. We estimated that long-term exposure to ambient PM 2.5 contributed to 49,303 (95% confidence interval (CI) 40,914–57,379) deaths in adults ≥ 25 yr. from all-natural causes based on ground monitored data and 58,873 (95% CI 49,024–68,287) deaths using satellite-based models for PM 2.5 . The crude death rate and the age-standardized death rate per 100,000 population for age group ≥ 25 year due to ground-monitored PM 2.5 data versus satellite-based exposure estimates was 97 (95% CI 81–113) versus 116 (95% CI 97–135) and 125 (95% CI 104–145) versus 149 (95% CI 124–173), respectively. For ground-monitored and satellite-based PM 2.5 data, the economic loss attributable to ambient PM 2.5 -total mortality was approximately 10,713 (95% CI 8890–12,467) and 12,792.1 (95% CI 10,652.0–14,837.6) million USD, equivalent to nearly 3.7% (95% CI 3.06–4.29) and 4.3% (95% CI 3.6–4.5.0) of the total gross domestic product in Iran in 2018.

Acute lower respiratory infections (ALRI) account for nearly one fifth of mortality in young children worldwide and have been associated with exposures to indoor and outdoor sources of combustion-derived air pollution. A systematic review was conducted to identify relevant articles on air pollution and ALRI in children. Using a Bayesian approach to meta-analysis, a summary estimate of 1.12 (1.03, 1.30) increased risk in ALRI occurrence per 10 μg/m 3 increase in annual average PM 2.5 concentration was derived from the longer-term (subchronic and chronic) effects studies. This analysis strengthens the evidence for a causal relationship between exposure to PM 2.5 and the occurrence of ALRI and provides a basis for estimating the global attributable burden of mortality due to ALRI that is not influenced by the wide variation in regional case fatality rates. Most studies, however, have been conducted in settings with relatively low levels of PM 2.5 . Extrapolating their results to other, more polluted, regions will require a model that is informed by evidence from studies of the effects on ALRI of exposure to PM 2.5 from other combustion sources, such as secondhand smoke and household solid fuel use.

Increasing number of studies have investigated the impact of maternal exposure to air pollution during pregnancy and adverse birth outcomes, particularly low birth weight (LBW, <2,500 g at birth) and preterm birth (PTB, <37 completed weeks of gestation). We performed a comprehensive review of the peer-reviewed literature and a meta-analysis to quantify the association between maternal exposure to particulate matter with aerodynamic diameter 2.5 and 10 μm (PM 2.5 and PM 10 ) during pregnancy and the risk of LBW and PTB. We identified 20 peer-reviewed articles providing quantitative estimate of exposure and outcome that met our selection criteria. There was significant heterogeneity between studies, particularly for findings related to PM 10 exposure (LBW, I -squared 54%, p  = 0.01; PTB, I -squared = 73%, p  < 0.01). Results from random-effect meta-analysis suggested a 9% increase in risk of LBW associated with a 10-μg/m 3 increase in PM 2.5 (combined odds ratios (OR), 1.09; 95% confidence interval (CI), 0.90–1.32), but our 95% CI included the null value. We estimated a 15% increase in risk of PTB for each 10-μg/m 3 increase in PM 2.5 (combined OR, 1.15; CI, 1.14–1.16). The magnitude of risk associated with PM 10 exposure was smaller (2% per 10-μg/m 3 increase) and similar in size for both LBW and PTB, neither reaching formal statistical significance. We observed no significant publication bias, with p  > 0.05 based on both Begg's and Egger's bias tests. Our results suggest that maternal exposure to PM, particularly PM 2.5 may have adverse effect on birth outcomes. Additional mechanistic studies are needed to understand the underlying mechanisms for this association.

The effects of both ambient air pollution and socioeconomic position (SEP) on health are well documented. A limited number of recent studies suggest that SEP may itself play a role in the epidemiology of disease and death associated with exposure to air pollution. Together with evidence that poor and working-class communities are often more exposed to air pollution, these studies have stimulated discussion among scientists, policy makers, and the public about the differential distribution of the health impacts from air pollution. Science and public policy would benefit from additional research that integrates the theory and practice from both air pollution and social epidemiologies to gain a better understanding of this issue. In this article we aim to promote such research by introducing readers to methodologic and conceptual approaches in the fields of air pollution and social epidemiology; by proposing theories and hypotheses about how air pollution and socioeconomic factors may interact to influence health, drawing on studies conducted worldwide; by discussing methodologic issues in the design and analysis of studies to determine whether health effects of exposure to ambient air pollution are modified by SEP; and by proposing specific steps that will advance knowledge in this field, fill information gaps, and apply research results to improve public health in collaboration with affected communities.

Exposure to ambient air pollution increases morbidity and mortality, and is a leading contributor to global disease burden. We explored spatial and temporal trends in mortality and burden of disease attributable to ambient air pollution from 1990 to 2015 at global, regional, and country levels. We estimated global population-weighted mean concentrations of particle mass with aerodynamic diameter less than 2·5 μm (PM2·5) and ozone at an approximate 11 km × 11 km resolution with satellite-based estimates, chemical transport models, and ground-level measurements. Using integrated exposure–response functions for each cause of death, we estimated the relative risk of mortality from ischaemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, lung cancer, and lower respiratory infections from epidemiological studies using non-linear exposure–response functions spanning the global range of exposure. Ambient PM2·5 was the fifth-ranking mortality risk factor in 2015. Exposure to PM2·5 caused 4·2 million (95% uncertainty interval [UI] 3·7 million to 4·8 million) deaths and 103·1 million (90·8 million 115·1 million) disability-adjusted life-years (DALYs) in 2015, representing 7·6% of total global deaths and 4·2% of global DALYs, 59% of these in east and south Asia. Deaths attributable to ambient PM2·5 increased from 3·5 million (95% UI 3·0 million to 4·0 million) in 1990 to 4·2 million (3·7 million to 4·8 million) in 2015. Exposure to ozone caused an additional 254 000 (95% UI 97 000–422 000) deaths and a loss of 4·1 million (1·6 million to 6·8 million) DALYs from chronic obstructive pulmonary disease in 2015. Ambient air pollution contributed substantially to the global burden of disease in 2015, which increased over the past 25 years, due to population ageing, changes in non-communicable disease rates, and increasing air pollution in low-income and middle-income countries. Modest reductions in burden will occur in the most polluted countries unless PM2·5 values are decreased substantially, but there is potential for substantial health benefits from exposure reduction. Bill & Melinda Gates Foundation and Health Effects Institute.

Abstract China is one of the largest producers and consumers of coal in the world. The National Action Plan on Air Pollution Prevention and Control in China (2013–2017) particularly aimed to reduce emissions from coal combustion. Here, we show whether the acute health effects of PM2.5 changed from 2013 to 2018 and factors that might account for any observed changes in the Beijing–Tianjin–Hebei (BTH) and the surrounding areas where there were major reductions in PM2.5 concentrations. We used a two-stage analysis strategy, with a quasi-Poisson regression model and a random effects meta-analysis, to assess the effects of PM2.5 on mortality in the 47 counties of BTH. We found that the mean daily PM2.5 levels and the SO42− component ratio dramatically decreased in the study period, which was likely related to the control of coal emissions. Subsequently, the acute effects of PM2.5 were significantly decreased for total and circulatory mortality. A 10 μg/m3 increase in PM2.5 concentrations was associated with a 0.16% (95% CI: 0.08, 0.24%) and 0.02% (95% CI: −0.09, 0.13%) increase in mortality from 2013 to 2015 and from 2016 to 2018, respectively. The changes in air pollution sources or PM2.5 components appeared to have played a core role in reducing the health effects. The air pollution control measures implemented recently targeting coal emissions taken in China may have resulted in significant health benefits.

This paper describes progress made in research to evaluate whether actions taken to improve air quality have resulted in reduced ambient concentrations of relevant air pollutants, exposure, and adverse health effects, also known as air quality health outcomes or accountability research. The past two decades have seen a number of accountability studies that have started to tackle the many difficulties encountered in conducting such research. Difficulties may range from a lack of good quality data on air quality and health outcomes, interventions that are part of complex programs affecting air quality in different ways and the need for advanced statistical approaches that can address confounding issues, especially when evaluating regulations that are implemented over an extended period of time. Substantial progress has been made on many fronts. Early studies of short to medium-term interventions (e.g., shutting down a steel mill) have shown dramatic, sudden improvements in air quality with clear improvements in health outcomes. However, in many cases, the changes in air quality may be more subtle (e.g., measures to reduce traffic congestion). Studies of complex regulations that are implemented in multiple-year programs (e.g., national ambient air quality standards for particulate matter) remain challenging due to the need to correct for other changes that occur over the same time frame, such as changes in smoking and demographic characteristics. We describe recent progress to study the effectiveness of air quality regulations, using examples from around the globe, and discuss the challenges inherent in this type of research. Common study design issues that remain important for future studies are the selection of appropriate control populations, counterfactual air quality scenarios, and time periods surrounding the implementation of the regulatory action, as well as appropriately adjusting for unmeasured and potentially confounding factors or regional meteorological effects. Continued exploration of alternative approaches and additional methods development, especially for evaluating complex long-term regulatory actions, is recommended.

As World War I shaped and molded European culture to an unprecedented degree, it also had a profound influence on the politics and aesthetics of early-twentieth-century Russian culture. In this provocative and fascinating work, Aaron J. Cohen shows how World War I changed Russian culture and especially Russian art. A wartime public culture destabilized conventional patterns in cultural politics and aesthetics and fostered a new artistic world by integrating the iconoclastic avant-garde into the art establishment and mass culture. This new wartime culture helped give birth to nonobjective abstraction (including Kazimir Malevich's famous Black Square ), which revolutionized modern aesthetics. Of the new institutions, new public behaviors, and new cultural forms that emerged from this artistic engagement with war, some continued, others were reinterpreted, and still others were destroyed during the revolutionary period. Imagining the Unimaginable deftly reveals the experiences of artists and developments in mass culture and in the press against the backdrop of the broader trends in Russian politics, economics, and social life from the mid-nineteenth century to the revolution. After 1914, avant-garde artists began to imagine many things that had once seemed unimaginable. As Marc Chagall later remarked, \"The war was another plastic work that totally absorbed us, which reformed our forms, destroyed the lines, and gave a new look to the universe.\"