Search Results (72)

Background: Fine particulate matter (PM_2.5) and wastewater may carry severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and provide early signals for coronavirus disease 2019 (COVID-19) surveillance. This study investigated environmental factors affecting SARS-CoV-2 distribution in PM_2.5 and wastewater in Fuzhou. Methods: PM_2.5 and wastewater samples collected from January to December 2023 were tested for SARS-CoV-2 RNA using reverse transcription quantitative polymerase chain reaction (RT-qPCR). Associations between air pollutants and meteorological factors were analyzed using generalized additive models (GAMs) and distributed lag nonlinear models (DLNMs). Results: SARS-CoV-2 was detected in 45.9% of PM_2.5 samples. PM_2.5 viral concentrations were positively associated with CO, PM_2.5, and atmospheric pressure, and negatively associated with temperature and sunshine duration. Wastewater viral concentrations were positively associated with relative humidity and precipitation and negatively associated with NO₂ and SO₂. PM_2.5 signals showed the strongest lag effect at approximately 2 days, while wastewater signals peaked at lag 0. The lag effect herein describes the time interval between environmental SARS-CoV-2 signals and predicted COVID-19 outpatient cases. Elderly populations showed higher environmental sensitivity, with sex-specific differences observed. Conclusions: SARS-CoV-2 signals in PM_2.5 and wastewater reflected COVID-19 trends. Integrated multi-media monitoring may improve early warning and support targeted public health interventions. Full article

Background: This study aims to thoroughly examine the relationship between weather conditions and reported pulmonary tuberculosis (PTB) cases in Haikou City. The goal is to provide a scientific basis for developing more targeted and timely prevention measures, thereby enhancing local efforts to control PTB. Methods: In this retrospective time-series study from 2010 to 2023, a total of 22,083 PTB cases (15,723 males and 6360 females) were analyzed. Using monthly PTB case counts (overall and stratified by sex and age) and meteorological variables, descriptive analyses along with distributed lag non-linear models (DLNMs) and generalized additive distributed lag models (GADLMs) combined with quasi-Poisson regression model regression were applied. Results: Taking the median of each meteorological factor as the reference, temperature exhibited significant delayed effects. For the overall population, temperatures between 14.30 °C and 24.24 °C posed significant lagged risks, with the effect decreasing as temperature rose. At the minimum monthly average temperature (14.30 °C), the relative risk (RR) peaked at lag 7 months (RR = 1.37, 95% CI: 1.23–1.53). Sex-stratified analysis showed similar patterns for males (14.30–23.94 °C) and females (14.30–23.84 °C), with peak RRs of 1.40 (1.25–1.58) and 1.37 (1.21–1.56), respectively, at 14.30 °C. In the adults group, temperatures between 14.30 °C and 25.45 °C produced significant lagged effects (maximum lag 14 months), with the highest RR of 1.42 (1.27–1.60) at lag 8 under 14.30 °C. The older age group showed a linear association. Average relative humidity exhibited a weak lag-4 correlation with PTB counts in some subgroups, but model testing indicated no statistically significant lagged risk effect in any group. Conclusions: A significant nonlinear lagged exposure–response relationship exists between temperature and PTB incidence in Haikou, with population-specific variations, while relative humidity shows no significant lagged effect. These findings underscore the necessity of incorporating temporal lag effects and population differences into regional PTB early warning and prevention strategies. Full article

Background: Previous studies have explored the association between ambient ozone (O₃) exposure and gestational diabetes mellitus (GDM). However, little is known about the association of O₃ with different GDM clinical classifications—diet-controlled GDM (GDMA1) and insulin-treated GDM (GDMA2), and whether temperature modifies the associations. Methods: We conducted a retrospective cohort study including 11,491 pregnant women between 2017 and 2023 in Tianjin, China. O₃ exposure levels for each participant were assessed using the Tracking Air Pollution in China dataset. Logistic regression models were employed to analyze the associations of trimester-specific O₃ exposure with GDMA1 and GDMA2. Distributed lag nonlinear model (DLNM) was used to identify potential critical gestational weeks of O₃ exposure. Ambient temperature was categorized using the 10th and 90th percentiles to evaluate the effect modification of extreme temperatures on these associations. Results: No statistically significant association was observed in the fully adjusted trimester-specific models. In the weekly-specific DLNM analyses, we observed 5–12 weeks before pregnancy and 26–28 gestational weeks as sensitive windows where O₃ exposure was weakly associated with elevated GDMA1 risk, and 11–25 gestational weeks for GDMA2. Each 10 μg/m³ increase in O₃ during pregnancy was associated with small increases in the odds of GDMA1 (28 weeks: OR = 1.019, 95% CI: 1.002, 1.035) and GDMA2 (25 weeks: OR = 1.018, 95% CI: 1.002, 1.035). High temperatures appeared to strengthen the observed association between preconception O₃ exposure and GDMA1. Additionally, O₃ exposure during pregnancy may increase the risk of GDMA1 among women aged <35 years, preconception obesity, gestational hypertension, and family history of diabetes. Conclusions: This study suggests possible weak weekly-specific associations between O₃ exposure and GDM classifications and indicates that ambient high temperature may modify the O₃-GDM association. These findings should be interpreted cautiously and require confirmation in future studies. Full article

Background/Objectives: Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by persistent synovial inflammation and vascular abnormalities. Emerging evidence suggests that dysbiosis of the microbiome contributes to the pathogenesis of this disease, while seasonal and meteorological variations represent significant factors influencing microbial community dynamics. However, the specific pathological mechanisms mediated by microbial populations within knee joint effusions of RA patients remain poorly elucidated. The present study employs 16S rRNA high-throughput sequencing technology to characterize seasonal variation patterns affecting microbial communities in knee joint effusions of RA patients and to investigate the relationship between microbial community structures and climatic lag effects. Methods: Microbial communities in knee joint effusion samples obtained from RA patients were analyzed using 16S rRNA high-throughput sequencing methodologies. A Distributed Lag Non-linear Model (DLNM) was applied to quantify the delayed effects of climatic variables on microbial community composition. The correlation patterns between meteorological parameters and community structure were elucidated through the integration of ridge regression and redundancy analysis (RDA). Preliminary identification of potential biomarkers was conducted using random forest algorithms. Results: According to research findings, the microbial composition of knee joint effusions in RA patients shows seasonal fluctuation patterns that are compatible with those seen in RA patients, even though there is no discernible seasonal change in β-diversity. Compared with samples obtained during other seasons, spring specimens exhibited significantly elevated relative abundances of both beneficial microorganisms and opportunistic pathogenic taxa. Random forest modeling identified Escherichia-Shigella and Curtobacterium as preliminary candidate biomarkers; however, external validation is required to establish their specificity as disease indicators. Further analysis revealed that although short-term meteorological fluctuations exert minimal influence on overall microbial diversity, specific alterations in mean wind speed (MWS) and relative humidity (RH) drive compositional changes in the microbial community, manifested as rapid responses from dominant bacterial taxa and compensatory buffering effects from rare taxa. Conclusions: This study suggests that the synovial cavity microbiota in RA patients may exhibit seasonal variation patterns that are statistically associated with environmental parameters, particularly humidity and temperature. Due to the inherent limitations of the cross-sectional study design, the preliminary candidate biomarkers identified herein require validation through external cohorts. Additional investigations incorporating healthy controls and osteoarthritis (OA) cohorts are necessary to confirm specificity and to elucidate the therapeutic potential of these microbial targets for RA microbiome interventions. Currently, insufficient evidence exists to establish causal relationships among microbial populations, joint pathology, and climatic factors. Longitudinal cohort studies are imperative to validate the temporal dynamics and clinical significance of these associations. Full article

This study examines the dynamic and nonlinear effects of global interest rate (based on the G7 market) shocks on equity markets in BRICS countries. A World Interest Rate (WIR) index is constructed using principal component analysis of short-term interest rates from developed economies. The analysis applies Distributed Lag Nonlinear Models (DLNMs) to evaluate the temporal response of each market to positive and negative WIR shocks over a six-period horizon. The results reveal notable asymmetries and heterogeneity. Brazil and Russia experience stronger reactions to negative shocks, while India and China show milder or delayed effects. South Africa stands out for its persistent and symmetric sensitivity to both types of shocks, suggesting deeper exposure to global financial cycles. The DLNM framework allows for a nuanced interpretation of exposure-lag relationships, offering new insights into how global monetary conditions affect emerging markets. These findings highlight that financial integration does not imply uniform vulnerability across countries and that global liquidity shocks can trigger diverse equity market responses. This paper contributes to the literature on international financial linkages and provides relevant implications for investors and policymakers managing portfolio exposure or economic risk in emerging markets. Full article

Climate change and air pollution are associated with a range of health outcomes, including cardiovascular and respiratory disease. Evaluation of the synergic effects of air pollution and increasing natural temperature on mortality is important for understanding their potential joint health effects. In this study, the modification effects of air temperature on the short-term association of ambient fine particulate matter (PM_2.5) and ozone (O₃) with non-accidental death (NAD) and cardiovascular disease (CVD) mortality were evaluated by using the generalized additive model (GAM) combined with the distributed lag nonlinear model (DLNM) in urban areas of Taiyuan, a representative of energy and heavy industrial cities in Northern China. The data on the daily cause-specific death numbers, air pollutants concentrations, and meteorological factors were collected from January 2013 to December 2019, and the temperature was divided into low (<25th percentile), medium (25–75th percentile), and high (>75th percentile) categories. Significant associations of PM_2.5 and O₃ with NAD and CVD mortality were observed in single-effect analysis. A statistically significant increase in the effect estimates of PM_2.5 and O₃ on NAD and CVD mortality was also observed on high-temperature days. But the associations of those were not statistically significant on medium- and low-temperature days. At the same temperature level, the effects of PM_2.5 and O₃ on the CVD mortality were larger than those on NAD (1.74% vs. 1.21%; 1.67% vs. 0.57%), and the elderly and males appeared to be more vulnerable to both higher temperatures and air pollution. The results suggest that the acute effect of PM_2.5 and O₃ on NAD and CVD mortality in urban Taiyuan was enhanced by increasing temperatures, particularly for the elderly and males. It highlights the importance of reducing PM_2.5 and O₃ exposure in urban areas to reduce the public health burden under the situation of global warming. Full article

This study investigates the health impacts of air pollution in the Greater Athens Area (GAA), Greece, by estimating the Relative Risk (RR) of hospital admissions (HA) for cardiovascular (CVD) and respiratory diseases (RD) from 2018 to 2020. The analysis focuses on daily exceedances of key air pollutants—PM₁₀, O₃, and NO₂—based on the “Fair” threshold and above, as defined by the European Union Air Quality Index (EU AQI). Data from ten monitoring stations operated by the Ministry of Environment and Energy were spatially matched with six hospitals across the GAA. A Distributed Lag Non-linear Model (DLNM) was employed to capture both the delayed and non-linear exposure–response (ER) relationships between pollutant exceedances and daily HA. Additionally, the synergistic effects of pollutant interactions were assessed to provide a more comprehensive understanding of cumulative health risks. The combined exposure term showed a peak RR of 1.49 (95% CI: 0.79–2.78), indicating a notable amplification of risk when multiple pollutants exceed thresholds simultaneously. The study utilizes R for data processing and statistical modeling. Findings aim to inform public health strategies by identifying critical exposure thresholds and time-lagged effects, ultimately supporting targeted interventions in urban environments experiencing air quality challenges. Full article

Little is known about the effects of wet-bulb temperature (WBT) and short-term black carbon (BC) exposure on emergency department visits for cause-stable ischemic heart disease (CSIHD). In this study, we improved and extended a set of distributed lag nonlinear models (DLNMs). After controlling for the interaction effect of WBT and BC and multiple confounding factors, we found that the lagged effect of low WBT reached the maximum risk of 1.076 (95% CI, 1.083–1.134) at lag day 7, which was greater than the maximum value of 1.057 (95% CI, 1.016–1.093) of high WBT occurring at lag day 0. The lagged effects of low and high BC both approached their maximum at lag day 0, corresponding to the risk of 1.061 (95% CI, 1.021–1.085) and 1.326 (95% CI, 1.072–1.187), respectively. The effect of short-term consecutive extreme low WBT was significant over a duration of 0–5.5 days and became insignificant after 5.5 days, whereas extreme high WBT had no impact except for the duration of 0–3 days. Exposure to short-term consecutive extreme low and high BC was found to have significant effects over a certain period, manifested in the durations of 0–1, 4–10, and 0–10 days, respectively. Our study confirmed the association of varying degrees of WBT and BC with emergency department visits for CSIHD, and targeted public health interventions for individuals are recommended under specific external humid thermal and high air pollution environments. Full article

Background: Ozone pollution has increased alongside China’s economic development, contributing to public health issues such as cardiovascular and cerebrovascular diseases. At present, the problem of an aging population is aggravated, which is worth more attention in terms of the health problems of elderly people. Methods: This study employed a distributional lag nonlinear model (DLNM) with Poisson regression to analyze the impact of ozone on cardiovascular and cerebrovascular disease mortality among the elderly in Shenyang, China, from 2014 to 2018. In addition, a time-series generalized additive regression model (GAM) was used to analyze the joint effect between PM_2.5 and ozone. Results: We found a positive correlation between ozone and mortality from cardiovascular and cerebrovascular diseases in the elderly. The maximum relative risk (RR) of mortality from cardiovascular and cerebrovascular diseases for every 10 μg/m³ increase in ozone was 1.005 (95% CI: 1.002–1.008). Males (RR: 1.018, 95% CI: 1.007–1.030), individuals in unconventional marital status (RR: 1.024, 95% CI: 1.011–1.038), and outdoor workers (RR: 1.017, 95% CI: 1.002–1.031) were more vulnerable to ozone pollution. This study did not find significant differences in the impact of ozone pollution on cardiovascular and cerebrovascular disease mortality risks among different educational groups. Additionally, a joint effect between ozone and PM_2.5 was observed. Conclusion: This study confirms that ozone exposure is positively associated with increased mortality from cardiovascular and cerebrovascular diseases. It emphasizes the joint effect of ozone and PM_2.5 in exacerbating cardiovascular and cerebrovascular disease mortality. Full article

Climate change and related events such as temperature increase over time and more frequent extreme weather events constitute a risk to the population and wellbeing. This study contributes to the knowledge on this subject by analyzing changes in mortality in Portugal using the most recent historical and future climate projections from the Coupled Model Intercomparison Project Phase 6 (CMIP6). A time-series distributed lag non-linear model (DLNM) was used to estimate the temperature-related mortality burdens in Portugal in the historical period (or reference, 1995–2014), the mid-century period (2046–2065), and the end of the century period (2081–2100) under moderate (SSP2-4.5) and extreme (SSP5-8.5) climate change scenarios. The findings show that winter periods of the contemporary climate (1995–2014) showed a significantly elevated risk of deaths from cold temperatures (RR = 2.23 (95% CI: 1.07, 4.64) at a minimum value of −3 °C), while at the maximum value (35.9 °C), the RR of 1.69 (95% CI: 1.01, 2.82) in the summer period indicated a moderate increase in risk. In terms of future projections, heat-related and extreme-heat-related mortality are higher under SSP5-8.5, while cold-related and extreme-cold-related mortality are generally higher under SSP2-4.5. Under the SSP2-4.5 scenario, the future periods of 2046–2065 and 2081–2100 showed a small net change in heat-related mortality. However, there is projected to be an increase in heat-related mortality due to increased heat, ranging from 0.13% to 0.14%. The impact of extreme heat is expected to result in a mortality increase of 0.03% to 0.04%, while extreme cold is expected to decrease mortality by −0.10%. Under the SSP5-8.5 scenario, the net change in mortality during the future period of 2046–2065 is estimated to decrease by −0.13%, with some uncertainty in the estimate. From 2081 to 2100, there is expected to be an estimated increase of 0.06% in mortality. The specific impact of increased heat shows an increase in heat-related mortality ranging from 0.15% to 0.17%, while extreme heat has an estimated increase of 0.04% to 0.05%. The developed framework provides a comprehensive assessment of excess mortality attributed to varying non-optimum temperatures for designing public health policies in Portugal. Full article

The relationship between ozone (O₃) exposure and gestational diabetes mellitus (GDM) in twin pregnancies remains unexplored. This study aimed to investigate the association between O₃ exposure and GDM risk in twin pregnancies, and to explore the synergistic effects of O₃ exposure with other maternal factors. A total of 428 pregnancies recruited from a prospective twin cohort were included. Cox proportional hazard models with distributed lag non-linear models (DLNMs) were applied to examine the associations between O₃ exposure and the risk of GDM and to identify the critical windows. The multiplicative and additive interaction were further analyzed to test the synergistic effects. A 10 μg/m³ increase in average O₃ exposure during the 12 weeks before pregnancy was associated with a 26% higher risk of GDM. The critical windows were identified in the period from the 3rd week before gestation to the 2nd gestational week as well as from the 17th to 19th gestational week. There were synergistic effects between high O₃ exposure during preconception and advanced maternal age, and a history of preterm birth/abortion/stillbirth. Periconceptional O₃ exposure could increase the risk of GDM in twin pregnancy women, and the synergism of O₃ exposure with certain GDM risk factors was observed. Full article

Evidence from megacity registry data regarding the independent association between ambient temperature and cardiovascular disease (CVD) mortality, after accounting for Particulate Matter 2.5 (PM_2.5), remains scarce. In this study, we collected 308,116 CVD mortality cases in Shanghai from 2015 to 2020. The distributed lag non-linear model (DLNM) was utilized. The daily PM_2.5 concentration was transformed using a natural spline (ns) function and integrated into the model for adjustment. The DLNM analysis revealed that the exposure–response curve between daily temperature and CVD mortality approximated an inverted “J” shape, consistent for both women and men. The minimum mortality temperature (MMT) for total CVD mortality was 25 °C, with an MMT of 26 °C for females and 24 °C for males. The highest relative risk (RR) of CVD mortality was 2.424 [95% confidence interval (95% CI): 2.035, 2.887] at the lowest temperature of −6.1 °C, with 2.244 (95% CI: 1.787, 2.818) for female and 2.642 (95% CI: 2.100, 3.326) for male. High temperatures exert acute and short-term effects, with the peak risk occurring on the day of exposure. In contrast, the risk from low temperature peaks on day 3 of the lag time and subsequently declines until days 16–21. This study offers evidence-based support for the prevention of temperature-induced CVD mortality. Full article

While the impact of air pollution on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has been widely studied, its effect on hospitalization outcomes remains less explored. This study examines the influence of short-term air pollution exposure on adverse hospitalization outcomes—mortality, mechanical ventilation use, and prolonged hospitalization—in patients with non-infectious severe AECOPD in Novi Sad, Serbia. Using a five-year time-series analysis, concentrations of selected air pollutants (PM₁₀, PM_2.5, SO₂, and NO₂) and meteorological data were integrated with hospitalization outcomes. Distributed lag non-linear models (DLNMs) revealed significant associations between rising air pollutant levels and some unfavorable outcomes. Exposure to rising PM_2.5 (urban background) and SO₂ (urban traffic) concentrations were linked to higher risks of mechanical ventilation (cumulative OR 21.95 (95% CI 1.07–449.45) and 11.37 (95% CI 1.25–103.27), respectively) and prolonged non-infectious AECOPD hospitalization (cumulative RR 2.27 (95% CI 1.14–4.52) and 2.24 (95% CI 1.38–3.64), respectively). No cumulative lag effects on mortality were observed, though specific patterns emerged in individual lag models. These findings highlight the critical role of improving air quality in reducing some COPD-related hospitalization risks. Full article

This study investigates the correlation between short-term exposure to nitrogen dioxide (NO₂) and hospitalization for chronic kidney disease (CKD) in Lanzhou, China. A distributed lag nonlinear model (DLNM) was employed to examine the relationship between changes in NO₂ concentration and CKD hospitalizations. Subgroup analyses were conducted to assess the sensitivity of different populations to NO₂ exposure. A total of 35,857 CKD hospitalizations occurred from 1 January 2014 to 31 December 2019. The average daily concentration of NO₂ was 47.33 ± 17.27 µg/m³. A significant exposure response relationship was observed between changes in NO₂ concentration and the relative risk (RR) of CKD hospitalization. At lag0 (the same day) and lag0-1 (cumulative same day and the previous 1 day) to lag0-4 (cumulative same day and the previous 4 days), NO₂ exhibited a harmful effect on CKD hospitalizations, with the maximum effect occurring at lag0-1. For every 10 µg/m³ increase in NO₂ concentration, the RR of CKD hospitalization was 1.034 [95% confidence interval (CI): 1.017, 1.050]. Subgroup analyses revealed that the adverse effects of NO₂ were more pronounced in females and individuals aged ≥65 years. The harmful effects were also more significant during the cold season. In conclusion, short-term NO₂ exposure is associated with an increased relative risk of CKD hospitalization. Continuous efforts to improve air quality are essential to protect public health. Full article

Bacterial foodborne diseases caused by Vibrio parahaemolyticus pose persistent challenges to coastal cities in China. In this study, we employed multiple logistic regression analysis and distributed lag non-linear models (DLNM) to investigate the epidemiological characteristics and associated risk factors of vibriosis in the metropolitan area of Hangzhou from 2014 to 2018. Analysis of foodborne cases indicated that certain demographics and occupational factors, including age between 16 and 44 years; houseworkers or unemployed individuals; preference for aquatic and meat products; and dining in collective canteens or catering services contribute to an increased likelihood of V. parahaemolyticus infection. Moreover, a higher per capita GDP and exposure to high temperatures were identified as risk factors for vibriosis. This study highlights the significance of the daily mean temperature as a meteorological factor influencing V. parahaemolyticus infection, with varying lag effects observed depending on temperature conditions. At low temperatures, the risk of infection occurs after a lag of 21 days, whereas at high temperatures, the risk is highest on the same day, while the second infection risk period occurs after a lag of 21 days. These findings provide a spatiotemporal perspective of the risk analysis of foodborne diseases, with a daily timescale and street spatial scale, which contributes to the development of public health strategies and food safety protocols in coastal cities. Full article