Abstract：
BACKGROUND: The effects of fine particulate matter (PM2.5) on acute myocardial infarction (AMI) have been widely recognized. However, no studies have comprehensively evaluated future PM2.5-attributed AMI burdens under different climate mitigation and population change scenarios. We aimed to quantify the PM2.5-AMI association and estimate the future change in PM2.5-attributed AMI incident cases under six integrated scenarios in 2030 and 2060 in Shandong Province, China.
METHODS: Daily AMI incident cases and air pollutant data were collected from 136 districts/counties in Shandong Province from 2017 - 2019. A two-stage analysis with a distributed lag nonlinear model was conducted to quantify the baseline PM2.5-AMI association. The future change in PM2.5-attributed AMI incident cases was estimated by combining the fitted PM2.5-AMI association with the projected daily PM2.5 concentrations under six integrated scenarios. We further analyzed the factors driving changes in PM2.5-related AMI incidence using a decomposition method.
RESULTS: Each 10 μg/m3 increase in PM2.5 exposure at lag05 was related to an excess risk of 1.3 % (95 % confidence intervals: 0.9 %, 1.7 %) for AMI incidence from 2017 - 2019 in Shandong Province. The estimated total PM2.5-attributed AMI incident cases would increase by 10.9-125.9 % and 6.4-244.6 % under Scenarios 1 - 3 in 2030 and 2060, whereas they would decrease by 0.9-5.2 % and 33.0-46.2 % under Scenarios 5 - 6 in 2030 and 2060, respectively. Furthermore, the percentage increases in PM2.5-attributed female cases (2030: -0.3 % to 135.1 %; 2060: -33.2 % to 321.5 %) and aging cases (2030: 15.2-171.8 %; 2060: -21.5 % to 394.2 %) would wholly exceed those in male cases (2030: -1.8 % to 133.2 %; 2060: -41.1 % to 264.3 %) and non-aging cases (2030: -41.0 % to 45.7 %; 2060: -89.5 % to -17.0 %) under six scenarios in 2030 and 2060. Population aging is the main driver of increased PM2.5-related AMI incidence under Scenarios 1 - 3 in 2030 and 2060, while improved air quality can offset these negative effects of population aging under the implementation of the carbon neutrality and 1.5 °C targets.
CONCLUSIONS: The combination of ambitious climate policies (i.e., 1.5 °C warming limits and carbon neutrality targets) with stringent clean air policies is necessary to reduce the health impacts of air pollution in Shandong Province, China, regardless of population aging.
METHODS: Daily AMI incident cases and air pollutant data were collected from 136 districts/counties in Shandong Province from 2017 - 2019. A two-stage analysis with a distributed lag nonlinear model was conducted to quantify the baseline PM2.5-AMI association. The future change in PM2.5-attributed AMI incident cases was estimated by combining the fitted PM2.5-AMI association with the projected daily PM2.5 concentrations under six integrated scenarios. We further analyzed the factors driving changes in PM2.5-related AMI incidence using a decomposition method.
RESULTS: Each 10 μg/m3 increase in PM2.5 exposure at lag05 was related to an excess risk of 1.3 % (95 % confidence intervals: 0.9 %, 1.7 %) for AMI incidence from 2017 - 2019 in Shandong Province. The estimated total PM2.5-attributed AMI incident cases would increase by 10.9-125.9 % and 6.4-244.6 % under Scenarios 1 - 3 in 2030 and 2060, whereas they would decrease by 0.9-5.2 % and 33.0-46.2 % under Scenarios 5 - 6 in 2030 and 2060, respectively. Furthermore, the percentage increases in PM2.5-attributed female cases (2030: -0.3 % to 135.1 %; 2060: -33.2 % to 321.5 %) and aging cases (2030: 15.2-171.8 %; 2060: -21.5 % to 394.2 %) would wholly exceed those in male cases (2030: -1.8 % to 133.2 %; 2060: -41.1 % to 264.3 %) and non-aging cases (2030: -41.0 % to 45.7 %; 2060: -89.5 % to -17.0 %) under six scenarios in 2030 and 2060. Population aging is the main driver of increased PM2.5-related AMI incidence under Scenarios 1 - 3 in 2030 and 2060, while improved air quality can offset these negative effects of population aging under the implementation of the carbon neutrality and 1.5 °C targets.
CONCLUSIONS: The combination of ambitious climate policies (i.e., 1.5 °C warming limits and carbon neutrality targets) with stringent clean air policies is necessary to reduce the health impacts of air pollution in Shandong Province, China, regardless of population aging.
摘要：
背景：细颗粒物（PM2.5）对急性心肌梗死（AMI）的影响已得到广泛认可。然而,没有研究全面评估不同气候缓解和人口变化情景下未来PM2.5导致的AMI负担.我们旨在量化PM2.5-AMI关联，并估计山东省2030年和2060年六种综合情景下PM2.5导致AMI事件病例的未来变化。中国。
方法：收集2017-2019年山东省136个区县每日AMI事件病例和大气污染物数据。使用分布滞后非线性模型进行了两阶段分析，以量化基线PM2.5-AMI关联。通过将拟合的PM2.5-AMI关联与六种综合情景下的预计每日PM2.5浓度相结合，估计了PM2.5引起的AMI事件病例的未来变化。我们使用分解方法进一步分析了驱动PM2.5相关AMI发病率变化的因素。
结果：在lag05时，PM2.5暴露量每增加10μg/m3，与1.3％的超额风险相关（95％置信区间：0.9％，1.7%）为2017-2019年山东省AMI发病率。在2030年和2060年的情况1-3下，估计PM2.5导致的AMI事件总数将增加10.9-125.9％和6.4-244.6％，而在2030年和2060年的情况5-6下，它们将分别减少0.9-5.2％和33.0-46.2％。此外，由PM2.5引起的女性病例（2030年：-0.3％至135.1％；2060年：-33.2％至321.5％）和老龄化病例（2030年：15.2-171.8％；2060年：-21.5％至394.2％）的百分比增长将完全超过男性病例（2030年：-1.8％至133.2％；2060年：-41.1％至264.3％）和非老龄化病例（2030年：4在2030年和2060年的情况1-3下，人口老龄化是PM2.5相关AMI发病率增加的主要驱动因素，而空气质量的改善可以抵消碳中和和1.5°C目标实施下人口老龄化的负面影响。
结论：雄心勃勃的气候政策（即，1.5°C的变暖限制和碳中和目标）以及严格的清洁空气政策对于减少山东省空气污染对健康的影响是必要的，中国,无论人口老龄化。
方法：收集2017-2019年山东省136个区县每日AMI事件病例和大气污染物数据。使用分布滞后非线性模型进行了两阶段分析，以量化基线PM2.5-AMI关联。通过将拟合的PM2.5-AMI关联与六种综合情景下的预计每日PM2.5浓度相结合，估计了PM2.5引起的AMI事件病例的未来变化。我们使用分解方法进一步分析了驱动PM2.5相关AMI发病率变化的因素。
结果：在lag05时，PM2.5暴露量每增加10μg/m3，与1.3％的超额风险相关（95％置信区间：0.9％，1.7%）为2017-2019年山东省AMI发病率。在2030年和2060年的情况1-3下，估计PM2.5导致的AMI事件总数将增加10.9-125.9％和6.4-244.6％，而在2030年和2060年的情况5-6下，它们将分别减少0.9-5.2％和33.0-46.2％。此外，由PM2.5引起的女性病例（2030年：-0.3％至135.1％；2060年：-33.2％至321.5％）和老龄化病例（2030年：15.2-171.8％；2060年：-21.5％至394.2％）的百分比增长将完全超过男性病例（2030年：-1.8％至133.2％；2060年：-41.1％至264.3％）和非老龄化病例（2030年：4在2030年和2060年的情况1-3下，人口老龄化是PM2.5相关AMI发病率增加的主要驱动因素，而空气质量的改善可以抵消碳中和和1.5°C目标实施下人口老龄化的负面影响。
结论：雄心勃勃的气候政策（即，1.5°C的变暖限制和碳中和目标）以及严格的清洁空气政策对于减少山东省空气污染对健康的影响是必要的，中国,无论人口老龄化。
