Vivian C. Pun

Short-Term Associations of Cause-Specific Emergency Hospitalizations and Particulate Matter Chemical Components in Hong Kong

Despite an increasing number of recent studies, the overall epidemiologic evidence associating specific particulate matter chemical components with health outcomes has been mixed. The links between components and hospitalizations have rarely been examined in Asia. We estimated associations between exposures to 18 chemical components of particulate matter with aerodynamic diameter less than 10 μm (PM10) and daily emergency cardiorespiratory hospitalizations in Hong Kong, China, between 2001 and 2007. Carbonaceous particulate matter, sulfate, nitrate, and ammonium accounted for two-thirds of the PM10 mass. After adjustment for time-varying confounders, a 3.4-μg/m(3) increment in 2-day moving average of same-day and previous-day nitrate concentrations was associated with the largest increase of 1.32% (95% confidence interval: 0.73, 1.92) in cardiovascular hospitalizations; elevation in manganese level (0.02 μg/m(3)) was linked to a 0.91% (95% confidence interval: 0.19, 1.64) increase in respiratory hospitalizations. Upon further adjustment for gaseous copollutants, nitrate, sodium ion, chloride ion, magnesium, and nickel remained significantly associated with cardiovascular hospitalizations, whereas sodium ion, aluminum, and magnesium, components abundantly found in coarser PM10, were associated with respiratory hospitalizations. Most positive links were seen during the cold season. These findings lend support to the growing body of literature concerning the health associations of particulate matter composition and provide important insight into the differential health risks of components found in fine and coarse modes of PM10.

Ambient Carbon Monoxide and the Risk of Hospitalization Due to Chronic Obstructive Pulmonary Disease

Data from recent experimental and clinical studies have indicated that lower concentrations of inhaled carbon monoxide might have beneficial antiinflammatory effects. Inhaled carbon monoxide has the potential to be a therapeutic agent for chronic obstructive pulmonary diseases (COPD). However, population-based epidemiologic studies of environmentally relevant carbon monoxide exposure have generated mixed findings. We conducted a time-series study in Hong Kong to estimate the association of short-term exposure to ambient carbon monoxide with emergency hospitalizations for COPD. We collected daily emergency hospital admission data and air pollution data from January 2001 to December 2007. We used log-linear Poisson models to estimate the associations between daily hospital admissions for COPD and the average daily concentrations of carbon monoxide while controlling for the traffic-related co-pollutants nitrogen dioxide and particulate matter with an aerodynamic diameter less than 2.5 μm. Results showed that ambient carbon monoxide was negatively associated with the risk of hospitalizations for COPD. After adjustment for levels nitrogen dioxide or particulate matter with an aerodynamic diameter less than 2.5 μm, the negative associations of carbon monoxide with COPD hospitalizations became stronger. The risk estimates were similar for female and male subjects. In conclusion, short-term exposure to ambient carbon monoxide was associated with a decreased risk of hospitalization for COPD, which suggests that carbon monoxide exposure provides some acute protection of against exacerbation of COPD.

Differential Effects of Source-Specific Particulate Matter on Emergency Hospitalizations for Ischemic Heart Disease in Hong Kong

Background: Ischemic heart disease (IHD) is a major public health concern. Although many epidemiologic studies have reported evidence of adverse effects of particulate matter (PM) mass on IHD, significant knowledge gaps remain regarding the potential impacts of different PM sources. Much the same as PM size, PM sources may influence toxicological characteristics. Objectives: We identified contributing sources to PM10 mass and estimated the acute effects of PM10 sources on daily emergency IHD hospitalizations in Hong Kong. Methods: We analyzed the concentration data of 19 PM10 chemical components measured between 2001 and 2007 by positive matrix factorization to apportion PM10 mass, and used generalized additive models to estimate associations of interquartile range (IQR) increases in PM10 exposures with IHD hospitalization for different lag periods (up to 5 days), adjusted for potential confounders. Results: We identified 8 PM10 sources: vehicle exhaust, soil/road dust, regional combustion, residual oil, fresh sea salt, aged sea salt, secondary nitrate, and secondary sulfate. Vehicle exhaust, secondary nitrate, and secondary sulfate contributed more than half of the PM10 mass. Although associations with IQR increases in 2-day moving averages (lag01) were statistically significant for most sources based on single-source models, only PM10 from vehicle exhaust [1.87% (95% CI: 0.66, 3.10); IQR = 4.9 μg/m3], secondary nitrate [2.28% (95% CI: 1.15, 3.42); IQR = 8.6 μg/m3], and aged sea salt [1.19% (95% CI: 0.04, 2.36); IQR = 5.9 μg/m3] were significantly associated with IHD hospitalizations in the multisource model. Analysis using chemical components provided similar findings. Conclusion: Emergency IHD hospitalization was significantly linked with PM10 from vehicle exhaust, nitrate-rich secondary PM, and sea salt–related PM. Findings may help prioritize toxicological research and guide future monitoring and emission-control polices. Citation: Pun VC, Yu IT, Ho KF, Qiu H, Sun Z, Tian L. 2014. Differential effects of source-specific particulate matter on emergency hospitalizations for ischemic heart disease in Hong Kong. Environ Health Perspect 122:391–396; http://dx.doi.org/10.1289/ehp.1307213

Air pollution and mortality: Effect modification by personal characteristics and specific cause of death in a case-only study

Short-term effects of air pollution on mortality have been well documented in the literature worldwide. Less is known about which subpopulations are more vulnerable to air pollution. We conducted a case-only study in Hong Kong to examine the potential effect modification by personal characteristics and specific causes of death. Individual information of 402,184 deaths of non-external causes and daily mean concentrations of air pollution were collected from 2001 to 2011. For a 10 μg/m(3) increase of pollution concentration, people aged ≥ ∇65 years (compared with younger ages) had a 0.9-1.8% additional increase in mortality related to PM, NO2, and SO2. People dying from cardiorespiratory diseases (compared with other non-external causes) had a 1.6-2.3% additional increase in PM and NO2 related mortality. Other subgroups that were particularly susceptible were females and those economically inactive. Lower socioeconomic status and causes of cardiorespiratory diseases would increase the likelihood of death associated with air pollution.

Long-Term PM2.5 Exposure and Respiratory, Cancer, and Cardiovascular Mortality in Older US Adults

The impact of chronic exposure to fine particulate matter (particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5)) on respiratory disease and lung cancer mortality is poorly understood. In a cohort of 18.9 million Medicare beneficiaries (4.2 million deaths) living across the conterminous United States between 2000 and 2008, we examined the association between chronic PM2.5 exposure and cause-specific mortality. We evaluated confounding through adjustment for neighborhood behavioral covariates and decomposition of PM2.5 into 2 spatiotemporal scales. We found significantly positive associations of 12-month moving average PM2.5 exposures (per 10-μg/m3 increase) with respiratory, chronic obstructive pulmonary disease, and pneumonia mortality, with risk ratios ranging from 1.10 to 1.24. We also found significant PM2.5-associated elevated risks for cardiovascular and lung cancer mortality. Risk ratios generally increased with longer moving averages; for example, an elevation in 60-month moving average PM2.5 exposures was linked to 1.33 times the lung cancer mortality risk (95% confidence interval: 1.24, 1.40), as compared with 1.13 (95% confidence interval: 1.11, 1.15) for 12-month moving average exposures. Observed associations were robust in multivariable models, although evidence of unmeasured confounding remained. In this large cohort of US elderly, we provide important new evidence that long-term PM2.5 exposure is significantly related to increased mortality from respiratory disease, lung cancer, and cardiovascular disease.

Carbon monoxide and stroke: A time series study of ambient air pollution and emergency hospitalizations

BACKGROUND Recent experimental and clinical studies suggested that exogenous carbon monoxide (CO) at low concentrations may have beneficial neuroprotective effects under certain circumstances. However, population-based epidemiological studies of environmentally relevant CO exposure generated mixed findings. The present study aimed to examine the short-term association of ambient CO with emergency stroke hospitalizations. METHODS A time series study was conducted. Daily air pollution concentrations and emergency hospital admission data from January 2004 to December 2011 in Hong Kong were collected. Generalized additive Poisson models were used to estimate the associations between daily 24-hour mean concentrations of CO and emergency hospital admissions for stroke, while controlling for other traffic related co-pollutants: NO₂ and PM₂.₅. Sensitivity analyses were performed using daily 1-hour maximum concentration of CO as exposure indicator. RESULTS Negative associations were observed between ambient CO concentrations and emergency hospital admissions for stroke. The previous 1-3 day cumulative exposure to CO was associated with a -2.0% (95%CI, -3.3% to -0.7%) decrease in stroke admissions per interquartile range (IQR) increment in CO concentration (0.3 ppm). Similar results were obtained when using 1-hour maximum concentration of CO as exposure indicator. The negative association was robust to the co-pollutant adjustment for either NO₂ or PM₂.₅. Females and elders appeared to be more sensitive to ambient CO exposure. The negative association tended to be larger in cool season. CONCLUSION Short-term exposure to ambient CO was associated with decreased risk of emergency hospitalizations for stroke, suggesting some acute protective effects of CO exposure against stroke onsets.

Differential Distributed Lag Patterns of Source-Specific Particulate Matter on Respiratory Emergency Hospitalizations

While different emission sources and formation processes generate mixtures of particulate matter (PM) with different physicochemical compositions that may differentially affect PM toxicity, evidence of associations between PM sources and respiratory events is scarce. We estimated PM10 sources contributed from 19 chemical constituents by positive matrix factorization, and examined association of short-term sources exposure with emergency respiratory hospitalizations using generalized additive models for single- and distributed lag periods. PM10 contributions from eight sources were identified. Respiratory risks over a consecutive 6-day exposure period were the highest for vehicle exhaust [2.01%; 95% confidence interval (CI): 1.04, 2.99], followed by secondary sulfate (1.59%; 95% CI: 0.82, 2.37). Vehicle exhaust, regional combustion, and secondary nitrate were significantly associated with 0.93%-2.04% increase in respiratory hospitalizations at cumulative lag2-5; significant associations of aged sea salt (1.2%; 95% CI: 0.63, 1.78) and soil/road dust (0.42%; 95% CI: 0.03, 0.82) were at lag0-1. Some effect estimates were no longer significant in two-pollutant models adjusting for PM10; however, a similar temporal pattern of associations remains. Differential lag associations of respiratory hospitalizations with PM10 sources were indicated, which may reflect the different particle size fractions that sources tend to emit. Findings may have potential biological and policy implications.

Understanding Walking Behavior among University Students Using Theory of Planned Behavior

Walking has been shown to improve physical and mental well-being, yet insufficient walking among university students has been increasingly reported. This study aimed to understand walking behavior of university students using theory of planned behavior (TPB). We recruited 169 undergraduate students by university mass email of the Chinese University of Hong Kong, and first administered a salient belief elicitation survey, which was used to design the TPB questionnaire, to a subset of the study sample. Secondly, all participants completed the TPB questionnaire and walking-oriented diary in a two-day period in December 2012. We mapped the walking behavior data obtained from the diary using geographic information system, and examined the extent to which TPB constructs explained walking intentions and walking behavior using Structural equation model (SEM). We found perceived behavioral control to be the key determinant of walking intention. Shaped by participants’ perceived behavioral control, attitude toward walking and subjective norms, and behavioral intention, in turn had a moderate explanatory effect on their walking behavior. In summary, our findings suggest that walking behavior among university students can be understood within the TPB framework, and could inform walking promotion interventions on the university campuses.