Yuming Guo, MD, PhD

ImportancePreterm birth (PTB) is associated with adverse health outcomes. The outcomes of heat exposure during pregnancy and the moderating association of greenness with PTB remain understudied.ObjectiveTo investigate associations between heat exposure, greenness, and PTB, as well as interactions between these factors.Design, Setting, and ParticipantsIncluded in this cohort study were births occurring in Sydney, New South Wales, Australia, between 2000 and 2020, retrieved from New South Wales Midwives Data Collection. Participants with incomplete or missing data on their residential address or those who resided outside of New South Wales during their pregnancy were excluded. Data were analyzed from March to October 2023.ExposuresGreenness measured using normalized difference vegetation index (NDVI) and tree cover derived from satellite images. Daily extreme heat and nighttime …

Epidemiological evidence for long-term air pollution exposure and Parkinson’s disease (PD) is controversial, and analysis of causality is limited. We identified 293,888 participants who were free of PD at baseline in the UK Biobank (2006-2010). Time-varying air pollution [fine particulate (PM2.5) and ozone (O3)] exposures were estimated using spatio-temporal models. Incident cases of PD were identified using validated algorithms. Four methods were used to investigate the associations between air pollution and PD, including (1) standard time-varying Cox proportional-hazard model; (2) Cox models weighted by generalized propensity score (GPS) and inverse-probability weights (IPW); (3) instrumental variable (IV) analysis; and (4) negative control outcome analysis. During a median of 11.6 years of follow-up, 1,822 incident PD cases were identified. Based on standard Cox regression, the hazard ratios (95 …

Background More intense tropical cyclones (TCs) are expected in the future under a warming climate scenario, but little is known about their mortality effect pattern across countries and over decades. We aim to evaluate the TC-specific mortality risks, periods of concern (POC) and characterize the spatiotemporal pattern and exposure-response (ER) relationships on a multicountry scale. Methods and findings Daily all-cause, cardiovascular, and respiratory mortality among the general population were collected from 494 locations in 18 countries or territories during 1980 to 2019. Daily TC exposures were defined when the maximum sustained windspeed associated with a TC was ≥34 knots using a parametric wind field model at a 0.5° × 0.5° resolution. We first estimated the TC-specific mortality risks and POC using an advanced flexible statistical framework of mixed Poisson model, accounting for the population changes, natural variation, seasonal and day of the week effects. Then, a mixed meta-regression model was used to pool the TC-specific mortality risks to estimate the overall and country-specific ER relationships of TC characteristics (windspeed, rainfall, and year) with mortality. Overall, 47.7 million all-cause, 15.5 million cardiovascular, and 4.9 million respiratory deaths and 382 TCs were included in our analyses. An overall average POC of around 20 days was observed for TC-related all-cause and cardiopulmonary mortality, with relatively longer POC for the United States of America, Brazil, and Taiwan (>30 days). The TC-specific relative risks (RR) varied substantially, ranging from 1.04 to 1.42, 1.07 to 1.77, and 1.12 to 1.92 among …

Cancer etiology is multifactorial, with climate change and environmental factors such as extreme weather events and ozone layer destruction potentially increasing cancer risk. Investigating climate factors with cancer incidence can provide valuable insights for prevention and future disease burden prediction. We conducted a population-based ecological study using data from the World Health Organization’s Cancer Incidence in Five Continents (CI5plus, 89 cancer registries from 1998 to 2012) and the Surveillance, Epidemiology, and End Results (SEER, 607 US counties from 2000 to 2018) Program. We tracked climate factors through satellite-based remote sensing, including green space, stratospheric ozone concentration, solar radiation, precipitation, and temperature. We performed linear panel regression models to estimate the effects of both long-term exposure, lag effect, and change rate of climate factors on cancer incidences. We adjusted for smoking prevalence, air pollution, and gross domestic product (GDP) per capita to account for potential confounding factors. Our study included more than 430 million underlying populations across 37 countries. Higher green space exposure (per 0.1-unit normalized difference vegetation index, NDVI) was associated with decreased incidence of lung cancer (up to 6.66 cases [95%CI 4.38–8.93] per 100,000) and prostate cancer (up to 10.84 cases [95% CI 7.73–13.95] per 100,000). Increased solar radiation was associated with a higher incidence of melanoma, but a lower incidence of prostate cancer. No evidence was found to suggest associations between temperature or precipitation and cancer …

Enormous health burden has been associated with air pollution and its effects continue to grow. However, the impact of air pollution on labour productivity at the population level is still unknown. This study assessed the association between premature death due to PM2.5 exposure and the loss of productivity-adjusted life years (PALYs), in Brazil. We applied a novel variant of the difference-in-difference (DID) approach to assess the association. Daily all-cause mortality data in Brazil were collected from 2000–2019. The PALYs lost increased by 5.11% (95% CI: 4.10–6.13%), for every 10 µg/m3 increase in the 2-day moving average of PM2.5. A total of 9,219,995 (95% CI: 7,491,634–10,921,141) PALYs lost and US$ 268.05 (95% CI: 217.82–317.50) billion economic costs were attributed to PM2.5 exposure, corresponding to 7.37% (95% CI: 5.99–8.73%) of the total PALYs lost due to premature death. This study also …

BackgroundGreenspace is known to have a positive impact on human health and well-being, but its potential effects on visual acuity have not been extensively studied.ObjectivesOur aim was to examine the relationship between long-term greenspace exposure and visual acuity in children, while also exploring the potential mechanisms in this association.MethodsWe conducted this prospective cohort study based on the Children’s growth environment, lifestyle, physical, and mental health development project (COHERENCE), which screened 286,801 schoolchildren in Guangzhou, China, starting in the 2016/17 academic year and followed them up for three academic years (2017/18-2019/20). Visual acuity was measured using a standardized logarithmic chart, and visual impairment was defined as visual acuity worse than 0.0 logarithm of the minimum angle of resolution (LogMAR) units in the better eye. We used …

BackgroundThe acute health effects of short-term (hours to days) exposure to fine particulate matter (PM2·5) have been well documented; however, the global mortality burden attributable to this exposure has not been estimated. We aimed to estimate the global, regional, and urban mortality burden associated with short-term exposure to PM2·5 and the spatiotemporal variations in this burden from 2000 to 2019.MethodsWe combined estimated global daily PM2·5 concentrations, annual population counts, country-level mortality rates, and epidemiologically derived exposure–response functions to estimate the mortality attributable to short-term PM2·5 exposure from 2000 to 2019, in the continental regions and in 13 189 urban centres worldwide at a spatial resolution of 0·1° × 0·1°. We tested the robustness of our mortality estimates with different theoretical minimum risk exposure levels, lag effects, and exposure …

BackgroundPrenatal fine particulate matter (PM 2.5) constituents exposure and reduced fetal growth may be risk factors for accelerated growth in early childhood, an important indicator for lifelong health.ObjectiveThe study investigated whether the joint effects are present between PM 2.5 constituents and reduced fetal growth.MethodsThe study was embedded in a birth cohort in China, including 5424 mother-child pairs. Prenatal PM 2.5 and its constituents’[organic carbon (OC), elementary carbon (EC), ammonium (NH 4+), nitrate (NO 3−), and sulfate (SO 4 2−)] concentrations were estimated based on maternal residential addresses. Fetal growth was evaluated by fetal growth trajectory in utero and preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA). Children’s accelerated growth was defined as body mass index (BMI) Z-score change of> 0.67 between birth and 3 years. Generalized …

Increasing evidence is appearing that ozone has adverse effects on health. However, the association between long-term ozone exposure and lung function is still inconclusive. To investigate the associations between long-term exposure to ozone and lung function in Chinese young adults. We conducted a prospective cohort study among 1594 college students with a mean age of 19.2 years at baseline in Shandong, China from September 2020 to September 2021. Lung function indicators were measured in September 2020 and September 2021, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow at the 25th, 50th, and 75th percentile of the FVC (FEF25, FEF50, and FEF75) and mean flow rate between 25% and 75% of the FVC (FEF25-75) were measured. Daily 10 km×10 km ozone concentrations come from a well-validated data-fusion approach. The time-weighted average concentrations in 12 months before the lung function test were defined as the long-term ozone exposure. The associations between long-term ozone exposure and lung function indicators in Chinese young adults were investigated using a linear mixed effects model, followed by stratified analyses regarding sex, BMI and history of respiratory diseases. Each interquartile range (IQR) (8.9 µg/m3) increase in long-term ozone exposure were associated with a -204.3 (95% confidence interval (CI): -361.6, -47.0) ml/s, -146.3 (95% CI: -264.1, -28.4) ml/s, and − 132.8 (95% CI: -239.2, -26.4) ml/s change in FEF25, FEF50, and FEF25-75, respectively. Stronger adverse associations were found in female participants or those with BMI ≥ …

BackgroundClimate change can directly impact temperature-related excess deaths and might subsequently change the seasonal variation in mortality. In this study, we aimed to provide a systematic and comprehensive assessment of potential future changes in the seasonal variation, or seasonality, of mortality across different climate zones.MethodsIn this modelling study, we collected daily time series of mean temperature and mortality (all causes or non-external causes only) via the Multi-Country Multi-City Collaborative (MCC) Research Network. These data were collected during overlapping periods, spanning from Jan 1, 1969 to Dec 31, 2020. We projected daily mortality from Jan 1, 2000 to Dec 31, 2099, under four climate change scenarios corresponding to increasing emissions (Shared Socioeconomic Pathways [SSP] scenarios SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5). We compared the seasonality in …

Older adults are generally amongst the most vulnerable to heat and cold. While temperature-related health impacts are projected to increase with global warming, the influence of population aging on these trends remains unclear. Here we show that at 1.5 °C, 2 °C, and 3 °C of global warming, heat-related mortality in 800 locations across 50 countries/areas will increase by 0.5%, 1.0%, and 2.5%, respectively; among which 1 in 5 to 1 in 4 heat-related deaths can be attributed to population aging. Despite a projected decrease in cold-related mortality due to progressive warming alone, population aging will mostly counteract this trend, leading to a net increase in cold-related mortality by 0.1%–0.4% at 1.5–3 °C global warming. Our findings indicate that population aging constitutes a crucial driver for future heat- and cold-related deaths, with increasing mortality burden for both heat and cold due to the aging …

Model-estimated air pollution exposure assessments have been extensively employed in the evaluation of health risks associated with air pollution. However, few studies synthetically evaluate the reliability of model-estimated PM2.5 products in health risk assessment by comparing them with ground-based monitoring station air quality data. In response to this gap, we undertook a meticulously structured systematic review and meta-analysis. Our objective was to aggregate existing comparative studies to ascertain the disparity in mortality effect estimates derived from model-estimated ambient PM2.5 exposure versus those based on monitoring station-observed PM2.5 exposure. We conducted searches across multiple databases, namely PubMed, Scopus, and Web of Science, using predefined keywords. Ultimately, ten studies were included in the review. Of these, seven investigated long-term annual exposure …

BackgroundNon-optimum temperatures are associated with a considerable mortality burden. However, evidence of temperature with all-cause and cause-specific hospital admissions in tropical countries like Thailand is still limited.MethodsDaily all-cause and cause-specific hospital admissions for outpatient and inpatient visits were collected from 77 provinces in Thailand from January 2013 to August 2019. A two-stage time-series approach was applied to assess the association between non-optimum temperatures and hospital admission. We first fitted the province-specific temperature-morbidity association and then obtained the national association in the second stage using a random-effects meta-analysis regression. The attributable fraction (AF) of hospital admissions with 95% empirical confidence interval (eCI) was calculated.FindingsA total of 878,513,460 all-cause outpatient admissions and 32,616,600 all …

The multidrug-resistant Gram-negative bacteria has evolved into a worldwide threat to human health; over recent decades, polymyxins have re-emerged in clinical practice due to their high activity against multidrug-resistant bacteria. Nevertheless, the nephrotoxicity and neurotoxicity of polymyxins seriously hinder their practical use in the clinic. Based on the quantitative structure-activity relationship (QSAR), analogue design is an efficient strategy for discovering biologically active compounds with fewer adverse effects. To accelerate the polymyxin analogues discovery process and find the polymyxin analogues with high antimicrobial activity against Gram-negative bacteria, here we developed PmxPred, a GCN and catBoost-based machine learning framework. The RDKit descriptors were used for the molecule and residues representation, and the ensemble learning model was utilized for the antimicrobial activity …

BackgroundExposure to cold spells is associated with mortality. However, little is known about the global mortality burden of cold spells.MethodsA three-stage meta-analytical method was used to estimate the global mortality burden associated with cold spells by means of a time series dataset of 1960 locations across 59 countries (or regions). First, we fitted the location-specific, cold spell-related mortality associations using a quasi-Poisson regression with a distributed lag non-linear model with a lag period of up to 21 days. Second, we built a multivariate meta-regression model between location-specific associations and seven predictors. Finally, we predicted the global grid-specific cold spell-related mortality associations during 2000–19 using the fitted meta-regression model and the yearly grid-specific meta-predictors. We calculated the annual excess deaths, excess death ratio (excess deaths per 1000 deaths …

Environmental pollution is escalating due to rapid global development that often prioritizes human needs over planetary health. Despite global efforts to mitigate legacy pollutants, the continuous introduction of new substances remains a major threat to both human and ecosystem health. In response, global initiatives are focusing on risk assessment and regulation of emerging contaminants, as demonstrated by the establishment of the UN's Intergovernmental Science-Policy Panel on Chemicals, Waste, and Pollution Prevention. This review identifies the sources and impacts of emerging contaminants on planetary health, emphasizing the importance of adopting a One Health approach. Strategies for monitoring and addressing these pollutants are discussed, underscoring the need for robust and socially equitable environmental policies at both regional and international levels. Urgent actions are needed to …

Particulate of diameter ≤1 μm (PM1) presents a novel risk factor of adverse health effects. Nevertheless, the association of PM1 with the risk of chronic kidney disease (CKD) in the general population is not well understood, particularly in regions with high PM1 levels like China. Based on a nationwide representative survey involving 47,204 adults and multi-source ambient air pollution inversion data, the present study evaluated the association of PM1 with CKD prevalence in China. The two-year average PM1, particulate of diameter ≤2.5μm (PM2.5), and PM1–2.5 values were accessed using a satellite-based random forest approach. CKD was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2 or albuminuria. The results suggested that a 10 μg/m3 rise in PM1 was related to a higher CKD risk (odds ratio [OR], 1.13; 95% confidence interval [CI] 1.08-1.18) and albuminuria (OR, 1.11; 95% CI, 1.05-1.17 …

BackgroundThe association between long-term exposure to ozone (O3) and adult-onset asthma (AOA) remains inconclusive, and analysis of causality is lacking.ObjectivesTo examine the causal association between long-term O3 exposure and AOA.MethodsA prospective cohort study of 362,098 participants was conducted using the UK Biobank study. Incident cases of AOA were identified using health administrative data of the National Health Services. O3 exposure at participants’ residential addresses was estimated by a spatio-temporal model. Instrumental variable (IV) modelling was used to analyze the causal association between O3 exposure and AOA, by incorporating wind speed and planetary boundary layer height as IVs into time-dependent Cox model. Negative control outcome (accidental injury) was also used to additionally evaluate unmeasured confounding.ResultsDuring a mean follow-up of 11.38 …

BackgroundParticulate matter (PM) exposure has been linked with cardiovascular disease (CVD) and metabolic syndrome (MetS), the latter characterized by concurrent multiple metabolic disorders. As a result, the mechanisms assumption from PM to CVD through MetS have emerged, thus requiring further epidemiological evidence. This cohort study aimed to assess whether MetS mediates the associations of PM with CVD risk.MethodsThis study included 14,195 participants from the Chengdu cohort of the China Multi-Ethnic Cohort (CMEC) study in 2018. The primary outcome of incident CVD diagnoses was identified using matched hospital records from the Health Information Center of Sichuan Province. Residence-specific levels of PM with aerodynamic diameters of ≤ 1 µm (PM1), ≤ 2.5 µm (PM2.5), and ≤ 10 µm (PM10) were estimated by spatiotemporal models. Causal mediation analyses were applied to …

Wildfire episodes have become more frequent and severe in recent years. 1 The record-breaking fires devastated the Arctic, Amazon, and Australia in 2019–2020. This year, fires began in Canada in May and lasted for several months, resulting in an area burned of 16.5 million hectares by early September. This size is 6-7 times the annual fire area for a normal year in Canada. The favorable fire weather for burning and spread lasted for months (https://cwfis. cfs. nrcan. gc. ca/maps/fw). Furthermore, most Canadian fires occur in remote regions far from firefighting facilities, causing fire extinction to be difficult. Unfortunately, such ‘unprecedented’fire events occurred routinely in boreal regions during 2020–2023, although the locations varied from year to year (Figure 1).Biomass burning releases tremendous amounts of CO2 into the atmosphere, contributing to global warming. Moreover, fire emissions generate many air …