Zhang Qingli, Meng Xia, Shi Su, Kan Lena, Chen Renjie, Kan Haidong
School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032, China.
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, MD 21205, USA.
Innovation (Camb). 2022 Sep 6;3(6):100312. doi: 10.1016/j.xinn.2022.100312. eCollection 2022 Nov 8.
Ambient particulate matter (PM) pollution in China continues to be a major public health challenge. With the release of the new WHO air quality guidelines in 2021, there is an urgent need for China to contemplate a revision of air quality standards (AQS). In the recent decade, there has been an increase in epidemiological studies on PM in China. A comprehensive evaluation of such epidemiological evidence among the Chinese population is central for revision of the AQS in China and in other developing countries with similar air pollution problems. We thus conducted a systematic review on the epidemiological literature of PM published in the recent decade. In summary, we identified the following: (1) short-term and long-term PM exposure increase mortality and morbidity risk without a discernible threshold, suggesting the necessity for continuous improvement in air quality; (2) the magnitude of long-term associations with mortality observed in China are comparable with those in developed countries, whereas the magnitude of short-term associations are appreciably smaller; (3) governmental clean air policies and personalized mitigation measures are potentially effective in protecting public and individual health, but need to be validated using mortality or morbidity outcomes; (4) particles of smaller size range and those originating from fossil fuel combustion appear to show larger relative health risks; and (5) molecular epidemiological studies provide evidence for the biological plausibility and mechanisms underlying the hazardous effects of PM. This updated review may serve as an epidemiological basis for China's AQS revision and proposes several perspectives in designing future health studies.
中国的环境颗粒物（PM）污染仍是一项重大的公共卫生挑战。随着世界卫生组织（WHO）2021年发布新的空气质量指南，中国迫切需要考虑修订空气质量标准（AQS）。在最近十年中，中国关于PM的流行病学研究有所增加。对中国人群中此类流行病学证据进行全面评估，对于中国以及其他存在类似空气污染问题的发展中国家修订AQS至关重要。因此，我们对近十年发表的PM流行病学文献进行了系统综述。概括而言，我们发现了以下几点：（1）短期和长期暴露于PM会增加死亡和发病风险，且无明显阈值，这表明空气质量有持续改善的必要性；（2）在中国观察到的与死亡率的长期关联程度与发达国家相当，而短期关联程度则明显较小；（3）政府的清洁空气政策和个性化缓解措施可能对保护公众和个人健康有效，但需要通过死亡率或发病率结果进行验证；（4）较小粒径范围的颗粒物以及源自化石燃料燃烧的颗粒物似乎显示出更大的相对健康风险；（5）分子流行病学研究为PM有害影响的生物学合理性和潜在机制提供了证据。这篇更新的综述可为中国修订AQS提供流行病学依据，并为设计未来的健康研究提出了几个观点。
