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      Cleaner heating policies contribute significantly to health benefits and cost-savings: A case study in Beijing, China

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          Summary

          Cleaner heating policies aim to reduce air pollution and may bring about health benefits to individuals. Based on a fixed-effect model focusing on Beijing, this study found that after the onset of air pollution, daily clinic visits, hospitalization days, and hospitalization expenses increased several days after the occurrence of air pollution. These hospitalization changes were observed in males and females and three different age groups. A difference-in-differences (DID) model was constructed to identify the influences of cleaner heating policies on health consequences. The study revealed that the policy positively affects health outcomes, with an average decrease of 3.28 thousand clinic visits for all diseases. The total hospitalization days and expenses tend to decrease by 0.22 thousand days and 0.34 million CNY (Chinese Yuan), respectively. Furthermore, implementing the policy significantly reduced the number of daily clinic visits for respiratory diseases, asthma, stroke, diabetes, and chronic obstructive pulmonary diseases (COPDs).

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          Highlights

          • •

            Cleaner heating policies lead to a significant decline in hospitalization expenses

          • •

            Hospitalization changes caused by cleaner heating policies differ in gender

          • •

            Different age groups suffered differences from the cleaner heating policies

          • •

            Cleaner heating policies reduced the number of clinic visits for different diseases

          Abstract

          Earth sciences; Environmental science; Environmental health; Environmental management

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          Most cited references45

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          Drivers of improved PM 2.5 air quality in China from 2013 to 2017

          Qiang Zhang, Yixuan Zheng, Dan Tong … (2019)
          Significance The high frequency of haze pollution in China has attracted broad attention and triggered, in 2013, the promulgation of the toughest-ever clean air policy in the country. In this study, we quantified the air quality and health benefits from specific clean air actions by combining a chemical transport model with a detailed emission inventory. As tremendous efforts and resources are needed for mitigating emissions from various sources, evaluation of the effectiveness of these measures can provide crucial information for developing air quality policies in China as well as in other developing and highly polluting countries. Based on measure-specific analysis, our results bear out several important implications for designing future clean air policies.
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            Long-term exposure to PM and all-cause and cause-specific mortality: A systematic review and meta-analysis

            Jie Chen, Gerard Hoek (2020)
            As new scientific evidence on health effects of air pollution is generated, air quality guidelines need to be periodically updated. The objective of this review is to support the derivation of updated guidelines by the World Health Organization (WHO) by performing a systematic review of evidence of associations between long-term exposure to particulate matter with diameter under 2.5 µm (PM2.5) and particulate matter with diameter under 10 µm (PM10), in relation to all-cause and cause-specific mortality. As there is especially uncertainty about the relationship at the low and high end of the exposure range, the review needed to provide an indication of the shape of the concentration-response function (CRF). We systematically searched MEDLINE and EMBASE from database inception to 9 October 2018. Articles were checked for eligibility by two reviewers. We included cohort and case-control studies on outdoor air pollution in human populations using individual level data. In addition to natural-cause mortality, we evaluated mortality from circulatory diseases (ischemic heart disease (IHD) and cerebrovascular disease (stroke) also specifically), respiratory diseases (Chronic Obstructive Pulmonary Disease (COPD) and acute lower respiratory infection (ALRI) also specifically) and lung cancer. A random-effect meta-analysis was performed when at least three studies were available for a specific exposure-outcome pair. Risk of bias was assessed for all included articles using a specifically developed tool coordinated by WHO. Additional analyses were performed to assess consistency across geographic region, explain heterogeneity and explore the shape of the CRF. An adapted GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment of the body of evidence was made using a specifically developed tool coordinated by WHO. A large number (N = 107) of predominantly cohort studies (N = 104) were included after screening more than 3000 abstracts. Studies were conducted globally with the majority of studies from North America (N = 62) and Europe (N = 25). More studies used PM2.5 (N = 71) as the exposure metric than PM10 (N = 42). PM2.5 was significantly associated with all causes of death evaluated. The combined Risk Ratio (RR) for PM2.5 and natural-cause mortality was 1.08 (95%CI 1.06, 1.09) per 10 µg/m3. Meta analyses of studies conducted at the low mean PM2.5 levels (<25, 20, 15, 12, 10 µg/m3) yielded RRs that were similar or higher compared to the overall RR, consistent with the finding of generally linear or supra-linear CRFs in individual studies. Pooled RRs were almost identical for studies conducted in North America, Europe and Western Pacific region. PM10 was significantly associated with natural-cause and most but not all causes of death. Application of the risk of bias tool showed that few studies were at a high risk of bias in any domain. Application of the adapted GRADE tool resulted in an assessment of "high certainty of evidence" for PM2.5 with all assessed endpoints except for respiratory mortality (moderate). The evidence was rated as less certain for PM10 and cause-specific mortality ("moderate" for circulatory, IHD, COPD and "low" for stroke mortality. Compared to the previous global WHO evaluation, the evidence base has increased substantially. However, studies conducted in low- and middle- income countries (LMICs) are still limited. There is clear evidence that both PM2.5 and PM10 were associated with increased mortality from all causes, cardiovascular disease, respiratory disease and lung cancer. Associations remained below the current WHO guideline exposure level of 10 µg/m3 for PM2.5. Systematic review registration number (PROSPERO ID): CRD42018082577.
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              All-cause mortality risk associated with long-term exposure to ambient PM2·5 in China: a cohort study

              Tiantian Li, Yi Zhang, Jiaonan Wang … (2018)
              Evidence from cohort studies in North America and Europe indicates that long-term exposure to fine particulate matter (PM2·5) is associated with an increased mortality risk. However, this association has rarely been quantified at higher ambient concentrations. We estimated the hazard ratio (HR) for all-cause mortality from long-term exposure to PM2·5 in a well established Chinese cohort of older adults.
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                Author and article information

                Contributors
                Yang Xie
                Feng Lu
                Journal
                Journal ID (nlm-ta): iScience
                Journal ID (iso-abbrev): iScience
                Title: iScience
                Publisher: Elsevier
                ISSN (Electronic): 2589-0042
                Publication date PMC-release: 11 June 2024
                Publication date Collection: 19 July 2024
                Publication date (Electronic): 11 June 2024
                Volume: 27
                Issue: 7
                Electronic Location Identifier: 110249
                Affiliations
                [1 ]Institute of Circular Economy, Beijing University of Technology, Beijing 100124, China
                [2 ]School of Materials Science and Engineering, Beihang University, Beijing 100191, China
                [3 ]School of Economics and Management, Beihang University, Beijing 100191, China
                [4 ]School of Management, Wuhan Institute of Technology, Wuhan 430205, China
                [5 ]Beijing Municipal Health Commission Information Center, Beijing 100034, China
                Author notes
                [∗ ]Corresponding author xieyangdaisy@ 123456buaa.edu.cn
                [∗∗ ]Corresponding author lufeng@ 123456wjw.beijing.gov.cn
                [6]

                These authors contributed equally

                [7]

                Lead contact

                Article
                Publisher Item ID: S2589-0042(24)01474-3 Publisher ID: 110249
                DOI: 10.1016/j.isci.2024.110249
                PMC ID: 11254592
                PubMed ID: 39027367
                SO-VID: 586bc965-9118-47da-abe2-955167b9233e
                Copyright © © 2024 The Authors. Published by Elsevier Inc.
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 27 February 2024
                Date revision received : 20 March 2024
                Date accepted : 7 June 2024
                Categories
                Subject: Article

                Keywords: earth sciences,environmental science,environmental health,environmental management
                Data availability:
                Keywords: earth sciences, environmental science, environmental health, environmental management

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