Airborne particulate matter with a diameter of 2.5 µm or less (PM_2.5) has often been reported to be associated with the cardiovascular toxic effects of air pollution mixtures and ozone (O₃) with respiratory illness.^1,2 However, there is increasing evidence that O₃, independent of PM_2.5, is also associated with cardiovascular mortality.^3,4 For example, O₃ has been associated with increases in mortality due to embolism and thrombosis,⁵ ischemic heart disease,³ heart failure,⁴ and stroke.⁶ However, not all studies reporting associations of O₃ with cardiovascular outcomes found that the associations were independent from particulate matter and other gaseous pollutants, such as nitrogen dioxide (NO₂) and sulfur dioxide (SO₂).^7,8 Other studies have found nonsignificant or seemingly “beneficial” associations between O₃ and cardiovascular outcomes.^9,10 The uncertainty in epidemiologic findings of O₃ cardiovascular effects is further enhanced by the limited understanding of biological mechanisms underlying the epidemiologic associations.¹¹

Over the past three decades, China has experienced rapid urbanization. The risks to its urban population posed by inhalation exposure to hazardous air pollutants (HAPs) have not been well characterized. Here, we summarize recent measurements of 16 highly prevalent HAPs in urban China and compile their distribution inputs. Based on activity patterns of urban Chinese working adults, we derive personal exposures. Using a probabilistic risk assessment method, we determine cancer and non-cancer risks for working females and males. We also assess the uncertainty associated with risk estimates using Monte Carlo simulation, accounting for variations in HAP concentrations, cancer potency factors (CPFs) and inhalation rates. Average total lifetime cancer risks attributable to HAPs are 2.27×10(-4) (2.27 additional cases per 10,000 people exposed) and 2.93×10(-4) for Chinese urban working females and males, respectively. Formaldehyde, 1,4-dichlorobenzene, benzene and 1,3-butadiene are the major risk contributors yielding the highest median cancer risk estimates, >1×10(-5). About 70% of the risk is due to exposures occurring in homes. Outdoor sources contribute most to the risk of benzene, ethylbenzene and carbon tetrachloride, while indoor sources dominate for all other compounds. Chronic exposure limits are not exceeded for non-carcinogenic effects, except for formaldehyde. Risks are overestimated if variation is not accounted for. Sensitivity analyses demonstrate that the major contributors to total variance are range of inhalation rates, CPFs of formaldehyde, 1,4-dichlorobenzene, benzene and 1,3-butadiene, and indoor home concentrations of formaldehyde and benzene. Despite uncertainty, risks exceeding the acceptable benchmark of 1×10(-6) suggest actions to reduce exposures. Future efforts should be directed toward large-scale measurements of air pollutant concentrations, refinement of CPFs and investigation of population exposure parameters. The present study is a first effort to estimate carcinogenic and non-carcinogenic risks of inhalation exposure to HAPs for the large working populations of Chinese cites.

Asthma, rhinitis and eczema (allergic or non-allergic) have increased throughout the world during the last decades, especially among children. Changes in the indoor environment are suspected to be important causes. China has experienced a dramatic change in indoor environmental exposures during the past two decades. However, such changes and their associations with children’s asthma and other health aspects have not been thoroughly studied. China, Children, Homes, Health (CCHH), Phase I, was a cross-sectional questionnaire survey of 48219 children 1–8 years old in 10 Chinese cities during 2010–2012. The questionnaire includes the International Study of Asthma and Allergies in Childhood (ISAAC) core health questions and additional questions regarding housing, life habits and outdoor environment. In health analyses, children aged 3–6 years old were included. The prevalences of doctor diagnosed asthma varied from 1.7% to 9.8% (mean 6.8%), a large increase from 0.91% in 1999 and 1.50% in 2000. The prevalence of wheeze, rhinitis and atopic eczema (last 12 months) varied from 13.9% to 23.7%, 24.0% to 50.8% and 4.8% to 15.8%, respectively. Taiyuan had the lowest prevalences of all illnesses and Shanghai the highest, except for wheezewhere the highest value was for Urumqi. We found (1) no obvious association between disease prevalences and ambient PM₁₀ concentrations and (2) higher prevalences of disease in humid climates with hot summers and cold winters, but with no centrally heated buildings. Associations between the diseases and economic status as indexed by Gross Domestic Product (GDP) requires further study.