Health Impact of Outdoor Air Pollution in China: Current Knowledge and Future Research Needs

By Kan, Haidong; Chen, Bingheng et al. | Environmental Health Perspectives, May 2009 | Go to article overview

Health Impact of Outdoor Air Pollution in China: Current Knowledge and Future Research Needs


Kan, Haidong, Chen, Bingheng, Hong, Chuanjie, Environmental Health Perspectives


doi: 10.1289/ehp. 12737

Outdoor air pollution is one of China's most serious environmental problems. Coal is still the major source of energy, constituting about 75% of all energy sources. Consequently, air pollution in China predominantly consists of coal smoke, with suspended particulate matter (PM) and sulfur dioxide ([SO.sub.2]) as the principal air pollutants. In large cities, however, with the rapid increase in the number of motor vehicles, air pollution has gradually changed from the conventional coal combustion type to the mixed coal combustion/motor vehicle emission type. Currently, inhalable particles (PM <10 [micro]m in aerodynamic diameter; ([PM.sub.10]), [SO.sub.2], and nitrogen dioxide ([NO.sub.2]) are the criteria pollutants of concern in China. Generally, PM levels in cities in the north are higher than those in the south, whereas [SO.sub.2] and [NO.sub.2] levels do not differ much. In 2004, the annual average [PM.sub.10] concentrations for major Chinese cities were 102 [micro]g/[m.sup.3] in southern cities, 140 [micro]g/[m.sup.3] in northern cities, and 121 [micro]g/[m.sup.3] in cities nationwide. The annual average concentrations of [SO.sub.2] and [NO.sub.2] nationwide were 66 [micro]g/[m.sup.3] and 38 [micro]g/[m.sup.3], respectively (China State Environmental Protection Agency 2005).

Although its ambient air quality has improved substantially, China is still facing the worst air pollution problem in the world. Outdoor air-pollution has become a major concern for public health. The World Bank (2007) estimated that the total health cost associated with outdoor air pollution in urban areas of China in 2003 was between 157 and 520 billion Chinese yuan, accounting for 1.2-3.3% of China's gross domestic product. Health end points studied in China in association with air pollution include all-cause mortality, mortality and morbidity due to cardiopulmonary disease, and numbers of outpatient and emergency department visits (Chen et al. 2004). Changes in respiratory and other clinical symptoms, lung function, and immune function are also studied.

Dozens of time-series studies have been conducted in large Chinese cities, including Beijing, Shanghai, Chongqing, Shenyang, Wuhan, and Taiyuan, to assess the association of short-term exposure to air pollution with mortality or morbidity (Chen et al. 2004). Mortality or morbidity risk estimates per unit increase in air pollution level among Chinese populations are generally similar in magnitude to risks estimated in other parts of the world. A recent multicity time-series analysis in Hong Kong, Shanghai, and Wuhan provided further evidence of short-term risks (Wong et al. 2008), with significant health effects detected at air pollution levels below minimum air quality standards in China. Currently, a new national-level air pollution time-series study, the China Air Pollution and Health Effects Study (CAPES), is under way. In addition, several ongoing panel studies are examining associations between air pollution and subclinical health outcomes before, during, and after the 2008 Summer Olympic Games in Beijing. These panel studies should provide a unique opportunity to assess the public health benefits of air pollution reduction in a city where air pollution levels have been high.

Relatively few studies have examined long-term effects of air pollution in China. …

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