BACKGROUND: The impact of the urban environment on human health is a contemporary subject of environmental research. Air pollution is often considered a leading environmental driver. However, a plethora of other factors within the urban exposome may be involved. At the same time, the resolution of spatial data is also an important facet to consider. Generally, systematic tools for accurate health risk assessment in the urban environment are missing or are not implemented. METHODS: The long-term impact of air quality (PM10, PM2.5, NO2, benzene, and SO2) on respiratory and cardiovascular health was assessed with a log-linear model. We used the most accurate health data in high city scale spatial resolution over the period 2010 to 2018. Selected external exposome parameters were also included in the analysis. RESULTS: Statistically significant associations between air pollution and the health of the urban population were found. The strongest association was between benzene and the incidence of bronchitis in the adult population [RR 1.552 95% CI (1.415-1.704) per 0.5 μg/m3 change in benzene concentration]. A similar relation was observed between NO2 and the same health condition [RR 1.483 95% CI (1.227-1.792) per 8.9 μg/m3 of change in NO2]. Other weaker associations were also found between asthma in children and PMs, NO2, or benzene. Cardiovascular-related hospitalizations in the general population were linked with NO2 [RR 1.218 95% CI (1.119-1.325) per 9.7 μg/m3 change in NO2]. The remaining pollutants were slightly less but still significantly associated with cardiovascular-related hospitalizations. CONCLUSION: Our findings are mostly highly statistically significant (p ≤ 0.001) and are in line with current literature on the adverse effects of air pollution on the human population. The results highlight the need for continual improvements in air quality. We propose the implementation of this approach as a systematic tool for the investigation of possible health risks over a long period of time. However, further research involving other variables is an essential step toward understanding the complex urban exposome and its implications for human health. An increase in data spatial resolution is especially important in this respect as well as for improving city health risk management.

RECETOX Faculty of Science Masaryk University Brno Czechia

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WHO . (2016). Ambient Air Pollution: A Global Assessment of Exposure and Burden of Disease. Geneva: WHO.

Gurjar BR, Jain A, Sharma A, Agarwal A, Gupta P, Nagpure AS, et al. . Human health risks in megacities due to air pollution. Atmos Environ. (2010) 44:4606–13. 10.1016/j.atmosenv.2010.08.011 DOI

EEA . Air Quality in Europe - 2020 report, EEA Report. (2020). Available online at: https://www.eea.europa.eu/publications/air-quality-in-europe-2020-report/at_download/file

Raaschou-Nielsen O, Andersen ZJ, Beelen R, Samoli E, Stafoggia M, Weinmayr G, et al. . Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE). Lancet Oncol. (2013) 14:813–22. 10.1016/S1470-2045(13)70279-1 PubMed DOI

MacIntyre EA, Gehring U, Mölter A, Fuertes E, Klümper C, Krämer U, et al. . Air pollution and respiratory infections during early childhood: an analysis of 10 European birth cohorts within the ESCAPE project. Environ Health Perspect. (2014) 122:107–13. 10.1289/ehp.1306755-erratum PubMed DOI PMC

Bang KM. Chronic obstructive pulmonary disease in nonsmokers by occupation and exposure: a brief review. Curr Opin Pulm Med. (2015) 21:149–54. 10.1097/MCP.0000000000000135 PubMed DOI

Ierodiakonou D, Zanobetti A, Coull BA, Melly S, Postma DS, Boezen HM, et al. . Ambient air pollution, lung function, and airway responsiveness in asthmatic children. J Allergy Clin Immunol. (2016) 137:390–9. 10.1016/j.jaci.2015.05.028 PubMed DOI PMC

Hooper LG, Young MT, Keller JP, Szpiro AA, O'Brien KM, Sandler DP, et al. . Ambient air pollution and chronic bronchitis in a cohort of U.S. Women. Environ. Health Perspect. (2018) 126:1–9. 10.1289/EHP2199 PubMed DOI PMC

Sheehan MC, Lam J, Navas-Acien A, Chang HH. Ambient air pollution epidemiology systematic review and meta-analysis: a review of reporting and methods practice. Environ Int. (2016) 92–93:647–56. 10.1016/j.envint.2016.02.016 PubMed DOI

Atkinson RW, Kang S, Anderson HR, Mills IC, Walton HA. Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis. Thorax. (2014) 69:660–5. 10.1136/thoraxjnl-2013-204492 PubMed DOI PMC

Song Q, Christiani DC, Wang X, Ren J. The global contribution of outdoor air pollution to the incidence, prevalence, mortality and hospital admission for chronic obstructive pulmonary disease: a systematic review and meta-analysis. Int J Environ Res Public Health. (2014) 11:11822–32. 10.3390/ijerph111111822 PubMed DOI PMC

Wong TW, Lau TS, Yu TS, Neller A, Wong SL, Tam W, et al. . Air pollution and hospital admissions for respiratory and cardiovascular diseases in Hong Kong. Occup Environ Med. (1999) 56:679–83. 10.1136/oem.56.10.679 PubMed DOI PMC

Bakonyi SMC, Danni-Oliveira IM, Martins LC, Braga ALF. Poluição atmosférica e doenças respiratórias em crianças na cidade de Curitiba, PR. Rev Saude Publica. (2004) 38:695–700. 10.1590/S0034-89102004000500012 PubMed DOI

Nascimento LFC, Vieira LCPF, Mantovani KCC, Moreira DS. Air pollution and respiratory diseases: ecological time series. São Paulo Med J. (2016) 134:315–21. 10.1590/1516-3180.2015.0237250216 PubMed DOI PMC

Lee D, Ferguson C, Mitchell R. Air pollution and health in Scotland: a multicity study. Biostatistics. (2009) 10:409–23. 10.1093/biostatistics/kxp010 PubMed DOI

Rodriguez-Villamizar LA, Belalcázar-Ceron LC, Fernández-Niño JA, Marín-Pineda DM, Rojas-Sánchez OA, Acuña-Merchán LA, et al. . Air pollution, sociodemographic and health conditions effects on COVID-19 mortality in Colombia: an ecological study. Sci Total Environ. (2021) 756:144020. 10.1016/j.scitotenv.2020.144020 PubMed DOI PMC

Sanyal S, Rochereau T, Maesano CN, Com-Ruelle L, Annesi-Maesano I. Long-term effect of outdoor air pollution on mortality and morbidity: a 12-year follow-up study for metropolitan France. Int J Environ Res Public Health. (2018) 15:1–8. 10.3390/ijerph15112487 PubMed DOI PMC

Zhang Z, Chai P, Wang J, Ye Z, Shen P, Lu H, et al. . Association of particulate matter air pollution and hospital visits for respiratory diseases: a time-series study from China. Environ Sci Pollut Res. (2019) 26:12280–7. 10.1007/s11356-019-04397-7 PubMed DOI

Dehghan A, Khanjani N, Bahrampour A, Goudarzi G, Yunesian M. The relation between air pollution and respiratory deaths in Tehran, Iran- using generalized additive models. BMC Pulm Med. (2018) 18:1–9. 10.1186/s12890-018-0613-9 PubMed DOI PMC

Li YR, Xiao CC, Li J, Tang J, Geng XY, Cui LJ, et al. . Association between air pollution and upper respiratory tract infection in hospital outpatients aged 0–14 years in Hefei, China: a time series study. Public Health. (2018) 156:92–100. 10.1016/j.puhe.2017.12.006 PubMed DOI

Pascal L, Pascal M, Stempfelet M, Goria S, Declercq C. Ecological study on hospitalizations for cancer, cardiovascular, and respiratory diseases in the industrial area of Etang-de-Berre in the South of France. J Environ Public Health. (2013). 10.1155/2013/328737 PubMed DOI PMC

Robinson O, Tamayo I, de Castro M, Valentin A, Giorgis-Allemand L, Krog NH, et al. . The urban exposome during pregnancy and its socioeconomic determinants. Environ Health Perspect. (2018) 126:077005. 10.1289/EHP2862 PubMed DOI PMC

Nieuwenhuijsen MJ, Agier L, Basagaña X, Urquiza J, Tamayo-Uria I, Giorgis-Allemand L, et al. . Influence of the urban exposome on birth weight. Environ Health Perspect. (2019) 127:047007. 10.1289/EHP3971 PubMed DOI PMC

Vermeulen R, Schymanski EL, Barabási AL, Miller GW. The exposome and health: WHERE chemistry meets biology. Science. (2020) 367:392–6. 10.1126/science.aay3164 PubMed DOI PMC

CENIA . Report on the state of the environment of the Czech Republic. Prague. (2018).

CHMI . Czech Hydrometeorological Institute [WWW Document]. (2021). Available online at: https://www.chmi.cz/historicka-data/ovzdusi (accessed March 3, 2021).

CHMI . Czech Hydrometeorological Institute 5 Years Mean Concentrations [WWW Document]. (2019). Available online at: https://www.chmi.cz/files/portal/docs/uoco/isko/ozko/ozko_CZ.html (accessed December 12, 2019).

CHMI . Czech Hydrometeorological Institute Tabular Survey 2019 [WWW Document]. Tabular Surv. (2019). Available online at: https://www.chmi.cz/files/portal/docs/uoco/isko/tab_roc/2019_enh/index_GB.html (accessed April 27, 2021).

WHO . Health Risks of Air Pollution in Europe – HRAPIE project New Emerging Risks to Health From Air Pollution – Results From the Survey of Experts. Geneva: World Heath Organization; (2013), p. 65.

IHISCR . Institute of Health Information and Statistics of the Czech Republic [WWW Document]. (2022). Available online at: https://www.uzis.cz/index-en.php (accessed March 14, 2020).

CZSO . Population and housing census [WWW Document]. (2020). Available online at: https://www.czso.cz/csu/czso/population-and-housing-census (accessed August 1, 2020).

CZSO . Population of Municipalities of the Czech Republic [WWW Document]. (2020). Availabl online at: https://www.czso.cz/csu/czso/population-of-municipalities-of-the-czech-republic-1-january-2010-e07bs6msu3 (accessed August 6, 2020).

CZSO . Czech Statistical Office [WWW Document]. (2021). Available onlie at: https://www.czso.cz/csu/czso/home (accessed January 5, 2021).

R Core Team . R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing; (2021).

Hauke J, Kossowski T. Comparison of values of pearson's and spearman's correlation coefficients on the same sets of data. Quaest Geogr. (2011) 30:87–93. 10.2478/v10117-011-0021-1 DOI

Hubbard AE, Ahern J, Fleischer NL, Van Der Laan M, Lippman SA, Jewell N, et al. . To GEE or not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology. (2010) 21:467–474. 10.1097/EDE.0b013e3181caeb90 PubMed DOI

Tan YQ, Rashid SKA, Pan W-C, Chen Y-C, Yu LE, Seow WJ. Association between microenvironment air quality and cardiovascular health outcomes. Sci Total Environ. (2020) 716:137027. 10.1016/j.scitotenv.2020.137027 PubMed DOI

Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc. (1995) 57:289–300. 10.1111/j.2517-6161.1995.tb02031.x DOI

WHO . WHO global air quality guidelines. Particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. Geneva: WHO; (2021). PubMed

WHO . European Health Information Gateway [WWW Document]. (2021). Available online at: https://gateway.euro.who.int/en/ (accessed April 7, 21).

Xie M, Liu X, Cao X, Guo M, Li X. Trends in prevalence and incidence of chronic respiratory diseases from 1990 to 2017. Respir Res. (2020) 21:1–13. 10.1186/s12931-020-1291-8 PubMed DOI PMC

CSO . Proměny Věkového SloŽení Obyvatelstva 2001–2050. Prague: (2019).

Wilkins E, Wilson L, Wickramasinghe K, Bhatnagar P. European Cardiovascular Disease Statistics 2017. Brussels: European Heart Network; (2017).

Kotzeva M, Brandmüller T, Önefors A. Eurostat regional Yearbook 2020 Edition. Luxembourg: (2020).

WB . The World Bank [WWW Document]. (2021). Availble online at: https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=CZ (accessed November 09, 2021).

OECD . Health at a Glance: Europe 2020: State of Health in the EU Cycle, Health at a Glance, Health at a Glance: Europe. Paris: OECD Publishing; (2020).

Oftedal B, Nafstad P, Magnus P, Bjørkly S, Skrondal A. Traffic related air pollution and acute hospital admission for respiratory diseases in Drammen, Norway 1995–2000. Eur J Epidemiol. (2002) 18:671–6. 10.1023/A:1024884502114 PubMed DOI

Penard-Morand C, Raherison C, Charpin D, Kopferschmitt C, Lavaud F, Caillaud D, et al. . Long-term exposure to close-proximity air pollution and asthma and allergies in urban children. Eur Respir J. (2010) 36:33–40. 10.1183/09031936.00116109 PubMed DOI

Hirsch T, Weiland Sk, von Mutius E, Safeca AF, Gräfe H, Csaplovics E, et al. . Inner city air pollution and respiratory health and atopy in children. Eur Respir J. (1999) 14:669. 10.1034/j.1399-3003.1999.14c29.x PubMed DOI

Idavain J, Julge K, Rebane T, Lang A, Orru H. Respiratory symptoms, asthma and levels of fractional exhaled nitric oxide in schoolchildren in the industrial areas of Estonia. Sci Total Environ. (2019) 650:65–72. 10.1016/j.scitotenv.2018.08.391 PubMed DOI

Ran J, Sun S, Yang A, Yang L, Han L, Mason TG, et al. . Effects of ambient benzene and toluene on emergency COPD hospitalizations: a time series study in Hong Kong. Sci Total Environ. (2019) 657:28–35. 10.1016/j.scitotenv.2018.12.015 PubMed DOI

D'Andrea MA, Reddy GK. Health risks associated with benzene exposure in children: a systematic review. Glob Pediatr Health. (2018) 5:2333794X1878927. 10.1177/2333794X18789275 PubMed DOI PMC

Pranata R, Vania R, Tondas AE, Setianto B, Santoso A. A time-to-event analysis on air pollutants with the risk of cardiovascular disease and mortality: a systematic review and meta-analysis of 84 cohort studies. J Evid Based Med. (2020) 13:102–15. 10.1111/jebm.12380 PubMed DOI

Huang S, Li H, Wang M, Qian Y, Steenland K, Caudle WM, et al. . Long-term exposure to nitrogen dioxide and mortality: a systematic review and meta-analysis. Sci Total Environ. (2021) 776:145968. 10.1016/j.scitotenv.2021.145968 PubMed DOI PMC

Fasola S, Maio S, Baldacci S, La Grutta S, Ferrante G, Forastiere F, et al. . Short-term effects of air pollution on cardiovascular hospitalizations in the pisan longitudinal study. Int J Environ Res Public Health. (2021) 18:1164. 10.3390/ijerph18031164 PubMed DOI PMC

Sofwan NM, Mahiyuddin WRW, Latif MT, Ayub NA, Yatim ANM, Mohtar AAA, et al. . Risks of exposure to ambient air pollutants on the admission of respiratory and cardiovascular diseases in Kuala Lumpur. Sustain Cities Soc. (2021) 75:103390. 10.1016/j.scs.2021.103390 DOI

Nascimento AP, Santos JM, Mill JG, Toledo de Almeida Albuquerque T, Reis Júnior NC, Reisen VA, et al. . Association between the incidence of acute respiratory diseases in children and ambient concentrations of SO2, PM10 and chemical elements in fine particles. Environ Res. (2020) 188:109619. 10.1016/j.envres.2020.109619 PubMed DOI

Lenters V, Uiterwaal CS, Beelen R, Bots ML, Fischer P, Brunekreef B, et al. . Long-term exposure to air pollution and vascular damage in young adults. Epidemiology. (2010) 21:512–20. 10.1097/EDE.0b013e3181dec3a7 PubMed DOI

Dong GH, Qian ZM, Xaverius PK, Trevathan E, Maalouf S, Parker J, et al. . Association between long-term air pollution and increased blood pressure and hypertension in China. Hypertension. (2013) 61:578–84. 10.1161/HYPERTENSIONAHA.111.00003 PubMed DOI

Chen Y, Yang Q, Krewski D, Shi Y, Burnett RT, McGrail K. Influence of relatively low level of particulate air pollution on hospitalization for COPD in elderly people. Inhal Toxicol. (2004) 16:21–5. 10.1080/08958370490258129 PubMed DOI

Brunekreef B, Forsberg B. Epidemiological evidence of effects of coarse airborne particles on health. Eur Respir J. (2005) 26:309–18. 10.1183/09031936.05.00001805 PubMed DOI

Pun VC, Kazemiparkouhi F, Manjourides J, Suh HH. Long-Term PM2.5 exposure and respiratory, cancer, and cardiovascular mortality in older US adults. Am J Epidemiol. (2017) 186:961–9. 10.1093/aje/kwx166 PubMed DOI PMC

Yazdi MD, Wang Y, Di Q, Zanobetti A, Schwartz J. Long-term exposure to PM 2. 5 and ozone and hospital admissions of Medicare participants in the Southeast USA. Environ Int. (2019) 130:104879. 10.1016/j.envint.2019.05.073 PubMed DOI PMC

Vaduganathan M, De Palma G, Manerba A, Goldoni M, Triggiani M, Apostoli P, et al. . Risk of cardiovascular hospitalizations from exposure to coarse particulate matter (PM10) below the European Union Safety Threshold. Am J Cardiol. (2016) 117:1231–5. 10.1016/j.amjcard.2016.01.041 PubMed DOI

Larrieu S, Jusot JF, Blanchard M, Prouvost H, Declercq C, Fabre P, et al. . Short term effects of air pollution on hospitalizations for cardiovascular diseases in eight French cities: the PSAS program. Sci Total Environ. (2007) 387:105–12. 10.1016/j.scitotenv.2007.07.025 PubMed DOI

Dominici F, Peng RD, Bell ML, Pham L, McDermott A, Zeger SL, et al. . Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. J Am Med Assoc. (2006) 295:1127–34. 10.1001/jama.295.10.1127 PubMed DOI PMC

Vidale S, Arnaboldi M, Bosio V, Corrado G, Guidotti M, Sterzi R, et al. . Short-term air pollution exposure and cardiovascular events: a 10-year study in the urban area of Como, Italy. Int J Cardiol. (2017) 248:389–93. 10.1016/j.ijcard.2017.06.037 PubMed DOI

Lu F, Xu D, Cheng Y, Dong S, Guo C, Jiang X, et al. . Systematic review and meta-analysis of the adverse health effects of ambient PM2.5 and PM10 pollution in the Chinese population. Environ Res. (2015) 136:196–204. 10.1016/j.envres.2014.06.029 PubMed DOI

Darrow LA, Klein M, Dana Flanders W, Mulholland JA, Tolbert PE, Strickland MJ. Air pollution and acute respiratory infections among children 0-4 years of age: an 18-year time-series study. Am J Epidemiol. (2014) 180:968–77. 10.1093/aje/kwu234 PubMed DOI PMC

de Keijzer C, Agis D, Ambrós A, Arévalo G, Baldasano JM, Bande S, et al. . The association of air pollution and greenness with mortality and life expectancy in Spain: a small-area study. Environ Int. (2017) 99:170–6. 10.1016/j.envint.2016.11.009 PubMed DOI

Janssen NAH, Fischer P, Marra M, Ameling C, Cassee FR. Short-term effects of PM2.5, PM10 and PM2.5-10 on daily mortality in the Netherlands. Sci Total Environ. (2013) 463–464, 20–6. 10.1016/j.scitotenv.2013.05.062 PubMed DOI

Sicard P, Khaniabadi YO, Perez S, Gualtieri M, De Marco A. Effect of O3, PM10 and PM2.5 on cardiovascular and respiratory diseases in cities of France, Iran and Italy. Environ Sci Pollut Res. (2019) 26:32645–65. 10.1007/s11356-019-06445-8 PubMed DOI

Carey IM, Anderson HR, Atkinson RW, Beevers S, Cook DG, Dajnak D, et al. . Traffic pollution and the incidence of cardiorespiratory outcomes in an adult cohort in London. Occup Environ Med. (2016) 73:32645–65. 10.1136/oemed-2015-103531 PubMed DOI PMC

Luginaah IN, Fung KY, Gorey KM, Webster G, Wills C. Association of ambient air pollution with respiratory hospitalization in a government-designated “area of concern”: the case of Windsor, Ontario. Environ Health Perspect. (2005) 113:290–6. 10.1289/ehp.7300 PubMed DOI PMC

Pope CA, Burnett RT, Thurston GD, Thun MJ, Calle EE, Krewski D, et al. . Cardiovascular mortality and long-term exposure to particulate air pollution. Circulation. (2004) 109:71–7. 10.1161/01.CIR.0000108927.80044.7F PubMed DOI

Kloog I, Coull BA, Zanobetti A, Koutrakis P, Schwartz JD. Acute and chronic effects of particles on hospital admissions in New-England. PLoS ONE. (2012) 7:e34664. 10.1371/journal.pone.0034664 PubMed DOI PMC

Kim V, Criner GJ. Chronic bronchitis and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. (2013) 187:228–37. 10.1164/rccm.201210-1843CI PubMed DOI PMC

Cao M, Xu T, Yin D. Understanding light pollution: recent advances on its health threats and regulations. J Environ Sci. (2023) 127:589–602. 10.1016/j.jes.2022.06.020 PubMed DOI

Tran QA, Le VTH, Ngo VT, Le TH, Phung DT, Berman JD, et al. . The association between ambient temperatures and hospital admissions due to respiratory diseases in the Capital City of Vietnam. Front Public Heal. (2022) 10:1–8. 10.3389/fpubh.2022.903623 PubMed DOI PMC

Effatpanah M, Effatpanah H, Jalali S, Parseh I, Goudarzi G, Barzegar G, et al. . Hospital admission of exposure to air pollution in Ahvaz megacity during 2010–2013. Clin Epidemiol Glob Heal. (2020) 8:550–6. 10.1016/j.cegh.2019.12.001 DOI

Momtazan M, Geravandi S, Rastegarimehr B, Valipour A, Ranjbarzadeh A, Yari AR, et al. . An investigation of particulate matter and relevant cardiovascular risks in Abadan and Khorramshahr in 2014–2016. Toxin Rev. (2019) 38:290–7. 10.1080/15569543.2018.1463266 DOI

Moradi M, Mokhtari A, Mohammadi MJ, Hadei M, Vosoughi M. Estimation of long-term and short-term health effects attributed to PM2.5 standard pollutants in the air of Ardabil (using Air Q + model). Environ Sci Pollut Res. (2022) 29:21508–16. 10.1007/s11356-021-17303-x PubMed DOI

Social and environmental stressors of cardiometabolic health