Aug 2026· Sustainability· Vol 18, pp. 8674· 0 citations· 43 references
Abstract
The implementation of the Air Quality Health Index (AQHI) is a regional climate action intended to protect population health, but its empirical linkage to the sustainability goal of good health and well-being remains untested. Using mortality data from Hong Kong (2013–2022), we employed a two-month-lag fixed-effects model to estimate the change in years of life lost (YLL) associated with monthly AQHI warning frequency. We further assessed heterogeneity across demographic and geographic subgroups, and explored the underlying mechanisms. The findings show that monthly AQHI warning frequency is negatively associated with YLL two months later. Each additional warning per month is associated with a reduction of 0.0032 units (SE = 0.0011) in per capita YLL across districts in Hong Kong. The baseline result was further supported by extended survival analyses. Heterogeneity analyses showed that each additional AQHI warning was associated with a significant reduction in YLL among males (coef. = −0.0066, SE = 0.0001) and those with spouses (coef. = −0.0065, SE = 0.0083), but not among females or those without spouses. Mechanism analyses suggested that the effect of AQHI warning frequency on YLL reduction was significantly moderated by individual behavioral responses, including increased face mask usage (int. coef. = −0.0047, SE = 0.0016) and reduced short-term travel (int. coef.= −0.0069, SE = 0.0004), and through socio-environmental pathways such as reduced traffic accidents (int. coef. = −0.0134, SE = 0.0034) and lower carbon emissions (int. coef. = −0.0367, SE = 0.0112). Hong Kong’s AQHI forecasting experience demonstrates the viability of health risk warnings as a climate adaptation strategy in sustainable urban governance, while its observed equity gaps offer critical lessons for refining inclusive environmental health policies.
China has invested heavily in air pollution control in recent years, yet comprehensive assessments of the associated health economic benefits remain limited. Prior research on the health economic benefits of air pollution control has mainly focused on mortality outcomes and PM2.5, which may substantially underestimates the true benefits of clean air policies. This study aims to evaluate the health economic benefits and losses associated with air pollution control by incorporating multiple health outcomes, population groups and air pollutants. We integrate daily mortality, hospital admission and outpatient visits and air pollutant (nitrogen dioxide, ozone [O3] and fine particulate matter) data from 18 cities from 2015 to 2022 to assess the health economic benefits. A generalized additive model was used to estimate concentration-response relationships. Health economic benefits were calculated based on the value of statistical life (VSL) and direct medical costs. Between 2015 and 2022, controlling PM2.5 and NO2 yielded significant health economic benefits across all health outcomes. Air pollution control generated significant health economic benefits across multiple outcomes in Guangdong Province. The total health economic benefits associated with PM2.5 and NO2 were 10,305.35 and 1017.00 million CNY, respectively. In contrast, O3 control yielded negative net benefits across all outcomes. Between 2015 and 2022, the multi-outcome health benefits of controlling PM2.5 exceeded mortality-only estimates by 31.79%, respectively For PM2.5 control, the elderly accounted for over 85% of the mortality-related benefits. These findings highlight the need for coordinated PM2.5-O3 control, the integration of multi-outcome evaluations into policy design, and targeted protection for vulnerable populations particularly the elderly.
OBJECTIVES
We developed and evaluated a risk-based Air Quality Index (AQI) for Germany that harmonizes pollutant categories on risk equivalence, incorporates hourly concentrations, and improves health-relevant communication.
METHODS
We identified pollutant-outcome pairs with causal or likely causal evidence, extracted effect estimates from systematic reviews and meta-analyses, and transformed daily mean effects into hourly effect estimates using German monitoring data. Equivalence coefficients were derived via Monte Carlo simulations and standardized to PM2.5 as the reference pollutant. PM2.5 thresholds were anchored in WHO Air Quality Guideline 2021 and the EU information threshold; risk-equivalent thresholds for PM10, NO2, O3, and SO2 were generated accordingly. An additional module was developed to account for concurrent elevation of multiple pollutants. The index was empirically evaluated using hourly data from German monitoring stations for 2019 and 2022, and the results were compared with the previous AQI. In sensitivity analyses, we assessed the effects of incorporating updated evidence and excluding asthma-related outcomes.
RESULTS
Application of the risk-based AQI resulted in a marked shift from "very good" to "good" and "moderate" categories in comparison with the previous AQI, particularly for PM2.5 and O3, reflecting stricter concentration thresholds. "Poor" classifications increased modestly, while "very poor" remained rare. The multipollutant episodes module affected less than 1% of hours.
CONCLUSION
Overall, the risk-based AQI represents a significant step toward health-based communication of air quality in Germany. By integrating scientific evidence into its design and providing tailored guidance, it enhances preventive public health protection. Its implementation may improve risk awareness and support behavioural changes that reduce exposure.
K. Ogurtsova, M. Tobollik, T. Zschachlitz et al.· International Journal of Hyg...· 0 citations
This study investigated the spatiotemporal variability of fine particulate matter (PM2.5) in Addis Ababa, Ethiopia and assessed its associated health risks and economic burden using data from January 2022 to December 2023. Hourly PM2.5 concentrations were collected through a hybrid monitoring network comprising seven low-cost sensors and two Beta Attenuation Monitors (BAM). Spatiotemporal analysis was performed using Python, and health risks were assessed by estimating the Hazard Quotient (HQ) and Excess Lifetime Cancer Risk (ELCR). The economic burden attributable to PM2.5 exposure was assessed by monetizing disease-specific Disability-Adjusted Life Years (DALYs) using a locally adapted Value of Statistical Life (VSL) approach. Over the two-year periods, mean PM2.5 concentrations ranged from 15 to 33 μg/m3 across monitoring sites, with an overall a citywide average of 27 μg/m3, exceeding the World Health Organization (WHO) Air Quality Guideline (AQG) of 5 μg/m3 by more than fivefold. Seasonal analysis revealed elevated PM2.5 concentrations during the wet season (Kiremt), while diurnal patterns showed peaks of 38 µg/m3 at 7:00 AM. The HQ values for all age groups exceeded the acceptable threshold of 1, indicating non-carcinogenic health risks. ELCR estimates calculated using a slope factor of 0.008 exceeded the risk threshold (1 ×10-4), whereas estimates based on the slope factor of 0.0012 remained within the acceptable limits, highlighting the sensitivity of cancer risk estimates to the toxicity parameter applied. The economic burden attributable to PM2.5 exposure was estimated at USD 652.95 million over the two-year study period, contributing an external cost share to national GDP of 0.25% in 2022 and 0.25% in 2023. Cardiovascular diseases, particularly ischemic heart disease (IHD), accounted for the largest share of economic losses, significantly exceeding acute respiratory infections and PM2.5 related cancers. These findings provide evidence to support targeted policies aimed at reducing PM2.5 related cancers combined.
To continuously improve air quality and protect public health, China issued the Continuous Improvement of Air Quality Action Plan in 2023. This study introduces a dual-pollutant health impact trade-off analysis to explore the effects of the action plan on air quality (including PM2.5 and O3 concentrations), health, and economic consequences in China. First, air quality before and after the implementation of the action plan was explored in three key regions using the air quality model, introducing updated chemical mechanisms to capture the nonlinear concentration changes. Second, the health benefits of avoiding premature deaths attributable to PM2.5 and O3 exposure, due to improvements in air quality, were estimated using the Global Exposure Mortality Model. Third, the economic impacts associated with human health improvements were monetised based on the willingness-to-pay method. The main findings are summarised as follows. (1) Regarding air quality impacts, through the implementation of the action plan, the annual mean PM2.5 concentrations across three key regions would decrease by 1.05, 0.3, and 0.18 μg/m3 on average in the Fen-Wei Plain, Beijing-Tianjin-Hebei and surrounding areas, and Yangtze River Delta region, respectively, during 2020-2025; in contrast, the increases in O3 concentrations would reach 3.08, 1.03, and 0.91 μg/m3 on average, respectively, during this period. (2) Concerning health impacts, the action plan would prevent approximately 5581 (95% confidence interval (CI): 4720-6378) premature deaths from PM2.5 reductions but lead to 3043 (95% CI: 1136-4547) additional deaths from O3 increases in three key regions. (3) From an economic perspective, the action plan would generate economic benefits of 1414.14 (95% CI: 1195.05-1617.21) million USD from PM2.5-related avoided premature deaths, but economic disbenefits of 993.33 (95% CI: 368.67-1492.98) million USD from O3-related increased premature deaths in the three key regions.
Weiming An, Hong-Tao Mao, Xiaoda Xue et al.· Environmental Pollution· 0 citations
Introduction Mississippi ranks among the lowest US states in health-related quality of life (HRQoL), with disparities most severe in rural and socioeconomically disadvantaged counties, particularly the Mississippi Delta. Understanding long-term spatial and temporal patterns is critical for equity-focused public health strategies. We aimed to describe geographic disparities in HRQoL across Mississippi’s 82 counties from 2015 through 2025, identify persistent hot spots of poor health, assess convergence with national averages, and inform tailored interventions. Methods We used County Health Rankings & Roadmaps data (2015–2025) to construct an annual principal component analysis–derived composite HRQoL index from Behavioral Risk Factor Surveillance System measures (poor/fair health, physically unhealthy days, mentally unhealthy days). Local indicators of spatial association (LISA), emerging hot spot analysis (EHSA), and a spatial autoregressive lag model with year fixed effects assessed clustering, spatiotemporal trends, and predictors. Results We found persistent disadvantage in poor/fair health in Mississippi (stable gap of 6 to 7 percentage points above national averages) but recent convergence in physically unhealthy days and reversal in mentally unhealthy days (fewer days in disadvantaged subgroups). LISA identified a persistent hot spot in the Delta and contraction of cold spots along the Gulf Coast by 2025. EHSA showed sporadic and consecutive hot spots concentrated in the Delta. The spatial autoregressive lag model confirmed significant dependence (ρ = 0.13, P < .001), with adult smoking and uninsurance as leading modifiable predictors. Conclusion Mississippi’s HRQoL trajectory shows symptom-based improvements but persistent structural inequities and geographic disparities. Expanding smoke-free policies, strengthening primary care access, and increasing health insurance coverage are high-impact strategies to reduce disparities and advance health equity in the South.
These findings provide a scientific basis for targeted O3 mitigation policies in China and offer a "Chinese solution" for developing nations around the world to seek a balance between air quality management and economic development.
Yilan Shu, Hui-Juan Wang, Zilin Han et al.· Environmental Research· 0 citations
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