Despite sustained reductions in smoking prevalence and improvements in ambient air quality, lung cancer incidence in China continues to rise, suggesting that important risk factors remain insufficiently recognised. Asbestos is a well-established carcinogen, yet its contribution to China’s lung cancer burden has received limited attention, particularly given the continued use of chrysotile and widespread legacy asbestos-containing materials. This review highlights how non-specific clinical presentation, incomplete exposure documentation, and limitations in surveillance systems contribute to systematic underestimation of asbestos-related lung cancer. Diverse exposure scenarios, including occupational, para-occupational, and environmental pathways, further complicate etiologic attribution beyond traditionally defined asbestos workers. A comprehensive asbestos ban represents an important long-term strategy to reduce the future burden of asbestos-related disease in China.
Extreme heat is an escalating health threat, particularly as Europe warms faster than the global average. However, mortality estimates depend on how heat exposure is measured, because different metrics can capture different dimensions of heat, including intensity, duration, acclimatisation and combined thermal stress. We examined how alternative heat metrics influence estimates of heat-related mortality across five European sites representing diverse climate conditions: Heraklion (Greece), Bologna (Italy), Geneva (Switzerland), Augsburg (Germany) and Oulu (Finland). Using harmonised daily mortality and climate data for 2020–2023, we applied distributed lag non-linear models to estimate heat-mortality associations. Mortality data were population-based for all sites except Augsburg, where hospital-based mortality data were used. Continuous exposure-response functions were modelled for air temperature, UTCI and WBGT across the full observed exposure range. Binary heatwave indicators, including EHF, WSDI and percentile-based definitions, were analysed separately under the same framework. Results are presented first as cumulative relative risks (RRs) and then as attributable mortality burdens. RRs indicated stronger heat-mortality associations in Heraklion and Bologna, moderate associations in Geneva, and non-significant associations in Oulu or in the hospital-based Augsburg data. Attributable mortality burdens showed similar spatial patterns but also varied according to how heat exposure was defined and captured by different metrics. Older adults and women consistently emerged as the most vulnerable groups. Continuous models generally produced higher burden estimates than binary heatwave definitions, reflecting their ability to capture risk across the full range of heat exposure rather than during heatwave events. The findings demonstrate that the choice of heat exposure metric can influence mortality estimates, highlighting the importance of using multiple complementary heat metrics to characterise heat-related health risks. Reporting both RRs and attributable burdens can support fair comparisons across settings and help policymakers identify locally appropriate heat adaptation strategies. Not applicable.
Despite widespread recognition of its carcinogenicity and bans in many countries, asbestos remains a persistent global public health challenge. Regulatory fragmentation, transnational trade, and the rapid expansion of digital marketplaces continue to facilitate the circulation of asbestos-containing materials (ACM) across national borders. While all forms of asbestos, including chrysotile are prohibited in several jurisdictions, chrysotile is still mined, manufactured, and extensively used in major economies, including Russia and China, and remains incorporated into construction materials throughout large parts of Asia, the Middle East, and other regions. This regulatory asymmetry undermines national bans and compromises efforts to achieve zero exposure. In this Comment, we examine the consequences of the absence of a global asbestos ban and the continued failure to include chrysotile in Annex III of the Rotterdam Convention. We discuss how these regulatory gaps contribute to unrecognized exposure among the general population, create legal and economic liabilities for industries, and exacerbate environmental health risks in conflict zones and during large-scale construction and demolition activities. To illustrate the practical implications of these shortcomings, we present a case study demonstrating the ease with which asbestos-containing consumer products can be purchased through international e-commerce platforms. Laboratory analyses confirmed the presence of regulated chrysotile fibres in heat-resistant gloves purchased online, highlighting substantial deficiencies in product disclosure, regulatory enforcement, and cross-border accountability. This finding demonstrates how digital trade can bypass existing regulatory safeguards and expose unsuspecting consumers to carcinogenic materials. Asbestos should no longer be viewed as a legacy hazard but as an evolving global risk sustained by economic globalization, regulatory inconsistency, and technological change. Addressing this challenge will require coordinated international action, greater supply-chain transparency, and regulatory frameworks capable of responding to the realities of twenty-first century commerce. Not applicable.
Postpartum depression (PPD) is a global health issue associated with high levels of maternal morbidity. We previously found that higher exposure to particulate matter (PM2.5) during pregnancy is associated with PPD. However, the modifying role of prenatal stress on this relationship is unclear. We measured prenatal stress in the PROGRESS cohort (n = 585 mothers) using negative life events (NLE) and perceived stress score (PSS). Daily residence level of PM2.5 estimates generated from a spatiotemporal model were averaged over pregnancy. PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS ≥ 13) and categorized as prevalent PPD (EPDS ≥ 13 at 6 months). Modified Poisson regression was used to evaluate the association between PM2.5 and PPD, stratified by NLE and PSS scores, dichotomized at the median (low/high). We repeated the analyses with chronic depression, new-onset PPD, including using trimester-specific PM2.5 exposure, and with another proposed cut-off for Mexico (EPDS ≥ 10). Each 5-µg/m³ increase in average pregnancy PM2.5 exposure was associated with 130
Congenital heart defects (CHD) are a leading cause of infant mortality, but the etiology of most cases is unknown, and the potential role of industrial pollution exposure is largely unexplored. There are no studies of CHD and pollution in Louisiana, a state with among the worst birth outcomes in the nation and relatively high levels of toxic industrial emissions. Our study aimed to investigate the possible relationship between industrial air pollution and CHD in southeast Louisiana, encompassing the region commonly referred to as Cancer Alley or the Mississippi River Industrial Corridor. We conducted a matched case-control study of industrial air pollution and CHD among infants in Louisiana Department of Health Regions 1–3 born from 2018 to 2021 (n = 454 cases and 1,362 controls), using summed toxicity-weighted concentrations of 20 developmental toxins from EPA’s MicroRSEI dataset. We calculated CHD odds for the highest (> 75th percentile) and intermediate (10th to 75th percentile) pollution categories from a logistic regression conditioned on race, insurance status, and gestational timing. To eliminate confounding by insurance status, we excluded individuals with private insurance. We then compared chemical data distributions between cases and controls and, for select chemicals, calculated CHD odds. Among infants without private insurance, higher pollution levels were associated with increased odds of severe CHD, with response increasing as dose increased. These odds were 4.29 times higher (95
