Using ensemble forecasts from the Global Ensemble Forecast System and controlled integrations with the Weather Research and Forecasting (WRF) model, we investigate how the North American stratospheric sub-vortex, closely linked to the 2019 sudden stratospheric warming (SSW), influences a large-scale precipitation event over the eastern United States in late January 2019 and further quantify its contribution to the precipitation anomalies of the event. This precipitation event is directly driven by a tropospheric cyclone and a downstream anticyclone, which jointly transport warm, moist air from the Gulf of Mexico into the eastern U.S. Through a series of WRF experiments, we indicate that a nudged run (NOBS), in which the stratospheric circulation is nudged toward the observed evolution represented by the ERA5 reanalysis data set, successfully captures the evolution of the tropospheric cyclone and anticyclone, whereas a parallel run (NCLM) nudged toward the ERA5 winter climatology fails to capture them. The NOBS run accurately simulates the sub-vortex over North America, which facilitates the southward invasion of cold air. Moreover, in the NOBS experiment, the well-captured stratospheric sub-vortex enhances downward coupling through the phase-locking mechanism, directly promoting the development of the tropospheric cyclone and indirectly influencing the downstream anticyclone. Our results indicate that the stratospheric anomalies contribute to approximately 37% of the total precipitation during the event. This finding underscores the importance of the sub-vortex's geometry in the lowermost stratosphere for driving this precipitation event and highlights the need to focus on polar vortex geometry to fully understand regional stratosphere-troposphere coupling.

The Tibetan Plateau (TP), known as “the Asian Water Tower”, stores vast amounts of freshwater resources that sustain the livelihoods for nearly 40% of the global population in downstream regions. Using ERA5 reanalysis data and the FLEXPART model, moisture transport pathways over the TP in summers during 2000–2023 are categorized into four types, namely, the midlatitude westerly (MWW), South Asian high, Indian summer monsoon (ISM) and nonmonsoon low-level pathways. The contributions to interannual variations in summer moisture over the TP and the underlying mechanisms are further investigated. The results show that the seesaw between the drier MWW and wetter ISM pathways, modulated by wave trains originating from the North Atlantic, is an important factor regulating the interannual variations in summer water vapor over the TP. In years with high precipitable water over the TP, wave train-associated southwesterly anomalies over the southwestern TP-Tarim Basin cause air parcels in the MWW to bypass the TP to the north, whereas northeasterly anomalies over the Caspian-Aral Sea region weaken the eastward transport of air parcels in the MWW, reducing water vapor transport to the TP via the MWW pathway. In addition, low-tropospheric easterly anomalies south of the TP related to the wave train favor the westward transport of moisture along the southern foothills of the TP. After being lifted on the southwestern flank of the TP, such moisture converges toward the TP interior under the pumping effect of anomalous ascending motion over the TP, thereby strengthening moisture transport along the ISM pathway. This study gives a Lagrangian perspective highlighting the critical roles of different moisture transport pathways in regulating TP humidity.

The Pacific/North American (PNA) pattern is a dominant mode of mid-latitude climate variability with major impacts on North American weather. Its extended-range prediction remains challenging, influenced by complex drivers including upstream wave dynamics, tropical forcing, and the stratosphere. This study investigates the notable failure of extended-range forecasts to capture the extreme negative PNA event of February 2018 using the novel Stratospheric Nudging and Predictable Surface Impacts (SNAPSI) multi-model ensemble designed to isolate stratospheric sources of predictability. The results reveal that the forecast error stems from an underestimation of several key processes, including a chain of misrepresented factors. The primary bottleneck is the poor simulation of the East Asian trough, a well-established upstream precursor; models that better represent it produce more accurate PNA forecasts. Biases in both tropical (La Ni & ntilde;a) and extratropical North Pacific sea surface temperatures also contribute to the PNA forecast bias. While the Madden-Julian Oscillation has limited direct influence within the SNAPSI forecasts, a supplementary analysis shows that its accurate simulation in earlier weeks is critical for EAT development based on models from the Subseasonal-to-Seasonal prediction project database. The stratospheric contribution is initialization-dependent: for a late-January forecast, the tropospheric response to the February 2018 sudden stratospheric warming varies widely, limiting its net effect, while for a February initialization, most models produce an excessive negative Arctic Oscillation response, which amplifies a positive PNA bias. The findings highlight priorities for improving predictions: better representing mid-latitude wave dynamics, refining the representation of stratosphere-troposphere coupling, and integrating tropical-extratropical linkages.

BACKGROUND:Cold and hypoxic conditions often coexist in high-altitude environments and are associated with alterations in blood pressure during short-term exposure. Increasing evidence suggests that the microbiota-gut-brain axis may be involved in blood pressure regulation under environmental stress. However, evidence remains scarce, especially the related mechanisms. AIMS:This study aimed to investigate whether short-term combined exposure to cold and hypoxia is associated with blood pressure elevation and to explore the potential involvement of the microbiota-gut-brain axis in this process. METHODS:A rat model was established using combined exposure to cold (4°C) and hypoxia (61 kPa). Blood pressure, gut microbiota composition, intestinal and blood-brain barrier integrity, inflammatory responses, endothelial function, neuroinflammation, and sympathetic activity were assessed. The role of microbiota-gut-brain axis was also examined by γ-aminobutyric acid (GABA) supplementation. RESULTS:Short-term cold and hypoxia exposure was associated with elevated blood pressure, accompanied by gut microbiota dysbiosis, intestinal inflammation, and impaired intestinal barrier function. These changes coincided with increased circulating lipopolysaccharide (LPS) and pro-inflammatory cytokines, which were associated with vascular inflammation, oxidative stress, and endothelial dysfunction. Concurrently, impairment of the blood-brain barrier was detected, accompanied by increased accumulation of LPS and cytokines in the paraventricular nucleus, neuroinflammation, activation of microglia, and heightened sympathetic activity. Mechanistic analyses indicated the activation of the LPS-TLR4/MyD88/NF-κB signaling pathway in both the gut and brain. GABA supplementation lowered the blood pressure, restored the microbiota-gut-brain axis, and suppressed the LPS-TLR4/MyD88/NF-κB signaling pathway. CONCLUSION:Short-term cold-hypoxia exposure may contribute to hypertension through disruption of the microbiota-gut-brain axis, suggesting it may act as a potential therapeutic target for hypertension prevention during short-term cold-hypoxia conditions.

Successful ageing is a global priority, yet the impact of the physical environment on this multidimensional process is not fully understood. Previous research has predominantly focused on isolated exposures or specific diseases, overlooking the complex physical “exposome.” We aimed to evaluate the associations between a comprehensive array of environmental exposures and a holistic Successful Ageing Index (SAI). In this cross-sectional study of 28,090 UK Biobank participants aged ≥ 60 years, we constructed a continuous SAI integrating 11 indicators across cognitive, physical, psychosocial, and disease domains. Fourteen residential environmental exposures—including air pollutants, noise, and natural environments—were assessed. We used multivariable linear regression, restricted cubic splines, and mediation analyses to evaluate independent associations, non-linearity, and biological pathways. In crude models, most air pollutants were negatively associated, and natural environments positively associated, with the SAI. However, after extensive adjustment for sociodemographic and lifestyle factors, associations with natural environments were largely attenuated. Conversely, PM2.5 (β = -0.15; 95

BACKGROUND:Hypertension is a major global health burden. While air pollution is a known risk factor, the interactive effects of co-occurring stressors like cold weather and geographic elevation are poorly understood. This study investigated the independent and joint effects of long-term particulate matter (PM) exposure, cold waves, and elevation on hypertension. METHODS:We conducted a cross-sectional study of 27 602 adults across multiple regions in China. Long-term exposures to PM and its chemical components were estimated using 3 independent, high-resolution data sets, alongside cumulative cold-wave days and residential elevation. Generalized linear models and principal component analysis were used to estimate associations with hypertension prevalence and blood pressure, assessing both multiplicative and additive interactions. RESULTS:Long-term exposure to PM with a diameter of ≤2.5 μm was significantly associated with higher odds of hypertension (odds ratio per 10 μg/m3 increase, 1.100 [95% CI, 1.079-1.123]; P<0.001). Cold waves and elevation significantly modified this effect. The adverse association of PM with hypertension was synergistically amplified in regions with frequent cold waves (P for interaction<0.05). Conversely, while higher elevation was independently associated with lower hypertension odds (odds ratio per 100 m increase, 0.995; P<0.001), it significantly potentiated the adverse association between PM and hypertension. CONCLUSIONS:The association between air pollution and hypertension is significantly modified by local climatic and geographic conditions. The synergistic effect of PM and cold waves suggests current assessments may underestimate the burden in susceptible regions, necessitating integrated, climate-informed public health strategies.

This study investigated the combined effects of fine particulate matter (PM2.5) exposure and ambient oxygen (O2) availability on peripheral artery disease (PAD) hospitalizations in Gansu Province, China, from 2018 to 2022 (N = 38,514). A time-series case-crossover design with conditional logistic regression assessed short-term exposure to daily PM2.5 and its major chemical components (black carbon [BC], organic carbon [OC], sulfate [SO42−], nitrate [NO3−], ammonium [NH4+], and chloride [Cl−]). Atmospheric O2 levels were estimated based on altitude, temperature, and humidity. Short-term exposure to PM2.5 was associated with an increased risk of PAD hospitalization, notably at lag 1 (odds ratio [OR] = 1.003; 95% confidence interval [CI]: 1.002–1.004). Carbonaceous pollutants exhibited delayed effects, with peak associations at lag 6 for BC (OR = 1.069; 95% CI: 1.035–1.105) and OC (OR = 1.028; 95% CI: 1.011–1.050), per 1 μg/m3 increase. Secondary inorganic aerosols showed acute effects at lag 1: Cl− (OR = 1.107; 95% CI: 1.063–1.150), NH4+ (OR = 1.040; 95% CI: 1.022–1.060), SO42− (OR = 1.025; 95% CI: 1.015–1.036), and NO3− (OR = 1.030; 95% CI: 1.018–1.042), per 1 μg/m3 increase. Nonlinear exposure–response curves revealed a stronger PAD risk under lower O2 conditions (<18%). The PM2.5-related risk was amplified in high-altitude residents (>1500 m), older adults (>60 years), females, emergency admissions, and during the cold season. These findings suggest that ambient PM2.5 and lower O2 levels interact synergistically to elevate PAD hospitalization risk, emphasizing the urgent need for region-specific air quality controls and targeted health protection strategies.

Atmospheric particulate pollution is an important risk factors for stroke. The aim of this study was to investigate the association of size-specific particulate matter (PM) and their components with stroke hospitalization in Northwest China's arid area from 2018 to 2022. Stroke hospitalization data were collected from Gansu Province. Size-specific PM with chemical speciation profiles and concurrent meteorological Data spatially aligned with the geographical coordinates of the included hospitals. The space-time-stratified case-crossover design and the conditional quasi-Poisson regression model were used to analyze the association between PM and stroke hospitalization, and stratified analysis was conducted based on age, gender, region, season and stroke type. This study included 759,473 stroke patients. PM1, PM1-2.5, PM2.5 and PM10 were all observed the highest risk of stroke hospitalization at lag 06 day, with RRs of 1.238 (95 % CI: 1.217-1.260), 1.057 (95 % CI: 1.049-1.066), 1.067 (95 % CI: 1.060-1.074) and 1.012 (95 % CI: 1.009-1.015). Among PM components, black carbon (BC) demonstrated the most pronounced association with stroke hospitalization risk (PM2.5, RR = 1.045 per 1 mu g/m3 increase, 95 % CI:1.037-1.054; PM1 and PM10, RR = 1.580 per 1 mu g/m3 increase, 95 % CI:1.535-1.626). Subgroup analyses further indicated greater vulnerability among women, the elderly, during the cold season, and for ischemic stroke (IS) compared to hemorrhagic stroke (HS). Our findings indicate strict air quality intervention measures based on size-specific effect of PM should be taken to reduce the burden of stroke.

Objective:Chronic obstructive pulmonary disease (COPD) is a major health concern in northwest China; however, the impact of particulate matter (PM) exposure during sand-dust storms (SDS) remains poorly understood. Therefore, this study aimed to investigate the association between PM exposure on SDS days and COPD hospitalization risk in arid regions. Methods:Data on daily COPD hospitalizations were collected from 323 hospitals from 2018 to 2022, along with the corresponding air pollutant and meteorological data for each city in Gansu Province. Employing a space-time-stratified case-crossover design and conditional Poisson regression, we analyzed 265,379 COPD hospitalizations. Results:PM exposure during SDS days significantly increased COPD hospitalization risk [relative risk ( RR) for PM 2.5, lag 3:1.028, 95% confidence interval ( CI): 1.021-1.034], particularly among men and the elderly, and during the cold season. The burden of PM exposure on COPD hospitalization was substantially high in Northwest China, especially in the arid and semi-arid regions. Conclusion:Our findings revealed a positive correlation between PM exposure during SDS episodes and elevated hospitalization rates for COPD in arid and semi-arid zones in China. This highlights the urgency of developing region-specific public health strategies to address adverse respiratory outcomes associated with SDS-related air quality deterioration.

The plateau region is conventionally regarded as a "clean land" with minimal environmental pollution, leading to scarce research on the distribution of emerging pollutants such as per- and polyfluoroalkyl substances (PFAS) and their effects on the health of plateau inhabitants. To understand that, we studied participants from two representative towns in Gannan Tibetan Autonomous Prefecture, Gansu Province, China. Lung function parameters (FVC%, FEV1%, and FEV1/FVC) were measured, while PFAS concentrations in urine and indoor dust were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). We measured the levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG), 8-epi-prostaglandin F2α (8-epi-PGF2α), and malondialdehyde (MDA) in urine. The results demonstrated a preponderance of short-chain PFAS in urine, with PFBS, PFPeA, and PFBA showing the highest detection rates. PFBA had the highest median concentration at 0.47 ng/mL. Similarly, in indoor dust, PFBA was the most frequently detected, followed by PFOA, with median concentrations of 0.56 and 0.44 ng/g, respectively. Multiple PFAS compounds showed significant inverse correlations with FVC% and FEV1%. PFAS exposure was associated with elevated oxidative stress biomarker levels (8-OHdG, 8-epi-PGF2α, and MDA), and their synergistic interaction aggravated the decline in lung function. This research provides valuable evidence of PFAS exposure patterns in the plateau population, highlighting the dominance of short-chain PFAS compounds and the concerning link between PFAS exposure and impaired lung function.

Social isolation and loneliness are associated with an increased risk of various diseases and all-cause mortality. Coronary heart disease (CHD) is the main cause of heart disease deaths worldwide, which affects people's quality of life and longevity. However, the causal relationship between social isolation, loneliness, and CHD remains uncertain. This study aims to explore the potential impacts of social isolation and loneliness on the risk of CHD, thereby helping identify those most susceptible to these conditions. A total of 442,811 individuals (mean and sd of age = 56.24 ± 8.07, 55.8% women, 91.5% white) were included in the study. The UK Biobank cohort study documented 25,120 CHD cases during a mean follow-up of 14.77 years. The relationship between loneliness, social isolation and CHD were first examined using the COX proportional risk model. A two-sample Mendelian randomization (MR) study was then conducted to further the association. We found that the hazard ratio (95% CI) of coronary heart disease (CHD) when comparing the most socially isolated groups to the least was 1.15 (1.05-1.26; P = 0.0017). Additionally, the hazard ratio (95% CI) for comparing the presence of loneliness to its absence was 1.15 (1.10-1.20; P < 0.001).Subgroup analyses showed that the risk of CHD was higher in individuals with low sleep quality who experienced social isolation and in women who experienced loneliness. MR analyses further revealed that individuals who felt lonely (OR = 1.03; 95% CI: 1.01,1.06) and those less involved in sports/social activities (OR = 1.02; 95% CI: 1.00,1.04) had a higher likelihood of developing CHD. MR provided further evidence supporting the causal relationship between social isolation, loneliness and CHD risk. Our findings suggest a significant association between social isolation, loneliness and increased risk of coronary heart disease. These findings suggest that both social isolation and loneliness are critical risk factors for CHD.

Background: While mounting evidence suggests a connection between environmental contaminants and sleep problems, it remains uncertain whether exposure to volatile organic compounds (VOCs) specifically is associated with such problems. Methods: Data from the National Health and Nutrition Examination Survey program’s five survey cycles (2005–2006, 2011–2018) were used to conduct cross-sectional research. Data on short sleep duration (SSD) and self-reported trouble sleeping were collected from questionnaire data. Data on urine VOCs were gathered from laboratory data. The association between urinary VOCs and sleep problems was examined using weighted generalized linear models and the restricted cubic spline (RCS), weighted quantile sum (WQS), and quantile-based g-calculation (QGC) methods. Results: In all, a total of 4131 general adult individuals were included in this study. The prevalence of SSD and self-reported trouble sleeping was 34.11% and 25.03%, respectively. 3,4-MHA, AAMA, AMCC, SBMA, and MA were risk factors for SSD after adjusting several covariates, with the largest effect being AMCC (OR = 1.47, 95% CI: 1.08, 2.02). Risk factors for sleep issues included AAMA, AMCC, CEMA, CYMA, DGBMA, 2HPMA, 3HPMA, MA, and PGA, with AMCC having the highest impact with an OR of 1.69 (95% CI: 1.28, 2.22). Both the WQS model and the QGC model showed that the co-exposure to VOCs was positively associated with SSD and self-reported trouble sleeping, with AMCC being the most influential VOC. Conclusions: According to our research, high levels of single or mixed urine VOCs are linked to a higher prevalence of SSD and self-reported trouble sleeping in the general adult population of the United States. Further prospective and experimental studies are needed in the future to validate these potential relationships and explore the underlying mechanisms.

Objectives: The relationship between long-term exposure to occupational noise and hearing loss has been extensively documented. We aimed to assess spatial and temporal changes in the burden of occupational noise-induced hearing loss (ONIHL) in 204 countries and territories with varying socio-demographic indexes (SDI) from 1990 to 2019. Design: Temporal and spatial trends in age-standardized disability-adjusted life year rates (ASDR) for ONIHL were estimated by sex, age, SDI level, country, and geographic region from 1990 to 2019. We used the Joinpoint model to calculate annual average percentage changes to assess such trends and projected trends in ASDR for ONIHL globally and across different income regions from 2020 to 2044 using an age-period-cohort model. We fitted the relationship between ASDR and SDI, ASDR and healthcare access and quality index, respectively. Results: Overall, the global burden of ONIHL has decreased since 1990, especially in middle and lower SDI regions. In 2019, the global ASDR for ONIHL was 84.23 (95% confidence interval: 57.46 to 120.52) per 100,000 population. From 1990 to 2019, the global ASDR for ONIHL decreased by 1.72% (annual average percentage change = -0.05, 95% confidence interval: -0.07 to -0.03). Our projections showed a decreasing trend in the global ONIHL burden until 2044. ASDR and SDI (R = -0.8, p < 0.05), ASDR and healthcare access and quality index (R = -0.75, p < 0.05) showed significant negative correlations. Conclusions: The global ONIHL burden has decreased over the past three decades, especially in regions with middle and lower SDI levels. However, the global ONIHL burden still remained severe in 2019, notably among males, the middle-aged and elderly, and regions with lower SDI levels.

Using the ERA5 reanalysis data, we analyzed the impacts of the Arctic stratospheric polar vortex weakening on Ural Blocking (UB). The results indicate that UB activities are suppressed following the weakening of the polar vortex. Specifically, the probability of UB is significantly reduced, with a maximum decrease of 30% observed around day 24 following the polar vortex weakening. The average life cycle of UB shortens by approximately one day. The amplitude of UB, as measured by the negative potential vorticity (PV) anomalies over the Urals, experiences a significant decrease, particularly with the presence of positive PV anomalies on the western side of Urals. Further analysis indicates that the suppression of UB following the weakened polar vortex is closely linked to both the equatorward horizontal transport of high-PV air over the Arctic across the dynamic tropopause, and the anomalous increase in static stability over the Urals resulting from a descent of the isentropic surface near the tropopause. Finally, we evaluate the relative roles of the polar vortex weakening and the negative phase of the Arctic Oscillation (AO) in suppressing the development of UB. Our analysis reveals that the impacts of the weak polar vortex on the suppression of UB are stronger and more long-lasting compared to the negative AO, suggesting that the impacts of the weakened polar vortex on UB cannot be simply explained by the AO response.

Using ERA-Interim reanalysis data and ensemble forecasts from the Global Ensemble Forecast System (GEFS), we explore the roles of the Arctic stratospheric polar vortex throughout the life cycle of the 2016 East Asian cold air outbreak (CAO). Our results reveal the distinct roles of the stratosphere in the initiation and intensification stages of this CAO. The occurrence of this CAO was directly related to an exceptionally strong Ural blocking ridge that advected cold air mass toward East Asia. Notably, the strengthening of Ural blocking is largely influenced by the behavior of the stratospheric polar vortex. Specifically, the contraction of the polar vortex toward the western Urals paved the way for reflecting planetary waves originating from the North Atlantic via changing the buoyancy frequency just above the tropopause. The reflected waves converged over the western Urals and acted to strengthen Ural blocking that in turn affected this CAO. Subsequently, an elongation of the polar vortex toward East Asia was observed, leading to a significant descent of the tropopause over East Asia. According to the invertibility theory of potential vorticity, the descending tropopause likely induced a cyclonic anomaly over East Asia, further contributing to the intensification of this CAO. However, the impact of this cyclonic anomaly induced by the polar vortex elongation is relatively limited compared to the influence of Ural blocking. In summary, our study highlights that the geometry of the polar vortex, rather than its strength, is crucial in understanding the stratospheric impacts on the 2016 East Asian CAO.

Low temperature conditions have been linked to a heightened susceptibility to lower respiratory infections (LRIs). Yet, our comprehension of the LRIs’ disease burden due to such conditions remains limited, especially when considering the diverse socio-demographic indexes (SDIs) and climate types across various nations and regions. We examined the variations over time and space in the impact of LRIs due to low temperatures across a diverse set of 204 nations and regions, each with unique SDIs and climate types, spanning the years 1990 to 2019. Data from the Global Burden of Disease Study 2019 was used for this retrospective analysis. The burden of LRIs attributable to low temperatures was estimated by stratifying by sex, age, country, climate type, and SDI, including age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year rate (ASDR). We employed Joinpoint models to compute the annual average percent changes (AAPCs) in order to evaluate the trends in LRIs burden due to low temperatures from 1990 to 2019. Furthermore, we utilized Poisson age-period-cohort models to forecast the global and income-specific trends in LRIs burden due to low temperatures for the period 2020–2044. Generalized additive mixed models were used to fit changes in the disease burden of different climate regions. The relationship between SDI and both ASMR and ASDR was determined using models grounded in Gaussian process regression. In general, since the year 1990, there has been a significant reduction in the worldwide impact of LRIs due to low temperatures. This decrease is particularly noticeable among infants and the elderly, as well as in regions with a boreal climate and those with an average SDI. In 2019, LRIs induced by low temperatures showed an ASMR of 2.2 (95

Background Previous research has found a link between dietary factors and asthma. However, few studies have analyzed the relationship between dietary factors and asthma using Mendelian randomization. Methods: The IEU Open GWAS project (https://gwas.mrcieu.ac.uk/) was the source of exposure and outcome datasets. The exposure datasets included Alcoholic drinks per week, Alcohol intake frequency, Processed meat intake, Poultry intake, Beef intake, Non-oily fish intake, Oily fish intake, Pork intake, Lamb/mutton intake, Bread intake, Cheese intake, Cooked vegetable intake, Tea intake, Fresh fruit intake, Cereal intake, Salad/raw vegetable intake, Coffee intake, and Dried fruit intake. The weighted median, MR-Egger, and Inverse Variance Weighted methods were used as the main methods of Mendelian randomization analysis. Heterogeneity and pleiotropic analysis were performed to ensure the accuracy of the results. Results Alcohol intake frequency (after removing outliers OR: 1.217; 95% CI: 1.048-1.413; p=0.00993) was related to an increased risk of Asthma. Fresh fruit intake (OR: 0.489; 95% CI: 0.320-0.748; p=0.000954) and Dried fruit intake (after removing outliers OR: 0.482; 95% CI: 0.325-0.717; p= 0.000312) were discovered as protective factors. Other dietary intakes found no causal relationship with asthma. Conclusion This study found that dried fruit intake and fresh fruit intake were associated with a reduced risk of asthma, and alcohol intake frequency was associated with an increased risk of asthma. This study also found that other factors included in this study were not associated with asthma.

BACKGROUND:Exposure to lead (Pb) is associated with an increased risk of chronic kidney disease (CKD). However, limited studies explored the global burden of CKD attributable to Pb exposure, especially in countries with different development levels. This study aimed to comprehensively evaluate the temporal and spatial trend in the disease burden of CKD attributable to Pb exposure in 204 countries and territories from 1990 to 2019.METHODS:We used the data from Global Burden of Disease Study (GBD) 2019 to estimate annual deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized DALYs rate (ASDR) of CKD attributable to Pb exposure. The annual average percentage change (AAPCs) was calculated using the Joinpoint model to evaluate the changing trend of CKD ASMR and ASDR attributable to Pb exposure from 1990 to 2019. Meanwhile, age-period-cohort (APC) model was used to assess changes in the mortality of CKD attributable to Pb exposure from 1990 to 2019.RESULTS:Global ASMR for CKD attributable to Pb exposure trended upward from 1990 to 2019. ASMR and ASDR were the highest in low and low-middle SDI regions. With the APC model, we found that global mortality rates for CKD attributable to Pb exposure increased with age. The global period rate ratio showed the highest value in 2000-2004 and the lowest in 2015-2019, while the global cohort rate ratio showed the highest value in 1941-1949 and the lowest during 1986-1994.CONCLUSIONS:From 1990 to 2019, the global burden of CKD attributable to Pb exposure increased globally, especially in low and low-middle SDI regions, as well as the elderly. Pb exposure is still a great threat to the global burden of CKD, and the implementation of effective prevention measures to reduce Pb exposure in the environment should be continually strengthened.

Background: Previous studies have shown that extreme heat likely increases the risk of road injuries. However, the global burden of road injuries due to high temperature and contributing factors remain unclear. This study aims to characterize the global, regional and national burden of road injuries due to high temperature from 1990 to 2019.Methods: Based on the Global Burden of Disease (GBD) study 2019, we obtained the numbers and age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years (DALY) rates (ASDR) of the road injury due to high temperature at global, regional, and national levels from 1990 to 2019. The world is divided into five cli-mate zones according to the average annual temperature of each country: tropical, subtropical, warm temperate, cold temperate, and boreal. We used the generalized additive models (GAM) to model the trends of road injuries globally and by region.Results: Globally, between 1990 and 2019, the deaths of road injury attributable to high temperature increased signif-icantly from 20,270 (95% uncertainty interval [UI], 7836 to 42,716) to 28,396 (95% UI, 13,311 to 51,178), and the DALYs increased from 1,169,309 (95% UI, 450,834 to 2,491,075) to 1,414,527 (95% UI, 658,347 to 2,543,613). But the ASMR and the ASDR slightly decreased by 8.49% and 13.16%, respectively. The burden of road injury death attributable to high temperature remained high in low SDI and tropical regions. In addition, road transport infrastruc-ture investment per inhabitant is associated with the burden of road injuries attributable to high temperature.Conclusions: Globally, the ASMR and ASDR for road injuries attributable to high temperature decreased from 1990 to 2019, but the absolute death and DALYs continued to increase. Thus, concerning global warming, implementation of prevention and interventions to reduce road injuries from heat exposure should be stressed globally.

BackgroundDiabetes disproportionately affects minorities and those with low socioeconomic status (SES) in the United States, and differences in behavioral lifestyles are largely responsible for the unequal distribution of diabetes among different groups.MethodsWith data of 9,969 participants collected in the 2007–2008 and 2009–2010 cycles of the US National Health and Nutrition Examination Survey (NHANES), this study examined several mediators and their mediating effects in the connection between SES and the risk of diabetes. The SES is assessed by the income-to-poverty ratio (IPR), education level, and employment status. For the mediation analysis, we used health-related behaviors as mediators (smoking, alcohol use, consumption of green vegetables and fruits, physical activity and sedentary time, health insurance, and healthcare). In this study, the structural equation model was utilized to evaluate the mediating effects of behavioral lifestyle as a mediator in the relationship between SES and diabetes.ResultsA total of 9,969 participants were included in this study. We found a negative nonlinear association between IPR and diabetes risk (Poverall < 0.001; Pnon-linear = 0.46), which was independent of the majority of known or suspected risk factors and confounding variables (gender, age, race). Participants with lower SES had higher risk of diabetes compared with those with higher SES. In mediating analysis, we found alcohol intake (OR = 0.996), physical activity (OR = 0.993), health insurance (OR = 0.998), and healthcare (OR = 1.002) mediated the IPR-diabetes association. But in the relationship between education status and diabetes, the mediation effect of alcohol intake (OR = 0.995), physical activity (OR = 0.991), and health care (OR = 1.008) were obvious. Likewise, alcohol intake (OR = 0.996), fruit intake (OR = 0.998), and health care (OR = 0.975) were important mediators in the association between employment status and diabetes.ConclusionThis study provides critical insights on the link between SES and diabetes. Our results highlight that poor health-related behaviors and limited access to healthcare are important pathways for increased diabetes risk related to those with low SES, particularly among Mexican Americans and males. They should be top priorities for agencies and healthcare providers to develop behavior-related interventions to reduce inequalities in diabetes risk.