Presented by Pan Xiao-chuan et al.
Dept. of Occupational and Environmental Health
Peking University School of Public Health
Workshop in Oslo, Oct.17-19, 2004


The indoor air quality is concerned more and more by the government and the public in China nowadays and the health effects of indoor air pollution are becoming a serious challenge in both urban and rural areas of China. In order to further study the health effects of indoor air pollution and population exposure to them, it is very important for us to know clearly what the key pollutants is in the urban and rural areas of
China.

 from housing fitment and decoration:

Formaldehyde

Benzene, toluene and xylene

Ammonia

VOCs

Radon and dust mite


From fuel combustion:

Particular Matter

SO2

CO

Environmental Tobacco Smoke (ETS)


Indoor air monitoring: the average level of ammonia, formaldehyde, total volatile organic compounds (TVOC), house dust mites, moulds and other allergens in 400-1400 households in 6 provinces of China, which measured by the standard procedure and methods in 2001-2002.

Case-control epidemiologic studies: asthma, leukemia and allergic rhinitis.

Fig.1 Le ve l of of the indoor air form alde hyde in w inte r(m g/m 3)
19.91%
46.67%
14.06%
1.68%
17.69%
~0.1
0.1~0.3
0.3~0.5
0.5~1.0
1.0~

Fig.2 the ave rage le ve l of indoor air form alde hyde in 6 citie s in w inte r formaldehyde
(mg/m
3
)
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
0.142
C hon gq in g
0.205
Sh an gh ai
0.210
Be iji ng
0.267
0.412
Ti an jin
C han gc hu n
0.610
Sh iz ui sh an
0.290
Tot al

Fig.3 Level of of the indoor air formaldehyde in summer(mg/m3)
26.02%
11.17%
1.02%
6.35%
55.46%
~0.1
0.1~0.3
0.3~0.5
0.5~1.0
1.0~

Fig.4 the average level of indoor air formaldehyde in 3 cities in summer form alde hyde
(m g/m 3)
0 . 5 0 0
0 . 4 0 0
0 . 3 0 0
0 . 2 5 1
0 . 2 0 0
0 . 1 0 0
0 . 0 0 0
Shizuishan
0 . 2 7 8
B eijing
0 . 3 9 7
Chongqing
0 . 2 9 3
Total

mg/m3
Fig.5 the average level of indoor air am m onia in 6 cities in w inter
0 .1
0 .0 8
0.081 0.081
0.06
0 .0 6
0.059
0 .0 4
0 .0 2
0.042
0.037
0.022
0
Be iji ng
C han gc hu n
Sh iz un sh an
C hon gq in g
Ti an jin
Sh an gh ai
Tot al

Fig. 6 The level of the indoor air ammonia in summer(mg/m3)
27.38%
5.85%
2.46%
64.31%
~0.2
0.2~0.4
0.4~0.6
0.6~

Fig. 7 the level of indoor air TVOC in
4 cities in winter(mg/m3)
21.79%
27.86%
16.07%
4.29%
30.00%
~0.6
0.6~1.8
1.8~3.0
3.0~6.0
6.0~

Fig. 8 the average level of indoor air
TVOC in 4 cities in winter mg/m3
5
4
3
2
1
0
4.142
2.216
Changchun Shanghai
1.900
Shizuishan
1.354
Tianjin
2.110
Total

Fig. 9 the level of indoor air TVOC in
4 cities in summer(mg/m3)
31.73%
8.65%
5.77%
2.88%
50.96%
~0.6
0.6~1.8
1.8~3.0
3.0~6.0
6.0~

Fig. 10 The average level of indoor air 17
VOCs Compounds in winter and summer mg/m3
0.5
0.4
0.3
0.2
0.1
0 be nz en e en e to lu m
_p
_x e yl en a_ xy le ne fo rm al de hy de
苯乙酰 ca m ph or c1
3 c1
4 s u m m e r c1
5
辛基醛异辛醇 w i n t e r
壬醛 癸醛 be lo ro ch
2,
2nz en e ch lo ro be nz en e ph th al na en e

Tab.11 Level of the allergen from dust mite, bacteria and epiphyte in the office buildings
OFFICE
E
F
G
H
A
B
C
D
I
J
K
L
Allergen （ IU/100Ml ）
Der.P Der.f
1.22 1.13
1.44
1.29
1.29
0.69
1.35
1.25
Bacteria （ cfu/m
3 ）
75
62
0
200
462
～
38 ～ 212
25 ～ 425
～
～ 1075
0 ～ 1000
25 ～ 1150
～
～
800
825
1025
1350
488 ～ 913
0 ～ 1863
363 ～ 2738 epiphyte （ cfu/m
3 ）
Sum Mildew penicillium
0 ～ 1050 0 ～ 1050 12 ～ 88
0 ～ 50
0 ～ 38
0
0
～
～
25
25
0 ～ 238 0 ～ 25 0
0
0
～
～
～
12
12
100
0 ～ 250 0 ～ 38
0 ～ 200 0 ～ 38
0 ～ 5000 0 ～ 75
12 ～ 350 12 ～ 150
112 ～ 450 62 ～ 225
88 ～ 375 12 ～ 188
0 ～ 438 0 ～ 25
25 ～ 350 0 ～ 50
0 ～ 150
0 ～ 50
0 ～ 38
0 ～ 25
0 ～ 25
0 ～ 25
0 ～ 12
0 ～ 12

Indoor environmental risk factors for allergic asthma in adults
— a case-control study
Yue Wei, Pan Xiao-chuan et al.
Peking University School of Public health

1.Background
 Allergic asthma is a kind of common disease. In recent years, it has an obviously increasing trend in our China.
The prevalence in our China is about 1% ， in adults is about 0.5%.
 To the epidemiological study about the adults’ allergic asthma, many researches have been done in foreign countries in recent 20 years. While in China, few researches have been reported, especially the researches between the adults’ allergic asthma and indoor environmental risk factors.
 This study is to investigate the risk factors of adults’ allergic asthma or its onset, especially the indoor environmental risk factors. It is also one of the key research subjects in our China.

2. Methods: case-control study:
 Questionnaire by face to face interview

Formaldehyde, NO2 and dust mite measure
102 cases
Age: 20～70y
Gender: no limited
Ratio 1 ： 4
Asthma patients in a d u l t s f r o m t h e
P e k i n g U n i v e r s i t y a f f i l i a t e d R e n m i n
H o s p i t a l .
394 controls
Healthy residents from
Beijing Xicheng district which is near the
Renmin hospital. They all have no allergic or respiratory diseases.

3.Results:
Tab.1 Single risk factors analysis of the allergic asthma in adults
Risk factors
Vocational exposure to dust
Vocational exposure to harmful gases
Housing type
Drying bedding in sunshine
Yes
No
Yes
No bungalow
A storied building
Not often often
Wood
Floor of the living room
Cooking oil smoke indoors
Family history of the chronic bronchitis or asthma
Not wood
Moderate/ severe
Low
No
Yes
No
70
32
31
71
13 case
45 control
120
P value OR value
(95 ％ CI)
<0.01
*** 1.87(1.19-2.93)
55
35
64
8
94
274
97
297
13
381
<0.05
**
<0.05
**
1.67(1.05-2.68)
2.49(1.01-6.19)
73
16
42
60
225
169
72
322
40
234
120
85
309
<0.05
** 1.64(1.03-2.61)
<0.05
** 1.95(1.20-3.20)
<0.05
** 2.44(1.08-5.51)
2.34(1.31-4.20)
<0.01
*** 2.55(1.60-4.04)

Tab.2 Multiple risk factors logistic analysis of the allergic asthma in adults
Risk factors
Intercept
Vocational exposure to dust
β Sx(β) waldχ 2 value
P- value OR value
-3.11 0.37
0.58 0.24
71.92
5.76
<0.0001
0.0164
—
1.78
Housing type 1.18 0.51 5.41 0.0201 drying Bedding in the sunshine 0.42 0.25 2.74 0.0978
Floor of the living room 0.84 0.27 9.77 0.0018
Cooking oil smoke indoors 0.92 0.31 8.65 0.0033
Family history of the 0.84 0.25 11.40 0.0007 chronic bronchitis or asthma
SAS stepwise Sle ＝ 0.10,Sls ＝ 0.10
.
3.24
1.53
2.33
2.52
2.32

Table3 Correlative analysis between the different concentration of the indoor formaldehyde and allergic asthma in adults
Level
(μg/m3)
N Control (%) Case (%) Unadjusted OR value
(95%CI)
Adjusted OR value #
(95%CI)
Level
Original value
1(24.68) 28 25(30.86%) 3(10.00%) 1 1
2(43.59) 27 23(28.40%) 4(13.33%) 1.45（0.29，7.18） 1.86（0.35，9.78）
3(69.68) 28 22(27.16%) 6(20.00%) 2.27（0.51，10.18） 1.87（0.39，8.92）
4(120.11) 28 11(13.58%) 17(56.67%) 12.87（3.12，53.12）* 12.94（2.86，58.54）*
Trend Analysis 2.51（1.57，4.00）* 2.36（1.45，3.84）*
Formaldehyde concentration（μg/m3） 1.02（1.01，1.03）* 1.02（1.01，1.03）*
*: P value < 0.01
# the adjusted factors: age, sex, cigarette smoking, family history of the chronic bronchitis or asthma

4.
Conclusion & Indication：
There were 6 risk factors correlated with the allergic asthma in adults in our study:
 Vocational exposure to dust
 Housing type
 Drying Bedding in the sunshine
 Floor type of the living room
 Cooking oil smoke contamination indoors
 Family history of the chronic bronchitis or asthma
It indicated that the adults ’ allergic asthma is a kind of complicated disease caused by genetic and environmental multiple factors. Meanwhile, there is concentration-response relationship between the indoor air formaldehyde level and the adults ’ allergic asthma.

Ａ case-control study of the risk factors for adult leukemia
DING Wen-qing, BAO li , HUANG xiao-jun, PAN
Xiao-chuan.
Peaking University School of Public Health and
Second Hospital


With the increasing of the living standards of the residents, the problems caused by the indoor air pollution have been the hotspot in China recently.
In recent years, the incidence of leukemia has the increasing tendency , some reports says it is probably related with the indoor decoration of the house. The purpose of this study was to ascertain primarily the relationship between the indoor decoration and other suspicious risk factors related with adult leukemia.

A total of 127 cases (age 15-75 years old) of
Adult leukemia survivors were interviewed with health questionnaire by face to face,which included general conditions, living environment, harmful materials contact, living style, disease and family history ,etc. The conditional Logistic regression model in univariate and multivariate analysis were used to seek the key risk factors, specially for adult leukemia.

In the single factor analysis,14 of
98 indexes were obviously significant<0.05)

Tab. The Single Factor Analysis
Variables P value OR value
1 、 Occupation 0.004 0.90
2 、 Times of common cold in past 0.030 1.23
two years
3 、 History of other blood diseases 0.020 0.49
4. The degree of the indoor decoration 0.001 3.81
5. Using indoor air-condition 0.001 3.84
6. Flower planting in the house 0.009 3.40
7. Frequently using pesticides 0.018 12.56
for flower at home


Variables P value OR value
8. Having factory nearby house 0.020 0.292
(<500meters)
9. Using the cosmetic often 0.050 0.437
10. Using perfume often 0.020 0.400
11. Cigarette smoking 0.002 4.420
12. Milk drinking frequently 0.009 0.530
13. Over intake of salt 0.005 0.436
14. Number of cigarette smoking 0.004 3.452

the multi-factor stepwise regression analysis

There were 4 variables significantly associated with adult leukemia (P<0.05)
Variables P value OR value
1
、
The degree of the indoor decoration 0.006
5.46
2 、 cigarette smoking 0.011 6.52
3 、 flower planting in house 0.009 3.40
4 、 Using indoor air-conditioner often 0.022
4.51


It is suggested that the degree of the indoor decoration might be one of risk factors for adult leukemia.

Liu Ying, Pan Xiao-chuan et al.
Peking University School of public health

 we chose 95 patients and 45 controls to perform case-control study. Patients were selected from
Peking University affiliated hospitals, where they had been diagnosed as allergic rhinitis. Controls are patients from the same hospital but not suffer from allergic rhinitis. Block-paired design of Logistic regression was utilized to conduct multi-factor analysis. We use SPSS 11.0 to do the statistics.

age sex married
Allergy history
β
-1.460
1.753
S.E
1.002
-.047
.052
1.622
P value OR value
.145
.361
.280
-.930
1.513
.539
Passive smoking in family -1.797
1.267
.156
.232
.954
5.770
.395
.166
Passive smoking in office .306
1.083
.777
1.358
The cooking oil
The type of housing
Family history of allergy
.031*
.874
-1.239
1.610
.442
.290

group Salad oil* Peanut oil other total case 58 control 12 total 70
22
28
50
1
3
4
81
43
124
•P=0.008, OR value=12.918( Logistic Regression)
The results suggests that use of salad oil may cause the increase of the prevalence rate of allergic rhinitis.

1999-2004

INDOOR AIR POLLUTION AND
RESPIRATORY HEALTH OF THE
PEOPLES IN BEIJING:
A COMMUNITY-BASED STUDY
Dept. of Occupational and Environmental Health,
Peking University School of Public Health,
Beijing 100083, P.R. China
Xiao-chuan Pan, et.al.



In recent years the housing of Beijing peoples have been improved enormously with the fast development of the economy as well as living level. A lot of the new fitments, soft furnishings, fitted carpets and mechanical air ventilation systems are now introduced into more and more households in Beijing, especially in urban areas.
How about indoor air quality caused by them?



Participants: About 270 households, living in 3 communities of urban area were selected randomly for indoor air monitoring, about 3000 individuals aged from
18 – 65 yr. from the study households and their neighbors were interviewed by questionnaire for their respiratory health.
The mass concentration of particles smaller than
10 μ m/2.5
μ dioxide (SO
2 m in diameter （ PM
10
/PM
2.5
） and sulphur
) was measured in the bedroom and kitchen of the study households in real time twice a day for two weeks, respectively in winter and summer.


Health: The health questionnaire was based on that of the British Medical Respiratory
Committee and revised according to the different status in Beijing. It consisted of age, gender, education, occupation, and general health status, living habits, exposure to indoor microenvironment factors, cooking, and smoking, respiratory symptoms and other daily activities. The trained students of a medical college conducted the health survey with the questionnaire by face-to-face interview.


Determination and Data analysis: The determination of levels of PM
10
, PM
2.5
taken with standardized procedures.
and SO
2 and X-square test
The t-test were used for estimates of variances of the pollutants level. Effect size of various factors for respiratory symptoms and lung function were estimated with two models. First, is a linear model with an ordinary least-squares regression of symptoms rates. We accounted for clustering of observations in units of Household.
Second, we used a logistic probability model y=
(X × β +u): y, X, and β are defined as in the linear model; F =cumulative logistic distribution,
(z)=exp (z) divided by [1+exp (z)].
was
F
F

Fig.1 Indoor Air PM10 Level in 3
Districts of Beijing(mg/M3) in winter in summer
0.8
0.6
0.4
0.2
0
B K B K B K
Dongcheng Shijingshan Haidian
Districts
B: bedroom, K: kitchen. the same as below

Fig.2: The Indoor Air PM2.5 Level among
Three Districts in Beijing(mcg/m3)
700
600
500
400
300
200
100
0
B
Dongcheng
K B K
Shijingshan
Districts
B
Haidian
K in winter in summer

Fig3: The Indoor Air SO2 Level among
Three Districts in Beijing(mcg/m3)
450
400
350
300
250
200
150
100
50
0
B
Dongcheng
K B K
Shijingshan
Districts
B
Haidian
K in winter in summer

Graph1: PM10 Level in 24 Hours in A Bedroom in Haidian District in Beijing(in winter)

Graph2: PM2.5 Level in 24 Hours in A Bedroom in Haidian District in Beijing(in winter)

Graph3: PM10 Level in 24 Hours in A Kitchen in Shijingshan District in Beijing(in winter)

Graph4: PM2.5 Level in 24 Hours in A Kitchen in Shijingshan District in Beijing(in winter)

Table 4. Coefficients of Logistic Regression for
Respiratory Symptoms and indoor air pollutants and other factors
Variables intercept
Cough
-2.3494
Phlegm
-1.4326
Asthma Breathe short
-2.5023
1.8412**
PM
10
PM
2.5
SO
2
Exp. To Occup. Dust
Exp. To Chemicls
Smoking
Passive Smoking
Much time to Cooking smoke exhauster in kitch
Cooking oil indoors
*: P<0.05, **: P<0.01
0.5473
-0.3231
-0.0267
-0.1010
0.4700
-0.0394
0.4816**
0.5650** 0.3329
0.6498** 1.0195**
0.4653**
0.000928
-0.0201
-0.00069
-0.2730
-0.2569
-0.4170**
0.1618
1.5789
-2.7718
-0.1220
0.6822*
1.4811
-1.6727
1.0048
0.1579
0.2164
0.4245
-0.0642
-0.4009*
0.2571
0.2228*
0.0119* 0.00711*
*
-0.0809
0.4238**
-0.2516
0.4215*

An Evaluation Of The Indoor Air
Pollution And Respiratory Health Of
Farmers in Anhui Province, China
Cooperated with Harvard University of USA and World Bank


 more and more people living in urban areas of China spend the greater part of their time indoors, where concentrations of many air pollutants are higher than outdoors, and the health effects maybe the same as that in the urban areas.
But similar studies in China have scarcely counted indoor air pollution in rural areas and their adverse health effects.




Now, more than 70 percent of China ’ s populations also live in rural areas and some of them have quite poor living conditions, where respiratory diseases are also the leading cause of death.
Nowadays the research on health effects of indoor air pollution in developing countries has been hindered by lack of detailed data about human exposure and adverse outcomes. The basic study should be conducted first.
In the present study we measured the level of indoor air pollution and examined primarily the related health effects (respiratory symptoms) in rural areas of southeast China.




Participants
The study field covered more than 30 small towns of 4 counties, consisting of lake, plain, hill and mountain areas in Anhui province of China. 189 households (62 from the lake area, 74 from the plains and 53 from the mountain area) were selected randomly to represent various geographic and socioeconomic background of this area.
They had similar tribal backgrounds, living habits, and diet.
At the same time, about 500 individuals aged from 15 – 65 yr. from the study households were interviewed by questionnaire for their respiratory health conditions.





Exposure
We did the research in the winter of 1999. The level of sulphur dioxide (SO smaller than 10 μ
), particulate matter m in diameter （ PM
10
） and carbon monoxide (CO) indoors were selected as the index of indoor air pollution for the study.
We monitored the level of these pollutants in the bedrooms, kitchens, courtyards and the farmlands of the study households in real-time measure, twice a day for two weeks.
We also interviewed household members about household energy use technology and their timeactivity patterns with questionnaire by face-to-face interview.

Sex
Mean (SD) Age
Education (years)
Smokers
Male
246
35.67

13.70
6.73

3.4
134
Female
221
36.58

12.84
2.71

3.8
11
Total
467
36.12

12.62
5.06

4.4
145

10
2

Kitchen Bedroom Yard Farmland
N 373 504 366 55
PM
10
(
 g/m 3 ) 518

27* 340

9
SO
2
(
 g/m 3 )
287

9 270

10
12.4

36 10.9

18 11.0

19 10.8

18
CO (mg/m 3 ) 2.0

9.9
1.62

6.0
1.62

4.5
2.0

4.5#
*(t-test, P<0.01, kitchen/bedroom) ； # （ t-test, P<0.01
， farmland/yard ）

Cooking Non-cooking P ( T -test)
N
PM
10
(
 g/m 3 )
SO
2
(
 g/m 3 )
CO (mg/m 3 )
123
1251

39.2
13.9

49.4
3.0

2.1
228
332

10
11.8

33
1.62

5.5
-
<0.001
0.26
<0.001

（
）
N
Bedroom (
 s.d)
Kitchen (
 s.d)
Yard (
 s.d)
Farmland (
 s.d)
Others (
 s.d)
Male
245
9.59

4.09
1.36

2.15
2.44

2.51
0.84

2.66
8.87

6.12
Female
222
10.56

3.59
3.78

2.48
2.69

2.16
0.62

1.49
5.07

6.06
t-test
2.72
11.2
1.15
1.10
6.71
-
P
<0.01
<0.01
0.25
0.27
<0.01

Table.5 the factors associated with asthma, cough and phlegm (Logistic model)
Symptoms
Asthma attack
Variables OR 95% CI P
Using the pesticides often 1.13
0.98
～
1.03
Warming with the charcoal stove
2.85
1.61
～ 5.03
0.06
<0.00
1
Phlegm
Cough
(N ＝ 467)
Using the pesticides often 1.19
1.04
～ 1.37
Room cleaning often 0.41
0.19
～
0.87
0.01
0.02

Table.6 Regression coefficient ( × 1000) of exposure indices to PM and the lung functions
10
Place
Bedroom
Kitchen
Yard
Farmland
FVC (n=324)

SE
-11

6
-4

6
-37

42
FEV1 (n=325)

SE
-25

7
**
-2

7
11

27
-38

48
FEV1% (n=324)

SE
-6

1
**
-0.5

1
-2

6
-3

8
FVC: forced vital capacity; FEV1: forced expiratory volume in first second **: (P<0.01 )
FEV1%: percentage of forced expiratory volume in first second to forced vital capacity



There is quite serious indoor air pollution in the households of the rural areas of China, about 1/3 of them > 450 μ g/m 3 of PM
10
.
Exposure indices to PM
10 in bedrooms were negatively associated with the level of lung functions of study subjects(P<0.01).

The one cause of the indoor air pollution in the rural areas comes from the fuel combustion when cooking in kitchen as well as heating in winter.

Cooperated with China Agriculture University in
Beijing


The questionnaire and indoor air monitoring were carried out at the same period from May 18 to June 9, 2004, in 3 villages, Shuanglong,
Zhaoban, Sifangzui, in north Sichuan Province.

Twenty-four-hour averaged PM2.5 concentrations were obtained by using 1.5-literper-minute SKC universal sample pumps. 150 families were random selected to monitor the concentration of PM2.5 of kitchen in 5 counties of 3 Province (Sichuan, Hunan, Hubei)

Pollutants Instruments Monitoring time
Sampling time
CO
HOBO CO
SO
2
XH-3050
Infrared CO
Analyzer
HOBO CO logger
QC-1 air sampling instrument
9:00, 12:00,
15:00, 18:00
9:00 to next day’s 9:00
9:00, 12:00,
15:00. 18:00
――
24 hours
20 min

The pollution level of SO2 and CO in 3 villages
Pollutants Villages
Average concentration
Samples
No.
Median
(mg/m 3 )
Average
(mg/m 3 )
Maximum
(mg/m 3 )
SO
CO
2
Shuanglong
Zhaoban
Sifangzui
Shuanglong
Zhaoban
Sifangzui
30
30
30
30
30
30
0.318
0.129
1.872
5.687
4.938
2.666
0.284
2.996
8.896
9.413
12.063
17.859
21.839
4.133
16.309
101.875
129.875
128.5

Indoor air PM2.5 Level in Rural Areas of
Sichuan Province in China (2004.5)
County N
PM
2.5 concentration
(ug/m 3 )
Temp. Humid.
℃ % air P.
(Kpa)
Langzhong 30 221.7
± 137.9
Yilong 30 123 ± 68.6
Nanbu
Enshi
30 212.7
± 163.2
30 192 ± 180.3
Yongshun 30 186.4
± 168.4
24.3
71% 96.5
23.1
79% 96.6
24.8
68% 97.7
24.5
77% 95.5
24.3
85% 95.2

Daily energy consumption in three villages

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Health effects of indoor air pollution should be considered as a factor in evaluation of environmental cost model.
Exposure-response relations: the population study on health effects of indoor air pollution remains in primary stage now and there is few on quantitative evaluation for it in China. the pollutants and microenvironment indoors are very complicated, so the health effects should be the integrated results caused by both pollutants and microclimates.