Ambient air pollution and lung disease in China: health effects, study design approaches and future research

Ambient air pollution in China has worsened following dramatic increases in industrialization, automobile use and energy consumption. Particularly bothersome is the increase in the PM2.5 fraction of pollutants. This fraction has been associated with increasing rates of cardio-respiratory disease in China and elsewhere. Ambient pollutant levels have been described in many of China's cities and are comparable to previous levels in southern California. Lung cancer mortality in China has increased since the 1970s and has been higher in men and in urban areas, the exact explanation for which has not been determined. The estimation of individual risk for Chinese citizens living in areas of air pollution will require further research. Occupational cohort and case-control designs each have unique attributes that could make them helpful to use in this setting. Other important future research considerations include detailed exposure assessment and the possible use of biomarkers as a means to better understand and manage the threat posed by air pollution in China.