Death-by-Air in Beijing Shows China’s Heart Risk From Worsening Pollution
Lungs weren’t the problem, says Ding Rongjing, the hospital’s deputy head of cardiology. Five people were admitted for heart attacks from Dec. 4 to 6, compared with one or two a week typically. One 60-year-old male patient died.
The illnesses are an unwanted consequence of the economic growth that helped spur a 32 percent jump in China’s car sales last year. Outdoor air pollution kills 1.3 million people globally each year, the World Health Organization estimates. A growing body of evidence shows dirty air not only triggers asthma and other respiratory conditions, over time it may the damage heart and blood vessels, and even cause birth defects.
“Whenever we have days with bad pollution, we get significantly more patients with symptoms like high blood pressure, feeling of suffocation, and chest pains,” Ding said in an interview at the hospital, where she’s worked since 1996. On days of extreme pollution, heart and stroke cases at the 1,450-bed center can increase as much as 40 percent to 280 patients, she said.
Before hosting the 2008 Olympics, Beijing imposed driving limits, suspended work at construction sites and moved factories out of the city to clean up the capital’s air. Economic growth, averaging 10 percent a year, and a population of 19.6 million people expanding at a 3.8 percent clip is making air-quality improvements harder to sustain.
Starve the Heart
Microscopic air particles 30 times smaller than the width of a human hair penetrate deep in the lungs, where they can pass into the bloodstream, said Jon Ayres, professor of environmental and respiratory medicine at the University of Birmingham, in a telephone interview. The contaminants increase the risk of artery-blocking clots that can starve the heart, brain and other organs of oxygen, according to Ayres.
“In somebody with coronary artery disease where the arteries are narrower anyway, having blood that is more likely to clot is a bad thing,” said Ayres, who chairs a U.K. panel on the medical effects of air pollutants.
The danger is increased when the inhaled substances cause the coronary arteries to become inflamed, he said. Cardiovascular disease is the biggest killer in China, accounting for 38 percent of deaths, the WHO says.
Constant traffic jams and resultant idling engines emit lung-penetrating toxic material, said Pan Xiaochuan, a professor of environmental health at Peking University who studies the impact of air pollution.
The U.S. embassy in Beijing monitors pollutants smaller than 2.5 micrometers in diameter, known as PM2.5, and releases the information via Twitter.
“What is needed is better traffic management,” Pan said. “People still drive even if the traffic is bad, and it’s hard to convince them to take public transport after they spent so much money to buy their own cars.”
There were 4.81 million vehicles on Beijing roads last year, triple the number in 2000, government data show. Car ownership in China is offsetting the benefits of the past decade’s efforts to limit industrial emissions, said Xu Dongqun, deputy director of the Institute for Environmental Health and Related Product Safety at the Chinese Center for Disease Control and Prevention.
“The level of fine particulate matter is still increasing because it comes not just from industrial emission and coal- burning, but also from the large amount of cars on the roads,” Xu said on Dec. 5 from a second-floor meeting room in central Beijing, where murky haze outside rendered the housing blocks across the street barely visible. “This is why we see the level of PM2.5 worsening in cities.”
Emissions data on PM2.5 are slated to be made publicly available throughout China’s cities, including Beijing, by 2016. The timeframe is too slow, according to a Dec. 8 editorial in the state-owned China Daily newspaper, which called on the government to be “brave enough” to measure the tiny contaminants.
The government currently uses an indicator known as PM10 that measures particulate as big as 10 micrometers in diameter for its public pollution data.
Air quality in all of the 32 Chinese cities that track pollution fall short of WHO guidelines. The air in Beijing is the fifth-worst in China, based on the PM10 measure. Annual levels average 121 micrograms per cubic meter of air, compared with a global average of 71 micrograms and the 20 micrograms recommended by the Geneva-based agency.
Each 10-microgram increase above WHO guidelines for PM2.5 boosts emergency room visits for cardiovascular ailments by as much as 7 percent, a 2009 study by the Peking University School of Public Health found.
Breathing dirty air does have an impact on mortality, researchers found in a 12-year study in June involving 12,584 residents of the northeastern city of Shenyang. After adjusting for smoking and other known risk factors, the authors found levels of PM10 and the air pollutant nitrogen oxide “were significantly associated” with death from cardiovascular and cerebrovascular diseases, they said.
Information on air quality in Beijing is provided by multiple sources, including the U.S. embassy, and daily measurements are often inconsistent. That makes it harder for residents to know how and when they should take extra precautions, says cardiologist Ding.
The Chinese CDC would like to see coordinated warning data broadcast on the nightly news, the center’s Xu said. Publicizing the data may have implications for businesses if it means more people are worried about air quality and are reluctant to live in the city.
“That’s one of the major factors that has an impact on standard of living in Beijing,” said Lee Quane, the Hong Kong- based regional director for Asia at ECA International. Executives relocating from abroad will typically opt for Hong Kong over Beijing if they have choice, he said.
“Beijing has historically had the worst air pollution out of the 20 mainland Chinese cities that we look at,” he said. “Many of these senior executives are married and have children, who are much more affected by air pollution, so they need greater financial incentives to come.”
ECA recommends companies offer an extra 15-to-25 percent of base salary to top-level executives relocating to Beijing, compared with 10-20 percent for Shanghai.
“We definitely worry about young kids and elderly people with lung and heart diseases,” said Richard Saint Cyr, a doctor at the Beijing United Family Hospital. “Most people think it’s just lungs. But if you’re already on the edge with heart disease, and you’re out playing golf when the air pollution is really bad, it is a very high risk for having a heart attack.”
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