While the existing evidence affirms beneficial impacts of greenspace on health, much remains to be learned about the specific pathways and functional form of such relationships, and how these may vary by context, population groups and health outcomes. This Report provides guidance for further epidemiological research with the goal of creating new evidence upon which to develop policy recommendations.

Modifiable risk factors for cardiovascular disease and mortality (26•3% of the PAF), although the single largest risk factor was a low education level (12.5% of the PAF). Ambient air pollution was associated with 13•9% of the PAF for CVD (although different statistical methods were used for this analysis). In MIC and LIC, the importance of household air pollution, poor diet, low education, and low grip strength were larger compared with HIC.Interpretation: The majority of CVD cases and deaths can be attributed to a small number of common, modifiable risk factors. While some factors have extensive global impacts (e.g. hypertension, education), others (e.g. household air pollution, poor diet) vary by a country's economic level. Health policies should focus on risk factors that have the greatest effects on averting CVD and death globally, with additional emphasis on risk factors of greatest importance in specific groups of countries.Funding: See acknowledgements.

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BackgroundFew studies examining the associations between long-term exposure to ambient air pollution and mortality have considered multiple pollutants when assessing changes in exposure due to residential mobility during follow-up.ObjectiveWe investigated associations between cause-specific mortality and ambient concentrations of fine particulate matter (≤ 2.5 μm; PM2.5), ozone (O3), and nitrogen dioxide (NO2) in a national cohort of about 2.5 million Canadians.MethodsWe assigned estimates of annual concentrations of these pollutants to the residential postal codes of subjects for each year during 16 years of follow-up. Historical tax data allowed us to track subjects’ residential postal code annually. We estimated hazard ratios (HRs) for each pollutant separately and adjusted for the other pollutants. We also estimated the product of the three HRs as a measure of the cumulative association with mortality for several causes of death for an increment of the mean minus the 5th percentile of each pollutant: 5.0 μg/m3 for PM2.5, 9.5 ppb for O3, and 8.1 ppb for NO2.ResultsPM2.5, O3, and NO2 were associated with nonaccidental and cause-specific mortality in single-pollutant models. Exposure to PM2.5 alone was not sufficient to fully characterize the toxicity of the atmospheric mix or to fully explain the risk of mortality associated with exposure to ambient pollution. Assuming additive associations, the estimated HR for nonaccidental mortality corresponding to a change in exposure from the mean to the 5th percentile for all three pollutants together was 1.075 (95% CI: 1.067, 1.084). Accounting for residential mobility had only a limited impact on the association between mortality and PM2.5 and O3, but increased associations with NO2.ConclusionsIn this large, national-level cohort, we found positive associations between several common causes of death and exposure to PM2.5, O3, and NO2.CitationCrouse DL, Peters PA, Hystad P, Brook JR, van Donkelaar A, Martin RV, Villeneuve PJ, Jerrett M, Goldberg MS, Pope CA III, Brauer M, Brook RD, Robichaud A, Menard R, Burnett RT. 2015. Ambient PM2.5, O3, and NO2 exposures and associations with mortality over 16 years of follow-up in the Canadian Census Health and Environment Cohort (CanCHEC). Environ Health Perspect 123:1180–1186; http://dx.doi.org/10.1289/ehp.1409276

Background Paediatric asthma incidence is associated with exposure to traffic-related air pollution (TRAP), but the TRAP-attributable burden remains poorly quantified. Nitrogen dioxide (NO 2 ) is a major component and common proxy of TRAP. In this study, we estimated the annual global number of new paediatric asthma cases attributable to NO 2 exposure at a resolution sufficient to resolve intra-urban exposure gradients. MethodsWe obtained 2015 country-specific and age-group-specific asthma incidence rates from the Institute for Health Metrics and Evaluation for 194 countries and 2015 population counts at a spatial resolution of 250 × 250 m from the Global Human Settlement population grid. We used 2010-12 annual average surface NO 2 concentrations derived from land-use regression at a resolution of 100 × 100 m, and we derived concentration-response functions from relative risk estimates reported in a multinational meta-analysis. We then estimated the NO 2 -attributable burden of asthma incidence in children aged 1-18 years in 194 countries and 125 major cities at a resolution of 250 × 250 m.Findings Globally, we estimated that 4•0 million (95% uncertainty interval [UI] 1•8-5•2) new paediatric asthma cases could be attributable to NO₂ pollution annually; 64% of these occur in urban centres. This burden accounts for 13% (6-16) of global incidence. Regionally, the greatest burdens of new asthma cases associated with NO 2 exposure per 100 children were estimated for Andean Latin America (340 cases per year, 95% UI 150-440), high-income North America (310, 140-400), and high-income Asia Pacific (300, 140-370). Within cities, the greatest burdens of new asthma cases associated with NO 2 exposure per 100 000 children were estimated for Lima, Peru (690 cases per year, 95% UI 330-870); Shanghai, China (650, 340-770); and Bogota, Colombia (580, 270-730). Among 125 major cities, the percentage of new asthma cases attributable to NO 2 pollution ranged from 5•6% (95% UI 2•4-7•4) in Orlu, Nigeria, to 48% (25-57) in Shanghai, China. This contribution exceeded 20% of new asthma cases in 92 cities. We estimated that about 92% of paediatric asthma incidence attributable to NO 2 exposure occurred in areas with annual average NO 2 concentrations lower than the WHO guideline of 21 parts per billion.Interpretation Efforts to reduce NO 2 exposure could help prevent a substantial portion of new paediatric asthma cases in both developed and developing countries, and especially in urban areas. Traffic emissions should be a target for exposure-mitigation strategies. The adequacy of the WHO guideline for ambient NO 2 concentrations might need to be revisited.Funding George Washington University.