Air pollution and childhood respiratory consultations in primary care: a systematic review

BACKGROUND

Outdoor air pollution is a known risk factor for respiratory morbidity worldwide. Compared with the adult population, there are fewer studies that analyse the association between short-term exposure to air pollution and respiratory morbidity in children in primary care.

OBJECTIVE

To evaluate whether children in a primary care setting exposed to outdoor air pollutants during short-term intervals are at increased risk of respiratory diagnoses.

METHODS

A search in Medline, the Cochrane Library, Web of Science and Embase databases throughout March 2023. Percentage change or risk ratios with corresponding 95% CI for the association between air pollutants and respiratory diseases were retrieved from individual studies. Risk of bias assessment was conducted with the Newcastle-Ottawa Scale (NOS) for cohort or case-control studies and an adjusted NOS for time series studies.

RESULTS

From 1366 studies, 14 were identified as meeting the inclusion criteria. Most studies had intermediate or high quality. A meta-analysis was not conducted due to heterogeneity in exposure and health outcome. Overall, studies on short-term exposure to air pollutants (carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2) and particulate matter ≤10 µm (PM10)) were associated with increased childhood respiratory consultations in primary care. In general, exposure to ozone was associated with a reduction in respiratory consultations.

CONCLUSIONS

The evidence suggests CO, SO2, NO2, PM10 and PM2.5 are risk factors for respiratory diseases in children in primary care in the short term. However, given the heterogeneity of the studies, interpretation of these findings must be done with caution.

PROSPERO REGISTRATION NUMBER

CRD42022259279.

Lifetime losses due to cardiovascular and respiratory diseases attributable to air pollution in polluted and unpolluted areas

The article assesses differences in lifetime losses caused by premature deaths from cardiopulmonary disease in populations living in areas with different environmental burdens. The results provide different perspectives on data on total years lost and lifetime losses attributable to air pollution. Such lifetime losses in the industrial area related to cardiovascular causes of death are 7.6 or 5.1 years per male or female deceased, representing an average lifetime loss of 0.01907 years (i.e. 7 days) per 1 male or 0.01273 years (i.e. 4.6 days) per 1 female in the entire population. Losses related to cerebrovascular or respiratory causes of death are about 5.4 or 5.9 years per 1 deceased male or 3.9 or 5 years per 1 deceased female, respectively, which represents a loss of 0.00481 (1.8 days), or 0.00148 years (0.5 days) per 1 male or 0.00466 (1.7 days), or 0.00058 years (0.2 days) per 1 female.

The impact of environmental conditions on non-communicable diseases in sub-Saharan Africa: A scoping review of epidemiologic evidence

Background

The burden of non-communicable diseases (NCDs) in sub-Saharan Africa (SSA) is increasing. Environmental conditions such as heavy metals and air pollution have been linked with the incidence and mortality of chronic diseases such as cancer, as well as cardiovascular and respiratory diseases. We aimed to scope the current state of evidence on the impact of environmental conditions on NCDs in SSA.

Methods

We conducted a scoping review to identify environmental conditions linked with NCDs in SSA by identifying studies published from January 1986 through February 2023. We searched African Index Medicus, Ovid Medline, Scopus, Web of Science, and Greenfile. Using the PICOS study selection criteria, we identified studies conducted in SSA focussed on physical environmental exposures and incidence, prevalence, and mortality of NCDs. We included only epidemiologic or quantitative studies.

Results

We identified 6754 articles from electronic database searches; only 36 met our inclusion criteria and were qualitatively synthesised. Two studies were conducted in multiple SSA countries, while 34 were conducted across ten countries in SSA. Air pollution (58.3%) was the most common type of environmental exposure reported, followed by exposure to dust (19.4%), meteorological variables (13.8%), heavy metals (2.7%), soil radioactivity (2.7%), and neighbourhood greenness (2.7%). The examined NCDs included respiratory diseases (69.4%), cancer (2.7%), stroke (5.5%), diabetes (2.7%), and two or more chronic diseases (19.4%). The study results suggest an association between environmental exposures and NCDs, particularly for respiratory diseases. Only seven studies found a null association between environmental conditions and chronic diseases.

Conclusions

There is a growing body of research on environmental conditions and chronic diseases in the SSA region. Although some cities in SSA have started implementing environmental monitoring and control measures, there remain high levels of environmental pollution. Investment can focus on improving environmental control measures and disease surveillance.

Case-crossover study for the association between increased hospital admissions for respiratory diseases and the increase in atmospheric PM2.5 and PM2.5-bound trace elements in Pretoria, South Africa

Outdoor PM2.5 was sampled in Pretoria, 18 April 2017 to 28 February 2020. A case-crossover epidemiology study was associated for increased PM2.5 and trace elements with increased hospital admissions for respiratory disorders (J00-J99). The results included a significant increase in hospital admissions, with total PM2.5 of 2.7% (95% CI: 0.6, 4.9) per 10 µg·m-3 increase. For the trace elements, Ca of 4.0% (95% CI: 1.4%-6.8%), Cl of 0.7% (95% CI: 0.0%-1.4%), Fe of 3.3% (95% CI: 0.5%-6.1%), K of 1.8% (95% CI: 0.2-3.5) and Si of 1.3% (95% CI: 0.1%-2.5%). When controlling for PM2.5, only Ca of 3.2% (95% CI: 0.3, 6.1) and within the 0-14 age group by 5.2% (95% CI: 1.5, 9.1). Controlling for a co-pollutant that is highly correlated with PM2.5 does reduce overestimation, but further studies should include deposition rates and parallel sampling analysis.

Characterization of risks and pathogenesis of respiratory diseases caused by rural atmospheric PM2.5

Forty-six percent of the world's population resides in rural areas, the majority of whom belong to vulnerable groups. They mainly use cheap solid fuels for cooking and heating, which release a large amount of PM2.5 and cause adverse effects to human health. PM2.5 exhibits urban-rural differences in its health risk to the respiratory system. However, the majority of research on this issue has focused on respiratory diseases induced by atmospheric PM2.5 in urban areas, while rural areas have been ignored for a long time, especially the pathogenesis of respiratory diseases. This is not helpful for promoting environmental equity to aid vulnerable groups under PM2.5 pollution. Thus, this study focuses on rural atmospheric PM2.5 in terms of its chemical components, toxicological effects, respiratory disease types, and pathogenesis, represented by PM2.5 from rural areas in the Sichuan Basin, China (Rural SC-PM2.5). In this study, organic carbon is the most significant component of Rural SC-PM2.5. Rural SC-PM2.5 significantly induces cytotoxicity, oxidative stress, and inflammatory response. Based on multiomics, bioinformatics, and molecular biology, Rural SC-PM2.5 inhibits ribonucleotide reductase regulatory subunit M2 (RRM2) to disrupt the cell cycle, impede DNA replication, and ultimately inhibit lung cell proliferation. Furthermore, this study supplements and supports the epidemic investigation. Through an analysis of the transcriptome and human disease database, it is found that Rural SC-PM2.5 may mainly involve pulmonary hypertension, sarcoidosis, and interstitial lung diseases; in particular, congenital diseases may be ignored by epidemiological surveys in rural areas, including tracheoesophageal fistula, submucous cleft of the hard palate, and congenital hypoplasia of the lung. This study contributes to a greater scientific understanding of the health risks posed by rural PM2.5, elucidates the pathogenesis of respiratory diseases, clarifies the types of respiratory diseases, and promotes environmental equity.

Associations between fine particulate air pollution with small-airway inflammation: A nationwide analysis in 122 Chinese cities

Alveolar nitric oxide is a non-invasive indicator of small-airway inflammation, a key pathophysiologic mechanism underlying lower respiratory diseases. However, no epidemiological studies have investigated the impact of fine particulate matter (PM2.5) exposure on the concentration of alveolar nitric oxide (CANO). To explore the associations between PM2.5 exposure in multiple periods and CANO, we conducted a nationwide cross-sectional study in 122 Chinese cities between 2019 and 2021. Utilizing a satellite-based model with a spatial resolution of 1 × 1 km, we matched long-term, mid-term, and short-term PM2.5 exposure for 28,399 individuals based on their home addresses. Multivariable linear regression models were applied to estimate the associations between PM2.5 at multiple exposure windows and CANO. Stratified analyses were also performed to identify potentially vulnerable subgroups. We found that per interquartile range (IQR) unit higher in 1-year average, 1-month average, and 7-day average PM2.5 concentration was significantly associated with increments of 17.78% [95% confidence interval (95%CI): 12.54%, 23.26%], 8.76% (95%CI: 7.35%, 10.19%), and 4.00% (95%CI: 2.81%, 5.20%) increment in CANO, respectively. The exposure-response relationship curves consistently increased with the slope becoming statistically significant beyond 20 μg/m3. Males, children, smokers, individuals with respiratory symptoms or using inhaled corticosteroids, and those living in Southern China were more vulnerable to PM2.5 exposure. In conclusion, our study provided novel evidence that PM2.5 exposure in long-term, mid-term, and short-term periods could significantly elevate small-airway inflammation represented by CANO. Our results highlight the significance of CANO measurement as a non-invasive tool for early screening in the management of PM2.5-related inflammatory respiratory diseases.

Associations between long-term ozone exposure and small airways function in Chinese young adults: a longitudinal cohort study

BACKGROUND

Increasing evidence is appearing that ozone has adverse effects on health. However, the association between long-term ozone exposure and lung function is still inconclusive.

OBJECTIVES

To investigate the associations between long-term exposure to ozone and lung function in Chinese young adults.

METHODS

We conducted a prospective cohort study among 1594 college students with a mean age of 19.2 years at baseline in Shandong, China from September 2020 to September 2021. Lung function indicators were measured in September 2020 and September 2021, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow at the 25th, 50th, and 75th percentile of the FVC (FEF25, FEF50, and FEF75) and mean flow rate between 25% and 75% of the FVC (FEF25-75) were measured. Daily 10 km×10 km ozone concentrations come from a well-validated data-fusion approach. The time-weighted average concentrations in 12 months before the lung function test were defined as the long-term ozone exposure. The associations between long-term ozone exposure and lung function indicators in Chinese young adults were investigated using a linear mixed effects model, followed by stratified analyses regarding sex, BMI and history of respiratory diseases.

RESULTS

Each interquartile range (IQR) (8.9 µg/m3) increase in long-term ozone exposure were associated with a -204.3 (95% confidence interval (CI): -361.6, -47.0) ml/s, -146.3 (95% CI: -264.1, -28.4) ml/s, and - 132.8 (95% CI: -239.2, -26.4) ml/s change in FEF25, FEF50, and FEF25-75, respectively. Stronger adverse associations were found in female participants or those with BMI ≥ 24 kg/m2 and history of respiratory diseases.

CONCLUSION

Long-term exposure to ambient ozone is associated with impaired small airway indicators in Chinese young adults. Females, participants with BMI ≥ 24 kg/m2 and a history of respiratory disease have stronger associations.

[Respiratory changes in children exposed to dust from mining waste in Brumadinho, Minas Gerais State, Brazil: Bruminha Project]

This study aimed to investigate the occurrence of respiratory diseases in children exposed to dust from mining waste after the Brumadinho dam disaster, Minas Gerais State, Brazil. The study population included children aged 0-6 years, living in three communities exposed to mining waste dust (Córrego do Feijão, Parque da Cachoeira, and Tejuco) and one unexposed community (Aranha). Data were collected from July 19 to 30, 2021, using questionnaires that addressed sociodemographic information and a recall survey on signs, symptoms, and respiratory diseases. A total of 217 children were evaluated, 119 living in the exposed communities and 98 in the non-exposed community. The residents in the exposed communities reported an increase in the frequency of home cleaning (p = 0.04) and in vehicular traffic (p = 0.03). Among children aged four, a higher frequency of upper (p = 0.01) and lower (p = 0.01) airway disorders, as well as respiratory allergy (p = 0.05) was observed. The exposed group had 1.5 times more reports of respiratory allergy (75%; p = 0.02) compared to the non-exposed group (50.5%). Children living in communities exposed to waste dust were three times more likely (adjusted OR = 3.63; 95%CI: 1.37; 9.57) to have respiratory allergies than those not exposed. Two years and six months after the environmental disaster occurred, children living in the communities affected by waste from mining and remediation activities remained exposed to dust with harmful effects on respiratory health.

Hospitalisations and fatality due to respiratory diseases according to a national database in Brazil: a longitudinal study

BACKGROUND

Respiratory diseases (RDs) cause millions of hospitalisations and deaths worldwide, resulting in economic and social impacts. Strategies for health promotion and disease prevention based on the epidemiological profile of the population may reduce hospital costs.

AIM

To characterise hospitalisations and deaths due to RDs in Brazilian adults above 20 years old between 2008 and 2021.

METHODS

This ecological study used secondary data of hospitalisations and deaths due to RDs from the Hospital Information System of the Brazilian Unified Health System between 2008 and 2021. Data were grouped according to region, age group and sex. The period was divided into first (2008-2011), second (2012-2015) and third (2016-2019) quadrennia and one biennium (2020-2021), and all data were analysed using the GraphPad Prism; statistical significance was set at p<0.05.

RESULTS

A total of 9 502 378 hospitalisations due to RDs were registered between 2008 and 2021. The south and southeast regions presented the highest hospitalisation and fatality rate, respectively, in the age group ≥80 years with no significant differences between sexes. Also, RDs caused 1 170 504 deaths, with a national fatality rate of 12.32%.

CONCLUSION

RDs affected the Brazilian population and impaired the health system, especially the hospital environment. The south/southeast regions were the most affected, and the ageing process contributed to the increased incidence of RDs.

From "Immunity Debt" to "Immunity Theft"-How COVID-19 Might Be Tied to Recent Respiratory Disease Surges

This Medical News story discusses the relationship between the COVID-19 pandemic and recent increases in other respiratory diseases.

Comparison and interobserver reliability between a visual analog scale and the Wisconsin Calf Health Scoring Chart for detection of respiratory disease in dairy calves

Respiratory disease is an ongoing challenge for calves in the dairy sector with a relatively high prevalence and impact on welfare and economics. Applying scoring protocols for detecting respiratory disease requires that they are easily implemented, consistent between observers and fast to use in daily management. This study was conducted in one Danish dairy farm from September 2020 through January 2021. The study included 126 heifer calves enrolled in the age of 17 to 24 d. All calves were observed every second day for a period of 46 d. At each visit all calves were scored with a new visual analog scale (VAS) and the Wisconsin Calf Health Scoring Chart (WCHSC). We calculated agreement between the 2 scoring systems based on conditional probability to score higher or lower than a cutoff in the VAS compared with a specified cutoff in WCHSC used as reference test. A generalized mixed effects regression model was developed to estimate the prevalence of respiratory disease and the overall agreement between the 2 scoring systems. The overall agreement between the VAS and WCHSC was 89.6%. The second part of the study assessed interobserver reliability between 2 experienced observers and between an experienced observer and veterinary students. The interobserver reliability was calculated by intraclass correlation coefficient and was 0.58 between experienced observers and was 0.34 between an experienced observer and veterinary students indicating a moderate to poor reliability between the observers. It was possible to use VAS as an alternative clinical scoring method, which primarily focuses on the general condition of the individual calf rather than specific categories of clinical signs. Our study set up lacked a comparison to other diagnostic tools i.e., thoracic ultrasound to confirm the findings which should be considered in future studies when exploring VAS as a screening tool for detection of respiratory disease in dairy calves.

Short-term exposure to extreme temperature and outpatient visits for respiratory diseases among children in the northern city of China: a time-series study

BACKGROUND

Although studies have indicated that extreme temperature is strongly associated with respiratory diseases, there is a dearth of studies focused on children, especially in China. We aimed to explore the association between extreme temperature and children's outpatient visits for respiratory diseases and seasonal modification effects in Harbin, China.

METHODS

A distributed lag nonlinear model (DLNM) was used to explore the effect of extreme temperature on daily outpatient visits for respiratory diseases among children, as well as lag effects and seasonal modification effects.

RESULTS

Extremely low temperatures were defined as the 1st percentile and 2.5th percentile of temperature. Extremely high temperatures were defined as the 97.5th percentile and 99th percentile of temperature. At extremely high temperatures, both 26 °C (97.5th) and 27 °C (99th) showed adverse effects at lag 0-6 days, with relative risks (RRs) of 1.34 [95% confidence interval (CI): 1.21-1.48] and 1.38 (95% CI: 1.24-1.53), respectively. However, at extremely low temperatures, both - 26 °C (1st) and - 23 °C (2.5th) showed protective effects on children's outpatient visits for respiratory diseases at lag 0-10 days, with RRs of 0.86 (95% CI: 0.76-0.97) and 0.85 (95% CI: 0.75-0.95), respectively. We also found seasonal modification effects, with the association being stronger in the warm season than in the cold season at extremely high temperatures.

CONCLUSIONS

Our study indicated that extremely hot temperatures increase the risk of children's outpatient visits for respiratory diseases. Efforts to reduce the exposure of children to extremely high temperatures could potentially alleviate the burden of pediatric respiratory diseases, especially during the warm season.

Air pollution and oxidative stress in adults suffering from airway diseases. Insights from the Gene Environment Interactions in Respiratory Diseases (GEIRD) multi-case control study

Air pollution is a leading risk factor for global mortality and morbidity. Oxidative stress is a key mechanism underlying air-pollution-mediated health effects, especially in the pathogenesis/exacerbation of airway impairments. However, evidence lacks on subgroups at higher risk of developing more severe outcomes in response to air pollution. This multi-centre study aims to evaluate the association between air pollution and oxidative stress in healthy adults and in patients affected by airway diseases from the Italian GEIRD (Gene Environment Interactions in Respiratory Diseases) multi-case control study. Overall, 1841 adults (49 % females, 20-83 years) were included from four Italian centres: Pavia, Sassari, Turin, and Verona. Following a 2-stage screening process, we identified 1273 cases of asthma, chronic bronchitis, rhinitis, or COPD and 568 controls. Systemic oxidative stress was quantified by urinary 8-isoprostane and 8-OH-dG. Individual residential exposures to NO2, PM10, PM2.5, and O3 were derived using an innovative five-stage machine-learning-based approach. Linear mixed regression models tested the association between oxidative stress biomarkers and air pollution tertiles, adjusting by age, sex, BMI, smoking, education and season, with recruiting centres as random intercept. Only cases exhibited higher levels of log-transformed 8-isoprostane and 8-OH-dG in association with NO2 (β: 0.30 95 % CI: 0.08-0.52 and 0.20 95 % CI: 0.03-0.37), PM10 (0.34 95 % CI: 0.12-0.55 and 0.21 95 % CI: 0.05-0.37) and PM2.5 (0.27 95 % CI: 0.09-0.49 and 0.18 95 % CI: 0.02-0.34) as compared to the first tertile of exposure. No significant associations were observed for summer O3. Our findings suggest that exposure to air pollution may increase systemic oxidative stress levels in people suffering from airway diseases. This introduces a potential novel approach available for future epidemiological studies and Public Health for effective prevention strategies oriented at the quantification of early biological effects in susceptible people, whose additional risk level might be currently underrated. Air-pollution-mediated exacerbations, driven by oxidative stress, still deserve our attention.

Effect of ambient air pollution on hospital admission for respiratory diseases in Hanoi children during 2007-2019

Air pollution poses a threat to children's respiratory health. This study aims to quantify the association between short-term air pollution exposure and respiratory hospital admissions among children in Hanoi, Vietnam, and estimate the population-attributable burden using local data. A case-crossover analysis was conducted based on the individual records where each case is their own control. The health data was obtained from 13 hospitals in Hanoi and air pollution data was collected from four monitoring stations from 2007 to 2019. We used conditional logistic regression to estimate Percentage Change (PC) and 95% Confidence Interval (CI) in odd of hospital admissions per 10 μg/m3 increase in daily average particulate matter (e.g. PM1, PM2.5, PM10), Sulfur Dioxide (SO2), Nitrogen Dioxide (NO2), 8-h maximum Ozone and per 1000 μg/m3 increase in daily mean of Carbon Monoxide (CO). We also calculated the number and fraction of admissions attributed to air pollution in Hanoi by using the coefficient at lag 0. A 10 μg/m3 increase in the concentration of PM10, PM2.5, PM1, SO2, NO2, O3 8-h maximum and 1000 μg/m3 increase in CO concentration was associated with 0.6%, 1.2%, 1.4%, 0.8%, 1.6%, 0.3%, and 1.7% increase in odd of admission for all respiratory diseases among children under 16 years at lag 0-2. All PM metrics and NO2 are associated with childhood admission for pneumonia and bronchitis. Admissions due to asthma and upper respiratory diseases are related to increments in NO2 and CO. For attributable cases, PM2.5 concentrations in Hanoi exceeding the World Health Organization Air Quality Guidelines accounted for 1619 respiratory hospital admissions in Hanoi children in 2019. Our findings show that air pollution has a detrimental impact on the respiratory health of Hanoi children and there will be important health benefits from improved air quality management planning to reduce air pollution in Vietnam.

Associations between ultrafine particle pollution and daily outpatient visits for respiratory diseases in Shanghai, China: a time-series analysis

Previous epidemiological studies have linked short-term exposure to particulate matter with outpatient visits for respiratory diseases. However, evidence on ultrafine particle (UFP) is still scarce in China. To investigate the association between short-term UFP exposure and outpatient visits for respiratory diseases as well as the corresponding lag patterns, information on outpatient visits for main respiratory diseases during January 1, 2017, to December 31, 2019 was collected from electronic medical records of two large tertiary hospitals in Shanghai, China. Generalized additive models employing a Quasi-Poisson distribution were employed to investigate the relationships between UFP and respiratory diseases. We computed the percentage change and its corresponding 95% confidence interval (CI) for outpatient visits related to respiratory diseases per interquartile range (IQR) increase in UFP concentrations. Based on a total of 1,034,394 hospital visits for respiratory diseases in Shanghai, China, we found that the strongest associations of total UFP with acute upper respiratory tract infection (AURTI), bronchitis, chronic obstructive pulmonary disease (COPD), and pneumonia occurred at lag 03, 03, 0, and 03 days, respectively. Each IQR increase in the total UFP concentrations was associated with increments of 9.02% (95% CI: 8.64-9.40%), 3.94% (95% CI: 2.84-5.06%), 4.10% (95% CI: 3.01-5.20%), and 10.15% (95% CI: 9.32-10.99%) for AURTI, bronchitis, COPD, and pneumonia, respectively. Almost linear concentration-response relationship curves without apparent thresholds were observed between total UFP and outpatient-department visits for four respiratory diseases. Stratified analyses illustrated significantly stronger associations of total UFP with AURTI, bronchitis, and pneumonia among female patients, while that with COPD was stronger among male patients. After adjustment of criteria air pollutants, these associations all remained robust. This time-series study indicates that short-term exposure to UFP was associated with increased risk of hospital visits for respiratory diseases, underscoring the importance of reducing ambient UFP concentrations for respiratory diseases control and prevention.

Long-term health complications of chemical weapon exposure: a study on Halabja chemical attack survivors (Iraqi Kurds)

OBJECTIVE

In 1988, the Iraqi government used a range of chemical weapons (CWs) against the Iraqi Kurds of Halabja. Here, we aim to investigate the long-term health consequences in exposed survivors as they are not sufficiently studied.

MATERIALS AND METHODS

This was a retrospective study conducted from November 2019 to May 2020 assessing the health status of all exposed Halabja chemical attack survivors compared to non-exposed people from the same area.

RESULTS AND DISCUSSION

Two hundred thirty survivors and 240 non-exposed participants were enrolled in this study, with control participants matched to age, gender, and occupation. Among the survivors, females were more prevalent. The respiratory system was the most common single exposure route (83, 36.1%), with 138 (60%) of the survivors being exposed by multiple routes. The vast majority (88.7%) of survivors had activities of daily living (ADL) impairment. There was female predominance in mild and moderate cases, with more males in severe cases (p < 0.01). Respiratory and cardiac diseases were significantly more common in the survivors compared to the controls (p < 0.001). Survivors with multiple CW exposure routes had significantly higher rates of ADL impairment (p < 0.001) and cardiac disease, respiratory diseases, and miscarriage (p < 0.01), than those with a single exposure route.

CONCLUSION

In this study comparing CW survivors with a local control population, a single, high-dose exposure to CWs was associated with significant increases in chronic respiratory and cardiac conditions, in addition to high rates of ADL impairment. Similar studies are needed in other, more recent CW survivor cohorts.

Short-term air pollution exposure and mortality in Brazil: Investigating the susceptible population groups

This is the first study to examine the association between ambient air pollution (PM2.5, O3, and NO2) and mortality (in different population groups by sex and age) based on a nationwide death record across Brazil over a 15-year period (2003-2017). We used a time-series analytic approach with a distributed lag model. Our study population includes 2,872,084 records of deaths in Brazil between 2003 and 2017. Men accounted for a higher proportion of deaths, with 58% for all-cause mortality, 54% for respiratory mortality, and 52% for circulatory mortality. Most individuals were over 65 years of age. Our results suggest an association between air pollution and mortality in Brazil. The direction, statistical significance, and effect size of these associations varied considerably by type of air pollutant, region, and population group (sex and age group). In particular, the older population group (>65 years) was most affected. The national meta-analysis for the entire data set (without stratification by sex and age) showed that for every 10 μg/m3 increase in PM2.5 concentration, the risk of death from respiratory diseases increased by 2.93% (95%CI: 1.42; 4.43). For every 10 ppb increase in O3, there is a 2.21% (95%CI: 0.59; 3.83) increase in the risk of all-cause mortality for the group of all people between 46 and 65 years old, and a 3.53% (95%CI: 0.34; 6.72) increase in the risk of circulatory mortality for the group of women, all ages. For every 10 ppb increase in NO2, the risk of respiratory mortality increases by 17.56% (95%CI: 4.44; 30.64) and the risk of all-cause mortality by 5.63% (95%CI: 1.83; 9.44). The results of our study provide epidemiological evidence that air pollution is associated with a higher risk of cardiorespiratory mortality in Brazil. Given the lack of nationwide studies on air pollution in Brazil, our research is an important contribution to the local and international literature that can provide better support to policymakers to improve air quality and public health.

Identification of potential food sources affecting blood lead levels and their health hazards (CVD, respiratory diseases, cancer)

Environmental lead exposure is a well-known and significant public health concern. In areas with low lead exposure, comprehensive and detailed research and validation are needed to eliminate the adverse effects of environmental lead exposure. This study aims to understand the possible food pathways of environmental lead exposure by exploring the contribution of food to blood lead and the mediating effect of blood lead in the occurrence of diseases. Similarly, as lead is a heavy metal pollutant with good research foundation, fine analysis of lead in this period can also be a reference for other unknown pollutants. In this cross-sectional study of 1162 peoples, the data are taken from National Health and Nutrition Examination Survey (NANHES) 2015-2016, we grouped the population according to the median blood lead level (0.038 μmol/L) to screen the variables adjusted by the model. we grouped foods by code and used a generalized additive mixed model (GAMM) to study their relationship with blood lead levels, a correlation has been found between egg mixtures (p = 0.007) and legumes (p = 0.041) consumption and blood lead levels. We analyzed how metabolic status, exercise, and macronutrient intake modulate the impact of certain foods on blood lead levels to infer its possible process. To verify whether adverse effects are caused by lead, we explored the mediating effect of blood lead on the relationship between food intake and disease [cardiovascular diseases (CVD), respiratory diseases, cancer], however, no statistically significant mediating effect was found. Overall, environmental lead exposure through food still affects blood lead levels, but it has not led to adverse outcomes in blood, respiratory system, or cancers Under conditions where lead exposure levels were equivalent to those in the study (blood lead levels， mean = 0.052 μmol/L, standard deviation = 0.048 μmol/L, median = 0.038 μmol/L, min = 0.002 μmol/L, max = 0.904 μmol/L, skewness = 6.543, kurtosis = 89.391).

Exposure to outdoor particulate matter and risk of respiratory diseases: a systematic review and meta-analysis

According to epidemiological studies, particulate matter (PM) is an important air pollutant that poses a significant threat to human health. The relationship between particulate matter and respiratory diseases has been the subject of numerous studies, but these studies have produced inconsistent findings. The purpose of this systematic review was to examine the connection between outdoor particulate matter (PM2.5 and PM10) exposure and respiratory disorders (COPD, lung cancer, LRIs, and COVID-19). For this purpose, we conducted a literature search between 2012 and 2022 in PubMed, Web of Science, and Scopus. Out of the 58 studies that were part of the systematic review, meta-analyses were conducted on 53 of them. A random effect model was applied separately for each category of study design to assess the pooled association between exposure to PM2.5 and PM10 and respiratory diseases. Based on time-series and cohort studies, which are the priorities of the strength of evidence, a significant relationship between the risk of respiratory diseases (COPD, lung cancer, and COVID-19) was observed (COPD: pooled HR = 1.032, 95% CI: 1.004-1.061; lung cancer: pooled HR = 1.017, 95% CI: 1.015-1.020; and COVID-19: pooled RR = 1.004, 95% CI: 1.002-1.006 per 1 μg/m3 increase in PM2.5). Also, a significant relationship was observed between PM10 and respiratory diseases (COPD, LRIs, and COVID-19) based on time-series and cohort studies. Although the number of studies in this field is limited, which requires more investigations, it can be concluded that outdoor particulate matter can increase the risk of respiratory diseases.

Spatiotemporal varying coefficient model for respiratory disease mapping in Taiwan

Respiratory diseases have been global public health problems for a long time. In recent years, air pollutants as important risk factors have drawn lots of attention. In this study, we investigate the influence of $\pm2.5$ (particulate matters in diameter less than 2.5 ${\rm{\mu }} m$) on hospital visit rates for respiratory diseases in Taiwan. To reveal the spatiotemporal pattern of data, we propose a Bayesian disease mapping model with spatially varying coefficients and a parametric temporal trend. Model fitting is conducted using the integrated nested Laplace approximation, which is a widely applied technique for large-scale data sets due to its high computational efficiency. The finite sample performance of the proposed method is studied through a series of simulations. As demonstrated by simulations, the proposed model can improve both the parameter estimation performance and the prediction performance. We apply the proposed model on the respiratory disease data in 328 third-level administrative regions in Taiwan and find significant associations between hospital visit rates and $\pm2.5$.

Efficacy and Safety of an mRNA-Based RSV PreF Vaccine in Older Adults

BACKGROUND

Respiratory syncytial virus (RSV) can cause substantial morbidity and mortality among older adults. An mRNA-based RSV vaccine, mRNA-1345, encoding the stabilized RSV prefusion F glycoprotein, is under clinical investigation.

METHODS

In this ongoing, randomized, double-blind, placebo-controlled, phase 2-3 trial, we randomly assigned, in a 1:1 ratio, adults 60 years of age or older to receive one dose of mRNA-1345 (50 μg) or placebo. The two primary efficacy end points were the prevention of RSV-associated lower respiratory tract disease with at least two signs or symptoms and with at least three signs or symptoms. A key secondary efficacy end point was the prevention of RSV-associated acute respiratory disease. Safety was also assessed.

RESULTS

Overall, 35,541 participants were assigned to receive the mRNA-1345 vaccine (17,793 participants) or placebo (17,748). The median follow-up was 112 days (range, 1 to 379). The primary analyses were conducted when at least 50% of the anticipated cases of RSV-associated lower respiratory tract disease had occurred. Vaccine efficacy was 83.7% (95.88% confidence interval [CI], 66.0 to 92.2) against RSV-associated lower respiratory tract disease with at least two signs or symptoms and 82.4% (96.36% CI, 34.8 to 95.3) against the disease with at least three signs or symptoms. Vaccine efficacy was 68.4% (95% CI, 50.9 to 79.7) against RSV-associated acute respiratory disease. Protection was observed against both RSV subtypes (A and B) and was generally consistent across subgroups defined according to age and coexisting conditions. Participants in the mRNA-1345 group had a higher incidence than those in the placebo group of solicited local adverse reactions (58.7% vs. 16.2%) and of systemic adverse reactions (47.7% vs. 32.9%); most reactions were mild to moderate in severity and were transient. Serious adverse events occurred in 2.8% of the participants in each trial group.

CONCLUSIONS

A single dose of the mRNA-1345 vaccine resulted in no evident safety concerns and led to a lower incidence of RSV-associated lower respiratory tract disease and of RSV-associated acute respiratory disease than placebo among adults 60 years of age or older. (Funded by Moderna; ConquerRSV ClinicalTrials.gov number, NCT05127434.).

Prepayment meters strongly associated with multiple types of deprivation and emergency respiratory hospital admissions: an observational, cross-sectional study

BACKGROUND

Prepayment meters (PPMs) require energy to be paid in advance. Action groups and media contend that PPMs are concentrated in the most vulnerable groups, prone to run out of credit and experience financial burden. This led to forced installation for those over age 85 being banned in April 2023 and a 'prepayment premium' scrapped in July 2023. Yet, we lack empirical evidence of which groups PPMs are concentrated. This ecological study examines the extent to which PPMs are associated with multiple measures of structural social, economic and health deprivation to establish evidence-based policy.

METHODS

Combining multiple regional data and census estimates at the Lower Layer Super Output Area and the Middle Layer Super Output Area level from England and Wales, we use Spearman's rank correlation, Pearson correlation and multivariate linear regression to empirically establish associations between PPMs and multiple types of deprivation.

RESULTS

Higher PPM prevalence is strongly associated with: lower income, receipt of employment benefits, ethnic minorities, lower education and higher health deprivation. Higher PPM prevalence is strongly associated with higher income deprivation affecting children, the elderly and social rental properties. PPMs are significantly associated with emergency hospital admissions for respiratory diseases in England, even after controlling for confounders (coefficient=1.81; 95% CI 1.51 to 2.11).

CONCLUSIONS

We found empirical evidence that PPM users are concentrated among the population who already experience multiple disadvantages. Furthermore, PPM concentrated areas are associated with higher emergency hospital admissions for respiratory diseases.

Effect of Ambient Temperature on Hospital Admissions for Respiratory Disease in Suburban Rural Villages of a Semi-Arid Region in Northwest China

OBJECTIVE

This study evaluated the effects of extreme temperatures on hospital admissions for respiratory diseases (RDs) in a semi-arid region in the Northwest of China.

METHODS

Distributed lag nonlinear model was constructed, and stratified analysis by gender and age was performed.

RESULTS

The exposure-response curve between temperature and RD hospital admissions was almost W-shaped. Either extremely cold temperatures or moderately cold temperatures presented a short-term acute harmful effect, and the relative risks were higher among males (1.976, 95% confidence interval [CI]: 1.773-2.203; 1.242, 95% CI: 1.203-1.282) and the elderly (2.363, 95% CI: 1.724-3.240; 1.267, 95% CI: 1.154-1.390). Both extreme and moderately hot temperatures had higher risks among females (2.040, 95% CI: 1.815-2.292; 1.328, 95% CI: 1.276-1.381).

CONCLUSIONS

The relationship between air temperature and RD hospital admissions was nonlinear. Vulnerable populations varied according to extreme temperature conditions.

Epidemiology and pathogenicity of M. equirhinis in equine respiratory disorders

Mycoplasmas are pathogens involved in respiratory disorders of various animal hosts. In horses, Mycoplasma (M.) equirhinis is the species most frequently detected in clinical respiratory specimens, with a prevalence of 12-16%, but its clinical implication in equine respiratory disorders remains unclear. Here we screened 1948 clinical specimens for the presence of M. equirhinis. The samples were both tracheal washes (TW) and bronchoalveolar lavages (BAL) collected by veterinarians in France in day-to-day work between 2020 and 2022. The samples were associated with a standardized form that served to collect key general and clinical information, such as horse age, breed, and living environment. M. equirhinis was detected using a combination of culture and post-enrichment PCR. Other diagnostic data included virology and bacteriology as well as neutrophil counts, when available. Prevalence of M. equirhinis was examined as a function of a clinical score based on four significant clinical signs (nasal discharge, cough, dyspnoea, and hyperthermia). Multivariate logistic regression analysis was run to identify risk factors for the presence of M. equirhinis, and comparative prevalence analysis was used to test for association with other bacteria and viruses. TW and BAL were analysed independently, as we found that TW samples were associated with a higher prevalence of M. equirhinis. As prevalence remained steady whatever the clinical score, M. equirhinis cannot be considered a primary pathogen. M. equirhinis was more frequently isolated in thoroughbreds and trotters and in horses living exclusively stabled compared to other horses or other living environments. M. equirhinis was never detected in BAL specimens with a 'normal' neutrophil count, i.e. 5%, suggesting it could be associated with an inflammatory response, similar to that observed in equine asthma. Prevalence of M. equirhinis was shown to increase in the presence of other bacteria such as Streptococcus equi subsp. zooepidemicus (S. zoo) or viruses, and S. zoo load was higher in M. equirhinis-positive samples, suggesting a potential increase of clinical signs in the event of co-infection.