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Hébert JR. Reducing Racial Disparities in Surviving Gastrointestinal Cancer Will Require Looking Beyond the Fact That African-Americans Have Low Rates of Surgery. Cancer Epidemiol Biomarkers Prev 2021; 30:438-440. [PMID: 33857014 DOI: 10.1158/1055-9965.epi-20-1808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
This article by Bliton and colleagues in this issue of the journal concludes that disproportionately low surgery rates among Black patients contribute to the known survival disparity between Blacks and Whites. Using data from the National Cancer Database (NCDB), they were able to address the implicit hypothesis that the measured outcome disparities are partly attributable to failure to deliver surgical care equitably. As with most good research on difficult and complex topics, it also raises interesting and provocative questions about the role of race in poor survival among African-American patients with gastrointestinal cancer. The main limitation of the NCDB is its inability to account for individual-level factors. Those things related to health behaviors, such as diet, physical activity, and tobacco use, but that also include characteristics of the built environment, comprehensive access to care measures, clinical decision-making, racial discrimination and other forms of psychosocial stress, and environmental contamination, would influence both the likelihood of getting cancer and the probability of having aggressive disease with poor prognosis. These factors also may be related to clinical decision-making. Suggestions are made to design studies and collect data that would help to inform future investigations to deepen our understanding of racial disparities in cancer survival.See related article by Bliton et al., p. 529.
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Affiliation(s)
- James R Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
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Alexeeff SE, Deosaransingh K, Liao NS, Van Den Eeden SK, Schwartz J, Sidney S. Particulate Matter and Cardiovascular Risk in Adults with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2021; 204:159-167. [PMID: 33662228 DOI: 10.1164/rccm.202007-2901oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: People with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular disease and may be more susceptible to air pollution exposure. However, no study has examined the association between long-term fine particulate matter exposure (≤2.5 μm in aerodynamic diameter) and risk of cardiovascular events in this potentially vulnerable population. Objectives: To estimate the association between long-term fine particulate matter and risk of cardiovascular events among adults with COPD. Methods: This retrospective cohort study included 169,714 adults with COPD who were members of the Kaiser Permanente Northern California health plan during 2007-2016. Electronic health record data were linked to 1 km modeled particulate matter ≤2.5 μm in aerodynamic diameter exposure estimates. We fit Cox proportional hazard models, adjusting for age, sex, race/ethnicity, calendar year, smoking, body mass index, comorbidities, medications, and socioeconomic status. In low exposure analyses, we examined effects below the current regulation limit (12 μg/m3). Measurements and Main Results: Among adults with COPD, a 10-μg/m3 increase in 1-year mean fine particulate matter exposure was associated with an elevated risk of cardiovascular mortality (hazard ratio, 1.10; 95% confidence interval [CI], 1.01-1.20). Effects were stronger in low exposure analyses (hazard ratio, 1.88; 95% CI, 1.56-2.27). Fine particulate matter exposure was not associated with acute myocardial infarction or stroke in overall analyses. Conclusions: Long-term fine particulate matter exposure was associated with an increased risk of cardiovascular mortality among adults with COPD. Current regulations may not sufficiently protect those with COPD.
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Affiliation(s)
- Stacey E Alexeeff
- Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, California; and
| | - Kamala Deosaransingh
- Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, California; and
| | - Noelle S Liao
- Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, California; and
| | | | - Joel Schwartz
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Stephen Sidney
- Kaiser Permanente Division of Research, Kaiser Permanente, Oakland, California; and
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Tu R, Hou J, Liu X, Li R, Dong X, Pan M, Yin S, Hu K, Mao Z, Huo W, Chen G, Guo Y, Wang X, Li S, Wang C. Low socioeconomic status aggravated associations of exposure to mixture of air pollutants with obesity in rural Chinese adults: A cross-sectional study. ENVIRONMENTAL RESEARCH 2021; 194:110632. [PMID: 33345892 DOI: 10.1016/j.envres.2020.110632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Socio-economic status (SES) and air pollutants are thought to play an important role in human obesity. The evidence of interactive effect between SES and long-term exposure to mixture of air pollutants on obesity is limited, thus, this study is aimed to investigate their interactive effects on obesity among a rural Chinese population. METHODS A total of 38,817 individuals were selected from the Henan Rural Cohort Study. Structural equation modeling (SEM) was applied to construct the latent variables of low SES (educational level, marital status, family yearly income, and number of family members), air pollution (particulate matter with aerodynamics diameters ≤ 1.0 μm, ≤ 2.5 μm or ≤ 10 μm, and nitrogen dioxide) and obesity (body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, body fat percentage and visceral fat index). Generalized linear regression models were used to assess associations between the constructed latent variables. Interaction plots were applied to describe interactive effect of air pollution and low SES on obesity and biological interaction indicators (the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S)) were also calculated. RESULTS Increased latent variables of low SES and mixture of air pollution were associated with a higher odds of latent variable of obesity (odds ratios (OR) (95% confidence interval (CI)) were 1.055 (1.049, 1.060) and 1.050 (1.045, 1.055)). The association of the mixture of air pollutants on obesity was aggravated by increased values of the latent variable of low SES (P < 0.001). Furthermore, the values of RERI, AP and S were 0.073 (0.051, 0.094), 0.057 (0.040, 0.073) and 1.340 (1.214, 1.479), respectively, indicating an additive effect of estimated latent variable of low SES and air pollution on obesity. CONCLUSIONS These findings suggested that low SES aggravated the negative effect of mixture of air pollutants on obesity, implying that individuals with low SES may be more susceptible to exposure to high levels of mixture of air pollutants related to increased risk of prevalent obesity.
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Affiliation(s)
- Runqi Tu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Ruiying Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaokang Dong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Mingming Pan
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Shanshan Yin
- Department of health policy research, Henan Academy of Medical Sciences, Zhengzhou, China
| | - Kai Hu
- Department of health policy research, Henan Academy of Medical Sciences, Zhengzhou, China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wenqian Huo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Gongbo Chen
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Yuming Guo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Xian Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
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Guo H, Wei J, Li X, Ho HC, Song Y, Wu J, Li W. Do socioeconomic factors modify the effects of PM1 and SO2 on lung cancer incidence in China? THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 756:143998. [PMID: 33310217 DOI: 10.1016/j.scitotenv.2020.143998] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/27/2020] [Accepted: 11/15/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND It remains uncertain whether socioeconomic factors modify the effect of air pollution on human health. Moreover, studies investigating socioeconomic modifying roles on the effect of PM1 are quite limited, especially in developing countries. OBJECTIVES The present study aims to investigate socioeconomic modification effects on the associations of the incidence rate of male lung cancer with ambient PM1 and SO2 in China. METHODS We conducted a nationwide analysis in 345 Chinese counties (districts) between 2014 and 2015. In terms of multivariable linear regression models, we examined the modification effects of urban-rural division, education level and proportion of construction workers in the stratified and combined datasets according to the tertile and binary divisions of the three factors. Moreover, we performed three sensitivity analyses to test the robustness of socioeconomic modification effects. RESULTS We found a larger effect of PM1 on the incidence rate of male lung cancer in urban areas than in rural areas. The association between PM1 (or SO2) and the incidence rate of male lung cancer was stronger in counties with low education levels than in those with high education levels. The findings of the significant modification effects of urban-rural division and education level were robust in the three sensitivity analyses. No significant modification effect was observed for the proportion of construction workers. CONCLUSIONS Male residents in urban areas have a high risk of lung cancer incidence associated with ambient PM1. Male residents with low education levels suffer from larger effects of PM1 and SO2 on the incidence rate of lung cancer. Area- and population-specific strategies should be developed to reduce the urban-rural and educational disparities in air pollution effects, which thereby alleviates air pollution-associated health disparities in China.
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Affiliation(s)
- Huagui Guo
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China; Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen 518057, PR China.
| | - Jing Wei
- State Key Laboratory of Remote Sensing Science, College of Global Change and Earth System Science, Beijing Normal University, Beijing 100875, China; Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA.
| | - Xin Li
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong, China.
| | - Hung Chak Ho
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China.
| | - Yimeng Song
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China.
| | - Jiansheng Wu
- Key Laboratory for Urban Habitat Environmental Science and Technology, Shenzhen Graduate School, Peking University, Shenzhen 518055, PR China; Key Laboratory for Earth Surface Processes, Ministry of Education, College of Urban and Environmental Sciences, Peking University, Beijing 100871, PR China.
| | - Weifeng Li
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China; Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen 518057, PR China.
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Settels J, Leist AK. Changes in neighborhood-level socioeconomic disadvantage and older Americans' cognitive functioning. Health Place 2021; 68:102510. [PMID: 33493963 DOI: 10.1016/j.healthplace.2021.102510] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND While associations of neighborhood conditions with cognitive functioning at older ages have been established, few studies have investigated with a dynamic perspective if changing neighborhood socioeconomic conditions affect older residents' cognitive declines, and which putative factors mediate this relationship. METHOD Using data from waves 2 (2010-2011) and 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP) survey (n = 1837), ordinary least squares regressions and mediation analyses were conducted, adjusting for multiple confounders and testing eight putative mediators. RESULTS Worsening neighborhood socioeconomic circumstances were associated with cognitive declines. Changes in depressive symptoms, sizes of close social networks, and physical activity substantially mediated this relationship. DISCUSSION While 18.10% of the total effect occurred through these mechanisms, further pathways may work through contextual- and individual-level variables not assessed in the NSHAP.
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Affiliation(s)
- Jason Settels
- University of Luxembourg, Department of Social Sciences, Institute for Research on Socio-Economic Inequality, 11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg.
| | - Anja K Leist
- University of Luxembourg, Department of Social Sciences, Institute for Research on Socio-Economic Inequality, 11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg.
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56
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Alexeeff SE, Liao NS, Liu X, Van Den Eeden SK, Sidney S. Long-Term PM 2.5 Exposure and Risks of Ischemic Heart Disease and Stroke Events: Review and Meta-Analysis. J Am Heart Assoc 2020; 10:e016890. [PMID: 33381983 PMCID: PMC7955467 DOI: 10.1161/jaha.120.016890] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Fine particulate matter <2.5 µm in diameter (PM2.5) has known effects on cardiovascular morbidity and mortality. However, no study has quantified and compared the risks of incident myocardial infarction, incident stroke, ischemic heart disease (IHD) mortality, and cerebrovascular mortality in relation to long‐term PM2.5 exposure. Methods and Results We sought to quantitatively summarize studies of long‐term PM2.5 exposure and risk of IHD and stroke events by conducting a review and meta‐analysis of studies published by December 31, 2019. The main outcomes were myocardial infarction, stroke, IHD mortality, and cerebrovascular mortality. Random effects meta‐analyses were used to estimate the combined risk of each outcome among studies. We reviewed 69 studies and included 42 studies in the meta‐analyses. In meta‐analyses, we found that a 10‐µg/m3 increase in long‐term PM2.5 exposure was associated with an increased risk of 23% for IHD mortality (95% CI, 15%–31%), 24% for cerebrovascular mortality (95% CI, 13%–36%), 13% for incident stroke (95% CI, 11%–15%), and 8% for incident myocardial infarction (95% CI, −1% to 18%). There were an insufficient number of studies of recurrent stroke and recurrent myocardial infarction to conduct meta‐analyses. Conclusions Long‐term PM2.5 exposure is associated with increased risks of IHD mortality, cerebrovascular mortality, and incident stroke. The relationship with incident myocardial infarction is suggestive of increased risk but not conclusive. More research is needed to understand the relationship with recurrent events.
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Affiliation(s)
| | | | - Xi Liu
- Kaiser Permanente Division of Research Oakland CA
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57
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Petkus AJ, Younan D, Wang X, Beavers DP, Espeland MA, Gatz M, Gruenewald TL, Kaufman JD, Chui HC, Manson JE, Resnick SM, Wellenius GA, Whitsel EA, Widaman K, Chen JC. Air Pollution and the Dynamic Association Between Depressive Symptoms and Memory in Oldest-Old Women. J Am Geriatr Soc 2020; 69:474-484. [PMID: 33205418 DOI: 10.1111/jgs.16889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND/OBJECTIVES Exposure to air pollution may contribute to both increasing depressive symptoms and decreasing episodic memory in older adulthood, but few studies have examined this hypothesis in a longitudinal context. Accordingly, we examined the association between air pollution and changes in depressive symptoms (DS) and episodic memory (EM) and their interrelationship in oldest-old (aged 80 and older) women. DESIGN Prospective cohort data from the Women's Health Initiative Memory Study-Epidemiology of Cognitive Health Outcomes. SETTING Geographically diverse community-dwelling population. PARTICIPANTS A total of 1,583 dementia-free women aged 80 and older. MEASUREMENTS Women completed up to six annual memory assessments (latent composite of East Boston Memory Test and Telephone Interview for Cognitive Status) and the 15-item Geriatric Depression Scale (GDS-15). We estimated 3-year average exposures to regional particulate matter with aerodynamic diameter below 2.5 μm (PM2.5 ) (interquartile range [IQR] = 3.35 μg/m3 ) and gaseous nitrogen dioxide (NO2 ) (IQR = 9.55 ppb) at baseline and during a remote period 10 years earlier, using regionalized national universal kriging. RESULTS Latent change structural equation models examined whether residing in areas with higher pollutant levels was associated with annual changes in standardized EM and DS while adjusting for potential confounders. Remote NO2 (β = .287 per IQR; P = .002) and PM2.5 (β = .170 per IQR; P = .019) exposure was significantly associated with larger increases in standardized DS, although the magnitude of the difference, less than 1 point on the GDS-15, is of questionable clinical significance. Higher DS were associated with accelerated EM declines (β = -.372; P = .001), with a significant indirect effect of remote NO2 and PM2.5 exposure on EM declines mediated by DS. There were no other significant indirect exposure effects. CONCLUSION These findings in oldest-old women point to potential adverse effects of late-life exposure to air pollution on subsequent interplay between DS and EM, highlighting air pollution as an environmental health risk factor for older women.
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Affiliation(s)
- Andrew J Petkus
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Diana Younan
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Xinhui Wang
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - Daniel P Beavers
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Margaret Gatz
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
| | - Tara L Gruenewald
- Department of Psychology, Chapman University, Orange, California, USA
| | - Joel D Kaufman
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Helena C Chui
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | - JoAnn E Manson
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Susan M Resnick
- The Laboratory of Behavioral Neuroscience, National Institute on Aging, Laboratory of Behavioral Neuroscience, Bethesda, Maryland, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University, Boston, Massachusetts, USA
| | - Eric A Whitsel
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Keith Widaman
- Graduate School of Education, University of California, Riverside, Riverside, California, USA
| | - Jiu-Chiuan Chen
- Department of Neurology, University of Southern California, Los Angeles, California, USA.,Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
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Kaufman JD, Elkind MSV, Bhatnagar A, Koehler K, Balmes JR, Sidney S, Burroughs Peña MS, Dockery DW, Hou L, Brook RD, Laden F, Rajagopalan S, Bishop Kendrick K, Turner JR. Guidance to Reduce the Cardiovascular Burden of Ambient Air Pollutants: A Policy Statement From the American Heart Association. Circulation 2020; 142:e432-e447. [PMID: 33147996 DOI: 10.1161/cir.0000000000000930] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In 2010, the American Heart Association published a statement concluding that the existing scientific evidence was consistent with a causal relationship between exposure to fine particulate matter and cardiovascular morbidity and mortality, and that fine particulate matter exposure is a modifiable cardiovascular risk factor. Since the publication of that statement, evidence linking air pollution exposure to cardiovascular health has continued to accumulate and the biological processes underlying these effects have become better understood. This increasingly persuasive evidence necessitates policies to reduce harmful exposures and the need to act even as the scientific evidence base continues to evolve. Policy options to mitigate the adverse health impacts of air pollutants must include the reduction of emissions through action on air quality, vehicle emissions, and renewable portfolio standards, taking into account racial, ethnic, and economic inequality in air pollutant exposure. Policy interventions to improve air quality can also be in alignment with policies that benefit community and transportation infrastructure, sustainable food systems, reduction in climate forcing agents, and reduction in wildfires. The health care sector has a leadership role in adopting policies to contribute to improved environmental air quality as well. There is also potentially significant private sector leadership and industry innovation occurring in the absence of and in addition to public policy action, demonstrating the important role of public-private partnerships. In addition to supporting education and research in this area, the American Heart Association has an important leadership role to encourage and support public policies, private sector innovation, and public-private partnerships to reduce the adverse impact of air pollution on current and future cardiovascular health in the United States.
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Healthy lifestyle and risk of incident heart failure with preserved and reduced ejection fraction among post-menopausal women: The Women's Health Initiative study. Prev Med 2020; 138:106155. [PMID: 32473271 DOI: 10.1016/j.ypmed.2020.106155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/16/2020] [Accepted: 05/22/2020] [Indexed: 01/09/2023]
Abstract
We examined associations of diet, physical activity, cigarette smoking, and body mass index (BMI), separately and as a cumulative lifestyle score, with incident hospitalized HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). This analysis included 40,095 postmenopausal women in the Women's Health Initiative clinical trial and observational studies, aged 50-79 years and without self-reported HF at baseline. A healthy lifestyle score (HLS) was developed, in which women received 1 point for each healthy lifestyle. A weighted HLS was also created to examine the independent magnitude of each of the lifestyle factors in HF subtypes. Trained adjudicators determined cases of incident hospitalized HF, HFpEF, HFrEF through March 2018. Multiple variable Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). During a mean follow-up period of 14.5 years, 659 incident HFrEF and 1276 HFpEF cases were documented. Across unweighted HLS of 0 (referent), 1, 2, 3, and 4, multivariable adjusted HRs (95% CI) for HFrEF were 1.00, 0.52 (0.38, 0.71), 0.40 (0.29, 0.56), 0.33 (0.23, 0.48), and 0.33 (0.19, 0.56) (P-trend = 0.03) and for HFpEF were 1.00, 0.47 (0.37, 0.59), 0.39 (0.30, 0.49), 0.26 (0.20, 0.34), and 0.23 (0.15, 0.35) (P-trend < 0.001). Results were similar for the weighted HLS. Our findings suggest that following a healthy lifestyle pattern is associated with lower risks of HFpEF and HFrEF among postmenopausal women.
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60
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Larsen A, Kolpacoff V, McCormack K, Seewaldt V, Hyslop T. Using Latent Class Modeling to Jointly Characterize Economic Stress and Multipollutant Exposure. Cancer Epidemiol Biomarkers Prev 2020; 29:1940-1948. [PMID: 32856601 DOI: 10.1158/1055-9965.epi-19-1365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 06/10/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Work is needed to better understand how joint exposure to environmental and economic factors influence cancer. We hypothesize that environmental exposures vary with socioeconomic status (SES) and urban/rural locations, and areas with minority populations coincide with high economic disadvantage and pollution. METHODS To model joint exposure to pollution and SES, we develop a latent class mixture model (LCMM) with three latent variables (SES Advantage, SES Disadvantage, and Air Pollution) and compare the LCMM fit with K-means clustering. We ran an ANOVA to test for high exposure levels in non-Hispanic black populations. The analysis is at the census tract level for the state of North Carolina. RESULTS The LCMM was a better and more nuanced fit to the data than K-means clustering. Our LCMM had two sublevels (low, high) within each latent class. The worst levels of exposure (high SES disadvantage, low SES advantage, high pollution) are found in 22% of census tracts, while the best levels (low SES disadvantage, high SES advantage, low pollution) are found in 5.7%. Overall, 34.1% of the census tracts exhibit high disadvantage, 66.3% have low advantage, and 59.2% have high mixtures of toxic pollutants. Areas with higher SES disadvantage had significantly higher non-Hispanic black population density (NHBPD; P < 0.001), and NHBPD was higher in areas with higher pollution (P < 0.001). CONCLUSIONS Joint exposure to air toxins and SES varies with rural/urban location and coincides with minority populations. IMPACT Our model can be extended to provide a holistic modeling framework for estimating disparities in cancer survival.See all articles in this CEBP Focus section, "Environmental Carcinogenesis: Pathways to Prevention."
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Affiliation(s)
- Alexandra Larsen
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Viktoria Kolpacoff
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Kara McCormack
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | | | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina. .,Duke Cancer Institute, Durham, North Carolina
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Chen C, Xun P, Kaufman JD, Hayden KM, Espeland MA, Whitsel EA, Serre ML, Vizuete W, Orchard T, Harris WS, Wang X, Chui HC, Chen JC, He K. Erythrocyte omega-3 index, ambient fine particle exposure, and brain aging. Neurology 2020; 95:e995-e1007. [PMID: 32669395 PMCID: PMC7668549 DOI: 10.1212/wnl.0000000000010074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 02/20/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To examine whether long-chain omega-3 polyunsaturated fatty acid (LCn3PUFA) levels modify the potential neurotoxic effects of particle matter with diameters <2.5 µm (PM2.5) exposure on normal-appearing brain volumes among dementia-free elderly women. METHODS A total of 1,315 women (age 65-80 years) free of dementia were enrolled in an observational study between 1996 and 1999 and underwent structural brain MRI in 2005 to 2006. According to prospectively collected and geocoded participant addresses, we used a spatiotemporal model to estimate the 3-year average PM2.5 exposure before the MRI. We examined the joint associations of baseline LCn3PUFAs in red blood cells (RBCs) and PM2.5 exposure with brain volumes in generalized linear models. RESULTS After adjustment for potential confounders, participants with higher levels of RBC LCn3PUFA had significantly greater volumes of white matter and hippocampus. For each interquartile increment (2.02%) in omega-3 index, the average volume was 5.03 cm3 (p < 0.01) greater in the white matter and 0.08 cm3 (p = 0.03) greater in the hippocampus. The associations with RBC docosahexaenoic acid and eicosapentaenoic acid levels were similar. Higher LCn3PUFA attenuated the inverse associations between PM2.5 exposure and white matter volumes in the total brain and multimodal association areas (frontal, parietal, and temporal; all p for interaction <0.05), while the associations with other brain regions were not modified. Consistent results were found for dietary intakes of LCn3PUFAs and nonfried fish. CONCLUSIONS Findings from this prospective cohort study among elderly women suggest that the benefits of LCn3PUFAs on brain aging may include the protection against potential adverse effects of air pollution on white matter volumes.
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Affiliation(s)
- Cheng Chen
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles.
| | - Pengcheng Xun
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Joel D Kaufman
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Kathleen M Hayden
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Mark A Espeland
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Eric A Whitsel
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Marc L Serre
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles
| | - William Vizuete
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Tonya Orchard
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles
| | - William S Harris
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Xinhui Wang
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Helena C Chui
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Jiu-Chiuan Chen
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles.
| | - Ka He
- From the Department of Obstetrics and Gynecology and Department of Epidemiology (C.C., K.H.), Columbia University Irving Medical Center, New York, NY; Department of Epidemiology and Biostatistics (P.X.), School of Public Health-Bloomington, Indiana University; Department of Environmental and Occupational Health Sciences (J.D.K.), Department of Medicine, and Department of Epidemiology (J.D.K.), School of Public Health, University of Washington, Seattle; Department of Social Sciences and Health Policy (K.M.H.) and Department of Biostatistics and Data Science (M.A.E.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology (E.A.W.) and Department of Environmental Sciences and Engineering (M.L.S., W.V.), Gillings School of Global Public Health, and Department of Medicine (E.A.W.), School of Medicine, University of North Carolina Chapel Hill; Department of Human Sciences (T.O.), Human Nutrition Program, The Ohio State University, Columbus; Department of Internal Medicine (W.S.H.), Sanford School of Medicine, University of South Dakota; OmegaQuant Analytics LLC (W.S.H.), Sioux Falls, SD; and Department of Neurology (X.W., H.C.C., J.-C.C.) and Department of Preventive Medicine (J.-C.C.), Keck School of Medicine, University of Southern California, Los Angeles.
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Suwannasual U, Lucero J, Davis G, McDonald JD, Lund AK. Mixed Vehicle Emissions Induces Angiotensin II and Cerebral Microvascular Angiotensin Receptor Expression in C57Bl/6 Mice and Promotes Alterations in Integrity in a Blood-Brain Barrier Coculture Model. Toxicol Sci 2020; 170:525-535. [PMID: 31132127 DOI: 10.1093/toxsci/kfz121] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Exposure to traffic-generated pollution is associated with alterations in blood-brain barrier (BBB) integrity and exacerbation of cerebrovascular disorders. Angiotensin (Ang) II signaling through the Ang II type 1 (AT1) receptor is known to promote BBB disruption. We have previously reported that exposure to a mixture of gasoline and diesel vehicle engine emissions (MVE) mediates alterations in cerebral microvasculature of C57Bl/6 mice, which is exacerbated through consumption of a high-fat (HF) diet. Thus, we investigated the hypothesis that inhalation exposure to MVE results in altered central nervous system microvascular integrity mediated by Ang II-AT1 signaling. Three-month-old male C57Bl/6 mice were placed on an HF or low-fat diet and exposed via inhalation to either filtered air (FA) or MVE (100 μg/m3 PM) 6 h/d for 30 days. Exposure to HF+MVE resulted in a significant increase in plasma Ang II and expression of AT1 in the cerebral microvasculature. Results from a BBB coculture study showed that transendothelial electrical resistance was decreased, associated with reduced expression of claudin-5 and occludin when treated with plasma from MVE+HF animals. These effects were attenuated through pretreatment with the AT1 antagonist, Losartan. Our BBB coculture showed increased levels of astrocyte AT1 and decreased expression of aryl hydrocarbon receptor and glutathione peroxidase-1, associated with increased interleukin-6 and transforming growth factor-β in the astrocyte media, when treated with plasma from MVE-exposed groups. Our results indicate that inhalation exposure to traffic-generated pollutants results in altered BBB integrity, mediated through Ang II-AT1 signaling and inflammation, which is exacerbated by an HF diet.
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Affiliation(s)
- Usa Suwannasual
- Department of Biological Sciences, Advanced Environmental Research Institute, University of North Texas, Denton, Texas 76201
| | - JoAnn Lucero
- Department of Biological Sciences, Advanced Environmental Research Institute, University of North Texas, Denton, Texas 76201
| | - Griffith Davis
- Department of Biological Sciences, Advanced Environmental Research Institute, University of North Texas, Denton, Texas 76201
| | - Jacob D McDonald
- Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico 87108
| | - Amie K Lund
- Department of Biological Sciences, Advanced Environmental Research Institute, University of North Texas, Denton, Texas 76201
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Tapia V, Steenland K, Sarnat SE, Vu B, Liu Y, Sánchez-Ccoyllo O, Vasquez V, Gonzales GF. Time-series analysis of ambient PM 2.5 and cardiorespiratory emergency room visits in Lima, Peru during 2010-2016. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2020; 30:680-688. [PMID: 31745179 PMCID: PMC7234897 DOI: 10.1038/s41370-019-0189-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/26/2019] [Accepted: 09/19/2019] [Indexed: 05/21/2023]
Abstract
INTRODUCTION There have been no time-series studies of air pollution in Peru. Here we evaluate the effect of ambient PM2.5 on emergency room (ER) visits in Lima. METHODS We estimated daily PM2.5 levels at a 1 km2 resolution during 2010-2016 using ground measurements, satellite data, and chemical transport model simulations. Population-weighted average daily PM2.5 levels were calculated for each district in Lima (n = 40), and assigned to patients based on residence. ER visits for respiratory and circulatory diseases were gathered from nine large public hospitals. Poisson regression was used to estimate the rate ratio for daily ER visits with change in daily PM2.5, controlling for meteorology, time trends, and district. RESULTS For each interquartile range (IQR) increase in PM2.5, respiratory disease ER visits increased 4% (95% CI: 0-5%), stroke visits 10% (3-18%), and ischemic heart disease visits (adults, 18-64 years) 11% (-1, 24%). Districts with higher poverty showed significantly stronger associations of PM2.5 and respiratory disease ER visits than districts with lower poverty. Effects were diminished 24-42% using Lima-wide instead of district-specific PM2.5 levels. CONCLUSIONS Short-term exposure to ambient PM2.5 is associated with increases in ER visits in Lima for respiratory diseases and stroke, and among middle-aged adults, ischemic heart disease.
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Affiliation(s)
- V Tapia
- Faculty of Sciences and Philosophy, and Laboratory of Investigation and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - K Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory U., Atlanta, GA, USA.
| | - S E Sarnat
- Department of Environmental Health, Rollins School of Public Health, Emory U., Atlanta, GA, USA
| | - B Vu
- Department of Environmental Health, Rollins School of Public Health, Emory U., Atlanta, GA, USA
| | - Y Liu
- Department of Environmental Health, Rollins School of Public Health, Emory U., Atlanta, GA, USA
| | - O Sánchez-Ccoyllo
- Faculty of Sciences and Philosophy, and Laboratory of Investigation and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
- Professional Career of Environmental Engineering, Universidad Nacional Tecnológica de Lima Sur (UNTELS), Lima, Peru
| | - V Vasquez
- Faculty of Sciences and Philosophy, and Laboratory of Investigation and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - G F Gonzales
- Faculty of Sciences and Philosophy, and Laboratory of Investigation and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
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Wister A, Rosenkrantz L, Shashank A, Walker BB, Schuurman N. Multimorbidity and Socioeconomic Deprivation among Older Adults: A Cross-sectional Analysis in Five Canadian Cities Using the CLSA. JOURNAL OF AGING AND ENVIRONMENT 2020. [DOI: 10.1080/26892618.2020.1734138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Andrew Wister
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Leah Rosenkrantz
- Department of Geography, Simon Fraser University, Burnaby, Canada
| | - Aateka Shashank
- Department of Geography, Simon Fraser University, Burnaby, Canada
| | - Blake Byron Walker
- Institut für Geographie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nadine Schuurman
- Department of Geography, Simon Fraser University, Burnaby, Canada
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Gondalia R, Holliday KM, Baldassari A, Justice AE, Stewart JD, Liao D, Yanosky JD, Engel SM, Jordahl KM, Bhatti P, Horvath S, Assimes TL, Pankow JS, Demerath EW, Guan W, Fornage M, Bressler J, North KE, Conneely KN, Li Y, Hou L, Baccarelli AA, Whitsel EA. Leukocyte Traits and Exposure to Ambient Particulate Matter Air Pollution in the Women's Health Initiative and Atherosclerosis Risk in Communities Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:17004. [PMID: 31903802 PMCID: PMC7015624 DOI: 10.1289/ehp5360] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/25/2019] [Accepted: 12/03/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND Inflammatory effects of ambient particulate matter (PM) air pollution exposures may underlie PM-related increases in cardiovascular disease risk and mortality, although evidence of PM-associated leukocytosis is inconsistent and largely based on small, cross-sectional, and/or unrepresentative study populations. OBJECTIVES Our objective was to estimate PM-leukocyte associations among U.S. women and men in the Women's Health Initiative and Atherosclerosis Risk in Communities study (n = 165,675 ). METHODS We based the PM-leukocyte estimations on up to four study visits per participant, at which peripheral blood leukocytes and geocoded address-specific concentrations of PM ≤ 10 , ≤ 2.5 , and 2.5 - 10 μ m in diameter (PM 10 , PM 2.5 , and PM 2.5 - 10 , respectively) were available. We multiply imputed missing data using chained equations and estimated PM-leukocyte count associations over daily to yearly PM exposure averaging periods using center-specific, linear, mixed, longitudinal models weighted for attrition and adjusted for sociodemographic, behavioral, meteorological, and geographic covariates. In a subset of participants with available data (n = 8,457 ), we also estimated PM-leukocyte proportion associations in compositional data analyses. RESULTS We found a 12 cells / μ L (95% confidence interval: - 9 , 33) higher leukocyte count, a 1.2% (0.6%, 1.8%) higher granulocyte proportion, and a - 1.1 % (- 1.9 % , - 0.3 % ) lower CD 8 + T-cell proportion per 10 - μ g / m 3 increase in 1-month mean PM 2.5 . However, shorter-duration PM 10 exposures were inversely and only modestly associated with leukocyte count. DISCUSSION The PM 2.5 -leukocyte estimates, albeit imprecise, suggest that among racially, ethnically, and environmentally diverse U.S. populations, sustained, ambient exposure to fine PM may induce subclinical, but epidemiologically important, inflammatory effects. https://doi.org/10.1289/EHP5360.
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Affiliation(s)
- Rahul Gondalia
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Katelyn M. Holliday
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Antoine Baldassari
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Anne E. Justice
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
- Geisinger Health System, Danville, Pennsylvania
| | - James D. Stewart
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Duanping Liao
- Division of Epidemiology, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jeff D. Yanosky
- Division of Epidemiology, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Stephanie M. Engel
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Kristina M. Jordahl
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Parveen Bhatti
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Steve Horvath
- Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
- Department of Biostatistics, School of Public Health, University of California, Los Angeles, Los Angeles, California
| | | | - James S. Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Ellen W. Demerath
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Weihua Guan
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Myriam Fornage
- Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Jan Bressler
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Kari E. North
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
- Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karen N. Conneely
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - Yun Li
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Population Epigenetics, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrea A. Baccarelli
- Laboratory of Environmental Epigenetics, Departments of Environmental Health Sciences and Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Eric A. Whitsel
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Humphrey JL, Reid CE, Kinnee EJ, Kubzansky LD, Robinson LF, Clougherty JE. Putting Co-Exposures on Equal Footing: An Ecological Analysis of Same-Scale Measures of Air Pollution and Social Factors on Cardiovascular Disease in New York City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234621. [PMID: 31766340 PMCID: PMC6926874 DOI: 10.3390/ijerph16234621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/13/2022]
Abstract
Epidemiologic evidence consistently links urban air pollution exposures to health, even after adjustment for potential spatial confounding by socioeconomic position (SEP), given concerns that air pollution sources may be clustered in and around lower-SEP communities. SEP, however, is often measured with less spatial and temporal resolution than are air pollution exposures (i.e., census-tract socio-demographics vs. fine-scale spatio-temporal air pollution models). Although many questions remain regarding the most appropriate, meaningful scales for the measurement and evaluation of each type of exposure, we aimed to compare associations for multiple air pollutants and social factors against cardiovascular disease (CVD) event rates, with each exposure measured at equal spatial and temporal resolution. We found that, in multivariable census-tract-level models including both types of exposures, most pollutant-CVD associations were non-significant, while most social factors retained significance. Similarly, the magnitude of association was higher for an IQR-range difference in the social factors than in pollutant concentrations. We found that when offered equal spatial and temporal resolution, CVD was more strongly associated with social factors than with air pollutant exposures in census-tract-level analyses in New York City.
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Affiliation(s)
- Jamie L. Humphrey
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA;
| | - Colleen E. Reid
- Geography Department, University of Colorado Boulder, Boulder, CO 80309, USA;
| | - Ellen J. Kinnee
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Laura D. Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Lucy F. Robinson
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA;
| | - Jane E. Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA;
- Correspondence: ; Tel.: +1-267-359-6072
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Guo H, Chang Z, Wu J, Li W. Air pollution and lung cancer incidence in China: Who are faced with a greater effect? ENVIRONMENT INTERNATIONAL 2019; 132:105077. [PMID: 31415963 DOI: 10.1016/j.envint.2019.105077] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Whether socioeconomic indicators modify the relationship between air pollution exposure and health outcomes remains uncertain, especially in developing countries. OBJECTIVE This work aims to examine modification effects of socioeconomic indicators on the association between PM2.5 and annual incidence rate of lung cancer for males in China. METHODS We performed a nationwide analysis in 295 counties (districts) from 2006 to 2014. Using multivariable linear regression models controlling for weather conditions and socioeconomic indicators, we examined modification effects in the stratified and combined datasets according to the tertile and binary divisions of socioeconomic indicators. We also extensively investigated whether the roles of socioeconomic modifications were sensitive to the further adjustment of demographic factors, health and behaviour covariates, household solid fuel consumption, the different operationalization of socioeconomic indicators and PM2.5 exposure with single and moving average lags. RESULTS We found a stronger relationship between PM2.5 and incidence rate of male lung cancer in urban areas, in the lower economic or lower education counties (districts). If PM2.5 changes by 10 μg/m3, then the shift in incidence rate relative to its mean was significantly higher by 3.97% (95% CI: 2.18%, 4.96%, p = 0.000) in urban than in rural areas. With regard to economic status, if PM2.5 changes by 10 μg/m3, then the change in incidence rate relative to its mean was significantly lower by 0.99% (95% CI: -2.18%, 0.20%, p = 0.071) and 1.39% (95% CI: -2.78%, 0.00%, p = 0.037) in the middle and high economic groups than in the low economic group, respectively. The change in incidence rate relative to its mean was significantly lower by 1.98% (95% CI: -3.18%, -0.79%, p = 0.001) and 2.78% (95% CI: -4.17%, -1.39%, p = 0.000) in the middle and high education groups compared with the low education group, respectively, if PM2.5 changes by 10 μg/m3. We found no robust modification effects of employment rate and urbanisation growth rate. CONCLUSION Male residents in urban areas, in the lower economic or lower education counties are faced with a greater effect of PM2.5 on the incidence rate of lung cancer in China. The findings emphasize the need for public health intervention and urban planning initiatives targeting the urban-rural, educational or economic disparities in health associated with air pollution exposure. Future prediction on air pollution-induced health effects should consider such socioeconomic disparities, especially for the dominant urban-rural disparity in China.
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Affiliation(s)
- Huagui Guo
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, SAR, PR China; Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen 518057, PR China.
| | - Zheng Chang
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong, SAR, PR China.
| | - Jiansheng Wu
- Key Laboratory for Urban Habitat Environmental Science and Technology, Shenzhen Graduate School, Peking University, Shenzhen 518055, PR China; Key Laboratory for Earth Surface Processes, Ministry of Education, College of Urban and Environmental Sciences, Peking University, Beijing 100871, PR China.
| | - Weifeng Li
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, SAR, PR China; Shenzhen Institute of Research and Innovation, The University of Hong Kong, Shenzhen 518057, PR China.
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68
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Ambient air pollution and lung cancer risk among never-smokers in the Women's Health Initiative. Environ Epidemiol 2019; 3:e076. [PMID: 33778344 PMCID: PMC7939397 DOI: 10.1097/ee9.0000000000000076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022] Open
Abstract
Background Ambient air pollution is classified as a human carcinogen by the International Agency for Research on Cancer (IARC). However, epidemiologic studies supporting this classification have focused on lung cancer mortality rather than incidence, and spatial and temporal resolutions of exposure estimates have varied considerably across studies. Methods We evaluated the association of outdoor air pollution and lung cancer incidence among never-smoking participants of the Women's Health Initiative (WHI) study, a large, US-based cohort of postmenopausal women (N = 65,419; 265 cases). We used geospatial models to estimate exposures to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) based on residential addresses at baseline and throughout follow-up. We also characterized exposures to traffic-related air pollution by proximity to major roadways. We estimated hazard ratios (HRs) for the risk of lung cancer in association with these exposure metrics using Cox proportional hazards regression models. Results No compelling associations of PM2.5 and NO2 exposures with lung cancer risk were observed. An increased risk of lung cancer was observed when comparing those individuals with residences <50 versus ≥200 meters from a primary limited access highway (HR = 5.23; 95% confidence interval = 1.94, 14.13). Conclusions Our results do not exclude lung cancer risk estimates observed in association with PM2.5 and NO2 exposures identified in previous studies. Our results suggest that residential proximity to major roadways may be a proxy for carcinogenic exposures not correlated with PM2.5 or NO2 levels. New studies of air pollution and lung cancer incidence should characterize additional aspects of proximity to major roadways.
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69
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Ghassabian A, Pierotti L, Basterrechea M, Chatzi L, Estarlich M, Fernández-Somoano A, Fleisch AF, Gold DR, Julvez J, Karakosta P, Lertxundi A, Lopez-Espinosa MJ, Mulder TA, Korevaar TIM, Oken E, Peeters RP, Rifas-Shiman S, Stephanou E, Tardón A, Tiemeier H, Vrijheid M, Vrijkotte TGM, Sunyer J, Guxens M. Association of Exposure to Ambient Air Pollution With Thyroid Function During Pregnancy. JAMA Netw Open 2019; 2:e1912902. [PMID: 31617922 PMCID: PMC6806433 DOI: 10.1001/jamanetworkopen.2019.12902] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Air pollutants interact with estrogen nuclear receptors, but their effect on thyroid signaling is less clear. Thyroid function is of particular importance for pregnant women because of the thyroid's role in fetal brain development. OBJECTIVE To determine the short-term association of exposure to air pollution in the first trimester with thyroid function throughout pregnancy. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, 9931 pregnant women from 4 European cohorts (the Amsterdam Born Children and Their Development Study, the Generation R Study, Infancia y Medio Ambiente, and Rhea) and 1 US cohort (Project Viva) with data on air pollution exposure and thyroid function during pregnancy were included. The recruitment period for the Amsterdam Born Children and Their Development Study was January 2003 to March 2004; for Generation R, April 2002 to January 2006; for Infancia y Medio Ambiente, November 2003 to January 2008; for Rhea, February 2007 to February 2008; and for Project Viva, April 1999 to November 2002. Statistical analyses were conducted from January 2018 to April 2019. MAIN OUTCOMES AND MEASURES Residential air pollution concentrations (ie, nitrogen oxide and particulate matter [PM]) during the first trimester of pregnancy were estimated using land-use regression and satellite-derived aerosol optical depth models. Free thyroxine, thyrotropin, and thyroid peroxidase antibody levels were measured across gestation. Hypothyroxinemia was defined as free thyroxine below the fifth percentile of the cohort distribution with normal thyrotropin levels, following the American Thyroid Association guidelines. RESULTS Among 9931 participants, the mean (SD) age was 31.2 (4.8) years, 4853 (48.9%) had more than secondary educational levels, 5616 (56.6%) were nulliparous, 404 (4.2%) had hypothyroxinemia, and 506 (6.7%) tested positive for thyroid peroxidase antibodies. Concentrations of nitrogen dioxide and PM with an aerodynamic diameter of 2.5 μm or less (PM2.5) were lower and had less variation in women in the US cohort than those in European cohorts. No associations of nitrogen oxide with thyroid function were found. Higher exposures to PM2.5 were associated with higher odds of hypothyroxinemia in pregnant women (odds ratio per 5-μg/m3 change, 1.21; 95% CI, 1.00-1.47). Although exposure to PM with an aerodynamic diameter of 10 μm or less was not significantly associated with hypothyroxinemia, the coefficient was similar to that for the association of PM2.5 with hypothyroxinemia (odds ratio per 10-μg/m3 change, 1.18; 95% CI, 0.93-1.48). Absorbances of PM2.5 and PM with aerodynamic diameter from 2.5 to 10 μg and were not associated with hypothyroxinemia. There was substantial heterogeneity among cohorts with respect to thyroid peroxidase antibodies (P for heterogeneity, <.001), showing associations of nitrogen oxide and PM with thyroid autoimmunity only in the women in the Generation R Study. CONCLUSIONS AND RELEVANCE The findings of this study suggest that first-trimester exposures to PM2.5 were associated with mild thyroid dysfunction throughout pregnancy. The association of PM2.5 exposure with thyroid function during pregnancy is of global health importance because air pollution exposure is widespread and hypothyroxinemia may adversely influence the brain development of offspring.
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Affiliation(s)
- Akhgar Ghassabian
- Departments of Pediatrics, Environmental Medicine, and Population Health, School of Medicine, New York University, New York
| | - Livia Pierotti
- ISGlobal, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Mikel Basterrechea
- Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
- Biodonostia Health Research Institute, San Sebastian, Spain
- Public Health Division of Gipuzkoa, Basque Government, San Sebastian, Spain
| | - Leda Chatzi
- Department of Social Medicine, University of Crete, Heraklion, Greece
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Marisa Estarlich
- Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Ana Fernández-Somoano
- Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
- Instituto Universaitario de Oncología del Principado de Asturias, Departament of Medicine, University of Oviedo, Oviedo, Spain
| | - Abby F Fleisch
- Department of Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland
| | - Diane R Gold
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jordi Julvez
- ISGlobal, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
| | - Polyxeni Karakosta
- Department of Social Medicine, University of Crete, Heraklion, Greece
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aitana Lertxundi
- Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
- Biodonostia Health Research Institute, San Sebastian, Spain
- Department of Public Health and Preventive Medicine, University of Basque Country, Bilbao, Spain
| | - Maria-Jose Lopez-Espinosa
- Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
- Epidemiology and Environmental Health Joint Research Unit, The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Tessa A Mulder
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Tim I M Korevaar
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institution, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Robin P Peeters
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sheryl Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institution, Boston, Massachusetts
| | | | - Adonina Tardón
- Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
- Instituto Universaitario de Oncología del Principado de Asturias, Departament of Medicine, University of Oviedo, Oviedo, Spain
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Martine Vrijheid
- ISGlobal, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Tanja G M Vrijkotte
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Hospital del Mar Research Institute, Barcelona, Spain
| | - Mònica Guxens
- ISGlobal, Barcelona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
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Chevrier J, Rauch S, Obida M, Crause M, Bornman R, Eskenazi B. Sex and poverty modify associations between maternal peripartum concentrations of DDT/E and pyrethroid metabolites and thyroid hormone levels in neonates participating in the VHEMBE study, South Africa. ENVIRONMENT INTERNATIONAL 2019; 131:104958. [PMID: 31284115 PMCID: PMC6728182 DOI: 10.1016/j.envint.2019.104958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 05/05/2023]
Abstract
Indoor Residual Spraying (IRS), the application of insecticides on the inside walls of dwellings, is used by 84 countries for malaria control. Although effective in preventing malaria, this practice results in elevated insecticide exposure to >100 million people, most of whom are Africans. Pyrethroid insecticides and dichlorodiphenyl trichloroethane (DDT) are currently used for IRS. Animal and in vitro studies suggest that pyrethroids and DDT interfere with thyroid hormone homeostasis but human studies are inconsistent and no prior study has investigated this question in a population residing in an area where IRS is conducted. Our objective was thus to evaluate whether prenatal exposure to pyrethroids, DDT or DDT's breakdown product dichlorodiphenyl dichloroethylene (DDE) is associated with altered thyroid hormone levels among neonates from Limpopo, South Africa, where pyrethroids and DDT are used annually to control malaria. We measured serum DDT/E and urinary pyrethroid metabolite concentrations in maternal peripartum samples from 717 women participating in the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE), a birth cohort study conducted in Limpopo's Vhembe district. We measured total thyroxine (T4) and thyroid-stimulating hormone (TSH) in dried blood spots collected via heel stick. We found that all pyrethroid metabolites were positively associated with TSH; trans-DCCA and 3-PBA showed the strongest associations with a 12.3% (95%CI = 3.0, 22.3) and 14.0% (95%CI = 0.5, 30.2) change for each 10-fold increase in biomarker concentration, respectively. These associations were substantially stronger among children from households below the South African food poverty line. DDT and DDE were associated with lower total T4 among boys only (β = -0.27 μg/dL per 10-fold increase; 95%CI = -0.47, -0.04). Results suggest that prenatal exposure to DDT, DDE and pyrethroid insecticides is associated with changes in neonatal thyroid hormones consistent with hypothyroidism/hypothyroxinemia and that sex and poverty modify associations. Further research is needed to confirm these findings and examine whether they have implications for child development.
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Affiliation(s)
- Jonathan Chevrier
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada.
| | - Stephen Rauch
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Muvhulawa Obida
- University of Pretoria School of Health Systems and Public Health, and Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa
| | - Madelein Crause
- University of Pretoria School of Health Systems and Public Health, and Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa
| | - Riana Bornman
- University of Pretoria School of Health Systems and Public Health, and Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, Berkeley, CA, USA
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Sun Y, Liu B, Snetselaar LG, Wallace RB, Caan BJ, Rohan TE, Neuhouser ML, Shadyab AH, Chlebowski RT, Manson JE, Bao W. Association of Normal-Weight Central Obesity With All-Cause and Cause-Specific Mortality Among Postmenopausal Women. JAMA Netw Open 2019; 2:e197337. [PMID: 31339542 PMCID: PMC6659146 DOI: 10.1001/jamanetworkopen.2019.7337] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Current public health guidelines for obesity prevention and control focus on promoting a normal body mass index (BMI), rarely addressing central obesity, which is reflected by high waist circumference (WC) and common in the general population. Studies of the association of normal-weight central obesity with long-term health outcomes are sparse. OBJECTIVE To examine associations of normal-weight central obesity with all-cause and cause-specific mortality in postmenopausal women in the United States. DESIGN, SETTING, AND PARTICIPANTS A nationwide prospective cohort study of 156 624 postmenopausal women enrolled in the Women's Health Initiative at 40 clinical centers in the United States between 1993 and 1998. These women were observed through February 2017. Data analysis was performed from September 15, 2017, to March 13, 2019. EXPOSURES Different combinations of BMI (calculated as weight in kilograms divided by height in meters squared; normal weight: BMI, 18.5-24.9; overweight: BMI, 25.0-29.9; and obesity: BMI, ≥30) and WC (normal: WC, ≤88 cm and high: WC, >88 cm). MAIN OUTCOMES AND MEASURES Mortality from all causes, cardiovascular disease, and cancer. RESULTS Of the 156 624 women (mean [SD] age, 63.2 [7.2] years), during 2 811 187 person-years of follow-up, 43 838 deaths occurred, including 12 965 deaths from cardiovascular disease (29.6%) and 11 828 deaths from cancer (27.0%). Compared with women with normal weight and no central obesity and adjusted for demographic characteristics, socioeconomic status, lifestyle factors, and hormone use, the hazard ratio for all-cause mortality was 1.31 (95% CI, 1.20-1.42) among women with normal weight and central obesity, 0.91 (95% CI, 0.89-0.94) among women with overweight and no central obesity, 1.16 (95% CI, 1.13-1.20) for women with overweight and central obesity, 0.93 (95% CI, 0.89-0.94) for women with obesity and no central obesity, and 1.30 (95% CI, 1.27-1.34) for women with obesity and central obesity. Compared with normal weight without central obesity, normal-weight central obesity was associated with higher risk of cardiovascular disease mortality (hazard ratio, 1.25; 95% CI, 1.05-1.46) and cancer mortality (hazard ratio, 1.20; 95% CI, 1.01-1.43). CONCLUSIONS AND RELEVANCE Normal-weight central obesity in women was associated with excess risk of mortality, similar to that of women with BMI-defined obesity with central obesity. These findings underscore the need for future public health guidelines to include the prevention and control of central obesity, even in individuals with normal BMI.
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Affiliation(s)
- Yangbo Sun
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Buyun Liu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Linda G. Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Robert B. Wallace
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Bette J. Caan
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Thomas E. Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Marian L. Neuhouser
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Aladdin H. Shadyab
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla
| | - Rowan T. Chlebowski
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center Duarte, Duarte, California
| | - JoAnn E. Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
- Obesity Research and Education Initiative, University of Iowa, Iowa City
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City
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72
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Huang K, Yang X, Liang F, Liu F, Li J, Xiao Q, Chen J, Liu X, Cao J, Shen C, Yu L, Lu F, Wu X, Zhao L, Wu X, Li Y, Hu D, Huang J, Liu Y, Lu X, Gu D. Long-Term Exposure to Fine Particulate Matter and Hypertension Incidence in China. Hypertension 2019; 73:1195-1201. [PMID: 31067193 PMCID: PMC6656583 DOI: 10.1161/hypertensionaha.119.12666] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The risk of incident hypertension associated with long-term exposure to fine particulate matter (PM2.5) was still unclear by studies conducted in North America and Europe, and this relationship has rarely been quantified at higher ambient concentrations typically found in developing countries. We aimed to investigate the association between PM2.5 and incident hypertension using the large-scale prospective cohorts in China. We included 59 456 participants without hypertension aged ≥18 years from the China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) project. Data on ambient PM2.5 at participants' residential address were obtained during 2004 to 2015 using a satellite-based spatial-temporal model. Hazard ratios and 95% CIs were calculated for incident hypertension using stratified Cox proportional hazards models with adjustment of potential confounders. The findings indicated that average PM2.5 concentration from 2004 to 2015 at study participants' address was 77.7 μg/m3. During the follow-up of 364 947 person-years, we identified 13 981 incident hypertension cases. Compared with the lowest quartile exposure of PM2.5, participants in the highest quartile had an increased risk of incident hypertension with a hazard ratio (95% CI) of 1.77 (1.56-2.00). Each 10 μg/m3 increment of PM2.5 concentration could increase 11% risk of hypertension (hazard ratio, 1.11; 95% CI, 1.05-1.17). This cohort study provided the first evidence from China that long-term exposure to PM2.5 was independently associated with incident hypertension at relatively high ambient concentrations. Stringent strategies on PM2.5 pollution control are warranted to improve the air quality and contribute to the reduction of disease burden of hypertension in China.
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Affiliation(s)
- Keyong Huang
- Department of Epidemiology, Key Laboratory of
Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
| | - Xueli Yang
- Department of Epidemiology, Key Laboratory of
Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
| | - Fengchao Liang
- Department of Epidemiology, Key Laboratory of
Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
| | - Fangchao Liu
- Department of Epidemiology, Key Laboratory of
Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
| | - Jianxin Li
- Department of Epidemiology, Key Laboratory of
Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
| | - Qingyang Xiao
- Department of Environmental Health, Rollins School of
Public Health, Emory University, Atlanta, Georgia 30322, USA
| | - Jichun Chen
- Department of Epidemiology, Key Laboratory of
Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
| | - Xiaoqing Liu
- Division of Epidemiology, Guangdong Provincial
People’s Hospital and Cardiovascular Institute, Guangzhou 510080,
China
| | - Jie Cao
- Department of Epidemiology, Key Laboratory of
Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
| | - Chong Shen
- Department of Epidemiology and Biostatistics, School of
Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Ling Yu
- Department of Cardiology, Fujian Provincial People’s
Hospital, Fuzhou 350014, China
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center,
Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan 250062,
China
| | - Xianping Wu
- Sichuan Center for Disease Control and Prevention, Chengdu
610041, China
| | - Liancheng Zhao
- Department of Epidemiology, Key Laboratory of
Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
| | - Xigui Wu
- Department of Epidemiology, Key Laboratory of
Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
| | - Ying Li
- Department of Epidemiology, Key Laboratory of
Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
| | - Dongsheng Hu
- Department of Prevention Medicine, Shenzhen University
School of Medicine, Shenzhen 518060, China
| | - Jianfeng Huang
- Department of Epidemiology, Key Laboratory of
Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
| | - Yang Liu
- Department of Environmental Health, Rollins School of
Public Health, Emory University, Atlanta, Georgia 30322, USA
| | - Xiangfeng Lu
- Department of Epidemiology, Key Laboratory of
Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
| | - Dongfeng Gu
- Department of Epidemiology, Key Laboratory of
Cardiovascular Epidemiology, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing 100037, China
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73
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Samoli E, Stergiopoulou A, Santana P, Rodopoulou S, Mitsakou C, Dimitroulopoulou C, Bauwelinck M, de Hoogh K, Costa C, Marí-Dell'Olmo M, Corman D, Vardoulakis S, Katsouyanni K. Spatial variability in air pollution exposure in relation to socioeconomic indicators in nine European metropolitan areas: A study on environmental inequality. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2019; 249:345-353. [PMID: 30909127 DOI: 10.1016/j.envpol.2019.03.050] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/12/2019] [Accepted: 03/13/2019] [Indexed: 05/17/2023]
Abstract
A limited number of studies have addressed environmental inequality, using various study designs and methodologies and often reaching contradictory results. Following a standardized multi-city data collection process within the European project EURO-HEALTHY, we conducted an ecological study to investigate the spatial association between nitrogen dioxide (NO2), as a surrogate for traffic related air pollution, and ten socioeconomic indicators at local administrative unit level in nine European Metropolitan Areas. We applied mixed models for the associations under investigation with random intercepts per Metropolitan Area, also accounting for the spatial correlation. The stronger associations were observed between NO2 levels and population density, population born outside the European Union (EU28), total crimes per 100,000 inhabitants and unemployment rate that displayed a highly statistically significant trend of increasing concentrations with increasing levels of the indicators. Specifically, the highest vs the lowest quartile of each indicator above was associated with 48.7% (95% confidence interval (CI): 42.9%, 54.8%), 30.9% (95%CI: 22.1%, 40.2%), 19.8% (95%CI: 13.4%, 26.6%) and 15.8% (95%CI: 9.9%, 22.1%) increase in NO2 respectively. The association with population density most probably reflects the higher volume in vehicular traffic, which is the main source of NO2 in urban areas. Higher pollution levels in areas with higher percentages of people born outside EU28, crime or unemployment rates indicate that worse air quality is typically encountered in deprived European urban areas. Policy makers should consider spatial environmental inequalities to better inform actions aiming to lower urban air pollution levels that will subsequently lead to improved quality of life, public health and health equity across the population.
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Affiliation(s)
- E Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece.
| | - A Stergiopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - P Santana
- Centre of Studies in Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Portugal
| | - S Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - C Mitsakou
- Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK
| | - C Dimitroulopoulou
- Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK
| | - M Bauwelinck
- Interface Demography - Department of Sociology, Vrije Universiteit Brussel, Belgium
| | - K de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - C Costa
- Centre of Studies in Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Portugal
| | - M Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - D Corman
- Department of Public Health Sciences, Karolinksa Institute, Stockholm, Sweden
| | - S Vardoulakis
- Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK; Institute of Occupational Medicine, UK
| | - K Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece; Department Population Health Sciences and Department of Analytical, Environmental and Forensic Sciences, School of Population Health & Environmental Sciences, King's College London, UK
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74
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The Role of Socioeconomic Status in the Association of Lung Function and Air Pollution-A Pooled Analysis of Three Adult ESCAPE Cohorts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111901. [PMID: 31146441 PMCID: PMC6603717 DOI: 10.3390/ijerph16111901] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 12/20/2022]
Abstract
Ambient air pollution is a leading environmental risk factor and its broad spectrum of adverse health effects includes a decrease in lung function. Socioeconomic status (SES) is known to be associated with both air pollution exposure and respiratory function. This study assesses the role of SES either as confounder or effect modifier of the association between ambient air pollution and lung function. Cross-sectional data from three European multicenter adult cohorts were pooled to assess factors associated with lung function, including annual means of home outdoor NO2. Pre-bronchodilator lung function was measured according to the ATS-criteria. Multiple mixed linear models with random intercepts for study areas were used. Three different factors (education, occupation and neighborhood unemployment rate) were considered to represent SES. NO2 exposure was negatively associated with lung function. Occupation and neighborhood unemployment rates were not associated with lung function. However, the inclusion of the SES-variable education improved the models and the air pollution-lung function associations got slightly stronger. NO2 associations with lung function were not substantially modified by SES-variables. In this multicenter European study we could show that SES plays a role as a confounder in the association of ambient NO2 exposure with lung function.
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Gao X, Colicino E, Shen J, Kioumourtzoglou MA, Just AC, Nwanaji-Enwerem JC, Coull B, Lin X, Vokonas P, Zheng Y, Hou L, Schwartz J, Baccarelli AA. Impacts of air pollution, temperature, and relative humidity on leukocyte distribution: An epigenetic perspective. ENVIRONMENT INTERNATIONAL 2019; 126:395-405. [PMID: 30826618 PMCID: PMC6441628 DOI: 10.1016/j.envint.2019.02.053] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND Exploring the associations of air pollution and weather variables with blood leukocyte distribution is critical to understand the impacts of environmental exposures on the human immune system. OBJECTIVES As previous analyses have been mainly based on data from cell counters, which might not be feasible in epidemiologic studies including large populations of long-stored blood samples, we aimed to expand the understanding of this topic by employing the leukocyte distribution estimated by DNA methylation profiles. METHODS We measured DNA methylation profiles in blood samples using Illumina HumanMethylation450 BeadChip from 1519 visits of 774 Caucasian males participating in the Normative Aging Study. Leukocyte distribution was estimated using Houseman's and Horvath's algorithms. Data on air pollution exposure, temperature, and relative humidity within 28 days before each blood draw was obtained. RESULTS After fully adjusting for potential covariates, PM2.5, black carbon, particle number, carbon monoxide, nitrogen dioxide, sulfur dioxide, temperature, and relative humidity were associated with the proportions of at least one subtype of leukocytes. Particularly, an interquartile range-higher 28-day average exposure of PM2.5 was associated with 0.147-, 0.054- and 0.101-unit lower proportions (z-scored) of plasma cells, naïve CD8+ T cells, and natural killers, respectively, and 0.059- and 0.161-unit higher proportions (z-scored) of naïve CD4+ T cells and CD8+ T cells, respectively. CONCLUSIONS Our study suggests that short-term air pollution exposure, temperature, and relative humidity are associated with leukocyte distribution. Our study further provides a successful attempt to use epigenetic patterns to assess the influences of environmental exposures on human immune profiles.
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Affiliation(s)
- Xu Gao
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jincheng Shen
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | | | - Allan C Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Brent Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xihong Lin
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Pantel Vokonas
- Veterans Affairs Normative Aging Study, Veterans Affairs Boston Healthcare System, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Yinan Zheng
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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76
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Feng C, Forthman KL, Kuplicki R, Yeh HW, Stewart JL, Paulus MP. Neighborhood affluence is not associated with positive and negative valence processing in adults with mood and anxiety disorders: A Bayesian inference approach. Neuroimage Clin 2019; 22:101738. [PMID: 30870735 PMCID: PMC6416773 DOI: 10.1016/j.nicl.2019.101738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/09/2019] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
Survey-based studies show that neighborhood disadvantage is associated with community reported mental health problems. However, fewer studies have examined whether neighborhood characteristics have measurable impact on mental health status of individuals in general and whether neighborhood characteristics impact positive/negative valence processing at both behavioral and brain levels. This study addressed these questions by investigating effects of census-based neighborhood affluence on self-reported symptoms, brain functions, and structures associated with positive/negative valence processing in a sample of individuals with mood and anxiety disorders (n = 262). Employing a Bayesian inference approach, our investigation demonstrates that neighborhood affluence fails to be associated with positive/negative valence processing measured across multiple modalities, with the only effects of neighborhood affluence identified in trait anxiety scores. These findings highlight that while community-based relationships between neighborhood characteristics and mental health problems are strong, it is much less clear that these characteristics have a measurable impact on the individual.
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Affiliation(s)
- Chunliang Feng
- Laureate Institute for Brain Research, Tulsa, OK, United States of America
| | - Katherine L Forthman
- Laureate Institute for Brain Research, Tulsa, OK, United States of America; University of Tulsa, Tulsa, OK, United States of America
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, Tulsa, OK, United States of America
| | - Hung-Wen Yeh
- Laureate Institute for Brain Research, Tulsa, OK, United States of America
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States of America
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, United States of America.
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77
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Woo B, Kravitz-Wirtz N, Sass V, Crowder K, Teixeira S, Takeuchi DT. Residential Segregation and Racial/Ethnic Disparities in Ambient Air Pollution. RACE AND SOCIAL PROBLEMS 2019; 11:60-67. [PMID: 31440306 PMCID: PMC6706065 DOI: 10.1007/s12552-018-9254-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Race and ethnicity are consequential constructs when it comes to exposure to air pollution. Persistent environmental racial/ethnic inequalities call for attention to identifying the factors that maintain them. We examined associations between racial residential segregation and racial/ethnic inequalities in exposure to three types of air pollutants. Using data from the Panel Study of Income Dynamics (1990-2011), the U.S. Census (1990- 2010), and the Environmental Protection Agency, we tested the independent and joint contributions of race/ethnicity and metropolitan-level residential segregation on individual levels of exposure to air pollution nationwide. We found that racial and ethnic minorities were exposed to significantly higher levels of air pollution compared to Whites. The difference between minorities and Whites in exposure to all three types of air pollution was most pronounced in metropolitan areas with high levels of residential segregation. The environmental inequities observed in this study call for public health and policy initiatives to ameliorate the sources of racial/ethnic gaps in pollution exposure. Given the links between the physical environment and health, addressing such uneven environmental burdens may be a promising way to improve population health and decrease racial/ethnic inequalities therein.
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Affiliation(s)
- Bongki Woo
- College of Social Work, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208
| | | | - Victoria Sass
- Department of Sociology, University of Washington, Seattle
| | - Kyle Crowder
- Department of Sociology, University of Washington, Seattle
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Snow SJ, Phillips PM, Ledbetter A, Johnstone AF, Schladweiler MC, Gordon CJ, Kodavanti UP. The influence of maternal and perinatal high-fat diet on ozone-induced pulmonary responses in offspring. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2019; 82:86-98. [PMID: 30755101 PMCID: PMC10926063 DOI: 10.1080/15287394.2018.1564101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is growing interest in understanding how maternal diet might affect the sensitivity of offspring to environmental exposures. Previous studies demonstrated that adult rat offspring (approximately 6-months-old) from dams given a high-fat diet (HFD) prior to, during, and after pregnancy displayed elevated pulmonary responses to an acute ozone (O3) exposure. The aim of this study was to examine the influence of maternal and perinatal HFD on pulmonary and metabolic responses to O3 in male and female young-adult offspring (approximately 3-month old). One-month-old F0 female Long-Evans rats commenced HFD (60% kcal from fat) or control diet (CD; 10.5% kcal from fat) and were bred on PND 72. Offspring were maintained on respective HFD or CD until PND 29 when all groups were switched to CD. The 3-months-old female and male offspring (n = 10/group) were exposed to air or 0.8 ppm O3 for 5hr/day for 2 consecutive days. Maternal and perinatal HFD significantly increased body weight and body fat % in offspring regardless of gender. Ozone exposure, but not maternal and perinatal diet, induced hyperglycemia and glucose intolerance in the offspring. Ozone-induced alterations in pulmonary function were exacerbated by maternal and perinatal HFD in both offspring genders. Pulmonary injury/inflammation markers in response to O3 exposure such as bronchoalveolar lavage fluid total protein, lactate dehydrogenase, total cells, and neutrophils were further augmented in offspring (males>females) from dams fed the HFD. Data suggest that maternal and perinatal HFD may enhance the susceptibility of offspring to O3-induced pulmonary injury and that these effects may be sex-specific.
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Affiliation(s)
- Samantha J. Snow
- Environmental Public Health Division, US Environmental Protection Agency, Durham, North Carolina, USA
| | - Pamela M. Phillips
- Toxicity Assessment Division, US Environmental Protection Agency, Durham, North Carolina, USA
| | - Allen Ledbetter
- Environmental Public Health Division, US Environmental Protection Agency, Durham, North Carolina, USA
| | - Andrew F.M. Johnstone
- Toxicity Assessment Division, US Environmental Protection Agency, Durham, North Carolina, USA
| | - Mette C. Schladweiler
- Environmental Public Health Division, US Environmental Protection Agency, Durham, North Carolina, USA
| | - Christopher J. Gordon
- Toxicity Assessment Division, US Environmental Protection Agency, Durham, North Carolina, USA
| | - Urmila P. Kodavanti
- Environmental Public Health Division, US Environmental Protection Agency, Durham, North Carolina, USA
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Zhong P, Huang S, Zhang X, Wu S, Zhu Y, Li Y, Ma L. Individual-level modifiers of the acute effects of air pollution on mortality in Wuhan, China. Glob Health Res Policy 2018; 3:27. [PMID: 30214944 PMCID: PMC6131956 DOI: 10.1186/s41256-018-0080-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/20/2018] [Indexed: 11/25/2022] Open
Abstract
Background Ambient air pollution has posed negative effects on human health. Individual-level factors may modify this effect, but previous studies have controversial conclusions, and evidence is lacking especially in developing countries. This study aims to examine the modifying effects of sex, age, and education level of individuals on the associated between daily mortality and air pollutants, including particulate matter < 10 μm in aerodynamic diameter (PM10), sulfur dioxide (SO2), and nitrogen dioxide (NO2). Methods Time-series analysis was conducted to investigate the acute effects of the air pollution on daily mortality from January 2002 to December 2010 in Wuhan, China. Generalized Additive Models (GAM) were used to examine the association stratified by sex for non-accidental, cardiovascular, and respiratory mortality. For non-accidental mortality, stratified analysis was also conducted by age and educational level. Results Outdoor air pollution was associated with daily non-accidental and cardiovascular mortality. An increase of 10 μg/m3 in a 2-day average concentration of PM10, SO2, and NO2 was corresponding to the increase in non-accidental mortality of 0.29% (95%CI: 0.06–0.53%), 1.22% (95%CI: 0.77–1.67%) and 1.60% (95%CI: 1.00–2.19%), respectively. The effects of air pollution were faster in females than males. The magnitude of the estimates was higher for females with low education, aged 65–75 years for PM10 and < 65 years for SO2. To be more specific, we observed that per 10 μg/m3 increase in SO2 was association with increases in non-accidental mortality of 2.03% (95%CI: 1.38–2.67) for all females and 3.10% (95%CI: 2.05–4.16) for females with low education. Conclusion Females and people with low-education are more susceptible to the effect of air pollution, which would provide a sound scientific basis for determination of air pollution standards.
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Affiliation(s)
- Peirong Zhong
- 1Department of Healthcare Management, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071 China
| | - Shichun Huang
- 1Department of Healthcare Management, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071 China
| | - Xiaotong Zhang
- 1Department of Healthcare Management, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071 China
| | - Simin Wu
- 1Department of Healthcare Management, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071 China
| | - Yaohui Zhu
- 1Department of Healthcare Management, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071 China
| | - Yang Li
- Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Hongshan District, Wuhan, 430079 China
| | - Lu Ma
- 1Department of Healthcare Management, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan, 430071 China.,3Global Health Institute, Wuhan University, 115 Donghu Road, Wuchang District, Wuhan City, 430071 China
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80
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Arthur KN, Spencer-Hwang R, Knutsen SF, Shavlik D, Soret S, Montgomery S. Are perceptions of community safety associated with respiratory illness among a low-income, minority adult population? BMC Public Health 2018; 18:1089. [PMID: 30176823 PMCID: PMC6122647 DOI: 10.1186/s12889-018-5933-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/03/2018] [Indexed: 12/11/2022] Open
Abstract
Background Growing evidence suggests social disadvantage magnifies the harmful health effects of environmental hazards; however, there is limited research related to perceptions of risk among individuals who live near such environmental hazard sites. We explored the association between individual-level perception of community safety and respiratory illness among low-income, minority adults who live in a region with routine poor air quality exacerbated by the emissions of a nearby freight railyard. Methods Interview-administered household surveys were collected (87% response rate; n = 965) in English/Spanish from varying distances surrounding a freight railyard (analytic total n = 792: nearest region n = 215, middle n = 289, farthest n = 288). Illness outcome was an affirmative response to doctor-diagnosed asthma, bronchial condition, emphysema, COPD, or prescribed-inhaler usage. Respiratory symptoms outcome was an affirmative response to chronic cough, chronic mucus, or wheezing. The independent variable was perceived community safety. Results Outcome prevalences were similar across environmental hazard regions; 205 (25.9%) were diagnosed-illness cases and 166 (21.0%) diagnosis-free participants reported symptoms. Nearly half (47.5%) of participants reported lack of perceived community safety, which was associated with environmental hazard region (p < 0.0001). In multivariable log-binomial regression models adjusting for covariables (age, gender, race/ethnicity, smoking status, smoke exposure, residential duration, and distance from the railyard) respiratory illness diagnosis was associated with lack of perceived community safety (PR = 1.39; 95% CI 1.09, 1.76). Sensitivity analyses showed a non-significant but increasing trend in the strength of association between safety perceptions and illness diagnoses with closer proximity to the railyard. Conclusions Our findings contribute to the literature that individuals’ perceptions of community safety are associated with adverse respiratory health among a population living in high air pollution exposure areas. Electronic supplementary material The online version of this article (10.1186/s12889-018-5933-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristen N Arthur
- School of Public Health, Center for Community Resilience, Loma Linda University, 24951 N. Circle Drive, Nichol Hall, room 1401, Loma Linda, CA, 92350, USA.
| | - Rhonda Spencer-Hwang
- School of Public Health, Center for Community Resilience, Loma Linda University, 24951 N. Circle Drive, Nichol Hall, room 1401, Loma Linda, CA, 92350, USA
| | - Synnøve F Knutsen
- School of Public Health, Center for Nutrition, Health Lifestyle and Disease Prevention, Loma Linda University, Loma Linda, USA
| | - David Shavlik
- School of Public Health, Center for Community Resilience, Loma Linda University, 24951 N. Circle Drive, Nichol Hall, room 1401, Loma Linda, CA, 92350, USA
| | - Samuel Soret
- School of Public Health, Center for Community Resilience, Loma Linda University, 24951 N. Circle Drive, Nichol Hall, room 1401, Loma Linda, CA, 92350, USA
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81
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Robinson O, Tamayo I, de Castro M, Valentin A, Giorgis-Allemand L, Hjertager Krog N, Marit Aasvang G, Ambros A, Ballester F, Bird P, Chatzi L, Cirach M, Dėdelė A, Donaire-Gonzalez D, Gražuleviciene R, Iakovidis M, Ibarluzea J, Kampouri M, Lepeule J, Maitre L, McEachan R, Oftedal B, Siroux V, Slama R, Stephanou EG, Sunyer J, Urquiza J, Vegard Weyde K, Wright J, Vrijheid M, Nieuwenhuijsen M, Basagaña X. The Urban Exposome during Pregnancy and Its Socioeconomic Determinants. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:077005. [PMID: 30024382 PMCID: PMC6108870 DOI: 10.1289/ehp2862] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 05/31/2018] [Accepted: 06/03/2018] [Indexed: 05/15/2023]
Abstract
BACKGROUND The urban exposome is the set of environmental factors that are experienced in the outdoor urban environment and that may influence child development. OBJECTIVE The authors' goal was to describe the urban exposome among European pregnant women and understand its socioeconomic determinants. METHODS Using geographic information systems, remote sensing and spatio-temporal modeling we estimated exposure during pregnancy to 28 environmental indicators in almost 30,000 women from six population-based birth cohorts, in nine urban areas from across Europe. Exposures included meteorological factors, air pollutants, traffic noise, traffic indicators, natural space, the built environment, public transport, facilities, and walkability. Socioeconomic position (SEP), assessed at both the area and individual level, was related to the exposome through an exposome-wide association study and principal component (PC) analysis. RESULTS Mean±standard deviation (SD) NO2 levels ranged from 13.6±5.1 μg/m3 (in Heraklion, Crete) to 43.2±11 μg/m3 (in Sabadell, Spain), mean±SD walkability score ranged from 0.22±0.04 (Kaunas, Lithuania) to 0.32±0.07 (Valencia, Spain) and mean±SD Normalized Difference Vegetation Index ranged from 0.21±0.05 in Heraklion to 0.51±0.1 in Oslo, Norway. Four PCs explained more than half of variation in the urban exposome. There was considerable heterogeneity in social patterning of the urban exposome across cities. For example, high-SEP (based on family education) women lived in greener, less noisy, and less polluted areas in Bradford, UK (0.39 higher PC1 score, 95% confidence interval (CI): 0.31, 0.47), but the reverse was observed in Oslo (-0.57 PC1 score, 95% CI: -0.73, -0.41). For most cities, effects were stronger when SEP was assessed at the area level: In Bradford, women living in high SEP areas had a 1.34 higher average PC1 score (95% CI: 1.21, 1.48). CONCLUSIONS The urban exposome showed considerable variability across Europe. Pregnant women of low SEP were exposed to higher levels of environmental hazards in some cities, but not others, which may contribute to inequities in child health and development. https://doi.org/10.1289/EHP2862.
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Affiliation(s)
- Oliver Robinson
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, UK
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Ibon Tamayo
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Montserrat de Castro
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Antonia Valentin
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Lise Giorgis-Allemand
- Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Institut national de la santé et de la recherche médicale (Inserm), Institute for Advanced Biosciences (IAB), Inserm, CNRS, University Grenoble-Alpes, Grenoble, France
| | | | | | - Albert Ambros
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Ferran Ballester
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Epidemiology and Environmental Health Joint Research Unit, FISABIO–Universitat Jaume I–Universitat de Valencia, Valencia, Spain
| | - Pippa Bird
- Bradford Teaching Hospitals NHS Foundation Trust (BTHFT), Bradford Institute for Health Research, Bradford, UK
| | - Leda Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Genetics & Cell Biology, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Marta Cirach
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Audrius Dėdelė
- Department of Environmental Sciences, Vytautas Magnus University, Kaunus, Lithuania
| | - David Donaire-Gonzalez
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - Minas Iakovidis
- Environmental Chemical Processes Laboratory (ECPL), Chemistry Department, University of Crete, Heraklion, Crete, Greece
| | - Jesus Ibarluzea
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Health Research Institute (BIODONOSTIA), San Sebastian, Spain
- School of Psychology, University of the Basque Country, San Sebastián, Spain
- Public Health Department, Basque Government, San Sebastián, Spain
| | - Mariza Kampouri
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Johanna Lepeule
- Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Institut national de la santé et de la recherche médicale (Inserm), Institute for Advanced Biosciences (IAB), Inserm, CNRS, University Grenoble-Alpes, Grenoble, France
| | - Léa Maitre
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Rosie McEachan
- Bradford Teaching Hospitals NHS Foundation Trust (BTHFT), Bradford Institute for Health Research, Bradford, UK
| | - Bente Oftedal
- Norwegian Institute of Public Health (NIPH), Oslo, Norway
| | - Valerie Siroux
- Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Institut national de la santé et de la recherche médicale (Inserm), Institute for Advanced Biosciences (IAB), Inserm, CNRS, University Grenoble-Alpes, Grenoble, France
| | - Remy Slama
- Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Institut national de la santé et de la recherche médicale (Inserm), Institute for Advanced Biosciences (IAB), Inserm, CNRS, University Grenoble-Alpes, Grenoble, France
| | - Euripides G Stephanou
- Environmental Chemical Processes Laboratory (ECPL), Chemistry Department, University of Crete, Heraklion, Crete, Greece
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Jose Urquiza
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - John Wright
- Bradford Teaching Hospitals NHS Foundation Trust (BTHFT), Bradford Institute for Health Research, Bradford, UK
| | - Martine Vrijheid
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Mark Nieuwenhuijsen
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Xavier Basagaña
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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Schulz AJ, Mentz GB, Sampson N, Ward M, Dvonch JT, de Majo R, Israel BA, Reyes AG, Wilkins D. Independent and Joint Contributions of Fine Particulate Matter Exposure and Population Vulnerability to Mortality in the Detroit Metropolitan Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061209. [PMID: 29890666 PMCID: PMC6024972 DOI: 10.3390/ijerph15061209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/25/2018] [Accepted: 06/06/2018] [Indexed: 01/31/2023]
Abstract
Fine particulate matter is associated with adverse health outcomes. Exposure to fine particulate matter may disproportionately affect urban communities with larger numbers of vulnerable residents. We used multilevel logistic regression models to estimate the joint effects of fine particulate matter (PM2.5) and population vulnerabilities on cardiopulmonary mortality (CPM). We estimated the health benefits of reductions in PM2.5 across census tracts in the Detroit metropolitan area with varying levels of population vulnerability, using cluster-specific odds ratios scaled to reflect PM2.5-attributable cardiopulmonary risk. PM2.5 and population vulnerability were independently associated with odds of CPM. Odds of CPM and the number of deaths attributable to PM2.5 were greatest in census tracts with both high PM2.5 exposures and population vulnerability. Reducing PM2.5 in census tracts with high PM2.5 would lead to an estimated 18% annual reduction in PM2.5-attributable CPM. Between 78–79% of those reductions in CPM would occur within census tracts with high population vulnerabilities. These health benefits of reductions in PM2.5 occurred at levels below current U.S. reference concentrations. Focusing efforts to reduce PM2.5 in the Detroit metropolitan area in census tracts with currently high levels would also lead to greater benefits for residents of census tracts with high population vulnerabilities.
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Affiliation(s)
- Amy J Schulz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
| | - Graciela B Mentz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
| | - Natalie Sampson
- Department of Health and Human Services, University of Michigan-Dearborn, Dearborn, MI 48128, USA.
| | - Melanie Ward
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
| | - J Timothy Dvonch
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
| | - Ricardo de Majo
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
| | - Barbara A Israel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
| | - Angela G Reyes
- Detroit Hispanic Development Corporation, Detroit, MI 48216, USA.
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83
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Early-Life Air Pollution Exposure, Neighborhood Poverty, and Childhood Asthma in the United States, 1990⁻2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061114. [PMID: 29848979 PMCID: PMC6025399 DOI: 10.3390/ijerph15061114] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 12/17/2022]
Abstract
Ambient air pollution is a well-known risk factor of various asthma-related outcomes, however, past research has often focused on acute exacerbations rather than asthma development. This study draws on a population-based, multigenerational panel dataset from the United States to assess the association of childhood asthma risk with census block-level, annual-average air pollution exposure measured during the prenatal and early postnatal periods, as well as effect modification by neighborhood poverty. Findings suggest that early-life exposures to nitrogen dioxide (NO2), a marker of traffic-related pollution, and fine particulate matter (PM2.5), a mixture of industrial and other pollutants, are positively associated with subsequent childhood asthma diagnosis (OR = 1.25, 95% CI = 1.10–1.41 and OR = 1.25, 95% CI = 1.06–1.46, respectively, per interquartile range (IQR) increase in each pollutant (NO2 IQR = 8.51 ppb and PM2.5 IQR = 4.43 µ/m3)). These effects are modified by early-life neighborhood poverty exposure, with no or weaker effects in moderate- and low- (versus high-) poverty areas. This work underscores the importance of a holistic, developmental approach to elucidating the interplay of social and environmental contexts that may create conditions for racial-ethnic and socioeconomic disparities in childhood asthma risk.
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84
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Hooper LG, Kaufman JD. Ambient Air Pollution and Clinical Implications for Susceptible Populations. Ann Am Thorac Soc 2018; 15:S64-S68. [PMID: 29676646 PMCID: PMC5955035 DOI: 10.1513/annalsats.201707-574mg] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/16/2017] [Indexed: 11/20/2022] Open
Abstract
Air pollution is associated with a diversity of health effects, and evidence for a causal relationship with specific diseases exists. Exposure to air pollution is ubiquitous and typically beyond the control of the individual; the resulting health burden for the population can be high. Disproportionate effects are seen in individuals who have increased susceptibility to air pollution owing to individual- or community-level characteristics. As studies grow increasingly sophisticated, the understanding of who comprises the susceptible population continuously expands. Characteristics of susceptibility include genetic predisposition; socioeconomic factors; life stage; the presence of preexisting diseases, such as asthma, chronic obstructive pulmonary disease, cystic fibrosis; and the unique population of lung transplant recipients. This review explores how select populations, namely individuals with preexisting pulmonary disease and those living in communities of low socioeconomic status, have an increased susceptibility to the health effects of ambient air pollution. Genetic susceptibility, though a fundamental determinant of risk, is beyond the scope of this review and is not discussed. Strategies designed to mitigate air pollution-related health effects are discussed using a framework that addresses pollution exposure at multiple levels-government, state, community, and the individual. Emission reduction strategies remain the basis for public health protection; however, ancillary harm reduction measures are explored that can be adopted by susceptible communities and individuals.
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Affiliation(s)
| | - Joel D. Kaufman
- Department of Environmental and Occupational Health Sciences
- Department of Medicine, and
- Department of Epidemiology, University of Washington, Seattle, Washington
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85
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Individual and Neighborhood Stressors, Air Pollution and Cardiovascular Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018. [PMID: 29518012 PMCID: PMC5877017 DOI: 10.3390/ijerph15030472] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psychosocial and environmental stress exposures across the life course have been shown to be relevant in the development of cardiovascular disease (CVD). Assessing more than one stressor from different domains (e.g., individual and neighborhood) and across the life course moves us towards a more integrated picture of how stress affects health and well-being. Furthermore, these individual and neighborhood psychosocial stressors act on biologic pathways, including immune function and inflammatory response, which are also impacted by ubiquitous environmental exposures such as air pollution. The objective of this study is to evaluate the interaction between psychosocial stressors, at both the individual and neighborhood level, and air pollution on CVD. This study used data from the 2009–2011 Behavioral Risk Factor Surveillance System (BRFSS) from Washington State. Adverse childhood experiences (ACEs) measured at the individual level, and neighborhood deprivation index (NDI) measured at the zip code level, were the psychosocial stressors of interest. Exposures to three air pollutants—particulate matter (both PM2.5 and PM10) and nitrogen dioxide (NO2)—were also calculated at the zip code level. Outcome measures included several self-reported CVD-related health conditions. Both multiplicative and additive interaction quantified using the relative excess risk due to interaction (RERI), were evaluated. This study included 32,151 participants in 502 unique zip codes. Multiplicative and positive additive interactions were observed between ACEs and PM10 for diabetes, in models adjusted for NDI. The prevalence of diabetes was 1.58 (95% CI: 1.40, 1.79) times higher among those with both high ACEs and high PM10 compared to those with low ACEs and low PM10 (p-value = 0.04 for interaction on the multiplicative scale). Interaction was also observed between neighborhood-level stressors (NDI) and air pollution (NO2) for the stroke and diabetes outcomes on both multiplicative and additive scales. Modest interaction was observed between NDI and air pollution, supporting prior literature on the importance of neighborhood-level stressors in cardiovascular health and reinforcing the importance of NDI on air pollution health effects. ACEs may exert health effects through selection into disadvantaged neighborhoods and more work is needed to understand the accumulation of risk in multiple domains across the life course.
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86
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Cohen G, Levy I, Yuval, Kark JD, Levin N, Witberg G, Iakobishvili Z, Bental T, Broday DM, Steinberg DM, Kornowski R, Gerber Y. Chronic exposure to traffic-related air pollution and cancer incidence among 10,000 patients undergoing percutaneous coronary interventions: A historical prospective study. Eur J Prev Cardiol 2018; 25:659-670. [PMID: 29482439 DOI: 10.1177/2047487318760892] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Exposure to traffic-related air pollution (TRAP) is considered to have a carcinogenic effect. The authors previously reported a nonsignificant association between TRAP and cancer risk in a relatively small cohort of myocardial infarction survivors. This study assessed whether TRAP exposure is associated with subsequent cancer in a large cohort of coronary patients. Methods & results Consecutive patients undergoing percutaneous coronary interventions in a major medical centre in central Israel from 2004 to 2014 were followed for cancer through 2015. Residential levels of nitrogen oxides (NOx) - a proxy for TRAP - were estimated based on a high-resolution national land use regression model. Cox proportional hazards models were constructed to study relationships with cancer. Among 12,784 candidate patients, 9816 had available exposure data and no history of cancer (mean age, 68 years; 77% men). During a median (25th-75th percentiles) follow-up of 7.0 (3.9-9.3) years, 773 incident cases of cancer (8%) were diagnosed. In a multivariable-adjusted model, a 10-ppb increase in mean NOx exposure was associated with hazard ratios (HRs) of 1.07 (95% confidence interval [CI] 1.00-1.15) for all-site cancer and 1.16 (95% CI 1.05-1.28) for cancers previously linked to TRAP (lung, breast, prostate, kidney and bladder). A stronger association was observed for breast cancer (HR = 1.43; 95% CI 1.12-1.83). Associations were slightly strengthened after limiting the cohort to patients with more precise exposure assessment. Conclusion Coronary patients exposed to TRAP are at increased risk of several types of cancer, particularly lung, prostate and breast. As these cancers are amenable to prevention strategies, identifying highly exposed patients may provide an opportunity to improve clinical care.
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Affiliation(s)
- Gali Cohen
- 1 Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ilan Levy
- 2 Technion Center of Excellence in Exposure Science and Environmental Health, Technion - Israel Institute of Technology, Israel
| | - Yuval
- 2 Technion Center of Excellence in Exposure Science and Environmental Health, Technion - Israel Institute of Technology, Israel
| | - Jeremy D Kark
- 3 Epidemiology Unit, Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Organization, Jerusalem, Israel
| | - Noam Levin
- 4 Department of Geography, Hebrew University of Jerusalem, Israel
| | - Guy Witberg
- 5 Department of Cardiology, Rabin Medical Center (Beilinson and Hasharon Hospitals), Petach-Tikva, Israel
| | - Zaza Iakobishvili
- 5 Department of Cardiology, Rabin Medical Center (Beilinson and Hasharon Hospitals), Petach-Tikva, Israel
| | - Tamir Bental
- 5 Department of Cardiology, Rabin Medical Center (Beilinson and Hasharon Hospitals), Petach-Tikva, Israel
| | - David M Broday
- 2 Technion Center of Excellence in Exposure Science and Environmental Health, Technion - Israel Institute of Technology, Israel
| | - David M Steinberg
- 6 Department of Statistics and Operations Research, School of Mathematical Sciences, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Israel
| | - Ran Kornowski
- 5 Department of Cardiology, Rabin Medical Center (Beilinson and Hasharon Hospitals), Petach-Tikva, Israel.,7 Department of Cardiovascular Medicine, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yariv Gerber
- 1 Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel
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87
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Malecki KMC, Schultz AA, Bergmans RS. Neighborhood Perceptions and Cumulative Impacts of Low Level Chronic Exposure to Fine Particular Matter (PM 2.5) on Cardiopulmonary Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E84. [PMID: 29316641 PMCID: PMC5800183 DOI: 10.3390/ijerph15010084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/20/2017] [Accepted: 12/29/2017] [Indexed: 11/25/2022]
Abstract
Adverse perceptions of neighborhood safety, aesthetics and quality including access to resources can induce stress and may make individuals more sensitive to cardiopulmonary effects of air pollution exposure. Few studies have examined neighborhood perceptions as important and modifiable non-chemical stressors of the built environment that may exacerbate effects of air pollution on cardiopulmonary health outcomes, particularly among general population based cohorts. This study examined associations between low-level chronic exposure to fine particulate matter (PM2.5) and cardiopulmonary health, and the potential mediating or modifying effects of adverse neighborhood perceptions. Using data from the Survey of the Health of Wisconsin (SHOW), 2230 non-asthmatic adults age 21-74 were included in the analyses. The overall goals of this study were to assess if individuals who experience stress from neighborhood environments in which they live were more sensitive to low levels of fine particular matter (PM2.5 μg/m³). Demographic predictors of air pollution exposure included younger age, non-White race, lower education and middle class income. After adjustments, objective lung function measures (FEV1 and FEV1 to FVC ratio) were the only cardiopulmonary health indicators significantly associated with chronic three-year annual averages of PM2.5. Among all non-asthmatics, a ten unit increase in estimated three year annual average PM2.5 exposure was significantly associated with lower forced expiratory volume (L) in one second FEV1 (β = -0.40 μg/L; 95% CI -0.45, -0.06). Among all individuals, adverse perceptions of the neighborhood built environment did not appear to statistically moderate or mediate associations. However, stratified analysis did reveal significant associations between PM2.5 and lung function (FEV1) only among individuals with negative perceptions and increased reports of neighborhood stressors. These findings included individuals who felt their neighborhoods were poorly maintained (β = -0.82; 95% CI -1.35, -0.28), experienced stress from crime (β = -0.45; 95% CI -0.94, 0.04) or reported neighborhood is not well maintained (β = -1.13, CI -2.04, -0.24). These significant associations were similar for FEV1 to FVC ratio. Multi-pronged approaches addressing both neighborhood built environment aesthetics and air pollution regulation may be necessary to protect vulnerable and susceptible individuals and reduce persistent inequalities.
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Affiliation(s)
- Kristen M C Malecki
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 N. Walnut Street, Madison, WI 53726, USA.
| | - Amy A Schultz
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 N. Walnut Street, Madison, WI 53726, USA.
| | - Rachel S Bergmans
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
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88
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Vedal S, Han B, Xu J, Szpiro A, Bai Z. Design of an Air Pollution Monitoring Campaign in Beijing for Application to Cohort Health Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121580. [PMID: 29244738 PMCID: PMC5750998 DOI: 10.3390/ijerph14121580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 12/25/2022]
Abstract
No cohort studies in China on the health effects of long-term air pollution exposure have employed exposure estimates at the fine spatial scales desirable for cohort studies with individual-level health outcome data. Here we assess an array of modern air pollution exposure estimation approaches for assigning within-city exposure estimates in Beijing for individual pollutants and pollutant sources to individual members of a cohort. Issues considered in selecting specific monitoring data or new monitoring campaigns include: needed spatial resolution, exposure measurement error and its impact on health effect estimates, spatial alignment and compatibility with the cohort, and feasibility and expense. Sources of existing data largely include administrative monitoring data, predictions from air dispersion or chemical transport models and remote sensing (specifically satellite) data. New air monitoring campaigns include additional fixed site monitoring, snapshot monitoring, passive badge or micro-sensor saturation monitoring and mobile monitoring, as well as combinations of these. Each of these has relative advantages and disadvantages. It is concluded that a campaign in Beijing that at least includes a mobile monitoring component, when coupled with currently available spatio-temporal modeling methods, should be strongly considered. Such a campaign is economical and capable of providing the desired fine-scale spatial resolution for pollutants and sources.
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Affiliation(s)
- Sverre Vedal
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA 98105, USA.
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100112, China.
| | - Bin Han
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100112, China.
| | - Jia Xu
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA 98105, USA.
| | - Adam Szpiro
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA 98195, USA.
| | - Zhipeng Bai
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100112, China.
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89
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Orban E, Arendt M, Hennig F, Lucht S, Eisele L, Jakobs H, Dürig J, Hoffmann B, Jöckel KH, Moebus S. Is long-term particulate matter and nitrogen dioxide air pollution associated with incident monoclonal gammopathy of undetermined significance (MGUS)? An analysis of the Heinz Nixdorf Recall study. ENVIRONMENT INTERNATIONAL 2017; 108:237-245. [PMID: 28886417 DOI: 10.1016/j.envint.2017.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Exposure to air pollution activates the innate immune system and influences the adaptive immune system in experimental settings. We investigated the association of residential long-term exposure to particulate matter (PM) and NO2 air pollution with monoclonal gammopathy of undetermined significance (MGUS) as a marker of adaptive immune system activation. METHODS We used data from the baseline (2000-2003), 5-year (2006-2008) and 10-year (2011-2015) follow-up examinations of the German Heinz Nixdorf Recall cohort study of 4814 participants (45-75years). Residential exposure to PM size fractions and NO2 was estimated by land-use regression (ESCAPE-LUR, annual mean 2008/2009) and dispersion chemistry transport models (EURAD-CTM, 3-year mean at baseline). We used logistic regression to estimate the effects of air pollutants on incident MGUS, adjusting for age, sex, education, smoking status, physical activity, and BMI. As a non-linear approach, we looked at quartiles (2-4) of the air pollutants in comparison to quartile 1. RESULTS Of the 3949 participants with complete data, 100 developed MGUS during the 10-year follow-up. In the main model, only PMcoarse was associated with incident MGUS (OR per IQR (1.9μg/m3): 1.32, 95% CI 1.04-1.67). We further found positive associations between PM size fractions estimated by ESCAPE-LUR and incident MGUS by quartiles of exposure (OR Q4 vs Q1: PM2.5 2.03 (1.08-3.80); PM10 1.97 (1.05-3.67); PMcoarse 1.98 (1.09-3.60)). CONCLUSIONS Our results indicate that an association between long-term exposure to PM and MGUS may exist. Further epidemiologic studies are needed to corroborate this possible link.
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Affiliation(s)
- Ester Orban
- Centre for Urban Epidemiology (CUE), Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Marina Arendt
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Frauke Hennig
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sarah Lucht
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lewin Eisele
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hermann Jakobs
- Rhenish Institute for Environmental Research at the University of Cologne, Cologne, Germany
| | - Jan Dürig
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - Barbara Hoffmann
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Susanne Moebus
- Centre for Urban Epidemiology (CUE), Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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90
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Sass V, Kravitz-Wirtz N, Karceski SM, Hajat A, Crowder K, Takeuchi D. The effects of air pollution on individual psychological distress. Health Place 2017; 48:72-79. [PMID: 28987650 PMCID: PMC6023621 DOI: 10.1016/j.healthplace.2017.09.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/08/2017] [Accepted: 09/15/2017] [Indexed: 12/20/2022]
Abstract
This study is the first of its kind to utilize longitudinal, nationally representative panel data from the United States to assess the relationship between exposure to air pollution and reports of psychological distress. Using annual-average measures of air pollution in respondents' census blocks of residence we find that over the period 1999-2011 particulate matter 2.5 is significantly associated with increased psychological distress; this association remains even after controlling for a robust set of demographic, socioeconomic, and health-related covariates. This study suggests that public health efforts to reduce the personal and societal costs of mental illness should consider addressing not only individual characteristics and factors in the social environment, but also underexplored facets of the physical environment such as air pollution.
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Affiliation(s)
- Victoria Sass
- Department of Sociology, University of Washington, 211 Savery Hall, Box 353340, Seattle, WA 98195, USA.
| | - Nicole Kravitz-Wirtz
- Department of Emergency Medicine, School of Medicine, University of California, Davis, 2315 Stockton Blvd, Sacramento, CA, USA
| | - Steven M Karceski
- Department of Sociology, University of Washington, 211 Savery Hall, Box 353340, Seattle, WA 98195, USA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, F-262, Box 357236, Seattle, WA 98195, USA
| | - Kyle Crowder
- Department of Sociology, University of Washington, 211 Savery Hall, Box 353340, Seattle, WA 98195, USA
| | - David Takeuchi
- School of Social Work, Boston College, 264 Bay State Road, Boston, MA 02215, USA
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91
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Prescott SL, Logan AC. Each meal matters in the exposome: Biological and community considerations in fast-food-socioeconomic associations. ECONOMICS AND HUMAN BIOLOGY 2017; 27:328-335. [PMID: 29107462 DOI: 10.1016/j.ehb.2017.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/23/2017] [Accepted: 09/25/2017] [Indexed: 06/07/2023]
Abstract
Advances in omics and microbiome technology have transformed the ways in which the biological consequences of life in the 'ecological theatre' can be visualized. Exposome science examines the total accumulated environmental exposures (both detrimental and beneficial) as a means to understand the response of the 'total organism to the total environment' over time. The repetitive stimulation of compensatory physiological responses (immune, cardiovascular, neuroendocrine) in response to stress - including sources of stress highly relevant to socioeconomic disadvantage - may lead to metabolic dysregulation and cellular damage, ultimately influencing behavior and disease. The collective toll of physiological wear and tear, known as allostatic load, is not paid equally throughout developed societies. It is paid in excess by the disadvantaged. In the context of fast-food, human and experimental research demonstrates that the biological response to a single fast-food-style meal - especially as mediated by the microbiome- is a product of the person's total lived experience, including the ability to buffer the fast-food meal-induced promotion of inflammation and oxidative stress. Emerging research indicates that each meal and its nutritional context matters. As we discuss, equal weekly visits to major fast-food outlets by the affluent and deprived do not translate into biological equivalency. Hence, debate concerning reducing fast-food outlets through policy - especially in disadvantaged neighborhoods where they are prevalent - requires a biological context. The fast-food establishment and fast-food meal - as they represent matters of food justice and press upon non-communicable disease risk - are far more than physical structures and collections of carbohydrate, fat, sugar and sodium.
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Affiliation(s)
- Susan L Prescott
- School of Medicine, University of Western Australia, PO Box D184, Princess Margaret Hospital, Perth, WA, 6001, Australia; International Inflammation (in-FLAME) Network, Research Group of the Worldwide Universities Network (WUN), 6010 Park Ave, Suite #4081, West New York, NJ, 07093, United States.
| | - Alan C Logan
- International Inflammation (in-FLAME) Network, Research Group of the Worldwide Universities Network (WUN), 6010 Park Ave, Suite #4081, West New York, NJ, 07093, United States
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92
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Milojevic A, Niedzwiedz CL, Pearce J, Milner J, MacKenzie IA, Doherty RM, Wilkinson P. Socioeconomic and urban-rural differentials in exposure to air pollution and mortality burden in England. Environ Health 2017; 16:104. [PMID: 28985761 PMCID: PMC6389046 DOI: 10.1186/s12940-017-0314-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/02/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Socioeconomically disadvantaged populations often have higher exposures to particulate air pollution, which can be expected to contribute to differentials in life expectancy. We examined socioeconomic differentials in exposure and air pollution-related mortality relating to larger scale (5 km resolution) variations in background concentrations of selected pollutants across England. METHODS Ozone and particulate matter (sub-divided into PM10, PM2.5, PM2.5-10, primary, nitrate and sulphate PM2.5) were simulated at 5 km horizontal resolution using an atmospheric chemistry transport model (EMEP4UK). Annual mean concentrations of these pollutants were assigned to all 1,202,578 residential postcodes in England, which were classified by urban-rural status and socioeconomic deprivation based on the income and employment domains of the 2010 English Index of Multiple Deprivation for the Lower-level Super Output Area of residence. We used life table methods to estimate PM2.5-attributable life years (LYs) lost in both relative and absolute terms. RESULTS Concentrations of the most particulate fractions, but not of nitrate PM2.5 or ozone, were modestly higher in areas of greater socioeconomic deprivation. Relationships between pollution level and socioeconomic deprivation were non-linear and varied by urban-rural status. The pattern of PM2.5 concentrations made only a small contribution to the steep socioeconomic gradient in LYs lost due to PM2.5 per 103 population, which primarily was driven by the steep socioeconomic gradient in underlying mortality rates. In rural areas, the absolute burden of air pollution-related LYs lost was lowest in the most deprived deciles. CONCLUSIONS Air pollution shows modest socioeconomic patterning at 5 km resolution in England, but absolute attributable mortality burdens are strongly related to area-level deprivation because of underlying mortality rates. Measures that cause a general reduction in background concentrations of air pollution may modestly help narrow socioeconomic differences in health.
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Affiliation(s)
- Ai Milojevic
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Claire L. Niedzwiedz
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Drummond Street, Edinburgh, EH8 9XP UK
| | - Jamie Pearce
- Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Drummond Street, Edinburgh, EH8 9XP UK
| | - James Milner
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Ian A. MacKenzie
- School of GeoSciences, University of Edinburgh, James Hutton Road, Edinburgh, EH9 3FE UK
| | - Ruth M. Doherty
- School of GeoSciences, University of Edinburgh, James Hutton Road, Edinburgh, EH9 3FE UK
| | - Paul Wilkinson
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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93
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Yang L, Liu G, Zheng M, Jin R, Zhu Q, Zhao Y, Wu X, Xu Y. Highly Elevated Levels and Particle-Size Distributions of Environmentally Persistent Free Radicals in Haze-Associated Atmosphere. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:7936-7944. [PMID: 28613843 DOI: 10.1021/acs.est.7b01929] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Levels and particle-size distributions of environmentally persistent free radicals (EPFRs) in haze-associated atmospheric particulate matter (PM) have not been highlighted, even though they may enter the human body along with PM and adversely affect human health. This study quantified the levels of EPFRs in airborne PM with different aerodynamic diameters (dae) using electron paramagnetic resonance (EPR) spectroscopy. EPR spectra showed a single, unstructured signal from persistent semiquinone radicals. The average concentration of EPFRs in the airborne PM during haze events was 2.18 × 1220 spins/g (range: 3.06 × 1019-6.23 × 1020 spins/g), approximately 2 orders of magnitude higher than that reported previously in the US atmosphere. Particle-size distributions of EPFRs in four different PM fractions (dae > 10 μm, 10 μm < dae < 2.5 μm, 2.5 μm <dae < 1 μm, dae < 1 μm) indicated the highest levels of EPFRs in the PM fraction with dae < 1 μm, with average 1/e lifetime of 59.2 days. A significant occurrence of EPFRs in PM samples collected from coal-burning activities (1.52 × 1022 spins/g), automobile exhaust (3.0 × 1022 spins/g), and biomass burning activities (1.14 × 1022 spins/g) was detected, which may be potential primary sources of EPFRs in airborne PM. The results in this study may help to understand the sources and potential risks of EPFRs in airborne fine particles.
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Affiliation(s)
- Lili Yang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences , P.O. Box 2871, Beijing 100085, China
- University of Chinese Academy of Sciences , Beijing 100049, China
| | - Guorui Liu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences , P.O. Box 2871, Beijing 100085, China
- University of Chinese Academy of Sciences , Beijing 100049, China
| | - Minghui Zheng
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences , P.O. Box 2871, Beijing 100085, China
- University of Chinese Academy of Sciences , Beijing 100049, China
| | - Rong Jin
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences , P.O. Box 2871, Beijing 100085, China
- University of Chinese Academy of Sciences , Beijing 100049, China
| | - Qingqing Zhu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences , P.O. Box 2871, Beijing 100085, China
- University of Chinese Academy of Sciences , Beijing 100049, China
| | - Yuyang Zhao
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences , P.O. Box 2871, Beijing 100085, China
- University of Chinese Academy of Sciences , Beijing 100049, China
| | - Xiaolin Wu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences , P.O. Box 2871, Beijing 100085, China
- University of Chinese Academy of Sciences , Beijing 100049, China
| | - Yang Xu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences , P.O. Box 2871, Beijing 100085, China
- University of Chinese Academy of Sciences , Beijing 100049, China
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94
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Fuller CH, Feeser KR, Sarnat JA, O’Neill MS. Air pollution, cardiovascular endpoints and susceptibility by stress and material resources: a systematic review of the evidence. Environ Health 2017; 16:58. [PMID: 28615066 PMCID: PMC5471931 DOI: 10.1186/s12940-017-0270-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/06/2017] [Indexed: 05/29/2023]
Abstract
BACKGROUND AND METHODS Evidence shows that both the physical and social environments play a role in the development of cardiovascular disease. The purpose of this systematic review is two-fold: First, we summarize research from the past 12 years from the growing number of studies focused on effect modification of the relationships between air pollution and cardiovascular disease (CVD) outcomes by socioeconomic position (SEP) and; second, we identify research gaps throughout the published literature on this topic and opportunities for addressing these gaps in future study designs. RESULTS We identified 30 articles that examined the modifying effects of either material resources or psychosocial stress (both related to SEP) on associations between short and long-term air pollution exposure and CVD endpoints. Although 18 articles identified at least one interaction between an air pollutant and material resource indicator, 11 others did not. Support for susceptibility to air pollution by psychosocial stress was weaker; however, only three articles tested this hypothesis. Further studies are warranted to investigate how air pollution and SEP together may influence CVD. CONCLUSIONS We recommend that such research include thorough assessment of air pollution and SEP correlations, including spatial correlation; investigate air pollution indices or multi-pollutant models; use standardized metrics of SEP to enhance comparability across studies; and evaluate potentially susceptible populations.
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Affiliation(s)
- Christina H. Fuller
- Division of Environmental Health, School of Public Health, Georgia State University, Atlanta, GA USA
| | - Karla R. Feeser
- Division of Environmental Health, School of Public Health, Georgia State University, Atlanta, GA USA
| | - Jeremy A. Sarnat
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Marie S. O’Neill
- Departments of Environmental Health Sciences and Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI USA
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Air Quality Strategies on Public Health and Health Equity in Europe-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121196. [PMID: 27918457 PMCID: PMC5201337 DOI: 10.3390/ijerph13121196] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/02/2016] [Accepted: 11/25/2016] [Indexed: 12/04/2022]
Abstract
Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI), were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO2) and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter) and NO2 were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined, but no consistent impact on health equity from the strategies was found. The strategy types aiming to control air pollution in Europe and the health impact assessment methodology were also discussed in this review.
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Kaufman JD, Spalt EW, Curl CL, Hajat A, Jones MR, Kim SY, Vedal S, Szpiro AA, Gassett A, Sheppard L, Daviglus ML, Adar SD. Advances in Understanding Air Pollution and CVD. Glob Heart 2016; 11:343-352. [PMID: 27741981 PMCID: PMC5082281 DOI: 10.1016/j.gheart.2016.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/13/2016] [Accepted: 07/21/2016] [Indexed: 12/21/2022] Open
Abstract
The MESA Air (Multi-Ethnic Study of Atherosclerosis and Air Pollution) leveraged the platform of the MESA cohort into a prospective longitudinal study of relationships between air pollution and cardiovascular health. MESA Air researchers developed fine-scale, state-of-the-art air pollution exposure models for the MESA Air communities, creating individual exposure estimates for each participant. These models combine cohort-specific exposure monitoring, existing monitoring systems, and an extensive database of geographic and meteorological information. Together with extensive phenotyping in MESA-and adding participants and health measurements to the cohort-MESA Air investigated environmental exposures on a wide range of outcomes. Advances by the MESA Air team included not only a new approach to exposure modeling, but also biostatistical advances in addressing exposure measurement error and temporal confounding. The MESA Air study advanced our understanding of the impact of air pollutants on cardiovascular disease and provided a research platform for advances in environmental epidemiology.
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Affiliation(s)
- Joel D Kaufman
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Elizabeth W Spalt
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Cynthia L Curl
- Department of Community and Environmental Health, College of Health Sciences, Boise State University, Boise, ID, USA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Miranda R Jones
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sun-Young Kim
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Sverre Vedal
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Amanda Gassett
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sara D Adar
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
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