Socioeconomic status, particulate air pollution, and daily mortality: differential exposure or differential susceptibility

An investigation of inequalities in exposure to PM2.5 air pollution across small areas in Ireland

The link between exposure to air pollution and adverse effects on human health is well documented. Yet, in a European context, research on the spatial distribution of air pollution and the characteristics of areas is relatively scarce, and there is a need for research using different spatial scales, a wider variety of socioeconomic indicators (such as ethnicity) and new methodologies to assess these relationships. This study uses comprehensive data on a wide range of demographic and socioeconomic indicators, matched to data on PM2.5 concentrations for small areas in Ireland, to assess the relationship between social vulnerability and PM2.5 air pollution. Examining a wide range of socioeconomic indicators revealed some differentials in PM2.5 concentration levels by measure and by rural and urban classification. However, statistical modelling using concentration curves and concentration indices did not present substantial evidence of inequalities in PM2.5 concentrations across small areas. In common with other western European countries, an overall decline in the levels of PM2.5 between 2011 and 2016 was observed in Ireland, though the data indicates that almost all small areas in Ireland were found to have exceeded the World Health Organization (WHO)'s PM2.5 annual guideline (of 5 µg/m3), calling for greater policy efforts to reduce air pollution in Ireland. The recent Clean Air Strategy contains a commitment to achieve the WHO guideline limits for PM2.5 by 2040, with interim targets at various points over the next two decades. Achieving these targets will require policy measures to decarbonise home heating, promote active travel and the transition to electric vehicles, and further regulations on burning fossil fuels and enforcing environmental regulations more tightly. From a research and information-gathering perspective, installing more monitoring stations at key points could improve the quality and spatial dimension of the data collected and facilitate the assessment of the implementation of the measures in the Clean Air Strategy.

The mediating role of air pollutants in the association between education and lung function among the elderly, the HAPIEE study

BACKGROUND

Chronic exposure to air pollutants harms human health, and at a geographical level, concentrations of air pollutants are often associated with socioeconomic disadvantage.

OBJECTIVES

The aim of this study was to investigate the effects of educational attainment and air pollution on lung function in older adults, and whether air pollution may mediate the effect of education.

METHODS

The study included 6381 individuals (mean age 58.24 ± 7.14 years) who participated in the Czech HAPPIE (Health, Alcohol, and Psychosocial Factors in Eastern Europe) study. Participants' residential addresses were linked to air pollution data, including mean exposures to PM10 (particulate matter of aerodynamic diameter below 10 μm) and NO2 (nitrogen dioxide). We used path analysis to link educational attainment and air pollutants to a standardized measure of the Forced Expiratory Volume in the first second (FEV1).

RESULTS

Higher levels of participants' education were associated with lower exposures to PM10 and NO2. Individuals with tertiary education had higher standardized FEV1 than individuals with primary education (88 % vs 95 %). Path analysis revealed a direct positive effect of education on FEV1, while about 12 % of the relationship between education and lung function was mediated by PM10 and NO2. CONCLUSIONS: Education (typically completed at young ages) appeared to have a protective effect on lung function later in life, and a small part of this effect was mediated by air pollution.

Ambient air pollution and hypertensive disorders of pregnancy in Rome

BACKGROUND

Ambient air pollution has been associated with hypertensive disorders of pregnancy (HDP), but few studies rely on assessment of fine-scale variation in air quality, specific subtypes and multi-pollutant exposures.

AIM

To study the impact of long-term exposure to individual and mixture of air pollutants on all and specific subtypes of HDP.

METHODS

We obtained data from 130,470 liveborn singleton pregnacies in Rome during 2014-2019. Spatiotemporal land-use random-forest models at 1 km spatial resolution assigned to the maternal residential addresses were used to estimate the exposure to particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), and ozone (O3).

RESULTS

For PM2.5, PM10 and NO2, there was suggestive evidence of increased risk of preeclampsia (PE, n = 442), but no evidence of increased risk for all subtypes of HDP (n = 2297) and gestational hypertension (GH, n = 1901). For instance, an interquartile range of 7.0 μg/m3 increase in PM2.5 exposure during the first trimester of pregnancy was associated with an odds ratio (OR) of 1.06 (95% confidence interval: 0.81, 1.39) and 1.04 (0.92, 1.17) after adjustment for NO2 and the corresponding results for a 15.7 μg/m3 increase in NO2 after adjustment for PM2.5 were 1.11 (0.92, 1.34) for PE and 0.83 (0.76, 0.90) for HDP. Increased risks for HDP and GH were suggested for O3 in single-pollutant models and for PM after adjustment for NO2, but all other associations were stable or attenuated in two-pollutant models.

CONCLUSIONS

The results of our study suggest that PM2.5, PM10 and NO2 increases the risk of PE and that these effects are robust to adjustment for O3 while the increased risks for GH and HDP suggested for O3 attenuated after adjustment for PM or NO2. Additional studies are needed to evaluate the effects of source-specific component of PM on subtypes as well as all types of HDP which would help to target preventive actions.

Unveiling the lead exposure attributed burden in Iran from 1990 to 2019 through the lens of the Global Burden of Disease study 2019

This study aimed to investigate the estimated burden attributed to lead exposure (LE), at the national and subnational levels from 1990 to 2019 in Iran. The burden attributed to LE was determined through the estimation of deaths, disability-adjusted life years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) using the comparative risk assessment method of Global Burden of Disease (GBD) study presenting as age-standardized per 100,000 person year (PY) with 95% uncertainty intervals (95% UI). Furthermore, the burden of each disease were recorded independently. Eventually, the age-standardized YLLs, DALYs, deaths and YLDs rates attributed to LE demonstrated a decrease of 50.7%, 48.9%, 38.0%, and 36.4%, respectively, from 1990 to 2019. The most important causes of LE burden are divided into two acute and chronic categories: acute, mainly causes mental disorders (DALYs rate of 36.0 in 2019), and chronic, results in cardiovascular diseases (CVDs) (DALYs rate of 391.8) and chronic kidney diseases (CKDs) (DALYs rate of 26.6), with CVDs bearing the most significant burden. At the sub-national level, a decrease in burden was evident in most provinces; moreover, low and low-middle SDI provinces born the highest burden. The burden increased mainly by ageing and was higher in males than females. It was concluded that although the overall decrease in the burden; still it is high, especially in low and low-middle SDI provinces, in advanced ages and in males. Among IDID, CKDs and CVDs that are the most important causes of LE-attributed burden in Iran; CVDs bear the highest burden.

Climate change, ambient air pollution, and students' mental health

The impact of global climate change and air pollution on mental health has become a crucial public health issue. Increased public awareness of health, advancements in medical diagnosis and treatment, the way media outlets report environmental changes and the variation in social resources affect psychological responses and adaptation methods to climate change and air pollution. In the context of climate change, extreme weather events seriously disrupt people's living environments, and unstable educational environments lead to an increase in mental health issues for students. Air pollution affects students' mental health by increasing the incidence of diseases while decreasing contact with nature, leading to problems such as anxiety, depression, and decreased cognitive function. We call for joint efforts to reduce pollutant emissions at the source, improve energy structures, strengthen environmental monitoring and gover-nance, increase attention to the mental health issues of students, and help student groups build resilience; by establishing public policies, enhancing social support and adjusting lifestyles and habits, we can help students cope with the constantly changing environment and maintain a good level of mental health. Through these comprehensive measures, we can more effectively address the challenges of global climate change and air pollution and promote the achievement of the United Nations Sustainable Development Goals.

Long-term effects of air pollutants on respiratory and cardiovascular mortality in a port city along the Adriatic sea

BACKGROUND

Shipping and port-related air pollution has a significant health impact on a global scale. The present study aimed to assess the mortality burden attributable to long-term exposure to ambient particulate matter (PM2.5, PM10) and nitrogen dioxide (NO2) in the city of Ancona (Italy), with one of the leading national commercial harbours.

METHODS

Exposure to air pollutants was derived by dispersion models. The relationship between the long-term exposure of air pollution exposure and cause-specific mortality was evaluated by Poisson regression models, after adjustment for gender, age and socioeconomic status. Results are expressed as percent change of risk (and relative 95% confidence intervals) per 5 unit increases in the exposures. The health impact on the annual number of premature cause-specific deaths was also assessed.

RESULTS

PM2.5 and NO2 annual concentrations were higher in the area close to the harbour than in the rest of the city. Positive associations between each pollutant and most of the mortality outcomes were observed, with estimates of up to 7.6% (95%CI 0.1, 15.6%) for 10 µg/m3 increase in NO2 and cardiovascular mortality and 15.3% (95%CI-1.1, 37.2%) for 10 µg/m3 increase PM2.5 and lung cancer. In the subpopulation living close to the harbour, there were excess risks of up to 13.5%, 24.1% and 37.9% for natural, cardiovascular and respiratory mortality. The number of annual premature deaths due to the excess of PM2.5 and NO2 exposure (having as a reference the 2021 World Health Organization Air Quality Guidelines) was 82 and 25, respectively.

CONCLUSIONS

Our study confirms the long-term health effects of PM and NO2 on mortality and reveals a higher mortality burden in areas close to shipping and port-related emissions. Estimating the source-specific health burdens is key to achieve a deeper understanding of the role of different emission sources, as well as to support effective and targeted mitigation strategies.

Monitoring Sensors for Urban Air Quality: The Case of the Municipality of Lisbon

Air pollution is a global issue that impacts environmental inequalities, and air quality sensors can have a decisive role in city policymaking for future cities. Science and society are already aware that during the most challenging times of COVID-19, the levels of air pollution in cities decreased, especially during lockdowns, when road traffic was reduced. Several pollution parameters can be used to analyse cities' environmental challenges, and it is more pressing than ever to have city climate decisions supported by sensor data. We have applied a data science approach to understand the evolution of the levels of carbon monoxide, nitrogen dioxide, particulate matter 2.5, and particulate matter 10 between August 2021 and July 2022. The analysis of the air quality levels, captured for the first time via 80 monitoring stations distributed throughout the municipality of Lisbon, has allowed us to realize that nitrogen dioxide and particulate matter 10 exceed the levels that are recommended by the World Health Organization, thereby increasing the health risk for those who live and work in Lisbon. Supported by these findings, we propose a central role for air quality sensors for policymaking in future cities, taking as a case study the municipality of Lisbon, Portugal, which is among the European cities that recently proposed be climate-neutral and smart city by 2030.

Age-period-cohort analysis of lung cancer mortality inequalities in Southern Spain: missed opportunities for implementing equitable tobacco control policies

BACKGROUND

Lung cancer mortality in European countries shows different epidemiological patterns according to sex and socioeconomic variables. Some countries show decreasing rates in both sexes, while others show a delayed profile, with increasing mortality in women, inconsistently influenced by socioeconomic status. Our aim was to evaluate the effect of age, period and birth cohort on lung cancer mortality inequalities in men and women in Andalusia, the southernmost region in Spain.

METHODS

We used the Longitudinal Database of the Andalusian Population, which collects demographic and mortality data from the 2001 census cohort of more than 7.35 million Andalusians, followed up between 2002 and 2016. Mortality rates were calculated for men and women by educational level, and small-area deprivation. Poisson models were used to assess trends in socioeconomic inequalities in men and women. Finally, age-period-cohort (APC) models were used separately for each educational level and gender.

RESULTS

There were 39,408 lung cancer deaths in men and 5,511 in women, yielding crude mortality rates of 78.1 and 11.4 × 105 person-years, respectively. In men higher mortality was found in less educated groups and inequalities increased during the study period: i.e. the rate ratio for primary studies compared to university studies increased from 1.30 (CI95:1.18-1.44) to 1.57 (CI95:1.43-1.73). For women, educational inequalities in favour of the less educated tended to decrease moderately. In APC analysis, a decreasing period effect in men and an increasing one in women were observed. Cohort effect differed significantly by educational level. In men, the lower the educational level, the earlier the peak effect was reached, with a 25-year difference between the least-educated and college-educated. Conversely, college-educated women reached the peak effect with a 12-year earlier cohort than the least-educated women. The decline of mortality followed the same pattern both in men and women, with the best-educated groups experiencing declining rates with earlier birth cohorts.

CONCLUSIONS

Our study reveals that APC analysis by education helps to uncover changes in trends occurring in different socioeconomic and gender groups, which, combined with data on smoking prevalence, provide important clues for action. Despite its limitations, this approach to the study of lung cancer inequalities allows for the assessment of gaps in historical and current tobacco policies and the identification of population groups that need to be prioritised for public health interventions.

Inequalities in Environmental Cancer Risk and Carcinogen Exposures: A Scoping Review

Background: Cancer is the leading cause of death in Canada and a major cause of death worldwide. Environmental exposure to carcinogens and environments that may relate to health behaviors are important to examine as they can be modified to lower cancer risks. Built environments include aspects such as transit infrastructure, greenspace, food and tobacco environments, or land use, which may impact how people move, exercise, eat, and live. While environments may play a role in overall cancer risk, exposure to carcinogens or healthier environments is not equitably spread across space. Exposures to carcinogens commonly concentrate among socially and/or economically disadvantaged populations. While many studies have examined inequalities in exposure or cancer risk, this has commonly been for one exposure. Methods: This scoping review collected and synthesized research that examines inequities in carcinogenic environments and exposures. Results: This scoping review found that neighborhoods with higher proportions of low-income residents, racialized people, or same-sex couples had higher exposures to carcinogens and environments that may influence cancer risk. There are currently four main themes in research studying inequitable exposures: air pollution and hazardous substances, tobacco access, food access, and other aspects of the built environment, with most research still focusing on air pollution. Conclusions: More work is needed to understand how exposures to these four areas intersect with other factors to reduce inequities in exposures to support longer-term goals toward cancer prevention.

Aerosol Oxidative Potential in the Greater Los Angeles Area: Source Apportionment and Associations with Socioeconomic Position

Oxidative potential (OP) has been proposed as a possible integrated metric for particles smaller than 2.5 μm in diameter (PM_2.5) to evaluate adverse health outcomes associated with particulate air pollution exposure. Here, we investigate how OP depends on sources and chemical composition and how OP varies by land use type and neighborhood socioeconomic position in the Los Angeles area. We measured OH formation (OP^OH), dithiothreitol loss (OP^DTT), black carbon, and 52 metals and elements for 54 total PM_2.5 samples collected in September 2019 and February 2020. The Positive Matrix Factorization source apportionment model identified four sources contributing to volume-normalized OP^OH: vehicular exhaust, brake and tire wear, soil and road dust, and mixed secondary and marine. Exhaust emissions contributed 42% of OP^OH, followed by 21% from brake and tire wear. Similar results were observed for the OP^DTT source apportionment. Furthermore, by linking measured PM_2.5 and OP with census tract level socioeconomic and health outcome data provided by CalEnviroScreen, we found that the most disadvantaged neighborhoods were exposed to both the most toxic particles and the highest particle concentrations. OP^OH exhibited the largest inverse social gradients, followed by OP^DTT and PM_2.5 mass. Finally, OP^OH was the metric most strongly correlated with adverse health outcome indicators.

Pathways to Environmental Inequality: How Urban Traffic Noise Annoyance Varies across Socioeconomic Subgroups

The article investigates how socioeconomic background affects noise annoyance caused by residential road traffic in urban areas. It is argued that the effects of socioeconomic variables (migration background, education, and income) on noise annoyance tend to be underestimated because these effects are mainly indirect. We specify three indirect pathways. (1) A "noise exposure path" assumes that less privileged households are exposed to a higher level of noise and therefore experience stronger annoyance. (2) A "housing attributes path" argues that less privileged households can shield themselves less effectively from noise due to unfavorable housing conditions and that this contributes to annoyance. (3) Conversely, an "environmental susceptibility path" proposes that less privileged people are less concerned about the environment and have a lower noise sensitivity, and that this reduces their noise annoyance. Our analyses rest on a study carried out in four European cities (Mainz and Hanover in Germany, Bern and Zurich in Switzerland), and the results support the empirical validity of the three indirect pathways.

Inequality of Low Air Quality-Related Health Impacts among Socioeconomic Groups in the World of Work

This research aimed to assess the perceptions of air quality and health symptoms caused by low urban air quality among vulnerable socio-economic groups in the world of work in Bangkok, Thailand through a questionnaire survey of 400 workers of both formal and informal sectors in the five districts with different socio-economic characteristics and levels of air pollution. The findings showed symmetry between air quality-monitoring data and health symptoms of different socio-economic groups but asymmetry between air quality-monitoring data and people's perceptions of air quality in their areas. It also showed inequalities of low air quality-related health impacts on socio-economic groups in the world of work. People working near the streets, highways, and industrial zones tended to have more health symptoms related to low air quality, and informal sector workers faced more health risks than formal sector workers. The study appeals for effective air pollution communication to enhance the public and informal sector worker population's literacy of air pollution, the sources of air pollution and its critical health impacts, and the available and sufficient primary care organizations and community health care centers to address work-related health needs to reach the informal sector worker population.

Extreme Temperature and Mortality by Educational Attainment in Spain, 2012-2018

Extreme temperatures are a threat to public health, increasing mortality in the affected population. Moreover, there is substantial research showing how age and gender shape vulnerabilities to this environmental risk. However, there is only limited knowledge on how socioeconomic status (SES), operationalized using educational attainment, stratifies the effect of extreme temperatures on mortality. Here, we address this link using Poisson regression and administrative data from 2012 to 2018 for 50 Spanish Provinces on individuals aged above 65 matched with meteorological data provided by the E-OBS dataset. In line with previous studies, results show that hot and cold days increase mortality. Results on the interaction between SES and extreme temperatures show a positive and significant effect of exposure to heat and cold for individuals with medium and low SES level. Conversely, for high SES individuals we do not find evidence of a robust association with heat or cold. We further investigate how the local climate moderates these associations. A warmer climate increases risks with exposures to low temperatures and vice versa for hot temperatures in the pooled sample. Moreover, we observe that results are mostly driven by low SES individuals being particularly vulnerable to heat in colder climates and cold in warmer climates. In conclusion, results highlight how educational attainment stratifies the effect of extreme temperatures and the relevance of the local climate in shaping risks of low SES individuals aged above 65.

Carcinogenic air pollution along the United States' southern border: Neighborhood inequities in risk

Air pollution poses serious and socially inequitable risks to public health. Social disparities are marked along the US-Mexico border, yet prior research has not assessed inequities in air pollution exposure across the entire US-side of the border region. We apply an intersectional approach to examine contextually relevant sociodemographic variables, including (1) Hispanic/Latinx ethnicity by race and (2) nativity (US vs. Foreign) by citizenship, and cancer risks attributable to air pollution exposures. We pair data from the 2012-2016 American Community Survey with 2014 National Air Toxics Assessment estimates of carcinogenic risks from all sources of hazardous air pollutants at the census tract level (n = 1448) and use a series of generalized estimating equations to assess inequities in risk. Increased concentrations of renter-occupants, Hispanics, mid-to-high socioeconomic status households, and foreign-born citizens were associated with elevated risks. Hispanic ethnicity intersected with non-White racial identification to amplify risks. In contrast, increased concentrations of non-Hispanic Black people and foreign-born non-citizens were not associated with disparate risks. To ameliorate environmental health inequities in this context, research and policy actions must be tailored to the US-Mexico border and consider intersectional positions within the Hispanic population.

Does the environmental inequality matter? A literature review

The environmental inequality theory reveals that the risk of environmental pollution exposure varies among regions and groups and that particular groups face a higher threat of environmental pollution. In recent years, studies on the environmental inequality issue in developed countries have been increasing, while related literature on developing countries is very scarce. It has been found that some factors, such as race and economic status, have a close relationship with the risk of environmental pollution exposure faced by individuals. For the first time, this paper provides an extensive review of existing theoretical and empirical studies on environmental inequality. We review, in detail, the evolution of the environmental inequality theory, including the definition and measurement of environmental inequality. Further, we provide a systematic refresher on the main performance of environmental inequality, including health, education, labor productivity, and real estate prices. We also identify several causes of environmental inequality, such as ethnic differences, economic status, human capital, and household registration systems. Finally, we discuss prospects for the future research on this issue.

Air pollution at the residence of Danish adults, by socio-demographic characteristics, morbidity, and address level characteristics

BACKGROUND

Exposure to outdoor air pollution is associated with adverse health effects. Previous studies have indicated higher levels of air pollution in socially deprived areas.

AIM

To investigate associations between air pollution and socio-demographic variables, comorbidity, stress, and green space at the residence in Denmark.

METHODS

We included 2,237,346 persons living in Denmark, aged 35 years or older in 2017. We used the high resolution, multi-scale DEHM/UBM/AirGIS air pollution modelling system to calculate mean concentrations of air pollution with PM_2.5, elemental carbon, ultrafine particles and NO₂ at residences held the preceding five years. We used nationwide registries to retrieve information about socio-demographic indicators at the individual and neighborhood levels. We used general linear regression models to analyze associations between socio-demographic indicators and air pollution at the residence.

RESULTS

Individuals with high SES (income, higher white-collar worker and high educational level) and of non-Danish origin were exposed to higher levels of air pollution than individuals of low SES and of Danish origin, respectively. We found comparable levels of air pollution according to sex, stress events and morbidity. For neighborhood level SES indicators, we found high air pollution levels in neighborhoods with low SES measured as proportion of social housing, sole providers, low income and unemployment. In contrast, we found higher air pollution levels in neighborhoods with higher educational level and a low proportion of manual labor. People living in an apartment and/or with little green space had higher air pollution levels.

CONCLUSION

In Denmark, high levels of residential air pollution were associated with higher individual SES and non-Danish origin. For neighborhood-level indicators of SES, no consistent pattern was observed. These results highlight the need for analyzing many different socio-demographic indicators to understand the complex associations between SES and exposure to air pollution.

Evaluating health outcome metrics and their connections to air pollution and vulnerability in Southern California's Coachella Valley

The ongoing desiccation of California's Salton Sea has led to increasing concerns about air quality and health for its surrounding communities, including the nearby Coachella Valley - a region already experiencing severe air quality and health disparities. Here we explore spatial air pollution and human health disparities in the Coachella Valley with particular attention to disparities arising across population characteristics including both socioeconomic and demographic vulnerabilities. We use two different measures of respiratory and cardiovascular health outcomes at the individual and census tract levels - one measure based on a randomly sampled telephone survey and the other measure based on emergency room visitation data - to investigate the degree to which these health outcomes are connected to air pollution and socioeconomic metrics. We further investigate biases and differences between the health outcome metrics themselves and suggest opportunities to address them in future analyses and survey efforts. We find that more vulnerable communities are associated with higher levels of fine particulates, but lower levels of ozone. While emergency visit rates show a significant positive correlation with both pollutants, no such association is found when using surveyed health outcome data. The ratio of emergency visits versus survey rates shows a positive relationship with socioeconomic and demographic vulnerability, indicating that vulnerable communities are less likely to self-report diagnoses despite higher rates of respiratory or cardiovascular hospitalization. Additionally, survey respondents tend to show less vulnerability relative to their surrounding census-based demographics. These findings suggest the need for greater attention to health issues specifically within disadvantaged communities in the Coachella Valley, building upon and working within existing community networks and local resources, to better address current and projected health needs. Our findings also highlight disparities in air pollution exposure, health outcomes, and population characteristics in the Coachella Valley, providing context for crucial pollution reduction efforts in the face of increasing environmental threats.

[Societal inequalities and the urban exposome: Social origins for different exposures]

Today, many epidemiological studies have proved the adverse health consequences of environmental exposure. For instance, air pollution exposure is recognized to be related with respiratory and cardiovascular diseases as well as adverse pregnancy outcomes. Noise nuisances are also known to increase cardiovascular diseases and to disturb the sleeping quality. Inversely, the access and availability of various resources, as parks, green spaces, and playgrounds positively affect health, psychological and physical well-being, and favorable health behaviors. In this present literature review, we will focus on the urban dimension of exposome, defined by Robinson et al. as the accumulation of all urban settings favorable or unfavorable to health, from the time of life in utero [1].

Genome-wide gene-air pollution interaction analysis of lung function in 300,000 individuals

BACKGROUND

Impaired lung function is predictive of mortality and is a key component of chronic obstructive pulmonary disease. Lung function has a strong genetic component but is also affected by environmental factors such as increased exposure to air pollution, but the effect of their interactions is not well understood.

OBJECTIVES

To identify interactions between genetic variants and air pollution measures which affect COPD risk and lung function. Additionally, to determine whether previously identified lung function genetic association signals showed evidence of interaction with air pollution, considering both individual effects and combined effects using a genetic risk score (GRS).

METHODS

We conducted a genome-wide gene-air pollution interaction analysis of spirometry measures with three measures of air pollution at home address: particulate matter (PM2.5 & PM10) and nitrogen dioxide (NO2), in approximately 300,000 unrelated European individuals from UK Biobank. We explored air pollution interactions with previously identified lung function signals and determined their combined interaction effect using a GRS.

RESULTS

We identified seven new genome-wide interaction signals (P<5×10-8), and a further ten suggestive interaction signals (P<5×10-7). Additionally, we found statistical evidence of interaction for FEV1/FVC between PM2.5 and previously identified lung function signal, rs10841302, near AEBP2, suggesting increased susceptibility as copies of the G allele increased (but size of the impact was small - interaction beta: -0.363 percentage points, 95% CI: -0.523, -0.203 per 5 µg/m3). There was no observed interaction between air pollutants and the weighted GRS.

DISCUSSION

We carried out the largest genome-wide gene-air pollution interaction study of lung function and identified potential effects of clinically relevant size and significance. We observed up to 440 ml lower lung function for certain genotypes when exposed to mean levels of outdoor air pollution, which is approximately equivalent to nine years of average normal loss of lung function in adults.

Association between Exposure to Particulate Matter during Pregnancy and Multidimensional Development in School-Age Children: A Cross-Sectional Study in Italy

Air pollutants can potentially affect the development of children. However, data on the effect of exposure to air pollution during pregnancy and developmental outcomes in school children are rare. We investigated the link between prenatal exposure to particulate matters smaller than 10 microns (PM₁₀) and the development of school-age children in multiple domains. Cross-sectional data were collected in Italy between 2013 and 2014. Children aged between 5 and 8 years (n = 1187) were assessed on cognitive, communication, socio-emotional, adaptive, and motor developmental domains using the Developmental Profile 3 questionnaire. The monthly average concentration of PM₁₀ during the entire fetal period was linked to the municipality of residence of the children. The increase in the prenatal PM₁₀ was associated with a decrease in the cognitive score during the second (+13.2 µg/m³ PM₁₀ increase: −0.30 points; 95%CI: −0.12–−0.48) and third trimesters of pregnancy (−0.31 points; 95%CI: −0.11–−0.50). The communicative domain was also negatively influenced by PM₁₀ increases in the second trimester. The development of cognitive and communicative abilities of children was negatively associated with the exposure to PM₁₀ during the period of fetal development, confirming that exposure to air pollution during pregnancy can potentially hinder the development of the brain.

Fine resolution air quality dynamics related to socioeconomic and land use factors in the most polluted desert metropolitan in the American Southwest

Air pollution kills approximately 4.2 million people every year. As air pollution varies significantly in different urban areas, the assessment of urban emissions is key to taking appropriate actions and formulating policies for sustainable built environments and to promote the wellbeing of people. The overarching goal of this study was to generate fine resolution aerosol optical depth (AOD) using Landsat imagery and examine both the socioeconomic inequalities of air pollution exposure and the air quality variation related to different land-use categories. This study has focused on a period of unusual population growth, 2000-2010, in the Phoenix Metropolitan Area. It was found that socioeconomic factors, vegetation indexes, and land use land cover types are all strong predictors of AOD, and the negative coefficients of socioeconomic values reveal insight into the social inequality of air pollution exposure. Results suggest that the government regulation on air pollution during the study period helped to improve air quality. Meanwhile, planting vegetation to mitigate air pollution should be carefully examined in order to find the right vegetation species and spatial configuration of vegetation cover in urban settings.

Exposure to Air Pollution in Relation to Risk of Dementia and Related Outcomes: An Updated Systematic Review of the Epidemiological Literature

BACKGROUND

Dementia is a devastating neurologic condition that is common in older adults. We previously reviewed the epidemiological evidence examining the hypothesis that long-term exposure to air pollution affects dementia risk. Since then, the evidence base has expanded rapidly.

OBJECTIVES

With this update, we collectively review new and previously identified epidemiological studies on air pollution and late-life cognitive health, highlighting new developments and critically discussing the merits of the evidence.

METHODS

Using a registered protocol (PROSPERO 2020 CRD42020152943), we updated our literature review to capture studies published through 31 December 2020, extracted data, and conducted a bias assessment.

RESULTS

We identified 66 papers (49 new) for inclusion in this review. Cognitive level remained the most commonly considered outcome, and particulate matter (PM) remained the most commonly considered air pollutant. Since our prior review, exposure estimation methods in this research have improved, and more papers have looked at cognitive change, neuroimaging, and incident cognitive impairment/dementia, though methodological concerns remain common. Many studies continue to rely on administrative records to ascertain dementia, have high potential for selection bias, and adjust for putative mediating factors in primary models. A subset of 35 studies met strict quality criteria. Although high-quality studies of fine particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ) and cognitive decline generally supported an adverse association, other findings related to PM 2.5 and findings related to particulate matter with aerodynamic diameter ≤ 10 μ m (PM 10 , NO 2 , and NO x ) were inconclusive, and too few papers reported findings with ozone to comment on the likely direction of association. Notably, only a few findings on dementia were included for consideration on the basis of quality criteria.

DISCUSSION

Strong conclusions remain elusive, although the weight of the evidence suggests an adverse association between PM 2.5 and cognitive decline. However, we note a continued need to confront methodological challenges in this line of research. https://doi.org/10.1289/EHP8716.

Lung Inflammatory Response to Environmental Dust Exposure in Mice Suggests a Link to Regional Respiratory Disease Risk

PURPOSE

The Salton Sea, California's largest lake, is designated as an agricultural drainage reservoir. In recent years, the lake has experienced shrinkage due to reduced water sources, increasing levels of aerosolized dusts in surrounding regions. Communities surrounding the Salton Sea have increased asthma prevalence versus the rest of California; however, a connection between dust inhalation and lung health impacts has not been defined.

METHODS

We used an established intranasal dust exposure murine model to study the lung inflammatory response following single or repetitive (7-day) exposure to extracts of dusts collected in regions surrounding the Salton Sea (SSDE), complemented with in vitro investigations assessing SSDE impacts on the airway epithelium.

RESULTS

In these investigations, single or repetitive SSDE exposure induced significant lung inflammatory cytokine release concomitant with neutrophil influx. Repetitive SSDE exposure led to significant lung eosinophil recruitment and altered expression of genes associated with allergen-mediated immune response, including Clec4e. SSDE treatment of human bronchial epithelial cells (BEAS-2B) induced inflammatory cytokine production at 5- and 24-hours post-treatment. When BEAS-2B were exposed to protease activity-depleted SSDE (PDSSDE) or treated with SSDE in the context of protease-activated receptor-1 and -2 antagonism, inflammatory cytokine release was decreased. Furthermore, repetitive exposure to PDSSDE led to decreased neutrophil and eosinophilic influx and IL-6 release in mice compared to SSDE-challenged mice.

CONCLUSION

These investigations demonstrate potent lung inflammatory responses and tissue remodeling in response to SSDE, in part due to environmental proteases found within the dusts. These studies provide the first evidence supporting a link between environmental dust exposure, protease-mediated immune activation, and respiratory disease in the Salton Sea region.

Spatiotemporal analysis of traffic congestion, air pollution, and exposure vulnerability in Tanzania

Using new satellite data from the European Space Agency's Sentinel-5P system, this article investigates the spatial and temporal dynamics of vehicular traffic congestion, air pollution, and the distributional impacts on vulnerable populations in Dar es Salaam, Tanzania. The metro region's rapid growth in vehicle traffic exceeds road network capacity, generating congestion, transport delays, and air pollution from excess fuel use. Dangerously high pollution levels from tailpipe emissions put the health of vulnerable residents at risk, calling for the need to adopt continuous air-quality monitoring and effective pollution control. Our results highlight significant impacts of seasonal weather and wind-speed factors on the spatial distribution and intensity of air pollution from vehicle emissions, which vary widely by area. In seasons when weather factors maximize pollution, the worst exposure occurs along the wind path of high-traffic roadways. The study identifies priority areas for reducing congestion to yield the greatest exposure reduction for young children and the elderly in poor households. This new research direction, based only on the use of free global information sources with the same coverage for all cities, offers metropolitan areas in developing regions the opportunity to benefit from the rigorous analyses traditionally limited to well-endowed cites in developing countries.

When particulate matter strikes cities: Social disparities and health costs of air pollution

We investigate the heterogeneous effects of particle pollution on Italian daily hospitalizations and their costs by exploiting public transportation strikes as plausibly-exogenous shocks in pollution exposure. We find that a one standard deviation increase in PM₁₀ causes additional 0.79 hospitalizations per 100,000 residents, and the effect is stronger for the elderly, low educated individuals and migrants. Furthermore, we find that young individuals, an arguably healthy age group, exhibit economically meaningful responses to air pollution with an effect ranging between 0.45 and 1.04. Our results imply a large role of avoidance behavior driving heterogeneous marginal health effects. Total daily costs of a one standard deviation increase in PM₁₀ represent 0.5% of the total daily health expenditure, and 85% of this additional spending comes from more patients hospitalized, while the remaining 15% can be attributable to more costly, and likely more complex, hospitalizations.

Relationship between Air Pollutant Exposure and Gynecologic Cancer Risk

Exposure to air pollution has been suggested to be associated with an increased risk of women's health disorders. However, it remains unknown to what extent changes in ambient air pollution affect gynecological cancer. In our case-control study, the logistic regression model was combined with the restricted cubic spline to examine the association of short-term exposure to air pollution with gynecological cancer events using the clinical data of 35,989 women in Beijing from December 2008 to December 2017. We assessed the women's exposure to air pollutants using the monitor located nearest to each woman's residence and working places, adjusting for age, occupation, ambient temperature, and ambient humidity. The adjusted odds ratios (ORs) were examined to evaluate gynecologic cancer risk in six time windows (Phase 1-Phase 6) of women's exposure to air pollutants (PM2.5, CO, O3, and SO2) and the highest ORs were found in Phase 4 (240 days). Then, the higher adjusted ORs were found associated with the increased concentrations of each pollutant (PM2.5, CO, O3, and SO2) in Phase 4. For instance, the adjusted OR of gynecological cancer risk for a 1.0-mg m-3 increase in CO exposures was 1.010 (95% CI: 0.881-1.139) below 0.8 mg m-3, 1.032 (95% CI: 0.871-1.194) at 0.8-1.0 mg m-3, 1.059 (95% CI: 0.973-1.145) at 1.0-1.4 mg m-3, and 1.120 (95% CI: 0.993-1.246) above 1.4 mg m-3. The ORs calculated in different air pollution levels accessed us to identify the nonlinear association between women's exposure to air pollutants (PM2.5, CO, O3, and SO2) and the gynecological cancer risk. This study supports that the gynecologic risks associated with air pollution should be considered in improved public health preventive measures and policymaking to minimize the dangerous effects of air pollution.

Systemic inequalities in indoor air pollution exposure in London, UK

Deprived communities in many cities are exposed to higher levels of outdoor air pollution, and there is increasing evidence of similar disparities for indoor air pollution exposure. There is a need to understand the drivers for this exposure disparity in order to develop effective interventions aimed at improving population health and reducing health inequities. With a focus on London, UK, this paper assembles evidence to examine why indoor exposure to PM2.5, NOx and CO may disproportionately impact low-income groups. In particular, five factors are explored, namely: housing location and ambient outdoor levels of pollution; housing characteristics, including ventilation properties and internal sources of pollution; occupant behaviours; time spent indoors; and underlying health conditions. Evidence is drawn from various sources, including building physics models, modelled outdoor air pollution levels, time-activity surveys, housing stock surveys, geographical data, and peer-reviewed research. A systems framework is then proposed to integrate these factors, highlighting how exposure to high levels of indoor air pollution in low-income homes is in large part due to factors beyond the control of occupants, and is therefore an area of systemic inequality.

POLICY RELEVANCE

There is increasing public and political awareness of the impact of air pollution on public health. Strong scientific evidence links exposure to air pollution with morbidity and mortality. Deprived communities may be more affected, however, with limited evidence on how deprivation may influence their personal exposure to air pollution, both outdoors and indoors. This paper describes different factors that may lead to low-income households being exposed to higher levels of indoor air pollution than the general population, using available data and models for London (i.e. living in areas of higher outdoor air pollution, in poor-quality housing, undertaking more pollution-generating activities indoors and spending more time indoors). A systems approach is used to show how these factors lead to systemic exposure inequalities, with low-income households having limited opportunities to improve their indoor air quality. This paper can inform actions and public policies to reduce environmental health inequalities, considering both indoor and outdoor air.

Ambient air pollution and the development of overweight and obesity in children: a large longitudinal study

BACKGROUND

Ambient air pollution may play a role in childhood obesity development, but evidence is scarce, and the modifying role of socioeconomic status (SES) is unclear. We aimed to examine the association between exposure to air pollution during early childhood and subsequent risk of developing overweight and obesity, and to evaluate whether SES is a modifier of this association.

METHODS

This longitudinal study included 416,955 children identified as normal weight between 2-5 years old and registered in an electronic primary healthcare record between 2006 and 2016 in Catalonia (Spain). Children were followed-up until they developed overweight or obesity, reached 15 years of age, died, transferred out, or end of study period (31/12/2018). Overweight and obesity were defined following the WHO reference obtained from height and weight measures. We estimated annual residential census levels of nitrogen dioxide (NO₂) and particulate matter <10 μm (PM₁₀), <2.5 μm (PM_2.5), and 2.5-10 μm (PM_coarse) at study entry. We estimated the risk of developing overweight and obesity per interquartile range increase in air pollution exposure with Cox proportional hazard models.

RESULTS

A total of 142,590 (34.2%) children developed overweight or obesity. Increased exposure to NO₂, PM₁₀, and PM_coarse was associated with a 2-3% increased risk of developing overweight and obesity (hazard ratio [HR] per 21.8 μg/m³ NO₂ = 1.03 [95% CI: 1.02-1.04]; HR per 6.4 μg/m³ PM₁₀ = 1.02 [95% CI: 1.02-1.03]; HR per 4.6 µg/m³ PM_coarse = 1.02, [95% CI: 1.01-1.02]). For all air pollutants, associations were stronger among children living in most compared to least deprived areas.

CONCLUSIONS

This study suggests that early life exposure to air pollution may be associated with a small increase in the risk of developing overweight and obesity in childhood, and that this association may be exacerbated in the most deprived areas. Even these small associations are of potential global health importance because air pollution exposure is widespread and the long-term health consequences of childhood obesity are clear.

The sociospatial factors of death: Analyzing effects of geospatially-distributed variables in a Bayesian mortality model for Hong Kong

Human mortality is in part a function of multiple socioeconomic factors that differ both spatially and temporally. Adjusting for other covariates, the human lifespan is positively associated with household wealth. However, the extent to which mortality in a geographical region is a function of socioeconomic factors in both that region and its neighbors is unclear. There is also little information on the temporal components of this relationship. Using the districts of Hong Kong over multiple census years as a case study, we demonstrate that there are differences in how wealth indicator variables are associated with longevity in (a) areas that are affluent but neighbored by socially deprived districts versus (b) wealthy areas surrounded by similarly wealthy districts. We also show that the inclusion of spatially-distributed variables reduces uncertainty in mortality rate predictions in each census year when compared with a baseline model. Our results suggest that geographic mortality models should incorporate nonlocal information (e.g., spatial neighbors) to lower the variance of their mortality estimates, and point to a more in-depth analysis of sociospatial spillover effects on mortality rates.

Vehicular traffic density and cognitive performance in the ELSA-Brasil study

BACKGROUND

Despite the knowledge about the deleterious effects of air pollutants and their influence on mortality and morbidity due to respiratory and cardiovascular diseases, little is known about the relationship between atmospheric pollutants and neurological diseases. Recently, studies from high-income countries have suggested an association between exposures to air pollutants with cognitive impairment. Thus, we investigated the association of air pollution with cognitive performance in the participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

METHODS

Cognitive function was evaluated using the word list, the verbal fluency, and the trail making tests (TMT). Pollutant exposure was evaluated indirectly using the distance-weighted traffic density (DWTD) of participants' residence and workplace. We investigated the cross-sectional association between DWTD and cognitive test scores using adjusted linear regression models for sociodemographic and clinical variables.

RESULTS

3050 were included (mean age = 52.1 ± 9.2 years old, 56.5% women, and 63.6% white). In the simple linear regression models, participants in the higher tertile of combined DWTD (residence and workplace) presented better cognitive performance in all tests when compared to participants in the lower tertile. The DWTD was not associated with cognitive performance in adjusted linear models especially when adjusted for socioeconomic variables (age, sex, education, and race). We found similar results when we investigated the association of cognitive performance with DTWD near participants' workplace and residence separately.

CONCLUSION

Air pollutants were not associated with worse cognitive performance in a large sample of middle-aged and older adults.

Radon Exposure and Neurodegenerative Disease

Background: To carry out a systematic review of scientific literature about the association between radon exposure and neurodegenerative diseases. Methods: We performed a bibliographic search in the following databases: Pub med (Medline), Cochrane, BioMed Central and Web of Science. We collected the data by following a predetermined search strategy in which several terms werecombined. After an initial search, 77 articles were obtained.10 of which fulfilled the inclusion criteria. Five of these 10 studies were related to multiple sclerosis (MS), 2 were about motor neuron diseases (MND), in particular amyotrophic lateral sclerosis (ALS) and 3 were related to both Alzheimer's disease (AD) and Parkinson's disease (PD). Results: The majority of the included articles, suggested a possible association between radon exposure and a subsequent development of neurodegenerative diseases. Some of the studies that obtained statistically significant resultsrevealed a possible association between radon exposure and an increase in MS prevalence. Furthermore, it was also suggested that radon exposure increases MND and AD mortality. Regarding AD and PD, it was observed that certainde cay products of radon-222 (²²²Rn), specifically polonium-210 (²¹⁰Po) and bismuth-210 (²¹⁰Bi), present a characteristic distributionpattern within the brain anatomy. However, the study with the highest scientific evidence included in this review, which investigated a possible association between the concentration of residential radon gas and the MS incidence, revealed no significant results. Conclusions: It cannot be concluded, although it is observed, that there is a possible causal association between radon exposure and neurodegenerative diseases. Most of the available studies are ecological so, studies of higher statistical evidence are needed to establish a causal relationship. Further research is needed on this topic.

Effects of PM2.5 on Third Grade Students' Proficiency in Math and English Language Arts

Fine particulate air pollution is harmful to children in myriad ways. While evidence is mounting that chronic exposures are associated with reduced academic proficiency, no research has examined the frequency of peak exposures. It is also unknown if pollution exposures influence academic proficiency to the same degree in all schools or if the level of children's social disadvantage in schools modifies the effects, such that some schools' academic proficiency levels are more sensitive to exposures. We address these gaps by examining the percentage of third grade students who tested below the grade level in math and English language arts (ELA) in Salt Lake County, Utah primary schools (n = 156), where fine particulate pollution is a serious health threat. More frequent peak exposures were associated with reduced math and ELA proficiency, as was greater school disadvantage. High frequency peak exposures were more strongly linked to lower math proficiency in more advantaged schools. Findings highlight the need for policies to reduce the number of days with peak air pollution.

Education differences in women's body weight trajectories: The role of motherhood

Studies have found that education differences in women's body weight increase until middle adulthood. The explanatory mechanisms behind this increase are not well-understood. This study examined the role of education differences in the prevalence of motherhood as a risk factor for weight gain and in vulnerability to its effects on weight gain. We used longitudinal data from the German Socio-economic Panel Study. Our sample included 2,668 women aged between 17 and 45 and observed at least twice between 2002 and 2016 (n = 13,899 panel observations). We used OLS regression models to estimate initial education differences in body weight and fixed-effects panel regression models to estimate education differences in body-weight trajectories. Motherhood was associated with increasing body weight, and the effects of motherhood on weight gain varied by education. Motherhood partially accounted for the increase of education differences during reproductive age. Until the age of 30, differences in the prevalence of motherhood accounted for about 20% of the bodyweight gap between lower and higher educated women. From age 35 until 45, differential vulnerability to the effects of motherhood on body weight explained about 15% of the education gap in body weight.

Race or racial segregation? Modification of the PM2.5 and cardiovascular mortality association

BACKGROUND

Many studies have identified an inequitable distribution of exposure to PM2.5 (particulate matter less than 2.5 microns) by race. We investigated the association of PM2.5 and cardiovascular mortality considering both the decedents' race and neighborhood racial composition as potential modifiers.

METHODS

We obtained geocoded cardiovascular mortality records of all black and white decedents from urban block-groups in Massachusetts between 2001 and 2011 (n = 130,863). We examined the association between PM2.5 and cardiovascular mortality, and assessed effect modification by three types of racial modifiers: decedents' race, census block-group percent black and white, and two novel measures of racial segregation. The Racial Residential Segregation (RRS) quantifies the concentration of non-Hispanic blacks and whites in each block-group. The Index of Racial Dissimilarity measures dissimilarity in non-Hispanic black and white racial distribution between the smaller census block-group and larger tract.

RESULTS

We found a 2.35%(95%CI: 0.92%;3.79%) increase in mortality for each 10μg/m3 increase in two-day average exposure to PM2.5. The effect was modified by the block-group racial composition, with higher risks in block-groups with the highest percentage of black residents (interaction p-value = 0.04), and in block-groups with the lowest RRS (i.e. higher black to white resident ratio, interaction p-value = 0.072). Racial dissimilarity did not modify the associations.

CONCLUSION

Current levels of PM2.5 are associated with increased cardiovascular deaths in Massachusetts, with different risks between areas with different racial composition and segregation. This suggests that pollution reductions in neighborhoods with the highest percentage of non-Hispanic blacks would be most beneficial in reducing cardiovascular mortality and disparities.

Ambient air pollution exposure association with diabetes prevalence and glycosylated hemoglobin (HbA1c) levels in China. Cross-sectional analysis from the WHO study of AGEing and adult health wave 1

Over the past decades, air pollution has become one of the critical environmental health issues in China. The present study aimed to evaluate links between ambient air pollution and the prevalence of type 2 diabetes mellitus (T2DM) and the levels of glycosylated hemoglobin (HbA1c). A multilevel linear and logistic regression was used to assess these associations among 7,770 participants aged ≥50 years from the WHO Study on global AGEing and adult health (SAGE) in China in 2007-2010. The average exposure to each of pollutants (particulate matter with an aerodynamic diameter of ≤10 μm/≤2.5 μm/≤1 μm [PM₁₀/PM_2.5/PM₁] and nitrogen dioxide [NO₂]) was estimated using a satellite-based spatial statistical model. In logistic models, a 10 µg/m³ increase in PM₁₀ and PM_2.5 was associated with increased T2DM prevalence (Prevalence Odds Ratio, POR: 1.27; 95% CI: 1.11, 1.45 and POR: 1.23; 95% CI: 1.03, 1.46). Similar increments in PM₁₀, PM_2.5, PM₁ and NO₂ were associated with increase in HbA1c levels of 1.8% (95% CI: 1.3, 2.3), 1.3% (95% CI: 1.1, 1.5), 0.7% (95% CI: 0.1, 1.3), and 0.8% (95% CI: 0.4, 1.2), respectively. In a large cohort of older Chinese adults, air pollution was liked to both higher T2DM prevalence and elevated HbA1c levels.

Levels of Polonium-210 in brain and pulmonary tissues: Preliminary study in autopsies conducted in the city of Sao Paulo, Brazil

The accumulation of detectable amounts of radon progeny in human tissues may be a risk factor for development and progression of chronic diseases. In this preliminary study, we analyzed the levels of alpha-emitting radon progeny Polonium-210 (²¹⁰Po) in the olfactory epithelium, olfactory bulb, frontal lobe, and lung tissues in cadavers from the city of Sao Paulo, SP, Brazil. We also assessed the association between ²¹⁰Po levels and exposure parameters for urban air pollution using linear regression models adjusted for age, sex, smoke, time living in Sao Paulo, daily commuting, socioeconomic index, and anthracosis (traffic-related black carbon accumulation in the pleural region and in lymph). Our findings show that the concentration of ²¹⁰Po was associated with anthracosis in lungs of non-smokers (coefficient = 6.0; standard error = 2.9; p = 0.04). Individuals with lower socioeconomic status also had significantly higher ²¹⁰Po levels in lungs (coefficient = -1.19; standard error = 0.58; p = 0.042). The olfactory bulb had higher ²¹⁰Po levels than either olfactory epithelium (p = 0.071), frontal lobe (p < 0.001), or lungs (p = 0.037). Our findings of the deposition of ²¹⁰Po in autopsy tissues suggest that airborne radionuclides may contribute to the development of chronic diseases, including neurodegenerative diseases.

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

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.

Social Inequalities in Exposure to Ambient Air Pollution: A Systematic Review in the WHO European Region

Ambient air pollution is a long-standing and significant public health issue. The aim of this review is to systematically examine the peer-reviewed evidence on social inequalities and ambient air pollution in the World Health Organization European Region. Articles published between 2010 and 2017 were analyzed in the review. In total 31 articles were included in the review. There is good evidence from ecological studies that higher deprivation indices and low economic position are usually linked with higher levels of pollutants such as particulate matter (particulate matter under 2.5 and 10 microns in diameter, PM_2.5, PM₁₀) and oxides of nitrogen (e.g., NO₂, and NO_x). There is also evidence that ethnic minorities experience a mixed exposure in comparison to the majority population being sometimes higher and sometimes lower depending on the ethnic minority under consideration. The studies using data at the individual level in this review are mainly focused on pregnant women or new mothers, in these studies deprivation and ethnicity are more likely to be linked to higher exposures of poor air quality. Therefore, there is evidence in this review that the burden of higher pollutants falls disproportionally on different social groups.

Estimating the causal effect of annual PM2.5 exposure on mortality rates in the Northeastern and mid-Atlantic states

Background

Dozens of cohort studies have associated particulate matter smaller than 2.5 µm in diameter (PM_2.5) exposure with early deaths, and the Global Burden of Disease identified PM_2.5 as the fifth-ranking mortality risk factor in 2015. However, few studies have used causal modeling techniques. We assessed the effect of annual PM_2.5 exposure on all-cause mortality rates among the Medicare population in the Northeastern and mid-Atlantic states, using the difference-in-differences approach for causal modeling.

Methods

We obtained records of Medicare beneficiaries 65 years of age or more who reside in the Northeastern or mid-Atlantic states from 2000 to 2013 and followed each participant from the year of enrollment to the last year of follow-up. We estimated the causal effect of annual PM_2.5 exposure on mortality rates using the difference-in-differences approach in the Poisson survival analysis. We controlled for individual confounders, for spatial differences using dummy variables for each ZIP code and for time trends using a penalized spline of year.

Results

We included 112,376,805 person-years from 15,401,064 people, of whom 37.4% died during the study period. The interquartile range (IQR) of the annual PM_2.5 concentration was 3 µg/m³, and the mean annual PM_2.5 concentration ranged between 6.5 and 14.5 µg/m³ during the study period. An IQR incremental increase in PM_2.5 was associated with a 4.04% increase (95% CI = 3.49%, 4.59%) in mortality rates.

Conclusions

Assuming no omitted predictors changing differently across ZIP codes over time in correlation with PM_2.5, we found a causal effect of PM_2.5 on mortality incidence rate.

[Environmental justice as an approach to tackle environmental health inequalities]

Current international studies show that environment-related diseases disproportionately affect vulnerable people. This is a case of environmental injustice. Environmental justice goes beyond the mere description of environment- and health-related social inequalities by comprising two dimensions of justice as a normative approach: distributional and procedural justice. Attempts to explain the link between social circumstances, the environment and health deal with both the socially unequal distribution of environmental hazards and environmental resources (exposure variation) and social differences in vulnerability to the health effects of environmental exposures (effect modification). Integrated monitoring approaches provide the basis for deriving interventions under various aspects of environmental justice. Parting from public health research and embedded in the Health in All Policies (HiAP) concept, environmental justice has now been taken up in a number of fields, including politics, administration and practice. There are strategic considerations and attempts to anchor it in politics at the federal, state and the communal level, both by government and non-government groups. Health-promoting urban development is a core field for intervention. The Soziale Stadt (Social City) programme for promoting urban planning and construction as well as place oriented sectoral planning make an important contribution by helping to focus on urban spaces with multiple health hazards and to implement target group-oriented participation processes. There continues to be a need to develop methods and systematically implemented evaluations of political strategies and corresponding interventions regarding their effects on inequalities in health and environmental justice.

Air pollution, lung function and COPD: results from the population-based UK Biobank study

Ambient air pollution increases the risk of respiratory mortality, but evidence for impacts on lung function and chronic obstructive pulmonary disease (COPD) is less well established. The aim was to evaluate whether ambient air pollution is associated with lung function and COPD, and explore potential vulnerability factors.We used UK Biobank data on 303 887 individuals aged 40-69 years, with complete covariate data and valid lung function measures. Cross-sectional analyses examined associations of land use regression-based estimates of particulate matter (particles with a 50% cut-off aerodynamic diameter of 2.5 and 10 µm: PM_2.5 and PM₁₀, respectively; and coarse particles with diameter between 2.5 μm and 10 μm: PM_coarse) and nitrogen dioxide (NO₂) concentrations with forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), the FEV₁/FVC ratio and COPD (FEV₁/FVC <lower limit of normal). Effect modification was investigated for sex, age, obesity, smoking status, household income, asthma status and occupations previously linked to COPD.Higher exposures to each pollutant were significantly associated with lower lung function. A 5 µg·m^-3 increase in PM_2.5 concentration was associated with lower FEV₁ (-83.13 mL, 95% CI -92.50- -73.75 mL) and FVC (-62.62 mL, 95% CI -73.91- -51.32 mL). COPD prevalence was associated with higher concentrations of PM_2.5 (OR 1.52, 95% CI 1.42-1.62, per 5 µg·m^-3), PM₁₀ (OR 1.08, 95% CI 1.00-1.16, per 5 µg·m^-3) and NO₂ (OR 1.12, 95% CI 1.10-1.14, per 10 µg·m^-3), but not with PM_coarse Stronger lung function associations were seen for males, individuals from lower income households, and "at-risk" occupations, and higher COPD associations were seen for obese, lower income, and non-asthmatic participants.Ambient air pollution was associated with lower lung function and increased COPD prevalence in this large study.

Potential health and equity co-benefits related to the mitigation policies reducing air pollution from residential wood burning in Athens, Greece

Athens, Greece has been in economic and social crises after the 2008 global recession, resulting in an increase in wood burning as a cheaper method of residential heating in the winter. Reducing wood burning emissions is a source-specific method to address air quality degradation, and indirectly climate change, through instituting policies aimed at human health co-benefits. In this work, we investigate and quantify the potential health co-benefits from policies reducing outdoor particulate matter (PM) pollution from residential wood burning by assessing the pollution conditions during the 2015 calendar year in Athens, Greece, emphasizing vulnerable populations. We conducted a systematic literature search to extract data regarding effective improvements to outdoor PM due to wood burning interventions, and get a range of potential ambient PM reduction estimates regarding realistic benefits from different interventions. We applied a health impact assessment methodology and used existing Athens specific data to calculate the preventable daily average non-accidental deaths associated with reducing PM, additionally considering low and high socioeconomic status (SES) groups. We found that the reduction in outdoor PM concentration showed the potential to benefit lower SES groups as much as 13.5 times more than the high SES group, representing an opportunity for policies to improve not only the health of the total population but also improve environmental equity and health disparities.

The Role of Socioeconomic Status in the Association of Lung Function and Air Pollution-A Pooled Analysis of Three Adult ESCAPE Cohorts

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.

Ambient Particulate Matter and Paramedic Assessments of Acute Diabetic, Cardiovascular, and Respiratory Conditions

Supplemental Digital Content is available in the text.

Background:

Ambulance data provide a useful source of population-based and spatiotemporally resolved information for assessing health impacts of air pollution in nonhospital settings. We used the clinical records of paramedics to quantify associations between particulate matter (PM_2.5) and diabetic, cardiovascular, and respiratory conditions commonly managed by those responding to calls for emergency ambulance services.

Methods:

We evaluated 394,217 paramedic assessments from three states in Southeastern Australia (population 13.2 million) and daily PM_2.5 concentrations modeled at 5 km resolution from 2009 to 2014. We used a time-stratified, case-crossover analysis adjusted for daily meteorology to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for each clinical outcome per 10 µg/m³ increase in daily PM_2.5 at lags from 0 to 2 days.

Results:

Increased PM_2.5 was associated with increased odds of paramedic assessments of hypoglycemia (OR = 1.07; 95% CI = 1.02, 1.12, lag 0), arrhythmia (OR = 1.05; 95% CI = 1.02, 1.09, lag 0), heart failure (OR = 1.07; 95% CI = 1.02, 1.12, lag 1), faint (OR = 1.09; 95% CI = 1.04–1.13, lag 0), asthma (OR = 1.06; 95% CI = 1.01, 1.11, lag 1), chronic obstructive pulmonary disease (OR = 1.07; 95% CI = 1.01, 1.13, lag 1), and croup (OR = 1.09; 95% CI = 1.02, 1.17). We did not identify associations with cerebrovascular outcomes.

Conclusions:

Ambulance data enable the evaluation of important clinical syndromes that are often initially managed in nonhospital settings. Daily PM_2.5 was associated with hypoglycemia, faint, and croup in addition to the respiratory and cardiovascular outcomes that are better established.

Social Inequalities in Environmental Noise Exposure: A Review of Evidence in the WHO European Region

Environmental noise is an important public health problem, being among the top environmental risks to health. The burden of noise exposure seems to be unequally distributed in societies. Up to now there is fragmentary evidence regarding which social groups are most affected. The aim of this review was to systematically assess published evidence on social inequalities in environmental noise exposure in the WHO European Region, taking different sociodemographic and socioeconomic dimensions as well as subjective and objective measures of environmental noise exposure into account. Articles published in English in a peer reviewed journal between 2010 and 2017 were included in the review. Eight studies were finally included in the review, four of them analysed aggregated data and four analysed individual data. Though results of social inequalities in noise exposures were mixed between and within studies, there was a trend that studies using indicators of material deprivation and deprivation indices showed higher environmental noise exposures in groups with lower socioeconomic position. More research on the social distribution of environmental noise exposure on a small spatial scale is needed, taking into account aspects of vulnerability and procedural justice.

Socioeconomic factors increase the adverse effects of air pollution and temperature on mortality

OBJECTIVE

To verify the effects of PM2.5 and temperature on mortality due to cardiovascular diseases according to socioeconomic status and traffic proximity.

METHOD

Time series were used, using the generalized additive models with the Poisson regression option, at 5% significance level. Interactionbetween proximity of traffic and socioeconomic status was analyzed through stratification. The proximity to the traffic was divided into distances up to 150m or over 150m. Socioeconomic status in the residential environment was categorized as high and low based on the median (3.9%). The relative risk percentage (%RR) of cardiovascular disease deaths was calculated for each linear increase of 10 µg/m3 at PM2.5 and 1ºC at the maximum temperature.

RESULTS

Mortality due to cardiovascular diseases presented %RR 1.64 (95%CI -0.03; 3.33), related to the maximum temperature and %RR 4.60 (95%CI 0.78; 8.56) related to PM2.5, in areas with high traffic exposure. In areas with poor living conditions, %RR 1.34 (95%CI -0.31; 3.01) was observed, related to maximum temperature and RR% 3.95 (95%CI -0.27; 8.34) associated with PM2.5.

CONCLUSION

Areas with poor living conditions and high-exposure to vehicular traffic had an increased risk of cardiovascular disease mortality related to high temperature and PM2.5.

Neighborhood Greenness Attenuates the Adverse Effect of PM2.5 on Cardiovascular Mortality in Neighborhoods of Lower Socioeconomic Status

Features of the environment may modify the effect of particulate matter ≤2.5 µm in aerodynamic diameter (PM2.5) on health. Therefore, we investigated how neighborhood sociodemographic and land-use characteristics may modify the association between PM2.5 and cardiovascular mortality. We obtained residence-level geocoded cardiovascular mortality cases from the Massachusetts Department of Public Health (n = 179,986), and PM2.5 predictions from a satellite-based model (2001⁻2011). We appended census block group-level information on sociodemographic factors and walkability, and calculated neighborhood greenness within a 250 m buffer surrounding each residence. We found a 2.54% (1.34%; 3.74%) increase in cardiovascular mortality associated with a 10 µg/m³ increase in two-day average PM2.5. Walkability or greenness did not modify the association. However, when stratifying by neighborhood sociodemographic characteristics, smaller PM2.5 effects were observed in greener areas only among cases who resided in neighborhoods with a higher population density and lower percentages of white residents or residents with a high school diploma. In conclusion, the PM2.5 effects on cardiovascular mortality were attenuated by higher greenness only in areas with sociodemographic features that are highly correlated with lower socioeconomic status. Previous evidence suggests health benefits linked to neighborhood greenness may be stronger among lower socioeconomic groups. Attenuation of the PM2.5⁻mortality relationship due to greenness may explain some of this evidence.

Socioeconomic Deprivation Status and Air Pollution by PM10 and NO2: An Assessment at Municipal Level of 11 Years in Italy

The aim of this observational study was to assess the relationship between environmental risk factors and some aspects of social economic status (SES) of the population in different Italian municipalities. Nitrogen dioxide (NO₂) and particulate matter (PM₁₀) annual means were extracted from ISPRA-BRACE (environmental information system of 483 Italian municipalities, 6% of the total amount of administrative units) from 2002 to 2012. As an indicator of sociodemographic and SES data, we collected the following: resident population, foreign nationality, low level of education, unemployment, nonhome ownership, single-parent family, and overcrowding. Low educational level, unemployment, and lack of home ownership were indirectly associated with the higher mean values of NO₂ at the statistically significant level (p < 0.05). Major resident population and rental housing percentage determined higher levels of PM₁₀. Northern regions showed similar results compared to the national level, with the exception of foreign residency that showed direct correlation with the increase of PM₁₀. The central regions showed a direct relationship between NO₂ and PM₁₀ levels and higher educational levels and between NO₂ levels and percentage of single-parent family. In the southern areas, higher NO₂ levels were correlated with a higher rental housing percentage, as well as higher PM₁₀ levels with a higher percentage of unemployment and lower housing density. The study shows high heterogeneity in the findings but confirms the relationship between high educational level and employment with the increased concentration of pollutants. The higher rental housing percentage may increase the pollutants' levels too. The housing density does not seem to be in relationship with NO₂ and PM₁₀ at the national level. The analysis stratified by geographical areas showed that the direction of the correlations was different over time as the analysis was at a national level. The study represents an example of how data from national information systems can provide a preliminary evaluation and be a comparative tool for policy-makers to assess environmental risk factors and social inequalities.