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Manca F, Lewsey J, Mackay D, Angus C, Fitzpatrick D, Fitzgerald N. The effect of a minimum price per unit of alcohol in Scotland on alcohol-related ambulance call-outs: A controlled interrupted time-series analysis. Addiction 2024; 119:846-854. [PMID: 38286951 DOI: 10.1111/add.16436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/20/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND AND AIMS On 1 May 2018, Scotland introduced a minimum unit price (MUP) of £0.50 for alcohol, with one UK unit of alcohol being 10 ml of pure ethanol. This study measured the association between MUP and changes in the volume of alcohol-related ambulance call-outs in the overall population and in call-outs subsets (night-time call-outs and subpopulations with higher incidence of alcohol-related harm). DESIGN An interrupted time-series (ITS) was used to measure variations in the daily volume of alcohol-related call-outs. We performed uncontrolled ITS on both the intervention and control group and a controlled ITS built on the difference between the two series. Data were from electronic patient clinical records from the Scottish Ambulance Service. SETTING AND CASES Alcohol-related ambulance call-outs (intervention group) and total ambulance call-outs for people aged under 13 years (control group) in Scotland, from December 2017 to March 2020. MEASUREMENTS Call-outs were deemed alcohol-related if ambulance clinicians indicated that alcohol was a 'contributing factor' in the call-out and/or a validated Scottish Ambulance Service algorithm determined that the call-out was alcohol-related. FINDINGS No statistically significant association in the volume of call-outs was found in both the uncontrolled series [step change = 0.062, 95% confidence interval (CI) = -0.012, 0.0135 P = 0.091; slope change = -0.001, 95% CI = -0.001, 0.1 × 10-3 P = 0.139] and controlled series (step change = -0.01, 95% CI = -0.317, 0.298 P = 0.951; slope change = -0.003, 95% CI = -0.008, 0.002 P = 0.257). Similarly, no significant changes were found for the night-time series or for any population subgroups. CONCLUSIONS There appears to be no statistically significant association between the introduction of minimum unit pricing for alcohol in Scotland and the volume of alcohol-related ambulance call-outs. This was observed overall, across subpopulations and at night-time.
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Affiliation(s)
- Francesco Manca
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jim Lewsey
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel Mackay
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - David Fitzpatrick
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Niamh Fitzgerald
- SPECTRUM (Shaping Public hEalth poliCies To Reduce ineqUalities and harM) Consortium, Institute for Social Marketing and Health (ISM), Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Li Y, Varghese BM, Liu J, Bi P, Tong M. Association between High Ambient Temperatures and Road Crashes in an Australian City with Temperate Climate: A Time-Series Study, 2012-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6000. [PMID: 37297604 PMCID: PMC10252869 DOI: 10.3390/ijerph20116000] [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: 03/16/2023] [Revised: 05/20/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
(1) Background: High ambient temperatures are associated with increased morbidity and mortality rates, and some evidence suggests that high temperatures increase the risk of road crashes. However, little is known regarding the burden of road crashes attributable to no-optimal high temperatures in Australia. Therefore, this study examined the effects of high temperatures on road crashes using Adelaide in South Australia as a case study. (2) Methods: Ten-year daily time-series data on road crashes (n = 64,597) and weather during the warm season (October-March) were obtained between 2012 and 2021. A quasi-Poisson distributed lag nonlinear model (DLNM) was used to quantify the cumulative effect of high temperatures over the previous five days. The associations and attributable burden at moderate and extreme temperature ranges were computed as relative risk (RR) and attributable fraction. (3) Results: There was a J-shaped association between high ambient temperature and the risk of road crashes during the warm season in Adelaide, and pronounced effects were observed for minimum temperatures. The highest risk was observed at a 1 day lag and lasting for 5 days. High temperatures were responsible for 0.79% (95% CI: 0.15-1.33%) of road crashes, with moderately high temperatures accounting for most of the burden compared with extreme temperatures (0.55% vs. 0.32%). (4) Conclusions: In the face of a warming climate, the finding draws the attention of road transport, policy, and public health planners to design preventive plans to reduce the risk of road crashes attributable to high temperatures.
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Affiliation(s)
- Yannan Li
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | | | - Jingwen Liu
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Michael Tong
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, ACT 2601, Australia
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Kanti FS, Alari A, Chaix B, Benmarhnia T. Comparison of various heat waves definitions and the burden of heat-related mortality in France: Implications for existing early warning systems. ENVIRONMENTAL RESEARCH 2022; 215:114359. [PMID: 36152888 DOI: 10.1016/j.envres.2022.114359] [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: 07/25/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION In France, a heat warning system (HWS) has been implemented almost two decades ago and rely on some official heat wave (HW) definitions. However, no study has compared the burden associated with a large set of alternative HW definitions to the official definitions. Such comparison could be particularly helpful to identify HW conditions for which effective HWS would minimize the health burden across various geographical contexts and possibly update thresholds to trigger HWS. The aim of this study is to identify (and rank) definitions that drive the highest health burden in terms of mortality to inform future HWS across multiple cities in France. METHODS Based on weather data for 16 French cities, we compared the two official definitions used in France to: i) the Excess Heat Factor (EHF) used in Australia, and ii) 18 alternative hypothetical HW definitions based on various combinations of temperature metrics, intensity, and duration. Propensity score matching and Poisson regressions were used to estimate the effect of each HW exposure on non-accidental mortality for the May-September period from 2000 to 2015. RESULTS The associations between HW and mortality differed greatly depending on the definition. The greatest burden of heat was 1,055 (95% confidence interval "CI": [856; 1,302]) deaths per summer and was obtained with the EHF. The EHF identified HW with 2.46 (95% CI: [1.92; 3.58]) or 8.18 (95% CI: [6.63; 10.61]) times the global burden at the national level obtained with the climatological indicator of the French national weather service and the HW indicator of the French national HWS, respectively and was the most impactful definition pattern for both temperate oceanic and Mediterranean climate types. CONCLUSION Identifying the set of extreme heat conditions that drive the highest health burden in a given geographical context is particularly helpful when designing or updating heat early warning systems.
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Affiliation(s)
- Fleur Serge Kanti
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Nemesis team, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012, Paris, France.
| | - Anna Alari
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Nemesis team, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012, Paris, France
| | - Basile Chaix
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Nemesis team, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012, Paris, France
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography University of California, San Diego, La Jolla, San Diego, CA, USA
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Kim H, Lee JT, Fong KC, Bell ML. Alternative adjustment for seasonality and long-term time-trend in time-series analysis for long-term environmental exposures and disease counts. BMC Med Res Methodol 2021; 21:2. [PMID: 33397295 PMCID: PMC7780665 DOI: 10.1186/s12874-020-01199-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background Time-series analysis with case-only data is a prominent method for the effect of environmental determinants on disease events in environmental epidemiology. In this analysis, adjustment for seasonality and long-term time-trend is crucial to obtain valid findings. When applying this analysis for long-term exposure (e.g., months, years) of which effects are usually studied via survival analysis with individual-level longitudinal data, unlike its application for short-term exposure (e.g., days, weeks), a standard adjustment method for seasonality and long-term time-trend can extremely inflate standard error of coefficient estimates of the effects. Given that individual-level longitudinal data are difficult to construct and often available to limited populations, if this inflation of standard error can be solved, rich case-only data over regions and countries would be very useful to test a variety of research hypotheses considering unique local contexts. Methods We discuss adjustment methods for seasonality and time-trend used in time-series analysis in environmental epidemiology and explain why standard errors can be inflated. We suggest alternative methods to solve this problem. We conduct simulation analyses based on real data for Seoul, South Korea, 2002–2013, and time-series analysis using real data for seven major South Korean cities, 2006–2013 to identify whether the association between long-term exposure and health outcomes can be estimated via time-series analysis with alternative adjustment methods. Results Simulation analyses and real-data analysis confirmed that frequently used adjustment methods such as a spline function of a variable representing time extremely inflate standard errors of estimates for associations between long-term exposure and health outcomes. Instead, alternative methods such as a combination of functions of variables representing time can make sufficient adjustment with efficiency. Conclusions Our findings suggest that time-series analysis with case-only data can be applied for estimating long-term exposure effects. Rich case-only data such as death certificates and hospitalization records combined with repeated measurements of environmental determinants across countries would have high potentials for investigating the effects of long-term exposure on health outcomes allowing for unique contexts of local populations. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-020-01199-1.
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Affiliation(s)
- Honghyok Kim
- School of the Environment, Yale University, 195 Prospect Street, New Haven, CT, 06511, USA.
| | - Jong-Tae Lee
- BK21PLUS Program in 'Embodiment: Health -Society Interaction', Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea.,School of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
| | - Kelvin C Fong
- School of the Environment, Yale University, 195 Prospect Street, New Haven, CT, 06511, USA
| | - Michelle L Bell
- School of the Environment, Yale University, 195 Prospect Street, New Haven, CT, 06511, USA
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Slama A, Śliwczyński A, Woźnica-Pyzikiewicz J, Zdrolik M, Wiśnicki B, Kubajek J, Turżańska-Wieczorek O, Studnicki M, Wierzba W, Franek E. The short-term effects of air pollution on respiratory disease hospitalizations in 5 cities in Poland: comparison of time-series and case-crossover analyses. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:24582-24590. [PMID: 32356054 PMCID: PMC7326830 DOI: 10.1007/s11356-020-08542-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/23/2020] [Indexed: 05/30/2023]
Abstract
Very few publications have compared different study designs investigating the short-term effects of air pollutants on healthcare visits and hospitalizations for respiratory tract diseases. This study describes, using two different study designs (a case-crossover design and a time-series analysis), the association of air pollutants and respiratory disease hospitalizations. The study has been conducted on 5 cities in Poland on a timeline of almost 4 years. DLNM and regression models were both used for the assessment of the short-term effects of air pollution peaks on respiratory hospitalizations. Both case-crossover and time-series studies equally revealed a positive association between air pollution peaks and hospitalization occurrences. Results were provided in the form of percentage increase of a respiratory visit/hospitalization, for each 10-μg/m3 increment in single pollutant level for both study designs. The most significant estimated % increases of hospitalizations linked to increase of 10 μg/m3 of pollutant have been recorded in general with particulate matter, with highest values for 24 h PM2.5 in Warsaw (6.4%, case-crossover; 4.5%, time series, respectively) and in Białystok (5.6%, case-crossover; 4.5%, time series, respectively). The case-crossover analysis results have shown a larger CI in comparison to the results of the time-series analysis, while the lag days were easier to identify with the case-crossover design. The trends and the overlap of the results occurring from both methods are good and show applicability of both study designs to air pollution effects on short-term hospitalizations.
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Affiliation(s)
- Alessandro Slama
- Central Clinical Hospital MSWiA in Warsaw, Wołoska 137, 02-507, Warsaw, Poland
| | - Andrzej Śliwczyński
- University of Humanities and Economics in Łodz, Satellite Campus in Warsaw, ul. Wolność 2a, 01-018, Warsaw, Poland
| | | | - Maciej Zdrolik
- Chancellery of the Prime Minister of Poland, al. Ujazdowskie 1/3, 00-001, Warsaw, Poland
| | - Bartłomiej Wiśnicki
- Department of Business Economics, Warsaw School of Economics, Al. Niepodleglosci 162, 02-554, Warsaw, Poland
| | - Jakub Kubajek
- Chancellery of the Prime Minister of Poland, al. Ujazdowskie 1/3, 00-001, Warsaw, Poland
| | | | - Marcin Studnicki
- Warsaw University of Life Sciences, Nowoursynowska 166, 02-787, Warsaw, Poland
| | - Waldemar Wierzba
- University of Humanities and Economics in Łodz, Satellite Campus in Warsaw, ul. Wolność 2a, 01-018, Warsaw, Poland
| | - Edward Franek
- Central Clinical Hospital MSWiA in Warsaw, Wołoska 137, 02-507, Warsaw, Poland.
- Mossakowski Clinical Research Centre, Polish Academy of Sciences, Pawinskiego 5, 02-106, Warsaw, Poland.
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Beard E, Marsden J, Brown J, Tombor I, Stapleton J, Michie S, West R. Understanding and using time series analyses in addiction research. Addiction 2019; 114:1866-1884. [PMID: 31058392 DOI: 10.1111/add.14643] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/17/2018] [Accepted: 04/29/2019] [Indexed: 11/29/2022]
Abstract
Time series analyses are statistical methods used to assess trends in repeated measurements taken at regular intervals and their associations with other trends or events, taking account of the temporal structure of such data. Addiction research often involves assessing associations between trends in target variables (e.g. population cigarette smoking prevalence) and predictor variables (e.g. average price of a cigarette), known as a multiple time series design, or interventions or events (e.g. introduction of an indoor smoking ban), known as an interrupted time series design. There are many analytical tools available, each with its own strengths and limitations. This paper provides addiction researchers with an overview of many of the methods available (GLM, GLMM, GLS, GAMM, ARIMA, ARIMAX, VAR, SVAR, VECM) and guidance on when and how they should be used, sample size det ermination, reporting and interpretation. The aim is to provide increased clarity for researchers proposing to undertake these analyses concerning what is likely to be acceptable for publication in journals such as Addiction. Given the large number of choices that need to be made when setting up time series models, the guidance emphasizes the importance of pre-registering hypotheses and analysis plans before the analyses are undertaken.
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Affiliation(s)
- Emma Beard
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - John Marsden
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Jamie Brown
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Ildiko Tombor
- Department of Behavioural Science and Health, University College London, London, UK
| | - John Stapleton
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
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Guo B, Chen F, Deng Y, Zhang H, Qiao X, Qiao Z, Ji K, Zeng J, Luo B, Zhang W, Zhang Y, Zhao X. Using rush hour and daytime exposure indicators to estimate the short-term mortality effects of air pollution: A case study in the Sichuan Basin, China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 242:1291-1298. [PMID: 30121483 DOI: 10.1016/j.envpol.2018.08.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/16/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Daily mean concentrations of air pollutants have been widely used as exposure indicators to estimate the short-term mortality effects of outdoor air pollution. However, daily mean concentrations might insufficiently represent the true exposure level because of the diurnal variations of air pollutants and various human activity patterns. Daytime or rush-hour concentrations may lead to better estimations. OBJECTIVE Our study aimed to imitate the true exposure level under assumptions about human activity patterns and to examine the short-term mortality effects of the exposure to air pollution during a) the morning-evening rush hours (ME), b) the morning-lunch-evening rush hours (MLE), and c) the whole daytime (WDT) in Chengdu, Sichuan Basin, China. METHODS We investigated the diurnal variations of PM2.5, SO2, and O3 and examined the associations between the three pollutants and nonaccidental mortality, cardiovascular mortality, respiratory mortality using generalized additive model. Three novel exposure indicators (ME, MLE, and WDT) were employed to imitate the most probable exposure levels. Relative change of excess risk (ER) was used to compare effects estimated from models with different exposure indicators. RESULTS In the relationship of PM2.5 and mortality, ERs estimated from the novel-indicator models decreased by 4.88%-11.89% in comparison with ERs from the daily-indicator models. All the three novel indicators of SO2 offered lower ERs of respiratory mortality than the daily indicator did. Significant associations were observed in O3-nonaccidental mortality at lag0 in both winter and spring, and O3-cardiovascular mortality at lag0 in winter. Overall, majority of effect estimates based on rush-hour or daytime indicators were lower than the estimates based on daily mean concentrations. CONCLUSION The use of daily mean concentrations may bias exposure assessment and thus inflating effect estimates. This study highlights the importance of rush-hour and daytime exposure and provides alternative indicators for estimating acute effects of air pollution.
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Affiliation(s)
- Bing Guo
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fei Chen
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ying Deng
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, China
| | - Hongliang Zhang
- Department of Civil and Environmental Engineering, Louisiana State University, Baton Rouge, LA, 70803, USA
| | - Xue Qiao
- Institute of New Energy and Low-Carbon Technology, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhijiao Qiao
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Kui Ji
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, China
| | - Jing Zeng
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, China
| | - Bin Luo
- Sichuan Environmental Monitoring Center, Chengdu, 610041, Sichuan, China
| | - Wei Zhang
- Sichuan Environmental Monitoring Center, Chengdu, 610041, Sichuan, China
| | - Yuqin Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xing Zhao
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, 610041, Sichuan, China.
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Rodopoulou S, Katsouyanni K, Lagiou P, Samoli E. Assessing the cumulative health effect following short term exposure to multiple pollutants: An evaluation of methodological approaches using simulations and real data. ENVIRONMENTAL RESEARCH 2018; 165:228-234. [PMID: 29727823 DOI: 10.1016/j.envres.2018.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/03/2018] [Accepted: 04/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Assessment of the cumulative effect of correlated exposures is an open methodological issue in environmental epidemiology. Most previous studies have applied regression models with interaction terms or dimension reduction methods. The combined effect of pollutants has been also evaluated through the use of exposure scores that incorporate weights based on the strength of the component-specific associations with health outcomes. METHODS We compared three approaches addressing multi-pollutant exposures in epidemiological models: main effects models, the adaptive least absolute shrinkage and selection operator (LASSO) and a weighted exposure score. We assessed the performance of the methods by simulations under various scenarios for the pollutants' correlations. We further applied these methods to time series data from Athens, Greece in 2007-12 to investigate the combined effect of short-term exposure to six regulated pollutants on all-cause and respiratory mortality. RESULTS The exposure score provided the least biased estimate under all correlation scenarios for both mortality outcomes. The adaptive LASSO performed well in the case of low and medium correlation between exposures while the main effect model resulted in severe bias. In the real data application, the cumulative effect estimate was similar between approaches for all-cause mortality ranging from 0.7% increase per interquartile range (IQR) (score) to 1.1% (main effects), while for respiratory mortality conclusions were contradictive and ranged from - 0.6% (adaptive LASSO) to 2.8% (score). CONCLUSIONS Τhe use of a weighted exposure score to address cumulative effects of correlated metrics may perform well under different exposure correlation and variability in the health outcomes.
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Affiliation(s)
- Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str, 115 27 Athens, Greece
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str, 115 27 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
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str, 115 27 Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str, 115 27 Athens, Greece.
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Beaudeau P. A Systematic Review of the Time Series Studies Addressing the Endemic Risk of Acute Gastroenteritis According to Drinking Water Operation Conditions in Urban Areas of Developed Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050867. [PMID: 29701701 PMCID: PMC5981906 DOI: 10.3390/ijerph15050867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/02/2022]
Abstract
Time series studies (TSS) can be viewed as an inexpensive way to tackle the non-epidemic health risk from fecal pathogens in tap water in urban areas. Following the PRISMA recommendations, I reviewed TSS addressing the endemic risk of acute gastroenteritis risk according to drinking water operation conditions in urban areas of developed countries. Eighteen studies were included, covering 17 urban sites (seven in North-America and 10 in Europe) with study populations ranging from 50,000 to 9 million people. Most studies used general practitioner consultations or visits to hospitals for acute gastroenteritis (AGE) as health outcomes. In 11 of the 17 sites, a significant and plausible association was found between turbidity (or particle count) in finished water and the AGE indicator. When provided and significant, the interquartile excess of relative risk estimates ranged from 3–13%. When examined, water temperature, river flow, and produced flow were strongly associated with the AGE indicator. The potential of TSS for the study of the health risk from fecal pathogens in tap water is limited by the lack of specificity of turbidity and its site-sensitive value as an exposure proxy. Nevertheless, at the DWS level, TSS could help water operators to identify operational conditions most at risk, almost if considering other water operation indicators, in addition to turbidity, as possible relevant proxies for exposure.
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Affiliation(s)
- Pascal Beaudeau
- Santé Publique France, 14 rue du Val-d'Osne, 94415 Saint-Maurice CEDEX, France.
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10
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Short-Term Associations between Air Pollution Concentrations and Respiratory Health-Comparing Primary Health Care Visits, Hospital Admissions, and Emergency Department Visits in a Multi-Municipality Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14060587. [PMID: 28561792 PMCID: PMC5486273 DOI: 10.3390/ijerph14060587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/17/2017] [Accepted: 05/27/2017] [Indexed: 12/04/2022]
Abstract
Acute effects of air pollution on respiratory health have traditionally been investigated with data on inpatient admissions, emergency room visits, and mortality. In this study, we aim to describe the total acute effects of air pollution on health care use for respiratory symptoms (ICD10-J00-J99). This will be done by investigating primary health care (PHC) visits, inpatient admissions, and emergency room visits together in five municipalities in southern Sweden, using a case-crossover design. Between 2005 and 2010, there were 81,019 visits to primary health care, 38,217 emergency room visits, and 25,271 inpatient admissions for respiratory symptoms in the study area. There was a 1.85% increase (95% CI: 0.52 to 3.20) in the number of primary health care visits associated with a 10 µg/m3 increase in nitrogen dioxide (NO2) levels in Malmö, but not in the other municipalities. Air pollution levels were generally not associated with emergency room visits or inpatient admissions, with one exception (in Helsingborg there was a 2.52% increase in emergency room visits for respiratory symptoms associated with a 10 µg/m3 increase in PM10). In conclusion, the results give weak support for short-term effects of air pollution on health care use associated with respiratory health symptoms in the study area.
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Chen K, Glonek G, Hansen A, Williams S, Tuke J, Salter A, Bi P. The effects of air pollution on asthma hospital admissions in Adelaide, South Australia, 2003-2013: time-series and case-crossover analyses. Clin Exp Allergy 2016; 46:1416-1430. [PMID: 27513706 DOI: 10.1111/cea.12795] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 07/15/2016] [Accepted: 07/17/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Air pollution can have adverse health effects on asthma sufferers, but the effects vary with geographic, environmental and population characteristics. There has been no long time-series study in Australia to quantify the effects of environmental factors including pollen on asthma hospitalizations. OBJECTIVES This study aimed to assess the seasonal impact of air pollutants and aeroallergens on the risk of asthma hospital admissions for adults and children in Adelaide, South Australia. METHODS Data on hospital admissions, meteorological conditions, air quality and pollen counts for the period 2003-2013 were sourced. Time-series analysis and case-crossover analysis were used to assess the short-term effects of air pollution on asthma hospitalizations. For the time-series analysis, generalized log-linear quasi-Poisson and negative binomial regressions were used to assess the relationships, controlling for seasonality and long-term trends using flexible spline functions. For the case-crossover analysis, conditional logistic regression was used to compute the effect estimates with time-stratified referent selection strategies. RESULTS A total of 36,024 asthma admissions were considered. Findings indicated that the largest effects on asthma admissions related to PM2.5 , NO2 , PM10 and pollen were found in the cool season for children (0-17 years), with the 5-day cumulative effects of 30.2% (95% CI: 13.4-49.6%), 12.5% (95% CI: 6.6-18.7%), 8.3% (95% CI: 2.5-14.4%) and 4.2% (95% CI: 2.2-6.1%) increases in risk of asthma hospital admissions per 10 unit increments, respectively. The largest effect for ozone was found in the warm season for children with the 5-day cumulative effect of an 11.7% (95% CI: 5.8-17.9%) increase in risk of asthma hospital admissions per 10 ppb increment in ozone level. CONCLUSION Findings suggest that children are more vulnerable and the associations between exposure to air pollutants and asthma hospitalizations tended to be stronger in the cool season compared to the warm season, with the exception of ozone. This study has important public health implications and provides valuable evidence for the development of policies for asthma management.
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Affiliation(s)
- K Chen
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - G Glonek
- School of Mathematical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - A Hansen
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - S Williams
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - J Tuke
- School of Mathematical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - A Salter
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - P Bi
- School of Public Health, University of Adelaide, Adelaide, SA, Australia.
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