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Zhu S, Zhang F, Xie X, Zhu W, Tang H, Zhao D, Ruan L, Li D. Association between long-term exposure to fine particulate matter and its chemical constituents and premature death in individuals living with HIV/AIDS. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 351:124052. [PMID: 38703976 DOI: 10.1016/j.envpol.2024.124052] [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: 10/26/2023] [Revised: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
Long-term exposure to fine particulate matter (PM2.5) is associated with an increased total mortality. However, the association of PM2.5 with mortality in people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS, PLWHA) and the relationship between its constituents and adverse outcomes remain unknown. In this cohort study, 28,140 PLWHA were recruited from the HIV/AIDS Comprehensive Response Information Management System of the Hubei Provincial Centre for Disease Control and Prevention in China between 2001 and 2020. The annual PM2.5 chemical composition data, including sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), black carbon (BC), and organic matter (OM), was extracted from the Tracking Air Pollution (TAP) dataset in China. A Cox proportional hazard model with time-varying exposure and time-to-event quantile-based generalized (g) computation was used to assess the associations between PM2.5 chemical constituents, and mortality in PLWHA. A multivariate Cox proportional hazard model estimated an excess hazard ratio (eHR) of 0.32% [95% confidence interval (CI): (0.01%, 0.64%)] for AIDS-related death (ARD), associated with 1 μg/m3 rise in PM2.5 exposure. An increase of 1 μg/m3 in NH4+ was associated with 5.13% [95% CI: (2.89%, 7.43%)] and 2.97% [95% CI: (1.52%, 4.44%)] increase in the risk of ARD and all-cause deaths (ACD), respectively. When estimated using survival-based quantile g-computation, the eHR for ARD with a joint change in a decile increase in all five components was 6.10% [95% CI: 3.77%, 8.48%)]. Long-term exposure to PM2.5 chemical composition, particularly NH4+ increased the risk of death in PLWHA. This study provides epidemiological evidence that SO42- and NH4+ increased the risk of ARD and that NH4+ increased the risk of ACD in PLWHA. Multi-constituent analyses further suggested that NH4+ may be a key component in increasing the risk of premature death in patients with HIV/AIDS. Individuals aged ≥65 with HIV/AIDS are more vulnerable to SO42-, and consequent ACD.
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Affiliation(s)
- Shijie Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Faxue Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Xiaoxin Xie
- Guiyang Public Health Treatment Center, Guiyang, 550004, China
| | - Wei Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Heng Tang
- Institute for the Prevention and Control of HIV/AIDS, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Dingyuan Zhao
- Institute for the Prevention and Control of HIV/AIDS, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Lianguo Ruan
- Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Hubei Clinical Research Center for Infectious Diseases, Wuhan Research Center for Communicable Disease Diagnosis and Treatment, Chinese Academy of Medical Sciences, Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, 430023, China
| | - Dejia Li
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China.
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Gomez F, Ayo-Yusuf O, Yershova K, Jain V, Alcheva A, Hatsukami DK, Parascandola M, Stepanov I. Heterogeneity of Harmful Constituent Profiles in Smokeless Tobacco Products from Five African Countries. Chem Res Toxicol 2023; 36:1901-1911. [PMID: 38051542 DOI: 10.1021/acs.chemrestox.3c00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Addictive, toxic, and carcinogenic constituents present in smokeless tobacco (SLT) products are responsible for the harmful effects associated with SLT use. There are limited data on levels of such constituents in SLT products used in Africa, a region with high prevalence of SLT use and the associated morbidity and mortality. Manufactured and custom-made SLT products were purchased from five African countries (South Africa, Uganda, Mauritania, Nigeria, and Zambia) using a standard approach for sample collection, labeling, and storage. Moisture content, pH, total and unprotonated (biologically available) nicotine, five tobacco-specific N-nitrosamines (TSNA), 10 polycyclic aromatic hydrocarbons (PAH), five metals and metalloids (As, Cd, Cr, Ni, and Pb), nitrate, and nitrite were analyzed. A total of 54 samples representing 15 varieties of manufactured SLT products and 13 varieties of custom-made SLT products were purchased and analyzed. In all samples, the total nicotine ranged from 1.6 to 20.5 mg/g product and unprotonated nicotine accounted for 5.3-99.6% of the total nicotine content. The sum of all five TSNA ranged from 1.6 to 100 μg/g product, with significant within-country variations observed across both the manufactured and custom-made varieties. Significant variations were also found for PAH, metals and metalloids, nitrates, and nitrites. This is the most comprehensive report on the chemical profiling of products from African countries. This is also the first study illustrating the variability of harmful constituents within the same types and brands of African SLT. Our findings emphasize the need for consumer education and interventions to reduce SLT use in Africa. The data reported here can be useful to regulators in considering measures to prevent the occurrence of high levels of known toxicants and carcinogens in manufactured products.
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Affiliation(s)
- Francisco Gomez
- Masonic Cancer Center, University of Minnesota, CCRB 2-140, 2231 Sixth Street SE, Minneapolis, Minnesota 55455, United States
| | - Olalekan Ayo-Yusuf
- Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM), School of Health Systems and Public Health, University of Pretoria, Hatfield 0028, South Africa
| | - Katrina Yershova
- Masonic Cancer Center, University of Minnesota, CCRB 2-140, 2231 Sixth Street SE, Minneapolis, Minnesota 55455, United States
| | - Vipin Jain
- Masonic Cancer Center, University of Minnesota, CCRB 2-140, 2231 Sixth Street SE, Minneapolis, Minnesota 55455, United States
| | - Aleksandra Alcheva
- Masonic Cancer Center, University of Minnesota, CCRB 2-140, 2231 Sixth Street SE, Minneapolis, Minnesota 55455, United States
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota, CCRB 2-140, 2231 Sixth Street SE, Minneapolis, Minnesota 55455, United States
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota 55454, United States
- Institute for Global Cancer Prevention Research, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Mark Parascandola
- Center for Global Health, National Cancer Institute, Bethesda, Maryland 20892, United States
| | - Irina Stepanov
- Masonic Cancer Center, University of Minnesota, CCRB 2-140, 2231 Sixth Street SE, Minneapolis, Minnesota 55455, United States
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455, United States
- Institute for Global Cancer Prevention Research, University of Minnesota, Minneapolis, Minnesota 55455, United States
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