High life in the sky? Mortality by floor of residence in Switzerland

Residents’ Spatial-Usage Behavior and Interaction According to the Spatial Configuration of a Social Housing Complex: A Comparison between High-Rise Apartments and Perimeter Block Housing

It has been claimed that high-rise apartments, unlike perimeter block housing, cause social pathology; however, no studies have quantitatively proven this. Therefore, this study aimed to analyze the difference between space-use behavior and social interactions with a focus on high-rise apartments, the main residential mode in South Korea, and the newly created perimeter block housing. This was done by first comparing and analyzing the spatial configurations of high-rise apartments and perimeter block housing using the space syntax methodology. Second, the space-use behaviors that affect interaction were explained by regression analysis after analyzing correlations among the spatial configurations of individual residence locations, the frequency of use of community facilities, and interaction. Third, differences in interaction for people living in complexes with different spatial configurations were analyzed using t-tests. The main finding was that people whose living arrangements include a good spatial configuration or that often use children’s playgrounds interact more. Additionally, when the spatial configuration of a complex is systematic and the complex is closely connected to the city, the interaction between neighbors appears better. The results of this study demonstrate that block housing promotes interaction, which will be helpful for establishing new planning standards for sustainable apartments.

Indoor Air Pollution and Susceptibility to Tuberculosis Infection in Urban Vietnamese Children

RATIONALE

The Southeast Asian tuberculosis burden is high, and it remains unclear if urban indoor air pollution in this setting is exacerbating the epidemic.

OBJECTIVES

To determine the associations of latent tuberculosis with common urban indoor air pollution sources (secondhand smoke, indoor motorcycle emissions, and cooking) in Southeast Asia.

METHODS

We enrolled child household contacts of patients with microbiologically confirmed active tuberculosis in Vietnam, July 2017-December 2019. We tested children for latent tuberculosis and evaluated air pollution exposures with questionnaires and personal aerosol sampling. We tested hypotheses using generalized estimating equations.

MEASUREMENTS AND MAIN RESULTS

We enrolled 72 tuberculosis patients (27% with cavitary disease) and 109 of their child household contacts. Of household contacts, 58 (53%) were diagnosed with latent tuberculosis at baseline visit. Children experienced a 2.56-fold increased odds of latent tuberculosis for each additional household member who smoked (95%CI 1.27-5.16). Odds were highest among children exposed to indoor smokers and children under five years old exposed to household smokers. Each residential floor above street-level pollution decreased the odds of latent tuberculosis by 36% (aOR 0.64, 95%CI 0.42-0.96). Motorcycles parked inside children's homes and cooking with liquid petroleum gas compared to electricity increased the odds of latent tuberculosis while kitchen ventilation decreased the effect, but these findings were not statistically significant.

CONCLUSION

Common urban indoor air pollution sources were associated with increased odds of latent tuberculosis infection in child household contacts of active tuberculosis patients.

Method-Specific Suicide Rates and Accessibility of Means

Abstract.Background: Few studies have investigated whether means accessibility is related to the spatial distribution of suicide. Aims: To examine the hypothesis that indicators of the accessibility to specific suicide methods were associated with method-specific suicide rates in Taipei City, Taiwan. Method: Smoothed standardized mortality ratios for method-specific suicide rates across 432 neighborhoods and their associations with means accessibility indicators were estimated using Bayesian hierarchical models. Results: The proportion of single-person households, indicating the ease of burning charcoal in the home, was associated with charcoal-burning suicide rates (adjusted rate ratio [aRR] = 1.13, 95% credible interval [CrI] = 1.03–1.25). The proportion of households living on the sixth floor or above, indicating easy access to high places, was associated with jumping suicide rates (aRR = 1.16, 95% CrI, 1.04–1.29). Neighborhoods’ adjacency to rivers, indicating easy access to water, showed no statistical evidence of an association with drowning suicide rates (aRR = 1.27, 95% CrI = 0.92–1.69). Hanging and overall suicide rates showed no associations with any of these three accessibility indicators. Limitations: This is an ecological study; associations between means accessibility and suicide cannot be directly inferred as causal. Conclusion: The findings have implications for identifying high-risk groups for charcoal-burning suicide (e.g., vulnerable individuals living alone) and preventing jumping suicides by increasing the safety of high buildings.

Associations of self-reported stair climbing with all-cause and cardiovascular mortality: The Harvard Alumni Health Study

To evaluate the association between numbers of floors climbed (per week) and all-cause and cardiovascular (CVD) mortality in men. A prospective study was conducted in 8874 men (Median [interquartile range] age: 65 years [60-71.6 years]) from the Harvard Alumni Health Study. Participants reported the number of floors habitually climbed, physical activity in their leisure time, other health related behaviours and any physician diagnosed disease in 1988. Men were followed for mortality through December 2008. Multivariate Cox hazard models to examine the association between weekly number of floors climbed and all-cause and CVD mortality adjusted for participation in total physical activity and other confounders. During a median follow-up of 12.4 years, 4063 men died (1195 from CVD). After adjusting for confounders (age, walking, sports/recreation, body mass index, alcohol intake, and smoking, diagnoses of hypertension or diabetes or high cholesterol) number of stairs habitually climbed was inversely associated with all-cause mortality (p trend <0.001). Compared with the group who climbed <10 floors/week, the hazard ratio (HR) for the ≥35 floors/week group was 0.84 95% confidence interval (CI) (0.78-0.91). In contrast, we found no evidence for an association between stair climbing and CVD mortality risk (p trend = 0.38), in the ≥35 floors/week group: HR = 0.94 95%CI (0.81-1.09). In this cohort of older men, stair climbing was associated with a lower risk of mortality from any causes. Further insights may be gained from future observational studies utilizing emerging pattern recognition of stair climbing from objective measurements of physical activity.

Modelling the vertical gradient of nitrogen dioxide in an urban area

INTRODUCTION

Land use regression models environmental predictors to estimate ground-floor air pollution concentration surfaces of a study area. While many cities are expanding vertically, such models typically ignore the vertical dimension.

METHODS

We took integrated measurements of NO₂ at up to three different floors on the facades of 25 buildings in the mid-sized European city of Basel, Switzerland. We quantified the decrease in NO₂ concentration with increasing height at each facade over two 14-day periods in different seasons. Using predictors of traffic load, population density and street configuration, we built conventional land use regression (LUR) models which predicted ground floor concentrations. We further evaluated which predictors best explained the vertical decay rate. Ultimately, we combined ground floor and decay models to explain the measured concentrations at all heights.

RESULTS

We found a clear decrease in mean nitrogen dioxide concentrations between measurements at ground level and those at higher floors for both seasons. The median concentration decrease was 8.1% at 10 m above street level in winter and 10.4% in summer. The decrease with height was sharper at buildings where high concentrations were measured on the ground and in canyon-like street configurations. While the conventional ground floor model was able to explain ground floor concentrations with a model R² of 0.84 (RMSE 4.1 μg/m³), it predicted measured concentrations at all heights with an R² of 0.79 (RMSE 4.5 μg/m³), systematically overpredicting concentrations at higher floors. The LUR model considering vertical decay was able to predict ground floor and higher floor concentrations with a model R² of 0.84 (RMSE 3.8 μg/m³) and without systematic bias.

DISCUSSION

Height above the ground is a relevant determinant of outdoor residential exposure, even in medium-sized European cities without much high-rise. It is likely that conventional LUR models overestimate exposure for residences at higher floors near major roads. This overestimation can be minimized by considering decay with height.

A Dynamic Three-Dimensional Air Pollution Exposure Model for Hong Kong

INTRODUCTION

High-density high-rise cities have become a more prominent feature globally. Air quality is a significant public health risk in many of these cities. There is a need to better understand the extent to which vertical variation in air pollution and population mobility in such cities affect exposure and exposure-response relationships in epidemiological studies.

METHODS

We used a novel strategy to execute a staged model development that incorporated horizontal and vertical pollutant dispersion, building infiltration, and population mobility patterns in estimating traffic-related air pollution (TRAP) exposures in the Hong Kong Special Administrative Region (HK SAR).

Two street-level spatial monitoring campaigns were undertaken to facilitate the creation of a two-dimensional land-use regression (LUR) model. A network of approximately 100 passive nitric oxide-nitrogen dioxide (NO-NO2) monitors was deployed for two-week periods during the cool and warm seasons. Sampling locations were selected based on population and road network density with a range of physical and geographical characteristics represented. Eight sets of portable monitors for black carbon (BC) and particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5) were rotated so as to be deployed at 80 locations for a 24-hour period. Land-use, geographical, and emissions layers were combined with the spatial monitoring campaign results to create spatiotemporal exposure models.

Vertical air pollution monitoring was carried out at six strategic locations for two weeks in the warm season and two weeks in the cool season. Continuous measurements were carried out at four different heights of a residential building and on both sides of a street canyon. The heights ranged from as close to street level as practically possible up to a maximum of 50 meters (i.e., below the 20th floor). Paired indoor monitoring was included to allow the calculation of infiltration coefficients to feed into the dynamic component of the exposure model.

The final phase of model development addressed population mobility. A population-representative travel behavior survey (n = 89,358) was used to produce the dynamic component of the model, with time-weighted exposure estimates split between home and work or school. Transport microenvironment exposures were taken from published literature. Time-activity exposure estimates were split by age, sex, and employment status.

Development of the exposure model in distinct packages allowed the application of a staged approach to an existing cohort data set. Mortality risk estimates for an elderly cohort of 66,000 Hong Kong residents were calculated using increasing exposure model complexity.

RESULTS

The street-level (2-dimensional [2D]) LUR modeling captured important spatial parameters and represented spatial patterns of air quality in Hong Kong that were consistent with the literature. Higher concentrations of gaseous pollutants were centered in Kowloon and the northern region of Hong Kong Island. PM2.5 and BC predictions exhibited a north-south/west-east gradient, with higher concentrations in the northwest due to regional transport of particulate pollutants from Mainland China. While the degree of explained variance of the models was in line with other LUR modeling efforts in Asia, R2 values ranged from 0.46 (NO2) to 0.59 (PM2.5).

Exponential decay rates (k) were calculated at each monitoring location. While it was clear that k values were higher during the warm season than the cool season, no robust patterns were identified relating to the canyon physical parameters. Therefore, a single decay rate was used for each pollutant across the whole region for derivation of the 3-dimensional (3D) exposure layer (k = 0.004 and 0.012 for PM2.5 and BC, respectively). An alternative decay profile that capped decay at 20 meters above street level was proposed and evaluated. The electrochemical sensors deployed during the canyon campaigns did not exhibit the degree of interunit precision necessary to detect vertical variations in gaseous pollutants, and these results were excluded from the study.

We found that values of the median infiltration efficiencies (Finf) for both BC and PM2.5 were especially high during the cool season (91%). Finf values were somewhat lower during the warm season (81% and 88% for PM2.5 and BC, respectively), and we found a significant negative correlation between air conditioning use and Finf. The Finf for a mechanically ventilated office building was 45% and 40% during the cool and warm seasons, respectively.

Dynamic exposure estimates were compared against home outdoor estimates. As expected, the addition of an indoor component decreased time-weighted exposure estimates, which were balanced out to some extent by the inclusion of transport microenvironments. Overall, mean time-weighted exposures for the full dynamic model were around 20% lower than home outdoor estimates.

Higher levels of exposures were found with working adults and students than for those neither in work nor study. This was due to the increased mobility of people going to work or school. The exposures to PM2.5, BC, and NO2 were, respectively, 13%, 39%, and 14% higher for people who were under age 18, compared with people who were 65 or older. Exposure estimates for the female population were approximately 4% lower.

The availability of an existing cohort data set of elderly Hong Kong residents (n = 66,820) facilitated the calculation and comparison of mortality risk estimates for the different exposure models.

Overall, results indicated that the application of exposure estimates that incorporated infiltration, vertical, and to a lesser extent, dynamic components resulted in higher hazard ratios (HRs) than the standard street-level model and increased the number of significant associations with all-natural-cause, cardiovascular, and respiratory mortality outcomes.

CONCLUSIONS

The results from the study provided the first evidence that considering air pollution exposure in a dynamic 3D landscape would benefit epidemiological studies. Higher HRs and a greater number of significant associations were found between mortality and pollutant exposures that would not have been found had standard 2D exposure models been used. Dynamic models can also identify differential exposures between population subtypes (e.g., students and working adults; those neither in work nor study).

Improved urban building design appears to be stimulating the dispersion of local TRAP in street canyons. Conversely, Finf values found in naturally ventilated buildings were high, and residences provided little protection from ambient air pollution.

We have demonstrated that the creation of effective advanced exposure models is possible in Asian cities without an undue burden on resources. We recommend that vertical exposure patterns be incorporated in future epidemiological studies in high-rise cities where the floor of residence is recorded in health record data.

Exploring the Impacts of Housing Condition on Migrants' Mental Health in Nanxiang, Shanghai: A Structural Equation Modelling Approach

Although rapid urbanization and associated rural-to-urban migration has brought in enormous economic benefits in Chinese cities, one of the negative externalities include adverse effects upon the migrant workers’ mental health. The links between housing conditions and mental health are well-established in healthy city and community planning scholarship. Nonetheless, there has thusfar been no Chinese study deciphering the links between housing conditions and mental health accounting for macro-level community environments, and no study has previously examined the nature of the relationships in locals and migrants. To overcome this research gap, we hypothesized that housing conditions may have a direct and indirect effects upon mental which may be mediated by neighbourhood satisfaction. We tested this hypothesis with the help of a household survey of 368 adult participants in Nanxiang Town, Shanghai, employing a structural equation modeling approach. Our results point to the differential pathways via which housing conditions effect mental health in locals and migrants. For locals, housing conditions have direct effects on mental health, while as for migrants, housing conditions have indirect effects on mental health, mediated via neighborhood satisfaction. Our findings have significant policy implications on building an inclusive and harmonious society. Upstream-level community interventions in the form of sustainable planning and designing of migrant neighborhoods can promote sense of community, social capital and support, thereby improving mental health and overall mental capital of Chinese cities.

Oceanic Meteorological Conditions Influence Incidence of Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE

Publications concerning the weather pattern of occurrence of the subarachnoid hemorrhage have produced controversial results. We chose to study subarachnoid hemorrhage occurring in oceanic climate with deep variations focusing on partial oxygen volume (pO₂) and patient history.

METHODS

Seventy-one patients had been successively recruited from a single center 45 km from the Atlantic shore. Climate conditions had been analyzed from 72 hours before subarachnoid hemorrhage to 24 hours after. According to Dalton's law, climate conditions influence pO_2, recalculated with Dupré's formula, and patient history analyzed and scored according to the induced oxidative stress.

RESULTS

Subarachnoid hemorrhage risk is highest during spring and autumn, lowest between midnight and 6:00 a.m. Risk is highest after a period of atmospheric pressure higher than 1010 hPa (83%) and high pO₂ and lowest for atmospheric pressure lower than 990 hPa and pO₂ lower than 20.6_. According to the medical history, 2 groups of patients could be identified: patients without history (22%), women (62%), high atmospheric pressure, and relatively lower pO₂; and patients with a medical history, relatively lower atmospheric pressure, and higher pO₂. Atmospheric pressure decreased significantly before disruption (994 hPa) but with a constant pO₂. Subarachnoid hemorrhages during high atmospheric pressure were preceded by a decrease of pO₂ despite a highly stable period of high atmospheric pressure.

DISCUSSION

Atmospheric O₂ changes and the subsequent oxidative stress could be the local ultimate trigger of subarachnoid hemorrhage that could result in the "ideal" fit of patient's health conditions with the meteorological environment.

The Association between Residence Floor Level and Cardiovascular Disease: The Health and Environment in Oslo Study

Background. Increasingly more people live in tall buildings and on higher floor levels. Factors relating to floor level may protect against or cause cardiovascular disease (CVD). Only one previous study has investigated the association between floor level and CVD. Methods. We studied associations between floor of bedroom and self-reported history of stroke, venous thromboembolism (VTE), and intermittent claudication (IC) among 12.525 inhabitants in Oslo, Norway. We fitted multivariate logistic regression models and adjusted for sociodemographic variables, socioeconomic status (SES), and health behaviors. Additionally, we investigated block apartment residents (N = 5.374) separately. Results. Trend analyses showed that disease prevalence increased by floor level, for all three outcomes. When we investigated block apartment residents alone, the trends disappeared, but one association remained: higher odds of VTE history on 6th floor or higher, compared to basement and 1st floor (OR: 1.504; 95% CI: 1.007–2.247). Conclusion. Floor level is positively associated with CVD, in Oslo. The best-supported explanation may be residual confounding by building height and SES. Another explanation, about the impact of atmospheric electricity, is also presented. The results underline a need to better understand the associations between residence floor level and CVD and multistory housing and CVD.

Is Living in a High-Rise Building Bad for Your Self-Rated Health?

While the construction of high-rise buildings is a popular policy strategy for accommodating population growth in cities, there is still much debate about the health consequences of living in high flats. This study examines the relationship between living in high-rise buildings and self-rated health in Belgium. We use data from the Belgian Census of 2001, merged with the National Register of Belgium (N = 6,102,820). Results from multilevel, binary logistic regression analyses show that residents living in high-rise buildings have considerable lower odds to have a good or very good self-rated health in comparison with residents in low-rise buildings (OR 0.67; 95 % CI 0.67-0.68). However, this negative relationship disappears completely after adjusting for socioeconomic and demographic variables (OR 1.04; 95 % CI 1.03-1.05), which suggests that residents' worse self-rated health in high-rise buildings can be explained by the strong demographic and socioeconomic segregation between high- and low-rise buildings in Belgium. In addition, there is a weak, but robust curvilinear relationship between floor level and self-rated health within high-rise buildings. Self-rated health increases until the sixth floor (OR 1.19; 95 % CI 1.15-1.24) and remains stable from the seventh floor and upwards. These findings refute one of the central ideas in architectural sciences that living in high buildings is bad for one's health.

Independent at heart: persistent association of altitude with ischaemic heart disease mortality after consideration of climate, topography and built environment

BACKGROUND

Living at higher altitude was dose-dependently associated with lower risk of ischaemic heart disease (IHD). Higher altitudes have different climatic, topographic and built environment properties than lowland regions. It is unclear whether these environmental factors mediate/confound the association between altitude and IHD. We examined how much of the altitude-IHD association is explained by variations in exposure at place of residence to sunshine, temperature, precipitation, aspect, slope and distance to main road.

METHODS

We included 4.2 million individuals aged 40-84 at baseline living in Switzerland at altitudes 195-2971 m above sea level (ie, full range of residence), providing 77 127 IHD deaths. Mortality data 2000-2008, sociodemographic/economic information and coordinates of residence were obtained from the Swiss National Cohort, a longitudinal, census-based record linkage study. Environment information was modelled to residence level using Weibull regression models.

RESULTS

In the model not adjusted for other environmental factors, IHD mortality linearly decreased with increasing altitude resulting in a lower risk (HR, 95% CI 0.67, 0.60 to 0.74) for those living >1500 m (vs<600 m). This association remained after adjustment for all other environmental factors 0.74 (0.66 to 0.82).

CONCLUSIONS

The benefit of living at higher altitude was only partially confounded by variations in climate, topography and built environment. Rather, physical environment factors appear to have an independent effect and may impact on cardiovascular health in a cumulative way. Inclusion of additional modifiable factors as well as individual information on traditional IHD risk factors in our combined environmental model could help to identify strategies for the reduction of inequalities in IHD mortality.

The Rotterdam Study: 2016 objectives and design update

The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over 1200 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.

Trends of Mortality of Road Traffic Accidents in Fars Province, Southern Iran, 2004 - 2010

BACKGROUND

The aim of this study was to investigate the trends in mortality from road traffic accidents (RTA) in Fars Province, southern Iran.

METHODS

The Age and sex-standardized mortality rate attributed to RTA from 2004 to 2010 in Fars Province was calculated using world standard population. We also used linear regression and chi-squared tests.

RESULTS

Over the period of study (7 years), 12954 people died in RTA. The age- and sex-standardized mortality rate was 27 per 100,000. While the rate of death due to RTA had an incremental rate in age group 18-30 years and among women, it had a decreasing trend in age groups 35-45, under18 and among men.

CONCLUSION

An increase in mortality rate of RTA among people aged 18-30 yr and women need to be addressed by health policy makers and other involved sections.