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Rida J, Bouchriti Y, Ait Haddou M, Achbani A, Sine H, Serhane H. Meteorological factors and climate change impact on asthma: a systematic review of epidemiological evidence. J Asthma 2024:1-10. [PMID: 38953539 DOI: 10.1080/02770903.2024.2375272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/28/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE This systematic review aimed to investigate the epidemiological data about meteorological factors and climate change (CC) impact on asthma. DATA SOURCES A search was performed using three databases (Web of Science, Science Direct, and MEDLINE) for all relevant studies published from January 1, 2018, to December 31, 2022. STUDY SELECTIONS This systematic review complied with the PRISMA document's requirements, including studies related to meteorological factors and CC impact on asthma. The search included studies published in English or French language, and was based on title, abstract, and complete text. Documents not meeting inclusion requirements were excluded. RESULTS We identified 18 studies published in the last five years that were eligible for inclusion in this review. We found that these studies concerned European, Asian, American, and Oceanic cities. Extreme variations in temperature, humidity, wind speed, exceptional incidents like hurricanes, cold and heat waves, and seasonal shifts were strongly correlated with the worsening of asthmatic symptoms, particularly in childhood. In addition, excessive concentrations of air pollutants and aeroallergens were linked to pediatric asthma emergency hospital admissions. CONCLUSIONS A significant association between the consequences of CC and asthma in adults particularly in children has been demonstrated. Future research should quantify the impact of global change in climate regarding the aeroallergens' distribution in terms of geography and time. It is also necessary to research the impact of air pollution on asthmatic health, like sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and particles having an aerodynamic diameter lower than 2.5 µm (PM2.5).
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Affiliation(s)
- Jamila Rida
- Research Laboratory of Innovation in Health Sciences, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
- High Institute of Nursing Professions and Health Techniques, Health Sciences and Environment Laboratory, Health Sciences, Epidemiology and Human Pathologies Research Team, Agadir, Morocco
| | - Youssef Bouchriti
- High Institute of Nursing Professions and Health Techniques, Health Sciences and Environment Laboratory, Health Sciences, Epidemiology and Human Pathologies Research Team, Agadir, Morocco
- Geosciences, Environment and Geomatic Laboratory, Faculty of Sciences, Ibn Zohr University, Agadir, Morocco
| | - Mohamed Ait Haddou
- Geosciences, Environment and Geomatic Laboratory, Faculty of Sciences, Ibn Zohr University, Agadir, Morocco
- Department of Geography, Faculty of Humanities and Social Sciences, Ibn Tofail University, Kenitra, Morocco
| | - Abderrahmane Achbani
- Laboratory of Cell Biology and Molecular Genetics, Faculty of Sciences, Ibn Zohr University, Agadir, Morocco
- High Institute of Nursing Professions and Health Techniques, Marrakesh, Morocco
| | - Hasnaa Sine
- Laboratory of Cell Biology and Molecular Genetics, Faculty of Sciences, Ibn Zohr University, Agadir, Morocco
- High Institute of Nursing Professions and Health Techniques, Marrakesh, Morocco
| | - Hind Serhane
- Research Laboratory of Innovation in Health Sciences, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
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Boura D, Spanakis M, Markakis G, Notas G, Lionis C, Tzanakis N, Paraskakis E. Exploring the Relationship between Wind Patterns and Hospital Admissions Due to Respiratory Symptoms in Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:717. [PMID: 38929296 PMCID: PMC11201383 DOI: 10.3390/children11060717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/31/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Respiratory disorders significantly impact adolescents' health, often resulting in hospital admissions. Meteorological elements such as wind patterns have emerged as potential contributors to respiratory symptoms. However, it remains uncertain whether fluctuations in wind characteristics over extended periods have a tangible impact on respiratory health, particularly in regions characterized by distinct annual wind patterns. Crete is situated in the central-eastern Mediterranean Sea and frequently faces southerly winds carrying Sahara Desert sand from Africa and northerly winds from the Aegean Sea. This retrospective study analyzes long-term wind direction data and their relationship to respiratory symptoms observed in children up to 14 years old admitted at the University Hospital of Heraklion between 2002 and 2010. Symptoms such as headache, dyspnea, dry cough, dizziness, tachypnea, throat ache, and earache were predominantly reported during the presence of southern winds. Fever, productive cough, and chest pain were more frequently reported during northern winds. Cough was the most common symptom regardless of the wind pattern. Southern winds were significantly associated with higher probabilities of productive or non-productive cough, headache, dyspnea, tachypnea, dizziness, earache, and throat ache. Northern winds were related to a higher incidence of productive cough. Rhinitis, asthma, allergies, pharyngitis, and sinusitis were related to southern winds, while bronchiolitis and pneumonia were associated with northern winds. These findings underscore the critical role of local climatic factors, emphasizing their potential impact on exacerbating respiratory conditions in children. Moreover, they point out the need for further research to elucidate the underlying mechanisms and develop targeted interventions for at-risk populations.
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Affiliation(s)
- Despoina Boura
- Department of Respiratory Medicine, University Hospital of Heraklion, School of Medicine, University of Crete, 71003 Heraklion, Greece; (D.B.); (N.T.)
| | - Marios Spanakis
- Department of Forensic Sciences and Toxicology, School of Medicine, University of Crete, 71003 Heraklion, Greece;
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research & Technology–Hellas, 71110 Heraklion, Greece
| | - George Markakis
- Department of Social Work, Faculty of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Greece;
| | - George Notas
- Department of Emergency Medicine, University Hospital of Heraklion, School of Medicine, University of Crete, 71003 Heraklion, Greece;
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece;
| | - Nikolaos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, School of Medicine, University of Crete, 71003 Heraklion, Greece; (D.B.); (N.T.)
| | - Emmanouil Paraskakis
- Paediatric Respiratory Unit, Paediatric Department, University of Crete, 71500 Heraklion, Greece
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Hu Y, Cheng J, Liu S, Tan J, Yan C, Yu G, Yin Y, Tong S. Evaluation of climate change adaptation measures for childhood asthma: A systematic review of epidemiological evidence. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 839:156291. [PMID: 35644404 DOI: 10.1016/j.scitotenv.2022.156291] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Global climate change (GCC) is widely accepted as the biggest threat to human health of the 21st century. Children are particularly vulnerable to GCC due to developing organ systems, psychological immaturity, nature of daily activities, and higher level of per-body-unit exposure. There is a rising trend in the disease burden of childhood asthma and allergies in many parts of the world. The associations of CC, air pollution and other environmental exposures with childhood asthma are attracting more research attention, but relatively few studies have focused on CC adaptation measures and childhood asthma. This study aimed to bridge this knowledge gap and conducted the first systematic review on CC adaptation measures and childhood asthma. We searched electronic databases including PubMed, Embase, and Web of Science using a set of MeSH terms and related synonyms, and identified 20 eligible studies included for review. We found that there were a number of adaptation measures proposed for childhood asthma in response to GCC, including vulnerability assessment, improving ventilation and heating, enhancing community education, and developing forecast models and early warning systems. Several randomized controlled trials show that improving ventilation and installing heating in the homes appear to be an effective way to relieve childhood asthma symptoms, especially in winter. However, the effectiveness of most adaptation measures, except for improving ventilation and heating, have not been explored and quantified. Given more extreme weather events (e.g., cold spells and heatwaves) may occur as climate change progresses, this finding may have important implications. Evidently, further research is urgently warranted to evaluate the impacts of CC adaptation measures on childhood asthma. These adaptation measures, if proven to be effective, should be integrated in childhood asthma control and prevention programs as GCC continues.
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Affiliation(s)
- Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Shijian Liu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianguo Tan
- Shanghai Key Laboratory of Meteorology and Health (Shanghai Meteorological Service), Shanghai, China
| | - Chonghuai Yan
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangjun Yu
- Center for Biomedical Informatics, Shanghai Children's Hospital, Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
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4
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Eghomwanre AF, Oguntoke O, Taiwo AM. Levels of indoor particulate matter and association with asthma in children in Benin City, Nigeria. ENVIRONMENTAL MONITORING AND ASSESSMENT 2022; 194:467. [PMID: 35648237 DOI: 10.1007/s10661-022-10135-3] [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: 02/01/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
The relationship between indoor particulate matter and asthma in children was assessed in this study. Forty-five (45) locations were randomly selected across the five local government areas in Benin City, Edo State, for air quality assessment. Indoor and outdoor particulates (PM1.0, PM2.5, and PM10) were monitored monthly using a handheld BLATN particulate sampler (Br-Smart-126S series). Reported clinical cases of asthma in children from 2008 to 2017 were collected from two major hospitals in the metropolis. The data obtained were analysed with SPSS for Windows version 21.0. The average concentrations of indoor and ambient PM ranged between 10.7-26.2 and 19.0-49.4 µg/m3 (PM1.0), 27.4-59.6 and 45.6-93.0 µg/m3 (PM2.5), and 33.5-67.9 and 60.9-106.1 µg/m3 (PM10) in the wet and dry seasons. PM2.5 and PM10 concentrations were observed above the WHO standards. Indoor particulate concentration was significantly (p = 0.001-0.012) higher in the dry season across the locations. Outdoor PM correlated positively (R = 0.568-0.855, p < 0.05; R2 = 0.322-0.724, p < 0.001) with their corresponding indoor PM concentration. The hazard ratio (HR) values of PM2.5 and PM10 exceeded 1 in all the sampling locations during the dry season, while the mean total hazard ratio (THR) of both PM metrics was considerably higher during the dry season than in the wet season. Indoor PM concentrations showed a significant positive correlation with reported cases of asthma (R = 0.498-0.542, p < 0.001) and accounted for 40.6% of the asthma cases during the dry season. The study showed that children in the selected households are at risk of increased asthma exacerbation due to exposure to particulate matter pollution.
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Affiliation(s)
- A F Eghomwanre
- Department of Environmental Management and Toxicology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria.
- Department of Environmental Management and Toxicology, College of Environmental Resources Management, Federal University of Agriculture, Abeokuta, Nigeria.
| | - O Oguntoke
- Department of Environmental Management and Toxicology, College of Environmental Resources Management, Federal University of Agriculture, Abeokuta, Nigeria
| | - A M Taiwo
- Department of Environmental Management and Toxicology, College of Environmental Resources Management, Federal University of Agriculture, Abeokuta, Nigeria
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Kumar M, Chand S. MedHypChain: A patient-centered interoperability hyperledger-based medical healthcare system: Regulation in COVID-19 pandemic. JOURNAL OF NETWORK AND COMPUTER APPLICATIONS (ONLINE) 2021. [PMID: 34173429 DOI: 10.1016/j.jnca.2021.102995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Recently, an infectious disease, coronavirus disease 2019 (COVID-19), has been reported in Wuhan, China, and spread worldwide within a couple of months. There have been seen an outbreak of COVID-19 in many countries, where the infected patients' rate overwhelmed the inadequate medical services. The push of patient-centered interoperability (PCI) from medical institution-centered interoperability may defeat the current and post resultant disease of the COVID-19 pandemic. This paper proposes a state-of-the-art privacy-preserving medical data sharing system based on Hyperledger Fabric (MedHypChain), where each transaction is secured via an Identity-based broadcast group signcryption scheme. We proved that MedHypChain achieves confidentiality, anonymity, traceability, and unforgeability. Besides, we regularize the MedHypChain to implement the PCI healthcare system, where the patient manages its health-related information in the blockchain that can be accessible to the authorized entity. We also use the Hyperledger caliber as a benchmark tool to analyze the performance of MedHypChain in three metrics (latency time, execution time, and throughput) for up to 20 permissioned nodes. Finally, we compare MedHypChain with related blockchain-based healthcare systems and found that the proposed scheme needs the least computation cost and communication cost and achieves all security features, such as authenticity, scalability, and access control.
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Affiliation(s)
- Mahender Kumar
- School of Computer and Systems Sciences, India
- Jawharlal Nehru University, New Delhi, India
| | - Satish Chand
- School of Computer and Systems Sciences, India
- Jawharlal Nehru University, New Delhi, India
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Kabir AF, Ng CFS, Yasumoto S, Hayashi T, Watanabe C. Effect of Ambient Temperature on Daily Nebulized Asthma Hospital Visits in a Tropical City of Dhaka, Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030890. [PMID: 33498592 PMCID: PMC7908622 DOI: 10.3390/ijerph18030890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
Abstract
The acute effect of temperature on asthma morbidity in Bangladesh is not well understood. As climate varies extensively in different parts of the world, the relation between temperature and asthma might also differ. We investigated the association between temperature and asthma-related hospital visits in the tropical city of Dhaka. We analyzed information from a total of 5989 asthma patients who received ambulatory care in the form of nebulized medication at the National Asthma Center in Mohakhali, Dhaka from February to November 2013. A time-stratified case-crossover study was conducted to estimate the effect of daily temperature, with consideration of delayed effects and possible confounders such as relative humidity and political strikes. An inverse association was observed between temperature and the number of hospital visits. The effect was delayed for approximately a week. A degree centigrade decrease in mean temperature (averaged across lags 0-6) was associated with an increase of approximately 4.5% (95% CI 1.5, 7.5) in all asthma visits. The association was evident in adult males but marginal in elderly males. A positive association (lag 0) was observed among adult females, whereas no association was observed among children. Strikes significantly modified the effect among the elderly. Findings suggest temperature declines affect asthma outcomes in a warm climate, and this effect can be delayed and vary by sex and age group.
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Affiliation(s)
- Ayesha Ferdosi Kabir
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (A.F.K.); (S.Y.); (C.W.)
| | - Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan
- Correspondence:
| | - Shinya Yasumoto
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (A.F.K.); (S.Y.); (C.W.)
| | - Taiichi Hayashi
- Center for Southeast Asian Studies, Kyoto University, Kyoto 606-8501, Japan;
| | - Chiho Watanabe
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (A.F.K.); (S.Y.); (C.W.)
- National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan
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7
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Ma R, Liang L, Kong Y, Zhai S, Gu J, Zhang G, Wang T. Hotspot detection and socio-ecological factor analysis of asthma hospitalization rate in Guangxi, China. ENVIRONMENTAL RESEARCH 2020; 183:109201. [PMID: 32050128 DOI: 10.1016/j.envres.2020.109201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/15/2020] [Accepted: 01/29/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Asthma is a major public health concern throughout the world. Numerous researches have shown that the spatial-temporal patterns of asthma are inconsistent, leading to the suggestion that these patterns are determined by multiple factors. This study aims to detect spatial-temporal clusters of asthma and analyze socio-ecological factors associated with the asthma hospitalization rate in Guangxi, China. METHODS Asthma hospitalization and socio-ecological data for 88 counties/municipal districts in Guangxi, China in 2015 was collected. Space-time scan statistics were applied to identify the high-risk periods and areas of asthma hospital admissions. We further used GeoDetector and Spearman correlation coefficient to investigate the socio-ecological factors associated with the asthma hospitalization rates. RESULTS There were a total of 7804 asthma admissions in 2015. The high-risk period was from April to June. The age groups of 0-4 and ≥65 years were both at the highest risk, with hospital admission rates of 45.0/105 and 46.5/105, respectively. High-risk areas were found in central and western Guangxi with relative risk (RR) values of asthma hospitalizations greater than 2.0. GDP per capita and altitude were positively associated with asthma hospitalizations, while air pressure and wind speed had a negative association. The explanatory powers of these factors (i.e., GDP per capita, altitude, air pressure, wind speed) were 22%, 20%, 14% and 10%, respectively. CONCLUSIONS The GDP per capita appears to have the strongest correlation with asthma hospitalization rates. High-risk areas were identified in central and western Guangxi characterized by high GDP per capita. These findings may be helpful for authorities developing targeted asthma prevention policies for high-risk areas and vulnerable populations, especially during high-risk periods.
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Affiliation(s)
- Rui Ma
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Ministry of Education, Henan University, Kaifeng, 475004, China.
| | - Lizhong Liang
- The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China.
| | - Yunfeng Kong
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Ministry of Education, Henan University, Kaifeng, 475004, China.
| | - Shiyan Zhai
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Ministry of Education, Henan University, Kaifeng, 475004, China.
| | - Jiangyan Gu
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Ministry of Education, Henan University, Kaifeng, 475004, China.
| | - Guangli Zhang
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Ministry of Education, Henan University, Kaifeng, 475004, China.
| | - Tuanhui Wang
- Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Ministry of Education, Henan University, Kaifeng, 475004, China.
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Zhang H, Liu S, Chen Z, Zu B, Zhao Y. Effects of variations in meteorological factors on daily hospital visits for asthma: A time-series study. ENVIRONMENTAL RESEARCH 2020; 182:109115. [PMID: 31923850 DOI: 10.1016/j.envres.2020.109115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/28/2019] [Accepted: 01/02/2020] [Indexed: 06/10/2023]
Abstract
Few studies have explored the relationships between meteorological factors and asthma. This study explored the associations between daily variations in meteorological factors and hospital visits for asthma among different ages, genders, and asthma subtypes in Shenyang, China. A distributed lag non-linear model with Poisson regression was used; confounding factors included day of the week, holidays, and seasonal patterns, and long-term trends and air pollutants were adjusted using natural cubic splines. The meteorological factor with the largest cumulative effect was barometric pressure, which increased the risk of hospital visits for adult asthma (relative risk [RR] = 2.414), followed by maximum wind speed, which increased hospital visits for asthma for children aged 0-5 years old (RR = 1.47), and pressure, which increased hospital visits for bronchial asthma (RR = 1.298). Meteorological factors showed stronger associations with asthma than air pollutants. Further research should focus more on the effects of meteorological factors on asthma.
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Affiliation(s)
- Hehua Zhang
- Clinical Research Center, Shengjing Hospital of China Medical University, Huaxiang Road No. 39, Tiexi District, Shenyang, China
| | - Shu Liu
- Department of Atmospheric Environment Monitoring Office, Environmental Monitoring Experiment Center of Liaoning Province, Shuang Road, No.30 A3, Hunnan District, Shenyang, China
| | - Zongjiao Chen
- Department of Atmospheric Environment Monitoring Office, Environmental Monitoring Experiment Center of Liaoning Province, Shuang Road, No.30 A3, Hunnan District, Shenyang, China
| | - Biao Zu
- Department of Atmospheric Environment Monitoring Office, Environmental Monitoring Experiment Center of Liaoning Province, Shuang Road, No.30 A3, Hunnan District, Shenyang, China
| | - Yuhong Zhao
- Department of Clinical Epidemiology, Shenjing Hospital of China Medical University, Sanhao Street, No. 36, Heping District, China.
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Pan R, Gao J, Wang X, Bai L, Wei Q, Yi W, Xu Z, Duan J, Cheng Q, Zhang Y, Su H. Impacts of exposure to humidex on the risk of childhood asthma hospitalizations in Hefei, China: Effect modification by gender and age. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 691:296-305. [PMID: 31323575 DOI: 10.1016/j.scitotenv.2019.07.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/08/2019] [Accepted: 07/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND With global climate change, there is growing concern about the effects of temperature changes on childhood asthma. However, current research only focuses on the effects of temperature, while ignoring the adverse effects of humidity on children. OBJECTIVES Our study aimed to quantify the impact of humidex on childhood asthma hospitalizations, which combined temperature and humidity, and further to assess how the effect is modified by individual-factors, such as age and gender. METHODS Poisson generalized linear models combined with distributed lag nonlinear models were used to estimate the association between daily childhood asthma hospitalizations and humidex from 2013 to 2016. Air pollutions (CO, O3, and NO2) and wind velocity were modelled simultaneously using DLNM, as well as day of week, seasonality and long-term trend. RESULTS Low humidex was associated with an increased risk of admissions for asthma in children. The adverse effect appeared on the 4th day, with the RR of 1.045 (95%CI: 1.007-1.084) and lasted until the 7th day (RR: 1.045, 95%CI: 1.006-1.085). Compared with the male, there was an immediate effect on female exposed to low humidex. And the female seems to be more sensitive to low humidex. Besides, the significant effects of humidex on children asthma were detected in the children with preschool and school-age, whereas not for the subgroup of infants. And the school-age children are most sensitive to low humidex. CONCLUSIONS Low humidex was associated with the increased risk of admissions for childhood asthma in Hefei. Children suffering from asthma should avoid exposure to the low humidex environment, especially in female and school-age children. In addition, the index of humidex was more significant for disease prevention and public health than the average temperature. These findings may provide epidemiology evidence for formulating precaution guidelines to reduce the risk of childhood asthma hospitalizations.
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Affiliation(s)
- Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Jiaojiao Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Xu Wang
- Anhui province Children's hospital, China
| | - Lijun Bai
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Qiannan Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Zihan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Jun Duan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Qiang Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Yanwu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Anhui Province Key Laboratory of Major Autoimmune Disease, China.
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Kadhim Yousif M, Al Muhyi AHA. Impact of weather conditions on childhood admission for wheezy chest and bronchial asthma. Med J Islam Repub Iran 2019; 33:89. [PMID: 31696083 PMCID: PMC6825404 DOI: 10.34171/mjiri.33.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Indexed: 01/18/2023] Open
Abstract
Background: Climate change represents a possible threat to patients with bronchial asthma. The purpose of this study was to investigate any association between specific meteorological conditions and the rate of hospital admission for bronchial asthma and wheezy chest. Methods: A retrospective study was conducted to observe the effects of changes in some meteorological variables on children aged 1-13 years with bronchial asthma and wheezy chest. Data were obtained from hospital registries for the study period involving all patients admitted with the diagnosis of wheezy chest and bronchial asthma. The meteorological data were obtained from the Iraqi World Meteorological Organization and Seismology and consisted of the mean monthly values of humidity, rain, temperature, dust, wind, and thunderstorms. The correlation between the mean monthly admission for bronchial asthma and changes in weather variables were investigated. Results: There were 1043 admissions for asthma or wheezy chest (7.76%). Out of all asthma cases, 75% (n=783) were 1-5 years, while 25% (n=260) were 6-13 years. Male patients predominate 67.8%, with a male to female ratio of 2:1. Hospital admissions for asthma and wheezy chest showed a seasonal variation especially for younger children. Higher monthly admission rates were associated with high relative humidity, rain, increase in wind speed, and lower temperature, whereas rising dust and thunderstorms did not show notable effects on children's admission for asthma. Conclusion: The findings suggested that changes in weather conditions, especially high relative humidity and cold weather, may trigger asthma attacks especially in younger children, and thus protective measures are recommended for at risk children.
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Kumarihamy RMK, Tripathi NK. Geostatistical predictive modeling for asthma and chronic obstructive pulmonary disease using socioeconomic and environmental determinants. ENVIRONMENTAL MONITORING AND ASSESSMENT 2019; 191:366. [PMID: 31254075 DOI: 10.1007/s10661-019-7417-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/20/2019] [Indexed: 06/09/2023]
Abstract
The spatial distribution of the prevalence of asthma and chronic obstructive pulmonary disease (COPD) remains under the influence of a wide array of environmental, climatic, and socioeconomic determinants. However, a large proportion of these influences remain unexplained. In completion, this study examined the spatial associations between asthma/COPD morbidity and their determinants using ordinary least squares (OLS) and geographically weighted regressions (GWR). Inpatient records collected from the secondary and tertiary care hospitals in Kandy from 2010 to 2014 were considered as the dependent variable. Potential risk factors (explanatory variables) were identified in four distinguished classes: 1) meteorological factors, (2) direct and indirect factors of air pollution, (3) socioeconomic factors, and (4) characteristics of the physical environment. All possible combinations of candidate explanatory variables were evaluated through an exploratory regression. A comparison between the regression models was also explored. The best OLS regression models revealed about 55% of asthma variation and 62% of COPD variation while GWR models yielded 78% and 74% of the variation of asthma and COPD occurrences respectively. Relative humidity, proximity to roads (0-200 m), road density, use of firewood as a source of fuel, and elevation play a vital role in predicting morbidity from asthma and COPD. Both local and global regression models are important in assessing spatial relationships of asthma and COPD. However, the local models exhibit a better prediction capability for assessing non-stationary relationships of asthma and COPD than global models. The geostatistical aspects used in this study may also provide insights for evaluating heterogeneous environmental risk factors in other epidemiological studies across different spatial settings.
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Affiliation(s)
- R M K Kumarihamy
- Remote Sensing and Geographic Information System AoS, School of Engineering and Technology, Asian Institute of Technology, P.O. Box 4, Klong Luang, Pathumthani, 12120, Thailand.
- Department of Geography, University of Peradeniya, Peradeniya, Sri Lanka.
| | - N K Tripathi
- Remote Sensing and Geographic Information System AoS, School of Engineering and Technology, Asian Institute of Technology, P.O. Box 4, Klong Luang, Pathumthani, 12120, Thailand
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Sharma KI, Abraham R, Mowrey W, Toh J, Rosenstreich D, Jariwala S. The association between pollutant levels and asthma-related emergency department visits in the Bronx after the World Trade Center attacks. J Asthma 2018; 56:1049-1055. [PMID: 30359141 DOI: 10.1080/02770903.2018.1531989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To examine the potential impact of the World Trade Center (WTC) attacks on asthma-related emergency department visits (AREDV) in the New York City borough of the Bronx. Methods: We obtained daily nitrogen dioxide (NO2), sulfur dioxide (SO2) and ozone (O3) values from the National Climatic Data Center's collection station in the Bronx from 1999 and 2002, a year before and after the WTC attacks. We compared daily AREDV and pollutant levels between 1999 and 2002 using the Wilcoxon signed rank sum test. We considered each season separately due to seasonal variations of AREDV and pollutants. We then used multiple linear regression models to assess the relationships between the changes in AREDV and the changes in pollutants from 1999 to 2002 in each season. Results: There were statistically significant increases from 1999 to 2002 in the daily NO2 in the summer. Significant increases for daily SO2 and O3 values from 1999 to 2002 occurred in all seasons. Significant increases occurred in daily AREDV values in the spring and fall. Multiple linear regression analyses showed that increases in the daily O3 values were significantly associated with increases in AREDV from 1999 to 2002 in the summer season. Conclusion: We observed a possible association between the WTC attacks and significant increases in O3 and SO2 for all seasons, and NO2 for the summer. AREDV significantly increased following the WTC attacks. Increases in daily O3 values were significantly associated with increases in AREDV in the summer season.
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Affiliation(s)
- Kunwar Ishan Sharma
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ryan Abraham
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wenzhu Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jennifer Toh
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Rosenstreich
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sunit Jariwala
- Division of Allergy/Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
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13
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Witonsky J, Abraham R, Toh J, Desai T, Shum M, Rosenstreich D, Jariwala SP. The association of environmental, meteorological, and pollen count variables with asthma-related emergency department visits and hospitalizations in the Bronx. J Asthma 2018; 56:927-937. [PMID: 30207818 DOI: 10.1080/02770903.2018.1514627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To better understand how meteorological variables, air quality variables, and pollen counts collectively contribute to asthma-related emergency department visits (AREDV) and asthma-related hospitalizations (ARH) among pediatric and adult patients in the New York City borough of the Bronx. Methods: The numbers of daily adult and pediatric AREDV and ARH from 2001 to 2008 were obtained from three Bronx hospitals. After removing outliers, interpolating missing data, and standardizing variable values by scaling the data using z-scores, data were analyzed using Spearman rank tests and linear regression models for the full year and each season. Results: There were a total of 42,065 AREDV and 1,664 ARH at both Bronx hospitals. With the exception of a spring peak in AREDVs, AREDVs and ARHs follow a cyclical pattern, climbing in the fall, plateauing in the winter, dropping in the spring, and reaching a low in the summer. Among the 11 air quality, meteorological, and pollen count variables, temperature and tree pollen made the greatest contribution to AREDV with scaled coefficients of -0.337 and 0.311 respectively; equating to an additional AREDV for every 5.0-unit decrease in temperature and an additional AREDV for every 186.0-unit increase in tree pollen. These two variables were confirmed to have independent associations with AREDV prior to the data interpolation. Grass pollen was also found to have a relatively large contribution to AREDV during the summer with a scaled coefficient of 0.314, equating to an additional AREDV for every 2.3-unit increase in grass pollen. Conclusion: There are distinct peaks of increased AREDVs that are closely associated with increased tree pollen counts in the spring and decreasing temperatures in the fall. Early anticipation of these air quality, meteorological, and pollen factor changes based on ongoing surveillance could potentially guide clinical practice and minimize AREDVs in the Bronx.
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Affiliation(s)
- Jonathan Witonsky
- a Department of Pediatrics, University of California , San Francisco , CA , USA ; Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ryan Abraham
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - Jennifer Toh
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - Tulsi Desai
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - Mili Shum
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - David Rosenstreich
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
| | - Sunit P Jariwala
- b Division of Allergy/Immunology, Albert Einstein College of Medicine ; Bronx , NY , USA
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Xu Z, Crooks JL, Davies JM, Khan AF, Hu W, Tong S. The association between ambient temperature and childhood asthma: a systematic review. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:471-481. [PMID: 29022096 DOI: 10.1007/s00484-017-1455-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/18/2017] [Accepted: 09/24/2017] [Indexed: 05/09/2023]
Abstract
The objectives of this study are to review available information on the association between ambient temperature and childhood asthma, and to elucidate the possible underlying mechanisms of this relationship. A systematic review was conducted based on the papers retrieved from four databases, including PubMed, ProQuest, ScienceDirect, and Scopus. Papers examining the association of absolute temperature or temperature variation with childhood asthma published from 1 January 2000 to 31 December 2016 were included. Thirteen papers have quantified the effect of absolute temperature on childhood asthma, and six papers have examined the effect of intra- or inter-day temperature variation on childhood asthma. All studies were conducted in urban areas. Aeroallergen sensitizations were only considered in the analyses of one study. Discrepancy existed in the significance of the relationship between absolute temperature and childhood asthma, and also in the shape of this relationship (i.e. linear or non-linear) and whether temperature effects were lagged. Increasing evidence is suggesting non-linear relationship between absolute temperature and childhood asthma. Future research should investigate the burden of childhood asthma specifically attributable to extreme temperatures and temperature variation using advanced statistical approach, particularly in rural areas, after properly considering aeroallergens and air pollution. Projecting future burden of childhood asthma under climate change scenarios is also warranted.
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Affiliation(s)
- Zhiwei Xu
- School of Public Health and Social Work & Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, 4059, Australia.
| | | | - Janet Mary Davies
- School of Biomedical Sciences & Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Al Fazal Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Wenbiao Hu
- School of Public Health and Social Work & Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, 4059, Australia
| | - Shilu Tong
- School of Public Health and Social Work & Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, 4059, Australia
- School of Public Health and Institute of Environment and Human Health, Anhui Medical University, Hefei, China
- Shanghai Children's Medical Centre, Shanghai Jiao-Tong University, Shanghai, China
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Olaniyan T, Jeebhay M, Röösli M, Naidoo R, Baatjies R, Künzil N, Tsai M, Davey M, de Hoogh K, Berman D, Parker B, Leaner J, Dalvie MA. A prospective cohort study on ambient air pollution and respiratory morbidities including childhood asthma in adolescents from the western Cape Province: study protocol. BMC Public Health 2017; 17:712. [PMID: 28915873 PMCID: PMC5602849 DOI: 10.1186/s12889-017-4726-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/08/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is evidence from existing literature that ambient air pollutant exposure in early childhood likely plays an important role in asthma exacerbation and other respiratory symptoms, with greater effect among asthmatic children. However, there is inconclusive evidence on the role of ambient air pollutant exposures in relation to increasing asthma prevalence as well as asthma induction in children. At the population level, little is known about the potential synergistic effects between pollen allergens and air pollutants since this type of association poses challenges in uncontrolled real life settings. In particular, data from sub-Sahara Africa is scarce and virtually absent among populations residing in informal residential settlements. METHODS/DESIGN A prospective cohort study of 600 school children residing in four informal settlement areas with varying potential ambient air pollutant exposure levels in the Western Cape in South Africa is carried-out. The study has two follow-up periods of at least six-months apart including an embedded panel study in summer and winter. The exposure assessment component models temporal and spatial variability of air quality in the four study areas over the study duration using land-use regression modelling (LUR). Additionally, daily pollen levels (mould spores, tree, grass and weed pollen) in the study areas are recorded. In the panel study asthma symptoms and serial peak flow measurements is recorded three times daily to determine short-term serial airway changes in relation to varying ambient air quality and pollen over 10-days during winter and summer. The health outcome component of the cohort study include; the presence of asthma using a standardised ISAAC questionnaire, spirometry, fractional exhaled nitric-oxide (FeNO) and the presence of atopy (Phadiatop). DISCUSSION This research applies state of the art exposure assessment approaches to characterize the effects of ambient air pollutants on childhood respiratory health, with a specific focus on asthma and markers of airway inflammation (FeNO) in South African informal settlement areas by considering also pollen counts and meteorological factors. The study will generate crucial data on air pollution and asthma in low income settings in sub-Sahara Africa that is lacking in the international literature.
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Affiliation(s)
- Toyib Olaniyan
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box 4002, Basel, Switzerland
| | - Mohamed Jeebhay
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Rajen Naidoo
- University of Kwazulu-Natal, Durban, South Africa
| | - Roslynn Baatjies
- Cape Peninsula University of Technology, Cape Town, South Africa
| | - Nino Künzil
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Ming Tsai
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
- University of Washington, Seattle, WA 98195 USA
| | - Mark Davey
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003 Basel, Switzerland
| | - Dilys Berman
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bhawoodien Parker
- Department of Environmental Affairs and Developmental Planning, Western Cape Government, Cape Town, South Africa
| | - Joy Leaner
- Department of Environmental Affairs and Developmental Planning, Western Cape Government, Cape Town, South Africa
| | - Mohamed Aqiel Dalvie
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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16
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Pesce G, Bugiani M, Marcon A, Marchetti P, Carosso A, Accordini S, Antonicelli L, Cogliani E, Pirina P, Pocetta G, Spinelli F, Villani S, de Marco R. Geo-climatic heterogeneity in self-reported asthma, allergic rhinitis and chronic bronchitis in Italy. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 544:645-652. [PMID: 26674694 DOI: 10.1016/j.scitotenv.2015.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/29/2015] [Accepted: 12/04/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Several studies highlighted a great variability, both between and within countries, in the prevalence of asthma and chronic airways diseases. AIM To evaluate if geo-climatic variations can explain the heterogeneity in the prevalence of asthma and respiratory diseases in Italy. METHODS Between 2006 and 2010, a postal screening questionnaire on respiratory health was administered to 18,357 randomly selected subjects, aged 20-44, living in 7 centers in northern, central, and southern Italy. A random-effects meta-analysis was fitted to evaluate the between-centers heterogeneity in the prevalence of asthma, asthma-like symptoms, allergic rhinitis, and chronic bronchitis (CB). A principal component analysis (PCA) was performed to synthetize the geo-climatic information (annual mean temperature, range of temperature, annual rainfalls, global solar radiations, altitude, distance from the sea) of all the 110 Italian province capital towns. The associations between these geo-climatic components obtained with PCA and the prevalence of respiratory diseases were analyzed through meta-regression models. RESULTS 10,464 (57%) subjects responded to the questionnaire. There was a significant between-centers heterogeneity in the prevalence of asthma (I(2)=59.5%, p=0.022) and CB (I(2)=60.5%, p=0.019), but not in that of asthma-like symptoms or allergic rhinitis. Two independent geo-climatic components explaining together about 80% of the overall geo-climatic variability were identified: the first principally summarized the climatic variables; the second the topographic ones. Variations in the prevalence of asthma across centers were significantly associated with differences in the climatic component (p=0.017), but not with differences in the topographic one. CONCLUSIONS Our findings suggest that climate play a role in determining the between-center heterogeneity in the prevalence of asthma in Italy, with higher prevalence in dry-hot Mediterranean climates, and lower in rainy-cold northern climates.
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Affiliation(s)
- G Pesce
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - M Bugiani
- Unit of Respiratory Medicine and Allergology, CPA-ASL TO-2, Turin, Italy
| | - A Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - P Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - A Carosso
- Unit of Respiratory Medicine and Allergology, CPA-ASL TO-2, Turin, Italy
| | - S Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - L Antonicelli
- Dept of Internal Medicine, Immuno-Allergic and Respiratory Diseases, Ospedali Riuniti di Ancona, Ancona, Italy
| | - E Cogliani
- Casaccia Research Centre, Italian National Agency for New Technologies, Energy, and Substainable Economic Development (ENEA), Rome, Italy
| | - P Pirina
- Institute of Respiratory Diseases, University of Sassari, Sassari, Italy
| | - G Pocetta
- Dept of Experimental Medicine, University of Perugia, Perugia, Italy
| | - F Spinelli
- Casaccia Research Centre, Italian National Agency for New Technologies, Energy, and Substainable Economic Development (ENEA), Rome, Italy
| | - S Villani
- Dept of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - R de Marco
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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