Anemia prevalence and hemoglobin levels are associated with long-term exposure to air pollution in an older population

Association between exposure to smoke from cooking fuels and anaemia among women of reproductive age in Ghana

In low- and middle-income countries, indoor air pollution (IAP) is a serious public health concern, especially for women and children who cook with solid fuels. IAP exposure has been linked to a number of medical conditions, including pneumonia, ischemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lung cancer, and anaemia. Around 500 million women of reproductive age (WRA) suffer from anaemia globally, with an estimated 190 million cases in sub-Saharan Africa (SSA). This study, which is based on prior research, investigates the relationship between IAP exposure and anaemia among WRA in Ghana. A diverse sample of 2,406 WRA living in Ghana were interviewed, of which 58.06% were anaemic and used high-pollutant fuels for cooking. Age, place of residence, region, education level, religion, ethnicity, wealth index, type of drinking water, type of toilet facility, and type of cooking fuels were all found to be significantly linked with anaemic state by bivariate analysis. Type of cooking fuels utilized, age, region of residence, and the type of residence were shown to be significant predictors of anaemia status using sequential binary logit regression models. The results emphasise the critical need for efforts to promote the usage of clean cooking fuel in an attempt to lower anaemia prevalence in Ghana. To reduce dependency on solid fuels for cooking, initiatives should promote the use of cleaner cooking fuels and enhance the socioeconomic status of households. These interventions could have significant public health effects by reducing the burden of anaemia and improving maternal and child health outcomes due to the prevalence of anaemia among WRA. Overall, this study sheds light on the relationship between IAP exposure and anaemia in Ghana and highlights the demand for focused public health initiatives to address this serious health problem.

Risk analysis of air pollutants and types of anemia: a UK Biobank prospective cohort study

Previous studies have suggested that exposure to air pollutants may be associated with specific blood indicators or anemia in certain populations. However, there is insufficient epidemiological data and prospective evidence to evaluate the relationship between environmental air pollution and specific types of anemia. We conducted a large-scale prospective cohort study based on the UK Biobank. Annual average concentrations of NO2, PM2.5, PM2.5-10, and PM10 were obtained from the ESCAPE study using the Land Use Regression (LUR) model. The association between atmospheric pollutants and different types of anemia was investigated using the Cox proportional hazards model. Furthermore, restricted cubic splines were used to explore exposure-response relationships for positive associations, followed by stratification and effect modification analyses by gender and age. After adjusting for demographic characteristics, 3-4 of the four types of air pollution were significantly associated with an increased risk of iron deficiency, vitamin B12 deficiency and folate deficiency anemia, while there was no significant association with other defined types of anemia. After full adjustment, we estimated that the hazard ratios (HRs) of iron deficiency anemia associated with each 10 μg/m3 increase in NO2, PM2.5, and PM10 were 1.04 (95%CI: 1.02, 1.07), 2.00 (95%CI: 1.71, 2.33), and 1.10 (95%CI: 1.02, 1.20) respectively. The HRs of folate deficiency anemia with each 10 μg/m3 increase in NO2, PM2.5, PM2.5-10, and PM10 were 1.25 (95%CI: 1.12, 1.40), 4.61 (95%CI: 2.03, 10.47), 2.81 (95%CI: 1.11, 7.08), and 1.99 (95%CI: 1.25, 3.15) respectively. For vitamin B12 deficiency anemia, no significant association with atmospheric pollution was found. Additionally, we estimated almost linear exposure-response curves between air pollution and anemia, and interaction analyses suggested that gender and age did not modify the association between air pollution and anemia. Our research provided reliable evidence for the association between long-term exposure to PM10, PM2.5, PM2.5-10, NO2, and several types of anemia. NO2, PM2.5, and PM10 significantly increased the risk of iron deficiency anemia and folate deficiency anemia. Additionally, we found that the smaller the PM diameter, the higher the risk, and folate deficiency anemia was more susceptible to air pollution than iron deficiency anemia. No association was observed between the four types of air pollution and hemolytic anemia, aplastic anemia, and other types of anemia. Although the mechanisms are not well understood, we emphasize the need to limit the levels of PM and NO2 in the environment to reduce the potential impact of air pollution on folate and iron deficiency anemia.

Association of anaemia with indoor air pollution among older Indian adult population: multilevel modelling analysis of nationally representative cross-sectional study

INTRODUCTION

Anaemia is a disease of public health importance with multi-causal pathways. Previous literature suggests the role of indoor air pollution (IAP) on haemoglobin levels, but this has been studied less due to logistic constraints. A high proportion of the population in developing countries, including India, still depends on unclean fuel, which exacerbates IAP. The objective was to study the association between anaemia and IAP among the older Indian adult population (≥ 45 years) as per gender.

METHODS

Our study analysed the nationally representative dataset of the Longitudinal Ageing Study in India (LASI 2017-18, Wave-1). We have documented the association of anaemia (outcome variable) with IAP (explanatory variable). To reduce the confounding effects of demographic and socioeconomic; health related and behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression modelling was conducted. States and union territories were categorised cross tabulated as low, middle and high as per anaemia and IAP exposure. P value < 0.05 was considered statistically significant. SATA version 17 was used for analysis.

RESULTS

More than half (52.52%) of the participants were exposed to IAP (male (53.55%) > female (51.63%)). The odds of having anaemia was significantly 1.19 times higher (AOR 1.19 (1.09-1.31)) among participants using unclean/ solid fuel. The adjusted odds were significantly higher among participants exposed to pollution-generating sources (AOR 1.30; 1.18-1.43), and household indoor smoking (AOR 1.17 (1.07-1.29). The odds of having anaemia were significantly higher (AOR 1.26; 1.15-1.38) among participants exposed to IAP, which was higher in males (AOR 1.36; 1.15-1.61) than females (AOR 1.21; 1.08-1.35). Empowered Action Group (EAG) states like Uttar Pradesh, Chhattisgarh, Madhya Pradesh, Bihar had both high anaemia and IAP exposure.

CONCLUSION

This study established the positive association of anaemia with indoor air pollution among older Indian adults through a nationally representative large dataset. The association was higher among men. Further research is recommended to understand detailed causation and to establish temporality. It is a high time to implement positive intervention nationally to decrease solid/ unclean fuel usage, vulnerable ventilation, indoor smoking, IAP and health hazards associated with these with more focused actions towards EAG states.

Association of household air pollution exposure and anemia among pregnant women: Analysis of baseline data from 'Household Air Pollution Intervention Network (HAPIN)' trial

BACKGROUND

Anemia is common in low- and middle-income countries (LMICs), causing significant health issues and social burdens. Exposure to household air pollution from using biomass fuels for cooking and heating has been associated with anemia, but the exposure-response association has not been studied.

OBJECTIVES

We evaluated the associations between personal exposure to air pollution and both hemoglobin levels and anemia prevalence among pregnant women in a multi-country randomized controlled trial.

METHODS

We studied 3,163 pregnant women aged 18-35 years with 9-20 weeks of gestation, recruited as part of the Household Air Pollution Intervention Network (HAPIN) randomized controlled trial in Guatemala, India, Peru, and Rwanda. We assessed 24-hour personal exposures to fine particulate matter (PM2.5), black carbon (BC), and carbon monoxide (CO), and measured hemoglobin levels at baseline (15 ± 3 weeks gestation). Linear and logistic regression models were used to examine the associations of measured pollutants with hemoglobin levels and anemia prevalence, adjusting for confounding.

RESULTS

Single-pollutant models showed associations of CO with higher hemoglobin levels and lower anemia prevalence. Bipollutant models involving CO and PM2.5 also revealed that an interquartile range (IQR) increase in CO concentrations (2.26 ppm) was associated with higher hemoglobin levels [β = 0.04; 95 % confidence interval (CI): 0.01, 0.07], and a lower odds of anemia prevalence [odds ratios (OR) = 0.90; 95 % CI: 0.83, 0.98]. PM2.5 was inversely related to hemoglobin and positively associated with anemia, but results were not statistically significant at the 0.05 alpha level. County-specific results showed that 3 of 4 countries showed a similar association between CO and hemoglobin. We found no association of BC levels with hemoglobin levels or with anemia prevalence.

CONCLUSION

Our findings suggest that exposure to CO is associated with higher hemoglobin and lower anemia prevalence among pregnant women, whereas PM2.5 showed the opposite associations.

Lead exposure by E-waste disposal and recycling in Agbogbloshie, Ghana

BACKGROUND

Agbogbloshie in Ghana is the world's biggest dumpsite for the informal recycling of electronic waste (e-waste). E-waste is dismantled by rudimentary methods without personal or environmental protection. Workers and occupants are exposed to lead. There are no data so far about the extent and the consequences. We therefore analyzed blood lead levels (BLL) and creatinine levels (CL).

METHODS

Full blood samples and basic data (i.e. age, job, length of stay) were collected from dumpsite volunteers. BLL were measured by atomic absorption spectrometry; CL were assessed using the standard clinical laboratory procedures of Aachen Technical University. European BLL reference values were used as Ghana lacks its own. Statistical analysis was by non-parametric tests (Mann-Whitney U test), with p < 0.05.

RESULTS

Participants of both sexes (n = 327; 12-68 years; median age 23 years) were assessed. Most workers were aged <30 years. The collective's BLL was in pathological range for 77.7%; 14% had a BLL >10.0 μg/dl with symptoms consistent with high lead exposure including severe (6.5%) and intermediate (39%) renal disorder. BLL above 15.0 μg/dl were found in 5.9% of all workers which is the German threshold for those working with lead. Elevated CL in a pathological range were found in 254 participants. This is problematic as 75% of the lead entering the body is excreted via urine.

CONCLUSION

Most of our volunteers had pathological BLL and CL. Preventive strategies are necessary to reduce health risks, particularly for vulnerable populations (i.e. children, pregnant women).

High ambient temperature may increase the risk of anemia in pregnancy: Identifying susceptible exposure windows

Anemia in pregnancy (AIP) is associated with multiple severe maternal and perinatal adverse outcomes. However, there is a lack of evidence on the association between environmental factors and AIP. Aim to explore the association between ambient temperature and the risk of AIP, and identify susceptible exposure windows, we conducted a matched case-control study from 2013 to 2016 in Xi'an, China, which included 710 women with AIP and 1420 women without AIP. The conditional logistic regression model was used to evaluate the association between ambient temperature and AIP at different gestational weeks and gestational months. The association between extreme temperature and AIP was evaluated using the distributed lag nonlinear model (DLNM). We conducted stratified analyses of age, parity, and season of conception, and estimated the interaction between ambient temperature and air pollutants on AIP. Ambient temperature was significantly positively associated with the risk of AIP, and the susceptible exposure windows were 2-25 gestational weeks and 1-6 gestational months, respectively. The strongest effect was observed in the week 8 and month 2, for each 1 °C increase in weekly and monthly mean temperature, the odds ratio (OR) for AIP was 1.038 (95 % confidence interval (CI): 1.022, 1.055) and 1.040 (95 % CI: 1.020, 1.060), respectively. Extreme heat may increase the risk of AIP. Stratified analyses showed that there was no significant difference among different age, parity, and season of conception groups. No significant interaction effect of ambient temperature with air pollution on AIP was found. In summary, high ambient temperature may increase the risk of AIP, and the first and second trimesters may be susceptible exposure windows. Understanding the effect of temperature on pregnant women will be beneficial to reduce the occurrence of AIP.

Dynamic alterations in physiological and biochemical indicators of Cirrhinus mrigala hatchlings: A sublethal exposure of triclosan

Triclosan (TCS), a biocide used in various day-to-day products, has been associated with several toxic effects in aquatic organisms. In the present study, biochemical and hematological alterations were evaluated after 14 d (sublethal) exposure of tap water (control), acetone (solvent control), 5, 10, 20, and 50 μg/L (environmentally relevant concentrations) TCS to the embryos/hatchlings of Cirrhinus mrigala, a major freshwater carp distributed in tropic and sub-tropical areas of Asia. A concentration-dependent increase in the content of urea and protein carbonyl, while a decrease in the total protein, glucose, cholesterol, triglycerides, uric acid, and bilirubin was observed after the exposure. Hematological analysis revealed a decrease in the total erythrocyte count, hemoglobin, and partial pressure of oxygen, while there was an increase in the total leucocyte count, carbon dioxide, and partial pressure of carbon dioxide and serum electrolytes. Comet assay demonstrates a concentration-dependent increase in tail length, tail moment, olive tail moment, and percent tail DNA. An amino acid analyzer showed a TCS-dose-dependent increase in various amino acids. Sodium dodecyl sulphate polyacrylamide gel electrophoresis analysis revealed different proteins ranging from 6.5 to 200 kDa, demonstrating TCS-induced upregulation. Fourier transform infrared spectra analysis exhibited a decline in peak area percents with an increase in the concentration of TCS in water. Curve fitting of amide I (1,700-1600 cm-1) showed a decline in α-helix and turns and an increase in β-sheets. Nuclear magnetic resonance study also revealed concentration-dependent alterations in the metabolites after 14 d exposure. TCS caused alterations in the biomolecules and heamatological parameters of fish, raising the possibility that small amounts of TCS may change the species richness in natural aquatic habitats. In addition, consuming TCS-contaminated fish may have detrimental effects on human health. Consequently, there is a need for the proper utilisation and disposal of this hazardous compound in legitimate quantities.

Association of ambient air pollution with hemoglobin levels and anemia in the general population of Korean adults

BACKGROUND

Emerging evidence has suggested significant associations between ambient air pollution and changes in hemoglobin levels or anemia in specific vulnerable groups, but few studies have assessed this relationship in the general population. This study aimed to evaluate the association between long-term exposure to air pollution and hemoglobin concentrations or anemia in general adults in South Korea.

METHODS

A total of 69,830 Korean adults from a large-scale nationwide survey were selected for our final analysis. Air pollutants included particulate matter with an aerodynamic diameter less than or equal to 10 micrometers (PM10), particulate matter with an aerodynamic diameter less than or equal to 2.5 micrometers, nitrogen dioxide, sulfur dioxide (SO2), and carbon monoxide (CO). We measured the serum hemoglobin concentration to assess anemia for each participant.

RESULTS

In the fully adjusted model, exposure levels to PM10, SO2, and CO for one and two years were significantly associated with decreased hemoglobin concentrations (all p < 0.05), with effects ranging from 0.15 to 0.62% per increase in interquartile range (IQR) for each air pollutant. We also showed a significant association of annual exposure to PM10 with anemia (p = 0.0426); the odds ratio (OR) [95% confidence interval (CI)] for anemia per each increase in IQR in PM10 was estimated to be 1.039 (1.001-1.079). This association was also found in the 2-year duration of exposure (OR = 1.046; 95% CI = 1.009-1.083; adjusted Model 2). In addition, CO exposure during two years was closely related to anemia (OR = 1.046; 95% CI = 1.004-1.091; adjusted Model 2).

CONCLUSIONS

This study provides the first evidence that long-term exposure to air pollution, especially PM10, is significantly associated with reduced hemoglobin levels and anemia in the general adult population.

Exposure to air pollution as a risk factor for anaemia: a global scoping review

Anaemia is an important global health issue with various factors responsible for its occurrence. Though nutritional deficiency is one of the main causes of the disease, evidence suggests a potential link between long-term exposure to ambient air pollution and an increased risk of developing anaemia. Our scoping review evaluates studies conducted across the world to examine possible associations between anaemia and ambient air pollution. Six databases were searched, 153 sources were identified, and 21 articles were included in the review. Apart from one article which showed no significant effect, studies reported positive associations between anaemia and air pollution. This was true for both indoor and outdoor air pollution, various types of particulate matter exposure, and across demographic groups. The review highlights the importance of recognizing exposure to air pollution as a potential risk factor for anaemia and emphasizes the imperative for focused interventions and policy measures to mitigate air pollution.

Effects of fine particulate matter on bone marrow-conserved hematopoietic and mesenchymal stem cells: a systematic review

The harmful effects of fine particulate matter ≤2.5 µm in size (PM2.5) on human health have received considerable attention. However, while the impact of PM2.5 on the respiratory and cardiovascular systems has been well studied, less is known about the effects on stem cells in the bone marrow (BM). With an emphasis on the invasive characteristics of PM2.5, this review examines the current knowledge of the health effects of PM2.5 exposure on BM-residing stem cells. Recent studies have shown that PM2.5 enters the circulation and then travels to distant organs, including the BM, to induce oxidative stress, systemic inflammation and epigenetic changes, resulting in the reduction of BM-residing stem cell survival and function. Understanding the broader health effects of air pollution thus requires an understanding of the invasive characteristics of PM2.5 and its direct influence on stem cells in the BM. As noted in this review, further studies are needed to elucidate the underlying processes by which PM2.5 disturbs the BM microenvironment and inhibits stem cell functionality. Strategies to prevent or ameliorate the negative effects of PM2.5 exposure on BM-residing stem cells and to maintain the regenerative capacity of those cells must also be investigated. By focusing on the complex relationship between PM2.5 and BM-resident stem cells, this review highlights the importance of specific measures directed at safeguarding human health in the face of rising air pollution.

Associations of Long-Term Exposure to PM2.5 and Its Constituents with Erythrocytosis and Thrombocytosis in Rural Populations

Evidence on the effect of long-term exposure to fine particulate matter (PM2.5) on erythrocytosis and thrombocytosis prevalence was limited. We aimed to investigate the association of PM2.5 and its constituents with the risks of erythrocytosis and thrombocytosis. The present study included a total of 33,585 participants from the Henan Rural Cohort at baseline between 2015 and 2017. A hybrid satellite-based model was employed to estimate the concentrations of PM2.5 mass and its constituents (including black carbon [BC], nitrate [NO3-], ammonium [NH4+], inorganic sulfate [SO42-], organic matter [OM], and soil particles [SOIL]). The logistic regression model was used to assess the associations of single exposure to PM2.5 and its constituents with the risks of erythrocytosis and thrombocytosis, and the quantile G-computation method was applied to evaluate their joint exposure risk. For the independent association, the odds ratios for erythrocytosis/thrombocytosis with 1 μg/m3 increase was 1.049/1.043 for PM2.5 mass, 1.596/1.610 for BC, 1.410/1.231 for NH4+, 1.205/1.139 for NO3-, 1.221/1.359 for OM, 1.300/1.143 for SO42-, and 1.197/1.313 for SOIL. Joint exposure to PM2.5 and its components was also positively associated with erythrocytosis and thrombocytosis. The estimated weight of NH4+ was found to be the largest for erythrocytosis, while OM had the largest weight for thrombocytosis. PM2.5 mass and its constituents were positively linked to prevalent erythrocytosis and thrombocytosis, both in single-exposure and joint-exposure models. Additionally, NH4+/OM was identified as a potentially responsible component for the association between PM2.5 and erythrocytosis/thrombocytosis.

Associations between hemoglobin levels and source-specific exposure to ambient fine particles among children aged <5 years in low- and middle-income countries

OBJECTIVE

We investigated associations between source-specific fine particulate matter (PM2.5) exposure and hemoglobin levels among children in low- and middle-income countries (LMICs).

METHOD

36,675 children aged < 5 years were collected in 11 LMICs during 2017. We associated child hemoglobin with 20 source-specific PM2.5, and calculated changes in hemoglobin that could be attributed to different PM2.5-mixture scenarios, established using real-world data from 88 Asian and African LMICs (AA-LMICs).

RESULTS

Multiple-source analysis revealed PM2.5 produced by solvents (change in hemoglobin for 1-μg/m3 increment in PM2.5: -10.34 g/L, 95% CI -14.88 to -5.91), industrial coal combustion (-0.51 g/L, 95% CI -9.25 to -0.08), road transportation (-0.50 g/L, 95% CI -6.96 to -0.29), or waste handling and disposal (-0.34 g/L, 95% CI -4.38 to -0.23) was significantly associated with a decrease in hemoglobin level. Decreases in hemoglobin attributable to the PM2.5 mixtures were co-determined by the concentrations and their source profiles. The largest PM2.5-related change in hemoglobin was -10.25 g/L (95% CI -15.54 to -5.27) for a mean exposure of 61.01 μg/m3 in India.

CONCLUSION

Association between PM2.5 and a decrease in hemoglobin was affected by variations in PM2.5 source profiles. Source-oriented interventions are warranted to protect children in LMICs from air pollution.

Anemia is associated with long-term exposure to PM2.5 and its components: a large population-based study in Southwest China

Background

Anemia is linked to PM2.5 (particulate matter with aerodynamic diameters of ⩽2.5 μm) exposure, which can increase the risk of various negative health outcomes. It remains unclear which PM2.5 components are associated with anemia and the respective contribution of each component to this association.

Objective

This study aimed at investigating the association between PM2.5 and anemia in the general population and to identify the most critical PM2.5 toxic components in this association.

Design

Cross-sectional study.

Methods

Our study involved a large cohort of 73,511 individuals aged 30-79 from China's multi-ethnic population. We employed satellite observations and the chemical transport model (GEOS-Chem)to estimate the long-term exposure to PM2.5 and its components. Anemia was defined, according to WHO guidelines, as Hb levels below 130 g/L for men and below 120 g/L for women. Through logistic regression, we investigated the association between PM2.5 components and anemia. By utilizing weighted quantile sum (WQS) analysis, we identified key components and gained insights into their combined impact on anemia. Overall, our study sheds light on the relationship between PM2.5 exposure, its constituents, and the risk of anemia in a large cohort.

Results

PM2.5 and three components, nitrate (NIT), organic matter (OM), and soil particles (SOIL), were associated with anemia. Per-standard deviation increase in the 3-year average concentrations of PM2.5 [odds ratio (OR): 1.14, 95% confidence interval (CI): 1.01, 1.28], NIT (1.20, 1.06, 1.35), OM (1.17, 1.04, 1.32), and SOIL (1.22, 1.11, 1.33) were associated with higher odds of anemia. In WQS regression analysis, the WQS index was associated with anemia (OR: 1.29, 95% CI: 1.13, 1.47). SOIL has the highest weight among all PM2.5 components.

Conclusions

Long-term exposure to PM2.5 and its constituents is associated with anemia. Moreover, SOIL might be the most critical component of the relationship between PM2.5 and anemia. Our research increases the evidence of the association between PM2.5 and anemia in the general population, and targeted emission control measures should be taken into consideration to mitigate the adverse effects of PM2.5-related anemia.

A cross-sectional analysis of ambient fine particulate matter (PM2.5) exposure and haemoglobin levels in children aged under 5 years living in 36 countries

Low haemoglobin (Hb) concentrations and anaemia in children have adverse effects on development and functioning, some of which may have consequences in later life. Exposure to ambient air pollution is reported to be associated with anaemia, but there is little evidence specific to low- and middle-income countries (LMICs), where childhood anaemia prevalence is greatest. We aimed to determine if long-term ambient fine particulate matter (≤2.5 μm in aerodynamic diameter [PM_2.5]) exposure was associated with Hb levels and the prevalence of anaemia in children aged <5 years living in 36 LMICs. We used Demographic and Health Survey data, collected between 2010 and 2019, which included blood Hb measurements. Satellite-derived estimates of annual average PM_2.5 was the main exposure variable, which was linked to children's area of residence. Anaemia was defined according to standard World Health Organization guidelines (Hb < 11 g/dL). The association of PM_2.5 with Hb levels and anaemia prevalence was examined using multivariable linear and logistic regression models, respectively. We examined whether the effects of ambient PM_2.5 were modified by a child's sex and age, household wealth index, and urban/rural place of residence. Models were adjusted for relevant covariates, including other outdoor pollutants and household cooking fuel. The study included 154,443 children, of which 89,904 (58.2%) were anaemic. The country-level prevalence of anaemia ranged from 15.8% to 87.9%. Mean PM_2.5 exposure was 33.0 (±21.6) μg/m³. The adjusted model showed that a 10 μg/m³ increase in annual PM_2.5 concentration was associated with greater odds of anaemia (OR = 1.098 95% CI: 1.087, 1.109). The same increase in PM_2.5 was associated with a decrease in average Hb levels of 0.075 g/dL (95% CI: 0.081, 0.068). There was evidence of effect modification by household wealth index and place of residence, with greater adverse effects in children from lower wealth quintiles and children in rural areas. Exposure to annual PM_2.5 was cross-sectionally associated with decreased blood Hb levels, and greater risk of anaemia, in children aged <5 years living in 36 LMICs.

Effect of PM concentration on anemia blood indicators reduced by air purifiers

Housewives perform daily household chores, which directly expose them to indoor particulate matter (PM). Indoor PM exposure is a potential factor that increases systemic inflammation and affects hematopoietic action. This study investigated the decrease in indoor PM concentration by air purifiers on indicators of anemia, such as hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). We analyzed the data of 40 housewives who were subjected to an air purifier intervention in Seoul and Ulsan, Republic of Korea. Indoor exposure levels of PM2.5 and PM10 were analyzed with sensor adjusted and gravimetric measurement. We also investigated the same anemia indicators before and after the installation of an air purifier for three months (short-term: one month, long-term: three months). Statistical analysis was performed by a multiple linear model and a linear mixed model. The indoor PM exposure levels and air purifier use were related to anemia indicators (hemoglobin and MCHC). The increase in indoor PM2.5 level was associated with a decrease in MCHC (β: 0.034, P = 0.031) and hemoglobin (β: 0.013, P = 0.04). The decrease in indoor PM2.5 concentration by air purifier was associated with an increase in MCHC (β: 0.204, P = 0.087) and hemoglobin (β: 0.190, P = 0.039). In particular, after air purifier intervention, the amounts of MCHC and hemoglobin significantly increased. Our results suggest that indoor air purifier use could decrease indoor PM level and the risk of anemia to housewives. Because the effect on anemia is subacute, it was confirmed three months after air purifier operation. In conclusion, anemia indicators can be improved by PM reduction management.

Prenatal Exposure to Air Pollution and Pre-Labor Rupture of Membranes in a Prospective Cohort Study: The Role of Maternal Hemoglobin and Iron Supplementation

BACKGROUND

Exposure to air pollution in prenatal period is associated with prelabor rupture of membranes (PROM). However, the sensitive exposure time windows and the possible biological mechanisms underlying this association remain unclear.

OBJECTIVE

We aimed to identify the sensitive time windows of exposure to air pollution for PROM risk. Further, we examined whether maternal hemoglobin levels mediate the association between exposure to air pollution and PROM, as well as investigated the potential effect of iron supplementation on this association.

METHOD

From 2015 to 2021, 6,824 mother-newborn pairs were enrolled in the study from three hospitals in Hefei, China. We obtained air pollutant data [particulate matter (PM) with aerodynamic diameter ≤2.5μm (PM2.5), PM with aerodynamic diameter ≤10μm (PM10), sulfur dioxide (SO2), and carbon monoxide (CO)] from the Hefei City Ecology and Environment Bureau. Information on maternal hemoglobin levels, gestational anemia, iron supplementation, and PROM was obtained from medical records. Logistic regression models with distributed lags were used to identify the sensitive time window for the effect of prenatal exposure to air pollutant on PROM. Mediation analysis estimated the mediated effect of maternal hemoglobin in the third trimester, linking prenatal air pollution with PROM. Stratified analysis was used to investigate the potential effect of iron supplementation on PROM risk.

RESULTS

We found significant association between prenatal exposure to air pollution and increased PROM risk after adjusting for confounders, and the critical exposure windows of PM2.5, PM10, SO2 and CO were the 21th to 24th weeks of pregnancy. Every 10-μg/m3 increase in PM2.5 and PM10, 5-μg/m3 increase in SO2, and 0.1-mg/m3 increase in CO was associated with low maternal hemoglobin levels [-0.94g/L (95% confidence interval (CI): -1.15, -0.73), -1.31g/L (95% CI: -1.55, -1.07), -2.96g/L (95% CI: -3.32, -2.61), and -1.11g/L (95% CI: -1.31, -0.92), respectively] in the third trimester. The proportion of the association between air pollution and PROM risk mediated by hemoglobin levels was 20.61% [average mediation effect (95% CI): 0.02 (0.01, 0.05); average direct effect (95%): 0.08 (0.02, 0.14)]. The PROM risk associated with exposure to low-medium air pollution could be attenuated by maternal iron supplementation in women with gestational anemia.

CONCLUSIONS

Prenatal exposure to air pollution, especially in the 21st to 24th weeks of pregnancy, is associated with PROM risk, which is partly mediated by maternal hemoglobin levels. Iron supplementation in anemia pregnancies may have protective effects against PROM risk associated with exposure to low-medium air pollution. https://doi.org/10.1289/EHP11134.

Effects of ambient air pollution on cause-specific hospitalizations in Wuhan during 2017-2019

BACKGROUND

Few studies have focused on the associations between air pollutants and multiple organ system diseases in the entire hospitalized population. The present study aims to explore the short-term effects of six routinely monitored air pollutants on the broad causes of hospital admissions and estimate the resulting hospital admission burdens.

METHODS

Daily hospital admission records from 2017 to 2019 were obtained from the Wuhan Information center of Health and Family Planning. Generalized additive models (GAMs) were employed to evaluate the effects of air pollutants on the percent increase in the cause-specific daily number of hospital admissions. Increased hospital admission numbers, days, and expenses were also estimated.

RESULTS

A total of 2636,026 hospital admissions were identified. We found that both PM_2.5 and PM₁₀ increased the risk of hospital admissions for most disease categories. Short-term exposure to PM_2.5 was positively associated with hospitalizations of several rarely studied disease categories, such as diseases of the eye and adnexa (2.83%, 95%CI: 0.96-4.73%, P < 0.01) and diseases of the musculoskeletal system and connective tissue (2.17%, 95% CI: 0.88-3.47%, P < 0.001). NO₂ was observed to have a robust effect on diseases of the respiratory system (1.36%, 95%CI: 0.74-1.98%, P < 0.001). CO was significantly associated with hospital admissions for six disease categories. Furthermore, each 10-μg/m³ increase in PM_2.5 was associated with an annual increase of 13,444 hospital admissions (95% CI: 6239-20,649), 124,344 admission days (95% CI: 57,705-190,983), and 166-million-yuan admission expenses (95% CI: 77-255).

CONCLUSION

Our study suggested that particulate matter (PM) had a short-term effect on hospital admissions of most major disease categories and resulted in a considerable hospital admission burden. In addition, the health effects of NO₂ and CO emissions require more attention in megacities.

Kitchen ventilation attenuated the associations of solid fuel use and long duration for cooking with the increased prevalence of normocytic anemia

Evidence on the potential risk factors of normocytic anemia, the most prevalent morphology subtype of anemia, was scarce to date. The purpose of this study is to investigate the association of cooking fuel use or daily cooking duration with normocytic anemia and further explore the modification effect of mechanical ventilation. Participants totaling 29,448 from the Henan Rural Cohort were included in this study. Normocytic anemia was defined by hemoglobin (based on the World Health Organization criteria) and mean corpuscular volume. Cooking-related data was collected by questionnaire, and the average daily cooking duration was calculated by the weekly cooking frequency and the cooking duration of each meal. Logistic regression models were employed to derive the combined and independent associations of cooking fuel type and daily cooking duration with normocytic anemia and the modification effect of ventilation. Compared with people who never cooked, both clean fuel and solid fuel users were significantly associated with increased prevalent normocytic anemia [OR (95% CI) = 1.196 (1.014, 1.411) and 1.335 (1.105, 1.614), respectively], and the effect estimates on normocytic anemia risk were 1.260 (1.043, 1.523), 1.320 (1.104, 1.578), and 1.310 (1.081, 1.587) in participants who daily cooked < 1 h/day, 1-2 h/day, and ≥ 2 h/day, respectively. These relationships were attenuated in subjects with mechanical ventilation (All P < 0.05). Cooking with solid fuel or for a long duration are independently associated with prevalent normocytic anemia in rural population, and mechanical ventilation could attenuate these associations. Future efforts to reduce the burden of anemia could target the universal use of ventilation and solid fuel use or cooking duration reduction.Clinical trial registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July, 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375.

Racial Differences in C-Reactive Protein, Depression Symptoms, and Social Relationships in Older Adults: A Moderated Network Analysis

INTRODUCTION

We introduce moderated network analysis as an integrative approach to assess the moderation effects of race on the relationship between C-reactive protein (CRP) and depression symptoms in older adults. This study further explores how the observed relationships differ adjusting for social relationships.

METHODS

This secondary analysis of cross-sectional data from the National Social Life, Health, and Aging Project (2010-2011) includes 2,880 older adults. We used different depression symptom domains (depressed affect, low positive affect, somatic symptoms, and interpersonal problems) from the Center for Epidemiologic Studies-Depression Scale. Social relationships were assessed with measures of social integration, social support, and social strain. The moderated networks were constructed using the R-package mgm. The racial moderator was coded as White/African American racial groups.

RESULTS

In the moderated networks of CRP and depression symptoms, CRP-"interpersonal problems" edge was present only among African Americans. CRP-"somatic symptoms" edge was present in both racial groups with equal edge weights. After adjusting for social relationships, the aforementioned patterns remained the same, but the edge weights were attenuated. We additionally observed CRP-social strain and social integration-"depressed affect" edges only in African Americans.

DISCUSSION

Race may moderate the relationship between the CRP and depression symptoms in older adults and social relationships might be important covariates to consider while analyzing them. This study as an initiation point; future network investigations would benefit from leveraging more contemporary cohorts of older adults, gaining a large sample size with diverse racial/ethnic backgrounds, and important covariates. Several important methodological issues of the current study are addressed.

Associations of Air Pollution and Serum Biomarker Abnormalities in Individuals with Hemodialysis-Dependent Kidney Failure

BACKGROUND

Ambient particles with a median aerodynamic diameter of <2.5 µm (PM2.5) is a ubiquitous air pollutant with established adverse health consequences. While postulated to promote a systemic inflammatory response, limited studies have demonstrated changes in serum biomarkers related to PM2.5 exposure. We aim to examine associations between short-term PM2.5 exposure and commonly measured biomarkers known to be affected by inflammation among patients receiving maintenance in-center hemodialysis.

METHODS

We conducted a retrospective open cohort study from January 1, 2008, to December 31, 2014. Adult hemodialysis patients were identified from the United States Renal Data System and linked at the patient level to laboratory data from a large dialysis organization. Daily ambient PM2.5 was estimated on a 1-km grid and assigned to cohort patients based on the ZIP codes of dialysis clinics. Serum albumin, serum ferritin, transferrin saturation (TSAT), and serum hemoglobin were ascertained from the dialysis provider organization database. Mixed-effect models were used to assess the changes in biomarker levels associated with PM2.5 exposure.

RESULTS

The final cohort included 173,697 hemodialysis patients. Overall, the daily ZIP-level ambient PM2.5 averages were 8.4-8.5 µg/m3. A 10-µg/m3 increase in same-day ambient PM2.5 exposure was associated with higher relative risks of lower albumin (relative risk [RR], 1.01; 95% confidence interval [95% CI], 1.01 to 1.02) and lower hemoglobin (RR, 1.02; 95% CI, 1.01 to 1.03). Associations of same-day ambient PM2.5 exposure and higher ferritin and lower TSAT did not reach statistical significance.

CONCLUSIONS

Short-term PM2.5 exposure was associated with lower serum hemoglobin and albumin among patients receiving in-center hemodialysis. These findings lend support to the role of inflammation in PM2.5 exposure-outcome associations.

Air Quality Is Predictive of Mistakes in Professional Baseball and American Football

Air quality is a growing environmental concern that has implications for human physical and mental health. While air pollution has been linked to cognitive disease progression and declines in overall health, the impacts of air quality on athletic performance have not been extensively investigated. Much of the previous research focused on endurance sports indicates that air quality negatively impacts athletic performance; however, the effects of air quality on non-endurance elite team performance remains largely unknown. The purpose of this study was to examine the impact of air quality on errors committed by Major League Baseball (MLB) teams, interceptions thrown by quarterbacks in the National Football League (NFL), and overall quarterback performance in the NFL. Linear regression analysis was used to determine the impact of the median air quality index (AQI) of counties with MLB and NFL teams on errors, interceptions, and overall quarterback performance of players on those MLB and NFL teams. AQI was a significant positive predictor of errors and interceptions, indicating increased errors and interceptions with decreased air quality. Similarly, quarterback performance was significantly reduced for quarterbacks from teams in counties with worse air quality. These findings suggest that air quality has a significant impact on performance in the MLB and NFL, indicating impairments in physical and cognitive performance in professional athletes when competing in areas with poorer air quality. Hence, it is likely that air quality impacts athletic performance in numerous sports that have not yet been investigated.

Severe Air Pollution Exposure and Long-Term Health Outcomes

BACKGROUND

There is a large literature that documents the negative health implications of exposure to air pollution, particularly PM2.5. Much of this literature, however, relies on short-term cross-sectional data, which cannot establish a true causal link between pollution and health. There are also very few studies that document long- and very long-term effects.

PURPOSE

This study intends to estimate a causal relationship between exposure to severe air pollution and negative health outcomes that persist over long periods of time.

METHODS

We use a large longitudinal dataset that spans almost 2 decades and that allows us to not only document the persistence of negative health effects, but also a pattern of recovery from a severe pollution episode. We use multivariate regression methods to estimate a causal link between air pollution and health over time. A large pollution shock that occurred in 1997 in Indonesia is used as a natural experiment to pinpoint the true causal effects of pollution exposure and not mere correlations.

RESULTS

Exposure to an additional unit of pollution in 1997 leads to a loss of roughly six units of lung capacity and to an increase of 4.3% in the probability of being in poor general health, as measured ten years after the pollution exposure. These effects somewhat diminish over time, to a loss of roughly three units of lung capacity and to an increase of only about 3% in the probability of being in poor general health, as measured 17 years after exposure.

CONCLUSIONS

Our study finds significant health consequences of exposure to air pollution, which persist over long periods of time, with some patterns of recovery. Policymakers should pay special attention to such massive sources of pollution and try to mitigate these negative health consequences.

Early-life environmental exposures and anaemia among children under age five in Sub-Saharan Africa: An insight from the Demographic & Health Surveys

BACKGROUND

Reports show that the majority (60%) of children under age five years in Sub-Saharan Africa are anaemic. Studies in the region have mainly focused on the effect of individual, maternal and household socioeconomic status on the prevalence of anaemia. Currently, there is limited understanding of the association between early-life environmental exposures and anaemia among children in Sub-Saharan Africa.

OBJECTIVE

The study examines the association between early-life environmental exposures and anaemia among children under five in Sub-Saharan Africa.

METHODS

The study used health and demographic data from the Demographic and Health Survey (DHS) program and environmental data from NASA's Geospatial Interactive Online Visualization ANd aNalysis Infrastructure (GIOVANNI) and Atmospheric Composition Analysis Group. Three exposure periods were defined for the study, namely: in-utero, post-utero and cumulative life exposures. Multilevel mixed-effect models were used to assess the associations between environmental exposures and anaemia in each exposure period.

RESULTS

The findings show that 63% of children in the study were anaemic. It also reveals that mean PM 2.5 exposure for in-utero (34.93 μgm^-3), post-utero (35.23 μgm^-3) and cumulative exposure (35.08 μgm^-3) were seven times higher than the new air quality guideline WHO recommended. A 10 μgm^-3 increase in in-utero, post-utero and cumulative PM 2.5 exposures was associated with 4% to 5% increase in the prevalence of anaemia among children. A 10ppbv increase in in-utero, post-utero and cumulative carbon monoxide exposures was associated with 1% increase in the prevalence of anaemia among children. The spatial risk distribution maps show that socioeconomic factors modify the spatial risk distribution pattern.

CONCLUSION

The findings of the study suggest that early-life exposure to ambient air pollution is significantly associated with anaemia among children in Sub-Saharan Africa. Thus, policies aimed at addressing air quality should be incorporated into targeted interventions for anaemia among children in the region.

Lower socioeconomic status strengthens the effect of cooking fuel use on anemia risk and anemia-related parameters: Findings from the Henan Rural Cohort

The established evidence of cooking fuel use and socioeconomic status related to anemia is limited in low- and middle-income countries. The current study aims to examine the independent and combined effects of cooking fuel use and socioeconomic status on anemia risk as well as anemia-related parameters in rural China. A total of 21,050 participants were included from the baseline of the Henan Rural Cohort. Anemia was determined according to the World Health Organization criteria. Data on cooking fuel use (electricity, gas and solid fuel) and socioeconomic status (education and income levels) were collected using a standardized questionnaire by face-to-face interview. Logistic and linear regression models were applied to evaluate the effects of cooking fuel use or socioeconomic indicators on anemia risk, hemoglobin (HGB), red blood count (RBC), and hematocrit (HCT) levels. Using gas or solid fuel for cooking was positively associated with prevalent anemia risk and negatively related to HGB, RBC, and HCT levels compared to using electricity. Significant independent associations were also found between socioeconomic status (education and income levels) and prevalent anemia risk as well as these anemia-related parameters. In general, with decreased socioeconomic status, associations of using gas or solid fuel for cooking with advanced anemia risk as well as lower anemia-related parameters were increased. Furthermore, participants using gas or solid fuel for cooking and with lower education or income level were related to increased high anemia risk as well as low HGB, RBC and HCT levels, compared to those using electricity for cooking and with high education or income level (P <0.05 for all). The finding suggested that lower socioeconomic status strengthens the adverse effect of cooking fuel use on the higher anemia risk and lower HGB, RBC, and HCT levels in rural China.

Ambient particulate air pollution, blood cell parameters, and effect modification by psychosocial stress: Findings from two studies in three major Chinese cities

The associations between particulate matter (PM) exposure, psychosocial stress and blood cell parameters are bringing novel insights to characterize the early damage of multiple diseases. Based on two studies conducted in three Chinses cities using cross-sectional (Beijing, 425 participants) and panel study (Tianjin and Shanghai, 92 participants with 361 repeated measurements) designs, this study explored the associations between short-term exposure to ambient PM and blood cell parameters, and the effect modification by psychosocial stress. Increasing PM_2.5 exposure was significantly associated with decreases in red blood cell (RBC) count and mean corpuscular hemoglobin concentration (MCHC), and increases in mean corpuscular volume (MCV), platelets count (PLT) and platelet hematocrit (PCT) in both studies. For instance, a 10 μg/m³ increment in PM_2.5 concentration was associated with a 1.04% (95%CI: 0.16%, 1.92%) increase in PLT (4-d) and a 1.09% (95%CI: 0.31%, 1.87%) increase in PCT (4-d) in the cross-sectional study, and a 0.64% (95%CI: 0.06%, 1.22%) increase in PLT (1-d) and a 0.72% (95%CI: 0.33%, 1.11%) increase in PCT (1-d) in the panel study, respectively. In addition, stronger increases in MCV, PLT, and PCT associated with PM_2.5 exposure were found in higher psychosocial stress group compared to lower psychosocial stress group (p for interaction <0.10), indicating that blood cell parameters of individuals with higher psychosocial stress might be more susceptible to the early damages of PM_2.5 exposure.

Autoimmune hemolytic anemia: causes and consequences

INTRODUCTION

Autoimmune hemolytic anemia (AIHA) is classified according to the direct antiglobulin test (DAT) and thermal characteristics of the autoantibody into warm and cold forms, and in primary versus secondary depending on the presence of associated conditions.

AREAS COVERED

AIHA displays a multifactorial pathogenesis, including genetic (association with congenital conditions and certain mutations), environmental (drugs, infections, including SARS-CoV-2, pollution, etc.), and miscellaneous factors (solid/hematologic neoplasms, systemic autoimmune diseases, etc.) contributing to tolerance breakdown. Several mechanisms, such as autoantibody production, complement activation, monocyte/macrophage phagocytosis, and bone marrow compensation are implicated in extra-/intravascular hemolysis. Treatment should be differentiated and sequenced according to AIHA type (i.e. steroids followed by rituximab for warm, rituximab alone or in association with bendamustine or fludarabine for cold forms). Several new drugs targeting B-cells/plasma cells, complement, and phagocytosis are in clinical trials. Finally, thrombosis and infections may complicate disease course burdening quality of life and increasing mortality.

EXPERT OPINION

Beyond warm and cold AIHA, a gray-zone still exists including mixed and DAT negative forms representing an unmet need. AIHA management is rapidly changing through an increasing knowledge of the pathogenic mechanisms, the refinement of diagnostic tools, and the development of novel targeted and combination therapies.

Air Pollution, Foreign Direct Investment, and Mental Health: Evidence From China

Recently, there has been interest in the relationship between mental health and air pollution; however, the results are inconsistent and the contribution of foreign direct investment (FDI) has received little attention. This article studies the effects of air pollution on mental health and the moderating role of FDI based on the China Health and Retirement Longitudinal Study (CHARLS) data in 2015 and 2018 applying the fixed effects panel regression approach and the threshold model. The results show that mental health is adversely affected by air pollution, especially PM_2.5, PM₁₀, sulfur dioxide (SO₂), carbon monoxide (CO), and nitrogen dioxide (NO₂). Second, FDI has an alleviating influence on the negative relationship. Third, the effects of air pollution and FDI are heterogeneous based on regional characteristics, including location, medical resource and investment in science and technology, and individual characteristics covering education level, age, income, and physical health. Finally, the threshold effects show that FDI has a moderating effect when it is >1,745.59 million renminbi (RMB). There are only 11.19% of cities exceeding the threshold value in China. When the value of air quality index (AQI) exceeds 92.79, air pollution is more harmful to mental health. Government should actively introduce high-quality FDI at the effective level and control air pollution to improve mental health.

Effects of PM2.5 and its constituents on hemoglobin during the third trimester in pregnant women

Anemia has been a public health issue evoking global concern, and the low hemoglobin (Hb) concentration links to adverse pregnancy outcomes. However, the associations of PM_2.5 and its constituents with Hb and anemia in pregnant women remain unclear. In this retrospective birth cohort study, 7932 pregnant women who delivered in the First Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2018 were included. The Hb during the third trimester in pregnant women was assessed before delivery. PM_2.5 and its constituents (BC, NH₄⁺, NO₃^-, OM, SO₄^2-, and Dust) during pregnancy were retrieved from the V4.CH.03 product constructed by the Atmospheric Composition Analysis Group. Generalized linear regression model was applied to investigate the effects of PM_2.5 and its constituents on Hb and anemia during the third trimester in pregnant women. The means and standard deviations of PM_2.5, BC, NH₄⁺, NO₃^-, OM, SO₄^2-, and Dust were 69.56 (15.24), 10.02 (2.72), 8.11 (1.77), 14.96 (5.42), 15.36 (4.11), 10.08 (1.20), and 10.98 (1.85) μg/m³, respectively. Per IQR increase (μg/m³) of PM_2.5, BC, NO₃^-, and OM linked to - 0.75 (- 1.50, - 0.01), - 0.85 (- 1.65, - 0.04), - 0.79 (- 1.56, - 0.03), and - 0.73 (- 1.44, - 0.03) g/L decrease of Hb during the third trimester in multiparous pregnant women, but not for NH₄⁺, SO₄^2-, Dust, and primiparous pregnant women. PM_2.5 and its constituents had no significant association with anemia, except for Dust (OR: 0.90, 95% CI: 0.82, 0.99, per IQR increase) in primiparous pregnant women. Besides, SO4^2- was of lag effects on Hb and anemia in multiparous pregnant women. Moreover, non-linear associations were found among PM_2.5 and its constituents, Hb, and anemia. Therefore, exposure to PM_2.5 and some constituents of PM_2.5 was associated with reduced Hb level during the third trimester in multiparous pregnant women. Related departments and pregnant women should take targeted actions to eliminate the detrimental effects of PM_2.5 and its constituents on pregnancy outcomes.

Associations between differences in anemia-related blood cell parameters and short-term exposure to ambient particle pollutants in middle-aged and elderly residents in Beijing, China

Anemia is a highly prevalent disease among older populations, with multiple adverse health outcomes, and particles exposure is a potential risk factor for anemia. However, evidence on associations of exposure to particles with small size with anemia-related blood cell parameters levels in the elderly is limited, and the underlying mechanisms are unclear. Based on a panel study in Beijing, we found that in 135 elderly participants, mass concentrations of particle with an aerodynamic diameter ≤ 2.5 μm (PM_2.5), black/elemental carbon (BC/EC, particle size range: 0-2.5 μm), and number concentrations of ultrafine particles (UFPs, particle size range: 5.6-93.1 nm) and accumulated mode particles (Acc, size range: 93.1-560 nm) were significantly associated with levels of red blood cell count (RBC), hemoglobin (HGB), hematocrit (HCT), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC). The mean ± SD for PM_2.5, UFPs, Acc, BC, OC, and EC were 69.7 ± 61.1 μg/m³, 12.5 ± 4.3 × 10³/cm³, 1.6 ± 1.2 × 10³/cm³, 3.0 ± 2.0 μg/m³, 8.7 ± 6.7 μg/m³, and 2.1 ± 1.6 μg/m³, respectively. Cotinine (higher than 50 ng/mL) is used as an indicator of smoking exposure. The association between MCHC difference and per interquartile range (IQR) increase in average UFPs concentration 14 d before clinical visits was -0.7% (95% CI: -1.1% to -0.3%). Significant associations of UFPs and Acc exposure with MCHC and MCH levels remain robust after adjustment for other pollutants. Furthermore, 25.2% (95% CI: 7.4% to 64.8%) and 29.8% (95% CI: 5.3% to 214.4%) of the difference in MCHC associated with average UFPs and Acc concentrations 14 d before clinical visits were mediated by the level of tumor necrosis factor α (TNF α), a biomarker of systemic inflammation. Our findings for the first time provide the evidence that short-term UFPs and Acc exposure contributed to the damage of anemia-related blood cell in the elderly, and systemic inflammation was a potential internal mediator.

Effect of individual, household and regional socioeconomic factors and PM2.5 on anaemia: A cross-sectional study of sub-Saharan African countries

There is limited knowledge on the effect of contextual and environmental factors on the risk of anaemia, as well as the spatial distribution of anaemia in the Sub-Saharan Africa region. In this study, we used multi-country data from the Demographic & Health survey (DHS) with 270,011 observations and PM_2.5 data from NASA, applied to the spatial risk pattern of anaemia in the SSA region. The prevalence of anaemia amongst women (41%) was almost twice that of men (22%). A Bayesian hierarchical model showed that individual household, neighbourhood and regional socioeconomic factors were significantly associated with the likelihood of being anaemic. 1 μg/m³ increase in cumulative lifetime PM_2.5 exposure accounted for 1% (β = 0.011, CI = 0.008 - 0.015) increase in the likelihood of being anaemic. The results suggest the need for a multidimensional approach to tackle anaemia in the Sub-Saharan African region and identify high-risk areas for target intervention policies or programs.

Population Health Effects of Air Pollution: Fresh Evidence From China Health and Retirement Longitudinal Survey

The effects of air pollution on population health are currently a hot topic. However, few studies have examined the physical and mental health effects of air pollution jointly in China. Using data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018, this study explores how air pollution affects the physical and mental health of middle-aged and elderly residents. The empirical results highlight that air pollution can negatively affect both physical and mental health. In terms of physical health, those exposed to chronic shock are likely to suffer more adverse effects from air pollution than those exposed to acute shock. In terms of mental health, those exposed to depression suffer greater adverse effects than those exposed to episodic memory and mental cognition. Besides, heterogeneity analysis also shows that air pollution affects the mental and physical health of males more than females. Furthermore, the increase in air pollution is expected to result in huge hospitalization costs. Therefore, the Chinese government should formulate differentiated public health policies to reduce the effects of air pollution on the health of middle-aged and elderly residents.

Direct and Indirect Effects of Indoor Particulate Matter on Blood Indicators Related to Anemia

Exposure to indoor particulate matter (PM) is a potential risk factor that increases systemic inflammation and affects erythropoiesis. This study investigated the association between exposure to indoor PM and blood indicators related to anemia (BIRA) in housewives. Indoor PM and blood folate status are important factors in the risk of anemia. This was a housewife cohort study; we recruited 284 housewives in Seoul and Ulsan, Republic of Korea. Indoor exposure to PM2.5 and PM10 was measured by gravimetric analysis and sensors. We investigated the BIRA, such as hemoglobin (Hb), hematocrit, mean corpuscular volume (MCV), mean corpuscular Hb (MCH), and mean corpuscular Hb concentration (MCHC). Statistical analysis was performed by multiple linear regression model and mediation analysis. The association between BIRA and PM was assessed by multiple linear regression models fitted by mediation analyses. The increase in the level of indoor PM2.5 was associated with a decrease in MCV (Beta coefficient (B): −0.069, Standard error (SE): 0.022) and MCH (B: −0.019, SE: 0.009) in gravimetric measurements. The increase in the level of indoor PM2.5 was associated with a decrease in Hb (B: −0.024, SE: 0.011), hematocrit (B: −0.059, SE: 0.033), and MCV (B: −0.081, SE: 0.037) and MCH (B: −0.037, SE: 0.012) in sensor measurements (PM2.5-Lag10). Further, we identified a serum folate-mediated PM effect. The indoor PM exposure was significantly associated with decreased Hb, MCV, and MCH in housewives. Taken together, our data show that exposure to indoor PM is a risk factor for anemia in housewives. Blood folate concentration can be a mediating factor in the effect of indoor PM on BIRA. Therefore, folate intake should be recommended to prevent anemia in housewives. Moreover, indoor PM exposure should be managed.

Mechanisms of cardiovascular toxicity induced by PM2.5: a review

An increasing number of studies have shown that exposure to particulate matter with a diameter ≤ 2.5 μm (PM_2.5) could affect the onset and development of cardiovascular diseases. To explore the underlying mechanisms, the studies conducted in vitro investigations using different cell lines. In this review, we examined recently published reports cited by PubMed or Web of Science on the topic of cardiovascular toxicity induced by PM_2.5 that carried the term in vitro. Here, we summarized the suggested mechanisms of PM_2.5 leading to adverse effects and cardiovascular toxicity including oxidative stress; the increase of vascular endothelial permeability; the injury of vasomotor function and vascular reparative capacity in vascular endothelial cell lines; macrophage polarization and apoptosis in macrophage cell lines; and hypermethylation and apoptosis in the AC16 cell line and the related signaling pathways, which provided a new research direction of cardiovascular toxicity of PM_2.5.

A rapid spectrophotometric method to identify inhibitors of human erythropoiesis

Erythropoiesis is a complex physiological process by which erythroid progenitors proliferate and differentiate into nonnucleated red blood cells. Several methods can be used to monitor in vitro the differentiation of erythroid precursors, and hence the toxic effects of drugs, chemicals, or pollutants. One of the most commonly available assay of erythropoiesis is the microscopic observation of differentiated cells after benzidine staining, which forms a blue complex with hemoglobin. However, this method is laborious and does not provide accurate results since it heavily relies on the reader's interpretation. Moreover, benzidine is a carcinogen and a highly reactive molecule which forces the reader to microscopically count differentiated and non-differentiated cells within a short time frame (5 min). Here we have developed a simple, inexpensive, in-vitro spectrophotometric assay to measure erythroid differentiation using K562 cell line as a model. Materials needed included 96-well round-bottomed microplates and a microplate reader. Remarkably, carcinogenic benzidine was replaced by its isomeric tetramethyl derivative, the 3,3', 5,5'- tetramethylbenzidine (TMB), which presents several advantages: it is cheap, not mutagenic and a ready-to-use chromogenic substrate. A small volume (50 μl) of TMB added to the samples forms a blue complex in 15 min, and the reaction can be easily stopped and stabilized by the addition of H₂SO₄. The yellow precipitate is then solubilized, and the absorbance is measured at 450 nm. In addition, the suitability of the assay to determine the effects of compounds on erythroid differentiation was further tested with known inhibitors (artemisinin derivatives) of K562 differentiation. Overall, the reported methodology permits to measure in an accurate and reproducible manner the K562 differentiation and can be used for medium throughput screenings (MTS) of compounds or environmental toxics with potential erythro-toxicity and ability to inhibit erythroid differentiation.

Anemia among Men in Malaysia: A Population-Based Survey in 2019

This study aimed to determine the prevalence of anemia and factors associated with anemia among men in Malaysia. The researchers used data from the 2019 National Health and Morbidity Survey (NHMS). The hemoglobin levels of men aged 15 years and above who gave their consent was measured using the HemoCue® Hb 201+ System©. The majority of them (87.2%) were men aged 15-59 years, referred to as the younger age group in this study. The prevalence of anemia among men was 12.6% (95% confidence interval (CI): 10.9, 14.5). The prevalence was higher among older men (30.7%; 95% CI: 26.6, 35.1) than younger men (10.0%; 95% CI: 8.2, 12.2). Anemia among men was associated with older age (adjusted odds ratios (aOR) = 3.1; 95% CI: 2.1, 4.4) and those with diabetes (aOR = 1.5; 95% CI: 1.2, 2.1) via a logistic regression analysis. In conclusion, older men were more affected by anemia than younger men in this study. Anemia among older men in Malaysia is at the level of moderate to severe public health significance. The likelihood of developing anemia is increased among older men with diabetes compared to older men without diabetes. These often-overlooked issues among men need to be detected and treated early in order to prevent complications and improve their quality of life.

Air Pollution as a Determinant of Undernutrition Prevalence among Under-Five Children in India: An Exploratory Study

AIM

The association of air pollution with prevalence of undernutrition indices (namely, anaemia, stunting, wasting and underweight) among under-five children in India was investigated.

METHODS

Estimates of population weighted annual average gridded PM2.5 concentrations and proportion of households using solid cooking fuel (HSCF usage percent) during 2017 in India, reflecting the magnitude of ambient and household air pollution respectively, were extracted in a state-wise manner from India State Level Disease Burden Initiative (ISLDBI) reports. Their relationships with the corresponding prevalence of anaemia, underweight, wasting and stunting in under-five children were analysed.

RESULTS

The state-level PM2.5 concentrations (mean: 65.5 µg/m3; median: 49.2 µg/m3; range: 17.3-209.0 µg/m3) correlated significantly (P < 0.01) with anaemia (r = 0.65), stunting (r = 0.58) and underweight (r = 0.50) prevalence; while HSCF usage (mean: 49.3%; median: 46.0%; range: 1.9-81.5%) correlated significantly (P < 0.01) with stunting (r = 0.69) and underweight (r = 0.58) prevalence. When examined across median cut-offs and after adjusting for socio-demographic index, the association of anaemia prevalence with PM2.5 concentrations persisted. This association was maintained even after controlling for the coverage of anaemia-specific interventions (namely, iron supplements and deworming medications). The mean difference in PM2.5 concentrations between the high and low PM2.5 states was 58.6 µg/m3, which accounted for 11.8% higher anaemia prevalence in the former as compared to the latter.

CONCLUSION

The burden of childhood undernutrition, particularly anaemia, in India may be linked to PM2.5 levels. To mitigate this burden, it may be necessary to complement the ongoing nutritional interventions with air pollution control measures.

Risk of anaemia among women engaged in biomass-based fish smoking as their primary livelihood in the central region of Ghana: a comparative cross-sectional study

BACKGROUND

Fish smoking using biomass fuel is an important livelihood for women living in the coastal regions of Ghana and may contribute to anaemia risk. We assessed whether women who smoke fish as their primary livelihood are at increased risk of anaemia compared to women in other livelihoods in the Central Region of Ghana.

METHODS

We conducted a comparative cross-sectional study of 330 randomly selected adult women (18-49 years) whose primary livelihood was either fish smoking (FSL) involving the burning of biomass fuel (n = 175) or other livelihoods (OL) not involving burning of firewood (n = 155). Data on participants' recent diet were collected from a single, quantitative 24-h dietary recall and qualitative 7-day food frequency questionnaire of animal-source food (ASF) consumption. We further assessed participants' haemoglobin concentration using the Urit 12 Hemocue system. We compared total iron intakes, the proportion of dietary iron from animal and plant sources, mean haemoglobin concentrations, and anaemia prevalence between FSL and OL women.

RESULTS

Fish was the most frequently consumed ASF by both groups of women. Although OL women consumed more diverse ASFs in the past week compared with the FSL women (3.4 ± 1.2 vs. 2.7 ± 1.3; p < 0.001), the contribution of ASFs to total iron intake in the past day was greater for the FSL women (49.5% vs. 44.0%; p = 0.030). Estimated total dietary iron intake in the past day was generally low (5.2 ± 4.7 mg) and did not differ by group. The unadjusted prevalence of anaemia was 32 and 27.1% among the FSL and OL women, respectively (p = 0.33). After covariates adjustment, the FSL women had statistically higher anaemia prevalence (36.4% vs. 20.5%; p = 0.032) and 80% greater risk of being anemic (RR: 1.8; 95% CI: 1.1, 3.0) than the OL women.

CONCLUSION

Women who use biomass fuel to smoke fish as their primary livelihood had an increased risk of anaemia. Furthermore, the average 24-h dietary iron intake among both the FSL and OL women was below their daily iron requirement. Interventions to enhance women's dietary iron intake and reduce their livelihood related biomass smoke exposure may be warranted in this population.

Particulate Matter 2.5 and Hematological Disorders From Dust to Diseases: A Systematic Review of Available Evidence

Particulate matter 2.5 (PM_2.5) in the air enters the human body by diffusion into the blood. Therefore, hematological abnormalities might occur because of these toxic particles, but few studies on this issue have been reported. According to Cochrane guidance, we performed a systematic review on the relationship between exposure to PM_2.5 and the risk of hematological disorders. Ten articles were included in this review. Anemia was found among children and elderly populations with 2- to 5-year PM_2.5 exposure. Young children from mothers exposed to air pollution during pregnancy had a higher incidence of leukemia similar to the elderly. Supporting these data, outdoor workers also showed abnormal epigenetic modifications after exposure to very high PM_2.5 levels. Adults living in high PM_2.5 areas for 2 years were more likely to develop thrombocytosis. Finally, elderly populations with 7- to 8-year PM_2.5 exposure showed increased risks of venous thromboembolism. In conclusion, the associations between PM_2.5 and hematological aberrations among high-risk people with long-term exposure were reported.

The Association Between Ambient PM2.5 Exposure and Anemia Outcomes Among Children Under Five Years of Age in India

Anemia is highly prevalent in India, especially in children. Exposure to ambient fine particulate matter (PM2.5) is a potential risk factor for anemia via. systemic inflammation. Using health data from the National Family and Health Survey 2015-2016, we examined the association between ambient PM2.5 exposure and anemia in children under five across India through district-level ecological and individual-level analyses.

METHODS

The ecological analysis assessed average hemoglobin levels and anemia prevalence (hemoglobin < 11 g/dL considered anemic) by district using multiple linear regression models. The individual-level analysis assessed average individual hemoglobin level and anemia status (yes/no) using generalized linear mixed models to account for clustering by district. Ambient PM2.5 exposure data were derived from the Multiangle Imaging SpectroRadiometer (MISR) level 2 aerosol optical depth (AOD) data and averaged from birth date to date of interview.

RESULTS

The district-level ecological analysis found that, for every 10 μg m-3 increase in ambient PM2.5 exposure, average anemia prevalence increased by 1.90% (95% CI = 1.43, 2.36) and average hemoglobin decreased by 0.07 g/dL (95% CI = 0.09, 0.05). At the individual level, for every 10 μg m-3 increase in ambient PM2.5 exposure, average hemoglobin decreased by 0.14 g/dL (95% CI = 0.12, 0.16). The odds ratio associated with a 10-μg m-3 increase in ambient PM2.5 exposure was 1.09 (95% CI = 1.06, 1.11). There was evidence of effect modification by wealth index, maternal anemia status, and child BMI.

CONCLUSION

Our results suggest that ambient PM2.5 exposure could be linked to anemia in Indian children, although additional research on the underlying biologic mechanisms is needed. Future studies on this association should specifically consider interactions with dietary iron deficiency, maternal anemia status, and child BMI.Keywords: Anemia; Children; Ambient PM2.5 exposure; India; Association.

The effect of air pollution on immunological, antioxidative and hematological parameters, and body condition of Eurasian tree sparrows

Air pollution constitutes potential threats to wildlife and human health; therefore, it must be monitored accurately. However, little attention has been given to understanding the toxicological effects induced by air pollution and the suitability of bird species as bioindicators. The Eurasian tree sparrow (Passer montanus), a human commensal species, was used as a study model to examine toxic metal accumulation, retention of particulate matter (PM), immunological and antioxidant capacities, and hematological parameters in birds inhabiting those areas with relatively higher (Shijiazhuang city) or lower (Chengde city) levels of PM_2.5 and PM₁₀ in China. Our results showed that Shijiazhuang birds had significantly more particle retention in the lungs and toxic metal (including aluminum, arsenic, cadmium, iron, manganese, and lead) accumulation in the feathers relative to Chengde birds. They also had lower superoxide dismutase, albumin, immunoglobulin M concentrations in the lung lavage fluid, and total antioxidant capacity (T-AOC) in the lungs and hearts. Furthermore, although they had higher proportions of microcytes, hypochromia, and polychromatic erythrocytes in the peripheral blood (a symptom of anemia), both populations exhibited comparable body conditions, white cell counts, heterophil and lymphocyte ratios, and plasma T-AOC and corticosterone levels. Therefore, our results not only confirmed that Shijiazhuang birds experienced a greater burden from environmental PM and toxic metals but also identified a suite of adverse effects of environmental pollution on immunological, antioxidative, and hematological parameters in multiple tissues. These findings contribute to our understanding of the physiological health consequences induced by PM exposure in wild animals. They suggest that free-living birds inhabiting urban areas could be used as bioindicators for evaluating the adverse effects induced by environmental pollution.

Fatigability as a Predictor of Subclinical and Clinical Anemia in Well-Functioning Older Adults

BACKGROUND/OBJECTIVES

Anemia is a common condition in older adults for which fatigue, the primary symptom, often goes unrecognized as individuals typically equilibrate their activity to avoid fatigue. Whether assessing fatigability (i.e., susceptibility to fatigue) facilitates identification of anemia is unknown. This study examines the association between fatigability and prevalent, incident, and persistent subclinical and clinical anemia in well-functioning older adults.

DESIGN, SETTING, PARTICIPANTS

Longitudinal analysis of 905 well-functioning men and women aged 60 to 89 years and followed for 1 to 5 years from the Baltimore Longitudinal Study of Aging conducted at the National Institute on Aging, Clinical Research Unit, Baltimore, MD.

MEASUREMENTS

Perceived fatigability was assessed as a rating of perceived exertion (RPE) from 6 to 20 following a 5-minute treadmill walk at 1.5 mph (.67 m/s); fatigue was assessed as reported unusual tiredness in the past month. Clinical anemia was defined using World Health Organization hemoglobin cutpoints of below 13 g/dL and below 12 g/dL for men and women, respectively, and subclinical anemia was defined as 13.0 to 13.9 g/dL and 12.0 to 12.9 g/dL, respectively.

RESULTS

Overall, 14% of participants had clinical and 30% had subclinical anemia at baseline. Each increment (1 RPE) of fatigability was associated after covariate adjustment with 14% (95% confidence interval [CI] = 5-25%, P = .005) and 8% (CI = 1-17%; P = .031), respectively, greater likelihood of prevalent clinical and subclinical anemia. An average of 2.2 years later, each 1 RPE increment in baseline fatigability predicted an 11% (CI = 2-20%; P = .016) higher likelihood of incident and/or persistent subclinical and clinical anemia. Reports of unusual tiredness were associated with prevalent subclinical anemia only.

CONCLUSION

This study provides evidence that perceived fatigability may help identify well-functioning older adults with borderline to clinical anemia who are on a trajectory of persistently suboptimal or worsening hemoglobin status. Assessing fatigability may facilitate earlier diagnosis of health conditions that underlie persistent suboptimal hemoglobin status. J Am Geriatr Soc 68:2297-2302, 2020.

Air pollution impairs recovery and tissue remodeling in a murine model of acute lung injury

Evidence regarding the impact of air pollution on acute respiratory distress syndrome (ARDS) is limited, and most studies focus on ARDS onset. Our study aimed to evaluate whether exposure to fine particulate matter interferes with lung recovery and remodeling in a murine model of acute lung injury. Forty-eight mice received nebulized LPS or the vehicle (controls). Blood, BALF, lungs and spleen were collected after 5 weeks of exposure to either PM_2.5 (PM and LPS + PM group) or filtered air (control and LPS5w groups). Inflammatory cells and cytokines were assessed in the blood, BALF, lungs and spleen. Stereological analyses and remodeling assessments were performed by histology. The LPS + PM group showed increased BALF leukocytes, characterized by increased macrophages, increased IL-1β and IL-6 levels, anemia and thrombocytopenia. Moreover, we also observed septal thickening, decreased alveolar air space total volume and, septa surface density. Finally, regarding tissue remodeling, we observed elastosis of the lung parenchyma, and unlike in the LPS5w group, we did not observe fibrosis in the LPS + PM group. In conclusion, the delayed inflammation resolution due to subchronic exposure to PM_2.5 could be influenced by low systemic and local lymphocyte counts, which lead to impaired lung injury recovery and tissue remodeling.

Evaluating the Effectiveness of an Educational Intervention for Care of Anemic Patients in a Long-Term Care Geropsychiatric Unit: A Pilot Study

Anemia is one of the most common age-related health conditions. When concurrently present with psychiatric conditions, the problem is confounded. The primary objective of the current research was to evaluate the effectiveness of an educational intervention for geropsychiatric nurses about nutritional deficiency anemia, anemia of chronic disease, and unexplained anemia in older adults. Fifty nurses employed by an inpatient psychiatric facility participated in the pilot study. A 10-item knowledge evaluation questionnaire was administered prior to and following a 45-minute educational intervention. Analysis of a paired samples t test indicated a significant difference between pretest scores (mean = 36.8, SD = 16.3) and posttest scores (mean = 90.8, SD = 10.66) (p < 0.001). Despite initial knowledge gaps, significant improvement in nursing knowledge was noted following the intervention. As a result of improved knowledge, RNs may be better able to recognize and respond to signs and symptoms that commonly go unnoticed in geropsychiatric patients with anemia. [Journal of Gerontological Nursing, 46(8), 12-16.].

A Framework to Classify Environmental Inequity in Absolute and Relative Terms, and Its Application in Beijing

Although reducing environmental inequities is widely recognized as an essential step towards sustainable cities, decision-makers frequently lack the tools to identify inequity distribution patterns and designing effective intervention policies. This study seeks to present a framework that can help decision-making processes by classifying environmental inequity districts in multiple perspectives, especially in absolute and relative terms. This framework includes four steps: (A) variable selection, (B) data normalization, (C) ranking indicators, (D) summarizing inequity classification, which then assign results to selected areas. The framework aims to classify and compare environmental inequities in multiple perspectives, and can be applied in various environmental problems, with advantages such as high acceptability and clear comprehensibility. To show the potential use of this framework, a case application in Beijing, China, was conducted to evaluate the environmental inequity of air pollution. The results suggest that decision-makers should focus on the central urban area and some southern regions of Beijing to implement various improvement policies. Based on the results from Beijing, how the framework can be used to help decision-makers, the future roles of this framework with the government and the public, as well as the framework’s limitations are further discussed.

Association between ambient beta particle radioactivity and lower hemoglobin concentrations in a cohort of elderly men

Although ionizing radiation is known to have detrimental effects on red blood cells, the effect of environmental radioactivity associated with ambient particulate matter (PM) is unknown. We hypothesized that exposure to ambient PM-associated beta particle radioactivity (PR_β) would be associated with a lower hemoglobin concentration. We studied 1.704 participants from the Normative Aging Study (NAS) over 36 years (1981-2017) who lived in Eastern, MA and the surrounding area. Exposures to PR_β was assessed using USEPA's RadNet monitoring network that measures gross beta radiation associated with ambient PM. Mixed effect models with a random intercept adjusting for potential confounders was used, including ambient black carbon (BC) and particulate matter ≤2.5 μm (PM_2.5) concentrations. Greater cumulative PR_β activities at 7-, 14-, 21- and 28-days before the hemoglobin determination were associated with lower hemoglobin concentrations. The greatest effect was for a 28-day moving average. An IQR of 0.83 × 10^-4 Bq/m³ of ambient PR_β was associated with a 0.12 g/dL decrease in hemoglobin concentration (95%CI: -0.18 to -0.05). The effects of PR_β were similar when the models were adjusted for ambient BC or PM_2.5. This is the first study to demonstrate an association between environmental ionizing radiation released from particulate matter with a lower hemoglobin concentration, suggesting that ambient radiation may contribute to the development of anemia.

Ambient Air Pollution Exposure Association with Anaemia Prevalence and Haemoglobin Levels in Chinese Older Adults

BACKGROUND

Health effects of air pollution on anaemia have been scarcely studied worldwide. We aimed to explore the associations of long-term exposure to ambient air pollutants with anaemia prevalence and haemoglobin levels in Chinese older adults.

METHODS

We used two-level linear regression models and modified Poisson regression with robust error variance to examine the associations of particulate matter (PM) and nitrogen dioxide (NO₂) on haemoglobin concentrations and the prevalence of anaemia, respectively, among 10,611 older Chinese adults enrolled in World Health Organization (WHO) Study on global AGEing and adult health (SAGE) China. The average community exposure to ambient air pollutants (PM with an aerodynamic diameter of 10 μm or less (PM₁₀), 2.5 μm or less (PM_2.5), 1 μm or less (PM₁) and nitrogen dioxide (NO₂)) for each participant was estimated using a satellite-based spatial statistical model. Haemoglobin levels were measured for participants from dried blood spots. The models were controlled for confounders.

RESULTS

All the studied pollutants were significantly associated with increased anaemia prevalence in single pollutant model (e.g., the prevalence ratios associated with an increase in inter quartile range in three years moving average PM₁₀ (1.05; 95% CI: 1.02-1.09), PM_2.5 (1.11; 95% CI: 1.06-1.16), PM₁ (1.13; 95% CI: 1.06-1.20) and NO₂ (1.42; 95% CI: 1.34-1.49), respectively. These air pollutants were also associated with lower concentrations of haemoglobin: PM₁₀ (-0.53; 95% CI: -0.67, -0.38); PM_2.5 (-0.52; 95% CI: -0.71, -0.33); PM₁ (-0.55; 95% CI: -0.69, -0.41); NO₂ (-1.71; 95% CI: -1.85, -1.57) respectively.

CONCLUSIONS

Air pollution exposure was significantly associated with increased prevalence of anaemia and decreased haemoglobin levels in a cohort of older Chinese adults.

The impact of smoke from grilled fish on the hematological parameters of Indonesian grilled fish sellers

Purpose

Fish processing by grilling can produce emissions that contain toxic compounds that can have short- and long-term effects on human health. Another study reported that exposure to air pollutants is hematotoxic. The purpose of this paper is to determine the effect of smoke exposure on fish grill results on hematological parameters.

Design/methodology/approach

The subjects of this study were 90 grilled fish sellers, with 32 processed food sellers who did not sell grill food as a control. The hematological analysis was performed using the Hematology Analyzers KX300 instrument.

Findings

The results showed that the mean value of hematological parameters in the test group was higher than the control group except for the number of lymphocytes and mixed cell parameters.

Originality/value

The content of harmful compounds contained in fish grill smoke can increase hematological value in the blood of exposed individuals, which has the potential for health problems and disease progression.

Daily ambient temperature is associated with biomarkers of kidney injury in older Americans

BACKGROUND

Increases in ambient temperature have recently been associated with increased emergency department visits and hospital admissions for acute renal failure. However, potential biological mechanisms through which short-term ambient temperature affects kidney function are not known.

METHODS

We used multiple regression models to evaluate the association between 1- and 3-day average, ambient temperature levels and two biomarkers of kidney injury (neutrophil gelatinase-associated lipocalin (NGAL) and adiponectin), among 3377 individuals over 57 years of age enrolled in the National Social Life, Health, and Aging Project. Ambient temperature was estimated on a 6-km grid covering the conterminous United States using ambient temperature measurements obtained from the National Climatic Data Center (NCDC). NGAL and adiponectin levels were measured from whole blood collected for each participant. All health effect models were adjusted for a number of demographics, socioeconomic, health behavior, medical history variables, with non-linear exposure-response relationships examined using natural cubic splines.

RESULTS

The relationship between 1- and 3-day average temperature and both NGAL and adiponectin levels was significant and non-linear, with largely null associations below 10 °C, and positive association for temperatures >10 °C. In fully adjusted, linear multiple regression models restricted to >10 °C, NGAL and adiponectin levels increased by 1.89% (95% CI: 0.77, 3.91) and 2.51% (95% CI: 1.34, 3.69), respectively, for a 1 °C increase in daily average temperature. Additionally, every 1 °C increase in temperature over 10 °C was associated with a 1.83% increased odds of having plasma NGAL levels consistent with acute kidney injury (>150 μg/L).

CONCLUSIONS

In a cohort of older men and women in the United States, our study is the first to observe that short-term ambient temperature exposures were significantly associated with biomarkers of kidney injury. These associations suggest that ambient temperature exposures could be an important risk factor for renal pathology.

Increased Outdoor PM2.5 Concentration Is Associated with Moderate/Severe Anemia in Children Aged 6-59 Months in Lima, Peru

Anemia affects 1.62 billion people worldwide. Although iron deficiency is the main cause of anemia, several other factors may explain its high prevalence. In this study, we sought to analyze the association between outdoor particulate matter PM2.5 levels with anemia prevalence in children aged 6-59 months residing in Lima, Peru (n = 139,368), one of the cities with the worst air pollution in Latin America. The study period was from 2012 to 2016. Anemia was defined according to the World Health Organization (Hb < 11 g/dL). PM2.5 values were estimated by a mathematical model that combined data observed from monitors, with satellite and meteorological data. PM2.5 was analyzed by quintiles. Multiple linear and logistic regressions were used to estimate the associations between hemoglobin concentration (beta) and anemia (odds ratio) with PM2.5, after adjusting by covariates. Prevalence of anemia was 39.6% (95% confidence interval (CI): 39.3-39.9). Mild anemia was observed in 30.8% of children and moderate/severe in 8.84% of children. Anemic children compared with nonanemic children are mainly males, have low body weight, higher rate of stunting, and live in an environment with high PM2.5 concentration. A slight decrease in hemoglobin (4Q B: -0.03, 95% CI: -0.05 to -0.02; 5Q B: -0.04, 95% CI: -0.06 to -0.01) and an increase in the probability of moderate/severe anemia (4Q OR: 1.18, 95% CI: 1.10-1.27; 5Q OR: 1.18, 95% CI: 1.08-1.29) were observed with increased exposure to PM2.5. We conclude that outdoor PM2.5 levels were significantly associated with decreased hemoglobin values and an increase in prevalence of moderate/severe anemia in children under 5 years old.