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Seposo X, Ueda K, Fook Sheng Ng C, Madaniyazi L, Sugata S, Yoshino A, Takami A. Role of oxides of nitrogen in the ozone-cardiorespiratory visit association. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 317:120802. [PMID: 36473642 DOI: 10.1016/j.envpol.2022.120802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Ozone (O3)-induced health effects vary in terms of severity, from deterioration of lung function and hospitalization to death. Several studies have reported a linear increase in health risks after O3 exposure. However, current evidence suggests a non-linear U- and J-shaped concentration-response (C-R) function. The potential increasing risks with decreasing O3 concentrations may seem counterintuitive from the traditional standpoint that decreasing exposure should lead to decreasing health risks. Tus, the question of whether the increasing risks with decreasing concentrations are truly O3-induced or might be from other C-R mechanisms. If these potential risks were not accounted for, this may have contributed to the risks observed at the low ozone concentration range. In this study, we examined the short-term effects of photochemical oxidant (Ox, parts per billiion) on outpatient cardiorespiratory visits in 21 Japanese cities after adjusting for other air pollutant-specific C-R functions. Daily cardiorespiratory visits from January 1, 2014 to December 31, 2016 were obtained from the Japanese Medical Data Center Co. Ltd. Similar period of meteorological and air pollution variables were obtained from relevant data sources. We utilized a time-stratified case crossover design coupled with the generalized additive mixed model (TSCC-GAMM) to estimate the association between Ox and cardiorespiratory outpatient visits, after adjusting for several covariates. A total of 2,588,930 visits were recorded across the study period, with a mean of 111.87 and a standard deviation of 138.75. The results revealed that crude Ox-cardiorespiratory visits exhibited a U-shaped pattern. However, adjustment of the oxides of nitrogen, particularly nitrogen monoxide (NO), attenuated the lower risk curve and subsequently altered the shape of the C-R function, with a substantial reduction observed during winter. NO- and nitrogen dioxide (NO2)-adjusted Ox-cardiorespiratory associations increased nearly linearly, without an apparent threshold. Current evidence suggests the importance of adjusting the oxides of nitrogen in estimating the Ox C-R risk functions.
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Affiliation(s)
- Xerxes Seposo
- School of Tropical Medicine and Global Health, Nagasaki University, Japan; Department of Hygiene, Graduate School of Medicine, Hokkaido University, Japan; Ateneo Center for Research and Innovation, Ateneo School of Medicine and Public Health, Atene de Manila University, Philippines.
| | - Kayo Ueda
- Environmental Health Division, Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan; Environmental Health Sciences, Department of Global Ecology, Graduate School of Global Environmental Sciences, Kyoto University, Japan; Department of Hygiene, Graduate School of Medicine, Hokkaido University, Japan
| | - Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Japan; School of International Health, Graduate School of Medicine, The University of Tokyo, Japan
| | - Lina Madaniyazi
- School of Tropical Medicine and Global Health, Nagasaki University, Japan; Institute of Tropical Medicine, Nagasaki University, Japan
| | - Seiji Sugata
- Regional Environment Conservation Division, National Institute for Environmental Studies, Japan
| | - Ayako Yoshino
- Regional Environment Conservation Division, National Institute for Environmental Studies, Japan
| | - Akinori Takami
- Regional Environment Conservation Division, National Institute for Environmental Studies, Japan
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Qu Y, Zhang W, Boutelle AYM, Ryan I, Deng X, Liu X, Lin S. Associations Between Ambient Extreme Heat Exposure and Emergency Department Visits Related to Kidney Disease. Am J Kidney Dis 2022; 81:507-516.e1. [PMID: 36241010 DOI: 10.1053/j.ajkd.2022.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
RATIONALE & OBJECTIVE Extreme heat exposure is associated with multiple diseases. However, our current understanding of the specific impact of extreme heat exposure on kidney disease is limited. STUDY DESIGN Case-crossover study. SETTING & PARTICIPANTS 1,114,322 emergency department (ED) visits with a principal diagnosis of kidney disease were identified in New York state, 2005-2013. EXPOSURE Extreme heat exposure was defined as when the daily temperature exceeded the 90th percentile temperature of that month during the study period in the county. OUTCOME ED visits with a principal diagnosis of kidney disease and its subtypes (ICD-9 [International Classification of Diseases, Ninth Revision] codes 580-599, 788). ANALYTICAL APPROACH Extreme heat exposure on the ED visit days was compared with extreme heat exposure on control days using a conditional logistic regression model, controlling for humidity, air pollutants, and holidays. The excess risk of kidney disease was calculated for a week (lag days 0-6) after extreme heat exposure during the warm season (May through September). We also stratified our estimates by sociodemographic characteristics. RESULTS Extreme heat exposure was associated with a 1.7% (lag day 0) to 3.1% (lag day 2) higher risk of ED visits related to kidney disease; this association was stronger with a greater number of extreme heat exposure days in the previous week. The association with extreme heat exposure lasted for an entire week and was stronger in the transitional months (ie, May and September; excess rates ranged from 1.8% to 5.1%) rather than the summer months (June through August; excess rates ranged from 1.5% to 2.7%). The strength of association was greater among those with ED visits related to acute kidney injury, kidney stones, and urinary tract infections. Age and sex may modify the association between extreme heat exposure and ED visits. LIMITATIONS Individual exposure to heat-how long people were outside or whether they had access to air conditioning-was unknown. CONCLUSIONS Extreme heat exposure was significantly associated with a dose-dependent greater risk of ED visits for kidney disease.
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Seposo X, Ueda K, Sugata S, Yoshino A, Takami A. Short-term effects of air pollution on daily single- and co-morbidity cardiorespiratory outpatient visits. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 729:138934. [PMID: 32371210 DOI: 10.1016/j.scitotenv.2020.138934] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 04/14/2023]
Abstract
Several studies have noted that the existence of comorbidities lead to an increase in the risk of premature mortality and morbidity. Most of the studies examining the effects of air pollution on comorbidity visits were from Northern American countries, with scarce literature from Asia. This study contributes to existing, yet limited understanding of air pollution-comorbidity by examining the effects of daily air pollutants on outpatient single morbidity and comorbid cardiorespiratory visits in Japan. A total of 1,452,505 outpatient cardiorespiratory visits were recorded among the 21 Japanese cities from 2013 to 2016. Daily outpatient cardiorespiratory visit data were obtained from a health insurance claims database managed by the Japan Medical Data Center Co., Ltd. (JMDC). A time-stratified case crossover analysis coupled with Generalized Additive Mixed Model was used to analyze the association of daily air pollutants (particulate matter 2.5 μm or less in diameter, ozone and nitrogen dioxide) on daily single (respiratory and cardiovascular) and comorbidity health outcomes. We further examined single and cumulative effects for 0-3 and 0-14 lag periods. Ozone, NO2, and PM2.5 were positively associated with cardiorespiratory visits in either shorter or longer lags, with more apparent comorbidity associations with NO2 exposure. A 10-unit increase in NO2, after adjusting for ozone, was associated with a 2.24% (95% CI: 1.34-3.15) and 6.49% (95% CI: 5.00-8.01) increase in comorbidity visit at Lag 0 (of Lag 0-3) and cumulative lag 0-3, respectively. Our results contribute to existing evidence suggesting that short-term and extended exposure to air pollution elicit health risks on cardiovascular, respiratory and comorbid clinic visits. Exposure to NO2, in particular, was associated with increase in the risk of single and comorbidity cardiorespiratory visits. Results can be potentially utilized for both individual health (e.g. risk population health management) and health facility management (e.g. health visit influx determination).
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Affiliation(s)
- Xerxes Seposo
- School of Tropical Medicine and Global Health, Nagasaki University, Japan.
| | - Kayo Ueda
- Environmental Health Division, Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan; Environmental Health Sciences, Department of Global Ecology, Graduate School of Global Environmental Studies, Kyoto University, Japan
| | - Seiji Sugata
- Center for Regional Environmental Research, National Institute for Environmental Studies, Japan
| | - Ayako Yoshino
- Center for Regional Environmental Research, National Institute for Environmental Studies, Japan
| | - Akinori Takami
- Center for Regional Environmental Research, National Institute for Environmental Studies, Japan
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Zhang W, Lin S, Hopke PK, Thurston SW, van Wijngaarden E, Croft D, Squizzato S, Masiol M, Rich DQ. Triggering of cardiovascular hospital admissions by fine particle concentrations in New York state: Before, during, and after implementation of multiple environmental policies and a recession. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 242:1404-1416. [PMID: 30142556 DOI: 10.1016/j.envpol.2018.08.030] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 05/25/2023]
Abstract
BACKGROUND Previous studies reported triggering of acute cardiovascular events by short-term increasedPM2.5 concentrations. From 2007 to 2013, national and New York state air quality policies and economic influences resulted in reduced concentrations of PM2.5 and other pollutants across the state. We estimated the rate of cardiovascular hospital admissions associated with increased PM2.5 concentrations in the previous 1-7 days, and evaluated whether they differed before (2005-2007), during (2008-2013), and after these concentration changes (2014-2016). METHODS Using the Statewide Planning and Research Cooperative System (SPARCS) database, we retained all hospital admissions with a primary diagnosis of nine cardiovascular disease (CVD) subtypes, for residents living within 15 miles of PM2.5 monitoring sites in Buffalo, Rochester, Albany, Queens, Bronx, and Manhattan from 2005 to 2016 (N = 1,922,918). We used a case-crossover design and conditional logistic regression to estimate the admission rate for total CVD, and nine specific subtypes, associated with increased PM2.5 concentrations. RESULTS Interquartile range (IQR) increases in PM2.5 on the same and previous 6 days were associated with 0.6%-1.2% increases in CVD admission rate (2005-2016). There were similar patterns for cardiac arrhythmia, ischemic stroke, congestive heart failure, ischemic heart disease (IHD), and myocardial infarction (MI). Ambient PM2.5 concentrations and annual total CVD admission rates decreased across the period. However, the excess rate of IHD admissions associated with each IQR increase in PM2.5 in previous 2 days was larger in the after period (2.8%; 95%CI = 1.5%-4.0%) than in the during (0.6%; 95%CI = 0.0%-1.2%) or before periods (0.8%; 95%CI = 0.2%-1.3%), with similar patterns for total CVD and MI, but not other subtypes. CONCLUSIONS While pollutant concentrations and CVD admission rates decreased after emission changes, the same PM2.5 mass was associated with a higher rate of ischemic heart disease events. Future work should confirm these findings in another population, and investigate whether specific PM components and/or sources trigger IHD events.
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Affiliation(s)
- Wangjian Zhang
- Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany, NY, USA
| | - Shao Lin
- Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany, NY, USA
| | - Philip K Hopke
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA; Center for Air Resources Engineering and Science, Clarkson University, Potsdam, NY, USA
| | - Sally W Thurston
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA; Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA; Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Daniel Croft
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Stefania Squizzato
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Mauro Masiol
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - David Q Rich
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA; Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA; Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
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O’ Lenick CR, Chang HH, Kramer MR, Winquist A, Mulholland JA, Friberg MD, Sarnat SE. Ozone and childhood respiratory disease in three US cities: evaluation of effect measure modification by neighborhood socioeconomic status using a Bayesian hierarchical approach. Environ Health 2017; 16:36. [PMID: 28381221 PMCID: PMC5382444 DOI: 10.1186/s12940-017-0244-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 03/24/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Ground-level ozone is a potent airway irritant and a determinant of respiratory morbidity. Susceptibility to the health effects of ambient ozone may be influenced by both intrinsic and extrinsic factors, such as neighborhood socioeconomic status (SES). Questions remain regarding the manner and extent that factors such as SES influence ozone-related health effects, particularly across different study areas. METHODS Using a 2-stage modeling approach we evaluated neighborhood SES as a modifier of ozone-related pediatric respiratory morbidity in Atlanta, Dallas, & St. Louis. We acquired multi-year data on emergency department (ED) visits among 5-18 year olds with a primary diagnosis of respiratory disease in each city. Daily concentrations of 8-h maximum ambient ozone were estimated for all ZIP Code Tabulation Areas (ZCTA) in each city by fusing observed concentration data from available network monitors with simulations from an emissions-based chemical transport model. In the first stage, we used conditional logistic regression to estimate ZCTA-specific odds ratios (OR) between ozone and respiratory ED visits, controlling for temporal trends and meteorology. In the second stage, we combined ZCTA-level estimates in a Bayesian hierarchical model to assess overall associations and effect modification by neighborhood SES considering categorical and continuous SES indicators (e.g., ZCTA-specific levels of poverty). We estimated ORs and 95% posterior intervals (PI) for a 25 ppb increase in ozone. RESULTS The hierarchical model combined effect estimates from 179 ZCTAs in Atlanta, 205 ZCTAs in Dallas, and 151 ZCTAs in St. Louis. The strongest overall association of ozone and pediatric respiratory disease was in Atlanta (OR = 1.08, 95% PI: 1.06, 1.11), followed by Dallas (OR = 1.04, 95% PI: 1.01, 1.07) and St. Louis (OR = 1.03, 95% PI: 0.99, 1.07). Patterns of association across levels of neighborhood SES in each city suggested stronger ORs in low compared to high SES areas, with some evidence of non-linear effect modification. CONCLUSIONS Results suggest that ozone is associated with pediatric respiratory morbidity in multiple US cities; neighborhood SES may modify this association in a non-linear manner. In each city, children living in low SES environments appear to be especially vulnerable given positive ORs and high underlying rates of respiratory morbidity.
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Affiliation(s)
- Cassandra R. O’ Lenick
- Department of Environmental Health, Rollins School of Public Health, Emory University, Second Floor, Claudia Nance Rollins Building, Rm. 2030 B, 1518 Clifton Road NE, Atlanta, GA 30322 USA
| | - Howard H. Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Michael R. Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Andrea Winquist
- Department of Environmental Health, Rollins School of Public Health, Emory University, Second Floor, Claudia Nance Rollins Building, Rm. 2030 B, 1518 Clifton Road NE, Atlanta, GA 30322 USA
| | - James A. Mulholland
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA USA
| | - Mariel D. Friberg
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA USA
| | - Stefanie Ebelt Sarnat
- Department of Environmental Health, Rollins School of Public Health, Emory University, Second Floor, Claudia Nance Rollins Building, Rm. 2030 B, 1518 Clifton Road NE, Atlanta, GA 30322 USA
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O'Lenick CR, Winquist A, Mulholland JA, Friberg MD, Chang HH, Kramer MR, Darrow LA, Sarnat SE. Assessment of neighbourhood-level socioeconomic status as a modifier of air pollution-asthma associations among children in Atlanta. J Epidemiol Community Health 2016; 71:129-136. [PMID: 27422981 DOI: 10.1136/jech-2015-206530] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 02/15/2016] [Accepted: 06/29/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND A broad literature base provides evidence of association between air pollution and paediatric asthma. Socioeconomic status (SES) may modify these associations; however, previous studies have found inconsistent evidence regarding the role of SES. METHODS Effect modification of air pollution-paediatric asthma morbidity by multiple indicators of neighbourhood SES was examined in Atlanta, Georgia. Emergency department (ED) visit data were obtained for 5-18 years old with a diagnosis of asthma in 20-county Atlanta during 2002-2008. Daily ZIP Code Tabulation Area (ZCTA)-level concentrations of ozone, nitrogen dioxide, fine particulate matter and elemental carbon were estimated using ambient monitoring data and emissions-based chemical transport model simulations. Pollutant-asthma associations were estimated using a case-crossover approach, controlling for temporal trends and meteorology. Effect modification by ZCTA-level (neighbourhood) SES was examined via stratification. RESULTS We observed stronger air pollution-paediatric asthma associations in 'deprivation areas' (eg, ≥20% of the ZCTA population living in poverty) compared with 'non-deprivation areas'. When stratifying analyses by quartiles of neighbourhood SES, ORs indicated stronger associations in the highest and lowest SES quartiles and weaker associations among the middle quartiles. CONCLUSIONS Our results suggest that neighbourhood-level SES is a factor contributing vulnerability to air pollution-related paediatric asthma morbidity in Atlanta. Children living in low SES environments appear to be especially vulnerable given positive ORs and high underlying asthma ED rates. Inconsistent findings of effect modification among previous studies may be partially explained by choice of SES stratification criteria, and the use of multiplicative models combined with differing baseline risk across SES populations.
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Affiliation(s)
- Cassandra R O'Lenick
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Andrea Winquist
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - James A Mulholland
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Mariel D Friberg
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lyndsey A Darrow
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Stefanie Ebelt Sarnat
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Modification of the effect of ambient air pollution on pediatric asthma emergency visits: susceptible subpopulations. Epidemiology 2015; 25:843-50. [PMID: 25192402 DOI: 10.1097/ede.0000000000000170] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children may have differing susceptibility to ambient air pollution concentrations depending on various background characteristics of the children. METHODS Using emergency department (ED) data linked with birth records from Atlanta, Georgia, we identified ED visits for asthma or wheeze among children 2 to 16 years of age from 1 January 2002 through 30 June 2010 (n = 109,758). We stratified by preterm delivery, term low birth weight, maternal race, Medicaid status, maternal education, maternal smoking, delivery method, and history of a bronchiolitis ED visit. Population-weighted daily average concentrations were calculated for 1-hour maximum carbon monoxide and nitrogen dioxide; 8-hour maximum ozone; and 24-hour average particulate matter less than 10 microns in diameter, particulate matter less than 2.5 microns in diameter (PM2.5), and the PM2.5 components sulfate, nitrate, ammonium, elemental carbon, and organic carbon, using measurements from stationary monitors. Poisson time-series models were used to estimate rate ratios for associations between 3-day moving average pollutant concentrations and daily ED visit counts and to investigate effect-measure modification by the stratification factors. RESULTS Associations between pollutant concentrations and asthma exacerbations were larger among children born preterm and among children born to African American mothers. Stratification by race and preterm status together suggested that both factors affected susceptibility. The largest estimated effect size (for an interquartile range increase in pollution) was observed for ozone among preterm births to African American mothers: rate ratio = 1.138 (95% confidence interval = 1.077-1.203). In contrast, the rate ratio for the ozone association among full-term births to mothers of other races was 1.025 (0.970-1.083). CONCLUSIONS Results support the hypothesis that children vary in their susceptibility to ambient air pollutants.
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Jones RR, Hogrefe C, Fitzgerald EF, Hwang SA, Özkaynak H, Garcia VC, Lin S. Respiratory hospitalizations in association with fine PM and its components in New York State. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2015; 65:559-569. [PMID: 25947314 DOI: 10.1080/10962247.2014.1001500] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Despite observed geographic and temporal variation in particulate matter (PM)-related health morbidities, only a small number of epidemiologic studies have evaluated the relation between PM2.5 chemical constituents and respiratory disease. Most assessments are limited by inadequate spatial and temporal resolution of ambient PM measurements and/or by their approaches to examine the role of specific PM components on health outcomes. In a case-crossover analysis using daily average ambient PM2.5 total mass and species estimates derived from the Community Multiscale Air Quality (CMAQ) model and available observations, we examined the association between the chemical components of PM (including elemental and organic carbon, sulfate, nitrate, ammonium, and other remaining) and respiratory hospitalizations in New York State. We evaluated relationships between levels (low, medium, high) of PM constituent mass fractions, and assessed modification of the PM2.5-hospitalization association via models stratified by mass fractions of both primary and secondary PM components. In our results, average daily PM2.5 concentrations in New York State were generally lower than the 24-hr average National Ambient Air Quality Standard (NAAQS). Year-round analyses showed statistically significant positive associations between respiratory hospitalizations and PM2.5 total mass, sulfate, nitrate, and ammonium concentrations at multiple exposure lags (0.5-2.0% per interquartile range [IQR] increase). Primarily in the summer months, the greatest associations with respiratory hospitalizations were observed per IQR increase in the secondary species sulfate and ammonium concentrations at lags of 1-4 days (1.0-2.0%). Although there were subtle differences in associations observed between mass fraction tertiles, there was no strong evidence to support modification of the PM2.5-respiratory disease association by a particular constituent. We conclude that ambient concentrations of PM2.5 and secondary aerosols including sulfate, ammonium, and nitrate were positively associated with respiratory hospitalizations, although patterns varied by season. Exposure to specific fine PM constituents is a plausible risk factor for respiratory hospitalization in New York State. IMPLICATIONS The association between ambient concentrations of PM2.5 components has been evaluated in only a small number of epidemiologic studies with refined spatial and temporal scale data. In New York State, fine PM and several of its constituents, including sulfate, ammonium, and nitrate, were positively associated with respiratory hospitalizations. Results suggest that PM species relationships and their influence on respiratory endpoints are complex and season dependent. Additional work is needed to better understand the relative toxicity of PM species, and to further explore the role of co-pollutant relationships and exposure prediction error on observed PM-respiratory disease associations.
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Affiliation(s)
- Rena R Jones
- a New York State Department of Health , Center for Environmental Health , Albany , NY , USA
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Kearney GD, Namulanda G, Qualters JR, Talbott EO. A decade of environmental public health tracking (2002-2012): progress and challenges. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 21 Suppl 2:S23-35. [PMID: 25621442 PMCID: PMC5667361 DOI: 10.1097/phh.0000000000000181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The creation of the Centers for Disease Control and Prevention Environmental Public Health Tracking Program spawned an invigorating and challenging approach toward implementing the nation's first population-based, environmental disease tracking surveillance system. More than 10 years have passed since its creation and an abundance of peer-reviewed articles have been published spanning a broad variety of public health topics related primarily to the goal of reducing diseases of environmental origin. OBJECTIVE To evaluate peer-reviewed literature related to Environmental Public Health Tracking during 2002-2012, recognize major milestones and challenges, and offer recommendations. DESIGN A narrative overview was conducted using titles and abstracts of peer-reviewed articles, key word searches, and science-based search engine databases. MAIN OUTCOMES Eighty published articles related to "health tracking" were identified and categorized according to 4 crossed-central themes. The Science and Research theme accounted for the majority of published articles, followed by Policy and Practice, Collaborations Among Health and Environmental Programs, and Network Development. CONCLUSIONS Overall, progress was reported in the areas of data linkage, data sharing, surveillance methods, and network development. Ongoing challenges included formulating better ways to establish the connections between health and the environment, such as using biomonitoring, public water systems, and private well water data. Recommendations for future efforts include use of data to inform policy and practice and use of electronic health records data for environmental health surveillance.
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Affiliation(s)
- Gregory D Kearney
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville North Carolina (Dr Kearney); Division of Environmental Hazards & Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Namulanda and Dr Qualters); and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Talbott)
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Franck U, Leitte AM, Suppan P. Multifactorial airborne exposures and respiratory hospital admissions--the example of Santiago de Chile. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 502:114-21. [PMID: 25244038 DOI: 10.1016/j.scitotenv.2014.08.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/18/2014] [Accepted: 08/25/2014] [Indexed: 05/05/2023]
Abstract
UNLABELLED Our results provide evidence for respiratory effects of combined exposure to airborne pollutants in Santiago de Chile. Different pollutants account for varying adverse effects. Ozone was not found to be significantly associated with respiratory morbidity. BACKGROUND High concentrations of various air pollutants have been associated with hospitalization due to development and exacerbation of respiratory diseases. The findings of different studies vary in effect strength and are sometimes inconsistent. OBJECTIVES We aimed to assess associations between airborne exposures by particulate matter as well as gaseous air pollutants and hospital admissions due to respiratory disease groups under the special orographic and meteorological conditions of Santiago de Chile. METHODS The study was performed in the metropolitan area of Santiago de Chile during 2004-2007. We applied a time-stratified case-crossover analysis taking temporal variation, meteorological conditions and autocorrelation into account. We computed associations between daily ambient concentrations of carbon monoxide (CO), nitrogen dioxide (NO2), particulate matter (PM10 and PM2.5 - particulate matter with aerodynamic diameters less than 10 or 2.5 μm, respectively) or ozone (O3) and hospital admissions for respiratory illnesses. RESULTS We found for CO, NO2, PM10 and PM2.5 adverse relationships to respiratory admissions while effect strength and lag depended on the pollutant and on the disease group. By trend, in 1-pollutant models most adverse pollutants were CO and PM10 followed by PM2.5, while in 2-pollutant models effects of NO2 persisted in most cases whereas other effects weakened and significant effects remain for PM2.5, only. In addition the strongest effects seemed to be immediate or with a delay of up to one day, but effects were found until day 7, too. Adverse effects of ozone could not be detected. CONCLUSIONS Taking case numbers and effect strength of all cardiovascular diseases into account, mitigation measures should address all pollutants especially CO, NO2, and PM10.
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Affiliation(s)
- Ulrich Franck
- Core Facility Studies, Helmholtz Centre for Environmental Research - UFZ, Leipzig, Germany.
| | - Arne Marian Leitte
- Core Facility Studies, Helmholtz Centre for Environmental Research - UFZ, Leipzig, Germany.
| | - Peter Suppan
- Institute of Meteorology and Climate Research (IMK-IFU), Karlsruhe Institute of Technology (KIT), Garmisch-Partenkirchen, Germany.
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Jones RR, Özkaynak H, Nayak SG, Garcia V, Hwang SA, Lin S. Associations between summertime ambient pollutants and respiratory morbidity in New York City: comparison of results using ambient concentrations versus predicted exposures. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2013; 23:616-26. [PMID: 23982122 DOI: 10.1038/jes.2013.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 05/24/2013] [Accepted: 06/11/2013] [Indexed: 05/04/2023]
Abstract
Epidemiological analyses of air quality often estimate human exposure from ambient monitoring data, potentially leading to exposure misclassification and subsequent bias in estimated health risks. To investigate this, we conducted a case-crossover study of summertime ambient ozone and fine particulate matter (PM(2.5)) levels and daily respiratory hospitalizations in New York City during 2001-2005. Comparisons were made between associations estimated using two pollutant exposure metrics: observed concentrations and predicted exposures from the EPA's Stochastic Human Exposure and Dose Simulation (SHEDS) model. Small, positive associations between interquartile range mean ozone concentrations and hospitalizations were observed and were strongest for 0-day lags (hazard ratio (HR)=1.013, 95% confidence interval (CI): 0.998, 1.029) and 3-day lags (HR=1.006, 95% CI: 0.991, 1.021); applying mean predicted ozone exposures yielded similar results. PM(2.5) was also associated with admissions, strongest at 2- and 4-day lags, with few differences between exposure metrics. Subgroup analyses support recognized sociodemographic differences in concentration-related hospitalization risk, whereas few inter-stratum variations were observed in relation to SHEDS exposures. Predicted exposures for these spatially homogenous pollutants were similar across sociodemographic strata, therefore SHEDS predictions coupled with the case-crossover design may have masked observable heterogeneity in risks. However, significant effect modification was found for subjects in the top exposure-to-concentration ratio tertiles, suggesting risks may increase as a consequence of infiltration or greater exposure to outdoor air.
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Affiliation(s)
- Rena R Jones
- 1] New York State Department of Health, Center for Environmental Health, Empire State Plaza, Albany, New York, USA [2] Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, SUNY, Rensselaer, New York, USA
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Lin YK, Chang SC, Lin C, Chen YC, Wang YC. Comparing ozone metrics on associations with outpatient visits for respiratory diseases in Taipei Metropolitan area. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2013; 177:177-84. [PMID: 23333210 PMCID: PMC7127381 DOI: 10.1016/j.envpol.2012.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 12/09/2012] [Accepted: 12/14/2012] [Indexed: 05/05/2023]
Abstract
This study reported cumulative 6-day (lag 0-5 days) relative risks (RR) and confidence intervals (CI) of daily outpatient visits for total respiratory disease (RD), asthma, and chronic airway obstruction not otherwise classified (CAO) associated with three ozone metrics (daily 1-h maximum (O3, 1 h max), 8-h average maximum (O3, 8 h max), 24-h average (O3, 24 h avg)), and an alternative oxidant indicator (Ox) in Taipei Metropolitan, using distributed lag non-linear models after controlling for potential confounders. The Ox showed the strongest association with outpatient visits for total RD (RR = 1.10, 95% CI: 1.10, 1.11) and asthma (RR = 1.18, 95% CI: 1.00, 1.39) in the cold season. The O3, 24 h avg appeared to be the optimal ozone metric associating with total RD than O3, 1 h max and O3, 8 h max based on model selection. In conclusion, outpatient visits for total RD associated with ozone vary with ozone metrics, disease and season.
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Affiliation(s)
- Yu-Kai Lin
- Institute of Environmental Health, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei 10055, Taiwan
- Harvard School of Public Health, Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology Program, 677 Huntington Ave, Boston, MA 02115, USA
| | - Shuenn-Chin Chang
- Taiwan Environmental Protection Administration, 83, Sec. 1, Jhonghua Road, Taipei City 10042, Taiwan
- School of Public Health, National Defense Medical Center, 161, Sec. 6, Min-Chuan East Road, Taipei 114, Taiwan
| | - ChitSan Lin
- Department of Marine Environmental Engineering, National Kaohsiung Marine University, 142 Haijhuan Road, Nanzih District, Kaohsiung City 811, Taiwan
| | - Yi-Chun Chen
- Department of Health Management, I-Shou University, Kaohsiung 824, Taiwan
| | - Yu-Chun Wang
- Department of Bioenvironmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Chung Li 320, Taiwan
- Corresponding author.
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Lin YK, Chang CK, Chang SC, Chen PS, Lin C, Wang YC. Temperature, nitrogen dioxide, circulating respiratory viruses and acute upper respiratory infections among children in Taipei, Taiwan: a population-based study. ENVIRONMENTAL RESEARCH 2013; 120:109-18. [PMID: 23040210 PMCID: PMC7127042 DOI: 10.1016/j.envres.2012.09.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 08/30/2012] [Accepted: 09/11/2012] [Indexed: 05/22/2023]
Abstract
OBJECTIVE This study investigated whether outpatient visits of acute upper respiratory infections for children aged less than 15 years are associated with temperature, air pollutants and circulating respiratory viruses in Taipei, Taiwan, from 2003 to 2007. METHODS Outpatient records for acute upper respiratory infections (ICD9 CM codes: 460, 462, 463,464, 465.9 and 487) in a randomly selected sample (n=39,766 children in 2005) was used to estimate the cumulative relative risks (RR) associated with average temperature lasting for 8 days (lag 0-7 days), air pollutants (NO2, O3 and PM(2.5)) lasting for 6 days (lag 0-5 days), and virus-specific positive isolation rate lasting for 11 days (lag 0-10 days) using distributed lag non-linear models after controlling for relative humidity, wind speed, day of week, holiday effects and long-term trend. RESULTS Average temperature of 33 °C was associated with the lowest risk for outpatient visits of acute upper respiratory infections. Relative to 33 °C, cumulative 8-day RR was highest at 15 °C of ambient average temperature [RR=1.94; 95% confidence interval (CI): 1.78, 2.11]. With the first quartile as reference, cumulative 6-day RRs were 1.25 (95% CI: 1.21, 1.29) for NO2, 1.04 (95% CI: 1.01, 1.06) for O3, and 1.00 (95% CI: 0.98, 1.03) for PM(2.5) at the 95th percentile. Per-standard deviation (SD) increase of virus-specific isolation rate for influenza type A (SD=13.2%), type B (SD=8.76%), and adenoviruses (SD=5.25%) revealed statistical significance for overall 11-day RRs of 1.02 (95% CI: 1.01, 1.03), 1.05 (95% CI: 1.03, 1.06) and 1.04 (95% CI: 1.03, 1.05), respectively. CONCLUSIONS Current study suggested a positive association between outpatient visits for acute upper respiratory infections and ambient environment factors, including average temperature, air pollutants, and circulating respiratory viruses.
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Affiliation(s)
- Yu-Kai Lin
- Institute of Environmental Health, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei 10055, Taiwan
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Chin-Kuo Chang
- Department of Health Service and Population Research, King’s College London, Denmark Hill, London SE5 8AF, UK
| | - Shuenn-Chin Chang
- School of Public Health, National Defense Medical Center, 161 Sec. 6, Min-Chuan East Road, Taipei 114, Taiwan
- Taiwan Environmental Protection Administration, 83 Sec. 1, Jhonghua Road, Taipei City 10042, Taiwan
| | - Pei-Shih Chen
- Institute and Department of Public Health, College of Health Science, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan
| | - Chitsan Lin
- Department of Marine Environmental Engineering, College of Ocean Engineering, National Kaohsiung Marine University, 142 Haijhuan Road, Nanzih District, Kaohsiung City 811, Taiwan
| | - Yu-Chun Wang
- Department of Bioenvironmental Engineering, College of Ocean Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Chung Li 320, Taiwan
- Corresponding author at: Department of Bioenvironmental Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Chung Li 320, Taiwan. Fax: +886 3 265 4949.
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Lin S, Jones R, Pantea C, Özkaynak H, Rao ST, Hwang SA, Garcia VC. Impact of NO(x) emissions reduction policy on hospitalizations for respiratory disease in New York State. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2013; 23:73-80. [PMID: 22829050 DOI: 10.1038/jes.2012.69] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 05/24/2012] [Indexed: 05/25/2023]
Abstract
To date, only a limited number of studies have examined the impact of ambient pollutant policy on respiratory morbidities. This accountability study examined the effect of a regional pollution control policy, namely, the US Environmental Protection Agency's (EPA) nitrogen oxides (NO(x)) Budget Trading Program (NBP), on respiratory health in New York State (NYS). Time-series analysis using generalized additive models was applied to assess changes in daily hospitalizations for respiratory diseases in NYS after the implementation of the NBP policy. Respiratory end points in the summers during the baseline period (1997-2000) were compared with those during the post-intervention period (2004-2006). Stratified analyses were also conducted to examine whether health impacts of the NBP differed by socio-demographic, regional, or clinical characteristics. Following the implementation of EPA's NBP policy, there were significant reductions in mean ozone levels (-2% to -9%) throughout NYS. After adjusting for time-varying variables, PM(2.5) concentration, and meteorological factors, significant post-intervention declines in respiratory admissions were observed in the Central (-10.18, 95% confidence interval (CI): -14.18, -6.01), Lower Hudson (-11.05, 95% CI: -16.54, -5.19), and New York City Metro regions (-5.71, 95% CI: -7.39, -4.00), consistent with wind trajectory patterns. Stratified analyses suggest that admissions for asthma, chronic airway obstruction, among those 5-17 years old, self-payers, Medicaid-covered, and rural residents declined the most post-NBP. This study suggests that the NO(x) control policy may have had a positive impact on both air pollution levels statewide and respiratory health in some NYS regions. However, the effect varied by disease subgroups, region, and socio-demographic characteristics.
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Affiliation(s)
- Shao Lin
- New York State Department of Health, Center for Environmental Health, 547 River Street, Room 200, Troy, New York 12180, USA.
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Perez L, Lurmann F, Wilson J, Pastor M, Brandt SJ, Künzli N, McConnell R. Near-roadway pollution and childhood asthma: implications for developing "win-win" compact urban development and clean vehicle strategies. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:1619-26. [PMID: 23008270 PMCID: PMC3556611 DOI: 10.1289/ehp.1104785] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 09/05/2012] [Indexed: 05/05/2023]
Abstract
BACKGROUND The emerging consensus that exposure to near-roadway traffic-related pollution causes asthma has implications for compact urban development policies designed to reduce driving and greenhouse gases. OBJECTIVES We estimated the current burden of childhood asthma-related disease attributable to near-roadway and regional air pollution in Los Angeles County (LAC) and the potential health impact of regional pollution reduction associated with changes in population along major traffic corridors. METHODS The burden of asthma attributable to the dual effects of near-roadway and regional air pollution was estimated, using nitrogen dioxide and ozone as markers of urban combustion-related and secondary oxidant pollution, respectively. We also estimated the impact of alternative scenarios that assumed a 20% reduction in regional pollution in combination with a 3.6% reduction or 3.6% increase in the proportion of the total population living near major roads, a proxy for near-roadway exposure. RESULTS We estimated that 27,100 cases of childhood asthma (8% of total) in LAC were at least partly attributable to pollution associated with residential location within 75 m of a major road. As a result, a substantial proportion of asthma-related morbidity is a consequence of near-roadway pollution, even if symptoms are triggered by other factors. Benefits resulting from a 20% regional pollution reduction varied markedly depending on the associated change in near-roadway proximity. CONCLUSIONS Our findings suggest that there are large and previously unappreciated public health consequences of air pollution in LAC and probably in other metropolitan areas with dense traffic corridors. To maximize health benefits, compact urban development strategies should be coupled with policies to reduce near-roadway pollution exposure.
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Affiliation(s)
- Laura Perez
- Swiss Tropical and Public Health Institute, Basel, Switzerland
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Hůnová I, Malý M, Řezáčová J, Braniš M. Association between ambient ozone and health outcomes in Prague. Int Arch Occup Environ Health 2012; 86:89-97. [PMID: 22366988 DOI: 10.1007/s00420-012-0751-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 02/10/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Though numerous studies investigating ambient ozone (O(3)) effects on human health were published, such a study for Central Europe is still lacking. We have investigated the association between ozone (O(3)) levels and hospital admissions and mortality due to cardiovascular and respiratory diseases for Prague inhabitants for summer months (April-September) over the 5-year period 2002-2006. Our hypothesis was that ambient O(3) levels in Prague resulted in adverse health outcomes and were associated with increased mortality and hospital admissions. METHODS The effect of O(3) on mortality and hospital admissions was investigated using the negative binomial regression after controlling for the influence of meteorological factors (air temperature and relative humidity) and calendar effects (seasonal patterns, long-term trends and day of week). RESULTS We found a statistically significant association between O(3) levels and daily mortality from respiratory diseases. Relative risk of 1.080 (95% CI: 1.031-1.132) was observed for mortality from respiratory diseases per 10 μg m(-3) increase in 1-day lagged daily mean O(3) concentration. No statistically significant association was detected between O(3) concentrations and daily mortality from all causes, daily mortality from cardiovascular diseases and hospital admissions for respiratory and cardiovascular diseases. The O(3) effects differed in men and women, nevertheless, the results were ambiguous with respect to used lag and O(3) metrics. No significant confounding effects of PM(10) on the investigated association were observed. CONCLUSIONS O(3) exposure in Prague, though lower as compared to many other cities in Europe, is high enough to cause adverse health effects.
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Affiliation(s)
- Iva Hůnová
- Faculty of Science, Institute for Environmental Studies, Charles University in Prague, Prague, Czech Republic,
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Lim YH, Hong YC, Kim H. Effects of diurnal temperature range on cardiovascular and respiratory hospital admissions in Korea. THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 417-418:55-60. [PMID: 22281041 DOI: 10.1016/j.scitotenv.2011.12.048] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 12/19/2011] [Accepted: 12/20/2011] [Indexed: 05/31/2023]
Abstract
The effects of heat and cold waves have been studied as risk factors for cardiovascular and respiratory diseases. However, few studies have examined the effect of diurnal temperature changes on health. We hypothesized that the diurnal temperature range (DTR) may affect the rate of hospital admissions for cardiovascular- and respiratory-related diseases, and therefore investigated the risk of hospital admissions of cardiovascular (stroke, myocardial infarction, ischemic heart disease, cardiac failure, cardiac disease, and arrhythmia) and respiratory (asthma, chronic obstructive pulmonary disease, and pneumonia) diseases attributable to DTR in four metropolitan areas in Korea during 2003-2006. The area-combined effects of DTR on some cardiovascular and respiratory diseases were significantly increased by an increment of DTR. In particular, the effects on cardiac failure and asthma were significant with the percentage change of hospital admissions per 1 °C increment of DTR at 3.0% (95% CI, 1.4-4.6) and 1.1% (95% CI, 0.1-2.0), respectively, among 9 diseases. For those 75 years and older, the DTR effect on asthma admissions was greater than in those aged under 75 years. These results support the hypothesis of a positive association between DTR and cardiovascular and respiratory hospital admission.
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Affiliation(s)
- Youn-Hee Lim
- Department of Epidemiology and Biostatistics, School of Public Health, Seoul National University, Seoul, South Korea
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Jasinski R, Pereira LAA, Braga ALF. Poluição atmosférica e internações hospitalares por doenças respiratórias em crianças e adolescentes em Cubatão, São Paulo, Brasil, entre 1997 e 2004. CAD SAUDE PUBLICA 2011; 27:2242-52. [DOI: 10.1590/s0102-311x2011001100017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 08/29/2011] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo foi avaliar os efeitos dos poluentes atmosféricos e suas estruturas de defasagem sobre a morbidade respiratória de crianças e adolescentes, na cidade de Cubatão, São Paulo, Brasil, entre 1997 e 2004. Um estudo ecológico de séries temporais foi realizado, analisando internações nos hospitais do Sistema Único de Saúde por doenças respiratórias de crianças e adolescentes residentes no município. Foram utilizados modelos lineares generalizados de regressão de Poisson, controlando-se para sazonalidade, temperatura, umidade e tendência de curta duração. PM10 e ozônio estiveram positiva e estatisticamente associados com as internações por doenças respiratórias. No grupo de crianças, aumentos de um interquartil nas médias móveis de sete dias do PM10 (56,5µg/m³) e de cinco dias do ozônio (46,7µg/m³) levaram a aumentos nas internações hospitalares de 9,6% (IC95%: 3,0%-16,1%) e 2,4% (IC95%: 0,1%-4,7%), respectivamente. Esforços para redução das concentrações dos poluentes do ar ainda precisam ser implementados para minimizar os seus efeitos adversos sobre crianças e adolescentes em Cubatão.
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Lin S, Fletcher BA, Luo M, Chinery R, Hwang SA. Health impact in New York City during the Northeastern blackout of 2003. Public Health Rep 2011; 126:384-93. [PMID: 21553667 DOI: 10.1177/003335491112600312] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study assessed the health effects of the 2003 Northeastern blackout, the largest one in history, on mortality and hospital admissions due to respiratory, cardiovascular, and renal diseases in New York City (NYC), and compared the disease patterns and sociodemographic profiles of cases during the blackout with those on control days. METHOD We investigated the effects of the blackout on health using incidence rate ratios to compare the disease on blackout days (August 14 and 15, 2003) with those on normal and comparably hot days (controls). Normal days were defined as summer days (June-August) between the 25th and 75th percentiles of maximum temperature during 1991-2004. Comparably hot days were days with maximum temperatures in the same range as that of the blackout days. We evaluated the interactive effects of demographics and the blackout using a case-only design. RESULTS We found that mortality and respiratory hospital admissions in NYC increased significantly (two- to eightfold) during the blackout, but cardiovascular and renal hospitalizations did not. The most striking increases occurred among elderly, female, and chronic bronchitis admissions. We identified stronger effects during the blackout than on comparably hot days. In contrast to the pattern observed for comparably hot days, higher socioeconomic status groups were more likely to be hospitalized during the blackout. CONCLUSIONS This study suggests that power outages may have important health impacts, even stronger than the effects of heat alone. The findings provide some direction for future emergency planning and public health preparedness.
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Affiliation(s)
- Shao Lin
- New York State Department of Health, Center for Environmental Health, Bureau of Environmental and Occupational Epidemiology, 547 River St., Room 200, Troy, NY 12180-2216, USA.
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Uyen LTM, Lan TTN. RETRACTED: Development of new sensitive diffusive passive samplers for ambient air ozone and ozone concentration in HoChiMinh City. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2011:S0269-7491(11)00229-6. [PMID: 21600682 DOI: 10.1016/j.envpol.2011.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 03/26/2011] [Accepted: 04/15/2011] [Indexed: 05/30/2023]
Abstract
This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Le Thi Minh Uyen
- Department of Chemistry, University of Sciences, Vietnam National University - Ho Chi Minh City, 227 Nguyen van Cu, HoChiMinh, Viet Nam
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Sheffield P, Roy A, Wong K, Trasande L. Fine particulate matter pollution linked to respiratory illness in infants and increased hospital costs. Health Aff (Millwood) 2011; 30:871-8. [PMID: 21543422 DOI: 10.1377/hlthaff.2010.1279] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There has been little research to date on the linkages between air pollution and infectious respiratory illness in children, and the resulting health care costs. In this study we used data on air pollutants and national hospitalizations to study the relationship between fine particulate air pollution and health care charges and costs for the treatment of bronchiolitis, an acute viral infection of the lungs. We found that as the average exposure to fine particulate matter over the lifetime of an infant increased, so did costs for the child's health care. If the United States were to reduce levels of fine particulate matter to 7 percent below the current annual standard, the nation could save $15 million annually in reduced health care costs from hospitalizations of children with bronchiolitis living in urban areas. These findings reinforce the need for ongoing efforts to reduce levels of air pollutants. They should trigger additional investigation to determine if the current standards for fine-particulate matter are sufficiently protective of children's health.
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Ji M, Cohan DS, Bell ML. Meta-analysis of the Association between Short-Term Exposure to Ambient Ozone and Respiratory Hospital Admissions. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2011; 6:024006. [PMID: 21779304 PMCID: PMC3138529 DOI: 10.1088/1748-9326/6/2/024006] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Ozone is associated with health impacts including respiratory outcomes; however, results differ across studies. Meta-analysis is an increasingly important approach to synthesizing evidence across studies. We conducted meta-analysis of short-term ozone exposure and respiratory hospitalizations to evaluate variation across studies and explore some of the challenges in meta-analysis. We identified 136 estimates from 96 studies and investigated how estimates differed by age, ozone metric, season, lag, region, disease category, and hospitalization type. Overall results indicate associations between ozone and various types of respiratory hospitalizations; however, study characteristics affected risk estimates. Estimates were similar, but higher, for the elderly compared to all ages and for previous day exposure compared to same day exposure. Comparison across studies was hindered by variation in definitions of disease categories, as some (e.g., asthma) were identified through ≥3 different sets of ICD codes. Although not all analyses exhibited evidence of publication bias, adjustment for publication bias generally lowered overall estimates. Emergency hospitalizations for total respiratory disease increased 4.47% (95% interval 2.48, 6.50%) per 10ppb 24-hr ozone among the elderly without adjustment for publication bias and 2.97% (1.05, 4.94%) with adjustment. Comparison of multi-city study results and meta-analysis based on single-city studies further suggested publication bias.
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Affiliation(s)
- Meng Ji
- School of Forestry and Environmental Studies, School of Public Health, Yale University, New Haven, CT, U.S.A
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Azevedo JM, Gonçalves FLT, de Fátima Andrade M. Long-range ozone transport and its impact on respiratory and cardiovascular health in the north of Portugal. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2011; 55:187-202. [PMID: 20593201 DOI: 10.1007/s00484-010-0324-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 12/04/2009] [Accepted: 04/26/2010] [Indexed: 05/29/2023]
Abstract
Ozone dynamics depend on meteorological characteristics such as wind, radiation, sunshine, air temperature and precipitation. The aim of this study was to determine ozone trajectories along the northern coast of Portugal during the summer months of 2005, when there was a spate of forest fires in the region, evaluating their impact on respiratory and cardiovascular health in the greater metropolitan area of Porto. We investigated the following diseases, as coded in the ninth revision of the International Classification of Diseases: hypertensive disease (codes 401-405); ischemic heart disease (codes 410-414); other cardiac diseases, including heart failure (codes 426-428); chronic obstructive pulmonary disease and allied conditions, including bronchitis and asthma (codes 490-496); and pneumoconiosis and other lung diseases due to external agents (codes 500-507). We evaluated ozone data from air quality monitoring stations in the study area, together with data collected through HYbrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model analysis of air mass circulation and synoptic-scale zonal wind from National Centers for Environmental Prediction data. High ozone levels in rural areas were attributed to the dispersion of pollutants induced by local circulation, as well as by mesoscale and synoptic scale processes. The fires of 2005 increased the levels of pollutants resulting from the direct emission of gases and particles into the atmosphere, especially when there were incoming frontal systems. For the meteorological case studies analyzed, peaks in ozone concentration were positively associated with higher rates of hospital admissions for cardiovascular diseases, although there were no significant associations between ozone peaks and admissions for respiratory diseases.
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Affiliation(s)
- Jezabel M Azevedo
- Department of Atmospheric Sciences, Institute of Astronomy, Geophysics and Atmospheric Sciences, University of São Paulo, Sala 301, Butantã, Rua do Matão 1226, Cidade Universitária, 05508-900, São Paulo, SP, Brazil.
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Giovannini M, Sala M, Riva E, Radaelli G. Hospital admissions for respiratory conditions in children and outdoor air pollution in Southwest Milan, Italy. Acta Paediatr 2010; 99:1180-5. [PMID: 20219045 DOI: 10.1111/j.1651-2227.2010.01786.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To evaluate whether a relationship exists in hospital admissions for respiratory conditions in children with outdoor pollution in the Southwest Milan, Italy. METHODS Daily count of hospital admissions for asthma, upper or lower respiratory diseases (LRD) occurred among children aged < or =14 years at the San Paolo Hospital during 2007-2008 was recorded. Pollutants included the particular matter of <10 microm diameter, ozone, carbon monoxide (CO) and nitrogen dioxide (NO(2)), reported on the same day of admission and 1 up to 5 days before admission. The moving weekly average (MWA) was also considered. RESULTS Total respiratory admissions were associated with the same day level of CO (30.6% increase per 1 mg/m(3) increase, 95% confidence interval, 3.9-69.9%) and with the MWA of NO(2) (9.0% increase per 10 microg/m(3) increase, 1.2-16.8%). The effect of CO was stronger on upper respiratory diseases (URD) (lag 0, 21.3% increase, 6.4-38.3%). The effect of NO(2) was stronger on LRD (MWA, 5.3% increase, 0.9-10.2%). Multipollutant models confirmed the role of CO on URD and that of NO(2) on LRD. CONCLUSION Carbon monoxide and nitrogen dioxide may be associated with emergency hospital admissions for respiratory conditions among children in Southwest Milan.
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Affiliation(s)
- M Giovannini
- Department of Pediatrics, University of Milan, San Paolo Hospital, Milan, Italy
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Affiliation(s)
- Qinghua Sun
- Division of Environmental Health Sciences, College of Public Health, Division of Cardiovascular Medicine, Ohio State University, Columbus, USA.
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Chen L, Bell EM, Caton AR, Druschel CM, Lin S. Residential mobility during pregnancy and the potential for ambient air pollution exposure misclassification. ENVIRONMENTAL RESEARCH 2010; 110:162-8. [PMID: 19963212 DOI: 10.1016/j.envres.2009.11.001] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 10/19/2009] [Accepted: 11/04/2009] [Indexed: 05/21/2023]
Abstract
Studies of environmental exposures and adverse birth outcomes often rely on maternal address at birth obtained from the birth certificate to classify exposure. Although the gestational age of interest is often early pregnancy, maternal addresses are not available for women who move during pregnancy when using maternal addresses abstracted from birth certificates. The aim of this study was to explore the extent of ambient air pollutant exposure misclassification due to maternal residential mobility during pregnancy among the subgroup of a New York birth cohort. The authors obtained the maternal addresses at birth from the New York Birth Certificate, and the maternal addresses by gestational age from the National Birth Defect Prevention Study for New York participants for the study period 1997-2002. Among the 1324 mothers, 172 (13.0%) moved once during pregnancy and 46 (3.5%) moved at least twice. When accounting for multiple addresses among some individuals, of the 218 mothers who moved, 38 (2.9%) moved in the 3rd to 8th weeks after conception (critical period, not exclusive from the 1st trimester), 80 (6.0%) moved in the 1st trimester, 112 (8.5%) in the 2nd trimester, and 51 (3.9%) in the 3rd trimester. Air monitoring data from the New York Department of Environmental Conservation were used as surrogates to compute the ambient ozone and PM(10) exposures for mothers with complete residential data. This study estimates exposure using maternal address at birth obtained from birth certificates, compared to exposure estimates when using maternal addresses by gestational age obtained from maternal interview, the gold standard. Average exposures during pregnancy were similar when using interview based versus birth certificate addresses (0.035 vs. 0.035 ppm for ozone, and 20.11 vs. 20.09 microg/m(3) for PM(10), respectively). Kappa statistics and percent agreement were calculated to measure the degree of agreement for dichotomous exposure measurements (<median vs.>=median) and weighted kappa for quartile exposure measurements by gestational age. All the statistics indicated a high agreement between the two measurements. For mothers who moved, the majority maintained their address in the same exposure region. Given the low mobility during pregnancy and the short distance moved, the exposure assignment did not change substantially when using the more accurate interview based addresses in this study. However, the level of observed agreement may decrease for studies that require smaller geographic zones for exposure assignments or with more mobile study populations.
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Affiliation(s)
- Lei Chen
- University at Albany, School of Public Health, Department of Epidemiology and Biostatistics, State University of New York, One University Place, Rensselaer, NY 12144-3456, USA.
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