Children living near chipboard and wood industries are at an increased risk of hospitalization for respiratory diseases: A prospective study

Residential exposure to air pollution and incidence of leukaemia in the industrial area of Viadana, Northern Italy

BACKGROUND

Exposure to air pollution has been proposed as one of the potential risk factors for leukaemia. Work-related formaldehyde exposure is suspected to cause leukaemia.

METHODS

We conducted a nested register-based case-control study on leukaemia incidence in the Viadana district, an industrial area for particleboard production in Northern Italy. We recruited 115 cases and 496 controls, frequency-matched by age, between 1999 and 2014. We assigned estimated exposures to particulate matter (PM10, PM2.5), nitrogen dioxide (NO2), and formaldehyde at residential addresses, averaged over the susceptibility window 3rd to 10th year prior to the index date. We considered potential confounding by sex, age, nationality, socio-economic status, occupational exposures to benzene and formaldehyde, and prior cancer diagnoses.

RESULTS

There was no association of exposures to PM10, PM2.5, and NO2 with leukaemia incidence. However, an indication of increased risk emerged for formaldehyde, despite wide statistical uncertainty (OR 1.46, 95%CI 0.65-3.25 per IQR-difference of 1.2 μg/m3). Estimated associations for formaldehyde were higher for acute (OR 2.07, 95%CI 0.70-6.12) and myeloid subtypes (OR 1.79, 95%CI 0.64-5.01), and in the 4-km buffer around the industrial facilities (OR 2.78, 95%CI 0.48-16.13), although they remained uncertain.

CONCLUSIONS

This was the first study investigating the link between ambient formaldehyde exposure and leukaemia incidence in the general population. The evidence presented suggests an association, although it remains inconclusive, and a potential significance of emissions related to industrial activities in the district. Further research is warranted in larger populations incorporating data on other potential risk factors.

Residential exposure to air pollution and adverse respiratory and allergic outcomes in children and adolescents living in a chipboard industrial area of Northern Italy

BACKGROUND

Chipboard production is a source of wood dust, formaldehyde, and combustion-related pollutants such as nitrogen dioxide (NO₂) and particulate matter (PM). In this cohort study, we assessed whether exposures to NO₂, formaldehyde, PM₁₀, PM_2.5, and black carbon were associated with adverse respiratory and allergic outcomes among all 7525 people aged 0-21 years residing in the Viadana district, an area in Northern Italy including the largest chipboard industrial park in the country.

METHODS

Data on hospitalizations, emergency room (ER) admissions, and specialist visits in pneumology, allergology, ophthalmology, and otorhinolaryngology were obtained from the Local Health Unit. Residential air pollution concentrations in 2013 (baseline) were derived using local (Viadana II), national (EPISAT), and continental (ELAPSE) exposure models. Associations were estimated using negative binomial regression models for counts of events occurred during 2013-2017, with follow-up time as an offset term and adjustment for sex, age, nationality, and a census-block socio-economic indicator.

RESULTS

Median annual exposures to NO₂, PM₁₀, and PM_2.5 were below the European Union annual air quality standards (40, 40, and 25 μg/m³) but above the World Health Organization 2021 air quality guideline levels (10, 15, and 5 μg/m³). Exposures to NO₂ and PM_2.5 were significantly associated with higher rates of ER pneumology admissions (13 to 30 % higher rates per interquartile range exposure differences, all p < 0.01). Higher rates of allergology and ophthalmology visits were found for participants exposed to higher pollutants' concentrations. When considering the 4-km buffer around the industries, associations with respiratory hospitalizations became significant, and associations with ER pneumology admissions, allergology and ophthalmology visits became stronger. Formaldehyde was not associated with the outcomes considered.

CONCLUSION

Using administrative indicators of health effects a priori attributable to air pollution, we documented the adverse impact of long-term air pollution exposure in residential areas close to the largest chipboard industries in Italy. These findings, combined with evidence from previous studies, call for an action to improve air quality through preventive measures especially targeting emissions related to the industrial activities.

Spatial variability of nitrogen dioxide and formaldehyde and residential exposure of children in the industrial area of Viadana, Northern Italy

Chipboard production is a source of ambient air pollution. We assessed the spatial variability of outdoor pollutants and residential exposure of children living in proximity to the largest chipboard industry in Italy and evaluated the reliability of exposure estimates obtained from a number of available models. We obtained passive sampling data on NO₂ and formaldehyde collected by the Environmental Protection Agency of Lombardy region at 25 sites in the municipality of Viadana during 10 weeks (2017-2018) and compared NO₂ measurements with average weekly concentrations from continuous monitors. We compared interpolated NO₂ and formaldehyde surfaces with previous maps for 2010. We assessed the relationship between residential proximity to the industry and pollutant exposures assigned using these maps, as well as other available countrywide/continental models based on routine data on NO₂, PM₁₀, and PM_2.5. The correlation between NO₂ concentrations from continuous and passive sampling was high (Pearson's r = 0.89), although passive sampling underestimated NO₂ especially during winter. For both 2010 and 2017-2018, we observed higher NO₂ and formaldehyde concentrations in the south of Viadana, with hot-spots in proximity to the industry. PM₁₀ and PM_2.5 exposures were higher for children at < 1 km compared to the children living at > 3.5 km to the industry, whereas NO₂ exposure was higher at 1-1.7 km to the industry. Road and population densities were also higher close to the industry. Findings from a variety of exposure models suggest that children living in proximity to the chipboard industry in Viadana are more exposed to air pollution and that exposure gradients are relatively stable over time.

Respiratory Hospitalizations and Their Relationship with Air Pollution Sources in the Period of FIFA World Cup and Olympic Games in Rio de Janeiro, Brazil

Background: From 2010 onwards, the city of Rio de Janeiro has undergone changes related to the 2014 FIFA World Cup and the 2016 Olympic Games, potentially affecting the respiratory health of inhabitants. Thus, the spatial distribution of respiratory hospitalizations (2008–2017) and the relationship between this outcome and potential air pollution sources in the city of Rio de Janeiro (2013–2017) were evaluated. Methods: An ecological study was performed using the Bayesian model with multivariate Poisson regression for the period of the sporting events (2013–2017). The outcome was the ratio of hospitalizations for respiratory diseases by the population at risk. Data analysis was performed in the total population and by sex and age group. The air pollution-related variables included industrial districts, traffic density, tunnel portals, a seaport, airports, and construction/road work. Results: All explanatory variables, except tunnel portals, were associated with an increase in the outcome. Construction/road work showed a greater magnitude of association than the other pollution-related variables. Airports were associated with an increased hospitalization ratio among the ≥60 year-old group (mean = 2.46, 95% credible intervals = 1.35–4.46). Conclusion: This study allows for a better understanding of the geographical distribution of respiratory problems in the city of Rio de Janeiro. Present results may contribute to improved healthcare planning and raise hypotheses concerning exposure to air pollution and respiratory hospitalizations.

Cooking/Window Opening and Associated Increases of Indoor PM2.5 and NO2 Concentrations of Children’s Houses in Kaohsiung, Taiwan

High concentrations of air pollutants and increased morbidity and mortality rates are found in industrial areas, especially for the susceptible group, children; however, most studies use atmospheric dispersion modeling to estimate household air pollutants. Therefore, the aim of this study was to assess the indoor air quality, e.g., CO, CO2, NO2, SO2, O3, particulate matter with aerodynamic diameter less than 2.5 μm (PM2.5), and their influence factors in children’s homes in an industrial city. Children in the “general school”, “traffic school”, and “industrial school” were randomly and proportionally selected. Air pollutants were sampled for 24 h in the living rooms and on the balcony of their houses and questionnaires of time–microenvironment–activity-diary were recorded. The indoor CO concentration of the traffic area was significantly higher than that of the industrial area and the general area. In regard to the effects of window opening, household NO2 and PM2.5 concentrations during window opening periods were significantly higher than of the reference periods. For the influence of cooking, indoor CO2, NO2, and PM2.5 levels during the cooking periods were significantly higher than that of the reference periods. The indoor air quality of children in industrial cities were affected by residential areas and household activities.

Association of ambient air pollution with lengths of hospital stay for hanoi children with acute lower-respiratory infection, 2007-2016

INTRODUCTION

The association between ambient air pollution and length of hospital stay (LOS) for children with lower-respiratory infection is unclear.

MATERIALS AND METHODS

The association was examined using admission data for 75,432 children in Hanoi, aged 0-5 years, hospitalized with acute lower-respiratory infection (ALRI) and daily air pollutant levels in Hanoi between 2007 and 2016. We estimated the odds ratio of being discharged for an interquartile range (IQR) increment (IQR) of ambient pollutants during one to four days prior to admission date. We used pooled logistic regression models including a B-spline function of calendar time and terms describing the baseline odds, adjusting for meteorological factors, age, gender, residential location, week-day of admission, discharge on weekends or holidays, and number of respiratory hospitalizations one day prior to the discharge date.

RESULTS

An IQR increase in O₃ concentrations (85.8 μg/m³) was associated with a 5% (95%CI: 2%-8%) decrease in the odds of discharge from hospital among children with ALRI. Results were similar for PM₁₀, but only for children aged 2-5 years. For the other pollutants, corresponding associations were close to null or in the opposite direction. For example, increase in CO was associated with shorter LOS.

CONCLUSIONS

Our study provides the first investigation of the associations between lengths of hospital stays and air pollutant levels prior to hospitalization in Asian children. Increased levels of O₃ prior to admission predicted prolonged hospitalizations. The inconsistencies in the findings for other pollutants call for further investigations.

A population-based birth cohort study of the association between childhood-onset asthma and exposure to industrial air pollutant emissions

BACKGROUND

Studies of the association between air pollution and asthma onset have mostly focused on urban and traffic-related air pollution. We investigated the associations between exposure to industrial emissions and childhood-onset asthma in a population-based birth cohort in Quebec, Canada, 2002-2011.

METHODS

The cohort was built from administrative health databases. We developed separately for PM_2.5 and SO₂ different metrics representing children's time-varying residential exposure to industrial emissions: 1) yearly number of tons of air pollutant emitted by industries located within 2.5 km of the residence; 2) distance to the nearest "major emitter" (≥100 tons) of either PM_2.5 and SO₂ within 7.5 km of the residence, and; 3) tons of air pollutant emitted by the nearest "major emitter" within 7.5 km, weighted by the inverse of the distance and the percentage of time that the residence was downwind. To handle the large number of zeros (i.e., children unexposed) we decomposed the exposure variable into two covariates simultaneously included in the regression model: a binary indicator of exposure and a continuous exposure variable centered at the mean value among exposed children. We performed Cox models using age as the time axis, adjusted for gender, material and social deprivation and calendar year. We indirectly adjusted for unmeasured secondhand smoke.

RESULTS

The cohort included 722,667 children and 66,559 incident cases of asthma. Across the different exposure metrics, mean percentage changes in the risk of asthma onset in children exposed to the mean relative to those unexposed ranged from 4.5% (95% CI: 2.8, 6.3%) to 10.6% (95% CI: 6.2, 15.2%) for PM_2.5 and, from 1.1% (95% CI: -0.1, 3.3%) to 8.9% (95% CI: 7.1, 11.1%) for SO₂. Indirect adjustment for secondhand smoke did not substantially affect the associations. In children exposed, the risk of asthma onset increased with the magnitude of the exposure for all metrics, except the distance to the nearest major emitter of SO₂.

CONCLUSIONS

In this population-based birth cohort, residential exposure to industrial air pollutant emissions was associated with childhood-onset asthma. Additional studies with improved models for estimating exposure to industrial point-sources are needed to further support the observed associations.

A new approach to spatial identification of potential health hazards associated with childhood asthma

RESEARCH BACKGROUND

Childhood asthma is a chronic disease, known to be linked to prolonged exposure to air pollution. However, the identification of specific health hazards, associated with childhood asthma is not always straightforward, due to the presence of multiple sources of air pollution in urban areas. In this study, we test a novel approach to the spatial identification of environmental hazards that have the highest probability of association with the observed asthma morbidity patterns.

METHODS

The effect of a particular health hazard on population morbidity is expected to weaken with distance. To account for this effect, we rank potential health hazards based on the strength of association between the observed morbidity patterns and wind-direction weighted proximities to these locations. We validate this approach by applying it to a study of spatial patterns of childhood asthma in the Greater Haifa Metropolitan Area (GHMA) in Israel, characterised by multiple health hazards.

RESULTS

We identified a spot in the local industrial zone as the primary risk source for the observed asthma morbidity patterns. Multivariate regressions, controlling for socio-economic and geographic variables, revealed that the observed incidence rates of asthma tend to decline as a function of distance from the identified industrial location.

CONCLUSION

The proposed identification approach uses disease patterns as its main input, and can be used by researches as a preliminary risk assessment tool, in cases in which specific sources of locally elevated morbidity are unclear or cannot be identified by traditional methods.

A score for measuring health risk perception in environmental surveys

BACKGROUND

In environmental surveys, risk perception may be a source of bias when information on health outcomes is reported using questionnaires. Using the data from a survey carried out in the largest chipboard industrial district in Italy (Viadana, Mantova), we devised a score of health risk perception and described its determinants in an adult population.

METHODS

In 2006, 3697 parents of children were administered a questionnaire that included ratings on 7 environmental issues. Items dimensionality was studied by factor analysis. After testing equidistance across response options by homogeneity analysis, a risk perception score was devised by summing up item ratings.

RESULTS

Factor analysis identified one latent factor, which we interpreted as health risk perception, that explained 65.4% of the variance of five items retained after scaling. The scale (range 0-10, mean ± SD 9.3 ± 1.9) had a good internal consistency (Cronbach's alpha 0.87). Most subjects (80.6%) expressed maximum risk perception (score = 10). Italian mothers showed significantly higher risk perception than foreign fathers. Risk perception was higher for parents of young children, and for older parents with a higher education, than for their counterparts. Actual distance to major roads was not associated with the score, while self-reported intense traffic and frequent air refreshing at home predicted higher risk perception.

CONCLUSIONS

When investigating health effects of environmental hazards using questionnaires, care should be taken to reduce the possibility of awareness bias at the stage of study planning and data analysis. Including appropriate items in study questionnaires can be useful to derive a measure of health risk perception, which can help to identify confounding of association estimates by risk perception.

Outdoor formaldehyde and NO2 exposures and markers of genotoxicity in children living near chipboard industries

BACKGROUND

Industrial air pollution is a public health hazard. Previous evidence documented increased respiratory symptoms and hospitalizations in children who live near the factories in the largest chipboard manufacturing district in Italy (Viadana).

OBJECTIVES

We evaluated the association of outdoor exposure to formaldehyde and nitrogen dioxide (NO2) with markers of early genotoxic damage in oral mucosa cells of randomly selected children (6-12 years of age) living in Viadana.

METHODS

In 2010-2011, DNA strand breaks and nuclear abnormalities were evaluated in exfoliated buccal cells by the comet and micronucleus assays, respectively, and formaldehyde and NO2 were monitored by passive sampling. Annual exposure estimates to pollutants were assigned to children's houses by spatial interpolation.

RESULTS

Of 656 children, 413 (63%) participated. Children living near (< 2 km) the chipboard industries had the highest average exposure to formaldehyde and NO2 (p < 0.001). A 1-SD increase in formaldehyde (0.20 μg/m(3)) was associated with a 0.13% (95% CI: 0.03, 0.22%) higher comet tail intensity, a 0.007 (95% CI: 0.001, 0.012) higher tail moment, and a 12% relative increase [relative risk (RR) = 1.12; 95% CI: 1.02, 1.23] in nuclear buds. A 1-SD NO2 increase (2.13 μg/m(3)) was associated with a 0.13% (95% CI: 0.07, 0.19%) increase in binucleated cells and a 16% relative increase (RR = 1.16; 95% CI: 1.06, 1.26) in nuclear buds.

CONCLUSIONS

Exposure to pollutants was associated with markers of genotoxicity in exfoliated buccal cells of children living in a region with chipboard industries. These findings, combined with previously reported associations between chipboard industrial activities and respiratory outcomes in children, add to concerns about potential adverse effects of industry-related exposures in the Viadana district.