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Yang H, Shi P, Li M, Liu S, Mou B, Xia Y, Sun J. Plasma proteome mediate the impact of PM 2.5 on stroke: A 2-step Mendelian randomization study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 281:116624. [PMID: 38908058 DOI: 10.1016/j.ecoenv.2024.116624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 06/24/2024]
Abstract
The objectives of this study were to measure the mediation effect of plasma proteins and to clarify their mediating role in the relationship between stroke risk and particulate matter 2.5 (PM2.5) exposure. The possible mediating role of plasma proteins on the causative link between PM2.5 exposure and stroke incidence were examined using a two-step Mendelian randomization (MR) approach based on two-sample Mendelian randomization (TSMR). The findings revealed a significant positive causal relationship between PM2.5 exposure and stroke, with an inverse variance weighted odds ratio of 1.219 (95 % CI: 1.002 - 1.482, P < 0.05). Additionally, a positive causal association was identified between PM2.5 exposure and several plasma proteins, including FAM134B, SAP, ITGB7, Elafin, and DCLK3. Among these, FAM134B, ITGB7, Elafin, and DCLK3 also demonstrated a positive causal association with stroke, whereas only SAP was found to be negatively causally associated with stroke. Remarkably, four plasma proteins, namely DCLK3, FAM134B, Elafin, and ITGB7, were identified as mediators, accounting for substantial proportions (14.5 %, 13.6 %, 11.1 %, and 9.9 %) of the causal association between PM2.5 and stroke. These results remained robust across various sensitivity analyses. Consequently, the study highlights the significant and independent impact of PM2.5 on stroke risk and identifies specific plasma proteins as potential targets for preventive interventions against PM2.5-induced stroke.
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Affiliation(s)
- Huajie Yang
- Key Laboratory of Environmental Stress and Chronic Disease Control and Prevention, Ministry of Education, China Medical University, Shenyang 110122, China; Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Peng Shi
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Mingzheng Li
- Key Laboratory of Environmental Stress and Chronic Disease Control and Prevention, Ministry of Education, China Medical University, Shenyang 110122, China; Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Shuailing Liu
- Department of Child and Adolescent Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Baohua Mou
- First Affiliated Hospital of Dalian Medical University, Dalian 116000, China
| | - Yinglan Xia
- Zhejiang Greentown Cardiovascular Hospital, Hangzhou 310000, China
| | - Jiaxing Sun
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, China.
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Lu H, Wang R, Li J, Tong M, Cao M, Liu H, Xiao Q, Zheng Y, Liu Y, Guan T, Xue T. Long-term exposure to the components of fine particulate matters and disability after stroke: Findings from the China National Stroke Screening Surveys. JOURNAL OF HAZARDOUS MATERIALS 2023; 460:132244. [PMID: 37611391 DOI: 10.1016/j.jhazmat.2023.132244] [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: 04/22/2023] [Revised: 07/04/2023] [Accepted: 08/05/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Long-term exposure to ambient fine particulate matter (PM2.5) has been linked to an increased risk of stroke. However, the effect of long-term exposure to PM2.5 and its major components on the functional disability of stroke patients remains unclear. METHODS Based on China National Stroke Screening Survey data obtained from 2013 to 2019, we conducted a national multicenter longitudinal study of the associations of long-term exposure to PM2.5 and its components with the risk of disability after stroke in China. Post-stroke disability was assessed using the modified Rankin scale (mRS), which ranges from 0 to 5, with higher scores indicating greater disability. Long-term exposure to PM2.5 and its five components [sulfate (SO42-), nitrate (NO3-), ammonium salt (NH4+), organic matter (OM), and black carbon (BC)] was determined based on average concentrations during the 3 years preceding mRS administration according to the geographic coordinates of residential communities, using state-of-the-art estimates from multiple sources. We used a fixed-effect model to evaluate the associations between mRS scores and PM2.5 exposure, with adjustment for multiple covariates. RESULTS Every 10 µg/m3 increase in PM2.5 was associated with a 0.019 (95% confidence interval, 0.003, 0.036) increase in mRS score, but the effect was not significant after adjusting for all covariates [0.016 (95% CI, -0.003, 0.032)]. For PM2.5 components, each IQR (7.92 µg/m3) increment in OM exposure was associated significantly with 0.062 (95% CI, 0.013, 0.111) increment in the mRS score. A significant association was observed between SO42- exposure and the mRS score [0.057 (95% CI, 0.003, 0.112), per IQR: 6.28 µg/m3]. However, no significant association was found with BC, NO3-, or NH4+ exposure. Furthermore, the nonlinear curves were observed for the exposure-response relationship between PM2.5 exposure and the mRS score. CONCLUSION Greater PM2.5 exposure increased the mRS score and was associated with post-stroke functional disability among stroke patients. However, different chemical components showed unequal neurotoxic effects, and long-term exposure to OM and SO42- may play a more important role. SYNOPSIS This study reports fine particulate matter at higher concentrations damages the functional ability among specific stroke patients, and PM2.5 components have different neurotoxicities.
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Affiliation(s)
- Hong Lu
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Ruohan Wang
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jiajianghui Li
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Mingkun Tong
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Man Cao
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hengyi Liu
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Qingyang Xiao
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, China
| | - Yixuan Zheng
- Center for Regional Air Quality Simulation and Control, Chinese Academy for Environmental Planning, Beijing 100012, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianjia Guan
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Tao Xue
- Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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3
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Kirby-McGregor M, Chen C, Chen H, Benmarhnia T, Kaufman JS. Inequities in ambient fine particulate matter: A spatiotemporal analysis in Canadian communities. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 858:159766. [PMID: 36309259 DOI: 10.1016/j.scitotenv.2022.159766] [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: 06/23/2022] [Revised: 10/03/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Exposure to fine particulate matter (PM2.5) is associated with adverse health outcomes but communities are not randomly exposed to PM2.5. Previous cross-sectional environmental injustice analyses in Canada found disproportionately higher exposure to PM2.5 in low-income populations, visible minorities and immigrants. Beyond static surveillance, it is also important to evaluate how changes in PM2.5 exposure over time may differentially impact disadvantaged communities. We examine whether communities with different sociodemographic characteristics benefited equitably from the overall decreases in ambient concentrations of PM2.5 from 2001 to 2016 in Canada. METHODS We derived census tract level estimates of average annual PM2.5 using validated satellite-based estimations of annual average PM2.5 concentration surfaces. We investigated how the spatial distribution of PM2.5 has evolved over 15 years (2001-2016) by comparing absolute values and rank percentiles of census tract level annual average PM2.5 concentrations in 2001 and 2016. Using decennial census data and multivariable linear regression, we determined if sociodemographic characteristics are associated with changes in exposure to PM2.5, accounting for geographic boundary changes between census periods. RESULTS Overall, ambient PM2.5 concentrations decreased from 2001 (median of 9.1 μg/m3) to 2016 (median of 6.4 μg/m3), with varying provincial patterns. Across communities, ranked census tract specific PM2.5 in 2001 and in 2016 are highly correlated (Spearman's rho = 0.75). We found that, on average and accounting for provincial differences and baseline PM2.5, communities with greater density of aboriginal population, lower education, higher shelter-cost-to-income ratio, unemployment or lower income experienced smaller absolute decreases in PM2.5 from 2001 to 2016. CONCLUSIONS Identifying sociodemographic groups that benefit least from decreasing exposure to PM2.5 highlights the need to consider environmental injustice when designing or revising air pollution policies.
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Affiliation(s)
- Megan Kirby-McGregor
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Chen Chen
- Scripps Institution of Oceanography, University of California, San Diego, USA.
| | - Hong Chen
- Environmental Health Science and Research Bureau, Health Canada, Canada
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, USA
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
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McCunney RJ, Borm P, Driscoll K, Krueger N, Levy L. Editorial: Particles and Health 2021: An international conference addressing issues in science and regulation. Front Public Health 2022; 10:1062221. [PMID: 36582379 PMCID: PMC9793851 DOI: 10.3389/fpubh.2022.1062221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/20/2022] [Indexed: 12/07/2022] Open
Affiliation(s)
- Robert J. McCunney
- Brigham and Women's Hospital, Pulmonary Division and Harvard Medical School, Boston, MA, United States,*Correspondence: Robert J. McCunney
| | - Paul Borm
- Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Kevin Driscoll
- Rutgers, The State University of New Jersey—Busch Campus, Piscataway, NJ, United States
| | | | - Len Levy
- Cranfield University, Cranfield, United Kingdom
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5
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Dwivedi AK, Vishwakarma D, Dubey P, Reddy SY. Air Pollution and the Heart: Updated Evidence from Meta-analysis Studies. Curr Cardiol Rep 2022; 24:1811-1835. [PMID: 36434404 DOI: 10.1007/s11886-022-01819-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Although environmental exposure such as air pollution is detrimental to cardiovascular disease (CVD), the effects of different air pollutants on different CVD endpoints produced variable findings. We provide updated evidence between air pollutants and CVD outcomes including mitigation strategies with meta-analytic evidence. RECENT FINDINGS An increased exposure to any class of air pollutants including particulate matter (PM), gas, toxic metals, and disruptive chemicals has been associated with CVD events. Exposure to PM < 2.5 μm has been consistently associated with most heart diseases and stroke as well as CVDs among at-risk individuals. Despite this, there is no clinical approach available for systemic evaluation of air pollution exposure and management. A large number of epidemiological evidence clearly suggests the importance of air pollution prevention and control for reducing the risk of CVDs and mortality. Cost-effective and feasible strategies for air pollution monitoring, screening, and necessary interventions are urgently required among at-risk populations and those living or working, or frequently commuting in polluted areas.
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Affiliation(s)
- Alok Kumar Dwivedi
- Division of Biostatistics & Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001, El Paso Drive, El Paso, TX, 79905, USA. .,Biostatistics and Epidemiology Consulting Lab, Office of Research, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
| | - Deepanjali Vishwakarma
- Division of Biostatistics & Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001, El Paso Drive, El Paso, TX, 79905, USA
| | - Pallavi Dubey
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Sireesha Y Reddy
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
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Gao L, Qin JX, Shi JQ, Jiang T, Wang F, Xie C, Gao Q, Zhi N, Dong Q, Guan YT. Fine particulate matter exposure aggravates ischemic injury via NLRP3 inflammasome activation and pyroptosis. CNS Neurosci Ther 2022; 28:1045-1058. [PMID: 35403328 PMCID: PMC9160454 DOI: 10.1111/cns.13837] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/26/2021] [Accepted: 11/11/2021] [Indexed: 12/12/2022] Open
Abstract
Aims Accumulating evidence has suggested that airborne fine particulate matter (PM2.5) exposure is associated with an increased risk of ischemic stroke. However, the underlying mechanisms have not been fully elucidated. In this study, we aim to investigate the role and mechanisms of NLRP3 inflammasome and pyroptosis in ischemic stroke after PM2.5 exposure. Methods The BV‐2 and HMC‐3 microglial cell lines were established and subjected to oxygen–glucose deprivation and reoxygenation (OGD/R) with or without PM2.5 exposure. We used the CCK‐8 assay to explore the effects of PM2.5 on cell viability of BV‐2 and HMC‐3 cells. Then, the effects of PM2.5 exposure on NLRP3 inflammasome and pyroptosis following OGD/R were detected by western blotting, ELISA, and the confocal immunofluorescence staining. Afterwards, NLRP3 was knocked down to further validate the effects of PM2.5 on cell viability, NLRP3 inflammasome activation, and pyroptosis after OGD/R in HMC‐3 cells. Finally, the intracellular reactive oxygen species (ROS) was measured and the ROS inhibitor N‐acetyl‐L‐cysteine (NAC) was used to investigate whether ROS was required for PM2.5‐induced NLRP3 inflammasome activation and pyroptosis under ischemic conditions. Results We found that PM2.5 exposure decreased the viability of BV‐2 and HMC‐3 cells in a dose‐ and time‐dependent manner under ischemic conditions. Furthermore, PM2.5 exposure aggravated NLRP3 inflammasome activation and pyroptosis after OGD/R, as indicated by an increased expression of NLRP3, ASC, pro‐caspase‐1, Caspase‐1, GSDMD, and GSDMD‐N; increased production of IL‐1β and IL‐18; and enhanced Caspase‐1 activity and SYTOX green uptake. However, shRNA NLRP3 treatment attenuated the effects of PM2.5 on cell viability, NLRP3 inflammasome activation, and pyroptosis. Moreover, we observed that PM2.5 exposure increased the production of intracellular ROS following OGD/R, while inhibiting ROS production with NAC partially attenuated PM2.5‐induced NLRP3 inflammasome activation and pyroptosis under ischemic conditions. Conclusion These results suggested that PM2.5 exposure triggered the activation of NLRP3 inflammasome and pyroptosis under ischemic conditions, which may be mediated by increased ROS production after ischemic stroke. These findings may provide a more enhanced understanding of the interplay between PM2.5 and neuroinflammation and cell death, and reveal a novel mechanism of PM2.5‐mediated toxic effects after ischemic stroke.
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Affiliation(s)
- Li Gao
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie-Xing Qin
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Quan Shi
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Teng Jiang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Wang
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chong Xie
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Gao
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nan Zhi
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Dong
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang-Tai Guan
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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7
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Khosravipour M, Safari-Faramani R, Rajati F, Omidi F. The long-term effect of exposure to respirable particulate matter on the incidence of myocardial infarction: a systematic review and meta-analysis study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:42347-42371. [PMID: 35355187 DOI: 10.1007/s11356-022-18986-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
Although several studies have investigated the long-term association of respirable particulate matter (PM ≤ 10 µm) with the incidence of myocardial infarction (MI), this association is inconclusive or even contradictory. This systematic review and meta-analysis study aimed to quantify the long-term effect of exposure to respirable PM on the incidence of MI. To find relevant publications, online databases, including Scopus, PubMed, and Web of Science, were searched on October 10, 2021. A random-effect model was used to calculate the pooled hazard ratio (HR) and 95% confidence interval (95% CI) of MI across studies. Heterogeneity was presented with reporting I2 index. Of 4591 records found in the primary searching, the number of 24 prospective cohort studies with more than 70 million participants was included. The pooled HR (95% CI) of MI per 1 µg/m3 increment of respirable PM was estimated as 1.01 (1.00, 1.01). Subgroup analyses according to aerodynamic diameter of PM showed an only significant stronger risk of MI per 1 µg/m3 increase in PM with aerodynamic diameter < 2.5 µm (HR = 1.01, 95% CI = 1.00, 1.01). No sex difference was found in the association of respirable PM with MI incidence. There was only a significant association among studies defined MI as ICD-10: I21 code (HR = 1.01, 95% CI = 1.00, 1.01) and studies defined MI as ICD-10: I21-22 (HR = 1.02, 95% CI = 1.00, 1.04). No significant publication bias was observed across studies. In conclusion, this study confirms a significant association between long-term exposure to respirable PM air pollution and development of MI.
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Affiliation(s)
- Masoud Khosravipour
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Safari-Faramani
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Rajati
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Fariborz Omidi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Occupational Health Engineering, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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8
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de Bont J, Jaganathan S, Dahlquist M, Persson Å, Stafoggia M, Ljungman P. Ambient air pollution and cardiovascular diseases: An umbrella review of systematic reviews and meta-analyses. J Intern Med 2022; 291:779-800. [PMID: 35138681 PMCID: PMC9310863 DOI: 10.1111/joim.13467] [Citation(s) in RCA: 162] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The available evidence on the effects of ambient air pollution on cardiovascular diseases (CVDs) has increased substantially. In this umbrella review, we summarized the current epidemiological evidence from systematic reviews and meta-analyses linking ambient air pollution and CVDs, with a focus on geographical differences and vulnerable subpopulations. We performed a search strategy through multiple databases including articles between 2010 and 31 January 2021. We performed a quality assessment and evaluated the strength of evidence. Of the 56 included reviews, the most studied outcomes were stroke (22 reviews), all-cause CVD mortality, and morbidity (19). The strongest evidence was found between higher short- and long-term ambient air pollution exposure and all-cause CVD mortality and morbidity, stroke, blood pressure, and ischemic heart diseases (IHD). Short-term exposures to particulate matter <2.5 μm (PM2.5 ), <10 μm (PM10 ), and nitrogen oxides (NOx ) were consistently associated with increased risks of hypertension and triggering of myocardial infarction (MI), and stroke (fatal and nonfatal). Long-term exposures of PM2.5 were largely associated with increased risk of atherosclerosis, incident MI, hypertension, and incident stroke and stroke mortality. Few reviews evaluated other CVD outcomes including arrhythmias, atrial fibrillation, or heart failure but they generally reported positive statistical associations. Stronger associations were found in Asian countries and vulnerable subpopulations, especially among the elderly, cardiac patients, and people with higher weight status. Consistent with experimental data, this comprehensive umbrella review found strong evidence that higher levels of ambient air pollution increase the risk of CVDs, especially all-cause CVD mortality, stroke, and IHD. These results emphasize the importance of reducing the alarming levels of air pollution across the globe, especially in Asia, and among vulnerable subpopulations.
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Affiliation(s)
- Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Suganthi Jaganathan
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Environmental Health, Public Health Foundation of India, Delhi-NCR, India.,Centre for Chronic Disease Control, New Delhi, India
| | - Marcus Dahlquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Persson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Danderyd, Sweden
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9
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Viana M, Karatzas K, Arvanitis A, Reche C, Escribano M, Ibarrola-Ulzurrun E, Adami PE, Garrandes F, Bermon S. Air Quality Sensors Systems as Tools to Support Guidance in Athletics Stadia for Elite and Recreational Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3561. [PMID: 35329250 PMCID: PMC8950704 DOI: 10.3390/ijerph19063561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/23/2022]
Abstract
While athletes have high exposures to air pollutants due to their increased breathing rates, sport governing bodies have little guidance to support events scheduling or protect stadium users. A key limitation for this is the lack of hyper-local, high time-resolved air quality data representative of exposures in stadia. This work aimed to evaluate whether air quality sensors can describe ambient air quality in Athletics stadia. Sensing nodes were deployed in 6 stadia in major cities around the globe, monitoring NO2, O3, NO, PM10, PM2.5, PM1, CO, ambient temperature, and relative humidity. Results demonstrated that the interpretation of hourly pollutant patterns, in combination with self-organising maps (SOMs), enabled the interpretation of probable emission sources (e.g., vehicular traffic) and of atmospheric processes (e.g., local vs. regional O formation). The ratios between PM size fractions provided insights into potential emission sources (e.g., local dust re-suspension) which may help design mitigation strategies. The high resolution of the data facilitated identifying optimal periods of the day and year for scheduling athletic trainings and/or competitions. Provided that the necessary data quality checks are applied, sensors can support stadium operators in providing athlete communities with recommendations to minimise exposure and provide guidance for event scheduling.
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Affiliation(s)
- Mar Viana
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), 08034 Barcelona, Spain;
| | - Kostas Karatzas
- Environmental Informatics Research Group, School of Mechanical Engineering, Aristotle University, 54124 Thessaloniki, Greece; (K.K.); (A.A.)
| | - Athanasios Arvanitis
- Environmental Informatics Research Group, School of Mechanical Engineering, Aristotle University, 54124 Thessaloniki, Greece; (K.K.); (A.A.)
| | - Cristina Reche
- Institute of Environmental Assessment and Water Research (IDAEA-CSIC), 08034 Barcelona, Spain;
| | | | | | - Paolo Emilio Adami
- Health and Science Department, World Athletics, 98000 Monaco, Monaco; (P.E.A.); (F.G.); (S.B.)
- Laboratoire Motricité Humaine Expertise Sport Santé (LAMHESS), Université Côte d’Azur, 06000 Nice, France
| | - Fréderic Garrandes
- Health and Science Department, World Athletics, 98000 Monaco, Monaco; (P.E.A.); (F.G.); (S.B.)
- Laboratoire Motricité Humaine Expertise Sport Santé (LAMHESS), Université Côte d’Azur, 06000 Nice, France
| | - Stéphane Bermon
- Health and Science Department, World Athletics, 98000 Monaco, Monaco; (P.E.A.); (F.G.); (S.B.)
- Laboratoire Motricité Humaine Expertise Sport Santé (LAMHESS), Université Côte d’Azur, 06000 Nice, France
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10
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Zhu C, Fu Z, Liu L, Shi X, Li Y. Health risk assessment of PM 2.5 on walking trips. Sci Rep 2021; 11:19249. [PMID: 34584180 PMCID: PMC8478890 DOI: 10.1038/s41598-021-98844-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/13/2021] [Indexed: 12/31/2022] Open
Abstract
PM2.5 has an impact on residents' physical health during travelling, especially walking completely exposed to the environment. In order to obtain the specific impact of PM2.5 on walking, 368 healthy volunteers were selected and they were grouped according to gender and age. In the experiment, the heart rate change rate (HR%) is taken as test variable. According to receiver operating characteristic (ROC) curve, the travel is divided into two states: safety and risk. Based on this, a binary logit model considering Body Mass Index (BMI) is established to determine the contribution of PM2.5 concentration and body characteristics to travel risk. The experiment was conducted on Chang'an Middle Road in Xi'an City. The analysis results show that the threshold of HR% for safety and risk ranges from 31.1 to 40.1%, and that of PM2.5 concentration ranges from 81 to 168 μg/m3. The probability of risk rises 5.8% and 11.4%, respectively, for every unit increase in PM2.5 concentration and HR%. Under same conditions, the probability of risk for male is 76.8% of that for female. The probability of risk for youth is 67.5% of that for middle-aged people, and the probability of risk for people with BMI in healthy range is 72.1% of that for non-healthy range. The research evaluates risk characteristics of walking in particular polluted weather, which can improve residents' health level and provide suggestions for travel decision while walking.
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Affiliation(s)
- Caihua Zhu
- College of Transportation Engineering, Chang'an University, Middle section of south 2nd Ring Road, Xi'an, 710064, Shaanxi Province, China
| | - Zekun Fu
- College of Transportation Engineering, Chang'an University, Middle section of south 2nd Ring Road, Xi'an, 710064, Shaanxi Province, China
| | - Linjian Liu
- College of Transportation Engineering, Chang'an University, Middle section of south 2nd Ring Road, Xi'an, 710064, Shaanxi Province, China
| | - Xuan Shi
- College of Transportation Engineering, Chang'an University, Middle section of south 2nd Ring Road, Xi'an, 710064, Shaanxi Province, China
| | - Yan Li
- College of Transportation Engineering, Chang'an University, Middle section of south 2nd Ring Road, Xi'an, 710064, Shaanxi Province, China.
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11
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Zhu S, Kinnon MM, Paradise A, Dabdub D, Samuelsen GS. Health Benefits in California of Strengthening the Fine Particulate Matter Standards. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:12223-12232. [PMID: 34506112 DOI: 10.1021/acs.est.1c03177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Clean Air Act requires the United States Environmental Protection Agency to review routinely the National Ambient Air Quality Standards, including fine particulate matter (PM2.5). A non-governmental Independent Particulate Matter Review Panel recently concluded that the current PM2.5 standards do not protect public health adequately and recommended revising the daily standard from 35 to 25-30 μg/m3 and the annual standard from 12 to 8-10 μg/m3. To assess the public health implications of adopting the PM2.5 standards proposed by the panel, the health benefits are quantified from their implementation based on both current (observed) and future (simulated) air quality data for California. The findings indicate that strengthening the standards would provide significant public health benefits valued at $42-$149 billion. Additionally, the stronger standards are shown to benefit environmental justice via health savings that are allocated more within environmentally and socioeconomically disadvantaged communities.
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Affiliation(s)
- Shupeng Zhu
- Advanced Power and Energy Program, University of California, Irvine, California 92697-3550, United States
| | - Michael Mac Kinnon
- Advanced Power and Energy Program, University of California, Irvine, California 92697-3550, United States
| | - Andre Paradise
- Computational Environmental Sciences Laboratory, University of California, Irvine, California 92697-3975, United States
| | - Donald Dabdub
- Computational Environmental Sciences Laboratory, University of California, Irvine, California 92697-3975, United States
| | - G Scott Samuelsen
- Advanced Power and Energy Program, University of California, Irvine, California 92697-3550, United States
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12
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Marczynski M, Lieleg O. Forgotten but not gone: Particulate matter as contaminations of mucosal systems. BIOPHYSICS REVIEWS 2021; 2:031302. [PMID: 38505633 PMCID: PMC10903497 DOI: 10.1063/5.0054075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/14/2021] [Indexed: 03/21/2024]
Abstract
A decade ago, environmental issues, such as air pollution and the contamination of the oceans with microplastic, were prominently communicated in the media. However, these days, political topics, as well as the ongoing COVID-19 pandemic, have clearly taken over. In spite of this shift in focus regarding media representation, researchers have made progress in evaluating the possible health risks associated with particulate contaminations present in water and air. In this review article, we summarize recent efforts that establish a clear link between the increasing occurrence of certain pathological conditions and the exposure of humans (or animals) to airborne or waterborne particulate matter. First, we give an overview of the physiological functions mucus has to fulfill in humans and animals, and we discuss different sources of particulate matter. We then highlight parameters that govern particle toxicity and summarize our current knowledge of how an exposure to particulate matter can be related to dysfunctions of mucosal systems. Last, we outline how biophysical tools and methods can help researchers to obtain a better understanding of how particulate matter may affect human health. As we discuss here, recent research has made it quite clear that the structure and functions of those mucosal systems are sensitive toward particulate contaminations. Yet, our mechanistic understanding of how (and which) nano- and microparticles can compromise human health via interacting with mucosal barriers is far from complete.
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13
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Shin HH, Gogna P, Maquiling A, Parajuli RP, Haque L, Burr B. Comparison of hospitalization and mortality associated with short-term exposure to ambient ozone and PM 2.5 in Canada. CHEMOSPHERE 2021; 265:128683. [PMID: 33158503 DOI: 10.1016/j.chemosphere.2020.128683] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Hospitalization and mortality (H-M) have been linked to air pollution separately. However, previous studies have not adequately compared whether air pollution is a stronger risk factor for hospitalization or mortality. This study aimed to investigate differences in H-M risk from short-term ozone and PM2.5 exposures, and determine whether differences are modified by season, age, and sex. METHODS Daily ozone, PM2.5, temperature, and all-cause H-M counts (ICD-10, A00-R99) were collected for 22-24 Canadian cities for up to 29 years. Generalized additive Poisson models were employed to estimate associations between each pollutant and health outcome, which were compared across season (warm, cold, or year-round), age (all ages or seniors > 65), and sex. RESULTS Overall, ozone and PM2.5 showed higher season-specific risk of mortality than hospitalization: warm-season ozone: 0.54% (95% credible interval, 0.20, 0.85) vs. 0.14% (0.02, 0.27) per 10 ppb; and year-round PM2.5: 0.90% (0.33, 1.41) vs. 0.29% (0.03, 0.56) per 10 μg/m3. While age showed little H-M difference, sex appeared to be a modifier of H-M risk. While females had higher mortality risk, males had higher hospitalization risk: for females, ozone 0.87% (0.36, 1.35) vs. -0.03% (-0.18, 0.11) and PM2.5 1.19% (0.40, 1.90) vs. 0.19% (-0.10, 0.47); and for males ozone 0.20% (-0.28, 0.65) vs. 0.35% (0.18, 0.51). CONCLUSION This study found H-M differences attributable to ozone and PM2.5, suggesting that both are stronger risk factors for mortality than hospitalization. In addition, there were clear H-M differences by sex: specifically, females showed higher mortality risk and males showed higher hospitalization risk.
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Affiliation(s)
- Hwashin Hyun Shin
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada; Department of Mathematics and Statistics, Queen's University, Kingston, ON, Canada.
| | - Priyanka Gogna
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
| | - Aubrey Maquiling
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada.
| | | | - Lani Haque
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada.
| | - Benjamin Burr
- Department of Mathematics and Statistics, Carleton University, Ottawa, ON, Canada.
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14
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Alexeeff SE, Liao NS, Liu X, Van Den Eeden SK, Sidney S. Long-Term PM 2.5 Exposure and Risks of Ischemic Heart Disease and Stroke Events: Review and Meta-Analysis. J Am Heart Assoc 2020; 10:e016890. [PMID: 33381983 PMCID: PMC7955467 DOI: 10.1161/jaha.120.016890] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Fine particulate matter <2.5 µm in diameter (PM2.5) has known effects on cardiovascular morbidity and mortality. However, no study has quantified and compared the risks of incident myocardial infarction, incident stroke, ischemic heart disease (IHD) mortality, and cerebrovascular mortality in relation to long‐term PM2.5 exposure. Methods and Results We sought to quantitatively summarize studies of long‐term PM2.5 exposure and risk of IHD and stroke events by conducting a review and meta‐analysis of studies published by December 31, 2019. The main outcomes were myocardial infarction, stroke, IHD mortality, and cerebrovascular mortality. Random effects meta‐analyses were used to estimate the combined risk of each outcome among studies. We reviewed 69 studies and included 42 studies in the meta‐analyses. In meta‐analyses, we found that a 10‐µg/m3 increase in long‐term PM2.5 exposure was associated with an increased risk of 23% for IHD mortality (95% CI, 15%–31%), 24% for cerebrovascular mortality (95% CI, 13%–36%), 13% for incident stroke (95% CI, 11%–15%), and 8% for incident myocardial infarction (95% CI, −1% to 18%). There were an insufficient number of studies of recurrent stroke and recurrent myocardial infarction to conduct meta‐analyses. Conclusions Long‐term PM2.5 exposure is associated with increased risks of IHD mortality, cerebrovascular mortality, and incident stroke. The relationship with incident myocardial infarction is suggestive of increased risk but not conclusive. More research is needed to understand the relationship with recurrent events.
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Affiliation(s)
| | | | - Xi Liu
- Kaiser Permanente Division of Research Oakland CA
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15
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Rhinehart ZJ, Kinnee E, Essien UR, Saul M, Guhl E, Clougherty JE, Magnani JW. Association of Fine Particulate Matter and Risk of Stroke in Patients With Atrial Fibrillation. JAMA Netw Open 2020; 3:e2011760. [PMID: 32930777 PMCID: PMC7492916 DOI: 10.1001/jamanetworkopen.2020.11760] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Air pollution is associated with cardiovascular outcomes. Specifically, fine particulate matter measuring 2.5 μm or less (PM2.5) is associated with thrombosis, stroke, and myocardial infarction. Few studies have examined particulate matter and stroke risk in individuals with atrial fibrillation (AF). OBJECTIVE To assess the association of residential-level pollution exposure in 1 year and ischemic stroke in individuals with AF. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 31 414 individuals with AF from a large regional health care system in an area with historically high industrial pollution. All participants had valid residential addresses for geocoding and ascertainment of neighborhood-level income and educational level. Participants were studied from January 1, 2007, through September 30, 2015, with prospective follow-up through December 1, 2017. Data analysis was performed from March 14, 2018, to October 9, 2019. EXPOSURES Exposure to PM2.5 ascertained using geocoding of addresses and fine-scale air pollution exposure surfaces derived from a spatial saturation monitoring campaign and land-use regression modeling. Exposure to PM2.5 was estimated annually across the study period at the residence level. MAIN OUTCOMES AND MEASURES Multivariable-adjusted stroke risk by quartile of residence-level and annual PM2.5 exposure. RESULTS The cohort included 31 414 individuals (15 813 [50.3%] female; mean [SD] age, 74.4 [13.5] years), with a median follow-up of 3.5 years (interquartile range, 1.6-5.8 years). The mean (SD) annual PM2.5 exposure was 10.6 (0.7) μg/m3. A 1-SD increase in PM2.5 was associated with a greater risk of stroke after both adjustment for demographic and clinical variables (hazard ratio [HR], 1.08; 95% CI, 1.03-1.14) and multivariable adjustment that included neighborhood-level income and educational level (HR, 1.07; 95% CI, 1.00-1.14). The highest quartile of PM2.5 exposure had an increased risk of stroke relative to the first quartile (HR, 1.36; 95% CI, 1.18-1.58). After adjustment for clinical covariates, income, and educational level, risk of stroke remained greater for the highest quartile of exposure relative to the first quartile (HR, 1.21; 95% CI, 1.01-1.45). CONCLUSIONS AND RELEVANCE This large cohort study of individuals with AF identified associations between PM2.5 and risk of ischemic stroke. The results suggest an association between fine particulate air pollution and cardiovascular disease and outcomes.
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Affiliation(s)
| | - Ellen Kinnee
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Utibe R. Essien
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Melissa Saul
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emily Guhl
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jane E. Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Jared W. Magnani
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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16
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Hayes RB, Lim C, Zhang Y, Cromar K, Shao Y, Reynolds HR, Silverman DT, Jones RR, Park Y, Jerrett M, Ahn J, Thurston GD. PM2.5 air pollution and cause-specific cardiovascular disease mortality. Int J Epidemiol 2020; 49:25-35. [PMID: 31289812 DOI: 10.1093/ije/dyz114] [Citation(s) in RCA: 240] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Ambient air pollution is a modifiable risk factor for cardiovascular disease, yet uncertainty remains about the size of risks at lower levels of fine particulate matter (PM2.5) exposure which now occur in the USA and elsewhere. METHODS We investigated the relationship of ambient PM2.5 exposure with cause-specific cardiovascular disease mortality in 565 477 men and women, aged 50 to 71 years, from the National Institutes of Health-AARP Diet and Health Study. During 7.5 x 106 person-years of follow up, 41 286 cardiovascular disease deaths, including 23 328 ischaemic heart disease (IHD) and 5894 stroke deaths, were ascertained using the National Death Index. PM2.5 was estimated using a hybrid land use regression (LUR) geostatistical model. Multivariate Cox regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CI). RESULTS Each increase of 10 μg/m3 PM2.5 (overall range, 2.9-28.0 μg/m3) was associated, in fully adjusted models, with a 16% increase in mortality from ischaemic heart disease [hazard ratio (HR) 1.16; 95% CI 1.09-1.22] and a 14% increase in mortality from stroke (HR 1.14; CI 1.02-1.27). Compared with PM2.5 exposure <8 μg/m3 (referent), risks for CVD were increased in relation to PM2.5 exposures in the range of 8-12 μg/m3 (CVD: HR 1.04; 95% CI 1.00-1.08), in the range 12-20 μg/m3 (CVD: HR 1.08; 95% CI 1.03-1.13) and in the range 20+ μg/m3 (CVD: HR 1.19; 95% CI 1.10-1.28). Results were robust to alternative approaches to PM2.5 exposure assessment and statistical analysis. CONCLUSIONS Long-term exposure to fine particulate air pollution is associated with ischaemic heart disease and stroke mortality, with excess risks occurring in the range of and below the present US long-term standard for ambient exposure to PM2.5 (12 µg/m3), indicating the need for continued improvements in air pollution abatement for CVD prevention.
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Affiliation(s)
- Richard B Hayes
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Chris Lim
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Yilong Zhang
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,Merck Research Laboratory, Rahway, NJ, USA
| | - Kevin Cromar
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Yongzhao Shao
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Harmony R Reynolds
- Cardiovascular Clinical Research Center, New York University School of Medicine, New York, NY, USA
| | | | - Rena R Jones
- NIH National Cancer Institute, Bethesda, MD, USA
| | - Yikyung Park
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO, USA
| | - Michael Jerrett
- Division of Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Jiyoung Ahn
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - George D Thurston
- Department of Population Health, New York University School of Medicine, New York, NY, USA.,Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
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17
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Liu B, Fan D, Huang F. Relationship of chronic kidney disease with major air pollutants - A systematic review and meta-analysis of observational studies. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2020; 76:103355. [PMID: 32143119 DOI: 10.1016/j.etap.2020.103355] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/15/2020] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Articles concerning the correlation of the risk of chronic kidney disease (CKD) with air contaminant exposure present inconsistent findings and the magnitude of the link is still unclear. Therefore, we planned to systematically and quantitatively investigate the overall strength of proofs in this field. METHODS Relevant articles on Cochrane, EMBASE, Medline, Web of Science, and CINHAL were searched as per relevant strategies. Only observational studies that disclosed the link of CKD risk with major air pollutants were enrolled, including PM10 and PM2.5, which were particulate matter less than 10 um and less than 2.5 um in erodynamic diameter respectively. Pooled relative risk (RR) and 95 % confidence interval (CI) were determined using random--effects models, regardless of the heterogeneity quantified by I2 statistic. RESULTS Finally, 7 studies involving 5,812,381 participants were included. The incidence of CKD was increased by long-term exposure to PM10 (including solely estimated exposure to PM10 from studies using PM2.5) (RR 1.08, 95 %CI 1.04-1.11) with considerable heterogeneity (I2 = 79 %), and the risk of CKD was raised by 8% when the long-time exposure to PM10 increased by 10 ug/m3. The pooled RR (95 %CI) with a 10 μg/m3 increase in PM2.5 for risk of CKD was 1.09 (1.03-1.17). Stratified analysis also verified the general negative effects. CONCLUSIONS Chronic subjection to major air contaminants (PM10 and PM2.5) is more likely to cause CKD. Thus, developing global approaches of air pollution elimination to prevent CKD is urgent.
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Affiliation(s)
- Bo Liu
- Department of Nephrology, Huzhou Central Hospital, Affiliated central hospital Huzhou University, Huzhou, Zhejiang, PR China
| | - Deyong Fan
- Department of Nephrology, Huzhou Central Hospital, Affiliated central hospital Huzhou University, Huzhou, Zhejiang, PR China
| | - Fuhan Huang
- Department of Nephrology, Huzhou Central Hospital, Affiliated central hospital Huzhou University, Huzhou, Zhejiang, PR China.
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18
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Jones CG, Rappold AG, Vargo J, Cascio WE, Kharrazi M, McNally B, Hoshiko S. Out-of-Hospital Cardiac Arrests and Wildfire-Related Particulate Matter During 2015-2017 California Wildfires. J Am Heart Assoc 2020; 9:e014125. [PMID: 32290746 PMCID: PMC7428528 DOI: 10.1161/jaha.119.014125] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background The natural cycle of large‐scale wildfires is accelerating, increasingly exposing both rural and populous urban areas to wildfire emissions. While respiratory health effects associated with wildfire smoke are well established, cardiovascular effects have been less clear. Methods and Results We examined the association between out‐of‐hospital cardiac arrest and wildfire smoke density (light, medium, heavy smoke) from the National Oceanic Atmospheric Association's Hazard Mapping System. Out‐of‐hospital cardiac arrest data were provided by the Cardiac Arrest Registry to Enhance Survival for 14 California counties, 2015–2017 (N=5336). We applied conditional logistic regression in a case‐crossover design using control days from 1, 2, 3, and 4 weeks before case date, at lag days 0 to 3. We stratified by pathogenesis, sex, age (19–34, 35–64, and ≥65 years), and socioeconomic status (census tract percent below poverty). Out‐of‐hospital cardiac arrest risk increased in association with heavy smoke across multiple lag days, strongest on lag day 2 (odds ratio, 1.70; 95% CI, 1.18–2.13). Risk in the lower socioeconomic status strata was elevated on medium and heavy days, although not statistically significant. Higher socioeconomic status strata had elevated odds ratios with heavy smoke but null results with light and medium smoke. Both sexes and age groups 35 years and older were impacted on days with heavy smoke. Conclusions Out‐of‐hospital cardiac arrests increased with wildfire smoke exposure, and lower socioeconomic status appeared to increase the risk. The future trajectory of wildfire, along with increasing vulnerability of the aging population, underscores the importance of formulating public health and clinical strategies to protect those most vulnerable.
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Affiliation(s)
- Caitlin G. Jones
- California Department of Public HealthEnvironmental Health Investigations BranchRichmondCA
- California Department of Public HealthCalifornia Epidemiologic Investigation Service ProgramRichmondCA
| | - Ana G. Rappold
- United States Environmental Protection AgencyResearch Triangle ParkNC
| | - Jason Vargo
- California Department of Public HealthOffice of Health EquityRichmondCA
| | - Wayne E. Cascio
- United States Environmental Protection AgencyResearch Triangle ParkNC
| | - Martin Kharrazi
- California Department of Public HealthEnvironmental Health Investigations BranchRichmondCA
| | | | - Sumi Hoshiko
- California Department of Public HealthEnvironmental Health Investigations BranchRichmondCA
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19
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Guo Y, Xie X, Lei L, Zhou H, Deng S, Xu Y, Liu Z, Bao J, Peng J, Huang C. Short-term associations between ambient air pollution and stroke hospitalisations: time-series study in Shenzhen, China. BMJ Open 2020; 10:e032974. [PMID: 32198300 PMCID: PMC7103818 DOI: 10.1136/bmjopen-2019-032974] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the association between ambient air pollution and stroke morbidity in different subgroups and seasons. METHODS We performed a time-series analysis based on generalised linear models to study the short-term exposure-response relationships between air pollution and stroke hospitalisations, and conducted subgroup analyses to identify possible sensitive populations. RESULTS For every 10 µg/m3 increase in the concentration of air pollutants, across lag 0-3 days, the relative risk of stroke hospitalisation was 1.029 (95% CI 1.013 to 1.045) for PM2.5, 1.054 (95% CI 1.031 to 1.077) for NO2 and 1.012 (95% CI 1.002 to 1.022) for O3. Subgroup analyses showed that statistically significant associations were found in both men and women, middle-aged and older populations, and both cerebral infarction and intracerebral haemorrhage. The seasonal analyses showed that statistically significant associations were found only in the winter. CONCLUSIONS Our study indicates that short-term exposure to PM2.5, NO2 and O3 may induce stroke morbidity, and the government should take actions to mitigate air pollution and protect sensitive populations.
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Affiliation(s)
- Yanfang Guo
- Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, China
| | - Xiufang Xie
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lin Lei
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Haibin Zhou
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Shizhou Deng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ying Xu
- Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, China
| | - Zheng Liu
- Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, China
| | - Junzhe Bao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ji Peng
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Cunrui Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
- School of Public Health, Zhengzhou University, Zhengzhou, China
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20
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Qiu X, Wei Y, Wang Y, Di Q, Sofer T, Awad YA, Schwartz J. Inverse probability weighted distributed lag effects of short-term exposure to PM 2.5 and ozone on CVD hospitalizations in New England Medicare participants - Exploring the causal effects. ENVIRONMENTAL RESEARCH 2020; 182:109095. [PMID: 31927244 PMCID: PMC7024653 DOI: 10.1016/j.envres.2019.109095] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/27/2019] [Accepted: 12/26/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND Although many studies have established significant associations between short-term air pollution and the risk of getting cardiovascular diseases, there is a lack of evidence based on causal distributed lag modeling. METHODS Inverse probability weighting (ipw) propensity score models along with conditional logistic outcome regression models based on a case-crossover study design were applied to get the causal unconstrained distributed (lag0-lag5) as well as cumulative lag effect of short-term exposure to PM2.5/Ozone on hospital admissions of acute myocardial infarction (AMI), congestive heart failure (CHF) and ischemic stroke (IS) among New England Medicare participants during 2000-2012. Effect modification by gender, race, secondary diagnosis of Chronic Obstructive Pulmonary Diseases (COPD) and Diabetes (DM) was explored. RESULTS Each 10 μg/m3 increase in lag0-lag5 cumulative PM2.5 exposure was associated with an increase of 4.3% (95% confidence interval: 2.2%, 6.4%, percentage change) in AMI hospital admission rate, an increase of 3.9% (2.4%, 5.5%) in CHF rate and an increase of 2.6% (0.4%, 4.7%) in IS rate. A weakened lagging effect of PM2.5 from lag0 to lag5 could be observed. No cumulative short-term effect of ozone on CVD was found. People with secondary diagnosis of COPD, diabetes, female gender and black race are sensitive population. CONCLUSIONS Based on our causal distributed lag modeling, we found that short-term exposure to an increased ambient PM2.5 level had the potential to induce higher risk of CVD hospitalization in a causal way. More attention should be paid to population of COPD, diabetes, female gender and black race.
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Affiliation(s)
- Xinye Qiu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Yaguang Wei
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yan Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Qian Di
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorder, Brigham & Women's Hospital, 221 Longwood Avenue, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Yara Abu Awad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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21
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Chun H, Leung C, Wen SW, McDonald J, Shin HH. Maternal exposure to air pollution and risk of autism in children: A systematic review and meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 256:113307. [PMID: 31733973 DOI: 10.1016/j.envpol.2019.113307] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/22/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The number of children diagnosed with autism spectrum disorder (ASD) has been increasing. Previous studies suggested potential association between pregnancy air pollution exposure and ASD. This systematic review and meta-analysis is intended to summarize the association between maternal exposure to outdoor air pollution and ASD in children by trimester based on recent studies. METHODS A systematic literature search in 3 databases (Medline, Embase, and Web of Science) was performed using subject headings related to ASD and air pollution since 2007. Eligible studies were screened and evaluated based on predetermined criteria. For meta-analyses, the studies were grouped by air pollutant and exposure time (prenatal period and trimesters). Within-group studies were standardized by log odds ratio (OR) and then combined by three meta-analysis methods: frequentist fixed and random effects models, and Bayesian random effects model. RESULTS Initial search identified 1564 papers, of which 25 studies remained for final analysis after duplicates and ineligible studies were removed. Of the 25 studies, 13, 14, 12, and 7 studies investigated ASD in children associated with PM2.5, PM10, NO2, and ozone, respectively. The frequentist and Bayesian random effects models resulted in different statistical significance. For prenatal period, frequentist meta-analysis returned significant pooled ORs with 95% confidence intervals, 1.06(1.01,1.11) for PM2.5 and 1.02(1.01,1.04) for NO2, whereas Bayesian meta-analysis showed similar ORs with wider 95% posterior intervals, 1.06(1.00,1.13) for PM2.5 and 1.02(1.00,1.05) for NO2. Third trimester appeared to have higher pooled ORs for PM2.5, PM10, and ozone, but patterns in the time-varying associations over the trimester were inconsistent. CONCLUSIONS For positive association between maternal exposure to ambient air pollution and ASD in children, there is some evidence for PM2.5, weak evidence for NO2 and little evidence for PM10 and ozone. However, patterns in associations over trimesters were inconsistent among studies and among air pollutants.
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Affiliation(s)
- HeeKyoung Chun
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA
| | - Cheryl Leung
- Department of Obstetrics, Gynecology, and Newborn Care, University of Ottawa, Ottawa, ON, Canada
| | - Shi Wu Wen
- Department of Obstetrics, Gynecology, and Newborn Care, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute Clinical Epidemiology, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Judy McDonald
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON, Canada
| | - Hwashin H Shin
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada; Department of Mathematics and Statistics, Queen's University, Kingston, ON, Canada.
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Abstract
OBJECTIVE Exposure to airborne particulate matter (PM) is estimated to cause millions of premature deaths annually. This work conveys known routes of exposure to PM and resultant health effects. METHODS A review of available literature. RESULTS Estimates for daily PM exposure are provided. Known mechanisms by which insoluble particles are transported and removed from the body are discussed. Biological effects of PM, including immune response, cytotoxicity, and mutagenicity, are reported. Epidemiological studies that outline the systemic health effects of PM are presented. CONCLUSION While the integrated, per capita, exposure of PM for a large fraction of the first-world may be less than 1 mg per day, links between several syndromes, including attention deficit hyperactivity disorder (ADHD), autism, loss of cognitive function, anxiety, asthma, chronic obstructive pulmonary disease (COPD), hypertension, stroke, and PM exposure have been suggested. This article reviews and summarizes such links reported in the literature.
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Nzwalo H, Guilherme P, Nogueira J, Félix C, André A, Teles J, Mouzinho M, Ferreira F, Marreiros A, Logallo N, Bentes C. Fine particulate air pollution and occurrence of spontaneous intracerebral hemorrhage in an area of low air pollution. Clin Neurol Neurosurg 2019; 176:67-72. [DOI: 10.1016/j.clineuro.2018.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/20/2018] [Accepted: 11/30/2018] [Indexed: 01/18/2023]
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Mazidi M, Speakman JR. Impact of Obesity and Ozone on the Association Between Particulate Air Pollution and Cardiovascular Disease and Stroke Mortality Among US Adults. J Am Heart Assoc 2018; 7:JAHA.117.008006. [PMID: 29848499 PMCID: PMC6015356 DOI: 10.1161/jaha.117.008006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cardiovascular diseases (CVDs) and stroke are the highest and third highest causes of death, respectively, in the whole United States. It is well established that both long‐ and short‐term exposure to particulate air pollution (particulate matter with diameters <2.5 μm [PM2.5]) increases the risks of both CVD and stroke mortality. Methods and Results We combined county‐level data for CVD and stroke mortality, and prevalence of hypertension and obesity, with spatial patterns of PM2.5 and ozone in a cross‐sectional ecological study. We found significant positive associations between both CVD (β=15.4, P<0.001) and stroke (β=2.7, P<0.001) mortality with PM2.5. Ozone had significant link with just CVD (β=1372.1, P<0.001). Once poverty, ethnicity, and education were taken into account, there were still significant positive associations between PM2.5 and both CVD (β=1.2, P<0.001) and stroke (β=1.1, P<0.001) mortality. Moreover, the association between CVD and ozone remained after adjustment for these factors (β=21.8, P<0.001). PM2.5 and ozone were independent risk factors. The impact of PM2.5 on CVD and stroke mortality was strongly dependent on the prevalence of obesity. Hypertension partially mediated the associations of PM2.5 and mortality from CVD and stroke. Conclusions There was a spatial association between PM2.5 exposure and the leading causes of death and disability in United States. The effect of PM2.5 was considerably greater in areas where obesity is more prevalent. Hypertension is a possible mediator of the association of PM2.5 and both CVD and stroke.
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Affiliation(s)
- Mohsen Mazidi
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Chaoyang Beijing, China.,University of the Chinese Academy of Sciences, Beijing, China
| | - John R Speakman
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Chaoyang Beijing, China .,Institute of Biological and Environmental Science, University of Aberdeen, Scotland, United Kingdom
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Argacha JF, Bourdrel T, van de Borne P. Ecology of the cardiovascular system: A focus on air-related environmental factors. Trends Cardiovasc Med 2018; 28:112-126. [DOI: 10.1016/j.tcm.2017.07.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 07/09/2017] [Accepted: 07/29/2017] [Indexed: 12/18/2022]
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Chen H, Kwong JC, Copes R, Hystad P, van Donkelaar A, Tu K, Brook JR, Goldberg MS, Martin RV, Murray BJ, Wilton AS, Kopp A, Burnett RT. Exposure to ambient air pollution and the incidence of dementia: A population-based cohort study. ENVIRONMENT INTERNATIONAL 2017; 108:271-277. [PMID: 28917207 DOI: 10.1016/j.envint.2017.08.020] [Citation(s) in RCA: 225] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Emerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially at the relatively low levels, on developing dementia. We conducted a population-based cohort study in Ontario, Canada, where the concentrations of pollutants are among the lowest in the world, to assess whether air pollution exposure is associated with incident dementia. METHODS The study population comprised all Ontario residents who, on 1 April 2001, were 55-85years old, Canadian-born, and free of physician-diagnosed dementia (~2.1 million individuals). Follow-up extended until 2013. We used population-based health administrative databases with a validated algorithm to ascertain incident diagnosis of dementia as well as prevalent cases. Using satellite observations, land-use regression model, and an optimal interpolation method, we derived long-term average exposure to fine particulate matter (≤2.5μm in diameter) (PM2.5), nitrogen dioxide (NO2), and ozone (O3), respectively at the subjects' historical residences based on a population-based registry. We used multilevel spatial random-effects Cox proportional hazards models, adjusting for individual and contextual factors, such as diabetes, brain injury, and neighborhood income. We conducted various sensitivity analyses, such as lagging exposure up to 10years and considering a negative control outcome for which no (or weaker) association with air pollution is expected. RESULTS We identified 257,816 incident cases of dementia in 2001-2013. We found a positive association between PM2.5 and dementia incidence, with a hazard ratio (HR) of 1.04 (95% confidence interval (CI): 1.03-1.05) for every interquartile-range increase in exposure to PM2.5. Similarly, NO2 was associated with increased incidence of dementia (HR=1.10; 95% CI: 1.08-1.12). No association was found for O3. These associations were robust to all sensitivity analyses examined. These estimates translate to 6.1% of dementia cases (or 15,813 cases) attributable to PM2.5 and NO2, based on the observed distribution of exposure relative to the lowest quartile in concentrations in this cohort. DISCUSSION In this large cohort, exposure to air pollution, even at the relative low levels, was associated with higher dementia incidence.
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Affiliation(s)
- Hong Chen
- Public Health Ontario, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Ray Copes
- Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
| | - Karen Tu
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital Family Health Team, University Health Network, Canada
| | - Jeffrey R Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Mark S Goldberg
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada; Harvard-Smithsonian Centre for Astrophysics, Cambridge, MA, USA
| | - Brian J Murray
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Andrew S Wilton
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Alexander Kopp
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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Chen JC, Wang X, Serre M, Cen S, Franklin M, Espeland M. Particulate Air Pollutants, Brain Structure, and Neurocognitive Disorders in Older Women. Res Rep Health Eff Inst 2017; 2017:1-65. [PMID: 31898881 PMCID: PMC7266369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Introduction An increasing number of studies have suggested that exposure to particulate matter (PM) may represent a novel - and potentially amendable - environmental determinant of brain aging. The current longitudinal environmental epidemiological study addressed some important knowledge gaps in this emerging field, which combines the study of air pollution and neuroepidemiology. The investigators hypothesized that long-term PM exposure adversely influences global brain volume and brain regions (e.g., frontal lobe or hippocampus) that are critical to memory and complex cognitive processing or that are affected by neuropathological changes in dementia. It was also hypothesized that long-term PM exposure results in neurovascular damage and may increase the risk of mild cognitive impairment (MCI) and -dementia. Methods The investigators selected a well-characterized and geographically diverse population of older women (N = 7,479; average age = 71.0 ± 3.8 years at baseline) in the Women's Health Initiative (WHI) Memory Study (WHIMS) cohort (1996-2007), which included a subcohort (n = 1,403) enrolled in the WHIMS-Magnetic Resonance Imaging (WHIMS-MRI) study (2005-2006). Residence-specific yearly exposures to PM ≤ 2.5 µm in aerodynamic diameter (PM₂.₅) were estimated using a Bayesian maximum entropy spatiotemporal model of annual monitoring data (1999-2007) recorded in the U.S. Environmental Protection Agency (U.S. EPA) Air Quality System (AQS). Annual exposures (1996-2005) to diesel PM (DPM) were assigned to each residential census tract in a nationwide spatiotemporal mapping, based on a generalized additive model (GAM), to conduct census tract-specific temporal interpolation of DPM on-road estimates given by the U.S. EPA National-Scale Air Toxics Assessment Program. Multiple linear regression and multicovariate-adjusted Cox models were used to examine the associations, with statistical adjustment for multiple potential confounders. Results The investigators found that participants had smaller brain volumes, especially in the normal-appearing white matter (WM), if they lived in locations with higher levels of cumulative exposure (1999-2006) to PM ₂.₅ before the brain MRI scans were performed. The associations were not explained by sociodemographic factors, socioeconomic status, lifestyle factors, or other clinical characteristics. Analyses showed that the adverse effect on brain structure in the participants was driven primarily by the smaller WM volumes associated with cumulative PM₂.₅ exposures, which were present in the WM divisions of the association brain area (frontal, parietal, and temporal lobes) and corpus callosum. Increased DPM exposures were associated with larger ventricular volume, suggesting an overall atrophic effect on the aging brains. The participants tended to have smaller gray matter (GM) volumes if they lived in areas with the highest (i.e., fourth quartile) estimated cumulative DPM exposure in the 10 years before the brain MRI scans, compared with women in the first to third quartiles. This observed association was present in the total brain GM and in the association brain cortices. The associations with normal-appearing WM varied by DPM exposure range. For women with estimated cumulative exposure below that of the fourth quartile, increased DPM estimates were associated with smaller WM volumes. However, for women with increased cumulative DPM exposures estimates in the fourth quartile, WM volumes were larger. This pattern of association was found consistently in the association brain area; no measurable difference was found in the volume of the corpus callosum. These observed adverse effects of cumulative exposure to PM₂.₅ (linking exposure with smaller WM volumes) and to DPM (linking exposure in the highest quartile with smaller GM volumes) were not significantly modified by existing cardiovascular diseases, diabetes mellitus, obesity, or measured white blood cell (WBC) count. MRI measurements of the structural brain showed no differences in small-vessel ischemic diseases (SVID) in participants with varying levels of cumulative exposure to PM₂.₅ (1999-2006) or DPM (1996-2005), and no associations between PM exposures and SVID volumes were noted for total brain, association brain area, GM, or WM. For neurocognitive outcomes followed until 2007, the investigators found no evidence for increased risk of MCI/dementia associated with long-term PM exposures. Although exploratory secondary analyses showed different patterns of associations linking PM exposures separately with MCI and dementia, none of the -results was statistically significant. A similar lack of associations between PM exposures and MCI/dementia was found across the subgroups, with no strong indications for effect modification by cardiovascular diseases, diabetes mellitus, obesity, or WBC count. Conclusions The investigators concluded that their study findings support the hypothesized brain-structure neurotoxicity associated with PM exposures, a result that is in line with emerging neurotoxicological data. However, the investigators found no evidence of increased risk of MCI/dementia associated with long-term PM exposures. To better test the neurovascular effect hypothesis in PM-associated neurotoxic effects on the aging brain, the investigators recommend that future studies pay greater attention to selecting optimal populations with repeated measurements of cerebrovascular damage and address the possibility of selection biases accordingly. To further investigate the long-term consequence of brain-structure neurotoxicity on pathological brain aging, future researchers should take the pathobiologically heterogeneous neurocognitive outcomes into account and design adequately powered prospective cohort studies with improved exposure estimation and valid outcome ascertainment to assess whether PM-associated neurotoxicity increases the risks of pathological brain aging, including MCI and dementia.
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Affiliation(s)
- J-C Chen
- Keck School of Medicine, University of Southern California, Los Angeles
| | - X Wang
- Keck School of Medicine, University of Southern California, Los Angeles
| | - M Serre
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - S Cen
- Keck School of Medicine, University of Southern California, Los Angeles
| | - M Franklin
- Keck School of Medicine, University of Southern California, Los Angeles
| | - M Espeland
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Bourdrel T, Bind MA, Béjot Y, Morel O, Argacha JF. Cardiovascular effects of air pollution. Arch Cardiovasc Dis 2017; 110:634-642. [PMID: 28735838 DOI: 10.1016/j.acvd.2017.05.003] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/15/2017] [Accepted: 05/17/2017] [Indexed: 12/31/2022]
Abstract
Air pollution is composed of particulate matter (PM) and gaseous pollutants, such as nitrogen dioxide and ozone. PM is classified according to size into coarse particles (PM10), fine particles (PM2.5) and ultrafine particles. We aim to provide an original review of the scientific evidence from epidemiological and experimental studies examining the cardiovascular effects of outdoor air pollution. Pooled epidemiological studies reported that a 10μg/m3 increase in long-term exposure to PM2.5 was associated with an 11% increase in cardiovascular mortality. Increased cardiovascular mortality was also related to long-term and short-term exposure to nitrogen dioxide. Exposure to air pollution and road traffic was associated with an increased risk of arteriosclerosis, as shown by premature aortic and coronary calcification. Short-term increases in air pollution were associated with an increased risk of myocardial infarction, stroke and acute heart failure. The risk was increased even when pollutant concentrations were below European standards. Reinforcing the evidence from epidemiological studies, numerous experimental studies demonstrated that air pollution promotes a systemic vascular oxidative stress reaction. Radical oxygen species induce endothelial dysfunction, monocyte activation and some proatherogenic changes in lipoproteins, which initiate plaque formation. Furthermore, air pollution favours thrombus formation, because of an increase in coagulation factors and platelet activation. Experimental studies also indicate that some pollutants have more harmful cardiovascular effects, such as combustion-derived PM2.5 and ultrafine particles. Air pollution is a major contributor to cardiovascular diseases. Promotion of safer air quality appears to be a new challenge in cardiovascular disease prevention.
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Affiliation(s)
- Thomas Bourdrel
- Radiology Department, Imaging Medical Centre Étoile-Neudorf, 67100 Strasbourg, France.
| | - Marie-Abèle Bind
- Department of Statistics, Harvard University Faculty of Arts and Sciences, MA 02138-2901 Cambridge, USA
| | - Yannick Béjot
- Department of Neurology, Dijon Stroke Registry, University Hospital and Medical School of Dijon, University of Burgundy, 21079 Dijon cedex, France
| | - Olivier Morel
- Cardiology Department, Nouvel Hôpital Civil, University of Strasbourg, 67000 Strasbourg, France
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Matsuo R, Michikawa T, Ueda K, Ago T, Nitta H, Kitazono T, Kamouchi M. Short-Term Exposure to Fine Particulate Matter and Risk of Ischemic Stroke. Stroke 2016; 47:3032-3034. [PMID: 27811333 DOI: 10.1161/strokeaha.116.015303] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 08/31/2016] [Accepted: 09/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE There is a strong association between ambient concentrations of particulate matter (PM) and cardiovascular disease. However, it remains unclear whether acute exposure to fine PM (PM2.5) triggers ischemic stroke events and whether the timing of exposure is associated with stroke risk. We, therefore, examined the association between ambient PM2.5 and occurrence of ischemic stroke. METHODS We analyzed data for 6885 ischemic stroke patients from a multicenter hospital-based stroke registry in Japan who were previously independent and hospitalized within 24 hours of stroke onset. Time of symptom onset was confirmed, and the association between PM (suspended PM and PM2.5) and occurrence of ischemic stroke was analyzed by time-stratified case-crossover analysis. RESULTS Ambient PM2.5 and suspended PM at lag days 0 to 1 were associated with subsequent occurrence of ischemic stroke (ambient temperature-adjusted odds ratio [95% confidence interval] per 10 μg/m3: suspended PM, 1.02 [1.00-1.05]; PM2.5, 1.03 [1.00-1.06]). In contrast, ambient suspended PM and PM2.5 at lag days 2 to 3 or 4 to 6 showed no significant association with stroke occurrence. The association between PM2.5 at lag days 0 to 1 and ischemic stroke was maintained after adjusting for other air pollutants (nitrogen dioxide, photochemical oxidants, or sulfur dioxide) or influenza epidemics and was evident in the cold season. CONCLUSIONS These findings suggest that short-term exposure to PM2.5 within 1 day before onset is associated with the subsequent occurrence of ischemic stroke.
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Affiliation(s)
- Ryu Matsuo
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.)
| | - Takehiro Michikawa
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.)
| | - Kayo Ueda
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.)
| | - Tetsuro Ago
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.)
| | - Hiroshi Nitta
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.)
| | - Takanari Kitazono
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.)
| | - Masahiro Kamouchi
- From the Department of Health Care Administration and Management (R.M., M.K.), Department of Medicine and Clinical Science (R.M., T.A., T.K.), and Center for Cohort Studies (T.K., M.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Environmental Epidemiology Section, Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan (T.M., K.U., H.N.); and Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Japan (K.U.).
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Cascio WE. Proposed pathophysiologic framework to explain some excess cardiovascular death associated with ambient air particle pollution: Insights for public health translation. Biochim Biophys Acta Gen Subj 2016; 1860:2869-79. [PMID: 27451957 DOI: 10.1016/j.bbagen.2016.07.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 02/08/2023]
Abstract
The paper proposes a pathophysiologic framework to explain the well-established epidemiological association between exposure to ambient air particle pollution and premature cardiovascular mortality, and offers insights into public health solutions that extend beyond regulatory environmental protections to actions that can be taken by individuals, public health officials, healthcare professionals, city and regional planners, local and state governmental officials and all those who possess the capacity to improve cardiovascular health within the population. The foundation of the framework rests on the contribution of traditional cardiovascular risk factors acting alone and in concert with long-term exposures to air pollutants to create a conditional susceptibility for clinical vascular events, such as myocardial ischemia and infarction; stroke and lethal ventricular arrhythmias. The conceptual framework focuses on the fact that short-term exposures to ambient air particulate matter (PM) are associated with vascular thrombosis (acute coronary syndrome, stroke, deep venous thrombosis, and pulmonary embolism) and electrical dysfunction (ventricular arrhythmia); and that individuals having prevalent heart disease are at greatest risk. Moreover, exposure is concomitant with changes in autonomic nervous system balance, systemic inflammation, and prothrombotic/anti-thrombotic and profibrinolytic-antifibrinolytic balance. Thus, a comprehensive solution to the problem of premature mortality triggered by air pollutant exposure will require compliance with regulations to control ambient air particle pollution levels, minimize exposures to air pollutants, as well as a concerted effort to decrease the number of people at-risk for serious clinical cardiovascular events triggered by air pollutant exposure by improving the overall state of cardiovascular health in the population. This article is part of a Special Issue entitled Air Pollution, edited by Wenjun Ding, Andrew J. Ghio and Weidong Wu.
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Affiliation(s)
- Wayne E Cascio
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Chapel Hill, NC, USA.
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31
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Sheehan MC, Lam J, Navas-Acien A, Chang HH. Ambient air pollution epidemiology systematic review and meta-analysis: A review of reporting and methods practice. ENVIRONMENT INTERNATIONAL 2016; 92-93:647-56. [PMID: 26923218 DOI: 10.1016/j.envint.2016.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/12/2016] [Accepted: 02/11/2016] [Indexed: 05/22/2023]
Abstract
BACKGROUND Systematic review and meta-analysis (SRMA) are increasingly employed in environmental health (EH) epidemiology and, provided methods and reporting are sound, contribute to translating science evidence to policy. Ambient air pollution (AAP) is both among the leading environmental causes of mortality and morbidity worldwide, and of growing policy relevance due to health co-benefits associated with greenhouse gas emissions reductions. OBJECTIVES We reviewed the published AAP SRMA literature (2009 to mid-2015), and evaluated the consistency of methods, reporting and evidence evaluation using a 22-point questionnaire developed from available best-practice consensus guidelines and emerging recommendations for EH. Our goal was to contribute to enhancing the utility of AAP SRMAs to EH policy. RESULTS AND DISCUSSION We identified 43 studies that used both SR and MA techniques to examine associations between the AAPs PM2.5, PM10, NO2, SO2, CO and O3, and various health outcomes. On average AAP SRMAs partially or thoroughly addressed 16 of 22 questions (range 10-21), and thoroughly addressed 13 of 22 (range 5-19). We found evidence of an improving trend over the period. However, we observed some weaknesses, particularly infrequent formal reviews of underlying study quality and risk-of-bias that correlated with lower frequency of thorough evaluation for key study quality parameters. Several other areas for enhanced reporting are highlighted. CONCLUSIONS The AAP SRMA literature, in particular more recent studies, indicate broad concordance with current and emerging best practice guidance. Development of an EH-specific SRMA consensus statement including a risk-of-bias evaluation tool, would be a contribution to enhanced reliability and robustness as well as policy utility.
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Affiliation(s)
- Mary C Sheehan
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, United States.
| | - Juleen Lam
- Program on Reproductive Health and the Environment, Department of OB/GYN & RS, University of California, San Francisco, United States.
| | - Ana Navas-Acien
- Environmental Health Sciences Department, Johns Hopkins Bloomberg School of Public Health, United States.
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Emory University, United States.
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Buonocore JJ, Lambert KF, Burtraw D, Sekar S, Driscoll CT. An Analysis of Costs and Health Co-Benefits for a U.S. Power Plant Carbon Standard. PLoS One 2016; 11:e0156308. [PMID: 27270222 PMCID: PMC4896433 DOI: 10.1371/journal.pone.0156308] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/12/2016] [Indexed: 11/18/2022] Open
Abstract
Reducing carbon dioxide (CO2) emissions from power plants can have important "co-benefits" for public health by reducing emissions of air pollutants. Here, we examine the costs and health co-benefits, in monetary terms, for a policy that resembles the U.S. Environmental Protection Agency's Clean Power Plan. We then examine the spatial distribution of the co-benefits and costs, and the implications of a range of cost assumptions in the implementation year of 2020. Nationwide, the total health co-benefits were $29 billion 2010 USD (95% CI: $2.3 to $68 billion), and net co-benefits under our central cost case were $12 billion (95% CI: -$15 billion to $51 billion). Net co-benefits for this case in the implementation year were positive in 10 of the 14 regions studied. The results for our central case suggest that all but one region should experience positive net benefits within 5 years after implementation.
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Affiliation(s)
- Jonathan J. Buonocore
- Center for Health and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, 02215, United States of America
| | - Kathleen F. Lambert
- Harvard Forest, Harvard University, Petersham, Massachusetts, 01366, United States of America
| | - Dallas Burtraw
- Resources for the Future, Washington, District of Columbia, 20036, United States of America
| | - Samantha Sekar
- Resources for the Future, Washington, District of Columbia, 20036, United States of America
| | - Charles T. Driscoll
- Department of Civil and Environmental Engineering, Syracuse University, Syracuse, New York, 13244, United States of America
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Stroke Damage Is Exacerbated by Nano-Size Particulate Matter in a Mouse Model. PLoS One 2016; 11:e0153376. [PMID: 27071057 PMCID: PMC4829199 DOI: 10.1371/journal.pone.0153376] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 03/29/2016] [Indexed: 11/19/2022] Open
Abstract
This study examines the effects of nano-size particulate matter (nPM) exposure in the setting of murine reperfused stroke. Particulate matter is a potent source of inflammation and oxidative stress. These processes are known to influence stroke progression through recruitment of marginally viable penumbral tissue into the ischemic core. nPM was collected in an urban area in central Los Angeles, impacted primarily by traffic emissions. Re-aerosolized nPM or filtered air was then administered to mice through whole body exposure chambers for forty-five cumulative hours. Exposed mice then underwent middle cerebral artery occlusion/ reperfusion. Following cerebral ischemia/ reperfusion, mice exposed to nPM exhibited significantly larger infarct volumes and less favorable neurological deficit scores when compared to mice exposed to filtered air. Mice exposed to nPM also demonstrated increases in markers of inflammation and oxidative stress in the region of the ischemic core. The findings suggest a detrimental effect of urban airborne particulate matter exposure in the setting of acute ischemic stroke.
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Huang F, Li X, Wang C, Xu Q, Wang W, Luo Y, Tao L, Gao Q, Guo J, Chen S, Cao K, Liu L, Gao N, Liu X, Yang K, Yan A, Guo X. PM2.5 Spatiotemporal Variations and the Relationship with Meteorological Factors during 2013-2014 in Beijing, China. PLoS One 2015; 10:e0141642. [PMID: 26528542 PMCID: PMC4631325 DOI: 10.1371/journal.pone.0141642] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/12/2015] [Indexed: 02/06/2023] Open
Abstract
Objective Limited information is available regarding spatiotemporal variations of particles with median aerodynamic diameter < 2.5 μm (PM2.5) at high resolutions, and their relationships with meteorological factors in Beijing, China. This study aimed to detect spatiotemporal change patterns of PM2.5 from August 2013 to July 2014 in Beijing, and to assess the relationship between PM2.5 and meteorological factors. Methods Daily and hourly PM2.5 data from the Beijing Environmental Protection Bureau (BJEPB) were analyzed separately. Ordinary kriging (OK) interpolation, time-series graphs, Spearman correlation coefficient and coefficient of divergence (COD) were used to describe the spatiotemporal variations of PM2.5. The Kruskal-Wallis H test, Bonferroni correction, and Mann-Whitney U test were used to assess differences in PM2.5 levels associated with spatial and temporal factors including season, region, daytime and day of week. Relationships between daily PM2.5 and meteorological variables were analyzed using the generalized additive mixed model (GAMM). Results Annual mean and median of PM2.5 concentrations were 88.07 μg/m3 and 71.00 μg/m3, respectively, from August 2013 to July 2014. PM2.5 concentration was significantly higher in winter (P < 0.0083) and in the southern part of the city (P < 0.0167). Day to day variation of PM2.5 showed a long-term trend of fluctuations, with 2–6 peaks each month. PM2.5 concentration was significantly higher in the night than day (P < 0.0167). Meteorological factors were associated with daily PM2.5 concentration using the GAMM model (R2 = 0.59, AIC = 7373.84). Conclusion PM2.5 pollution in Beijing shows strong spatiotemporal variations. Meteorological factors influence the PM2.5 concentration with certain patterns. Generally, prior day wind speed, sunlight hours and precipitation are negatively correlated with PM2.5, whereas relative humidity and air pressure three days earlier are positively correlated with PM2.5.
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Affiliation(s)
- Fangfang Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xia Li
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Chao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Qin Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Wei Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- School of Medical Sciences, Edith Cowan University, Perth, Australia
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Lixin Tao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Qi Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Jin Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Sipeng Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Kai Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Long Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Ni Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xiangtong Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Kun Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Aoshuang Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Science and Technology Commission, Beijing, China
- * E-mail: (ASY); (XHG)
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- * E-mail: (ASY); (XHG)
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