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Rogerson C, Owora A, Tu W, Mendonca E. The influence of social and environmental determinants of health on hospitalizations for pediatric asthma. J Asthma 2024; 61:453-462. [PMID: 38010826 DOI: 10.1080/02770903.2023.2288323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Asthma is the most common chronic disease of childhood, and has several social, environmental, and demographic factors potentially influential to its disease burden. This study sought to determine the influence of these factors on hospital admissions and readmissions for pediatric asthma. METHODS This was a retrospective cohort study using data from the Indiana Network for Patient Care, a state-wide health information exchange in the United States. Study participants were children 2-18 years old admitted to the hospital with a respiratory diagnostic code between 2010 and 2021. Clinical variables were obtained from electronic health record data, and social and environmental determinants of health data were obtained from the Indiana Social Assets and Vulnerabilities Indicators using geocoding systems. Negative binomial models were used to examine community level social and environmental risk factors modifying the relationship between patient characteristics and the risk of asthma-related hospitalizations and 30-day readmissions. RESULTS The study sample included 25,063 patients with an average follow-up of 9 (SD = 5) years. Of these, there were 17,816 asthma-related admissions. There were a total of 1,037 asthma-related 30-day readmissions, with an incidence rate of readmissions relative to total visits of 0.028 per person-year. A high social vulnerability index (SVI) was associated with an increased rate of hospital admissions (Proportion attributable ratio: 1.09, 95%CI (1.03,1.15), p < 0.05). No environmental determinants of health were significantly associated with hospitalization rate. CONCLUSION High SVI was significantly associated with increased risk of total hospital admissions for pediatric asthma.
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Affiliation(s)
- Colin Rogerson
- Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Arthur Owora
- Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Wanzhu Tu
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eneida Mendonca
- Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
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2
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Kannoth S, Chung SE, Tamakloe KD, Albrecht SS, Azan A, Chambers EC, Sheffield PE, Thompson A, Woo Baidal JA, Lovinsky-Desir S, Stingone JA. Neighborhood environmental vulnerability and pediatric asthma morbidity in US metropolitan areas. J Allergy Clin Immunol 2023; 152:378-385.e2. [PMID: 36990323 PMCID: PMC10524145 DOI: 10.1016/j.jaci.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Research suggests demographic, economic, residential, and health-related factors influence vulnerability to environmental exposures. Greater environmental vulnerability may exacerbate environmentally related health outcomes. We developed a neighborhood environmental vulnerability index (NEVI) to operationalize environmental vulnerability on a neighborhood level. OBJECTIVE We explored the relationship between NEVI and pediatric asthma emergency department (ED) visits (2014-19) in 3 US metropolitan areas: Los Angeles County, Calif; Fulton County, Ga; and New York City, NY. METHODS We performed separate linear regression analyses examining the association between overall NEVI score and domain-specific NEVI scores (demographic, economic, residential, health status) with pediatric asthma ED visits (per 10,000) across each area. RESULTS Linear regression analyses suggest that higher overall and domain-specific NEVI scores were associated with higher annual pediatric asthma ED visits. Adjusted R2 values suggest that overall NEVI scores explained at least 40% of the variance in pediatric asthma ED visits. Overall NEVI scores explained more of the variance in pediatric asthma ED visits in Fulton County. NEVI scores for the demographic, economic, and health status domains explained more of the variance in pediatric asthma ED visits in each area compared to the NEVI score for the residential domain. CONCLUSION Greater neighborhood environmental vulnerability was associated with greater pediatric asthma ED visits in each area. The relationship differed in effect size and variance explained across the areas. Future studies can use NEVI to identify populations in need of greater resources to mitigate the severity of environmentally related outcomes, such as pediatric asthma.
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Affiliation(s)
- Sneha Kannoth
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY.
| | - Sarah E Chung
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Kelvin D Tamakloe
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Sandra S Albrecht
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Alexander Azan
- Department of Population Health, New York University Langone Health, New York City, NY
| | - Earle C Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Azure Thompson
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Jennifer A Woo Baidal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY
| | - Jeanette A Stingone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
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3
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Song M, Hwang S, Son E, Yeo HJ, Cho WH, Kim TW, Kim K, Lee D, Kim YH. Geographical Differences of Risk of Asthma and Allergic Rhinitis according to Urban/Rural Area: a Systematic Review and Meta-analysis of Cohort Studies. J Urban Health 2023:10.1007/s11524-023-00735-w. [PMID: 37191813 DOI: 10.1007/s11524-023-00735-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/17/2023]
Abstract
Several studies have demonstrated an association between the risk asthma/allergic rhinitis and the environment. However, to date, no systematic review or meta-analysis has investigated these factors. We conducted a systematic review and meta-analysis to assess the association between urban/rural living and the risk of asthma and allergic rhinitis. We searched the Embase and Medline databases for relevant articles and included only cohort studies to observe the effects of time-lapse geographical differences. Papers containing information on rural/urban residence and respiratory allergic diseases were eligible for inclusion. We calculated the relative risk (RR) and 95% confidence interval (CI) using a 2 × 2 contingency table and used random effects to pool data. Our database search yielded 8388 records, of which 14 studies involving 50,100,913 participants were finally included. The risk of asthma was higher in urban areas compared to rural areas (RR, 1.27; 95% CI, 1.12-1.44, p < 0.001), but not for the risk of allergic rhinitis (RR, 1.17; 95% CI, 0.87-1.59, p = 0.30). The risk of asthma in urban areas compared to rural areas was higher in the 0-6 years and 0-18 years age groups, with RRs of 1.21 (95% CI, 1.01-1.46, p = 0.04) and 1.35 (95% CI, 1.12-1.63, p = 0.002), respectively. However, there was no significant difference in the risk of asthma between urban and rural areas for children aged 0-2 years, with a RR of 3.10 (95% CI, 0.44-21.56, p = 0.25). Our study provides epidemiological evidence for an association between allergic respiratory diseases, especially asthma, and urban/rural living. Future research should focus on identifying the factors associated with asthma in children living in urban areas. The review was registered in PROSPERO (CRD42021249578).
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Affiliation(s)
- Mincheol Song
- Department of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Seohyeon Hwang
- Department of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Eunjeong Son
- Division of Respiratory and Allergy, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hye Ju Yeo
- Division of Respiratory and Allergy, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Woo Hyun Cho
- Division of Respiratory and Allergy, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Tae Woo Kim
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Kihun Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, Republic of Korea.
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, Republic of Korea.
| | - Dongjun Lee
- Department of Convergence Medicine, School of Medicine, Pusan National University, Yangsan, 50612, Republic of Korea.
| | - Yun Hak Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan, Republic of Korea.
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan, Republic of Korea.
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4
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Maio S, Fasola S, Marcon A, Angino A, Baldacci S, Bilò MB, Bono R, La Grutta S, Marchetti P, Sarno G, Squillacioti G, Stanisci I, Pirina P, Tagliaferro S, Verlato G, Villani S, Gariazzo C, Stafoggia M, Viegi G. Relationship of long-term air pollution exposure with asthma and rhinitis in Italy: an innovative multipollutant approach. ENVIRONMENTAL RESEARCH 2023; 224:115455. [PMID: 36791835 DOI: 10.1016/j.envres.2023.115455] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND air pollution is a complex mixture; novel multipollutant approaches could help understanding the health effects of multiple concomitant exposures to air pollutants. AIM to assess the relationship of long-term air pollution exposure with the prevalence of respiratory/allergic symptoms and diseases in an Italian multicenter study using single and multipollutant approaches. METHODS 14420 adults living in 6 Italian cities (Ancona, Pavia, Pisa, Sassari, Turin, Verona) were investigated in 2005-2011 within 11 different study cohorts. Questionnaire information about risk factors and health outcomes was collected. Machine learning derived mean annual concentrations of PM10, PM2.5, NO2 and mean summer concentrations of O3 (μg/m3) at residential level (1-km resolution) were used for the period 2013-2015. The associations between the four pollutants and respiratory/allergic symptoms/diseases were assessed using two approaches: a) logistic regression models (single-pollutant models), b) principal component logistic regression models (multipollutant models). All the models were adjusted for age, sex, education level, smoking habits, season of interview, climatic index and included a random intercept for cohorts. RESULTS the three-year average (± standard deviation) pollutants concentrations at residential level were: 20.3 ± 6.8 μg/m3 for PM2.5, 29.2 ± 7.0 μg/m3 for PM10, 28.0 ± 11.2 μg/m3 for NO2, and 70.9 ± 4.3 μg/m3 for summer O3. Through the multipollutant models the following associations emerged: PM10 and PM2.5 were related to 14-25% increased odds of rhinitis, 23-34% of asthma and 30-33% of night awakening; NO2 was related to 6-9% increased odds of rhinitis, 7-8% of asthma and 12% of night awakening; O3 was associated with 37% increased odds of asthma attacks. Overall, the Odds Ratios estimated through the multipollutant models were attenuated when compared to those of the single-pollutant models. CONCLUSIONS this study enabled to obtain new information about the health effects of air pollution on respiratory/allergic outcomes in adults, applying innovative methods for exposure assessment and multipollutant analyses.
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Affiliation(s)
- Sara Maio
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.
| | - Salvatore Fasola
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Anna Angino
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Sandra Baldacci
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Maria Beatrice Bilò
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy; Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Torino, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
| | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giuseppe Sarno
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Giulia Squillacioti
- Department of Public Health and Pediatrics, University of Turin, Torino, Italy
| | - Ilaria Stanisci
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Pietro Pirina
- Respiratory Unit, Sassari University, Sassari, Italy
| | - Sofia Tagliaferro
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simona Villani
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Claudio Gariazzo
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Roma, Italy
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | - Giovanni Viegi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
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5
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Juber NF, Waits A, Dlamini LP, Nguyen T, Masango BZ. Associations between pediatric asthma and age at menarche: evidence from the Indonesian Family Life Survey. J Asthma 2023; 60:105-114. [PMID: 35034545 DOI: 10.1080/02770903.2022.2030750] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To examine the association between pediatric asthma and age at menarche, and to assess whether early life factors modify the association. METHODS This is a retrospective cross-sectional study using the Indonesian Family Life Survey Fifth Wave which had a total of 11 822 females aged 15-57 years to evaluate whether those with pediatric asthma were associated with earlier menarche, compared to females without asthma. We performed a weighted linear regression model adjusting for age, urbanicity, parental smoking, infectious disease history during childhood, childhood socioeconomic status, and health status during childhood. We also performed analyses by age at asthma diagnosis, interval length between asthma diagnosis and menarche, urbanicity, parental smoking, and infectious disease history during childhood. RESULTS In the adjusted model, females with pediatric asthma had an earlier average age at menarche by 5.2 months and those diagnosed with asthma at 5-8 years of age had the fastest acceleration by 14.9 months. The significant association persisted among those with 0-5 years interval between asthma diagnosis and menarche, who resided in urban areas, and those without infectious disease history during childhood. CONCLUSIONS Our findings showed that females with pediatric asthma were associated with an earlier age at menarche, and some early life factors modified the association. Better asthma management with more targeted strategies at those at risk of earlier menarche may improve the reproductive and future health of children with asthma. Future studies to elucidate the mechanisms between pediatric asthma and age at menarche are warranted.
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Affiliation(s)
- Nirmin F Juber
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, UAE
| | - Alexander Waits
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Tao Yuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | | | - Tan Nguyen
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Bongani Zakhele Masango
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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6
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Zhou Q, Kang SL, Lin X, Zhang XY. Impact of air pollutants on hospital visits for pediatric asthma in Fuzhou city, southeast China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:58664-58674. [PMID: 35366721 DOI: 10.1007/s11356-022-19928-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
Rapid social development in China has resulted in severe air pollution and adverse impacts on people's health. Although studies have been conducted on the relationship between exposure to air pollutants and asthma exacerbation, most studies were performed in relatively heavily polluted areas, while little is known about the effect of air pollutants in less polluted areas. We assessed the effects of air pollutants on the risk of asthma-related outpatient and emergency visits of infants and children aged from 0 to 13 years during 2018 to 2020 in Fuzhou city, southeast China. Data of six air pollutants: sulfur dioxide (SO2), nitrogen dioxides (NO2), carbon monoxide (CO), daily maximum 8-h average ozone (O3-8 h), particulate matter with an aerodynamic diameter ≤ 10 μm (PM10), and particulate matter with an aerodynamic diameter ≤ 2.5 μm (PM2.5), were obtained from the Environmental Protection Administration of Fuzhou. Data of temperature, humidity, and wind speed were provided by the Meteorological Bureau of Fuzhou. Results revealed that on lag day 6, NO2, SO2, and CO were positively associated with the number of outpatient and emergency visits. Among the pollutants, SO2 had the highest effects on both outpatient visits (RR = 1.672, 95%CI 1.545, 1.809) and emergency visits (RR = 1.495, 95%CI 1.241, 1.800), and its effect on outpatient visits was stronger in children aged 0-4 years than in those aged 5-13 years (RR = 2.331 vs. 1.439). In conclusion, SO2 contributes substantially to the adverse effects of air pollutants on pediatric respiratory health in Fuzhou. Younger children were more affected by air pollution than their older counterparts.
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Affiliation(s)
- Quan Zhou
- Fuzhou Center for Disease Control and Prevention, Fuzhou, 350004, Fujian, China
- Fuzhou Center for Disease Control and Prevention affiliated to Fujian Medical University, Fuzhou, China
| | - Shu-Ling Kang
- Fuzhou Center for Disease Control and Prevention, Fuzhou, 350004, Fujian, China
- Fuzhou Center for Disease Control and Prevention affiliated to Fujian Medical University, Fuzhou, China
| | - Xin Lin
- Fuzhou Center for Disease Control and Prevention, Fuzhou, 350004, Fujian, China.
- Fuzhou Center for Disease Control and Prevention affiliated to Fujian Medical University, Fuzhou, China.
| | - Xiao-Yang Zhang
- Fuzhou Center for Disease Control and Prevention, Fuzhou, 350004, Fujian, China.
- Fuzhou Center for Disease Control and Prevention affiliated to Fujian Medical University, Fuzhou, China.
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7
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Maio S, Baldacci S, Tagliaferro S, Angino A, Parmes E, Pärkkä J, Pesce G, Maesano CN, Annesi-Maesano I, Viegi G. Urban grey spaces are associated with increased allergy in the general population. ENVIRONMENTAL RESEARCH 2022; 206:112428. [PMID: 34838570 DOI: 10.1016/j.envres.2021.112428] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/27/2021] [Accepted: 11/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND the built environment in urban areas may have side effects on children's respiratory health, whilst less is known for adulthood. AIM to assess the association between increasing exposure to grey spaces and allergic status in an adult general population sample. METHODS 2070 subjects (age range 15-84 yrs), living in Pisa/Cascina, Italy, were investigated in 1991-93 through a questionnaire on health status and risk factors, skin prick test (SPT), serum Immunoglobulins E (IgE), and serum antibodies to benzo(a)pyrene diol epoxide (BPDE)-DNA adducts. Land-cover exposure within a 1000 m buffer from each subject's home address was assessed through the CORINE Land Cover program (CLC 1990) within the FP7/HEALS project (2013-2018). Participants' residential addresses were geocoded and the proportion of surrounding grey spaces was calculated. Through logistic regression models, adjusting for potential confounding factors, the effect of a 10% increase in grey spaces exposure on allergic biomarkers/conditions was assessed; the relationship with serum antibodies to BPDE-DNA adducts positivity was also analyzed. RESULTS A 10% increase in grey spaces coverage was associated with a higher probability of having SPT positivity (OR 1.07, 95% CI 1.02-1.13), seasonal SPT positivity (OR 1.12, 1.05-1.19), polysensitization (OR 1.11, 1.04-1.19), allergic rhinitis (OR 1.10, 1.04-1.17), co-presence of SPT positivity and asthma/allergic rhinitis (OR 1.16, 1.08-1.25), asthma/allergic rhinitis (OR 1.06, 1.00-1.12), presence of serum antibodies to BPDE-DNA adducts positivity (OR 1.07, 1.01-1.14). CONCLUSIONS grey spaces have adverse effects on allergic status and are related to a biomarker of polycyclic aromatic hydrocarbons exposure in adulthood. Thus, they may be used as a proxy of urban environmental exposure.
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Affiliation(s)
- S Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
| | - S Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - S Tagliaferro
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - A Angino
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - E Parmes
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - J Pärkkä
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - G Pesce
- INSERM, Paris-Saclay University, UVSQ, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
| | - C N Maesano
- INSERM, Montpellier University, Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
| | - I Annesi-Maesano
- INSERM, Montpellier University, Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy; CNR Institute for Research and Biomedical Innovation, Palermo, Italy
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8
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Paciência I, Moreira A, Cavaleiro Rufo J, Santos AC, Barros H, Ribeiro AI. Association between Land Use Mix and Respiratory Symptoms and Asthma in Children from the Generation XXI Birth Cohort. J Urban Health 2022; 99:218-230. [PMID: 35066785 PMCID: PMC9033904 DOI: 10.1007/s11524-021-00604-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
Land use mix (LUM) in the neighbourhoods has been associated with healthier lifestyles. However, less is known about the association between LUM and health outcomes, namely during childhood. The objective of this study was to evaluate the association between different LUM indexes for Porto Metropolitan Area and asthma and respiratory symptoms in children. A cross-sectional analysis was performed involving 6260 children enrolled in Generation XXI. Land use around the child's residence was assessed with the Portuguese official map of land cover using a GIS. Generalized linear mixed-effects models were fitted to estimate the association between LUM and respiratory symptoms and asthma at 7 years of age. Adjusted associations were quantified using odds ratio (OR) and 95% confidence interval (95% CI). After adjustment, LUM was associated with a lower odds of wheezing in the last 12 months [OR (95% CI) = 0.37 (0.15; 0.93) using Shannon's Evenness Index within 500 m; and OR = 0.93 (0.89; 0.98) using the number of different land use types within 250 m]. Living in neighbourhoods with high LUM has a protective effect on current wheezing symptoms. Our results highlight the association between LUM and respiratory symptoms among children, suggesting that public health considerations should be incorporated in land use decision-making.
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Affiliation(s)
- Inês Paciência
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal. .,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal.
| | - André Moreira
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal.,Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - João Cavaleiro Rufo
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
| | - Henrique Barros
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
| | - Ana Isabel Ribeiro
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-600, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600, Porto, Portugal.,Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200- 319, Porto, Portugal
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9
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Bushong A, McKeon T, Regina Boland M, Field J. Publicly available data reveals association between asthma hospitalizations and unconventional natural gas development in Pennsylvania. PLoS One 2022; 17:e0265513. [PMID: 35358226 PMCID: PMC8970380 DOI: 10.1371/journal.pone.0265513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/02/2022] [Indexed: 11/20/2022] Open
Abstract
Since the early 2000s, unconventional natural gas development (UNGD) has rapidly grown throughout Pennsylvania. UNGD extracts natural gas using a relatively new method known as hydraulic fracturing (HF). Here we addressed the association of HF with asthma Hospitalization Admission Rates (HAR) using publicly available data. Using public county-level data from the Pennsylvania Department of Health (PA-DOH) and the Pennsylvania Department of Environmental Protection for the years 2001-2014, we constructed regression models to study the previously observed association between asthma exacerbation and HF. After considering multicollinearity, county-level demographics and area-level covariables were included to account for known asthma risk factors. We found a significant positive association between the asthma HAR and annual well density for all the counties in the state (3% increase in HAR attributable to HF, p<0.001). For a sensitivity analysis, we excluded urban counties (urban counties have higher asthma exacerbations) and focused on rural counties for the years 2005-2014 and found a significant association (3.31% increase in HAR attributable to HF in rural counties, p<0.001). An even stronger association was found between asthma hospitalization admission rates (HAR) and PM2.5 levels (7.52% increase in HAR attributable to PM2.5, p<0.001). As expected, asthma HAR was significantly higher in urban compared to rural counties and showed a significant racial disparity. We conclude that publicly available data at the county-level supports an association between an increase in asthma HAR and UNGD in rural counties in Pennsylvania.
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Affiliation(s)
- Anna Bushong
- Biology Program, Centre College, Danville, KY, United States of America
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA, United States of America
| | - Thomas McKeon
- Center of Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA, United States of America
| | - Mary Regina Boland
- Center of Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine
| | - Jeffrey Field
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA, United States of America
- Center of Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, PA, United States of America
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