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Wang W, Gulliver J, Beevers S, Freni Sterrantino A, Davies B, Atkinson RW, Fecht D. Short-Term Nitrogen Dioxide Exposure and Emergency Hospital Admissions for Asthma in Children: A Case-Crossover Analysis in England. J Asthma Allergy 2024; 17:349-359. [PMID: 38623450 PMCID: PMC11016460 DOI: 10.2147/jaa.s448600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/12/2024] [Indexed: 04/17/2024] Open
Abstract
Background There is an increasing body of evidence associating short-term ambient nitrogen dioxide (NO2) exposure with asthma-related hospital admissions in children. However, most studies have relied on temporally resolved exposure information, potentially ignoring the spatial variability of NO2. We aimed to investigate how daily NO2 estimates from a highly resolved spatio-temporal model are associated with the risk of emergency hospital admission for asthma in children in England. Methods We conducted a time-stratified case-crossover study including 111,766 emergency hospital admissions for asthma in children (aged 0-14 years) between 1st January 2011 and 31st December 2015 in England. Daily NO2 levels were predicted at the patients' place of residence using spatio-temporal models by combining land use data and chemical transport model estimates. Conditional logistic regression models were used to obtain the odds ratios (OR) and confidence intervals (CI) after adjusting for temperature, relative humidity, bank holidays, and influenza rates. The effect modifications by age, sex, season, area-level income deprivation, and region were explored in stratified analyses. Results For each 10 µg/m³ increase in NO2 exposure, we observed an 8% increase in asthma-related emergency admissions using a five-day moving NO2 average (mean lag 0-4) (OR 1.08, 95% CI 1.06-1.10). In the stratified analysis, we found larger effect sizes for male (OR 1.10, 95% CI 1.07-1.12) and during the cold season (OR 1.10, 95% CI 1.08-1.12). The effect estimates varied slightly by age group, area-level income deprivation, and region. Significance Short-term exposure to NO2 was significantly associated with an increased risk of asthma emergency admissions among children in England. Future guidance and policies need to consider reflecting certain proven modifications, such as using season-specific countermeasures for air pollution control, to protect the at-risk population.
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Affiliation(s)
- Weiyi Wang
- UK Small Area Health Statistics Unit, MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health and Care Research Health Protection Research Unit in Chemical and Radiation Threats and Hazards, School of Public Health, Imperial College London, London, UK
| | - John Gulliver
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Sean Beevers
- MRC Centre for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, UK
- National Institute for Health and Care Research Health Protection Research Unit in Environmental Exposures and Health, School of Public Health, Imperial College London, London, UK
| | - Anna Freni Sterrantino
- UK Small Area Health Statistics Unit, MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- The Alan Turing Institute, London, UK
| | - Bethan Davies
- UK Small Area Health Statistics Unit, MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health and Care Research Health Protection Research Unit in Chemical and Radiation Threats and Hazards, School of Public Health, Imperial College London, London, UK
| | - Richard W Atkinson
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Daniela Fecht
- UK Small Area Health Statistics Unit, MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health and Care Research Health Protection Research Unit in Chemical and Radiation Threats and Hazards, School of Public Health, Imperial College London, London, UK
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You J, Liu Y, Dong J, Wang J, Bao H. Ambient carbon monoxide and the risk of cardiovascular disease emergency room visits: a time-series study in Lanzhou, China. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:7621-7636. [PMID: 37395909 DOI: 10.1007/s10653-023-01653-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/07/2023] [Indexed: 07/04/2023]
Abstract
Until now, the epidemiological evidence on the association between short-term exposure to ambient carbon monoxide (CO) and cardiovascular diseases (CVDs) is relatively lacking and controversial. This study aims to examine the relationship between ambient CO and daily emergency room visits (ERVs) for total and cause-specific CVD in Lanzhou, China. A distributed lag nonlinear model was used to examine the association. For every 1 mg/m3 increase in the CO concentration, the relative risks of daily ERVs were 1.041 (95% CI: 1.017, 1.065) for total CVD, 1.065 (95% CI: 1.018, 1.114) for ischemic heart disease (IHD), 1.083 (95% CI: 1.020, 1.149) for heart rhythm disturbances (HRD), 1.062 (95% CI: 1.011, 1.115) for heart failure (HF), and 1.057 (95% CI: 1.017, 1.098) for cerebrovascular diseases (CD). For the two different gender subgroups, the short-term impact of CO on total CVD, IHD, and CD was relatively stronger for the females than for the males, while the opposite was true for HRD and HF. In the age subgroup analyses, the effect of ambient CO on total CVD and IHD appeared to be greater for the age ≥ 65 years group, while the opposite was true for HRD, HF, and CD. The associations for all disease categories were stronger in cold seasons than in warm seasons. We also observed a nearly linear correlation between CO and CVD ERVs. In conclusion, the study showed that exposure to ambient CO may increase the risks of ERVs for total and cause-specific CVD. Besides, CO-ERVs associations may vary by gender and age.
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Affiliation(s)
- Jianhua You
- School of Public Health, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Yaocong Liu
- School of Public Health, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Jiyuan Dong
- School of Public Health, Lanzhou University, Lanzhou, 730000, People's Republic of China.
| | - Jiancheng Wang
- Gansu Provincial Hospital, Lanzhou, 730050, People's Republic of China
| | - Hairong Bao
- Department of Gerontal Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou, 730000, China
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Biagioni B, Cecchi L, D'Amato G, Annesi-Maesano I. Environmental influences on childhood asthma: Climate change. Pediatr Allergy Immunol 2023; 34:e13961. [PMID: 37232282 DOI: 10.1111/pai.13961] [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] [Received: 04/12/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Abstract
Climate change is a key environmental factor for allergic respiratory diseases, especially in childhood. This review describes the influences of climate change on childhood asthma considering the factors acting directly, indirectly and with their amplifying interactions. Recent findings on the direct effects of temperature and weather changes, as well as the influences of climate change on air pollution, allergens, biocontaminants and their interplays, are discussed herein. The review also focusses on the impact of climate change on biodiversity loss and on migration status as a model to study environmental effects on childhood asthma onset and progression. Adaptation and mitigation strategies are urgently needed to prevent further respiratory diseases and human health damage in general, especially in younger and future generations.
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Affiliation(s)
- Benedetta Biagioni
- Allergy and Clinical Immunology Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Lorenzo Cecchi
- Centre of Bioclimatology, University of Florence, Florence, Italy
- SOS Allergy and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Gennaro D'Amato
- Division of Respiratory Diseases and Allergy AORN Cardarelli and University of Naples, Federico II, Naples, Italy
| | - Isabella Annesi-Maesano
- Department of Allergic and Respiratory Diseases, Montpellier University Hospital, Institute Desbrest of Epidemiology and Public Health, University of Montpellier and INSERM, Montpellier, France
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Bailie CR, Ghosh JKC, Kirk MD, Sullivan SG. Effect of ambient PM 2.5 on healthcare utilisation for acute respiratory illness, Melbourne, Victoria, Australia, 2014-2019. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2023; 73:120-132. [PMID: 36376253 DOI: 10.1080/10962247.2022.2146810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
Ambient particulate matter (PM2.5) is an important component of natural and human-generated air pollution and a major contributor to the global burden of disease. Short-term effects of PM2.5 exposure on respiratory illness have been described but most evidence arises from high pollution settings. We used case-crossover methods to estimate effects of outdoor PM2.5 levels on emergency department (ED) presentations and hospital admissions for a range of acute respiratory illnesses and age groups in Melbourne, Australia from 2014-2019, with and without adjustment for other pollutants and weather conditions, using daily and one-week averaged lags. We estimated incidence rate ratios for a 10 μg/m3 increase in 7-day average ambient PM2.5 of 1.043 (95% confidence interval (CI): 1.000-1.089) on ED presentation and 1.013 (95% CI: 0.971-1.056) on hospital admissions for acute respiratory illnesses for patients of any age. We observed distinct temporal patterns in daily lag effect by disease. The largest effects on acute lower respiratory tract infection and asthma were observed in children. Ambient PM2.5 levels rarely exceeded standards in place at the time. Although uncertainty around most point estimates was relatively wide, these findings are most compatible with adverse health effects of ambient PM2.5 at levels below currently established Australian national standards.Implications: Understanding the health impacts of air pollution is important for setting air quality targets, as well as for informing robust health system planning. Adverse effects of exposure to outdoor fine particulate matter on human respiratory health have been consistently described. However, most studies have been done in higher-pollution settings. Further, many studies have assessed health effects in broad categories such as all-cause respiratory mortality or hospitalization, and thus lack the granularity to inform detailed health service planning. Our study aimed to estimate effects of outdoor fine particulate matter on emergency department (ED) presentations and hospital admissions for a range of acute respiratory illnesses and age groups in Melbourne, Australia, a city with relatively good air quality by international comparison. Our study estimated consistent effects on both ED presentations and hospital admissions compatible with distinct patterns of adverse health effects at levels at or below established Australian national (and many international) standards. These results will help to inform both air quality policy and public health policy in similar settings.
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Affiliation(s)
- Christopher R Bailie
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, Australia
| | - Jo Kay C Ghosh
- Heluna Health, City of Industry, Los Angeles County, CA, USA
| | - Martyn D Kirk
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, Australia
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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Nitschke M, Dear KBG, Venugopal K, Lyne KMR, Jersmann HPA, Simon DL, Spurrier N. Association between grass, tree and weed pollen and asthma health outcomes in Adelaide, South Australia: a time series regression analysis. BMJ Open 2022; 12:e066851. [PMID: 36414301 PMCID: PMC9723903 DOI: 10.1136/bmjopen-2022-066851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We aim to establish daily risk estimates of the relationships between grass, tree and weed pollen and asthma health outcomes. DESIGN Time series regression analysis of exposure and health outcomes using interaction by month to determine risk estimates all year round. SETTING Metropolitan Adelaide, South Australia. PARTICIPANTS Health outcomes for asthma are based on 15 years of hospital admissions, 13 years emergency presentations and ambulance callouts. In adults (≥18 years), there were 10 381 hospitalisations, 26 098 emergency department (ED) presentations and 11 799 ambulance callouts and in children (0-17 years), 22 114, 39 813 and 3774, respectively. OUTCOME MEASURES The cumulative effect of 7 day lags was calculated as the sum of the coefficients and reported as incidence rate ratio (IRR) related to an increase in 10 grains of pollen/m3. RESULTS In relation to grass pollen, children and adults were disparate in their timing of health effects. Asthma outcomes in children were positively related to grass pollen in May, and for adults in October. Positive associations with weed pollen in children was seen from February to May across all health outcomes. For adults, weed pollen-related health outcomes were restricted to February. Adults were not affected by tree pollen, while children's asthma morbidity was associated with tree pollen in August and September. In children, IRRs ranged from 1.14 (95% CI 1.06 to 1.21) for ED presentations for tree pollen in August to 1.98 (95% CI 1.06 to 3.72) for weed pollen in February. In adults, IRRs ranged from 1.28 (95% CI 1.01 to 1.62) for weed pollen in February to 1.31 (95% CI 1.08 to 1.57) for grass pollen in October. CONCLUSION Monthly risk assessment indicated that most pollen-related asthma health outcomes in children occur in the colder part of the year, while adults are affected in the warm season. The findings indicate a need for year-round pollen monitoring and related health campaigns to provide effective public health prevention.
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Affiliation(s)
- Monika Nitschke
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | | | - Kamalesh Venugopal
- Prevention and Population Health, Wellbeing SA, Adelaide, South Australia, Australia
| | - Katrina Margaret Rose Lyne
- Health Protection and Licensing Services, SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - Hubertus Paul Anton Jersmann
- Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - David Leslie Simon
- Health Protection and Licensing Services, SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
| | - Nicola Spurrier
- SA Health Department for Health and Wellbeing, Adelaide, South Australia, Australia
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Cheng J, Tong S, Su H, Xu Z. Association between sub-daily exposure to ambient air pollution and risk of asthma exacerbations in Australian children. ENVIRONMENTAL RESEARCH 2022; 212:113556. [PMID: 35618005 DOI: 10.1016/j.envres.2022.113556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
Short-term exposure to ambient air pollution is associated with risk of asthma attacks. We investigated the association between ultra-short-term exposure to air pollution and risk of childhood asthma exacerbations. Hourly data on emergency department visits (EDVs) for asthma in children during 2013-2015 in Brisbane, Australia, were obtained. We undertook time-stratified case-crossover analyses to examine the hourly association between exposure to air pollutants (particles with diameter ≤10 μm (PM10), particles with diameter ≤2.5 μm (PM2.5), ozone (O3), and nitrogen dioxide (NO2)) and risk of EDVs for asthma after controlling for temperature, relative humidity, public holidays and circulating levels of influenza and respiratory syncytial virus. Risk of EDVs for asthma increased within a few hours after exposure to O3 (odds ratio [OR]: 1.170, 95% confidence interval (CI): 1.003-1.365) or NO2 (OR: 1.359, 95%CI: 1.049-1.760). The association between O3 exposure and risk of EDVs for asthma was stronger in boys (OR: 1.244, 95%CI: 1.025-1.511) than that in girls (OR: 1.055, 95%CI: 0.818-1.361). The association between NO2 exposure and risk of EDVs for asthma was stronger in school-age children [OR ranged from 1.376 (95%CI: 1.044-1.813) to 3.607 (95%CI: 1.552-8.385) across different lags] than that in preschool-age children, whereas the association between PM10 exposure and risk of EDVs for asthma was greater in preschool-age children [OR ranged from 1.873 (95%CI: 1.022-3.433) to 1.878 (95%CI: 1.028-3.431)] than that in school-age children. We observed an association of risk of EDVs for asthma with daytime air pollution exposure, but not with night-time air pollution exposure. This study suggests that risk of childhood asthma exacerbations increases within a few hours of air pollution exposure.
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Affiliation(s)
- Jian Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Hong Su
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China.
| | - Zhiwei Xu
- School of Public Health, Faculty of Medicine, University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia.
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Eghomwanre AF, Oguntoke O, Taiwo AM. Levels of indoor particulate matter and association with asthma in children in Benin City, Nigeria. ENVIRONMENTAL MONITORING AND ASSESSMENT 2022; 194:467. [PMID: 35648237 DOI: 10.1007/s10661-022-10135-3] [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: 02/01/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
The relationship between indoor particulate matter and asthma in children was assessed in this study. Forty-five (45) locations were randomly selected across the five local government areas in Benin City, Edo State, for air quality assessment. Indoor and outdoor particulates (PM1.0, PM2.5, and PM10) were monitored monthly using a handheld BLATN particulate sampler (Br-Smart-126S series). Reported clinical cases of asthma in children from 2008 to 2017 were collected from two major hospitals in the metropolis. The data obtained were analysed with SPSS for Windows version 21.0. The average concentrations of indoor and ambient PM ranged between 10.7-26.2 and 19.0-49.4 µg/m3 (PM1.0), 27.4-59.6 and 45.6-93.0 µg/m3 (PM2.5), and 33.5-67.9 and 60.9-106.1 µg/m3 (PM10) in the wet and dry seasons. PM2.5 and PM10 concentrations were observed above the WHO standards. Indoor particulate concentration was significantly (p = 0.001-0.012) higher in the dry season across the locations. Outdoor PM correlated positively (R = 0.568-0.855, p < 0.05; R2 = 0.322-0.724, p < 0.001) with their corresponding indoor PM concentration. The hazard ratio (HR) values of PM2.5 and PM10 exceeded 1 in all the sampling locations during the dry season, while the mean total hazard ratio (THR) of both PM metrics was considerably higher during the dry season than in the wet season. Indoor PM concentrations showed a significant positive correlation with reported cases of asthma (R = 0.498-0.542, p < 0.001) and accounted for 40.6% of the asthma cases during the dry season. The study showed that children in the selected households are at risk of increased asthma exacerbation due to exposure to particulate matter pollution.
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Affiliation(s)
- A F Eghomwanre
- Department of Environmental Management and Toxicology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria.
- Department of Environmental Management and Toxicology, College of Environmental Resources Management, Federal University of Agriculture, Abeokuta, Nigeria.
| | - O Oguntoke
- Department of Environmental Management and Toxicology, College of Environmental Resources Management, Federal University of Agriculture, Abeokuta, Nigeria
| | - A M Taiwo
- Department of Environmental Management and Toxicology, College of Environmental Resources Management, Federal University of Agriculture, Abeokuta, Nigeria
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New Homogeneous Spatial Areas Identified Using Case-Crossover Spatial Lag Grid Differences between Aerosol Optical Depth-PM2.5 and Respiratory-Cardiovascular Emergency Department Visits and Hospitalizations. ATMOSPHERE 2022; 13:1-33. [PMID: 36003277 PMCID: PMC9393882 DOI: 10.3390/atmos13050719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Optimal use of Hierarchical Bayesian Model (HBM)-assembled aerosol optical depth (AOD)-PM2.5 fused surfaces in epidemiologic studies requires homogeneous temporal and spatial fused surfaces. No analytical method is available to evaluate spatial heterogeneity. The temporal case-crossover design was modified to assess the spatial association between four experimental AOD-PM2.5 fused surfaces and four respiratory–cardiovascular hospital events in 12 km2 grids. The maximum number of adjacent lag grids with significant odds ratios (ORs) identified homogeneous spatial areas (HOSAs). The largest HOSA included five grids (lag grids 04; 720 km2) and the smallest HOSA contained two grids (lag grids 01; 288 km2). Emergency department asthma and inpatient asthma, myocardial infarction, and heart failure ORs were significantly higher in rural grids without air monitors than in urban grids with air monitors at lag grids 0, 1, and 01. Rural grids had higher AOD-PM2.5 concentration levels, population density, and poverty percentages than urban grids. Warm season ORs were significantly higher than cold season ORs for all health outcomes at lag grids 0, 1, 01, and 04. The possibility of elevated fine and ultrafine PM and other demographic and environmental risk factors synergistically contributing to elevated respiratory–cardiovascular chronic diseases in persons residing in rural areas was discussed.
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Zhao Y, Kong D, Fu J, Zhang Y, Chen Y, Liu Y, Chang Z, Liu Y, Liu X, Xu K, Jiang C, Fan Z. Increased Risk of Hospital Admission for Asthma in Children From Short-Term Exposure to Air Pollution: Case-Crossover Evidence From Northern China. Front Public Health 2022; 9:798746. [PMID: 34976938 PMCID: PMC8718688 DOI: 10.3389/fpubh.2021.798746] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Previous studies suggested that exposure to air pollution could increase risk of asthma attacks in children. The aim of this study is to investigate the short-term effects of exposure to ambient air pollution on asthma hospital admissions in children in Beijing, a city with serious air pollution and high-quality medical care at the same time. Methods: We collected hospital admission data of asthma patients aged ≤ 18 years old from 56 hospitals from 2013 to 2016 in Beijing, China. Time-stratified case-crossover design and conditional Poisson regression were applied to explore the association between risk of asthma admission in children and the daily concentration of six air pollutants [particulate matter ≤ 2.5 μm (PM2.5), particulate matter ≤ 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3)], adjusting for meteorological factors and other pollutants. Additionally, stratified analyses were performed by age, gender, and season. Results: In the single-pollutant models, higher levels of PM2.5, SO2, and NO2 were significantly associated with increased risk of hospital admission for asthma in children. The strongest effect was observed in NO2 at lag06 (RR = 1.25, 95%CI: 1.06-1.48), followed by SO2 at lag05 (RR = 1.17, 95%CI: 1.05–1.31). The robustness of effects of SO2 and NO2 were shown in two-pollutant models. Stratified analyses further indicated that pre-school children (aged ≤ 6 years) were more susceptible to SO2. The effects of SO2 were stronger in the cold season, while the effects of NO2 were stronger in the warm season. No significant sex-specific differences were observed. Conclusions: These results suggested that high levels of air pollution had an adverse effect on childhood asthma, even in a region with high-quality healthcare. Therefore, it will be significant to decrease hospital admissions for asthma in children by controlling air pollution emission and avoiding exposure to air pollution.
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Affiliation(s)
- Yakun Zhao
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dehui Kong
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Fu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongqiao Zhang
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuxiong Chen
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanbo Liu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhen'ge Chang
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yijie Liu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaole Liu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Kaifeng Xu
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chengyu Jiang
- National Key Laboratory of Medical Molecular Biology, Department of Biochemistry, Institute of Basic Medical Sciences, Peking Union Medical Colleges, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhongjie Fan
- Department of Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Areal AT, Zhao Q, Wigmann C, Schneider A, Schikowski T. The effect of air pollution when modified by temperature on respiratory health outcomes: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 811:152336. [PMID: 34914983 DOI: 10.1016/j.scitotenv.2021.152336] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND Respiratory diseases are a leading cause of mortality and morbidity, and are exacerbated by air pollution and temperature. AIM To assess published literature on the effect of air pollution modified by temperature on respiratory mortality and hospital admissions. METHODS We identified 26,656 papers in PubMed and Web of Science, up to March 2021, and selected for analysis; inclusion criteria included observational studies, short-term air pollution, and temperature exposure. Air pollutants considered were particulate matter with a diameter of 2.5 μg/m3, and 10 μg/m3 (PM2.5, and PM10), ozone (O3), and nitrogen dioxide (NO2). A random-effects model was used for our meta-analysis. RESULTS For respiratory mortality we found that when the effect PM10 is modified by high temperatures there is an increased pooled Odds Ratio [OR, 95% Confidence Interval (CI)] of 1.021 (1.008 to 1.034) and for the effect of O3 the pooled OR is 1.006 (1.001-1.012) during the warm season. For hospital admissions, the effects of PM10 and O3 respectively, during the warm season found an increased pooled OR of 1.011 (0.999-1.024), and 1.015 (0.995-1.036). In our analysis for low temperatures, results were inconsistent. CONCLUSIONS Exposure to air pollution when modified by high temperature is likely to increase the odds of respiratory mortality and hospital admissions. Analysis on the interaction effect of air pollution and temperature on health outcomes is a relatively new research field and results are largely inconsistent; therefore, further research is encouraged to establish a more conclusive conclusion on the strength and direction of this effect.
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Affiliation(s)
- Ashtyn Tracey Areal
- Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Qi Zhao
- Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany; Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Claudia Wigmann
- Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Tamara Schikowski
- Department of Epidemiology, IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
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Li J, Hu Y, Li H, Lin Y, Tong S, Li Y. Assessing the impact of air pollutants on clinical visits for childhood allergic respiratory disease induced by house dust mite in Shanghai, China. Respir Res 2022; 23:48. [PMID: 35248029 PMCID: PMC8897928 DOI: 10.1186/s12931-022-01967-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/21/2022] [Indexed: 01/16/2023] Open
Abstract
Background The prevalence of allergic respiratory disease (ARD) is increasing worldwide during the last few decades, causing a great disease burden especially for children. Air pollution has been increasingly considered as a potential contributor to this trend, but its role in ARD induced by house dust mite (HDM-ARD) remains unclear, especially in time-series study. Methods A positive reporting of respiratory allergy to named allergens was included by serum specific IgE testing. A time series Quasi-Poisson regression with distributed lag non-linear model, combined with generalized linear model was used to examine the effects of air pollutants on ARD, HDM-ARD and ARD induced by non-house dust mite (NHDM-ARD). Results A total of 16,249 cases of ARD, including 8,719 HDM-ARD and 8,070 NHDM-ARD from 1 Jan 2013 to 31 Dec 2017 were involved in this study. Air pollutants were significantly associated with clinical visits for childhood ARD and HDM-ARD. Exposure to higher O3 and interquartile range (IQR) increment in O3 (40.6 µg/m3) increased the risks of clinical visits for childhood HDM-ARD (RRlag0-5 for the 95th percentile of O3: 1.26, 95% confidence interval (CI): 1.03, 1.55; RRlag0-5 for IQR increment (40.6 µg/m3): 1.09, 95% CI: 1.01, 1.17) and ARD (RRlag0-5 for the 95th percentile of O3: 1.19, 95% CI: 1.03, 1.38; RRlag0-5 for IQR increment (40.6 µg/m3): 1.06, 95% CI: 1.01, 1.12). In addition, higher O3 was associated with increased RR of boys with ARD (RRlag0-5 for the 95th percentile: 1.26, 95% CI: 1.05, 1.51; RRlag0-5 for IQR increment (40.6 µg/m3): 1.09, 95% CI: 1.02, 1.16) and HDM-ARD (RRlag0-5 for the 95th percentile: 1.36, 95% CI: 1.06, 1.75; RRlag0-5 for IQR increment (40.6 µg/m3): 1.11, 95% CI: 1.02, 1.22), but not in girls. Conclusions Exposure to O3 appeared to be a trigger of clinical visits for childhood ARD, especially for HDM-ARD and boys. These findings provide novel evidence on the impact of air pollution on HDM-ARD, which may have significant implications for designing effective intervention programs to control and prevent childhood ARD, especially HDM-ARD, in China and other similar developing countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-01967-1.
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12
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Hu Y, Cheng J, Yin Y, Liu S, Tan J, Li S, Wu M, Yan C, Yu G, Hu Y, Tong S. Association of childhood asthma with intra-day and inter-day temperature variability in Shanghai, China. ENVIRONMENTAL RESEARCH 2022; 204:112350. [PMID: 34762926 DOI: 10.1016/j.envres.2021.112350] [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: 07/31/2021] [Revised: 09/28/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Short-term temperature variability (TV) is associated with the exacerbation of asthma, but little is known about the relative effects of intra- and inter-day TV. We aimed to assess the relative impacts of intra- and inter-day TV on childhood asthma and to explore the modification effects by season. METHODS A quasi-Poisson generalized linear regression model combined with a distributed lag nonlinear model was adopted to evaluate the nonlinear and lagged effects of TV on childhood asthma in Shanghai from 2009 to 2017. Intra- and inter-day TV was measured with diurnal temperature range (DTR) and temperature changes between neighboring days (TCN), respectively. RESULTS Increased DTR was associated with the elevated relative risk (RR) of daily outpatient visits for childhood asthma (DOVCA) in both the whole year (RRlag0-14 for the 99th percentile: 1.264, 95% confidence interval (CI): 1.052, 1.518) and cold season (RRlag0-12 for the 99th percentile: 1.411, 95% CI: 1.053, 1.889). Higher TCN in the warm season was associated with the increased RR of DOVCA (RRlag0-14 for the 99th percentile: 2.964, 95% CI: 1.636, 5.373). The number and fraction of DOVCA attributed to an interquartile range (IQR) increase of TCN were higher than those attributed to DTR in both the whole year period and warm season. However, the number and fraction of DOVCA attributed to an IQR increase of DTR were greater than those attributed to TCN in the cold season. CONCLUSIONS Our results provide novel evidence that both intra- and inter-day TV might be a trigger of childhood asthma. Higher DTR appeared to have greater impacts on childhood asthma in the cold season while an increase in TCN seemed to have bigger effects in the warm season.
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Affiliation(s)
- Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Cheng
- School of Public Health, Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shijian Liu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianguo Tan
- Shanghai Key Laboratory of Meteorology and Health (Shanghai Meteorological Service), Shanghai, China
| | - Shenghui Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Meiqin Wu
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chonghuai Yan
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangjun Yu
- Center for Biomedical Informatics, Shanghai Children's Hospital, Shanghai, China
| | - Yi Hu
- Center for Biomedical Informatics, Shanghai Children's Hospital, Shanghai, China
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
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Gladson LA, Cromar KR, Ghazipura M, Knowland KE, Keller CA, Duncan B. Communicating respiratory health risk among children using a global air quality index. ENVIRONMENT INTERNATIONAL 2022; 159:107023. [PMID: 34920275 DOI: 10.1016/j.envint.2021.107023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
Air pollution poses a serious threat to children's respiratory health around the world. Satellite remote-sensing technology and air quality models can provide pollution data on a global scale, necessary for risk communication efforts in regions without ground-based monitoring networks. Several large centers, including NASA, produce global pollution forecasts that may be used alongside air quality indices to communicate local, daily risk information to the public. Here we present a health-based, globally applicable air quality index developed specifically to reflect the respiratory health risks among children exposed to elevated outdoor air pollution. Additive, excess-risk air quality indices were developed using 51 different coefficients derived from time-series health studies evaluating the impacts of ambient fine particulate matter, nitrogen dioxide, and ozone on children's respiratory morbidity outcomes. A total of four indices were created which varied based on whether or not the underlying studies controlled for co-pollutants and in the adjustment of excess risks of individual pollutants. Combined with historical estimates of air pollution provided globally at a 25 × 25 km2 spatial resolution from the NASA's Goddard Earth Observing System composition forecast (GEOS-CF) model, each of these indices were examined in a global sample of 664 small and 140 large cities for study year 2017. Adjusted indices presented the most normal distributions of locally-scaled index values, which has been shown to improve associations with health risks, while indices based on coefficients controlling for co-pollutants had little effect on index performance. We provide the steps and resources need to apply our final adjusted index at the local level using freely-available forecasting data from the GEOS-CF model, which can provide risk communication information for cities around the world to better inform individual behavior modification to best protect children's respiratory health.
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Affiliation(s)
- Laura A Gladson
- Marron Institute of Urban Management, New York University, New York, USA; New York University Grossman School of Medicine, New York, NY, USA
| | - Kevin R Cromar
- Marron Institute of Urban Management, New York University, New York, USA; New York University Grossman School of Medicine, New York, NY, USA.
| | - Marya Ghazipura
- Marron Institute of Urban Management, New York University, New York, USA; New York University Grossman School of Medicine, New York, NY, USA
| | - K Emma Knowland
- Universities Space Research Association, Columbia, MD, USA; NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - Christoph A Keller
- Universities Space Research Association, Columbia, MD, USA; NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - Bryan Duncan
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
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14
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Shahunja KM, Sly PD, Begum T, Biswas T, Mamun A. Family, neighborhood and psychosocial environmental factors and their associations with asthma in Australia: a systematic review and Meta-analysis. J Asthma 2021; 59:2539-2552. [PMID: 34905415 DOI: 10.1080/02770903.2021.2018707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Various associations between different environmental exposures and asthma have been reported in different countries and populations. We aimed to investigate the associations between family, neighborhood and psychosocial environmental factors and asthma-symptoms in Australia by conducting a systematic review and meta-analysis. DATA SOURCES We analyzed the primary research studies conducted in Australia across multiple databases, including PubMed, EMBASE and Scopus, published between 2000 and 2020. STUDY SELECTIONS The reviews and analyses focused on the overall association of different environmental exposures with the exacerbation of asthma-symptoms or asthma-related hospital visits. Quality-effect meta-analysis was done to estimate the pooled odds ratio for different environmental exposures for asthma-symptoms. RESULTS Among the 4799 unique published articles found, 46 were included here for systematic review and 28 for meta-analysis. Our review found that psychosocial factors, including low socioeconomic condition, maternal depression, mental stress, ethnicity, and discrimination, are associated with asthma-symptoms. Pooled analysis was conducted on family and neighborhood environmental factors and revealed that environmental tobacco smoking (ETS) (OR 1·69, 95% CI 1·19-2·38), synthetic bedding (OR 1·91, 95% CI 1·48-2·47) and gas heaters (OR 1·40, 95% CI 1·12-1·76) had significant overall associations with asthma-symptoms in Australia. CONCLUSION Although the studies were heterogeneous, both systematic review and meta-analysis found several psychosocial and family environmental exposures significantly associated with asthma-symptoms. Further study to identify their causal relationship and modification may reduce asthma-symptoms in the Australian population.
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Affiliation(s)
- K M Shahunja
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia.,The Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Australia
| | - Peter D Sly
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tahmina Begum
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia
| | - Tuhin Biswas
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia.,ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia.,The Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Australia
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15
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Zhang P, Zhou X. Pricing air pollution: evidence from short-term exposure to air pollution on hospitalization of acute bronchitis and chronic obstructive pulmonary disease in southwestern China. Int Health 2021; 14:572-579. [PMID: 34849952 DOI: 10.1093/inthealth/ihab071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/24/2021] [Accepted: 10/15/2021] [Indexed: 11/14/2022] Open
Abstract
Existing evidence suggests that ambient air pollution has serious adverse effects on respiratory diseases, yet there is little direct evidence from China regarding corresponding economic losses. Here we quantified air pollution-related acute health effects and related economic losses of the most common two respiratory diseases in southwestern China, acute bronchitis and chronic obstructive pulmonary disease (COPD). We applied a distributed lag non-linear model to analyse the relationship between ambient air pollutants and hospital admissions of acute bronchitis and COPD, then applied the cost of illness method to explore the attributing economic burden. During the study period, 528 334 and 99 419 hospital admissions of acute bronchitis and COPD, respectively, were recorded. As a result, during the study period the total hospitalization economic losses attributable to air pollution were 486.40 and 254.74 million yuan for acute bronchitis and COPD, respectively, accounting for 0.015% of local gross domestic product. Our research provides intuitive evidence on the health and economic impacts of short-term exposure to air pollution, which is a key basis for the formulation of environmental policies.
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Affiliation(s)
- Pei Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaoyuan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
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16
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Yu Z, Ma Y, Zhang Y, Cheng B, Feng F, Ma B, Jiao H, Zhou J. A study on the short-term effect of particulate matter pollution on hospital visits for asthma in children in Shanghai, China. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2021; 43:4123-4138. [PMID: 33774778 DOI: 10.1007/s10653-021-00888-0] [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: 01/01/2020] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
Recently, particulate matter pollution has been worsening, which has been affecting the asthma visits in children. In this study, we assessed the short-term effects of PM10 and PM2.5 on asthma visits in children in Shanghai, China from January 1, 2009 and December 31, 2010, using a generalized additive model. We controlled the confounding factors, such as long-term trends, week day effect, and weather elements. The lag effects of different age subgroups (≤ 2 yr, 3-5 yr, and 6-18 yr subgroups) were performed. The results showed significant effects of PM10 and PM2.5 on asthma visits in children, though the seasonal lags varied for the three age subgroups. In general, the effect of PM2.5 on asthma visits in children was stronger and more acute than that of PM10. PM2.5 showed the highest relative risk of 1.192 at lag 0 day in summer; and PM10 showed the highest relative risk of 1.073 at lag 3 day in autumn. Overall, particulate matter pollution showed a greater effect on relatively younger children. In particular, the ≤ 2 yr subgroup showed the highest seasonal relative risk of PM10. Especially, seasonal relative risk of PM10 in autumn for the ≤ 2 yr subgroup was much higher than that for the other two subgroups. The 3-5 yr and 6-18 yr subgroups showed the highest seasonal relative risk of PM2.5 in summer and winter, respectively. But the pediatric visits data we obtained cannot reflect the true prevalence of asthma and multiple visits. Thus, selection bias may exist in our analysis.
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Affiliation(s)
- Zhiang Yu
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Yuxia Ma
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China.
| | - Yifan Zhang
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Bowen Cheng
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Fengliu Feng
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Bingji Ma
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Haoran Jiao
- College of Atmospheric Sciences, Key Laboratory of Semi-Arid Climate Change, Ministry of Education, Lanzhou University, Lanzhou, 730000, China
| | - Ji Zhou
- Key Laboratory of Meteorology and Health in Shanghai, Shanghai, 200030, China
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17
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Jiang F, Wei T, Hu X, Han Y, Jia J, Pan B, Ni W. The association between ambient air pollution and scarlet fever in Qingdao, China, 2014-2018: a quantitative analysis. BMC Infect Dis 2021; 21:987. [PMID: 34548016 PMCID: PMC8456591 DOI: 10.1186/s12879-021-06674-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 09/08/2021] [Indexed: 12/16/2022] Open
Abstract
Background We conducted a distributed lag non-linear time series analysis to quantify the association between air pollution and scarlet fever in Qingdao city during 2014–2018. Methods A distributed lag non-linear model (DLNM) combined with a generalized additive mixed model (GAMM) was applied to quantify the distributed lag effects of air pollutions on scarlet fever, with daily incidence of scarlet fever as the dependent variable and air pollutions as the independent variable adjusted for potential confounders. Results A total of 6316 cases of scarlet fever were notified, and there were 376 days occurring air pollution during the study period. Scarlet fever was significantly associated with air pollutions at a lag of 7 days with different relative risk (RR) of air pollution degrees [1.172, 95% confidence interval (CI): 1.038–1.323 in mild air pollution; 1.374, 95% CI 1.078–1.749 in moderate air pollution; 1.610, 95% CI 1.163–2.314 in severe air pollution; 1.887, 95% CI 1.163–3.061 in most severe air pollution]. Conclusions Our findings show that air pollution is positively associated with scarlet fever in Qingdao, and the risk of scarlet fever could be increased along with the degrees of air pollution. It contributes to developing strategies to prevent and reduce health impact from scarlet fever and other non-vaccine-preventable respiratory infectious diseases in air polluted areas. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06674-8.
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Affiliation(s)
- Fachun Jiang
- Department of Acute Infectious Diseases, Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Tao Wei
- Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, Qingdao City, 266000, Shandong Province, People's Republic of China
| | - Xiaowen Hu
- Department of Acute Infectious Diseases, Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Yalin Han
- Department of Acute Infectious Diseases, Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Jing Jia
- Department of Acute Infectious Diseases, Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Bei Pan
- Department of Acute Infectious Diseases, Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Wei Ni
- Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, Qingdao City, 266000, Shandong Province, People's Republic of China.
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18
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Walter CM, Schneider-Futschik EK, Hall NL, Sly PD, Head BW, Knibbs LD. The health impacts of ambient air pollution in Australia: A systematic literature review. Intern Med J 2021; 51:1567-1579. [PMID: 34105222 DOI: 10.1111/imj.15415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ambient (outdoor) air pollution is a key risk factor for health, for which effective policy plays an important preventative role. Australian federal and related state air quality standards have historically relied on international evidence for guidance, which may not accurately reflect the Australian context. There has been, however, a large increase in Australian epidemiological studies over recent years. AIMS To provide an updated systematic literature review of peer-reviewed epidemiological studies that examined the health impacts of outdoor air pollution in Australia, including short- and long-term exposure. METHODS Following PRISMA guidelines, we conducted a systematic literature review. Broad search terms were applied to two databases (PubMed and Web of Science) and Google Scholar. Quality assessment and risk of bias were assessed using standard metrics. Included studies were summarised by tabulating key study characteristics, grouped by health outcomes. RESULTS In total, 72 studies were included in the review. Sixty-four studies (89%) used daily or hourly pollutant concentrations to examine short-term exposure impacts, of which 59 (92%) revealed significant associations with one or more health outcomes, including cardio-respiratory, all-cause mortality or morbidity, and birth outcomes. Eight studies (11%) used annual average pollutant concentrations to investigate long-term exposure finding significant associations with asthma, reduced lung function, atopy and cardio-respiratory mortality across five studies. The remaining three studies found no significant association with asthma, mortality and a range of self-reported diseases, respectively. CONCLUSIONS Ambient air pollution has substantial health impacts in Australia. The body of domestic evidence has increased markedly since national air quality standards were first set in the 1990s, which could be drawn on by policy-makers when revising the existing standards, or considering new standards. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Clare M Walter
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Pharmacology and Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Australian-German Climate and Energy College, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elena K Schneider-Futschik
- Department of Pharmacology and Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nina L Hall
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, Qld, Australia
| | - Brian W Head
- School of Political Science and Centre for Policy Futures, The University of Queensland
| | - Luke D Knibbs
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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19
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Hu Y, Jiang F, Tan J, Liu S, Li S, Wu M, Yan C, Yu G, Hu Y, Yin Y, Tong S. Environmental Exposure and Childhood Atopic Dermatitis in Shanghai: A Season-Stratified Time-Series Analysis. Dermatology 2021; 238:101-108. [PMID: 34082421 DOI: 10.1159/000514685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Childhood atopic dermatitis (AD) is an inflammatory skin disease which sometimes predisposes to allergies. Environmental factors (low humidity, irritants, etc.) are prominent causative triggers of AD. OBJECTIVES This study aims to explore the effects of both meteorological factors and air pollutants on childhood AD, and the modification effects by season in Shanghai, China. METHODS Quasi-Poisson generalized linear regression model, combined with a distributed lag nonlinear model was used to examine the nonlinear and lagged effects of environmental factors on childhood AD from 2009 to 2017 in Shanghai. We also performed a season-stratified analysis to determine the modification effects of environmental exposure by season on childhood AD. RESULTS There were 1,043,240 outpatient visits for childhood AD in total, at 3 major pediatric hospitals. Low temperature and relative humidity (RH), and high daily temperature difference (DTD) and air pollutants (i.e., NO2) increased the relative risks (RRs) of outpatient visits for childhood AD in the whole year. In the cold season, an increased risk of outpatient visits for childhood AD was associated with low RH (RR 2.26, 95% CI 1.69-3.02) and high NO2 (1.11, 95% CI 1.06-1.17). In the warm season, outpatient visits for childhood AD were associated with low temperature (3.49, 95% CI 3.22-3.77), low RH (1.89, 95% CI 1.74-2.06), high DTD (1.41, 95% CI 1.31-1.53), and high NO2 (1.05, 95% CI 1.03-1.06). CONCLUSIONS This study suggests that environmental exposure may be a key trigger for outpatient visits for childhood AD with apparent seasonal effects. Tailored preventive strategies to avoid environmental triggers of childhood AD should be developed.
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Affiliation(s)
- Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institution, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianguo Tan
- Shanghai Key Laboratory of Meteorology and Health (Shanghai Meteorological Service), Shanghai, China
| | - Shijian Liu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shenghui Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Meiqin Wu
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chonghuai Yan
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangjun Yu
- Center for Biomedical Informatics, Shanghai Children's Hospital, Shanghai, China
| | - Yi Hu
- Center for Biomedical Informatics, Shanghai Children's Hospital, Shanghai, China
| | - Yong Yin
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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20
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Outdoor Air Pollution and New-Onset Airway Disease. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2021; 17:387-398. [PMID: 32233861 PMCID: PMC7175976 DOI: 10.1513/annalsats.202001-046st] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Although it is well accepted that air pollution exposure exacerbates preexisting airway disease, it has not been firmly established that long-term pollution exposure increases the risk of new-onset asthma or chronic obstruction pulmonary disease (COPD). This Workshop brought together experts on mechanistic, epidemiological, and clinical aspects of airway disease to review current knowledge regarding whether air pollution is a causal factor in the development of asthma and/or COPD. Speakers presented recent evidence in their respective areas of expertise related to air pollution and new airway disease incidence, followed by interactive discussions. A writing committee summarized their collective findings. The Epidemiology Group found that long-term exposure to air pollution, especially metrics of traffic-related air pollution such as nitrogen dioxide and black carbon, is associated with onset of childhood asthma. However, the evidence for a causal role in adult-onset asthma or COPD remains insufficient. The Mechanistic Group concluded that air pollution exposure can cause airway remodeling, which can lead to asthma or COPD, as well as asthma-like phenotypes that worsen with long-term exposure to air pollution, especially fine particulate matter and ozone. The Clinical Group concluded that air pollution is a plausible contributor to the onset of both asthma and COPD. Available evidence indicates that long-term exposure to air pollution is a cause of childhood asthma, but the evidence for a similar determination for adult asthma or COPD remains insufficient. Further research is needed to elucidate the exact biological mechanism underlying incident childhood asthma, and the specific air pollutant that causes it.
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Lam HCY, Jarvis D, Fuertes E. Interactive effects of allergens and air pollution on respiratory health: A systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 757:143924. [PMID: 33310575 PMCID: PMC7812370 DOI: 10.1016/j.scitotenv.2020.143924] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND Studies have demonstrated an adverse role of outdoor allergens on respiratory symptoms. It is unknown whether this effect is independent or synergistic of outdoor air pollutants. METHODS We systematically reviewed all epidemiological studies that examined interaction effects between counts of outdoor airborne allergens (pollen, fungal spores) and air pollutants, on any respiratory health outcome in children and adults. We searched the MEDLINE, EMBASE and Scopus databases. Each study was summarized qualitatively and assessed for quality and risk of bias (International Prospective Register for Systematic Reviews, registration number CRD42020162571). RESULTS Thirty-five studies were identified (15 timeseries, eight case-crossovers, 11 panels and one cohort study), of which 12 reported a significant statistical interaction between an allergen and air pollutant. Eight interactions were related to asthma outcomes, including one on lung function measures and wheeze, three to medical consultations for pollinosis and one to allergic symptoms (nasal, ocular or bronchial). There was no consensus as to which allergen or air pollutant is more likely to interact. No study investigated whether interactions are stronger in atopic individuals. CONCLUSION Despite strong evidence from small experimental studies in humans, only a third of studies identified significant allergen-pollutant interactions using common epidemiological study designs. Exposure misclassification, failure to examine subgroups at risk, inadequate statistical power or absence of population-level effects are possible explanations.
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Affiliation(s)
- Holly C Y Lam
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; MRC Centre for Environment & Health, Imperial College, London, United Kingdom.
| | - Deborah Jarvis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; MRC Centre for Environment & Health, Imperial College, London, United Kingdom.
| | - Elaine Fuertes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
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Bonyadi Z, Arfaeinia H, Fouladvand M, Farjadfard S, Omidvar M, Ramavandi B. Impact of exposure to ambient air pollutants on the admission rate of hospitals for asthma disease in Shiraz, southern Iran. CHEMOSPHERE 2021; 262:128091. [PMID: 33182159 DOI: 10.1016/j.chemosphere.2020.128091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
Asthma is a common chronic respiratory disease in the world. Short-term exposure to ambient air pollutants is closely related to acute respiratory diseases and asthmatic symptoms. The purpose of this research was to estimate the correlation between exposure to three air pollutants (O3, NO2, and SO2) and hospital admission because of asthmatic disease (HAAD) in the city of Shiraz, southern Iran. The data were collected from the two real-time monitoring stations located in this city. The acquired information was used for developing predictive models by the AirQ software. The findings of this study were reported for two age groups (<15 and 15-64 years old). The highest levels of O3, NO2, and SO2 were obtained 187.33 μg/m3, 34.1 μg/m3, and 491.2 μg/m3 in 2016, respectively, and 227.75 μg/m3, 92.26 μg/m3, and 190.21 μg/m3, respectively, in 2017. Among the mentioned pollutants, the yearly average concentration of SO2 was 8.62 times more than the WHO guideline, during the studied times. The number of extra cases of HAAD for <15 years and 15-64 years caused by the air pollutants in Shiraz were estimated to be 273 and 36, respectively, in 2016, and 243 and 30 for 2017, respectively. The results of this work displayed that air pollutants have caused respiratory problems in Shiraz city. The AirQ model is a facile and potential tool for the prediction of asthma disease to reduce the health risk of atmospheric pollutants in the worldwide.
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Affiliation(s)
- Ziaeddin Bonyadi
- Department of Environmental Health Engineering, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Arfaeinia
- Department of Environmental Health Engineering, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran; Systems Environmental Health and Energy Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Moradali Fouladvand
- The Persian Gulf Marine Biotechnology Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Sima Farjadfard
- Department of Environmental Engineering, Graduate School of the Environment and Energy, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohsen Omidvar
- Department of Occupational Health Engineering, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bahman Ramavandi
- Department of Environmental Health Engineering, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran; Systems Environmental Health and Energy Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
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23
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Anenberg SC, Haines S, Wang E, Nassikas N, Kinney PL. Synergistic health effects of air pollution, temperature, and pollen exposure: a systematic review of epidemiological evidence. Environ Health 2020; 19:130. [PMID: 33287833 PMCID: PMC7720572 DOI: 10.1186/s12940-020-00681-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/30/2020] [Indexed: 05/29/2023]
Abstract
BACKGROUND Exposure to heat, air pollution, and pollen are associated with health outcomes, including cardiovascular and respiratory disease. Studies assessing the health impacts of climate change have considered increased exposure to these risk factors separately, though they may be increasing simultaneously for some populations and may act synergistically on health. Our objective is to systematically review epidemiological evidence for interactive effects of multiple exposures to heat, air pollution, and pollen on human health. METHODS We systematically searched electronic literature databases (last search, April 29, 2019) for studies reporting quantitative measurements of associations between at least two of the exposures and mortality from any cause and cardiovascular and respiratory morbidity and mortality specifically. Following the Navigation Guide systematic review methodology, we evaluated the risk of bias of individual studies and the overall quality and strength of evidence. RESULTS We found 56 studies that met the inclusion criteria. Of these, six measured air pollution, heat, and pollen; 39 measured air pollution and heat; 10 measured air pollution and pollen; and one measured heat and pollen. Nearly all studies were at risk of bias from exposure assessment error. However, consistent exposure-response across studies led us to conclude that there is overall moderate quality and sufficient evidence for synergistic effects of heat and air pollution. We concluded that there is overall low quality and limited evidence for synergistic effects from simultaneous exposure to (1) air pollution, pollen, and heat; and (2) air pollution and pollen. With only one study, we were unable to assess the evidence for synergistic effects of heat and pollen. CONCLUSIONS If synergistic effects between heat and air pollution are confirmed with additional research, the health impacts from climate change-driven increases in air pollution and heat exposure may be larger than previously estimated in studies that consider these risk factors individually.
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Affiliation(s)
- Susan C. Anenberg
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC 20052 USA
| | - Shannon Haines
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC 20052 USA
- Now at: American Lung Association, Springfield, IL USA
| | - Elizabeth Wang
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC 20052 USA
| | - Nicholas Nassikas
- Department of Pulmonary, Critical Care, and Sleep Medicine, Brown University Alpert Medical School, Providence, RI 02903 USA
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Hu Y, Cheng J, Jiang F, Liu S, Li S, Tan J, Yin Y, Tong S. Season-stratified effects of meteorological factors on childhood asthma in Shanghai, China. ENVIRONMENTAL RESEARCH 2020; 191:110115. [PMID: 32846175 DOI: 10.1016/j.envres.2020.110115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/19/2020] [Accepted: 08/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES There has been increasing interest in identifying the adverse effects of ambient environmental factors on asthma exacerbations (AE), but season-stratified effects of meteorological factors on childhood asthma remain unclear. We explored the season-stratified effects of meteorological factors on childhood AE in Shanghai, China. METHODS Poisson generalized linear regression model combined with a distributed lag nonlinear model was used to examine the lagged and nonlinear effects of meteorological factors on childhood AE after adjustment for putative confounders. We also performed a season-stratified analysis to determine whether the season modified the relationship between meteorological factors and childhood AE. RESULTS There were 23,103 emergency department visits (EDVs) for childhood AE, including 15,466 boys and 7637 girls during 2008-2017. Most meteorological factors (e.g., temperature, diurnal temperature range (DTR), relative humidity (RH) and wind speed (WS)) were significantly associated with EDVs for childhood AE, even after adjustment for the confounding effects of air pollutants. In the whole year, extreme cold, moderate heat, higher DTR, lower RH and WS increased the relative risk (RR) for childhood AE. In the cold season, lower RH and wind speed increased the risks of childhood AE (RRlag0-28 for the 5th percentile (p5) of RH: 9.744, 95% CI: 3.567, 26.616; RRlag0-28 for the p5 of wind speed: 10.671, 95% CI: 1.096, 103.879). In the warm season, higher temperature and DTR, lower RH and WS increased the RR for childhood AE (RRlag0-5 for the p95 of temperature: 1.871, 95% CI: 1.246, 2.810; RRlag0-2 for the p95 of DTR: 1.146, 95% CI: 1.010, 1.300; RRlag0-5 for the p5 of RH: 1.931, 95% CI: 1.191, 3.128; RRlag0-2 for the p5 of WS: 1.311, 95% CI: 1.005, 1.709). CONCLUSIONS Extreme meteorological factors appeared to be triggers of EDVs for childhood AE in Shanghai and the effects modified by season. These findings provide evidence for developing season-specific and tailored strategies to prevent and control childhood AE.
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Affiliation(s)
- Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian Cheng
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institution, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shijian Liu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shenghui Li
- School of Public Health, Shanghai Jiaotong University, Shanghai, China
| | - Jianguo Tan
- Shanghai Key Laboratory of Meteorology and Health (Shanghai Meteorological Service), Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.
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25
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Byrwa-Hill BM, Venkat A, Presto AA, Rager JR, Gentile D, Talbott E. Lagged Association of Ambient Outdoor Air Pollutants with Asthma-Related Emergency Department Visits within the Pittsburgh Region. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8619. [PMID: 33233547 PMCID: PMC7699695 DOI: 10.3390/ijerph17228619] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/07/2020] [Accepted: 11/11/2020] [Indexed: 01/23/2023]
Abstract
Asthma affects millions of people globally and is especially concerning in populations living with poor air quality. This study examines the association of ambient outdoor air pollutants on asthma-related emergency department (ED) visits in children and adults throughout the Pittsburgh region. A time-stratified case-crossover design is used to analyze the lagged effects of fine particulate matter (PM2.5) and gaseous pollutants, e.g., ozone (O3), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) on asthma-related ED visits (n = 6682). Single-, double-, and multi-pollutant models are adjusted for temperature and analyzed using conditional logistic regression. In children, all models show an association between O3 and increased ED visits at lag day 1 (OR: 1.12, 95% CI, 1.03-1.22, p < 0.05) for the double-pollutant model (OR: 1.10, 95% CI: 1.01-1.20, p < 0.01). In adults, the single-pollutant model shows associations between CO and increased ED visits at lag day 5 (OR: 1.13, 95% CI, 1.00-1.28, p < 0.05) and average lag days 0-5 (OR: 1.22, 95% CI: 1.00-1.49, p < 0.05), and for NO2 at lag day 5 (OR: 1.04, 95% CI: 1.00-1.07, p < 0.05). These results show an association between air pollution and asthma morbidity in the Pittsburgh region and underscore the need for mitigation efforts to improve public health outcomes.
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Affiliation(s)
- Brandy M. Byrwa-Hill
- Department of Environmental and Occupational Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261, USA
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA 15212, USA;
| | - Albert A. Presto
- Center for Atmospheric Particle Studies and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA;
| | - Judith R. Rager
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15213, USA; (J.R.R.); (E.T.)
| | | | - Evelyn Talbott
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15213, USA; (J.R.R.); (E.T.)
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Terry D, Peck B, Kloot K, Hutchins T. Pediatric emergency asthma presentations in Southwest Victoria: a retrospective cross-sectional study 2017 to 2020. J Asthma 2020; 59:264-272. [PMID: 33143500 DOI: 10.1080/02770903.2020.1845725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Australia has one of the highest prevalence of asthma globally, and accessible emergency asthma presentation data remains vital, however, is currently underreported in regional and rural areas. Utilizing the Rural Acute Hospital Data Register (RAHDaR) which includes previously non-reported data, the aim of the study is to provide a more accurate understanding of asthma emergency presentation events, while investigating the factors associated with these presentations. METHODS A retrospective cross-sectional study collected de-identified emergency asthma presentation data from nine health services in regional Victoria for children aged 0 to 14 years between 2017 and 2020. Demographic and presentation data were collated along with government datasets. Asthma emergency presentations incidence rates and predictor variables were analyzed using hierarchical multiple regression after adjusting for smoking and sex. Significance was determined at p < 0.05. RESULTS Of the 1090 emergency asthma presentations, n = 369 occurred at health services who did not previously report data. This represents a 33.86% increase in our understanding of emergency asthma presentations and demonstrating a rate of 16.06 presentations per 1000 children per year. Key factors such as age, population density, and private health insurance were associated with asthma emergency presentation events among both sexes, while socioeconomic status and rurality were not predictive. CONCLUSIONS Although some findings are consistent with current research, the study highlights previously unrecognized specific factors that are predictive of asthma among 0-14-year-old children. These findings provide more accurate insights for healthcare workers and policymakers as they seek to support people with asthma and accurately address health inequities.
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Affiliation(s)
- Daniel Terry
- School of Health, Federation University, Ballarat, Victoria, Australia
| | - Blake Peck
- School of Health, Federation University, Ballarat, Victoria, Australia
| | - Kate Kloot
- Center for Rural Emergency Medicine, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
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27
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Qiu H, Bai CH, Chuang KJ, Fan YC, Chang TP, Yim SHL, Ho KF. Association of ambient non-methane hydrocarbons exposure with respiratory hospitalizations: A time series study in Taipei, Taiwan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 729:139010. [PMID: 32361457 DOI: 10.1016/j.scitotenv.2020.139010] [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: 03/17/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 06/11/2023]
Abstract
Ambient hydrocarbons are important precursors of ground-level ozone and secondary organic aerosol formation. However, few studies have assessed the health impact of airborne hydrocarbons. We conducted this time series ecological study to evaluate the association of short-term airborne hydrocarbons exposure with hospital admissions for respiratory diseases, while controlling for co-exposure to criteria pollutants. Taipei air pollution and weather data for the period spanning from January 2010 to December 2017 were obtained from Taiwan Air Quality Monitoring Network. Subsequently, daily pollutant concentrations were linked with daily hospital admission counts for respiratory diseases into a time series data frame. The standard generalized additive Poisson model adjusted for temporal trends, seasonal variations, weather conditions, and calendar effects, was applied to examine the short-term associations of acute airborne hydrocarbon exposure with respiratory hospital admissions. Next, the robustness of the associations was tested using two-pollutant models with further adjustment for fine particulate matter (PM2.5) and gaseous pollutants. The results demonstrated that an interquartile range increase in non-methane hydrocarbon (NMHC) exposure on lag0 day (0.15 ppm) was associated with a 0.86% (95% confidence interval: 0.37%-1.36%), 2.06% (0.77%-3.38%), and 1.25% (0.31%-2.20%) increment in all-respiratory-disease-, asthma-, and chronic-obstructive-pulmonary-disease-linked hospital admissions, respectively. The associations were robust with further adjustment for co-exposure to PM2.5 and ozone. The acute effect estimate of methane on each respiratory category was sensitive to the co-pollutant adjustment and lost statistical significance in the two-pollutant models. In conclusion, we confirmed that airborne NMHC exposure increased the risk of respiratory-disease-related hospital admissions in Taipei; this information may aid in the regulation of hydrocarbon pollution.
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Affiliation(s)
- Hong Qiu
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kai-Jen Chuang
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Chun Fan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Ta-Pang Chang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Steve Hung-Lam Yim
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Department of Geography and Resource Management, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Kin-Fai Ho
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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Zhao Q, Zhao Y, Dou H, Lu Y, Chen Y, Tao L. Adolescent Haze-Related Knowledge Level Study: A Cross-Sectional Survey With Sensitivity Analysis. Front Public Health 2020; 8:229. [PMID: 32733831 PMCID: PMC7363765 DOI: 10.3389/fpubh.2020.00229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/15/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to investigate the level of haze-related knowledge adolescents have and to explore relevant influencing factors. Methods: From June 2015 to January 2016, researchers randomly selected 2 districts from the 20 districts of Baoding, China. Then, researchers randomly selected two middle schools from two districts. By conducting a stratified cluster sampling and considering one class as a unit, researchers randomly selected, from the other middle school, five first-grade classes, five second-grade classes, five third-grade classes from the one middle school, and three first-grade classes, two second-grade classes, and two third-grade classes. Finally, 1,100 adolescents were investigated by using the demographic questionnaire and the Adolescent Haze-Related Knowledge Awareness Assessment Scale (AHRKAAS). Multiple linear regressions were conducted to explore factors affecting the adolescent haze-related knowledge. Sensitivity analysis was used to confirm associations between influencing factors and AHRKAAS scores. Results: The AHRKAAS score rate was 69.9%. The dimension of human factors of haze formation was the highest (score rate = 85.6%). The dimension of haze harms on the human body was the lowest (score rate = 57.1%). Compared with the group (monthly expenses <300 yuan), the group (monthly expenses ≥ 600 yuan) had a higher AHRKAAS score (β = 4.882, 95% CI: 0.979, 8.784). Compared with the group (Do not live with parents), the group (Live with parents) had a higher AHRKAAS score (β = 14.675, 95% CI: 9.494, 19.855). Compared with the group (Never undergo a physical examination), the group (Once a year) (β = 7.444, 95% CI: 2.922, 11.966) and the group (A few times a year) (β = 7.643, 95% CI: 2.367, 12.919) had a higher AHRKAAS score. Compared with the group (Know nothing), the group (Know most) (β = 9.623, 95% CI: 2.929, 16.316) and the group (Know very well) (β = 15.367, 95% CI: 7.220, 23.515) had a higher AHRKAAS score. These associations were still reliable and consistent in different sensitivity analysis models. Conclusion: The level of adolescent haze-related knowledge is low and is affected by monthly expenses, living condition, physical examination frequency, and knowledge of respiratory system diseases. Government bodies, schools, and research institutions should strengthen cooperation of health publicity and health education to improve adolescent haze-related knowledge.
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Affiliation(s)
- Qingchun Zhao
- Affiliated Hospital of Hebei University, Baoding, China
| | - Yuejia Zhao
- Affiliated Hospital of Hebei University, Baoding, China
| | - Hongzhe Dou
- Affiliated Hospital of Hebei University, Baoding, China
| | - Yanrong Lu
- United Front Department, Hebei University, Baoding, China
| | - Yanhong Chen
- Affiliated Hospital of Hebei University, Baoding, China
| | - Lingwei Tao
- School of Public Health, Peking University, Beijing, China
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Shrestha SK, Lambert KA, Erbas B. Ambient pollen concentrations and asthma hospitalization in children and adolescents: a systematic review and meta-analysis. J Asthma 2020; 58:1155-1168. [PMID: 32419541 DOI: 10.1080/02770903.2020.1771726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ObjectiveWe aimed to conduct a systematic review examining the association between outdoor pollen and childhood asthma hospitalizations.Data SourceA systematic search of articles in MEDLINE, EMBASE, CINAHL, ProQuest Central, Web of Science and Google Scholar published to 18 July 2019.Study selection: Studies that presented data on pollen exposure and childhood asthma hospitalization were included and evaluated for potential risk of bias by two independent authors. Random effects meta-analysis was performed where possible.ResultsA total of 1048 records were identified, and twelve studies included in the review. The synthesis suggested possible associations between outdoor pollen, especially for grass and birch and childhood asthma hospitalization. However, the results varied widely across geographical areas and settings for other pollen taxa. The meta-analysis of the case-crossover studies showed a positive association between grass and childhood asthma hospitalization, an increase in 10 grass pollen grains/m3 was associated with a 3% increase in childhood asthma admission (OR = 1.03; 95%CI:1.01, 1.04), but the pooled estimate was not significant for timeseries studies. The meta-analysis of the timeseries studies for birch pollen showed an increase in 10 pollen grains/m3 being significantly associated with a Mean Percentage Change (MPC) in childhood asthma admissions (MPC= 0.85; 95%CI:0.40, 1.30).Conclusion: Globally, grass and birch pollen are important triggers of childhood asthma hospitalization, but the association could not be ascertained for other pollen taxa. Pollen is a major environmental trigger of asthma exacerbations and more focus on early interventions to reduce this burden needs to be considered.
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Affiliation(s)
- Som Kumar Shrestha
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Katrina Anne Lambert
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Atmospheric Pollution and Hospitalization for Cardiovascular and Respiratory Diseases in the City of Manaus from 2008 to 2012. ScientificWorldJournal 2020; 2020:8458359. [PMID: 32308570 PMCID: PMC7152981 DOI: 10.1155/2020/8458359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/16/2020] [Accepted: 02/04/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To relate the levels of air pollution and hospital admissions for cardiovascular and respiratory diseases in the city of Manaus in Brazil from 2008 to 2012. Method This is an ecological time-series study among children (under 5 years of age) and elderly (above 60 years of age). Data on the daily number of hospitalizations for cardiovascular and respiratory diseases, pollutants (PM2.5), temperature, and humidity were used. Poisson generalized additive models were used to estimate the association between variables. Increases in hospitalizations for cardiovascular and respiratory diseases were estimated for the interquartile range (IQR) daily mean level of each variable studied, with a confidence interval of 95%. Results Respiratory diseases and children: −0.40% (95% CI: −1.11, 0.30), 0.59% (95% CI: −0.35, 1.52), and 0.47% (95% CI: −3.28, 4.21) for PM2.5, temperature, and humidity, respectively. Respiratory diseases and elderly: 0.19% (95% CI: −0.93, 1.31), −0.10% (95% CI: −1.85, 1.65), and −6.17% (95% CI: −13.08, 0.74) for PM2.5, temperature, and humidity, respectively. Cardiovascular diseases and elderly: −0.18% (95% CI: −0.86, 0.50), −0.04% (95% CI: −1.10, 1.03), and −3.37% (95% CI: −7.59, 0.85) for PM2.5, temperature, and humidity, respectively. Conclusions The time-series study found no significant association between PM2.5, temperature, humidity, and hospitalization, unlike the evidences provided by the present academic literature. Since there is no air quality monitoring network in Manaus and the option available in the present study was to reproduce some information obtained from remote sensing, there is a need for implementation of ground monitoring stations for health and environmental studies in the region.
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Jones PJ, Koolhof IS, Wheeler AJ, Williamson GJ, Lucani C, Campbell SL, Bowman DMJS, Johnston FH. Can smartphone data identify the local environmental drivers of respiratory disease? ENVIRONMENTAL RESEARCH 2020; 182:109118. [PMID: 32069747 DOI: 10.1016/j.envres.2020.109118] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/09/2019] [Accepted: 01/03/2020] [Indexed: 06/10/2023]
Abstract
Asthma and allergic rhinitis (or hay fever) are ubiquitous, chronic health conditions that seasonally affect a sizeable proportion of the population. Both are commonly triggered or exacerbated by environmental conditions including aeroallergens, air quality and weather. Smartphone technology offers new opportunities to identify environmental drivers by allowing large-scale, real-time collection of day-to-day symptoms. As yet, however, few studies have explored the potential of this technology to provide useful epidemiological data on environment-symptom relationships. Here, we use data from the smartphone app 'AirRater' to examine relationships between asthma and allergic rhinitis symptoms and weather, air quality and pollen loads in Hobart, Tasmania, Australia. We draw on symptom data logged by app users over a three-year period and use time-series analysis to assess the relationship between symptoms and environmental co-variates. Symptoms are associated with particulate matter (IRR 1.06, 95% CI: 1.04-1.08), maximum temperature (IRR 1.28, 95% CI: 1.13-1.44) and pollen taxa including Betula (IRR 1.04, 95% CI: 1.02-1.07), Cupressaceae (IRR 1.02, 95% CI: 1.01-1.04), Myrtaceae (IRR 1.06, 95% CI: 1.02-1.10) and Poaceae (IRR 1.05, 95% CI: 1.01-1.09). The importance of these pollen taxa varies seasonally and more taxa are associated with allergic rhinitis (eye/nose) than asthma (lung) symptoms. Our results are congruent with established epidemiological evidence, while providing important local insights including the association between symptoms and Myrtaceae pollen. We conclude that smartphone-sourced data can be a useful tool in environmental epidemiology.
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Affiliation(s)
- Penelope J Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia.
| | - Iain S Koolhof
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia; School of Natural Sciences, University of Tasmania, Hobart, TAS, 7001, Australia.
| | - Amanda J Wheeler
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia; Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, 3000, Australia.
| | - Grant J Williamson
- School of Natural Sciences, University of Tasmania, Hobart, TAS, 7001, Australia.
| | - Christopher Lucani
- School of Natural Sciences, University of Tasmania, Hobart, TAS, 7001, Australia.
| | - Sharon L Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia; Public Health Services, Department of Health, Hobart, TAS, 7000, Australia.
| | - David M J S Bowman
- School of Natural Sciences, University of Tasmania, Hobart, TAS, 7001, Australia.
| | - Fay H Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia; Public Health Services, Department of Health, Hobart, TAS, 7000, Australia.
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Contribution of Satellite-Derived Aerosol Optical Depth PM 2.5 Bayesian Concentration Surfaces to Respiratory-Cardiovascular Chronic Disease Hospitalizations in Baltimore, Maryland. ATMOSPHERE 2020; 11:209. [PMID: 33981453 PMCID: PMC8112581 DOI: 10.3390/atmos11020209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The fine particulate matter baseline (PMB), which includes PM2.5 monitor readings fused with Community Multiscale Air Quality (CMAQ) model predictions, using the Hierarchical Bayesian Model (HBM), is less accurate in rural areas without monitors. To address this issue, an upgraded HBM was used to form four experimental aerosol optical depth (AOD)-PM2.5 concentration surfaces. A case-crossover design and conditional logistic regression evaluated the contribution of the AOD-PM2.5 surfaces and PMB to four respiratory-cardiovascular hospital events in all 99 12 km2 CMAQ grids, and in grids with and without ambient air monitors. For all four health outcomes, only two AOD-PM2.5 surfaces, one not kriged (PMC) and the other kriged (PMCK), had significantly higher Odds Ratios (ORs) on lag days 0, 1, and 01 than PMB in all grids, and in grids without monitors. In grids with monitors, emergency department (ED) asthma PMCK on lag days 0, 1 and 01 and inpatient (IP) heart failure (HF) PMCK ORs on lag days 01 were significantly higher than PMB ORs. Warm season ORs were significantly higher than cold season ORs. Independent confirmation of these results should include AOD-PM2.5 concentration surfaces with greater temporal-spatial resolution, now easily available from geostationary satellites, such as GOES-16 and GOES-17.
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Zhao Q, Yang C, Tang S, Zhao Y, Dou H, Chen Y, Lu Y, Tao L. Developing and Testing the Reliability and Validity of the Brief Haze Weather Health Protection Behavior Assessment Scale-Adolescent Version (BHWHPBAS-AV). Front Pediatr 2020; 8:498885. [PMID: 33072666 PMCID: PMC7536278 DOI: 10.3389/fped.2020.498885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/12/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To develop a Brief Haze Weather Health Protection Behavior Assessment Scale-Adolescent Version (BHWHPBAS-AV). Methods: Considering primary prevention, secondary prevention and tertiary prevention as a theoretical basis, researchers developed a Brief Haze Weather Health Protection Behavior Assessment Scale-Adolescent Version-I(BHWHPBAS-AV-I). After performing 6 reviews by related experts, and after conducting six adolescent tests for BHWHPBAS-AV-I, researchers developed an updated BHWHPBAS-AV-II. Out of the 20 districts in Baoding, two districts were randomly selected; moreover, two middle schools from these two districts were also randomly selected. Considering one class as a unit, researchers subsequently randomly selected 22 classes by using stratified sampling. In the end, 1,025 valid questionnaires were used as part of the study. At which point, researchers investigated the validity and reliability of the scale and obtained the final scale (BHWHPBAS-AV). Results: BHWHPBAS-AV Cronbach's α = 0.878, content validity = 0.948, and factor cumulative contribution rate = 54.058% using exploratory factor analysis. By confirmatory factor analysis, Chi square value (χ2) = 271.791, degrees of freedom (df) = 94, Chi square value/degrees of freedom (χ2/df) = 2.891, root-mean-square error of approximation (RMSEA) = 0.051, normed fit index (NFI) = 0.930, incremental fit index (IFI) = 0.953, goodness of fit index (GFI) = 0.955, Tueker-Lewis index (TLI) = 0.940, comparative fit index (CFI) = 0.953. BHWHPBAS-AV was composed of 16 items as well as 3 dimensions. Conclusions: A BHWHPBAS-AV scale that has an acceptable reliability and validity can be applied to assess adolescent haze weather health protection behavior, and can also help school teachers, as well as medical staff working in community health care institutions, to perform targeted behavioral interventions and deliver health education programs to adolescents.
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Affiliation(s)
- Qingchun Zhao
- Outpatient Department, Operating Room, Blood Transfusion Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Chun Yang
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Shanshan Tang
- Outpatient Department, Operating Room, Blood Transfusion Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Yuejia Zhao
- Outpatient Department, Operating Room, Blood Transfusion Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Hongzhe Dou
- Outpatient Department, Operating Room, Blood Transfusion Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Yanhong Chen
- Outpatient Department, Operating Room, Blood Transfusion Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Yanrong Lu
- United Front Department, Hebei University, Baoding, China
| | - Lingwei Tao
- School of Public Health, Peking University, Beijing, China
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Li X, Chen Q, Zheng X, Li Y, Han M, Liu T, Xiao J, Guo L, Zeng W, Zhang J, Ma W. Effects of ambient ozone concentrations with different averaging times on asthma exacerbations: A meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 691:549-561. [PMID: 31325855 DOI: 10.1016/j.scitotenv.2019.06.382] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/10/2019] [Accepted: 06/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mounting evidence suggests that short-term exposure to ozone increases the risk of asthma exacerbations. However, ozone exposures have been assessed using ambient ozone concentrations averaged over different time periods in different studies. OBJECTIVE To evaluate the risks for asthma exacerbations related to ambient ozone measured as 1-hour or 8-hour daily maximum and 24-hour average concentrations. METHODS Based on a literature search in PubMed, EMBASE and Web of Science, we identified all time-series studies as of December 4th, 2018 and included 47 eligible studies in our analyses. Asthma exacerbation is defined as the risk for emergency room visits or hospital admissions. Pooled relative risks (RRs) and 95% confidence intervals (95%CIs) for a 10 μg/m3 increase in daily ozone concentration were estimated using random effect models. Subgroup analyses and sensitivity analyses were also performed to examine the risks for different seasons, regions and age groups and for the robustness of our main findings. RESULTS Significant and similar associations were found for O3-1 h max (RR,1.012; 95%CI, 1.005-1.019) and O3-8 h max (RR, 1.011; 95%CI, 1.007-1.014), while marginal effect was identified for O3-24 h average (RR, 1.005; 95%CI, 0.996-1.014). No significant publication bias but high heterogeneities were observed. During the warm season, ozone was significantly associated with asthma exacerbation. O3-1 h max had the highest RR of 1.014 (95%CI, 1.005-1.024), followed by O3-8 h max (RR, 1.012; 95%CI, 1.009-1.016), while marginal association was identified for O3-24 h avg (RR, 1.008; 95%CI, 0.998-1.017). During the cold season, null associations were identified for all the three averaging times. Variations were also observed in region and age. CONCLUSION Ozone exposure measured as 1-hour or 8-hour daily max were more consistently associated with asthma exacerbations than 24-hour average exposure during the warm season.
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Affiliation(s)
- Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China; Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Xueyan Zheng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Yongzhi Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Min Han
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Lingchuan Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Junfeng Zhang
- Nicholas School of the Environment, Duke Global Health Institute, Duke University, Durham, NC 27705, USA; Duke Kunshan University, Kunshan, Jiangsu Province 215316, China.
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China.
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Lee SW, Yon DK, James CC, Lee S, Koh HY, Sheen YH, Oh JW, Han MY, Sugihara G. Short-term effects of multiple outdoor environmental factors on risk of asthma exacerbations: Age-stratified time-series analysis. J Allergy Clin Immunol 2019; 144:1542-1550.e1. [PMID: 31536730 DOI: 10.1016/j.jaci.2019.08.037] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 08/13/2019] [Accepted: 08/21/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although the different age groups had differences in sensitivity of asthma exacerbations (AEs) to environmental factors, no comprehensive study has examined the age-stratified effects of environmental factors on AEs. OBJECTIVE We sought to examine the short-term effects in age-stratified groups (infants, preschool children, school-aged children, adults, and the elderly) of outdoor environmental factors (air pollutants, weather conditions, aeroallergens, and respiratory viral epidemics) on AEs. METHODS We performed an age-stratified analysis of the short-term effects of 4 groups of outdoor environmental factors on AEs in Seoul Metropolitan City (Korea) from 2008 and 2012. The statistical analysis used a Poisson generalized linear regression model, with a distributed lag nonlinear model for identification of lagged and nonlinear effects and convergent cross-mapping for identification of causal associations. RESULTS Analysis of the total population (n = 10,233,519) indicated there were 28,824 AE events requiring admission to an emergency department during the study period. Diurnal temperature range had significant effects in pediatric (infants, preschool children, and school-aged children) and elderly (relative risk [RR], 1.056-1.078 and 1.016, respectively) subjects. Tree and weed pollen, human rhinovirus, and influenza virus had significant effects in school-aged children (RR, 1.014, 1.040, 1.042, and 1.038, respectively). Tree pollen and influenza virus had significant effects in adults (RR, 1.026 and 1.044, respectively). Outdoor air pollutants (particulate matter of ≤10 μm in diameter, nitrogen dioxide, ozone, carbon monoxide, and sulfur dioxide) had significant short-term effects in all age groups (except for carbon monoxide and sulfur dioxide in infants). CONCLUSION These findings provide a need for the development of tailored strategies to prevent AE events in different age groups.
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Affiliation(s)
- Seung Won Lee
- Graduate School of Medicine, CHA University, Seongnam, Korea; Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea
| | - Dong Keon Yon
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea; Medical Corps, Republic of Korea Army, Seongnam, Korea
| | - Chase C James
- Scripps Institution of Oceanography, University of California San Diego, San Diego, Calif
| | - Shinhae Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hyun Yong Koh
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Youn Ho Sheen
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Jae-Won Oh
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
| | - George Sugihara
- Scripps Institution of Oceanography, University of California San Diego, San Diego, Calif
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Wu J, Zhong T, Zhu Y, Ge D, Lin X, Li Q. Effects of particulate matter (PM) on childhood asthma exacerbation and control in Xiamen, China. BMC Pediatr 2019; 19:194. [PMID: 31196028 PMCID: PMC6563520 DOI: 10.1186/s12887-019-1530-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 05/08/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The short-term effects of particulate matter (PM) exposure on childhood asthma exacerbation and disease control rate is not thoroughly assessed in Chinese population yet. The previous toxic effects of PM exposure are either based on long-term survey or experimental data from cell lines or mouse models, which also needs to be validated by real-world evidences. METHODS We evaluated the short-term effects of PM exposure on asthma exacerbation in a Chinese population of 3106 pediatric outpatientsand disease control rate (DCR) in a population of 3344 children using case-crossover design. All the subjects enrolled are non-hospitalized outpatients. All data for this study were collected from the electronic health record (EHR) in the period between January 1, 2016 and June 30, 2018 in Xiamen, China. RESULTS We found that exposure to PM2.5 and PM10 within the past two weeks was significantly associated with elevated risk of exacerbation (OR = 1.049, p < 0.001 for PM2.5and OR = 1.027, p < 0.001 for PM10). In addition, exposure to PM10 was associated with decreased DCR (OR = 0.976 for PM10, p < 0.001). CONCLUSIONS Our results suggest that exposure to both PM10 and PM2.5 has significant short-term effects on childhood asthma exacerbation and DCR, which serves as useful epidemiological parameters for clinical management of asthma risk in the sensitive population.
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Affiliation(s)
- Jinzhun Wu
- Department of Pediatrics, the First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xiamen, 361003 China
| | - Taoling Zhong
- National Institute for Data Science in Health and Medicine, School of Medicine, Xiamen University, South Xiang’an Road, Xiamen, 361102 China
| | - Yu Zhu
- Department of Pediatrics, the First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xiamen, 361003 China
| | - Dandan Ge
- Department of Pediatrics, the First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xiamen, 361003 China
| | - Xiaoliang Lin
- Department of Pediatrics, the First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xiamen, 361003 China
| | - Qiyuan Li
- Department of Pediatrics, the First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xiamen, 361003 China
- National Institute for Data Science in Health and Medicine, School of Medicine, Xiamen University, South Xiang’an Road, Xiamen, 361102 China
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Chen J, Jiang X, Shi C, Liu R, Lu R, Zhang L. Association between gaseous pollutants and emergency ambulance dispatches for asthma in Chengdu, China: a time-stratified case-crossover study. Environ Health Prev Med 2019; 24:20. [PMID: 30885130 PMCID: PMC6421698 DOI: 10.1186/s12199-019-0773-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/27/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives The association between concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), and emergency ambulance dispatches (EADs) for asthma was explored in the central Sichuan Basin of southwestern China for the first time. Methods EADs for asthma were collected from the Chengdu First-Aid Command Center. Pollutant concentrations were collected from 24 municipal environmental monitoring centers and including SO2, NO2, CO, daily 8-h mean concentrations of O3 (O3-8 h), and particulate matter less than 2.5 μm in aerodynamic diameter (PM2.5). The climatic data were collected from the Chengdu Municipal Meteorological Bureau. All data were collected from years spanning 2013–2017. A time-stratified case-crossover design was used to analyze the data. Results After controlling for temperature, relative humidity, and atmospheric pressure, IQR increases in SO2 (13 μg/m3), NO2 (17 μg/m3), and CO (498 μg/m3) were associated with 18.8%, 11.5%, and 3.1% increases in EADs for asthma, respectively. The associations were strongest for EADs and SO2, NO2, and CO levels with 3-, 5-, and 1-day lags, respectively. Conclusions This study provides additional data to the limited body of literature for potential health risks arising from ambient gaseous pollutants. The results of the study suggest that increased concentrations of SO2, NO2, and CO were positively associated with emergency ambulance dispatches for asthma in Chengdu, China. Further studies are needed to investigate the effects of individual air pollutants on asthma.
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Affiliation(s)
- Jianyu Chen
- Sichuan Provincial Center for Disease Control and Prevention, No.6, Zhongxue Road, Wuhou District, Chengdu, 610041, China.
| | - Xianyan Jiang
- Sichuan Provincial Center for Disease Control and Prevention, No.6, Zhongxue Road, Wuhou District, Chengdu, 610041, China
| | - Chunli Shi
- Sichuan Provincial Center for Disease Control and Prevention, No.6, Zhongxue Road, Wuhou District, Chengdu, 610041, China
| | - Ruicong Liu
- Sichuan Provincial Center for Disease Control and Prevention, No.6, Zhongxue Road, Wuhou District, Chengdu, 610041, China
| | - Rong Lu
- Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Li Zhang
- Sichuan Provincial Center for Disease Control and Prevention, No.6, Zhongxue Road, Wuhou District, Chengdu, 610041, China.
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Bao X, Tian X, Yang C, Li Y, Hu Y. Association between ambient air pollution and hospital admission for epilepsy in Eastern China. Epilepsy Res 2019; 152:52-58. [PMID: 30909052 DOI: 10.1016/j.eplepsyres.2019.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 01/26/2019] [Accepted: 02/24/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND We aimed to study the short-term association between air pollutants and hospitalization for epilepsy in 47 hospitals from 10 cities in eastern China. METHOD We identified hospital epilepsy admissions in 2014 and 2015. A conditional Poisson regression model was used to examine the association between air pollutants and hospital admission, with temperature and relative humidity adjusted using the natural spline (ns) function. Pollutants included sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and particulate matter (PM). The association was stratified by sex, age, and geographic region in single-pollutant and two-pollutant models. RESULTS An interquartile (IQR) increase of NO2 and CO on the concurrent day is correlated with an increased admission of 2.0% (0.5%, 3.6%) and 1.1% (0.1%, 2.1%), respectively. The association is stronger in children (≤18 years) and in northern China, but did not vary with sex. A positive association was also observed on the previous day for CO [1.5%, 95% confidence interval (CI): 0.3%, 2.6%], NO2 (2.5%, 95% CI: 0.6%, 4.3%), and PM2.5 (1.32%, 95% CI: 0.16%, 2.48%). Moving average concentration of 7 days for all pollutants was associated with decreased admission (CO: -1.29%, NO2: -0.4.69%, SO2:-2.12%, PM2.5:-0.98%, PM10:-1.70%). CONCLUSION Exposures to NO2 and CO on concurrent days, and PM2.5 on the previous day, are associated with increased epilepsy hospitalization, whereas cumulative exposure appeared protective.
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Affiliation(s)
- Xiaoyuan Bao
- Medical Informatics Center, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
| | - Xin Tian
- Department of Health Policy and Administration, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
| | - Chao Yang
- Renal Division, Peking University First Hospital, Peking Uni versity Institute of Nephrology, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Yan Li
- Department of Hospital Management, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
| | - Yonghua Hu
- Medical Informatics Center, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China; Department of Epidemiology and Biostatistics, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
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Hendryx M, Higginbotham N, Ewald B, Connor LH. Air Quality in Association With Rural Coal Mining and Combustion in New South Wales Australia. J Rural Health 2019; 35:518-527. [PMID: 30742340 DOI: 10.1111/jrh.12348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE Rural areas may face under-recognized threats to air quality. We tested 2 hypotheses that 1) rural areas in New South Wales, Australia, would have better air quality than metropolitan Sydney, and that 2) the rural Upper Hunter region characterized by coal mining and coal combustion would have worse air quality than other rural areas of the state. METHODS We analyzed 2017 daily mean values for New South Wales, Australia, for particulate matter (PM2.5 and PM10), sulfur dioxide (SO2 ), nitric oxide (NO), nitrogen dioxide (NO2 ), and NOx (sum of NO and NO2 ). Forty-six air monitoring stations were grouped into 6 rural and urban regional areas. Linear regression models examined pollution levels in association with rural and urban regions and meteorological covariates. RESULTS Findings show that daily mean pollutant levels in the rural Upper Hunter were the highest of all regions, and were significantly higher than metropolitan Sydney, with and without control for weather conditions, for every pollutant. For example, daily mean PM2.5 was 8.64 µg/m3 in the rural Upper Hunter, compared to 7.23 µg/m3 in metropolitan Sydney. CONCLUSIONS Results highlight the need to consider both urban and rural sources of pollution in air quality studies, and appropriate policy steps to address likely rural air pollution from coal mining.
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Affiliation(s)
- Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, Indiana
| | - Nicholas Higginbotham
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Benjamin Ewald
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Linda H Connor
- Department of Anthropology, University of Sydney, New South Wales, Australia
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Zhang Y, Ni H, Bai L, Cheng Q, Zhang H, Wang S, Xie M, Zhao D, Su H. The short-term association between air pollution and childhood asthma hospital admissions in urban areas of Hefei City in China: A time-series study. ENVIRONMENTAL RESEARCH 2019; 169:510-516. [PMID: 30544078 DOI: 10.1016/j.envres.2018.11.043] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 10/29/2018] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The impacts of air pollution on asthma attacks have become a hotspot. Previous studies mainly focused on the developed countries or cities. There have been very limited studies in less-developed region to quantify the effects of air pollutants on asthma admissions in children. This study aims to assess the short-term impact of air pollutants on asthma hospital admissions for children in Hefei, China. METHODS Poisson generalized linear regression combined with distributed lag non-linear model (DLNM) were applied to investigate the effects of air pollutants on daily childhood hospital admissions of asthma from 2015 to 2016, controlling for meteorological factors. Subgroup analyses by sex and age were performed. RESULTS There were a total of 17,227 asthma admissions during 2015-2016. We found positive correlations between childhood asthma hospital visits and concentrations of NO2, O3, PM10 and PM2.5. Significantly, NO2 exhibited robust positive correlations with cumulative effects 1.551 (95% CI: 1.306-1.841, lag0-3 days) in single-pollutant model and 1.580 (95% CI: 1.315-1.899, lag0-3 days) in multiple-pollutant model. CONCLUSIONS Air pollutants had adverse effects on childhood asthma. NO2 presented the greatest effect, followed by PM2.5. Results will be important for health authority and guardians to realize the severity of air pollution on the increased risk of asthma, so as to develop relevant strategies and health interventions to meet the challenges of childhood asthma and reduce air pollution.
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Affiliation(s)
- Yanwu Zhang
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Hong Ni
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Province Children's Hospital, Hefei, Anhui 230051, China
| | - Lijun Bai
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Qiang Cheng
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Heng Zhang
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Shusi Wang
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Mingyu Xie
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Desheng Zhao
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Hong Su
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China.
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Ab Manan N, Noor Aizuddin A, Hod R. Effect of Air Pollution and Hospital Admission: A Systematic Review. Ann Glob Health 2018; 84:670-678. [PMID: 30779516 DOI: 10.9204/aogh.2376] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IntroductionMany epidemiological studies have demonstrated associations between air pollution levels and human health in terms of hospital admissions. The aim of this paper is to gather evidence concerning air pollution effects on the risk of hospital admission. We hypothesised that increase in: particulate matter (PM), ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), and sulphur dioxide (SO2) levels would be associated with the increasing trend of hospital admission.MethodsA systematic review of literature was carried out. Literature search was done in Sage, Ovid Medline, Science Direct, Wiley and ProQuest from 2010 to 2016 using keywords "hospital admission and air pollution". Studies of any relevant design were included if they presented original data, included at least one analysis where hospital admission was the specific outcome, and one or more of the following exposures were investigated: PM, O3, CO, NO2 and SO2.ResultsA total of 175 potential studies were identified by the search. Twenty two studies qualified for the review. Air pollution was noted to have an excessive risk of 3.46 (95%CI, 1.67, 5.27) of total hospital admissions. Cardiovascular admission was noted to have an increased risk of hospitalization for PM2.5 of 1.5 to 2.0; PM10 (1.007 to 2.7); NO2 (1.04 to 1.17) and SO2 (1.007). For respiratory admission, PM2.5 can caused an increased risk of hospitalization by 1.1 to 1.8; PM10 (1.007 to 1.13); NO2 (1.08 to 1.94) and SO2 (1.02). While O3 have minimal effect on COPD and stroke, CO does not influence in the effect of these hospitalization.ConclusionThe exposure to air pollutants confers an increased risk of admission of several disease. Our findings call for greater awareness of environmental protection and the implementation of effective measures to improve the quality of air, which may reduce the risks of adverse effects on the population's health.
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Affiliation(s)
| | | | - Rozita Hod
- Department of Community Health, National University of Malaysia, MY
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Ab Manan N, Noor Aizuddin A, Hod R. Effect of Air Pollution and Hospital Admission: A Systematic Review. Ann Glob Health 2018. [PMID: 30779516 PMCID: PMC6748301 DOI: 10.29024/aogh.2376] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction: Many epidemiological studies have demonstrated associations between air pollution levels and human health in terms of hospital admissions. The aim of this paper is to gather evidence concerning air pollution effects on the risk of hospital admission. We hypothesised that increase in: particulate matter (PM), ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), and sulphur dioxide (SO2) levels would be associated with the increasing trend of hospital admission. Methods: A systematic review of literature was carried out. Literature search was done in Sage, Ovid Medline, Science Direct, Wiley, and ProQuest from 2010 to 2016 using keywords “hospital admission and air pollution”. Studies of any relevant design were included if they presented original data, included at least one analysis where hospital admission was the specific outcome, and one or more of the following exposures were investigated: PM, O3, CO, NO2 and SO2. Results: A total of 175 potential studies were identified by the search. Twenty-two studies qualified for the review. Air pollution was noted to have an excessive risk of 3.46 (95% CI, 1.67, 5.27) of total hospital admissions. Cardiovascular admission was noted to have an increased risk of hospitalization for PM2.5 of 1.5 to 2.0; PM10 (1.007 to 2.7); NO2 (1.04 to 1.17) and SO2 (1.007). For respiratory admission, PM2.5 can caused an increased risk of hospitalization by 1.1 to 1.8; PM10 (1.007 to 1.13); NO2 (1.08 to 1.94) and SO2 (1.02). While O3 have minimal effect on COPD and stroke, CO does not influence in the effect of these hospitalization. Conclusion: The exposure to air pollutants confers an increased risk of admission of several disease. Our findings call for greater awareness of environmental protection and the implementation of effective measures to improve the quality of air, which may reduce the risks of adverse effects on the population’s health.
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Affiliation(s)
| | | | - Rozita Hod
- Department of Community Health, National University of Malaysia, MY
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Chen K, Glonek G, Hansen A, Williams S, Tuke J, Salter A, Bi P. Reply to 'Comments on the effects of air pollution on asthma hospital admissions in Adelaide, South Australia, 2003-2013: time series and case-crossover analyses'. Clin Exp Allergy 2018; 47:141. [PMID: 27790759 DOI: 10.1111/cea.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K Chen
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - G Glonek
- School of Mathematical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - A Hansen
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - S Williams
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - J Tuke
- School of Mathematical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - A Salter
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - P Bi
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
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Shrestha SK, Katelaris C, Dharmage SC, Burton P, Vicendese D, Tham R, Abramson MJ, Erbas B. High ambient levels of grass, weed and other pollen are associated with asthma admissions in children and adolescents: A large 5-year case-crossover study. Clin Exp Allergy 2018; 48:1421-1428. [PMID: 29975808 DOI: 10.1111/cea.13225] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/30/2018] [Accepted: 07/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pollen is an important aeroallergen that triggers asthma exacerbations in children, but we know little about the impact of different pollen types in cities with varying climatic conditions and pollen seasons. OBJECTIVES We aimed to assess the role of ambient level of different types of pollen on a large time series of child and adolescent asthma hospitalizations in Sydney, Australia. METHODS Childhood asthma hospitalization and the daily ambient pollen concentrations of different species were collected in South-West Sydney. With a bidirectional case-crossover design, we fitted conditional logistic regression models to measure the associations between instantaneous and up to 3 days lagged effects of pollen concentrations on asthma hospitalizations after controlling for potential confounders and testing for interactions. RESULTS A total of 2098 children, more boys (59.7%) and 2-5 years old (62.6%), were hospitalized due to asthma. The geometric mean concentration of Cupressus, 7.88 [5.02] grains/m3 , was the highest during the study period. The increase from 75th to 90th percentile of grass (OR = 1.037, 95% CI 1.005-1.070), weed other than Plantago species (OR = 1.053, 95% CI 1.009-1.098) and unclassified pollen (OR = 1.034, 95% CI 1.010-1.058) were significantly associated with the odds of asthma hospitalizations. Boys were at greater risk of asthma exacerbations associated with grass (OR = 1.046, 95% CI 1.003-1.090) and unclassified pollen (OR = 1.041, 95% CI 1.010-1.073). There was evidence of effect modification by age groups for Cupressus, conifer, total tree and total pollen. CONCLUSIONS Although boys are more vulnerable to grass pollen, weed, and other pollen are also important triggers of asthma exacerbations in all children and adolescents. These findings are important for urban green space planning and the development of pollen monitoring systems for families with children at risk of asthma exacerbations during peak pollen seasons.
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Affiliation(s)
- Som K Shrestha
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | | | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Pamela Burton
- Department of Medicine, Campbelltown Hospital, Sydney, NSW, Australia
| | - Don Vicendese
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Rachel Tham
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
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Erbas B, Shrestha SK, Dharmage SC, Katelaris C, Davies J, Abramson MJ. The effects of Air Pollution on asthma Hospital admissions in Adelaide, South Australia, 2003-2013: time series and case-crossover analysis. Clin Exp Allergy 2018; 46:1623-1624. [PMID: 27797423 DOI: 10.1111/cea.12847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- B Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - S K Shrestha
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - S C Dharmage
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - C Katelaris
- School of Medicine, University of Western Sydney, Sydney, NSW, Australia
| | - J Davies
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, Qld, Australia
| | - M J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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Ming CR, Ban Yu-Lin A, Abdul Hamid MF, Latif MT, Mohammad N, Hassan T. Annual Southeast Asia haze increases respiratory admissions: A 2-year large single institution experience. Respirology 2018; 23:914-920. [PMID: 29923364 DOI: 10.1111/resp.13325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/22/2018] [Accepted: 03/26/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE The Southeast Asia (SEA) haze is an annual problem and at its worst could produce respirable particles of concentrations up to 500 μg/m3 which is five times the level considered as 'unhealthy'. However, there are limited reports examining the direct clinical impact of the annual haze. This study examines the effects of the SEA haze on respiratory admissions. METHODS Data from all respiratory admissions in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from 1st January 2014 to 31st December 2015 were collected retrospectively from chart and electronic database. A total of 16 weeks of haze period had been formally dated by the Department of Environment using the definition of weather phenomenon leading to atmospheric visibility of less than 10 km. Multivariable regression analyses were performed to estimate rate ratios and 95% CI. RESULTS There were 1968 subjects admitted for respiratory admissions in UKMMC during the study period. Incidence rates per week were significantly different between the two groups with 27.6 ± 9.2 cases per week during the haze versus 15.7 ± 6.7 cases per week during the non-haze period (P < 0.01). A total of 4% versus 2% was admitted to the intensive care unit in the haze and the non-haze groups, respectively (P = 0.02). The mean ± SD lengths of stay was 12.1 ± 5.2 days; the haze group had a longer stay (18.2 ± 9.7 days) compared to the non-haze groups (9.7 ± 3.9) (P < 0.001). CONCLUSION The annual SEA haze is associated with increased respiratory admissions.
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Affiliation(s)
- Chew R Ming
- Department of Medicine, National University Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Andrea Ban Yu-Lin
- Department of Medicine, National University Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mohammad F Abdul Hamid
- Department of Medicine, National University Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd T Latif
- School of Environmental and Natural Resource Sciences, Faculty of Science and Technology, National University Malaysia, Bangi, Malaysia
| | - Nurashikin Mohammad
- Department of Medicine, Universiti Sains Malaysia, Health Campus, George Town, Malaysia
| | - Tidi Hassan
- Department of Medicine, National University Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Dou H, Zhao Y, Chen Y, Zhao Q, Xiao B, Wang Y, Zhang Y, Chen Z, Guo J, Tao L. Development and testing of the reliability and validity of the adolescent haze related knowledge awareness assessment scale (AHRKAAS). BMC Public Health 2018; 18:734. [PMID: 29898700 PMCID: PMC6000920 DOI: 10.1186/s12889-018-5638-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/30/2018] [Indexed: 01/24/2023] Open
Abstract
Background Haze leads to many direct serious public health impacts. Understanding haze related knowledge can not only help adolescents organize health protection awareness to prevent the harmful effects that haze has on the body, but also promote their normal growth and development. Methods By considering, as the theoretical basis, the reasons behind the formation of haze and the underlying mechanisms of the diseases that it causes, in addition to also investigating extensive literature references, our research team developed the Adolescent Haze Related Knowledge Awareness Assessment Scale (AHRKAAS-I). After 6 experts reviewed AHRKAAS-I, and 6 adolescents tested the scale, the research team further revised and improved AHRKAAS-I to form AHRKAAS-II. After which, researchers randomly selected 2 districts from the 20 districts of Baoding, and subsequently randomly selected 2 middle schools from these 2 districts. Conducting a stratified cluster sampling method, considering class as a unit, the research team randomly selected 22 classes. Finally, a total of 1100 adolescents were investigated and 1034 valid questionnaires were recovered. By analyzing the data of 1034 valid questionnaires, the researchers tested the reliability and validity of the scale and obtained the final scale (AHRKAAS). Results AHRKAAS Cronbach’s α=0.923, content validity = 0.940, criterion validity = 0.444, and factor cumulative contribution rate = 66.178% by exploratory factor analysis. Using confirmatory factor analysis, Chi square value = 662.780, degrees of freedom = 242, Chi square value/degrees of freedom = 2.739, root-mean-square error of approximation = 0.049, goodness of fit index = 0.929, adjusted goodness of fit index = 0.905, comparative fit index = 0.964, normed fit index = 0.944, and Tueker-Lewis index = 0.955. AHRKAAS consisted of 25 items and 4 dimensions. Conclusion AHRKAAS with a good reliability and validity can be used to assess the cognition level of haze related knowledge among the adolescents, help medical workers and coordinators in schools when conducting targeted behavior interventions. Furthermore, it can be used for health guidance for adolescents relating to the health prevention of haze.
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Affiliation(s)
- Hongzhe Dou
- Affiliated Hospital of Hebei University, No.212 Yuhua East Road, Baoding, 071000, China
| | - Yuejia Zhao
- Affiliated Hospital of Hebei University, No.212 Yuhua East Road, Baoding, 071000, China
| | - Yanhong Chen
- Affiliated Hospital of Hebei University, No.212 Yuhua East Road, Baoding, 071000, China
| | - Qingchun Zhao
- Affiliated Hospital of Hebei University, No.212 Yuhua East Road, Baoding, 071000, China
| | - Bo Xiao
- The NO.5 Hospital of Baoding, No.340 Ruixiang Street, Baoding, 071000, China
| | - Yan Wang
- College of Nursing, Hebei University, No.342 Yuhua East Road, Baoding, 071000, China
| | - Yonghe Zhang
- College of Nursing, Hebei University, No.342 Yuhua East Road, Baoding, 071000, China
| | - Zhiguo Chen
- College of Nursing, Hebei University, No.342 Yuhua East Road, Baoding, 071000, China
| | - Jie Guo
- College of Nursing, Hebei University, No.342 Yuhua East Road, Baoding, 071000, China
| | - Lingwei Tao
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai, Beijing, 100069, China.
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Spatiotemporal Characteristics and Health Risk Assessment of Heavy Metals in PM 2.5 in Zhejiang Province. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040583. [PMID: 29587346 PMCID: PMC5923625 DOI: 10.3390/ijerph15040583] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/09/2018] [Accepted: 03/23/2018] [Indexed: 11/16/2022]
Abstract
The spatiotemporal characteristics and human health risks of 12 heavy metals (Al, As, Be, Cd, Cr, Hg, Mn, Ni, Pb, Sb, Se, and Tl) in fine particulate matter (PM2.5) in Zhejiang Province were investigated. The annual average PM2.5 concentration was 58.83 µg/m3 in 2015 in Zhejiang. Element contents in PM2.5 varied greatly with the season and locations. Al, Pb, and Mn were the most abundant elements among the studied metal(loid)s in PM2.5. The non-carcinogenic risks of the 12 elements through inhalation and dermal contact exposure were lower than the safe level for children and adults. However, there were potential non-carcinogenic risks of Tl, As, and Sb for children and Tl for adults through ingestion exposure. The carcinogenic risks from As, Be, Cd, Cr, Pb, and Ni through inhalation exposure were less than the acceptable level (1 × 10−4) for children and adults. Pb may carry a potential carcinogenic risk for both children and adults through ingestion. More attention should be paid to alleviate non-carcinogenic and carcinogenic health risks posed by particle-bound toxic elements through ingestion exposure.
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Bai L, Su X, Zhao D, Zhang Y, Cheng Q, Zhang H, Wang S, Xie M, Su H. Exposure to traffic-related air pollution and acute bronchitis in children: season and age as modifiers. J Epidemiol Community Health 2018; 72:426-433. [DOI: 10.1136/jech-2017-209948] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/28/2017] [Accepted: 01/17/2018] [Indexed: 12/22/2022]
Abstract
BackgroundAcute bronchitis (AB) is one of the principal causes of childhood morbidity. Increasing number of studies has shown that air pollution is an important environmental contributor of respiratory disease. However, evidence so far is scarce regarding the effects of air pollution on childhood AB, and it also remains unclear how the risk of AB will change by season and age.MethodsData on hospital visits for AB in children, air pollution and meteorological factors from 1 January 2015 to 31 December 2016 were collected in Hefei, China. Time-series analysis was applied to assess the short-term effects of traffic-related air pollution on childhood AB outpatient visits. A Poisson generalised linear regression model combined with a distributed lag non-linear model was used to estimate the relationships, controlling for long-term trends, seasonal patterns, meteorological factors and other possible confounders.ResultsWe found that an IQR increase in concentrations of nitrogen dioxide, particulate matter <2.5 µm and carbon monoxide significantly increased the daily hospital visits for childhood AB with 4-day cumulative effect estimates (relative risks: 1.03, 95% CI 1.01 to 1.05; 1.09, 95% CI 1.07 to 1.11; 1.07, 95% CI 1.05 to 1.09). Notably, the risk estimates during the cold season are pronounced; however, no significant association was observed during the warm season. Interestingly, children aged 6–14 years were more vulnerable to air pollutants than children aged less than 1 year and within 1–5 years. However, no gender difference was observed.ConclusionA significant association of traffic-related air pollution and increased department visits for childhood AB was observed, notably in school-age children and during the cold season.
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Ghaffari HR, Aval HE, Alahabadi A, Mokammel A, Khamirchi R, Yousefzadeh S, Ahmadi E, Rahmani-Sani A, Estaji M, Ghanbarnejad A, Gholizadeh A, Taghavi M, Miri M. Asthma disease as cause of admission to hospitals due to exposure to ambient oxidants in Mashhad, Iran. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:27402-27408. [PMID: 28975536 DOI: 10.1007/s11356-017-0226-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/13/2017] [Indexed: 05/21/2023]
Abstract
Nowadays, asthma is one of the most common chronic respiratory diseases, worldwide. Many reports have emphasized the correlation between the short-term exposure to the ambient air pollutants and acute respiratory diseases, especially among children with asthmatic symptoms. The aim of this study was to evaluate the relationship between the exposure to three atmospheric antioxidants (NO2, SO2, and O3) and hospital admission due to asthmatic disease (HAAD) in the city of Mashhad, Iran. The concentrations of atmospheric antioxidants were obtained from the real-time monitoring stations located in the city. The collected data were employed for developing predictive models in the AirQ software. In order to investigate the association between short-term exposure to air pollutants and HAAD, the study participants were categorized into two age groups: less than 15 and from 15 to 64 years old. The results indicated that in people less than 15 years increase in NO2 (attributable proportion (AP) = 3.775%, 95% CI 0.897-6.883%), SO2 (AP = 3.649%, 95% CI 1.295-5.937%), and O3 (AP = 0.554%,95% CI 0.00-3.321) results in increase in HAAD. While for those aged between 15 and 64 years, the AP was 4.192% (95% CI 0.450-7.662%) for NO2; 0.0% (95% CI 0.00-1.687%) for SO2; and 0.236% (95% CI 0.00-1.216%) for O3. The number of asthmatic cases who were less than 15 years admitted to the hospitals during the study period was higher than that of those within the age groups between 15 and 64 years as a consequence of exposure to NO2 (101 vs. 75), SO2 (98 vs. 0), and O3 (15 vs. 3), respectively. To the best of our knowledge, the AirQ model has not been applied before to estimate the effect of atmospheric antioxidant exposure on hospital admission because of asthma disease. Eventually, this model is proposed to be applicable for other cities around the world.
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Affiliation(s)
- Hamid Reza Ghaffari
- Department of Environmental Health Engineering, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamideh Ebrahimi Aval
- Department of Environmental Health, School of Public Health, Semnan University of Medical Sciences, Semnan, Iran
| | - Ahmad Alahabadi
- Department of Environmental Health, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Adel Mokammel
- Department of Environmental Health, School of Public Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ramzanali Khamirchi
- Department of Environmental Health, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Samira Yousefzadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health, School of Public Health, Semnan University of Medical Sciences, Semnan, Iran
| | - Ehsan Ahmadi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Rahmani-Sani
- Department of Environmental Health, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mehdi Estaji
- Department of Environmental Health Engineering, School of Public Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Amin Ghanbarnejad
- Department of Epidemiology and Biostatistics, School of Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolmajid Gholizadeh
- Department of Environmental Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahmoud Taghavi
- Department of Environmental Health, School of Public Health, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mohammad Miri
- Department of Environmental Health, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran.
- Department of Environmental Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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