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Adhikary M, Saikia N, Purohit P, Canudas‐Romo V, Schöpp W. Air Pollution and Mortality in India: Investigating the Nexus of Ambient and Household Pollution Across Life Stages. GEOHEALTH 2024; 8:e2023GH000968. [PMID: 39165477 PMCID: PMC11333718 DOI: 10.1029/2023gh000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/25/2024] [Accepted: 07/11/2024] [Indexed: 08/22/2024]
Abstract
Air pollution in India is a foremost environmental risk factor that affects human health. This study first investigates the geographical distribution of ambient and household air pollution (HAP) and then examines the associated mortality risk. Data on fine particulate matter (PM2.5) concentration has been extracted from the Greenhouse Gas Air Pollution Interactions and Synergies (GAINS) model. HAP, mortality and socio-demographic data were extracted from the National Family and Health Survey-5, India, 2019-2021. Regression models were applied to see the difference in age-group mortality by different pollution parameters. The districts with PM2.5 concentration above the National Ambient Air Quality Standard (NAAQS) level of 40 μg/m3 show a higher risk of neonatal (OR-1.86, CI 1.418-2.433), postneonatal (OR-2.04, CI 1.399-2.971), child (OR-2.19, CI 0.999-4.803) and adult death (OR-1.13, CI 1.060-1.208). The absence of a separate kitchen shows a higher probability of neonatal (OR: 1.18, CI 1.074-1.306) and adult death (OR-1.06, CI 1.027-1.088). The interaction between PM2.5 levels above NAAQS and HAP leads to a substantial rise in mortality observed for neonatal (OR 1.19 CI 1.051-1.337), child (OR 1.17 CI 1.054-1.289), and adult (OR 1.13 CI 1.096-1.168) age groups. This study advocates that there is a strong positive association between ambient and HAP and mortality risk. PM2.5 pollution significantly contributes to the mortality risk in all age groups. Children are more vulnerable to HAP than adults. In India, policymakers should focus on reducing the anthropogenic PM2.5 emission at least to reach the NAAQS, which can substantially reduce disease burden and, more precisely, mortality.
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Affiliation(s)
- Mihir Adhikary
- Department of Public Health and Mortality StudiesInternational Institute for Population SciencesMumbaiMaharashtraIndia
| | - Nandita Saikia
- Department of Public Health and Mortality StudiesInternational Institute for Population SciencesMumbaiMaharashtraIndia
| | - Pallav Purohit
- Pollution Management Research GroupEnergy, Climate and Environment (ECE) ProgramInternational Institute for Applied Systems Analysis (IIASA)LaxenburgAustria
| | - Vladimir Canudas‐Romo
- School of DemographyANU College of Arts and Social SciencesAustralian National UniversityCanberraACTAustralia
| | - Wolfgang Schöpp
- Pollution Management Research GroupEnergy, Climate and Environment (ECE) ProgramInternational Institute for Applied Systems Analysis (IIASA)LaxenburgAustria
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Luben TJ, Wilkie AA, Krajewski AK, Njie F, Park K, Zelasky S, Rappazzo KM. Short-term exposure to air pollution and infant mortality: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 898:165522. [PMID: 37459995 PMCID: PMC11094744 DOI: 10.1016/j.scitotenv.2023.165522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND AND AIM Infant mortality is a widely reported indicator of population health and a leading public health concern. In this systematic review and meta-analysis, we review the available literature for epidemiologic evidence of the association between short-term air pollution exposure and infant mortality. METHODS Relevant publications were identified through PubMed and Web of Science databases using comprehensive search terms and screened using predefined inclusion/exclusion criteria. We extracted data from included studies and applied a systematic rubric for evaluating study quality across domains including participant selection, outcome, exposure, confounding, analysis, selective reporting, sensitivity, and overall quality. We performed meta-analyses, using both fixed and random-effect methods, and estimated pooled odds ratios (ORs) and 95 % confidence intervals (95%CI) for pollutants (nitrogen dioxide (NO2), sulfur dioxide (SO2), coarse particulate matter (PM10), fine particulate matter (PM2.5), ozone (O3), carbon monoxide (CO)) and infant mortality, neonatal mortality, or postneonatal mortality. RESULTS Our search returned 549 studies. We excluded 490 studies in the abstract screening phase and an additional 37 studies in the full text screening phase, leaving 22 studies for inclusion. Among these 22 studies, 14 included effect estimates for PM10, 13 for O3, 11 for both NO2 and CO, 8 for SO2, and 3 for PM2.5. We did not calculate a pooled OR for PM2.5 due to the limited number of studies available and demonstrated heterogeneity in the effect estimates. The pooled ORs (95%CI) with the greatest magnitudes were for a 10-ppb increase in SO2 or NO2 concentration in the days before death (1.07 [95%CI: 1.02, 1.12], 1.04 [95%CI: 1.01, 1.08], respectively). The pooled OR for PM10 was 1.02 (95%CI: 1.00, 1.03), and the pooled ORs for CO and O3 were 1.01 (95%CI: 1.00, 1.02) and 0.99 (95%CI: 0.97, 1.01). CONCLUSIONS Increased exposure to SO2, NO2, PM10, or CO is associated with infant mortality across studies.
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Affiliation(s)
- Thomas J Luben
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, RTP, NC, USA.
| | - Adrien A Wilkie
- Oak Ridge Institute for Science and Education (ORISE) at the U.S. Environmental Protection Agency, RTP, NC, USA
| | - Alison K Krajewski
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, RTP, NC, USA
| | - Fanny Njie
- Oak Ridge Associated Universities (ORAU) at the U.S. Environmental Protection Agency, RTP, NC, USA
| | - Kevin Park
- Oak Ridge Associated Universities (ORAU) at the U.S. Environmental Protection Agency, RTP, NC, USA
| | - Sarah Zelasky
- Oak Ridge Associated Universities (ORAU) at the U.S. Environmental Protection Agency, RTP, NC, USA
| | - Kristen M Rappazzo
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Public Health and Environmental Assessment, RTP, NC, USA
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Bachwenkizi J, Liu C, Meng X, Zhang L, Wang W, van Donkelaar A, Martin RV, Hammer MS, Chen R, Kan H. Fine particulate matter constituents and infant mortality in Africa: A multicountry study. ENVIRONMENT INTERNATIONAL 2021; 156:106739. [PMID: 34217038 DOI: 10.1016/j.envint.2021.106739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/30/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Few studies have investigated the association between exposure to fine particulate matter (PM2.5) and infant mortality in developing countries, especially for the health effects of specific PM2.5 constituents. OBJECTIVE We aimed to examine the association of long-term exposure to specific PM2.5 constituents with infant mortality in 15 African countries from 2005 to 2015. METHODS Based on the Demographic and Health Surveys (DHS) dataset, we included birth history records from 15 countries in Africa and conducted a multicountry cross-sectional study to examine the associations between specific PM2.5 constituents and infant mortality. We estimated annual residential exposure using satellite-derived PM2.5 for mass and a chemical transport model (GEOS-Chem) for its six constituents, including organic matter (OM), black carbon (BC), sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), and soil dust (DUST). Multivariable logistic regression analysis was employed by fitting single-constituent models, the constituent-PM2.5 models, and the constituent-residual models. We also conducted stratified analyses by potential effect modifiers and examined the specific associations for each country. RESULTS We found positive and significant associations between PM2.5 total mass and most of its constituents with infant mortality. In the single-constituent model, for an IQR increase in pollutant concentrations, the odds ratio (OR) of infant mortality was 1.03 (95 %CI; 1.01, 1.06) for PM2.5 total mass, and was 1.04 (95 %CI: 1.02, 1.06), 1.04 (95 %CI: 1.02, 1.05), 1.02 (95 %CI: 1.00, 1.03), 1.04 (1.01, 1.06) for BC, OM, SO42-, and DUST, respectively. The associations of BC, OM, and SO42- remained significant in the other two models. We observed larger estimates in subgroups with older maternal age, living in urban areas, using unclean cooking energy, and with access to piped water. The associations varied among countries, and by different constituents. CONCLUSIONS The carbonaceous fractions and sulfate play a major important role among PM2.5 constituents on infant mortality. Our findings have certain policy implications for implementing effective measures for targeted reduction in specific sources (fossil fuel combustion and biomass burning) of PM2.5 constituents against the risk of infant mortality.
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Affiliation(s)
- Jovine Bachwenkizi
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Xia Meng
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Lina Zhang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Weidong Wang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, B3H 4R2 Halifax, Nova Scotia, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, B3H 4R2 Halifax, Nova Scotia, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Melanie S Hammer
- Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3), Fudan University, Shanghai 200030, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai 200032, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3), Fudan University, Shanghai 200030, China.
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Abstract
Ambient air pollution is produced by sources including vehicular traffic, coal-fired power plants, hydraulic fracturing, agricultural production, and forest fires. It consists of primary pollutants generated by combustion and secondary pollutants formed in the atmosphere from precursor gases. Air pollution causes and exacerbates climate change, and climate change worsens health effects of air pollution. Infants and children are uniquely sensitive to air pollution, because their organs are developing and they have higher air per body weight intake. Health effects linked to air pollution include not only exacerbations of respiratory diseases but also reduced lung function development and increased asthma incidence. Additional outcomes of concern include preterm birth, low birth weight, neurodevelopmental disorders, IQ loss, pediatric cancers, and increased risks for adult chronic diseases. These effects are mediated by oxidative stress, chronic inflammation, endocrine disruption, and genetic and epigenetic mechanisms across the life span. Natural experiments demonstrate that with initiatives such as increased use of public transportation, both air quality and community health improve. Similarly, the Clean Air Act has improved air quality, although exposure inequities persist. Other effective strategies for reducing air pollution include ending reliance on coal, oil, and gas; regulating industrial emissions; reducing exposure with attention to proximity of residences, schools, and child care facilities to traffic; and a greater awareness of the Air Quality Index. This policy reviews both short- and long-term health consequences of ambient air pollution, especially in relation to developmental exposures. It examines individual, community, and legislative strategies to mitigate air pollution.
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Affiliation(s)
- Heather L Brumberg
- Division of Neonatology, Maria Fareri Children's Hospital, Westchester Medical Center and Departments of Pediatrics and Public Health, New York Medical College, Valhalla, New York; and
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Examination of Air Pollution’s Relationship with COVID-19, Physical and Mental Health. JOURNAL OF INTERDISCIPLINARY MEDICINE 2020. [DOI: 10.2478/jim-2020-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Air pollution is a result of natural phenomena or human activities that can cause the release of harmful substances in the environment, leading to adverse health outcomes among living beings. Pollution is associated with adverse health impacts on multiple organ systems among humans. While the respiratory and cardiovascular systems are mainly affected, there are other health issues related to the eyes, skin, brain, blood, immunity, behavioral/mental well-being, and reproduction among exposed individuals. Air pollutants can especially have higher health impacts on people at the extremes of their ages (children and elderly) and on those suffering from underlying respiratory and heart issues. Pollutants such as ozone, sulfur dioxide, particulate matter, and nitrogen dioxide have respiratory effects among children and adults and are associated with increased respiratory diseases, asthma exacerbations, and related hospitalizations. Carbon monoxide interferes with transporting oxygen by forming carboxyhemoglobin leading to cardiovascular, neurological, and respiratory problems. Particulate matter is a heterogeneous mixture of tiny particles of varying compositions found in the atmosphere and has a wide variety of severe health effects. Particulate matter emits from combustion, diesel engines, power generation, and wood-burning, and certain industrial activities. Lead is considered neurotoxic and has more severe consequences among children. Here we summarize characteristics of six criteria air pollutants and associated air quality risk assessment parameters known as the Pollutant Standard Index (PSI). The present manuscript also examines the impact of air pollution on human behavior, mental well-being, and neurological health consequences, as air pollution has been associated with cognitive decline, hyperactivity, dementia, anxiety, depression, aggression, and Alzheimer’s disease-related changes. Lastly, we also attempt to look into any relationship between air pollutants and Coronavirus disease (COVID-19) and examine its possible association with a higher COVID-19 incidence, complications, and mortality.
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Oncioiu I, Dănescu T, Popa MA. Air-Pollution Control in an Emergent Market: Does It Work? Evidence from Romania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082656. [PMID: 32294934 PMCID: PMC7215349 DOI: 10.3390/ijerph17082656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 12/11/2022]
Abstract
Economic development in a national and international context must be based on a sustainability strategy established on the systemic interaction between the economic, sociocultural, and ecological environments. Today, the world is confronted by many challenges related to climate change and natural-resource flows, including waste streams resulting from economic activity. The need for national and European environmental standards and the work of an environment monitoring authority to reduce air pollution are highlighted by economic and industrial activities. Thus, our research focused on determining if emissions of sulfur dioxide (SO2), nitrogen (NO2), and particulate matter 10 (PM10) are influenced by planned and unplanned inspections made by competent authorities from Romania. We built a regression model that estimates the influence of economic measures imposed by the authorities on reducing industrial air pollution. Preliminary results showed that the number of inspections negatively influences air pollution, indicating that national and local authorities in Romania are striving to maintain air quality and are conducting more inspections when air pollution is high.
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Affiliation(s)
- Ionica Oncioiu
- Faculty of Finance–Banking, Accountancy and Business Administration, Titu Maiorescu University, 040051 Bucharest, Romania
- Correspondence: ; Tel.: +04-0241-6822-238
| | - Tatiana Dănescu
- Faculty of Economics and Law, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu-Mures, 540139 Targu Mures, Romania; (T.D.); (M.-A.P.)
| | - Maria-Alexandra Popa
- Faculty of Economics and Law, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu-Mures, 540139 Targu Mures, Romania; (T.D.); (M.-A.P.)
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Kihal-Talantikite W, Marchetta GP, Deguen S. Infant Mortality Related to NO 2 and PM Exposure: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082623. [PMID: 32290393 PMCID: PMC7215927 DOI: 10.3390/ijerph17082623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 12/27/2022]
Abstract
Background: We conducted this systematic review and meta-analysis to address the crucial public health issue of the suspected association between air pollution exposure during pregnancy and the risk of infant mortality. Methods: We searched on MEDLINE ® databases among articles published until February, 2019 for case-control, cohort, and ecological studies assessing the association between maternal exposure to Nitrogen Dioxide (NO2) or Particular matter (PM) and the risk of infant mortality including infant, neonatal, and post-neonatal mortality for all-and specific-causes as well. Study-specific risk estimates were pooled according to random-effect and fixed-effect models. Results: Twenty-four articles were included in the systematic review and 14 of the studies were taken into account in the meta-analysis. We conducted the meta-analysis for six combinations of air pollutants and infant death when at least four studies were available for the same combination. Our systematic review has revealed that the majority of studies concluded that death risk increased with increased exposure to air pollution including PM10, PM2.5, and NO2. Our meta-analysis confirms that the risk of post-neonatal mortality all-causes for short-term exposure to PM10 increased significantly (pooled-OR = 1.013, 95% CI (1.002, 1.025). When focusing on respiratory-causes, the risk of post-neonatal death related to long-term exposure to PM10 reached a pooled-OR = 1.134, 95% CI (1.011, 1.271). Regarding Sudden Infant Death Syndrome (SIDS), the risk also increased significantly: pooled-OR = 1.045, 95% CI (1.01, 1.08) per 10 µg/m3), but no specific gestational windows of exposure were identified. Conclusion: In spite of a few number of epidemiological studies selected in the present literature review, our finding is in favor of a significant increase of infant death with the increase of air pollution exposure during either the pregnancy period or the first year of a newborn’s life. Our findings have to be interpreted with caution due to weaknesses that could affect the strength of the associations and then the formulation of accurate conclusions. Future studies are called to overcome these limitations; in particular, (i) the definition of infant adverse outcome, (ii) exposure assessment, and (iii) critical windows of exposure, which could affect the strength of association.
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Affiliation(s)
- Wahida Kihal-Talantikite
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 6700 Strasbourg, France
- Correspondence: ; Tel.: +33-3-68-85-09-77
| | | | - Séverine Deguen
- EHESP School of Public Health, 35043 Rennes, France; (G.P.M.); (S.D.)
- Department of Social Epidemiology, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (UMRS 1136), Sorbonne Universités, UPMC Univ Paris 06, 75646 Paris, France
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Kim JB, Prunicki M, Haddad F, Dant C, Sampath V, Patel R, Smith E, Akdis C, Balmes J, Snyder MP, Wu JC, Nadeau KC. Cumulative Lifetime Burden of Cardiovascular Disease From Early Exposure to Air Pollution. J Am Heart Assoc 2020; 9:e014944. [PMID: 32174249 PMCID: PMC7335506 DOI: 10.1161/jaha.119.014944] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The disease burden associated with air pollution continues to grow. The World Health Organization (WHO) estimates ≈7 million people worldwide die yearly from exposure to polluted air, half of which-3.3 million-are attributable to cardiovascular disease (CVD), greater than from major modifiable CVD risks including smoking, hypertension, hyperlipidemia, and diabetes mellitus. This serious and growing health threat is attributed to increasing urbanization of the world's populations with consequent exposure to polluted air. Especially vulnerable are the elderly, patients with pre-existing CVD, and children. The cumulative lifetime burden in children is particularly of concern because their rapidly developing cardiopulmonary systems are more susceptible to damage and they spend more time outdoors and therefore inhale more pollutants. World Health Organization estimates that 93% of the world's children aged <15 years-1.8 billion children-breathe air that puts their health and development at risk. Here, we present growing scientific evidence, including from our own group, that chronic exposure to air pollution early in life is directly linked to development of major CVD risks, including obesity, hypertension, and metabolic disorders. In this review, we surveyed the literature for current knowledge of how pollution exposure early in life adversely impacts cardiovascular phenotypes, and lay the foundation for early intervention and other strategies that can help prevent this damage. We also discuss the need for better guidelines and additional research to validate exposure metrics and interventions that will ultimately help healthcare providers reduce the growing burden of CVD from pollution.
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Affiliation(s)
- Juyong Brian Kim
- Division of Cardiovascular MedicineDepartment of MedicineStanford UniversityStanfordCA
- Stanford Cardiovascular InstituteStanford UniversityStanfordCA
| | - Mary Prunicki
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCA
| | - Francois Haddad
- Division of Cardiovascular MedicineDepartment of MedicineStanford UniversityStanfordCA
- Stanford Cardiovascular InstituteStanford UniversityStanfordCA
| | - Christopher Dant
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCA
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCA
| | - Rushali Patel
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCA
| | - Eric Smith
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCA
| | - Cezmi Akdis
- Swiss Institute for Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - John Balmes
- Department of MedicineUniversity of California San Francisco and Division of Environmental Health SciencesSchool of Public HealthUniversity of California BerkeleyCA
| | - Michael P. Snyder
- Department of Genetics and Center for Genomics and Personalized MedicineStanford UniversityStanfordCA
| | - Joseph C. Wu
- Stanford Cardiovascular InstituteStanford UniversityStanfordCA
| | - Kari C. Nadeau
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCA
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Armstrong BG, Gasparrini A, Tobias A, Sera F. Sample size issues in time series regressions of counts on environmental exposures. BMC Med Res Methodol 2020; 20:15. [PMID: 31992211 PMCID: PMC6988321 DOI: 10.1186/s12874-019-0894-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 12/23/2019] [Indexed: 01/26/2023] Open
Abstract
Background Regression analyses of time series of disease counts on environmental determinants are a prominent component of environmental epidemiology. For planning such studies, it can be useful to predict the precision of estimated coefficients and power to detect associations of given magnitude. Existing generic approaches for this have been found somewhat complex to apply and do not easily extend to multiple series studies analysed in two stages. We have sought a simpler approximate approach which can easily extend to multiple series and give insight into factors determining precision. Methods We derive approximate expressions for precision and hence power in single and multiple time series studies of counts from basic statistical theory, compare the precision predicted by these with that estimated by analysis in real data from 51 cities of varying size, and illustrate the use of these estimators in a realistic planning scenario. Results In single series studies with Poisson outcome distribution, precision and power depend only on the usable variation of exposure (i.e. that conditional on covariates) and the total number of disease events, regardless of how many days those are spread over. In multiple time series (eg multi-city) studies focusing on the meta-analytic mean coefficient, the usable exposure variation and the total number of events (in all series) are again the sole determinants if there is no between-series heterogeneity or within-series overdispersion. With heterogeneity, its extent and the number of series becomes important. For all but the crudest approximation the estimates of standard errors were on average within + 20% of those estimated in full analysis of actual data. Conclusions Predicting precision in coefficients from a planned time series study is possible simply and given limited information. The total number of disease events and usable exposure variation are the dominant factors when overdispersion and between-series heterogeneity are low.
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Affiliation(s)
- Ben G Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK.,Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), C/ Jordi Girona 18-26, 08031, Barcelona, Spain
| | - Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK
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Wang J, Cao H, Sun D, Qi Z, Guo C, Peng W, Sun Y, Xie Y, Liu X, Li B, Luo Y, Pan Y, Li Y, Zhang L. Associations between ambient air pollution and mortality from all causes, pneumonia, and congenital heart diseases among children aged under 5 years in Beijing, China: A population-based time series study. ENVIRONMENTAL RESEARCH 2019; 176:108531. [PMID: 31226628 DOI: 10.1016/j.envres.2019.108531] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Previous studies have mainly focused on the associations between particulate matters and infant mortality. However, evidence regarding the associations between gaseous pollutants and mortality among children aged <5 years remains sparse. OBJECTIVES The aim of this study was to investigate the associations between ambient air pollution and death among children aged <5 years in Beijing, China, and explore the impact of age, gender and specific causes of death on these associations. METHODS Concentrations of ambient air pollution and the number of deaths among children aged <5 years in Beijing from January 2014 to September 2016 were extracted from authoritative electronic databases. The associations were estimated for a single-month lag from the current month up to the previous 5 months (lag0-lag5) and moving averages of the current and previous months (lag01-lag05) using generalized additive Poisson regression (adjusted for time trends, season, meteorological variables and holidays). Subgroup analyses related to age, gender and specific diseases were performed. Two-pollutant models were used to evaluate the possible role of single pollutants. RESULTS Sulfur dioxide (SO2), nitrogen dioxide (NO2) and carbon monoxide (CO) demonstrated the strongest associations with death among children aged <5 years at lag0, and the estimates decreased or even turned negative with the increasing lag periods. For an interquartile range increase in SO2, NO2 and CO at lag0, the odds ratios (OR) were 1.332 (95% CI 1.152-1.539), 1.383 (95% CI 1.113-1.718) and 1.273 (95% CI 1.028-1.575). However, CO lost significance after adjusting for SO2 and NO2, and PM2.5 gained significance (OR 1.548, 95% CI 1.061-2.258) after adjusting for PM10. The ORs for SO2 and NO2 remained the most stable across all two-pollutant models. The associations for children aged 1-5 years were stronger than those reported for infants at lag0 but lower at the other lag months. The pollutant associations were stronger for congenital heart disease-related death than overall and pneumonia-related death. We did not find significant differences in terms of gender. CONCLUSION Exposure to air pollution may increase the incidence of death among children aged <5 years. SO2 and NO2 may be the most stable pollutants reflecting associations between air pollution and death, deserving further attention. Children with congenital heart diseases are more susceptible to air pollution. Therefore, it is urgent to implement the clean air targets established by WHO and reduce the exposure of children to air pollution.
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Affiliation(s)
- Jing Wang
- Department of Children's Health Care, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China; Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Han Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Dianqin Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Zifan Qi
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Chunyue Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Wenjuan Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Yanyan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Yunyi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Xiaohui Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Bingxiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China
| | - Ying Pan
- Department of Children's Health Care, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
| | - Yichen Li
- Department of Children's Health Care, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China.
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10, Xi Toutiao You Anmenwai, Fengtai District, Beijing, 100069, China.
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11
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Gouveia N, Junger WL. Effects of air pollution on infant and children respiratory mortality in four large Latin-American cities. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 232:385-391. [PMID: 28966023 DOI: 10.1016/j.envpol.2017.08.125] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Air pollution is an important public health concern especially for children who are particularly susceptible. Latin America has a large children population, is highly urbanized and levels of pollution are substantially high, making the potential health impact of air pollution quite large. We evaluated the effect of air pollution on children respiratory mortality in four large urban centers: Mexico City, Santiago, Chile, and Sao Paulo and Rio de Janeiro in Brazil. METHODS Generalized Additive Models in Poisson regression was used to fit daily time-series of mortality due to respiratory diseases in infants and children, and levels of PM10 and O3. Single lag and constrained polynomial distributed lag models were explored. Analyses were carried out per cause for each age group and each city. Fixed- and random-effects meta-analysis was conducted in order to combine the city-specific results in a single summary estimate. RESULTS These cities host nearly 43 million people and pollution levels were above the WHO guidelines. For PM10 the percentage increase in risk of death due to respiratory diseases in infants in a fixed effect model was 0.47% (0.09-0.85). For respiratory deaths in children 1-5 years old, the increase in risk was 0.58% (0.08-1.08) while a higher effect was observed for lower respiratory infections (LRI) in children 1-14 years old [1.38% (0.91-1.85)]. For O3, the only summarized estimate statistically significant was for LRI in infants. Analysis by season showed effects of O3 in the warm season for respiratory diseases in infants, while negative effects were observed for respiratory and LRI deaths in children. DISCUSSION We provided comparable mortality impact estimates of air pollutants across these cities and age groups. This information is important because many public policies aimed at preventing the adverse effects of pollution on health consider children as the population group that deserves the highest protection.
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Affiliation(s)
- Nelson Gouveia
- Departamento de Medicina Preventiva, Faculdade de Medicina, FMUSP, Universidade de São Paulo, Av Dr Arnaldo, 455, Sao Paulo, 01246-903, Brazil.
| | - Washington Leite Junger
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, UERJ, Rio de Janeiro, Brazil
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12
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Mohammed G, Karani G, Mitchell D. Trace Elemental Composition in PM10 and PM2.5 Collected in Cardiff, Wales. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.egypro.2017.03.216] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Padilla CM, Kihal-Talantikit W, Vieira VM, Deguen S. City-Specific Spatiotemporal Infant and Neonatal Mortality Clusters: Links with Socioeconomic and Air Pollution Spatial Patterns in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E624. [PMID: 27338439 PMCID: PMC4924081 DOI: 10.3390/ijerph13060624] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/30/2016] [Accepted: 06/16/2016] [Indexed: 11/17/2022]
Abstract
Infant and neonatal mortality indicators are known to vary geographically, possibly as a result of socioeconomic and environmental inequalities. To better understand how these factors contribute to spatial and temporal patterns, we conducted a French ecological study comparing two time periods between 2002 and 2009 for three (purposefully distinct) Metropolitan Areas (MAs) and the city of Paris, using the French census block of parental residence as the geographic unit of analysis. We identified areas of excess risk and assessed the role of neighborhood deprivation and average nitrogen dioxide concentrations using generalized additive models to generate maps smoothed on longitude and latitude. Comparison of the two time periods indicated that statistically significant areas of elevated infant and neonatal mortality shifted northwards for the city of Paris, are present only in the earlier time period for Lille MA, only in the later time period for Lyon MA, and decrease over time for Marseille MA. These city-specific geographic patterns in neonatal and infant mortality are largely explained by socioeconomic and environmental inequalities. Spatial analysis can be a useful tool for understanding how risk factors contribute to disparities in health outcomes ranging from infant mortality to infectious disease-a leading cause of infant mortality.
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Affiliation(s)
- Cindy M Padilla
- Department of Quantitative Methods in Public Health, EHESP School of Public Health-Sorbonne-Paris Cité, Rennes 35043, France.
- IRSET-Research Institute of Environmental and Occupational Health, Rennes 35000, France.
| | - Wahida Kihal-Talantikit
- Department of Environmental and Occupational Health, EHESP School of Public Health, Rennes, Sorbonne-Paris Cité 35043, France.
| | - Verónica M Vieira
- Program in Public Health, Chao Family Cancer Center, University of Irvine, Irvine, CA 92697, USA.
| | - Séverine Deguen
- IRSET-Research Institute of Environmental and Occupational Health, Rennes 35000, France.
- Department of Environmental and Occupational Health, EHESP School of Public Health, Rennes, Sorbonne-Paris Cité 35043, France.
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Yorifuji T, Kashima S, Doi H. Acute exposure to fine and coarse particulate matter and infant mortality in Tokyo, Japan (2002-2013). THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 551-552:66-72. [PMID: 26874762 DOI: 10.1016/j.scitotenv.2016.01.211] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/30/2016] [Accepted: 01/31/2016] [Indexed: 06/05/2023]
Abstract
Few studies have evaluated the effect of short-term exposure to particulate matter (PM) less than 2.5μm in diameter (PM2.5) or to coarse particles on infant mortality. We evaluated the association between short-term exposure to PM and infant mortality in Japan and assessed whether adverse health effects were observable at PM concentrations below Japanese air quality guidelines. We used a time-stratified, case-crossover design. The participants included 2086 infants who died in the 23 urbanized wards of the Tokyo Metropolitan Government between January 2002 and December 2013. We obtained measures of PM2.5 and suspended particulate matter (SPM; PM<7μm in diameter) from one general monitoring station. As a measure of coarse particles, we calculated PM7-2.5 by subtracting PM2.5 from SPM. We then used conditional logistic regression to analyze the data. Same-day PM2.5 was associated with increased risks of infant and postneonatal mortality, especially for mortality related to respiratory causes. For a 10μg/m(3) increase in PM2.5, the odds ratios were 1.06 (95% confidence interval: 1.01-1.12) for infant mortality and 1.10 (1.02-1.19) for postneonatal mortality. PM7-2.5 was also associated with an increased risk of postneonatal mortality, independent of PM2.5. Even when PM2.5 and SPM concentrations were below Japanese air quality guidelines, we observed adverse health effects. This study provides further evidence that acute exposure to PM2.5 and coarse particles (PM7-2.5) is associated with an increased risk of infant mortality. Further, rigorous evaluation of air quality guidelines for daily average PM2.5 and larger particles is needed.
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Affiliation(s)
- Takashi Yorifuji
- Department of Human Ecology, Graduate School of Environmental and Life Science, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama 700-8530, Japan.
| | - Saori Kashima
- Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hiroyuki Doi
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
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15
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Luechinger S. Air pollution and infant mortality: a natural experiment from power plant desulfurization. JOURNAL OF HEALTH ECONOMICS 2014; 37:219-231. [PMID: 25105867 DOI: 10.1016/j.jhealeco.2014.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 06/06/2014] [Accepted: 06/17/2014] [Indexed: 06/03/2023]
Abstract
The paper estimates the effect of SO2 pollution on infant mortality in Germany, 1985-2003. To avoid endogeneity problems, I exploit the natural experiment created by the mandated desulfurization at power plants and power plants' location and prevailing wind directions, which together determine treatment intensity for counties. Estimates translate into an elasticity of 0.07-0.13 and the observed reduction in pollution implies an annual gain of 826-1460 infant lives. There is no evidence for disproportionate effects on neonatal mortality, but for an increase in the number of infants with comparatively low birth weight and length.
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Affiliation(s)
- Simon Luechinger
- University of Lucerne and KOF Swiss Economic Institute, ETH Zurich, Switzerland.
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Padilla CM, Deguen S, Lalloue B, Blanchard O, Beaugard C, Troude F, Navier DZ, Vieira VM. Cluster analysis of social and environment inequalities of infant mortality. A spatial study in small areas revealed by local disease mapping in France. THE SCIENCE OF THE TOTAL ENVIRONMENT 2013; 454-455:433-41. [PMID: 23563257 PMCID: PMC4097309 DOI: 10.1016/j.scitotenv.2013.03.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 01/07/2013] [Accepted: 03/08/2013] [Indexed: 05/13/2023]
Abstract
Mapping spatial distributions of disease occurrence can serve as a useful tool for identifying exposures of public health concern. Infant mortality is an important indicator of the health status of a population. Recent literature suggests that neighborhood deprivation status can modify the effect of air pollution on preterm delivery, a known risk factor for infant mortality. We investigated the effect of neighborhood social deprivation on the association between exposure to ambient air NO2 and infant mortality in the Lille and Lyon metropolitan areas, north and center of France, respectively, between 2002 and 2009. We conducted an ecological study using a neighborhood deprivation index estimated at the French census block from the 2006 census data. Infant mortality data were collected from local councils and geocoded using the address of residence. We generated maps using generalized additive models, smoothing on longitude and latitude while adjusting for covariates. We used permutation tests to examine the overall importance of location in the model and identify areas of increased and decreased risk. The average death rate was 4.2‰ and 4.6‰ live births for the Lille and Lyon metropolitan areas during the period. We found evidence of statistically significant precise clusters of elevated infant mortality for Lille and an east-west gradient of infant mortality risk for Lyon. Exposure to NO2 did not explain the spatial relationship. The Lille MA, socioeconomic deprivation index explained the spatial variation observed. These techniques provide evidence of clusters of significantly elevated infant mortality risk in relation with the neighborhood socioeconomic status. This method could be used for public policy management to determine priority areas for interventions. Moreover, taking into account the relationship between social and environmental exposure may help identify areas with cumulative inequalities.
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Affiliation(s)
- Cindy M. Padilla
- EHESP School of Public Health –Sorbonne Paris Cité – Rennes, France
- INSERM U1085-IRSET – Research Institute of Environmental and Occupational Health, Rennes, France
- French Environment and Energy Management Agency, Angers, France
| | - Severine Deguen
- EHESP School of Public Health –Sorbonne Paris Cité – Rennes, France
- INSERM U1085-IRSET – Research Institute of Environmental and Occupational Health, Rennes, France
| | - Benoit Lalloue
- EHESP School of Public Health –Sorbonne Paris Cité – Rennes, France
- INSERM U1085-IRSET – Research Institute of Environmental and Occupational Health, Rennes, France
- Lorraine University Medical School–Institut Elie Cartan UMR 7502, Nancy University, CNRS, INRIA, Vandoeuvre-les-Nancy, France
| | - Olivier Blanchard
- EHESP School of Public Health –Sorbonne Paris Cité – Rennes, France
- INSERM U1085-IRSET – Research Institute of Environmental and Occupational Health, Rennes, France
| | - Charles Beaugard
- Official Air Quality Monitoring Associations (AASQA), Atmo Nord Pas-de-Calais, Air Rhône-Alpes, France
| | - Florence Troude
- Official Air Quality Monitoring Associations (AASQA), Atmo Nord Pas-de-Calais, Air Rhône-Alpes, France
| | - Denis Zmirou Navier
- EHESP School of Public Health –Sorbonne Paris Cité – Rennes, France
- INSERM U1085-IRSET – Research Institute of Environmental and Occupational Health, Rennes, France
- Lorraine University Medical School–Institut Elie Cartan UMR 7502, Nancy University, CNRS, INRIA, Vandoeuvre-les-Nancy, France
| | - Verónica M. Vieira
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
- Program in Public Health, Chao Family Cancer Center, University of Irvine, CA 92697, USA
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Turker G, Ozsoy G, Ozdemir S, Barutçu B, Gökalp AS. Effect of heavy metals in the meconium on preterm mortality: preliminary study. Pediatr Int 2013; 55:30-4. [PMID: 23061406 DOI: 10.1111/j.1442-200x.2012.03744.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 03/02/2012] [Accepted: 10/03/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND There have been many studies that have investigated the risk factors of mortality in preterm infants, but none has shown an association between preterm mortality and exposure to heavy metals or trace elements. The aim of this study was therefore to measure the levels of toxic metals (lead, cadmium) and trace elements (zinc, iron, copper) in meconium samples and elucidate their association with preterm mortality. METHODS Metals and trace elements were measured in the meconium of 304 preterm infants using a flame atomic absorption spectrophotometer. RESULTS The level of heavy metals and trace elements in non-surviving infants was significantly higher than in surviving infants. Moreover, the level of heavy metals and trace elements in non-surviving infants whose gestational age was <30 weeks (n = 11) was significantly higher than in surviving infants (n = 12). Receiver operating characteristic curve analysis showed that gestational age and meconium lead level predicted early mortality in premature newborns. Furthermore, this curve analysis showed that, when comparing meconium lead level and gestational age, meconium lead level had a similar effect on mortality as gestational age. CONCLUSION Meconium lead level and gestational age are associated with increased mortality risk in preterm neonates.
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Affiliation(s)
- Gülcan Turker
- Neonatology Division, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
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Rückerl R, Schneider A, Breitner S, Cyrys J, Peters A. Health effects of particulate air pollution: A review of epidemiological evidence. Inhal Toxicol 2012; 23:555-92. [PMID: 21864219 DOI: 10.3109/08958378.2011.593587] [Citation(s) in RCA: 311] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Regina Rückerl
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, Neuherberg, Germany.
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Peel JL, Klein M, Flanders WD, Mulholland JA, Freed G, Tolbert PE. Ambient air pollution and apnea and bradycardia in high-risk infants on home monitors. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:1321-7. [PMID: 21447453 PMCID: PMC3230388 DOI: 10.1289/ehp.1002739] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 03/28/2011] [Indexed: 05/08/2023]
Abstract
BACKGROUND Evidence suggests that increased ambient air pollution concentrations are associated with health effects, although relatively few studies have specifically examined infants. OBJECTIVE We examined associations of daily ambient air pollution concentrations with central apnea (prolonged pauses in breathing) and bradycardia (low heart rate) events among infants prescribed home cardiorespiratory monitors. METHODS The home monitors record the electrocardiogram, heart rate, and respiratory effort for detected apnea and bradycardia events in high-risk infants [primarily premature and low birth weight (LBW) infants]. From August 1998 through December 2002, 4,277 infants had 8,960 apnea event-days and 29,450 bradycardia event-days in > 179,000 days of follow-up. We assessed the occurrence of apnea and bradycardia events in relation to speciated particulate matter and gaseous air pollution levels using a 2-day average of air pollution (same day and previous day), adjusting for temporal trends, temperature, and infant age. RESULTS We observed associations between bradycardia and 8-hr maximum ozone [odds ratio (OR) = 1.049 per 25-ppb increase; 95% confidence interval (CI), 1.021-1.078] and 1-hr maximum nitrogen dioxide (OR =1.025 per 20-ppb increase; 95% CI, 1.000-1.050). The association with ozone was robust to different methods of control for time trend and specified correlation structure. In secondary analyses, associations of apnea and bradycardia with pollution were generally stronger in infants who were full term and of normal birth weight than in infants who were both premature and LBW. CONCLUSIONS These results suggest that higher air pollution concentrations may increase the occurrence of apnea and bradycardia in high-risk infants.
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Affiliation(s)
- Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado 80523, USA.
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Scheers H, Mwalili SM, Faes C, Fierens F, Nemery B, Nawrot TS. Does air pollution trigger infant mortality in Western Europe? A case-crossover study. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:1017-22. [PMID: 21269926 PMCID: PMC3223000 DOI: 10.1289/ehp.1002913] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 01/26/2011] [Indexed: 05/04/2023]
Abstract
BACKGROUND Numerous studies show associations between fine particulate air pollutants [particulate matter with an aerodynamic diameter ≤ 10 μm (PM₁₀)] and mortality in adults. OBJECTIVES We investigated short-term effects of elevated PM₁₀ levels on infant mortality in Flanders, Belgium, and studied whether the European Union (EU) limit value protects infants from the air pollution trigger. METHODS In a case-crossover analysis, we estimated the risk of dying from nontraumatic causes before 1 year of age in relation to outdoor PM₁₀ concentrations on the day of death. We matched control days on temperature to exclude confounding by variations in daily temperature. RESULTS During the study period (1998-2006), PM₁₀ concentration averaged 31.9 ± 13.8 μg/m³. In the entire study population (n = 2,382), the risk of death increased by 4% [95% confidence interval (CI), 0-8%; p = 0.045] for a 10-μg/m³ increase in daily mean PM₁₀. However, this association was significant only for late neonates (2-4 weeks of age; n = 372), in whom the risk of death increased by 11% (95% CI, 1-22%; p = 0.028) per 10-μg/m³ increase in PM₁₀. In this age class, infants were 1.74 (95% CI, 1.18-2.58; p = 0.006) times more likely to die on days with a mean PM₁₀ above the EU limit value of 50 μg/m3 than on days below this cutoff. CONCLUSIONS Even in an affluent region in Western Europe, where infant mortality is low, days with higher PM air pollution are associated with an increased risk of infant mortality. Assuming causality, the current EU limit value for PM₁₀, which may be exceeded on 35 days/year, does not prevent PM₁₀ from triggering mortality in late neonates.
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Affiliation(s)
- Hans Scheers
- Department of Public Health, Occupational and Environmental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
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Son JY, Bell ML, Lee JT. Survival analysis of long-term exposure to different sizes of airborne particulate matter and risk of infant mortality using a birth cohort in Seoul, Korea. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:725-30. [PMID: 21169127 PMCID: PMC3094428 DOI: 10.1289/ehp.1002364] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 12/17/2010] [Indexed: 05/05/2023]
Abstract
BACKGROUND Several studies suggest that airborne particulate matter (PM) is associated with infant mortality; however, most focused on short-term exposure to larger particles. OBJECTIVES We evaluated associations between long-term exposure to different sizes of particles [total suspended particles (TSP), PM ≤ 10 μm in aerodynamic diameter (PM₁₀), ≤ 10-2.5 μm (PM(10-2.5)), and ≤ 2.5 μm (PM(2.5))] and infant mortality in a cohort in Seoul, Korea, 2004-2007. METHODS The study includes 359,459 births with 225 deaths. We applied extended Cox proportional hazards modeling with time-dependent covariates to three mortality categories: all causes, respiratory, and sudden infant death syndrome (SIDS). We calculated exposures from birth to death (or end of eligibility for outcome at 1 year of age) and pregnancy (gestation and each trimester) and treated exposures as time-dependent variables for subjects' exposure for each pollutant. We adjusted by sex, gestational length, season of birth, maternal age and educational level, and heat index. Each cause of death and exposure time frame was analyzed separately. RESULTS We found a relationship between gestational exposures to PM and infant mortality from all causes or respiratory causes for normal-birth-weight infants. For total mortality (all causes), risks were 1.44 (95% confidence interval, 1.06-1.97), 1.65 (1.18-2.31), 1.53 (1.22-1.90), and 1.19 (0.83-1.70) per interquartile range increase in TSP, PM₁₀, PM(2.5), and PM(10-2.5), respectively; for respiratory mortality, risks were 3.78 (1.18-12.13), 6.20 (1.50-25.66), 3.15 (1.26-7.85), and 2.86 (0.76-10.85). For SIDS, risks were 0.92 (0.33-2.58), 1.15 (0.38-3.48), 1.42 (0.71-2.87), and 0.57 (0.16-1.96), respectively. CONCLUSIONS Our findings provide supportive evidence of an association of long-term exposure to PM air pollution with infant mortality.
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Affiliation(s)
- Ji-Young Son
- School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut, USA
| | - Michelle L. Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut, USA
| | - Jong-Tae Lee
- Department of Environmental Health, College of Health Science, Korea University, Seoul, Korea
- Address correspondence to J.-T. Lee, Department of Environmental Health, College of Health Science, Korea University, San 1 Jeongreung-dong, Seongbuk-gu, Seoul, Korea 136-703. Telephone: 822-940-2867. Fax: 822-2298-0248. E-mail:
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Kelishadi R, Poursafa P. Air pollution and non-respiratory health hazards for children. Arch Med Sci 2010; 6:483-95. [PMID: 22371790 PMCID: PMC3284061 DOI: 10.5114/aoms.2010.14458] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 07/14/2009] [Accepted: 08/07/2009] [Indexed: 11/17/2022] Open
Abstract
Air pollution is a global health issue with serious public health implications, particularly for children. Usually respiratory effects of air pollutants are considered, but this review highlights the importance of non-respiratory health hazards. In addition to short-term effects, exposure to criteria air pollutants from early life might be associated with low birth weight, increase in oxidative stress and endothelial dysfunction, which in turn might have long-term effects on chronic non-communicable diseases. In view of the emerging epidemic of chronic disease in low- and middle- income countries, the vicious cycle of rapid urbanization and increasing levels of air pollution, public health and regulatory policies for air quality protection should be integrated into the main priorities of the primary health care system and into the educational curriculum of health professionals.
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Affiliation(s)
- Roya Kelishadi
- Isfahan Cardiovascular Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
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Bhaskaran K, Hajat S, Haines A, Herrett E, Wilkinson P, Smeeth L. Short term effects of temperature on risk of myocardial infarction in England and Wales: time series regression analysis of the Myocardial Ischaemia National Audit Project (MINAP) registry. BMJ 2010; 341:c3823. [PMID: 20699305 PMCID: PMC2919679 DOI: 10.1136/bmj.c3823] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the short term relation between ambient temperature and risk of myocardial infarction. DESIGN Daily time series regression analysis. SETTING 15 conurbations in England and Wales. PARTICIPANTS 84,010 hospital admissions for myocardial infarction recorded in the Myocardial Ischaemia National Audit Project during 2003-6 (median 57 events a day). MAIN OUTCOME MEASURES Change in risk of myocardial infarction associated with a 1 degrees C difference in temperature, including effects delayed by up to 28 days. RESULTS Smoothed graphs revealed a broadly linear relation between temperature and myocardial infarction, which was well characterised by log-linear models without a temperature threshold: each 1 degrees C reduction in daily mean temperature was associated with a 2.0% (95% confidence interval 1.1% to 2.9%) cumulative increase in risk of myocardial infarction over the current and following 28 days, the strongest effects being estimated at intermediate lags of 2-7 and 8-14 days: increase per 1 degrees C reduction 0.6% (95% confidence interval 0.2% to 1.1%) and 0.7% (0.3% to 1.1%), respectively. Heat had no detrimental effect. Adults aged 75-84 and those with previous coronary heart disease seemed more vulnerable to the effects of cold than other age groups (P for interaction 0.001 or less in each case), whereas those taking aspirin were less vulnerable (P for interaction 0.007). CONCLUSIONS Increases in risk of myocardial infarction at colder ambient temperatures may be one driver of cold related increases in overall mortality, but an increased risk of myocardial infarction at higher temperatures was not detected. The risk of myocardial infarction in vulnerable people might be reduced by the provision of targeted advice or other interventions, triggered by forecasts of lower temperature.
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Affiliation(s)
- Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT.
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Effets à court terme de la pollution atmosphérique sur la mortalité. REVUE FRANCAISE D ALLERGOLOGIE 2009. [DOI: 10.1016/j.reval.2009.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Stewart AG, Carter J. Towards the development of a multidisciplinary understanding of the effects of toxic chemical mixtures on health. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2009; 31:239-251. [PMID: 19023667 DOI: 10.1007/s10653-008-9210-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 09/10/2008] [Accepted: 09/11/2008] [Indexed: 05/27/2023]
Abstract
Mixtures can be divided into simple (chemicals with comparable properties--health risk assessments on the chemicals) and complex, which can be further subdivided into defined (a reasonably distinct composition, created at a specific time and place despite dissimilar components--risk assessments on the common source) and coincidental (chemicals without similar properties or constant composition in time or space-risk assessments on the receptor). Interactions recognized are: independent action, dose addition (additivity), and potentiation (synergy and antagonism). Unpredicted outcomes need recognition. New approaches in higher education and multidisciplinary investigations are essential. The community of the Society for Environmental Geochemistry and Health should help clarify points such as when transformations in mixtures may become important enough to alter the classification and the risk assessment. The multidisciplinary community is also well placed to support the integration of non-chemical influences into mixture analysis and to contribute to the investigation of cumulative and multiple exposures.
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Affiliation(s)
- Alex G Stewart
- Cheshire and Merseyside Health Protection Unit, Microbiology Laboratory, Countess of Chester Health Park, London Road, Chester CH12UL, UK.
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de Medeiros APP, Gouveia N, Machado RPP, de Souza MR, Alencar GP, Novaes HMD, de Almeida MF. Traffic-related air pollution and perinatal mortality: a case-control study. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:127-32. [PMID: 19165399 PMCID: PMC2627856 DOI: 10.1289/ehp.11679] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 09/22/2008] [Indexed: 05/22/2023]
Abstract
BACKGROUND Ambient levels of air pollution may affect the health of children, as indicated by studies of infant and perinatal mortality. Scientific evidence has also correlated low birth weight and preterm birth, which are important determinants of perinatal death, with air pollution. However, most of these studies used ambient concentrations measured at monitoring sites, which may not consider differential exposure to pollutants found at elevated concentrations near heavy-traffic roadways. OBJECTIVES Our goal was to examine the association between traffic-related pollution and perinatal mortality. METHODS We used the information collected for a case-control study conducted in 14 districts in the City of São Paulo, Brazil, regarding risk factors for perinatal deaths. We geocoded the residential addresses of cases (fetal and early neonatal deaths) and controls (children who survived the 28th day of life) and calculated a distance-weighted traffic density (DWTD) measure considering all roads contained in a buffer surrounding these homes. RESULTS Logistic regression revealed a gradient of increasing risk of early neonatal death with higher exposure to traffic-related air pollution. Mothers exposed to the highest quartile of the DWTD compared with those less exposed exhibited approximately 50% increased risk (adjusted odds ratio = 1.47; 95% confidence interval, 0.67-3.19). Associations for fetal mortality were less consistent. CONCLUSIONS These results suggest that motor vehicle exhaust exposures may be a risk factor for perinatal mortality.
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Affiliation(s)
| | - Nelson Gouveia
- Department of Preventive Medicine, Faculty of Medicine
- Address correspondence to N. Gouveia, Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455, São Paulo, SP 01246-903, Brazil. Telephone: (55 11) 3061-7075. Fax: (55 11) 3062-6018. E-mail:
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