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Jiang D, Wang L, Han X, Pan Z, Wang Z, Wang Y, Li J, Guo J, Liu Y, Huang S, Guan T. Short-term effects of ambient oxidation, and its interaction with fine particles on first-ever stroke: A national case-crossover study in China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 907:168017. [PMID: 37879462 DOI: 10.1016/j.scitotenv.2023.168017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/30/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023]
Abstract
Stroke is a significant global cause of disability and death, and its burden has been on the rise, while ambient air pollution has been conclusively linked to stroke incidence. However, knowledge about effects of atmospheric oxidation on stroke and its interactions with fine particles (PM2.5) are still limited. In this study, we investigated the short-term effects of ambient NO2, O3, and their combined oxidation (Owt) on first-ever stroke, based on data from the China National Stroke Screening Survey (CNSSS) conducted from 2013 to 2015. We found significant association between ambient NO2 exposure at lag0 day with first-ever stroke, with a 13.1 % (95 % CI: 3.5 %, 23.6 %) increase in the first-ever stroke risk per 10 μg/m3 exposure. We also found a significant interaction between NO2 and PM2.5 (p < 0.05): first-ever stroke risk increased 23.8 % (95 % CI: 9.6 %, 39.8 %) per 10 μg/m3 NO2 exposure in population exposed to higher PM2.5 concentrations, while no significant association was found in population exposed to lower PM2.5 concentrations. The results of stratified analyses indicated that physical inactivity enhanced the detrimental effects of O3 and Owt exposure, while smoking and transient ischemic attack (TIA) history enhanced the detrimental effects of NO2 exposure. However, TIA history appeared to mitigate the adverse effects of O3 exposure. This study is helpful to better understand the impact of ambient oxidation on stroke, as well as its interaction with PM2.5, and has implications for policies and standards for atmospheric protection and governance.
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Affiliation(s)
- Dongxia Jiang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Luyang Wang
- Beijing Key Lab of Indoor Air Quality Evaluation and Control, Beijing 100084, China
| | - Xueyan Han
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Zhaoyang Pan
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Zhaokun Wang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Yaqi Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China
| | - Jing Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China
| | - Jian Guo
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Shaodan Huang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China.
| | - Tianjia Guan
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
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Chen SW, Lin CY, Chen CY, Lin CL, Hsieh TL, Tsai FJ, Chang KH. Long-term exposure to air pollution and risk of Sarcopenia in adult residents of Taiwan: a nationwide retrospective cohort study. BMC Public Health 2023; 23:2172. [PMID: 37932727 PMCID: PMC10629182 DOI: 10.1186/s12889-023-17091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/28/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Sarcopenia is an age-related, multifactorial syndrome. Previous studies have shown that air pollutants are associated with inflammation and oxidative stress. However, the association between long-term exposure to air pollution and sarcopenia is not completely understood. METHODS The Taiwan National Health Research Database (NHIRD) contains medical records of almost all Taiwanese residents. Daily air pollution data collected by the Taiwan Environmental Protection Agency was used to analyze concentrations of sulfur oxide (SO2), carbon monoxide (CO), nitrogen monoxide (NO), nitrogen dioxide (NO2), and particulate matter (PM2.5, PM10). The databases were merged according to the insurants' living area and the location of the air quality monitoring station. We categorized the pollutants into quartiles (Q1, Q2, Q3, and Q4). RESULTS Our study population consisted of 286,044 patients, among whom 54.9% were female and 45.1% were male. Compared to Q1 levels of pollutants, Q4 levels of SO2 (adjusted hazard ratio [aHR] = 8.43; 95% confidence interval [CI] = 7.84, 9.07); CO (aHR = 3.03; 95%CI = 2.83, 3.25); NO (aHR = 3.47; 95%CI = 3.23, 3.73); NO2 (aHR = 3.72; 95%CI = 3.48, 3.98); PM2.5 (aHR = 21.9; 95% CI = 19.7, 24.5) and PM10 (aHR = 15.6; 95%CI = 14.1, 17.4) increased risk of sarcopenia. CONCLUSIONS Our findings indicated a significantly increased risk of sarcopenia in both male and female residents exposed to high levels of air pollutants.
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Affiliation(s)
- Ssu-Wen Chen
- Department of Family Medicine, Tungs' Taichung MetroHarbor Hospital, Taichung, 435, Taiwan
| | - Chih-Ying Lin
- Department of Public Health, China Medical University, Taichung, 404, Taiwan
| | - Chiu-Ying Chen
- Department of Public Health, China Medical University, Taichung, 404, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan
- College of Medicine, China Medical University, Taichung, 404, Taiwan
| | - Tsai-Ling Hsieh
- Department of Medical Research, Tungs' Taichung MetroHarbor Hospital, Taichung, 435, Taiwan
- Department of Otolaryngology, Tungs' Taichung MetroHarbor Hospital, Taichung, 435, Taiwan
| | - Fuu-Jen Tsai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
- Division of Medical Genetics, China Medical University Children's Hospital, Taichung, 404, Taiwan
- Department of Biotechnology and Bioinformatics, Asia University, Taichung, 413, Taiwan
| | - Kuang-Hsi Chang
- Department of Medical Research, Tungs' Taichung MetroHarbor Hospital, Taichung, 435, Taiwan.
- Center for General Education, China Medical University, Taichung, 404, Taiwan.
- General Education Center, Nursing and Management, Jen-Teh Junior College of Medicine, Miaoli, 356, Taiwan.
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Alhussaini AR, Aljabri MR, Al-Harbi ZT, Abdulrahman Almohammadi G, Al-Harbi TM, Bashir S. Air Pollution and Its Adverse Effects on the Central Nervous System. Cureus 2023; 15:e38927. [PMID: 37313075 PMCID: PMC10259194 DOI: 10.7759/cureus.38927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
Air pollution is recognized as a significant public health problem and is associated with illnesses of the central nervous system (CNS) as well as neuroinflammation and neuropathology. Air pollution may cause chronic brain inflammation, white matter abnormalities, and microglia activation, which increases the risk of autism spectrum disorders, neurodegenerative disorders, stroke, and multiple sclerosis (MS). Methods: A literature review was done on "PubMed, EMBASE and Web of Science" on the relationship of air pollution with MS and stroke, using the keywords "air pollution" OR "pollution"; "ambient air pollution," "particulate matter, ozone, black carbon" AND "stroke" OR "cerebrovascular diseases," "multiple sclerosis," "neuroinflammation," or "neurodegeneration." Results: We first identified 128 articles and their related websites, of which 44 articles were further selected for analysis mainly based on study relevance, study quality and reliability, and date of publication. Further studies on air pollution and its adverse effects on the CNS are needed. The findings of such studies will support the development of appropriate preventive measures in the future.
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Affiliation(s)
| | | | - Zeyad T Al-Harbi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | | | - Shahid Bashir
- Neuroscience, Neuroscience Center, King Fahad Specialist Hospital, Dammam, SAU
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Poulsen AH, Sørensen M, Hvidtfeldt UA, Ketzel M, Christensen JH, Brandt J, Frohn LM, Khan J, Jensen SS, Lund T, Raaschou-Nielsen O. Air pollution and stroke; effect modification by sociodemographic and environmental factors. A cohort study from Denmark. Int J Hyg Environ Health 2023; 251:114165. [PMID: 37121155 DOI: 10.1016/j.ijheh.2023.114165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/03/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Air pollution increases the risk of stroke, but the literature on identifying susceptible subgroups of populations is scarce and inconsistent. The aim of this study was to investigate if the association between air pollution and risk of stroke differed by sociodemographic factors, financial stress, comorbid conditions, and residential road traffic noise, population density and green space. METHODS We assessed long-term exposure to air pollution with ultrafine particles, PM2.5, elemental carbon and NO2 for a cohort of 1,971,246 Danes aged 50-85 years. During follow-up from 2005 to 2017, we identified 83,211 incident stroke cases. We used Cox proportional hazards model (relative risk) and Aalen additive hazards models (absolute risk) to estimate associations and confidence intervals (CI) between 5-year running means of air pollution at the residence and risk of stroke in population strata. RESULTS All four pollutants were associated with higher risk of stroke. The association between air pollution and stroke was strongest among individuals with comorbidities, with shorter education, lower income and being retired. The results also indicated stronger associations among individuals living in less populated areas, and with low noise levels and more green space around the residence. Estimates of absolute risk seemed better suited to detect such interactions than estimates of relative risk. For example for PM2.5 the hazard ratio for stroke was 1.28 (95%CI: 1.22-1.34) and 1.26 (95%CI: 1.16-1.37) among those with mandatory and medium/long education respectively. The corresponding rate difference estimates per 100,000 person years were 568 (95%CI: 543-594) and 423(95%CI: 390-456) CONCLUSION: The associations between air pollution and risk of stroke was stronger among individuals of lower socioeconomic status or with pre-existing comorbid conditions. Absolute risk estimates were better suited to identify such effect modification.
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Affiliation(s)
- Aslak Harbo Poulsen
- Work, Environment and Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Mette Sørensen
- Work, Environment and Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Universitetsvej 1, 4000, Roskilde, Denmark
| | - Ulla Arthur Hvidtfeldt
- Work, Environment and Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, University of Surrey, Guildford, UK
| | - Jesper H Christensen
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark; iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Lise Marie Frohn
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark; iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Jibran Khan
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark; Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Steen Solvang Jensen
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
| | - Thomas Lund
- Centre of Social Medicine, University Hospital Bispebjerg-Frederiksberg, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark; Department of Occupational and Social Medicine, Holbaek Hospital & Department of Public Health, University of Copenhagen, Denmark
| | - Ole Raaschou-Nielsen
- Work, Environment and Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, 4000, Roskilde, Denmark
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Keller K, Haghi SHR, Hahad O, Schmidtmann I, Chowdhury S, Lelieveld J, Münzel T, Hobohm L. Air pollution impacts on in-hospital case-fatality rate of ischemic stroke patients. Thromb Res 2023; 225:116-125. [PMID: 36990953 DOI: 10.1016/j.thromres.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND A growing body of evidence suggests that air pollution exposure is associated with an increased risk for cardiovascular diseases. Data regarding the impact of long-term air pollution exposure on ischemic stroke mortality are sparse. METHODS The German nationwide inpatient sample was used to analyse all cases of hospitalized patients with ischemic stroke in Germany 2015-2019, which were stratified according to their residency. Data of the German Federal Environmental Agency regarding average values of air pollutants were assessed from 2015 to 2019 at district-level. Data were combined and the impact of different air pollution parameters on in-hospital case-fatality was analyzed. RESULTS Overall, 1,505,496 hospitalizations of patients with ischemic stroke (47.7% females; 67.4 % ≥70 years old) were counted in Germany 2015-2019, of whom 8.2 % died during hospitalization. When comparing patients with residency in federal districts with high vs. low long-term air pollution, enhanced levels of benzene (OR 1.082 [95%CI 1.034-1.132],P = 0.001), ozone (O3, OR 1.123 [95%CI 1.070-1.178],P < 0.001), nitric oxide (NO, OR 1.076 [95%CI 1.027-1.127],P = 0.002) and PM2.5 fine particulate matter concentrations (OR 1.126 [95%CI 1.074-1.180],P < 0.001) were significantly associated with increased case-fatality independent from age, sex, cardiovascular risk-factors, comorbidities, and revascularization treatments. Conversely, enhanced carbon monoxide, nitrogen dioxide, PM10, and sulphur dioxide (SO2) concentrations were not significantly associated with stroke mortality. However, SO2-concentrations were significantly associated with stroke-case-fatality rate of >8 % independent of residence area-type and area use (OR 1.518 [95%CI 1.012-2.278],P = 0.044). CONCLUSION Elevated long-term air pollution levels in residential areas in Germany, notably of benzene, O3, NO, SO2, and PM2.5, were associated with increased stroke mortality of patients. RESEARCH IN CONTEXT Evidence before this study: Besides typical, established risk factors, increasing evidence suggests that air pollution is an important and growing risk factor for stroke events, estimated to be responsible for approximately 14 % of all stroke-associated deaths. However, real-world data regarding the impact of long-term exposure to air pollution on stroke mortality are sparse. Added value of this study: The present study demonstrates that the long-term exposure to the air pollutants benzene, O3, NO, SO2 and PM2.5 are independently associated with increased case-fatality of hospitalized patients with ischemic stroke in Germany. Implications of all the available evidence: The results of our study support the urgent need to reduce the exposure to air pollution by tightening emission controls to reduce the stroke burden and stroke mortality.
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Singh B, Pandey P, Wabaidur SM, Avtar R, Kumar P, Rahman S. Substantial changes in Gaseous pollutants and health effects during COVID-19 in Delhi, India. PeerJ 2023; 11:e14489. [PMID: 36643637 PMCID: PMC9835704 DOI: 10.7717/peerj.14489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/09/2022] [Indexed: 01/10/2023] Open
Abstract
Background Coronavirus disease has affected the entire population worldwide in terms of physical and environmental consequences. Therefore, the current study demonstrates the changes in the concentration of gaseous pollutants and their health effects during the COVID-19 pandemic in Delhi, the national capital city of India. Methodology In the present study, secondary data on gaseous pollutants such as nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), ammonia (NH3), and ozone (O3) were collected from the Central Pollution Control Board (CPCB) on a daily basis. Data were collected from January 1, 2020, to September 30, 2020, to determine the relative changes (%) in gaseous pollutants for pre-lockdown, lockdown, and unlockdown stages of COVID-19. Results The current findings for gaseous pollutants reveal that concentration declined in the range of 51%-83% (NO), 40%-69% (NOx), 31%-60% (NO2), and 25%-40% (NH3) during the lockdown compared to pre-lockdown period, respectively. The drastic decrease in gaseous pollutants was observed due to restricted measures during lockdown periods. The level of ozone was observed to be higher during the lockdown periods as compared to the pre-lockdown period. These gaseous pollutants are linked between the health risk assessment and hazard identification for non-carcinogenic. However, in infants (0-1 yr), Health Quotient (HQ) for daily and annual groups was found to be higher than the rest of the exposed group (toddlers, children, and adults) in all the periods. Conclusion The air quality values for pre-lockdown were calculated to be "poor category to "very poor" category in all zones of Delhi, whereas, during the lockdown period, the air quality levels for all zones were calculated as "satisfactory," except for Northeast Delhi, which displayed the "moderate" category. The computed HQ for daily chronic exposure for each pollutant across the child and adult groups was more than 1 (HQ > 1), which indicated a high probability to induce adverse health outcomes.
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Affiliation(s)
- Bhupendra Singh
- Delhi School of Climate Change and Sustainability (Institute of Eminence), University of Delhi, New Delhi, Delhi, India,Deshbandhu College, Department of Environmental Science, University of Delhi, New Delhi, Delhi, India
| | - Puneeta Pandey
- Department of Environmental Sciences and Technology, Central University of Punjab Bathinda, Bathinda, Punjab, India
| | | | - Ram Avtar
- Faculty of Environmental Earth Science, Hokkaido University, Sapporo, Japan, Sapporo, Japan
| | - Pramod Kumar
- Department of Chemistry, Sri Aurobindo College, University of Delhi, New Delhi, Delhi, India
| | - Shakilur Rahman
- Department of Medical Elementology and Toxicology, Jamia Hamdard, New Delhi, India
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Wu W, Xia X, Cui C, Qiu F. Haze and inbound tourism: Empirical evidence from China. Front Psychol 2023; 13:1056673. [PMID: 36687833 PMCID: PMC9853458 DOI: 10.3389/fpsyg.2022.1056673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/22/2022] [Indexed: 01/07/2023] Open
Abstract
The impact of climate change on tourism has always been an important topic for research in the field of international tourism, and haze has been widely recognized as the primary negative factor affecting the development of inbound tourism in China. In this study, we first conduct a theoretical analysis of the mechanism through which haze influences the tourism industry, and then we empirically analyze the impact on China's inbound tourism using surface particulate matter (PM2.5) concentrations as a proxy for haze, based on provincial panel data from 1998 to 2016. The empirical results show that haze not only has an inhibitory effect on inbound tourism, but also significantly reduces the average length of stay of international tourists. In addition, while there are significant regional differences in the crowding-out effect of haze pollution on inbound tourism, the effect varies depending on the origin of inbound tourists, exhibiting the greatest negative impact on inbound tourism from Taiwan and the smallest from foreign countries. Our research highlights that haze pollution can led to the change of human tourism behavior which enrich the literature on tourism and haze.
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Affiliation(s)
- Wenzhi Wu
- Faculty of Economics and Management, East China Normal University, Shanghai, China,*Correspondence: Wenzhi Wu,
| | - Xin Xia
- Glorious Sun School of Business and Management, Donghua University, Shanghai, China
| | - Chunyu Cui
- Management College, Ocean University of China, Qingdao, China
| | - Fudong Qiu
- Faculty of Economics and Management, East China Normal University, Shanghai, China
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Haddad P, Kutlar Joss M, Weuve J, Vienneau D, Atkinson R, Brook J, Chang H, Forastiere F, Hoek G, Kappeler R, Lurmann F, Sagiv S, Samoli E, Smargiassi A, Szpiro A, Patton AP, Boogaard H, Hoffmann B. Long-term exposure to traffic-related air pollution and stroke: A systematic review and meta-analysis. Int J Hyg Environ Health 2023; 247:114079. [PMID: 36446272 DOI: 10.1016/j.ijheh.2022.114079] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/10/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stroke remains the second cause of death worldwide. The mechanisms underlying the adverse association of exposure to traffic-related air pollution (TRAP) with overall cardiovascular disease may also apply to stroke. Our objective was to systematically evaluate the epidemiological evidence regarding the associations of long-term exposure to TRAP with stroke. METHODS PubMed and LUDOK electronic databases were searched systematically for observational epidemiological studies from 1980 through 2019 on long-term exposure to TRAP and stroke with an update in January 2022. TRAP was defined according to a comprehensive protocol based on pollutant and exposure assessment methods or proximity metrics. Study selection, data extraction, risk of bias (RoB) and confidence assessments were conducted according to standardized protocols. We performed meta-analyses using random effects models; sensitivity analyses were assessed by geographic area, RoB, fatality, traffic specificity and new studies. RESULTS Nineteen studies were included. The meta-analytic relative risks (and 95% confidence intervals) were: 1.03 (0.98-1.09) per 1 μg/m3 EC, 1.09 (0.96-1.23) per 10 μg/m3 PM10, 1.08 (0.89-1.32) per 5 μg/m3 PM2.5, 0.98 (0.92; 1.05) per 10 μg/m3 NO2 and 0.99 (0.94; 1.04) per 20 μg/m3 NOx with little to moderate heterogeneity based on 6, 5, 4, 7 and 8 studies, respectively. The confidence assessments regarding the quality of the body of evidence and separately regarding the presence of an association of TRAP with stroke considering all available evidence were rated low and moderate, respectively. CONCLUSION The available literature provides low to moderate evidence for an association of TRAP with stroke.
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Affiliation(s)
- P Haddad
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
| | - M Kutlar Joss
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany; Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - J Weuve
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - D Vienneau
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - R Atkinson
- Epidemiology, Population Health Research Institute and MRC-PHE Centre for Environment and Health, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - J Brook
- Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON M5T 3M7, Canada
| | - H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - F Forastiere
- School of Public Health, Faculty of Medicine, Imperial College, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ, UK
| | - G Hoek
- Institute for Risk Assessment Sciences, Environmental Epidemiology, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, the Netherlands
| | - R Kappeler
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland; University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - F Lurmann
- Sonoma Technology, Inc, 1450 N McDowell Blvd #200, Petaluma, CA, 94954, USA
| | - S Sagiv
- Center for Environmental Research and Children's Health, Division of Epidemiology, University of California Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA, 94704, USA
| | - E Samoli
- Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athina, 115 27, Greece
| | - A Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, 7101 Park Ave, Montreal, Quebec, H3N 1X9, Canada
| | - A Szpiro
- Department of Biostatistics, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351617, Seattle, WA, 98195-1617, USA
| | - A P Patton
- Health Effects Institute, 75 Federal suite UNIT 1400, Boston, MA, 02110, USA
| | - H Boogaard
- Health Effects Institute, 75 Federal suite UNIT 1400, Boston, MA, 02110, USA
| | - B Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
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Ma T, Yazdi MD, Schwartz J, Réquia WJ, Di Q, Wei Y, Chang HH, Vaccarino V, Liu P, Shi L. Long-term air pollution exposure and incident stroke in American older adults: A national cohort study. GLOBAL EPIDEMIOLOGY 2022; 4:100073. [PMID: 36644436 PMCID: PMC9838077 DOI: 10.1016/j.gloepi.2022.100073] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 01/19/2023] Open
Abstract
Aims Stroke is a leading cause of death and disability for Americans, and growing evidence suggests that air pollution may play an important role. To facilitate pollution control efforts, the National Academy of Sciences and the World Health Organization have prioritized determining which air pollutants are most toxic. However, evidence is limited for the simultaneous effects of multiple air pollutants on stroke. Methods and results We constructed a nationwide population-based cohort study, using the Medicare Chronic Conditions Warehouse (2000-2017) and high-resolution air pollution data, to investigate the impact of long-term exposure to ambient PM2.5, NO2, and ground-level O3 on incident stroke. Hazard ratios (HR) for stroke incidence were estimated using single-, bi-, and tri-pollutant Cox proportional hazards models. We identified ~2.2 million incident stroke cases among 17,443,900 fee-for-service Medicare beneficiaries. Per interquartile range (IQR) increase in the annual average PM2.5 (3.7 μg/m3), NO2 (12.4 ppb), and warm-season O3 (6.5 ppb) one-year prior to diagnosis, the HRs were 1.022 (95% CI: 1.017-1.028), 1.060 (95% CI: 1.054-1.065), and 1.021 (95% CI: 1.017-1.024), respectively, from the tri-pollutant model. There was strong evidence of linearity in concentration-response relationships for all three air pollutants in single-pollutant models. This linear relationship remained robust for NO2 and O3 in tri-pollutant models while the effect of PM2.5 attenuated at the lower end of concentrations. Conclusion Using a large nationwide cohort, our study suggests that long-term exposure to PM2.5, NO2, and O3 may independently increase the risk of stroke among the US elderly, among which traffic-related air pollution plays a particularly crucial role.
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Affiliation(s)
- Tszshan Ma
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mahdieh Danesh Yazdi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Weeberb J. Réquia
- School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil
| | - Qian Di
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yaguang Wei
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Howard H. Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Pengfei Liu
- School of Earth and Atmospheric Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Liuhua Shi
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Koch S, Khomenko S, Cirach M, Ubalde-Lopez M, Baclet S, Daher C, Hidalgo L, Lõhmus M, Rizzuto D, Rumpler R, Susilo Y, Venkataraman S, Wegener S, Wellenius GA, Woodcock J, Nieuwenhuijsen M. Impacts of changes in environmental exposures and health behaviours due to the COVID-19 pandemic on cardiovascular and mental health: A comparison of Barcelona, Vienna, and Stockholm. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 304:119124. [PMID: 35367103 PMCID: PMC8967404 DOI: 10.1016/j.envpol.2022.119124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 05/19/2023]
Abstract
Responses to COVID-19 altered environmental exposures and health behaviours associated with non-communicable diseases. We aimed to (1) quantify changes in nitrogen dioxide (NO2), noise, physical activity, and greenspace visits associated with COVID-19 policies in the spring of 2020 in Barcelona (Spain), Vienna (Austria), and Stockholm (Sweden), and (2) estimated the number of additional and prevented diagnoses of myocardial infarction (MI), stroke, depression, and anxiety based on these changes. We calculated differences in NO2, noise, physical activity, and greenspace visits between pre-pandemic (baseline) and pandemic (counterfactual) levels. With two counterfactual scenarios, we distinguished between Acute Period (March 15th - April 26th, 2020) and Deconfinement Period (May 2nd - June 30th, 2020) assuming counterfactual scenarios were extended for 12 months. Relative risks for each exposure difference were estimated with exposure-risk functions. In the Acute Period, reductions in NO2 (range of change from -16.9 μg/m3 to -1.1 μg/m3), noise (from -5 dB(A) to -2 dB(A)), physical activity (from -659 MET*min/wk to -183 MET*min/wk) and greenspace visits (from -20.2 h/m to 1.1 h/m) were largest in Barcelona and smallest in Stockholm. In the Deconfinement Period, NO2 (from -13.9 μg/m3 to -3.1 μg/m3), noise (from -3 dB(A) to -1 dB(A)), and physical activity levels (from -524 MET*min/wk to -83 MET*min/wk) remained below pre-pandemic levels in all cities. Greatest impacts were caused by physical activity reductions. If physical activity levels in Barcelona remained at Acute Period levels, increases in annual diagnoses for MI (mean: 572 (95% CI: 224, 943)), stroke (585 (6, 1156)), depression (7903 (5202, 10,936)), and anxiety (16,677 (926, 27,002)) would be anticipated. To decrease cardiovascular and mental health impacts, reductions in NO2 and noise from the first COVID-19 surge should be sustained, but without reducing physical activity. Focusing on cities' connectivity that promotes active transportation and reduces motor vehicle use assists in achieving this goal.
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Affiliation(s)
- Sarah Koch
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - Sasha Khomenko
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Marta Cirach
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Mònica Ubalde-Lopez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Sacha Baclet
- The Marcus Wallenberg Laboratory for Sound and Vibration Research (MWL), Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden; The Centre for ECO2 Vehicle Design, KTH Royal Institute of Technology, SE-100 44, Stockholm, Sweden
| | - Carolyn Daher
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Laura Hidalgo
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Mare Lõhmus
- Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences and Society, Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Romain Rumpler
- The Marcus Wallenberg Laboratory for Sound and Vibration Research (MWL), Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden; The Centre for ECO2 Vehicle Design, KTH Royal Institute of Technology, SE-100 44, Stockholm, Sweden
| | - Yusak Susilo
- Institute for Transport Studies, University of Natural Resources and Life Sciences, Vienna, Austria
| | - Siddharth Venkataraman
- The Marcus Wallenberg Laboratory for Sound and Vibration Research (MWL), Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden; The Centre for ECO2 Vehicle Design, KTH Royal Institute of Technology, SE-100 44, Stockholm, Sweden
| | - Sandra Wegener
- Institute for Transport Studies, University of Natural Resources and Life Sciences, Vienna, Austria
| | | | - James Woodcock
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Mark Nieuwenhuijsen
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
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11
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Li L, Huang S, Tian Y, Ji J, Zhang Y, Hu J, Lv Z, Liu N, Wang P, Yin P, Yu S. Short-term exposure to nitrogen dioxide and ischemic stroke incidence in Shenzhen, China: Modification effects by season and temperature. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 239:113644. [PMID: 35588618 DOI: 10.1016/j.ecoenv.2022.113644] [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: 12/19/2021] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES China has experienced a serious public health burden because of the increased incidence of ischemic stroke. Evidence describing the association between short-term exposure to nitrogen dioxide (NO2) and ischemic stroke morbidity is limited, and few studies have focused on the effects of season and temperature. This study aimed to evaluate the acute effects of NO2 on ischemic stroke incidence in Shenzhen, a southeastern city of China, considering the modified effects of season and temperature. METHODS A time-stratified case-crossover study was conducted between 2003 and 2014 among 98,482 ischemic stroke hospitalizations. Conditional quasi-Poisson regression was used to estimate the percentage changes in ischemic stroke admissions in relation to each 10 μg/m3 increment in NO2. RESULTS NO2 was positively associated with ischemic stroke onset over the full year, as well as in the cold season (November through April) and on cold days (ambient temperature≤median temperature), with significant single-day effects within 3 days after the exposure, and significant cumulative effects within the delayed five days. The maximum percentage changes were obtained at lag0-5, with 1.81% (95% confidence interval (CI) was 0.86-2.76%) over the full year, 2.75% (1.48-4.03%) in the cold season, and 3.04% (1.74-4.35%) on cold days. Additionally, the effects of exposure were found to be greater in males and people with higher education, and were lasting longer in subgroups of older individuals. CONCLUSIONS Our findings provide evidence that reductions in NO2 levels might decrease ischemic stroke morbidity, and enhance the understanding of ischemic stroke occurrence associated with NO2 modified by season and temperature.
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Affiliation(s)
- Lei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, Hubei, China
| | - Suli Huang
- Department of Environment and Health, Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, Guangdong, China
| | - Yuchen Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, Hubei, China
| | - Jiajia Ji
- Department of Environment and Health, Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, Guangdong, China
| | - Yu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, Hubei, China
| | - Jing Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, Hubei, China
| | - Ziquan Lv
- Department of Molecular Epidemiology, Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, Guangdong, China
| | - Ning Liu
- Department of Environment and Health, Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, Guangdong, China
| | - Peng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, Hubei, China.
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, Hubei, China.
| | - Shuyuan Yu
- Department of Environment and Health, Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, Guangdong, China.
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Lukina AO, Burstein B, Szyszkowicz M. Urban air pollution and emergency department visits related to central nervous system diseases. PLoS One 2022; 17:e0270459. [PMID: 35759498 PMCID: PMC9236246 DOI: 10.1371/journal.pone.0270459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/12/2022] [Indexed: 11/18/2022] Open
Abstract
Ambient air pollution has been associated with adverse neurological health outcomes. Ambient pollutants are thought to trigger oxidative stress and inflammation to which vulnerable populations, such as elderly may be particularly susceptible. Our study investigated the possible association between concentrations of ambient air pollutants and the number of emergency department (ED) visits for nervous system disorders among people residing in a large Canadian city. A time-stratified case-crossover study design combining data from the National Ambulatory Care Reporting System (NACRS) and the National Air Pollution Surveillance (NAPS) between 2004 and 2015 was used. Two air quality health indices were considered in additional to specific pollutants, including carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3) and fine particulate matter (PM2.5). Weather condition data were included in the models. ED visits with a discharge diagnosis were identified using ICD-10 codes (G00-G99). The analysis was stratified by sex and age, also by seasons. The associations were investigated in arrays organized as 18 strata and 15 time lags (in days) for each pollutant. Overall, 140,511 ED visits were included for the analysis. Most ED visits were related to episodic and paroxysmal diagnoses (G40-G47, 64%), with a majority of visits for migraines (G43, 39%). Among females, an increase of 0.1ppm ambient CO was associated with an increased risk of paroxysmal diagnoses at day 1 (RR = 1.019 (95%CI 1.004–1.033)), day 6 (1.024 (1.010–1.039)) and day 7 (1.022 (1.007–1.036). PM2.5 and SO2, and air quality indices were similarly associated with ED visits for episodic and paroxysmal disorders in days 6 and 7. Findings highlight that ambient air pollution is associated with an increased number of ED visits for nervous system disorders, particularly visits for paroxysmal diagnoses.
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Affiliation(s)
- Anna O. Lukina
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Mieczysław Szyszkowicz
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
- * E-mail:
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Short-Term Effects of Low-Level Ambient Air NO 2 on the Risk of Incident Stroke in Enshi City, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116683. [PMID: 35682266 PMCID: PMC9180296 DOI: 10.3390/ijerph19116683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022]
Abstract
Previous studies found that exposure to ambient nitrogen dioxide (NO2) was associated with an increased risk of incident stroke, but few studies have been conducted for relatively low NO2 pollution areas. In this study, the short-term effects of NO2 on the risk of incident stroke in a relatively low-pollution area, Enshi city of Hubei Province, China, were investigated through time-series analysis. Daily air-pollution data, meteorological data, and stroke incidence data of residents in Enshi city from 1 January 2015 to 31 December 2018 were collected. A time-series analysis using a generalised additive model (GAM) based on Poisson distribution was applied to explore the short-term effects of low-level NO2 exposure on the risk of incident stroke and stroke subtypes, as well as possible age, sex, and seasonal differences behind the effects. In the GAM model, potential confounding factors, such as public holidays, day of the week, long-term trends, and meteorological factors (temperature and relative humidity), were controlled. A total of 9122 stroke incident cases were included during the study period. We found that NO2 had statistically significant effects on the incidence of stroke and ischemic stroke, estimated by excess risk (ER) of 0.37% (95% CI: 0.04–0.70%) and 0.58% (95% CI: 0.18–0.98%), respectively. For the cumulative lag effects, the NO2 still had a statistically significant effect on incident ischemic stroke, estimated by ER of 0.61% (95% CI: 0.01–1.21%). The two-pollutant model showed that the effects of NO2 on incident total stroke were still statistically significant after adjusting for other air pollutants (PM2.5, PM10, SO2, CO, and O3). In addition, the effects of NO2 exposure on incident stroke were statistically significant in elderly (ER = 0.75%; 95% CI: 0.11–1.40%), males (ER = 0.47%; 95% CI: 0.05–0.89%) and cold season (ER = 0.83%; 95% CI: 0.15–1.51%) subgroups. Our study showed that, as commonly observed in high-pollution areas, short-term exposure to low-level NO2 was associated with an increased risk of incident stroke, including ischemic stroke. Males and elderly people were more vulnerable to the effects of NO2, and the adverse effects might be promoted in the cold season.
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14
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Chen PC, Sung FC, Mou CH, Chen CW, Tsai SP, Hsieh DHP, Hsu CY. A cohort study evaluating the risk of stroke associated with long-term exposure to ambient fine particulate matter in Taiwan. Environ Health 2022; 21:43. [PMID: 35439956 PMCID: PMC9017007 DOI: 10.1186/s12940-022-00854-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/11/2022] [Indexed: 05/06/2023]
Abstract
BACKGROUND Evidences have shown that the stroke risk associated with long-term exposure to particulate matter with an aerodynamic diameter of ≤2.5 μm (PM2.5) varies among people in North America, Europe and Asia, but studies in Asia rarely evaluated the association by stroke type. We examined whether long-term exposure to PM2.5 is associated with developing all strokes, ischemic stroke and hemorrhagic stroke. METHODS The retrospective cohort study consisted of 1,362,284 adults identified from beneficiaries of a universal health insurance program in 2011. We obtained data on air pollutants and meteorological measurements from air quality monitoring stations across Taiwan in 2010-2015. Annual mean levels of all environmental measurements in residing areas were calculated and assigned to cohort members. We used Cox proportional hazards models to estimate hazard ratio (HR) and 95% confidence interval (CI) of developing stroke associated with 1-year mean levels of PM2.5 at baseline in 2010, and yearly mean levels from 2010 to 2015 as the time-varying exposure, adjusting for age, sex, income and urbanization level. RESULTS During a median follow-up time of 6.0 years, 12,942 persons developed strokes, 9919 (76.6%) were ischemic. The adjusted HRs (95% CIs) per interquartile range increase in baseline 1-year mean PM2.5 were 1.03 (1.00-1.06) for all stroke, 1.06 (1.02-1.09) for ischemic stroke, and 0.95 (0.89-1.10) for hemorrhagic stroke. The concentration-response curves estimated in the models with and without additional adjustments for other environmental measurements showed a positively linear association between baseline 1-year mean PM2.5 and ischemic stroke at concentrations greater than 30 μg/m3, under which no evidence of association was observed. There was an indication of an inverse association between PM2.5 and hemorrhagic stroke, but the association no longer existed after controlling for nitrogen dioxide or ozone. We found similar shape of the concentration-response association in the Cox regression models with time-varying PM2.5 exposures. CONCLUSION Long-term exposure to PM2.5 might be associated with increased risk of developing ischemic stroke. The association with high PM2.5 concentrations remained significant after adjustment for other environmental factors.
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Affiliation(s)
- Pei-Chun Chen
- Department of Public Health, China Medical University College of Public Health, 100 Jingmao Rd Sec. 1, Taichung, 406040, Taiwan.
| | - Fung-Chang Sung
- Department of Health Services Administration, China Medical University College of Public Health, 100 Jingmao Rd Sec. 1, Taichung, 406040, Taiwan.
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan.
| | - Chih-Hsin Mou
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chao W Chen
- University of Maryland Global Campus, Adelphi, MD, USA
| | - Shan P Tsai
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - Dennis H P Hsieh
- Department of Environmental Toxicology, University of California, Davis, CA, USA
| | - Chung Y Hsu
- Graduate Institute of Biomedical Sciences, China Medical University College of Public Health, Taichung, Taiwan
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Avellaneda-Gómez C, Vivanco-Hidalgo RM, Olmos S, Lazcano U, Valentin A, Milà C, Ambrós A, Roquer J, Tonne C. Air pollution and surrounding greenness in relation to ischemic stroke: A population-based cohort study. ENVIRONMENT INTERNATIONAL 2022; 161:107147. [PMID: 35180670 DOI: 10.1016/j.envint.2022.107147] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Evidence for the association between environmental exposures and ischemic stroke (IS) is limited and inconsistent. We aimed to assess the relationship between exposure to air pollutants, residential surrounding greenness, and incident IS, and to identify population subgroups particularly sensitive to these exposures. METHODS We used data from administrative health registries of the public healthcare system in Catalonia, Spain to construct a cohort of individuals aged 18 years and older without a previous stroke diagnosis at 1st January 2016 (n = 3 521 274). We collected data on sociodemographic characteristics and cerebrovascular risk factors, and derived exposure at the participant's residence to ambient levels of fine particulate matter (PM2.5), black carbon (BC), nitrogen dioxide (NO2), and Normalized Difference Vegetation Index (NDVI) in a 300 m buffer as an indicator of greenness. The primary outcome was IS diagnosis at any point during the follow-up. We used Cox proportional hazards models to estimate associations between environmental exposures and incident IS and stratified analyses to investigate effect modification. RESULTS Between 1st January 2016 and 31st December 2017, 10 865 individuals were admitted to public hospitals with an IS diagnosis. Median exposure levels were: 17 µg/m3 PM2.5, 35 µg/m3 NO2, 2.28 µg/m3 BC and 0.27 NDVI. Individuals with higher residential exposure to air pollution were at greater risk of IS: HR 1·04 (95% CI:0·99-1·10) per 5 µg/m3 of PM2.5; HR 1.05 (95% CI:1·00-1·10) per 1 µg/m3 of BC; HR 1·04 (95% CI:1·03-1·06) per 10 µg/m3 of NO2. Conversely, individuals with higher residential surrounding green space, had lower risk of IS (HR 0·84; CI 95%:0·7-1.0). There was no evidence of effect modification by individual characteristics. CONCLUSIONS Higher incidence of IS was observed in relation to long-term exposures to air pollution, particularly NO2, in a region that meets European health-based air quality standards. Residential surrounding greenness was associated with lower incidence of IS.
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Affiliation(s)
- C Avellaneda-Gómez
- Neurology Department, IMIM-Hospital del Mar, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Complex Hospitalari Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain.
| | - R M Vivanco-Hidalgo
- Neurology Department, IMIM-Hospital del Mar, Barcelona, Spain; Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain.
| | - S Olmos
- ISGlobal, Barcelona, Spain; CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - U Lazcano
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain.
| | - A Valentin
- ISGlobal, Barcelona, Spain; CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - C Milà
- ISGlobal, Barcelona, Spain; CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - A Ambrós
- ISGlobal, Barcelona, Spain; CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | - J Roquer
- Neurology Department, IMIM-Hospital del Mar, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - C Tonne
- ISGlobal, Barcelona, Spain; CIBER epidemiología y salud pública (CIBERESP), Madrid, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain.
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Elser H, Chen KT, Arteaga D, Reimer R, Picciotto S, Costello S, Eisen EA. Metalworking Fluid Exposure and Stroke Mortality Among US Autoworkers. Am J Epidemiol 2022; 191:1040-1049. [PMID: 35029630 PMCID: PMC9393063 DOI: 10.1093/aje/kwac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/26/2021] [Accepted: 01/05/2022] [Indexed: 01/16/2023] Open
Abstract
Although air pollution is an important risk factor for stroke, few studies have considered the impact of workplace exposure to particulate matter (PM). We examined implications of exposure to PM composed of metalworking fluids (MWFs) for stroke mortality in the United Autoworkers-General Motors cohort. Cox proportional hazards models with age as the timescale were used to estimate the association of cumulative straight, soluble, and synthetic MWF exposure with stroke mortality, controlling for sex, race, plant, calendar year, and hire year. Among 38,553 autoworkers followed during 1941-1995, we identified 114 ischemic stroke deaths and 113 hemorrhagic stroke deaths. Overall stroke mortality risk was increased among workers in the middle exposure category for straight MWF (hazard ratio (HR) = 1.31, 95% confidence interval (CI): 0.87, 1.98) and workers in the highest exposure category for synthetic MWF (HR = 1.94, 95% CI: 1.13, 3.16) compared with workers who had no direct exposure. Ischemic stroke mortality risk was increased among workers in the highest exposure categories for straight MWF (HR = 1.45, 95% CI: 0.83, 2.52) and synthetic MWF (HR = 2.39, 95% CI: 1.39, 4.50). We observed no clear relationship between MWF exposure and hemorrhagic stroke mortality. Our results support a potentially important role for occupational PM exposures in stroke mortality and indicate the need for further studies of PM exposure and stroke in varied occupational settings.
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Affiliation(s)
- Holly Elser
- Correspondence to Dr. Holly Elser, Department of Neurology, 3 Gates, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (e-mail: )
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Cole-Hunter T, Dehlendorff C, Amini H, Mehta A, Lim YH, Jørgensen JT, Li S, So R, Mortensen LH, Westendorp R, Hoffmann B, Bräuner EV, Ketzel M, Hertel O, Brandt J, Jensen SS, Christensen JH, Geels C, Frohn LM, Backalarz C, Simonsen MK, Loft S, Andersen ZJ. Long-term exposure to road traffic noise and stroke incidence: a Danish Nurse Cohort study. Environ Health 2021; 20:115. [PMID: 34740347 PMCID: PMC8571835 DOI: 10.1186/s12940-021-00802-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/26/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Road traffic noise has been linked to increased risk of ischemic heart disease, yet evidence on stroke shows mixed results. We examine the association between long-term exposure to road traffic noise and incidence of stroke, overall and by subtype (ischemic or hemorrhagic), after adjustment for air pollution. METHODS Twenty-five thousand six hundred and sixty female nurses from the Danish Nurse Cohort recruited in 1993 or 1999 were followed for stroke-related first-ever hospital contact until December 31st, 2014. Full residential address histories since 1970 were obtained and annual means of road traffic noise (Lden [dB]) and air pollutants (particulate matter with diameter < 2.5 μm and < 10 μm [PM2.5 and PM10], nitrogen dioxide [NO2], nitrogen oxides [NOx]) were determined using validated models. Time-varying Cox regression models were used to estimate hazard ratios (HR) (95% confidence intervals [CI]) for the associations of one-, three-, and 23-year running means of Lden preceding stroke (all, ischemic or hemorrhagic), adjusting for stroke risk factors and air pollutants. The World Health Organization and the Danish government's maximum exposure recommendations of 53 and 58 dB, respectively, were explored as potential Lden thresholds. RESULTS Of 25,660 nurses, 1237 developed their first stroke (1089 ischemic, 148 hemorrhagic) during 16 years mean follow-up. For associations between a 1-year mean of Lden and overall stroke incidence, the estimated HR (95% CI) in the fully adjusted model was 1.06 (0.98-1.14) per 10 dB, which attenuated to 1.01 (0.93-1.09) and 1.00 (0.91-1.09) in models further adjusted for PM2.5 or NO2, respectively. Associations for other exposure periods or separately for ischemic or hemorrhagic stroke were similar. There was no evidence of a threshold association between Lden and stroke. CONCLUSIONS Long-term exposure to road traffic noise was suggestively positively associated with the risk of overall stroke, although not after adjusting for air pollution.
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Affiliation(s)
- Tom Cole-Hunter
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Centre for Air Pollution, Energy, and Health Research, University of New South Wales, Sydney, NSW Australia
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Heresh Amini
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amar Mehta
- Denmark Statistics, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Youn-Hee Lim
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T. Jørgensen
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Shuo Li
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rina So
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laust H. Mortensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rudi Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Elvira V. Bräuner
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, UK
| | - Ole Hertel
- Department of Bioscience, Aarhus University, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | | | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Lise M. Frohn
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Mette K. Simonsen
- Diakonissestiftelsen, Frederiksberg, Denmark
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Steffen Loft
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Zorana J. Andersen
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Song J, Lim Y, Ko I, Kim JY, Kim DK. Association between Air Pollutants and Initial Hospital Admission for Ischemic Stroke in Korea from 2002 to 2013. J Stroke Cerebrovasc Dis 2021; 30:106080. [PMID: 34496310 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES There is limited information regarding the association between air pollution exposure and stroke incidence. Therefore, this study aimed to assess the associations between short-term exposure to ambient air pollutants and initial hospital admission for ischemic stroke. MATERIALS AND METHODS From the Korea National Health Insurance Service-National Sample Cohort 2002-2013 database in South Korea, 55,852 first hospital admissions for ischemic stroke were identified. A generalized additive Poisson model was used to explore the association between air pollutants, including particulate matter, sulfur dioxide, nitrogen dioxide, and carbon monoxide and admissions for ischemic stroke. RESULTS All air pollutant models showed significant associations with ischemic stroke in the single lag model. In all air pollutant models excluding particulate matter 10 μm, a significant association was found between nitrogen dioxide exposure and initial admission for ischemic stroke after adjusting for other pollutants. An increment of 10 μg/m3 in nitrogen dioxide concentration at lag 0 and 14 days corresponded to a 0.259% (95% confidence interval, 0.231-0.287%) and 0.110% (95% confidence interval, 0.097-0.124) increase in initial admission for ischemic stroke, respectively. CONCLUSIONS The exposure-response relationship between nitrogen dioxide and initial admissions for ischemic stroke was approximately linear, with a sharper response at higher concentrations. Short-term exposure to nitrogen dioxide was positively associated with initial hospital admission for ischemic stroke.
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Affiliation(s)
- Jihye Song
- Department of Neurosurgery, Ajou College of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Yong Lim
- Department of Neurosurgery, Ajou College of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Inseok Ko
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Jong-Yeup Kim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea; Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea.
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea; Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea.
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Li J, Hauryliuk A, Malings C, Eilenberg SR, Subramanian R, Presto AA. Characterizing the Aging of Alphasense NO 2 Sensors in Long-Term Field Deployments. ACS Sens 2021; 6:2952-2959. [PMID: 34387087 DOI: 10.1021/acssensors.1c00729] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Low-cost NO2 sensors have been widely deployed for atmospheric sampling. While their initial performance has been characterized, few studies have examined their long-term degradation. This study focused on the performance of Alphasense low-cost NO2 sensors (NO2-B42F and NO2-B43F) over 4 years (2016-2020). A total of 29 NO2 sensors from 10 batches were collocated 78 times at two sites with reference instruments. Raw signals from "functional" NO2 sensors correlated linearly with reference NO2 concentrations. After long-term deployment, sensor raw signals started to deviate from reference NO2 concentrations due to sensor aging, an accumulated effect after sensor unpacking. Several sensors eventually became "non-functional" as sensor raw signals showed no correlation with reference NO2 concentrations. Sensor aging and non-functionality may be primarily caused by expiration of the ozone (O3) scrubber built into these sensors so that sensors responded to both ambient NO2 and O3. The influence of O3 on sensor response is quantified through the permutation importance method. Most of the sensors are non-functional after approximately 200-400 days of deployment, and no sensor was functional after 400 days of deployment. This result agrees well with the estimated lifetime of the built-in ozone scrubbers considering the ambient ozone concentration in the Pittsburgh area where these sensors were deployed. To ensure reliable data quality in long-term field deployments, we recommend collocating NO2 sensors with reference instruments regularly after 200-400 days of deployment to identify and replace non-functional sensors in a timely manner.
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Affiliation(s)
- Jiayu Li
- Center for Atmospheric Particle Studies (CAPS), Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
- Air and Aerosol Sensing Group (AASG), University of Minnesota, Twin Cities, Minnesota, Minnesota 55108, United States
| | - Aliaksei Hauryliuk
- Center for Atmospheric Particle Studies (CAPS), Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
| | - Carl Malings
- Center for Atmospheric Particle Studies (CAPS), Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
- OSU-EFLUVE - Observatoire Sciences de l’Univers-Enveloppes Fluides de la, Ville à l’Exobiologie, Université Paris-Est-Créteil, CNRS UMS 3563, Ecole Nationale des Ponts et Chaussés, Université de Paris, 75009 Paris, France
- Laboratoire Interuniversitaire des Systèmes Atmosphériques, UMR 7583, CNRS, Université Paris-Est-Créteil, Université de Paris, Institut Pierre Simon Laplace, 94010 Créteil, France
- NASA Postdoctoral Program Fellow, Goddard Space Flight Center, Greenbelt, Maryland 20771, United States
| | - S. Rose Eilenberg
- Center for Atmospheric Particle Studies (CAPS), Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
| | - R. Subramanian
- Center for Atmospheric Particle Studies (CAPS), Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
- OSU-EFLUVE - Observatoire Sciences de l’Univers-Enveloppes Fluides de la, Ville à l’Exobiologie, Université Paris-Est-Créteil, CNRS UMS 3563, Ecole Nationale des Ponts et Chaussés, Université de Paris, 75009 Paris, France
- Laboratoire Interuniversitaire des Systèmes Atmosphériques, UMR 7583, CNRS, Université Paris-Est-Créteil, Université de Paris, Institut Pierre Simon Laplace, 94010 Créteil, France
| | - Albert A. Presto
- Center for Atmospheric Particle Studies (CAPS), Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
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Danesh Yazdi M, Wang Y, Di Q, Wei Y, Requia WJ, Shi L, Sabath MB, Dominici F, Coull BA, Evans JS, Koutrakis P, Schwartz JD. Long-Term Association of Air Pollution and Hospital Admissions Among Medicare Participants Using a Doubly Robust Additive Model. Circulation 2021; 143:1584-1596. [PMID: 33611922 PMCID: PMC8055197 DOI: 10.1161/circulationaha.120.050252] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Studies examining the nonfatal health outcomes of exposure to air pollution have been limited by the number of pollutants studied and focus on short-term exposures. METHODS We examined the relationship between long-term exposure to fine particulate matter with an aerodynamic diameter <2.5 micrometers (PM2.5), NO2, and tropospheric ozone and hospital admissions for 4 cardiovascular and respiratory outcomes (myocardial infarction, ischemic stroke, atrial fibrillation and flutter, and pneumonia) among the Medicare population of the United States. We used a doubly robust method for our statistical analysis, which relies on both inverse probability weighting and adjustment in the outcome model to account for confounding. The results from this regression are on an additive scale. We further looked at this relationship at lower pollutant concentrations, which are consistent with typical exposure levels in the United States, and among potentially susceptible subgroups. RESULTS Long-term exposure to fine PM2.5 was associated with an increased risk of all outcomes with the highest effect seen for stroke with a 0.0091% (95% CI, 0.0086-0.0097) increase in the risk of stroke for each 1-µg/m3 increase in annual levels. This translated to 2536 (95% CI, 2383-2691) cases of hospital admissions with ischemic stroke per year, which can be attributed to each 1-unit increase in fine particulate matter levels among the study population. NO2 was associated with an increase in the risk of admission with stroke by 0.00059% (95% CI, 0.00039-0.00075) and atrial fibrillation by 0.00129% (95% CI, 0.00114-0.00148) per ppb and tropospheric ozone was associated with an increase in the risk of admission with pneumonia by 0.00413% (95% CI, 0.00376-0.00447) per parts per billion. At lower concentrations, all pollutants were consistently associated with an increased risk for all our studied outcomes. CONCLUSIONS Long-term exposure to air pollutants poses a significant risk to cardiovascular and respiratory health among the elderly population in the United States, with the greatest increase in the association per unit of exposure occurring at lower concentrations.
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Affiliation(s)
- Mahdieh Danesh Yazdi
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.)
| | - Yan Wang
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.).,Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (Y.W., M.B.S., F.D., B.A.C.)
| | - Qian Di
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.).,Vanke School of Public Health, Tsinghua University, Beijing, China (Q.D.).,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA (Q.D., J.D.S.)
| | - Yaguang Wei
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.)
| | - Weeberb J. Requia
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.)
| | - Liuhua Shi
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.).,Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA (L.S.)
| | - Matthew Benjamin Sabath
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (Y.W., M.B.S., F.D., B.A.C.)
| | - Francesca Dominici
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (Y.W., M.B.S., F.D., B.A.C.)
| | - Brent A. Coull
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (Y.W., M.B.S., F.D., B.A.C.)
| | - John S. Evans
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.)
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.)
| | - Joel D. Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.).,Vanke School of Public Health, Tsinghua University, Beijing, China (Q.D.)
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Systematic review and meta-analysis of cohort studies of long term outdoor nitrogen dioxide exposure and mortality. PLoS One 2021; 16:e0246451. [PMID: 33539450 PMCID: PMC7861378 DOI: 10.1371/journal.pone.0246451] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/10/2021] [Indexed: 01/04/2023] Open
Abstract
Objective To determine whether long term exposure to outdoor nitrogen dioxide (NO2) is associated with all-cause or cause-specific mortality. Methods MEDLINE, Embase, CENTRAL, Global Health and Toxline databases were searched using terms developed by a librarian. Screening, data extraction and risk of bias assessment were completed independently by two reviewers. Conflicts were resolved through consensus and/or involvement of a third reviewer. Pooling of results across studies was conducted using random effects models, heterogeneity among included studies was assessed using Cochran’s Q and I2 measures, and sources of heterogeneity were evaluated using meta-regression. Sensitivity of pooled estimates to individual studies was examined and publication bias was evaluated using Funnel plots, Begg’s and Egger’s tests, and trim and fill. Results Seventy-nine studies based on 47 cohorts, plus one set of pooled analyses of multiple European cohorts, met inclusion criteria. There was a consistently high degree of heterogeneity. After excluding studies with probably high or high risk of bias in the confounding domain (n = 12), pooled hazard ratios (HR) indicated that long term exposure to NO2 was significantly associated with mortality from all/ natural causes (pooled HR 1.047, 95% confidence interval (CI), 1.023–1.072 per 10 ppb), cardiovascular disease (pooled HR 1.058, 95%CI 1.026–1.091), lung cancer (pooled HR 1.083, 95%CI 1.041–1.126), respiratory disease (pooled HR 1.062, 95%CI1.035–1.089), and ischemic heart disease (pooled HR 1.111, 95%CI 1.079–1.144). Pooled estimates based on multi-pollutant models were consistently smaller than those from single pollutant models and mostly non-significant. Conclusions For all causes of death other than cerebrovascular disease, the overall quality of the evidence is moderate, and the strength of evidence is limited, while for cerebrovascular disease, overall quality is low and strength of evidence is inadequate. Important uncertainties remain, including potential confounding by co-pollutants or other concomitant exposures, and limited supporting mechanistic evidence. (PROSPERO registration number CRD42018084497)
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Zhang R, Jiang Y, Zhang G, Yu M, Wang Y, Liu G. Association between short-term exposure to ambient air pollution and hospital admissions for transient ischemic attacks in Beijing, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:6877-6885. [PMID: 33010014 PMCID: PMC7840640 DOI: 10.1007/s11356-020-10963-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/21/2020] [Indexed: 05/02/2023]
Abstract
Numerous studies have examined the associations between air pollution and stroke. However, little is known about the associations between air pollution and transient ischemic attack (TIA). In this study, we aimed to conduct a time-series study to systematically examine the associations between hospital admissions for TIA and air pollutants. Admissions for TIA (ICD-10: G45) from 1 January 2014 to 31 December 2016 were identified based on the primary diagnosis from 134 hospitals in Beijing, China. Hourly measurements of air pollutants were obtained from the National Air Pollution Monitoring System. Generalized additive models with quasi-Poisson regression were used to determine the associations for each pollutant. Additionally, stratified analysis was implemented to examine whether age, gender, temperature, and season were the potential effect modifiers. Restricted cubic spline was applied to investigate the exposure-response curve. In total, 109,975 hospital admissions for TIA were included. The positive associations were detected between PM2.5, PM10, SO2, NO2, and CO and hospital admissions for TIA. The effects of PM2.5 and PM10 in men are stronger than in women. Additionally, the effects of PM2.5, PM10, SO2, and O3 are more pronounced on warm days than cool days. From exposure-response curves, we observe a nearly linear relationship for PM2.5, PM10, CO, and NO2. Further studies are needed to verify the association. This research contributes evidence on the association between air pollution and admissions for TIA in the low- and middle-income countries and may promote related public health policy development.
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Affiliation(s)
- Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China
| | - Guitao Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China
| | - Miaoxin Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China.
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 10070, China.
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Association between exposure to ambient air pollution and hospital admission, incidence, and mortality of stroke: an updated systematic review and meta-analysis of more than 23 million participants. Environ Health Prev Med 2021; 26:15. [PMID: 33499804 PMCID: PMC7839211 DOI: 10.1186/s12199-021-00937-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous studies have suggested that exposure to air pollution may increase stroke risk, but the results remain inconsistent. Evidence of more recent studies is highly warranted, especially gas air pollutants. METHODS We searched PubMed, Embase, and Web of Science to identify studies till February 2020 and conducted a meta-analysis on the association between air pollution (PM2.5, particulate matter with aerodynamic diameter less than 2.5 μm; PM10, particulate matter with aerodynamic diameter less than 10 μm; NO2, nitrogen dioxide; SO2, sulfur dioxide; CO, carbon monoxide; O3, ozone) and stroke (hospital admission, incidence, and mortality). Fixed- or random-effects model was used to calculate pooled odds ratios (OR)/hazard ratio (HR) and their 95% confidence intervals (CI) for a 10 μg/m3 increase in air pollutant concentration. RESULTS A total of 68 studies conducted from more than 23 million participants were included in our meta-analysis. Meta-analyses showed significant associations of all six air pollutants and stroke hospital admission (e.g., PM2.5: OR = 1.008 (95% CI 1.005, 1.011); NO2: OR = 1.023 (95% CI 1.015, 1.030), per 10 μg/m3 increases in air pollutant concentration). Exposure to PM2.5, SO2, and NO2 was associated with increased risks of stroke incidence (PM2.5: HR = 1.048 (95% CI 1.020, 1.076); SO2: HR = 1.002 (95% CI 1.000, 1.003); NO2: HR = 1.002 (95% CI 1.000, 1.003), respectively). However, no significant differences were found in associations of PM10, CO, O3, and stroke incidence. Except for CO and O3, we found that higher level of air pollution (PM2.5, PM10, SO2, and NO2) exposure was associated with higher stroke mortality (e.g., PM10: OR = 1.006 (95% CI 1.003, 1.010), SO2: OR = 1.006 (95% CI 1.005, 1.008). CONCLUSIONS Exposure to air pollution was positively associated with an increased risk of stroke hospital admission (PM2.5, PM10, SO2, NO2, CO, and O3), incidence (PM2.5, SO2, and NO2), and mortality (PM2.5, PM10, SO2, and NO2). Our study would provide a more comprehensive evidence of air pollution and stroke, especially SO2 and NO2.
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Le Cornec CMA, Molden N, van Reeuwijk M, Stettler MEJ. Modelling of instantaneous emissions from diesel vehicles with a special focus on NO x: Insights from machine learning techniques. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 737:139625. [PMID: 32783820 DOI: 10.1016/j.scitotenv.2020.139625] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/14/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
Accurate instantaneous vehicle emissions models are vital for evaluating the impacts of road transport on air pollution at high temporal and spatial resolution. In this study, we apply machine learning techniques to a dataset of 70 diesel vehicles tested in real-world driving conditions to: (i) cluster vehicles with similar emissions performance, and (ii) model instantaneous emissions. The application of dynamic time warping and clustering analysis by NOx emissions resulted in 17 clusters capturing 88% of trips in the dataset. We show that clustering effectively groups vehicles with similar emissions profiles, however no significant correlation between emissions and vehicle characteristics (i.e. engine size, vehicle weight) were found. For each cluster, we evaluate three instantaneous emissions models: a look-up table (LT) approach, a non-linear regression (NLR) model and a neural network multi-layer perceptron (MLP) model. The NLR model provides accurate instantaneous NOx predictions, on par with the MLP: relative errors in prediction of emission factors are below 20% for both models, average fractional biases are -0.01 (s.d. 0.02) and -0.0003 (s.d. 0.04), and average normalised mean squared errors are 0.25 (s.d. 0.14) and 0.29 (s.d. 0.16), for the NLR and MLP models respectively. However, neural networks are better able to deal with vehicles not belonging to a specific cluster. The new models that we present rely on simple inputs of vehicle speed and acceleration, which could be extracted from existing sources including traffic cameras and vehicle tracking devices, and can therefore be deployed immediately to enable fast and accurate prediction of vehicle NOx emissions. The speed and the ease of use of these new models make them an ideal operational tool for policy makers aiming to build emission inventories or evaluate emissions mitigation strategies.
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Affiliation(s)
- Clémence M A Le Cornec
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, United Kingdom
| | - Nick Molden
- Emissions Analytics, Unit 2 CR Bates Industrial Estate, Wycombe Road, Stokenchurch, High Wycombe, Buckinghamshire, HP14 3PD, United Kingdom
| | - Maarten van Reeuwijk
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, United Kingdom
| | - Marc E J Stettler
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, United Kingdom.
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Amini H, Dehlendorff C, Lim YH, Mehta A, Jørgensen JT, Mortensen LH, Westendorp R, Hoffmann B, Loft S, Cole-Hunter T, Bräuner EV, Ketzel M, Hertel O, Brandt J, Solvang Jensen S, Christensen JH, Geels C, Frohn LM, Backalarz C, Simonsen MK, Andersen ZJ. Long-term exposure to air pollution and stroke incidence: A Danish Nurse cohort study. ENVIRONMENT INTERNATIONAL 2020; 142:105891. [PMID: 32593048 DOI: 10.1016/j.envint.2020.105891] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 05/23/2023]
Abstract
Ambient air pollution has been linked to stroke, but few studies have examined in detail stroke subtypes and confounding by road traffic noise, which was recently associated with stroke. Here we examined the association between long-term exposure to air pollution and incidence of stroke (overall, ischemic, hemorrhagic), adjusting for road traffic noise. In a nationwide Danish Nurse Cohort consisting of 23,423 nurses, recruited in 1993 or 1999, we identified 1,078 incident cases of stroke (944 ischemic and 134 hemorrhagic) up to December 31, 2014, defined as first-ever hospital contact. The full residential address histories since 1970 were obtained for each participant and the annual means of air pollutants (particulate matter with diameter < 2.5 µm and < 10 µm (PM2.5 and PM10), nitrogen dioxide (NO2), nitrogen oxides (NOx)) and road traffic noise were determined using validated models. Time-varying Cox regression models were used to estimate hazard ratios (HR) (95% confidence intervals (CI)) for the associations of one-, three, and 23-year running mean of air pollutants with stroke adjusting for potential confounders and noise. In fully adjusted models, the HRs (95% CI) per interquartile range increase in one-year running mean of PM2.5 and overall, ischemic, and hemorrhagic stroke were 1.12 (1.01-1.25), 1.13 (1.01-1.26), and 1.07 (0.80-1.44), respectively, and remained unchanged after adjustment for noise. Long-term exposure to ambient PM2.5 was associated with the risk of stroke independent of road traffic noise.
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Affiliation(s)
- Heresh Amini
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amar Mehta
- Statistics Denmark, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Statistics Denmark, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rudi Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine; Centre for Health and Society, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Air Pollution, Energy, and Health Research, University of New South Wales, Sydney, NSW, Australia; International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Elvira V Bräuner
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Aarhus, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, United Kingdom
| | - Ole Hertel
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | | | | | - Camilla Geels
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Lise M Frohn
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | | | - Mette K Simonsen
- Diakonissestiftelsen, Frederiksberg, Denmark; The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ambient Gaseous Pollutants in an Urban Area in South Africa: Levels and Potential Human Health Risk. ATMOSPHERE 2020. [DOI: 10.3390/atmos11070751] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Urban air pollution from gaseous pollutants is a growing public health problem in many countries including South Africa. Examining the levels, trends and health risk of exposure to ambient gaseous pollutants will assist in understanding the effectiveness of existing control measures and plan for suitable management strategies. This study determined the concentration levels and non-cancer risk of CO, SO2, NO2, and O3 at an industrial area in Pretoria West, South Africa. We utilised a set of secondary data for CO, NO2, SO2, and O3 that was obtained from a monitoring station. Analysis of the hourly monitored data was done. Their non-cancer risk (HQ) was determined using the human health risk assessment model for different age categories. The annual levels of NO2 (39.442 µg/m3), SO2 (22.464 µg/m3), CO (722.003 µg/m3) and the 8-hour concentration of CO (649.902 µg/m3) and O3 (33.556 µg/m3) did not exceed the South African National Ambient Air Quality Standards for each pollutant. The HQ for each pollutant across exposed groups (except children) was less than 1. This indicates that the recorded levels could not pose non-cancer risk to susceptible individuals.
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High-throughput analysis of single particles by micro laser induced breakdown spectroscopy. Anal Chim Acta 2020; 1095:14-19. [DOI: 10.1016/j.aca.2019.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 11/22/2022]
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Abstract
Ambient air pollution is a risk factor for both acute and chronic diseases and poses serious health threats to the world population. We aim to study the relationship between air pollution and all-cause mortality in the context of a city-state exposed to the Southeast Asian haze problem. The primary exposure was ambient air pollution, as measured by the Pollutants Standards Index (PSI). The outcome of interest was all-cause mortality from 2010–2015. A time-stratified case-crossover design was performed. A conditional Poisson regression model, including environmental variables such as PSI, temperature, wind speed, and rainfall, was fitted to the daily count of deaths to estimate the incidence rate ratio (IRR) of mortality per unit increase in PSI, accounting for overdispersion and autocorrelation. To account for intermediate exposure effects (maximum lag of 10 days), a distributed lag non-linear model was used. There were 105,504 deaths during the study period. Increment in PSI was significantly associated with an increased risk of mortality. The adjusted IRR of mortality per the 10-unit increase in PSI was 1.01 (95%CI = 1.00–1.01). The lag effect was stronger when PSI was in the unhealthy range compared to the good and moderate ranges. At lag = 7 days, PSI appeared to have an adverse effect on mortality, although the effect was not significant. These findings provide evidence on the general health hazard of exposure to air pollution and can potentially guide public health policies in the region.
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Li CY, Li CH, Martini S, Hou WH. Association between air pollution and risk of vascular dementia: A multipollutant analysis in Taiwan. ENVIRONMENT INTERNATIONAL 2019; 133:105233. [PMID: 31678904 DOI: 10.1016/j.envint.2019.105233] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/27/2019] [Accepted: 09/29/2019] [Indexed: 05/07/2023]
Abstract
Evidence regarding the association of specific air pollutants with vascular dementia (VaD) risk is limited. In this nested case-control study, we enrolled 831 adults aged >65 years with VaD (International Classification of Diseases, Ninth Revision, Clinical Modification code 290.4x) newly diagnosed during 2005-2013; 3324 controls were age-, sex-, and VaD diagnosis year-matched with the study patients. Both patients with VaD and controls were selected from among a cohort of one million beneficiaries of Taiwan's National Health Insurance program, all of whom were registered in 2005. Exposure to the mean daily air pollutant concentration, derived from 76 fixed air quality monitoring stations, in 3, 5, and 7 years before VaD diagnosis was assessed using the spatial analysis method (i.e., ordinary kriging) on ArcGIS. A logistic regression model was used to calculate covariate-adjusted odds ratios (ORs) of VaD in relation to specific air pollutants. After potential confounders and other air pollutants were controlled for, high concentrations of coarse particulate matter (10 µm or less in diameter) and carbon monoxide (CO) were sporadically associated with higher OR of VaD. The most prominent association was observed for nitrogen dioxide (NO2) exposure within 5 and 7 years before diagnosis. Compared with the <25th percentile of NO2 exposure, the 25th-50th, 50th-75th, and >75th percentiles of NO2 exposure significantly increased ORs (95% confidence intervals): 1.62 (1.28-2.23), 1.61 (1.11-2.33), and 2.22 (1.35-3.65) within 5 years before diagnosis, respectively, and 1.59 (1.20-2.11), 1.65 (1.15-2.37), and 2.05 (1.28-3.28) within 7 years before diagnosis, respectively. We found that higher NO2 exposure in the past was significantly associated with an elevated risk of VaD. Although less consistent, higher exposure to CO was also associated with a higher risk of VaD. Most NO2 in cities originates from motor vehicle exhaust; other sources of NO2 are petrol and metal refining, electricity generation from coal-fired power stations, other manufacturing industries, and food processing. Future studies should investigate associations of VaD with specific sources of NO2.
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Affiliation(s)
- Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Chien-Hsin Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Santi Martini
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Wen-Hsuan Hou
- School of Gerontology Health Management & Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, Taipei Medical University, Taipei, Taiwan; Center of Evidence-Based Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
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Cheong KH, Ngiam NJ, Morgan GG, Pek PP, Tan BYQ, Lai JW, Koh JM, Ong MEH, Ho AFW. Acute Health Impacts of the Southeast Asian Transboundary Haze Problem-A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183286. [PMID: 31500215 PMCID: PMC6765769 DOI: 10.3390/ijerph16183286] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/29/2019] [Indexed: 11/23/2022]
Abstract
Air pollution has emerged as one of the world’s largest environmental health threats, with various studies demonstrating associations between exposure to air pollution and respiratory and cardiovascular diseases. Regional air quality in Southeast Asia has been seasonally affected by the transboundary haze problem, which has often been the result of forest fires from “slash-and-burn” farming methods. In light of growing public health concerns, recent studies have begun to examine the health effects of this seasonal haze problem in Southeast Asia. This review paper aims to synthesize current research efforts on the impact of the Southeast Asian transboundary haze on acute aspects of public health. Existing studies conducted in countries affected by transboundary haze indicate consistent links between haze exposure and acute psychological, respiratory, cardiovascular, and neurological morbidity and mortality. Future prospective and longitudinal studies are warranted to quantify the long-term health effects of recurrent, but intermittent, exposure to high levels of seasonal haze. The mechanism, toxicology and pathophysiology by which these toxic particles contribute to disease and mortality should be further investigated. Epidemiological studies on the disease burden and socioeconomic cost of haze exposure would also be useful to guide policy-making and international strategy in minimizing the impact of seasonal haze in Southeast Asia.
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Affiliation(s)
- Kang Hao Cheong
- Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore.
| | - Nicholas Jinghao Ngiam
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119074, Singapore
| | - Geoffrey G Morgan
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119074, Singapore
| | - Joel Weijia Lai
- Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore
| | - Jin Ming Koh
- Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Andrew Fu Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore
- Cardiovascular & Metabolic Disorders Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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Cheong KH, Ngiam NJ, Morgan GG, Pek PP, Tan BYQ, Lai JW, Koh JM, Ong MEH, Ho AFW. Acute Health Impacts of the Southeast Asian Transboundary Haze Problem-A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019. [PMID: 31500215 DOI: 10.1007/s11270-007-9392-210.3390/ijerph16183286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Air pollution has emerged as one of the world's largest environmental health threats, with various studies demonstrating associations between exposure to air pollution and respiratory and cardiovascular diseases. Regional air quality in Southeast Asia has been seasonally affected by the transboundary haze problem, which has often been the result of forest fires from "slash-and-burn" farming methods. In light of growing public health concerns, recent studies have begun to examine the health effects of this seasonal haze problem in Southeast Asia. This review paper aims to synthesize current research efforts on the impact of the Southeast Asian transboundary haze on acute aspects of public health. Existing studies conducted in countries affected by transboundary haze indicate consistent links between haze exposure and acute psychological, respiratory, cardiovascular, and neurological morbidity and mortality. Future prospective and longitudinal studies are warranted to quantify the long-term health effects of recurrent, but intermittent, exposure to high levels of seasonal haze. The mechanism, toxicology and pathophysiology by which these toxic particles contribute to disease and mortality should be further investigated. Epidemiological studies on the disease burden and socioeconomic cost of haze exposure would also be useful to guide policy-making and international strategy in minimizing the impact of seasonal haze in Southeast Asia.
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Affiliation(s)
- Kang Hao Cheong
- Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore.
| | - Nicholas Jinghao Ngiam
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119074, Singapore
| | - Geoffrey G Morgan
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore 119074, Singapore
| | - Joel Weijia Lai
- Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore
| | - Jin Ming Koh
- Science and Math Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Andrew Fu Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore 169857, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore
- Cardiovascular & Metabolic Disorders Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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Chang KH, Hsu PY, Lin CJ, Lin CL, Juo SHH, Liang CL. Traffic-related air pollutants increase the risk for age-related macular degeneration. J Investig Med 2019; 67:1076-1081. [DOI: 10.1136/jim-2019-001007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2019] [Indexed: 11/03/2022]
Abstract
The aim of this study was to investigate whether ambient nitrogen dioxide (NO2) and carbon monoxide (CO) increase the risk for age-related macular degeneration (AMD). This is a longitudinal population-based study using the data on Taiwan National Health Insurance Program between year 2000 and 2010. From the nationwide dataset, we enrolled subjects aged 50 or older and the annually total NO2 and CO exposure was calculated from 1998 to 2010 for each subject. The Cox proportional hazard regression was used to estimate the HRs with adjustment for other variables. A total of 39,819 AMD-free residents were enrolled, and 1442 participants developed AMD during the 11 -year follow-up. Compared with the lowest exposure quartile, the highest quartile of each air pollutant was associated with an increased risk for AMD. The adjusted HR was 1.91 (95% CI 1.64 to 2.23, p<0.001) for the highest NO2 quartile, and was 1.84 (95% CI 1.5 to 2.15, p<0.001) for the highest CO quartile. In this study, chronic exposure to the highest quartile of ambient NO2 or CO significantly increases the risk for AMD.
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Shin S, Burnett RT, Kwong JC, Hystad P, van Donkelaar A, Brook JR, Goldberg MS, Tu K, Copes R, Martin RV, Liu Y, Kopp A, Chen H. Ambient Air Pollution and the Risk of Atrial Fibrillation and Stroke: A Population-Based Cohort Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:87009. [PMID: 31449466 PMCID: PMC6792368 DOI: 10.1289/ehp4883] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Although growing evidence links air pollution to stroke incidence, less is known about the effect of air pollution on atrial fibrillation (AF), an important risk factor for stroke. OBJECTIVES We assessed the associations between air pollution and incidence of AF and stroke. We also sought to characterize the shape of pollutant-disease relationships. METHODS The population-based cohort comprised 5,071,956 Ontario residents, age 35–85 y and without the diagnoses of both outcomes on 1 April 2001 and was followed up until 31 March 2015. AF and stroke cases were ascertained using health administrative databases with validated algorithms. Based on annual residential postal codes, we assigned 5-y running average concentrations of fine particulate matter ([Formula: see text]), nitrogen dioxide ([Formula: see text]), and ozone ([Formula: see text]) from satellite-derived data, a land-use regression model, and a fusion-based method, respectively, as well as redox-weighted averages of [Formula: see text] and [Formula: see text] ([Formula: see text]) for each year. Using Cox proportional hazards models, we estimated the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of AF and stroke with each of these pollutants, adjusting for individual- and neighborhood-level variables. We used newly developed nonlinear risk models to characterize the shape of pollutant–disease relationships. RESULTS Between 2001 and 2015, we identified 313,157 incident cases of AF and 122,545 cases of stroke. Interquartile range increments of [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text] were associated with increases in the incidence of AF [HRs (95% CIs): 1.03 (1.01, 1.04), 1.02 (1.01, 1.03), 1.01 (1.00, 1.02), and 1.01 (1.01, 1.02), respectively] and the incidence of stroke [HRs (95% CIs): 1.05 (1.03, 1.07), 1.04 (1.01, 1.06), 1.05 (1.03, 1.06), and 1.05 (1.04, 1.06), respectively]. Associations of similar magnitude were found in various sensitivity analyses. Furthermore, we found a near-linear association for stroke with [Formula: see text], whereas [Formula: see text], [Formula: see text]-, and [Formula: see text] relationships exhibited sublinear shapes. CONCLUSIONS Air pollution was associated with stroke and AF onset, even at very low concentrations. https://doi.org/10.1289/EHP4883.
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Affiliation(s)
- Saeha Shin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Richard T. Burnett
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Jeffrey C. Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Perry Hystad
- College of Public Health and Human Studies, Oregon State University, Corvallis, Oregon, USA
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey R. Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada
| | - Mark S. Goldberg
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ray Copes
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Randall V. Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | | | | | - Hong Chen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Air pollution increases the risk of SSNHL: A nested case-control study using meteorological data and national sample cohort data. Sci Rep 2019; 9:8270. [PMID: 31164673 PMCID: PMC6547844 DOI: 10.1038/s41598-019-44618-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/21/2019] [Indexed: 01/12/2023] Open
Abstract
This study aimed to evaluate the impact of weather conditions and air pollution on the onset of sudden sensorineural hearing loss (SSNHL). The Korean Health Insurance Review and Assessment Service - National Sample Cohort (HIRA-NSC) from 2002 through 2013 was used. A total of 5,200 participants with SSNHL were matched 1:4 for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia with 20,800 control participants. Meteorological data included daily mean temperature (°C), daily highest temperature (°C), daily lowest temperature (°C), daily temperature difference (°C), relative humidity (%), ambient atmospheric pressure (hPa), pressure, SO2 (ppm), NO2 (ppm), O3 (ppm), CO (ppm), and PM10 (μg/m3) of a mean of 60 days, 30 days, 14 days, 7 days, and 3 days before SSNHL were analyzed. Hourly measurements were taken from 94 places to assess the temperature, humidity, and atmospheric pressure and from 273 places to determine SO2, NO2, O3, CO, and PM10. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of meteorological data for SSNHL were analyzed using unconditional logistic regression analyses. Subgroup analyses were conducted by age and sex. The mean NO2 and O3 concentrations 14 days before the index date were different in the SSNHL group compared to those in the control group (P < 0.001 for NO2 and P = 0.021 for O3). The adjusted 14-day OR for NO2 (0.1 ppm) exposure was 3.12 in the SSNHL group compared to that in the control group (95% CI = 2.16–4.49, P < 0.001). The increased odds of NO2 exposure for 14 days in the SSNHL group persisted in the age group older than 30 years for both sexes. Other meteorological conditions did not show differences between the SSNHL and control groups. SSNHL was associated with high concentrations of NO2.
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Chen C, Wang X, Lv C, Li W, Ma D, Zhang Q, Dong L. The effect of air pollution on hospitalization of individuals with respiratory and cardiovascular diseases in Jinan, China. Medicine (Baltimore) 2019; 98:e15634. [PMID: 31145279 PMCID: PMC6708625 DOI: 10.1097/md.0000000000015634] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To analyze the short-term effects of air pollution on the hospitalization rates of individuals with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), stroke, and myocardial infarction (MI) after adjusting for confounding factors including weather, day of the week, holidays, and long-term trends in Jinan, China.Hospitalization information was extracted based on data from the primary class 3-A hospitals in Jinan from 2013 to 2015. The concentrations of PM2.5, PM10, SO2, NO2, and O3 were obtained from Jinan Environment Monitoring Center. The relative risk and 95% confidence intervals of AECOPD, stroke, and MI were estimated using generalized additive models with quasi-Poisson distribution in the mgcv package, using R software, version 1.0.136.The incremental increased concentrations of particulate pollutants including PM2.5 and PM10 were significantly associated with increased risk of hospitalization of AECOPD, stroke, and MI, and the adverse influences of PM2.5 on these diseases were generally stronger than that of PM10. The incremental increased concentrations of gaseous pollutants including SO2, NO2, and O3 were significantly associated with increased risk of hospitalization of stroke and MI in this population.Air pollution has significant adverse effects on hospitalization rates of individuals with AECOPD, stroke, and MI in Jinan, China.
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Affiliation(s)
- Cai Chen
- Biomedical Engineering Institute, School of Control Science and Engineering, Shandong University, Jinan
| | - Xianfeng Wang
- Department of Ecology and Environment of the People's Republic of Shandong
| | - Chenguang Lv
- Biomedical Engineering Institute, School of Control Science and Engineering, Shandong University, Jinan
| | - Wei Li
- Biomedical Engineering Institute, School of Control Science and Engineering, Shandong University, Jinan
| | - Dedong Ma
- Department of Pulmonary and Critical Care Medicine Qilu Hospital Shandong University
- NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, PR China
| | - Qi Zhang
- Department of Environmental Toxicology, University of California, Davis, CA
| | - Leilei Dong
- Biomedical Engineering Institute, School of Control Science and Engineering, Shandong University, Jinan
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Bazyar J, Pourvakhshoori N, Khankeh H, Farrokhi M, Delshad V, Rajabi E. A comprehensive evaluation of the association between ambient air pollution and adverse health outcomes of major organ systems: a systematic review with a worldwide approach. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:12648-12661. [PMID: 30903465 DOI: 10.1007/s11356-019-04874-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/13/2019] [Indexed: 05/28/2023]
Abstract
Ambient air pollution is nowadays one of the most crucial contributors to deteriorating health status worldwide. The components of air pollution include PM2.5 and PM10, NO2, SO2, CO, O3, and organic compounds. They are attributed to several health outcomes, for instance, cardiovascular diseases (CVD), respiratory diseases, birth outcomes, neurologic diseases, and psychiatric diseases. The objective of this study is to evaluate the association between different ambient air pollutants and the above-mentioned health outcomes. In this systematic review, a total of 76 articles was ultimately selected from 2653 articles, through multiple screening steps by the aid of a set of exclusion criteria as non-English articles, indoor air pollution assessment, work-related, occupational and home-attributed pollution, animal studies, tobacco smoking effects, letters to editors, commentaries, animal experiments, reviews, case reports and case series, out of 19,862 published articles through a systematic search in PubMed, Web of Science, and Scopus. Then, the associations between air pollution and different health outcomes were measured as relative risks and odds ratios. The association between air pollutants, PM2.5 and PM10, NO2, SO2, CO, O3, and VOC with major organ systems health was investigated through the gathered studies. Relative risks and/or odds ratios attributed to each air pollutant/outcome were ultimately reported. In this study, a thorough and comprehensive discussion of all aspects of the contribution of ambient air pollutants in health outcomes was proposed. To our knowledge up to now, there is no such comprehensive outlook on this issue. Growing concerns in concert with air pollution-induced health risks impose a great danger on the life of billions of people worldwide. Should we propose ideas and schemes to reduce ambient air pollutant, there will be dramatic reductions in the prevalence and occurrence of health-threatening conditions.
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Affiliation(s)
- Jafar Bazyar
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Negar Pourvakhshoori
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamidreza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehrdad Farrokhi
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Vahid Delshad
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Elham Rajabi
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Abstract
Supplemental Digital Content is available in the text. Background: Concentrations of outdoor nitrogen dioxide (NO2) have been associated with increased mortality. Hazard ratios (HRs) from cohort studies are used to assess population health impact and burden. We undertook meta-analyses to derive concentration–response functions suitable for such evaluations and assessed their sensitivity to study selection based upon cohort characteristics. Methods: We searched online databases and existing reviews for cohort studies published to October 2016 that reported HRs for NO2 and mortality. We calculated meta-analytic summary estimates using fixed/random-effects models. Results: We identified 48 articles analyzing 28 cohorts. Meta-analysis of HRs found positive associations between NO2 and all cause (1.02 [95% confidence interval (CI): 1.01, 1.03]; prediction interval [PI]: [0.99, 1.06] per 10 µg/m3 increment in NO2), cardiovascular (1.03 [95% CI: 1.02, 1.05]; PI: [0.98, 1.08]), respiratory (1.03 [95% CI: 1.01, 1.05]; PI: [0.97, 1.10]), and lung cancer mortality (1.05 [95% CI: 1.02, 1.08]; PI: [0.94, 1.17]) with evidence of substantial heterogeneity between studies. In subgroup analysis, summary HRs varied by age at cohort entry, spatial resolution of pollution estimates, and adjustment for smoking and body mass index at the individual level; for some subgroups, the HR was close to unity, with lower confidence limits below 1. Conclusions: Given the many uncertainties inherent in the assessment of this evidence base and the sensitivity of health impact calculations to small changes in the magnitude of the HRs, calculation of the impact on health of policies to reduce long-term exposure to NO2 should use prediction intervals and report ranges of impact rather than focusing upon point estimates.
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Hwang SE, Kwon H, Jeong SM, Kim HJ, Park JH. Ambient air pollution exposure and obesity-related traits in Korean adults. Diabetes Metab Syndr Obes 2019; 12:1365-1377. [PMID: 31496774 PMCID: PMC6691946 DOI: 10.2147/dmso.s208115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/23/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Although some studies have tried to determine the impact of long-term air pollution exposure on obesity, they have mainly focused on body mass index (BMI) and the results are inconsistent. Therefore, we investigated the association of annual ambient air pollution exposure with various obesity traits, including computed tomography-measured abdominal fatness, in a large Korean adult population. PATIENTS AND METHODS A total of 5,114 participants who underwent routine health check-ups at Seoul National University Hospital were included in the analysis. We calculated the annual average concentrations of ambient air pollutants, such as particulate matter ≤10 μm in diameter (PM10) and nitrogen dioxide (NO2), using the individual's zip code. Obesity-related indicators included the BMI, waist circumference (WC), percent body fat (PBF), total adipose tissue (TAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). RESULTS The mean age of the population was 53.5 and 70.9% were men. The mean annual concentrations of PM10 and NO2 were 49.4 μg/m3 and 30.3 ppb, respectively. In the full covariates model, adjusted for demographic and clinical variables, interquartile range increase in annual average concentration of PM10 and NO2 was not associated with any obesity-related phenotypes including BMI, WC, PBF, TAT, VAT, and SAT (all P>0.05). Likewise, no significant association between air pollutants and obesity-related traits was observed in any subgroups, stratified by sex and age (all P>0.05). CONCLUSION Annual exposure to ambient air pollution is not associated with any obesity-related traits in Korean adults.
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Affiliation(s)
- Seo Eun Hwang
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Su-Min Jeong
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyun-Jin Kim
- Big Data Center, National Cancer Control Institute, National Cancer Center, Goyang, South Korea
- Correspondence: Hyun-Jin KimBig Data Center, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si Gyeonggi-do10408, South KoreaTel +82 31 920 2914Fax +82 31 920 2189Email
| | - Jin-Ho Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Jin-Ho ParkDepartment of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul03080, South KoreaTel +82 22 072 0865Fax +82 2 766 3276Email
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Guerrina N, Traboulsi H, Eidelman DH, Baglole CJ. The Aryl Hydrocarbon Receptor and the Maintenance of Lung Health. Int J Mol Sci 2018; 19:E3882. [PMID: 30563036 PMCID: PMC6320801 DOI: 10.3390/ijms19123882] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 01/09/2023] Open
Abstract
Much of what is known about the Aryl Hydrocarbon Receptor (AhR) centers on its ability to mediate the deleterious effects of the environmental toxicant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD; dioxin). However, the AhR is both ubiquitously-expressed and evolutionarily-conserved, suggesting that it evolved for purposes beyond strictly mediating responses to man-made environmental toxicants. There is growing evidence that the AhR is required for the maintenance of health, as it is implicated in physiological processes such as xenobiotic metabolism, organ development and immunity. Dysregulation of AhR expression and activity is also associated with a variety of disease states, particularly those at barrier organs such as the skin, gut and lungs. The lungs are particularly vulnerable to inhaled toxicants such as cigarette smoke. However, the role of the AhR in diseases such as chronic obstructive pulmonary disease (COPD)-a respiratory illness caused predominately by cigarette smoking-and lung cancer remains largely unexplored. This review will discuss the growing body of literature that provides evidence that the AhR protects the lungs against the damaging effects of cigarette smoke.
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Affiliation(s)
- Necola Guerrina
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada.
- Department of Pathology, McGill University, Montreal, QC H3A 2B4, Canada.
| | - Hussein Traboulsi
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada.
| | - David H Eidelman
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada.
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada.
| | - Carolyn J Baglole
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada.
- Department of Pathology, McGill University, Montreal, QC H3A 2B4, Canada.
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada.
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC H3G 1Y6, Canada.
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Gandini M, Scarinzi C, Bande S, Berti G, Carnà P, Ciancarella L, Costa G, Demaria M, Ghigo S, Piersanti A, Rowinski M, Spadea T, Stroscia M, Cadum E. Long term effect of air pollution on incident hospital admissions: Results from the Italian Longitudinal Study within LIFE MED HISS project. ENVIRONMENT INTERNATIONAL 2018; 121:1087-1097. [PMID: 30366659 DOI: 10.1016/j.envint.2018.10.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND The LIFE MED HISS project aims at setting up a surveillance system on the long term effects of air pollution on health, using data from National Health Interview Surveys and other currently available sources of information in most European countries. Few studies assessed the long term effect of air pollution on hospital admissions in European cohorts. OBJECTIVE The objective of this paper is to estimate the long term effect of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) on first-ever (incident) cause-specific hospitalizations in Italy. METHODS We used data from the Italian Longitudinal Study (ILS), a cohort study based on the 1999-2000 National Health Interview Survey (NHIS), followed up for hospitalization (2001-2008) at individual level. The survey contains information on crucial potential confounders: occupational/educational/marital status, body mass index (BMI), smoking habit and physical activity. Annual mean exposure to PM2.5 and NO2 was assigned starting from simulated gridded data at spatial resolution of 4 × 4 km2 firstly integrated with data from monitoring stations and then up-scaled at municipality level. Statistical analyses were conducted using Cox proportional hazard models with robust variance estimator. RESULTS For each cause of hospitalization we estimated the hazard ratios (HRs) adjusted for confounders with 95% Confidence Interval (CI) related to a 10 μg/m3 increase in pollutants. For PM2.5 and NO2, respectively, we found positive associations for circulatory system diseases [1.05(1.03-1.06); 1.05(1.03-1.07)], myocardial infarction [1.15(1.12-1.18); 1.15(1.12-1.18)], lung cancer [1.18(1.10-1.26); 1.20(1.12-1.28)], kidney cancer [1.24(1.11-1.29); 1.20(1.07-1.33)], all cancers (but lung) [1.06(1.04-1.08); 1.06(1.04-1.08)] and Low Respiratory Tract Infections (LRTI) [1.07 (1.04-1.11); 1.05 (1.02-1.08)]. DISCUSSION Our results add new evidence on the effects of air pollution on first-ever (incident) hospitalizations, both in urban and rural areas. We demonstrated the feasibility of a low-cost monitoring system based on available data.
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Affiliation(s)
- M Gandini
- University of Torino, Department of Clinical and Biological Science, AOU San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy; Environmental Epidemiological Unit, Regional Environmental Protection Agency, Piedmont Region, Via Pio VII 9, 10135 Turin, Italy.
| | - C Scarinzi
- Environmental Epidemiological Unit, Regional Environmental Protection Agency, Piedmont Region, Via Pio VII 9, 10135 Turin, Italy
| | - S Bande
- Air quality Unit, Regional Environmental Protection Agency, Piedmont, Via Pio VII 9, 10135 Turin, Italy
| | - G Berti
- Environmental Epidemiological Unit, Regional Environmental Protection Agency, Piedmont Region, Via Pio VII 9, 10135 Turin, Italy
| | - P Carnà
- Regional Epidemiology Unit, ASL TO3, Piedmont Region, Via Sabaudia 164, 10095 Grugliasco, Italy
| | - L Ciancarella
- Laboratory of Atmospheric Pollution, ENEA-Bologna Research Center, Via Martiri di Monte Sole 4, 40129 Bologna, Italy
| | - G Costa
- University of Torino, Department of Clinical and Biological Science, AOU San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy; Regional Epidemiology Unit, ASL TO3, Piedmont Region, Via Sabaudia 164, 10095 Grugliasco, Italy
| | - M Demaria
- Environmental Epidemiological Unit, Regional Environmental Protection Agency, Piedmont Region, Via Pio VII 9, 10135 Turin, Italy
| | - S Ghigo
- Air quality Unit, Regional Environmental Protection Agency, Piedmont, Via Pio VII 9, 10135 Turin, Italy
| | - A Piersanti
- Laboratory of Atmospheric Pollution, ENEA-Bologna Research Center, Via Martiri di Monte Sole 4, 40129 Bologna, Italy
| | - M Rowinski
- Environmental Epidemiological Unit, Regional Environmental Protection Agency, Piedmont Region, Via Pio VII 9, 10135 Turin, Italy
| | - T Spadea
- Regional Epidemiology Unit, ASL TO3, Piedmont Region, Via Sabaudia 164, 10095 Grugliasco, Italy
| | - M Stroscia
- Hygiene and Public Health Unit, Turin Local Health Agency, Via della Consolata 10, 10122 Turin, Italy
| | - E Cadum
- Environmental Epidemiological Unit, Regional Environmental Protection Agency, Piedmont Region, Via Pio VII 9, 10135 Turin, Italy
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Brønnum-Hansen H, Bender AM, Andersen ZJ, Sørensen J, Bønløkke JH, Boshuizen H, Becker T, Diderichsen F, Loft S. Assessment of impact of traffic-related air pollution on morbidity and mortality in Copenhagen Municipality and the health gain of reduced exposure. ENVIRONMENT INTERNATIONAL 2018; 121:973-980. [PMID: 30408890 DOI: 10.1016/j.envint.2018.09.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 05/10/2023]
Abstract
BACKGROUND Health impact assessment (HIA) of exposure to air pollution is commonly based on city level (fine) particle concentration and may underestimate health consequences of changing local traffic. Exposure to traffic-related air pollution can be assessed at a high resolution by modelling levels of nitrogen dioxide (NO2), which together with ultrafine particles mainly originate from diesel-powered vehicles in urban areas. The purpose of this study was to estimate the health benefits of reduced exposure to vehicle emissions assessed as NO2 at the residence among the citizens of Copenhagen Municipality, Denmark. METHODS We utilized residential NO2 concentrations modelled by use of chemistry transport models to calculate contributions from emission sources to air pollution. The DYNAMO-HIA model was applied to the population of Copenhagen Municipality by using NO2 concentration estimates combined with demographic data and data from nationwide registers on incidence and prevalence of selected diseases, cause specific mortality, and total mortality of the population of Copenhagen. We used exposure-response functions linking NO2 concentration estimates at the residential address with the risk of diabetes, cardiovascular diseases, and respiratory diseases derived from a large Danish cohort study with the majority of subjects residing in Copenhagen between 1971 and 2010. Different scenarios were modelled to estimate the dynamic impact of NO2 exposure on related diseases and the potential health benefits of lowering the NO2 level in the Copenhagen Municipality. RESULTS The annual mean NO2 concentration was 19.6 μg/m3 and for 70% of the population the range of exposure was between 15 and 21 μg/m3. If NO2 exposure was reduced to the annual mean rural level of 6 μg/m3, life expectancy in 2040 would increase by one year. The greatest gain in disease-free life expectancy would be lifetime without ischemic heart disease (1.4 years), chronic obstructive pulmonary disease (1.5 years for men and 1.6 years for women), and asthma (1.3 years for men and 1.5 years for women). Lowering NO2 exposure by 20% would increase disease-free life expectancy for the different diseases by 0.3-0.5 years. Using gender specific relative risks affected the results. CONCLUSIONS Reducing the NO2 exposure by controlling traffic-related air pollution reduces the occurrence of some of the most prevalent chronic diseases and increases life expectancy. Such health benefits can be quantified by DYNAMO-HIA in a high resolution exposure modelling. This paper demonstrates how traffic planners can assess health benefits from reduced levels of traffic-related air pollution.
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Affiliation(s)
- Henrik Brønnum-Hansen
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Anne Mette Bender
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Zorana Jovanovic Andersen
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Centre for Epidemiological Research, Nykøbing F Hospital, Nykøbing F, Denmark
| | - Jan Sørensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jakob Hjort Bønløkke
- Department of Occupational and Environmental Diseases, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Hendriek Boshuizen
- Department Statistics, Informatics and Mathematical Modelling, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Biometrics, Wageningen University, Wageningen, the Netherlands
| | - Thomas Becker
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Finn Diderichsen
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Loft
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Ersbøll AK, Monrad M, Sørensen M, Baastrup R, Hansen B, Bach FW, Tjønneland A, Overvad K, Raaschou-Nielsen O. Low-level exposure to arsenic in drinking water and incidence rate of stroke: A cohort study in Denmark. ENVIRONMENT INTERNATIONAL 2018; 120:72-80. [PMID: 30071456 DOI: 10.1016/j.envint.2018.07.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/22/2018] [Accepted: 07/26/2018] [Indexed: 05/12/2023]
Abstract
INTRODUCTION High arsenic concentration in drinking water is associated with a higher incidence rate of stroke, but only few studies have investigated an association with arsenic in drinking water at low concentration (<50 μg/L). OBJECTIVE To examine if arsenic in drinking water at low concentration was associated with higher incidence rate of stroke in Denmark. METHODS A total of 57,053 individuals from the Danish Diet, Cancer, and Health cohort was included in the study (enrolment in 1993-1997, age 50-64 years), of which 2195 individuals had incident stroke between enrolment and November 2009. Individuals were enrolled in two major cities (Copenhagen and Aarhus). Residential addresses in the period 1973-2009 were geocoded and arsenic concentration in drinking water at each address was estimated by linking addresses with water supply areas. Associations between arsenic concentration and incidence rate of stroke were analysed using a generalized linear model with a Poisson distribution. Incidence rate ratios (IRR) were adjusted for differences in age, sex, calendar-year, lifestyle factors, and educational level. RESULTS Median arsenic concentration in drinking water was 0.7 μg/L at enrolment addresses (range: 0.03 to 25 μg/L), with highest concentrations in the Aarhus area. The adjusted IRRs were 1.17 (95% CI: 1.04-1.32) for the highest arsenic quartile (1.93-25.3 μg/L) when compared with the lowest quartile (0.049-0.57 μg/L), but the highest IRR was seen in the second quartile (0.57-0.76 μg/L) (IRR = 1.21; 95% CI: 1.07-1.36). The highest IRR in the upper quartile was seen in the Aarhus area (IRR = 1.79; 95% CI: 1.41-2.26). Having ever been exposed to10 μg/L or more arsenic in drinking water resulted in an IRR at 1.44 (95% CI: 1.00-2.08) for all strokes and 1.63 (95% CI: 1.11-2.39) for ischemic strokes. CONCLUSION The results indicate that arsenic in drinking water even at low concentration is associated with higher incidence rate of stroke.
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Affiliation(s)
- Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
| | - Maria Monrad
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mette Sørensen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Rikke Baastrup
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Birgitte Hansen
- Danish Ministry for Energy, Utilities and Climate, Geological Survey of Denmark and Greenland, GEUS Department of Groundwater and Quaternary Geology Mapping C.F. Aarhus, Denmark
| | | | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ole Raaschou-Nielsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
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Zhang R, Liu G, Jiang Y, Li G, Pan Y, Wang Y, Wei Z, Wang J, Wang Y. Acute Effects of Particulate Air Pollution on Ischemic Stroke and Hemorrhagic Stroke Mortality. Front Neurol 2018; 9:827. [PMID: 30333790 PMCID: PMC6176083 DOI: 10.3389/fneur.2018.00827] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/13/2018] [Indexed: 12/29/2022] Open
Abstract
Background and Purpose: A large body of literature reported the association of particulate matter (PM) with stroke in high-income countries. Few studies have examined the association between PM and stroke in middle- and low-income countries and considered the types of stroke. In this study, we examined the short-term effects of particulate matter <2.5 μm in diameter (PM2.5) and particulate matter <10 μm in diameter (PM10) on ischemic stroke mortality and hemorrhagic stroke mortality in Beijing, China. Methods: We used an ecological study design and quasi-Poisson generalized additive models to evaluate the association of PM2.5 and PM10 and cerebrovascular diseases mortality, as well as ischemic- and hemorrhagic stroke mortality. In the model, we controlled long-term and season trends, temperature, and relative humidity, the day of the week and air pollution. For cerebrovascular diseases mortality, we examined the effects stratified by sex and age with different lag days. Results: A total of 48,122 deaths for cerebrovascular disease (32,799 deaths for ischemic stroke and 13,051 deaths for hemorrhagic stroke) were included in the study. PM2.5 was associated with stroke mortality. The 10 μg/m3 increase of PM2.5 was associated with the increase of mortality, 0.27% (95% CI, 0.12–0.43%) for cerebrovascular diseases, 0.23% (95% CI, 0.04–0.42%) for ischemic stroke and 0.37% (95% CI, 0.07–0.67%) for hemorrhagic stroke -. The associations between PM10 and mortality were also detected for cerebrovascular diseases and ischemic stroke, but not in hemorrhagic stroke. The stratified analysis suggested age and gender did not modify the effects of PM on mortality significantly. Conclusions: Our study suggested that short-term exposure to ambient PM was associated with the risk of stroke mortality.
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Affiliation(s)
- Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Gang Li
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zaihua Wei
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Jing Wang
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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Dong H, Yu Y, Yao S, Lu Y, Chen Z, Li G, Yao Y, Yao X, Wang SL, Zhang Z. Acute effects of air pollution on ischaemic stroke onset and deaths: a time-series study in Changzhou, China. BMJ Open 2018; 8:e020425. [PMID: 30037864 PMCID: PMC6059268 DOI: 10.1136/bmjopen-2017-020425] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 05/10/2018] [Accepted: 06/05/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To investigate the acute effect of air pollutants on ischaemic stroke (IS) and IS-related death. SETTING Five urban districts in Changzhou, China, between 9 January 2015 and 31 December 2016. PARTICIPANTS A total of 32 840 IS cases and 4028 IS deaths were enrolled. MAIN OUTCOME MEASURES A time-series design, generalised additive model and multivariable regression model were used to examine the percentage change (95% CI) in daily IS counts and deaths with an IQR increase in air pollutant levels for different single or multiple lag days in single-pollutant and two-pollutant models. RESULTS Daily IS counts increased 0.208% (95% CI 0.036% to 0.381%) with an IQR increment in the levels of nitrogen dioxide (NO2). The estimated risk of NO2 was more robust in males and in the cold season. For daily IS counts, the estimated effects of NO2 and sulfur dioxide (SO2) were more significant when adjusted for particulate matter with aerodynamic diameters <2.5 µm (PM2.5) and PM10. An IQR increment in the concentration of PM10, SO2 and NO2 significantly increased IS deaths with 6 days of cumulative effects (0.268%, 95% CI 0.007% to 1.528%; 0.34%, 0.088% to 0.592%; and 0.263%, 0.004% to 0.522%, respectively). Young individuals (<65 years old) had a higher IS mortality risk for PM2.5, PM10, NO2 and CO. For IS death, the effect estimates of SO2 in the elderly, females and the cold season were more pronounced; statistical significance was also identified for SO2 when adjusted for carbon monoxide (CO). CONCLUSIONS This study suggested that short-term exposure to ambient NO2 was associated with increased IS risk. In addition, SO2 was associated with increased IS onset and death.
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Affiliation(s)
- Huibin Dong
- Department of Chronic Disease Control and Prevention, Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Yongquan Yu
- Department of Occupational Medicine and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Shen Yao
- Department of Occupational Medicine and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yan Lu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhiyong Chen
- Department of Chronic Disease Control and Prevention, Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Guiying Li
- Department of Chronic Disease Control and Prevention, Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Yao Yao
- Department of Chronic Disease Control and Prevention, Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Xingjuan Yao
- Department of Chronic Disease Control and Prevention, Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Shou-Lin Wang
- Department of Occupational Medicine and Environmental Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhan Zhang
- Department of Hygiene Analysis and Detection, School of Public Health, Nanjing Medical University, Nanjing, China
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Evaluation of the Danish AirGIS air pollution modeling system against measured concentrations of PM2.5, PM10, and black carbon. Environ Epidemiol 2018. [DOI: 10.1097/ee9.0000000000000014] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Alexeeff SE, Roy A, Shan J, Liu X, Messier K, Apte JS, Portier C, Sidney S, Van Den Eeden SK. High-resolution mapping of traffic related air pollution with Google street view cars and incidence of cardiovascular events within neighborhoods in Oakland, CA. Environ Health 2018; 17:38. [PMID: 29759065 PMCID: PMC5952592 DOI: 10.1186/s12940-018-0382-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/29/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Some studies have linked long-term exposure to traffic related air pollutants (TRAP) with adverse cardiovascular health outcomes; however, previous studies have not linked highly variable concentrations of TRAP measured at street-level within neighborhoods to cardiovascular health outcomes. METHODS Long-term pollutant concentrations for nitrogen dioxide [NO2], nitric oxide [NO], and black carbon [BC] were obtained by street-level mobile monitoring on 30 m road segments and linked to residential addresses of 41,869 adults living in Oakland during 2010 to 2015. We fit Cox proportional hazard models to estimate the relationship between air pollution exposures and time to first cardiovascular event. Secondary analyses examined effect modification by diabetes and age. RESULTS Long-term pollutant concentrations [mean, (standard deviation; SD)] for NO2, NO and BC were 9.9 ppb (SD 3.8), 4.9 ppb (SD 3.8), and 0.36 μg/m3 (0.17) respectively. A one SD increase in NO2, NO and BC, was associated with a change in risk of a cardiovascular event of 3% (95% confidence interval [CI] -6% to 12%), 3% (95% CI -5% to 12%), and - 1% (95% CI -8% to 7%), respectively. Among the elderly (≥65 yrs), we found an increased risk of a cardiovascular event of 12% for NO2 (95% CI: 2%, 24%), 12% for NO (95% CI: 3%, 22%), and 7% for BC (95% CI: -3%, 17%) per one SD increase. We found no effect modification by diabetes. CONCLUSIONS Street-level differences in long-term exposure to TRAP were associated with higher risk of cardiovascular events among the elderly, indicating that within-neighborhood differences in TRAP are important to cardiovascular health. Associations among the general population were consistent with results found in previous studies, though not statistically significant.
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Affiliation(s)
- Stacey E. Alexeeff
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
| | - Ananya Roy
- Environmental Defense Fund, New York, NY USA
| | - Jun Shan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
| | - Xi Liu
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
| | - Kyle Messier
- Environmental Defense Fund, New York, NY USA
- Dept. of Civil, Architectural and Environmental Engineering, University of Texas at Austin, Austin, TX USA
| | - Joshua S. Apte
- Dept. of Civil, Architectural and Environmental Engineering, University of Texas at Austin, Austin, TX USA
| | | | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
| | - Stephen K. Van Den Eeden
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
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Does the Short-Term Effect of Air Pollution Influence the Incidence of Spontaneous Intracerebral Hemorrhage in Different Patient Groups? Big Data Analysis in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121547. [PMID: 29232865 PMCID: PMC5750965 DOI: 10.3390/ijerph14121547] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 01/18/2023]
Abstract
Spontaneous intracerebral hemorrhage (sICH) has a high mortality rate. Research has demonstrated that the occurrence of sICH is related to air pollution. This study used big data analysis to explore the impact of air pollution on the risk of sICH in patients of differing age and geographic location. 39,053 cases were included in this study; 14,041 in the Taipei region (Taipei City and New Taipei City), 5537 in Taoyuan City, 7654 in Taichung City, 4739 in Tainan City, and 7082 in Kaohsiung City. The results of correlation analysis indicated that there were two pollutants groups, the CO and NO2 group and the PM2.5 and PM10 group. Furthermore, variations in the correlations of sICH with air pollutants were identified in different age groups. The co-factors of the influence of air pollutants in the different age groups were explored using regression analysis. This study integrated Taiwan National Health Insurance data and air pollution data to explore the risk factors of sICH using big data analytics. We found that PM2.5 and PM10 are very important risk factors for sICH, and age is an important modulating factor that allows air pollutants to influence the incidence of sICH.
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Babadjouni RM, Hodis DM, Radwanski R, Durazo R, Patel A, Liu Q, Mack WJ. Clinical effects of air pollution on the central nervous system; a review. J Clin Neurosci 2017; 43:16-24. [PMID: 28528896 PMCID: PMC5544553 DOI: 10.1016/j.jocn.2017.04.028] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/22/2017] [Indexed: 12/20/2022]
Abstract
The purpose of this review is to describe recent clinical and epidemiological studies examining the adverse effects of urban air pollution on the central nervous system (CNS). Air pollution and particulate matter (PM) are associated with neuroinflammation and reactive oxygen species (ROS). These processes affect multiple CNS pathways. The conceptual framework of this review focuses on adverse effects of air pollution with respect to neurocognition, white matter disease, stroke, and carotid artery disease. Both children and older individuals exposed to air pollution exhibit signs of cognitive dysfunction. However, evidence on middle-aged cohorts is lacking. White matter injury secondary to air pollution exposure is a putative mechanism for neurocognitive decline. Air pollution is associated with exacerbations of neurodegenerative conditions such as Alzheimer's and Parkinson's diseases. Increases in stroke incidences and mortalities are seen in the setting of air pollution exposure and CNS pathology is robust. Large populations living in highly polluted environments are at risk. This review aims to outline current knowledge of air pollution exposure effects on neurological health.
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Affiliation(s)
- Robin M Babadjouni
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Drew M Hodis
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ryan Radwanski
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ramon Durazo
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Arati Patel
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Qinghai Liu
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - William J Mack
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
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Chen CY, Hung HJ, Chang KH, Hsu CY, Muo CH, Tsai CH, Wu TN. Long-term exposure to air pollution and the incidence of Parkinson's disease: A nested case-control study. PLoS One 2017; 12:e0182834. [PMID: 28809934 PMCID: PMC5557354 DOI: 10.1371/journal.pone.0182834] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 07/25/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previous studies revealed that chronic exposure to air pollution can significantly increase the risk of the development of Parkinson's disease (PD), but this relationship is inconclusive as large-scale prospective studies are limited and the results are inconsistent. Therefore, the purpose of this study was to ascertain the adverse health effects of air pollution exposure in a nationwide population using a longitudinal approach. MATERIALS AND METHODS We conducted a nested case-control study using the National Health Insurance Research Dataset (NHIRD), which consisted of 1,000,000 beneficiaries in the National Health Insurance Program (NHI) in the year 2000 and their medical records from 1995 to 2013 and using public data on air pollution concentrations from monitoring stations across Taiwan released from the Environmental Protection Administration to identify people with ages ≥ 40 years living in areas with monitoring stations during 1995-1999 as study subjects. Then, we excluded subjects with PD, dementia, stroke and diabetes diagnosed before Jan. 1, 2000 and obtained 54,524 subjects to follow until Dec. 31, 2013. In this observational period, 1060 newly diagnosed PD cases were identified. 4240 controls were randomly selected from those without PD using a matching strategy for age, sex, the year of PD diagnosis and the year of entering the NHI program at a ratio of 1:4. Ten elements of air pollution were examined, and multiple logistic regression models were used to measure their risks in subsequent PD development. RESULTS The incidence of PD in adults aged ≥ 40 years was 1.9%, and the median duration for disease onset was 8.45 years. None of the chemical compounds (SO2, O3, CO, NOx, NO, NO2, THC, CH4, or NMHC) significantly affected the incidence of PD except for particulate matter. PM10 exposure showed significant effects on the likelihood of PD development (T3 level: > 65μg/m3 versus T1 level: ≤ 54μg/m3; OR = 1.35, 95% CI = 1.12-1.62, 0.001 ≤ P < 0.01). In addition, comorbid conditions such as dementia (ORs = 3.53-3.93, Ps < 0.001), stroke (ORs = 2.99-3.01, Ps < 0.001), depression (ORs = 2.51-2.64, Ps < 0.001), head injury (ORs = 1.24-1.29, 0.001 ≤ Ps < 0.01 or 0.01 ≤ Ps < 0.05), sleep disorder (OR = 1.23-1.26, 0.001 ≤ Ps < 0.01), and hypertension (ORs = 1.18-1.19, 0.01 ≤ Ps < 0.05) also significantly increased the risk for PD development. CONCLUSIONS Although PM10 plays a significant role in PD development, the associated chemical/metal compounds that are capable of inducing adverse biological mechanisms still warrant further exploration. Because of a link between comorbid conditions and PM exposure, research on the causal relationship between long-term exposure to PM and the development of PD should be considered with caution because other possible modifiers or mediators, comorbid diseases in particular, may be involved.
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Affiliation(s)
- Chiu-Ying Chen
- Department of Public Health, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hui-Jung Hung
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Kuang-Hsi Chang
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chon-Haw Tsai
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Trong-Neng Wu
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
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Qiu H, Sun S, Tsang H, Wong CM, Lee RSY, Schooling CM, Tian L. Fine particulate matter exposure and incidence of stroke. Neurology 2017; 88:1709-1717. [DOI: 10.1212/wnl.0000000000003903] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 02/07/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:We aimed to assess the association of long-term residential exposure to fine particulate matter (PM) with aerodynamic diameter less than 2.5 μm (PM2.5) with the incidence of stroke and its major subtypes.Methods:We ascertained the first occurrence of emergency hospital admission for stroke in a Hong Kong Chinese cohort of 66,820 older people (65+ years) who enrolled during 1998–2001 (baseline) and were followed up to December 31, 2010. High-resolution (1 × 1 km) yearly mean concentrations of PM2.5 were predicted from local monitoring data and US National Aeronautics and Space Administration satellite data using linear regression. Baseline residential PM2.5 exposure was used as a proxy for long-term exposure. We used Cox proportional hazards to evaluate the risk of incident stroke associated with PM2.5 exposure adjusted for potential confounders, including individual and neighborhood factors.Results:Over a mean follow-up of 9.4 years, we ascertained 6,733 cases of incident stroke, of which 3,526 (52.4%) were ischemic and 1,175 (17.5%) were hemorrhagic. The hazard ratio for every 10 μg/m3 higher PM2.5 concentration was statistically significant at 1.21 (95% confidence interval [CI] 1.04–1.41) for ischemic and non-statistically significant at 0.90 (95% CI 0.70–1.17) for hemorrhagic stroke in fully adjusted model 3. The estimates for ischemic stroke were higher in older participants (>70 years), less educated participants, and in men for current smokers.Conclusion:Long-term PM2.5 exposure was associated with higher risk of incident ischemic stroke, but the association with incident hemorrhagic stroke was less clear.
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