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Sun X, Liu X, Wang X, Pang C, Yin Z, Zang S. Association between residential proximity to major roadways and chronic multimorbidity among Chinese older adults: a nationwide cross-sectional study. BMC Geriatr 2024; 24:111. [PMID: 38287240 PMCID: PMC10826232 DOI: 10.1186/s12877-024-04712-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Multiple negative health outcomes were linked to residential proximity to major roadways. Nevertheless, there is limited knowledge regarding the association between residential proximity to major roadways and chronic multimorbidity. METHODS We used data from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey, which included 12,214 individuals aged ≥ 60. We derived the residential proximity to major roadways from self-reported data, defining chronic multimorbidity as the presence of two or more concurrent chronic diseases. A binary logistic regression model was utilized to investigate the association between residential proximity to major roadways and chronic multimorbidity. The model accounted for some demographic features, socioeconomic conditions, social participation, and health conditions. Subsequently, we conducted subgroup analyses to examine potential interaction effects. RESULTS Residential proximity to major roadways was associated with chronic multimorbidity, even after adjusting for confounding factors. Compared with those living > 300 m from major roadways, the OR for those living 201-300 m, 101-200 m, 50-100 m, and < 50 m were increased. When subgroup analyses were conducted using a cutoff point of 200 m, the risk of chronic multimorbidity associated with residential proximity to major roadways was stronger in participants with education levels > 6 years (P = 0.017). CONCLUSION Our findings provide important implications for improving residential area siting, transportation policies, and environmental regulations to reduce the risk of chronic multimorbidity caused by traffic-related exposure.
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Affiliation(s)
- Xuange Sun
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning Province, China
| | - Xu Liu
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning Province, China
| | - Xue Wang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning Province, China
| | - Chang Pang
- Department of General Practice, The Second Affiliated Hospital of Shenyang Medical College, No.20 Bei Jiu Road, Heping District, 110002, Shenyang, Liaoning Province, China
| | - Zhihua Yin
- Department of epidemiology, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning Province, China
| | - Shuang Zang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, 110122, Shenyang, Liaoning Province, China.
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Chen X, Wang J, Zhang X, Xiao G, Luo S, Liu L, Kong W, Zhang X, Yan LL, Zhang S. Residential proximity to major roadways and hearing impairment in Chinese older adults: a population-based study. BMC Public Health 2023; 23:2462. [PMID: 38066478 PMCID: PMC10709848 DOI: 10.1186/s12889-023-17433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND With rapid urban sprawl, growing people are living in the vicinity of major roadways. However, little is known about the relationship between residential proximity to major roadways and hearing impairment (HI). METHODS We derived data from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey, and included 13,775 participants aged 65 years or older. Multivariate logistic regressions were employed to examine the association between residential proximity to major roadways and HI. The effects of corresponding potentially modifiable factors were studied by three-way interaction analyses. Sensitivity analyses were performed to verify the robustness of the results. RESULTS The prevalence of HI was 38.3%. Participants living near major roadways were more likely to have a higher socioeconomic status. An exposure-response relation between residential proximity to major roadways and HI was observed (Ptrend < 0.05). Compared with individuals living > 300 m away from major roadways, the adjusted odds ratios (OR) were 1.07 (95% CI: 0.96-1.24), 1.15 (95% CI: 1.07-1.34), and 1.12 (95% CI: 1.01-1.31) for those living 101-200 m, 50-100 m, and < 50 m away from the roadways, respectively. Particularly, the association was more pronounced among individuals exposed to carbon monoxide (CO) pollution or opening windows frequently (Pinteraction < 0.05). Three-way interaction analyses confirmed that participants exposed to CO pollution and frequently leaving windows open had the highest OR of 1.73 (95% CI: 1.58-1.89). CONCLUSIONS This nation-wide cohort study suggested that residential proximity to major roadways was significantly associated with an increased exposure-response risk of HI in Chinese older adults. Exposure to CO pollution and opening windows frequently might strengthen the relations.
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Affiliation(s)
- Xingxing Chen
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xian Zhang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Gui Xiao
- Xiangya School of Nursing, Central South University, Changsha, China
- Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Siran Luo
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Lei Liu
- The First People's Hospital of Kunshan, Suzhou, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaomin Zhang
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Lijing L Yan
- School of Public Health, Wuhan University, Wuhan, China.
- Global Health Research Center, Duke Kunshan University, Kunshan, China.
- Duke Global Health Institute, Duke University, Durham, United States of America.
- Institute for Global Health and Management, Peking University, Beijing, China.
| | - Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Mallah MA, Soomro T, Ali M, Noreen S, Khatoon N, Kafle A, Feng F, Wang W, Naveed M, Zhang Q. Cigarette smoking and air pollution exposure and their effects on cardiovascular diseases. Front Public Health 2023; 11:967047. [PMID: 38045957 PMCID: PMC10691265 DOI: 10.3389/fpubh.2023.967047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/26/2023] [Indexed: 12/05/2023] Open
Abstract
Cardiovascular disease (CVD) has no socioeconomic, topographical, or sex limitations as reported by the World Health Organization (WHO). The significant drivers of CVD are cardio-metabolic, behavioral, environmental, and social risk factors. However, some significant risk factors for CVD (e.g., a pitiable diet, tobacco smoking, and a lack of physical activities), have also been linked to an elevated risk of cardiovascular disease. Lifestyles and environmental factors are known key variables in cardiovascular disease. The familiarity with smoke goes along with the contact with the environment: air pollution is considered a source of toxins that contribute to the CVD burden. The incidence of myocardial infarction increases in males and females and may lead to fatal coronary artery disease, as confirmed by epidemiological studies. Lipid modification, inflammation, and vasomotor dysfunction are integral components of atherosclerosis development and advancement. These aspects are essential for the identification of atherosclerosis in clinical investigations. This article aims to show the findings on the influence of CVD on the health of individuals and human populations, as well as possible pathology and their involvement in smoking-related cardiovascular diseases. This review also explains lifestyle and environmental factors that are known to contribute to CVD, with indications suggesting an affiliation between cigarette smoking, air pollution, and CVD.
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Affiliation(s)
| | - Tahmina Soomro
- Department of Sociology, Shah Abdul Latif University, Khairpur, Pakistan
| | - Mukhtiar Ali
- Department of Chemical Engineering, Quaid-e-Awam University of Engineering, Science and Technology, Nawabshah, Sindh, Pakistan
| | - Sobia Noreen
- Department of Pharmaceutics Technology, Institute of Pharmacy, University of Innsbruck, Insbruck, Austria
| | - Nafeesa Khatoon
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Akriti Kafle
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Feifei Feng
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Wei Wang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Muhammad Naveed
- Department of Physiology and Pharmacology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
| | - Qiao Zhang
- College of Public Health, Zhengzhou University, Zhengzhou, China
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Junck L, Malow BA. Climate Change and Air Pollution: Neurologists Should Educate Themselves and Get Involved. Neurology 2023; 100:454-455. [PMID: 36564208 DOI: 10.1212/wnl.0000000000206754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Larry Junck
- From the Department of Neurology (L.J.), University of Michigan, Ann Arbor; Department of Neurology (B.A.M.), Vanderbilt University Medical Center, Nashville, TN.
| | - Beth A Malow
- From the Department of Neurology (L.J.), University of Michigan, Ann Arbor; Department of Neurology (B.A.M.), Vanderbilt University Medical Center, Nashville, TN
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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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Sweeney C, Lazennec G, Vogel CFA. Environmental exposure and the role of AhR in the tumor microenvironment of breast cancer. Front Pharmacol 2022; 13:1095289. [PMID: 36588678 PMCID: PMC9797527 DOI: 10.3389/fphar.2022.1095289] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Activation of the aryl hydrocarbon receptor (AhR) through environmental exposure to chemicals including polycyclic aromatic hydrocarbons (PAHs) and polychlorinated dibenzo-p-dioxins (PCDDs) can lead to severe adverse health effects and increase the risk of breast cancer. This review considers several mechanisms which link the tumor promoting effects of environmental pollutants with the AhR signaling pathway, contributing to the development and progression of breast cancer. We explore AhR's function in shaping the tumor microenvironment, modifying immune tolerance, and regulating cancer stemness, driving breast cancer chemoresistance and metastasis. The complexity of AhR, with evidence for both oncogenic and tumor suppressor roles is discussed. We propose that AhR functions as a "molecular bridge", linking disproportionate toxin exposure and policies which underlie environmental injustice with tumor cell behaviors which drive poor patient outcomes.
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Affiliation(s)
- Colleen Sweeney
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA, United States
| | - Gwendal Lazennec
- Centre National de la Recherche Scientifique, SYS2DIAG-ALCEN, Cap Delta, Montpellier, France
| | - Christoph F. A. Vogel
- Center for Health and the Environment, University of California Davis, Davis, CA, United States
- Department of Environmental Toxicology, University of California Davis, Davis, CA, United States
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7
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Li L, Zhu Y, Han B, Chen R, Man X, Sun X, Kan H, Lei Y. Acute exposure to air pollutants increase the risk of acute glaucoma. BMC Public Health 2022; 22:1782. [PMID: 36127653 PMCID: PMC9487138 DOI: 10.1186/s12889-022-14078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Ambient air pollution is related to the onset and progression of ocular disease. However, the effect of air pollutants on the acute glaucoma remains unclear. Objective To investigate the effect of air pollutants on the incidence of acute glaucoma (acute angle closure glaucoma and glaucomatocyclitic crisis) among adults. Methods We conducted a time-stratified case-crossover study based on the data of glaucoma outpatients from January, 2015 to Dec, 2021 in Shanghai, China. A conditional logistic regression model combined with a polynomial distributed lag model was applied for the statistical analysis. Each case serves as its own referent by comparing exposures on the day of the outpatient visit to the exposures on the other 3–4 control days on the same week, month and year. To fully capture the delayed effect of air pollution, we used a maximum lag of 7 days in main model. Results A total of 14,385 acute glaucoma outpatients were included in this study. We found exposure to PM2.5, PM10, nitrogen dioxide (NO2) and carbon monoxide (CO) significantly increased the odds of outpatient visit for acute glaucoma. Wherein the odds of acute glaucoma related to PM2.5 and NO2 were higher and more sustained, with OR of 1.07 (95%CI: 1.03–1.11) and 1.12 (95% CI: 1.08–1.17) for an IQR increase over lag 0–3 days, than PM10 and CO over lag 0–1 days (OR:1.03; 95% CI: 1.01–1.05; OR: 1.04; 95% CI: 1.01–1.07). Conclusions This case-crossover study provided first-hand evidence that air pollutants, especially PM2.5 and NO2, significantly increased risk of acute glaucoma. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14078-9.
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Affiliation(s)
- Liping Li
- Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, China
| | - Yixiang Zhu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, P.O. Box 249, 130 Dong-An Road, Shanghai, 200032, China
| | - Binze Han
- Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, P.O. Box 249, 130 Dong-An Road, Shanghai, 200032, China.,Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai, 200030, China
| | - Xiaofei Man
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, China.
| | - Xinghuai Sun
- Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, China. .,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, P.O. Box 249, 130 Dong-An Road, Shanghai, 200032, China. .,Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, China.
| | - Yuan Lei
- Department of Ophthalmology & Visual Science, Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, China.
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Joshi SS, Miller MR, Newby DE. Air pollution and cardiovascular disease: the Paul Wood Lecture, British Cardiovascular Society 2021. Heart 2022; 108:1267-1273. [PMID: 35074847 DOI: 10.1136/heartjnl-2021-319844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022] Open
Abstract
Air pollution is associated with up to 8.8 million excess deaths worldwide each year and is a major contributor to the global burden of disease. Cardiovascular conditions are the predominant cause for air pollution-related deaths and there is an urgent need to address the silent pandemic of air pollution on cardiovascular health. Air pollution exposure is associated with acute events like acute coronary syndrome and stroke, and with chronic conditions, such as atherosclerosis and heart failure. Several potential mechanisms have been proposed that link particle inhalation to cardiovascular disease including oxidative stress and inflammation, changes in autonomic balance and neuroendocrine regulation and the particle translocation into the circulation itself. This, in turn, can cause endothelial, vasomotor and fibrinolytic dysfunction and increased thrombogenicity and blood pressure which are implicated in the mediation of adverse cardiovascular events. Certain interventions can help mitigate these adverse effects. At an individual level, this includes the use of a facemask and indoor air purification systems. At an environmental level, interventions reducing the generation or release of combustion-derived pollutants are key and include public health policies to facilitate active transport, cleaner sources of energy and reductions in vehicular and fossil fuel emissions. In this review, we summarise the key pathways and mechanisms that draw together how air pollution can lead to adverse cardiovascular effects, as well as explore potential interventions to reduce the burden of air pollution-induced cardiovascular morbidity and mortality.
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Affiliation(s)
- Shruti S Joshi
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Mark R Miller
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
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Yadav RS, Chaudhary D, Avula V, Shahjouei S, Azarpazhooh MR, Abedi V, Li J, Zand R. Social Determinants of Stroke Hospitalization and Mortality in United States' Counties. J Clin Med 2022; 11:jcm11144101. [PMID: 35887865 PMCID: PMC9320068 DOI: 10.3390/jcm11144101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/29/2022] [Accepted: 06/28/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Stroke incidence and outcomes are influenced by socioeconomic status. There is a paucity of reported population-level studies regarding these determinants. The goal of this ecological analysis was to determine the county-level associations of social determinants of stroke hospitalization and death rates in the United States. (2) Methods: Publicly available data as of 9 April 2021, for the socioeconomic factors and outcomes, was extracted from the Centers for Disease Control and Prevention. The outcomes of interest were “all stroke hospitalization rates per 1000 Medicare beneficiaries” (SHR) and “all stroke death rates per 100,000 population” (SDR). We used a multivariate binomial generalized linear mixed model after converting the outcomes to binary based on their median values. (3) Results: A total of 3226 counties/county-equivalents of the states and territories in the US were analyzed. Heart disease prevalence (odds ratio, OR = 2.03, p < 0.001), blood pressure medication nonadherence (OR = 2.02, p < 0.001), age-adjusted obesity (OR = 1.24, p = 0.006), presence of hospitals with neurological services (OR = 1.9, p < 0.001), and female head of household (OR = 1.32, p = 0.021) were associated with high SHR while cost of care per capita for Medicare patients with heart disease (OR = 0.5, p < 0.01) and presence of hospitals (OR = 0.69, p < 0.025) were associated with low SHR. Median household income (OR = 0.6, p < 0.001) and park access (OR = 0.84, p = 0.016) were associated with low SDR while no college degree (OR = 1.21, p = 0.049) was associated with high SDR. (4) Conclusions: Several socioeconomic factors (e.g., education, income, female head of household) were found to be associated with stroke outcomes. Additional research is needed to investigate intermediate and potentially modifiable factors that can serve as targeted interventions.
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Affiliation(s)
- Randhir Sagar Yadav
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (R.S.Y.); (D.C.); (S.S.)
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL 32207, USA
| | - Durgesh Chaudhary
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (R.S.Y.); (D.C.); (S.S.)
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Venkatesh Avula
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA; (V.A.); (J.L.)
| | - Shima Shahjouei
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (R.S.Y.); (D.C.); (S.S.)
| | - Mahmoud Reza Azarpazhooh
- Departments of Clinical Neurological Sciences and Epidemiology, University of Western Ontario, London, ON N6A 3K7, Canada;
| | - Vida Abedi
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA;
| | - Jiang Li
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA; (V.A.); (J.L.)
| | - Ramin Zand
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (R.S.Y.); (D.C.); (S.S.)
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
- Neuroscience Institute, The Pennsylvania State University, Hershey, PA 17033, USA
- Correspondence:
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Hahad O, Bayo Jimenez MT, Kuntic M, Frenis K, Steven S, Daiber A, Münzel T. Cerebral consequences of environmental noise exposure. ENVIRONMENT INTERNATIONAL 2022; 165:107306. [PMID: 35635962 DOI: 10.1016/j.envint.2022.107306] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/09/2022] [Accepted: 05/15/2022] [Indexed: 06/15/2023]
Abstract
The importance of noise exposure as a major environmental determinant of public health is being increasingly recognized. While in recent years a large body evidence has emerged linking environmental noise exposure mainly to cardiovascular disease, much less is known concerning the adverse health effects of noise on the brain and associated neuropsychiatric outcomes. Despite being a relatively new area of investigation, indeed, mounting research and conclusive evidence demonstrate that exposure to noise, primarily from traffic sources, may affect the central nervous system and brain, thereby contributing to an increased risk of neuropsychiatric disorders such as stroke, dementia and cognitive decline, neurodevelopmental disorders, depression, and anxiety disorder. On a mechanistic level, a significant number of studies suggest the involvement of reactive oxygen species/oxidative stress and inflammatory pathways, among others, to fundamentally drive the adverse brain health effects of noise exposure. This in-depth review on the cerebral consequences of environmental noise exposure aims to contribute to the associated research needs by evaluating current findings from human and animal studies. From a public health perspective, these findings may also help to reinforce efforts promoting adequate mitigation strategies and preventive measures to lower the societal consequences of unhealthy environments.
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Affiliation(s)
- Omar Hahad
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany; Leibniz Institute for Resilience Research (LIR), Mainz, Germany.
| | - Maria Teresa Bayo Jimenez
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marin Kuntic
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Katie Frenis
- Boston Children's Hospital and Harvard Medical School, Department of Hematology/Oncology, Boston, MA, USA
| | - Sebastian Steven
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Andreas Daiber
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
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11
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Chen D, Xie X, Lu Y, Chen S, Lin S. Predictive Value of Perioperative Cytokine Levels on the Risk for In-Stent Restenosis in Acute Myocardial Infarction Patients. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7832564. [PMID: 35542755 PMCID: PMC9056250 DOI: 10.1155/2022/7832564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/23/2022] [Accepted: 03/30/2022] [Indexed: 12/02/2022]
Abstract
To investigate the value of perioperative cytokine levels in predicting the risk for in-stent restenosis in patients with acute myocardial infarction. 452 patients with acute myocardial infarction admitted to our hospital between June 2018 and June 2020 were prospectively selected as subjects. All patients underwent percutaneous coronary intervention. The baseline data of the patients were collected. Venous blood was taken before, 24 hours, and 3 days after the operation to detect the levels of related cytokines. Follow-up was performed for 1 year. The patients were assigned to restenosis and nonrestenosis groups according to the presence and absence of restenosis. Multivariate logistic analysis was used to explore the influencing factors of the risk for in-stent restenosis in patients with acute myocardial infarction. By July 1, 2021, 449 cases had been followed up. Of them, 44 cases suffered from in-stent restenosis and 405 cases did not affect in-stent restenosis. The incidence of in-stent restenosis was 9.80%. Before, 24 hours, and 3 days after the operation, the lipoprotein-associated phospholipase A2 (Lp-PLA2) level was significantly higher in the restenosis group than that in the nonrestenosis group. At 3 days after the operation, the interleukin 6 (IL-6) level was significantly higher in the restenosis group than that in the nonrestenosis group (P < 0.05). Multivariate logistic analysis displayed that Lp-PLA2 level preoperatively (OR = 1.048, 95% CI 1.029-1.068), Lp-PLA2 level 24 hours postoperatively (OR = 1.013, 95% CI 1.007-1.019), Lp-PLA2 level 3 days postoperatively (OR = 1.032, 95% CI 1.015-1.048), and IL-6 level 3 days postoperatively (OR = 1.020, 95% CI 1.000-1.040) were risk factors for in-stent restenosis (all P < 0.05). IL-6 and Lp-PLA2 levels can predict the risk for in-stent restenosis in patients with acute myocardial infarction in the perioperative period.
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Affiliation(s)
- Dingdao Chen
- Department of Cardiology, The People's Hospital of Cangnan, Wenzhou 325800, Zhejiang Province, China
| | - Xueli Xie
- Department of Dispensary Pharmacy, Cangnan Maternal and Child Health Hospital, Wenzhou 325800, Zhejiang Province, China
| | - Yinling Lu
- Department of Dispensary Pharmacy, Cangnan Maternal and Child Health Hospital, Wenzhou 325800, Zhejiang Province, China
| | - Shengli Chen
- Department of Cardiology, The People's Hospital of Cangnan, Wenzhou 325800, Zhejiang Province, China
| | - Sunmei Lin
- Department of Cardiology, The People's Hospital of Cangnan, Wenzhou 325800, Zhejiang Province, China
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12
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Goldstein LB, Seshadri S, Sacco RL. Risk Factors and Prevention. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Abstract
Neurologic health disparities are created and perpetuated by structural and social determinants of health. These factors include, but are not limited to, interpersonal bias, institutional factors that lead to disparate access to care, and neighborhood-level factors, such as socioeconomic status, segregation, and access to healthy food. Effects of these determinants of health can be seen throughout neurology, including in stroke, epilepsy, headache, amyotrophic lateral sclerosis, multiple sclerosis, and dementia. Interventions to improve neurologic health equity require multilayered approaches to address these interdependent factors that create and perpetuate disparate neurologic health access and outcomes.
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Affiliation(s)
- Nicole Rosendale
- Neurohospitalist Division, Department of Neurology, University of California San Francisco, 1001 Potrero Avenue, Building 1, Room 101, Box 0870, San Francisco, CA 94110, USA.
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14
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Measuring the Effect of Place, Socioeconomic Status, and Racism on Coronary Heart Disease: Recent Trends and Missed Opportunities. CURR EPIDEMIOL REP 2021. [DOI: 10.1007/s40471-021-00281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Münzel T, Hahad O, Sørensen M, Lelieveld J, Duerr GD, Nieuwenhuijsen M, Daiber A. Environmental risk factors and cardiovascular diseases: a comprehensive review. Cardiovasc Res 2021; 118:2880-2902. [PMID: 34609502 PMCID: PMC9648835 DOI: 10.1093/cvr/cvab316] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/02/2021] [Accepted: 09/30/2021] [Indexed: 12/12/2022] Open
Abstract
Noncommunicable diseases (NCDs) are fatal for more than 38 million people each year and are thus the main contributors to the global burden of disease accounting for 70% of mortality. The majority of these deaths are caused by cardiovascular disease. The risk of NCDs is strongly associated with exposure to environmental stressors such as pollutants in the air, noise exposure, artificial light at night and climate change, including heat extremes, desert storms and wildfires. In addition to the traditional risk factors for cardiovascular disease such as diabetes, arterial hypertension, smoking, hypercholesterolemia and genetic predisposition, there is a growing body of evidence showing that physicochemical factors in the environment contribute significantly to the high NCD numbers. Furthermore, urbanization is associated with accumulation and intensification of these stressors. This comprehensive expert review will summarize the epidemiology and pathophysiology of environmental stressors with a focus on cardiovascular NCDs. We will also discuss solutions and mitigation measures to lower the impact of environmental risk factors with focus on cardiovascular disease.
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Affiliation(s)
- Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Germany
| | - Omar Hahad
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Germany
| | - Mette Sørensen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Jos Lelieveld
- Max Planck Institute for Chemistry, Atmospheric Chemistry Department, Mainz, Germany
| | - Georg Daniel Duerr
- Department of Cardiac Surgery, University Medical Center Mainz, Johannes Gutenberg University, Germany
| | - Mark Nieuwenhuijsen
- Institute for Global Health (ISGlobal), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Andreas Daiber
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Germany
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16
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Brugge D, Lerman Ginzburg S, Hudda N, Sprague Martinez L, Meunier L, Hersey SP, Hochman I, Walker DI, Echevarria B, Thanikachalam M, Durant JL, Zamore W, Eliasziw M. A randomized crossover trial of HEPA air filtration to reduce cardiovascular risk for near highway residents: Methods and approach. Contemp Clin Trials 2021; 108:106520. [PMID: 34332159 DOI: 10.1016/j.cct.2021.106520] [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: 04/15/2021] [Revised: 07/01/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Near highway residents are exposed to elevated levels of traffic-related air pollution (TRAP), including ultrafine particles, which are associated with adverse health effects. The efficacy of using in-home air filtration units that reduce exposure and potentially yield health benefits has not been tested in a randomized controlled trial. METHODS We will conduct a randomized double-blind crossover trial of portable air filtration units for 200 adults 30 years and older who live in near-highway homes in Somerville, MA, USA. We will recruit participants from 172 households. The intervention periods will be one month of true or sham filtration, followed by a one-month wash out period and then a month of the alternate intervention. The primary health outcome will be systolic blood pressure (BP); secondary outcome measures will include diastolic and central BP, C-Reactive Protein (CRP) and D-dimer. Reasons for success or failure of the intervention will be evaluated in a subset of homes using indoor/outdoor monitoring for particulate pollution, personal monitoring, size and composition of particulate pollution, tracking of time spent in the room with the filter, and interviews for qualitative feedback. RESULTS This trial has begun recruitment and is expected to take 2-3 years to be completed. Recruitment has been particularly challenging because of additional precautions required by the COVID-19 pandemic. DISCUSSION This study has the potential to shed light on the value of using portable air filtration in homes close to highways to reduce exposure to TRAP and whether doing so has benefits for cardiovascular health.
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Affiliation(s)
- Doug Brugge
- Department of Public Health Sciences, University of Connecticut, Farmington, CT 06032, United States of America
| | - Shir Lerman Ginzburg
- UConn Health Department of Public Health Sciences, Farmington, CT 06032., United States of America.
| | - Neelakshi Hudda
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, 02476, United States of America
| | - Linda Sprague Martinez
- Macro Department, Boston University School of Social Work, Boston, MA 02215, United States of America
| | - Leigh Meunier
- UConn Health Department of Public Health Sciences, Farmington, CT 06032., United States of America
| | - Scott P Hersey
- Franklin W. Olin College of Engineering, Needham, MA 02492, United States of America
| | - Ira Hochman
- inTouch Technology Corp., Cambridge, MA 02142, United States of America
| | - Douglas I Walker
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029l, United States of America
| | - Ben Echevarria
- Welcome Project, Somerville, MA 02145, United States of America
| | - Mohan Thanikachalam
- Tufts University School of Medicine, Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA 02111, United States of America
| | - John L Durant
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02476, United States of America
| | - Wig Zamore
- Somerville Transportation Equity Partnership, Somerville, MA 02145, United States of America
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University, Boston, MA 02111, United States of America
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17
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Magnoni P, Murtas R, Russo AG. Residential exposure to traffic-borne pollution as a risk factor for acute cardiocerebrovascular events: a population-based retrospective cohort study in a highly urbanized area. Int J Epidemiol 2021; 50:1160-1171. [PMID: 34279611 PMCID: PMC8522025 DOI: 10.1093/ije/dyab068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/17/2021] [Indexed: 01/03/2023] Open
Abstract
Background Long-term exposure to traffic-borne noise and air pollution has been variably
associated with incidence of acute vascular events, namely acute myocardial
infarction, ischaemic stroke and haemorrhagic stroke. This study aims at
exploring this association within a highly urbanized city. Methods This is a population-based retrospective dynamic cohort study including all
residents aged ≥ 35 years in the municipality of Milan over
the years 2011–18 (1 087 110 inhabitants).
Residential exposure to road traffic noise (day-evening-night levels) and
nitrogen dioxide was estimated using a noise predictive model and a land use
regression model, respectively. Cox proportional hazards regression analyses
were performed to assess the incidence of acute vascular events and specific
outcomes in single-exposure and two-exposure models including adjustment for
sociodemographic confounders, fine particulate matter and surrounding
greenness. Results A total of 27 282 subjects (2.5%) had an acute vascular
event. Models using nitrogen dioxide produced inconsistent results. The
strongest effect was observed for noise, with an optimal cut-off for
dichotomization set at 70 dBA (hazard ratio 1.025, 95% confidence
interval 1.000–1.050). This association was observed specifically
for ischaemic and haemorrhagic stroke. When stratifying by age group and
sex, a remarkable effect was found for haemorrhagic stroke in men aged
<60 years (hazard ratio 1.439, 95% confidence
interval 1.156–1.792). Conclusions Living by roads with a day-evening-night noise level above 70 dBA exerts a
small but tangible independent effect on the risks of both ischaemic and
haemorrhagic stroke. It is urgent to propose mitigation measures against
pollution and noise originating from vehicular traffic in order to reduce
their impact, especially in the population younger than
60 years.
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Affiliation(s)
- Pietro Magnoni
- Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy.,Postgraduate School of Public Health, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Rossella Murtas
- Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy
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18
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Butler L, Gallagher L, Winter M, Fabian MP, Wesselink A, Aschengrau A. Residential proximity to roadways and placental-associated stillbirth: a case-control study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2021; 31:465-474. [PMID: 31587563 PMCID: PMC7131873 DOI: 10.1080/09603123.2019.1673882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/25/2019] [Indexed: 06/10/2023]
Abstract
We conducted a retrospective case-control study of 1,097 women in Massachusetts and Rhode Island, USA, to examine the association between stillbirth related to placental abruption or placental insufficiency and maternal exposure to traffic-related air pollution. We utilized distance to nearest roadway proximity metrics as a proxy for traffic-related air pollution exposure. No meaningful increase in the overall odds of placental-associated stillbirths was observed (adjusted OR: 1.1, 95% CI: 0.5-2.8). However, mothers living within 50 m of a roadway had a 60% increased odds of experiencing a stillbirth related to placental abruption compared to mothers living greater than 200 m away. This suggestive finding was imprecise due to the small case number in the highest exposure category (95% CI: 0.6-4.0). Future studies of placental abruption with more precise exposure assessments are warranted.
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Affiliation(s)
- Lindsey Butler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Lisa Gallagher
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - M. Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Amelia Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
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19
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Kim Y, Twardzik E, Judd SE, Colabianchi N. Neighborhood Socioeconomic Status and Stroke Incidence: A Systematic Review. Neurology 2021; 96:897-907. [PMID: 33766995 PMCID: PMC8166445 DOI: 10.1212/wnl.0000000000011892] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 02/02/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To summarize overall patterns of the impact of neighborhood socioeconomic status (nSES) on stroke incidence and uncover potential gaps in the literature, we conducted a systematic review of studies examining the association between nSES and stroke incidence, independent of individual SES. METHODS Four electronic databases and reference lists of included articles were searched, and corresponding authors were contacted to locate additional studies. A keyword search strategy included the 3 broad domains of neighborhood, SES, and stroke. Eight studies met our inclusion criteria (e.g., nSES as an exposure, individual SES as a covariate, and stroke incidence as an outcome). We coded study methodology and findings across the 8 studies. RESULTS The results provide evidence for the overall nSES and stroke incidence association in Sweden and Japan, but not within the United States. Findings were inconclusive when examining the nSES-stroke incidence association stratified by race. We found evidence for the mediating role of biological factors in the nSES-stroke incidence association. CONCLUSIONS Higher neighborhood disadvantage was found to be associated with higher stroke risk, but it was not significant in all the studies. The relationship between nSES and stroke risk within different racial groups in the United States was inconclusive. Inconsistencies may be driven by differences in covariate adjustment (e.g., individual-level sociodemographic characteristics and neighborhood-level racial composition). Additional research is needed to investigate potential intermediate and modifiable factors of the association between nSES and stroke incidence, which could serve as intervention points.
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Affiliation(s)
- Yeonwoo Kim
- From the Department of Kinesiology (Y.K.), University of Texas at Arlington, TX; School of Kinesiology (E.T.), University of Michigan, MI; Department of Biostatistics (S.E.J.), University of Alabama at Birmingham, AL; School of Kinesiology (N.C.), University of Michigan, MI
| | - Erica Twardzik
- From the Department of Kinesiology (Y.K.), University of Texas at Arlington, TX; School of Kinesiology (E.T.), University of Michigan, MI; Department of Biostatistics (S.E.J.), University of Alabama at Birmingham, AL; School of Kinesiology (N.C.), University of Michigan, MI
| | - Suzanne E Judd
- From the Department of Kinesiology (Y.K.), University of Texas at Arlington, TX; School of Kinesiology (E.T.), University of Michigan, MI; Department of Biostatistics (S.E.J.), University of Alabama at Birmingham, AL; School of Kinesiology (N.C.), University of Michigan, MI
| | - Natalie Colabianchi
- From the Department of Kinesiology (Y.K.), University of Texas at Arlington, TX; School of Kinesiology (E.T.), University of Michigan, MI; Department of Biostatistics (S.E.J.), University of Alabama at Birmingham, AL; School of Kinesiology (N.C.), University of Michigan, MI.
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20
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Yao Y, Jin X, Cao K, Zhao M, Zhu T, Zhang J, Zeng Y. Residential proximity to major roadways and cognitive function among Chinese adults 65 years and older. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 766:142607. [PMID: 33097247 DOI: 10.1016/j.scitotenv.2020.142607] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 05/07/2023]
Abstract
Emerging evidence in North America and Europe suggests that traffic-related air pollution (TRAP) adversely affects cognition. However, little is known about this relationship in people living in low- and middle-income countries (LMICs). It is also unknown whether indoor air pollution can modify the effect of TRAP. We derived data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a prospective cohort study, including 11,187 individuals of 82.0 years old (53.9% female). We ascertained residential proximity to major roadways based on self-reports and assessed cognitive function using the Mini-Mental State Examination (MMSE). We used cooking fuel type and home ventilation as proxies for indoor air pollution. We examined the associations between major road proximity and cognitive impairment using multivariable logistic regressions, controlling for demographic, lifestyle, socioeconomic status, and chronic conditions. We did subgroup analyses and assessed the potential interaction effect. The prevalence of cognitive impairment was 33.4%. The adjusted odds ratios of cognitive impairment were 1.20 (1.05, 1.35), 1.26 (1.09, 1.46), 0.99 (0.84, 1.17), and 1.05 (0.88, 1.25) for individuals living <50 m, 50-100 m, 101-200 m, and 201-300 m compared to those living >300 m from a major roadway. In dichotomized analyses, the risk (OR) associated with living closer to roadways was greater in participants who did not implement any ventilation during cooking (compared to those using natural or mechanical ventilation, 1.86 [1.31-2.65] vs. 1.16 [1.03-1.26], P for interaction = 0.001) and in solid fuel users (compared to clean fuel users, 1.37 [1.13-1.67] vs. 1.13 [1.04-1.21], P for interaction = 0.028). The associations were robust in a set of sensitivity analyses. The results suggested that living closer to major roadways was associated with an increased risk for cognitive impairment in older adults in China, indicating an adverse TRAP effect. Indoor air pollution appeared to enhance the TRAP effect synergistically.
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Affiliation(s)
- Yao Yao
- Center for Healthy Aging and Development Studies, Raissun Institute for Advanced Studies, National School of Development, Peking University, Beijing, China; Center for the Study of Aging and Human Development and Geriatrics Division, Medical School of Duke University, Durham, NC, United States
| | - Xurui Jin
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, China
| | - Kaixi Cao
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, China
| | - Minghao Zhao
- Peking University Health Science Center, Beijing, China
| | - Tinglong Zhu
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu, China
| | - Junfeng Zhang
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, NC, United States.
| | - Yi Zeng
- Center for Healthy Aging and Development Studies, Raissun Institute for Advanced Studies, National School of Development, Peking University, Beijing, China; Center for the Study of Aging and Human Development and Geriatrics Division, Medical School of Duke University, Durham, NC, United States.
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21
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Residential proximity to major roads and fecundability in a preconception cohort. Environ Epidemiol 2020; 4:e112. [PMID: 33778352 PMCID: PMC7941774 DOI: 10.1097/ee9.0000000000000112] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023] Open
Abstract
Supplemental Digital Content is available in the text. Emerging evidence from animal and human studies indicates that exposure to traffic-related air pollution may adversely affect fertility.
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22
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Kaufman JD, Elkind MSV, Bhatnagar A, Koehler K, Balmes JR, Sidney S, Burroughs Peña MS, Dockery DW, Hou L, Brook RD, Laden F, Rajagopalan S, Bishop Kendrick K, Turner JR. Guidance to Reduce the Cardiovascular Burden of Ambient Air Pollutants: A Policy Statement From the American Heart Association. Circulation 2020; 142:e432-e447. [PMID: 33147996 DOI: 10.1161/cir.0000000000000930] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In 2010, the American Heart Association published a statement concluding that the existing scientific evidence was consistent with a causal relationship between exposure to fine particulate matter and cardiovascular morbidity and mortality, and that fine particulate matter exposure is a modifiable cardiovascular risk factor. Since the publication of that statement, evidence linking air pollution exposure to cardiovascular health has continued to accumulate and the biological processes underlying these effects have become better understood. This increasingly persuasive evidence necessitates policies to reduce harmful exposures and the need to act even as the scientific evidence base continues to evolve. Policy options to mitigate the adverse health impacts of air pollutants must include the reduction of emissions through action on air quality, vehicle emissions, and renewable portfolio standards, taking into account racial, ethnic, and economic inequality in air pollutant exposure. Policy interventions to improve air quality can also be in alignment with policies that benefit community and transportation infrastructure, sustainable food systems, reduction in climate forcing agents, and reduction in wildfires. The health care sector has a leadership role in adopting policies to contribute to improved environmental air quality as well. There is also potentially significant private sector leadership and industry innovation occurring in the absence of and in addition to public policy action, demonstrating the important role of public-private partnerships. In addition to supporting education and research in this area, the American Heart Association has an important leadership role to encourage and support public policies, private sector innovation, and public-private partnerships to reduce the adverse impact of air pollution on current and future cardiovascular health in the United States.
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23
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Pradilla I, Macea-Ortiz JE, Polo-Pantoja PP, Palacios-Ariza MA, Díaz-Forero AF, Velásquez-Torresc A, Vélez-van-Meerbeke A. Spatial analysis of service areas for stroke centers in a city with high traffic congestion. Spat Spatiotemporal Epidemiol 2020; 35:100377. [PMID: 33138955 DOI: 10.1016/j.sste.2020.100377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/21/2020] [Accepted: 08/28/2020] [Indexed: 01/01/2023]
Abstract
The effect that traffic congestion has on the service areas of stroke centers has received scarce attention. We aimed to determine the effect of traffic conditions on the characteristics of service areas of stroke centers in Bogotá, Colombia. Using a webservice, we sampled travel times from a set of census blocks to medical centers offering stroke management in the city. We obtained 179.340 transport times under different conditions. The size of service areas was reduced significantly with congestion (up to 94.83%). Overlap in the locations of centers led to large areas covered by only five centers. We identified areas with transport times to the closest center consistently exceeding 30-minutes to 1-hour in the west and south-west. Traffic conditions in Bogotá significantly affect service areas of centers capable of offering comprehensive stroke care. Spatial overlap of centers led to small catchment areas.
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Affiliation(s)
- Ivan Pradilla
- Master's Program in Epidemiology, Escuela de Medicina y Ciencias de la Salud, Bogotá D.C., Colombia. Carrera 24 # 63C-69. 111211; Neuroscience Research Group (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C., Colombia. Cra 24 #63C-74 1st floor, Bogotá D.C., Colombia, 111221.
| | - Jaiver Enrique Macea-Ortiz
- Master's Program in Epidemiology, Escuela de Medicina y Ciencias de la Salud, Bogotá D.C., Colombia. Carrera 24 # 63C-69. 111211
| | - Paola Pastora Polo-Pantoja
- Master's Program in Epidemiology, Escuela de Medicina y Ciencias de la Salud, Bogotá D.C., Colombia. Carrera 24 # 63C-69. 111211
| | - Maria Alejandra Palacios-Ariza
- Master's Program in Epidemiology, Escuela de Medicina y Ciencias de la Salud, Bogotá D.C., Colombia. Carrera 24 # 63C-69. 111211; Research Unit, Fundación Universitaria Sanitas, Bogotá D.C., Colombia. Calle 23 # 66-46 Clinica Colombia, 5th Floor. 111321
| | - Andrés Felipe Díaz-Forero
- Neuroscience Research Group (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C., Colombia. Cra 24 #63C-74 1st floor, Bogotá D.C., Colombia, 111221
| | - Alejandro Velásquez-Torresc
- Neuroscience Research Group (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C., Colombia. Cra 24 #63C-74 1st floor, Bogotá D.C., Colombia, 111221
| | - Alberto Vélez-van-Meerbeke
- Neuroscience Research Group (NeURos), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá D.C., Colombia. Cra 24 #63C-74 1st floor, Bogotá D.C., Colombia, 111221
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Abstract
Numerous epidemiological studies have demonstrated stroke disparities across race and ethnic groups. The goal of the NOMAS (Northern Manhattan Study) was to evaluate race and ethnic differences in stroke within a community with 3 different race-ethnic groups. Starting as a population-based incidence and case-control study, the study evolved into a cohort study. Results from NOMAS have demonstrated differences in stroke incidence, subtypes, risk factors, and outcomes. Disparities in ideal cardiovascular health can help explain many differences in stroke incidence and call for tailored risk factor modification through innovative portals to shift more diverse subjects to ideal cardiovascular health. The results of NOMAS and multiple other studies have provided foundational data to support interventions. Conceptual models to address health disparities have called for moving from detecting disparities in disease incidence, to determining the underlying causes of disparities and developing interventions, and then to testing interventions in human populations. Further actions to address race and ethnic stroke disparities are needed including innovative risk factor interventions, stroke awareness campaigns, quality improvement programs, workforce diversification, and accelerating policy changes.
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Affiliation(s)
- Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, FL
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Cao H, Li B, Peng W, Pan L, Cui Z, Zhao W, Zhang H, Tang N, Niu K, Sun J, Han X, Wang Z, Liu K, He H, Cao Y, Xu Z, Shan A, Meng G, Sun Y, Guo C, Liu X, Xie Y, Wen F, Shan G, Zhang L. Associations of long-term exposure to ambient air pollution with cardiac conduction abnormalities in Chinese adults: The CHCN-BTH cohort study. ENVIRONMENT INTERNATIONAL 2020; 143:105981. [PMID: 32738766 DOI: 10.1016/j.envint.2020.105981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Evidence regarding the effects of long-term and high-level ambient air pollution exposure on cardiac conduction systems remains sparse. OBJECTIVES To investigate the associations of long-term exposure to air pollution and cardiac conduction abnormalities in Chinese adults and explore the susceptibility characteristics. METHODS In 2017, a total of 27,047 participants aged 18-80 years were recruited from the baseline survey of the Cohort Study on Chronic Disease of Communities Natural Population in Beijing, Tianjin and Hebei (CHCN-BTH). The three year (2014-2016) average pollutant concentrations were assessed by a spatial statistical model for PM2.5 and air monitoring stations for PM10, SO2, NO2, O3 and CO. Residential proximity to a roadway was calculated by neighborhood analysis. Associations were estimated by two-level generalized linear mixed models. Stratified analyses related to demographic characteristics, health behaviors, and cardiometabolic risk factors were performed. Two-pollutant models were used to evaluate the possible role of single pollutants. RESULTS We detected significant associations of long-term air pollutant exposure with increased heart rate (HR), QRS and QTc, such that an interquartile range increase in PM2.5 was associated with 3.63% (95% CI: 3.07%, 4.19%), 1.21% (95% CI: 0.83%, 1.60%), and 0.13% (95% CI: 0.07%, 0.18%) changes in HR, QRS and QTc, respectively. Compared to the other pollutants, the estimates of PM2.5 remained the most stable across all two-pollutant models. Similarly, significant associations were observed between living closer to a major roadway and higher HR, QRS and QTc. Stratified analyses showed generally greater association estimates in older people, males, smokers, alcohol drinkers, and those with obesity, hypertension and diabetes. CONCLUSIONS Long-term exposure to ambient air pollution was associated with cardiac conduction abnormalities in Chinese adults, especially in older people, males, smokers, alcohol drinkers, and those with cardiometabolic risk factors. PM2.5 may be the most stable pollutant to reflect the associations.
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Affiliation(s)
- Han Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Bingxiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Wenjuan Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Li Pan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Ze Cui
- Department of Chronic and Noncommunicable Disease Prevention and Control, Hebei Provincial Center for Disease Prevention and Control, Shijiazhuang, Hebei, China
| | - Wei Zhao
- Department of Chronic and Noncommunicable Disease Prevention and Control, Chaoyang District Center for Disease Prevention and Control, Beijing, China
| | - Han Zhang
- Health Management Center, Beijing Aerospace General Hospital, Beijing, China
| | - Naijun Tang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jixin Sun
- Department of Chronic and Noncommunicable Disease Prevention and Control, Hebei Provincial Center for Disease Prevention and Control, Shijiazhuang, Hebei, China
| | - Xiaoyan Han
- Department of Chronic and Noncommunicable Disease Prevention and Control, Chaoyang District Center for Disease Prevention and Control, Beijing, China
| | - Zhengfang Wang
- Health Management Center, Beijing Aerospace General Hospital, Beijing, China
| | - Kuo Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Huijing He
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yajing Cao
- Department of Chronic and Noncommunicable Disease Prevention and Control, Hebei Provincial Center for Disease Prevention and Control, Shijiazhuang, Hebei, China
| | - Zhiyuan Xu
- Department of Chronic and Noncommunicable Disease Prevention and Control, Chaoyang District Center for Disease Prevention and Control, Beijing, China
| | - Anqi Shan
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ge Meng
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yanyan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Chunyue Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xiaohui Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yunyi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Fuyuan Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, and School of Basic Medicine, Peking Union Medical College, Beijing, China.
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, and Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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Kulick ER, Wellenius GA, Boehme AK, Joyce NR, Schupf N, Kaufman JD, Mayeux R, Sacco RL, Manly JJ, Elkind MSV. Long-term exposure to air pollution and trajectories of cognitive decline among older adults. Neurology 2020; 94:e1782-e1792. [PMID: 32269113 PMCID: PMC7274848 DOI: 10.1212/wnl.0000000000009314] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 11/22/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the association between long-term exposure to ambient air pollution and cognitive decline in older adults residing in an urban area. METHODS Data for this study were obtained from 2 prospective cohorts of residents in the northern Manhattan area of New York City: the Washington Heights-Inwood Community Aging Project (WHICAP) and the Northern Manhattan Study (NOMAS). Participants of both cohorts received in-depth neuropsychological testing at enrollment and during follow-up. In each cohort, we used inverse probability weighted linear mixed models to evaluate the cross-sectional and longitudinal associations between markers of average residential ambient air pollution (nitrogen dioxide [NO2], fine particulate matter [PM2.5], and respirable particulate matter [PM10]) levels in the year prior to enrollment and measures of global and domain-specific cognition, adjusting for sociodemographic factors, temporal trends, and censoring. RESULTS Among 5,330 participants in WHICAP, an increase in NO2 was associated with a 0.22 SD lower global cognitive score at enrollment (95% confidence interval [CI], -0.30, -0.14) and 0.06 SD (95% CI, -0.08, -0.04) more rapid decline in cognitive scores between visits. Results were similar for PM2.5 and PM10 and across functional cognitive domains. We found no evidence of an association between pollution and cognitive function in NOMAS. CONCLUSION WHICAP participants living in areas with higher levels of ambient air pollutants have lower cognitive scores at enrollment and more rapid rates of cognitive decline over time. In NOMAS, a smaller cohort with fewer repeat measurements, we found no statistically significant associations. These results add to the evidence regarding the adverse effect of air pollution on cognitive aging and brain health.
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Affiliation(s)
- Erin R Kulick
- From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL.
| | - Gregory A Wellenius
- From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL
| | - Amelia K Boehme
- From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL
| | - Nina R Joyce
- From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL
| | - Nicole Schupf
- From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL
| | - Joel D Kaufman
- From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL
| | - Richard Mayeux
- From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL
| | - Ralph L Sacco
- From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL
| | - Jennifer J Manly
- From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL
| | - Mitchell S V Elkind
- From the Department of Epidemiology (E.R.K., G.A.W., N.R.J.), Brown University School of Public Health, Providence, RI; Departments of Neurology (E.R.K., A.K.B., N.S., M.S.V.E.) and Psychiatry (R.M.) and Gertrude H. Sergievsky Center (N.S., R.M., J.J.M., M.S.V.E.), Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health (E.R.K., A.K.B., N.S., R.M., J.J.M., M.S.V.E.), and Taub Institute for Research on Alzheimer Disease and the Aging Brain (N.S., R.M., J.J.M.), Columbia University, New York, NY; Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology (J.D.K.), University of Washington, Seattle; and Departments of Neurology, Public Health Sciences, and Human Genetics (R.L.S.), Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL
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Kulick ER, Elkind MSV, Boehme AK, Joyce NR, Schupf N, Kaufman JD, Mayeux R, Manly JJ, Wellenius GA. Long-term exposure to ambient air pollution, APOE-ε4 status, and cognitive decline in a cohort of older adults in northern Manhattan. ENVIRONMENT INTERNATIONAL 2020; 136:105440. [PMID: 31926436 PMCID: PMC7024003 DOI: 10.1016/j.envint.2019.105440] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 05/18/2023]
Abstract
BACKGROUND There is mounting evidence that long-term exposure to air pollution is related to accelerated cognitive decline in aging populations. Factors that influence individual susceptibility remain largely unknown, but may involve the apolipoprotein E genotype E4 (APOE-ε4) allele. OBJECTIVES We assessed whether the association between long-term exposure to ambient air pollution and cognitive decline differed by APOE-ε4 status and cognitive risk factors. METHODS The Washington Heights Inwood Community Aging Project (WHICAP) is a prospective study of aging and dementia. Neuropsychological testing and medical examinations occur every 18-24 months. We used mixed-effects models to evaluate whether the association between markers of ambient air pollution (nitrogen dioxide [NO2]), fine [PM2.5], and coarse [PM10] particulate matter) and the rate of decline in global and domain-specific cognition differed across strata defined by APOE-ε4 genotypes and cognitive risk factors, adjusting for sociodemographic factors and temporal trends. RESULTS Among 4821 participants with an average of 6 years follow-up, higher concentrations of ambient air pollution were associated with more rapid cognitive decline. This association was more pronounced among APOE-ε4 carriers (p < 0.001). A one interquartile range increase in NO2 was associated with an additional decline of 0.09 standard deviations (SD) (95%CI -0.1, -0.06) in global cognition across biennial visits among APOE-ε4 positive individuals and a 0.07 SD (95%CI -0.09, -0.05) decline among APOE-ε4 negative individuals. Results for PM2.5, PM10 and cognitive domains were similar. The association between air pollutants and rate of cognitive decline also varied across strata of race-ethnicity with the association strongest among White non-Hispanic participants. CONCLUSIONS These results add to the body of evidence on the adverse impact of ambient air pollution on cognitive aging and brain health and provide new insights into the genetic and behavioral factors that may impact individual susceptibility.
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Affiliation(s)
- Erin R Kulick
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Amelia K Boehme
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Nina R Joyce
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Nicole Schupf
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer Disease and the Aging Brain, Columbia University, New York, NY, USA; Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Joel D Kaufman
- Departments of Environmental and Occupational Health Sciences, and Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Richard Mayeux
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer Disease and the Aging Brain, Columbia University, New York, NY, USA; Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jennifer J Manly
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Taub Institute for Research on Alzheimer Disease and the Aging Brain, Columbia University, New York, NY, USA; Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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28
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Combes A, Franchineau G. Fine particle environmental pollution and cardiovascular diseases. Metabolism 2019; 100S:153944. [PMID: 31610849 DOI: 10.1016/j.metabol.2019.07.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/06/2019] [Indexed: 01/24/2023]
Abstract
Air pollution affects 90% of the world's population and has caused 9 million deaths in 2015, becoming the most important cause of premature deaths in the world. Exposure to fine particulate matter, a major component of urban air pollution, has been associated with an increase in cardiovascular risk and associated mortality. Impact of fine particles on the cardiovascular system includes inflammation, activation of prothrombotic pathways, oxidative stress, vascular dysfunction and remodeling, and neurological dysfunction. Genetic and epigenetic factors might also increase the susceptibility to air pollution. Consequently, epidemiologic studies have identified correlations between air particulate matter concentrations and acute coronary events, ischemic cardiomyopathy, acute heart failure, and stroke. Interestingly, these effects are present even for fine particulate matter concentrations below current US and EU regulatory standards, and seems to be more harmful in the most fragile population such as low-income or elderly subjects, or patients with previous cardiovascular disease. This review aims to summarize recent data on the pathophysiology and epidemiology of cardiovascular disease after particulate matter exposure. It will also discuss potential strategies to reduce the impact of air pollution on current and future populations' health.
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Affiliation(s)
- Alain Combes
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France; Service de médecine intensive-réanimation, Institut de Cardiologie, APHP Hôpital Pitié-Salpêtrière, F-75013 Paris, France.
| | - Guillaume Franchineau
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France; Service de médecine intensive-réanimation, Institut de Cardiologie, APHP Hôpital Pitié-Salpêtrière, F-75013 Paris, France
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29
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Rajagopalan S, Al-Kindi SG, Brook RD. Air Pollution and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 72:2054-2070. [PMID: 30336830 DOI: 10.1016/j.jacc.2018.07.099] [Citation(s) in RCA: 645] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022]
Abstract
Fine particulate matter <2.5 μm (PM2.5) air pollution is the most important environmental risk factor contributing to global cardiovascular (CV) mortality and disability. Short-term elevations in PM2.5 increase the relative risk of acute CV events by 1% to 3% within a few days. Longer-term exposures over several years increase this risk by a larger magnitude (∼10%), which is partially attributable to the development of cardiometabolic conditions (e.g., hypertension and diabetes mellitus). As such, ambient PM2.5 poses a major threat to global public health. In this review, the authors provide an overview of air pollution and health, including assessment of exposure, impact on CV outcomes, mechanistic underpinnings, and impact of air pollution reduction strategies to mitigate CV risk. The review concludes with future challenges, including the inextricable link between air pollution and climate change, and calls for large-scale trials to allow the promulgation of formal evidence-based recommendations to lower air pollution-induced health risks.
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Affiliation(s)
- Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio; Case Cardiovascular Research Institute, Case Western Reserve University, Cleveland, Ohio.
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - Robert D Brook
- Michigan Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
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Graber M, Mohr S, Baptiste L, Duloquin G, Blanc-Labarre C, Mariet AS, Giroud M, Béjot Y. Air pollution and stroke. A new modifiable risk factor is in the air. Rev Neurol (Paris) 2019; 175:619-624. [PMID: 31153597 DOI: 10.1016/j.neurol.2019.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/19/2022]
Abstract
Evidence from epidemiological studies has demonstrated that outdoor air pollution is now a well-known major problem of public health, mainly in low and middle income countries. Contrasting with myocardial infarction, there are few data on the association of air pollution and stroke. METHODS We propose a narrative literature review of the effects and the underlying biological mechanisms of short- and long-term exposure to air pollutants on stroke risk and mortality, using the following key-words: stroke, cerebrovascular events, ischemic and haemorrhage stroke, transient ischaemic attack, mortality, air pollution and air pollutants. RESULTS Twenty-one papers were selected. Air pollution, of which whose small particulate matter are the most toxic, contributes to about one-third of the global burden of stroke. We can identify vulnerable patients with classical neuro-vascular risk factors or a prior history of stroke or transient ischemic attack or persons living in low-income countries. Biological mechanisms of this new morbid association are discussed. CONCLUSION Air pollution should be recognized as a silent killer inducing stroke whose mortality rates remain elevated by its role as a new modifiable neurovascular risk factor, needing public health policies.
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Affiliation(s)
- M Graber
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France
| | - S Mohr
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France
| | - L Baptiste
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France
| | - G Duloquin
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France
| | - C Blanc-Labarre
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France
| | - A S Mariet
- Clinical investigation center of Dijon (Inserm CIC 1432), university of Burgundy and Franche Comté, Inserm, biostatistique, biomathématique, pharmacoepidemiologie et maladies infectieuses (B2 PHI), UMR 1181, university Hospital of Dijon, Dijon, France
| | - M Giroud
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France.
| | - Y Béjot
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France
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Pan X, Yuan X, Li X, Gao S, Sun H, Zhou H, Hou L, Peng X, Jiang Y, Yan B. Induction of Inflammatory Responses in Human Bronchial Epithelial Cells by Pb 2+-Containing Model PM 2.5 Particles via Downregulation of a Novel Long Noncoding RNA lnc-PCK1-2:1. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2019; 53:4566-4578. [PMID: 30913382 DOI: 10.1021/acs.est.8b06916] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Airborne particular matter (PM2.5) contains complex mixtures of pollutants, and their compositions also vary with time and location. Inhalation of PM2.5 may cause a number of diseases, such as bronchial and lung inflammation and lung cancer. So far, how different components of PM2.5 contribute to inflammation and toxicity is still not known. To identify key PM2.5 components that are responsible for inflammation, here we took a reductionism approach and synthesized a model PM2.5 library containing 20 carbon nanoparticle based members with loadings of As(III), Pb2+, Cr(VI), and BaP individually or in combination at environment relevant concentrations. We discovered that only carbon nanoparticle-Pb2+ adducts, not other pollutants or adducts, induced inflammation in human bronchial cells by suppressing the expression of a novel long noncoding RNA lnc-PCK1-2:1, while lnc-PCK1-2:1 routinely plays a regulatory role in inhibiting inflammation. This finding was further substantiated by varying Pb2+ loadings on carbon nanoparticles and overexpressing lnc-PCK1-2:1. The success of this approach opens an avenue for further elucidation of molecular mechanisms of PM2.5-induced inflammation and toxicity.
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Affiliation(s)
- Xiujiao Pan
- School of Chemistry and Chemical Engineering , Shandong University , Jinan 250100 , China
| | - Xiaoru Yuan
- School of Chemistry and Chemical Engineering , Shandong University , Jinan 250100 , China
- Key Laboratory for Water Quality and Conservation of the Pearl River Delta, Ministry of Education, Institute of Environmental Research at Greater Bay , Guangzhou University , Guangzhou 510006 , China
| | - Xin Li
- State Key Laboratory of Respiratory Disease, Institute for Chemical Carcinogenesis , Guangzhou Medical University , Guangzhou 511436 , China
| | - Sulian Gao
- Environmental Monitoring Center , Jinan 250102 , China
| | - Hainan Sun
- School of Chemistry and Chemical Engineering , Shandong University , Jinan 250100 , China
| | - Hongyu Zhou
- Key Laboratory for Water Quality and Conservation of the Pearl River Delta, Ministry of Education, Institute of Environmental Research at Greater Bay , Guangzhou University , Guangzhou 510006 , China
| | - Lujian Hou
- Environmental Monitoring Center , Jinan 250102 , China
| | - Xiaowu Peng
- South China Institute of Environmental Sciences , Ministry of Environmental Protection , Guangzhou 510655 , China
| | - Yiguo Jiang
- State Key Laboratory of Respiratory Disease, Institute for Chemical Carcinogenesis , Guangzhou Medical University , Guangzhou 511436 , China
| | - Bing Yan
- Key Laboratory for Water Quality and Conservation of the Pearl River Delta, Ministry of Education, Institute of Environmental Research at Greater Bay , Guangzhou University , Guangzhou 510006 , China
- School of Environmental Science and Engineering , Shandong University , Jinan 250100 , China
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Yeh JJ, Lin CL, Kao CH. Relationship between pneumonia and cardiovascular diseases: A retrospective cohort study of the general population. Eur J Intern Med 2019; 59:39-45. [PMID: 30098854 DOI: 10.1016/j.ejim.2018.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/03/2018] [Accepted: 08/03/2018] [Indexed: 12/18/2022]
Abstract
AIMS To evaluate the relationship between cardiovascular diseases (CVDs) and pneumonia in the general population. METHODS This retrospective observational study included two cohorts, namely CVD (n = 28,363) and non-CVD (n = 28,363) cohorts, which were matched by propensity score and examined for cases of pneumonia. Data were obtained from 2000 to 2011. In both cohorts, pneumonia risk was measured using multivariable Cox proportional hazard models. RESULTS With the non-CVD cohort as reference, the corresponding adjusted hazard ratios (aHRs) [95% confidence intervals (CIs)] of pneumonia were 2.03 [1.77-2.31] for coronary artery disease, 4.11 [3.15-5.36] for heart failure, 3.21 [2.70-3.81] for cerebrovascular disease, 1.46 [1.07-1.98] for peripheral vascular disease, and 2.27 [2.01-2.56] for the CVD cohort. The cohort with comorbidities had a higher risk (all p < .05) of pneumonia compared with that without comorbidities, except for patients with the comorbidities of hypertension, hyperlipidemia, obesity, and liver disease. The aHR (95% CI) of pneumonia for antibiotic use was 1.26 (1.09-1.47). The aHRs of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) were 3.25 (95% CI = 1.04-10.1) and 2.95 (95% CI = 2.25-3.88), respectively. The aHRs (95% CI) were 1.78 (1.05-3.03) for intensive care unit (ICU) risk and 0.98 (0.96-0.99) for length of admission. CONCLUSION Pneumonia risk was associated with CVDs, especially heart failure, regardless of age, gender, comorbidities, and antibiotic use, particularly in elderly male patients. In addition, Patients with CVDs had a higher risk of CAP and HAP. The CVD cohort had a higher frequency of ICU admissions, but shorter admission lengths.
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Affiliation(s)
- Jun-Jun Yeh
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan; Chia Nan University of Pharmacy and Science, Tainan, Taiwan; Meiho University, Pingtung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Grdaduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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Ho AFW, Zheng H, De Silva DA, Wah W, Earnest A, Pang YH, Xie Z, Pek PP, Liu N, Ng YY, Wong TH, Foo LL, Ong MEH. The Relationship Between Ambient Air Pollution and Acute Ischemic Stroke: A Time-Stratified Case-Crossover Study in a City-State With Seasonal Exposure to the Southeast Asian Haze Problem. Ann Emerg Med 2018; 72:591-601. [PMID: 30172448 DOI: 10.1016/j.annemergmed.2018.06.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/02/2018] [Accepted: 06/22/2018] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE Studies are divided on the short-term association of air pollution with stroke. Singapore is exposed to seasonal transboundary haze. We aim to investigate the association between air pollution and stroke incidence in Singapore. METHODS We performed a time-stratified case-crossover analysis on all ischemic stroke cases reported to the Singapore Stroke Registry from 2010 to 2015. Exposure on days was compared with control days on which exposure did not occur. Control days were chosen on the same day of the week earlier and later in the same month in the same year. We fitted a conditional Poisson regression model to daily stroke incidence that included Pollutant Standards Index and environmental confounders. The index was categorized according to established classification (0 to 50=good, 51 to 100=moderate, and ≥101=unhealthy). We assessed the relationship between stroke incidence and Pollutant Standards Index in the entire cohort and in predetermined subgroups of individual-level characteristics. RESULTS There were 29,384 ischemic stroke cases. Moderate and unhealthy Pollutant Standards Index levels showed association with stroke occurrence, with incidence risk ratio 1.10 (95% confidence interval 1.06 to 1.13) and 1.14 (95% confidence interval 1.03 to 1.25), respectively. Subgroup analyses showed generally significant association, except in Indians and nonhypertensive patients. The association was significant in subgroups aged 65 years or older, women, Chinese, nonsmokers and those with history of diabetes, hypertension, and hyperlipidemia. Stratified by age and smoking, the risk diminished in smokers of all ages. Risk remained elevated for 5 days after exposure. CONCLUSION We found a short-term elevated risk of ischemic stroke after exposure to air pollution. These findings have public health implications for stroke prevention and emergency health services delivery.
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Affiliation(s)
- Andrew F W Ho
- SingHealth Emergency Medicine Residency Programme, Singapore Health Services, Singapore; Emergency Medicine Academic Clinical Programme, Singhealth Duke-NUS, Singapore; Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore.
| | - Huili Zheng
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | - Deidre A De Silva
- National Neuroscience Institute, Singapore; Duke-NUS Medical School, Singapore
| | - Win Wah
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Yee H Pang
- National Neuroscience Institute, Singapore
| | - Zhenjia Xie
- School of Computing, National University of Singapore, Singapore
| | - Pin P Pek
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nan Liu
- Health Services Research Centre, Singapore Health Services, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Yih Y Ng
- Medical Department, Singapore Civil Defense Force, Singapore, Singapore; Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore
| | - Ting H Wong
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Ling L Foo
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | - Marcus E H Ong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore
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