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Hinton P, Villeneuve PJ, Galarneau E, Larsen K, Wen D, Meng J, Savic-Jovcic V, Zhang J, King WD. Ambient polycyclic aromatic hydrocarbon exposure and breast cancer risk in a population-based Canadian case-control study. Cancer Causes Control 2024; 35:1165-1180. [PMID: 38630334 PMCID: PMC11266283 DOI: 10.1007/s10552-024-01866-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/20/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE Polycyclic aromatic hydrocarbons (PAHs) represent a class of ubiquitous pollutants recognized as established human carcinogens and endocrine-disrupting chemicals. PAHs have seldom been modeled at the population-level in epidemiological studies. Fluoranthene is a prevalent PAH in urban settings and correlates with the occurrence of other PAHs. The purpose of this study was to evaluate associations between long-term residential exposure to ambient PAHs and breast cancer risk, both pre- and post-menopausal, in Canada. METHODS Using the National Enhanced Cancer Surveillance System (NECSS), a national-scale Canadian population-based case-control study, annual fluoranthene exposures were estimated using the GEM-MACH-PAH chemical transport model on the basis of geocoded residential histories throughout a 20-year exposure window. Odds ratios (ORs) and 95% confidence intervals (CIs) controlling for potential confounders were estimated using logistic regression. Separate analyses were conducted for Ontario and national samples given a finer-resolution exposure surface and additional risk factor information available for Ontario. RESULTS Positive associations were observed between fluoranthene exposure and premenopausal breast cancer, with inconsistent findings for postmenopausal breast cancer. For premenopausal breast cancer, adjusted ORs of 2.48 (95% CI: 1.29, 4.77) and 1.59 (95% CI: 1.11, 2.29) were observed when comparing the second highest category of exposure to the lowest, among the Ontario and national samples, respectively. For postmenopausal breast cancer, adjusted ORs were 1.10 (95% CI: 0.67, 1.80) and 1.33 (95% CI: 1.02, 1.73). Associations for the highest level of exposure, across both samples and menopausal strata, were non-significant. CONCLUSION This study provides support for the hypothesis that ambient PAH exposures increase the risk of premenopausal breast cancer.
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Affiliation(s)
- Patrick Hinton
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Elisabeth Galarneau
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Kristian Larsen
- Office of Environmental Health, Health Canada, Ottawa, ON, Canada
| | - Deyong Wen
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Jun Meng
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Verica Savic-Jovcic
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Junhua Zhang
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | - Will D King
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
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Flanagan E, Malmqvist E, Gustafsson S, Oudin A. Estimated public health benefits of a low-emission zone in Malmö, Sweden. ENVIRONMENTAL RESEARCH 2022; 214:114124. [PMID: 35998694 DOI: 10.1016/j.envres.2022.114124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/27/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Air pollution is one of the leading causes of morbidity and mortality worldwide. Low-emission zones (LEZ) have been increasingly implemented in cities throughout Europe as a measure to reduce the adverse health effects and premature deaths associated with traffic-related air pollution. In the present study, a health impact analysis was conducted to estimate the effect of a hypothetical LEZ on mortality and morbidity in Malmö, Sweden. Baseline health statistics were gathered from health registers and applied to each resident according to individual-level data on age and/or sex. Concentration-response parameters were derived from current epidemiological literature, specifically meta-analyses. A Gaussian dispersion model (AERMOD) combined with a detailed emission database was used to calculate NO2 emissions from traffic, which could be applied on an individual-level using data on each person's residential coordinates. The adjusted exposure scenario replaced all vehicles on municipal roads having Euro 5 or lower emission standards with Euro 6 equivalents. This LEZ would, on average, decrease NO2 concentrations by 13.4%, preventing an estimated 9-26 deaths in Malmö each year. Additionally, 12 respiratory disease hospitalizations, 8 childhood asthma cases, and 9 cases of hypertensive disorders of pregnancy were estimated to be avoided annually. These results suggest that LEZs can effectively improve air quality, reduce greenhouse gas emissions, and safeguard public health.
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Affiliation(s)
- Erin Flanagan
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 22242, Lund, Skåne, Sweden.
| | - Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 22242, Lund, Skåne, Sweden.
| | - Susanna Gustafsson
- Environmental Department of the City of Malmö, 21154, Malmö, Skåne, Sweden.
| | - Anna Oudin
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 22242, Lund, Skåne, Sweden; Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 90187, Umeå, Västerbotten, Sweden.
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3
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Balidemaj F, Flanagan E, Malmqvist E, Rittner R, Källén K, Åström DO, Oudin A. Prenatal Exposure to Locally Emitted Air Pollutants Is Associated with Birth Weight: An Administrative Cohort Study from Southern Sweden. TOXICS 2022; 10:toxics10070366. [PMID: 35878271 PMCID: PMC9318414 DOI: 10.3390/toxics10070366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 12/10/2022]
Abstract
While prenatal exposure to ambient air pollution has been shown to be associated with reduced birth weight, there is substantial heterogeneity across studies, and few epidemiological studies have utilized source-specific exposure data. The aim of the present study was, therefore, to investigate the associations between local, source-specific exposure to fine particulate matter (PM2.5) during pregnancy and birth weight. An administrative cohort comprising 40,245 singleton births from 2000 to 2009 in Scania, Sweden, was combined with data on relevant covariates. Investigated sources of PM2.5 included all local sources together as well as tailpipe exhaust, vehicle wear-and-tear, and small-scale residential heating separately. The relationships between these exposures, represented as interquartile range (IQR) increases, and birth weight (continuous) and low birth weight (LBW; <2500 g) were analyzed in crude and adjusted models. Each local PM2.5 source investigated was associated with reduced birth weight; average decreases varied by source (12−34 g). Only small-scale residential heating was clearly associated with LBW (adjusted odds ratio: 1.14 (95% confidence interval: 1.04−1.26) per IQR increase). These results add to existing evidence that prenatal exposure to ambient air pollution disrupts fetal growth and suggest that PM2.5 from both vehicles and small-scale residential heating may reduce birth weight.
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Affiliation(s)
- Festina Balidemaj
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 222 42 Lund, Sweden; (F.B.); (E.F.); (E.M.); (R.R.); (K.K.); (D.O.Å.)
| | - Erin Flanagan
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 222 42 Lund, Sweden; (F.B.); (E.F.); (E.M.); (R.R.); (K.K.); (D.O.Å.)
| | - Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 222 42 Lund, Sweden; (F.B.); (E.F.); (E.M.); (R.R.); (K.K.); (D.O.Å.)
| | - Ralf Rittner
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 222 42 Lund, Sweden; (F.B.); (E.F.); (E.M.); (R.R.); (K.K.); (D.O.Å.)
| | - Karin Källén
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 222 42 Lund, Sweden; (F.B.); (E.F.); (E.M.); (R.R.); (K.K.); (D.O.Å.)
| | - Daniel Oudin Åström
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 222 42 Lund, Sweden; (F.B.); (E.F.); (E.M.); (R.R.); (K.K.); (D.O.Å.)
- Sustainable Health, Department for Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Anna Oudin
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 222 42 Lund, Sweden; (F.B.); (E.F.); (E.M.); (R.R.); (K.K.); (D.O.Å.)
- Sustainable Health, Department for Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
- Correspondence:
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Mandakh Y, Oudin A, Erlandsson L, Isaxon C, Hansson SR, Broberg K, Malmqvist E. Association of Prenatal Ambient Air Pollution Exposure With Placental Mitochondrial DNA Copy Number, Telomere Length and Preeclampsia. FRONTIERS IN TOXICOLOGY 2022; 3:659407. [PMID: 35295138 PMCID: PMC8915808 DOI: 10.3389/ftox.2021.659407] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/19/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Studies have shown that ambient air pollution is linked to preeclampsia (PE), possibly via generation of oxidative stress in the placenta. Telomere length and mitochondrial DNA copy number (mtDNAcn) are sensitive to oxidative stress damage. Objective: To study the association between prenatal exposure to ambient nitrogen oxides (NOx, a marker for traffic-related air pollution), and PE, as well as potential mediation effects by placental telomere length and mtDNAcn. Methods: This is a cross-sectional study of 42 preeclamptic and 95 arbitrarily selected normotensive pregnant women with gestational ambient NOx exposure assessment in southern Scania, Sweden. Hourly concentrations of NOx were estimated at the residential addresses by a Gaussian-plume dispersion model with 100 × 100 m spatial resolutions and aggregated into trimester-specific mean concentrations. Placental relative mtDNAcn and telomere length were measured using qPCR. Linear and logistic regression models were used to investigate associations, adjusted for perinatal and seasonal characteristics. Results: Exposure was categorized into low and high exposures by median cut-offs during first [11.9 μg/m3; interquartile range (IQR) 7.9, 17.9], second (11.6 μg/m3; IQR: 7.1, 21.1), third trimesters (11.9 μg/m3; IQR: 7.7, 19.5) and entire pregnancy (12.0 μg/m3; IQR: 7.6, 20.1). Increased risk of PE was found for high prenatal NOx exposure during the first trimester (OR 4.0; 95% CI: 1.4, 11.1; p = 0.008), and entire pregnancy (OR 3.7; 95% CI: 1.3, 10.4; p = 0.012). High exposed group during the first trimester had lower placental relative mtDNAcn compared with low exposed group (-0.20; 95% CI: -0.36, -0.04; p = 0.01). Changes in relative mtDNAcn did not mediate the association between prenatal NOx exposure and PE. No statistically significant association was found between placental relative telomere length, prenatal NOx exposure and PE. Conclusion: In this region with relatively low levels of air pollution, ambient NOx exposure during the first trimester was associated with reduced placental relative mtDNAcn and an increased risk of PE. However, we did not find any evidence that mtDNAcn or TL mediated the association between air pollution and PE. Future research should further investigate the role of mtDNAcn for pregnancy complications in relation to exposure to ambient air pollution during pregnancy.
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Affiliation(s)
- Yumjirmaa Mandakh
- Environment Society and Health, Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Anna Oudin
- Environment Society and Health, Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.,Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lena Erlandsson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Christina Isaxon
- Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Lund, Sweden
| | - Stefan R Hansson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics & Gynaecology, Skåne University Hospital, Malmö, Sweden
| | - Karin Broberg
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Ebba Malmqvist
- Environment Society and Health, Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
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Rittner R, Flanagan E, Oudin A, Malmqvist E. Health Impacts from Ambient Particle Exposure in Southern Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145064. [PMID: 32674378 PMCID: PMC7400131 DOI: 10.3390/ijerph17145064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/31/2022]
Abstract
A health impact assessment (HIA) is an important tool for making informed decisions regarding the design and evaluation of environmental interventions. In this study, we performed a quantitative HIA for the population of Scania (1,247,993), the southernmost county in Sweden, in 2016. The impact of annual mean concentrations of particulate matter with an aerodynamic diameter <2.5 µm (PM2.5), modeled at their home residences for the year 2011, on mortality, asthma, dementia, autism spectrum disorders, preeclampsia and low birth weight (LBW) was explored. Concentration–response (C-R) functions were taken from epidemiological studies reporting meta-analyses when available, and otherwise from single epidemiological studies. The average level of PM2.5 experienced by the study population was 11.88 µg/m3. The PM2.5 exposure was estimated to cause 9–11% of cases of LBW and 6% of deaths from natural causes. Locally produced PM2.5 alone contributed to 2–9% of the cases of diseases and disorders investigated. Reducing concentrations to a maximum of 10 µg/m3 would, according to our estimations, reduce mortality by 3% and reduce cases of LBW by 2%. Further analyses of separate emission sources’ distinct effects were also presented. Reduction of air pollution levels in the study area would, as expected, have a substantial effect on both mortality and adverse health outcomes. Reductions should be aimed for by local authorities and on national and even international levels.
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Affiliation(s)
- Ralf Rittner
- Division of Occupational and Environmental Health, Lund University, 221 00 Lund, Sweden; (E.F.); (A.O.); (E.M.)
- Correspondence: ; Tel.: +46-4617-3189
| | - Erin Flanagan
- Division of Occupational and Environmental Health, Lund University, 221 00 Lund, Sweden; (E.F.); (A.O.); (E.M.)
| | - Anna Oudin
- Division of Occupational and Environmental Health, Lund University, 221 00 Lund, Sweden; (E.F.); (A.O.); (E.M.)
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Ebba Malmqvist
- Division of Occupational and Environmental Health, Lund University, 221 00 Lund, Sweden; (E.F.); (A.O.); (E.M.)
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Rittner R, Gustafsson S, Spanne M, Malmqvist E. Particle concentrations, dispersion modelling and evaluation in southern Sweden. SN APPLIED SCIENCES 2020. [DOI: 10.1007/s42452-020-2769-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AbstractHealth impact assessments of differential air pollution rely on epidemiologically established relationships between concentration levels where people are exposed and adverse health outcomes. To assess air pollution concentrations, land use regression is commonly used. However, an alternative tool is dispersion modelling, where a detailed inventory of pollution sources together with meteorological data drives calculations of compound dispersion. With this, both spatial and temporal variation can be assessed. In this study, we evaluated results of a Gaussian dispersion model applied to an emissions inventory for Scania, the southernmost county in Sweden. The dispersion considered was particulate matter of aerodynamic diameter < 10 µm (PM10), particulate matter of aerodynamic diameter < 2.5 µm (PM2.5) and black carbon (BC) during an 11-year period (2000–2011). Mean concentrations and 95th percentiles expressed in µg/m3 ranged from 10.1 to 12.6 and 16.6 to 20.7 for PM2.5 and from 14.0 to 18.8 and 22.6 to 27.0 for PM10, respectively. Seven monitoring stations were used for evaluation. Correlations (R2) ranged from 0.44 to 0.86 for PM2.5 (mean bias from − 9.0 to 0.1 µg/m3) and from 0.46 to 0.83 for PM10 (mean bias − 6.1 to 3.5 µg/m3). An evaluated database of PM and BC concentrations for Scania is now available for future exposure assessment projects. Calculations were based on a well-known dispersion model with detailed emission data as input. The evaluation showed correlation coefficients for PM in line with previous literature. The data on PM10, PM2.5 and BC concentrations will, therefore, be used in subsequent studies, epidemiological as well as health impact assessments.
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Oudin A, Frondelius K, Haglund N, Källén K, Forsberg B, Gustafsson P, Malmqvist E. Prenatal exposure to air pollution as a potential risk factor for autism and ADHD. ENVIRONMENT INTERNATIONAL 2019; 133:105149. [PMID: 31629172 DOI: 10.1016/j.envint.2019.105149] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 08/20/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
Genetic and environmental factors both contribute to the development of Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). One suggested environmental risk factor for ASD and ADHD is air pollution, but knowledge of its effects, especially in low-exposure areas, are limited. Here, we investigate risks for ASD and ADHD associated with prenatal exposure to air pollution in an area with air pollution levels generally well below World Health Organization (WHO) air quality guidelines. We used an epidemiological database (MAPSS) consisting of virtually all (99%) children born between 1999 and 2009 (48,571 births) in the study area, in southern Sweden. MAPSS consists of data on modelled nitrogen oxide (NOx) levels derived from a Gaussian dispersion model; maternal residency during pregnancy; perinatal factors collected from a regional birth registry; and socio-economic factors extracted from Statistics Sweden. All ASD and ADHD diagnoses in our data were undertaken at the Malmö and Lund Departments of Child and Adolescent Psychiatry, using standardized diagnostic instruments. We used logistic regression analyses to obtain estimates of the risk of developing ASD and ADHD associated with different air pollution levels, with adjustments for potential perinatal and socio-economic confounders. In this longitudinal cohort study, we found associations between air pollution exposure during the prenatal period and and the risk of developing ASD. For example, an adjusted Odds Ratio (OR) of 1.40 and its 95% Confidence Interval (CI) (95% CI: 1.02-1.93) were found when comparing the fourth with the first quartile of NOx exposure. We did not find similar associations on the risk of developing ADHD. This study contributes to the growing evidence of a link between prenatal exposure to air pollution and autism spectrum disorders, suggesting that prenatal exposure even below current WHO air quality guidelines may increase the risk of autism spectrum disorders.
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Affiliation(s)
- Anna Oudin
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden; Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Kasper Frondelius
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden
| | - Nils Haglund
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Sweden
| | - Karin Källén
- Centre of Reproduction Epidemiology, Tornblad Institute, Department of Clinical Sciences, Lund University, Sweden
| | - Bertil Forsberg
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Peik Gustafsson
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Sweden
| | - Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
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Frondelius K, Oudin A, Malmqvist E. Traffic-Related Air Pollution and Child BMI-A Study of Prenatal Exposure to Nitrogen Oxides and Body Mass Index in Children at the Age of Four Years in Malmö, Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102294. [PMID: 30347657 PMCID: PMC6210059 DOI: 10.3390/ijerph15102294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/28/2018] [Accepted: 10/16/2018] [Indexed: 12/21/2022]
Abstract
Traffic-related air pollution could be a danger to the health of children. Earlier studies have linked prenatal exposure to an increased risk of a range of diseases and negative health outcomes, including overweight and obesity. Presently, a knowledge gap exists in investigating the risk of overweight and obesity among children exposed to lower levels of air pollution in utero. This study aimed to investigate the relationship between prenatal traffic-related air pollution (nitrogen dioxides (NOx) and traffic density) and childhood overweight and obesity in Malmö, Sweden. A cohort, based on attendance of a four-year check-up examination at Swedish Child Health Care (CHC) centers, and a parent-assessed questionnaire provided data on body-mass index adjusted for four-year-old children (ISO-BMI) as well as socioeconomic and health variables. We estimated exposure by using traffic density and levels of NOx at the maternal geocoded residential level. Analysis of 5815 children was performed using binary logistic regression models. This study showed no associations of increased risk for childhood overweight or obesity through to prenatal exposure to NOx in this low-exposure setting. We further suggest analysis of risks related to exposure levels ranging between the ones presented here and those proposed in previous literature.
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Affiliation(s)
- Kasper Frondelius
- Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, 221 85 Lund, Sweden.
| | - Anna Oudin
- Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, 221 85 Lund, Sweden.
| | - Ebba Malmqvist
- Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, 221 85 Lund, Sweden.
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Malmqvist E, Lisberg Jensen E, Westerberg K, Stroh E, Rittner R, Gustafsson S, Spanne M, Nilsson H, Oudin A. Estimated health benefits of exhaust free transport in the city of Malmö, Southern Sweden. ENVIRONMENT INTERNATIONAL 2018; 118:78-85. [PMID: 29807292 DOI: 10.1016/j.envint.2018.05.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/16/2018] [Accepted: 05/16/2018] [Indexed: 06/08/2023]
Abstract
Air pollution is responsible for one in eight premature deaths worldwide, and thereby a major threat to human health. Health impact assessments of hypothetic changes in air pollution concentrations can be used as a mean of assessing the health impacts of policy, plans and projects, and support decision-makers in choices to prevent disease. The aim of this study was to estimate health impacts attributable to a hypothetical decrease in air pollution concentrations in the city of Malmö in Southern Sweden corresponding to a policy on-road transportations without tail-pipe emissions in the municipality. We used air pollution data modelled for each of the 326,092 inhabitants in Malmö by a Gaussian dispersion model combined with an emission database with >40,000 sources. The dispersion model calculates Nitrogen Oxides (NOx) (later transformed into Nitrogen Dioxide (NO2)) and particulate matter with an aerodynamic diameter < 2.5 μg/m3 (PM2.5) with high spatial and temporal resolution (85 m and 1 h, respectively). The average individual reduction was 5.1 (ranging from 0.6 to 11.8) μg/m3 in NO2, which would prevent 55 (2% of all deaths) to 93 (4%) deaths annually, depending on dose-response function used. Furthermore, we estimate that the NO2 reduction would result in 21 (6%) fewer cases of incident asthma in children, 95 (10%) fewer children with bronchitis every year, 30 (1%) fewer hospital admissions for respiratory disease, 87(4%) fewer dementia cases, and 11(11%) fewer cases of preeclampsia every year. The average reduction in PM2.5 of 0.6 (ranging from 0.1 till 1.7) μg/m3 would mean that 2729 (0.3%) work days would not be lost due to sick-days and that there would be 16,472 fewer restricted activity days (0.3%) that year had all on-road transportations been without tail-pipe emissions. Even though the estimates are sensitive to the dose-response functions used and to exposure misclassification errors, even the most conservative estimate of the number of prevented deaths is 7 times larger than the annual traffic fatalities in Malmö, indicating a substantial possibility to reduce the health burden attributed to tail-pipe emissions in the study area.
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Affiliation(s)
- Ebba Malmqvist
- Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Sweden
| | | | | | - Emilie Stroh
- Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Sweden
| | - Ralf Rittner
- Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Sweden
| | | | - Mårten Spanne
- Environmental Department of the City of Malmö, Sweden
| | | | - Anna Oudin
- Occupational and Environmental Medicine, Department for Laboratory Medicine, Lund University, Sweden; Occupational and Environmental Medicine, Dept. Public Health and Clinical Medicine, Umeå University, Sweden.
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Hazlehurst MF, Spalt EW, Nicholas TP, Curl CL, Davey ME, Burke GL, Watson KE, Vedal S, Kaufman JD. Contribution of the in-vehicle microenvironment to individual ambient-source nitrogen dioxide exposure: the Multi-Ethnic Study of Atherosclerosis and Air Pollution. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2018; 28:371-380. [PMID: 29511286 PMCID: PMC6013355 DOI: 10.1038/s41370-018-0025-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/12/2017] [Accepted: 12/17/2017] [Indexed: 05/31/2023]
Abstract
Exposure estimates that do not account for time in-transit may underestimate exposure to traffic-related air pollution, but exact contributions have not been studied directly. We conducted a 2-week monitoring, including novel in-vehicle sampling, in a subset of the Multi-Ethnic Study of Atherosclerosis and Air Pollution cohort in two cities. Participants spent the majority of their time indoors and only 4.4% of their time (63 min/day) in-vehicle, on average. The mean ambient-source NO2 concentration was 5.1 ppb indoors and 32.3 ppb in-vehicle during drives. On average, indoor exposure contributed 69% and in-vehicle exposure contributed 24% of participants' ambient-source NO2 exposure. For participants in the highest quartile of time in-vehicle (≥1.3 h/day), indoor and in-vehicle contributions were 60 and 31%, respectively. Incorporating infiltrated indoor and measured in-vehicle NO2 produced exposure estimates 5.6 ppb lower, on average, than using only outdoor concentrations. The indoor microenvironment accounted for the largest proportion of ambient-source exposure in this older population, despite higher concentrations of NO2 outdoors and in vehicles than indoors. In-vehicle exposure was more influential among participants who drove the most and for participants residing in areas with lower outdoor air pollution. Failure to characterize exposures in these microenvironments may contribute to exposure misclassification in epidemiologic studies.
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Affiliation(s)
- Marnie F Hazlehurst
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Elizabeth W Spalt
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Tyler P Nicholas
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Cynthia L Curl
- Department of Community and Environmental Health, Boise State University, Boise, ID, USA
| | - Mark E Davey
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Karol E Watson
- Department of Medicine/Cardiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sverre Vedal
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
- Department of Medicine, University of Washington, Seattle, WA, USA.
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
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Salmón P, Stroh E, Herrera-Dueñas A, von Post M, Isaksson C. Oxidative stress in birds along a NO x and urbanisation gradient: An interspecific approach. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 622-623:635-643. [PMID: 29223087 DOI: 10.1016/j.scitotenv.2017.11.354] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 06/07/2023]
Abstract
Urbanisation is regarded as one of the most threatening global issues for wildlife, however, measuring its impact is not always straight forward. Oxidative stress physiology has been suggested to be a useful biomarker of health and therefore, a potentially important indicator of the impact that urban environmental stressors, especially air pollution, can have on wildlife. For example, nitrogen oxides (NOx), released during incomplete combustion of fossil fuels, are highly potent pro-oxidants, thus predicted to affect either the protective antioxidants and/or cause oxidative damage to bio-molecules. To date, epidemiological modelling of the predicted association between oxidative stress and NOx exposure has not been performed in wild animals. Here, we address this short-coming, by investigating multiple oxidative stress markers in four common passerine bird species, the blue tit (Cyanistes caeruleus), great tit (Parus major), house sparrow (Passer domesticus) and tree sparrow (Passer montanus), living along a gradient of NOx and urbanisation levels in southern Sweden. First of all, the results revealed that long- and medium-term (one month and one week, respectively) NOx levels were highly correlated with the level of urbanisation. This confirms that the commonly used urbanisation index is a reliable proxy for urban air pollution. Furthermore, in accordance to our prediction, individuals exposed to higher long- and medium-term NOx levels/urbanisation had higher plasma antioxidant capacity. However, only tree sparrows showed higher oxidative damage (protein carbonyls) in relation to NOx levels and this association was absent with urbanisation. Lipid peroxidation, glutathione and superoxide dismutase levels did not co-vary with NOx/urbanisation. Given that most oxidative stress biomarkers showed strong species-specificity, independent of variation in NOx/urbanisation, the present study highlights the need to study variation in oxidative stress across contexts, seasons and life-stages in order to understand how the ecology and phylogeny of species interact to affect species resilience to urban environmental stress.
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Affiliation(s)
- Pablo Salmón
- Evolutionary Ecology, Department of Biology, Lund University, Ecology Building, Lund, Sweden.
| | - Emilie Stroh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden
| | - Amparo Herrera-Dueñas
- Evolutionary Ecology, Department of Biology, Lund University, Ecology Building, Lund, Sweden; Evolution and Conservation Biology, Department of Biodiversity, Ecology and Evolution, Faculty of Biology, Complutense University of Madrid, Madrid, Spain
| | - Maria von Post
- Evolutionary Ecology, Department of Biology, Lund University, Ecology Building, Lund, Sweden
| | - Caroline Isaksson
- Evolutionary Ecology, Department of Biology, Lund University, Ecology Building, Lund, Sweden
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12
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Oudin A, Åström DO, Asplund P, Steingrimsson S, Szabo Z, Carlsen HK. The association between daily concentrations of air pollution and visits to a psychiatric emergency unit: a case-crossover study. Environ Health 2018; 17:4. [PMID: 29321054 PMCID: PMC5763570 DOI: 10.1186/s12940-017-0348-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/12/2017] [Indexed: 05/23/2023]
Abstract
BACKGROUND Air pollution is one of the leading causes of mortality and morbidity worldwide. Experimental studies, and a few epidemiological studies, suggest that air pollution may cause acute exacerbation of psychiatric disorders, and even increase the rate of suicide attempts, but epidemiological studies on air pollution in association with psychiatric disorders are still few. Our aim was to investigate associations between daily fluctuations in air pollution concentrations and the daily number of visits to a psychiatric emergency unit. METHODS Data from Sahlgrenska University Hospital, Gothenburg, Sweden, on the daily number of visits to the Psychiatric emergency unit were combined with daily data on monitored concentrations of respirable particulate matter(PM10), ozone(O3), nitrogen dioxides(NO2) and temperature between 1st July 2012 and 31st December 2016. We used a case-crossover design to analyze data with conditional Poisson regression models allowing for over-dispersion. We stratified data on season. RESULTS Visits increased with increasing PM10 levels during the warmer season (April to September) in both single-pollutant and two-pollutant models. For example, an increase of 3.6% (95% Confidence Interval, CI, 0.4-7.0%) was observed with a 10 μg/m3 increase in PM10 adjusted for NO2. In the three-pollutant models (adjusting for NO2 and O3 simultaneously) the increase was 3.3% (95% CI, -0.2-6.9). There were no clear associations between the outcome and NO2, O3, or PM10 during the colder season (October to March). CONCLUSIONS Ambient air particle concentrations were associated with the number of visits to the Psychiatric emergency unit in the warm season. The results were only borderline statistically significant in the fully adjusted (three-pollutant) models in this small study. The observation could be interpreted as indicative of air pollution as either exacerbating an underlying psychiatric disorder, or increasing mental distress, even in areas with comparatively low levels of air pollution. In combination with the severe impact of psychiatric disorders and mental distress on society and individuals, our results are a strong warrant for future research in this area.
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Affiliation(s)
- Anna Oudin
- Occupational and Environmental Medicine, Lund University, Medicon Village, Byggnad 402A, Scheelevägen 2, 223 63 Lund, Sweden
- Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Daniel Oudin Åström
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Peter Asplund
- Psykiatri Affektiva, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Steinn Steingrimsson
- Psykiatri Affektiva, Sahlgrenska University Hospital, Gothenburg, Sweden
- CELAM - Centre for Ethics, Law and Mental Health, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zoltan Szabo
- Psykiatri Affektiva, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanne Krage Carlsen
- Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
- Psykiatri Affektiva, Sahlgrenska University Hospital, Gothenburg, Sweden
- Environment and Natural Resources, University of Iceland, Reykjavík, Iceland
- Occupational and Environmental Medicine, Gothenburg University, Gothenburg, Sweden
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13
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Oudin A, Bråbäck L, Oudin Åström D, Forsberg B. Air Pollution and Dispensed Medications for Asthma, and Possible Effect Modifiers Related to Mental Health and Socio-Economy: A Longitudinal Cohort Study of Swedish Children and Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111392. [PMID: 29144419 PMCID: PMC5708031 DOI: 10.3390/ijerph14111392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 12/30/2022]
Abstract
It has been suggested that children that are exposed to a stressful environment at home have an increased susceptibility for air pollution-related asthma. The aim here was to investigate the association between air pollution exposure and asthma, and effect modification by mental health and by socio-economic status (as markers of a stressful environment). All individuals under 18 years of age in four Swedish counties during 2007 to 2010 (1.2 million people) were included. The outcome was defined as dispensing at least two asthma medications during follow up. We linked data on NO2 from an empirical land use regression to data from national registers on outcome and potential confounders. Data was analyzed with logistic regression. There was an odds ratio (OR) of 1.02 (95% Confidence Interval (CI: 1.01–1.03) for asthma associated with a 10 µg·m−3 increase in NO2. The association only seemed to be present in areas where NO2 was higher than 15 µg·m−3 with an OR of 1.09 (95% CI: 1.07–1.12), and the association seemed stronger in children with parents with a high education, OR = 1.05 (95% CI: 1.02–1.09) and OR = 1.04 (95% CI: 1.01–1.07) in children to mothers and father with a high education, respectively. The association did not seem to depend on medication history of psychiatric disorders. There was weak evidence for the association between air pollution and asthma to be stronger in neighborhoods with higher education levels. In conclusion, air pollution was associated with dispensed asthma medications, especially in areas with comparatively higher levels of air pollution, and in children to parents with high education. We did not observe support for our hypothesis that stressors linked to socio-economy or mental health problems would increase susceptibility to the effects of air pollution on the development of asthma.
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Affiliation(s)
- Anna Oudin
- Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Lennart Bråbäck
- Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Daniel Oudin Åström
- Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
| | - Bertil Forsberg
- Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
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Khreis H, Nieuwenhuijsen MJ. Traffic-Related Air Pollution and Childhood Asthma: Recent Advances and Remaining Gaps in the Exposure Assessment Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030312. [PMID: 28304360 PMCID: PMC5369148 DOI: 10.3390/ijerph14030312] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/09/2017] [Accepted: 03/15/2017] [Indexed: 12/26/2022]
Abstract
Background: Current levels of traffic-related air pollution (TRAP) are associated with the development of childhood asthma, although some inconsistencies and heterogeneity remain. An important part of the uncertainty in studies of TRAP-associated asthma originates from uncertainties in the TRAP exposure assessment and assignment methods. In this work, we aim to systematically review the exposure assessment methods used in the epidemiology of TRAP and childhood asthma, highlight recent advances, remaining research gaps and make suggestions for further research. Methods: We systematically reviewed epidemiological studies published up until 8 September 2016 and available in Embase, Ovid MEDLINE (R), and “Transport database”. We included studies which examined the association between children’s exposure to TRAP metrics and their risk of “asthma” incidence or lifetime prevalence, from birth to the age of 18 years old. Results: We found 42 studies which examined the associations between TRAP and subsequent childhood asthma incidence or lifetime prevalence, published since 1999. Land-use regression modelling was the most commonly used method and nitrogen dioxide (NO2) was the most commonly used pollutant in the exposure assessments. Most studies estimated TRAP exposure at the residential address and only a few considered the participants’ mobility. TRAP exposure was mostly assessed at the birth year and only a few studies considered different and/or multiple exposure time windows. We recommend that further work is needed including e.g., the use of new exposure metrics such as the composition of particulate matter, oxidative potential and ultra-fine particles, improved modelling e.g., by combining different exposure assessment models, including mobility of the participants, and systematically investigating different exposure time windows. Conclusions: Although our previous meta-analysis found statistically significant associations for various TRAP exposures and subsequent childhood asthma, further refinement of the exposure assessment may improve the risk estimates, and shed light on critical exposure time windows, putative agents, underlying mechanisms and drivers of heterogeneity.
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Affiliation(s)
- Haneen Khreis
- Centre for Research in Environmental Epidemiology (CREAL), ISGlobal, 08003 Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
- Institute for Transport Studies, University of Leeds, LS2 9JT Leeds, UK.
| | - Mark J Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), ISGlobal, 08003 Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
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15
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Malmqvist E, Liew Z, Källén K, Rignell-Hydbom A, Rittner R, Rylander L, Ritz B. Fetal growth and air pollution - A study on ultrasound and birth measures. ENVIRONMENTAL RESEARCH 2017; 152:73-80. [PMID: 27741452 DOI: 10.1016/j.envres.2016.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/05/2016] [Accepted: 09/20/2016] [Indexed: 05/04/2023]
Abstract
Air pollution has been suggested to affect fetal growth, but more data is needed to assess the timing of exposure effects by using ultrasound measures. It is also important to study effects in low exposure areas to assess eventual thresholds of effects. The MAPSS (Maternal Air Pollution in Southern Sweden) cohort consists of linked registry data for around 48,000 pregnancies from an ultrasound database, birth registry and exposure data based on residential addresses. Measures of air pollution exposure were obtained through dispersion modelling with input data from an emissions database (NOx) with high resolution (100-500m grids). Air pollution effects were assessed with linear regressions for the following endpoints; biparietal diameter, femur length, abdominal diameter and estimated fetal weight measured in late pregnancy and birth weight and head circumference measured at birth. We estimated negative effects for NOx; in the adjusted analyses the decrease of abdominal diameter and femur length were -0.10 (-0.17, -0.03) and -0.13 (-0.17, -0.01)mm, respectively, per 10µg/m3 increment of NOx. We also estimated an effect of NOx-exposures on birth weight by reducing birth weight by 9g per 10µg/m3 increment of NOx. We estimated small but statistically significant effects of air pollution on late fetal and birth size and reduced fetal growth late in pregnancy in a geographic area with levels below current WHO air quality guidelines.
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Affiliation(s)
- Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Lund University, Sweden.
| | - Zeyan Liew
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, CA, USA
| | - Karin Källén
- Division of Occupational and Environmental Medicine, Lund University, Sweden
| | - Anna Rignell-Hydbom
- Division of Occupational and Environmental Medicine, Lund University, Sweden
| | - Ralf Rittner
- Division of Occupational and Environmental Medicine, Lund University, Sweden
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Lund University, Sweden
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, CA, USA
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16
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Short-Term Fluctuations in Air Pollution and Asthma in Scania, Sweden. Is the Association Modified by Long-Term Concentrations? PLoS One 2016; 11:e0166614. [PMID: 27861543 PMCID: PMC5115756 DOI: 10.1371/journal.pone.0166614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/01/2016] [Indexed: 11/19/2022] Open
Abstract
Background and aims Asthma is one of the most common respiratory diseases in the world. Research has shown that temporal increases in air pollution concentrations can aggravate asthma symptoms. The aim of this study was to assess whether individuals living in areas with higher air pollution concentrations responded differently to short-term temporal exposure to air pollution than those living in lower air pollution areas. Method The study was designed as a case-crossover study in Scania, Sweden. Outcome data was visits to primary health care clinics with asthma as the main complaint during the years 2007 to 2010. Nitrogen dioxide levels were obtained from 21 different air pollution monitoring stations. Short-term exposure was defined as the average concentration four days prior to the visit. Data was pooled for areas above and below a two-year average NO2 concentration of 10 μg/m3, dispersion modelled with an emission database. Results The short-term association between NO2 and asthma visits seemed stronger in areas with NO2 levels below 10 μg/m3, with an odds ratio (OR) of 1.15 (95% confidence interval (CI): 1.08–1.23) associated with a 10 μg/m3 increase in NO2 compared to areas above 10 μg/m3 NO2 levels, where corresponding OR of 1.09 (95% CI: 1.02–1.17). However, this difference was not statistically significant. (p = 0.13) Conclusions The study provided some evidence, although not statistically significant, that short-term associations between air pollution and asthma may depend on background air pollution levels. However, we cannot rule out that the association is due to other spatially dependent factors in Scania. The study should be reproduced in other study areas.
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17
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Oudin A, Bråbäck L, Åström DO, Strömgren M, Forsberg B. Association between neighbourhood air pollution concentrations and dispensed medication for psychiatric disorders in a large longitudinal cohort of Swedish children and adolescents. BMJ Open 2016; 6:e010004. [PMID: 27259522 PMCID: PMC4893847 DOI: 10.1136/bmjopen-2015-010004] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To investigate associations between exposure to air pollution and child and adolescent mental health. DESIGN Observational study. SETTING Swedish National Register data on dispensed medications for a broad range of psychiatric disorders, including sedative medications, sleeping pills and antipsychotic medications, together with socioeconomic and demographic data and a national land use regression model for air pollution concentrations for NO2, PM10 and PM2.5. PARTICIPANTS The entire population under 18 years of age in 4 major counties. We excluded cohort members whose parents had dispensed a medication in the same medication group since the start date of the register. The cohort size was 552 221. MAIN OUTCOME MEASURES Cox proportional hazards models to estimate HRs and their 95% CIs for the outcomes, adjusted for individual-level and group-level characteristics. RESULTS The average length of follow-up was 3.5 years, with an average number of events per 1000 cohort members of ∼21. The mean annual level of NO2 was 9.8 µg/m(3). Children and adolescents living in areas with higher air pollution concentrations were more likely to have a dispensed medication for a psychiatric disorder during follow-up (HR=1.09, 95% CI 1.06 to 1.12, associated with a 10 µg/m(3) increase in NO2). The association with NO2 was clearly present in 3 out of 4 counties in the study area; however, no statistically significant heterogeneity was detected. CONCLUSION There may be a link between exposure to air pollution and dispensed medications for certain psychiatric disorders in children and adolescents even at the relatively low levels of air pollution in the study regions. The findings should be corroborated by others.
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Affiliation(s)
- Anna Oudin
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Lennart Bråbäck
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Daniel Oudin Åström
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Magnus Strömgren
- Department of Geography and Economic History, Umeå University, Umeå, Sweden
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
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18
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Lindgren A, Stroh E, Jakobsson K. Ever dispense of prescribed allergy medication in children growing up close to traffic: a registry-based birth cohort. BMC Public Health 2015; 15:1023. [PMID: 26444543 PMCID: PMC4595113 DOI: 10.1186/s12889-015-2356-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background Epidemiologic studies have shown conflicting results regarding the role of traffic pollution in the development of allergic disease. This study investigated the relationship between living close to traffic and ever dispense of prescribed oral antihistamines or nasal anti-allergic medication, among young children. The underlying aim was to investigate if children growing up close to traffic pollution are at higher risk of developing allergy in early childhood. Methods We investigated a birth cohort in southern Sweden, consisting of N = 26 128 children (0–6 years) with health outcome and exposure data. Of these children, N = 7898, had additional covariate information. Traffic intensity and yearly averages of dispersion-modeled concentrations of NOX (100 × 100 m grid) at residential addresses, were linked with registry data on dispensed allergy medication (the Swedish Prescribed Drug Register). Individual level covariate information was obtained from questionnaires distributed to parents at Child Health Care-center visits, eight months after birth. Cox proportional hazards regression was used for the statistical analyses. Results Living in close proximity to a road with equal to or greater than 8640 cars/day (compared to 0–8639 cars/day), was not associated with higher incidence of ever dispensed oral antihistamine or nasal anti-allergic medication, with or without adjustment for confounders (sex, breastfeeding, parental allergy, parental origin, season, and year of birth). Similar results were found in relation to NOX. Conclusions Traffic-related exposure was not associated with higher incidence of ever dispensed medication against allergy, in children 0–6 years in southern Sweden. These results indicates that traffic-related exposure may not be a risk factor for early onset allergy in children in southern Sweden. However, children with dispense of prescribed allergy medication may be a selected subgroup, and the results for this group may not be generalizable to all children with allergy. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2356-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Lindgren
- Division of Occupational and Environmental Medicine, Lund University, SE-221 85, Lund, Sweden.
| | - Emilie Stroh
- Division of Occupational and Environmental Medicine, Lund University, SE-221 85, Lund, Sweden.
| | - Kristina Jakobsson
- Division of Occupational and Environmental Medicine, Lund University, SE-221 85, Lund, Sweden.
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19
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Malmqvist E, Larsson HE, Jönsson I, Rignell-Hydbom A, Ivarsson SA, Tinnerberg H, Stroh E, Rittner R, Jakobsson K, Swietlicki E, Rylander L. Maternal exposure to air pollution and type 1 diabetes--Accounting for genetic factors. ENVIRONMENTAL RESEARCH 2015; 140:268-74. [PMID: 25880886 DOI: 10.1016/j.envres.2015.03.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/20/2015] [Accepted: 03/25/2015] [Indexed: 05/04/2023]
Abstract
BACKGROUND Genetic and non-genetic factors probably act together to initiate and accelerate development of type 1 diabetes [T1D]. One suggested risk factor contributing to development of T1D is air pollution. OBJECTIVE The aim of the study was to investigate whether maternal exposure during pregnancy to air pollution, measured as nitrogen oxides [NOx] and ozone, in a low-dose exposure area was associated with the child developing T1D. METHOD In Scania (Skåne), the most southern county in Sweden, 84,039 infants were born during the period 1999-2005. By the end of April 2013, 324 of those children had been diagnosed with T1D. For each of those T1D children three control children were randomly selected and matched for HLA genotype and birth year. Individually modelled exposure data at residence during pregnancy were assessed for nitrogen oxides [NOx], traffic density and ozone. RESULTS Ozone as well as NOx exposures were associated with T1D. When the highest exposure group was compared to the lowest group an odds ratios of 1.62 (95% confidence interval [CI] 0.99-2.65) was observed for ozone in the second trimester and 1.58 (95% CI 1.06-2.35) for NOx in the third trimester. CONCLUSION This study indicates that living in an area with elevated levels of air pollution during pregnancy may be a risk factor for offspring T1D.
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Affiliation(s)
- Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Lund University, SE-221 85 Lund, Sweden.
| | - Helena Elding Larsson
- Department of Clinical Sciences-Paediatrics, University Hospital MAS, SE-205 02 Malmö, Sweden
| | - Ida Jönsson
- Department of Clinical Sciences-Paediatrics, University Hospital MAS, SE-205 02 Malmö, Sweden
| | - Anna Rignell-Hydbom
- Division of Occupational and Environmental Medicine, Lund University, SE-221 85 Lund, Sweden
| | - Sten-Anders Ivarsson
- Department of Clinical Sciences-Paediatrics, University Hospital MAS, SE-205 02 Malmö, Sweden
| | - Håkan Tinnerberg
- Division of Occupational and Environmental Medicine, Lund University, SE-221 85 Lund, Sweden
| | - Emilie Stroh
- Division of Occupational and Environmental Medicine, Lund University, SE-221 85 Lund, Sweden
| | - Ralf Rittner
- Division of Occupational and Environmental Medicine, Lund University, SE-221 85 Lund, Sweden
| | - Kristina Jakobsson
- Division of Occupational and Environmental Medicine, Lund University, SE-221 85 Lund, Sweden
| | - Erik Swietlicki
- Division of Nuclear Physics, Lund University, SE-221 85 Lund, Sweden
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Lund University, SE-221 85 Lund, Sweden
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20
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Lemke LD, Lamerato LE, Xu X, Booza JC, Reiners JJ, Raymond III DM, Villeneuve PJ, Lavigne E, Larkin D, Krouse HJ. Geospatial relationships of air pollution and acute asthma events across the Detroit-Windsor international border: study design and preliminary results. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2014; 24:346-357. [PMID: 24220215 PMCID: PMC4063324 DOI: 10.1038/jes.2013.78] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 07/30/2013] [Accepted: 09/11/2013] [Indexed: 05/31/2023]
Abstract
The Geospatial Determinants of Health Outcomes Consortium (GeoDHOC) study investigated ambient air quality across the international border between Detroit, Michigan, USA and Windsor, Ontario, Canada and its association with acute asthma events in 5- to 89-year-old residents of these cities. NO2, SO2, and volatile organic compounds (VOCs) were measured at 100 sites, and particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) at 50 sites during two 2-week sampling periods in 2008 and 2009. Acute asthma event rates across neighborhoods in each city were calculated using emergency room visits and hospitalizations and standardized to the overall age and gender distribution of the population in the two cities combined. Results demonstrate that intra-urban air quality variations are related to adverse respiratory events in both cities. Annual 2008 asthma rates exhibited statistically significant positive correlations with total VOCs and total benzene, toluene, ethylbenzene and xylene (BTEX) at 5-digit zip code scale spatial resolution in Detroit. In Windsor, NO2, VOCs, and PM10 concentrations correlated positively with 2008 asthma rates at a similar 3-digit postal forward sortation area scale. The study is limited by its coarse temporal resolution (comparing relatively short term air quality measurements to annual asthma health data) and interpretation of findings is complicated by contrasts in population demographics and health-care delivery systems in Detroit and Windsor.
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Affiliation(s)
- Lawrence D Lemke
- Department of Geology, Wayne State University, Detroit, Michigan, USA
| | - Lois E Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Xiaohong Xu
- Department of Civil and Environmental Engineering, University of Windsor, Windsor, Ontario, Canada
| | - Jason C Booza
- Department of Academic and Student Programs, Wayne State University, Detroit, Michigan, USA
| | - John J Reiners
- Institute of Environmental Health Sciences, Wayne State University, Detroit, Michigan, USA
| | | | - Paul J Villeneuve
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eric Lavigne
- Environmental Issues Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Dana Larkin
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Helene J Krouse
- College of Nursing, Wayne State University, Detroit, Michigan, USA
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21
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Lindgren A, Stroh E, Björk J, Jakobsson K. Asthma incidence in children growing up close to traffic: a registry-based birth cohort. Environ Health 2013; 12:91. [PMID: 24160449 PMCID: PMC4016196 DOI: 10.1186/1476-069x-12-91] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/23/2013] [Indexed: 05/25/2023]
Abstract
BACKGROUND Recent reviews conclude an association between traffic-related pollution and incidence of asthma in children, but not all studies agree. Studies have almost exclusively relied on parental-reported symptoms or parental-reported diagnoses of asthma and wheeze. Our aim was to investigate if traffic exposure is associated with higher incidence of early onset asthma, using registry-based outcome data. METHODS We investigated a birth cohort in southern Sweden, consisting of N = 26,128 children with outcome and exposure data (born July 2005-2010). Of these children, N = 7898 had additional covariate information. The cohort was followed to the end of 2011.Traffic intensity, and dispersion-modeled concentrations of NOX (100×100 m grid), at residential addresses, were linked with registry data on dispensed asthma medication (the Swedish Prescribed Drug Register), and hospital and primary health care diagnoses of bronchiolitis, obstructive bronchitis and asthma (The Scania Health Care Register).Covariate information was obtained from questionnaires distributed to parents at Child Health Care-centre visits, eight months after birth. Cox proportional hazards regression was used for the statistical analyses. RESULTS Living in close proximity to a road with ≥8640 cars/day (compared to 0-8640 cars/day), was not associated with higher incidence of first purchase of inhaled β2-agonist (adjusted hazard ratio (adj.HR) = 0.9, 95% CI: 0.8-1.0); third year purchase of inhaled β2-agonist (adj.HR = 0.7, 95% CI: 0.6-0.9); bronchiolitis (adj.HR = 0.7, 95% CI: 0.6-0.9), obstructive bronchitis (adj.HR = 1.0, 95% CI: 0.9-1.2), or asthma (adj.HR = 0.7, 95% CI: 0.6- 0.9). Similar results were found for inhaled corticosteroids, and in relation to NOX. CONCLUSIONS Traffic-related exposure was not associated with higher incidence of asthma medication, or diagnoses of asthma, bronchiolitis, or obstructive bronchitis, in children 0-6 years in southern Sweden. This may depend on the low levels of traffic pollution in the area, mainly well below the WHO-guideline for NO2.
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Affiliation(s)
- Anna Lindgren
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Emilie Stroh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Kristina Jakobsson
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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Malmqvist E, Jakobsson K, Tinnerberg H, Rignell-Hydbom A, Rylander L. Gestational diabetes and preeclampsia in association with air pollution at levels below current air quality guidelines. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:488-93. [PMID: 23563048 PMCID: PMC3620758 DOI: 10.1289/ehp.1205736] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 01/15/2013] [Indexed: 05/20/2023]
Abstract
BACKGROUND Several studies have estimated associations between air pollution and birth outcomes, but few have evaluated potential effects on pregnancy complications. OBJECTIVE We investigated whether low-level exposure to air pollution is associated with gestational diabetes and preeclampsia. METHODS High-quality registry information on 81,110 singleton pregnancy outcomes in southern Sweden during 1999-2005 was linked to individual-level exposure estimates with high spatial resolution. Modeled exposure to nitrogen oxides (NOx), expressed as mean concentrations per trimester, and proximity to roads of different traffic densities were used as proxy indicators of exposure to combustion-related air pollution. The data were analyzed by logistic regression, with and without adjusting for potential confounders. RESULTS The prevalence of gestational diabetes increased with each NOx quartile, with an adjusted odds ratio (OR) of 1.69 (95% CI: 1.41, 2.03) for the highest (> 22.7 µg/m3) compared with the lowest quartile (2.5-8.9 µg/m3) of exposure during the second trimester. The adjusted OR for acquiring preeclampsia after exposure during the third trimester was 1.51 (1.32, 1.73) in the highest quartile of NOx compared with the lowest. Both outcomes were associated with high traffic density, but ORs were significant for gestational diabetes only. CONCLUSION NOx exposure during pregnancy was associated with gestational diabetes and preeclampsia in an area with air pollution levels below current air quality guidelines.
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Affiliation(s)
- Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
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