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Fecho K, Ahalt SC, Knowles M, Krishnamurthy A, Leigh M, Morton K, Pfaff E, Wang M, Yi H. Leveraging Open Electronic Health Record Data and Environmental Exposures Data to Derive Insights Into Rare Pulmonary Disease. Front Artif Intell 2022; 5:918888. [PMID: 35837616 PMCID: PMC9274244 DOI: 10.3389/frai.2022.918888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Research on rare diseases has received increasing attention, in part due to the realized profitability of orphan drugs. Biomedical informatics holds promise in accelerating translational research on rare disease, yet challenges remain, including the lack of diagnostic codes for rare diseases and privacy concerns that prevent research access to electronic health records when few patients exist. The Integrated Clinical and Environmental Exposures Service (ICEES) provides regulatory-compliant open access to electronic health record data that have been integrated with environmental exposures data, as well as analytic tools to explore the integrated data. We describe a proof-of-concept application of ICEES to examine demographics, clinical characteristics, environmental exposures, and health outcomes among a cohort of patients enriched for phenotypes associated with cystic fibrosis (CF), idiopathic bronchiectasis (IB), and primary ciliary dyskinesia (PCD). We then focus on a subset of patients with CF, leveraging the availability of a diagnostic code for CF and serving as a benchmark for our development work. We use ICEES to examine select demographics, co-diagnoses, and environmental exposures that may contribute to poor health outcomes among patients with CF, defined as emergency department or inpatient visits for respiratory issues. We replicate current understanding of the pathogenesis and clinical manifestations of CF by identifying co-diagnoses of asthma, chronic nasal congestion, cough, middle ear disease, and pneumonia as factors that differentiate patients with poor health outcomes from those with better health outcomes. We conclude by discussing our preliminary findings in relation to other published work, the strengths and limitations of our approach, and our future directions.
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Affiliation(s)
- Karamarie Fecho
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stanley C. Ahalt
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michael Knowles
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ashok Krishnamurthy
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Margaret Leigh
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Emily Pfaff
- North Carolina Clinical and Translational Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Max Wang
- CoVar Applied Technologies, Durham, NC, United States
| | - Hong Yi
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Breathing Room: Industrial Zoning and Asthma Incidence Using School District Health Records in the City of Santa Ana, California. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084820. [PMID: 35457688 PMCID: PMC9032322 DOI: 10.3390/ijerph19084820] [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: 03/03/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023]
Abstract
Background: Traffic and industrial emissions are associated with increased pediatric asthma morbidity. However, few studies have examined the influence of city industrial zoning on pediatric asthma outcomes among minoritized communities with limited access to air monitoring. Methods: In this cross-sectional analysis of 39,974 school-aged students in Santa Ana, CA, we investigated the effect of proximity to areas zoned for industrial use on pediatric asthma prevalence, physical fitness, school attendance, and standardized test scores. Results: The study population was 80.6% Hispanic, with 88.2% qualifying for free/reduced lunch. Compared to students living more than 1 km away from industrial zones, those living within 0.5 km had greater odds of having asthma (adjusted OR 1.21, 95% CI 1.09 to 1.34, p < 0.001). Among children with asthma, those living between 0.5−1.0 km had greater odds of being overweight or obese (aOR 1.47, 95% CI 1.00, 2.15, p = 0.047). Industrial zone proximity was not significantly associated with worse fitness and academic outcomes for students with asthma. Conclusion: These findings suggest that industrial zone proximity is associated with increased pediatric asthma in a predominantly Latino community in Southern California.
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Fecho K, Ahalt SC, Appold S, Arunachalam S, Pfaff E, Stillwell L, Valencia A, Xu H, Peden DB. Development and Application of an Open Tool for Sharing and Analyzing Integrated Clinical and Environmental Exposures Data: Asthma Use Case. JMIR Form Res 2022; 6:e32357. [PMID: 35363149 PMCID: PMC9015759 DOI: 10.2196/32357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Integrated Clinical and Environmental Exposures Service (ICEES) serves as an open-source, disease-agnostic, regulatory-compliant framework and approach for openly exposing and exploring clinical data that have been integrated at the patient level with a variety of environmental exposures data. ICEES is equipped with tools to support basic statistical exploration of the integrated data in a completely open manner. OBJECTIVE This study aims to further develop and apply ICEES as a novel tool for openly exposing and exploring integrated clinical and environmental data. We focus on an asthma use case. METHODS We queried the ICEES open application programming interface (OpenAPI) using a functionality that supports chi-square tests between feature variables and a primary outcome measure, with a Bonferroni correction for multiple comparisons (α=.001). We focused on 2 primary outcomes that are indicative of asthma exacerbations: annual emergency department (ED) or inpatient visits for respiratory issues; and annual prescriptions for prednisone. RESULTS Of the 157,410 patients within the asthma cohort, 26,332 (16.73%) had 1 or more annual ED or inpatient visits for respiratory issues, and 17,056 (10.84%) had 1 or more annual prescriptions for prednisone. We found that close proximity to a major roadway or highway, exposure to high levels of particulate matter ≤2.5 μm (PM2.5) or ozone, female sex, Caucasian race, low residential density, lack of health insurance, and low household income were significantly associated with asthma exacerbations (P<.001). Asthma exacerbations did not vary by rural versus urban residence. Moreover, the results were largely consistent across outcome measures. CONCLUSIONS Our results demonstrate that the open-source ICEES can be used to replicate and extend published findings on factors that influence asthma exacerbations. As a disease-agnostic, open-source approach for integrating, exposing, and exploring patient-level clinical and environmental exposures data, we believe that ICEES will have broad adoption by other institutions and application in environmental health and other biomedical fields.
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Affiliation(s)
- Karamarie Fecho
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stanley C Ahalt
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stephen Appold
- Kenan-Flagler Business School, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Saravanan Arunachalam
- Institute for the Environment, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily Pfaff
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lisa Stillwell
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alejandro Valencia
- Institute for the Environment, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hao Xu
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - David B Peden
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Division of Allergy & Immunology, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Anenberg SC, Mohegh A, Goldberg DL, Kerr GH, Brauer M, Burkart K, Hystad P, Larkin A, Wozniak S, Lamsal L. Long-term trends in urban NO 2 concentrations and associated paediatric asthma incidence: estimates from global datasets. Lancet Planet Health 2022; 6:e49-e58. [PMID: 34998460 DOI: 10.1016/s2542-5196(21)00255-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Combustion-related nitrogen dioxide (NO2) air pollution is associated with paediatric asthma incidence. We aimed to estimate global surface NO2 concentrations consistent with the Global Burden of Disease study for 1990-2019 at a 1 km resolution, and the concentrations and attributable paediatric asthma incidence trends in 13 189 cities from 2000 to 2019. METHODS We scaled an existing annual average NO2 concentration dataset for 2010-12 from a land use regression model (based on 5220 NO2 monitors in 58 countries and land use variables) to other years using NO2 column densities from satellite and reanalysis datasets. We applied these concentrations in an epidemiologically derived concentration-response function with population and baseline asthma rates to estimate NO2-attributable paediatric asthma incidence. FINDINGS We estimated that 1·85 million (95% uncertainty interval [UI] 0·93-2·80 million) new paediatric asthma cases were attributable to NO2 globally in 2019, two thirds of which occurred in urban areas (1·22 million cases; 95% UI 0·60-1·8 million). The proportion of paediatric asthma incidence that is attributable to NO2 in urban areas declined from 19·8% (1·22 million attributable cases of 6·14 million total cases) in 2000 to 16·0% (1·24 million attributable cases of 7·73 million total cases) in 2019. Urban attributable fractions dropped in high-income countries (-41%), Latin America and the Caribbean (-16%), central Europe, eastern Europe, and central Asia (-13%), and southeast Asia, east Asia, and Oceania (-6%), and rose in south Asia (+23%), sub-Saharan Africa (+11%), and north Africa and the Middle East (+5%). The contribution of NO2 concentrations, paediatric population size, and asthma incidence rates to the change in NO2-attributable paediatric asthma incidence differed regionally. INTERPRETATION Despite improvements in some regions, combustion-related NO2 pollution continues to be an important contributor to paediatric asthma incidence globally, particularly in cities. Mitigating air pollution should be a crucial element of public health strategies for children. FUNDING Health Effects Institute, NASA.
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Affiliation(s)
- Susan C Anenberg
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
| | - Arash Mohegh
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Daniel L Goldberg
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA; Energy Systems Division, Argonne National Laboratory, Washington, DC, USA
| | - Gaige H Kerr
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Michael Brauer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; University of British Columbia, Vancouver, BC, Canada
| | - Katrin Burkart
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | - Sarah Wozniak
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lok Lamsal
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
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Lan B, Haaland P, Krishnamurthy A, Peden DB, Schmitt PL, Sharma P, Sinha M, Xu H, Fecho K. Open Application of Statistical and Machine Learning Models to Explore the Impact of Environmental Exposures on Health and Disease: An Asthma Use Case. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11398. [PMID: 34769911 PMCID: PMC8582932 DOI: 10.3390/ijerph182111398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022]
Abstract
ICEES (Integrated Clinical and Environmental Exposures Service) provides a disease-agnostic, regulatory-compliant approach for openly exposing and analyzing clinical data that have been integrated at the patient level with environmental exposures data. ICEES is equipped with basic features to support exploratory analysis using statistical approaches, such as bivariate chi-square tests. We recently developed a method for using ICEES to generate multivariate tables for subsequent application of machine learning and statistical models. The objective of the present study was to use this approach to identify predictors of asthma exacerbations through the application of three multivariate methods: conditional random forest, conditional tree, and generalized linear model. Among seven potential predictor variables, we found five to be of significant importance using both conditional random forest and conditional tree: prednisone, race, airborne particulate exposure, obesity, and sex. The conditional tree method additionally identified several significant two-way and three-way interactions among the same variables. When we applied a generalized linear model, we identified four significant predictor variables, namely prednisone, race, airborne particulate exposure, and obesity. When ranked in order by effect size, the results were in agreement with the results from the conditional random forest and conditional tree methods as well as the published literature. Our results suggest that the open multivariate analytic capabilities provided by ICEES are valid in the context of an asthma use case and likely will have broad value in advancing open research in environmental and public health.
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Affiliation(s)
- Bo Lan
- UNC Highway Safety Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Perry Haaland
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Ashok Krishnamurthy
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27517, USA; (A.K.); (P.L.S.); (P.S.); (H.X.)
- Department of Computer Science, University of North Carolina, Chapel Hill, NC 27599, USA
| | - David B. Peden
- Division of Allergy, Immunology and Rheumatology, Center for Environmental Medicine, Asthma & Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Patrick L. Schmitt
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27517, USA; (A.K.); (P.L.S.); (P.S.); (H.X.)
| | - Priya Sharma
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27517, USA; (A.K.); (P.L.S.); (P.S.); (H.X.)
| | | | - Hao Xu
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27517, USA; (A.K.); (P.L.S.); (P.S.); (H.X.)
| | - Karamarie Fecho
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27517, USA; (A.K.); (P.L.S.); (P.S.); (H.X.)
- Copperline Professional Solutions, LLC, Pittsboro, NC 27312, USA
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Monetizing the Burden of Childhood Asthma Due to Traffic Related Air Pollution in the Contiguous United States in 2010. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157864. [PMID: 34360155 PMCID: PMC8345553 DOI: 10.3390/ijerph18157864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traffic-related air pollution (TRAP) refers to the wide range of air pollutants emitted by traffic that are dispersed into the ambient air. Emerging evidence shows that TRAP can increase asthma incidence in children. Living with asthma can carry a huge financial burden for individuals and families due to direct and indirect medical expenses, which can include costs of hospitalization, medical visits, medication, missed school days, and loss of wages from missed workdays for caregivers. OBJECTIVE The objective of this paper is to estimate the economic impact of childhood asthma incident cases attributable to nitrogen dioxide (NO2), a common traffic-related air pollutant in urban areas, in the United States at the state level. METHODS We calculate the direct and indirect costs of childhood asthma incident cases attributable to NO2 using previously published burden of disease estimates and per person asthma cost estimates. By multiplying the per person indirect and direct costs for each state with the NO2-attributable asthma incident cases in each state, we were able to estimate the total cost of childhood asthma cases attributable to NO2 in the United States. RESULTS The cost calculation estimates the total direct and indirect annual cost of childhood asthma cases attributable to NO2 in the year 2010 to be $178,900,138.989 (95% CI: $101,019,728.20-$256,980,126.65). The state with the highest cost burden is California with $24,501,859.84 (95% CI: $10,020,182.62-$38,982,261.250), and the state with the lowest cost burden is Montana with $88,880.12 (95% CI: $33,491.06-$144,269.18). CONCLUSION This study estimates the annual costs of childhood asthma incident cases attributable to NO2 and demonstrates the importance of conducting economic impacts studies of TRAP. It is important for policy-making institutions to focus on this problem by advocating and supporting more studies on TRAP's impact on the national economy and health, including these economic impact estimates in the decision-making process, and devising mitigation strategies to reduce TRAP and the population's exposure.
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7
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Impact of Air Pollution on Allergic Rhinitis and Asthma: Consensus Statement by Indian Academy of Pediatrics. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2288-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Chatkin J, Correa L, Santos U. External Environmental Pollution as a Risk Factor for Asthma. Clin Rev Allergy Immunol 2021; 62:72-89. [PMID: 33433826 PMCID: PMC7801569 DOI: 10.1007/s12016-020-08830-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
Air pollution is a worrisome risk factor for global morbidity and mortality and plays a special role in many respiratory conditions. It contributes to around 8 million deaths/year, with outdoor exposure being responsible for more than 4.2 million deaths throughout the world, while more than 3.8 million die from situations related to indoor pollution. Pollutant agents induce several respiratory symptoms. In addition, there is a clear interference in numerous asthma outcomes, such as incidence, prevalence, hospital admission, visits to emergency departments, mortality, and asthma attacks, among others. The particulate matter group of pollutants includes coarse particles/PM10, fine particles/PM2.5, and ultrafine particles/PM0.1. The gaseous components include ground-level ozone, nitrogen dioxide, sulfur dioxide, and carbon monoxide. The timing, load, and route of allergen exposure are other items affecting allergic disease phenotypes. The complex interaction between pollutant exposures and human host factors has an implication in the development and rise of asthma as a public health problem. However, there are hiatuses in the understanding of the pathways in this disease. The routes through which pollutants induce asthma are multiple, and include the epigenetic changes that occur in the respiratory tract microbiome, oxidative stress, and immune dysregulation. In addition, the expansion of the modern Westernized lifestyle, which is characterized by intense urbanization and more time spent indoors, resulted in greater exposure to polluted air. Another point to consider is the different role of the environment according to age groups. Children growing up in economically disadvantaged neighborhoods suffer more important negative health impacts. This narrative review highlights the principal polluting agents, their sources of emission, epidemiological findings, and mechanistic evidence that links environmental exposures to asthma.
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Affiliation(s)
- Jose Chatkin
- Pulmonology Division, School of Medicine, Pontifical Catholic University Rio Grande Do Sul (PUCRS), Hospital São Lucas da PUCRS, Porto Alegre, Brazil.
| | - Liana Correa
- Health Sciences Doctorate Program, School of Medicine, Pontifical Catholic University Rio Grande Do Sul (PUCRS), Pulmonologist Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| | - Ubiratan Santos
- Pulmonology Division of Instituto Do Coração, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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Fecho K, Haaland P, Krishnamurthy A, Lan B, Ramsey SA, Schmitt PL, Sharma P, Sinha M, Xu H. An approach for open multivariate analysis of integrated clinical and environmental exposures data. INFORMATICS IN MEDICINE UNLOCKED 2021; 26. [PMID: 35875189 PMCID: PMC9302917 DOI: 10.1016/j.imu.2021.100733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The Integrated Clinical and Environmental Exposures Service (ICEES)
provides regulatory-compliant open access to sensitive patient data that have
been integrated with public exposures data. ICEES was designed initially to
support dynamic cohort creation and bivariate contingency tests. The objective
of the present study was to develop an open approach to support multivariate
analyses using existing ICEES functionalities and abiding by all regulatory
constraints. We first developed an open approach for generating a multivariate
table that maintains contingencies between clinical and environmental variables
using programmatic calls to the open ICEES application programming interface. We
then applied the approach to data on a large cohort (N = 22,365) of patients
with asthma or related conditions and generated an eight-feature table. Due to
regulatory constraints, data loss was incurred with the incorporation of each
successive feature variable, from a starting sample size of N = 22,365 to a
final sample size of N = 4,556 (20.4%), but data loss was < 10% until the
addition of the final two feature variables. We then applied a generalized
linear model to the subsequent dataset and focused on the impact of seven select
feature variables on asthma exacerbations, defined as annual emergency
department or inpatient visits for respiratory issues. We identified five
feature variables—sex, race, obesity, prednisone, and airborne
particulate exposure—as significant predictors of asthma exacerbations.
We discuss the advantages and disadvantages of ICEES open multivariate analysis
and conclude that, despite limitations, ICEES can provide a valuable resource
for open multivariate analysis and can serve as an exemplar for
regulatory-compliant informatic solutions to open patient data, with
capabilities to explore the impact of environmental exposures on health
outcomes.
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Zhang L, Wilson JP, MacDonald B, Zhang W, Yu T. The changing PM2.5 dynamics of global megacities based on long-term remotely sensed observations. ENVIRONMENT INTERNATIONAL 2020; 142:105862. [PMID: 32599351 DOI: 10.1016/j.envint.2020.105862] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
Satellite observations show that the rapid urbanization and emergence of megacities with 10 million or more residents have raised PM2.5 concentrations across the globe during the past few decades. This study examines PM2.5 dynamics for the 33 cities included on the UN list of megacities published in 2018. These megacities were classified into densely (>1500 residents per km2), moderately (300-1500 residents per km2) and sparsely (<300 residents per km2) populated areas to examine the effect of human population density on PM2.5 concentrations in these areas during the period 1998-2016. We found that: (1) the higher population density areas experienced higher PM2.5 concentrations; and (2) the megacities with high PM2.5 concentrations in these areas had higher concentrations than those in the moderately and sparsely populated areas of other megacities as well. The numbers of residents experiencing poor air quality is substantial: approximately 452 and 163 million experienced average annual PM2.5 levels exceeding 10 and 35 μg/m3, respectively in 2016. We also examined PM2.5 trends during the past 18 years and predict that high PM2.5 levels will likely continue in many of these megacities in the future without substantial changes in their economies and/or pollution abatement practices. There will be more megacities in the highest PM2.5 pollution class and the number of megacities in the lowest PM2.5 pollution class will likely not change. Finally, we analyzed how the PM2.5 pollution burden varies geographically and ranked the 33 megacities in terms of PM2.5 pollution in 2016. The most polluted regions are China, India, and South Asia and the least polluted regions are Europe and Japan. None of the 33 megacities currently fall in the WHO's PM2.5 attainment class (<10 μg/m3) while 9 megacities fall into the PM2.5 non-attainment class (>35 μg/m3). In 2016, the least polluted megacity was New York and most polluted megacity was Delhi whose average annual PM2.5 concentration of 110 μg/m3 is nearly three times the WHO's non-attainment threshold.
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Affiliation(s)
- Lili Zhang
- Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100101, China; Spatial Sciences Institute, University of Southern California, Los Angeles, CA 90089-0374, USA.
| | - John P Wilson
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA 90089-0374, USA; Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China
| | - Beau MacDonald
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA 90089-0374, USA
| | - Wenhao Zhang
- North China Institute of Aerospace Engineering, Langfang, Hebei 065000, China
| | - Tao Yu
- Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100101, China
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Eatough DJ, Cropper P, Keeton W, Burrell E, Hansen JC, Farber R, Zack J, Cary RA, Hopke PK. Apportionment of PM 2.5 adjacent to the I-710 Harbor Freeway in Long Beach, CA. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2020; 70:260-282. [PMID: 31951805 DOI: 10.1080/10962247.2019.1705436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
During August and September 2012, a study was conducted to determine the sources of PM2.5 adjacent to the I-710 Long Beach Freeway. The site is directly affected by the emissions from heavy diesel traffic flowing from major container ports about 10 km south of the sampling site. Hourly average data were obtained for particulate species including PM2.5, black carbon and UV absorbing carbon, EC, fine particulate nonvolatile and semi-volatile organic material (NVOM and SVOM), sulfate, nitrate, chloride, ammonium ion, and Na ion, and for related factors including O3, CO, NOX, SO2, and total traffic flow on the I-710. A total of 520 hourly averaged data sets with 15 measured variables were analyzed by EPA-PMF v5.0. The data were best described by a 10-factor solution. Based on the composition and diurnal patterns of the factors, they were assigned to three diesel-related factors (two of which appeared to represent traffic from the ports and one general freeway diesel factor), a light-duty, spark-ignition vehicle-related factor, three secondary factors (one of which was associated with O3 formation processes), and three factors dominated by sulfate, SO2, and chloride, respectively. The diurnal patterns for these last three factors are strongly correlated. Meteorological and refinery upset data indicate that they are associated with emissions from a nearby refinery. The results of the PMF analysis were combined with nephelometer light scattering, corrected for coarse particle scattering and estimated aerosol water content in a multilinear regression analysis to identify visibility degradation sources. Major contributors were the aerosol water content, and the secondary PMF factors associated with either Nitrate and NVOM or NVOM and SVOM. The use of hourly average data made possible the identification of factors associated with gasoline vehicle emissions and both port and non-port diesel emissions.Implications: Hourly averaged data were obtained for PM2.5, its components and factors related to primary emissions and the formation of secondary material at a near freeway sampling location adjacent to the I-710 freeway just south of the Long Beach Boulevard entrance and 10 km north of the Ports of Long Beach and Los Angeles. The major objective of the study was to determine the impact of traffic from the ports at the monitoring site. This manuscript reports on the PMF analysis of the data set. Factors related to both diesel traffic originating from the ports and diesel traffic from non-port origins were identified. The diesel traffic originating from the ports was responsible for 9% of the total traffic and 95% of the BC measured at the sampling site. The non-port diesel traffic was responsible for 15% of the total traffic and 5% of the BC. While the Port 1 diesel traffic coming from the ports contributed a large fraction of the BC, this source contributed only 2% of the CO and 5% of the NOX at the sampling site. The impact of these traffic sources on light scattering was also small. Analysis of sources of sulfate and SO2 at the sampling site indicated that these species did not come from port activities of ships at or approaching the port, but rather from upset flare events at a nearby oil refinery.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Philip K Hopke
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Hauptman M, Gaffin JM, Petty CR, Sheehan WJ, Lai PS, Coull B, Gold DR, Phipatanakul W. Proximity to major roadways and asthma symptoms in the School Inner-City Asthma Study. J Allergy Clin Immunol 2020; 145:119-126.e4. [PMID: 31557500 PMCID: PMC6949366 DOI: 10.1016/j.jaci.2019.08.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/31/2019] [Accepted: 08/22/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Traffic proximity has been associated with adverse respiratory health outcomes. Less is known about the combined impact of residential and school exposures on pediatric asthma. OBJECTIVE We sought to use spatial analysis methodology to analyze residential and school proximity to major roadways and pediatric asthma morbidity. METHODS The School Inner-City Asthma Study (n = 350) recruited school-aged children with asthma. Each participant's school and home addresses were geocoded, and distances from major roadways were measured to calculate a composite measure accounting for both home and school traffic exposure. Generalized estimating equation models were clustered by subject and adjusted for age, race/ethnicity, sex, income, environmental tobacco smoke, controller medication, upper respiratory tract infections, and seasonality. RESULTS The majority of participants (62%) attended schools within 100 m from major roadways, and 40% also resided within 100 m of major roadways. In multivariate analyses major roadway proximity was independently associated with increased asthma symptom days. At greater than the threshold of 100 m, children had 29% less odds of a symptom day over the past 2 weeks for each 100-m increase in distance from a major roadway (odds ratio, 0.71; 95% CI, 0.58-0.87; P < .01). Children farther from a major roadway also had significantly less reported health care use (odds ratio, 0.63; 95% CI, 0.47-0.85; P < .01) and were significantly less likely to have poor asthma control (odds ratio, 0.80; 95% CI, 0.69-0.94; P < .01). There was not a meaningful association between distance to a major roadway and lung function outcomes. CONCLUSIONS Proximity to a major roadway, a composite measure of home and school exposure but primarily driven by home exposure, was associated with greater asthma morbidity. More studies are needed to evaluate the independent effect of school distance to a roadway on asthma morbidity.
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Affiliation(s)
- Marissa Hauptman
- Division of General Pediatrics, Boston Children's Hospital, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Jonathan M Gaffin
- Harvard Medical School, Boston, Mass; Division of Respiratory Diseases, Boston Children's Hospital, Boston, Mass
| | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - William J Sheehan
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass
| | - Peggy S Lai
- Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Mass
| | - Brent Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Diane R Gold
- Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Division of Respiratory Epidemiology, Channing Laboratory, Brigham and Women's Hospital, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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13
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Khreis H, Cirach M, Mueller N, de Hoogh K, Hoek G, Nieuwenhuijsen MJ, Rojas-Rueda D. Outdoor air pollution and the burden of childhood asthma across Europe. Eur Respir J 2019; 54:13993003.02194-2018. [PMID: 31391220 DOI: 10.1183/13993003.02194-2018] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 07/07/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Emerging evidence suggests that air pollution may contribute to childhood asthma development. We estimated the burden of incident childhood asthma that may be attributable to outdoor nitrogen dioxide (NO2), particulate matter ≤2.5 µm in diameter (PM2.5) and black carbon (BC) in Europe. METHODS We combined country-level childhood incidence rates and pooled exposure-response functions with childhood (age 1-14 years) population counts, and exposure estimates at 1 540 386 1 km×1 km cells, across 18 European countries and 63 442 419 children. Annual average pollutant concentrations were obtained from a validated and harmonised European land-use regression model. We investigated two exposure reduction scenarios. For the first, we used recommended annual World Health Organization (WHO) air quality guideline values. For the second, we used the minimum air pollution levels recorded across 41 studies in the underlying meta-analysis. RESULTS NO2 ranged from 1.4 to 70.0 µg·m-3, with a mean of 11.8 µg·m-3. PM2.5 ranged from 2.0 to 41.1 µg·m-3, with a mean of 11.6 µg·m-3. BC ranged from 0.003 to 3.7×10-5 m-1, with a mean of 1.0×10-5 m-1. Compliance with the NO2 and PM2.5 WHO guidelines was estimated to prevent 2434 (0.4%) and 66 567 (11%) incident cases, respectively. Meeting the minimum air pollution levels for NO2 (1.5 µg·m-3), PM2.5 (0.4 µg·m-3) and BC (0.4×10-5 m-1) was estimated to prevent 135 257 (23%), 191 883 (33%) and 89 191 (15%) incident cases, respectively. CONCLUSIONS A significant proportion of childhood asthma cases may be attributable to outdoor air pollution and these cases could be prevented. Our estimates underline an urgent need to reduce children's exposure to air pollution.
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Affiliation(s)
- Haneen Khreis
- Center for Advancing Research in Transportation Emissions, Energy, and Health (CARTEEH), Texas A&M Transportation Institute (TTI), College Station, TX, USA .,ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.,These authors are joint lead authors of the study
| | - Marta Cirach
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | - Natalie Mueller
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Gerard Hoek
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mark J Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | - David Rojas-Rueda
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.,These authors are joint lead authors of the study
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14
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Effects of policy-driven hypothetical air pollutant interventions on childhood asthma incidence in southern California. Proc Natl Acad Sci U S A 2019; 116:15883-15888. [PMID: 31332016 DOI: 10.1073/pnas.1815678116] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Childhood asthma is a major public health concern and has significant adverse impacts on the lives of the children and their families, and on society. There is an emerging link between air pollution, which is ubiquitous in our environment, particularly in urban centers, and incident childhood asthma. Here, using data from 3 successive cohorts recruited from the same 9 communities in southern California over a span of 20 y (1993 to 2014), we estimated asthma incidence using G-computation under hypothetical air pollution exposure scenarios targeting nitrogen dioxide (NO2) and particulate matter <2.5 μm (PM2.5) in separate interventions. We reported comparisons of asthma incidence under each hypothetical air pollution intervention with incidence under the observed natural course of exposure; results that may be more tangible for policymakers compared with risk ratios. Model results indicated that childhood asthma incidence rates would have been statistically significantly higher had the observed reduction in ambient NO2 in southern California not occurred in the 1990s and early 2000s, and asthma incidence rates would have been significantly lower had NO2 been lower than what it was observed to be. For example, compliance with a hypothetical standard of 20 ppb NO2 was estimated to result in 20% lower childhood asthma incidence (95% CI, -27% to -11%) compared with the exposure that actually occurred. The findings for hypothetical PM2.5 interventions, although statistically significant, were smaller in magnitude compared with results for the hypothetical NO2 interventions. Our results suggest a large potential public health benefit of air pollutant reduction in reduced incidence of childhood asthma.
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15
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Jazcilevich A, de la Cruz Zavala J, Erazo Arcos AM, Kanda I, Rosas I. Sidewalk pollution flows caused by vehicular traffic place children at a higher acute exposure risk. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2019; 29:491-499. [PMID: 30323243 DOI: 10.1038/s41370-018-0083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 06/08/2023]
Abstract
The objective of this work is to study the immediate transport flows of PM2.5 diesel exhaust emissions on a city sidewalk. Under calm conditions largest direct exhaust PM2.5 diesel concentrations tend to accumulate at two preferred heights: higher ones at 200-225 cm due to truck and buses aerodynamics, and lower ones at 130-160 cm due to light vehicles. Obtained flows indicate that exhaust emissions are transported to these heights via vortices generated by vehicular traffic. The lower height vortices transporting PM2.5 direct diesel emissions place children aged between 7 and 15 at a higher acute exposure risk due to their stature. Also, the hourly averaged PM2.5 concentrations tend to accumulate nearer to the roadside. This information was obtained using a specially designed electromechanical near-surface atmospheric profiler equipped with a PM2.5 measurement instrument, a thermistor and a sonic anemometer installed on a sidewalk. Using signal analysis techniques, coherent flows of direct PM2.5 emissions and thermal information were obtained. The proposed methodology can be used to evaluate before and after urban interventions, obtain full-scale sidewalk data for exposure studies and provides criteria on where to place sidewalk measurement instruments.
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Affiliation(s)
- Aron Jazcilevich
- Centro de Ciencias de la Atmósfera, Universidad Nacional Autónoma de México, Ciudad Universitaria, CdMx, Mexico.
| | - Juan de la Cruz Zavala
- Centro de Ciencias de la Atmósfera, Universidad Nacional Autónoma de México, Ciudad Universitaria, CdMx, Mexico
| | | | - Isao Kanda
- Environmental Engineering, Japg2018@DE!an Meteorological Association, Tokyo, Japan
| | - Irma Rosas
- Centro de Ciencias de la Atmósfera, Universidad Nacional Autónoma de México, Ciudad Universitaria, CdMx, Mexico
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Abstract
The global prevalence, morbidity and mortality related to childhood asthma among children has increased significantly over the last 40 years. Although asthma is recognized as the most common chronic disease in children, issues of underdiagnosis and undertreatment persist. There are substantial global variations in the prevalence of asthma symptoms in children, with up to 13-fold differences between countries. The rising number of hospital admissions for asthma may reflect an increase in asthma severity, poor disease management and/or the effect of poverty. The financial burden of asthma is relatively high within developed countries (those for which data is available) spending 1 to 2% of their healthcare budget on this condition. Established in 1989, the Global Initiative for Asthma (GINA) attempts to raise awareness about the increasing prevalence of asthma, improve management and reduce the burden of asthma worldwide. Despite global efforts, GINA has not achieved its goal, even among developed nations. There are multiple barriers to reducing the global burden of asthma, including limited access to care and/or medications, and lack of prioritization as a public healthcare priority. In addition, the diversity of healthcare systems worldwide and large differences in access to care require that asthma management guidelines be tailored to local needs.
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17
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Residential Ambient Traffic in Relation to Childhood Pneumonia among Urban Children in Shandong, China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061076. [PMID: 29799501 PMCID: PMC6025011 DOI: 10.3390/ijerph15061076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022]
Abstract
Pneumonia is a leading cause of childhood death. Few studies have investigated associations between residential ambient environmental exposures and pneumonia. In January⁻April 2015, we conducted a cross-sectional study in Shandong Province (China) and collected 9597 (response rate: 78.7%) parent-reported questionnaires for 3⁻6-year-old children from 69 urban kindergartens. We then selected 5640 children who had never changed residence since birth and examined associations between residential ambient traffic-related facilities and childhood pneumonia considering residential characteristics. Prevalence of doctor-diagnosed pneumonia during lifetime-ever was 25.9%. In the multivariate logistic regression analyses, residence close to a main traffic road (adjusted odds ratio, 95% confidence interval: 1.23, 1.08⁻1.40) and automobile 4S shop (1.76, 1.16⁻2.67) within 200 m, residence close to a filling station within 100 m (1.71, 1.10⁻2.65; reference: >200 m), as well as having a ground car park in the residential community (1.24, 1.08⁻1.42) were significantly associated with childhood pneumonia. The cumulative numbers of these traffic-related facilities had a positive dose-response relationship with the increased odds of childhood pneumonia. These associations and dose-response relationships were stronger among boys and among children with worse bedroom ventilation status during the night. Associations of residence close to the main traffic road and ground car parks in the residential community with childhood pneumonia were stronger among children living in the 1st⁻3rd floors than those living on higher floors. Similar results were found in the two-level (kindergarten-child) logistic regression analyses. Our findings indicate that living near traffic-related facilities is likely a risk factor for childhood pneumonia among urban children. The child's sex, bedroom floor level, and bedroom ventilation could modify associations of ambient traffic-related facilities with childhood pneumonia.
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18
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Khreis H, de Hoogh K, Nieuwenhuijsen MJ. Full-chain health impact assessment of traffic-related air pollution and childhood asthma. ENVIRONMENT INTERNATIONAL 2018; 114:365-375. [PMID: 29602620 DOI: 10.1016/j.envint.2018.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/04/2018] [Accepted: 03/07/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND Asthma is the most common chronic disease in children. Traffic-related air pollution (TRAP) may be an important exposure contributing to its development. In the UK, Bradford is a deprived city suffering from childhood asthma rates higher than national and regional averages and TRAP is of particular concern to the local communities. AIMS We estimated the burden of childhood asthma attributable to air pollution and specifically TRAP in Bradford. Air pollution exposures were estimated using a newly developed full-chain exposure assessment model and an existing land-use regression model (LUR). METHODS We estimated childhood population exposure to NOx and, by conversion, NO2 at the smallest census area level using a newly developed full-chain model knitting together distinct traffic (SATURN), vehicle emission (COPERT) and atmospheric dispersion (ADMS-Urban) models. We compared these estimates with measurements and estimates from ESCAPE's LUR model. Using the UK incidence rate for childhood asthma, meta-analytical exposure-response functions, and estimates from the two exposure models, we estimated annual number of asthma cases attributable to NO2 and NOx in Bradford, and annual number of asthma cases specifically attributable to traffic. RESULTS The annual average census tract levels of NO2 and NOx estimated using the full-chain model were 15.41 and 25.68 μg/m3, respectively. On average, 2.75 μg/m3 NO2 and 4.59 μg/m3 NOx were specifically contributed by traffic, without minor roads and cold starts. The annual average census tract levels of NO2 and NOx estimated using the LUR model were 21.93 and 35.60 μg/m3, respectively. The results indicated that up to 687 (or 38% of all) annual childhood asthma cases in Bradford may be attributable to air pollution. Up to 109 cases (6%) and 219 cases (12%) may be specifically attributable to TRAP, with and without minor roads and cold starts, respectively. CONCLUSIONS This is the first study undertaking full-chain health impact assessment of TRAP and childhood asthma in a disadvantaged population with public concern about TRAP. It further adds to scarce literature exploring the impact of different exposure assessments. In conservative estimates, air pollution and TRAP are estimated to cause a large, but largely preventable, childhood asthma burden. Future progress with childhood asthma requires a move beyond the prevalent disease control-based approach toward asthma prevention.
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Affiliation(s)
- Haneen Khreis
- Texas A&M Transportation Institute (TTI) and Center for Advancing Research in Transportation Emissions, Energy, and Health (CARTEEH), TX, United States of America; ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain; Institute for Transport Studies (ITS), University of Leeds, Leeds, United Kingdom.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.
| | - Mark J Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.
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19
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Negherbon JP, Romero K, Williams DL, Guerrero-Preston RE, Hartung T, Scott AL, Breysse PN, Checkley W, Hansel NN. Whole Blood Cytokine Response to Local Traffic-Related Particulate Matter in Peruvian Children With and Without Asthma. Front Pharmacol 2017; 8:157. [PMID: 28424616 PMCID: PMC5371665 DOI: 10.3389/fphar.2017.00157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 03/10/2017] [Indexed: 12/23/2022] Open
Abstract
This study sought to investigate if acute phase immune responses of whole blood from Peruvian children with controlled and uncontrolled asthma differed from children without asthma, following exposure to traffic-related particulate matter (TRPM). TRPM, including particulate matter from diesel combustion, has been shown to stimulate acute airway inflammation in individuals with and without asthma. For this study, a whole blood assay (WBA) was used to test peripheral whole blood samples from 27 children with asthma, and 12 without asthma. Participant blood samples were stimulated, ex vivo, for 24-h with an aqueous extract of TRPM that was collected near study area highways in Lima, Peru. All participant blood samples were tested against the same TRPM extract, in addition to purified bacterial endotoxin and pyrogen-free water, which served as positive and negative WBA controls, respectively. The innate and adaptive cytokine responses were evaluated in cell-free supernatants of the whole blood incubations. Comparatively similar levels were recorded for nine out of the 10 cytokines measured [e.g., – Interleukin (IL)-1β, IL-6, IL-10], regardless of study participant asthma status. However, IL-8 levels in TRPM-stimulated blood from children with uncontrolled asthma were diminished, compared to subjects without asthma (633 pg/ml vs. 1,023 pg/ml, respectively; p < 0.01); IL-8 responses for subjects with controlled asthma were also reduced, but to a lesser degree (799 pg/ml vs. 1,023 pg/ml, respectively; p = 0.10). These relationships were present before, and after, adjusting for age, sex, obesity/overweight status, C-reactive protein levels, and residential proximity to the study area’s major roadway. For tests conducted with endotoxin, there were no discernible differences in cytokine response between groups, for all cytokines measured. The WBA testing conducted for this study highlighted the capacity of the TRPM extract to potently elicit the release of IL-8 from the human whole blood system. Although the small sample size of the study limits the capacity to draw definitive conclusions, the IL-8 responses suggest that that asthma control may be associated with the regulation of a key mediator in neutrophil chemotaxis, at a systemic level, following exposure to PM derived from traffic-related sources.
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Affiliation(s)
- Jesse P Negherbon
- Department of Environmental Health Sciences, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA
| | | | - D'Ann L Williams
- Department of Environmental Health Sciences, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA
| | - Rafael E Guerrero-Preston
- Head and Neck Cancer Research Division, Department of Otolaryngology, School of Medicine, The Johns Hopkins University, BaltimoreMD, USA
| | - Thomas Hartung
- Department of Environmental Health Sciences, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA.,Center for Alternatives to Animal Testing, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA
| | - Alan L Scott
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA
| | - Patrick N Breysse
- Department of Environmental Health Sciences, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA
| | - William Checkley
- Asociación Benéfica PrismaLima, Perú.,Division of Pulmonary and Critical Care, School of Medicine, The Johns Hopkins University, BaltimoreMD, USA
| | - Nadia N Hansel
- Department of Environmental Health Sciences, Bloomberg School of Public Health, The Johns Hopkins University, BaltimoreMD, USA.,Division of Pulmonary and Critical Care, School of Medicine, The Johns Hopkins University, BaltimoreMD, USA
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20
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Su JG, Barrett MA, Henderson K, Humblet O, Smith T, Sublett JW, Nesbitt L, Hogg C, Van Sickle D, Sublett JL. Feasibility of Deploying Inhaler Sensors to Identify the Impacts of Environmental Triggers and Built Environment Factors on Asthma Short-Acting Bronchodilator Use. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:254-261. [PMID: 27340894 PMCID: PMC5289907 DOI: 10.1289/ehp266] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/29/2016] [Accepted: 05/26/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Epidemiological asthma research has relied upon self-reported symptoms or healthcare utilization data, and used the residential address as the primary location for exposure. These data sources can be temporally limited, spatially aggregated, subjective, and burdensome for the patient to collect. OBJECTIVES First, we aimed to test the feasibility of collecting rescue inhaler use data in space-time using electronic sensors. Second, we aimed to evaluate whether these data have the potential to identify environmental triggers and built environment factors associated with rescue inhaler use and to determine whether these findings would be consistent with the existing literature. METHODS We utilized zero-truncated negative binomial models to identify triggers associated with inhaler use, and implemented three sensitivity analyses to validate our findings. RESULTS Electronic sensors fitted on metered dose inhalers tracked 5,660 rescue inhaler use events in space and time for 140 participants from 13 June 2012 to 28 February 2014. We found that the inhaler sensors were feasible in passively collecting objective rescue inhaler use data. We identified several environmental triggers with a positive and significant association with inhaler use, including: AQI, PM10, weed pollen, and mold. Conversely, the spatial distribution of tree cover demonstrated a negative and significant association with inhaler use. CONCLUSIONS Utilizing a sensor to capture the signal of rescue inhaler use in space-time offered a passive and objective signal of asthma activity. This approach enabled detailed analyses to identify environmental triggers and built environment factors that are associated with asthma symptoms beyond the residential address. The application of these new technologies has the potential to improve our surveillance and understanding of asthma. Citation: Su JG, Barrett MA, Henderson K, Humblet O, Smith T, Sublett JW, Nesbitt L, Hogg C, Van Sickle D, Sublett JL. 2017. Feasibility of deploying inhaler sensors to identify the impacts of environmental triggers and built environment factors on asthma short-acting bronchodilator use. Environ Health Perspect 125:254-261; http://dx.doi.org/10.1289/EHP266.
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Affiliation(s)
- Jason G. Su
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | | | | | | | - Ted Smith
- Office of Civic Innovation, Louisville Metro Government, Louisville, USA
| | | | | | | | - David Van Sickle
- Propeller Health, San Francisco, USA
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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21
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Outdoor Environment and Pediatric Asthma: An Update on the Evidence from North America. Can Respir J 2017; 2017:8921917. [PMID: 28239256 PMCID: PMC5292365 DOI: 10.1155/2017/8921917] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/09/2016] [Accepted: 12/20/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction. The evidence about the association between asthma and outdoor environmental factors has been inadequate for certain allergens. Even less is known about how these associations vary across seasons and climate regions. We reviewed recent literature from North America for research related to outdoor environmental factors and pediatric asthma, with attention to spatial-temporal variations of these associations. Method. We included indexed literature between years 2010 and 2015 on outdoor environmental factors and pediatric asthma, by searching PubMed. Results. Our search resulted in 33 manuscripts. Studies about the link between pediatric asthma and traffic-related air pollutants (TRAP) consistently confirmed the correlation between TRAP and asthma. For general air pollution, the roles of PM2.5 and CO were consistent across studies. The link between asthma and O3 varied across seasons. Regional variation exists in the role of SO2. The impact of pollen was consistent across seasons, whereas the role of polycyclic aromatic hydrocarbon was less consistent. Discussion. Recent studies strengthened the evidence about the roles of PM2.5, TRAP, CO, and pollen in asthma, while the evidence for roles of PM10-2.5, PM10, O3, NO2, SO2, and polycyclic aromatic hydrocarbon in asthma was less consistent. Spatial-temporal details of the environment are needed in future studies of asthma and environment.
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Guerriero C, Chatzidiakou L, Cairns J, Mumovic D. The economic benefits of reducing the levels of nitrogen dioxide (NO2) near primary schools: The case of London. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2016; 181:615-622. [PMID: 27451292 DOI: 10.1016/j.jenvman.2016.06.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/28/2016] [Accepted: 06/21/2016] [Indexed: 05/24/2023]
Abstract
Providing a healthy school environment is a priority for child health. The aim of this study is to develop a methodology that allows quantification of the potential economic benefit of reducing indoor exposure to nitrogen dioxide (NO2) in children attending primary schools. Using environmental and health data collected in primary schools in London, this study estimates that, on average, 82 asthma exacerbations per school can be averted each year by reducing outdoor NO2 concentrations. The study expands upon previous analyses in two ways: first it assesses the health benefits of reducing children's exposure to indoor NO2 while at school, second it considers the children's perspective in the economic evaluation. Using a willingness to pay approach, the study quantifies that the monetary benefits of reducing children's indoor NO2 exposure while at school would range between £2.5 k per school if a child's perspective based on child's budget is adopted up to £60 k if a parent's perspective is considered. This study highlights that designers, engineers, policymakers and stakeholders need to consider the reduction of outdoor pollution, and particularly NO2 levels, near primary schools as there may be substantial health and monetary benefits.
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Affiliation(s)
- Carla Guerriero
- DISES, Università di Napoli Federico II, CSEF, Via Cintia 80126, Naples, Italy; HSRP London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH London, UK.
| | - Lia Chatzidiakou
- Centre for Atmospheric Science, Department of Chemistry, University of Cambridge, Lensfield Rd, Cambridge CB2 1EW, UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, WC1H 9SH Tavistock Place, London, UK
| | - Dejan Mumovic
- UCL Institute for Environmental Design and Engineering (UCL IEDE), Central House14 Upper Woburn Place, London WC1H 0NN, UK
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23
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Shandas V, Voelkel J, Rao M, George L. Integrating High-Resolution Datasets to Target Mitigation Efforts for Improving Air Quality and Public Health in Urban Neighborhoods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13080790. [PMID: 27527205 PMCID: PMC4997476 DOI: 10.3390/ijerph13080790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/21/2016] [Accepted: 07/27/2016] [Indexed: 11/16/2022]
Abstract
Reducing exposure to degraded air quality is essential for building healthy cities. Although air quality and population vary at fine spatial scales, current regulatory and public health frameworks assess human exposures using county- or city-scales. We build on a spatial analysis technique, dasymetric mapping, for allocating urban populations that, together with emerging fine-scale measurements of air pollution, addresses three objectives: (1) evaluate the role of spatial scale in estimating exposure; (2) identify urban communities that are disproportionately burdened by poor air quality; and (3) estimate reduction in mobile sources of pollutants due to local tree-planting efforts using nitrogen dioxide. Our results show a maximum value of 197% difference between cadastrally-informed dasymetric system (CIDS) and standard estimations of population exposure to degraded air quality for small spatial extent analyses, and a lack of substantial difference for large spatial extent analyses. These results provide the foundation for improving policies for managing air quality, and targeting mitigation efforts to address challenges of environmental justice.
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Affiliation(s)
- Vivek Shandas
- Toulan School of Urban Studies and Planning, Portland State University, 1825 SW Broadway, Portland, OR 97201, USA.
| | - Jackson Voelkel
- Toulan School of Urban Studies and Planning, Portland State University, 1825 SW Broadway, Portland, OR 97201, USA.
| | - Meenakshi Rao
- Toulan School of Urban Studies and Planning, Portland State University, 1825 SW Broadway, Portland, OR 97201, USA.
| | - Linda George
- Toulan School of Urban Studies and Planning, Portland State University, 1825 SW Broadway, Portland, OR 97201, USA.
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Belice PJ, Becker EA. Effective education parameters for trigger remediation in underserved children with asthma: A systematic review. J Asthma 2016; 54:186-201. [PMID: 27304997 DOI: 10.1080/02770903.2016.1198374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The prevalence of asthma is highest in minority children living in urban areas. Pediatric asthma research has focused on self-management education and trigger remediation using a multi-trigger, multi-component educational intervention approach. The purpose of this systematic review was to identify common educational parameters of these proposed interventions. The review also sought to identify which clinical outcomes improved with multi-trigger, multi-component educational interventions. DATA SOURCES PubMed, SCOPUS and ProQuest Dissertations were searched between 2000 to 2014 using the following terms: asthma; urban population or poverty area; environmental remediation; health education; allergens or dust mites or cockroaches or mold or mice or rats. STUDY SELECTIONS Studies were included if they met the following criteria: 1) participants were minority children identified as underserved; 2) there was a multi-trigger and multi-component intervention; 3) asthma severity was classified as persistent; and 4) asthma control was classified as not well controlled. RESULTS A total of 531 articles were retrieved of which 17 met the inclusion criteria. The interventions lacked consistency in their explanation. Most studies were vague in reporting pedagogical methods and educational content. Few studies reported a theoretical framework to guide their approach. Over half the studies did not report a learning assessment nor health literacy of the caregiver or the child with asthma. Yet all of the findings demonstrated statistically significant results in some or all of their primary outcomes. CONCLUSION Overall, the research lacked clarity in the approach to impact asthma outcomes and reduces the opportunity to substantiate the findings through replication.
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Affiliation(s)
- Paula Jo Belice
- a College of Health Sciences, Rush University Medical Center , Chicago , IL , USA
| | - Ellen A Becker
- b Department of Cardiopulmonary Sciences , Rush University Medical Center , Chicago , IL , USA
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Ghosh R, Lurmann F, Perez L, Penfold B, Brandt S, Wilson J, Milet M, Künzli N, McConnell R. Near-Roadway Air Pollution and Coronary Heart Disease: Burden of Disease and Potential Impact of a Greenhouse Gas Reduction Strategy in Southern California. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:193-200. [PMID: 26149207 PMCID: PMC4749075 DOI: 10.1289/ehp.1408865] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 06/15/2015] [Indexed: 05/24/2023]
Abstract
BACKGROUND Several studies have estimated the burden of coronary heart disease (CHD) mortality from ambient regional particulate matter ≤ 2.5 μm (PM2.5). The burden of near-roadway air pollution (NRAP) generally has not been examined, despite evidence of a causal link with CHD. OBJECTIVE We investigated the CHD burden from NRAP and compared it with the PM2.5 burden in the California South Coast Air Basin for 2008 and under a compact urban growth greenhouse gas reduction scenario for 2035. METHODS We estimated the population attributable fraction and number of CHD events attributable to residential traffic density, proximity to a major road, elemental carbon (EC), and PM2.5 compared with the expected disease burden if the population were exposed to background levels of air pollution. RESULTS In 2008, an estimated 1,300 CHD deaths (6.8% of the total) were attributable to traffic density, 430 deaths (2.4%) to residential proximity to a major road, and 690 (3.7%) to EC. There were 1,900 deaths (10.4%) attributable to PM2.5. Although reduced exposures in 2035 should result in smaller fractions of CHD attributable to traffic density, EC, and PM2.5, the numbers of estimated deaths attributable to each of these exposures are anticipated to increase to 2,500, 900, and 2,900, respectively, due to population aging. A similar pattern of increasing NRAP-attributable CHD hospitalizations was estimated to occur between 2008 and 2035. CONCLUSION These results suggest that a large burden of preventable CHD mortality is attributable to NRAP and is likely to increase even with decreasing exposure by 2035 due to vulnerability of an aging population. Greenhouse gas reduction strategies developed to mitigate climate change offer unexploited opportunities for air pollution health co-benefits.
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Affiliation(s)
- Rakesh Ghosh
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Laura Perez
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Sylvia Brandt
- University of Massachusetts Amherst, Amherst, Massachusetts
| | - John Wilson
- Spatial Sciences Institute, Dana and David Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California, USA
| | - Meredith Milet
- California Department of Public Health, Richmond, California, USA
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rob McConnell
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Bechle MJ, Millet DB, Marshall JD. National Spatiotemporal Exposure Surface for NO2: Monthly Scaling of a Satellite-Derived Land-Use Regression, 2000-2010. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2015; 49:12297-305. [PMID: 26397123 DOI: 10.1021/acs.est.5b02882] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Land-use regression (LUR) is widely used for estimating within-urban variability in air pollution. While LUR has recently been extended to national and continental scales, these models are typically for long-term averages. Here we present NO2 surfaces for the continental United States with excellent spatial resolution (∼100 m) and monthly average concentrations for one decade. We investigate multiple potential data sources (e.g., satellite column and surface estimates, high- and standard-resolution satellite data, and a mechanistic model [WRF-Chem]), approaches to model building (e.g., one model for the whole country versus having separate models for urban and rural areas, monthly LURs versus temporal scaling of a spatial LUR), and spatial interpolation methods for temporal scaling factors (e.g., kriging versus inverse distance weighted). Our core approach uses NO2 measurements from U.S. EPA monitors (2000-2010) to build a spatial LUR and to calculate spatially varying temporal scaling factors. The model captures 82% of the spatial and 76% of the temporal variability (population-weighted average) of monthly mean NO2 concentrations from U.S. EPA monitors with low average bias (21%) and error (2.4 ppb). Model performance in absolute terms is similar near versus far from monitors, and in urban, suburban, and rural locations (mean absolute error 2-3 ppb); since low-density locations generally experience lower concentrations, model performance in relative terms is better near monitors than far from monitors (mean bias 3% versus 40%) and is better for urban and suburban locations (1-6%) than for rural locations (78%, reflecting the relatively clean conditions in many rural areas). During 2000-2010, population-weighted mean NO2 exposure decreased 42% (1.0 ppb [∼5.2%] per year), from 23.2 ppb (year 2000) to 13.5 ppb (year 2010). We apply our approach to all U.S. Census blocks in the contiguous United States to provide 132 months of publicly available, high-resolution NO2 concentration estimates.
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Affiliation(s)
- Matthew J Bechle
- Department of Civil, Environmental, and Geo- Engineering and ‡Department of Soil, Water, and Climate, University of Minnesota , Minneapolis, Minnesota 55455, United States
| | - Dylan B Millet
- Department of Civil, Environmental, and Geo- Engineering and ‡Department of Soil, Water, and Climate, University of Minnesota , Minneapolis, Minnesota 55455, United States
| | - Julian D Marshall
- Department of Civil, Environmental, and Geo- Engineering and ‡Department of Soil, Water, and Climate, University of Minnesota , Minneapolis, Minnesota 55455, United States
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Longley I, Somervell E, Gray S. Roadside increments in PM 10, NO x and NO 2 concentrations observed over 2 months at a major highway in New Zealand. AIR QUALITY, ATMOSPHERE, & HEALTH 2014; 8:591-602. [PMID: 26478755 PMCID: PMC4602116 DOI: 10.1007/s11869-014-0305-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/11/2014] [Indexed: 06/05/2023]
Abstract
Continuous and simultaneous observational particulate matter (measured as PM10), nitrogen dioxide (NO2) and oxides of nitrogen (NOx) data were captured at a kerbside site alongside a major highway in Auckland, New Zealand, and at a pair of setback sites within 250 m of the highway, day and night over 8 weeks. The three measurement sites were intended to allow emissions from the highway to be largely isolated from other sources. By filtering the data and subtracting upwind concentrations, the average roadside increment was calculated to be 1.8, 7.2 and 101.4 μg m-3 for PM10, NO2 and NOx, respectively, relative to a predominantly upwind setback site, and -0.1, 9.4 and 98.5 μg m-3 for PM10, NO2 and NOx, respectively, relative to a downwind setback site. The negative value for PM10 was attributed to local evening heating sources impacting the setback site. On days when peak 24 h PM10 concentrations were observed, the absolute kerbside increment was 2.1 μg m-3. The absolute roadside 24 h average PM10 increment varied diurnally, peaking (on average) at 2.4 μg m-3 during peak traffic hours. The largest observed 24-h average PM10 roadside increment was 6.9 μg m-3 and exceeded 5 μg m-3 on nine occasions. On each of these occasions, the daily mean wind speed was less than 2 m s-1. The diurnally averaged difference in NOx concentrations between the kerbside site and the setback sites clearly resembled the diurnal cycle in traffic volume, and peaked during the morning traffic peak at around 180 μg m-3. Background NOx concentrations were slightly higher in our study compared to a similar study in Las Vegas but absolute roadside concentrations were higher. This may be consistent with higher NOx emission factors in Auckland, but differences in the precise distance of the monitor from the road lanes and differences in meteorology need to be considered.
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Affiliation(s)
- Ian Longley
- National Institute of Water and Atmospheric Research (NIWA) Ltd, Private Bag 99940, Auckland, 1149 New Zealand
| | - Elizabeth Somervell
- National Institute of Water and Atmospheric Research (NIWA) Ltd, Private Bag 99940, Auckland, 1149 New Zealand
| | - Sally Gray
- National Institute of Water and Atmospheric Research (NIWA) Ltd, Private Bag 99940, Auckland, 1149 New Zealand
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Cost of near-roadway and regional air pollution-attributable childhood asthma in Los Angeles County. J Allergy Clin Immunol 2014; 134:1028-35. [PMID: 25439228 DOI: 10.1016/j.jaci.2014.09.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 09/15/2014] [Accepted: 09/24/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Emerging evidence suggests that near-roadway air pollution (NRP) exposure causes childhood asthma. The associated costs are not well documented. OBJECTIVE We estimated the cost of childhood asthma attributable to residential NRP exposure and regional ozone (O3) and nitrogen dioxide (NO2) levels in Los Angeles County. We developed a novel approach to apportion the costs between these exposures under different pollution scenarios. METHODS We integrated results from a study of willingness to pay to reduce the burden of asthma with results from studies of health care use and charges to estimate the costs of an asthma case and exacerbation. We applied those costs to the number of asthma cases and exacerbations caused by regional pollution in 2007 and to hypothetical scenarios of a 20% reduction in regional pollution in combination with a 20% reduction or increase in the proportion of the total population living within 75 m of a major roadway. RESULTS Cost of air pollution-related asthma in Los Angeles County in 2007 was $441 million for O3 and $202 million for NO2 in 2010 dollars. Cost of routine care (care in absence of exacerbation) accounted for 18% of the combined NRP and O3 cost and 39% of the combined NRP and NO2 cost; these costs were not recognized in previous analyses. NRP-attributable asthma accounted for 43% (O3) to 51% (NO2) of the total annual cost of exacerbations and routine care associated with pollution. Hypothetical scenarios showed that costs from increased NRP exposure might offset savings from reduced regional pollution. CONCLUSIONS Our model disaggregates the costs of regional pollution and NRP exposure and illustrates how they might vary under alternative exposure scenarios. The cost of air pollution is a substantial burden on families and an economic loss for society.
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Liu F, Zhao Y, Liu YQ, Liu Y, Sun J, Huang MM, Liu Y, Dong GH. Asthma and asthma related symptoms in 23,326 Chinese children in relation to indoor and outdoor environmental factors: the Seven Northeastern Cities (SNEC) Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 497-498:10-17. [PMID: 25112820 DOI: 10.1016/j.scitotenv.2014.07.096] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Both the levels and patterns of outdoor and indoor air pollutants have changed dramatically during the last decade in China. However, few studies have evaluated the effects of the present air pollution on the health of Chinese children. This study examines the association between outdoor and indoor air pollution and respiratory diseases among children living in Liaoning, a heavy industrial province of China. METHODS A cross-sectional study of 23,326 Chinese children aged 6 to 13 years was conducted in 25 districts of 7 cities in Northeast China during 2009. Three-year (2006-2008) average concentrations of particles with an aerodynamic diameter of ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxides (NO2), and ozone (O3) were calculated from monitoring stations in each of the 25 districts. We used two-level logistic regression models to examine the effects of yearly variations in exposure to each pollutant, controlling for important covariates. RESULTS The prevalence of respiratory symptoms was higher for those dwelling close to a busy road, those living near smokestacks or factories, those living with smokers, those living in one-story houses typically with small yards, and those with home renovation, bedroom carpet or pets. Ventilation device use was associated with decreased odds of asthma in children. The adjusted odds ratio for diagnosed-asthma was 1.34 (95% confidence interval [CI], 1.24-1.45) per 31 μg/m(3) increase in PM10, 1.23 (95%CI, 1.14-1.32) per 21 μg/m(3) increase in SO2, 1.25 (95%CI, 1.16-1.36) per 10 μg/m(3) increase in NO2, and 1.31 (95%CI, 1.21-1.41) per 23 μg/m(3) increase in O3, respectively. CONCLUSION Outdoor and indoor air pollution was associated with an increased likelihood of respiratory morbidity among Chinese children.
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Affiliation(s)
- Fan Liu
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Yang Zhao
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Yu-Qin Liu
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Yang Liu
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Jing Sun
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Mei-Meng Huang
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Yi Liu
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Guang-Hui Dong
- Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province 510080, PR China.
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Shirinde J, Wichmann J, Voyi K. Association between wheeze and selected air pollution sources in an air pollution priority area in South Africa: a cross-sectional study. Environ Health 2014; 13:32. [PMID: 24885606 PMCID: PMC4018977 DOI: 10.1186/1476-069x-13-32] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 04/28/2014] [Indexed: 05/16/2023]
Abstract
BACKGROUND An association between wheeze (a symptom of asthma) and environmental tobacco smoke (ETS), types of fuel used for residential heating or cooking and the frequency of trucks passing near homes, has been reported mainly in developed countries. Little is known about the strength of such associations in developing countries. This study was conducted in residential areas situated in Ekurhuleni Metropolitan Municipality, namely Tembisa and Kempton Park, which form part of the Highveld region, a priority area in terms of air pollution in South Africa. METHODS From 3764 eligible school children, aged between 13 and 14 years, from 16 selected high schools in the study area, 3468 completed a modified questionnaire based on the International Study of Asthma and Allergies in Childhood (ISAAC). Data were analysed using multiple logistic regression models. RESULTS The results are based on data from 3424 children. In the adjusted models, exposure to ETS at school was associated with wheeze ever (OR 1.22 95% CI: 1.03 - 1.45) and current wheeze (OR 1.33 95% CI: 1.08 - 1.64). When gas was most frequently used for residential heating the likelihood of wheeze ever increased by 47% (OR 1.47 95% CI: 1.15 - 1.88). Trucks passing near homes for almost the whole day during weekdays, increased the likelihood of wheeze ever (OR 1.32 95% CI: 1.01 - 1.73), current wheeze (OR 1.61 95% CI: 1.15 - 2.24) and current severe wheeze (OR 2.22 95% CI: 1.28 - 3.77). When data were stratified according to residential area, for children living in Tembisa, ETS exposure at home was associated with current wheeze (OR 1.36 95% CI: 1.06 - 1.77); gas most frequently used for residential heating was associated with wheeze ever (OR 1.68 95% CI: 1.23 - 2.28) and current wheeze (OR 1.61 95% CI: 1.08 - 2.39); paraffin most frequently used for residential heating was associated with current severe wheeze (OR 1.85 95% CI: 1.04 - 3.28). CONCLUSION It was concluded that children living in one of the air pollution priority areas of South Africa, have an increased risk of wheezing due to exposure to both indoor and outdoor air pollution sources.
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Affiliation(s)
- Joyce Shirinde
- Department of Environmental Health, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa
- School of Health Systems and Public Health, Health Sciences Faculty, University of Pretoria, P.O. Box 667, Pretoria 0001, South Africa
| | - Janine Wichmann
- School of Health Systems and Public Health, Health Sciences Faculty, University of Pretoria, P.O. Box 667, Pretoria 0001, South Africa
| | - Kuku Voyi
- School of Health Systems and Public Health, Health Sciences Faculty, University of Pretoria, P.O. Box 667, Pretoria 0001, South Africa
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Abstract
Traffic and power generation are the main sources of urban air pollution. The idea that outdoor air pollution can cause exacerbations of pre-existing asthma is supported by an evidence base that has been accumulating for several decades, with several studies suggesting a contribution to new-onset asthma as well. In this Series paper, we discuss the effects of particulate matter (PM), gaseous pollutants (ozone, nitrogen dioxide, and sulphur dioxide), and mixed traffic-related air pollution. We focus on clinical studies, both epidemiological and experimental, published in the previous 5 years. From a mechanistic perspective, air pollutants probably cause oxidative injury to the airways, leading to inflammation, remodelling, and increased risk of sensitisation. Although several pollutants have been linked to new-onset asthma, the strength of the evidence is variable. We also discuss clinical implications, policy issues, and research gaps relevant to air pollution and asthma.
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Affiliation(s)
- Michael Guarnieri
- Department of Medicine, University of California, San Francisco, CA, USA; Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - John R Balmes
- Department of Medicine, University of California, San Francisco, CA, USA; Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
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Selgrade MK, Blain RB, Fedak KM, Cawley MA. Potential risk of asthma associated with in utero exposure to xenobiotics. ACTA ACUST UNITED AC 2014; 99:1-13. [PMID: 23723168 DOI: 10.1002/bdrc.21028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 03/06/2013] [Indexed: 12/27/2022]
Abstract
The incidence of asthma, a complex disease and significant public health problem, has been increasing over the last 30 years for unknown reasons. Changes in environmental exposures or lifestyle may be involved. In some cases asthma may originate in utero or in early life. Associations have been found between in utero exposures to several xenobiotics and increased risk of asthma. There is convincing evidence that maternal smoking and/or in utero and perinatal exposure to environmental tobacco smoke are associated with increased risk of asthma. Similar effects have been demonstrated in animal models of allergic asthma. Evidence also suggests that in utero and/or early-life exposures to various ambient air pollutants may increase the risk of asthma although supporting animal data are very limited. A few studies have suggested that in utero exposure to acetaminophen is associated with increased risk of asthma; however, animal data are lacking. Various vitamin deficiencies and supplements during pregnancy have been studied. In general, it appears that vitamins A, C, and E have protective effects and vitamins D and B may, in some instances, increase the risk, but the data are not conclusive. Some studies related to in utero exposures to polychlorinated biphenyls and bisphenol A and asthma risk are also reported. The underlying mechanisms for an association between xenobiotic exposures and asthma remain a matter of speculation. Genetic predisposition and epigenetic changes have been explored. The developing immune, respiratory, and nervous systems are potential targets. Oxidative stress and modulation of inflammation are thought to be involved.
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Urman R, McConnell R, Islam T, Avol EL, Lurmann FW, Vora H, Linn WS, Rappaport EB, Gilliland FD, Gauderman WJ. Associations of children's lung function with ambient air pollution: joint effects of regional and near-roadway pollutants. Thorax 2013; 69:540-7. [PMID: 24253832 DOI: 10.1136/thoraxjnl-2012-203159] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Previous studies have reported adverse effects of either regional or near-roadway air pollution (NRAP) on lung function. However, there has been little study of the joint effects of these exposures. OBJECTIVES To assess the joint effects of NRAP and regional pollutants on childhood lung function in the Children's Health Study. METHODS Lung function was measured on 1811 children from eight Southern Californian communities. NRAP exposure was assessed based on (1) residential distance to the nearest freeway or major road and (2) estimated near-roadway contributions to residential nitrogen dioxide (NO2), nitric oxide (NO) and total nitrogen oxides (NOx). Exposure to regional ozone (O3), NO2, particulate matter with aerodynamic diameter <10 µm (PM10) and 2.5 µm (PM2.5) was measured continuously at community monitors. RESULTS An increase in near-roadway NOx of 17.9 ppb (2 SD) was associated with deficits of 1.6% in forced vital capacity (FVC) (p=0.005) and 1.1% in forced expiratory volume in 1 s (FEV1) (p=0.048). Effects were observed in all communities and were similar for NO2 and NO. Residential proximity to a freeway was associated with a reduction in FVC. Lung function deficits of 2-3% were associated with regional PM10 and PM2.5 (FVC and FEV1) and with O3 (FEV1), but not NO2 across the range of exposure between communities. Associations with regional pollution and NRAP were independent in models adjusted for each. The effects of NRAP were not modified by regional pollutant concentrations. CONCLUSIONS The results indicate that NRAP and regional air pollution have independent adverse effects on childhood lung function.
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Affiliation(s)
- Robert Urman
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Rob McConnell
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Talat Islam
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Edward L Avol
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | | | - Hita Vora
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - William S Linn
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Edward B Rappaport
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Frank D Gilliland
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - W James Gauderman
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Batterman S. The Near-Road Ambient Monitoring Network and Exposure Estimates for Health Studies. EM (PITTSBURGH, PA.) 2013; 2013:24-30. [PMID: 25705106 PMCID: PMC4335686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The transport sector is the largest source of NOx and CO emissions, and among the largest sources of PM2.5 and VOCs. As a result of EPA's new near-road monitoring requirements, high-quality measurements of ambient NO2, CO, and PM2.5 concentrations will be available from more than 120 sites adjacent to major roads in over 100 cities nationwide in the next few years. This article discusses how data from the new network will provide opportunities to further develop, calibrate, and verify exposure assessment methods and models.
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Affiliation(s)
- Stuart Batterman
- professor of environmental health sciences at the University of Michigan.
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McCarthy MC, Ludwig JF, Brown SG, Vaughn DL, Roberts PT. Filtration effectiveness of HVAC systems at near-roadway schools. INDOOR AIR 2013; 23:196-207. [PMID: 23167831 DOI: 10.1111/ina.12015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/09/2012] [Indexed: 06/01/2023]
Abstract
UNLABELLED Concern for the exposure of children attending schools located near busy roadways to toxic, traffic-related air pollutants has raised questions regarding the environmental benefits of advanced heating, ventilation, and air-conditioning (HVAC) filtration systems for near-road pollution. Levels of black carbon and gaseous pollutants were measured at three indoor classroom sites and at seven outdoor monitoring sites at Las Vegas schools. Initial HVAC filtration systems effected a 31-66% reduction in black carbon particle concentrations inside three schools compared with ambient air concentrations. After improved filtration systems were installed, black carbon particle concentrations were reduced by 74-97% inside three classrooms relative to ambient air concentrations. Average black carbon particle concentrations inside the schools with improved filtration systems were lower than typical ambient Las Vegas concentrations by 49-96%. Gaseous pollutants were higher indoors than outdoors. The higher indoor concentrations most likely originated at least partially from indoor sources, which were not targeted as part of this intervention. PRACTICAL IMPLICATIONS Recent literature has demonstrated adverse health effects in subjects exposed to ambient air near major roadways. Current smart growth planning and infill development often require that buildings such as schools are built near major roadways. Improving the filtration systems of a school's HVAC system was shown to decrease children's exposure to near-roadway diesel particulate matter. However, reducing exposure to the gas-phase air toxics, which primarily originated from indoor sources, may require multiple filter passes on recirculated air.
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Affiliation(s)
- M C McCarthy
- Sonoma Technology, Inc. (STI), Petaluma, CA 94954, USA.
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Herbert C, Siegle JS, Shadie AM, Nikolaysen S, Garthwaite L, Hansbro NG, Foster PS, Kumar RK. Development of asthmatic inflammation in mice following early-life exposure to ambient environmental particulates and chronic allergen challenge. Dis Model Mech 2012; 6:479-88. [PMID: 23223614 PMCID: PMC3597029 DOI: 10.1242/dmm.010728] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Childhood exposure to environmental particulates increases the risk of development of asthma. The underlying mechanisms might include oxidant injury to airway epithelial cells (AEC). We investigated the ability of ambient environmental particulates to contribute to sensitization via the airways, and thus to the pathogenesis of childhood asthma. To do so, we devised a novel model in which weanling BALB/c mice were exposed to both ambient particulate pollutants and ovalbumin for sensitization via the respiratory tract, followed by chronic inhalational challenge with a low mass concentration of the antigen. We also examined whether these particulates caused oxidant injury and activation of AEC in vitro. Furthermore, we assessed the potential benefit of minimizing oxidative stress to AEC through the period of sensitization and challenge by dietary intervention. We found that characteristic features of asthmatic inflammation developed only in animals that received particulates at the same time as respiratory sensitization, and were then chronically challenged with allergen. However, these animals did not develop airway hyper-responsiveness. Ambient particulates induced epithelial injury in vitro, with evidence of oxidative stress and production of both pro-inflammatory cytokines and Th2-promoting cytokines such as IL-33. Treatment of AEC with an antioxidant in vitro inhibited the pro-inflammatory cytokine response to these particulates. Ambient particulates also induced pro-inflammatory cytokine expression following administration to weanling mice. However, early-life dietary supplementation with antioxidants did not prevent the development of an asthmatic inflammatory response in animals that were exposed to particulates, sensitized and challenged. We conclude that injury to airway epithelium by ambient environmental particulates in early life is capable of promoting the development of an asthmatic inflammatory response in sensitized and antigen-challenged mice. These findings are likely to be relevant to the induction of childhood asthma.
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Affiliation(s)
- Cristan Herbert
- Inflammation and Infection Research Centre, School of Medical Sciences, University of New South Wales, Sydney, 2052, Australia
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