Long-term ambient hydrocarbons exposure and incidence of ischemic stroke

Correlation between marital status and the prognosis of older patients with cerebrovascular disease in intensive care units: A retrospective cohort study

Background and Aims

Marital status has been shown to be associated with mortality, but evidence in critically ill elder intensive care unit (ICU) patients with cerebrovascular diseases (CeVD) is limited. This study was to explore the correlation between marital status and the prognosis of patients with CeVD aged 65 years and over in the ICU.

Methods

In the present study, 3564 patients were enrolled in the Medical Information Mart for Intensive Care IV database (version 2.2). Patients were divided into four groups based on marital status: married, single, divorced, and widowed. The primary outcome was all-cause mortality as patients were followed up for 3-, 6-, 9-, and 12-month. All-cause mortality risk for patients with different marital status was compared. Univariate and multivariable logistic regression analyses, survival curves and stratified analyses were performed to determine the correlation between marital status and mortality in critically ill patients with CeVD aged ≥65 years.

Results

Of the patients, 51.2% (1825/3564) were married, followed by 23.8% (847/3564) were widowed, 18.2% (647/3564) were single, and 6.9% (245/3567) were divorced. Compared with the married, the unmarried had a higher proportion of female (p < 0.001), older (p < 0.001), and less proportion of mechanical ventilation (p = 0.045). Multivariate analyses showed that no differences were observed for mortality risk among different marital statuses (p > 0.05), while at late follow-up, widowed had a significance higher mortality risk than the married (9-month: odds ratio [OR]: 1.30, 95% confidence interval [CI]: 1.05-1.61, p = 0.02; 12-month: OR: 1.38, 95% CI: 1.12-1.71, p = 0.003). Stratified analyses indicated a stable correlation between marital status and 12-month mortality rate in sub-analysis for gender (p = 0.46) and age (p = 0.35).

Conclusion

Marital status is associated with long-term prognosis in older patients with CeVD admitted to ICU. Widowed people should receive more societal attention irrespective of sex or age.

Long-term ambient hydrocarbon exposure and incidence of urinary bladder cancer

Particulate matter and volatile organic compounds, including total hydrocarbons (THCs), are major ambient air pollutants. Primary nonmethane hydrocarbons (NMHCs) originate from vehicle emissions. The association between air pollution and urinary bladder cancer (UBC) is debatable. We investigated whether long-term exposure to ambient hydrocarbons increases UBC risk among people aged ≥ 20 years in Taiwan. Linkage dataset research with longitudinal design was conducted among 589,135 initially cancer-free individuals during 2000-2013; 12 airborne pollutants were identified. Several Cox models considering potential confounders were employed. The study outcomes were invasive or in situ UBC incidence over time. The targeted pollutant concentration was divided into three tertiles: T1/T2/T3. The mean age of individuals at risk was 42.5 (SD 15.7), and 50.5% of the individuals were men. The mean daily average over 10 years of airborne THC concentration was 2.25 ppm (SD 0.13), and NMHC was 0.29 ppm (SD 0.09). Both pollutants show long-term monotonic downward trend over time using the Mann-Kendall test. There was a dose-dependent increase in UBC at follow-up. UBC incidence per 100,000 enrollees according to T1/T2/T3 exposure to THC was 60.9, 221.2, and 651.8, respectively; it was 170.0/349.5/426.7 per 100,000 enrollees, corresponding to T1/T2/T3 exposure to NMHC, respectively. Without controlling for confounding air pollutants, the adjusted hazard ratio (adj.HR) was 1.83 (95% CI 1.75-1.91) per 0.13-ppm increase in THC; after controlling for PM_2.5, adj.HR was even higher at 2.09 (95% CI 1.99-2.19). The adj.HR was 1.37 (95% CI 1.32-1.43) per 0.09-ppm increase in ambient NMHC concentration. After controlling for SO₂ and CH₄, the adj.HR was 1.10 (95% CI 1.06-1.15). Sensitivity analyses showed that UBC development risk was not sex-specific or influenced by diabetes status. Long-term exposure to THC and NMHC may be a risk factor for UBC development. Acknowledging pollutant sources can inform risk management strategies.

Residential exposure to petroleum refining and stroke in the southern United States

BACKGROUND

The southern United States (U.S.) sustains a disproportionate burden of incident stroke and associated mortality, compared to other parts of the U.S. A large proportion of this risk remains unexplained. Petroleum production and refining (PPR) is concentrated within this region and emits multiple pollutants implicated in stroke pathogenesis. The relationship between residential PPR exposure and stroke has not been studied.

OBJECTIVE

We aimed to investigate the census tract-level association between residential PPR exposure and stroke prevalence for adults (≥18 years) in seven southern U.S. states in 2018.

METHODS

We conducted spatial distance- and generalized propensity score-matched analysis that adjusts for sociodemographic factors, smoking, and unmeasured spatial confounding. PPR was measured as inverse-distance weighted averages of petroleum production within 2.5km or 5km from refineries, which was strongly correlated with measured levels of sulfur dioxide, a byproduct of PPR.

RESULTS

The prevalence of self-reported stroke ranged from 0.4% to 12.7% for all the census tracts of the seven states. People with low socioeconomic status and of Hispanic ethnicity resided closer to petroleum refineries. The non-Hispanic Black population was exposed to higher PPR, while the non-Hispanic White population was exposed to lower PPR. Residential PPR exposure was significantly associated with stroke prevalence. One standard deviation increase in PPR within 5km from refineries was associated with 0.22 (95% confidence interval: 0.09, 0.34) percentage point increase in stroke prevalence. PPR explained 5.6% (2.4, 8.9) of stroke prevalence in the exposed areas. These values differed by states: 1.1% (0.5, 1.7) in Alabama to 11.7% (4.9, 18.6) in Mississippi, and by census tract-level: 0.08% (0.03, 0.13) to 25.3% (10.6, 40.0).

CONCLUSIONS

PPR is associated with self-reported stroke prevalence, suggesting possible links between pollutants emitted from refineries and stroke. The increased prevalence due to PPR may differ by sociodemographic factors.

Association of cardiorespiratory hospital admissions with ambient volatile organic compounds: Evidence from a time-series study in Taipei, Taiwan

As important precursors of ozone and secondary organic aerosols, the harmful impact of exposure to ambient volatile organic compounds (VOCs) is of public health interest. However, few studies have investigated the health risks of numerous individual VOC species. This study linked the daily concentrations of 54 C2-C11 VOC species monitored from the Wanhua Photochemical Assessment Monitoring Station and hospital admissions for cardiorespiratory diseases in Taipei, Taiwan, from the National Health Insurance Research Database. A standard time-series approach entailing a series of sensitivity analyses was applied to investigate the short-term health risks of exposure to VOC subgroups and species. Consistent associations of all VOC subgroups and main species with chronic obstructive pulmonary disease (COPD) hospitalizations were demonstrated. In addition, associations of the C5-C6 alkanes, C2-C3 alkenes, toluene, and xylene with asthma hospitalizations were found, as were associations of aromatic hydrocarbons with hospitalizations for heart failure. An interquartile range increase in total VOC exposure at lag0 day (102.6 parts per billion carbon) was associated with increments of 1.84% (95% confidence interval: 0.54%-3.15%), 1.65% (0.71%-2.60%), and 1.21% (0.36%-2.07%) in hospitalizations for asthma, COPD, and heart failure, respectively. The effect estimates were robust with data excluding extreme values, the second pollutant adjustment for PM_2.5 and O₃, and the Bonferroni correction. The associations of ambient VOC exposure with cardiorespiratory hospitalizations in Taipei serve as a reference for VOC regulations and ozone control strategies.

Late-onset epilepsy and subsequent increased risk of dementia

Inflammation is considered as a key pathogenesis factor of dementia and epilepsy. However, epilepsy's association with dementia, particularly its role in the development of dementia, remains unclear. To evaluate the association between epilepsy and the risk of dementia, in Taiwan, we have now conducted a retrospective cohort study comprising 675 individuals (age, ≥50 years) with epilepsy and 2,025 matched control subjects without epilepsy. In order to match individuals diagnosed with epilepsy with those with no diagnosis of epilepsy (comparison cohort), we utilized exact matching at a ratio of 1:3. Compared with those in the comparison cohort, individuals in the epilepsy cohort had a significantly increased risk of developing dementia (adjusted hazard ratio = 2.87, p < 0.001). A similar result has been observed after stratifying for sex (adjusted hazard ratio in males = 2.95, p < 0.001; adjusted hazard ratio in females = 2.66, p < 0.001). To conclude, based on these data, epileptic individuals ≥50 years were at a greater risk of developing dementia than people who do not have epilepsy, which indicates that a diagnosis of epilepsy presents a greater risk for the development of dementia.

Association of ambient non-methane hydrocarbons exposure with respiratory hospitalizations: A time series study in Taipei, Taiwan

Ambient hydrocarbons are important precursors of ground-level ozone and secondary organic aerosol formation. However, few studies have assessed the health impact of airborne hydrocarbons. We conducted this time series ecological study to evaluate the association of short-term airborne hydrocarbons exposure with hospital admissions for respiratory diseases, while controlling for co-exposure to criteria pollutants. Taipei air pollution and weather data for the period spanning from January 2010 to December 2017 were obtained from Taiwan Air Quality Monitoring Network. Subsequently, daily pollutant concentrations were linked with daily hospital admission counts for respiratory diseases into a time series data frame. The standard generalized additive Poisson model adjusted for temporal trends, seasonal variations, weather conditions, and calendar effects, was applied to examine the short-term associations of acute airborne hydrocarbon exposure with respiratory hospital admissions. Next, the robustness of the associations was tested using two-pollutant models with further adjustment for fine particulate matter (PM_2.5) and gaseous pollutants. The results demonstrated that an interquartile range increase in non-methane hydrocarbon (NMHC) exposure on lag0 day (0.15 ppm) was associated with a 0.86% (95% confidence interval: 0.37%-1.36%), 2.06% (0.77%-3.38%), and 1.25% (0.31%-2.20%) increment in all-respiratory-disease-, asthma-, and chronic-obstructive-pulmonary-disease-linked hospital admissions, respectively. The associations were robust with further adjustment for co-exposure to PM_2.5 and ozone. The acute effect estimate of methane on each respiratory category was sensitive to the co-pollutant adjustment and lost statistical significance in the two-pollutant models. In conclusion, we confirmed that airborne NMHC exposure increased the risk of respiratory-disease-related hospital admissions in Taipei; this information may aid in the regulation of hydrocarbon pollution.