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Landguth EL, Knudson J, Graham J, Orr A, Coyle EA, Smith P, Semmens EO, Noonan C. Seasonal extreme temperatures and short-term fine particulate matter increases pediatric respiratory healthcare encounters in a sparsely populated region of the intermountain western United States. Environ Health 2024; 23:40. [PMID: 38622704 PMCID: PMC11017546 DOI: 10.1186/s12940-024-01082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Western Montana, USA, experiences complex air pollution patterns with predominant exposure sources from summer wildfire smoke and winter wood smoke. In addition, climate change related temperatures events are becoming more extreme and expected to contribute to increases in hospital admissions for a range of health outcomes. Evaluating while accounting for these exposures (air pollution and temperature) that often occur simultaneously and may act synergistically on health is becoming more important. METHODS We explored short-term exposure to air pollution on children's respiratory health outcomes and how extreme temperature or seasonal period modify the risk of air pollution-associated healthcare events. The main outcome measure included individual-based address located respiratory-related healthcare visits for three categories: asthma, lower respiratory tract infections (LRTI), and upper respiratory tract infections (URTI) across western Montana for ages 0-17 from 2017-2020. We used a time-stratified, case-crossover analysis with distributed lag models to identify sensitive exposure windows of fine particulate matter (PM2.5) lagged from 0 (same-day) to 14 prior-days modified by temperature or season. RESULTS For asthma, increases of 1 µg/m3 in PM2.5 exposure 7-13 days prior a healthcare visit date was associated with increased odds that were magnified during median to colder temperatures and winter periods. For LRTIs, 1 µg/m3 increases during 12 days of cumulative PM2.5 with peak exposure periods between 6-12 days before healthcare visit date was associated with elevated LRTI events, also heightened in median to colder temperatures but no seasonal effect was observed. For URTIs, 1 unit increases during 13 days of cumulative PM2.5 with peak exposure periods between 4-10 days prior event date was associated with greater risk for URTIs visits that were intensified during median to hotter temperatures and spring to summer periods. CONCLUSIONS Delayed, short-term exposure increases of PM2.5 were associated with elevated odds of all three pediatric respiratory healthcare visit categories in a sparsely population area of the inter-Rocky Mountains, USA. PM2.5 in colder temperatures tended to increase instances of asthma and LRTIs, while PM2.5 during hotter periods increased URTIs.
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Affiliation(s)
- Erin L Landguth
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA.
| | - Jonathon Knudson
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Jon Graham
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
- Mathematical Sciences, University of Montana, Missoula, USA
| | - Ava Orr
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Emily A Coyle
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Paul Smith
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
- Pediatric Pulmonology, Community Medical Center, Missoula, MT, USA
| | - Erin O Semmens
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Curtis Noonan
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
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Chitre SD, Crews CM, Tessema MT, Plėštytė-Būtienė I, Coffee M, Richardson ET. The impact of anthropogenic climate change on pediatric viral diseases. Pediatr Res 2024; 95:496-507. [PMID: 38057578 PMCID: PMC10872406 DOI: 10.1038/s41390-023-02929-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/12/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023]
Abstract
The adverse effects of climate change on human health are unfolding in real time. Environmental fragmentation is amplifying spillover of viruses from wildlife to humans. Increasing temperatures are expanding mosquito and tick habitats, introducing vector-borne viruses into immunologically susceptible populations. More frequent flooding is spreading water-borne viral pathogens, while prolonged droughts reduce regional capacity to prevent and respond to disease outbreaks with adequate water, sanitation, and hygiene resources. Worsening air quality and altered transmission seasons due to an increasingly volatile climate may exacerbate the impacts of respiratory viruses. Furthermore, both extreme weather events and long-term climate variation are causing the destruction of health systems and large-scale migrations, reshaping health care delivery in the face of an evolving global burden of viral disease. Because of their immunological immaturity, differences in physiology (e.g., size), dependence on caregivers, and behavioral traits, children are particularly vulnerable to climate change. This investigation into the unique pediatric viral threats posed by an increasingly inhospitable world elucidates potential avenues of targeted programming and uncovers future research questions to effect equitable, actionable change. IMPACT: A review of the effects of climate change on viral threats to pediatric health, including zoonotic, vector-borne, water-borne, and respiratory viruses, as well as distal threats related to climate-induced migration and health systems. A unique focus on viruses offers a more in-depth look at the effect of climate change on vector competence, viral particle survival, co-morbidities, and host behavior. An examination of children as a particularly vulnerable population provokes programming tailored to their unique set of vulnerabilities and encourages reflection on equitable climate adaptation frameworks.
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Affiliation(s)
- Smit D Chitre
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Cecilia M Crews
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mesfin Teklu Tessema
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA.
- International Rescue Committee, New York, NY, USA.
| | | | - Megan Coffee
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
- International Rescue Committee, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Chaudhary E, George F, Saji A, Dey S, Ghosh S, Thomas T, Kurpad AV, Sharma S, Singh N, Agarwal S, Mehta U. Cumulative effect of PM 2.5 components is larger than the effect of PM 2.5 mass on child health in India. Nat Commun 2023; 14:6955. [PMID: 37907499 PMCID: PMC10618175 DOI: 10.1038/s41467-023-42709-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/19/2023] [Indexed: 11/02/2023] Open
Abstract
While studies on ambient fine particulate matter (PM2.5) exposure effect on child health are available, the differential effects, if any, of exposure to PM2.5 species are unexplored in lower and middle-income countries. Using multiple logistic regression, we showed that for every 10 μg m-3 increase in PM2.5 exposure, anaemia, acute respiratory infection, and low birth weight prevalence increase by 10% (95% uncertainty interval, UI: 9-11), 11% (8-13), and 5% (4-6), respectively, among children in India. NO3-, elemental carbon, and NH4+ were more associated with the three health outcomes than other PM2.5 species. We found that the total PM2.5 mass as a surrogate marker for air pollution exposure could substantially underestimate the true composite impact of different components of PM2.5. Our findings provide key indigenous evidence to prioritize control strategies for reducing exposure to more toxic species for greater child health benefits in India.
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Affiliation(s)
- Ekta Chaudhary
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India
| | - Franciosalgeo George
- Division of Epidemiology, Biostatistics, and Population Health, St John's Research Institute, Bangalore, India
| | - Aswathi Saji
- Division of Epidemiology, Biostatistics, and Population Health, St John's Research Institute, Bangalore, India
| | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India.
- Centre of Excellence for Research on Clean Air, IIT Delhi, New Delhi, India.
- School of Public Policy, IIT Delhi, New Delhi, India.
| | - Santu Ghosh
- Department of Biostatistics, St John's Medical College, Bengaluru, India.
| | - Tinku Thomas
- Department of Biostatistics, St John's Medical College, Bengaluru, India
| | - Anura V Kurpad
- Department of Physiology, St John's Medical College, Bengaluru, India
| | | | - Nimish Singh
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India
- TERI, New Delhi, India
| | - Shivang Agarwal
- TERI, New Delhi, India
- Johns Hopkins University, Baltimore, MD, USA
| | - Unnati Mehta
- Harvard T.H. Chan School of Public Health, Boston, USA
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Landguth EL, Knudson J, Graham J, Orr A, Coyle EA, Smith P, Semmens EO, Noonan C. Seasonal extreme temperatures and short-term fine particulate matter increases child respiratory hospitalizations in a sparsely populated region of the intermountain western United States. RESEARCH SQUARE 2023:rs.3.rs-3438033. [PMID: 37886498 PMCID: PMC10602161 DOI: 10.21203/rs.3.rs-3438033/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background Western Montana, USA, experiences complex air pollution patterns with predominant exposure sources from summer wildfire smoke and winter wood smoke. In addition, climate change related temperatures events are becoming more extreme and expected to contribute to increases in hospital admissions for a range of health outcomes. Few studies have evaluated these exposures (air pollution and temperature) that often occur simultaneously and may act synergistically on health. Methods We explored short-term exposure to air pollution on childhood respiratory health outcomes and how extreme temperature or seasonal period modify the risk of air pollution-associated hospitalizations. The main outcome measure included all respiratory-related hospital admissions for three categories: asthma, lower respiratory tract infections (LRTI), and upper respiratory tract infections (URTI) across western Montana for all individuals aged 0-17 from 2017-2020. We used a time-stratified, case-crossover analysis and distributed lag models to identify sensitive exposure windows of fine particulate matter (PM2.5) lagged from 0 (same-day) to 15 prior-days modified by temperature or season. Results Short-term exposure increases of 1 μg/m3 in PM2.5 were associated with elevated odds of all three respiratory hospital admission categories. PM2.5 was associated with the largest increased odds of hospitalizations for asthma at lag 7-13 days [1.87(1.17-2.97)], for LRTI at lag 6-12 days [2.18(1.20-3.97)], and for URTI at a cumulative lag of 13 days [1.29(1.07-1.57)]. The impact of PM2.5 varied by temperature and season for each respiratory outcome scenario. For asthma, PM2.5 was associated most strongly during colder temperatures [3.11(1.40-6.89)] and the winter season [3.26(1.07-9.95)]. Also in colder temperatures, PM2.5 was associated with increased odds of LRTI hospitalization [2.61(1.15-5.94)], but no seasonal effect was observed. Finally, 13 days of cumulative PM2.5 prior to admissions date was associated with the greatest increased odds of URTI hospitalization during summer days [3.35(1.85-6.04)] and hotter temperatures [1.71(1.31-2.22)]. Conclusions Children's respiratory-related hospital admissions were associated with short-term exposure to PM2.5. PM2.5 associations with asthma and LRTI hospitalizations were strongest during cold periods, whereas associations with URTI were largest during hot periods. Classification environmental public health, fine particulate matter air pollution, respiratory infections.
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Dounce-Cuevas CA, Flores-Flores A, Bazán MS, Portales-Rivera V, Morelos-Ulíbarri AA, Bazán-Perkins B. Asthma and COVID-19: a controversial relationship. Virol J 2023; 20:207. [PMID: 37679779 PMCID: PMC10485988 DOI: 10.1186/s12985-023-02174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection induces a spectrum of clinical manifestations that depend on the immune response of the patient, i.e., from an asymptomatic form to an inflammatory response with multiorgan deterioration. In some cases, severe cases of SARS-CoV-2 are characterized by an excessive, persistent release of inflammatory mediators known as a cytokine storm. This phenomenon arises from an ineffective T helper (Th)-1 response, which is unable to control the infection and leads to a reinforcement of innate immunity, causing tissue damage. The evolution of the disease produced by SARS-CoV2, known as COVID-19, has been of interest in several research fields. Asthma patients have been reported to present highly variable outcomes due to the heterogeneity of the disease. For example, the Th2 response in patients with allergic asthma is capable of decreasing Th1 activation in COVID-19, preventing the onset of a cytokine storm; additionally, IL-33 released by damaged epithelium in the context of COVID-19 potentiates either Th1 or T2-high responses, a process that contributes to poor outcomes. IL-13, a T2-high inflammatory cytokine, decreases the expression of angiotensin converting enzyme-2 (ACE2) receptor, hindering SARS-CoV-2 entry; finally, poor outcomes have been observed in COVID-19 patients with severe neutrophilic asthma. In other contexts, the COVID-19 lockdown has had interesting effects on asthma epidemiology. The incidence of asthma in the most populated states in Mexico, including Tamaulipas, which has the highest asthma incidence in the country, showed similar tendencies independent of how strict the lockdown measures were in each state. As described worldwide for various diseases, a decrease in asthma cases was observed during the COVID-19 lockdown. This decrease was associated with a drop in acute respiratory infection cases. The drop in cases of various diseases, such as diabetes, hypertension or depression, observed in 2020 was restored in 2022, but not for asthma and acute respiratory infections. There were slight increases in asthma cases when in-person classes resumed. In conclusion, although many factors were involved in asthma outcomes during the pandemic, it seems that acute respiratory infection is intimately linked to asthma cases. Social distancing during remote learning, particularly school lockdown, appears to be an important cause of the decrease in cases.
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Affiliation(s)
- Carlos A Dounce-Cuevas
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 14380, Mexico City, Mexico
| | - Angélica Flores-Flores
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 14380, Mexico City, Mexico
- Laboratorio de Inmunofarmacología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, 14080, Mexico City, Mexico
| | - Mariana S Bazán
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 14380, Mexico City, Mexico
| | - Victor Portales-Rivera
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 14380, Mexico City, Mexico
| | | | - Blanca Bazán-Perkins
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 14380, Mexico City, Mexico.
- Laboratorio de Inmunofarmacología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, 14080, Mexico City, Mexico.
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Peng KK, Renouf EM, Dean CB, Hu XJ, Delatolla R, Manuel DG. An exploration of the relationship between wastewater viral signals and COVID-19 hospitalizations in Ottawa, Canada. Infect Dis Model 2023; 8:617-631. [PMID: 37342365 PMCID: PMC10245285 DOI: 10.1016/j.idm.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/22/2023] Open
Abstract
Monitoring of viral signal in wastewater is considered a useful tool for monitoring the burden of COVID-19, especially during times of limited availability in testing. Studies have shown that COVID-19 hospitalizations are highly correlated with wastewater viral signals and the increases in wastewater viral signals can provide an early warning for increasing hospital admissions. The association is likely nonlinear and time-varying. This project employs a distributed lag nonlinear model (DLNM) (Gasparrini et al., 2010) to study the nonlinear exposure-response delayed association of the COVID-19 hospitalizations and SARS-CoV-2 wastewater viral signals using relevant data from Ottawa, Canada. We consider up to a 15-day time lag from the average of SARS-CoV N1 and N2 gene concentrations to COVID-19 hospitalizations. The expected reduction in hospitalization is adjusted for vaccination efforts. A correlation analysis of the data verifies that COVID-19 hospitalizations are highly correlated with wastewater viral signals with a time-varying relationship. Our DLNM based analysis yields a reasonable estimate of COVID-19 hospitalizations and enhances our understanding of the association of COVID-19 hospitalizations with wastewater viral signals.
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Affiliation(s)
- K. Ken Peng
- Department of Statistics and Actuarial Science, Simon Fraser University, 8888 University Dr, Burnaby, V5A 1S6, BC, Canada
| | - Elizabeth M. Renouf
- Department of Statistics and Actuarial Science, University of Waterloo, 200 University Ave W, Waterloo, N2L 3G1, ON, Canada
| | - Charmaine B. Dean
- Department of Statistics and Actuarial Science, University of Waterloo, 200 University Ave W, Waterloo, N2L 3G1, ON, Canada
| | - X. Joan Hu
- Department of Statistics and Actuarial Science, Simon Fraser University, 8888 University Dr, Burnaby, V5A 1S6, BC, Canada
| | - Robert Delatolla
- Department of Civil Engineering, University of Ottawa, 75 Laurier Ave. E, Ottawa, K1N 6N5, ON, Canada
| | - Douglas G. Manuel
- The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, K1Y 4E9, ON, Canada
- Department of Family Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, K1N 6N5, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, 75 Laurier Ave. E, Ottawa, K1N 6N5, ON, Canada
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Jana A, Singh A, Adar SD, D'Souza J, Chattopadhyay A. In-utero exposure to multiple air pollutants and childhood undernutrition in India. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023:10.1038/s41370-023-00591-5. [PMID: 37563211 DOI: 10.1038/s41370-023-00591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Several studies have been conducted to understand the impact of socioeconomic and maternal factors on child undernutrition. However, the past literature has not directly examined the joint impacts of fuel use and ambient pollution and have primarily focused on PM2.5. OBJECTIVE This study explored the individual and community-level associations of both indoor (cooking fuel type) and ambient air pollution (PM2.5, NO2 and SO2) during maternal gestation on child undernutrition. METHODS This study analysed stunting, being underweight, and anaemia of children aged 0-59 months (n = 259,627) using the National Family Health Survey. In-utero exposures to ambient PM2.5, NO2, and SO2 were measured using satellite data and self-reported fuel type was a marker of indoor pollution exposure. The study used univariate and bivariate Moran's I, spatial lag model and multivariable logistic regression models after adjusting for other covariates to understand the effect of pollution on in-utero exposure and child health status at the individual and community-levels. RESULTS Higher concentration of indoor and ambient air pollution was found in the Northern and parts of Central regions of India. Estimates of spatial modelling show that each 1 μg/m-3 increase in maternal exposure to ambient PM2.5 across the clusters of India was associated with a 0.11, 9 and 19 percentage points increase in the prevalence of stunting, underweight and anaemia, respectively. The results of multi-pollutant model show that a higher ambient PM2.5 exposure during pregnancy was linked to higher odds of stunting (AOR:1.38; 95% CI:1.32-1.44), underweight (AOR:1.59; 95% CI:1.51-1.67) and anaemia (AOR:1.61; 95% CI:1.52-1.69) in children. Weaker but similar associations were observed for NO2, but not with SO2. Indoor pollution exposure during in-utero periods was also significantly associated with childhood undernutrition and this association was modified by ambient PM2.5 levels, where exposure to both indoor and ambient air pollution had even greater odds of being undernourished. IMPACT STATEMENT Our research on multi-pollutant models has revealed the initial proof of the individual impacts of indoor and outdoor pollution (PM2.5, NO2, and SO2) exposure during fetal development on children's nutrition.
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Affiliation(s)
- Arup Jana
- Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India
| | - Akancha Singh
- Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India
| | - Sara D Adar
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Jennifer D'Souza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Aparajita Chattopadhyay
- Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India.
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Zhang Y, Yin X, Zheng X. The relationship between PM2.5 and the onset and exacerbation of childhood asthma: a short communication. Front Pediatr 2023; 11:1191852. [PMID: 37593445 PMCID: PMC10429171 DOI: 10.3389/fped.2023.1191852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Much is known about the link between air pollution and asthma in adults, particularly fine particulate matter (PM2.5). Studies have found that certain levels of fine PM2.5 can increase airway responsiveness and worsen asthma. PM2.5 may play a role in the onset and exacerbation of childhood asthma. However, there is little in the literature on how PM2.5 affects asthma attacks and exacerbations in children. Asthma is a common chronic disease in children, and air pollution can aggravate it. The effect of PM2.5 on childhood asthma needs further research. By evaluating, reviewing, and collating existing results in this area, this paper aims to explore the relationship between PM2.5 and asthma onset and exacerbation in children.
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Affiliation(s)
- Yue Zhang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- The Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xixi Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- The Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xiangrong Zheng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- The Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
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Sarfo JO, Amoadu M, Gyan TB, Osman AG, Kordorwu PY, Adams AK, Asiedu I, Ansah EW, Amponsah-Manu F, Ofosu-Appiah P. Acute lower respiratory infections among children under five in Sub-Saharan Africa: a scoping review of prevalence and risk factors. BMC Pediatr 2023; 23:225. [PMID: 37149597 PMCID: PMC10163812 DOI: 10.1186/s12887-023-04033-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/25/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Acute lower respiratory tract infections (ALRTIs) among children under five are still the leading cause of mortality among this group of children in low and middle-income countries (LMICs), especially countries in sub-Saharan Africa (SSA). This scoping review aims to map evidence on prevalence and risk factors associated with ALRTIs among children under 5 years to inform interventions, policies and future studies. METHODS A thorough search was conducted via four main databases (PubMed, JSTOR, Web of Science and Central). In all, 3,329 records were identified, and 107 full-text studies were considered for evaluation after vigorous screening and removing duplicates, of which 43 were included in this scoping review. FINDINGS Findings indicate a high prevalence (between 1.9% to 60.2%) of ALRTIs among children under five in SSA. Poor education, poverty, malnutrition, exposure to second-hand smoke, poor ventilation, HIV, traditional cooking stoves, unclean fuel usage, poor sanitation facilities and unclean drinking water make children under five more vulnerable to ALRTIs in SSA. Also, health promotion strategies like health education have doubled the health-seeking behaviours of mothers of children under 5 years against ALRTIs. CONCLUSION ALRTIs among children under five still present a significant disease burden in SSA. Therefore, there is a need for intersectoral collaboration to reduce the burden of ALRTIs among children under five by strengthening poverty alleviation strategies, improving living conditions, optimising child nutrition, and ensuring that all children have access to clean water. There is also the need for high-quality studies where confounding variables in ALRTIs are controlled.
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Affiliation(s)
- Jacob Owusu Sarfo
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Mustapha Amoadu
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana.
| | - Thomas Boateng Gyan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Ganiyu Osman
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Peace Yaa Kordorwu
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Abdul Karim Adams
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Immanuel Asiedu
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Edward Wilson Ansah
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
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He Y, Jiang W, Gao X, Lin C, Li J, Yang L. Short-term effects and economic burden of air pollutants on acute lower respiratory tract infections in children in Southwest China: a time-series study. Environ Health 2023; 22:6. [PMID: 36641448 PMCID: PMC9840265 DOI: 10.1186/s12940-023-00962-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND There are few studies on the effects of air pollutants on acute lower respiratory tract infections (ALRI) in children. Here, we investigated the relationship of fine particulate matter (PM2.5), inhalable particulate matter (PM10), sulfur dioxide (SO2), and nitrogen dioxide (NO2) with the daily number of hospitalizations for ALRI in children in Sichuan Province, China, and to estimate the economic burden of disease due to exposure to air pollutants. METHODS We collected records of 192,079 cases of childhood ALRI hospitalization between January 1, 2017 and December 31, 2018 from nine municipal/prefecture medical institutions as well as the simultaneous meteorological and air pollution data from 183 monitoring sites in Sichuan Province. A time series-generalized additive model was used to analyze exposure responses and lagged effects while assessing the economic burden caused by air pollutant exposure after controlling for long-term trends, seasonality, day of the week, and meteorological factors. RESULTS Our single-pollutant model shows that for each 10 μg/m3 increase in air pollutant concentration (1 μg/m3 for SO2), the effect estimates of PM2.5, PM10, SO2, and NO2 for pneumonia reached their maximum at lag4, lag010, lag010, and lag07, respectively, with relative risk (RR) values of 1.0064 (95% CI, 1.0004-1.0124), 1.0168(95% CI 1.0089-1.0248), 1.0278 (95% CI 1.0157-1.0400), and 1.0378 (95% CI, 1.0072-1.0692). By contrast, the effect estimates of PM2.5, PM10, SO2, and NO2 for bronchitis all reached their maximum at lag010, with RRs of 1.0133 (95% CI 1.0025-1.0242), 1.0161(95% CI 1.0085-1.0238), 1.0135 (95% CI 1.0025-1.0247), and 1.1133(95% CI 1.0739-1.1541). In addition, children aged 5-14 years were more vulnerable to air pollutants than those aged 0-4 years (p < 0.05). According to the World Health Organization's air quality guidelines, the number of ALRI hospitalizations attributed to PM2.5, PM10, and NO2 pollution during the study period was 7551, 10,151, and 7575, respectively, while the incurring economic burden was CNY 2847.06, 3827.27, and 2855.91 million. CONCLUSION This study shows that in Sichuan Province, elevated daily average concentrations of four air pollutants lead to increases in numbers of childhood ALRI hospitalizations and cause a serious economic burden.
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Affiliation(s)
- Yi He
- HEOA Group, School of Public Health, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, China
| | - Wanyanhan Jiang
- HEOA Group, School of Public Health, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, China
| | - Xi Gao
- HEOA Group, School of Public Health, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, China
| | - Chengwei Lin
- HEOA Group, School of Public Health, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, China
| | - Jia Li
- HEOA Group, School of Management, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, China
| | - Lian Yang
- HEOA Group, School of Public Health, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, China
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Balasubramani K, Prasad KA, Kodali NK, Abdul Rasheed NK, Chellappan S, Sarma DK, Kumar M, Dixit R, James MM, Behera SK, Shekhar S, Balabaskaran Nina P. Spatial epidemiology of acute respiratory infections in children under 5 years and associated risk factors in India: District-level analysis of health, household, and environmental datasets. Front Public Health 2022; 10:906248. [PMID: 36582369 PMCID: PMC9792853 DOI: 10.3389/fpubh.2022.906248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022] Open
Abstract
Background In India, acute respiratory infections (ARIs) are a leading cause of mortality in children under 5 years. Mapping the hotspots of ARIs and the associated risk factors can help understand their association at the district level across India. Methods Data on ARIs in children under 5 years and household variables (unclean fuel, improved sanitation, mean maternal BMI, mean household size, mean number of children, median months of breastfeeding the children, percentage of poor households, diarrhea in children, low birth weight, tobacco use, and immunization status of children) were obtained from the National Family Health Survey-4. Surface and ground-monitored PM2.5 and PM10 datasets were collected from the Global Estimates and National Ambient Air Quality Monitoring Programme. Population density and illiteracy data were extracted from the Census of India. The geographic information system was used for mapping, and ARI hotspots were identified using the Getis-Ord Gi* spatial statistic. The quasi-Poisson regression model was used to estimate the association between ARI and household, children, maternal, environmental, and demographic factors. Results Acute respiratory infections hotspots were predominantly seen in the north Indian states/UTs of Uttar Pradesh, Bihar, Delhi, Haryana, Punjab, and Chandigarh, and also in the border districts of Uttarakhand, Himachal Pradesh, and Jammu and Kashmir. There is a substantial overlap among PM2.5, PM10, population density, tobacco smoking, and unclean fuel use with hotspots of ARI. The quasi-Poisson regression analysis showed that PM2.5, illiteracy levels, diarrhea in children, and maternal body mass index were associated with ARI. Conclusion To decrease ARI in children, urgent interventions are required to reduce the levels of PM2.5 and PM10 (major environmental pollutants) in the hotspot districts. Furthermore, improving sanitation, literacy levels, using clean cooking fuel, and curbing indoor smoking may minimize the risk of ARI in children.
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Affiliation(s)
| | - Kumar Arun Prasad
- Department of Geography, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Naveen Kumar Kodali
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | | | - Savitha Chellappan
- Department of Public Health and Community Medicine, ICMR—National Institute of Traditional Medicine, Belgaum, Karnataka, India
| | - Devojit Kumar Sarma
- Department of Molecular Biology, ICMR—National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India
| | - Manoj Kumar
- Department of Microbiology, ICMR—National Institute for Research in Environmental Health, Bhopal, Madhya Pradesh, India
| | - Rashi Dixit
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Meenu Mariya James
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Sujit Kumar Behera
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Sulochana Shekhar
- Department of Geography, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
| | - Praveen Balabaskaran Nina
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India,Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India,*Correspondence: Praveen Balabaskaran Nina
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