Fine particulate matter and incident coronary heart disease events up to 10 years of follow-up among Deepwater Horizon oil spill workers

BACKGROUND

During the 2010 Deepwater Horizon (DWH) disaster, in-situ burning and flaring were conducted to remove oil from the water. Workers near combustion sites were potentially exposed to burning-related fine particulate matter (PM2.5). Exposure to PM2.5 has been linked to increased risk of coronary heart disease (CHD), but no study has examined the relationship among oil spill workers.

OBJECTIVES

To investigate the association between estimated PM2.5 from burning/flaring of oil/gas and CHD risk among the DWH oil spill workers.

METHODS

We included workers who participated in response and cleanup activities on the water during the DWH disaster (N = 9091). PM2.5 exposures were estimated using a job-exposure matrix that linked modelled PM2.5 concentrations to detailed DWH spill work histories provided by participants. We ascertained CHD events as the first self-reported physician-diagnosed CHD or a fatal CHD event that occurred after each worker's last day of burning exposure. We estimated hazard ratios (HR) and 95% confidence intervals (95%CI) for the associations between categories of average or cumulative daily maximum PM2.5 exposure (versus a referent category of water workers not near controlled burning) and subsequent CHD. We assessed exposure-response trends by examining continuous exposure parameters in models.

RESULTS

We observed increased CHD hazard among workers with higher levels of average daily maximum exposure (low vs. referent: HR = 1.26, 95% CI: 0.93, 1.70; high vs. referent: HR = 2.11, 95% CI: 1.08, 4.12; per 10 μg/m3 increase: HR = 1.10, 95% CI: 1.02, 1.19). We also observed suggestively elevated HRs among workers with higher cumulative daily maximum exposure (low vs. referent: HR = 1.19, 95% CI: 0.68, 2.08; medium vs. referent: HR = 1.38, 95% CI: 0.88, 2.16; high vs. referent: HR = 1.44, 95% CI: 0.96, 2.14; per 100 μg/m3-d increase: HR = 1.03, 95% CI: 1.00, 1.05).

CONCLUSIONS

Among oil spill workers, exposure to PM2.5 from flaring/burning of oil/gas was associated with increased risk of CHD.

Longitudinal associations between objective and perceived healthy food environment and diet: The Multi-Ethnic Study of Atherosclerosis

INTRODUCTION

Research examining the influence of neighborhood healthy food environment on diet has been mostly cross-sectional and has lacked robust characterization of the food environment. We examined longitudinal associations between features of the local food environment and healthy diet, and whether associations were modified by race/ethnicity.

METHODS

Data on 3634 adults aged 45-84 followed for 10 years were obtained from the Multi-Ethnic Study of Atherosclerosis. Diet quality was assessed using the Alternative Healthy Eating Index at Exam 1 (2000-2002) and Exam 5 (2010-2012). We assessed four measures of the local food environment using survey-based measures (e.g. perceptions of healthier food availability) and geographic information system (GIS)-based measures (e.g. distance to and density of healthier food stores) at Exam 1 and Exam 5. Random effects models adjusted for age, sex, education, moving status, per capita adjusted income, and neighborhood socioeconomic status, and used interaction terms to assess effect measure modification by race/ethnicity.

RESULTS

Net of confounders, one standard z-score higher average composite local food environment was associated with higher average AHEI diet score (β=1.39, 95% CI: 1.05, 1.73) over the follow-up period from Exam 1 to 5. This pattern of association was consistent across both GIS-based and survey-based measures of local food environment and was more pronounced among minoritized racial/ethnic groups. There was no association between changes in neighborhood environment and change in AHEI score, or effect measure modification by race/ethnicity.

CONCLUSION

Our findings suggest that neighborhood-level food environment is associated with better diet quality, especially among racially/ethnically minoritized populations.

Sex differences in device therapy for heart failure: utilization, outcomes, and adverse events

BACKGROUND

Multiple studies of heart failure patients demonstrated significant improvement in exercise capacity, quality of life, cardiac left ventricular function, and survival from cardiac resynchronization therapy (CRT), but the underenrollment of women in these studies is notable. Etiological and pathophysiological differences may result in different outcomes in response to this treatment by sex. The observed disproportionate representation of women suggests that many women with heart failure either do not meet current clinical criteria to receive CRT in trials or are not properly recruited and maintained in these studies.

METHODS

We performed a systematic literature review through May 2014 of clinical trials and registries of CRT use that stratified outcomes by sex or reported percent women included. One-hundred eighty-three studies contained sex-specific information.

RESULTS

Ninety percent of the studies evaluated included ≤ 35% women. Fifty-six articles included effectiveness data that reported response with regard to specific outcome parameters. When compared with men, women exhibited more dramatic improvement in specific parameters. In the studies reporting hazard ratios for hospitalization or death, women generally had greater benefit from CRT.

CONCLUSIONS

Our review confirms women are markedly underrepresented in CRT trials, and when a CRT device is implanted, women have a therapeutic response that is equivalent to or better than in men, while there is no difference in adverse events reported by sex.

Association between duration and quality of sleep and the risk of pre-diabetes: evidence from NHANES

AIMS

To examine the association between duration and quality of sleep and the prevalence of undiagnosed and clinically identified diabetes mellitus and pre-diabetes in a nationally representative sample.

METHODS

Cross-sectional study of 2285 participants ≥ 30 years old and without diagnosed sleep disorders from the National Health and Nutrition Examination Survey (2005-2008). The primary exposures were sleep duration and quality. Sleep quality was assessed by questionnaire using trouble initiating sleep, trouble maintaining sleep, and waking up too early. The primary outcomes were clinically identified and undiagnosed pre-diabetes and diabetes as defined by the American Diabetes Association using fasting plasma glucose (5.6-6.9 mmol/l = pre-diabetes; ≥ 7.0 mmol/l = diabetes). Multivariate logistic regression was used to test the association between sleep quality, sleep duration and glycaemic status.

RESULTS

After adjustment for socio-demographic characteristics and health behaviors, sleeping ≤ 5 h/night was associated with clinically identified pre-diabetes (odds ratio 2.06, 95% CI 1.00-4.22 vs. 7 h). Both trouble maintaining sleep ≥ 5 times/month (odds ratio 3.50, 95% CI 1.30-9.45) and waking up too early ≥ 5 times/month (odds ratio 2.69, 95% CI 1.21-5.98) were also significantly associated with increased risk of clinically identified pre-diabetes. Trouble initiating sleep and sleeping ≥ 9 h/night were not found to be associated with having diabetes.

CONCLUSIONS

Only clinically identified pre-diabetes was associated with trouble maintaining sleep, waking up too early, and short sleep. No other relations were found to be significant. Findings suggest that poor sleep quality and short sleep duration were more strongly associated with clinically identified pre-diabetes than 7-8 hours per day.