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Chen J, Braun D, Christidis T, Cork M, Rodopoulou S, Samoli E, Stafoggia M, Wolf K, Wu X, Yuchi W, Andersen ZJ, Atkinson R, Bauwelinck M, de Hoogh K, Janssen NA, Katsouyanni K, Klompmaker JO, Kristoffersen DT, Lim YH, Oftedal B, Strak M, Vienneau D, Zhang J, Burnett RT, Hoek G, Dominici F, Brauer M, Brunekreef B. Long-Term Exposure to Low-Level PM2.5 and Mortality: Investigation of Heterogeneity by Harmonizing Analyses in Large Cohort Studies in Canada, United States, and Europe. Environ Health Perspect 2023; 131:127003. [PMID: 38039140 PMCID: PMC10691665 DOI: 10.1289/ehp12141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 08/10/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Studies across the globe generally reported increased mortality risks associated with particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ) exposure with large heterogeneity in the magnitude of reported associations and the shape of concentration-response functions (CRFs). We aimed to evaluate the impact of key study design factors (including confounders, applied exposure model, population age, and outcome definition) on PM 2.5 effect estimates by harmonizing analyses on three previously published large studies in Canada [Mortality-Air Pollution Associations in Low Exposure Environments (MAPLE), 1991-2016], the United States (Medicare, 2000-2016), and Europe [Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), 2000-2016] as much as possible. METHODS We harmonized the study populations to individuals 65 + years of age, applied the same satellite-derived PM 2.5 exposure estimates, and selected the same sets of potential confounders and the same outcome. We evaluated whether differences in previously published effect estimates across cohorts were reduced after harmonization among these factors. Additional analyses were conducted to assess the influence of key design features on estimated risks, including adjusted covariates and exposure assessment method. A combined CRF was assessed with meta-analysis based on the extended shape-constrained health impact function (eSCHIF). RESULTS More than 81 million participants were included, contributing 692 million person-years of follow-up. Hazard ratios and 95% confidence intervals (CIs) for all-cause mortality associated with a 5 - μ g / m 3 increase in PM 2.5 were 1.039 (1.032, 1.046) in MAPLE, 1.025 (1.021, 1.029) in Medicare, and 1.041 (1.014, 1.069) in ELAPSE. Applying a harmonized analytical approach marginally reduced difference in the observed associations across the three studies. Magnitude of the association was affected by the adjusted covariates, exposure assessment methodology, age of the population, and marginally by outcome definition. Shape of the CRFs differed across cohorts but generally showed associations down to the lowest observed PM 2.5 levels. A common CRF suggested a monotonically increased risk down to the lowest exposure level. https://doi.org/10.1289/EHP12141.
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Affiliation(s)
- Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tanya Christidis
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Michael Cork
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodstrian University of Athens, Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodstrian University of Athens, Athens, Greece
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Xiao Wu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Weiran Yuchi
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Zorana J. Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Richard Atkinson
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Mariska Bauwelinck
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole A.H. Janssen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodstrian University of Athens, Athens, Greece
- MRC Center for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - Jochem O. Klompmaker
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Doris Tove Kristoffersen
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bente Oftedal
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Maciej Strak
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
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2
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Jerrett M, Nau CL, Young DR, Butler RK, Batteate CM, Padilla A, Tartof SY, Su J, Burnett RT, Kleeman MJ. Air pollution and the sequelae of COVID-19 patients: A multistate analysis. Environ Res 2023; 236:116814. [PMID: 37558120 DOI: 10.1016/j.envres.2023.116814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
IMPORTANCE Recent evidence links air pollution to the severity COVID-19 symptoms and to death from the disease. To date, however, few studies have assessed whether air pollution affects the sequelae to more severe states or recovery from COVID-19 in a cohort with individual data. OBJECTIVE To assess how air pollution affects the transition to more severe COVID-19 states or to recovery from COVID-19 infection in a cohort with detailed patient information. DESIGN AND OUTCOMES We used a cohort design that followed patients admitted to hospital in the Kaiser Permanente Southern California (KPSC) Health System, which has 4.7 million members with characteristics similar to the general population. Enrollment began on 06/01/2020 and ran until 01/30/2021 for all patients admitted to hospital while ill with COVID-19. All possible states of sequelae were considered, including deterioration to intensive care, to death, discharge to recovery, or discharge to death. Transition risks were estimated with a multistate model. We assessed exposure using chemical transport model that predicted ambient concentrations of nitrogen dioxide, ozone, and fine particulate matter (PM2.5) at a 1 km scale. RESULTS Each increase in PM2.5 concentration equivalent to the interquartile range was associated with increased risk of deterioration to intensive care (HR of 1.16; 95% CI: 1.12-1.20) and deterioration to death (HR of 1.11; 95% CI: 1.04-1.17). Results for ozone were consistent with PM2.5 effects, but ozone also affected the transition from recovery to death: HR of 1.24 (95% CI: 1.01-1.51). NO2 had weaker effects but displayed some elevated risks. CONCLUSIONS PM2.5 and ozone were significantly associated with transitions to more severe states while in hospital and to death after discharge from hospital. Reducing air pollution could therefore lead to improved prognosis for COVID-19 patients and a sustainable means of reducing the health impacts of coronaviruses now and in the future.
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Affiliation(s)
- Michael Jerrett
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles 650 Charles Young Dr. S, 56-070 CHS Box 951772, Los Angeles, CA, 90095, USA.
| | - Claudia L Nau
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 5th Floor, Pasadena, CA, 91101, USA
| | - Deborah R Young
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 5th Floor, Pasadena, CA, 91101, USA
| | - Rebecca K Butler
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 5th Floor, Pasadena, CA, 91101, USA
| | - Christina M Batteate
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles 650 Charles Young Dr. S, 56-070 CHS Box 951772, Los Angeles, CA, 90095, USA
| | - Ariadna Padilla
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 5th Floor, Pasadena, CA, 91101, USA
| | - Sara Y Tartof
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 5th Floor, Pasadena, CA, 91101, USA
| | - Jason Su
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Room 5302, Berkeley, CA, 94720, USA
| | - Richard T Burnett
- Population Studies Division, Environmental Health Directorate, Health Canada, 251 Sir Frederick Banting Driveway, Ottawa, Ontario, K1A 0K9, Canada
| | - Michael J Kleeman
- Department of Civil and Environmental Engineering, University of California, Davis, 1 Sheilds Avenue, Davis, CA, 95616, USA
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3
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Weichenthal S, Lavigne E, You H, Pollitt K, Shin T, Kulka R, Stieb DM, Hatzopoulou M, Evans G, Burnett RT. Daily Summer Temperatures and Hospitalization for Acute Cardiovascular Events: Impact of Outdoor PM 2.5 Oxidative Potential on Observed Associations Across Canada. Epidemiology 2023; 34:897-905. [PMID: 37732880 DOI: 10.1097/ede.0000000000001651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND Oxidative stress plays an important role in the health impacts of both outdoor fine particulate air pollution (PM 2.5 ) and thermal stress. However, it is not clear how the oxidative potential of PM 2.5 may influence the acute cardiovascular effects of temperature. METHODS We conducted a case-crossover study of hospitalization for cardiovascular events in 35 cities across Canada during the summer months (July-September) between 2016 and 2018. We collected three different metrics of PM 2.5 oxidative potential each month in each location. We estimated associations between lag-0 daily temperature (per 5ºC) and hospitalization for all cardiovascular (n = 44,876) and ischemic heart disease (n = 14,034) events across strata of monthly PM 2.5 oxidative potential using conditional logistical models adjusting for potential time-varying confounders. RESULTS Overall, associations between lag-0 temperature and acute cardiovascular events tended to be stronger when outdoor PM 2.5 oxidative potential was higher. For example, when glutathione-related oxidative potential (OP GSH ) was in the highest tertile, the odds ratio (OR) for all cardiovascular events was 1.040 (95% confidence intervals [CI] = 1.004, 1.074) compared with 0.980 (95% CI = 0.943, 1.018) when OP GSH was in the lowest tertile. We observed a greater difference for ischemic heart disease events, particularly for older subjects (age >70 years). CONCLUSIONS The acute cardiovascular health impacts of summer temperature variations may be greater when outdoor PM 2.5 oxidative potential is elevated. This may be particularly important for ischemic heart disease events.
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Affiliation(s)
- Scott Weichenthal
- From the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Air Health Science Division, Health Canada, Ottawa, Canada
| | - Eric Lavigne
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Hongyu You
- Air Health Science Division, Health Canada, Ottawa, Canada
| | | | - Tim Shin
- Air Health Science Division, Health Canada, Ottawa, Canada
| | - Ryan Kulka
- Air Health Science Division, Health Canada, Ottawa, Canada
| | - Dave M Stieb
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Marianne Hatzopoulou
- Department of Civil & Mineral Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Greg Evans
- Chemical Engineering & Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
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4
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Li C, van Donkelaar A, Hammer MS, McDuffie EE, Burnett RT, Spadaro JV, Chatterjee D, Cohen AJ, Apte JS, Southerland VA, Anenberg SC, Brauer M, Martin RV. Reversal of trends in global fine particulate matter air pollution. Nat Commun 2023; 14:5349. [PMID: 37660164 PMCID: PMC10475088 DOI: 10.1038/s41467-023-41086-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/21/2023] [Indexed: 09/04/2023] Open
Abstract
Ambient fine particulate matter (PM2.5) is the world's leading environmental health risk factor. Quantification is needed of regional contributions to changes in global PM2.5 exposure. Here we interpret satellite-derived PM2.5 estimates over 1998-2019 and find a reversal of previous growth in global PM2.5 air pollution, which is quantitatively attributed to contributions from 13 regions. Global population-weighted (PW) PM2.5 exposure, related to both pollution levels and population size, increased from 1998 (28.3 μg/m3) to a peak in 2011 (38.9 μg/m3) and decreased steadily afterwards (34.7 μg/m3 in 2019). Post-2011 change was related to exposure reduction in China and slowed exposure growth in other regions (especially South Asia, the Middle East and Africa). The post-2011 exposure reduction contributes to stagnation of growth in global PM2.5-attributable mortality and increasing health benefits per µg/m3 marginal reduction in exposure, implying increasing urgency and benefits of PM2.5 mitigation with aging population and cleaner air.
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Affiliation(s)
- Chi Li
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA.
| | - Aaron van Donkelaar
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Melanie S Hammer
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Erin E McDuffie
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
- Office of Atmospheric Protection, Climate Change Division, U.S. Environmental Protection Agency, Washington, D.C., USA
| | - Richard T Burnett
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Population Studies Division, Health Canada, Ottawa, ON, Canada
| | - Joseph V Spadaro
- Spadaro Environmental Research Consultants (SERC), Philadelphia, PA, USA
- European Centre for Environment and Health, World Health Organization (Consultant), Bonn, North Rhine-Westphalia, Germany
| | - Deepangsu Chatterjee
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Aaron J Cohen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Health Effects Institute, Boston, MA, USA
| | - Joshua S Apte
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Veronica A Southerland
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Susan C Anenberg
- 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
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Randall V Martin
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
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5
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Chen C, Chen H, van Donkelaar A, Burnett RT, Martin RV, Chen L, Tjepkema M, Kirby-McGregor M, Li Y, Kaufman JS, Benmarhnia T. Using Parametric g-Computation to Estimate the Effect of Long-Term Exposure to Air Pollution on Mortality Risk and Simulate the Benefits of Hypothetical Policies: The Canadian Community Health Survey Cohort (2005 to 2015). Environ Health Perspect 2023; 131:37010. [PMID: 36920446 PMCID: PMC10016347 DOI: 10.1289/ehp11095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Numerous epidemiological studies have documented the adverse health impact of long-term exposure to fine particulate matter [particulate matter ≤2.5μm in aerodynamic diameter (PM2.5)] on mortality even at relatively low levels. However, methodological challenges remain to consider potential regulatory intervention's complexity and provide actionable evidence on the predicted benefits of interventions. We propose the parametric g-computation as an alternative analytical approach to such challenges. METHOD We applied the parametric g-computation to estimate the cumulative risks of nonaccidental death under different hypothetical intervention strategies targeting long-term exposure to PM2.5 in the Canadian Community Health Survey cohort from 2005 to 2015. On both relative and absolute scales, we explored the benefits of hypothetical intervention strategies compared with the natural course that a) set the simulated exposure value at each follow-up year to a threshold value if exposure was above the threshold (8.8 μg/m3, 7.04 μg/m3, 5 μg/m3, and 4 μg/m3), and b) reduced the simulated exposure value by a percentage (5% and 10%) at each follow-up year. We used the 3-y average PM2.5 concentration with 1-y lag at the postal code of respondents' annual mailing addresses as their long-term exposure to PM2.5. We considered baseline and time-varying confounders, including demographics, behavior characteristics, income level, and neighborhood socioeconomic status. We also included the R syntax for reproducibility and replication. RESULTS All hypothetical intervention strategies explored led to lower 11-y cumulative mortality risks than the estimated value under the natural course without intervention, with the smallest reduction of 0.20 per 1,000 participants (95% CI: 0.06, 0.34) under the threshold of 8.8 μg/m3, and the largest reduction of 3.40 per 1,000 participants (95% CI: -0.23, 7.03) under the relative reduction of 10% per interval. The reductions in cumulative risk, or numbers of deaths that would have been prevented if the intervention was employed instead of maintaining the status quo, increased over time but flattened toward the end of the follow-up period. Estimates among those ≥65 years of age were greater with a similar pattern. Our estimates were robust to different model specifications. DISCUSSION We found evidence that any intervention further reducing the long-term exposure to PM2.5 would reduce the cumulative mortality risk, with greater benefits in the older population, even in a population already exposed to low levels of ambient PM2.5. The parametric g-computation used in this study provides flexibilities in simulating real-world interventions, accommodates time-varying exposure and confounders, and estimates adjusted survival curves with clearer interpretation and more information than a single hazard ratio, making it a valuable analytical alternative in air pollution epidemiological research. https://doi.org/10.1289/EHP11095.
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Affiliation(s)
- Chen Chen
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California, USA
| | - Hong Chen
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aaron van Donkelaar
- Department of Energy, Environmental, and Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Richard T. Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Randall V. Martin
- Department of Energy, Environmental, and Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Li Chen
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Michael Tjepkema
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Megan Kirby-McGregor
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Yi Li
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jay S. Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California, USA
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6
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Jerrett M, Nau CL, Young DR, Butler RK, Batteate CM, Su J, Burnett RT, Kleeman MJ. Air pollution and meteorology as risk factors for COVID-19 death in a cohort from Southern California. Environ Int 2023; 171:107675. [PMID: 36565571 PMCID: PMC9715495 DOI: 10.1016/j.envint.2022.107675] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND Recent evidence links ambient air pollution to COVID-19 incidence, severity, and death, but few studies have analyzed individual-level mortality data with high quality exposure models. METHODS We sought to assess whether higher air pollution exposures led to greater risk of death during or after hospitalization in confirmed COVID-19 cases among patients who were members of the Kaiser Permanente Southern California (KPSC) healthcare system (N=21,415 between 06-01-2020 and 01-31-2022 of whom 99.85 % were unvaccinated during the study period). We used 1 km resolution chemical transport models to estimate ambient concentrations of several common air pollutants, including ozone, nitrogen dioxide, and fine particle matter (PM2.5). We also derived estimates of pollutant exposures from ultra-fine particulate matter (PM0.1), PM chemical species, and PM sources. We employed Cox proportional hazards models to assess associations between air pollution exposures and death from COVID-19 among hospitalized patients. FINDINGS We found significant associations between COVID-19 death and several air pollution exposures, including: PM2.5 mass, PM0.1 mass, PM2.5 nitrates, PM2.5 elemental carbon, PM2.5 on-road diesel, and PM2.5 on-road gasoline. Based on the interquartile (IQR) exposure increment, effect sizes ranged from hazard ratios (HR) = 1.12 for PM2.5 mass and PM2.5 nitrate to HR ∼ 1.06-1.07 for other species or source markers. Humidity and temperature in the month of diagnosis were also significant negative predictors of COVID-19 death and negative modifiers of the air pollution effects. INTERPRETATION Air pollution exposures and meteorology were associated the risk of COVID-19 death in a cohort of patients from Southern California. These findings have implications for prevention of death from COVID-19 and for future pandemics.
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Affiliation(s)
- Michael Jerrett
- Department of Environmental Health Sciences, University of California, Los Angeles 650 Charles Young Dr. S., 56-070 CHS Box 951772, Los Angeles, CA, 90095, United States.
| | - Claudia L Nau
- Department of Research & Evaluation, Kaiser Permanente Southern California 100 S. Los Robles Ave., 5th Floor, Pasadena, CA 91101, United States
| | - Deborah R Young
- Department of Research & Evaluation, Kaiser Permanente Southern California 100 S. Los Robles Ave., 5th Floor, Pasadena, CA 91101, United States
| | - Rebecca K Butler
- Department of Research & Evaluation, Kaiser Permanente Southern California 100 S. Los Robles Ave., 5th Floor, Pasadena, CA 91101, United States
| | - Christina M Batteate
- Department of Environmental Health Sciences, University of California, Los Angeles 650 Charles Young Dr. S., 56-070 CHS Box 951772, Los Angeles, CA, 90095, United States
| | - Jason Su
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley 2121 Berkeley Way, Room 5302, Berkeley, CA 94720, United States
| | - Richard T Burnett
- Population Studies Division, Environmental Health Directorate, Health Canada 251 Sir Frederick Banting Driveway, Ottawa, Ontario K1A 0K9, Canada
| | - Michael J Kleeman
- Department of Civil and Environmental Engineering, University of California, Davis 1 Sheilds Avenue, Davis, CA 95616, United States
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7
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Korsiak J, Lavigne E, You H, Pollitt K, Kulka R, Hatzopoulou M, Evans G, Burnett RT, Weichenthal S. Air Pollution and Pediatric Respiratory Hospitalizations: Effect Modification by Particle Constituents and Oxidative Potential. Am J Respir Crit Care Med 2022; 206:1370-1378. [PMID: 35802828 DOI: 10.1164/rccm.202205-0896oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale: Outdoor particulate and gaseous air pollutants impair respiratory health in children, and these associations may be influenced by particle composition. Objectives: To examine whether associations between short-term variations in fine particulate air pollution, oxidant gases, and respiratory hospitalizations in children are modified by particle constituents (metals and sulfur) or oxidative potential. Methods: We conducted a case-crossover study of 10,500 children (0-17 years of age) across Canada. Daily fine particle mass concentrations and oxidant gases (nitrogen dioxide and ozone) were collected from ground monitors. Monthly estimates of fine particle constituents (metals and sulfur) and oxidative potential were also measured. Conditional logistic regression models were used to estimate associations between air pollutants and respiratory hospitalizations, above and below median values for particle constituents and oxidative potential. Measurements and Main Results: Lag-1 fine particulate matter mass concentrations were not associated with respiratory hospitalizations (odds ratio and 95% confidence interval per 10 μg/m3 increase in fine particulate matter: 1.004 [0.955-1.056]) in analyses ignoring particle constituents and oxidative potential. However, when models were examined above or below median metals, sulfur, and oxidative potential, positive associations were observed above the median. For example, the odds ratio and 95% confidence interval per 10 μg/m3 increase in fine particulate matter were 1.084 (1.007-1.167) when copper was above the median and 0.970 (0.929-1.014) when copper was below the median. Similar trends were observed for oxidant gases. Conclusions: Stronger associations were observed between outdoor fine particles, oxidant gases, and respiratory hospitalizations in children when metals, sulfur, and particle oxidative potential were elevated.
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Affiliation(s)
- Jill Korsiak
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Eric Lavigne
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Hongyu You
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | - Krystal Pollitt
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut; and
| | - Ryan Kulka
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | | | - Greg Evans
- Department of Chemical Engineering and Applied Chemistry, and
| | | | - Scott Weichenthal
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
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8
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Bai L, Benmarhnia T, Chen C, Kwong JC, Burnett RT, van Donkelaar A, Martin RV, Kim J, Kaufman JS, Chen H. Chronic Exposure to Fine Particulate Matter Increases Mortality Through Pathways of Metabolic and Cardiovascular Disease: Insights From a Large Mediation Analysis. J Am Heart Assoc 2022; 11:e026660. [DOI: 10.1161/jaha.122.026660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background
Long‐term exposure to outdoor fine particulate matter (PM
2.5
) is the leading environmental risk factor for premature mortality worldwide. Characterizing important pathways through which PM
2.5
increases individuals' mortality risk can clarify the PM
2.5
–mortality relationship and identify possible points of interventions. Recent evidence has linked PM
2.5
to the onset of diabetes and cardiovascular disease, but to what extent these associations contribute to the effect of PM
2.5
on mortality remains poorly understood.
Methods and Results
We conducted a population‐based cohort study to investigate how the effect of PM
2.5
on nonaccidental mortality is mediated by its impacts on incident diabetes, acute myocardial infarction, and stroke. Our study population comprised ≈200 000 individuals aged 20 to 90 years who participated in population‐based health surveys in Ontario, Canada, from 1996 to 2014. Follow‐up extended until December 2017. Using causal mediation analyses with Aalen additive hazards models, we decomposed the total effect of PM
2.5
on mortality into a direct effect and several path‐specific indirect effects mediated by diabetes, each cardiovascular event, or both combined. A series of sensitivity analyses were also conducted. After adjusting for various individual‐ and neighborhood‐level covariates, we estimated that for every 1000 adults, each 10 μg/m
3
increase in PM
2.5
was associated with ≈2 incident cases of diabetes, ≈1 major cardiovascular event (acute myocardial infarction and stroke combined), and ≈2 deaths annually. Among PM
2.5
‐related deaths, 31.7% (95% CI, 17.2%–53.2%) were attributable to diabetes and major cardiovascular events in relation to PM
2.5
. Specifically, 4.5% were explained by PM
2.5
‐induced diabetes, 22.8% by PM
2.5
‐induced major cardiovascular events, and 4.5% through their interaction.
Conclusions
This study suggests that a significant portion of the estimated effect of long‐term exposure to PM
2.5
on deaths can be attributed to its effect on diabetes and cardiovascular diseases, highlighting the significance of PM
2.5
on deteriorating cardiovascular health. Our findings should raise awareness among professionals that improving metabolic and cardiovascular health may reduce mortality burden in areas with higher exposure to air pollution.
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Affiliation(s)
- Li Bai
- ICES Toronto Ontario Canada
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography University of California San Diego, La Jolla CA
- Department of Family Medicine and Public Health University of California San Diego, La Jolla CA
| | - Chen Chen
- Scripps Institution of Oceanography University of California San Diego, La Jolla CA
| | - Jeffrey C. Kwong
- ICES Toronto Ontario Canada
- Public Health Ontario Toronto Ontario Canada
- Dalla Lana School of Public Health University of Toronto Ontario Canada
- Department of Family and Community Medicine University of Toronto Ontario Canada
| | - Richard T. Burnett
- Environmental Health Science and Research Bureau Health Canada Ottawa Ontario Canada
| | - Aaron van Donkelaar
- Department of Energy, Environment and Chemical Engineering Washington University St Louis MO USA
| | - Randall V. Martin
- Department of Energy, Environment and Chemical Engineering Washington University St Louis MO USA
| | - JinHee Kim
- Public Health Ontario Toronto Ontario Canada
- Dalla Lana School of Public Health University of Toronto Ontario Canada
| | - Jay S. Kaufman
- Department of Epidemiology and Biostatistics McGill University Montreal Quebec Canada
- Institute for Health and Social Policy McGill University Montreal Quebec Canada
| | - Hong Chen
- ICES Toronto Ontario Canada
- Public Health Ontario Toronto Ontario Canada
- Dalla Lana School of Public Health University of Toronto Ontario Canada
- Environmental Health Science and Research Bureau Health Canada Ottawa Ontario Canada
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9
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Toyib O, Lavigne E, Traub A, Umbrio D, You H, Ripley S, Pollitt K, Shin T, Kulka R, Jessiman B, Tjepkema M, Martin R, Stieb DM, Hatzopoulou M, Evans G, Burnett RT, Weichenthal S. Long-term Exposure to Oxidant Gases and Mortality: Effect Modification by PM 2.5 Transition Metals and Oxidative Potential. Epidemiology 2022; 33:767-776. [PMID: 36165987 PMCID: PMC9531968 DOI: 10.1097/ede.0000000000001538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Populations are simultaneously exposed to outdoor concentrations of oxidant gases (i.e., O 3 and NO 2 ) and fine particulate air pollution (PM 2.5 ). Since oxidative stress is thought to be an important mechanism explaining air pollution health effects, the adverse health impacts of oxidant gases may be greater in locations where PM 2.5 is more capable of causing oxidative stress. METHODS We conducted a cohort study of 2 million adults in Canada between 2001 and 2016 living within 10 km of ground-level monitoring sites for outdoor PM 2.5 components and oxidative potential. O x exposures (i.e., the redox-weighted average of O 3 and NO 2 ) were estimated using a combination of chemical transport models, land use regression models, and ground-level data. Cox proportional hazards models were used to estimate associations between 3-year moving average O x and mortality outcomes across strata of transition metals and sulfur in PM 2.5 and three measures of PM 2.5 oxidative potential adjusting for possible confounding factors. RESULTS Associations between O x and mortality were consistently stronger in regions with elevated PM 2.5 transition metal/sulfur content and oxidative potential. For example, each interquartile increase (6.27 ppb) in O x was associated with a 14.9% (95% CI = 13.0, 16.9) increased risk of nonaccidental mortality in locations with glutathione-related oxidative potential (OP GSH ) above the median whereas a 2.50% (95% CI = 0.600, 4.40) increase was observed in regions with OP GSH levels below the median (interaction P value <0.001). CONCLUSION Spatial variations in PM 2.5 composition and oxidative potential may contribute to heterogeneity in the observed health impacts of long-term exposures to oxidant gases.
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Affiliation(s)
- Olaniyan Toyib
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | - Eric Lavigne
- Air Health Science Division, Health Canada, Ottawa, ON, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Alison Traub
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON, Canada
| | - Dana Umbrio
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON, Canada
| | - Hongyu You
- Air Health Science Division, Health Canada, Ottawa, ON, Canada
| | - Susannah Ripley
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Krystal Pollitt
- Department of Environmental Health Sciences, Yale, New Haven, CT
| | - Tim Shin
- Air Health Science Division, Health Canada, Ottawa, ON, Canada
| | - Ryan Kulka
- Air Health Science Division, Health Canada, Ottawa, ON, Canada
| | | | | | - Randall Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
- Department of Physics and Atmospheric Science, Washington University, St Louis, MI
| | - Dave M. Stieb
- Population Studies Division, Health Canada, Ottawa, ON, Canada
| | - Marianne Hatzopoulou
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, ON, Canada
| | - Greg Evans
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON, Canada
| | | | - Scott Weichenthal
- Air Health Science Division, Health Canada, Ottawa, ON, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
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10
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Weichenthal S, Pinault L, Christidis T, Burnett RT, Brook JR, Chu Y, Crouse DL, Erickson AC, Hystad P, Li C, Martin RV, Meng J, Pappin AJ, Tjepkema M, van Donkelaar A, Weagle CL, Brauer M. How low can you go? Air pollution affects mortality at very low levels. Sci Adv 2022; 8:eabo3381. [PMID: 36170354 PMCID: PMC9519036 DOI: 10.1126/sciadv.abo3381] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/11/2022] [Indexed: 05/29/2023]
Abstract
The World Health Organization (WHO) recently released new guidelines for outdoor fine particulate air pollution (PM2.5) recommending an annual average concentration of 5 μg/m3. Yet, our understanding of the concentration-response relationship between outdoor PM2.5 and mortality in this range of near-background concentrations remains incomplete. To address this uncertainty, we conducted a population-based cohort study of 7.1 million adults in one of the world's lowest exposure environments. Our findings reveal a supralinear concentration-response relationship between outdoor PM2.5 and mortality at very low (<5 μg/m3) concentrations. Our updated global concentration-response function incorporating this new information suggests an additional 1.5 million deaths globally attributable to outdoor PM2.5 annually compared to previous estimates. The global health benefits of meeting the new WHO guideline for outdoor PM2.5 are greater than previously assumed and indicate a need for continued reductions in outdoor air pollution around the world.
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Affiliation(s)
- Scott Weichenthal
- McGill University, Montreal, QC, Canada
- Health Canada, Ottawa, ON, Canada
| | | | | | - Richard T. Burnett
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Yen Chu
- University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Chi Li
- Dalhousie University, Halifax, NS, Canada
| | - Randall V. Martin
- Dalhousie University, Halifax, NS, Canada
- Washington University, Saint Louis, WA, USA
| | - Jun Meng
- Washington University, Saint Louis, WA, USA
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | | | | | - Aaron van Donkelaar
- Dalhousie University, Halifax, NS, Canada
- Washington University, Saint Louis, WA, USA
| | | | - Michael Brauer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- University of British Columbia, Vancouver, BC, Canada
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11
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Brauer M, Brook JR, Christidis T, Chu Y, Crouse DL, Erickson A, Hystad P, Li C, Martin RV, Meng J, Pappin AJ, Pinault LL, Tjepkema M, van Donkelaar A, Weagle C, Weichenthal S, Burnett RT. Mortality-Air Pollution Associations in Low Exposure Environments (MAPLE): Phase 2. Res Rep Health Eff Inst 2022; 2022:1-91. [PMID: 36224709 PMCID: PMC9556709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
INTRODUCTION Mortality is associated with long-term exposure to fine particulate matter (particulate matter ≤2.5 μm in aerodynamic diameter; PM2.5), although the magnitude and form of these associations remain poorly understood at lower concentrations. Knowledge gaps include the shape of concentration-response curves and the lowest levels of exposure at which increased risks are evident and the occurrence and extent of associations with specific causes of death. Here, we applied improved estimates of exposure to ambient PM2.5 to national population-based cohorts in Canada, including a stacked cohort of 7.1 million people who responded to census year 1991, 1996, or 2001. The characterization of the shape of the concentration-response relationship for nonaccidental mortality and several specific causes of death at low levels of exposure was the focus of the Mortality-Air Pollution Associations in Low Exposure Environments (MAPLE) Phase 1 report. In the Phase 1 report we reported that associations between outdoor PM2.5 concentrations and nonaccidental mortality were attenuated with the addition of ozone (O3) or a measure of gaseous pollutant oxidant capacity (Ox), which was estimated from O3 and nitrogen dioxide (NO2) concentrations. This was motivated by our interests in understanding both the effects air pollutant mixtures may have on mortality and also the role of O3 as a copollutant that shares common sources and precursor emissions with those of PM2.5. In this Phase 2 report, we further explore the sensitivity of these associations with O3 and Ox, evaluate sensitivity to other factors, such as regional variation, and present ambient PM2.5 concentration-response relationships for specific causes of death. METHODS PM2.5 concentrations were estimated at 1 km2 spatial resolution across North America using remote sensing of aerosol optical depth (AOD) combined with chemical transport model (GEOS-Chem) simulations of the AOD:surface PM2.5 mass concentration relationship, land use information, and ground monitoring. These estimates were informed and further refined with collocated measurements of PM2.5 and AOD, including targeted measurements in areas of low PM2.5 concentrations collected at five locations across Canada. Ground measurements of PM2.5 and total suspended particulate matter (TSP) mass concentrations from 1981 to 1999 were used to backcast remote-sensing-based estimates over that same time period, resulting in modeled annual surfaces from 1981 to 2016. Annual exposures to PM2.5 were then estimated for subjects in several national population-based Canadian cohorts using residential histories derived from annual postal code entries in income tax files. These cohorts included three census-based cohorts: the 1991 Canadian Census Health and Environment Cohort (CanCHEC; 2.5 million respondents), the 1996 CanCHEC (3 million respondents), the 2001 CanCHEC (3 million respondents), and a Stacked CanCHEC where duplicate records of respondents were excluded (Stacked CanCHEC; 7.1 million respondents). The Canadian Community Health Survey (CCHS) mortality cohort (mCCHS), derived from several pooled cycles of the CCHS (540,900 respondents), included additional individual information about health behaviors. Follow-up periods were completed to the end of 2016 for all cohorts. Cox proportional hazard ratios (HRs) were estimated for nonaccidental and other major causes of death using a 10-year moving average exposure and 1-year lag. All models were stratified by age, sex, immigrant status, and where appropriate, census year or survey cycle. Models were further adjusted for income adequacy quintile, visible minority status, Indigenous identity, educational attainment, labor-force status, marital status, occupation, and ecological covariates of community size, airshed, urban form, and four dimensions of the Canadian Marginalization Index (Can-Marg; instability, deprivation, dependency, and ethnic concentration). The mCCHS analyses were also adjusted for individual-level measures of smoking, alcohol consumption, fruit and vegetable consumption, body mass index (BMI), and exercise behavior. In addition to linear models, the shape of the concentration-response function was investigated using restricted cubic splines (RCS). The number of knots were selected by minimizing the Bayesian Information Criterion (BIC). Two additional models were used to examine the association between nonaccidental mortality and PM2.5. The first is the standard threshold model defined by a transformation of concentration equaling zero if the concentration was less than a specific threshold value and concentration minus the threshold value for concentrations above the threshold. The second additional model was an extension of the Shape Constrained Health Impact Function (SCHIF), the eSCHIF, which converts RCS predictions into functions potentially more suitable for use in health impact assessments. Given the RCS parameter estimates and their covariance matrix, 1,000 realizations of the RCS were simulated at concentrations from the minimum to the maximum concentration, by increments of 0.1 μg/m3. An eSCHIF was then fit to each of these RCS realizations. Thus, 1,000 eSCHIF predictions and uncertainty intervals were determined at each concentration within the total range. Sensitivity analyses were conducted to examine associations between PM2.5 and mortality when in the presence of, or stratified by tertile of, O3 or Ox. Additionally, associations between PM2.5 and mortality were assessed for sensitivity to lower concentration thresholds, where person-years below a threshold value were assigned the mean exposure within that group. We also examined the sensitivity of the shape of the nonaccidental mortality-PM2.5 association to removal of person-years at or above 12 μg/m3 (the current U.S. National Ambient Air Quality Standard) and 10 μg/m3 (the current Canadian and former [2005] World Health Organization [WHO] guideline, and current WHO Interim Target-4). Finally, differences in the shapes of PM2.5-mortality associations were assessed across broad geographic regions (airsheds) within Canada. RESULTS The refined PM2.5 exposure estimates demonstrated improved performance relative to estimates applied previously and in the MAPLE Phase 1 report, with slightly reduced errors, including at lower ranges of concentrations (e.g., for PM2.5 <10 μg/m3). Positive associations between outdoor PM2.5 concentrations and nonaccidental mortality were consistently observed in all cohorts. In the Stacked CanCHEC analyses (1.3 million deaths), each 10-μg/m3 increase in outdoor PM2.5 concentration corresponded to an HR of 1.084 (95% confidence interval [CI]: 1.073 to 1.096) for nonaccidental mortality. For an interquartile range (IQR) increase in PM2.5 mass concentration of 4.16 μg/m3 and for a mean annual nonaccidental death rate of 92.8 per 10,000 persons (over the 1991-2016 period for cohort participants ages 25-90), this HR corresponds to an additional 31.62 deaths per 100,000 people, which is equivalent to an additional 7,848 deaths per year in Canada, based on the 2016 population. In RCS models, mean HR predictions increased from the minimum concentration of 2.5 μg/m3 to 4.5 μg/m3, flattened from 4.5 μg/m3 to 8.0 μg/m3, then increased for concentrations above 8.0 μg/m3. The threshold model results reflected this pattern with -2 log-likelihood values being equal at 2.5 μg/m3 and 8.0 μg/m3. However, mean threshold model predictions monotonically increased over the concentration range with the lower 95% CI equal to one from 2.5 μg/m3 to 8.0 μg/m3. The RCS model was a superior predictor compared with any of the threshold models, including the linear model. In the mCCHS cohort analyses inclusion of behavioral covariates did not substantially change the results for both linear and nonlinear models. We examined the sensitivity of the shape of the nonaccidental mortality-PM2.5 association to removal of person-years at or above the current U.S. and Canadian standards of 12 μg/m3 and 10 μg/m3, respectively. In the full cohort and in both restricted cohorts, a steep increase was observed from the minimum concentration of 2.5 μg/m3 to 5 μg/m3. For the full cohort and the <12 μg/m3 cohort the relationship flattened over the 5 to 9 μg/m3 range and then increased above 9 μg/m3. A similar increase was observed for the <10 μg/m3 cohort followed by a clear decline in the magnitude of predictions over the 5 to 9 μg/m3 range and an increase above 9 μg/m3. Together these results suggest that a positive association exists for concentrations >9 μg/m3 with indications of adverse effects on mortality at concentrations as low as 2.5 μg/m3. Among the other causes of death examined, PM2.5 exposures were consistently associated with an increased hazard of mortality due to ischemic heart disease, respiratory disease, cardiovascular disease, and diabetes across all cohorts. Associations were observed in the Stacked CanCHEC but not in all other cohorts for cerebrovascular disease, pneumonia, and chronic obstructive pulmonary disease (COPD) mortality. No significant associations were observed between mortality and exposure to PM2.5 for heart failure, lung cancer, and kidney failure. In sensitivity analyses, the addition of O3 and Ox attenuated associations between PM2.5 and mortality. When analyses were stratified by tertiles of copollutants, associations between PM2.5 and mortality were only observed in the highest tertile of O3 or Ox. Across broad regions of Canada, linear HR estimates and the shape of the eSCHIF varied substantially, possibly reflecting underlying differences in air pollutant mixtures not characterized by PM2.5 mass concentrations or the included gaseous pollutants. Sensitivity analyses to assess regional variation in population characteristics and access to healthcare indicated that the observed regional differences in concentration-mortality relationships, specifically the flattening of the concentration-mortality relationship over the 5 to 9 μg/m3 range, was not likely related to variation in the makeup of the cohort or its access to healthcare, lending support to the potential role of spatially varying air pollutant mixtures not sufficiently characterized by PM2.5 mass concentrations. CONCLUSIONS In several large, national Canadian cohorts, including a cohort of 7.1 million unique census respondents, associations were observed between exposure to PM2.5 with nonaccidental mortality and several specific causes of death. Associations with nonaccidental mortality were observed using the eSCHIF methodology at concentrations as low as 2.5 μg/m3, and there was no clear evidence in the observed data of a lower threshold, below which PM2.5 was not associated with nonaccidental mortality.
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Affiliation(s)
- M Brauer
- The University of British Columbia, Vancouver, British Columbia, Canada
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - J R Brook
- University of Toronto, Toronto, Ontario, Canada
| | - T Christidis
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Y Chu
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - D L Crouse
- University of New Brunswick, Fredericton, New Brunswick, Canada
| | - A Erickson
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - P Hystad
- Oregon State University, Corvallis, Oregon
| | - C Li
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - R V Martin
- Dalhousie University, Halifax, Nova Scotia, Canada
- Washington University, Saint Louis, Missouri
- Harvard-Smithsonian Center for Astrophysics, Cambridge, Massachusetts
| | - J Meng
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - A J Pappin
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - L L Pinault
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - M Tjepkema
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | | | - C Weagle
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - R T Burnett
- Population Studies Division, Health Canada, Ottawa, Ontario, Canada
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12
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Korsiak J, Pinault L, Christidis T, Burnett RT, Abrahamowicz M, Weichenthal S. Long-term exposure to wildfires and cancer incidence in Canada: a population-based observational cohort study. Lancet Planet Health 2022; 6:e400-e409. [PMID: 35550079 DOI: 10.1016/s2542-5196(22)00067-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Wildfires emit many carcinogenic pollutants that contaminate air, water, terrestrial, and indoor environments. However, little is known about the relationship between exposure to wildfires and cancer risk. We aimed to assess the associations between residential exposure to wildfires and the incidence of several cancer outcomes (lung cancer, brain cancer, non-Hodgkin lymphoma, multiple myeloma, and leukaemia) in Canada. METHODS We did a population-based observational cohort study of participants in the 1996 Canadian Census Health and Environment Cohort. The 1996 Canadian Census Health and Environment Cohort is a nationally representative sample of Canadian adults, followed up for cancer incidence and mortality from 1996 to 2015. For this analysis, we excluded participants who lived in major Canadian cities (with a population size greater than 1·5 million people), recent immigrants, and individuals younger than 25 years or 90 years of age or older at baseline. Exposures to wildfires were assigned on the basis of area burned within a 20 km or 50 km radius of residential locations and updated for annual residential mobility. Multivariable Cox proportional hazards models were used to estimate associations between exposure to wildfires and specific cancers associated with carcinogenic compounds released by wildfires, including lung and brain cancer, non-Hodgkin lymphoma, multiple myeloma, and leukaemia, adjusted for many personal and neighbourhood-level covariates. FINDINGS Our analyses included more than 2 million people followed up for a median of 20 years, for a total of 34 million person-years. Wildfire exposure was associated with slightly increased incidence of lung cancer and brain tumours. For example, cohort members exposed to a wildfire within 50 km of residential locations in the past 10 years had a 4·9% relatively higher incidence (adjusted hazard ratio [HR] 1·049, 95% CI 1·028-1·071) of lung cancer than unexposed populations, and a 10% relatively higher incidence (adjusted HR 1·100, 1·026-1·179) of brain tumours. Similar associations were observed for the 20 km buffer size. Wildfires were not associated with haematological cancers in this study, and concentration-response trends were not readily apparent when area burned was modelled as a continuous variable. INTERPRETATION Long-term exposure to wildfires might increase the risk of lung cancer and brain tumours. Further work is needed to develop long-term estimates of wildfire exposures that capture the complex mixture of environmental pollutants released during these events. FUNDING Canadian Institute for Health Research and Fonds de recherche du Quebec.
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Affiliation(s)
- Jill Korsiak
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Lauren Pinault
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | | | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Scott Weichenthal
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
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13
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Olaniyan T, Pinault L, Li C, van Donkelaar A, Meng J, Martin RV, Hystad P, Robichaud A, Ménard R, Tjepkema M, Bai L, Kwong JC, Lavigne E, Burnett RT, Chen H. Ambient air pollution and the risk of acute myocardial infarction and stroke: A national cohort study. Environ Res 2022; 204:111975. [PMID: 34478722 DOI: 10.1016/j.envres.2021.111975] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/27/2021] [Accepted: 08/24/2021] [Indexed: 05/07/2023]
Abstract
We used a large national cohort in Canada to assess the incidence of acute myocardial infarction (AMI) and stroke hospitalizations in association with long-term exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3). The study population comprised 2.7 million respondents from the 2006 Canadian Census Health and Environment Cohort (CanCHEC), followed for incident hospitalizations of AMI or stroke between 2006 and 2016. We estimated 10-year moving average estimates of PM2.5, NO2, and O3, annually. We used Cox proportional hazards models to examine the associations adjusting for various covariates. For AMI, each interquartile range (IQR) increase in exposure was found to be associated with a hazard ratio of 1.026 (95% CI: 1.007-1.046) for PM2.5, 1.025 (95% CI: 1.001-1.050) for NO2, and 1.062 (95% CI: 1.041-1.084) for O3, respectively. Similarly, for stroke, an IQR increase in exposure was associated with a hazard ratio of 1.078 (95% CI: 1.052-1.105) for PM2.5, 0.995 (95% CI: 0.965-1.030) for NO2, and 1.055 (95% CI: 1.028-1.082) for O3, respectively. We found consistent evidence of positive associations between long-term exposures to PM2.5, and O3, and to a lesser degree NO2, with incident AMI and stroke hospitalizations.
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Affiliation(s)
- Toyib Olaniyan
- Health Analysis Division, Statistics Canada, 100 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada.
| | - Lauren Pinault
- Health Analysis Division, Statistics Canada, 100 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada.
| | - Chi Li
- Department of Chemistry, University of California, Berkeley, CA, 94720, United States.
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, B3H 3J5, Canada; Department of Energy, Environment & Chemical Engineering, Washington University in St Louis, St Louis, MO, 63130, United States.
| | - Jun Meng
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, B3H 3J5, Canada.
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, B3H 3J5, Canada; Department of Energy, Environment & Chemical Engineering, Washington University in St Louis, St Louis, MO, 63130, United States.
| | - Perry Hystad
- School of Biological & Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, 97331, United States.
| | - Alain Robichaud
- Air Quality Research Division, Environment and Climate Change Canada, Dorval, Québec, H9P 1J3, Canada.
| | - Richard Ménard
- Air Quality Research Division, Environment and Climate Change Canada, Dorval, Québec, H9P 1J3, Canada.
| | - Michael Tjepkema
- Health Analysis Division, Statistics Canada, 100 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada.
| | - Li Bai
- ICES, Toronto, Ontario, M4N 3M5, Canada.
| | - Jeffrey C Kwong
- ICES, Toronto, Ontario, M4N 3M5, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada; Public Health Ontario, Toronto, Ontario, M5G 1V5, Canada.
| | - Eric Lavigne
- Air Health Science Division, Health Canada, Ottawa, Ontario, K1A 0L4, Canada; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada.
| | - Richard T Burnett
- Institute of Health Metrics & Evaluation, University of Washington, Seattle, WA, 98121, United States; Population Studies Division, Environmental Health and Research Bureau, Health Canada, Ottawa, Ontario K1A 0T6, Canada.
| | - Hong Chen
- ICES, Toronto, Ontario, M4N 3M5, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada; Public Health Ontario, Toronto, Ontario, M5G 1V5, Canada; Population Studies Division, Environmental Health and Research Bureau, Health Canada, Ottawa, Ontario K1A 0T6, Canada.
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14
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Masselot P, Sera F, Schneider R, Kan H, Lavigne É, Stafoggia M, Tobias A, Chen H, Burnett RT, Schwartz J, Zanobetti A, Bell ML, Chen BY, Guo YLL, Ragettli MS, Vicedo-Cabrera AM, Åström C, Forsberg B, Íñiguez C, Garland RM, Scovronick N, Madureira J, Nunes B, De la Valencia Cruz C, Diaz MH, Honda Y, Hashizume M, Ng CFC, Samoli E, Katsouyanni K, Schneider A, Breitner S, Ryti NR, Jaakkola JJ, Maasikmets M, Orru H, Guo Y, Ortega NV, Correa PM, Tong S, Gasparrini A. Differential Mortality Risks Associated With PM2.5 Components: A Multi-Country, Multi-City Study. Epidemiology 2022; 33:167-175. [PMID: 34907973 PMCID: PMC7612311 DOI: 10.1097/ede.0000000000001455] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The association between fine particulate matter (PM2.5) and mortality widely differs between as well as within countries. Differences in PM2.5 composition can play a role in modifying the effect estimates, but there is little evidence about which components have higher impacts on mortality. METHODS We applied a 2-stage analysis on data collected from 210 locations in 16 countries. In the first stage, we estimated location-specific relative risks (RR) for mortality associated with daily total PM2.5 through time series regression analysis. We then pooled these estimates in a meta-regression model that included city-specific logratio-transformed proportions of seven PM2.5 components as well as meta-predictors derived from city-specific socio-economic and environmental indicators. RESULTS We found associations between RR and several PM2.5 components. Increasing the ammonium (NH4+) proportion from 1% to 22%, while keeping a relative average proportion of other components, increased the RR from 1.0063 (95% confidence interval [95% CI] = 1.0030, 1.0097) to 1.0102 (95% CI = 1.0070, 1.0135). Conversely, an increase in nitrate (NO3-) from 1% to 71% resulted in a reduced RR, from 1.0100 (95% CI = 1.0067, 1.0133) to 1.0037 (95% CI = 0.9998, 1.0077). Differences in composition explained a substantial part of the heterogeneity in PM2.5 risk. CONCLUSIONS These findings contribute to the identification of more hazardous emission sources. Further work is needed to understand the health impacts of PM2.5 components and sources given the overlapping sources and correlations among many components.
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Affiliation(s)
- Pierre Masselot
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Francesco Sera
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK
- Department of Statistics, Computer Science and Applications “G. Parenti”, University of Florence, Florence, Italy
| | - Rochelle Schneider
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- European Centre for Medium-Range Weather Forecast, Reading, UK
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Éric Lavigne
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Air Health Science Division, Health Canada, Ottawa, Canada
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service/ASL Roma 1, Rome, Italy
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | | | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Bing-Yu Chen
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
| | - Yue-Liang Leon Guo
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
| | | | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Carmen Íñiguez
- Department of Statistics and Computational Research. Universitat de València, València, Spain
- Ciberesp, Madrid. Spain
| | - Rebecca M. Garland
- Natural Resources and the Environment Unit, Council for Scientific and Industrial Research, Pretoria 0001, South Africa
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom 2520, South Africa
- Department of Geography, Geo-informatics and Meteorology, University of Pretoria, Pretoria 0001, South Africa
| | - Noah Scovronick
- Gangarosa Department of Environmental Health. Rollins School of Public Health, Emory University, Atlanta, USA
| | - Joana Madureira
- Department of Environmental Health, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Baltazar Nunes
- Department of Epidemiology, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - César De la Valencia Cruz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Magali Hurtado Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Yasushi Honda
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chris Fook Cheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Greece
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Greece
- School of Population Health and Environmental Sciences, King’s College, London, UK
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- IBE-Chair of Epidemiology, LMU Munich, Munich, Germany
| | - Niilo R.I. Ryti
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jouni J.K. Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- Finnish Meteorological Institute, Helsinki, Finland
| | | | - Hans Orru
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Shilu Tong
- Shanghai Children’s Medical Centre, Shanghai Jiao-Tong University, Shanghai, China
- School of Public Health and Institute of Environment and Human Health, Anhui Medical University, Hefei, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London, WC1H 9SH, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
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15
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Burnett RT, Spadaro JV, Garcia GR, Pope CA. Designing health impact functions to assess marginal changes in outdoor fine particulate matter. Environ Res 2022; 204:112245. [PMID: 34687750 DOI: 10.1016/j.envres.2021.112245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/17/2021] [Accepted: 10/17/2021] [Indexed: 06/13/2023]
Abstract
Estimating health benefits from improvements in ambient air quality requires the characterization of the magnitude and shape of the association between marginal changes in exposure and marginal changes in risk, and its uncertainty. Several attempts have been made to do this, each requiring different assumptions. These include the Log-Linear(LL), IntegratedExposure-Response(IER), and GlobalExposureMortalityModel(GEMM). In this paper we develop an improved relative risk model suitable for use in health benefits analysis that incorporates features of existing models while addressing limitations in each model. We model the derivative of the relative risk function within a meta-analytic framework; a quantity directly applicable to benefits analysis, incorporating a Fusion of algebraic functions used in previous models. We assume a constant derivative in concentration over low exposures, like the LL model, a declining derivative over moderate exposures observed in cohort studies, and a derivative declining as the inverse of concentration over high global exposures in a similar manner to the GEMM. The model properties are illustrated with examples of fitting it to data for the six specific causes of death previously examined by the GlobalBurdenofDisease program with ambient fine particulate matter (PM2.5). In a test case analysis assuming a 1% (benefits analysis) or 100% (burden analysis), reduction in country-specific fine particulate matter concentrations, corresponding estimated global attributable deaths using the Fusion model were found to lie between those of the IER and LL models, with the GEMM estimates similar to those based on the LL model.
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Affiliation(s)
- Richard T Burnett
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, 98195, USA.
| | - Joseph V Spadaro
- Spadaro Environmental Research Consultants (SERC), Philadelphia, PA, 19142, USA
| | - George R Garcia
- School of Law, Stanford University, Palo Alto, CA, 94305, USA
| | - C Arden Pope
- Department of Economics, Brigham Young University, Provo, UT, 84602, USA
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16
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Chen H, Kaufman JS, Olaniyan T, Pinault L, Tjepkema M, Chen L, van Donkelaar A, Martin RV, Hystad P, Chen C, Kirby-McGregor M, Bai L, Burnett RT, Benmarhnia T. Changes in exposure to ambient fine particulate matter after relocating and long term survival in Canada: quasi-experimental study. BMJ 2021; 375:n2368. [PMID: 34625469 PMCID: PMC8498990 DOI: 10.1136/bmj.n2368] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the association between changes in long term residential exposure to ambient fine particulate matter (PM2.5) and premature mortality in Canada. DESIGN Population based quasi-experimental study. SETTING Canada. PARTICIPANTS 663 100 respondents to the 1996, 2001, and 2006 Canadian censuses aged 25-89 years who had consistently lived in areas with either high or low PM2.5 levels over five years preceding census day and moved during the ensuing five years. INTERVENTIONS Changes in long term exposure to PM2.5 arising from residential mobility. MAIN OUTCOME MEASURES The primary outcome was deaths from natural causes. Secondary outcomes were deaths from any cardiometabolic cause, any respiratory cause, and any cancer cause. All outcomes were obtained from the national vital statistics database. RESULTS Using a propensity score matching technique with numerous personal, socioeconomic, health, and environment related covariates, each participant who moved to a different PM2.5 area was matched with up to three participants who moved within the same PM2.5 area. In the matched groups that moved from high to intermediate or low PM2.5 areas, residential mobility was associated with a decline in annual PM2.5 exposure from 10.6 μg/m3 to 7.4 and 5.0 μg/m3, respectively. Conversely, in the matched groups that moved from low to intermediate or high PM2.5 areas, annual PM2.5 increased from 4.6 μg/m3 to 6.7 and 9.2 μg/m3. Five years after moving, individuals who experienced a reduction in exposure to PM2.5 from high to intermediate levels showed a 6.8% (95% confidence interval 1.7% to 11.7%) reduction in mortality (2510 deaths in 56 025 v 4925 deaths in 101 960). A greater decline in mortality occurred among those exposed to a larger reduction in PM2.5. Increased mortality was found with exposure to PM2.5 from low to high levels, and to a lesser degree from low to intermediate levels. Furthermore, the decreases in PM2.5 exposure were most strongly associated with reductions in cardiometabolic deaths, whereas the increases in PM2.5 exposure were mostly related to respiratory deaths. No strong evidence was found for the changes in PM2.5 exposure with cancer related deaths. CONCLUSIONS In Canada, decreases in PM2.5 were associated with lower mortality, whereas increases in PM2.5 were associated with higher mortality. These results were observed at PM2.5 levels considerably lower than many other countries, providing support for continuously improving air quality.
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Affiliation(s)
- Hong Chen
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, K1A 0K9, Canada
- Public Health Ontario, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jay S Kaufman
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
- Institute for Health and Social Policy, McGill University, Montreal, QC, Canada
| | - Toyib Olaniyan
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | - Lauren Pinault
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | | | - Li Chen
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, K1A 0K9, Canada
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
| | - Randall V Martin
- Department of Energy, Environment and Chemical Engineering, Washington University, St Louis, MO, USA
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Chen Chen
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Megan Kirby-McGregor
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - Li Bai
- ICES, Toronto, ON, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, K1A 0K9, Canada
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA, USA
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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17
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Weichenthal S, Lavigne E, Traub A, Umbrio D, You H, Pollitt K, Shin T, Kulka R, Stieb DM, Korsiak J, Jessiman B, Brook JR, Hatzopoulou M, Evans G, Burnett RT. Association of Sulfur, Transition Metals, and the Oxidative Potential of Outdoor PM2.5 with Acute Cardiovascular Events: A Case-Crossover Study of Canadian Adults. Environ Health Perspect 2021; 129:107005. [PMID: 34644144 PMCID: PMC8513754 DOI: 10.1289/ehp9449] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/30/2021] [Accepted: 09/28/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND We do not currently understand how spatiotemporal variations in the composition of fine particulate air pollution [fine particulate matter with aerodynamic diameter ≤2.5μm (PM2.5)] affects population health risks. However, recent evidence suggests that joint concentrations of transition metals and sulfate may influence the oxidative potential (OP) of PM2.5 and associated health impacts. OBJECTIVES The purpose of the study was to evaluate how combinations of transition metals/OP and sulfur content in outdoor PM2.5 influence associations with acute cardiovascular events. METHODS We conducted a national case-crossover study of outdoor PM2.5 and acute cardiovascular events in Canada between 2016 and 2017 (93,344 adult cases). Monthly mean transition metal and sulfur (S) concentrations in PM2.5 were determined prospectively along with estimates of OP using acellular assays for glutathione (OPGSH), ascorbate (OPAA), and dithiothreitol depletion (OPDTT). Conditional logistic regression models were used to estimate odds ratios (OR) [95% confidence intervals (CI)] for PM2.5 across strata of transition metals/OP and sulfur. RESULTS Among men, the magnitudes of observed associations were strongest when both transition metal and sulfur content were elevated. For example, an OR of 1.078 (95% CI: 1.049, 1.108) (per 10μg/m3) was observed for cardiovascular events in men when both copper and S were above the median, whereas a weaker association was observed when both elements were below median values (OR=1.019, 95% CI: 1.007, 1.031). A similar pattern was observed for OP metrics. PM2.5 was not associated with acute cardiovascular events in women. DISCUSSION The combined transition metal and sulfur content of outdoor PM2.5 influences the strength of association with acute cardiovascular events in men. Regions with elevated concentrations of both sulfur and transition metals in PM2.5 should be examined as priority areas for regulatory interventions. https://doi.org/10.1289/EHP9449.
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Affiliation(s)
- Scott Weichenthal
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
- Air Health Science Division, Health Canada, Ottawa, Canada
| | - Eric Lavigne
- Air Health Science Division, Health Canada, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Alison Traub
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada
| | - Dana Umbrio
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada
| | - Hongyu You
- Air Health Science Division, Health Canada, Ottawa, Canada
| | - Krystal Pollitt
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Tim Shin
- Air Health Science Division, Health Canada, Ottawa, Canada
| | - Ryan Kulka
- Air Health Science Division, Health Canada, Ottawa, Canada
| | - Dave M. Stieb
- Population Studies Division, Health Canada, Ottawa, Canada
| | - Jill Korsiak
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Barry Jessiman
- Air Health Science Division, Health Canada, Ottawa, Canada
| | - Jeff R. Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Marianne Hatzopoulou
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, Canada
| | - Greg Evans
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada
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18
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Zhang Z, Wang J, Kwong JC, Burnett RT, van Donkelaar A, Hystad P, Martin RV, Bai L, McLaughlin J, Chen H. Long-term exposure to air pollution and mortality in a prospective cohort: The Ontario Health Study. Environ Int 2021; 154:106570. [PMID: 33892223 DOI: 10.1016/j.envint.2021.106570] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND Air pollution has been associated with increased mortality. However, updated evidence from cohort studies with detailed information on various risk factors is needed, especially in regions with low air pollution levels. We investigated the associations between long-term exposure to air pollution and mortality in a prospective cohort. METHODS We studied 88,615 participants aged ≥30 years from an ongoing cohort study in Ontario, Canada from 2009 to 2017. Exposure to ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2) was estimated at participants' residence. Cox proportional hazard models were used to investigate the associations between air pollution and non-accidental, cardiovascular, and respiratory mortality, adjusted for a wide array of individual-level and contextual covariates. Potential effect modification by socio-demographic and behavioral factors was also examined in exploratory stratified analyses. RESULTS The fully adjusted hazard ratios (HRs) per 1 µg/m3 increment in PM2.5 were 1.037 [95% confidence interval (CI): 1.018, 1.057]¸ 1.083 (95% CI: 1.040, 1.128) and 1.109 (95% CI: 1.035, 1.187) for non-accidental, cardiovascular, and respiratory mortality, respectively. Positive associations were also found for NO2; the corresponding HRs per 1 ppb increment were 1.027 (95% CI: 1.021, 1.034), 1.032 (95% CI: 1.019, 1.046) and 1.044 (95% CI: 1.020, 1.068). We found suggestive evidence of stronger associations in physically active participants, smokers, and those with lower household income. CONCLUSIONS Long-term exposure to PM2.5 and NO2 was associated with increased risks for non-accidental, cardiovascular, and respiratory mortality, suggesting potential benefits of further improvement in air quality even in low-exposure environments.
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Affiliation(s)
- Zilong Zhang
- Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - John Wang
- Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Perry Hystad
- College of Public Health and Human Studies, Oregon State University, Corvallis, OR, USA
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA; Harvard-Smithsonian Centre for Astrophysics, Cambridge, MA, USA
| | - Li Bai
- ICES, Toronto, ON, Canada
| | - John McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hong Chen
- Public Health Ontario, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada.
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19
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Shin S, Bai L, Burnett RT, Kwong JC, Hystad P, van Donkelaar A, Lavigne E, Weichenthal S, Copes R, Martin RV, Kopp A, Chen H. Air Pollution as a Risk Factor for Incident Chronic Obstructive Pulmonary Disease and Asthma. A 15-Year Population-based Cohort Study. Am J Respir Crit Care Med 2021; 203:1138-1148. [PMID: 33147059 DOI: 10.1164/rccm.201909-1744oc] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rationale: Current evidence on the relationship between long-term exposure to air pollution and new onset of chronic lung disease is inconclusive.Objectives: To examine associations of incident chronic obstructive pulmonary disease (COPD) and adult-onset asthma with past exposure to fine particulate matter ≤ 2.5 μm in diameter (PM2.5), nitrogen dioxide (NO2), ozone (O3), and the redox-weighted average of NO2 and O3 (Ox) and characterize the concentration-response relationship.Methods: We conducted a population-based cohort study of all Ontarians, aged 35-85 years, from 2001 to 2015. A 3-year moving average of residential exposures to selected pollutants with a 1-year lag were estimated during follow-up. We used Cox proportional hazard models and Aalen additive-hazard models to quantify the pollution-disease associations and characterized the shape of these relationships using newly developed nonlinear risk models.Measurements and Main Results: Among 5.1 million adults, we identified 340,733 and 218,005 incident cases of COPD and asthma, respectively. We found positive associations of COPD with PM2.5 per interquartile-range (IQR) increase of 3.4 μg/m3 (hazard ratio, 1.07; 95% confidence interval, 1.06-1.08), NO2 per IQR increase of 13.9 ppb (1.04; 1.02-1.05), O3 per IQR increase of 6.3 ppb (1.04; 1.03-1.04), and Ox per IQR increase of 4.4 ppb (1.03; 1.03-1.03). By contrast, we did not find strong evidence linking these pollutants to adult-onset asthma. In addition, we quantified that each IQR increase in pollution exposure yielded 3.0 (2.4-3.6), 3.2 (2.0-4.3), 1.9 (1.3-2.5), and 2.3 (1.7-2.9) excess cases of COPD per 100,000 adults for PM2.5, NO2, O3, and Ox, respectively. Furthermore, most pollutant-COPD relationships exhibited supralinear shapes.Conclusions: Air pollution was associated with a higher incidence of COPD but was not associated with a higher incidence of adult-onset asthma.
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Affiliation(s)
- Saeha Shin
- Public Health Ontario, Toronto, Ontario, Canada
| | - Li Bai
- ICES, Toronto, Ontario, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Population Studies Division, and
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Family and Community Medicine and.,Centre for Vaccine Preventable Diseases.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Perry Hystad
- College of Public Health and Human Studies, Oregon State University, Corvallis, Oregon
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Energy, Environmental, and Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Eric Lavigne
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; and
| | - Scott Weichenthal
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Ray Copes
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Energy, Environmental, and Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri
| | | | - Hong Chen
- Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Environmental Health Science and Research Bureau, Population Studies Division, and.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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20
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Xu JW, Martin RV, Evans GJ, Umbrio D, Traub A, Meng J, van Donkelaar A, You H, Kulka R, Burnett RT, Godri Pollitt KJ, Weichenthal S. Predicting Spatial Variations in Multiple Measures of Oxidative Burden for Outdoor Fine Particulate Air Pollution across Canada. Environ Sci Technol 2021; 55:9750-9760. [PMID: 34241996 DOI: 10.1021/acs.est.1c01210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Fine particulate air pollution (PM2.5) is a leading contributor to the overall global burden of disease. Traditionally, outdoor PM2.5 has been characterized using mass concentrations which treat all particles as equally harmful. Oxidative potential (OP) (per μg) and oxidative burden (OB) (per m3) are complementary metrics that estimate the ability of PM2.5 to cause oxidative stress, which is an important mechanism in air pollution health effects. Here, we provide the first national estimates of spatial variations in multiple measures (glutathione, ascorbate, and dithiothreitol depletion) of annual median outdoor PM2.5 OB across Canada. To do this, we combined a large database of ground-level OB measurements collected monthly prospectively across Canada for 2 years (2016-2018) with PM2.5 components estimated using a chemical transport model (GEOS-Chem) and satellite aerosol observations. Our predicted ground-level OB values of all three methods were consistent with ground-level observations (cross-validation R2 = 0.63-0.74). We found that forested regions and urban areas had the highest OB, predicted primarily by black carbon and organic carbon from wildfires and transportation sources. Importantly, the dominant components associated with OB were different than those contributing to PM2.5 mass concentrations (secondary inorganic aerosol); thus, OB metrics may better indicate harmful components and sources on health than the bulk PM2.5 mass, reinforcing that OB estimates can complement the existing PM2.5 data in future national-level epidemiological studies.
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Affiliation(s)
- Jun-Wei Xu
- Department of Physics and Atmospheric Science, Dalhousie University, 6310 Coburg Road, Halifax, Nova Scotia B3H 4R2, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, 6310 Coburg Road, Halifax, Nova Scotia B3H 4R2, Canada
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, 1 Brookings Drive, St. Louis, Missouri 63130, United States
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, Massachusetts 02138, United States
| | - Greg J Evans
- Southern Ontario Centre for Atmospheric Aerosol Research, University of Toronto, 200 College Street, Toronto, Ontario M5S 3E5, Canada
- Dalla Lana School of Public Health, University of Toronto, 480 University Avenue, Toronto, Ontario M5G 1V2, Canada
| | - Dana Umbrio
- Southern Ontario Centre for Atmospheric Aerosol Research, University of Toronto, 200 College Street, Toronto, Ontario M5S 3E5, Canada
| | - Alison Traub
- Southern Ontario Centre for Atmospheric Aerosol Research, University of Toronto, 200 College Street, Toronto, Ontario M5S 3E5, Canada
| | - Jun Meng
- Department of Physics and Atmospheric Science, Dalhousie University, 6310 Coburg Road, Halifax, Nova Scotia B3H 4R2, Canada
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, 6310 Coburg Road, Halifax, Nova Scotia B3H 4R2, Canada
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, 1 Brookings Drive, St. Louis, Missouri 63130, United States
| | - Hongyu You
- Air Health Science Division, Health Canada, 269 Laurier Avenue West, Ottawa, Ontario K1A 0K0, Canada
| | - Ryan Kulka
- Air Health Science Division, Health Canada, 269 Laurier Avenue West, Ottawa, Ontario K1A 0K0, Canada
| | - Richard T Burnett
- Population Studies Division, Health Canada, 101 Tunney's Pasture Dr., Ottawa, Ontario K1A 0K9, Canada
| | - Krystal J Godri Pollitt
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, Connecticut 06520, United States
| | - Scott Weichenthal
- Air Health Science Division, Health Canada, 269 Laurier Avenue West, Ottawa, Ontario K1A 0K0, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada
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21
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Stieb DM, Evans GJ, To TM, Lakey PSJ, Shiraiwa M, Hatzopoulou M, Minet L, Brook JR, Burnett RT, Weichenthal SA. Within-City Variation in Reactive Oxygen Species from Fine Particle Air Pollution and COVID-19. Am J Respir Crit Care Med 2021; 204:168-177. [PMID: 33798018 PMCID: PMC8650790 DOI: 10.1164/rccm.202011-4142oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale: Evidence linking outdoor air pollution with coronavirus disease (COVID-19) incidence and mortality is largely based on ecological comparisons between regions that may differ in factors such as access to testing and control measures that may not be independent of air pollution concentrations. Moreover, studies have yet to focus on key mechanisms of air pollution toxicity such as oxidative stress. Objectives: To conduct a within-city analysis of spatial variations in COVID-19 incidence and the estimated generation of reactive oxygen species (ROS) in lung lining fluid attributable to fine particulate matter (particulate matter with an aerodynamic diameter ⩽2.5 μm [PM2.5]). Methods: Sporadic and outbreak-related COVID-19 case counts, testing data, population data, and sociodemographic data for 140 neighborhoods were obtained from the City of Toronto. ROS estimates were based on a mathematical model of ROS generation in lung lining fluid in response to iron and copper in PM2.5. Spatial variations in long-term average ROS were predicted using a land-use regression model derived from measurements of iron and copper in PM2.5. Data were analyzed using negative binomial regression models adjusting for covariates identified using a directed acyclic graph and accounting for spatial autocorrelation. Measurements and Main Results: A significant positive association was observed between neighborhood-level ROS and COVID-19 incidence (incidence rate ratio = 1.07; 95% confidence interval, 1.01-1.15 per interquartile range ROS). Effect modification by neighborhood-level measures of racialized group membership and socioeconomic status was also identified. Conclusions: Examination of neighborhood characteristics associated with COVID-19 incidence can identify inequalities and generate hypotheses for future studies.
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Affiliation(s)
- David M. Stieb
- Environmental Health Science and Research Bureau and
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Teresa M. To
- Dalla Lana School of Public Health, and
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pascale S. J. Lakey
- Department of Chemistry, University of California Irvine, Irvine, California; and
| | - Manabu Shiraiwa
- Department of Chemistry, University of California Irvine, Irvine, California; and
| | - Marianne Hatzopoulou
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Laura Minet
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey R. Brook
- Department of Chemical Engineering
- Dalla Lana School of Public Health, and
| | - Richard T. Burnett
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Scott A. Weichenthal
- Water and Air Quality Bureau, Health Canada, Ottawa, Ontario, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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22
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Zhang Z, Weichenthal S, Kwong JC, Burnett RT, Hatzopoulou M, Jerrett M, Donkelaar AV, Bai L, Martin RV, Copes R, Lu H, Lakey P, Shiraiwa M, Chen H. Long-term exposure to iron and copper in fine particulate air pollution and their combined impact on reactive oxygen species concentration in lung fluid: a population-based cohort study of cardiovascular disease incidence and mortality in Toronto, Canada. Int J Epidemiol 2021; 50:589-601. [PMID: 33367589 DOI: 10.1093/ije/dyaa230] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 10/26/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Exposure to fine particulate (PM2.5) air pollution is associated with increased cardiovascular disease (CVD), but less is known about its specific components, such as metals originating from non-tailpipe emissions. We investigated the associations of long-term exposure to metal components [iron (Fe) and copper (Cu)] in PM2.5 with CVD incidence. METHODS We conducted a population-based cohort study in Toronto, Canada. Exposures to Fe and Cu in PM2.5 and their combined impact on the concentration of reactive oxygen species (ROS) in lung fluid were estimated using land use regression models. Incidence of acute myocardial infarction (AMI), congestive heart failure (CHF) and CVD death was ascertained using health administrative datasets. We used mixed-effects Cox regression models to examine the associations between the exposures and health outcomes. A series of sensitivity analyses were conducted, including indirect adjustment for individual-level cardiovascular risk factors (e.g. smoking), and adjustment for PM2.5 and nitrogen dioxide (NO2). RESULTS In single-pollutant models, we found positive associations between the three exposures and all three outcomes, with the strongest associations detected for the estimated ROS. The associations of AMI and CHF were sensitive to indirect adjustment, but remained robust for CVD death in all sensitivity analyses. In multi-pollutant models, the associations of the three exposures generally remained unaltered. Interestingly, adjustment for ROS did not substantially change the associations between PM2.5 and CVD, but attenuated the associations of NO2. CONCLUSIONS Long-term exposure to Fe and Cu in PM2.5 and their combined impact on ROS were consistently associated with increased CVD death.
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Affiliation(s)
- Zilong Zhang
- Public Health Ontario, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Scott Weichenthal
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Air Health Science Division, Health Canada, Ottawa, ON, Canada
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Marianne Hatzopoulou
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, ON, Canada
| | - Michael Jerrett
- School of Public Health, University of California, Los Angeles, CA, USA
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada.,Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Li Bai
- ICES, Toronto, ON, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada.,Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA.,Harvard-Smithsonian Centre for Astrophysics, Cambridge, MA, USA
| | - Ray Copes
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Pascale Lakey
- Department of Chemistry, University of California Irvine, Irvine, CA, USA
| | - Manabu Shiraiwa
- Department of Chemistry, University of California Irvine, Irvine, CA, USA
| | - Hong Chen
- Public Health Ontario, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
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23
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Lavigne É, Talarico R, van Donkelaar A, Martin RV, Stieb DM, Crighton E, Weichenthal S, Smith-Doiron M, Burnett RT, Chen H. Fine particulate matter concentration and composition and the incidence of childhood asthma. Environ Int 2021; 152:106486. [PMID: 33684735 DOI: 10.1016/j.envint.2021.106486] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Several studies have found positive associations between outdoor fine particulate air pollution (≤2.5 μm, PM2.5) and childhood asthma incidence. However, the impact of PM2.5 composition on children's respiratory health remains uncertain. OBJECTIVE We examined whether joint exposure to PM2.5 mass concentrations and its major chemical components was associated with childhood asthma development. METHODS We conducted a population-based cohort study by identifying 1,130,855 singleton live births occurring between 2006 and 2014 in the province of Ontario, Canada. Concentrations of PM2.5 and its seven major chemical components were assigned to participants based on their postal codes using chemical transport models and remote sensing. The joint impact of outdoor PM2.5 concentrations and its major components and childhood asthma incidence (up to age 6) were estimated using Cox proportional hazards models, allowing for potential nonlinearity. RESULTS We identified 167,080 children who developed asthma before age 6. In adjusted models, outdoor PM2.5 mass concentrations during childhood were associated with increased incidence of childhood asthma (Hazard Ratio (HR) for each 1 μg/m3 increase = 1.026, 95% CI: 1.021-1.031). We found that the joint effects of PM2.5 and its components on childhood asthma incidence may be 24% higher than the conventional approach. Specific components/source markers such as black carbon, ammonium, and nitrate appeared to play an important role. CONCLUSIONS Early life exposure to PM2.5 and its chemical components is associated with an increased risk of asthma development in children. The heterogeneous nature of PM2.5 should be considered in future health risk assessments.
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Affiliation(s)
- Éric Lavigne
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.
| | - Robert Talarico
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA; Harvard-Smithsonian Centre for Astrophysics, Cambridge, MA, USA
| | - David M Stieb
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada; Population Studies Division, Health Canada, Ottawa, Ontario, Canada
| | - Eric Crighton
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, Ontario, Canada
| | - Scott Weichenthal
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Richard T Burnett
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hong Chen
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Population Studies Division, Health Canada, Ottawa, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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24
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Pinault L, Thomson EM, Christidis T, Colman I, Tjepkema M, van Donkelaar A, Martin RV, Hystad P, Shin H, Crouse DL, Burnett RT. The association between ambient air pollution concentrations and psychological distress. Health Rep 2021; 31:3-11. [PMID: 32761579 DOI: 10.25318/82-003-x202000700001-eng] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND A growing number of epidemiological studies have linked air pollution exposure to psychological conditions. Laboratory studies indicate that air pollutants can activate the neuroendocrine stress axis and modulate stress hormone levels, which could contribute to the development or exacerbation of psychological distress. The present study examined the spatial associations between air pollutants (fine particulate matter [PM2.5], nitrogen dioxide [NO2] and ground-level ozone [O3]) and psychological distress among subjects in the most populous provinces in Canada. DATA AND METHODS Subjects were sampled from the Canadian Community Health Survey in three regions (Quebec in 2005 [n=25,800], British Columbia and Alberta in 2005 [n=23,000], and Ontario in 2011 [n=36,000]), and were assigned estimates of annual exposure to three ambient air pollutants (PM2.5, NO2 and O3) for the same years. Individual psychological distress was assessed using the Kessler Psychological Distress Scale (K10), based on anxiety and depressive symptoms in the past month. Regression models (both ordinary least squares and simultaneous autoregressive models) were applied to estimate associations between K10 distress scores and each air pollutant, after adjusting for individual (demographic, socioeconomic and behavioural) and neighbourhood covariates.. RESULTS Psychological distress was positively associated with PM2.5 and NO2 in all three regions, and with O3 in Quebec. However, after further adjusting for individual and neighbourhood covariates, the associations between distress and air pollution remained statistically significant only in Quebec. DISCUSSION Some evidence for positive associations between psychological distress and ambient air pollution after adjusting for spatial autocorrelation was found.
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Affiliation(s)
- Lauren Pinault
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
| | - Errol M Thomson
- Hazard Identification Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario
| | | | - Ian Colman
- Faculty of Medicine, University of Ottawa
| | | | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, and Department of Energy, Environmental and Chemical Engineering, Washington University, St. Louis, Missouri, USA
| | - Randall V Martin
- Department of Energy, Environmental and Chemical Engineering, Washington University, St. Louis, Missouri, USA, Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, and Harvard-Smithsonian Center for Astrophysics
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University
| | - Hwashin Shin
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario
| | | | - Richard T Burnett
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario
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25
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Erickson AC, Christidis T, Pappin A, Brook JR, Crouse DL, Hystad P, Li C, Martin RV, Meng J, Pinault L, von Donkelaar A, Weichenthal S, Tjepkema M, Burnett RT, Brauer M. Disease assimilation: The mortality impacts of fine particulate matter on immigrants to Canada. Health Rep 2021; 31:14-26. [PMID: 32644760 DOI: 10.25318/82-003-x202000300002-eng] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND Immigrants make up 20% of the Canadian population; however, little is known about the mortality impacts of fine particulate matter (PM2.5) air pollution on immigrants compared with non-immigrants, or about how impacts may change with duration in Canada. DATA AND METHODS This study used the 2001 Canadian Census Health and Environment Cohort, a longitudinal cohort of 3.5 million individuals, of which 764,000 were classified as immigrants (foreign-born). Postal codes from annual income tax files were used to account for mobility among respondents and to assign annual PM2.5 concentrations from 1998 to 2016. Exposures were estimated as a three-year moving average prior to the follow-up year. Cox survival models were used to determine hazard ratios (HRs) for cause-specific mortality, comparing the Canadian and foreign-born populations, with further stratification by year of immigration grouped into 10-year cohorts. RESULTS Differences in urban-rural settlement patterns resulted in greater exposure to PM2.5 for immigrants compared with non-immigrants (mean = 9.3 vs. 7.5 μg/m3), with higher exposures among more recent immigrants. In fully adjusted models, immigrants had higher HRs per 10 μg/m3 increase in PM2.5 concentration compared with Canadian-born individuals for cardiovascular mortality (HR [95% confidence interval] = 1.22 [1.12 to 1.34] vs. 1.12 [1.07 to 1.18]) and cerebrovascular mortality (HR = 1.25 [1.03 to 1.52] vs. 1.03 [0.93 to 1.15]), respectively. However, tests for differences between the two groups were not significant when Cochran's Q test was used. No significant associations were found for respiratory outcomes, except for lung cancer in non-immigrants (HR = 1.10 [1.02 to 1.18]). When stratified by year of immigration, differences in HRs across varied by cause of death. DISCUSSION In Canada, PM2.5 is an equal-opportunity risk factor, with immigrants experiencing similar if not higher mortality risks compared with non-immigrants for cardiovascular-related causes of death. Some notable differences also existed with cerebrovascular and lung cancer deaths. Continued reductions in air pollution, particularly in urban areas, will improve the health of the Canadian population as a whole.
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Affiliation(s)
- Anders C Erickson
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
| | | | - Amanda Pappin
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
| | - Jeffrey R Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Daniel L Crouse
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Chi Li
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec
| | - Jun Meng
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia
| | - Lauren Pinault
- Health Analysis Division, Statistics Canada, Ottawa, Ontario
| | - Aaron von Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia
| | - Scott Weichenthal
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec
| | | | | | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
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26
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Zhang Z, Weichenthal S, Kwong JC, Burnett RT, Hatzopoulou M, Jerrett M, van Donkelaar A, Bai L, Martin RV, Copes R, Lu H, Lakey P, Shiraiwa M, Chen H. A Population-Based Cohort Study of Respiratory Disease and Long-Term Exposure to Iron and Copper in Fine Particulate Air Pollution and Their Combined Impact on Reactive Oxygen Species Generation in Human Lungs. Environ Sci Technol 2021; 55:3807-3818. [PMID: 33666410 DOI: 10.1021/acs.est.0c05931] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Metal components in fine particulate matter (PM2.5) from nontailpipe emissions may play an important role in underlying the adverse respiratory effects of PM2.5. We investigated the associations between long-term exposure to iron (Fe) and copper (Cu) in PM2.5 and their combined impact on reactive oxygen species (ROS) generation in human lungs, and the incidence of asthma, chronic obstructive pulmonary disease (COPD), COPD mortality, pneumonia mortality, and respiratory mortality. We conducted a population-based cohort study of ∼0.8 million adults in Toronto, Canada. Land-use regression models were used to estimate the concentrations of Fe, Cu, and ROS. Outcomes were ascertained using validated health administrative databases. We found positive associations between long-term exposure to Fe, Cu, and ROS and the risks of all five respiratory outcomes. The associations were more robust for COPD, pneumonia mortality, and respiratory mortality than for asthma incidence and COPD mortality. Stronger associations were observed for ROS than for either Fe or Cu. In two-pollutant models, adjustment for nitrogen dioxide somewhat attenuated the associations while adjustment for PM2.5 had little influence. Long-term exposure to Fe and Cu in PM2.5 and estimated ROS concentration in lung fluid was associated with increased incidence of respiratory diseases, suggesting the adverse respiratory effects of nontailpipe emissions.
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Affiliation(s)
- Zilong Zhang
- Public Health Ontario, Toronto, ON M5G 1V2, Canada
- ICES, Toronto, ON M4N 3M5, Canada
| | - Scott Weichenthal
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC H3A 0G4, Canada
- Air Health Science Division, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON M5G 1V2, Canada
- ICES, Toronto, ON M4N 3M5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - Marianne Hatzopoulou
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, ON ON M5S, Canada
| | - Michael Jerrett
- School of Public Health, University of California Los Angeles, Los Angeles, California 90095, United States
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
| | - Li Bai
- ICES, Toronto, ON M4N 3M5, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, United States
- Harvard-Smithsonian Centre for Astrophysics, Cambridge, Massachusetts 02138, United States
| | - Ray Copes
- Public Health Ontario, Toronto, ON M5G 1V2, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Hong Lu
- ICES, Toronto, ON M4N 3M5, Canada
| | - Pascale Lakey
- Department of Chemistry, University of California Irvine, Irvine, California 92697, United States
| | - Manabu Shiraiwa
- Department of Chemistry, University of California Irvine, Irvine, California 92697, United States
| | - Hong Chen
- Public Health Ontario, Toronto, ON M5G 1V2, Canada
- ICES, Toronto, ON M4N 3M5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON K1A 0K9, Canada
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27
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Stieb DM, Evans GJ, To TM, Brook JR, Burnett RT. Response to Goldberg and Villeneuve re: An ecological analysis of long-term exposure to PM 2.5 and incidence of COVID-19 in Canadian health regions. Environ Res 2021; 194:110623. [PMID: 33359701 PMCID: PMC7834156 DOI: 10.1016/j.envres.2020.110623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 05/29/2023]
Affiliation(s)
- David M Stieb
- Environmental Health Science and Research Bureau, Health Canada, 420-757 West Hastings St., Federal Tower, Vancouver, BC, V6C 1A1, Canada; School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Greg J Evans
- Department of Chemical Engineering, University of Toronto, 200 College Street, Toronto, Ontario, M5S 3E5, Canada.
| | - Teresa M To
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, Ontario, M5T 3M7, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada.
| | - Jeffrey R Brook
- Department of Chemical Engineering, University of Toronto, 200 College Street, Toronto, Ontario, M5S 3E5, Canada; Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, Ontario, M5T 3M7, Canada.
| | - Richard T Burnett
- School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
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Coleman NC, Ezzati M, Marshall JD, Robinson AL, Burnett RT, Pope CA. Fine Particulate Matter Air Pollution and Mortality Risk Among US Cancer Patients and Survivors. JNCI Cancer Spectr 2021; 5:pkab001. [PMID: 33644681 PMCID: PMC7898081 DOI: 10.1093/jncics/pkab001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/26/2020] [Accepted: 01/05/2021] [Indexed: 01/04/2023] Open
Abstract
Background Exposure to fine particulate matter (PM2.5) air pollution has been linked to increased risk of mortality, especially cardiopulmonary and lung cancer mortality. It is unknown if cancer patients and survivors are especially vulnerable to PM2.5 air pollution exposure. This study evaluates PM2.5 exposure and risk for cancer and cardiopulmonary mortality in cohorts of US cancer patients and survivors. Methods A primary cohort of 5 591 168 of cancer patients and a 5-year survivor cohort of 2 318 068 was constructed using Surveillance, Epidemiology, and End Results Program data from 2000 to 2016, linked with county-level estimates of long-term average concentrations of PM2.5. Cox proportional hazards models were used to estimate PM2.5-mortality hazard ratios controlling for age-sex-race combinations and individual and county-level covariables. Results Of those who died, 26% died of noncancer causes, mostly from cardiopulmonary disease. Minimal PM2.5-mortality associations were observed for all-cause mortality (hazard ratio [HR] = 1.01, 95% confidence interval [CI] = 1.00 to 1.03) per 10 µg/m3 increase in PM2.5. Substantial adverse PM2.5-mortality associations were observed for cardiovascular (HR = 1.32, 95% CI = 1.26 to 1.39), chronic obstructive pulmonary disease (HR = 1.10, 95% CI = 1.01 to 1.20), influenza and pneumonia (HR = 1.55, 95% CI = 1.33 to 1.80), and cardiopulmonary mortality combined (HR = 1.25, 95% CI = 1.21 to 1.30). PM2.5-cardiopulmonary mortality hazard ratio was higher for cancer patients who received chemotherapy or radiation treatments. Conclusions Air pollution is adversely associated with cardiopulmonary mortality for cancer patients and survivors, especially those who received chemotherapy or radiation treatment. Given ubiquitous and involuntary air pollution exposures and large numbers of cancer patients and survivors, these results are of substantial clinical and public health importance.
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Affiliation(s)
- Nathan C Coleman
- Department of Economics, Brigham Young University, Provo, UT, USA
| | - Majid Ezzati
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Julian D Marshall
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, USA
| | - Allen L Robinson
- Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | | | - C Arden Pope
- Department of Economics, Brigham Young University, Provo, UT, USA
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Lavigne E, Lima I, Hatzopoulou M, Van Ryswyk K, van Donkelaar A, Martin RV, Chen H, Stieb DM, Crighton E, Burnett RT, Weichenthal S. Ambient ultrafine particle concentrations and incidence of childhood cancers. Environ Int 2020; 145:106135. [PMID: 32979813 DOI: 10.1016/j.envint.2020.106135] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ambient air pollution has been associated with childhood cancer. However, little is known about the possible impact of ambient ultrafine particles (<0.1 μm) (UFPs) on childhood cancer incidence. OBJECTIVE This study aimed to evaluate the association between prenatal and childhood exposure to UFPs and development of childhood cancer. METHODS We conducted a population-based cohort study of within-city spatiotemporal variations in ambient UFPs across the City of Toronto, Canada using 653,702 singleton live births occurring between April 1, 1998 and March 31, 2017. Incident cases of 13 subtypes of paediatric cancers among children up to age 14 were ascertained using a cancer registry. Associations between ambient air pollutant concentrations and childhood cancer incidence were estimated using random-effects Cox proportional hazards models. We investigated both single- and multi-pollutant models accounting for co-exposures to PM2.5 and NO2. RESULTS A total of 1,066 childhood cancers were identified. We found that first trimester exposure to UFPs (Hazard Ratio (HR) per 10,000/cm3 increase = 1.13, 95% CI: 1.03-1.22) was associated with overall cancer incidence diagnosed before 6 years of age after adjusting for PM2.5, NO2, and for personal and neighborhood-level covariates. Association between UFPs and overall cancer incidence exhibited a linear shape. No statistically significant associations were found for specific cancer subtypes. CONCLUSION Ambient UFPs may represent a previously unrecognized risk factor in the aetiology of cancers in children. Our findings reinforce the importance of conducting further research on the effects of UFPs given their high prevalence of exposure in urban areas.
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Affiliation(s)
- Eric Lavigne
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - Isac Lima
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marianne Hatzopoulou
- Department of Civil Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Keith Van Ryswyk
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada; Harvard-Smithsonian Centre for Astrophysics, Cambridge, MA, USA; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada; Harvard-Smithsonian Centre for Astrophysics, Cambridge, MA, USA; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Hong Chen
- Population Studies Division, Health Canada, Ottawa, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - David M Stieb
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Population Studies Division, Health Canada, Vancouver, British Columbia, Canada
| | - Eric Crighton
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard T Burnett
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Population Studies Division, Health Canada, Ottawa, Ontario, Canada
| | - Scott Weichenthal
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Thomson EM, Christidis T, Pinault L, Tjepkema M, Colman I, Crouse DL, van Donkelaar A, Martin RV, Hystad P, Robichaud A, Ménard R, Brook JR, Burnett RT. Self-rated stress, distress, mental health, and health as modifiers of the association between long-term exposure to ambient pollutants and mortality. Environ Res 2020; 191:109973. [PMID: 32810502 DOI: 10.1016/j.envres.2020.109973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Individual and neighbourhood-scale socioeconomic characteristics modify associations between exposure to air pollution and mortality. The role of stress, which may integrate effects of social and environmental exposures on health, is unknown. We examined whether an individual's perspective on their own well-being, as assessed using self-rated measures of stress and health, modifies the pollutant-mortality relationship. METHODS The Canadian Community Health Survey (CCHS)-mortality cohort includes respondents from surveys administered between 2001 and 2012 linked to vital statistics and postal codes from 1981 until 2016. Annual fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) exposure estimates were attached to a sample of cohort members aged 30-89 years (n = 398,300 respondents/3,848,400 person-years). We examined whether self-rated stress, distress, mental health, and general health modified associations between long-term exposure to each pollutant (three-year moving average with one-year lag) and non-accidental mortality using Cox survival models, adjusted for individual- (i.e. socioeconomic and behavioural) and neighbourhood-scale covariates. RESULTS In fully-adjusted models, the relationship between exposure to pollutants and mortality was stronger among those with poor self-rated mental health, including a significant difference for NO2 (hazard ratio (HR) = 1.15, 95% CI 1.06-1.25 per IQR) compared to those with very good/excellent mental health (HR = 1.05, 95% CI 1.01-1.08; Cochran's Q = 4.01; p < 0.05). Poor self-rated health was similarly associated with higher pollutant-associated HRs, but only in unadjusted models. Stress and distress did not modify pollutant-mortality associations. CONCLUSIONS Poor self-rated mental and general health were associated with increased mortality attributed to exposure to ambient pollutants.
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Affiliation(s)
- Errol M Thomson
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, ON, Canada.
| | | | - Lauren Pinault
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | | | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Aaron van Donkelaar
- Department of Physics & Atmospheric Science, Dalhousie University, Halifax, NS, Canada; Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, MO, USA
| | - Randall V Martin
- Department of Physics & Atmospheric Science, Dalhousie University, Halifax, NS, Canada; Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, MO, USA; Harvard-Smithsonian Center for Astrophysics, Cambridge, MA, USA
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Alain Robichaud
- Air Quality Research Division, Environment and Climate Change Canada, Dorval, QC, Canada
| | - Richard Ménard
- Air Quality Research Division, Environment and Climate Change Canada, Dorval, QC, Canada
| | - Jeffrey R Brook
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
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Pope CA, Coleman N, Pond ZA, Burnett RT. Corrigendum to "Fine particulate air pollution and human mortality: 25+ years of cohort studies" [Environ. Res. 183 (2020) 108924]. Environ Res 2020; 191:109974. [PMID: 33181974 DOI: 10.1016/j.envres.2020.109974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- C Arden Pope
- Department of Economics, Brigham Young University, Provo, UT, USA.
| | - Nathan Coleman
- Department of Economics, Brigham Young University, Provo, UT, USA
| | - Zachari A Pond
- Department of Economics, Brigham Young University, Provo, UT, USA
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Stieb DM, Evans GJ, To TM, Brook JR, Burnett RT. An ecological analysis of long-term exposure to PM 2.5 and incidence of COVID-19 in Canadian health regions. Environ Res 2020; 191:110052. [PMID: 32860780 PMCID: PMC7448873 DOI: 10.1016/j.envres.2020.110052] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/16/2020] [Accepted: 08/05/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Ambient fine particulate matter (PM2.5) is associated with a wide range of acute and chronic health effects, including increased risk of respiratory infection. However, evidence specifically related to novel coronavirus disease (COVID-19) is limited. METHODS COVID-19 case counts for 111 Canadian health regions were obtained from the COVID-19 Canada Open Data portal. Annual PM2.5 data for 2000-2016 were estimated from a national exposure surface based on remote sensing, chemical transport modelling and ground observations, and minimum and maximum temperature data for 2000-2015 were based on a national interpolated surface derived from thin-plate smoothing splines. Population counts and sociodemographic data by health region were obtained from the 2016 census, and health data (self-rated health and prevalence of smoking, obesity, and selected chronic diseases) by health region, were obtained from the Canadian Community Health Survey. Data on total number of COVID-19 tests and changes in mobility comparing post-vs. pre-introduction of social distancing measures were available by province. Data were analyzed using negative binomial regression models. RESULTS After controlling for province, temperature, demographic and health characteristics and days since peak incidence by health region, long-term PM2.5 exposure exhibited a positive association with COVID-19 incidence (incidence rate ratio 1.07, 95% confidence interval 0.97-1.18 per μg/m3). This association was larger in magnitude and statistically significant in analyses excluding provinces that reported cases only for aggregated health regions, excluding health regions with less than median population density, and restricted to the most highly affected provinces (Quebec and Ontario). CONCLUSIONS We observed a positive association between COVID-19 incidence and long-term PM2.5 exposure in Canadian health regions. The association was larger in magnitude and statistically significant in more highly affected health regions and those with potentially less exposure measurement error. While our results generate hypotheses for further testing, they should be interpreted with caution and require further examination using study designs less prone to bias.
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Affiliation(s)
- David M Stieb
- Environmental Health Science and Research Bureau, Health Canada, 420-757 West Hastings St., Federal Tower, V6C 1A1, Vancouver, BC, Canada; School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, K1G 5Z3, Ottawa, ON, Canada.
| | - Greg J Evans
- Department of Chemical Engineering, University of Toronto, 200 College Street, M5S 3E5, Toronto, ON, Canada.
| | - Teresa M To
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, M5T 3M7, Toronto, ON, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, M5G 1X8, Toronto, ON, Canada.
| | - Jeffrey R Brook
- Department of Chemical Engineering, University of Toronto, 200 College Street, M5S 3E5, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, M5T 3M7, Toronto, ON, Canada.
| | - Richard T Burnett
- School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, K1G 5Z3, Ottawa, ON, Canada.
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Coleman NC, Burnett RT, Ezzati M, Marshall JD, Robinson AL, Pope CA. Fine Particulate Matter Exposure and Cancer Incidence: Analysis of SEER Cancer Registry Data from 1992-2016. Environ Health Perspect 2020; 128:107004. [PMID: 33035119 PMCID: PMC7546438 DOI: 10.1289/ehp7246] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/02/2020] [Accepted: 09/15/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND Previous research has identified an association between fine particulate matter (PM 2.5 ) air pollution and lung cancer. Most of the evidence for this association, however, is based on research using lung cancer mortality, not incidence. Research that examines potential associations between PM 2.5 and incidence of non-lung cancers is limited. OBJECTIVES The primary purpose of this study was to evaluate the association between the incidence of cancer and exposure to PM 2.5 using > 8.5 million cases of cancer incidences from U.S. registries. Secondary objectives include evaluating the sensitivity of the associations to model selection, spatial control, and latency period as well as estimating the exposure-response relationship for several cancer types. METHODS Surveillance, Epidemiology, and End Results (SEER) program data were used to calculate incidence rates for various cancer types in 607 U.S. counties. County-level PM 2.5 concentrations were estimated using integrated empirical geographic regression models. Flexible semi-nonparametric regression models were used to estimate associations between PM 2.5 and cancer incidence for selected cancers while controlling for important county-level covariates. Primary time-independent models using average incidence rates from 1992-2016 and average PM 2.5 from 1988-2015 were estimated. In addition, time-varying models using annual incidence rates from 2002-2011 and lagged moving averages of annual estimates for PM 2.5 were also estimated. RESULTS The incidences of all cancer and lung cancer were consistently associated with PM 2.5 . The incident rate ratios (IRRs), per 10 - μ g / m 3 increase in PM 2.5 , for all and lung cancer were 1.09 (95% CI: 1.03, 1.14) and 1.19 (95% CI: 1.09, 1.30), respectively. Less robust associations were observed with oral, rectal, liver, skin, breast, and kidney cancers. DISCUSSION Exposure to PM 2.5 air pollution contributes to lung cancer incidence and is potentially associated with non-lung cancer incidence. https://doi.org/10.1289/EHP7246.
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Affiliation(s)
| | | | - Majid Ezzati
- Medical Research Council–Public Health England Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Julian D. Marshall
- Department of Civil and Environmental Engineering, University of Washington, Seattle, Washington, USA
| | - Allen L. Robinson
- Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - C. Arden Pope
- Department of Economics, Brigham Young University, Provo, Utah, USA
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Yin P, Brauer M, Cohen AJ, Wang H, Li J, Burnett RT, Stanaway JD, Causey K, Larson S, Godwin W, Frostad J, Marks A, Wang L, Zhou M, Murray CJL. The effect of air pollution on deaths, disease burden, and life expectancy across China and its provinces, 1990-2017: an analysis for the Global Burden of Disease Study 2017. Lancet Planet Health 2020; 4:e386-e398. [PMID: 32818429 PMCID: PMC7487771 DOI: 10.1016/s2542-5196(20)30161-3] [Citation(s) in RCA: 224] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND Air pollution is an important public health concern in China, with high levels of exposure to both ambient and household air pollution. To inform action at provincial levels in China, we estimated the exposure to air pollution and its effect on deaths, disease burden, and loss of life expectancy across all provinces in China from 1990 to 2017. METHODS In all 33 provinces, autonomous regions, municipalities, and special administrative regions in China, we estimated exposure to air pollution, including ambient particulate matter pollution (defined as the annual gridded concentration of PM2·5), household air pollution (defined as the percentage of households using solid cooking fuels and the corresponding exposure to PM2·5), and ozone pollution (defined as average gridded ozone concentrations). We used the methods of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 to estimate deaths and disability-adjusted life-years (DALYs) attributable to air pollution, and what the life expectancy would have been if air pollution levels had been less than the minimum level causing health loss. FINDINGS The average annual population-weighted PM2·5 exposure in China was 52·7 μg/m3 (95% uncertainty interval [UI] 41·0-62·8) in 2017, which is 9% lower than in 1990 (57·8 μg/m3, 45·0-67·0). We estimated that 1·24 million (95% UI 1·08-1·40) deaths in China were attributable to air pollution in 2017, including 851 660 (712 002-990 271) from ambient PM2·5 pollution, 271 089 (209 882-346 561) from household air pollution from solid fuels, and 178 187 (67 650-286 229) from ambient ozone pollution. The age-standardised DALY rate attributable to air pollution was 1513·1 per 100 000 in China in 2017, and was higher in males (1839·8 per 100 000) than in females (1198·3 per 100 000). The age-standardised death rate attributable to air pollution decreased by 60·6% (55·7-63·7) for China overall between 1990 and 2017, driven by an 85·4% (83·2-87·3) decline in household air pollution and a 12·0% (1·4-22·1) decline in ambient PM2·5 pollution. 40·0% of DALYs for COPD were attributable to air pollution, as were 35·6% of DALYs for lower respiratory infections, 26·1% for diabetes, 25·8% for lung cancer, 19·5% for ischaemic heart disease, and 12·8% for stroke. We estimated that if the air pollution level in China was below the minimum causing health loss, the average life expectancy would have been 1·25 years greater. The DALY rate per 100 000 attributable to air pollution varied across provinces, ranging from 482·3 (371·1-604·1) in Hong Kong to 1725·6 (720·4-2653·1) in Xinjiang for ambient pollution, and from 18·7 (9·1-34·0) in Shanghai to 1804·5 (1339·5-2270·1) in Tibet for household pollution. Although the overall mortality attributable to air pollution decreased in China between 1990 and 2017, 12 provinces showed an increasing trend during the past 27 years. INTERPRETATION Pollution from ambient PM2·5 and household burning of solid fuels decreased markedly in recent years in China, after extensive efforts to control emissions. However, PM2·5 concentrations still exceed the WHO Air Quality Guideline for the entire population of China, with 81% living in regions exceeding the WHO Interim Target 1, and air pollution remains an important risk factor. Sustainable development policies should be implemented and enforced to reduce the impact of air pollution on long-term economic development and population health. FUNDING Bill & Melinda Gates Foundation; and China National Key Research and Development Program.
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Affiliation(s)
- Peng Yin
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aaron J Cohen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Health Effects Institute, Boston, MA, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jie Li
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Jeffrey D Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kate Causey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Samantha Larson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - William Godwin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joseph Frostad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ashley Marks
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lijun Wang
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Coffman E, Burnett RT, Sacks JD. Quantitative Characterization of Uncertainty in the Concentration-Response Relationship between Long-Term PM 2.5 Exposure and Mortality at Low Concentrations. Environ Sci Technol 2020; 54:10191-10200. [PMID: 32702976 PMCID: PMC8167809 DOI: 10.1021/acs.est.0c02770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Extensive epidemiologic evidence supports a linear, no-threshold concentration-response (C-R) relationship between long-term exposure to fine particles (PM2.5) and mortality in the United States. While examinations of the C-R relationship are designed to assess the shape of the C-R curve, they do not provide the information needed to quantitatively characterize uncertainty at specific PM2.5 concentrations, which is often needed in the context of risk assessments and benefits analyses. We developed a novel approach, using information that is typically available in published epidemiologic studies, to quantitatively characterize uncertainty at different concentrations along the PM2.5 concentration distribution. Our approach utilizes the annual mean PM2.5 concentration and corresponding standard deviation from a published epidemiologic study to estimate the standard deviation of hypothetical PM2.5 concentration distributions defined at 0.1 μg/m3 increments. The hypothetical distributions are then used to derive adjusted uncertainty estimates in the reported effect estimate at low concentrations (i.e., concentrations lower than the annual mean observed in the study). We demonstrate the application of this method in six individual epidemiologic studies that examined the relationship between long-term PM2.5 exposure and mortality and were conducted in different geographic locations worldwide and at different PM2.5 concentrations. This new method allows for a more comprehensive quantitative evaluation of uncertainty in the shape of the C-R relationship between long-term PM2.5 exposure and mortality at concentrations below the mean annual concentrations observed in current studies.
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Affiliation(s)
- Evan Coffman
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, United States
| | | | - Jason D Sacks
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, United States
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Bai L, Shin S, Oiamo TH, Burnett RT, Weichenthal S, Jerrett M, Kwong JC, Copes R, Kopp A, Chen H. Exposure to Road Traffic Noise and Incidence of Acute Myocardial Infarction and Congestive Heart Failure: A Population-Based Cohort Study in Toronto, Canada. Environ Health Perspect 2020; 128:87001. [PMID: 32783534 PMCID: PMC7422718 DOI: 10.1289/ehp5809] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Epidemiological evidence for the association between traffic-related noise and the incidence of major cardiovascular events such as acute myocardial infarction (AMI) and congestive heart failure (CHF) is inconclusive, especially in North America. OBJECTIVES We evaluated the associations between long-term exposure to road traffic noise and the incidence of AMI and CHF. METHODS Our study population comprised ∼1 million people 30-100 years of age who lived in Toronto, Canada, from 2001 to 2015 and were free of AMI (referred to as the AMI cohort) or CHF (the CHF cohort) at baseline. Outcomes were ascertained from health administrative databases using validated algorithms. Annual average noise levels were estimated as the A-weighted equivalent sound pressure level over the 24-h period (LAeq24) and during nighttime (LAeqNight), respectively, using propagation modeling, and assigned to participants' annual six-digit postal code addresses during follow-up. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for incident AMI and CHF in relation to LAeq24 and LAeqNight using random-effects Cox proportional hazards models adjusting for individual- and census tract-level covariates, including traffic-related air pollutants [e.g., ultrafine particles (UFPs) and nitrogen dioxide]. RESULTS During follow-up, there were 37,441 AMI incident cases and 95,138 CHF incident cases. Each interquartile range change in LAeq24 was associated with an increased risk of incident AMI (HR=1.07; 95% CI: 1.06, 1.08) and CHF (HR=1.07; 95% CI: 1.06, 1.09). Similarly, LAeqNight was associated with incident AMI (HR=1.07; 95% CI: 1.05, 1.08) and CHF (HR=1.06; 95% CI: 1.05, 1.07). These results were robust to various sensitivity analyses and remained elevated after controlling for long-term exposure to UFPs and nitrogen dioxide. We found near-linear relationships between noise and the incidence of AMI and CHF with no evidence of threshold values. CONCLUSION In this large cohort study in Toronto, Canada, chronic exposure to road traffic noise was associated with elevated risks for AMI and CHF incidence. https://doi.org/10.1289/EHP5809.
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Affiliation(s)
- Li Bai
- ICES, Toronto, Ontario, Canada
| | - Saeha Shin
- Public Health Ontario, Toronto, Ontario, Canada
| | - Tor H. Oiamo
- Department of Geography and Environmental Studies, Ryerson University, Toronto, Ontario, Canada
| | | | - Scott Weichenthal
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | - Michael Jerrett
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Jeffrey C. Kwong
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ray Copes
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Hong Chen
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Health Canada, Ottawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Chen H, Burnett RT, Bai L, Kwong JC, Crouse DL, Lavigne E, Goldberg MS, Copes R, Benmarhnia T, Ilango SD, van Donkelaar A, Martin RV, Hystad P. Residential Greenness and Cardiovascular Disease Incidence, Readmission, and Mortality. Environ Health Perspect 2020; 128:87005. [PMID: 32840393 PMCID: PMC7446772 DOI: 10.1289/ehp6161] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 07/21/2020] [Accepted: 07/31/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND Living in greener areas of cities was linked to increased physical activity levels, improved mental well-being, and lowered harmful environmental exposures, all of which may affect human health. However, whether living in greener areas may be associated with lower risk of cardiovascular disease incidence, progression, and premature mortality is unclear. OBJECTIVES We conducted a cohort study to examine the associations between residential green spaces and the incidence of acute myocardial infarction (AMI) and heart failure (HF), post-AMI and HF hospital readmissions, and mortality. METHODS We simultaneously followed four large population-based cohorts in Ontario, Canada, including the entire adult population, adults free of AMI and HF, and survivors of AMI or HF from 2000 to 2014. We estimated residential exposure to green spaces using satellite-derived observations and ascertained health outcomes using validated disease registries. We estimated the associations using spatial random-effects Cox proportional hazards models. We conducted various sensitivity analyses, including further adjusting for property values and performing exploratory mediation analysis. RESULTS Each interquartile range increase in residential greenness was associated with a 7% [95% confidence interval (CI): 4%, 9%] decrease in incident AMI and a 6% (95% CI: 4%, 7%) decrease in incident HF. Residential greenness was linked to a ∼10% decrease in cardiovascular mortality in both adults free of AMI and HF and the entire adult population. These associations remained consistent in sensitivity analyses and were accentuated among younger adults. Additionally, we estimated that the decreases in AMI and HF incidence associated with residential greenness explained ∼53% of the protective association between residential greenness and cardiovascular mortality. Conversely, residential greenness was not associated with any delay in readmission or mortality among AMI and HF patients. CONCLUSIONS Living in urban areas with more green spaces was associated with improved cardiovascular health in people free of AMI and HF but not among individuals who have already developed these conditions. https://doi.org/10.1289/EHP6161.
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Affiliation(s)
- Hong Chen
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Richard T. Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Li Bai
- ICES, Toronto, Ontario, Canada
| | - Jeffrey C. Kwong
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dan L. Crouse
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
- New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - Eric Lavigne
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark S. Goldberg
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ray Copes
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California, USA
| | - Sindana D. Ilango
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Randall V. Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
- Harvard-Smithsonian Centre for Astrophysics, Cambridge, Massachusetts, USA
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
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Coleman NC, Burnett RT, Higbee JD, Lefler JS, Merrill RM, Ezzati M, Marshall JD, Kim SY, Bechle M, Robinson AL, Pope CA. Cancer mortality risk, fine particulate air pollution, and smoking in a large, representative cohort of US adults. Cancer Causes Control 2020; 31:767-776. [PMID: 32462559 DOI: 10.1007/s10552-020-01317-w] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Air pollution and smoking are associated with various types of mortality, including cancer. The current study utilizes a publicly accessible, nationally representative cohort to explore relationships between fine particulate matter (PM2.5) exposure, smoking, and cancer mortality. METHODS National Health Interview Survey and mortality follow-up data were combined to create a study population of 635,539 individuals surveyed from 1987 to 2014. A sub-cohort of 341,665 never-smokers from the full cohort was also created. Individuals were assigned modeled PM2.5 exposure based on average exposure from 1999 to 2015 at residential census tract. Cox Proportional Hazard models were utilized to estimate hazard ratios for cancer-specific mortality controlling for age, sex, race, smoking status, body mass, income, education, marital status, rural versus urban, region, and survey year. RESULTS The risk of all cancer mortality was adversely associated with PM2.5 (per 10 µg/m3 increase) in the full cohort (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.08-1.22) and the never-smokers' cohort (HR 1.19, 95% CI 1.06-1.33). PM2.5-morality associations were observed specifically for lung, stomach, colorectal, liver, breast, cervix, and bladder, as well as Hodgkin lymphoma, non-Hodgkin lymphoma, and leukemia. The PM2.5-morality association with lung cancer in never-smokers was statistically significant adjusting for multiple comparisons. Cigarette smoking was statistically associated with mortality for many cancer types. CONCLUSIONS Exposure to PM2.5 air pollution contributes to lung cancer mortality and may be a risk factor for other cancer types. Cigarette smoking has a larger impact on cancer mortality than PM2.5 , but is associated with similar cancer types.
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Affiliation(s)
- Nathan C Coleman
- Department of Economics, Brigham Young University, 142 FOB, Provo, UT, 84602, USA
| | | | - Joshua D Higbee
- Department of Economics, University of Chicago, Chicago, IL, USA
| | - Jacob S Lefler
- Department of Agricultural and Resource Economics, University of California, Berkeley, CA, USA
| | - Ray M Merrill
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College, London, London, UK
| | - Julian D Marshall
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, USA
| | - Sun-Young Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
| | - Matthew Bechle
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, USA
| | - Allen L Robinson
- Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | - C Arden Pope
- Department of Economics, Brigham Young University, 142 FOB, Provo, UT, 84602, USA.
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Paul LA, Hystad P, Burnett RT, Kwong JC, Crouse DL, van Donkelaar A, Tu K, Lavigne E, Copes R, Martin RV, Chen H. Urban green space and the risks of dementia and stroke. Environ Res 2020; 186:109520. [PMID: 32344208 DOI: 10.1016/j.envres.2020.109520] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/16/2020] [Accepted: 04/10/2020] [Indexed: 05/11/2023]
Abstract
INTRODUCTION It is unknown whether urban green space is associated with reduced risk of major neurological conditions, especially dementia and stroke. METHODS Retrospective, population-based cohorts were created for each study outcome, including 1.7 and 4.3 million adults in Ontario, Canada for dementia and stroke, respectively. Residential green space was quantified using the satellite-derived Normalized Difference Vegetation Index. Incidence was ascertained using health administrative data with validated algorithms. Mixed-effects Cox models were used to estimate hazard ratios per interquartile range increase in green space exposure. RESULTS Between 2001 and 2013, 219,013 individuals were diagnosed with dementia and 89,958 had a stroke. The hazard ratio per interquartile range increase in green space was 0.97 (95% CI: 0.96-0.98) for dementia and 0.96 (0.95-0.98) for stroke. Estimates remained generally consistent in sensitivity analyses. DISCUSSION Increased exposure to urban green space was associated with reduced incidence of dementia and stroke. To our knowledge, this is the first population-based cohort study to assess these relationships.
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Affiliation(s)
- Lauren A Paul
- Department of Environmental and Occupational Health, Public Health Ontario, 480 University Ave. Suite 300, Toronto, ON, M5G 1V2, Canada.
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Women's Bldg, 160 SW 26th St., Corvallis, OR, 97331, USA.
| | - Richard T Burnett
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Finance Bldg, 101 Tunney's Pasture Drwy, Ottawa, ON, K1A 0K9, Canada.
| | - Jeffrey C Kwong
- Public Health Ontario Laboratories, Public Health Ontario, 661 University Ave. Suite 1701, Toronto, ON, M5G 1M1, Canada; ICES, 2075 Bayview Ave. G1 06, Toronto, ON, M4N 3M5, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 500, Toronto, ON, M5T 3M7, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave. 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | - Dan L Crouse
- Health Effects Institute, 75 Federal St. Suite 1400, Boston, MA, 02110-1817, USA.
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Sir James Dunn Bldg, 6310 Coburg Rd., Halifax, NS, B3H 4J5, Canada.
| | - Karen Tu
- Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 500, Toronto, ON, M5T 3M7, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave. 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | - Eric Lavigne
- Air Health Science Division, Health Canada, 269 Laurier Ave. W A.L. 4903B, Ottawa, ON, K1A 0K9, Canada; School of Epidemiology and Public Health, University of Ottawa, Alta Vista Campus, 600 Peter Morand Cres. Room 101, Ottawa, ON, K1G 5Z3, Canada.
| | - Ray Copes
- Department of Environmental and Occupational Health, Public Health Ontario, 480 University Ave. Suite 300, Toronto, ON, M5G 1V2, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 500, Toronto, ON, M5T 3M7, Canada.
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Sir James Dunn Bldg, 6310 Coburg Rd., Halifax, NS, B3H 4J5, Canada.
| | - Hong Chen
- Department of Environmental and Occupational Health, Public Health Ontario, 480 University Ave. Suite 300, Toronto, ON, M5G 1V2, Canada; ICES, 2075 Bayview Ave. G1 06, Toronto, ON, M4N 3M5, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 500, Toronto, ON, M5T 3M7, Canada.
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Elten M, Donelle J, Lima I, Burnett RT, Weichenthal S, Stieb DM, Hystad P, van Donkelaar A, Chen H, Paul LA, Crighton E, Martin RV, Decou ML, Luo W, Lavigne É. Ambient air pollution and incidence of early-onset paediatric type 1 diabetes: A retrospective population-based cohort study. Environ Res 2020; 184:109291. [PMID: 32120123 DOI: 10.1016/j.envres.2020.109291] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Studies have reported increasing incidence rates of paediatric diabetes, especially among those aged 0-5 years. Epidemiological evidence linking ambient air pollution to paediatric diabetes remains mixed. OBJECTIVE This study investigated the association between maternal and early-life exposures to common air pollutants (NO2, PM2.5, O3, and oxidant capacity [Ox; the redox-weighted average of O3 and NO2]) and the incidence of paediatric diabetes in children up to 6 years of age. METHODS All registered singleton births in Ontario, Ca nada occurring between April 1st, 2006 and March 31st, 2012 were included through linkage from health administrative data. Monthly exposures to NO2, PM2.5, O3, and Ox were estimated across trimesters, the entire pregnancy period and during childhood. Random effects Cox proportional hazards models were used to assess the relationships with paediatric diabetes incidence while controlling for important covariates. We also modelled the shape of concentration-response (CR) relationships. RESULTS There were 1094 children out of a cohort of 754,698 diagnosed with diabetes before the age of six. O3 exposures during the first trimester of pregnancy were associated with paediatric diabetes incidence (hazard ratio (HR) per interquartile (IQR) increase = 2.00, 95% CI: 1.04-3.86). The CR relationship between O3 during the first trimester and paediatric diabetes incidence appeared to have a risk threshold, in which there was little-to-no risk below 25 ppb of O3, while above this level risk increased sigmoidally. No other associations were observed. CONCLUSION O3 exposures during a critical period of development were associated with an increased risk of paediatric diabetes incidence.
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Affiliation(s)
- Michael Elten
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada; Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | | | - Isac Lima
- ICES UOttawa, Ottawa, Ontario, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Scott Weichenthal
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - David M Stieb
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada; Environmental Health Science and Research Bureau, Health Canada, Vancouver, British Columbia, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, USA
| | - Hong Chen
- ICES UOttawa, Ottawa, Ontario, Canada; Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada; Public Health Ontario, Toronto Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Eric Crighton
- ICES UOttawa, Ottawa, Ontario, Canada; Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, Ontario, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, USA
| | - Mary Lou Decou
- Maternal & Infant Health Section, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Wei Luo
- Maternal & Infant Health Section, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Éric Lavigne
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada; Air Health Science Division, Health Canada, Ottawa, Ontario, Canada.
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Chen H, Zhang Z, van Donkelaar A, Bai L, Martin RV, Lavigne E, Kwong JC, Burnett RT. Understanding the Joint Impacts of Fine Particulate Matter Concentration and Composition on the Incidence and Mortality of Cardiovascular Disease: A Component-Adjusted Approach. Environ Sci Technol 2020; 54:4388-4399. [PMID: 32101425 DOI: 10.1021/acs.est.9b06861] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Past health impact assessments of ambient fine particulate matter (particles with an aerodynamic diameter ≤2.5 μm; PM2.5) have generally considered mass concentration only, despite PM2.5 being a heterogeneous mixture. Given constant changes in the concentration and the composition of atmospheric aerosol, uncertainty exists as to whether the current focus on PM2.5 mass or individual components may fully characterize the health burden of PM2.5. We proposed a component-adjusted method that jointly estimates the health impacts of PM2.5 and its major components while allowing for a potential nonlinear PM2.5-outcome relationship. Using this method, we quantified the effects of PM2.5 on the risks of developing acute myocardial infarction (AMI) and dying from cardiovascular causes in comparison to three traditional approaches in the entire adult population across Ontario, Canada. We observed that PM2.5 was positively associated with AMI incidence and cardiovascular mortality with all four methods. Compared to the traditional approaches, however, the new component-adjusted approach demonstrated a significant improvement in explaining the health impacts of PM2.5, especially in the presence of a nonlinear PM2.5-outcome relationship. Using the new approach, we found that the effects of PM2.5 on AMI incidence and cardiovascular mortality may be 10% to 27% higher than what would be estimated from the conventional approaches examining PM2.5 alone.
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Affiliation(s)
- Hong Chen
- Environmental Health Science and Research Bureau, Health Canada, 101 Tunney's Pasture, Ottawa, Ontario K1A 0K9, Canada
- Public Health Ontario, Toronto, Ontario M5G 1V2, Canada
- ICES, Toronto, Ontario M4N 3M5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5S 1A1, Canada
| | - Zilong Zhang
- Public Health Ontario, Toronto, Ontario M5G 1V2, Canada
- ICES, Toronto, Ontario M4N 3M5, Canada
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
- Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, Missouri 63130, United States
| | - Li Bai
- ICES, Toronto, Ontario M4N 3M5, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
- Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, Missouri 63130, United States
- Harvard-Smithsonian Centre for Astrophysics, Cambridge, Massachusetts 02138, United States
| | - Eric Lavigne
- Environmental Health Science and Research Bureau, Health Canada, 101 Tunney's Pasture, Ottawa, Ontario K1A 0K9, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario K1G 5Z3, Canada
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, Ontario M5G 1V2, Canada
- ICES, Toronto, Ontario M4N 3M5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5S 1A1, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario M5S 1A1, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, 101 Tunney's Pasture, Ottawa, Ontario K1A 0K9, Canada
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Pope CA, Coleman N, Pond ZA, Burnett RT. Fine particulate air pollution and human mortality: 25+ years of cohort studies. Environ Res 2020; 183:108924. [PMID: 31831155 DOI: 10.1016/j.envres.2019.108924] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/15/2019] [Accepted: 11/11/2019] [Indexed: 05/02/2023]
Abstract
Much of the key epidemiological evidence that long-term exposure to fine particulate matter air pollution (PM2.5) contributes to increased risk of mortality comes from survival studies of cohorts of individuals. Although the first two of these studies, published in the mid-1990s, were highly controversial, much has changed in the last 25 + years. The objectives of this paper are to succinctly compile and summarize the findings of these cohort studies using meta-analytic tools and to address several of the key controversies. Independent reanalysis and substantial extended analysis of the original cohort studies have been conducted and many additional studies using a wide variety of cohorts, including cohorts constructed from public data and leveraging natural experiments have been published. Meta-analytic estimates of the mean of the distribution of effects from cohort studies that are currently available, provide substantial evidence of adverse air pollution associations with all-cause, cardiopulmonary, and lung cancer mortality.
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Affiliation(s)
- C Arden Pope
- Department of Economics, Brigham Young University, Provo, UT, USA.
| | - Nathan Coleman
- Department of Economics, Brigham Young University, Provo, UT, USA
| | - Zachari A Pond
- Department of Economics, Brigham Young University, Provo, UT, USA
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Higbee JD, Lefler JS, Burnett RT, Ezzati M, Marshall JD, Kim SY, Bechle M, Robinson AL, Pope CA. Estimating long-term pollution exposure effects through inverse probability weighting methods with Cox proportional hazards models. Environ Epidemiol 2020; 4:e085. [PMID: 32656485 PMCID: PMC7319228 DOI: 10.1097/ee9.0000000000000085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/19/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Fine particulate matter (PM2.5) is associated with negative health outcomes in both the short and long term. However, the cohort studies that have produced many of the estimates of long-term exposure associations may fail to account for selection bias in pollution exposure as well as covariate imbalance in the study population; therefore, causal modeling techniques may be beneficial. METHODS Twenty-nine years of data from the National Health Interview Survey (NHIS) was compiled and linked to modeled annual average outdoor PM2.5 concentration and restricted-use mortality data. A series of Cox proportional hazards models, adjusted using inverse probability weights, yielded causal risk estimates of long-term exposure to ambient PM2.5 on all-cause and cardiopulmonary mortality. RESULTS Covariate-adjusted estimated relative risks per 10 μg/m3 increase in PM2.5 exposure were estimated to be 1.117 (1.083, 1.152) for all-cause mortality and 1.232 (1.174, 1.292) for cardiopulmonary mortality. Inverse probability weighted Cox models provide relatively consistent and robust estimates similar to those in the unweighted baseline multivariate Cox model, though they have marginally lower point estimates and higher standard errors. CONCLUSIONS These results provide evidence that long-term exposure to PM2.5 contributes to increased mortality risk in US adults and that the estimated effects are generally robust to modeling choices. The size and robustness of estimated associations highlight the importance of clean air as a matter of public health. Estimated confounding due to measured covariates appears minimal in the NHIS cohort, and various distributional assumptions have little bearing on the magnitude or standard errors of estimated causal associations.
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Affiliation(s)
- Joshua D. Higbee
- Department of Economics, University of Chicago, Chicago, Illinois
| | - Jacob S. Lefler
- Department of Agricultural and Resource Economics, University of California – Berkeley, Berkeley, California
| | | | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Julian D. Marshall
- Department of Civil and Environmental Engineering, University of Washington, Seattle, Washington
| | - Sun-Young Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
| | - Matthew Bechle
- Department of Civil and Environmental Engineering, University of Washington, Seattle, Washington
| | - Allen L. Robinson
- Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - C. Arden Pope
- Department of Economics, Brigham Young University, Provo, Utah
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Shin S, Bai L, Oiamo TH, Burnett RT, Weichenthal S, Jerrett M, Kwong JC, Goldberg MS, Copes R, Kopp A, Chen H. Association Between Road Traffic Noise and Incidence of Diabetes Mellitus and Hypertension in Toronto, Canada: A Population-Based Cohort Study. J Am Heart Assoc 2020; 9:e013021. [PMID: 32146894 PMCID: PMC7335534 DOI: 10.1161/jaha.119.013021] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Exposure to road traffic noise has been linked to cardiometabolic complications, such as elevated blood pressure and glucose dysregulation. However, epidemiologic evidence linking road traffic noise to diabetes mellitus and hypertension remains scarce. We examined associations between road traffic noise and the incidence of diabetes mellitus and hypertension in Toronto, Canada. Methods and Results Using the Ontario Population Health and Environment Cohort, we conducted a retrospective, population-based cohort study of long-term residents of Toronto, aged 35 to 100 years, who were registered for provincial publicly funded health insurance, and were without a history of hypertension (n=701 174) or diabetes mellitus (n=914 607). Road traffic noise exposure levels were assessed by the equivalent continuous A-weighted sound pressure level (dBA) for the 24-hour day and the equivalent continuous A-weighted sound pressure level for the night (11 pm-7am). Noise exposures were assigned to subjects according to their annual residential postal codes during the 15-year follow-up. We used random-effect Cox proportional hazards models adjusting for personal and area-level characteristics. From 2001 to 2015, each interquartile range increase in the equivalent continuous A-weighted sound pressure level (dBA) for the 24-hour day (10.0 dBA) was associated with an 8% increase in incident diabetes mellitus (95% CI, 1.07-1.09) and a 2% increase in hypertension (95% CI, 1.01-1.03). We obtained similar estimates with the equivalent continuous A-weighted sound pressure level for the night (11 pm-7am). These results were robust to all sensitivity analyses conducted, including further adjusting for traffic-related air pollutants (ultrafine particles and nitrogen dioxide). For both hypertension and diabetes mellitus, we observed stronger associations with the equivalent continuous A-weighted sound pressure level (dBA) for the 24-hour day among women and younger adults (aged <60 years). Conclusions Long-term exposure to road traffic noise was associated with an increased incidence of diabetes mellitus and hypertension in Toronto.
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Affiliation(s)
- Saeha Shin
- Public Health Ontario Toronto Ontario Canada
| | - Li Bai
- ICES Toronto Ontario Canada
| | - Tor H Oiamo
- Department of Geography and Environmental Studies Ryerson University Toronto Ontario Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau Population Studies Division Health Canada Ottawa Ontario Canada
| | - Scott Weichenthal
- Department of Epidemiology, Biostatistics, and Occupational Health and Gerald Bronfman Department of Oncology McGill University Montreal Québec Canada.,Air Health Science Division Health Canada Ottawa Ontario Canada
| | - Michael Jerrett
- Department of Environmental Health Sciences Fielding School of Public Health University of California Los Angeles CA
| | - Jeffrey C Kwong
- Public Health Ontario Toronto Ontario Canada.,ICES Toronto Ontario Canada.,Dalla Lana School of Public Health University of Toronto Ontario Canada.,Department of Family and Community Medicine University of Toronto Ontario Canada
| | - Mark S Goldberg
- Department of Medicine McGill University Montreal Québec Canada.,Centre for Outcomes Research and Evaluation Research Institute of the McGill University Health Centre Montreal Québec Canada
| | - Ray Copes
- Public Health Ontario Toronto Ontario Canada.,Dalla Lana School of Public Health University of Toronto Ontario Canada
| | | | - Hong Chen
- Public Health Ontario Toronto Ontario Canada.,ICES Toronto Ontario Canada.,Environmental Health Science and Research Bureau Population Studies Division Health Canada Ottawa Ontario Canada.,Dalla Lana School of Public Health University of Toronto Ontario Canada
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Lavigne E, Donelle J, Hatzopoulou M, Van Ryswyk K, van Donkelaar A, Martin RV, Chen H, Stieb DM, Gasparrini A, Crighton E, Yasseen AS, Burnett RT, Walker M, Weichenthal S. Spatiotemporal Variations in Ambient Ultrafine Particles and the Incidence of Childhood Asthma. Am J Respir Crit Care Med 2020; 199:1487-1495. [PMID: 30785782 DOI: 10.1164/rccm.201810-1976oc] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Rationale: Little is known regarding the impact of ambient ultrafine particles (UFPs; <0.1 μm) on childhood asthma development. Objectives: To examine the association between prenatal and early postnatal life exposure to UFPs and development of childhood asthma. Methods: A total of 160,641 singleton live births occurring in the City of Toronto, Canada between April 1, 2006, and March 31, 2012, were identified from a birth registry. Associations between exposure to ambient air pollutants and childhood asthma incidence (up to age 6) were estimated using random effects Cox proportional hazards models, adjusting for personal- and neighborhood-level covariates. We investigated both single-pollutant and multipollutant models accounting for coexposures to particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5) and NO2. Measurements and Main Results: We identified 27,062 children with incident asthma diagnosis during the follow-up. In adjusted models, second-trimester exposure to UFPs (hazard ratio per interquartile range increase, 1.09; 95% confidence interval, 1.06-1.12) was associated with asthma incidence. In models additionally adjusted for PM2.5 and nitrogen dioxide, UFPs exposure during the second trimester of pregnancy remained positively associated with childhood asthma incidence (hazard ratio per interquartile range increase, 1.05; 95% confidence interval, 1.01-1.09). Conclusions: This is the first study to evaluate the association between perinatal exposure to UFPs and the incidence of childhood asthma. Exposure to UFPs during a critical period of lung development was linked to the onset of asthma in children, independent of PM2.5 and NO2.
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Affiliation(s)
- Eric Lavigne
- 1 Air Health Science Division and.,2 School of Epidemiology and Public Health
| | - Jessy Donelle
- 3 Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.,4 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | - Aaron van Donkelaar
- 6 Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Randall V Martin
- 6 Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada.,7 Harvard-Smithsonian Centre for Astrophysics, Cambridge, Massachusetts
| | - Hong Chen
- 8 Population Studies Division, Health Canada, Ottawa, Ontario, Canada.,10 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,9 Public Health Ontario, Toronto, Ontario, Canada.,11 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - David M Stieb
- 2 School of Epidemiology and Public Health.,12 Population Studies Division, Health Canada, Vancouver, British Columbia, Canada
| | - Antonio Gasparrini
- 13 Department of Public Health, Environments and Society and.,14 Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Eric Crighton
- 15 Department of Geography, Environment and Geomatics, and.,3 Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Abdool S Yasseen
- 16 Better Outcomes Registry and Network Ontario, Ottawa, Ontario, Canada
| | - Richard T Burnett
- 8 Population Studies Division, Health Canada, Ottawa, Ontario, Canada
| | - Mark Walker
- 18 Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.,16 Better Outcomes Registry and Network Ontario, Ottawa, Ontario, Canada.,17 Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; and
| | - Scott Weichenthal
- 1 Air Health Science Division and.,19 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Paul LA, Burnett RT, Kwong JC, Hystad P, van Donkelaar A, Bai L, Goldberg MS, Lavigne E, Copes R, Martin RV, Kopp A, Chen H. The impact of air pollution on the incidence of diabetes and survival among prevalent diabetes cases. Environ Int 2020; 134:105333. [PMID: 31775094 DOI: 10.1016/j.envint.2019.105333] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 05/18/2023]
Abstract
PURPOSE Growing evidence implicates ambient air pollutants in the development of major chronic diseases and premature mortality. However, epidemiologic evidence linking air pollution to diabetes remains inconclusive. This study sought to determine the relationships between selected air pollutants (nitrogen dioxide [NO2], fine particulate matter [PM2.5], ozone [O3], and oxidant capacity [Ox; the redox-weighted average of O3 and NO2]) and the incidence of diabetes, as well as the risk of cardiovascular or diabetes mortality among individuals with prevalent diabetes. RESEARCH DESIGN AND METHODS We followed two cohorts, which included 4.8 million Ontario adults free of diabetes and 452,590 Ontario adults with prevalent diabetes, from 2001 to 2015. Area-level air pollution exposures were assigned to subjects' residential areas, and outcomes were ascertained using health administrative data with validated algorithms. We estimated hazard ratios for the association between each air pollutant and outcome using Cox proportional hazards models, and modelled the shape of the concentration-response relationships. RESULTS Over the study period, 790,461 individuals were diagnosed with diabetes. Among those with prevalent diabetes, 26,653 died from diabetes and 64,773 died from cardiovascular diseases. For incident diabetes, each IQR increase in NO2 had a hazard ratio of 1.04 (95% CI: 1.03-1.05). This relationship was relatively robust to all sensitivity analyses considered, and exhibited a near-linear shape. There were also positive associations between incident diabetes and PM2.5, O3, and Ox, but these estimates were somewhat sensitive to different models considered. Among those with prevalent diabetes, almost all pollutants were associated with increased diabetes and cardiovascular mortality risk. The strongest association was observed between diabetes mortality and exposure to NO2 (HR = 1.08, 95% CI: 1.02-1.13). CONCLUSIONS Selected air pollutants, especially NO2, were linked to an increased risk of incident diabetes, as well as risk of cardiovascular or diabetes mortality among persons with prevalent diabetes. As NO2 is frequently used as a proxy for road traffic exposures, this result may indicate that traffic-related air pollution has the strongest effect on diabetes etiology and survival after diabetes development.
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Affiliation(s)
- Lauren A Paul
- Department of Environmental and Occupational Health, Public Health Ontario, 480 University Ave. Suite 300, Toronto, ON M5G 1V2, Canada.
| | - Richard T Burnett
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Finance Bldg, 101 Tunney's Pasture Drwy, Ottawa, ON K1A 0K9, Canada.
| | - Jeffrey C Kwong
- Public Health Ontario Laboratories, Public Health Ontario, 480 University Ave. Suite 300, Toronto, ON M5G 1V2, Canada; ICES, 2075 Bayview Ave. G1 06, Toronto, ON M4N 3M5, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 500, Toronto, ON M5T 3M7, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave. 5(th) Floor, Toronto, ON M5G 1V7, Canada.
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Women's Bldg, 160 SW 26th St., Corvallis, OR 97331, USA.
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Sir James Dunn Bldg, 6310 Coburg Rd., Halifax, NS B3H 4J5, Canada.
| | - Li Bai
- ICES, 2075 Bayview Ave. G1 06, Toronto, ON M4N 3M5, Canada.
| | - Mark S Goldberg
- Department of Medicine, McGill University, 1001 Decarie Blvd Suite D05-2212, Montreal, QC H4A 3J1, Canada; Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Ave. W R4.29, Montreal, QC H3A 1A1, Canada.
| | - Eric Lavigne
- Air Health Science Division, Health Canada, 269 Laurier Ave. W A.L. 4903B, Ottawa, ON K1A 0K9, Canada; School of Epidemiology and Public Health, University of Ottawa, Alta Vista Campus, 600 Peter Morand Cres. Room 101, Ottawa, ON K1G 5Z3, Canada.
| | - Ray Copes
- Department of Environmental and Occupational Health, Public Health Ontario, 480 University Ave. Suite 300, Toronto, ON M5G 1V2, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 500, Toronto, ON M5T 3M7, Canada.
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Sir James Dunn Bldg, 6310 Coburg Rd., Halifax, NS B3H 4J5, Canada.
| | - Alexander Kopp
- ICES, 2075 Bayview Ave. G1 06, Toronto, ON M4N 3M5, Canada.
| | - Hong Chen
- Department of Environmental and Occupational Health, Public Health Ontario, 480 University Ave. Suite 300, Toronto, ON M5G 1V2, Canada; Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Finance Bldg, 101 Tunney's Pasture Drwy, Ottawa, ON K1A 0K9, Canada; ICES, 2075 Bayview Ave. G1 06, Toronto, ON M4N 3M5, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 500, Toronto, ON M5T 3M7, Canada.
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Lefler JS, Higbee JD, Burnett RT, Ezzati M, Coleman NC, Mann DD, Marshall JD, Bechle M, Wang Y, Robinson AL, Arden Pope C. Air pollution and mortality in a large, representative U.S. cohort: multiple-pollutant analyses, and spatial and temporal decompositions. Environ Health 2019; 18:101. [PMID: 31752939 PMCID: PMC6873509 DOI: 10.1186/s12940-019-0544-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/07/2019] [Indexed: 05/15/2023]
Abstract
BACKGROUND Cohort studies have documented associations between fine particulate matter air pollution (PM2.5) and mortality risk. However, there remains uncertainty regarding the contribution of co-pollutants and the stability of pollution-mortality associations in models that include multiple air pollutants. Furthermore, it is unclear whether the PM2.5-mortality relationship varies spatially, when exposures are decomposed according to scale of spatial variability, or temporally, when effect estimates are allowed to change between years. METHODS A cohort of 635,539 individuals was compiled using public National Health Interview Survey (NHIS) data from 1987 to 2014 and linked with mortality follow-up through 2015. Modelled air pollution exposure estimates for PM2.5, other criteria air pollutants, and spatial decompositions (< 1 km, 1-10 km, 10-100 km, > 100 km) of PM2.5 were assigned at the census-tract level. The NHIS samples were also divided into yearly cohorts for temporally-decomposed analyses. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) in regression models that included up to six criteria pollutants; four spatial decompositions of PM2.5; and two- and five-year lagged mean PM2.5 exposures in the temporally-decomposed cohorts. Meta-analytic fixed-effect estimates were calculated using results from temporally-decomposed analyses and compared with time-independent results using 17- and 28-year exposure windows. RESULTS In multiple-pollutant analyses, PM2.5 demonstrated the most robust pollutant-mortality association. Coarse fraction particulate matter (PM2.5-10) and sulfur dioxide (SO2) were also associated with excess mortality risk. The PM2.5-mortality association was observed across all four spatial scales of PM2.5, with higher but less precisely estimated HRs observed for local (< 1 km) and neighborhood (1-10 km) variations. In temporally-decomposed analyses, the PM2.5-mortality HRs were stable across yearly cohorts. The meta-analytic HR using two-year lagged PM2.5 equaled 1.10 (95% CI 1.07, 1.13) per 10 μg/m3. Comparable results were observed in time-independent analyses using a 17-year (HR 1.13, CI 1.09, 1.16) or 28-year (HR 1.09, CI 1.07, 1.12) exposure window. CONCLUSIONS Long-term exposures to PM2.5, PM2.5-10, and SO2 were associated with increased risk of all-cause and cardiopulmonary mortality. Each spatial decomposition of PM2.5 was associated with mortality risk, and PM2.5-mortality associations were consistent over time.
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Affiliation(s)
- Jacob S. Lefler
- Department of Agricultural and Resource Economics, University of California, Berkeley, CA 94720 USA
| | | | | | - Majid Ezzati
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | | | - Dalton D. Mann
- Department of Economics, Brigham Young University, Provo, UT USA
| | - Julian D. Marshall
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA USA
| | - Matthew Bechle
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA USA
| | - Yuzhou Wang
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA USA
| | - Allen L. Robinson
- Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA USA
| | - C. Arden Pope
- Department of Economics, Brigham Young University, Provo, UT USA
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Bai L, Shin S, Burnett RT, Kwong JC, Hystad P, van Donkelaar A, Goldberg MS, Lavigne E, Copes R, Martin RV, Kopp A, Chen H. Exposure to ambient air pollution and the incidence of congestive heart failure and acute myocardial infarction: A population-based study of 5.1 million Canadian adults living in Ontario. Environ Int 2019; 132:105004. [PMID: 31387019 DOI: 10.1016/j.envint.2019.105004] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 05/23/2023]
Abstract
Long-term exposure to ambient air pollution has been linked to cardiovascular mortality, but the associations with incidence of major cardiovascular diseases are not fully understood, especially at low concentrations. We aimed to investigate the associations between exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2), ozone (O3), redox-weighted average of NO2 and O3 (Ox) and incidence of congestive heart failure (CHF) and acute myocardial infarction (AMI). Our study population included all long-term residents aged 35-85 years who lived in Ontario, Canada, from 2001 to 2015 (~5.1 million). Incidence of CHF and AMI were ascertained from validated registries. We assigned estimates of annual concentrations of pollutants to the residential postal codes of subjects for each year during follow-up. We estimated hazard ratios (HRs) and 95% CIs for each pollutant separately using Cox proportional hazards models. We examined the shape of concentration-response associations using shape-constrained health impact functions. From 2001 to 2015, there were 422,625 and 197,628 incident cases of CHF and AMI, respectively. In the fully adjusted analyses, the HRs of CHF corresponding to each interquartile range increase in exposure were 1.05 (95% CI: 1.04-1.05) for PM2.5, 1.02 (95% CI: 1.01-1.04) for NO2, 1.03 (95% CI: 1.02-1.03) for O3, and 1.02 (95% CI: 1.02-1.03) for Ox, respectively. Similarly, exposure to PM2.5, O3, and Ox were positively associated with AMI. The concentration-response relationships were different for individual pollutant and outcome combinations (e.g., for PM2.5 the relationship was supralinear with CHF, and linear with AMI).
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Affiliation(s)
- Li Bai
- ICES, Toronto, ON, Canada.
| | - Saeha Shin
- Public Health Ontario, Toronto, ON, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, ON, Canada
| | - Perry Hystad
- College of Public Health and Human Studies, Oregon State University, Oregon, USA
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
| | - Mark S Goldberg
- Department of Medicine, McGill University, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Eric Lavigne
- Air Health Effects Division, Health Canada, Ottawa, ON, Canada; School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ray Copes
- Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada; Smithsonian Astrophysical Observatory, Harvard-Smithsonian Center for Astrophysics, Cambridge, MA, USA
| | | | - Hong Chen
- ICES, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada; Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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49
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Brauer M, Brook JR, Christidis T, Chu Y, Crouse DL, Erickson A, Hystad P, Li C, Martin RV, Meng J, Pappin AJ, Pinault LL, Tjepkema M, van Donkelaar A, Weichenthal S, Burnett RT. Mortality-Air Pollution Associations in Low-Exposure Environments (MAPLE): Phase 1. Res Rep Health Eff Inst 2019; 2019:1-87. [PMID: 31909580 PMCID: PMC7334864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Fine particulate matter (particulate matter ≤2.5 μm in aerodynamic diameter, or PM2.5) is associated with mortality, but the lower range of relevant concentrations is unknown. Novel satellite-derived estimates of outdoor PM2.5 concentrations were applied to several large population-based cohorts, and the shape of the relationship with nonaccidental mortality was characterized, with emphasis on the low concentrations (<12 μg/m3) observed throughout Canada. METHODS Annual satellite-derived estimates of outdoor PM2.5 concentrations were developed at 1-km2 spatial resolution across Canada for 2000-2016 and backcasted to 1981 using remote sensing, chemical transport models, and ground monitoring data. Targeted ground-based measurements were conducted to measure the relationship between columnar aerosol optical depth (AOD) and ground-level PM2.5. Both existing and targeted ground-based measurements were analyzed to develop improved exposure data sets for subsequent epidemiological analyses. Residential histories derived from annual tax records were used to estimate PM2.5 exposures for subjects whose ages ranged from 25 to 90 years. About 8.5 million were from three Canadian Census Health and Environment Cohort (CanCHEC) analytic files and another 540,900 were Canadian Community Health Survey (CCHS) participants. Mortality was linked through the year 2016. Hazard ratios (HR) were estimated with Cox Proportional Hazard models using a 3-year moving average exposure with a 1-year lag, with the year of follow-up as the time axis. All models were stratified by 5-year age groups, sex, and immigrant status. Covariates were based on directed acyclical graphs (DAG), and included contextual variables (airshed, community size, neighborhood dependence, neighborhood deprivation, ethnic concentration, neighborhood instability, and urban form). A second model was examined including the DAG-based covariates as well as all subject-level risk factors (income, education, marital status, indigenous identity, employment status, occupational class, and visible minority status) available in each cohort. Additional subject-level behavioral covariates (fruit and vegetable consumption, leisure exercise frequency, alcohol consumption, smoking, and body mass index [BMI]) were included in the CCHS analysis. Sensitivity analyses evaluated adjustment for covariates and gaseous copollutants (nitrogen dioxide [NO2] and ozone [O3]), as well as exposure time windows and spatial scales. Estimates were evaluated across strata of age, sex, and immigrant status. The shape of the PM2.5-mortality association was examined by first fitting restricted cubic splines (RCS) with a large number of knots and then fitting the shape-constrained health impact function (SCHIF) to the RCS predictions and their standard errors (SE). This method provides graphical results indicating the RCS predictions, as a nonparametric means of characterizing the concentration-response relationship in detail and the resulting mean SCHIF and accompanying uncertainty as a parametric summary. Sensitivity analyses were conducted in the CCHS cohort to evaluate the potential influence of unmeasured covariates on air pollution risk estimates. Specifically, survival models with all available risk factors were fit and compared with models that omitted covariates not available in the CanCHEC cohorts. In addition, the PM2.5 risk estimate in the CanCHEC cohort was indirectly adjusted for multiple individual-level risk factors by estimating the association between PM2.5 and these covariates within the CCHS. RESULTS Satellite-derived PM2.5 estimates were low and highly correlated with ground monitors. HR estimates (per 10-μg/m3 increase in PM2.5) were similar for the 1991 (1.041, 95% confidence interval [CI]: 1.016-1.066) and 1996 (1.041, 1.024-1.059) CanCHEC cohorts with a larger estimate observed for the 2001 cohort (1.084, 1.060-1.108). The pooled cohort HR estimate was 1.053 (1.041-1.065). In the CCHS an analogous model indicated a HR of 1.13 (95% CI: 1.06-1.21), which was reduced slightly with the addition of behavioral covariates (1.11, 1.04-1.18). In each of the CanCHEC cohorts, the RCS increased rapidly over lower concentrations, slightly declining between the 25th and 75th percentiles and then increasing beyond the 75th percentile. The steepness of the increase in the RCS over lower concentrations diminished as the cohort start date increased. The SCHIFs displayed a supralinear association in each of the three CanCHEC cohorts and in the CCHS cohort. In sensitivity analyses conducted with the 2001 CanCHEC, longer moving averages (1, 3, and 8 years) and smaller spatial scales (1 km2 vs. 10 km2) of exposure assignment resulted in larger associations between PM2.5 and mortality. In both the CCHS and CanCHEC analyses, the relationship between nonaccidental mortality and PM2.5 was attenuated when O3 or a weighted measure of oxidant gases was included in models. In the CCHS analysis, but not in CanCHEC, PM2.5 HRs were also attenuated by the inclusion of NO2. Application of the indirect adjustment and comparisons within the CCHS analysis suggests that missing data on behavioral risk factors for mortality had little impact on the magnitude of PM2.5-mortality associations. While immigrants displayed improved overall survival compared with those born in Canada, their sensitivity to PM2.5 was similar to or larger than that for nonimmigrants, with differences between immigrants and nonimmigrants decreasing in the more recent cohorts. CONCLUSIONS In several large population-based cohorts exposed to low levels of air pollution, consistent associations were observed between PM2.5 and nonaccidental mortality for concentrations as low as 5 μg/m3. This relationship was supralinear with no apparent threshold or sublinear association.
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Affiliation(s)
- M Brauer
- University of British Columbia, Vancouver, British Columbia, Canada
| | - J R Brook
- University of Toronto, Toronto, Ontario, Canada
| | - T Christidis
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Y Chu
- University of British Columbia, Vancouver, British Columbia, Canada
| | - D L Crouse
- University of New Brunswick, Fredericton, New Brunswick, Canada
- New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - A Erickson
- University of British Columbia, Vancouver, British Columbia, Canada
| | - P Hystad
- Oregon State University, Corvallis, Oregon, U.S.A
| | - C Li
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - R V Martin
- Dalhousie University, Halifax, Nova Scotia, Canada
- Harvard-Smithsonian Center for Astrophysics, Cambridge, Massachusetts, U.S.A
| | - J Meng
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - A J Pappin
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - L L Pinault
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - M Tjepkema
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | | | | | - R T Burnett
- Population Studies Division, Health Canada, Ottawa, Ontario, Canada
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50
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Christidis T, Erickson AC, Pappin AJ, Crouse DL, Pinault LL, Weichenthal SA, Brook JR, van Donkelaar A, Hystad P, Martin RV, Tjepkema M, Burnett RT, Brauer M. Low concentrations of fine particle air pollution and mortality in the Canadian Community Health Survey cohort. Environ Health 2019; 18:84. [PMID: 31601202 PMCID: PMC6785886 DOI: 10.1186/s12940-019-0518-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 08/13/2019] [Indexed: 05/07/2023]
Abstract
BACKGROUND Approximately 2.9 million deaths are attributed to ambient fine particle air pollution around the world each year (PM2.5). In general, cohort studies of mortality and outdoor PM2.5 concentrations have limited information on individuals exposed to low levels of PM2.5 as well as covariates such as smoking behaviours, alcohol consumption, and diet which may confound relationships with mortality. This study provides an updated and extended analysis of the Canadian Community Health Survey-Mortality cohort: a population-based cohort with detailed PM2.5 exposure data and information on a number of important individual-level behavioural risk factors. We also used this rich dataset to provide insight into the shape of the concentration-response curve for mortality at low levels of PM2.5. METHODS Respondents to the Canadian Community Health Survey from 2000 to 2012 were linked by postal code history from 1981 to 2016 to high resolution PM2.5 exposure estimates, and mortality incidence to 2016. Cox proportional hazard models were used to estimate the relationship between non-accidental mortality and ambient PM2.5 concentrations (measured as a three-year average with a one-year lag) adjusted for socio-economic, behavioural, and time-varying contextual covariates. RESULTS In total, 50,700 deaths from non-accidental causes occurred in the cohort over the follow-up period. Annual average ambient PM2.5 concentrations were low (i.e. 5.9 μg/m3, s.d. 2.0) and each 10 μg/m3 increase in exposure was associated with an increase in non-accidental mortality (HR = 1.11; 95% CI 1.04-1.18). Adjustment for behavioural covariates did not materially change this relationship. We estimated a supra-linear concentration-response curve extending to concentrations below 2 μg/m3 using a shape constrained health impact function. Mortality risks associated with exposure to PM2.5 were increased for males, those under age 65, and non-immigrants. Hazard ratios for PM2.5 and mortality were attenuated when gaseous pollutants were included in models. CONCLUSIONS Outdoor PM2.5 concentrations were associated with non-accidental mortality and adjusting for individual-level behavioural covariates did not materially change this relationship. The concentration-response curve was supra-linear with increased mortality risks extending to low outdoor PM2.5 concentrations.
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Affiliation(s)
- Tanya Christidis
- Health Analysis Division, Statistics Canada, 100 Tunney’s Pasture Driveway, Ottawa, Ontario K1A 0T6 Canada
| | - Anders C. Erickson
- School of Population and Public Health, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Amanda J. Pappin
- Health Analysis Division, Statistics Canada, 100 Tunney’s Pasture Driveway, Ottawa, Ontario K1A 0T6 Canada
- Safe Environments Directorate, Health Canada, 269 Laurier Avenue West, Ottawa, Ontario K1A 0K9 Canada
| | - Daniel L. Crouse
- Department of Sociology, University of New Brunswick, PO Box 4400, Fredericton, New Brunswick E3B 5A3 Canada
| | - Lauren L. Pinault
- Health Analysis Division, Statistics Canada, 100 Tunney’s Pasture Driveway, Ottawa, Ontario K1A 0T6 Canada
| | - Scott A. Weichenthal
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1110 Pine Ave West, Montreal, Quebec H3A 1A3 Canada
- Air Health Science Division, Health Canada, 269 Laurier Avenue West, Ottawa, Ontario K1A 0K0 Canada
| | - Jeffrey R. Brook
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 223 College St., Toronto, ON M5T 1R4 Canada
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, 6310 Coburg Road, PO Box 15000, Halifax, NS B3H 4R2 Canada
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri 63130 USA
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, 2520 SW Campus Way, Corvallis, Oregon 97331 USA
| | - Randall V. Martin
- Department of Physics and Atmospheric Science, Dalhousie University, 6310 Coburg Road, PO Box 15000, Halifax, NS B3H 4R2 Canada
- Harvard-Smithsonian Center for Astrophysics, 60 Garden St, Cambridge, MA 02138 USA
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri 63130 USA
| | - Michael Tjepkema
- Health Analysis Division, Statistics Canada, 100 Tunney’s Pasture Driveway, Ottawa, Ontario K1A 0T6 Canada
| | - Richard T. Burnett
- Population Studies Division, Health Canada, 50 Columbine Driveway, Ottawa, Ontario K1A 0K9 Canada
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
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