Periodontal diseases and cardiovascular diseases, diabetes, and respiratory diseases: Summary of the consensus report by the European Federation of Periodontology and WONCA Europe

BACKGROUND

Periodontitis is a chronic inflammatory non-communicable disease (NCD) characterised by the destruction of the tooth-supporting apparatus (periodontium), including alveolar bone, the presence of periodontal pockets, and bleeding on probing.

OBJECTIVES

To outline, for family doctors, the implications of the association between periodontal and systemic diseases; to explore the role of family doctors in managing periodontitis as an ubiquitous non-communicable disease (NCD).

METHODS

The consensus reports of previous focused collaborative workshops between WONCA Europe and the European Federation of Periodontology (using previously undertaken systematic reviews), and a specifically commissioned systematic review formed the technical papers to underpin discussions. Working groups prepared proposals independently, and the proposals were subsequently discussed and approved at plenary meetings.

RESULTS

Periodontitis is independently associated with cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, obstructive sleep apnoea, and COVID-19 complications. Treatment of periodontitis has been associated with improvements in systemic health outcomes. The article also presents evidence gaps. Oral health care professionals (OHPs) and family doctors should collaborate in managing these conditions, including implementing strategies for early case detection of periodontitis in primary medical care centres and of systemic NCDs in oral/dental care settings. There is a need to raise awareness of periodontal diseases, their consequences, and the associated risk factors amongst family doctors.

CONCLUSION

Closer collaboration between OHPs and family doctors is important in the early case detection and management of NCDs like cardiovascular diseases, diabetes mellitus, and respiratory diseases. Strategies for early case detection/prevention of NCDs, including periodontitis, should be developed for family doctors, other health professionals (OHPs), and healthcare funders. Evidence-based information on the reported associations between periodontitis and other NCDs should be made available to family doctors, OHPs, healthcare funders, patients, and the general population.

Increased mortality in acromegaly is due to vascular and respiratory disease and is normalised by control of GH levels-A retrospective analysis from the UK Acromegaly Register 1970-2016

CONTEXT

Epidemiological studies involving patients with acromegaly have yielded conflicting results regarding cancer incidence and causes of mortality in relation to control of growth hormone (GH) excess.

OBJECTIVE

The objective of this retrospective cohort study is to clarify these questions and identify goals for treatment and monitoring patients.

METHODS

We studied 1845 subjects from the UK Acromegaly Register (1970-2016), obtaining cancer standardised incidence rates (SIR) and all causes standardised mortality rates (SMR) from UK Office for National Statistics, to determine the relationship between causes of mortality-age at diagnosis, duration of disease, post-treatment and mean GH levels.

RESULTS

We found an increased incidence of all cancers (SIR, 1.38; 95% CI: 1.06-1.33, p < .001), but no increase in incidence of female breast, thyroid, colon cancer or any measure of cancer mortality. All-cause mortality rates were increased (SMR, 1.35; 95% CI: 1.24-1.46, p < .001), as were those due to vascular and respiratory diseases. All-cause, all cancer and cardiovascular deaths were highest in the first 5 years following diagnosis. We found a positive association between post-treatment and mean treatment GH levels and all-cause mortality (p < .001 and p < .001), which normalised with posttreatment GH levels of <1.0 µg/L or meantreatment GH levels of <2.5 µg/L.

CONCLUSION

Acromegaly is associated with increased incidence of all cancers but not thyroid or colon cancer and no increase in cancer mortality. Excess mortality is due to vascular and respiratory disease. The risk is highest in the first 5 years following diagnosis and is mitigated by normalising GH levels.

Burden and outcome of respiratory morbidities among children and adolescents with sickle cell disease-A retrospective review of emergency presentations in some Nigerian tertiary institutions

BACKGROUND

Despite the huge burden of sickle cell disease (SCD) among Nigerian children, the burden and outcome of respiratory illnesses remain undocumented. Thus, we aimed to describe the spectrum and outcome of respiratory illnesses among SCD childrenand adolescentadmissions in ten Nigerian tertiary hospitals.

METHOD

A retrospective review of the SCD admission records of children and adolescents with a confirmed diagnosis of respiratory illnesses from 2012 to 2021 in ten tertiary health facilities across five geopolitical zones in Nigeria was conducted. The data, collectedbetween March and June 2023, included the age, sex, diagnosis, complications, duration and outcome of hospitalization.

RESULTS

Of the 72,333 paediatric admissions, 7,256 (10.0%) had SCD; the proportion of SCD from the total admission ranged from 2.1 to 16.3% in the facilities. Of the 7,256 children and adolescents with SCD, 1,213 (16.7%) had respiratory morbidities. Lower respiratory disease was the most common (70.0%) respiratory entity and the majority were pneumonia (40.1.0%), followed by acute chest syndrome (26.7%). Seventeen (1.4%) patients died; all had lower respiratory diseases [(acute chest syndrome ACS (11, 64.7%), pneumonia; 5, 29.4%, and asthma (1, 5.9%). Based on the proportion of deaths among overall SCD, the 17 death cases contributed 9.4% (95% CI 5.9 to 14.5). Factors associated with deaths included duration of hospitalization less than 72 hours and lower respiratory tract diseases.

CONCLUSION

Sickle cell disease is a major contributor to hospitalization among Nigerian children and adolescents, with high respiratory morbidity and mortality. Pneumonia and acute chest syndrome were associated with mortality, andthe highest risk of death within the first 72 hours.

When the smoke gets in your lungs: short-term effects of Indonesia's 2015 forest fires on health care use

BACKGROUND

The forest fires that ravaged parts of Indonesia in 2015 were the most severely polluting of this century but little is known about their effects on health care utilization of the affected population. We estimate their short-term impact on visit rates to primary and hospital care with particular focus on visits for specific smoke-related conditions (respiratory disease, acute respiratory tract infection (ARTI) and common cold).

METHOD

We estimate the short-term impact of the 2015 forest fire on visit rates to primary and hospital care by combining satellite data on Aerosol Optical Depth (AOD) with administrative records from Indonesian National Health Insurance Agency (BPJS Kesehatan) from January 2015-April  2016. The 16 months of panel data cover 203 districts in the islands of Sumatra and Kalimantan before, during and after the forest fires. We use the (more efficient) ANCOVA version adaptation of a fixed effects model to compare the trends in healthcare use of affected districts (with AOD value above 0.75) with control districts (AOD value below 0.75). Considering the higher vulnerability of children's lungs, we do this separately for children under 5 and the rest of the population adults (> 5), and for both urban and rural areas, and for both the period during and after the forest fires.

RESULTS

We find little effects for adults. For young children we estimate positive effects for care related to respiratory problems in primary health care facilities in urban areas. Hospital care visits in general, on the other hand, are negatively affected in rural areas. We argue that these patterns arise because accessibility of care during fires is more restricted for rural than for urban areas.

CONCLUSION

The severity of the fires and the absence of positive impact on health care utilization for adults and children in rural areas indicate large missed opportunities for receiving necessary care. This is particularly worrisome for children, whose lungs are most vulnerable to the effects. Our findings underscore the need to ensure ongoing access to medical services during forest fires and emphasize the necessity of catching up with essential care for children after the fires, particularly in rural areas.

Retrospective study of 540 cats with respiratory diseases in Japan (2003-2020)

BACKGROUND

Few epidemiological studies on respiratory medicine and the relationship between clinical signs and various respiratory diseases in cats have been reported.

OBJECTIVES

This retrospective study aimed to investigate the prevalence and breed predisposition to feline respiratory diseases in Japan and determine the association between clinical signs, duration and type of respiratory diseases.

METHODS

The medical records of cats with feline respiratory diseases were examined to obtain information on age, sex, breed, final diagnosis, clinical signs and duration. The odds ratios (ORs) and 95% confidence intervals were calculated to evaluate breed predispositions. Mann-Whitney U, Kruskal-Wallis and Dunn's tests were used to assess the duration of clinical signs.

RESULTS

This study included 540 cats with 615 respiratory diagnoses. The American Shorthair breed was predisposed to bronchopneumonia (BP; OR: 5.0) and pulmonary tumour (PT; OR: 3.6), while the Russian Blue breed exhibited a predisposition to inflammatory lower airway diseases (OR: 3.4), BP (OR: 6.1) and interstitial lung diseases (OR: 11.1). Similarly, the Scottish Fold breed displayed predisposition to PTs (OR: 5.8). The duration of clinical signs among nasal diseases, nasopharyngeal diseases and lower tracheal/bronchial and pulmonary diseases differed significantly (p = 0.001, p = 0.012, p < 0.0001, respectively).

CONCLUSIONS

The results suggest that some popular breeds in Japan are predisposed to feline respiratory diseases, especially the American Shorthair, Russian Blue and Scottish Fold breeds. The characteristics of occurrence, clinical signs and duration of each disease will aid in diagnosing, treating, preventing and elucidating the pathophysiology of feline respiratory disease.

ENDS, Cigarettes, and Respiratory Illness: Longitudinal Associations Among U.S. Youth

INTRODUCTION

ENDS use is highly prevalent among U.S. youth, and there is concern about its respiratory health effects. However, evidence from nationally representative longitudinal data is limited.

METHODS

Using youth (aged 12-17 years) data from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health Study, multilevel Poisson regression models were estimated to examine the association between ENDS use; cigarettes; and diagnosed bronchitis, pneumonia, or chronic cough. Current product use was lagged by 1 wave and categorized as (1) never/noncurrent use, (2) exclusive cigarette use, (3) exclusive ENDS use, and (4) dual ENDS/cigarette use. Multivariable models adjusted for age, sex, race and ethnicity; parental education; asthma; BMI; cannabis use; secondhand smoke exposure; and household use of combustible products. Data analysis was conducted in 2022-2023.

RESULTS

A total of 7.4% of respondents were diagnosed with bronchitis, pneumonia, or chronic cough at follow-up. In the multivariable model, exclusive cigarette use (incident rate ratio=1.85, 95% CI=1.29, 2.65), exclusive ENDS use (incident rate ratio=1.49, 95% CI=1.06, 2.08), and dual use (incident rate ratio=2.70, 95% CI=1.61, 3.50) were associated with a higher risk of diagnosed bronchitis, pneumonia, or chronic cough than never/noncurrent use.

CONCLUSIONS

These results suggest that ENDS and cigarettes, used exclusively or jointly, increased the risk of diagnosed bronchitis, pneumonia, or chronic cough among U.S. youth. However, dual use was associated with the highest risk. Targeted policies aimed at continuing to reduce cigarette smoking and ENDS use among youth, especially among those with dual use, are needed.

[Pesticide exposure and chronic respiratory diseases]

INTRODUCTION

Pesticides are used worldwide, mainly in agriculture as a means of controlling pests and protecting crops. That said, the entire world population is ultimately subject to pesticide exposure (consumption of fruits and vegetables, living near treated fields…), with varying degrees of toxicity involved.

STATE OF THE ART

In recent decades, epidemiological studies have contributed to the identification of chemical pesticide families with detrimental effects on human health: cognitive disorders, Parkinson's disease, prostate cancer… and impairment in respiratory functioning. Current scientific evidence points to the implication of the active substances in insecticides, herbicides and fungicides in chronic respiratory diseases, two examples being chronic obstructive pulmonary disease (COPD) in exposed workers, and asthmatic wheezing in children during prenatal or postnatal exposure.

PERSPECTIVES

The safety of individuals exposed to pesticides is of key importance in public health. Further epidemiological investigations are needed to identify the chemical families affecting certain populations.

CONCLUSIONS

The scientific literature suggests strong links between pesticide exposure and respiratory health. Whether it be environmental or occupational, pesticide exposure can lead to respiratory disorders and symptoms of varying severity.

Thermal stress and hospital admissions for cardiorespiratory disease in Brazil

The growing body of scientific literature underscores the intricate relationship between meteorological conditions and human health, particularly in the context of extreme temperatures. However, conventional temperature-centric approaches often fall short in capturing the complexity of thermal stress experienced by individuals. Temperature alone, as a metric, fails to encompass the entirety of the thermal stress individuals face, necessitating a more nuanced understanding. In response to this limitation, climatologists have devised thermal indices-composite measures meticulously crafted to reflect the intricate interplay of meteorological factors influencing human perception of temperature. Recognizing the inadequacy of simplistic temperature-focused methodologies, our study aims to address the multifaceted nature of thermal stress. In this study, we explored the association between thermal indices and hospital admissions for circulatory and respiratory diseases in Brazil. We used an extensive dataset spanning 11 years (2008-2018) from the Brazilian Ministry of Health, encompassing a total of 23,791,093 hospitalizations for circulatory and respiratory diseases. We considered four distinct thermal indices-Discomfort Index (DI), Net Effective Temperature (NET), Humidex (H), and Heat Index (HI). We used an extension of the two-stage design with a case time series to assess this relationship. In the first stage, we applied a distributed lag non-linear modeling framework to create a cross-basis function. We next applied quasi-Poisson regression models adjusted by time-varying confounders. In the second stage, we applied meta-analysis with random effects to estimate the national relative risk (RR). Our findings suggest robust variations among the thermal indices under examination. These variations underscore the intricate nature of associations between temperature and health, with each index capturing distinct aspects of thermal conditions. Our results indicate that extreme thermal conditions, both at the low and high ends, are associated with increased risks of hospital admissions. The diverse impact observed among different indices emphasizes the complex interplay between various meteorological factors and their specific physiological consequences. This underscores the necessity for a comprehensive comprehension of temperature metrics to guide precise public health interventions, recognizing the multifaceted nature of temperature-health relationships.

Potential Risks for Healthcare Disparities Among Individuals With Voice and Upper Airway Disorders: A Systematic Review

PURPOSE

To assess the potential epidemiological association between various possible risk factors and healthcare disparities specifically related to the access, use and/or quality of speech language pathology services for individuals with voice and upper airway disorders.

METHOD

A systematic review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis. Full text journal articles were identified through PubMed, PsycINFO and Web of Science. The reference sections of included articles were also manually screened and identified four additional studies for consideration of inclusion. Included articles specifically addressed healthcare disparities in voice and upper airway disorders related to speech pathology care. International literature was excluded. Eligible studies were reviewed and data extracted. Risk of bias of each eligible study was performed using the quality assessment tool from National Institute of Health for observational cohort and cross-sectional studies. Data from eligible studies were synthesized thematically.

RESULTS

A total of 1,101 resources were retrieved from the search; of these, 133 were duplicates. Titles and abstracts of 968 articles were screened, with 14 selected for full-text review. Eleven articles were considered eligible for inclusion. Voice disorders were the condition most frequently examined followed by only one article addressing upper airways disorders. There was considerable heterogeneity in the methodology and statistical analyses among the eligible papers. There was a lack of standard methodology for collecting and accurately determining patient characteristics as well as variability in measuring confounding variables and providing statistical analyses for such adjustments that may have impacted the findings. The information extracted from these articles revealed healthcare disparities related to sex/gender, age, insurance status/coverage, race/ethnicity, among others including etiology and preferred language.

CONCLUSIONS

This systematic review highlights the limited research on speech language pathology-specific healthcare disparities for individuals with voice and upper airway disorders. There was significant clinical and methodological heterogeneity between studies which may have contributed to varied results between studies. There is a need for greater methodological rigor and prospectively designed studies to better characterize the impact of disparities in the access to, use of, and quality of speech pathology care for this patient population.

Trends in work-related respiratory diseases attributed to nickel, chromium and cobalt in the UK: descriptive findings from The Health and Occupation Research (THOR) network 1996-2019

BACKGROUND

Occupational exposure to metals can be associated with respiratory diseases which can adversely affect the individual's health, finances and employment. Despite this, little is known about the incidence of these respiratory conditions over prolonged periods of time.

AIMS

This study aimed to investigate the trends in the incidence of work-related respiratory diseases attributed to nickel, chromium and cobalt in the UK.

METHODS

Cases of occupational respiratory diseases caused by nickel, chromium or cobalt reported to Surveillance of Work-related and Occupational Respiratory Disease (SWORD), the UK-based surveillance scheme between 1996 and 2019 (inclusive), were extracted and grouped into six 4-year time periods. Cases were characterised by causative metal exposure, occupational and industrial sector. Incidence rates diseases (adjusted for physician participation and response rate) were calculated using ONS employment data.

RESULTS

Of cases reported to SWORD during the study period, 1% (173 actual cases) of respiratory problems were attributed to nickel, chromium or cobalt. Diagnoses of asthma compromised the largest proportion of diagnoses (74.4%), followed by lung cancer (8.9%) and pneumoconiosis (6.7%). Cases had a mean age of 47 years (SD 13); 93% were men. The annual incidence fell from 1.6 per million employed in the first 4-year period, to 0.2 in the most recent period.

CONCLUSIONS

Over 24 years, a decline in the incidence of metal-related occupational respiratory diseases was observed in the UK. This could be attributed to improvements in working conditions which resulted in reduced metal exposure but could also be due to closure of industries that might have generated case returns.

Comparative analysis of antibodies to four major periodontal bacteria in respiratory diseases: a cohort study

OBJECTIVES

To make a descriptive comparison of antibodies to four major periodontal bacteria and their relation to the respiratory diseases asthma and bronchitis/emphysema, and to cancer incidence.

METHODS

The serum of a random sample of men with no history of cancer incidence (n=621) was analysed by the ELISA method for antibody levels of four periodontal bacteria; the anaerobes of the so-called red complex Tannerella forsythia (TF), Porphyromonas gingivalis (PG), and Treponema denticola (TD), and the facultative anaerobe Aggregatibacter actinomycetemcomitans (AA). The antibody readings were divided into quartiles and the distribution of cases of the relevant diseases as compared with the non-cases. Comparisons of the quartile distributions were by the Pearson χ2 test. Data and serum from the Oslo II study of Norwegian men from 2000 were used. The ELISA analyses were performed on thawed frozen serum. Cancer data from 17.5 years of follow-up were provided by the Norwegian Cancer Registry.

RESULTS

In all, 52 men had reported asthma and 23 men had bronchitis/emphysema at the health screening. Results on cancer incidence are given for all respiratory cancers, n=23, and bronchi and lung cancers separately, n=18. Stratified analyses were performed for the four endpoints showing significant association with low levels of TD antibodies for bronchitis; p=0.035. Both TF and TD were significant for low levels of antibodies among daily smokers; p=0.030 for TF and p<0.001 for TD in the analysis of the full study sample. For PG and AA, no such associations were observed. An association with respiratory cancers was not observed.

CONCLUSION

A low level of TD was associated with bronchitis/emphysema compared with the rest of the cohort. In the total study sample, low levels of antibodies to both TF and TD were associated with daily smoking.

The changing health effects of air pollution exposure for respiratory diseases: a multicity study during 2017-2022

BACKGROUND

Multifaceted SARS-CoV-2 interventions have modified exposure to air pollution and dynamics of respiratory diseases. Identifying the most vulnerable individuals requires effort to build a complete picture of the dynamic health effects of air pollution exposure, accounting for disparities across population subgroups.

METHODS

We use generalized additive model to assess the likely changes in the hospitalisation and mortality rate as a result of exposure to PM2.5 and O3 over the course of COVID-19 pandemic. We further disaggregate the population into detailed age categories and illustrate a shifting age profile of high-risk population groups. Additionally, we apply multivariable logistic regression to integrate demographic, socioeconomic and climatic characteristics with the pollution-related excess risk.

RESULTS

Overall, a total of 1,051,893 hospital admissions and 34,954 mortality for respiratory disease are recorded. The findings demonstrate a transition in the association between air pollutants and hospitalisation rates over time. For every 10 µg/m3 increase of PM2.5, the rate of hospital admission increased by 0.2% (95% CI: 0.1-0.7%) and 1.4% (1.0-1.7%) in the pre-pandemic and dynamic zero-COVID stage, respectively. Conversely, O3-related hospitalization rate would be increased by 0.7% (0.5-0.9%) in the pre-pandemic stage but lowered to 1.7% (1.5-1.9%) in the dynamic zero-COVID stage. Further assessment indicates a shift of high-risk people from children and young adolescents to the old, primarily the elevated hospitalization rates among the old people in Lianyungang (RR: 1.53, 95%CI: 1.46, 1.60) and Nantong (RR: 1.65, 95%CI: 1.57, 1.72) relative to those for children and young adolescents. Over the course of our study period, people with underlying diseases would have 26.5% (22.8-30.3%) and 12.7% (10.8-14.6%) higher odds of having longer hospitalisation and over 6 times higher odds of deaths after hospitalisation.

CONCLUSIONS

Our estimates provide the first comprehensive evidence on the dynamic pollution-health associations throughout the pandemic. The results suggest that age and underlying diseases collectively determines the disparities of pollution-related health effect across population subgroups, underscoring the urgency to identifying the most vulnerable individuals to air pollution.

[A prospective study on the relationship between exposure to solid fuels for heating and its duration and the risk of morbidity of respiratory diseases among residents aged 30-79 years]

Objective: To research the association between exposure to solid fuels for heating and its duration and the risk of respiratory diseases morbidity. Methods: Data from the China Kadoorie Biobank project sited in Pengzhou City, Sichuan Province. Cox proportional hazard regression model was used to analyze the association between exposure to solid fuels for heating and its duration and the risk of total respiratory diseases and the association between exposure to solid fuels for heating and the risk of chronic obstructive pulmonary disease (COPD) and pneumonia among respiratory diseases. Results: A total of 46 082 participants aged 30-79 years were enrolled, with 11 634 (25.25%) heating during the winter, of whom 8 885 (19.28%) used clean fuels and 2 749 (5.97%) used solid fuels, of whom 34 448 (74.75%) did not heat. After controlling for multiple confounding factors, Cox proportional hazard regression model was used, which revealed that compared with clean fuels, unheating could reduce the risk of total respiratory disease (HR=0.81,95%CI:0.77-0.86), COPD (HR=0.86,95%CI:0.78-0.95) and pneumonia (HR=0.80,95%CI:0.74-0.86), respectively. Exposure to solid fuels increased the risk of total respiratory disease (HR=1.10, 95%CI:1.01-1.20) and were not associated with COPD and pneumonia. Compared with no solid fuel exposure, the risk of total respiratory disease (1-19 years:HR=1.23, 95%CI:1.10-1.37; 20-39 years:HR=1.25, 95%CI:1.16-1.35; ≥40 years:HR=1.26, 95%CI:1.15-1.39) and COPD (1-19 years: HR=1.21, 95%CI:1.03-1.42; 20-39 years: HR=1.30, 95%CI:1.16-1.46; ≥40 years:HR=1.35, 95%CI:1.18-1.54) increased with the length of exposure of solid fuels (trend test P<0.001). Solid fuels exposure for 1-19 years and 20-39 years increased the risk of COPD by 23% (HR=1.23,95%CI:1.02-1.49) and 16% (HR=1.16, 95%CI:1.00-1.35). Conclusion: Heating solid fuels exposure increases the risk of total respiratory disease, COPD, and pneumonia.

Deployment to Military Bases With Open Burn Pits and Respiratory and Cardiovascular Disease

Importance

Many veterans who served in Afghanistan and Iraq during Operations Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) were deployed to military bases with open burn pits and exposed to their emissions, with limited understanding of the long-term health consequences.

Objective

To determine the association between deployment to military bases where open burn pits were used for waste disposal and the subsequent risk of developing respiratory and cardiovascular diseases.

Design, Setting, and Participants

This retrospective observational cohort study used Veterans Health Administration medical records and declassified deployment records from the Department of Defense to assess Army and Air Force veterans who were deployed between 2001 and 2011 and subsequently received health care from the Veterans Health Administration, with follow-up through December 2020. Data were analyzed from January 2023 through February 2024.

Exposure

Duration of deployment to military bases with open burn pits.

Main Outcomes and Measures

Diagnosis of asthma, chronic obstructive pulmonary disease, interstitial lung disease, hypertension, myocardial infarction, congestive heart failure, ischemic stroke, and hemorrhagic stroke.

Results

The study population included 459 381 OEF and OIF veterans (mean [SD] age, 31.6 [8.7] years; 399 754 [87.0%] male). Median (IQR) follow-up from end of deployment was 10.9 (9.4-12.7) years. For every 100 days of deployment to bases with burn pits, veterans experienced increased adjusted odds for asthma (adjusted odds ratio [aOR], 1.01; 95% CI, 1.01-1.02), chronic obstructive pulmonary disease (aOR, 1.04; 95% CI, 1.02-1.07), hypertension (aOR, 1.02; 95% CI, 1.02-1.03), and ischemic stroke (aOR, 1.06; 95% CI, 0.97-1.14). Odds of interstitial lung disease, myocardial infarction, congestive heart failure, or hemorrhagic stroke were not increased. Results based on tertiles of duration of burn pit exposures were consistent with those from the continuous exposure measures.

Conclusions and Relevance

In this cohort study, prolonged deployment to military bases with open burn pits was associated with increased risk of developing asthma, COPD, and hypertension. The results also point to a possible increased risk in ischemic stroke. The novel ability to use integrated data on deployment and health outcomes provides a model for additional studies of the health impact of environmental exposures during military service.

Occupational status and chronic respiratory diseases: a cross-sectional study based on the data of the Rafsanjan Cohort Study

BACKGROUND

The aim of the present study was to investigate the possible connection between occupational status and chronic respiratory diseases (CRDs) among the Iranian population.

METHODS

The present cross-sectional study was conducted on 9934 individuals aged 35-70 years enrolled in the Rafsanjan Cohort Study (RCS), a component of the Prospective Epidemiological Research Studies in Iran (PERSIAN). Detailed questionnaires were used to collect information on various factors, such as occupation, sociodemographic characteristics, medical history, anthropometric measurements, physical activity, cigarette and hookah smoking, opium use, and alcohol consumption. The association between occupational class and CRD was evaluated using logistic regression models for rare events.

RESULTS

In the present study, 4624 (46.55%) participants were male, and 5310 (53.45%) were female. The prevalence of CRD among all participants was 2.61%. Occupational activities were classified into two categories: In class I, the largest group was the homemaker and unemployment category (41.73%), followed by self-employment (34.39%), employment (13.03%), and retired individuals (10.84%). In class II, there were pistachio farmers (12.61%), copper miners (3.62%), and others in various occupations (83.76%). Subjects with CRD were significantly more likely to be homemakers, unemployed, elderly, female, less educated, and obese. There was no significant relationship between CRD and job type/occupational status after adjusting for some potential confounding variables.

CONCLUSIONS

There was no significant relationship between CRD and job type/occupational status. However, longitudinal studies are needed to assess the impact of job type/occupational status on the risk of CRD.

Research on the cascading mechanism of "urban built environment-air pollution-respiratory diseases": a case of Wuhan city

Background

Most existing studies have only investigated the direct effects of the built environment on respiratory diseases. However, there is mounting evidence that the built environment of cities has an indirect influence on public health via influencing air pollution. Exploring the "urban built environment-air pollution-respiratory diseases" cascade mechanism is important for creating a healthy respiratory environment, which is the aim of this study.

Methods

The study gathered clinical data from 2015 to 2017 on patients with respiratory diseases from Tongji Hospital in Wuhan. Additionally, daily air pollution levels (sulfur dioxide (SO2), nitrogen dioxide (NO2), particulate matter (PM2.5, PM10), and ozone (O3)), meteorological data (average temperature and relative humidity), and data on urban built environment were gathered. We used Spearman correlation to investigate the connection between air pollution and meteorological variables; distributed lag non-linear model (DLNM) was used to investigate the short-term relationships between respiratory diseases, air pollutants, and meteorological factors; the impacts of spatial heterogeneity in the built environment on air pollution were examined using the multiscale geographically weighted regression model (MGWR).

Results

During the study period, the mean level of respiratory diseases (average age 54) was 15.97 persons per day, of which 9.519 for males (average age 57) and 6.451 for females (average age 48); the 24 h mean levels of PM10, PM2.5, NO2, SO2 and O3 were 78.056 μg/m3, 71.962 μg/m3, 54.468 μg/m3, 12.898 μg/m3, and 46.904 μg/m3, respectively; highest association was investigated between PM10 and SO2 (r = 0.762, p < 0.01), followed by NO2 and PM2.5 (r = 0.73, p < 0.01), and PM10 and PM2.5 (r = 0.704, p < 0.01). We observed a significant lag effect of NO2 on respiratory diseases, for lag 0 day and lag 1 day, a 10 μg/m3 increase in NO2 concentration corresponded to 1.009% (95% CI: 1.001, 1.017%) and 1.005% (95% CI: 1.001, 1.011%) increase of respiratory diseases. The spatial distribution of NO2 was significantly influenced by high-density urban development (population density, building density, number of shopping service facilities, and construction land, the bandwidth of these four factors are 43), while green space and parks can effectively reduce air pollution (R2 = 0.649).

Conclusion

Previous studies have focused on the effects of air pollution on respiratory diseases and the effects of built environment on air pollution, while this study combines these three aspects and explores the relationship between them. Furthermore, the theory of the "built environment-air pollution-respiratory diseases" cascading mechanism is practically investigated and broken down into specific experimental steps, which has not been found in previous studies. Additionally, we observed a lag effect of NO2 on respiratory diseases and spatial heterogeneity of built environment in the distribution of NO2.

Air pollution and childhood respiratory consultations in primary care: a systematic review

BACKGROUND

Outdoor air pollution is a known risk factor for respiratory morbidity worldwide. Compared with the adult population, there are fewer studies that analyse the association between short-term exposure to air pollution and respiratory morbidity in children in primary care.

OBJECTIVE

To evaluate whether children in a primary care setting exposed to outdoor air pollutants during short-term intervals are at increased risk of respiratory diagnoses.

METHODS

A search in Medline, the Cochrane Library, Web of Science and Embase databases throughout March 2023. Percentage change or risk ratios with corresponding 95% CI for the association between air pollutants and respiratory diseases were retrieved from individual studies. Risk of bias assessment was conducted with the Newcastle-Ottawa Scale (NOS) for cohort or case-control studies and an adjusted NOS for time series studies.

RESULTS

From 1366 studies, 14 were identified as meeting the inclusion criteria. Most studies had intermediate or high quality. A meta-analysis was not conducted due to heterogeneity in exposure and health outcome. Overall, studies on short-term exposure to air pollutants (carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2) and particulate matter ≤10 µm (PM10)) were associated with increased childhood respiratory consultations in primary care. In general, exposure to ozone was associated with a reduction in respiratory consultations.

CONCLUSIONS

The evidence suggests CO, SO2, NO2, PM10 and PM2.5 are risk factors for respiratory diseases in children in primary care in the short term. However, given the heterogeneity of the studies, interpretation of these findings must be done with caution.

PROSPERO REGISTRATION NUMBER

CRD42022259279.

Lifetime losses due to cardiovascular and respiratory diseases attributable to air pollution in polluted and unpolluted areas

The article assesses differences in lifetime losses caused by premature deaths from cardiopulmonary disease in populations living in areas with different environmental burdens. The results provide different perspectives on data on total years lost and lifetime losses attributable to air pollution. Such lifetime losses in the industrial area related to cardiovascular causes of death are 7.6 or 5.1 years per male or female deceased, representing an average lifetime loss of 0.01907 years (i.e. 7 days) per 1 male or 0.01273 years (i.e. 4.6 days) per 1 female in the entire population. Losses related to cerebrovascular or respiratory causes of death are about 5.4 or 5.9 years per 1 deceased male or 3.9 or 5 years per 1 deceased female, respectively, which represents a loss of 0.00481 (1.8 days), or 0.00148 years (0.5 days) per 1 male or 0.00466 (1.7 days), or 0.00058 years (0.2 days) per 1 female.

The impact of environmental conditions on non-communicable diseases in sub-Saharan Africa: A scoping review of epidemiologic evidence

Background

The burden of non-communicable diseases (NCDs) in sub-Saharan Africa (SSA) is increasing. Environmental conditions such as heavy metals and air pollution have been linked with the incidence and mortality of chronic diseases such as cancer, as well as cardiovascular and respiratory diseases. We aimed to scope the current state of evidence on the impact of environmental conditions on NCDs in SSA.

Methods

We conducted a scoping review to identify environmental conditions linked with NCDs in SSA by identifying studies published from January 1986 through February 2023. We searched African Index Medicus, Ovid Medline, Scopus, Web of Science, and Greenfile. Using the PICOS study selection criteria, we identified studies conducted in SSA focussed on physical environmental exposures and incidence, prevalence, and mortality of NCDs. We included only epidemiologic or quantitative studies.

Results

We identified 6754 articles from electronic database searches; only 36 met our inclusion criteria and were qualitatively synthesised. Two studies were conducted in multiple SSA countries, while 34 were conducted across ten countries in SSA. Air pollution (58.3%) was the most common type of environmental exposure reported, followed by exposure to dust (19.4%), meteorological variables (13.8%), heavy metals (2.7%), soil radioactivity (2.7%), and neighbourhood greenness (2.7%). The examined NCDs included respiratory diseases (69.4%), cancer (2.7%), stroke (5.5%), diabetes (2.7%), and two or more chronic diseases (19.4%). The study results suggest an association between environmental exposures and NCDs, particularly for respiratory diseases. Only seven studies found a null association between environmental conditions and chronic diseases.

Conclusions

There is a growing body of research on environmental conditions and chronic diseases in the SSA region. Although some cities in SSA have started implementing environmental monitoring and control measures, there remain high levels of environmental pollution. Investment can focus on improving environmental control measures and disease surveillance.

Case-crossover study for the association between increased hospital admissions for respiratory diseases and the increase in atmospheric PM2.5 and PM2.5-bound trace elements in Pretoria, South Africa

Outdoor PM2.5 was sampled in Pretoria, 18 April 2017 to 28 February 2020. A case-crossover epidemiology study was associated for increased PM2.5 and trace elements with increased hospital admissions for respiratory disorders (J00-J99). The results included a significant increase in hospital admissions, with total PM2.5 of 2.7% (95% CI: 0.6, 4.9) per 10 µg·m-3 increase. For the trace elements, Ca of 4.0% (95% CI: 1.4%-6.8%), Cl of 0.7% (95% CI: 0.0%-1.4%), Fe of 3.3% (95% CI: 0.5%-6.1%), K of 1.8% (95% CI: 0.2-3.5) and Si of 1.3% (95% CI: 0.1%-2.5%). When controlling for PM2.5, only Ca of 3.2% (95% CI: 0.3, 6.1) and within the 0-14 age group by 5.2% (95% CI: 1.5, 9.1). Controlling for a co-pollutant that is highly correlated with PM2.5 does reduce overestimation, but further studies should include deposition rates and parallel sampling analysis.

Characterization of risks and pathogenesis of respiratory diseases caused by rural atmospheric PM2.5

Forty-six percent of the world's population resides in rural areas, the majority of whom belong to vulnerable groups. They mainly use cheap solid fuels for cooking and heating, which release a large amount of PM2.5 and cause adverse effects to human health. PM2.5 exhibits urban-rural differences in its health risk to the respiratory system. However, the majority of research on this issue has focused on respiratory diseases induced by atmospheric PM2.5 in urban areas, while rural areas have been ignored for a long time, especially the pathogenesis of respiratory diseases. This is not helpful for promoting environmental equity to aid vulnerable groups under PM2.5 pollution. Thus, this study focuses on rural atmospheric PM2.5 in terms of its chemical components, toxicological effects, respiratory disease types, and pathogenesis, represented by PM2.5 from rural areas in the Sichuan Basin, China (Rural SC-PM2.5). In this study, organic carbon is the most significant component of Rural SC-PM2.5. Rural SC-PM2.5 significantly induces cytotoxicity, oxidative stress, and inflammatory response. Based on multiomics, bioinformatics, and molecular biology, Rural SC-PM2.5 inhibits ribonucleotide reductase regulatory subunit M2 (RRM2) to disrupt the cell cycle, impede DNA replication, and ultimately inhibit lung cell proliferation. Furthermore, this study supplements and supports the epidemic investigation. Through an analysis of the transcriptome and human disease database, it is found that Rural SC-PM2.5 may mainly involve pulmonary hypertension, sarcoidosis, and interstitial lung diseases; in particular, congenital diseases may be ignored by epidemiological surveys in rural areas, including tracheoesophageal fistula, submucous cleft of the hard palate, and congenital hypoplasia of the lung. This study contributes to a greater scientific understanding of the health risks posed by rural PM2.5, elucidates the pathogenesis of respiratory diseases, clarifies the types of respiratory diseases, and promotes environmental equity.

Associations between fine particulate air pollution with small-airway inflammation: A nationwide analysis in 122 Chinese cities

Alveolar nitric oxide is a non-invasive indicator of small-airway inflammation, a key pathophysiologic mechanism underlying lower respiratory diseases. However, no epidemiological studies have investigated the impact of fine particulate matter (PM2.5) exposure on the concentration of alveolar nitric oxide (CANO). To explore the associations between PM2.5 exposure in multiple periods and CANO, we conducted a nationwide cross-sectional study in 122 Chinese cities between 2019 and 2021. Utilizing a satellite-based model with a spatial resolution of 1 × 1 km, we matched long-term, mid-term, and short-term PM2.5 exposure for 28,399 individuals based on their home addresses. Multivariable linear regression models were applied to estimate the associations between PM2.5 at multiple exposure windows and CANO. Stratified analyses were also performed to identify potentially vulnerable subgroups. We found that per interquartile range (IQR) unit higher in 1-year average, 1-month average, and 7-day average PM2.5 concentration was significantly associated with increments of 17.78% [95% confidence interval (95%CI): 12.54%, 23.26%], 8.76% (95%CI: 7.35%, 10.19%), and 4.00% (95%CI: 2.81%, 5.20%) increment in CANO, respectively. The exposure-response relationship curves consistently increased with the slope becoming statistically significant beyond 20 μg/m3. Males, children, smokers, individuals with respiratory symptoms or using inhaled corticosteroids, and those living in Southern China were more vulnerable to PM2.5 exposure. In conclusion, our study provided novel evidence that PM2.5 exposure in long-term, mid-term, and short-term periods could significantly elevate small-airway inflammation represented by CANO. Our results highlight the significance of CANO measurement as a non-invasive tool for early screening in the management of PM2.5-related inflammatory respiratory diseases.

Associations between long-term ozone exposure and small airways function in Chinese young adults: a longitudinal cohort study

BACKGROUND

Increasing evidence is appearing that ozone has adverse effects on health. However, the association between long-term ozone exposure and lung function is still inconclusive.

OBJECTIVES

To investigate the associations between long-term exposure to ozone and lung function in Chinese young adults.

METHODS

We conducted a prospective cohort study among 1594 college students with a mean age of 19.2 years at baseline in Shandong, China from September 2020 to September 2021. Lung function indicators were measured in September 2020 and September 2021, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow at the 25th, 50th, and 75th percentile of the FVC (FEF25, FEF50, and FEF75) and mean flow rate between 25% and 75% of the FVC (FEF25-75) were measured. Daily 10 km×10 km ozone concentrations come from a well-validated data-fusion approach. The time-weighted average concentrations in 12 months before the lung function test were defined as the long-term ozone exposure. The associations between long-term ozone exposure and lung function indicators in Chinese young adults were investigated using a linear mixed effects model, followed by stratified analyses regarding sex, BMI and history of respiratory diseases.

RESULTS

Each interquartile range (IQR) (8.9 µg/m3) increase in long-term ozone exposure were associated with a -204.3 (95% confidence interval (CI): -361.6, -47.0) ml/s, -146.3 (95% CI: -264.1, -28.4) ml/s, and - 132.8 (95% CI: -239.2, -26.4) ml/s change in FEF25, FEF50, and FEF25-75, respectively. Stronger adverse associations were found in female participants or those with BMI ≥ 24 kg/m2 and history of respiratory diseases.

CONCLUSION

Long-term exposure to ambient ozone is associated with impaired small airway indicators in Chinese young adults. Females, participants with BMI ≥ 24 kg/m2 and a history of respiratory disease have stronger associations.

[Respiratory changes in children exposed to dust from mining waste in Brumadinho, Minas Gerais State, Brazil: Bruminha Project]

This study aimed to investigate the occurrence of respiratory diseases in children exposed to dust from mining waste after the Brumadinho dam disaster, Minas Gerais State, Brazil. The study population included children aged 0-6 years, living in three communities exposed to mining waste dust (Córrego do Feijão, Parque da Cachoeira, and Tejuco) and one unexposed community (Aranha). Data were collected from July 19 to 30, 2021, using questionnaires that addressed sociodemographic information and a recall survey on signs, symptoms, and respiratory diseases. A total of 217 children were evaluated, 119 living in the exposed communities and 98 in the non-exposed community. The residents in the exposed communities reported an increase in the frequency of home cleaning (p = 0.04) and in vehicular traffic (p = 0.03). Among children aged four, a higher frequency of upper (p = 0.01) and lower (p = 0.01) airway disorders, as well as respiratory allergy (p = 0.05) was observed. The exposed group had 1.5 times more reports of respiratory allergy (75%; p = 0.02) compared to the non-exposed group (50.5%). Children living in communities exposed to waste dust were three times more likely (adjusted OR = 3.63; 95%CI: 1.37; 9.57) to have respiratory allergies than those not exposed. Two years and six months after the environmental disaster occurred, children living in the communities affected by waste from mining and remediation activities remained exposed to dust with harmful effects on respiratory health.

Hospitalisations and fatality due to respiratory diseases according to a national database in Brazil: a longitudinal study

BACKGROUND

Respiratory diseases (RDs) cause millions of hospitalisations and deaths worldwide, resulting in economic and social impacts. Strategies for health promotion and disease prevention based on the epidemiological profile of the population may reduce hospital costs.

AIM

To characterise hospitalisations and deaths due to RDs in Brazilian adults above 20 years old between 2008 and 2021.

METHODS

This ecological study used secondary data of hospitalisations and deaths due to RDs from the Hospital Information System of the Brazilian Unified Health System between 2008 and 2021. Data were grouped according to region, age group and sex. The period was divided into first (2008-2011), second (2012-2015) and third (2016-2019) quadrennia and one biennium (2020-2021), and all data were analysed using the GraphPad Prism; statistical significance was set at p<0.05.

RESULTS

A total of 9 502 378 hospitalisations due to RDs were registered between 2008 and 2021. The south and southeast regions presented the highest hospitalisation and fatality rate, respectively, in the age group ≥80 years with no significant differences between sexes. Also, RDs caused 1 170 504 deaths, with a national fatality rate of 12.32%.

CONCLUSION

RDs affected the Brazilian population and impaired the health system, especially the hospital environment. The south/southeast regions were the most affected, and the ageing process contributed to the increased incidence of RDs.

From "Immunity Debt" to "Immunity Theft"-How COVID-19 Might Be Tied to Recent Respiratory Disease Surges

This Medical News story discusses the relationship between the COVID-19 pandemic and recent increases in other respiratory diseases.

Comparison and interobserver reliability between a visual analog scale and the Wisconsin Calf Health Scoring Chart for detection of respiratory disease in dairy calves

Respiratory disease is an ongoing challenge for calves in the dairy sector with a relatively high prevalence and impact on welfare and economics. Applying scoring protocols for detecting respiratory disease requires that they are easily implemented, consistent between observers and fast to use in daily management. This study was conducted in one Danish dairy farm from September 2020 through January 2021. The study included 126 heifer calves enrolled in the age of 17 to 24 d. All calves were observed every second day for a period of 46 d. At each visit all calves were scored with a new visual analog scale (VAS) and the Wisconsin Calf Health Scoring Chart (WCHSC). We calculated agreement between the 2 scoring systems based on conditional probability to score higher or lower than a cutoff in the VAS compared with a specified cutoff in WCHSC used as reference test. A generalized mixed effects regression model was developed to estimate the prevalence of respiratory disease and the overall agreement between the 2 scoring systems. The overall agreement between the VAS and WCHSC was 89.6%. The second part of the study assessed interobserver reliability between 2 experienced observers and between an experienced observer and veterinary students. The interobserver reliability was calculated by intraclass correlation coefficient and was 0.58 between experienced observers and was 0.34 between an experienced observer and veterinary students indicating a moderate to poor reliability between the observers. It was possible to use VAS as an alternative clinical scoring method, which primarily focuses on the general condition of the individual calf rather than specific categories of clinical signs. Our study set up lacked a comparison to other diagnostic tools i.e., thoracic ultrasound to confirm the findings which should be considered in future studies when exploring VAS as a screening tool for detection of respiratory disease in dairy calves.

Short-term exposure to extreme temperature and outpatient visits for respiratory diseases among children in the northern city of China: a time-series study

BACKGROUND

Although studies have indicated that extreme temperature is strongly associated with respiratory diseases, there is a dearth of studies focused on children, especially in China. We aimed to explore the association between extreme temperature and children's outpatient visits for respiratory diseases and seasonal modification effects in Harbin, China.

METHODS

A distributed lag nonlinear model (DLNM) was used to explore the effect of extreme temperature on daily outpatient visits for respiratory diseases among children, as well as lag effects and seasonal modification effects.

RESULTS

Extremely low temperatures were defined as the 1st percentile and 2.5th percentile of temperature. Extremely high temperatures were defined as the 97.5th percentile and 99th percentile of temperature. At extremely high temperatures, both 26 °C (97.5th) and 27 °C (99th) showed adverse effects at lag 0-6 days, with relative risks (RRs) of 1.34 [95% confidence interval (CI): 1.21-1.48] and 1.38 (95% CI: 1.24-1.53), respectively. However, at extremely low temperatures, both - 26 °C (1st) and - 23 °C (2.5th) showed protective effects on children's outpatient visits for respiratory diseases at lag 0-10 days, with RRs of 0.86 (95% CI: 0.76-0.97) and 0.85 (95% CI: 0.75-0.95), respectively. We also found seasonal modification effects, with the association being stronger in the warm season than in the cold season at extremely high temperatures.

CONCLUSIONS

Our study indicated that extremely hot temperatures increase the risk of children's outpatient visits for respiratory diseases. Efforts to reduce the exposure of children to extremely high temperatures could potentially alleviate the burden of pediatric respiratory diseases, especially during the warm season.

Air pollution and oxidative stress in adults suffering from airway diseases. Insights from the Gene Environment Interactions in Respiratory Diseases (GEIRD) multi-case control study

Air pollution is a leading risk factor for global mortality and morbidity. Oxidative stress is a key mechanism underlying air-pollution-mediated health effects, especially in the pathogenesis/exacerbation of airway impairments. However, evidence lacks on subgroups at higher risk of developing more severe outcomes in response to air pollution. This multi-centre study aims to evaluate the association between air pollution and oxidative stress in healthy adults and in patients affected by airway diseases from the Italian GEIRD (Gene Environment Interactions in Respiratory Diseases) multi-case control study. Overall, 1841 adults (49 % females, 20-83 years) were included from four Italian centres: Pavia, Sassari, Turin, and Verona. Following a 2-stage screening process, we identified 1273 cases of asthma, chronic bronchitis, rhinitis, or COPD and 568 controls. Systemic oxidative stress was quantified by urinary 8-isoprostane and 8-OH-dG. Individual residential exposures to NO2, PM10, PM2.5, and O3 were derived using an innovative five-stage machine-learning-based approach. Linear mixed regression models tested the association between oxidative stress biomarkers and air pollution tertiles, adjusting by age, sex, BMI, smoking, education and season, with recruiting centres as random intercept. Only cases exhibited higher levels of log-transformed 8-isoprostane and 8-OH-dG in association with NO2 (β: 0.30 95 % CI: 0.08-0.52 and 0.20 95 % CI: 0.03-0.37), PM10 (0.34 95 % CI: 0.12-0.55 and 0.21 95 % CI: 0.05-0.37) and PM2.5 (0.27 95 % CI: 0.09-0.49 and 0.18 95 % CI: 0.02-0.34) as compared to the first tertile of exposure. No significant associations were observed for summer O3. Our findings suggest that exposure to air pollution may increase systemic oxidative stress levels in people suffering from airway diseases. This introduces a potential novel approach available for future epidemiological studies and Public Health for effective prevention strategies oriented at the quantification of early biological effects in susceptible people, whose additional risk level might be currently underrated. Air-pollution-mediated exacerbations, driven by oxidative stress, still deserve our attention.

Effect of ambient air pollution on hospital admission for respiratory diseases in Hanoi children during 2007-2019

Air pollution poses a threat to children's respiratory health. This study aims to quantify the association between short-term air pollution exposure and respiratory hospital admissions among children in Hanoi, Vietnam, and estimate the population-attributable burden using local data. A case-crossover analysis was conducted based on the individual records where each case is their own control. The health data was obtained from 13 hospitals in Hanoi and air pollution data was collected from four monitoring stations from 2007 to 2019. We used conditional logistic regression to estimate Percentage Change (PC) and 95% Confidence Interval (CI) in odd of hospital admissions per 10 μg/m3 increase in daily average particulate matter (e.g. PM1, PM2.5, PM10), Sulfur Dioxide (SO2), Nitrogen Dioxide (NO2), 8-h maximum Ozone and per 1000 μg/m3 increase in daily mean of Carbon Monoxide (CO). We also calculated the number and fraction of admissions attributed to air pollution in Hanoi by using the coefficient at lag 0. A 10 μg/m3 increase in the concentration of PM10, PM2.5, PM1, SO2, NO2, O3 8-h maximum and 1000 μg/m3 increase in CO concentration was associated with 0.6%, 1.2%, 1.4%, 0.8%, 1.6%, 0.3%, and 1.7% increase in odd of admission for all respiratory diseases among children under 16 years at lag 0-2. All PM metrics and NO2 are associated with childhood admission for pneumonia and bronchitis. Admissions due to asthma and upper respiratory diseases are related to increments in NO2 and CO. For attributable cases, PM2.5 concentrations in Hanoi exceeding the World Health Organization Air Quality Guidelines accounted for 1619 respiratory hospital admissions in Hanoi children in 2019. Our findings show that air pollution has a detrimental impact on the respiratory health of Hanoi children and there will be important health benefits from improved air quality management planning to reduce air pollution in Vietnam.

Associations between ultrafine particle pollution and daily outpatient visits for respiratory diseases in Shanghai, China: a time-series analysis

Previous epidemiological studies have linked short-term exposure to particulate matter with outpatient visits for respiratory diseases. However, evidence on ultrafine particle (UFP) is still scarce in China. To investigate the association between short-term UFP exposure and outpatient visits for respiratory diseases as well as the corresponding lag patterns, information on outpatient visits for main respiratory diseases during January 1, 2017, to December 31, 2019 was collected from electronic medical records of two large tertiary hospitals in Shanghai, China. Generalized additive models employing a Quasi-Poisson distribution were employed to investigate the relationships between UFP and respiratory diseases. We computed the percentage change and its corresponding 95% confidence interval (CI) for outpatient visits related to respiratory diseases per interquartile range (IQR) increase in UFP concentrations. Based on a total of 1,034,394 hospital visits for respiratory diseases in Shanghai, China, we found that the strongest associations of total UFP with acute upper respiratory tract infection (AURTI), bronchitis, chronic obstructive pulmonary disease (COPD), and pneumonia occurred at lag 03, 03, 0, and 03 days, respectively. Each IQR increase in the total UFP concentrations was associated with increments of 9.02% (95% CI: 8.64-9.40%), 3.94% (95% CI: 2.84-5.06%), 4.10% (95% CI: 3.01-5.20%), and 10.15% (95% CI: 9.32-10.99%) for AURTI, bronchitis, COPD, and pneumonia, respectively. Almost linear concentration-response relationship curves without apparent thresholds were observed between total UFP and outpatient-department visits for four respiratory diseases. Stratified analyses illustrated significantly stronger associations of total UFP with AURTI, bronchitis, and pneumonia among female patients, while that with COPD was stronger among male patients. After adjustment of criteria air pollutants, these associations all remained robust. This time-series study indicates that short-term exposure to UFP was associated with increased risk of hospital visits for respiratory diseases, underscoring the importance of reducing ambient UFP concentrations for respiratory diseases control and prevention.

Long-term health complications of chemical weapon exposure: a study on Halabja chemical attack survivors (Iraqi Kurds)

OBJECTIVE

In 1988, the Iraqi government used a range of chemical weapons (CWs) against the Iraqi Kurds of Halabja. Here, we aim to investigate the long-term health consequences in exposed survivors as they are not sufficiently studied.

MATERIALS AND METHODS

This was a retrospective study conducted from November 2019 to May 2020 assessing the health status of all exposed Halabja chemical attack survivors compared to non-exposed people from the same area.

RESULTS AND DISCUSSION

Two hundred thirty survivors and 240 non-exposed participants were enrolled in this study, with control participants matched to age, gender, and occupation. Among the survivors, females were more prevalent. The respiratory system was the most common single exposure route (83, 36.1%), with 138 (60%) of the survivors being exposed by multiple routes. The vast majority (88.7%) of survivors had activities of daily living (ADL) impairment. There was female predominance in mild and moderate cases, with more males in severe cases (p < 0.01). Respiratory and cardiac diseases were significantly more common in the survivors compared to the controls (p < 0.001). Survivors with multiple CW exposure routes had significantly higher rates of ADL impairment (p < 0.001) and cardiac disease, respiratory diseases, and miscarriage (p < 0.01), than those with a single exposure route.

CONCLUSION

In this study comparing CW survivors with a local control population, a single, high-dose exposure to CWs was associated with significant increases in chronic respiratory and cardiac conditions, in addition to high rates of ADL impairment. Similar studies are needed in other, more recent CW survivor cohorts.

Short-term air pollution exposure and mortality in Brazil: Investigating the susceptible population groups

This is the first study to examine the association between ambient air pollution (PM2.5, O3, and NO2) and mortality (in different population groups by sex and age) based on a nationwide death record across Brazil over a 15-year period (2003-2017). We used a time-series analytic approach with a distributed lag model. Our study population includes 2,872,084 records of deaths in Brazil between 2003 and 2017. Men accounted for a higher proportion of deaths, with 58% for all-cause mortality, 54% for respiratory mortality, and 52% for circulatory mortality. Most individuals were over 65 years of age. Our results suggest an association between air pollution and mortality in Brazil. The direction, statistical significance, and effect size of these associations varied considerably by type of air pollutant, region, and population group (sex and age group). In particular, the older population group (>65 years) was most affected. The national meta-analysis for the entire data set (without stratification by sex and age) showed that for every 10 μg/m3 increase in PM2.5 concentration, the risk of death from respiratory diseases increased by 2.93% (95%CI: 1.42; 4.43). For every 10 ppb increase in O3, there is a 2.21% (95%CI: 0.59; 3.83) increase in the risk of all-cause mortality for the group of all people between 46 and 65 years old, and a 3.53% (95%CI: 0.34; 6.72) increase in the risk of circulatory mortality for the group of women, all ages. For every 10 ppb increase in NO2, the risk of respiratory mortality increases by 17.56% (95%CI: 4.44; 30.64) and the risk of all-cause mortality by 5.63% (95%CI: 1.83; 9.44). The results of our study provide epidemiological evidence that air pollution is associated with a higher risk of cardiorespiratory mortality in Brazil. Given the lack of nationwide studies on air pollution in Brazil, our research is an important contribution to the local and international literature that can provide better support to policymakers to improve air quality and public health.

Identification of potential food sources affecting blood lead levels and their health hazards (CVD, respiratory diseases, cancer)

Environmental lead exposure is a well-known and significant public health concern. In areas with low lead exposure, comprehensive and detailed research and validation are needed to eliminate the adverse effects of environmental lead exposure. This study aims to understand the possible food pathways of environmental lead exposure by exploring the contribution of food to blood lead and the mediating effect of blood lead in the occurrence of diseases. Similarly, as lead is a heavy metal pollutant with good research foundation, fine analysis of lead in this period can also be a reference for other unknown pollutants. In this cross-sectional study of 1162 peoples, the data are taken from National Health and Nutrition Examination Survey (NANHES) 2015-2016, we grouped the population according to the median blood lead level (0.038 μmol/L) to screen the variables adjusted by the model. we grouped foods by code and used a generalized additive mixed model (GAMM) to study their relationship with blood lead levels, a correlation has been found between egg mixtures (p = 0.007) and legumes (p = 0.041) consumption and blood lead levels. We analyzed how metabolic status, exercise, and macronutrient intake modulate the impact of certain foods on blood lead levels to infer its possible process. To verify whether adverse effects are caused by lead, we explored the mediating effect of blood lead on the relationship between food intake and disease [cardiovascular diseases (CVD), respiratory diseases, cancer], however, no statistically significant mediating effect was found. Overall, environmental lead exposure through food still affects blood lead levels, but it has not led to adverse outcomes in blood, respiratory system, or cancers Under conditions where lead exposure levels were equivalent to those in the study (blood lead levels， mean = 0.052 μmol/L, standard deviation = 0.048 μmol/L, median = 0.038 μmol/L, min = 0.002 μmol/L, max = 0.904 μmol/L, skewness = 6.543, kurtosis = 89.391).

Exposure to outdoor particulate matter and risk of respiratory diseases: a systematic review and meta-analysis

According to epidemiological studies, particulate matter (PM) is an important air pollutant that poses a significant threat to human health. The relationship between particulate matter and respiratory diseases has been the subject of numerous studies, but these studies have produced inconsistent findings. The purpose of this systematic review was to examine the connection between outdoor particulate matter (PM2.5 and PM10) exposure and respiratory disorders (COPD, lung cancer, LRIs, and COVID-19). For this purpose, we conducted a literature search between 2012 and 2022 in PubMed, Web of Science, and Scopus. Out of the 58 studies that were part of the systematic review, meta-analyses were conducted on 53 of them. A random effect model was applied separately for each category of study design to assess the pooled association between exposure to PM2.5 and PM10 and respiratory diseases. Based on time-series and cohort studies, which are the priorities of the strength of evidence, a significant relationship between the risk of respiratory diseases (COPD, lung cancer, and COVID-19) was observed (COPD: pooled HR = 1.032, 95% CI: 1.004-1.061; lung cancer: pooled HR = 1.017, 95% CI: 1.015-1.020; and COVID-19: pooled RR = 1.004, 95% CI: 1.002-1.006 per 1 μg/m3 increase in PM2.5). Also, a significant relationship was observed between PM10 and respiratory diseases (COPD, LRIs, and COVID-19) based on time-series and cohort studies. Although the number of studies in this field is limited, which requires more investigations, it can be concluded that outdoor particulate matter can increase the risk of respiratory diseases.

Spatiotemporal varying coefficient model for respiratory disease mapping in Taiwan

Respiratory diseases have been global public health problems for a long time. In recent years, air pollutants as important risk factors have drawn lots of attention. In this study, we investigate the influence of $\pm2.5$ (particulate matters in diameter less than 2.5 ${\rm{\mu }} m$) on hospital visit rates for respiratory diseases in Taiwan. To reveal the spatiotemporal pattern of data, we propose a Bayesian disease mapping model with spatially varying coefficients and a parametric temporal trend. Model fitting is conducted using the integrated nested Laplace approximation, which is a widely applied technique for large-scale data sets due to its high computational efficiency. The finite sample performance of the proposed method is studied through a series of simulations. As demonstrated by simulations, the proposed model can improve both the parameter estimation performance and the prediction performance. We apply the proposed model on the respiratory disease data in 328 third-level administrative regions in Taiwan and find significant associations between hospital visit rates and $\pm2.5$.

Efficacy and Safety of an mRNA-Based RSV PreF Vaccine in Older Adults

BACKGROUND

Respiratory syncytial virus (RSV) can cause substantial morbidity and mortality among older adults. An mRNA-based RSV vaccine, mRNA-1345, encoding the stabilized RSV prefusion F glycoprotein, is under clinical investigation.

METHODS

In this ongoing, randomized, double-blind, placebo-controlled, phase 2-3 trial, we randomly assigned, in a 1:1 ratio, adults 60 years of age or older to receive one dose of mRNA-1345 (50 μg) or placebo. The two primary efficacy end points were the prevention of RSV-associated lower respiratory tract disease with at least two signs or symptoms and with at least three signs or symptoms. A key secondary efficacy end point was the prevention of RSV-associated acute respiratory disease. Safety was also assessed.

RESULTS

Overall, 35,541 participants were assigned to receive the mRNA-1345 vaccine (17,793 participants) or placebo (17,748). The median follow-up was 112 days (range, 1 to 379). The primary analyses were conducted when at least 50% of the anticipated cases of RSV-associated lower respiratory tract disease had occurred. Vaccine efficacy was 83.7% (95.88% confidence interval [CI], 66.0 to 92.2) against RSV-associated lower respiratory tract disease with at least two signs or symptoms and 82.4% (96.36% CI, 34.8 to 95.3) against the disease with at least three signs or symptoms. Vaccine efficacy was 68.4% (95% CI, 50.9 to 79.7) against RSV-associated acute respiratory disease. Protection was observed against both RSV subtypes (A and B) and was generally consistent across subgroups defined according to age and coexisting conditions. Participants in the mRNA-1345 group had a higher incidence than those in the placebo group of solicited local adverse reactions (58.7% vs. 16.2%) and of systemic adverse reactions (47.7% vs. 32.9%); most reactions were mild to moderate in severity and were transient. Serious adverse events occurred in 2.8% of the participants in each trial group.

CONCLUSIONS

A single dose of the mRNA-1345 vaccine resulted in no evident safety concerns and led to a lower incidence of RSV-associated lower respiratory tract disease and of RSV-associated acute respiratory disease than placebo among adults 60 years of age or older. (Funded by Moderna; ConquerRSV ClinicalTrials.gov number, NCT05127434.).

Prepayment meters strongly associated with multiple types of deprivation and emergency respiratory hospital admissions: an observational, cross-sectional study

BACKGROUND

Prepayment meters (PPMs) require energy to be paid in advance. Action groups and media contend that PPMs are concentrated in the most vulnerable groups, prone to run out of credit and experience financial burden. This led to forced installation for those over age 85 being banned in April 2023 and a 'prepayment premium' scrapped in July 2023. Yet, we lack empirical evidence of which groups PPMs are concentrated. This ecological study examines the extent to which PPMs are associated with multiple measures of structural social, economic and health deprivation to establish evidence-based policy.

METHODS

Combining multiple regional data and census estimates at the Lower Layer Super Output Area and the Middle Layer Super Output Area level from England and Wales, we use Spearman's rank correlation, Pearson correlation and multivariate linear regression to empirically establish associations between PPMs and multiple types of deprivation.

RESULTS

Higher PPM prevalence is strongly associated with: lower income, receipt of employment benefits, ethnic minorities, lower education and higher health deprivation. Higher PPM prevalence is strongly associated with higher income deprivation affecting children, the elderly and social rental properties. PPMs are significantly associated with emergency hospital admissions for respiratory diseases in England, even after controlling for confounders (coefficient=1.81; 95% CI 1.51 to 2.11).

CONCLUSIONS

We found empirical evidence that PPM users are concentrated among the population who already experience multiple disadvantages. Furthermore, PPM concentrated areas are associated with higher emergency hospital admissions for respiratory diseases.

Effect of Ambient Temperature on Hospital Admissions for Respiratory Disease in Suburban Rural Villages of a Semi-Arid Region in Northwest China

OBJECTIVE

This study evaluated the effects of extreme temperatures on hospital admissions for respiratory diseases (RDs) in a semi-arid region in the Northwest of China.

METHODS

Distributed lag nonlinear model was constructed, and stratified analysis by gender and age was performed.

RESULTS

The exposure-response curve between temperature and RD hospital admissions was almost W-shaped. Either extremely cold temperatures or moderately cold temperatures presented a short-term acute harmful effect, and the relative risks were higher among males (1.976, 95% confidence interval [CI]: 1.773-2.203; 1.242, 95% CI: 1.203-1.282) and the elderly (2.363, 95% CI: 1.724-3.240; 1.267, 95% CI: 1.154-1.390). Both extreme and moderately hot temperatures had higher risks among females (2.040, 95% CI: 1.815-2.292; 1.328, 95% CI: 1.276-1.381).

CONCLUSIONS

The relationship between air temperature and RD hospital admissions was nonlinear. Vulnerable populations varied according to extreme temperature conditions.

Epidemiology and pathogenicity of M. equirhinis in equine respiratory disorders

Mycoplasmas are pathogens involved in respiratory disorders of various animal hosts. In horses, Mycoplasma (M.) equirhinis is the species most frequently detected in clinical respiratory specimens, with a prevalence of 12-16%, but its clinical implication in equine respiratory disorders remains unclear. Here we screened 1948 clinical specimens for the presence of M. equirhinis. The samples were both tracheal washes (TW) and bronchoalveolar lavages (BAL) collected by veterinarians in France in day-to-day work between 2020 and 2022. The samples were associated with a standardized form that served to collect key general and clinical information, such as horse age, breed, and living environment. M. equirhinis was detected using a combination of culture and post-enrichment PCR. Other diagnostic data included virology and bacteriology as well as neutrophil counts, when available. Prevalence of M. equirhinis was examined as a function of a clinical score based on four significant clinical signs (nasal discharge, cough, dyspnoea, and hyperthermia). Multivariate logistic regression analysis was run to identify risk factors for the presence of M. equirhinis, and comparative prevalence analysis was used to test for association with other bacteria and viruses. TW and BAL were analysed independently, as we found that TW samples were associated with a higher prevalence of M. equirhinis. As prevalence remained steady whatever the clinical score, M. equirhinis cannot be considered a primary pathogen. M. equirhinis was more frequently isolated in thoroughbreds and trotters and in horses living exclusively stabled compared to other horses or other living environments. M. equirhinis was never detected in BAL specimens with a 'normal' neutrophil count, i.e. 5%, suggesting it could be associated with an inflammatory response, similar to that observed in equine asthma. Prevalence of M. equirhinis was shown to increase in the presence of other bacteria such as Streptococcus equi subsp. zooepidemicus (S. zoo) or viruses, and S. zoo load was higher in M. equirhinis-positive samples, suggesting a potential increase of clinical signs in the event of co-infection.

Double trouble: The interaction of PM2.5 and O3 on respiratory hospital admissions

The co-occurrence of fine particulate matter (PM2.5) and ozone (O3) pollution during the warm season has become a growing public health concern. The interaction between PM2.5 and O3 and its contribution to disease burden associated with co-pollution has not been thoroughly examined. We collected data on hospital admissions for respiratory diseases from a city-wide hospital discharge database in Beijing between 2013 and 2019. City-wide 24-h mean PM2.5 and daily maximum 8-h mean O3 were averaged from 35 monitoring stations across Beijing. Conditional Poisson regression was employed to estimate the interaction between warm-season PM2.5 and O3 on respiratory admissions. A model incorporating a tensor product term was used to fit the non-linear interaction and estimate the number of respiratory admissions attributable to PM2.5 and O3 pollution. From January 18, 2013 to December 31, 2019, 1,191,308 respiratory admissions were recorded. We observed multiplicative interactions between warm-season PM2.5 and O3 on upper respiratory infections (P = 0.004), pneumonia (P = 0.002), chronic obstructive pulmonary disease (P = 0.041), and total respiratory disease (P < 0.001). PM2.5-O3 co-pollution during warm season exhibited a super-additive effect on respiratory admissions, with a relative excess risk due to interaction of 1.65% (95%CI: 0.46%-2.84%). There was a non-linear pattern of the synergistic effect between PM2.5 and O3 on respiratory admissions. Based on the World Health Organization global air quality guidelines, 12,421 respiratory admissions would be reduced if both daily PM2.5 and O3 concentrations had not exceeded the target (PM2.5 15 μg/m3, O3 100 μg/m3). The number of respiratory admissions attributable to either PM2.5 or O3 pollution decreased by 48.7% from 2013 to 2019. Prioritizing O3 control during the warm season is a cost-effective strategy for Beijing. These findings underscore the significance of concurrently addressing both PM2.5 pollution and O3 pollution during the warm season to alleviate the burden of respiratory diseases.

Ambient carbon monoxide and relative risk of daily hospital outpatient visits for respiratory diseases in Lanzhou, China

At present, evidence of the associations between carbon monoxide (CO) and respiratory diseases (RD) in Northwest China is limited and controversial. The aim of this study is to evaluate the impact of ambient CO on outpatient visits for RD in Lanzhou, China. The daily amount of outpatient visits for total and cause-specific RD, air pollutant, and weather variables were collected in Lanzhou, China from 1st January 2013 to 31st December 2019. A generalized additive model and distributed lag nonlinear model were used to assess associations between CO and outpatient visits for RD. During the study period, a total of 1,623,361 RD outpatient visits were recorded. For each interquartile range (IQR) (0.77 mg/m3) increase in CO, the relative risk (RR) was 1.163 (95% CI: 1.138, 1.188) for total RD at lag07, 1.153 (95% CI: 1.128,1.179) for upper respiratory tract infection (URTI) at lag07, 1.379 (95% CI: 1.338,1.422) for pneumonia at lag07, 1.029 (95% CI: 0.997,1.062) for chronic obstructive pulmonary disease (COPD) lag04, 1.068 (95% CI: 1.028,1.110) for asthma lag03, and 1.212 (95% CI: 1.178,1.247) for bronchitis lag07, respectively. In the subgroup analyses, the impacts of CO were more pronounced on total RD, pneumonia, COPD, and bronchitis in males than females, while the opposite was true in URTI and asthma. The impact of CO on RD was the strongest for children under 15 years-of-age. We also found significantly stronger effects during cold seasons compared to warm seasons. In addition, we observed a roughly linear exposure-response curve between CO and RD with no threshold effect. This study in Lanzhou revealed a remarkable association between CO level and an elevated risk of total and cause-specific RD outpatient visits, especially for pneumonia.

Temperature variability associated with respiratory disease hospitalisations, hospital stays and hospital expenses the warm temperate sub-humid monsoon climate

OBJECTIVES

The abrupt change of climate has led to an increasing trend of hospitalised patients in recent years. This study aimed to analyse the temperature variability (TV) associated with respiratory disease (RD) hospitalisations, hospital stays and hospital expenses.

STUDY DESIGN

The generalized linear model combined with distributed lag non-linear model was used to investigate the association between TV and RD hospitalisations.

METHODS

TV was determined by measuring the standard deviation of maximum and minimum temperatures for the current day and the previous 7 days. RD hospitalisations data were obtained from three major tertiary hospitals in Huaibei City, namely, the Huaibei People's Hospital, the Huaibei Hospital Of Traditional Chinese Medicine and the Huaibei Maternal and Child Health Care Hospital. First, using a time series decomposition model, the seasonality and long-term trend of hospitalisations, hospital stays and hospital expenses for RD were explored in this warm temperate sub-humid monsoon climate. Second, robust models were used to analyse the association between TV and RD hospitalisations, hospital stays and hospital expenses. In addition, this study stratified results by sex, age and season. Third, using the attributable fraction (AF) and attributable number (AN), hospitalisations, hospital stays and hospital expenses for RD attributed to TV were quantified.

RESULTS

Overall, 0.013% of hospitalisations were attributed to TV0-1 (i.e. TV at the current day and previous 1 day), corresponding to 220 cases, 1603 days of hospital stays and 1,308,000 RMB of hospital expenses. Females were more susceptible to TV than males, and the risk increased with longer exposure (the highest risk was seen at TV0-7 [i.e. TV at the current day and previous 7 days] exposure). Higher AF and AN were observed at ages 0-5 years and ≥65 years. In addition, it was also found that TV was more strongly linked to RD in the cool season. The hot season was positively associated with hospital stays and hospital expenses at TV0-3 to TV0-7 exposure.

CONCLUSIONS

Exposure to TV increased the risk of hospitalisations, longer hospital stays and higher hospital expenses for RD. The findings suggested that more attention should be paid to unstable weather conditions in the future to protect the health of vulnerable populations.

[Burning of sugarcane biomass and hospitalizations of children and older adults for respiratory problems in Pernambuco State, Brazil]

This study aimed to analyze the relationship between hospitalizations for respiratory problems and the regular burning of sugarcane in Pernambuco State, Brazil. This is an ecological time series study corresponding to the period from 2008 to 2018. The rates of hospitalizations for respiratory diseases in children aged under 5 years and in adults older than 60 years in sugarcane-producing and non-producing municipalities were compared using nonparametric Mann-Whitney statistical analysis. Together, we observed the monthly distribution of the hot spots occurrences in the case and control municipalities and applied Pearson's correlation to analyze the association between both variables. For both age groups, hospitalization rates are higher in sugarcane-producing municipalities, with a statistically significant difference p < 0.005. The rate of hospitalization in older adults is 28% higher in the case municipalities, and is even higher in children aged under 5 years whose ratio of the medians is 40%. However, the seasonal behavior of hospitalizations for respiratory diseases differs from that observed in the monthly distribution of hot spots, without statistically significant correlation. These findings suggest a possible association with chronic exposure to particulates emitted by biomass burning, compromising the health of vulnerable groups, and endorse the need to replace fires in the monoculture of sugarcane and to structure public policies to protect human and environmental health.

The impact of air pollution on respiratory diseases in an era of climate change: A review of the current evidence

The impacts of climate change and air pollution on respiratory diseases present significant global health challenges. This review aims to investigate the effects of the interactions between these challenges focusing on respiratory diseases. Climate change is predicted to increase the frequency and intensity of extreme weather events amplifying air pollution levels and exacerbating respiratory diseases. Air pollution levels are projected to rise due to ongoing economic growth and population expansion in many areas worldwide, resulting in a greater burden of respiratory diseases. This is especially true among vulnerable populations like children, older adults, and those with pre-existing respiratory disorders. These challenges induce inflammation, create oxidative stress, and impair the immune system function of the lungs. Consequently, public health measures are required to mitigate the effects of climate change and air pollution on respiratory health. The review proposes that reducing greenhouse gas emissions contribute to slowing down climate change and lessening the severity of extreme weather events. Enhancing air quality through regulatory and technological innovations also helps reduce the morbidity of respiratory diseases. Moreover, policies and interventions aimed at improving healthcare access and social support can assist in decreasing the vulnerability of populations to the adverse health effects of air pollution and climate change. In conclusion, there is an urgent need for continuous research, establishment of policies, and public health efforts to tackle the complex and multi-dimensional challenges of climate change, air pollution, and respiratory health. Practical and comprehensive interventions can protect respiratory health and enhance public health outcomes for all.

Temperature modifies the association between air pollution and respiratory disease mortality in Cape Town, South Africa

The aim of this 10-year study was to investigate whether and how temperature modifies the association between daily ambient PM10, NO2, SO2 air pollution and daily respiratory disease mortality in Cape Town. A time-stratified case-crossover epidemiological design was applied. Susceptibility by sex and age groups (15-64 years and ≥65 years) was also investigated. On days with medium Tapp levels, NO2 displayed a stronger association with respiratory mortality than PM10 or SO2. Females appeared to be more susceptible to NO2 at medium Tapp levels to males. The 15-64-year-old age group seemed to be more vulnerable to NO2 and PM10 at medium Tapp levels compared to the elderly (≥65 years). At high Tapp levels, females were more susceptible to PM10. The 15-64-year-old group were more vulnerable to NO2 and SO2. The results can be used in present-day early warning systems and in risk assessments to estimate the impact of increased air pollution and temperature.