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Xu S, Marcon A, Bertelsen RJ, Benediktsdottir B, Brandt J, Frohn LM, Geels C, Gislason T, Heinrich J, Holm M, Janson C, Markevych I, Modig L, Orru H, Schlünssen V, Sigsgaard T, Johannessen A. Long-term exposure to air pollution and greenness in association with respiratory emergency room visits and hospitalizations: The Life-GAP project. ENVIRONMENTAL RESEARCH 2025; 270:120938. [PMID: 39862954 DOI: 10.1016/j.envres.2025.120938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 01/06/2025] [Accepted: 01/22/2025] [Indexed: 01/27/2025]
Abstract
BACKGROUND Air pollution has been linked to respiratory diseases, while the effects of greenness remain inconclusive. OBJECTIVE We investigated the associations between exposure to particulate matter (PM2.5 and PM10), black carbon (BC), nitrogen dioxide (NO2), ozone (O3), and greenness (normalized difference vegetation index, NDVI) with respiratory emergency room visits and hospitalizations across seven Northern European centers in the European Community Respiratory Health Survey (ECRHS) study. METHODS We used modified mixed-effects Poisson regression to analyze associations of exposure in 1990, 2000 and mean exposure 1990-2000 with respiratory outcomes recorded duing ECRHS phases II and III. We assessed interactions of air pollution and greenness, and of atopic status (defined by nasal allergies and hay fever status) and greenness, on these outcomes. RESULTS The analysis included 1675 participants, resulting in 119 emergency visits and 48 hospitalizations. Increased PM2.5 by 5 μg/m³ was associated with higher relative risk (RR) of emergency visits (1990: RR 1.16, 95% CI: 1.00-1.35; 2000: RR 1.24, 95% CI: 0.98-1.57; 1990-2000: RR 1.17, 95% CI: 0.97-1.41) and hospitalizations (1990: RR 1.42, 95% CI: 1.00-2.01; 2000: RR 2.20, 95% CI: 1.43-3.38; 1990-2000: RR 1.44, 95% CI: 1.04-2.00). Similar trends were observed for PM10, BC, and NO2, with only PM10 showing significant associations with hospitalizations across all periods. No associations were found for O3. Greenness exposure was linked to more emergency visits in 2000 but to fewer hospitalizations in 1990. Significant interactions were observed between greenness and atopic status for emergency visits, and between NDVI with O3 and BC for some time windows. CONCLUSION Long-term exposure to particulate matter was associated with increased emergency room visits and hospitalizations. Significant associations were observed for BC and NO2 with hospitalizations. No link was found with O3. Greenness indicated a lower risk of hospitalizations, but increased risks for emergency visits for those with atopic status.
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Affiliation(s)
- Shanshan Xu
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Bryndis Benediktsdottir
- Department of Respiratory Medicine and Sleep, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland; Medical Faculty, University of Iceland, Iceland
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Lise Marie Frohn
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland; Medical Faculty, University of Iceland, Iceland
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland; Health and Quality of Life in a Green and Sustainable Environment", Strategic Research and Innovation Program for the Development of MU - Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria; Environmental Health Division, Research Institute at Medical University of Plovdiv, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Lars Modig
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Hans Orru
- Department of Public Health, Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Vivi Schlünssen
- Department of Public Health, Research Unit for Environment Occupation and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Research Unit for Environment Occupation and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Niu Y, Niu H, Meng X, Zhu Y, Ren X, He R, Wu H, Yu T, Zhang Y, Kan H, Chen R, Yang T, Wang C. Associations Between Air Pollution and the Onset of Acute Exacerbations of COPD: A Time-Stratified Case-Crossover Study in China. Chest 2024; 166:998-1009. [PMID: 38906462 DOI: 10.1016/j.chest.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Associations between air pollution and the acute exacerbations (AEs) of COPD have been established primarily in time-series studies in which exposure and health data were at the aggregate level, limiting the identification of susceptible populations. RESEARCH QUESTION Are air pollutants associated with the onset of AEs of COPD in China? Who is more susceptible to the effects of air pollutants? STUDY DESIGN AND METHODS Data regarding AEs of COPD were obtained from the Acute Exacerbation of Chronic Obstructive Pulmonary Disease Registry (ACURE) study, and air pollution data were assigned to individuals based on their residential address. We adopted a time-stratified case-crossover study design combined with conditional logistic regression models to estimate the associations between six air pollutants and AEs of COPD. Stratified analyses were performed by individual characteristics, disease severity, COPD types, and the season of exacerbations. RESULTS A total of 5,746 patients were included. At a 2-day lag, for each interquartile range increase in fine particulate matter and inhalable particulate matter concentrations, ORs for AEs of COPD were 1.054 (95% CI, 1.012-1.097) and 1.050 (95% CI, 1.009-1.092), respectively. The associations were more pronounced in participants who were younger than 65 years, who had experienced at least one severe AE of COPD in the past year, who had received a diagnosis of COPD between 20 and 50 years of age, and who had experienced AEs of COPD in the cool seasons. By contrast, significant associations for nitrogen dioxide, sulfur dioxide, and carbon monoxide lost significance when excluding patients collected before 2020 or with greater distance from the monitoring station, and no significant association was observed for ozone. INTERPRETATION This study provides robust evidence that short-term exposure to fine particulate matter and inhalable particulate matter was associated with higher odds of AEs of COPD onset. Individuals who are young, have severe COPD, or whose first diagnosis of COPD was made when they were between 20 and 50 years of age and experience an exacerbation during the cooler seasons may be particularly susceptible. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT2657525; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Yue Niu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Hongtao Niu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xia Meng
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yixiang Zhu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Xiaoxia Ren
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ruoxi He
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Hunan, China
| | - Hanna Wu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Tao Yu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yushi Zhang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Ting Yang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
| | - Chen Wang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zhu A, Cao Y, Li C, Yu J, Liu M, Xu K, Ruan Y. Effects of major air pollutants on angina hospitalizations: a correlation study. BMC Public Health 2024; 24:1877. [PMID: 39004712 PMCID: PMC11247793 DOI: 10.1186/s12889-024-19380-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/05/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Angina is a crucial risk signal for cardiovascular disease. However, few studies have evaluated the effects of ambient air pollution exposure on angina. OBJECTIVE We aimed to explore the short-term effects of air pollution on hospitalization for angina and its lag effects. METHODS We collected data on air pollutant concentrations and angina hospitalizations from 2013 to 2020. Distributed lag nonlinear model (DLNM) was used to evaluate the short-term effects of air pollutants on angina hospitalization under different lag structures. Stratified analysis by sex, age and season was obtained. RESULTS A total of 39,110 cases of angina hospitalization were included in the study. The results showed a significant positive correlation between PM2.5, SO2, NO2, and CO and angina hospitalization. Their maximum harmful effects were observed at lag0-7 (RR = 1.042; 95% CI: 1.017, 1.068), lag0-3 (RR = 1.067; 95% CI: 1.005, 1.133), lag0-6 (RR = 1.078; 95% CI: 1.041, 1.117), and lag0-6 (RR = 1.244; 95% CI: 1.109, 1.397), respectively. PM10 did not have an overall risk effect on angina hospitalization, but it did have a risk effect on women and the elderly. O3 was significantly negatively correlated with angina hospitalization, with the most pronounced effect observed at lag0-6 (RR = 0.960; 95% CI: 0.940, 0.982). Stratified analysis results showed that women and the elderly were more susceptible to pollutants, and the adverse effects of pollutants were stronger in the cold season. CONCLUSION Short-term exposure to PM2.5, SO2, NO2, and CO increases the risk of hospitalization for angina.
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Affiliation(s)
- Anning Zhu
- School of Public Health, Lanzhou University, Lanzhou, 730000, PR China
| | - Yongqin Cao
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, 730000, PR China
| | - Chunlan Li
- Third People's Hospital of Gansu Province, Lanzhou, 730000, PR China
| | - Jingze Yu
- School of Public Health, Lanzhou University, Lanzhou, 730000, PR China
| | - Miaoxin Liu
- School of Public Health, Lanzhou University, Lanzhou, 730000, PR China
| | - Ke Xu
- School of Public Health, Lanzhou University, Lanzhou, 730000, PR China
| | - Ye Ruan
- School of Public Health, Lanzhou University, Lanzhou, 730000, PR China.
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Zhang Z, Ding Y, Guo R, Wang Q, Jia Y. Research on the cascading mechanism of "urban built environment-air pollution-respiratory diseases": a case of Wuhan city. Front Public Health 2024; 12:1333077. [PMID: 38584928 PMCID: PMC10995312 DOI: 10.3389/fpubh.2024.1333077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/04/2024] [Indexed: 04/09/2024] Open
Abstract
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.
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Affiliation(s)
- Zhiqi Zhang
- School of Architecture and Urban Planning, Huazhong University of Science and Technology, Wuhan, China
- Hubei Engineering and Technology Research Center of Urbanization, Wuhan, China
| | - Yue Ding
- School of Architecture and Urban Planning, Huazhong University of Science and Technology, Wuhan, China
- Hubei Engineering and Technology Research Center of Urbanization, Wuhan, China
| | - Ruifeng Guo
- School of Architecture and Urban Planning, Huazhong University of Science and Technology, Wuhan, China
- Hubei Engineering and Technology Research Center of Urbanization, Wuhan, China
| | - Qi Wang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanfei Jia
- School of Architecture and Urban Planning, Huazhong University of Science and Technology, Wuhan, China
- Hubei Engineering and Technology Research Center of Urbanization, Wuhan, China
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Humphrey JL, Kinnee EJ, Robinson LF, Clougherty JE. Disentangling impacts of multiple pollutants on acute cardiovascular events in New York city: A case-crossover analysis. ENVIRONMENTAL RESEARCH 2024; 242:117758. [PMID: 38029813 PMCID: PMC11378578 DOI: 10.1016/j.envres.2023.117758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/29/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Ambient air pollution contributes to an estimated 6.67 million deaths annually, and has been linked to cardiovascular disease (CVD), the leading cause of death. Short-term increases in air pollution have been associated with increased risk of CVD event, though relatively few studies have directly compared effects of multiple pollutants using fine-scale spatio-temporal data, thoroughly adjusting for co-pollutants and temperature, in an exhaustive citywide hospitals dataset, towards identifying key pollution sources within the urban environment to most reduce, and reduce disparities in, the leading cause of death worldwide. OBJECTIVES We aimed to examine multiple pollutants against multiple CVD diagnoses, across lag days, in models adjusted for co-pollutants and meteorology, and inherently adjusted by design for non-time-varying individual and aggregate-level covariates, using fine-scale space-time exposure estimates, in an exhaustive dataset of emergency department visits and hospitalizations across an entire city, thereby capturing the full population-at-risk. METHODS We used conditional logistic regression in a case-crossover design - inherently controlling for all confounders not varying within case month - to examine associations between spatio-temporal nitrogen dioxide (NO2), fine particulate matter (PM2.5), sulfur dioxide (SO2), and ozone (O3) in New York City, 2005-2011, on individual risk of acute CVD event (n = 837,523), by sub-diagnosis [ischemic heart disease (IHD), heart failure (HF), stroke, ischemic stroke, acute myocardial infarction]. RESULTS We found significant same-day associations between NO2 and risk of overall CVD, IHD, and HF - and between PM2.5 and overall CVD or HF event risk - robust to all adjustments and multiple comparisons. Results were comparable by sex and race - though median age at CVD was 10 years younger for Black New Yorkers than White New Yorkers. Associations for NO2 were comparable for adults younger or older than 69 years, though PM2.5 associations were stronger among older adults. DISCUSSION Our results indicate immediate, robust effects of combustion-related pollution on CVD risk, by sub-diagnosis. Though acute impacts differed minimally by age, sex, or race, the much younger age-at-event for Black New Yorkers calls attention to cumulative social susceptibility.
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Affiliation(s)
- Jamie L Humphrey
- Center Public Health Methods; RTI International, Research Triangle Park, NC, 27709, USA
| | - Ellen J Kinnee
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Lucy F Robinson
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - Jane E Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA.
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Weismann D, Möckel M, Paeth H, Slagman A. Modelling variations of emergency attendances using data on community mobility, climate and air pollution. Sci Rep 2023; 13:20595. [PMID: 37996460 PMCID: PMC10667222 DOI: 10.1038/s41598-023-47857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/19/2023] [Indexed: 11/25/2023] Open
Abstract
Air pollution is associated with morbidity and mortality worldwide. We investigated the impact of improved air quality during the economic lockdown during the SARS-Cov2 pandemic on emergency room (ER) admissions in Germany. Weekly aggregated clinical data from 33 hospitals were collected in 2019 and 2020. Hourly concentrations of nitrogen and sulfur dioxide (NO2, SO2), carbon and nitrogen monoxide (CO, NO), ozone (O3) and particulate matter (PM10, PM2.5) measured by ground stations and meteorological data (ERA5) were selected from a 30 km radius around the corresponding ED. Mobility was assessed using aggregated cell phone data. A linear stepwise multiple regression model was used to predict ER admissions. The average weekly emergency numbers vary from 200 to over 1600 cases (total n = 2,216,217). The mean maximum decrease in caseload was 5 standard deviations. With the enforcement of the shutdown in March, the mobility index dropped by almost 40%. Of all air pollutants, NO2 has the strongest correlation with ER visits when averaged across all departments. Using a linear stepwise multiple regression model, 63% of the variation in ER visits is explained by the mobility index, but still 6% of the variation is explained by air quality and climate change.
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Affiliation(s)
- Dirk Weismann
- Intensive Care Unit, Department of Internal Medicine I, University Hospital of Wuerzburg, University of Wuerzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany.
| | - Martin Möckel
- Departments of Emergency and Acute Medicine, Campus Mitte and Virchow-Klinikum, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Paeth
- Geographical Institute, University of Wuerzburg, Wuerzburg, Germany
| | - Anna Slagman
- Departments of Emergency and Acute Medicine, Campus Mitte and Virchow-Klinikum, Charite-Universitätsmedizin Berlin, Berlin, Germany
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Tabaghi S, Sheibani M, Khaheshi I, Miri R, Haji Aghajani M, Safi M, Eslami V, Pishgahi M, Alipour Parsa S, Namazi MH, Beyranvand MR, Sohrabifar N, Hassanian‐Moghaddam H, Pourmotahari F, Khaiat S, Akbarzadeh MA. Associations between short-term exposure to fine particulate matter and acute myocardial infarction: A case-crossover study. Clin Cardiol 2023; 46:1319-1325. [PMID: 37501642 PMCID: PMC10642339 DOI: 10.1002/clc.24111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Previous studies evaluated the impact of particle matters (PM) on the risk of acute myocardial infarction (AMI) based on local registries. HYPOTHESIS This study aimed to evaluate possible short term effect of air pollutants on occurrence of AMI based on a specific case report sheet that was designed for this purpose. METHODS AMI was documented among 982 patients who referred to the emergency departments in Tehran, Iran, between July 2017 to March 2019. For each patient, case period was defined as 24 hour period preceding the time of emergency admission and referent periods were defined as the corresponding time in 1, 2, and 3 weeks before the admission. The associations of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2 .5 ) and particulate matter with an aerodynamic diameter ≤10 μm (PM10 ) with AMI were analyzed using conditional logistic regression in a case-crossover design. RESULT Increase in PM2.5 and PM10 was significantly associated with the occurrence of AMI with and without adjustment for the temperature and humidity. In the adjusted model each 10 μg/m3 increase of PM10 and PM2.5 in case periods was significantly associated with increase myocardial infarction events (95% CI = 1.041-1.099, OR = 1.069 and 95% CI = 1.073-1.196, and OR = 1.133, respectively). Subgroup analysis showed that increase in PM10 did not increase AMI events in diabetic subgroup, but in all other subgroups PM10 and PM2 .5 concentration showed positive associations with increased AMI events. CONCLUSION Acute exposure to ambient air pollution was associated with increased risk of AMI irrespective of temperature and humidity.
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Affiliation(s)
- Shiva Tabaghi
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Mehdi Sheibani
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Isa Khaheshi
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Reza Miri
- Prevention of Cardiovascular Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Haji Aghajani
- Prevention of Cardiovascular Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Morteza Safi
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Vahid Eslami
- Department of CardiologyShahid Labbafinejad Hospital, Shahid Beheshti University of Medical SciencesTehranIran
| | - Mehdi Pishgahi
- Department of CardiologyShohada‐e Tajrish Hospital, Shahid Beheshti University of Medical SciencesTehranIran
| | - Saeed Alipour Parsa
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | | | - Mohammad Reza Beyranvand
- Department of CardiologyTaleghani Hospital, Shahid Beheshti University of Medical SciencesTehranIran
| | - Nasim Sohrabifar
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | | | - Fatemeh Pourmotahari
- Department of Community MedicineSchool of Medicine, Dezful University of Medical SciencesDezfulIran
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Ross BA, Doiron D, Benedetti A, Aaron SD, Chapman K, Hernandez P, Maltais F, Marciniuk D, O'Donnell DE, Sin DD, Walker BL, Tan W, Bourbeau J. Short-term air pollution exposure and exacerbation events in mild to moderate COPD: a case-crossover study within the CanCOLD cohort. Thorax 2023; 78:974-982. [PMID: 37147124 DOI: 10.1136/thorax-2022-219619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/05/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Infections are considered as leading causes of acute exacerbations of chronic obstructive pulmonary disease (COPD). Non-infectious risk factors such as short-term air pollution exposure may play a clinically important role. We sought to estimate the relationship between short-term air pollutant exposure and exacerbations in Canadian adults living with mild to moderate COPD. METHODS In this case-crossover study, exacerbations ('symptom based': ≥48 hours of dyspnoea/sputum volume/purulence; 'event based': 'symptom based' plus requiring antibiotics/corticosteroids or healthcare use) were collected prospectively from 449 participants with spirometry-confirmed COPD within the Canadian Cohort Obstructive Lung Disease. Daily nitrogen dioxide (NO2), fine particulate matter (PM2.5), ground-level ozone (O3), composite of NO2 and O3 (Ox), mean temperature and relative humidity estimates were obtained from national databases. Time-stratified sampling of hazard and control periods on day '0' (day-of-event) and Lags ('-1' to '-6') were compared by fitting generalised estimating equation models. All data were dichotomised into 'warm' (May-October) and 'cool' (November-April) seasons. ORs and 95% CIs were estimated per IQR increase in pollutant concentrations. RESULTS Increased warm season ambient concentration of NO2 was associated with symptom-based exacerbations on Lag-3 (1.14 (1.01 to 1.29), per IQR), and increased cool season ambient PM2.5 was associated with symptom-based exacerbations on Lag-1 (1.11 (1.03 to 1.20), per IQR). There was a negative association between warm season ambient O3 and symptom-based events on Lag-3 (0.73 (0.52 to 1.00), per IQR). CONCLUSIONS Short-term ambient NO2 and PM2.5 exposure were associated with increased odds of exacerbations in Canadians with mild to moderate COPD, further heightening the awareness of non-infectious triggers of COPD exacerbations.
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Affiliation(s)
- Bryan A Ross
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Dany Doiron
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kenneth Chapman
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Paul Hernandez
- Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - François Maltais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Darcy Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Wan Tan
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Medicine, McGill University Health Centre, Montreal, Québec, Canada
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9
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Heft-Neal S, Gould CF, Childs ML, Kiang MV, Nadeau KC, Duggan M, Bendavid E, Burke M. Emergency department visits respond nonlinearly to wildfire smoke. Proc Natl Acad Sci U S A 2023; 120:e2302409120. [PMID: 37722035 PMCID: PMC10523589 DOI: 10.1073/pnas.2302409120] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/28/2023] [Indexed: 09/20/2023] Open
Abstract
Air pollution negatively affects a range of health outcomes. Wildfire smoke is an increasingly important contributor to air pollution, yet wildfire smoke events are highly salient and could induce behavioral responses that alter health impacts. We combine geolocated data covering all emergency department (ED) visits to nonfederal hospitals in California from 2006 to 2017 with spatially resolved estimates of daily wildfire smoke PM[Formula: see text] concentrations and quantify how smoke events affect ED visits. Total ED visits respond nonlinearly to smoke concentrations. Relative to a day with no smoke, total visits increase by 1 to 1.5% in the week following low or moderate smoke days but decline by 6 to 9% following extreme smoke days. Reductions persist for at least a month. Declines at extreme levels are driven by diagnoses not thought to be acutely impacted by pollution, including accidental injuries and several nonurgent symptoms, and declines come disproportionately from less-insured populations. In contrast, health outcomes with the strongest physiological link to short-term air pollution increase dramatically in the week following an extreme smoke day: We estimate that ED visits for asthma, COPD, and cough all increase by 30 to 110%. Data from internet searches, vehicle traffic sensors, and park visits indicate behavioral changes on high smoke days consistent with declines in healthcare utilization. Because low and moderate smoke days vastly outweigh high smoke days, we estimate that smoke was responsible for an average of 3,010 (95% CI: 1,760-4,380) additional ED visits per year 2006 to 2017. Given the increasing intensity of wildfire smoke events, behavioral mediation is likely to play a growing role in determining total smoke impacts.
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Affiliation(s)
- Sam Heft-Neal
- Center on Food Security and the Environment, Stanford University, Stanford, CA94305
| | - Carlos F. Gould
- Doerr School of Sustainability, Stanford University, Stanford, CA94305
| | | | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA94305
| | - Kari C. Nadeau
- Department of Environmental Health, Harvard University, Cambridge, MA02138
| | - Mark Duggan
- Department of Economics, Stanford University, Stanford, CA94305
- Stanford Institute of Economic Policy Research, Stanford University, Stanford, CA94305
- National Bureau of Economic Research, Cambridge, MA02138
| | - Eran Bendavid
- Department of Health Policy, Stanford University, Stanford, CA94305
- Department of Medicine, Stanford University, Stanford, CA94305
| | - Marshall Burke
- Center on Food Security and the Environment, Stanford University, Stanford, CA94305
- Doerr School of Sustainability, Stanford University, Stanford, CA94305
- National Bureau of Economic Research, Cambridge, MA02138
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10
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Jia Y, Lin Z, He Z, Li C, Zhang Y, Wang J, Liu F, Li J, Huang K, Cao J, Gong X, Lu X, Chen S. Effect of Air Pollution on Heart Failure: Systematic Review and Meta-Analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:76001. [PMID: 37399145 PMCID: PMC10317211 DOI: 10.1289/ehp11506] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 02/15/2023] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Heart failure (HF) poses a significant global disease burden. The current evidence on the impact of air pollution on HF remains inconsistent. OBJECTIVES We aimed to conduct a systematic review of the literature and meta-analysis to provide a more comprehensive and multiperspective assessment of the associations between short- and long-term air pollution exposure and HF from epidemiological evidences. METHODS Three databases were searched up to 31 August 2022 for studies investigating the association between air pollutants (PM 2.5 , PM 10 , NO 2 , SO 2 , CO, O 3 ) and HF hospitalization, incidence, or mortality. A random effects model was used to derive the risk estimations. Subgroup analysis was conducted by geographical location, age of participants, outcome, study design, covered area, the methods of exposure assessment, and the length of exposure window. Sensitivity analysis and adjustment for publication bias were performed to test the robustness of the results. RESULTS Of 100 studies covering 20 countries worldwide, 81 were for short-term and 19 were for long-term exposure. Almost all air pollutants were adversely associated with the risk of HF in both short- and long-term exposure studies. For short-term exposures, we found the risk of HF increased by 1.8% [relative risk ( RR ) = 1.018 , 95% confidence interval (CI): 1.011, 1.025] and 1.6% (RR = 1.016 , 95% CI: 1.011, 1.020) per 10 - μ g / m 3 increment of PM 2.5 and PM 10 , respectively. HF was also significantly associated with NO 2 , SO 2 , and CO, but not O 3 . Positive associations were stronger when exposure was considered over the previous 2 d (lag 0-1) rather than on the day of exposure only (lag 0). For long-term exposures, there were significant associations between several air pollutants and HF with RR (95% CI) of 1.748 (1.112, 2.747) per 10 - μ g / m 3 increment in PM 2.5 , 1.212 (1.010, 1.454) per 10 - μ g / m 3 increment in PM 10 , and 1.204 (1.069, 1.356) per 10 -ppb increment in NO 2 , respectively. The adverse associations of most pollutants with HF were greater in low- and middle-income countries than in high-income countries. Sensitivity analysis demonstrated the robustness of our results. DISCUSSION Available evidence highlighted adverse associations between air pollution and HF regardless of short- and long-term exposure. Air pollution is still a prevalent public health issue globally and sustained policies and actions are called for to reduce the burden of HF. https://doi.org/10.1289/EHP11506.
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Affiliation(s)
- Yanhui Jia
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Zhennan Lin
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Zhi He
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Chenyang Li
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Youjing Zhang
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Jingyu Wang
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Fangchao Liu
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Jianxin Li
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Keyong Huang
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Jie Cao
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Xinyuan Gong
- Department of Science and Education, Tianjin First Central Hospital, Tianjin, China
| | - Xiangfeng Lu
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Shufeng Chen
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
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11
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Vishram-Nielsen JK, Mueller B, Ross HJ, Fan CP, Rubin B, Alba AC, Manlhiot C. Association Between the Incidence of Hospitalizations for Acute Cardiovascular Events, Weather, and Air Pollution. JACC. ADVANCES 2023; 2:100334. [PMID: 38938234 PMCID: PMC11198195 DOI: 10.1016/j.jacadv.2023.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 06/29/2024]
Abstract
Background The incidence of hospitalizations for cardiovascular events has been associated with specific weather conditions and air pollution. A comprehensive model including the interactions between various environmental factors remains to be developed. Objectives The purpose of this study was to develop a comprehensive model of the association between weather patterns and the incidence of cardiovascular events and use this model to forecast near-term spatiotemporal risk. Methods We present a spatiotemporal analysis of the association between atmospheric data and the incidence rate of hospital admissions related to heart failure (922,132 episodes), myocardial infarction (521,988 episodes), and ischemic stroke (263,529 episodes) in ∼24 million people in Canada between 2007 and 2017. Our hierarchical Bayesian model captured the spatiotemporal distribution of hospitalizations and identified weather and air pollution-related factors that could partially explain fluctuations in incidence. Results Models that included weather and air pollution variables outperformed models without those covariates for most event types. Our results suggest that environmental factors may interact in complex ways on human physiology. The impact of environmental factors was magnified with increasing age. The weather and air pollution variables included in our models were predictive of the future incidence of heart failure, myocardial infarction, and ischemic strokes. Conclusions The increasing importance of environmental factors on cardiovascular events with increasing age raises the need for the development of educational materials for older patients to recognize environmental conditions where exacerbations are more likely. This model could be the basis of a forecasting system used for local, short-term clinical resource planning based on the anticipated incidence of events.
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Affiliation(s)
- Julie K.K. Vishram-Nielsen
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Brigitte Mueller
- Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Heather J. Ross
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Chun-Po Fan
- Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Barry Rubin
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Ana Carolina Alba
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Cedric Manlhiot
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, John Hopkins University School of Medicine, Baltimore, Maryland, USA
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12
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Song J, Qiu W, Huang X, Guo Y, Chen W, Wang D, Zhang X. Association of ambient carbon monoxide exposure with hospitalization risk for respiratory diseases: A time series study in Ganzhou, China. Front Public Health 2023; 11:1106336. [PMID: 36866098 PMCID: PMC9972102 DOI: 10.3389/fpubh.2023.1106336] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Background Ambient carbon monoxide (CO) exposure is associated with increased mortality and hospitalization risk for total respiratory diseases. However, evidence on the risk of hospitalization for specific respiratory diseases from ambient CO exposure is limited. Methods Data on daily hospitalizations for respiratory diseases, air pollutants, and meteorological factors from January 2016 to December 2020 were collected in Ganzhou, China. A generalized additive model with the quasi-Poisson link and lag structures was used to estimate the associations between ambient CO concentration and hospitalizations of total respiratory diseases, asthma, chronic obstructive pulmonary disease (COPD), upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), and influenza-pneumonia. Possible confounding co-pollutants and effect modification by gender, age, and season were considered. Results A total of 72,430 hospitalized cases of respiratory diseases were recorded. Significant positive exposure-response relationships were observed between ambient CO exposure and hospitalization risk from respiratory diseases. For each 1 mg/m3 increase in CO concentration (lag0-2), hospitalizations for total respiratory diseases, asthma, COPD, LRTI, and influenza-pneumonia increased by 13.56 (95% CI: 6.76%, 20.79%), 17.74 (95% CI: 1.34%, 36.8%), 12.45 (95% CI: 2.91%, 22.87%), 41.25 (95% CI: 18.19%, 68.81%), and 13.5% (95% CI: 3.41%, 24.56%), respectively. In addition, the associations of ambient CO with hospitalizations for total respiratory diseases and influenza-pneumonia were stronger during the warm season, while women were more susceptible to ambient CO exposure-associated hospitalizations for asthma and LRTI (all P < 0.05). Conclusion In brief, significant positive exposure-response relationships were found between ambient CO exposure and hospitalization risk for total respiratory diseases, asthma, COPD, LRTI, and influenza-pneumonia. Effect modification by season and gender was found in ambient CO exposure-associated respiratory hospitalizations.
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Affiliation(s)
- Jiahao Song
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weihong Qiu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuezan Huang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - You Guo
- First Affiliated Hospital, Gannan Medical University, Ganzhou, China,Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, China,School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Weihong Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dongming Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,*Correspondence: Dongming Wang ✉
| | - Xiaokang Zhang
- First Affiliated Hospital, Gannan Medical University, Ganzhou, China,Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, China,School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China,Xiaokang Zhang ✉
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13
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Yang YS, Pei YH, Gu YY, Zhu JF, Yu P, Chen XH. Association between short-term exposure to ambient air pollution and heart failure: An updated systematic review and meta-analysis of more than 7 million participants. Front Public Health 2023; 10:948765. [PMID: 36755739 PMCID: PMC9900180 DOI: 10.3389/fpubh.2022.948765] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/29/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Exposure to air pollution has been linked to the mortality of heart failure. In this study, we sought to update the existing systematic review and meta-analysis, published in 2013, to further assess the association between air pollution and acute decompensated heart failure, including hospitalization and heart failure mortality. Methods PubMed, Web of Science, EMBASE, and OVID databases were systematically searched till April 2022. We enrolled the studies regarding air pollution exposure and heart failure and extracted the original data to combine and obtain an overall risk estimate for each pollutant. Results We analyzed 51 studies and 7,555,442 patients. Our results indicated that heart failure hospitalization or death was associated with increases in carbon monoxide (3.46% per 1 part per million; 95% CI 1.0233-1.046, P < 0.001), sulfur dioxide (2.20% per 10 parts per billion; 95% CI 1.0106-1.0335, P < 0.001), nitrogen dioxide (2.07% per 10 parts per billion; 95% CI 1.0106-1.0335, P < 0.001), and ozone (0.95% per 10 parts per billion; 95% CI 1.0024-1.0166, P < 0.001) concentrations. Increases in particulate matter concentration were related to heart failure hospitalization or death (PM2.5 1.29% per 10 μg/m3, 95% CI 1.0093-1.0165, P < 0.001; PM10 1.30% per 10 μg/m3, 95% CI 1.0102-1.0157, P < 0.001). Conclusion The increase in the concentration of all pollutants, including gases (carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone) and particulate matter [(PM2.5), (PM10)], is positively correlated with hospitalization rates and mortality of heart failure. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021256241.
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Affiliation(s)
- Yu-shan Yang
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China,Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Ying-hao Pei
- Department of Intensive Care Unit, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuan-yuan Gu
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China,Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jun-feng Zhu
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China,Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Peng Yu
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,*Correspondence: Peng Yu ✉
| | - Xiao-hu Chen
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China,Xiao-hu Chen ✉
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14
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Short-term associations between ambient air pollution and emergency department visits for Alzheimer's disease and related dementias. ENVIRONMENTAL EPIDEMIOLOGY (PHILADELPHIA, PA.) 2022; 7:e237. [PMID: 36777523 PMCID: PMC9915954 DOI: 10.1097/ee9.0000000000000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022]
Abstract
Dementia is a seriously disabling illness with substantial economic and social burdens. Alzheimer's disease and its related dementias (AD/ADRD) constitute about two-thirds of dementias. AD/ADRD patients have a high prevalence of comorbid conditions that are known to be exacerbated by exposure to ambient air pollution. Existing studies mostly focused on the long-term association between air pollution and AD/ADRD morbidity, while very few have investigated short-term associations. This study aims to estimate short-term associations between AD/ADRD emergency department (ED) visits and three common air pollutants: fine particulate matter (PM2.5), nitrogen dioxide (NO2), and warm-season ozone. Methods For the period 2005 to 2015, we analyzed over 7.5 million AD/ADRD ED visits in five US states (California, Missouri, North Carolina, New Jersey, and New York) using a time-stratified case-crossover design with conditional logistic regression. Daily estimated PM2.5, NO2, and warm-season ozone concentrations at 1 km spatial resolution were aggregated to the ZIP code level as exposure. Results The most consistent positive association was found for NO2. Across five states, a 17.1 ppb increase in NO2 concentration over a 4-day period was associated with a 0.61% (95% confidence interval = 0.27%, 0.95%) increase in AD/ADRD ED visits. For PM2.5, a positive association with AD/ADRD ED visits was found only in New York (0.64%, 95% confidence interval = 0.26%, 1.01% per 6.3 µg/m3). Associations with warm-season ozone levels were null. Conclusions Our results suggest AD/ADRD patients are vulnerable to short-term health effects of ambient air pollution and strategies to lower exposure may reduce morbidity.
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Chandia-Poblete D, Cole-Hunter T, Haswell M, Heesch KC. The influence of air pollution exposure on the short- and long-term health benefits associated with active mobility: A systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 850:157978. [PMID: 35964755 DOI: 10.1016/j.scitotenv.2022.157978] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Active mobility (AM), defined as walking and cycling for transportation, can improve health through increasing regular physical activity. However, these health improvements could be outweighed by harm from inhaling traffic-related air pollutants during AM participation. The interaction of AM and air pollutants on health is complex physiologically, manifesting as acute changes in health indicators that may lead to poor long-term health consequences. The aim of this study was to systematically review the current evidence of effect modification by air pollution (AP) on associations between AM and health indicators. Studies were included if they examined associations between AM and health indicators being modified by AP or, conversely, associations between AP and health indicators being modified by AM. Thirty-three studies met eligibility criteria. The main AP indicators studied were particulate matter, ultrafine particles, and nitrogen oxides. Most health indicators studied were grouped into cardiovascular and respiratory indicators. There is evidence of a reduction by AP, mainly ultrafine particles and PM2.5, in the short-term health benefits of AM. Multiple studies suggest that long-term health benefits of AM are not negatively associated with levels of the single traffic-related pollutant NO2. However, other studies reveal reduced long-term health benefits of AM in areas affected by high levels of pollutant mixtures. We recommend that future studies adopt consistent and rigorous study designs and include reporting of interaction testing, to advance understanding of the complex relationships between AM, AP, and health indicators.
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Affiliation(s)
- Damian Chandia-Poblete
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland 4059, Australia.
| | - Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark.
| | - Melissa Haswell
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland 4059, Australia; Office of the Deputy Vice Chancellor (Indigenous Strategy and Services) and School of Geosciences, Faculty of Science, University of Sydney, Australia.
| | - Kristiann C Heesch
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland 4059, Australia.
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Han CH, Pak H, Lee JM, Chung JH. : Short-term effects of exposure to particulate matter on hospital admissions for asthma and chronic obstructive pulmonary disease. Medicine (Baltimore) 2022; 101:e30165. [PMID: 36107568 PMCID: PMC9439629 DOI: 10.1097/md.0000000000030165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We investigated the effects of particulate matter (PM) factors on hospitalization rates for asthma and chronic obstructive pulmonary disease (COPD). We obtained data on pollutants-PM10, PM2.5-in Seoul, South Korea. We also investigated data for asthma and COPD exacerbation that required hospitalization from 2006 to 2016. We used a time-stratified case-crossover design and generalized additive models with log transformation to assess adjusted risk, and conditional logistic regression was performed to analyze these data. Our study showed that PM10 and PM2.5, on different best lag days, were associated with increased risks of COPD or asthma hospitalization. The odds ratios (ORs) for each per-unit increase in PM10 and PM2.5 were higher in patients with male asthma (PM10: OR, 1.012; 95% confidence interval [CI], 1.008-1.016 and PM2.5: OR, 1.015; 95% CI, 1008-1.023), preschool asthma (PM10: OR, 1.015; 95% CI, 1.006-1.015 and PM2.5: OR, 1.015; 95% CI, 1.009-1.024), male COPD (PM10: OR, 1.012; 95% CI, 1.005-1.019 and PM2.5: OR, 1.013; 95% CI, 1.000-1.026), and senior COPD (PM10: OR, 1.016; 95% CI, 1.008-1.024 and PM2.5: OR, 1.022; 95% CI, 1.007-1.036). Increasing PM levels increased hospitalizations for asthma and COPD. Additionally, the consequences may be different according to age and sex, and PM2.5 may have a more significant effect on airway disease patients than PM10.
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Affiliation(s)
- Chang Hoon Han
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Haeyong Pak
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jung Mo Lee
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jae Ho Chung
- Department of Internal Medicine, International St. Mary`s Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
- *Correspondence: Jae Ho Chung, Department of Internal Medicine, International St. Mary`s Hospital, 22711 Simgokro 100Gil 25 Seo-gu Incheon, Republic of Korea (e-mail: )
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17
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Siegel EL, Ghassabian A, Hipwell AE, Factor-Litvak P, Zhu Y, Steinthal HG, Focella C, Battaglia L, Porucznik CA, Collingwood SC, Klein-Fedyshin M, Kahn LG. Indoor and outdoor air pollution and couple fecundability: a systematic review. Hum Reprod Update 2022; 29:45-70. [PMID: 35894871 PMCID: PMC9825271 DOI: 10.1093/humupd/dmac029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 05/27/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Air pollution is both a sensory blight and a threat to human health. Inhaled environmental pollutants can be naturally occurring or human-made, and include traffic-related air pollution (TRAP), ozone, particulate matter (PM) and volatile organic compounds, among other substances, including those from secondhand smoking. Studies of air pollution on reproductive and endocrine systems have reported associations of TRAP, secondhand smoke (SHS), organic solvents and biomass fueled-cooking with adverse birth outcomes. While some evidence suggests that air pollution contributes to infertility, the extant literature is mixed, and varying effects of pollutants have been reported. OBJECTIVE AND RATIONALE Although some reviews have studied the association between common outdoor air pollutants and time to pregnancy (TTP), there are no comprehensive reviews that also include exposure to indoor inhaled pollutants, such as airborne occupational toxicants and SHS. The current systematic review summarizes the strength of evidence for associations of outdoor air pollution, SHS and indoor inhaled air pollution with couple fecundability and identifies gaps and limitations in the literature to inform policy decisions and future research. SEARCH METHODS We performed an electronic search of six databases for original research articles in English published since 1990 on TTP or fecundability and a number of chemicals in the context of air pollution, inhalation and aerosolization. Standardized forms for screening, data extraction and study quality were developed using DistillerSR software and completed in duplicate. We used the Newcastle-Ottawa Scale to assess risk of bias and devised additional quality metrics based on specific methodological features of both air pollution and fecundability studies. OUTCOMES The search returned 5200 articles, 4994 of which were excluded at the level of title and abstract screening. After full-text screening, 35 papers remained for data extraction and synthesis. An additional 3 papers were identified independently that fit criteria, and 5 papers involving multiple routes of exposure were removed, yielding 33 articles from 28 studies for analysis. There were 8 papers that examined outdoor air quality, while 6 papers examined SHS exposure and 19 papers examined indoor air quality. The results indicated an association between outdoor air pollution and reduced fecundability, including TRAP and specifically nitrogen oxides and PM with a diameter of ≤2.5 µm, as well as exposure to SHS and formaldehyde. However, exposure windows differed greatly between studies as did the method of exposure assessment. There was little evidence that exposure to volatile solvents is associated with reduced fecundability. WIDER IMPLICATIONS The evidence suggests that exposure to outdoor air pollutants, SHS and some occupational inhaled pollutants may reduce fecundability. Future studies of SHS should use indoor air monitors and biomarkers to improve exposure assessment. Air monitors that capture real-time exposure can provide valuable insight about the role of indoor air pollution and are helpful in assessing the short-term acute effects of pollutants on TTP.
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Affiliation(s)
- Eva L Siegel
- Columbia University, Mailman School of Public Health, New York, NY, USA
| | | | - Alison E Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pam Factor-Litvak
- Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Carolina Focella
- New York University Grossman School of Medicine, New York, NY, USA
| | - Lindsey Battaglia
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | - Linda G Kahn
- Correspondence address. E-mail: https://orcid.org/0000-0002-6512-6160
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18
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Miao Y, Porter WC, Schwabe K, LeComte-Hinely J. Evaluating health outcome metrics and their connections to air pollution and vulnerability in Southern California's Coachella Valley. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 821:153255. [PMID: 35066029 DOI: 10.1016/j.scitotenv.2022.153255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
The ongoing desiccation of California's Salton Sea has led to increasing concerns about air quality and health for its surrounding communities, including the nearby Coachella Valley - a region already experiencing severe air quality and health disparities. Here we explore spatial air pollution and human health disparities in the Coachella Valley with particular attention to disparities arising across population characteristics including both socioeconomic and demographic vulnerabilities. We use two different measures of respiratory and cardiovascular health outcomes at the individual and census tract levels - one measure based on a randomly sampled telephone survey and the other measure based on emergency room visitation data - to investigate the degree to which these health outcomes are connected to air pollution and socioeconomic metrics. We further investigate biases and differences between the health outcome metrics themselves and suggest opportunities to address them in future analyses and survey efforts. We find that more vulnerable communities are associated with higher levels of fine particulates, but lower levels of ozone. While emergency visit rates show a significant positive correlation with both pollutants, no such association is found when using surveyed health outcome data. The ratio of emergency visits versus survey rates shows a positive relationship with socioeconomic and demographic vulnerability, indicating that vulnerable communities are less likely to self-report diagnoses despite higher rates of respiratory or cardiovascular hospitalization. Additionally, survey respondents tend to show less vulnerability relative to their surrounding census-based demographics. These findings suggest the need for greater attention to health issues specifically within disadvantaged communities in the Coachella Valley, building upon and working within existing community networks and local resources, to better address current and projected health needs. Our findings also highlight disparities in air pollution exposure, health outcomes, and population characteristics in the Coachella Valley, providing context for crucial pollution reduction efforts in the face of increasing environmental threats.
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Affiliation(s)
- Yaning Miao
- Department of Environmental Science, University of California, Riverside, CA 92521, USA
| | - William C Porter
- Department of Environmental Science, University of California, Riverside, CA 92521, USA.
| | - Kurt Schwabe
- School of Public Policy, University of California, Riverside, CA 92521, USA
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19
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Sousa AC, Pastorinho MR, Masjedi MR, Urrutia-Pereira M, Arrais M, Nunes E, To T, Ferreira AJ, Robalo-Cordeiro C, Borrego C, Teixeira JP, Taborda-Barata L. Issue 1 - "Update on adverse respiratory effects of outdoor air pollution" Part 2): Outdoor air pollution and respiratory diseases: Perspectives from Angola, Brazil, Canada, Iran, Mozambique and Portugal. Pulmonology 2022; 28:376-395. [PMID: 35568650 DOI: 10.1016/j.pulmoe.2021.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To analyse the GARD perspective on the health effects of outdoor air pollution, and to synthesise the Portuguese epidemiological contribution to knowledge on its respiratory impact. RESULTS Ambient air pollution has deleterious respiratory effects which are more apparent in larger, densely populated and industrialised countries, such as Canada, Iran, Brazil and Portugal, but it also affects people living in low-level exposure areas. While low- and middle-income countries (LMICs), are particularly affected, evidence based on epidemiological studies from LMICs is both limited and heterogeneous. While nationally, Portugal has a relatively low level of air pollution, many major cities face with substantial air pollution problems. Time series and cross-sectional epidemiological studies have suggested increased respiratory hospital admissions, and increased risk of respiratory diseases in people who live in urban areas and are exposed to even a relatively low level of air pollution. CONCLUSIONS Adverse respiratory effects due to air pollution, even at low levels, have been confirmed by epidemiological studies. However, evidence from LMICs is heterogeneous and relatively limited. Furthermore, longitudinal cohort studies designed to study and quantify the link between exposure to air pollutants and respiratory diseases are needed. Worldwide, an integrated approach must involve multi-level stakeholders including governments (in Portugal, the Portuguese Ministry of Health, which hosts GARD-Portugal), academia, health professionals, scientific societies, patient associations and the community at large. Such an approach not only will garner a robust commitment, establish strong advocacy and clear objectives, and raise greater awareness, it will also support a strategy with adequate measures to be implemented to achieve better air quality and reduce the burden of chronic respiratory diseases (CRDs).
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Affiliation(s)
- A C Sousa
- Comprehensive Health Research Centre (CHRC) and Department of Biology, University of Évora, Pólo da Mitra, Apartado 94, Évora 7002-554, Portugal; NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D. Henrique, Covilhã 6200-506, Portugal
| | - M R Pastorinho
- NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D. Henrique, Covilhã 6200-506, Portugal; Comprehensive Health Research Centre (CHRC), Department of Medical and Health Sciences, University of Évora, Colégio Luís António Verney, Rua Romão Ramalho, 59, Évora 7000-671, Portugal
| | - M R Masjedi
- Department of Pulmonary Medicine, Shahid Beheshti University of Medical Sciences, 7th Floor, Bldg n 2, SBUMS, Arabi Avenue, Daneshjoo Boulevard, Velenjak, Tehran 19839-63113, Iran
| | - M Urrutia-Pereira
- Universidade Federal do Pampa, BR 472 - Km 585, Caixa Postal 118, Uruguaiana (RS) CEP 97501-970, Brazil
| | - M Arrais
- Department of Pulmonology, Military Hospital, Rua 17 de Setembro, 27/29, Cidade Alta, Luanda, Angola; Centro de Investigação em Saúde de Angola - CISA, Caxito, Bengo, Angola
| | - E Nunes
- Department of Pulmonology, Central Hospital of Maputo, Agostinho Neto, 64, Maputo 1100, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Avenida Dr. Salvador Allende, Caixa Postal 257, Maputo, Mozambique
| | - T To
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5G 1 × 8, Canada
| | - A J Ferreira
- Department of Pulmonology, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra 3004-561, Portugal; Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, Coimbra 3000-548, Portugal
| | - C Robalo-Cordeiro
- Department of Pulmonology, Centro Hospitalar Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra 3004-561, Portugal; Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, Coimbra 3000-548, Portugal
| | - C Borrego
- CESAM & Department of Environment and Planning, University of Aveiro, Aveiro 3810-193, Portugal; IDAD - Instituto do Ambiente e Desenvolvimento, Campus Universitário de Santiago, Aveiro 3810-193, Portugal
| | - J P Teixeira
- EPIUnit - Instituto de Saúde Pública, University of Porto, Rua das Taipas, 135, Porto 4050-091, Portugal; Department of Environmental Health, Portuguese National Institute of Health, Rua Alexandre Herculano, 321, Porto 4000-055, Portugal
| | - L Taborda-Barata
- NuESA-Health and Environment Study Unit, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D. Henrique, Covilhã 6200-506, Portugal; UBIAir-Clinical & Experimental Lung Centre, UBIMedical, University of Beira Interior, EM506 Covilhã 6200-000, Portugal; CICS-Health Sciences Research Centre, University of Beira Interior, Avenida Infante D. Henrique, Covilhã 6200-506, Portugal.
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20
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PM2.5 Exposure and Asthma Development: The Key Role of Oxidative Stress. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:3618806. [PMID: 35419163 PMCID: PMC9001082 DOI: 10.1155/2022/3618806] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/24/2022] [Indexed: 12/21/2022]
Abstract
Oxidative stress is defined as the imbalance between reactive oxygen species (ROS) production and the endogenous antioxidant defense system, leading to cellular damage. Asthma is a common chronic inflammatory airway disease. The presence of asthma tends to increase the production of reactive oxygen species (ROS), and the antioxidant system in the lungs is insufficient to mitigate it. Therefore, asthma can lead to an exacerbation of airway hyperresponsiveness and airway inflammation. PM2.5 exposure increases ROS levels. Meanwhile, the accumulation of ROS will further enhance the oxidative stress response, resulting in DNA, protein, lipid, and other cellular and molecular damage, leading to respiratory diseases. An in-depth study on the relationship between oxidative stress and PM2.5-related asthma is helpful to understand the pathogenesis and progression of the disease and provides a new direction for the treatment of the disease. This paper reviews the research progress of oxidative stress in PM2.5-induced asthma as well as highlights the therapeutic potentials of antioxidant approaches in treatment of asthma.
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21
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Silva Rodriguez ME, Silveyra P. Air Pollution Exposure as a Relevant Risk Factor for Chronic Obstructive Pulmonary Disease Exacerbations in Male and Female Patients. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/21-00228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a multifactorial lung inflammatory disease that affects 174 million people worldwide, with a recently reported increased incidence in female patients. Patients with COPD are especially vulnerable to the detrimental effects of environmental exposures, especially from air particulate and gaseous pollutants; exposure to air pollution severely influences COPD outcomes, resulting in acute exacerbations, hospitalisations, and death. Here, a literature review of the recent work addressing air pollution-induced acute exacerbations of COPD (AECOPD) was conducted in order to determine whether sex was considered as a biological variable in these studies, and whether air pollution exposure affected patients with COPD in a sex-specific manner. It was found that, while the majority of studies enrolled both male and female patients, only a few reported results were disaggregated by sex. Most studies had a higher enrolment of male patients, only four compared AECOPD outcomes between sexes, and only one study identified sex differences in AECOPD, with females displaying higher rates. Overall, this analysis of the literature confirmed that air pollution exposure is a trigger for AECOPD hospitalisations and revealed a significant gap in the knowledge of sex-specific effects of air pollutants on COPD outcomes, highlighting the need for more studies to consider sex as a biological variable.
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Affiliation(s)
| | - Patricia Silveyra
- School of Public Health, Indiana University Bloomington, Indiana, USA
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22
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Review of Ground-Level Ozone Impact in Respiratory Health Deterioration for the Past Two Decades. ATMOSPHERE 2022. [DOI: 10.3390/atmos13030434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Ground-level ozone has been gaining notoriety with increasing evidence of its nefarious effects on health, especially respiratory diseases. Where do we stand on the solidity of this data and is there room for improvement? Objectives: Evaluate this evidence for incongruities or heterogeneity in this field of research. How is the exposure assessment conducted, where does Portugal stand in this field, and what can be improved? Health deterioration concerning asthma, chronic obstructive pulmonary disease (COPD), and acute respiratory distress syndrome (ARDS) are analysed. Methods: A review of 1735 studies was conducted through PubMed and Google Scholar engines for the past two decades. We identified 59 eligible studies and included an array of variables, including O3 measurements, number of air-quality monitoring stations used, relative risks, odds ratios, hazard ratios, number of hospital admissions, visits, or mortality, and size of population dataset used. Results: Approximately 83% of data in this review presents significant correlations of ozone with asthma, COPD, and ARDS. Studies that report negative or not significant associations mention a lack of data or topographic differences as the main issue with these divergent results. Studies consistently report summer as a period of particular concern. Portuguese data in this field is lacking. Conclusions: This research field is growing in interest and there is evidence that ozone plays a non-negligible role in health deterioration. The few Portuguese studies in this field seem aligned with the literature reviewed but more research is needed. Suggested improvements are more and better data through denser air-quality networks to accurately depict personal exposure to ozone. Homogenization of the exposure assessment concerning averaging times of ozone to daily maximum 8 h averages whenever possible. Risk increments based on 10 ppb instead of interquartile ranges. Lastly, contrary to some studies in this review, the topographic effect on concentrations and health deterioration should not be underestimated and seasonality should always be checked.
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23
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Jin JQ, Han D, Tian Q, Chen ZY, Ye YS, Lin QX, Ou CQ, Li L. Individual exposure to ambient PM 2.5 and hospital admissions for COPD in 110 hospitals: a case-crossover study in Guangzhou, China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:11699-11706. [PMID: 34545525 PMCID: PMC8794997 DOI: 10.1007/s11356-021-16539-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/10/2021] [Indexed: 05/22/2023]
Abstract
Few studies have evaluated the short-term association between hospital admissions and individual exposure to ambient particulate matter (PM2.5). Particularly, no studies focused on hospital admissions for chronic obstructive pulmonary disease (COPD) at the individual level. We assessed the short-term effects of PM2.5 on hospitalization admissions for COPD in Guangzhou, China, during 2014-2015, based on satellite-derived estimates of ambient PM2.5 concentrations at a 1-km resolution near the residential address as individual-level exposure for each patient. Around 40,002 patients with COPD admitted to 110 hospitals were included in this study. A time-stratified case-crossover design with conditional logistic regression models was applied to assess the effects of PM2.5 based on a 1-km grid data of aerosol optical depth provided by the National Aeronautics and Space Administration on hospital admissions for COPD. Further, we performed stratified analyses by individual demographic characteristics and season of hospital admission. Around 10 μg/m3 increase in individual-level PM2.5 was associated with an increase of 1.6% (95% confidence interval [CI]: 0.6%, 2.7%) in hospitalization for COPD at a lag of 0-5 days. The impact of PM2.5 on hospitalization for COPD was greater significantly in males and patients admitted in summer. Our study strengthened the evidence for the adverse effect of PM2.5 based on satellite-based individual-level exposure data.
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Affiliation(s)
- Jie-Qi Jin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Dong Han
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Qi Tian
- Guangzhou Health Technology Identification & Human Resources Assessment Center, Guangzhou, 510080, China
| | - Zhao-Yue Chen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Yun-Shao Ye
- Guangzhou Health Technology Identification & Human Resources Assessment Center, Guangzhou, 510080, China
| | - Qiao-Xuan Lin
- Guangzhou Health Technology Identification & Human Resources Assessment Center, Guangzhou, 510080, China
| | - Chun-Quan Ou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Li Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
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24
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Desperak P, Desperak A, Szyguła-Jurkiewicz B, Rozentryt P, Lekston A, Gąsior M. The Impact of Short-Term Outdoor Air Pollution on Clinical Status and Prognosis of Hospitalized Patients with Coronary Artery Disease Treated with Percutaneous Coronary Intervention. J Clin Med 2022; 11:484. [PMID: 35159936 PMCID: PMC8836379 DOI: 10.3390/jcm11030484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the influence of acute exposure to air pollutants on patients' profile, short- and mid-term outcomes of hospitalized patients with coronary artery disease (CAD) treated with coronary angioplasty. METHODS Out of 19,582 patients of the TERCET Registry, 7521 patients living in the Upper Silesia and Zaglebie Metropolis were included. The study population was divided into two groups according to the diagnosis of chronic (CCS) or acute coronary syndromes (ACS). Data on 24-h average concentrations of particulate matter with aerodynamic diameter <10 μm (PM10), sulfur dioxide (SO2), nitrogen monoxide (NO), nitrogen dioxide (NO2), and ozone (O3) were obtained from eight environmental monitoring stations. RESULTS No significant association between pollutants' concentration with baseline characteristic and in-hospital outcomes was observed. In the ACS group at 30 days, exceeding the 3rd quartile of PM10 was associated with almost 2-fold increased risk of adverse events and more than 3-fold increased risk of death. Exceeding the 3rd quartile of SO2 was connected with more than 8-fold increased risk of death at 30 days. In the CCS group, exceeding the 3rd quartile of SO2 was linked to almost 2,5-fold increased risk of 12-month death. CONCLUSIONS The acute increase in air pollutants' concentrations affect short- and mid-term prognosis in patients with CAD.
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Affiliation(s)
- Piotr Desperak
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-752 Katowice, Poland; (A.D.); (B.S.-J.); (P.R.); (A.L.); (M.G.)
| | - Aneta Desperak
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-752 Katowice, Poland; (A.D.); (B.S.-J.); (P.R.); (A.L.); (M.G.)
| | - Bożena Szyguła-Jurkiewicz
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-752 Katowice, Poland; (A.D.); (B.S.-J.); (P.R.); (A.L.); (M.G.)
| | - Piotr Rozentryt
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-752 Katowice, Poland; (A.D.); (B.S.-J.); (P.R.); (A.L.); (M.G.)
- Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, 41-902 Bytom, Poland
| | - Andrzej Lekston
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-752 Katowice, Poland; (A.D.); (B.S.-J.); (P.R.); (A.L.); (M.G.)
| | - Mariusz Gąsior
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-752 Katowice, Poland; (A.D.); (B.S.-J.); (P.R.); (A.L.); (M.G.)
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25
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Huang J, Yang X, Fan F, Hu Y, Wang X, Zhu S, Ren G, Wang G. Outdoor air pollution and the risk of asthma exacerbations in single lag0 and lag1 exposure patterns: a systematic review and meta-analysis. J Asthma 2021; 59:2322-2339. [PMID: 34809505 DOI: 10.1080/02770903.2021.2008429] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: To synthesize evidence regarding the relationship between outdoor air pollution and risk of asthma exacerbations in single lag0 and lag1 exposure patterns.Methods: We performed a systematic literature search using PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials, China National Knowledge Internet, Chinese BioMedical, and Wanfang databases. Articles published until August 1, 2020 and the reference lists of the relevant articles were reviewed. Two authors independently evaluated the eligible articles and performed structured extraction of the relevant information. Pooled relative risks (RRs) and 95% confidence intervals (CIs) of lag0 and lag1 exposure patterns were estimated using random-effect models.Results: Eighty-four studies met the eligibility criteria and provided sufficient information for meta-analysis. Outdoor air pollutants were associated with increased risk of asthma exacerbations in both single lag0 and lag1 exposure patterns [lag0: RR (95% CI) (pollutants), 1.057(1.011, 1.103) (air quality index, AQI), 1.007 (1.005, 1.010) (particulate matter of diameter ≤ 2.5 μm, PM2.5), 1.009 (1.005, 1.012) (particulate matter of diameter, PM10), 1.010 (1.006, 1.014) (NO2), 1.030 (1.011, 1.048) (CO), 1.005 (1.002, 1.009) (O3); lag1:1.064(1.022, 1.106) (AQI), 1.005 (1.002, 1.008) (PM2.5), 1.007 (1.004, 1.011) (PM10), 1.008 (1.004, 1.012) (NO2), 1.025 (1.007, 1.042) (CO), 1.010 (1.006, 1.013) (O3)], except SO2 [lag0: RR (95% CI), 1.004 (1.000, 1.007); lag1: RR (95% CI), 1.003 (0.999, 1.006)]. Subgroup analyses revealed stronger effects in children and asthma exacerbations associated with other events (including symptoms, lung function changes, and medication use).Conclusion: Outdoor air pollution increases the asthma exacerbation risk in single lag0 and lag1 exposure patterns.Trial registration: PROSPERO, CRD42020204097. https://www.crd.york.ac.uk/.Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2021.2008429 .
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Affiliation(s)
- Junjun Huang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Xiaoyu Yang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yan Hu
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Xi Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Sainan Zhu
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Guanhua Ren
- Department of Library, Peking University First Hospital, Beijing, China
| | - Guangfa Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
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Xu W, Liu X, Huang Z, Du Y, Zhang B, Wang Q, Xiang J, Zou Y, Ma L. Acute Effects of Air Pollution on Ischemic Heart Disease Hospitalizations: A Population-Based Time-Series Study in Wuhan, China, 2017-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12527. [PMID: 34886253 PMCID: PMC8656788 DOI: 10.3390/ijerph182312527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/19/2022]
Abstract
Evidence of the acute effects of air pollutants on ischemic heart disease (IHD) hospitalizations based on the entire population of a megacity in central China is lacking. All IHD hospitalization records from 2017 to 2018 were obtained from the Wuhan Information Center of Health and Family Planning. Daily air pollutant concentrations and meteorological data were synchronously collected from the Wuhan Environmental Protection Bureau. A time-series study using generalized additive models was conducted to systematically examine the associations between air pollutants and IHD hospitalizations. Stratified analyses by gender, age, season, hypertension, diabetes, and hyperlipidemia were performed. In total, 139,616 IHD hospitalizations were included. Short-term exposure to air pollutants was positively associated with IHD hospitalizations. The age group ≥76 was at higher exposure risk, and the associations appeared to be more evident in cold seasons. PM2.5 and PM10 appeared to have greater effects on males and those without hypertension or diabetes, whereas NO2 and SO2 had greater effects on females and those with hypertension or diabetes. The risk of IHD hospitalization due to air pollutants was greater in people without hyperlipidemia. Our study provides new evidence of the effects of air pollution on the increased incidence of IHD in central China.
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Affiliation(s)
- Wanglin Xu
- School of Public Health, Wuhan University, Wuhan 430071, China; (W.X.); (Z.H.); (Y.D.); (B.Z.); (Q.W.); (J.X.)
| | - Xingyuan Liu
- Information Center of Health and Family Planning, Wuhan 430021, China;
| | - Zenghui Huang
- School of Public Health, Wuhan University, Wuhan 430071, China; (W.X.); (Z.H.); (Y.D.); (B.Z.); (Q.W.); (J.X.)
| | - Yating Du
- School of Public Health, Wuhan University, Wuhan 430071, China; (W.X.); (Z.H.); (Y.D.); (B.Z.); (Q.W.); (J.X.)
| | - Biao Zhang
- School of Public Health, Wuhan University, Wuhan 430071, China; (W.X.); (Z.H.); (Y.D.); (B.Z.); (Q.W.); (J.X.)
| | - Qiaomai Wang
- School of Public Health, Wuhan University, Wuhan 430071, China; (W.X.); (Z.H.); (Y.D.); (B.Z.); (Q.W.); (J.X.)
| | - Jing Xiang
- School of Public Health, Wuhan University, Wuhan 430071, China; (W.X.); (Z.H.); (Y.D.); (B.Z.); (Q.W.); (J.X.)
| | - Yuliang Zou
- School of Public Health, Wuhan University, Wuhan 430071, China; (W.X.); (Z.H.); (Y.D.); (B.Z.); (Q.W.); (J.X.)
| | - Lu Ma
- School of Public Health, Wuhan University, Wuhan 430071, China; (W.X.); (Z.H.); (Y.D.); (B.Z.); (Q.W.); (J.X.)
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Leili M, Nadali A, Karami M, Bahrami A, Afkhami A. Short-term effect of multi-pollutant air quality indexes and PM 2.5 on cardiovascular hospitalization in Hamadan, Iran: a time-series analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:53653-53667. [PMID: 34036506 DOI: 10.1007/s11356-021-14386-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
Air pollutants are the most important environmental factors that contributed to cardiovascular disease (CVD). The present study aimed to investigate the number of hospitalization due to heart failure (HF) and myocardial infarction (MI) following the air pollutant exposure using a time-series regression analysis with a distributed lag model in Hamadan, Iran (2015-2019). A total of 2091 cases of CVD were registered. Based on the findings, the highest health effects on HF hospitalization were observed with air quality health index (AQHI) at lag 9 (RR = 1.043, 95% CI 0.991-1.098), and air quality index (AQI) at lags 2, 7, and 9 (RR = 1.001, 95% CI 0.998-1.002), for an increase in 1 unit of the indexes, and with PM2.5 at lag 0 (RR = 1.001, 95% CI 0.996-1.004) for 10 μg/m3 increase in PM2.5 levels. The highest health effects on MI hospitalization were calculated with AQHI at lag 10 (RR = 1.059, 95% CI 1.001-1.121) and AQI at lags 1 and 2 (RR = 1.001, 95% CI 0.998-1.002), for an increase in 1 unit of the indexes, and with PM2.5 at lag 8 (RR = 1.002, 95% CI 0.997-1.005) for 10 μg/m3 increase in PM2.5 levels. According to a seasonal classification, results showed that hospitalization in the warm season was higher than that of the cold season. Based on our knowledge, the current study is the first study that investigated the effect of air quality indexes on hospitalization due to HF and MI in Iran. Findings can provide basic information to plan preventive measures for reducing exposure chance and hospitalization rate in high-risk people.
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Affiliation(s)
- Mostafa Leili
- Department of Environmental Health Engineering, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Azam Nadali
- Department of Environmental Health Engineering, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Manoochehr Karami
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abdolrahman Bahrami
- Department of Occupational Health, Faculty of Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Afkhami
- Faculty of Chemistry, Bu-Ali Sina University, Fahmideh Av, Hamadan, 65174, Iran
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Szyszkowicz M, de Angelis N. Ambient air pollution and emergency department visits in Toronto, Canada. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:28789-28796. [PMID: 33548039 PMCID: PMC8164616 DOI: 10.1007/s11356-021-12519-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/13/2021] [Indexed: 05/31/2023]
Abstract
To investigate the acute impact of various air pollutants on various disease groups in the urban area of the city of Toronto, Canada. Statistical models were developed to estimate the relative risk of an emergency department visit associated with ambient air pollution concentration levels. These models were generated for 8 air pollutants (lagged from 0 to 14 days) and for 18 strata (based on sex, age group, and season). Twelve disease groups extracted from the International Classification of Diseases 10th Revision (ICD-10) were used as health classifications in the models. The qualitative results were collected in matrices composed of 18 rows (strata) and 15 columns (lags) for each air pollutant and the 12 health classifications. The matrix cells were assigned a value of 1 if the association was positively statistically significant; otherwise, they were assigned to a value of 0. The constructed matrices were totalized separately for each air pollutant. The resulting matrices show qualitative associations for grouped diseases, air pollutants, and their corresponding lagged concentrations and indicate the frequency of statistically significant positive associations. The results are presented in colour-gradient matrices with the number of associations for every combination of patient strata, pollutant, and lag in corresponding cells. The highest number of the associations was 8 (of 12 possible) obtained for the same day exposure to carbon monoxide, nitrogen dioxide, and days with elevated air quality health index (AQHI) values. For carbon monoxide, the number of the associations decreases with the increasing lags. For this air pollutant, there were almost no associations after 8 days of lag. In the case of nitrogen dioxide, the associations persist even for longer lags. The numerical values obtained from the models are provided for every pollutant. The constructed matrices are a useful tool to analyze the impact of ambient air pollution concentrations on public health.
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Affiliation(s)
| | - Nicholas de Angelis
- Biomedical Program, Department of Mechanical and Aerospace Engineering, Carleton University, Ottawa, Canada
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Huang YT, Chen CC, Ho YN, Tsai MT, Tsai CM, Chuang PC, Cheng FJ. Short-Term Effects of Particulate Matter and Its Constituents on Emergency Room Visits for Chronic Obstructive Pulmonary Disease: A Time-Stratified Case-Crossover Study in an Urban Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094400. [PMID: 33919089 PMCID: PMC8122505 DOI: 10.3390/ijerph18094400] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/25/2022]
Abstract
Background: PM2.5 exposure is associated with pulmonary and airway inflammation, and the health impact might vary by PM2.5 constitutes. This study evaluated the effects of increased short-term exposure to PM2.5 constituents on chronic obstructive pulmonary disease (COPD)-related emergency department (ED) visits and determined the susceptible groups. Methods: This retrospective observational study performed in a medical center from 2007 to 2010, and enrolled non-trauma patients aged >20 years who visited the emergency department (ED) and were diagnosed as COPD. Concentrations of PM2.5, PM10, and the four PM2.5 components, including organic carbon (OC), elemental carbon (EC), nitrate (NO3−), and sulfate (SO42−), were collected by three PM supersites in Kaohsiung City. We used an alternative design of the Poisson time series regression models called a time-stratified and case-crossover design to analyze the data. Results: Per interquartile range (IQR) increment in PM2.5 level on lag 2 were associated with increments of 6.6% (95% confidence interval (CI), 0.5–13.0%) in risk of COPD exacerbation. An IQR increase in elemental carbon (EC) was significantly associated with an increment of 3.0% (95% CI, 0.1–5.9%) in risk of COPD exacerbation on lag 0. Meanwhile, an IQR increase in sulfate, nitrate, and OC levels was not significantly associated with COPD. Patients were more sensitive to the harmful effects of EC on COPD during the warm season (interaction p = 0.019). The risk of COPD exacerbation after exposure to PM2.5 was higher in individuals who are currently smoking, with malignancy, or during cold season, but the differences did not achieve statistical significance. Conclusion: PM2.5 and EC may play an important role in COPD events in Kaohsiung, Taiwan. Patients were more susceptible to the adverse effects of EC on COPD on warm days.
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Affiliation(s)
- Yii-Ting Huang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (Y.-T.H.); (C.-C.C.); (Y.-N.H.); (M.-T.T.); (P.-C.C.)
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
| | - Chien-Chih Chen
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (Y.-T.H.); (C.-C.C.); (Y.-N.H.); (M.-T.T.); (P.-C.C.)
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
| | - Yu-Ni Ho
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (Y.-T.H.); (C.-C.C.); (Y.-N.H.); (M.-T.T.); (P.-C.C.)
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
| | - Ming-Ta Tsai
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (Y.-T.H.); (C.-C.C.); (Y.-N.H.); (M.-T.T.); (P.-C.C.)
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
| | - Chih-Min Tsai
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan
| | - Po-Chun Chuang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (Y.-T.H.); (C.-C.C.); (Y.-N.H.); (M.-T.T.); (P.-C.C.)
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan; (Y.-T.H.); (C.-C.C.); (Y.-N.H.); (M.-T.T.); (P.-C.C.)
- College of Medicine, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
- Correspondence:
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Baek JO, Cho J, Roh JY. Associations between ambient air pollution and medical care visits for atopic dermatitis. ENVIRONMENTAL RESEARCH 2021; 195:110153. [PMID: 32926890 DOI: 10.1016/j.envres.2020.110153] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 05/22/2023]
Abstract
BACKGROUND Previous studies have reported numerous environmental factors for atopic dermatitis (AD), such as allergens and chemical stimulants. However, few studies have addressed the relationship between ambient air pollution and AD at a population level. OBJECTIVE To evaluate the effect of air pollutants on medical care visits for AD and to identify susceptible populations. METHODS In this time-series study conducted on 513,870 medical care visits for AD from 2012 to 2015 identified by reviewing national health insurance claim data in Incheon, Republic of Korea. Treating daily number of medical care visits for AD as a dependent variable, generalized additive models with Poisson distributions were constructed, which included air pollutant levels, ambient temperature, relative humidity, day of the week, national holiday, and season. Risks were expressed as relative risks (RR) with 95% confidence intervals (95% CIs) per interquartile range increase of each air pollutant. RESULTS Higher levels of particulate matter of diameter ≤10 μm (PM10) (RR, 1.009; 95% CI, 1.007-1.012), ozone (1.028; 1.023-1.033), and sulfur dioxide (1.033; 1.030-1.037) were significantly associated with increased risk of medical care visits for AD on same days. In all age and sex groups, ozone was associated with a significantly higher risk of medical care visits, with the greatest risk among 13- to 18-year-old males (RR, 1.127; 95% CI, 1.095-1.159). CONCLUSION This study suggests relationships of ambient PM10, ozone, and sulfur dioxide levels with medical care visits for AD.
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Affiliation(s)
- Jin-Ok Baek
- Department of Dermatology, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Jaelim Cho
- Department of Dermatology, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
| | - Joo-Young Roh
- Department of Dermatology, Gil Medical Center, Gachon University, Incheon, Republic of Korea.
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31
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Wang H, Lu F, Guo M, Fan W, Ji W, Dong Z. Associations between PM 1 exposure and daily emergency department visits in 19 hospitals, Beijing. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 755:142507. [PMID: 33032134 DOI: 10.1016/j.scitotenv.2020.142507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 05/06/2023]
Abstract
Although the adverse health effects caused by PM2.5 (particulate matter (PM) with an aerodynamic diameter <2.5 μm) and PM10 (PM with an aerodynamic diameter <10 μm) have been examined in numeric studies, far less scientific evidence is available for PM with an aerodynamic diameter <1 μm (PM1). We performed a time series analysis to elucidate the associations between PM1 exposure and emergency department visits (EDVs) in 19 hospitals within Beijing. During the study period from January 2016 to December 2017, the average PM1 (mean ± standard deviation) was determined to be 39 ± 39 μg/m3, which was approximately 36% lower than that of 61 ± 56 μg/m3 for PM2.5. Results based on meta-analysis suggest that non-accidental and respiratory EDVs increased by 0.47% (95% confidence interval, CI: 0.35, 0.59%) and 0.59% (95%CI: 0.38, 0.8%) per 10 μg/m3 uptick in PM1 exposure. By comparison, the magnitude downgraded to 0.27% (95%CI: 0.15, 0.39%) in non-accidental and 0.32% (95%CI: 0.18, 0.47%) in respiratory EDVs for PM2.5 exposure, indicating that PMs of a smaller size may be a higher risk factor for EDVs. No significant differences in PM-associated EDV effects were noted between males and females, while stratified analysis by age and season illustrated that stronger effects were found for a warm season and young population. Our analysis reinforces the notion that PM1 exhibited a higher risk for EDVs, suggesting more efforts may be required to mitigate PM1 pollution.
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Affiliation(s)
- Hao Wang
- School of Space and Environment, Beihang University, Beijing 100191, China
| | - Feng Lu
- Beijing Municipal Health Commission Information Center, Beijing 100034, China
| | - Moning Guo
- Beijing Municipal Health Commission Information Center, Beijing 100034, China
| | - Wenhong Fan
- School of Space and Environment, Beihang University, Beijing 100191, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing 100191, China
| | - Wei Ji
- State Environmental Protection Key Laboratory of Regional Eco-process and Function Assessment, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Zhaomin Dong
- School of Space and Environment, Beihang University, Beijing 100191, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing 100191, China.
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Yoo S, Kim DW, Kim YE, Park JH, Kim YY, Cho KD, Gwon MJ, Shin JI, Lee EJ. Data resource profile: the allergic disease database of the Korean National Health Insurance Service. Epidemiol Health 2021; 43:e2021010. [PMID: 33494129 PMCID: PMC8060521 DOI: 10.4178/epih.e2021010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/20/2021] [Indexed: 11/30/2022] Open
Abstract
Researchers have been interested in probing how the environmental factors associated with allergic diseases affect the use of medical services. Considering this demand, we have constructed a database, named the Allergic Disease Database, based on the National Health Insurance Database (NHID). The NHID contains information on demographic and medical service utilization for approximately 99% of the Korean population. This study targeted 3 major allergic diseases, including allergic rhinitis, atopic dermatitis, and asthma. For the target diseases, our database provides daily medical service information, including the number of daily visits from 2013 and 2017, categorized by patients’ characteristics such as address, sex, age, and duration of residence. We provide additional information, including yearly population, a number of patients, and averaged geocoding coordinates by eup, myeon, and dong district code (the smallest-scale administrative units in Korea). This information enables researchers to analyze how daily changes in the environmental factors of allergic diseases (e.g., particulate matter, sulfur dioxide, and ozone) in certain regions would influence patients’ behavioral patterns of medical service utilization. Moreover, researchers can analyze long-term trends in allergic diseases and the health effects caused by environmental factors such as daily climate and pollution data. The advantages of this database are easy access to data, additional levels of geographic detail, time-efficient data-refining and processing, and a de-identification process that minimizes the exposure of identifiable personal information. All datasets included in the Allergic Disease Database can be downloaded by accessing the National Health Insurance Service data sharing webpage (https://nhiss.nhis.or.kr).
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Affiliation(s)
- Sunyong Yoo
- Big Data Department, National Health Insurance Service, Wonju, Korea.,Department of ICT Convergence System Engineering, Chonnam National University, Gwangju, Korea
| | - Dong-Wook Kim
- Big Data Department, National Health Insurance Service, Wonju, Korea
| | - Young-Eun Kim
- Big Data Department, National Health Insurance Service, Wonju, Korea
| | - Jong Heon Park
- Department of Benefits Strategy, National Health Insurance Service, Wonju, Korea
| | - Yeon-Yong Kim
- Big Data Department, National Health Insurance Service, Wonju, Korea
| | - Kyu-Dong Cho
- Big Data Department, National Health Insurance Service, Wonju, Korea
| | - Mi-Ji Gwon
- Chungbuk National University Hospital, Cheongju, Korea
| | - Jae-In Shin
- Big Data Department, National Health Insurance Service, Wonju, Korea
| | - Eun-Joo Lee
- Big Data Department, National Health Insurance Service, Wonju, Korea
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Cascetta E, Henke I, Di Francesco L. The Effects of Air Pollution, Sea Exposure and Altitude on COVID-19 Hospitalization Rates in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E452. [PMID: 33430024 PMCID: PMC7828064 DOI: 10.3390/ijerph18020452] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 02/06/2023]
Abstract
Early known cases of COVID-19 emerged in late 2019 in the city of Wuhan (China) and in a relatively short time, it has reached more than 200 countries up to July 2020. In Italy, from 21 February 2020, (first official Italian positive case of COVID-19) until 27 July 2020, 246,286 confirmed cases were observed of which over 68,150 (28%) needed hospitalization and 35,112 died. In recent scientific research, it has been shown that the severity of symptoms and mortality rates were different not only among the various countries of the world but also in different regions of the same country. This research investigates whether and by how much air environmental conditions (such as exposure to fine particulate matter-PM2.5, sea air masses and altitude) influences the risk of hospitalization due to COVID-19 in Italy, once the spreading of the virus and the percentage of the elderly in the population have been accounted for. A log-linear multiple regression model was estimated where the log of the ratio of hospitalized patients per inhabitant, since the beginning of the epidemic up to July 27, has been considered as a dependent variable. Among the independent variables, the ones that have been taken into account are the spreading of the virus, the rate of people over 50 years of age, the concentration of PM2.5, the rate of population living by the sea, the rate of green public space for each resident and the ratio of population living at a high altitude. The results showed an increase in the hospitalization rate in terms of the percentage of people over 50 and the average concentration of PM2.5. If average limits of PM2.5 concentration allowed by the current European regulations (25 µg/m3) were respected in all Italian provinces, that would have led to 7339 less hospitalizations for COVID-19 (-11%). On the contrary, near the coast there were lower hospitalized cases in the referred period. In the hypothetical case that no Italians lived near the sea, about 1363 (+2%) more hospitalizations would have been recorded in the analysis period in addition to the effect of a lower PM concentration. This paper wanted to investigate which are the areas with a higher risk of hospitalization in Italy, so as to help the Italian Government to strengthen Health System measures, predicting the most suffering areas and health care systems. According to the results, this is directly related to the severity of symptoms which decreased with the long-time exposure to the sea.
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Affiliation(s)
- Ennio Cascetta
- Department of Civil, Construction and Environmental Engineering, University of Naples “Federico II”, 80125 Napoli, Italy;
| | - Ilaria Henke
- Department of Civil, Construction and Environmental Engineering, University of Naples “Federico II”, 80125 Napoli, Italy;
| | - Luigi Di Francesco
- Department of Engineering, University of Campania “Luigi Vanvitelli”, 81031 Aversa, Italy;
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Harnessing the Four Horsemen of Climate Change: A Framework for Deep Resilience, Decarbonization, and Planetary Health in Ontario, Canada. SUSTAINABILITY 2021. [DOI: 10.3390/su13010379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Widespread implementation of nature-based solutions like green infrastructure, provides a multi-functional strategy to increase climate resilience, enhance ecological connectivity, create healthier communities, and support sustainable urban development. This paper presents a decision-support framework to facilitate adoption of green infrastructure within communities using the Climate Change Local Adaptation Action Model (CCLAAM) developed for this purpose. It also presents an ecosystems-based approach to bridging the gap between climate change mitigation and adaptation actions in Ontario, Canada. Green infrastructure could be a viable strategy to address multiple climate change impacts and support the implementation of the UN Sustainable Development Goals (SDGs).
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An Optimal Stacked Ensemble Deep Learning Model for Predicting Time-Series Data Using a Genetic Algorithm—An Application for Aerosol Particle Number Concentrations. COMPUTERS 2020. [DOI: 10.3390/computers9040089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Time-series prediction is an important area that inspires numerous research disciplines for various applications, including air quality databases. Developing a robust and accurate model for time-series data becomes a challenging task, because it involves training different models and optimization. In this paper, we proposed and tested three machine learning techniques—recurrent neural networks (RNN), heuristic algorithm and ensemble learning—to develop a predictive model for estimating atmospheric particle number concentrations in the form of a time-series database. Here, the RNN included three variants—Long-Short Term Memory, Gated Recurrent Network, and Bi-directional Recurrent Neural Network—with various configurations. A Genetic Algorithm (GA) was then used to find the optimal time-lag in order to enhance the model’s performance. The optimized models were used to construct a stacked ensemble model as well as to perform the final prediction. The results demonstrated that the time-lag value can be optimized by using the heuristic algorithm; consequently, this improved the model prediction accuracy. Further improvement can be achieved by using ensemble learning that combines several models for better performance and more accurate predictions.
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Wang M, Chen J, Zhang Z, Yu P, Gan W, Tan Z, Bao J. Associations between air pollution and outpatient visits for arrhythmia in Hangzhou, China. BMC Public Health 2020; 20:1524. [PMID: 33032561 PMCID: PMC7542945 DOI: 10.1186/s12889-020-09628-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/29/2020] [Indexed: 11/27/2022] Open
Abstract
Background Arrhythmia is a common cardiovascular event that is associated with increased cardiovascular health risks. Previous studies that have explored the association between air pollution and arrhythmia have obtained inconsistent results, and the association between the two in China is unclear. Methods We collected daily data on air pollutants and meteorological factors from 1st January 2014 to 31st December 2016, along with daily outpatient visits for arrhythmia in Hangzhou, China. We used a quasi-Poisson regression along with a distributed lag nonlinear model to study the association between air pollution and arrhythmia morbidity. Results The results of the single-pollutant model showed that each increase of 10 μg/m3 of Fine particulate matter (PM2.5), Coarse particulate matter (PM10), Sulphur dioxide (SO2), Nitrogen dioxide (NO2), and Ozone (O3) resulted in increases of 0.6% (− 0.9, 2.2%), 0.7% (− 0.4, 1.7%), 11.9% (4.5, 19.9%), 6.7% (3.6, 9.9%), and − 0.9% (− 2.9, 1.2%), respectively, in outpatient visits for arrhythmia; each increase of 1 mg/m3 increase of carbon monoxide (CO) resulted in increase of 11.3% (− 5.9, 31.6%) in arrhythmia. The short-term effects of air pollution on arrhythmia lasted 3 days, and the most harmful effects were observed on the same day that the pollution occurred. Results of the subgroup analyses showed that SO2 and NO2 affected both men and women, but differences between the sexes were not statistically significant. The effect of SO2 on the middle-aged population was statistically significant. The effect of NO2 was significant in both the young and middle-aged population, and no significant difference was found between them. Significant effects of air pollution on arrhythmia were only detected in the cold season. The results of the two-pollutants model and the single-pollutant model were similar. Conclusions SO2 and NO2 may induce arrhythmia, and the harmful effects are primarily observed in the cold season. There is no evidence of PM2.5, PM10, CO and O3 increasing arrhythmia risk. Special attention should be given to sensitive populations during the high-risk period.
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Affiliation(s)
- Mingwei Wang
- Department of Cardiology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Juan Chen
- Department of Cardiology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Zhi Zhang
- Department of Cardiology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Ping Yu
- Department of Cardiology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Wentao Gan
- Department of Cardiology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Zhaoming Tan
- Nanjing Municipal Human Resources and Social Security Bureau, Nanjing, China
| | - Junzhe Bao
- College of Public Health, Zhengzhou University, Zhengzhou, China.
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Lee KK, Spath N, Miller MR, Mills NL, Shah ASV. Short-term exposure to carbon monoxide and myocardial infarction: A systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2020; 143:105901. [PMID: 32634667 DOI: 10.1016/j.envint.2020.105901] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND Previous studies suggest an association between short-term exposure to carbon monoxide and myocardial infarction. We performed a systematic review and meta-analysis to assess current evidence on this association to support the update of the World Health Organization (WHO) Global Air Quality Guidelines. METHODS We searched Medline, Embase and Cochrane Central Register of Controlled Trials to update the evidence published in a previous systematic review up to 30th September 2018 for studies investigating the association between short-term exposure to ambient carbon monoxide (up to lag of seven days) and emergency department visits or hospital admissions and mortality due to myocardial infarction. Two reviewers assessed potentially eligible studies and performed data extraction independently. Random-effects meta-analysis was used to derive the pooled risk estimate per 1 mg/m3 increase in ambient carbon monoxide concentration. Risk of bias in individual studies was assessed using a domain-based assessment tool. The overall certainty of the body of evidence was evaluated using an adapted certainty of evidence assessment framework. RESULTS We evaluated 1,038 articles from the previous review and our updated literature search, of which, 26 satisfied our inclusion criteria. Overall, myocardial infarction was associated with exposure to ambient carbon monoxide concentration (risk ratio of 1.052, 95% confidence interval 1.017-1.089 per 1 mg/m3 increase). A third of studies were assessed to be at high risk of bias (RoB) due to inadequate adjustment for confounding. Using an adaptation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, the overall evidence was assessed to be of moderate certainty. CONCLUSIONS This review demonstrated that the pooled risk ratio for myocardial infarction was 1.052 (95% CI 1.017-1.089) per 1 mg/m3 increase in ambient carbon monoxide concentration. However, very few studies originated from low- and middle-income countries.
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Affiliation(s)
- Kuan Ken Lee
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Nicholas Spath
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Mark R Miller
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom
| | - Anoop S V Shah
- BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom.
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Chang Q, Liu S, Chen Z, Zu B, Zhang H. Association between air pollutants and outpatient and emergency hospital visits for childhood asthma in Shenyang city of China. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:1539-1548. [PMID: 32388688 DOI: 10.1007/s00484-020-01934-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
Effects of air pollution on asthma vary in different study areas, and long-term time series research on the effects of air pollution on asthma outpatients and emergency hospital visits has not been conducted in Northeast China. We assessed the impact of air pollutants on the risk of asthma outpatients and emergency hospital visits in Shenyang, China. A distributed lag non-linear model with a Poisson regression was used to assess the short-term effects of air pollutants on asthma outpatient and emergency hospital visits between January 1, 2013 and December 31, 2017. Confounding factors were adjusted using natural cubic splines. Ozone (O3), carbon monoxide (CO), and suspended particulates < 10 μm in aerodynamic diameter (PM10) were positively associated with the number of asthma hospital visits. The largest cumulative effects of O3, CO, and PM10 on hospital visits were on lag day 2 (RR = 1.163, 95% CI 1.051-1.287) for 0-5-year-old childhood asthma, on lag day 3 (RR = 1.386, 95% CI 1.136-1.69) for asthma in winter, and on lag day 10 (RR = 1.148, 95% CI 0.942-1.399) for female asthma, respectively. The cumulative effect of air pollution represented by the air quality index (AQI) was largest on lag day 10 for 0-5-year-old childhood asthma with an increase of 28.6% (95% CI 6.5-55.4) hospital visits every IQR increment of the AQI. CO, O3, and PM10 were the main air pollutants in Shenyang city. Children with bronchitis asthma were more vulnerable to air pollution during the cold season.
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Affiliation(s)
- Qing Chang
- Clinical Research Center, Shengjing Hospital of China Medical University, Huaxiang Road, No. 39, Tiexi District, Shenyang, China
| | - Shu Liu
- Department of Atmospheric Environment Monitoring Office, Environmental Monitoring Experiment Center of Liaoning Province, Shuang Road, No. 30 A3, Hunnan District, Shenyang, China
| | - Zongjiao Chen
- Department of Atmospheric Environment Monitoring Office, Environmental Monitoring Experiment Center of Liaoning Province, Shuang Road, No. 30 A3, Hunnan District, Shenyang, China
| | - Biao Zu
- Department of Atmospheric Environment Monitoring Office, Environmental Monitoring Experiment Center of Liaoning Province, Shuang Road, No. 30 A3, Hunnan District, Shenyang, China
| | - Hehua Zhang
- Clinical Research Center, Shengjing Hospital of China Medical University, Huaxiang Road, No. 39, Tiexi District, Shenyang, China.
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Stieb DM, Zheng C, Salama D, BerjawI R, Emode M, Hocking R, Lyrette N, Matz C, Lavigne E, Shin HH. Systematic review and meta-analysis of case-crossover and time-series studies of short term outdoor nitrogen dioxide exposure and ischemic heart disease morbidity. Environ Health 2020; 19:47. [PMID: 32357902 PMCID: PMC7195719 DOI: 10.1186/s12940-020-00601-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/20/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Nitrogen dioxide (NO2) is a pervasive urban pollutant originating primarily from vehicle emissions. Ischemic heart disease (IHD) is associated with a considerable public health burden worldwide, but whether NO2 exposure is causally related to IHD morbidity remains in question. Our objective was to determine whether short term exposure to outdoor NO2 is causally associated with IHD-related morbidity based on a synthesis of findings from case-crossover and time-series studies. METHODS MEDLINE, Embase, CENTRAL, Global Health and Toxline databases were searched using terms developed by a librarian. Screening, data extraction and risk of bias assessment were completed independently by two reviewers. Conflicts between reviewers were resolved through consensus and/or involvement of a third reviewer. Pooling of results across studies was conducted using random effects models, heterogeneity among included studies was assessed using Cochran's Q and I2 measures, and sources of heterogeneity were evaluated using meta-regression. Sensitivity of pooled estimates to individual studies was examined using Leave One Out analysis and publication bias was evaluated using Funnel plots, Begg's and Egger's tests, and trim and fill. RESULTS Thirty-eight case-crossover studies and 48 time-series studies were included in our analysis. NO2 was significantly associated with IHD morbidity (pooled odds ratio from case-crossover studies: 1.074 95% CI 1.052-1.097; pooled relative risk from time-series studies: 1.022 95% CI 1.016-1.029 per 10 ppb). Pooled estimates for case-crossover studies from Europe and North America were significantly lower than for studies conducted elsewhere. The high degree of heterogeneity among studies was only partially accounted for in meta-regression. There was evidence of publication bias, particularly for case-crossover studies. For both case-crossover and time-series studies, pooled estimates based on multi-pollutant models were smaller than those from single pollutant models, and those based on older populations were larger than those based on younger populations, but these differences were not statistically significant. CONCLUSIONS We concluded that there is a likely causal relationship between short term NO2 exposure and IHD-related morbidity, but important uncertainties remain, particularly related to the contribution of co-pollutants or other concomitant exposures, and the lack of supporting evidence from toxicological and controlled human studies.
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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, Ottawa, Canada
| | - Carine Zheng
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Dina Salama
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Rania BerjawI
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Monica Emode
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Robyn Hocking
- Learning, Knowledge and Library Services, Health Canada, Ottawa, Canada
| | - Ninon Lyrette
- Water and Air Quality Bureau, Health, Canada, Ottawa, Canada
| | - Carlyn Matz
- Water and Air Quality Bureau, Health, Canada, Ottawa, Canada
| | - Eric Lavigne
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Water and Air Quality Bureau, Health, Canada, Ottawa, Canada
| | - Hwashin H. Shin
- Environmental Health Science and Research Bureau, Health Canada, 420-757 West Hastings St. - Federal Tower, Vancouver, BC V6C 1A1 Canada
- Department of Mathematics and Statistics, Queen’s University, Kingston, Canada
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Zhang Y, Fang J, Mao F, Ding Z, Xiang Q, Wang W. Age- and season-specific effects of ambient particles (PM 1, PM 2.5, and PM 10) on daily emergency department visits among two Chinese metropolitan populations. CHEMOSPHERE 2020; 246:125723. [PMID: 31887489 DOI: 10.1016/j.chemosphere.2019.125723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Ambient PM2.5 has been identified as the top leading cause of risk-attributable deaths worldwide, particularly in China. Evidence suggested that PM1 contributed the most majority of PM2.5 concentrations in Chinese cities. However, epidemiologic knowledge to date is of wide lack regarding PM1-associated health effects. METHODS We collected daily records of all-cause emergency department visits (EDVs) and ground measurements of ambient air pollutants and meteorological factors in Guangzhou and Shenzhen, China, 2015-2016. Case-crossover design and conditional logistic regression models were used to comparatively assess the short-term effects of ambient PM1, PM2.5, and PM10 on EDVs. Stratified analyses by gender, age and season were performed to identify vulnerable groups and periods. RESULTS PM1, PM2.5 and PM10 were all significantly associated with increased EDVs in both cities. Population risks for EDVs increased by 2.2% [95% confidence interval, 1.8 to 2.6] in Guangzhou and 1.7% [1.0 to 2.4] in Shenzhen, for a 10 μg/m3 rise in PM1 at lag 0-1 days and lag 0-4 days, respectively. Relatively lower risks were found to be associated with PM2.5 and PM10. PM-EDVs associations exhibited no gender differences, but varied across age groups. Compared with adults and the elderly, children under 14 years-of-age suffered higher PM-induced risks. Results from both cities suggested greatly significant effect modification by season, with consistently stronger PM-EDVs associations during cold months. CONCLUSIONS Our study added comparative evidence for increased EDVs risks associated with short-term exposures to ambient PM1, PM2.5 and PM10. Besides, PM-associated effects were significantly stronger among children and during cold months.
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Affiliation(s)
- Yunquan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, 430065, China; Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, 430065, China.
| | - Jiaying Fang
- Medical Department, Huadu District People's Hospital, Southern Medical University, Guangzhou, 510800, China
| | - Feiyue Mao
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, 430071, China; State Key Laboratory of Information Engineering in Surveying, Mapping, and Remote Sensing, Wuhan University, Wuhan, 430071, China
| | - Zan Ding
- The Institute of Metabolic Diseases, Baoan Central Hospital of Shenzhen, The Fifth Affiliated Hospital of Shenzhen University, Shenzhen, 518102, China
| | - Qianqian Xiang
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Wei Wang
- School of Geosciences and Info-Physics, Central South University, Changsha, China
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Gao H, Wang K, W. Au W, Zhao W, Xia ZL. A Systematic Review and Meta-Analysis of Short-Term Ambient Ozone Exposure and COPD Hospitalizations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062130. [PMID: 32210080 PMCID: PMC7143242 DOI: 10.3390/ijerph17062130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 02/05/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and ozone exposure is a main cause of its disease burden. However, studies on COPD hospitalizations from short-term ambient level ozone exposure have not generated consensus results. To address the knowledge gap, comprehensive and systematic searches in several databases were conducted using specific keywords for publications up to February 14, 2020. Random-effect models were used to derive overall excess risk estimates between short-term ambient-level ozone exposure and COPD hospitalizations. The influence analyses were used to test the robustness of the results. Both meta-regression and subgroup analyses were used to explore the sources of heterogeneity and potential modifying factors. Based on the results from 26 eligible studies, the random-effect model analyses show that a 10 µg/m3 increase in maximum 8-h ozone concentration was associated with 0.84% (95% CI: 0.09%, 1.59%) higher COPD hospitalizations. The estimates were higher for warm season and multiple-day lag but lower for old populations. Results from subgroup analyses also indicate a multiple-day lag trend and bigger significant health effects during longer day intervals. Although characteristics of individual studies added modest heterogeneity to the overall estimates, the results remained robust during further analyses and exhibited no evidence of publication bias. Our systematic review and meta-analysis indicate that short-term ambient level ozone exposure was associated with increased risk of COPD hospitalizations. The significant association with multiple-day lag trend indicates that a multiple-day exposure metric should be considered for establishing ambient ozone quality and exposure standards for improvement of population health. Future investigations and meta-analysis studies should include clinical studies as well as more careful lag selection protocol.
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Affiliation(s)
- Hui Gao
- Changning Center for Disease Control and Prevention, Shanghai 200051, China;
| | - Kan Wang
- School of Public Health, & Key Laboratory of Public Health Safety of Ministry of Education of China, Fudan University, Shanghai 200032, China;
- Department of Epidemiology, Erasmus Medical Center, 3000CA Rotterdam, The Netherlands
| | - William W. Au
- University of Medicine, Pharmacy, Science and Techonology, 540142 Tirgu Mures, Romania;
- Faculty of Preventive Medicine and MPH Education Center, Shantou University Medical College, Shantou 515041, China
| | - Wensui Zhao
- Changning Center for Disease Control and Prevention, Shanghai 200051, China;
- Correspondence: (W.Z.); (Z.-l.X.); Tel./Fax: +86-21-520-641-06 (W.Z.); +86-21-542-370-90 (Z.-l.X.)
| | - Zhao-lin Xia
- School of Public Health, & Key Laboratory of Public Health Safety of Ministry of Education of China, Fudan University, Shanghai 200032, China;
- Correspondence: (W.Z.); (Z.-l.X.); Tel./Fax: +86-21-520-641-06 (W.Z.); +86-21-542-370-90 (Z.-l.X.)
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Farhadi Z, Abulghasem Gorgi H, Shabaninejad H, Aghajani Delavar M, Torani S. Association between PM 2.5 and risk of hospitalization for myocardial infarction: a systematic review and a meta-analysis. BMC Public Health 2020; 20:314. [PMID: 32164596 PMCID: PMC7068986 DOI: 10.1186/s12889-020-8262-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background It is generally assumed that there have been mixed results in the literature regarding the association between ambient particulate matter (PM) and myocardial infarction (MI). The aim of this meta-analysis was to explore the rate of short-term exposure PM with aerodynamic diameters ≤2.5 μm (PM2.5) and examine its potential effect(s) on the risk of MI. Methods A systematic search was conducted on databases like PubMed, Scopus, Web of Science, and Embase with components: “air pollution” and “myocardial infarction”. The summary relative risk (RR) and 95% confidence intervals (95%CI) were also calculated to assess the association between the PM2.5 and MI. Results Twenty-six published studies were ultimately identified as eligible candidates for the meta-analysis of MI until Jun 1, 2018. The results illustrated that a 10-μg/m 3 increase in PM2.5 was associated with the risk of MI (RR = 1.02; 95% CI 1.01–1.03; P ≤ 0.0001). The heterogeneity of the studies was assessed through a random-effects model with p < 0.0001 and the I2 was 69.52%, indicating a moderate degree of heterogeneity. We also conducted subgroup analyses including study quality, study design, and study period. Accordingly, it was found that subgroups time series study design and high study period could substantially decrease heterogeneity (I2 = 41.61, 41.78). Conclusions This meta-analysis indicated that exposure – response between PM2.5 and MI. It is vital decision makers implement effective strategies to help improve air pollution, especially in developing countries or prevent exposure to PM2.5 to protect human health.
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Affiliation(s)
- Zeynab Farhadi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Abulghasem Gorgi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. .,Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Hosein Shabaninejad
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mouloud Aghajani Delavar
- Infertility and Reproductive Health Research Center, Research Institute for Health, Babol University of Medical Sciences, Babol, Iran
| | - Sogand Torani
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Yalnız E, Uslu Ö, Bolat E, Altın S, Polat G. Does the Hospital Admission of Patients with Respiratory Disease Increase in Izmir When the PM10 Level is High? Turk Thorac J 2020; 21:32-38. [PMID: 32163361 PMCID: PMC7020896 DOI: 10.5152/turkthoracj.2019.180148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/28/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Air pollution is caused by exhaust emissions from motor vehicles, fuel consumption for heating of residences, and especially emissions from industrial facilities around the world. The exposure to outdoor air pollution has been associated with acute and chronic health problems, from irritation to death. In this study, we aimed to determine whether air pollution increases the frequency of hospital admission and whether there is a difference between disease subgroups, age, and gender, in the 2-year period in Izmir province where - air pollution is increasing. MATERIALS AND METHODS Collection of health data for the project compiled by the Ministry of Health, in cooperation with the Izmir Provincial Health Directory Information Processing Department, and information obtained on the age groups, gender, admission time, and diagnosis of illness [International Classification of Diseases (ICD)10 code] on the residents of Izmir in 2016/2017. RESULTS The daily numbers of patients with respiratory complaints and air pollution were found to be related. Both air pollution and the admission rate increase in the January-March period. In male patients, the risk of hospitalization increases for 1.14%. Males had a higher increase in the rate of diagnosis of chronic rhinitis (increase of 6.22%) than females who had an increase of 0.97%. It was observed that there was a 2.62% increase in the incidence of bronchiectasis, 2.53% in that of asthma, and 2.49% in that of dyspnea. CONCLUSION There was a significant increase in respiratory diseases during the days when the air pollution was high, and this was observed as the upper respiratory tract infection and acute bronchitis in the young group and chronic respiratory diseases in the elderly group upon hospital admissions. The reduction of air pollutants and inhalation of clean air are the most important aspects in providing a healthier and longer life.
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Affiliation(s)
- Enver Yalnız
- Clinic of Chest Diseases, İzmir Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, İzmir, Turkey
| | - Özgür Uslu
- Clinic of Chest Diseases, İzmir Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, İzmir, Turkey
| | - Erkut Bolat
- Department of Biostatistics, İstanbul University School of Medicine, İstanbul, Turkey
| | - Sedat Altın
- Clinic of Chest Diseases, İstanbul Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey
| | - Gülru Polat
- Clinic of Chest Diseases, İzmir Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, İzmir, Turkey
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Li X, Chen Q, Zheng X, Li Y, Han M, Liu T, Xiao J, Guo L, Zeng W, Zhang J, Ma W. Effects of ambient ozone concentrations with different averaging times on asthma exacerbations: A meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 691:549-561. [PMID: 31325855 DOI: 10.1016/j.scitotenv.2019.06.382] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/10/2019] [Accepted: 06/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mounting evidence suggests that short-term exposure to ozone increases the risk of asthma exacerbations. However, ozone exposures have been assessed using ambient ozone concentrations averaged over different time periods in different studies. OBJECTIVE To evaluate the risks for asthma exacerbations related to ambient ozone measured as 1-hour or 8-hour daily maximum and 24-hour average concentrations. METHODS Based on a literature search in PubMed, EMBASE and Web of Science, we identified all time-series studies as of December 4th, 2018 and included 47 eligible studies in our analyses. Asthma exacerbation is defined as the risk for emergency room visits or hospital admissions. Pooled relative risks (RRs) and 95% confidence intervals (95%CIs) for a 10 μg/m3 increase in daily ozone concentration were estimated using random effect models. Subgroup analyses and sensitivity analyses were also performed to examine the risks for different seasons, regions and age groups and for the robustness of our main findings. RESULTS Significant and similar associations were found for O3-1 h max (RR,1.012; 95%CI, 1.005-1.019) and O3-8 h max (RR, 1.011; 95%CI, 1.007-1.014), while marginal effect was identified for O3-24 h average (RR, 1.005; 95%CI, 0.996-1.014). No significant publication bias but high heterogeneities were observed. During the warm season, ozone was significantly associated with asthma exacerbation. O3-1 h max had the highest RR of 1.014 (95%CI, 1.005-1.024), followed by O3-8 h max (RR, 1.012; 95%CI, 1.009-1.016), while marginal association was identified for O3-24 h avg (RR, 1.008; 95%CI, 0.998-1.017). During the cold season, null associations were identified for all the three averaging times. Variations were also observed in region and age. CONCLUSION Ozone exposure measured as 1-hour or 8-hour daily max were more consistently associated with asthma exacerbations than 24-hour average exposure during the warm season.
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Affiliation(s)
- Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China; Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Xueyan Zheng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Yongzhi Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Min Han
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Lingchuan Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China
| | - Junfeng Zhang
- Nicholas School of the Environment, Duke Global Health Institute, Duke University, Durham, NC 27705, USA; Duke Kunshan University, Kunshan, Jiangsu Province 215316, China.
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province 511430, China.
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Air pollutants and outpatient visits for cardiovascular disease in a severe haze-fog city: Shijiazhuang, China. BMC Public Health 2019; 19:1366. [PMID: 31651288 PMCID: PMC6814061 DOI: 10.1186/s12889-019-7690-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/25/2019] [Indexed: 12/27/2022] Open
Abstract
Background Many studies have reported the impact of air pollution on cardiovascular disease (CVD), but few of these studies were conducted in severe haze-fog areas. The present study focuses on the impact of different air pollutant concentrations on daily CVD outpatient visits in a severe haze-fog city. Methods Data regarding daily air pollutants and outpatient visits for CVD in 2013 were collected, and the association between six pollutants and CVD outpatient visits was explored using the least squares mean (LSmeans) and logistic regression. Adjustments were made for days of the week, months, air temperature and relative humidity. Results The daily CVD outpatient visits for particulate matter (PM10 and PM2.5), sulphur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) in the 90th-quantile group were increased by 30.01, 29.42, 17.68, 14.98, 29.34%, and − 19.87%, respectively, compared to those in the <10th-quantile group. Odds ratios (ORs) and 95% confidence intervals (CIs) for the increase in daily CVD outpatient visits in PM10 300- and 500-μg/m3, PM2.5 100- and 300-μg/m3 and CO 3-mg/m3 groups were 2.538 (1.070–6.020), 7.781 (1.681–36.024), 3.298 (1.559–6.976), 8.72 (1.523–49.934), and 5.808 (1.016–33.217), respectively, and their corresponding attributable risk percentages (AR%) were 60.6, 87.15, 69.68, 88.53 and 82.78%, respectively. The strongest associations for PM10, PM2.5 and CO were found only in lag 0 and lag 1. The ORs for the increase in CVD outpatient visits per increase in different units of the six pollutants were also analysed. Conclusions All five air pollutants except O3 were positively associated with the increase in daily CVD outpatient visits in lag 0. The high concentrations of PM10, PM2.5 and CO heightened not only the percentage but also the risk of increased daily CVD outpatient visits. PM10, PM2.5 and CO may be the main factors of CVD outpatient visits.
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The association of chronic air pollutants with coronary artery spasm, vasospastic angina, and endothelial dysfunction. Coron Artery Dis 2019; 29:336-343. [PMID: 29334505 DOI: 10.1097/mca.0000000000000603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND We evaluated the effect of chronic exposure to air pollutants (APs) on coronary endothelial function and significant coronary artery spasm (CAS) as assessed by intracoronary acetylcholine (ACH) provocation test. PATIENTS AND METHODS A total of 6430 patients with typical or atypical chest pain who underwent intracoronary ACH provocation test were enrolled. We obtained data on APs from the Korean National Institute of Environmental Research (http://www.nier.go.kr/). APs are largely divided into two types: particulate matter with aerodynamic diameter of less than or equal to 10 µm in size (PM10) and gaseous pollutants such as nitrogen dioxide, sulfur dioxide, carbon monoxide, and ozone. The primary endpoint is the incidence of significant CAS and its associated parameters during ACH provocation test. RESULTS The incidence of CAS was positively correlated with an exposure duration of PM10, whereas nitrogen dioxide, sulfur dioxide, carbon monoxide, and ozone were shown to be unrelated to CAS. During the ACH provocation test, as PM10 increased, the frequency of CAS was increased, and the incidence of transient ST-segment elevation was also increased. There was a trend toward higher incidence of spontaneous spasm as PM10 increased. The mean exposure level of PM10 was 51.3±25.4 µg/m. The CAS risk increased by 4% when the level of PM10 increased by 20 µg/m by an adjusted Cox regression analysis. CONCLUSION CAS incidence is closely related to exposure to PMs but not to gaseous pollutants. Particularly, higher exposure concentrations and longer exposure duration of PM10 increased the risk of CAS. These important findings provide a plausible mechanism that links air pollution to vasospastic angina and provide new insights into environmental factors.
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Zhao Y, Hu J, Tan Z, Liu T, Zeng W, Li X, Huang C, Wang S, Huang Z, Ma W. Ambient carbon monoxide and increased risk of daily hospital outpatient visits for respiratory diseases in Dongguan, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 668:254-260. [PMID: 30852202 DOI: 10.1016/j.scitotenv.2019.02.333] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 04/13/2023]
Abstract
BACKGROUND The toxicity of high-concentration carbon monoxide (CO) on human health has previously been documented. However, the epidemiological evidence on the association between acute exposure to ambient CO and respiratory diseases is relatively lacking and controversial. OBJECTIVES To examine the short-term association between ambient CO and hospital outpatient visits for respiratory diseases in Dongguan, China. METHODS The number of daily hospital outpatient visits for respiratory diseases, and air pollution and meteorological data were collected from January 2013 to August 2017. A generalized additive model with a quasi-Poisson link was used to estimate the association between ambient CO concentration and the total number of hospital outpatient visits for all respiratory diseases and those for asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD) and pneumonia. We further analyzed the effect of ambient CO by gender and age. RESULTS Over the study period, a 24-h mean concentration of ambient CO of 0.88 mg/m3 (below the limit for CO in China) and a total of 89,484 hospital outpatient visits for respiratory diseases were recorded. Ambient CO was found to increase the risk for asthma, bronchiectasis, pneumonia and the total number of respiratory diseases. The per interquartile range (IQR) increase in ambient CO at lag03 day corresponded to a 5.62% (95% confidence interval (CI): 3.24%, 8.05%), 8.86% (95% CI: 4.89%, 12.98%), 6.67% (95% CI: 0.87%, 12.81%) and 7.20% (95% CI: 2.35%, 12.29%) increased risk in outpatient visits for all respiratory diseases, asthma, bronchiectasis and pneumonia, respectively. Each association was partially weakened after adjusting for co-pollutants. The effect of ambient CO on respiratory diseases appeared to be greater for females and the elderly. CONCLUSIONS Short-term exposure to ambient CO was associated with increased risk of outpatient visits for respiratory diseases. Our analysis may help to understand the health effects of low-levels of CO and provide evidence for the creation of air quality standards.
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Affiliation(s)
- Yiju Zhao
- Department of Respirator Medicine, The Fifth People's Hospital of Dongguan, Dongguan 523905, China
| | - Jianxiong Hu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510220, China
| | - Zhenwei Tan
- Record Room, The Fifth People's Hospital of Dongguan, Dongguan 523905, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Xing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Caiyan Huang
- Department of Respirator Medicine, The Fifth People's Hospital of Dongguan, Dongguan 523905, China
| | - Shengyong Wang
- Medical College, Jinan University, Guangzhou 510632, China
| | - Zhao Huang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510220, China
| | - Wenjun Ma
- School of Public Health, Southern Medical University, Guangzhou 510515, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China.
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Slama A, Śliwczyński A, Woźnica J, Zdrolik M, Wiśnicki B, Kubajek J, Turżańska-Wieczorek O, Gozdowski D, Wierzba W, Franek E. Impact of air pollution on hospital admissions with a focus on respiratory diseases: a time-series multi-city analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:16998-17009. [PMID: 30929168 PMCID: PMC6546668 DOI: 10.1007/s11356-019-04781-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/04/2019] [Indexed: 05/20/2023]
Abstract
Together with the growing availability of data from electronic records from healthcare providers and healthcare systems, an assessment of associations between different environmental parameters (e.g., pollution levels and meteorological data) and hospitalizations, morbidity, and mortality has become possible. This study aimed to assess the association of air pollution and hospitalizations using a large database comprising almost all hospitalizations in Poland. This time-series analysis has been conducted in five cities in Poland (Warsaw, Białystok, Bielsko-Biała, Kraków, Gdańsk) over a period of almost 4 years (2014-2017, 1255 days), covering more than 20 million of hospitalizations. The hospitalizations have been extracted from the National Health Fund registries as daily summaries. Correlation analysis and distributed lag nonlinear models have been used to investigate for statistically relevant associations of air pollutants on hospitalizations, trying by various methods to minimize potential bias from atmospheric parameters, days of the week, bank holidays, etc. A statistically significant increase of respiratory disease hospitalizations has been detected after peaks of particulate matter concentrations (particularly PM2.5, between 0.9 and 4.5% increase per 10 units of pollutant increase, and PM10, between 0.9 and 3.5% per 10 units of pollutant increase), with a typical time lag between the pollutant peak and the event of 2 to 6 days. For other pollution parameters and other types of hospitalizations (e.g., cardiovascular events, eye and skin diseases, etc.), a weaker and ununiform correlations were recorded. Ambient air pollution exposure increases are associated with a short-term increase of hospitalizations due to respiratory tract diseases. The most prominent effect was recorded with the correlation of PM2.5 and PM10. There is only weak evidence indicating that such short-term associations exist between peaks of air pollution concentrations and increased hospitalizations for other (e.g., cardiovascular) diseases. The obtained information could be used to better predict hospitalization patterns and costs for the healthcare system and perhaps trigger additional vigilance on particulate matter pollution in the cities.
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Affiliation(s)
- Alessandro Slama
- Central Clinical Hospital MSWiA in Warsaw, Wołoska 137, 02-507, Warsaw, Poland
| | - Andrzej Śliwczyński
- University of Humanities and Economics in Łodz, Satellite Campus in Warsaw, ul. Wolność 2a, 01-018, Warsaw, Poland
| | - Jolanta Woźnica
- Chancellery of the Prime Minister of Poland, al. Ujazdowskie 1/3, 00-001, Warsaw, Poland
| | - Maciej Zdrolik
- Chancellery of the Prime Minister of Poland, al. Ujazdowskie 1/3, 00-001, Warsaw, Poland
| | - Bartłomiej Wiśnicki
- Chancellery of the Prime Minister of Poland, al. Ujazdowskie 1/3, 00-001, Warsaw, Poland
| | - Jakub Kubajek
- Chancellery of the Prime Minister of Poland, al. Ujazdowskie 1/3, 00-001, Warsaw, Poland
| | | | - Dariusz Gozdowski
- Warsaw University of Life Sciences, Nowoursynowska 166, 02-787, Warsaw, Poland
| | - Waldemar Wierzba
- University of Humanities and Economics in Łodz, Satellite Campus in Warsaw, ul. Wolność 2a, 01-018, Warsaw, Poland
| | - Edward Franek
- Central Clinical Hospital MSWiA in Warsaw, Wołoska 137, 02-507, Warsaw, Poland.
- Mossakowski Clinical Research Centre, Polish Academy of Sciences, Pawinskiego 5, 02-106 Warsaw, Poland.
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Chowdhury S, Dey S, Guttikunda S, Pillarisetti A, Smith KR, Di Girolamo L. Indian annual ambient air quality standard is achievable by completely mitigating emissions from household sources. Proc Natl Acad Sci U S A 2019; 116:10711-10716. [PMID: 30988190 PMCID: PMC6561163 DOI: 10.1073/pnas.1900888116] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Exposures to ambient and household fine-particulate matter (PM2.5) together are among the largest single causes of premature mortality in India according to the Global Burden of Disease Studies (GBD). Several recent investigations have estimated that household emissions are the largest contributor to ambient PM2.5 exposure in the country. Using satellite-derived district-level PM2.5 exposure and an Eulerian photochemical dispersion model CAMx (Comprehensive Air Quality Model with Extensions), we estimate the benefit in terms of population exposure of mitigating household sources--biomass for cooking, space- and water-heating, and kerosene for lighting. Complete mitigation of emissions from only these household sources would reduce India-wide, population-weighted average annual ambient PM2.5 exposure by 17.5, 11.9, and 1.3%, respectively. Using GBD methods, this translates into reductions in Indian premature mortality of 6.6, 5.5, and 0.6%. If PM2.5 emissions from all household sources are completely mitigated, 103 (of 597) additional districts (187 million people) would meet the Indian annual air-quality standard (40 μg m-3) compared with baseline (2015) when 246 districts (398 million people) met the standard. At 38 μg m-3, after complete mitigation of household sources, compared with 55.1 μg m-3 at baseline, the mean annual national population-based concentration would meet the standard, although highly polluted areas, such as Delhi, would remain out of attainment. Our results support expansion of programs designed to promote clean household fuels and rural electrification to achieve improved air quality at regional scales, which also has substantial additional health benefits from directly reducing household air pollution exposures.
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Affiliation(s)
- Sourangsu Chowdhury
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi 110016, India
- School of Public Health, University of California, Berkeley, CA 94720-7360
| | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi 110016, India;
- School of Public Policy, Indian Institute of Technology Delhi, New Delhi 110016, India
| | | | - Ajay Pillarisetti
- School of Public Health, University of California, Berkeley, CA 94720-7360
| | - Kirk R Smith
- School of Public Health, University of California, Berkeley, CA 94720-7360;
- Collaborative Clean Air Policy Centre, Delhi 110003, India
| | - Larry Di Girolamo
- Department of Atmospheric Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801
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Wang Y, Yao C, Xu C, Zeng X, Zhou M, Lin Y, Zhang P, Yin P. Carbon monoxide and risk of outpatient visits due to cause-specific diseases: a time-series study in Yichang, China. Environ Health 2019; 18:36. [PMID: 31014335 PMCID: PMC6477706 DOI: 10.1186/s12940-019-0477-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/05/2019] [Indexed: 05/08/2023]
Abstract
BACKGROUND Previous studies showed inconsistent results on risk of increased outpatient visits for cause-specific diseases associated with ambient carbon monoxide (CO). METHODS Daily data for CO exposure and outpatient visits for all-causes and five specific diseases in Yichang, China from 1st January 2016 to 31st December 2017 were collected. Generalised additive models with different lag structures were used to examine the short-term effects of ambient CO on outpatient visits. Potential effect modifications by age, sex and season were examined. RESULTS A total of 5,408,021 outpatient visits were recorded. We found positive and statistically significant associations between CO and outpatient visits for multiple outcomes and all the estimated risks increased with longer moving average lags. An increase of 1 mg/m3 of CO at lag06 (a moving average of lag0 to lag6), was associated with 24.67% (95%CI: 14.48, 34.85%), 21.79% (95%CI: 12.24, 31.35%), 39.30% (95%CI: 25.67, 52.92%), 25.83% (95%CI: 13.91, 37.74%) and 19.04% (95%CI: 8.39, 29.68%) increase in daily outpatient visits for all-cause, respiratory, cardiovascular, genitourinary and gastrointestinal diseases respectively. The associations for all disease categories except for genitourinary diseases were statistically significant and stronger in warm seasons than cool seasons. CONCLUSION Our analyses provide evidences that the CO increased the total and cause-specific outpatient visits and strengthen the rationale for further reduction of CO pollution levels in Yichang. Ambient CO exerted adverse effect on respiratory, cardiovascular, genitourinary, gastrointestinal and neuropsychiatric diseases especially in the warm seasons.
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Affiliation(s)
- Yu Wang
- Department of Anesthesiology, Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Chengye Yao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Chengzhong Xu
- Yichang Center for Disease Control and Prevention, 3 Dalian Road, Yichang, 443005 China
| | - Xinying Zeng
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050 China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050 China
| | - Yun Lin
- Department of Anesthesiology, Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Pei Zhang
- Yichang Center for Disease Control and Prevention, 3 Dalian Road, Yichang, 443005 China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050 China
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