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Huang SP, Su CC, Lin CY, Nethery R, Josey K, Bates B, Robinson D, Gandhi P, Rua M, Parthasarathi A, Setoguchi S, Kao Yang YH. Exposure-Response to High PM 2.5 Levels for Cardiovascular Events in High-risk Older Adults in Taiwan. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.08.24306967. [PMID: 38766145 PMCID: PMC11100932 DOI: 10.1101/2024.05.08.24306967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Multiple studies from countries with relatively lower PM 2.5 level demonstrated that acute and chronic exposure even at lower than recommended level, e.g., 9 μg/m 3 in the US increased the risk of cardiovascular (CV) events. However, limited studies using individual level data exist from countries with a wider range of PM levels to illustrate shape of the exposure-response curve throughout the range including > 20 μg/m 3 PM 2·5 concentrations. Taiwan with its policies reduced PM 2.5 over time provide opportunities to illustrate the dose response curves and how reductions of PM 2.5 over time correlated with CV events incidence in a nationwide sample. Methods Using data from the 2009-2019 Taiwan National Health Insurance Database linked to nationwide PM2.5 data. We examined the shape and magnitude of the exposure-response curve between seasonal average PM 2·5 level and CV events-related hospitalizations among older adults at high-risk for CV events. We used history-adjusted marginal structural models including potential confounding by individual demographic factors, baseline comorbidities, and health service measures. To quantify the risk below and above 20 μg/m 3 we conducted stratified Cox regression. We also plotted PM 2.5 and CV events from 2009-2019 as well as average temperature as a comparison. Findings Using the PM 2.5 concentration <15 μg/m 3 (Taiwan regulatory standard) as a reference, the seasonal average PM 2.5 concentration (15-23.5μg/m 3 and > 23.5 μg/m 3 ) were associated with hazard ration of 1.13 (95%CI 1.09-1.18) and 1.19 (95%CI 1.14-1.24), 1.07 (95%CI 1.03-1.11) and 1.14 (95%CI 1.10-1.18), 1.22 (95%CI 1.08-1.38) and 1.31 (95%CI 1.16-1.48), 1.04 (95%CI 0.98-1.10) and 1.10 (95%CI 1.04-1.16) respectively for HF, IS/TIA,PE/DVT and MI/ACS. A nonlinear relationship between PM 2·5 and CV events outcomes was observed at PM 2·5 levels above 20 μg/m 3 . Interpretation A nonlinear exposure-response relationship between PM2·5 concentration and the incidence of cardiovascular events exists when PM2.5 is higher than the levels recommended by WHO Air Quality Guidelines. Further lowering PM2·5 levels beyond current regulatory standards may effectively reduce the incidence of cardiovascular events, particularly HF and DVT, and can lead to tangible health benefits in high-risk elderly population.
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Byanova KL, Abelman R, North CM, Christenson SA, Huang L. COPD in People with HIV: Epidemiology, Pathogenesis, Management, and Prevention Strategies. Int J Chron Obstruct Pulmon Dis 2023; 18:2795-2817. [PMID: 38050482 PMCID: PMC10693779 DOI: 10.2147/copd.s388142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by airflow limitation and persistent respiratory symptoms. People with HIV (PWH) are particularly vulnerable to COPD development; PWH have demonstrated both higher rates of COPD and an earlier and more rapid decline in lung function than their seronegative counterparts, even after accounting for differences in cigarette smoking. Factors contributing to this HIV-associated difference include chronic immune activation and inflammation, accelerated aging, a predilection for pulmonary infections, alterations in the lung microbiome, and the interplay between HIV and inhalational toxins. In this review, we discuss what is known about the epidemiology and pathobiology of COPD among PWH and outline screening, diagnostic, prevention, and treatment strategies.
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Affiliation(s)
- Katerina L Byanova
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca Abelman
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Crystal M North
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie A Christenson
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laurence Huang
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Wang Y, Mahdieh DY, Wei Y, Schwartz J. Long-Term Exposure to Air Pollution Below Regulatory Standards and Cardiovascular Diseases Among US Medicare Beneficiaries: A Double Negative Control Approach. RESEARCH SQUARE 2023:rs.3.rs-3530201. [PMID: 38045234 PMCID: PMC10690329 DOI: 10.21203/rs.3.rs-3530201/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Growing evidence suggests that long-term air pollution exposure is a risk factor for cardiovascular mortality and morbidity. However, few studies have investigated air pollution below current regulatory limits, and causal evidence is limited. We used a double negative control approach to examine the association between long-term exposure to air pollution at low concentrations and three major cardiovascular events among Medicare beneficiaries aged ≥ 65 years across the contiguous United States between 2000 and 2016. We derived ZIP code-level estimates of ambient fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ), and warm-season ozone (O 3 ) from high-resolution spatiotemporal models. The outcomes of interest were hospitalizations for stroke, heart failure (HF), and atrial fibrillation and flutter (AF). The analyses were restricted to areas with consistently low pollutant levels on an annual basis (PM 2.5 <10 µg/m³, NO 2 < 45 or 40 ppb, warm-season O 3 < 45 or 40 ppb). For each 1 µg/m 3 increase in PM 2.5 , the hospitalization rates increased by 2.25% (95% confidence interval (CI): 1.96%, 2.54%) for stroke and 3.14% (95% CI: 2.80%, 3.94%) for HF. Each ppb increase in NO 2 increased hospitalization rates for stroke, HF, and AF by 0.28% (95% CI: 0.25%, 0.31%), 0.56% (95% CI: 0.52%, 0.60%), and 0.45% (95% CI: 0.41%, 0.49%), respectively. For each ppb increase in warm-season O 3 , there was a 0.32% (95% CI: 0.21%, 0.44%) increase in hospitalization rate for stroke. The associations for NO 2 and warm-season O 3 became stronger under a more restrictive upper threshold. Using an approach robust to omitted confounders, we concluded that long-term exposure to low-level PM 2.5 , NO 2 , and warm-season O 3 was associated with increased risks of cardiovascular diseases in the US elderly. Stricter national air quality standards should be considered.
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Josey K, Nethery R, Visaria A, Bates B, Gandhi P, Parthasarathi A, Rua M, Robinson D, Setoguchi S. Retrospective cohort study investigating synergism of air pollution and corticosteroid exposure in promoting cardiovascular and thromboembolic events in older adults. BMJ Open 2023; 13:e072810. [PMID: 37709308 PMCID: PMC10503335 DOI: 10.1136/bmjopen-2023-072810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE To evaluate the synergistic effects created by fine particulate matter (PM2.5) and corticosteroid use on hospitalisation and mortality in older adults at high risk for cardiovascular thromboembolic events (CTEs). DESIGN AND SETTING A retrospective cohort study using a US nationwide administrative healthcare claims database. PARTICIPANTS A 50% random sample of participants with high-risk conditions for CTE from the 2008-2016 Medicare Fee-for-Service population. EXPOSURES Corticosteroid therapy and seasonal-average PM2.5. MAIN OUTCOME MEASURES Incidences of myocardial infarction or acute coronary syndrome (MI/ACS), ischaemic stroke or transient ischaemic attack, heart failure (HF), venous thromboembolism, atrial fibrillation and all-cause mortality. We assessed additive interactions between PM2.5 and corticosteroids using estimates of the relative excess risk due to interaction (RERI) obtained using marginal structural models for causal inference. RESULTS Among the 1 936 786 individuals in the high CTE risk cohort (mean age 76.8, 40.0% male, 87.4% white), the mean PM2.5 exposure level was 8.3±2.4 µg/m3 and 37.7% had at least one prescription for a systemic corticosteroid during follow-up. For all outcomes, we observed increases in risk associated with corticosteroid use and with increasing PM2.5 exposure. PM2.5 demonstrated a non-linear relationship with some outcomes. We also observed evidence of an interaction existing between corticosteroid use and PM2.5 for some CTEs. For an increase in PM2.5 from 8 μg/m3 to 12 μg/m3 (a policy-relevant change), the RERI of corticosteroid use and PM2.5 was significant for HF (15.6%, 95% CI 4.0%, 27.3%). Increasing PM2.5 from 5 μg/m3 to 10 μg/m3 yielded significant RERIs for incidences of HF (32.4; 95% CI 14.9%, 49.9%) and MI/ACSs (29.8%; 95% CI 5.5%, 54.0%). CONCLUSION PM2.5 and systemic corticosteroid use were independently associated with increases in CTE hospitalisations. We also found evidence of significant additive interactions between the two exposures for HF and MI/ACSs suggesting synergy between these two exposures.
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Affiliation(s)
- Kevin Josey
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Rachel Nethery
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Aayush Visaria
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Benjamin Bates
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Poonam Gandhi
- Rutgers University Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey, USA
| | - Ashwaghosha Parthasarathi
- Rutgers University Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey, USA
| | - Melanie Rua
- Rutgers University Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey, USA
| | - David Robinson
- Department of Geography, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Soko Setoguchi
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
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Gutman L, Pauly V, Papazian L, Roch A. Effects of ambient air pollutants on ARDS incidence and outcome: a narrative review. Ann Intensive Care 2023; 13:84. [PMID: 37704926 PMCID: PMC10499767 DOI: 10.1186/s13613-023-01182-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Exposure to air pollutants promotes inflammation, cancer, and mortality in chronic diseases. Acute respiratory distress syndrome (ARDS) is a common condition among intensive care unit patients and is associated with a high mortality rate. ARDS is characterized by significant lung inflammation, which can be replicated in animal models by acute exposure to high doses of various air pollutants. Recently, several clinical studies have been conducted in different countries to investigate the role of chronic or acute air pollutant exposure in enhancing both ARDS incidence and severity. RESULTS Chronic exposure studies have mainly been conducted in the US and France. The results of these studies suggest that some air pollutants, notably ozone, nitrogen dioxide, and particulate matter, increase susceptibility to ARDS and associated mortality. Furthermore, their impact may differ according to the cause of ARDS. A cohort study conducted in an urbanized zone in China showed that exposure to very high levels of air pollutants in the few days preceding intensive care unit admission was associated with an increased incidence of ARDS. The effects of acute exposure are more debatable regarding ARDS incidence and severity. CONCLUSION There is a likely relationship between air pollutant exposure and ARDS incidence and severity. However, further studies are required to determine which pollutants are the most involved and which patients are the most affected. Due to the prevalence of ARDS, air pollutant exposure may have a significant impact and could be a key public health issue.
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Affiliation(s)
- Laëtitia Gutman
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin Des Bourrely, 13015, Marseille, France.
- Faculté de Médecine, Centre d'Etudes et de Recherches Sur Les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France.
| | - Vanessa Pauly
- Faculté de Médecine, Centre d'Etudes et de Recherches Sur Les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
- Unité d'Analyse Des Données de Santé, Assistance Publique, Hôpitaux de Marseille, 13005, Marseille, France
| | - Laurent Papazian
- Faculté de Médecine, Centre d'Etudes et de Recherches Sur Les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
- Médecine Intensive Réanimation, Centre Hospitalier de Bastia, 20600, Bastia, Corsica, France
| | - Antoine Roch
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin Des Bourrely, 13015, Marseille, France
- Faculté de Médecine, Centre d'Etudes et de Recherches Sur Les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
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Li X, Xie J, Xu J, Deng L, Cao G, Huang S, Zeng C, Liu C, Zhu S, He G, Lin Z, Ma W, Yang P, Liu T. Long-Term Exposure to Ambient PM 2.5 and Age-Related Cataracts among Chinese Middle-Aged and Older Adults: Evidence from Two National Cohort Studies. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:11792-11802. [PMID: 37534997 DOI: 10.1021/acs.est.3c02646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Cataract is one key cause of visual disability and blindness. Ambient particulate matter is more likely to increase cataract risk due to eye continuous exposure to the environment. However, less is known about whether long-term exposure to particulate matter 2.5 (PM2.5) is related to age-related cataracts. We conducted a population-based study among 22,298 adults from two multicenter cohort studies [China Family Panel Studies (CFPS) and Chinese Longitudinal Healthy Longevity Survey (CLHLS)]. The associations between PM2.5 and age-related cataracts were analyzed by Cox proportional hazard regression models, which were also stratified according to demographic characteristics. The restricted cubic spline (RCS) model was used to explore the dose-response relationships between PM2.5 and age-related cataracts. The population attributable fraction (PAF) was calculated to assess the burden of age-related cataracts that can be attributed to PM2.5. In the final analysis, 1897 participants reported age-related cataracts during follow-up. Long-term exposure to PM2.5 was associated with age-related cataracts, with HRs of 1.165 (1.130, 1.201), 1.138 (1.103, 1.173), and 1.091 (1.057, 1.126) for per 10 μg/m3 increase at one-, two-, and three-year before the end of follow-up, respectively. Furthermore, associations between PM2.5 and age-related cataracts were also demonstrated in RCS models. The PAF of age-related cataracts to PM2.5 in the total participants was 24.63%. Our research found that long-term exposure to PM2.5 may increase the risk of age-related cataracts, and age-related cataracts should be considered as an important public health issue due to air pollution.
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Affiliation(s)
- Xiaojie Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Jinying Xie
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Jiahong Xu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Langjing Deng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Ganxiang Cao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510080, China
| | - Songyi Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Chenyan Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Chaoqun Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Sui Zhu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Guanhao He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Ziqiang Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
- Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China
| | - Pan Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Tao Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
- Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou 510632, China
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Pradhan SH, Gibb M, Kramer AT, Sayes CM. Peripheral (lung-to-brain) exposure to diesel particulate matter induces oxidative stress and increased markers for systemic inflammation. ENVIRONMENTAL RESEARCH 2023; 231:116267. [PMID: 37257747 DOI: 10.1016/j.envres.2023.116267] [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: 04/03/2023] [Revised: 05/09/2023] [Accepted: 05/27/2023] [Indexed: 06/02/2023]
Abstract
Combustion-derived air pollution is a complex environmental toxicant that has become a global health concern due to urbanization. Air pollution contains pro-inflammatory stimulants such as fine and ultrafine particulate matter, gases, volatile organic compounds, and metals. This study is focused on the particulate phase, which has been shown to induce systemic inflammation after chronic exposure due to its ability to travel to the lower airway, resulting in the activation of local immune cell populations, releasing acute phase reactants to mitigate ongoing inflammation. The systemic response is a potential mechanism for the co-morbidity associated with regions with high pollution and neuropathology. We exposed diesel particulate matter (DPM) to a pulmonary cell-derived in vitro model where macrophages mimic the diffusion of cytokines into the peripheral circulation to microglia. Alveolar macrophages (transformed U937) were inoculated with resuspended DPM in an acute exposure (24-h incubation) and analyzed for MCP-1 expression and acute phase reactants (IL-1β, IL-6, IL-8, and TNF-α). Post-exposure serum was collected and filtered from cultured alveolar macrophages, introduced to a healthy culture of microglial cells (HMC3), and measured for neurotoxic cytokines, oxidative stress, and pattern recognition receptors. After DPM exposure, the macrophages significantly upregulated all measured acute phase reactants, increased H2O2 production, and increased MCP-1 expression. After collection and filtration to remove excess particulates, microglia cells were incubated with the collected serum for 48 h to allow for cytokine diffusion between the periphery of microglia. Microglia significantly upregulated IL-6, IL-8, and oxidative stress with a moderate increase in IL-1β and TNF-α. As a marker required for signaling tissue damage, CD14 indicated that compared to direct inoculation of DPM, peripheral exposure resulted in the potent activation of microglia cells. The specificity and potency of the response have implications for neuropathology through lung-to-brain mechanisms after inhalation of environmental pollutants.
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Affiliation(s)
- Sahar H Pradhan
- Department of Environmental Science, Baylor University, Waco, TX 76798, USA
| | - Matthew Gibb
- Department of Environmental Science, Baylor University, Waco, TX 76798, USA; Institute of Biomedical Sciences, Baylor University, Waco, TX 76798, USA
| | - Alec T Kramer
- Department of Environmental Science, Baylor University, Waco, TX 76798, USA
| | - Christie M Sayes
- Department of Environmental Science, Baylor University, Waco, TX 76798, USA; Institute of Biomedical Sciences, Baylor University, Waco, TX 76798, USA.
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Reilly JP, Zhao Z, Shashaty MGS, Koyama T, Jones TK, Anderson BJ, Ittner CA, Dunn T, Miano TA, Oniyide O, Balmes JR, Matthay MA, Calfee CS, Christie JD, Meyer NJ, Ware LB. Exposure to ambient air pollutants and acute respiratory distress syndrome risk in sepsis. Intensive Care Med 2023; 49:957-965. [PMID: 37470831 PMCID: PMC10561716 DOI: 10.1007/s00134-023-07148-y] [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: 04/06/2023] [Accepted: 06/20/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Exposures to ambient air pollutants may prime the lung enhancing risk of acute respiratory distress syndrome (ARDS) in sepsis. Our objective was to determine the association of short-, medium-, and long-term pollutant exposures and ARDS risk in critically ill sepsis patients. METHODS We analyzed a prospective cohort of 1858 critically ill patients with sepsis, and estimated short- (3 days), medium- (6 weeks), and long- (5 years) term exposures to ozone, nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), particulate matter < 2.5 μm (PM2.5), and PM < 10 μm (PM10) using weighted averages of daily levels from monitors within 50 km of subjects' residences. Subjects were followed for 6 days for ARDS by the Berlin Criteria. The association between each pollutant and ARDS was determined using multivariable logistic regression adjusting for preselected confounders. In 764 subjects, we measured plasma concentrations of inflammatory proteins at presentation and tested for an association between pollutant exposure and protein concentration via linear regression. RESULTS ARDS developed in 754 (41%) subjects. Short- and long-term exposures to SO2, NO2, and PM2.5 were associated with ARDS risk (SO2: odds ratio (OR) for the comparison of the 75-25th long-term exposure percentile 1.43 (95% confidence interval (CI) 1.16, 1.77); p < 0.01; NO2: 1.36 (1.06, 1.74); p = 0.04, PM2.5: 1.21 (1.04, 1.41); p = 0.03). Long-term exposures to these three pollutants were also associated with plasma interleukin-1 receptor antagonist and soluble tumor necrosis factor receptor-1 concentrations. CONCLUSION Short and long-term exposures to ambient SO2, PM2.5, and NO2 are associated with increased ARDS risk in sepsis, representing potentially modifiable environmental risk factors for sepsis-associated ARDS.
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Affiliation(s)
- John P Reilly
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA.
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, USA
| | - Michael G S Shashaty
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, USA
| | - Tiffanie K Jones
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
- Center for Clinical Epidemiology and Biostatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Brian J Anderson
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Caroline A Ittner
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Thomas Dunn
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Todd A Miano
- Center for Clinical Epidemiology and Biostatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Oluwatosin Oniyide
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - John R Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, USA
- Department of Medicine, University of California, San Francisco, USA
| | - Michael A Matthay
- Department of Medicine, University of California, San Francisco, USA
- Department of Anesthesia and Cardiovascular Research Institute, University of California, San Francisco, USA
| | - Carolyn S Calfee
- Department of Medicine, University of California, San Francisco, USA
- Department of Anesthesia and Cardiovascular Research Institute, University of California, San Francisco, USA
| | - Jason D Christie
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
- Center for Clinical Epidemiology and Biostatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Nuala J Meyer
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Lorraine B Ware
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, USA
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Chen S, Wang X, Li D, Zhao J, Zhang J, Zhang Y, Zhang X, Kan X. Association Between Exposure to Ozone (O 3) and the Short-Term Effect on Tuberculosis Outpatient Visits: A Time-Series Study in 16 Cities of Anhui Province, China. J Multidiscip Healthc 2023; 16:2045-2055. [PMID: 37496636 PMCID: PMC10366443 DOI: 10.2147/jmdh.s412394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction Evidence has shown that air pollutant exposure plays a vital role in the progression of tuberculosis (TB). The aim of this research was to assess the short-term effects of ozone (O3) exposure and TB outpatient visits in 16 prefecture-level cities of Anhui, China, 2015-2020. Methods Distributed lag nonlinear model (DLNM), Poisson generalized linear regression model and random effects model were applied in this study. The effects of different age and gender on TB were investigated by stratified analysis, and then we performed sensitivity analyses to verify the stability of the results. Results A total of 186,623 active TB cases were registered from January 1, 2015 to December 31,2020 in Anhui. The average concentration of ozone is 92.77 ± 42.95 μg/m3. The maximum lag-specific and cumulative relative risk (RR) of TB outpatient visits was 1.0240 (95% CI: 1.0170-1.0310, lag 28 days) for each 10 µg/m³ increase in O3 in the single-pollutant model. Estimation for 16 prefecture-level cities indicated that the strong association between O3 and the risk of TB outpatient visits was in tongling (RR = 1.0555, 95% CI: 1.0089-1.1042), Suzhou (RR = 1.0475, 95% CI: 1.0268-1.0687), wuhu (RR = 1.0358, 95% CI: 1.0023-1.0704). Stratified analysis showed that the health effects of ozone exposure remained significant in male and older adults, and there was no significant association between exposure to ozone in children and adolescents and the risk of tuberculosis. Discussion We found that ozone exposure increases the risk of TB infection in outpatient patients, with males and the elderly being more susceptible, and it is necessary for government departments to develop targeted publicity and prevention measures in response to the local air quality conditions.
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Affiliation(s)
- Shuangshuang Chen
- Department of Tuberculosis Prevent and Control, Center for Disease Control and Prevention of Hefei, Hefei, Anhui, 230051, People’s Republic of China
- Department of Scientific Research and Education, Anhui Chest Hospital, Hefei, Anhui, 230022, People’s Republic of China
- Department of Scientific Research and Education, Anhui Provincial Tuberculosis Institute, Hefei, Anhui, 230022, People’s Republic of China
| | - Xinqiang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Danhui Li
- Department of Hospital Infection and Management, Anhui Chest Hospital, Hefei, Anhui, 230022, People’s Republic of China
| | - Jiawen Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Jingjing Zhang
- Department of Scientific Research and Education, Anhui Provincial Tuberculosis Institute, Hefei, Anhui, 230022, People’s Republic of China
| | - Yongzhong Zhang
- Department of Tuberculosis Prevent and Control, Anhui Provincial Tuberculosis Institute, Hefei, Anhui, 230022, People’s Republic of China
| | - Xiujun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Xiaohong Kan
- Department of Scientific Research and Education, Anhui Chest Hospital, Hefei, Anhui, 230022, People’s Republic of China
- Department of Scientific Research and Education, Anhui Provincial Tuberculosis Institute, Hefei, Anhui, 230022, People’s Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
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Zhang F, Li H, Xu W, Song G, Wang Z, Mao X, Wei Y, Dai M, Zhang Y, Shen Q, Fu F, Tan J, Ge L, He X, Yin T, Yang S, Li S, Yang P, Jia P, Zhang Y. Sulfur dioxide may predominate in the adverse effects of ambient air pollutants on semen quality among the general population in Hefei, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 867:161472. [PMID: 36638985 DOI: 10.1016/j.scitotenv.2023.161472] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/24/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Previous studies have reported potential adverse effects of exposure to ambient air pollutants on semen quality in infertile men, but studies on the general population have been limited and inconsistent, and the pollutants that play a major role remain unclear. This study aimed to explore the potential association between exposure to six air pollutants (PM2.5, PM10, NO2, SO2, O3 and CO) during different sperm development periods and semen quality among the general population, and to explore the interaction between different air pollutant exposures. We included 1515 semen samples collected from the Human Sperm Bank. We improved individuals' exposure level estimation by combining inverse distance weighting (IDW) interpolation with satellite remote sensing data. Multivariate linear regression models, restricted cubic spline functions and double-pollutant models were used to assess the relationship between exposure to six air pollutants and sperm volume, concentration, total sperm number and sperm motility. A negative association was found between SO2 exposure and progressive motility and total motility during 0-90 lag days and 70-90 lag days, and SO2 exposure during 10-14 lag days adversely affected sperm concentration and total sperm number. Sensitive analyses for qualified sperm donors and the double-pollutant models obtained similar results. Additionally, there were nonlinear relationships between exposure to PM, NO2, O3, CO and a few semen parameters, with NO2 and O3 exposure above the threshold showing negative correlations with total motility and progressive motility, respectively. Our study suggested that SO2 may play a dominant role in the adverse effects of ambient air pollutants on semen quality in the general population by decreasing sperm motility, sperm concentration and total sperm number. Also, even SO2 exposure lower than the recommended standards of the World Health Organization (WHO) could still cause male reproductive toxicity, which deserves attention.
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Affiliation(s)
- Feng Zhang
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hang Li
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Wenting Xu
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, Hubei, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, Hubei, China
| | - Ge Song
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, Hubei, China
| | - Zhanpeng Wang
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, Hubei, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, Hubei, China
| | - Xiaohong Mao
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Yiqiu Wei
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Mengyang Dai
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yuying Zhang
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qunshan Shen
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Feifei Fu
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Jing Tan
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Lei Ge
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Xiaojin He
- Reproductive Medicine Center, Anhui Provincial Human Sperm Bank, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, Anhui, China
| | - Tailang Yin
- Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, Hubei, China
| | - Siwei Li
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, Hubei, China; State Key Laboratory of Information Engineering in Surveying, Mapping and Remote Sensing, Wuhan University, Wuhan, Hubei, China.
| | - Pan Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, Hubei, China; Hubei Luojia Laboratory, Wuhan, Hubei, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, Hubei, China; School of Public Health, Wuhan University, Wuhan, Hubei, China.
| | - Yan Zhang
- Department of Clinical Laboratory, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
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Josey KP, deSouza P, Wu X, Braun D, Nethery R. Estimating a Causal Exposure Response Function with a Continuous Error-Prone Exposure: A Study of Fine Particulate Matter and All-Cause Mortality. JOURNAL OF AGRICULTURAL, BIOLOGICAL, AND ENVIRONMENTAL STATISTICS 2023; 28:20-41. [PMID: 37063643 PMCID: PMC10103900 DOI: 10.1007/s13253-022-00508-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 07/08/2022] [Accepted: 07/23/2022] [Indexed: 10/14/2022]
Abstract
Numerous studies have examined the associations between long-term exposure to fine particulate matter (PM2.5) and adverse health outcomes. Recently, many of these studies have begun to employ high-resolution predicted PM2.5 concentrations, which are subject to measurement error. Previous approaches for exposure measurement error correction have either been applied in non-causal settings or have only considered a categorical exposure. Moreover, most procedures have failed to account for uncertainty induced by error correction when fitting an exposure-response function (ERF). To remedy these deficiencies, we develop a multiple imputation framework that combines regression calibration and Bayesian techniques to estimate a causal ERF. We demonstrate how the output of the measurement error correction steps can be seamlessly integrated into a Bayesian additive regression trees (BART) estimator of the causal ERF. We also demonstrate how locally-weighted smoothing of the posterior samples from BART can be used to create a more accurate ERF estimate. Our proposed approach also properly propagates the exposure measurement error uncertainty to yield accurate standard error estimates. We assess the robustness of our proposed approach in an extensive simulation study. We then apply our methodology to estimate the effects of PM2.5 on all-cause mortality among Medicare enrollees in New England from 2000-2012.
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Affiliation(s)
- Kevin P. Josey
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Priyanka deSouza
- Department of Urban and Regional Planning, University of Colorado, Denver, CO
| | - Xiao Wu
- Department of Statistics, Stanford University, Stanford, CA
- Stanford Data Science, Stanford University, Stanford, CA
| | - Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Rachel Nethery
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
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12
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Koch S, Klitzman R. Reliance on fossil fuels: ethical implications for intensivists. Intensive Care Med 2023; 49:330-333. [PMID: 36811637 PMCID: PMC9944793 DOI: 10.1007/s00134-023-06994-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Susanne Koch
- Department of Anaesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Charité Mitte and Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Robert Klitzman
- Columbia University New York, Joseph Mailman School of Public Health, Master of Bioethics Program, New York, USA
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Koch S, Hoffmann C, Caseiro A, Ledebur M, Menk M, von Schneidemesser E. Air quality in Germany as a contributing factor to morbidity from COVID-19. ENVIRONMENTAL RESEARCH 2022; 214:113896. [PMID: 35841971 PMCID: PMC9277987 DOI: 10.1016/j.envres.2022.113896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/27/2022] [Accepted: 07/10/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND The SARS-CoV-2 virus has been spreading in Germany since January 2020, with regional differences in incidence, morbidity, and mortality. Long-term exposure to air pollutants as nitrogen dioxide (NO2), nitrogen monoxide (NO), ozone (O3), and particulate matter (<10 μm PM10, <2.5 μm PM2.5) has a negative impact on respiratory functions. We analyze the association between long-term air pollution and the outcome of SARS-CoV-2 infections in Germany. METHODS We conducted an observational study in Germany on county-level, investigating the association between long-term (2010-2019) air pollutant exposure (European Environment Agency, AirBase data set) and COVID-19 incidence, morbidity, and mortality rate during the first outbreak of SARS-CoV-2 (open source data Robert Koch Institute). We used negative binominal models, including adjustment for risk factors (age, sex, days since first COVID-19 case, population density, socio-economic and health parameters). RESULTS After adjustment for risk factors in the tri-pollutant model (NO2, O3, PM2.5) an increase of 1 μg/m³ NO2 was associated with an increase of the need for intensive care due to COVID-19 by 4.2% (95% CI 1.011-1.074), and mechanical ventilation by 4.6% (95% CI 1.010-1.084). A tendency towards an association of NO2 with COVID-19 incidence was indicated, as the results were just outside of the defined statistical significance (+1.6% (95% CI 1.000-1.032)). Long-term annual mean NO2 level ranged from 4.6 μg/m³ to 32 μg/m³. CONCLUSIONS Our results indicate that long-term NO2 exposure may have increased susceptibility for COVID-19 morbidity in Germany. The results demonstrate the need to reduce ambient air pollution to improve public health.
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Affiliation(s)
- Susanne Koch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anaesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Christina Hoffmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Diagnostic Laboratory Medicine, Clinical Chemistry, And Pathobiochemistry, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Alexandre Caseiro
- Institute for Advanced Sustainability Studies e.V. (IASS), Berliner Strasse 130, 14467, Potsdam, Germany
| | - Marie Ledebur
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anaesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Mario Menk
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anaesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Erika von Schneidemesser
- Institute for Advanced Sustainability Studies e.V. (IASS), Berliner Strasse 130, 14467, Potsdam, Germany
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Hassan MA, Mehmood T, Lodhi E, Bilal M, Dar AA, Liu J. Lockdown Amid COVID-19 Ascendancy over Ambient Particulate Matter Pollution Anomaly. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13540. [PMID: 36294120 PMCID: PMC9603700 DOI: 10.3390/ijerph192013540] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/10/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
Air is a diverse mixture of gaseous and suspended solid particles. Several new substances are being added to the air daily, polluting it and causing human health effects. Particulate matter (PM) is the primary health concern among these air toxins. The World Health Organization (WHO) addressed the fact that particulate pollution affects human health more severely than other air pollutants. The spread of air pollution and viruses, two of our millennium's most serious concerns, have been linked closely. Coronavirus disease 2019 (COVID-19) can spread through the air, and PM could act as a host to spread the virus beyond those in close contact. Studies on COVID-19 cover diverse environmental segments and become complicated with time. As PM pollution is related to everyday life, an essential awareness regarding PM-impacted COVID-19 among the masses is required, which can help researchers understand the various features of ambient particulate pollution, particularly in the era of COVID-19. Given this, the present work provides an overview of the recent developments in COVID-19 research linked to ambient particulate studies. This review summarizes the effect of the lockdown on the characteristics of ambient particulate matter pollution, the transmission mechanism of COVID-19, and the combined health repercussions of PM pollution. In addition to a comprehensive evaluation of the implementation of the lockdown, its rationales-based on topographic and socioeconomic dynamics-are also discussed in detail. The current review is expected to encourage and motivate academics to concentrate on improving air quality management and COVID-19 control.
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Affiliation(s)
- Muhammad Azher Hassan
- Tianjin Key Lab of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin 300072, China
| | - Tariq Mehmood
- College of Ecology and Environment, Hainan University, Haikou 570228, China
- Department of Environmental Engineering, Helmholtz Centre for Environmental Research—UFZ, D-04318 Leipzig, Germany
| | - Ehtisham Lodhi
- The SKL for Management and Control of Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Muhammad Bilal
- School of Surveying and Land Information Engineering, Henan Polytechnic University, Jiaozuo 454000, China
| | - Afzal Ahmed Dar
- School of Environmental Science and Engineering, Shaanxi University of Science and Technology, Xi’an 710000, China
| | - Junjie Liu
- Tianjin Key Lab of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin 300072, China
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Gutman L, Pauly V, Orleans V, Piga D, Channac Y, Armengaud A, Boyer L, Papazian L. Long-term exposure to ambient air pollution is associated with an increased incidence and mortality of acute respiratory distress syndrome in a large French region. ENVIRONMENTAL RESEARCH 2022; 212:113383. [PMID: 35569534 DOI: 10.1016/j.envres.2022.113383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/18/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Air pollution exposure is suspected to alter both the incidence and mortality in acute respiratory distress syndrome (ARDS). The impact of chronic air pollutant exposure on the incidence and mortality of ARDS from various aetiologies in Europe remains unknown. The main objective of this study was to evaluate the incidence of ARDS in a large European region, 90-day mortality being the main secondary outcome. METHODS The study was performed in the Provence-Alpes-Cote-d'Azur (PACA) region. Nitrogen dioxide (NO2), particulate matter (PM2.5 and PM10) and ozone (O3) were measured. The Programme de Médicalisation des Systèmes d'Information (PMSI), which captures all patient hospital stays in France, was used to identify adults coded as ARDS in an intensive care unit. RESULTS From 2016 to 2018, 4733 adults with ARDS treated in intensive care units were analysed. The incidence rate ratios for 1-year average exposure to PM2.5 and PM10 were 1.207 ([95% confidence interval (95% CI), 1.145-1.390]; P < 0.01) and 1.168 (95% CI, 1.083-1.259; P < 0.001), respectively. The same trend was observed for both 2- and 3-year exposures, while only chronic 1- and 2-year exposure NO2 exposures were related to a higher incidence of ARDS. Increased PM2.5 exposure was associated with a higher 90-day mortality for both 1- and 3-year exposures (OR 1.096 (95% CI, 1.001-1.201) and 1.078 (95% CI, 1.009-1.152), respectively). O3 was not associated with either of incidence nor mortality. CONCLUSIONS While chronic exposure to NO2, PM2.5, and PM10 was associated with an increased ARDS incidence and a higher mortality rate (for PM2.5) in those patients presenting with ARDS, further research on this topic is required.
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Affiliation(s)
- Laëtitia Gutman
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015, Marseille, France; Aix-Marseille Université, Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France.
| | - Vanessa Pauly
- Aix-Marseille Université, Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France; Unité d'Analyse des données de Santé, Assistance Publique, Hôpitaux de Marseille, 13005, Marseille, France
| | - Veronica Orleans
- Unité d'Analyse des données de Santé, Assistance Publique, Hôpitaux de Marseille, 13005, Marseille, France
| | - Damien Piga
- AtmoSud, Observatoire de la qualité de l'air en région Sud Provence-Alpes-Côte d'Azur, 13006, Marseille, France
| | - Yann Channac
- Unité d'Analyse des données de Santé, Assistance Publique, Hôpitaux de Marseille, 13005, Marseille, France
| | - Alexandre Armengaud
- AtmoSud, Observatoire de la qualité de l'air en région Sud Provence-Alpes-Côte d'Azur, 13006, Marseille, France
| | - Laurent Boyer
- Aix-Marseille Université, Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France; Unité d'Analyse des données de Santé, Assistance Publique, Hôpitaux de Marseille, 13005, Marseille, France
| | - Laurent Papazian
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015, Marseille, France; Aix-Marseille Université, Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France
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Data-Driven Prediction of COVID-19 Daily New Cases through a Hybrid Approach of Machine Learning Unsupervised and Deep Learning. ATMOSPHERE 2022. [DOI: 10.3390/atmos13081205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Air pollution is associated with respiratory diseases and the transmission of infectious diseases. In this context, the association between meteorological factors and poor air quality possibly contributes to the transmission of COVID-19. Therefore, analyzing historical data of particulate matter (PM2.5, and PM10) and meteorological factors in indoor and outdoor environments to discover patterns that allow predicting future confirmed cases of COVID-19 is a challenge within a long pandemic. In this study, a hybrid approach based on machine learning and deep learning is proposed to predict confirmed cases of COVID-19. On the one hand, a clustering algorithm based on K-means allows the discovery of behavior patterns by forming groups with high cohesion. On the other hand, multivariate linear regression is implemented through a long short-term memory (LSTM) neural network, building a reliable predictive model in the training stage. The LSTM prediction model is evaluated through error metrics, achieving the highest performance and accuracy in predicting confirmed cases of COVID-19, using data of PM2.5 and PM10 concentrations and meteorological factors of the outdoor environment. The predictive model obtains a root-mean-square error (RMSE) of 0.0897, mean absolute error (MAE) of 0.0837, and mean absolute percentage error (MAPE) of 0.4229 in the testing stage. When using a dataset of PM2.5, PM10, and meteorological parameters collected inside 20 households from 27 May to 13 October 2021, the highest performance is obtained with an RMSE of 0.0892, MAE of 0.0592, and MAPE of 0.2061 in the testing stage. Moreover, in the validation stage, the predictive model obtains a very acceptable performance with values between 0.4152 and 3.9084 for RMSE, and a MAPE of less than 4.1%, using three different datasets with indoor environment values.
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Akan AP. Transmission of COVID-19 pandemic (Turkey) associated with short-term exposure of air quality and climatological parameters. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:41695-41712. [PMID: 35098452 PMCID: PMC8801283 DOI: 10.1007/s11356-021-18403-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/25/2021] [Indexed: 05/21/2023]
Abstract
The study aims to investigate associations between air pollution, climate parameters, and the diffusion of COVID-19-confirmed cases in Turkey using Spearman's correlation test as an empirical methodology by Statgraphics Centurion XVI (version 16.1) and to determine the risk factors accelerating the spread of SARS-CoV-2 virus. The present study demonstrates the strong impacts of air pollutants and weather conditions on the transmission of COVID-19 morbidity. Particularly, O3 and PM10 from air quality parameters exhibited the strongest correlation with the number of daily cases in Kütahya (rs = -0.62; p < 0.05) and Sivas (rs = -0.62; p < 0.05) provinces, respectively. In meteorological parameters, rainfall showed the highest impact (rs = 0.76; p < 0.05) on the number of daily COVID-19 cases in Denizli distinct. Moreover, this study suggested that the diffusion of the novel coronavirus SARS-CoV-2 in regions with high levels of air pollution and low wind speed is dominant. To prevent the negative effects of the future pandemic crisis on public health and economic systems, manifold implications to encourage strategies to reduce air pollution in the polluted region such as being prevalent the usage of renewable energy technologies in particular electricity generation and sustainable policies such as improving the health system should be implemented by decision-makers.
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Affiliation(s)
- Aytac Perihan Akan
- Department of Environmental Engineering, Hacettepe University, 06800, Ankara, Turkey.
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Analysis of Particulate Matter Concentration Changes before, during, and Post COVID-19 Lockdown: A Case Study from Victoria, Mexico. ATMOSPHERE 2022. [DOI: 10.3390/atmos13050827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The lockdown measures implemented due to the SARS-CoV-2 pandemic to reduce the epidemic curve, in most cases, have had a positive impact on air quality indices. Our study describes the changes in the concentration levels of PM2.5 and PM10 during the lockdown and post-lockdown in Victoria, Mexico, considering the following periods: before the lockdown (BL) from 16 February to 14 March, during the lockdown (DL) from 15 March to 2 May, and in the partial lockdown (PL) from 3 May to 6 June. When comparing the DL period of 2019 and 2020, we document a reduction in the average concentration of PM2.5 and PM10 of −55.56% and −55.17%, respectively. Moreover, we note a decrease of −53.57% for PM2.5 and −51.61% for PM10 in the PL period. When contrasting the average concentration between the DL periods of 2020 and 2021, an increase of 91.67% for PM2.5 and 100.00% for PM10 was identified. Furthermore, in the PL periods of 2020 and 2021, an increase of 38.46% and 31.33% was observed for PM2.5 and PM10, respectively. On the other hand, when comparing the concentrations of PM2.5 in the three periods of 2020, we found a decrease between BL and DL of −50.00%, between BL and PL a decrease of −45.83%, and an increase of 8.33% between DL and PL. In the case of PM10, a decrease of −48.00% between BL and DL, −40.00% between BL and PL, and an increase of 15.38% between the DL and PL periods were observed. In addition, we performed a non-parametric statistical analysis, where a significant statistical difference was found between the DL-2020 and DL-2019 pairs (x2 = 1.204) and between the DL-2021 and DL-2019 pairs (x2 = 0.372), with a p<0.000 for PM2.5, and the contrast between pairs of PM10 (DL) showed a significant difference between all pairs with p<0.01.
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19
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Huang R, Li Z, Ivey CE, Zhai X, Shi G, Mulholland JA, Devlin R, Russell AG. Application of an Improved Gas-constrained Source Apportionment Method Using Data Fused Fields: a Case Study in North Carolina, USA. ATMOSPHERIC ENVIRONMENT (OXFORD, ENGLAND : 1994) 2022; 276:119031. [PMID: 35814352 PMCID: PMC9262331 DOI: 10.1016/j.atmosenv.2022.119031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A number of studies have found differing associations of disease outcomes with PM2.5 components (or species) and sources (e.g., biomass burning, diesel vehicles and gasoline vehicles). Here, a unique method of fusing daily chemical transport model (Community Multiscale Air Quality Modeling) results with observations has been utilized to generate spatiotemporal fields of the concentrations of major gaseous pollutants (CO, NO2, NOx, O3, and SO2), total PM2.5 mass, and speciated PM2.5 (including crustal elements) over North Carolina for 2002-2010. The fused results are then used in chemical mass balance source apportionment model, CMBGC-Iteration, which uses both gas constraint and particulate matter concentrations to quantify source impacts. The method, as applied to North Carolina, quantifies the impacts of ten source categories and provides estimates of source contributions to PM2.5 concentrations. The ten source categories include both primary sources (diesel vehicles, gasoline vehicles, dust, biomass burning, coal-fired power plants and sea salt) and secondary components (ammonium sulfate, ammonium bisulfate, ammonium nitrate and secondary organic carbon). The results show a steady decrease in anthropogenic source impacts, especially from diesel vehicles and coal-fired power plants. Secondary pollutant components accounted for approximately 70% of PM2.5 mass. This study demonstrates an ability to provide spatiotemporal fields of both PM components and source impacts using a chemical transport model fused with observation data, linked to a receptor-based source apportionment method, to develop spatiotemporal fields of multiple pollutants.
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Affiliation(s)
- Ran Huang
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Zongrun Li
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Cesunica E. Ivey
- Department of Chemical and Environmental Engineering, University of California Riverside, Riverside, California, USA
| | - Xinxin Zhai
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Guoliang Shi
- State Environmental Protection Key Laboratory of Urban Ambient Air Particulate Matter Pollution Prevention and Control, Center for Urban Transport Emission Research, College of Environmental Science and Engineering, Nankai University, Tianjin, China
| | - James A. Mulholland
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Robert Devlin
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Armistead G. Russell
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
- Correspondence:
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20
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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: 4] [Impact Index Per Article: 2.0] [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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21
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Abstract
The use of electronic (e)-cigarettes was initially considered a beneficial solution to conventional cigarette smoking cessation. However, paradoxically, e-cigarette use is rapidly growing among nonsmokers, including youth and young adults. In 2019, this rapid growth resulted in an epidemic of hospitalizations and deaths of e-cigarette users (vapers) due to acute lung injury; this novel disease was termed e-cigarette or vaping use-associated lung injury (EVALI). Pathophysiologic mechanisms of EVALI likely involve cytotoxicity and neutrophilic inflammation caused by inhaled chemicals, but further details remain unknown. The undiscovered mechanisms of EVALI are a barrier to identifying biomarkers and developing therapeutics. Furthermore, adverse effects of e-cigarette use have been linked to chronic lung diseases and systemic effects on multiple organs. In this comprehensive review, we discuss the diverse spectrum of vaping exposures, epidemiological and clinical reports, and experimental findings to provide a better understanding of EVALI and the adverse health effects of chronic e-cigarette exposure.
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Affiliation(s)
- Jin-Ah Park
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA;
| | - Laura E Crotty Alexander
- University of California at San Diego, La Jolla, California, USA.,Veterans Affairs (VA) San Diego Healthcare System, San Diego, California, USA
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; .,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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22
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Bozack A, Pierre S, DeFelice N, Colicino E, Jack D, Chillrud SN, Rundle A, Astua A, Quinn JW, McGuinn L, Yang Q, Johnson K, Masci J, Lukban L, Maru D, Lee AG. Long-Term Air Pollution Exposure and COVID-19 Mortality: A Patient-Level Analysis from New York City. Am J Respir Crit Care Med 2021; 205:651-662. [PMID: 34881681 DOI: 10.1164/rccm.202104-0845oc] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Risk factors for COVID-19 mortality may include environmental exposures, such as air pollution. OBJECTIVES Determine whether, amongst adults hospitalized with PCR-confirmed COVID-19, long-term air pollution exposure is associated with risk for mortality, intensive care unit (ICU) admission or intubation. METHODS We performed a retrospective analysis of SARS-CoV-2 PCR positive patients admitted to seven New York City hospitals from March 8, 2020 to August 30, 2020. The primary outcome was mortality; secondary outcomes were ICU admission and intubation. We estimated the annual average fine particulate matter (PM2.5), nitrogen dioxide (NO2) and black carbon (BC) concentrations at patients' residential addresses. We employed double-robust Poisson regression to analyze associations between annual average PM2.5, NO2 and BC exposure and COVID-19 outcomes, adjusting for age, sex, race/ethnicity, hospital, insurance and time from onset of the pandemic. RESULTS Of the 6,542 patients, 41% were female and aged median 65 years (IQR 53, 77). Over 50% self-identified as a person of color [N=1,687 (26%) Hispanic, N=1,659 (25%) Black]. Air pollution exposures were generally low. Overall, 31% (N=2,044) of the cohort died, 19% (N=1,237) were admitted to the ICU and 16% (1,051) were intubated. In multivariable models, higher long-term exposure to PM2.5 was associated with increased risk of mortality (RR 1.11, 95% CI 1.02, 1.21 per 1µg/m3 increase in PM2.5) and ICU admission (RR 1.13, 95% CI 1.00, 1.28 per 1µg/m3 increase in PM2.5). In multivariable models, neither NO2 nor BC exposure was associated with COVID-19 mortality, ICU admission or intubation. CONCLUSIONS Amongst patients hospitalized with COVID-19, higher long-term PM2.5 exposure was associated with increased risk of mortality and ICU admission. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Affiliation(s)
- Anne Bozack
- University of California Berkeley, 1438, Berkeley, California, United States
| | - Stanley Pierre
- NYC Health and Hospitals Queens, New York, New York, United States
| | - Nicholas DeFelice
- Icahn School of Medicine at Mount Sinai, 5925, Environmental Medicine and Public Health, New York, New York, United States
| | - Elena Colicino
- Icahn School of Medicine at Mount Sinai, 5925, New York, New York, United States
| | - Darby Jack
- Columbia University Mailman School of Public Health, 33638, Environmental Health Sciences, New York, New York, United States
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, 57699, Palisades, New York, United States
| | - Andrew Rundle
- Columbia University Mailman School of Public Health, 33638, New York, New York, United States
| | - Alfredo Astua
- Mount Sinai Health System, 5944, Internal Medicine, New York, New York, United States
| | - James W Quinn
- Columbia University Mailman School of Public Health, 33638, New York, New York, United States
| | - Laura McGuinn
- Icahn School of Medicine at Mount Sinai, 5925, Environmental Medicine and Public Health, New York, New York, United States
| | - Qiang Yang
- Lamont-Doherty Earth Observatory, 57699, Palisades, New York, United States
| | - Keely Johnson
- Icahn School of Medicine at Mount Sinai, 5925, Department of Internal Medicine, New York, New York, United States
| | - Joseph Masci
- Icahn School of Medicine at Mount Sinai, 5925, Division of Infectious Disease, New York, New York, United States
| | - Laureen Lukban
- Icahn School of Medicine at Mount Sinai, 5925, Pediatrics, New York, New York, United States
| | - Duncan Maru
- Icahn School of Medicine at Mount Sinai, 5925, Pediatrics, New York, New York, United States
| | - Alison G Lee
- Icahn School of Medicine at Mount Sinai, 5925, Division of Pulmonary, Sleep and Critical Care Medicine, New York, New York, United States;
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23
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De La Cruz N, Hines JH, Shaw C, Appiah D. Geographic Disparity in Asthma Hospitalizations: The Role of Race/Ethnicity, Socioeconomic Status, and Other Factors. Cureus 2021; 13:e20015. [PMID: 34873552 PMCID: PMC8631481 DOI: 10.7759/cureus.20015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/05/2022] Open
Abstract
Background In the United States, asthma is the most common chronic disease in children, and is associated with low sociodemographic, economic, and environmental factors. Objective To investigate geographic disparities in asthma hospitalizations and the roles that race/ethnicity, health insurance, and other environmental factors played on these disparities in Lubbock County, Texas. Methods Data were obtained from the Texas Inpatient Public Use Data File for the years 1999-2018. International classification of disease codes were used to identify primary diagnoses of asthma among all severe inpatient admissions. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results Of the 248,768 patients admitted for severe conditions, 4,224 had a primary diagnosis of asthma. In multivariable-adjusted models, the odds of asthma hospitalizations varied across geographic regions of Lubbock with the Northeast having the highest age-adjusted prevalence (7.17 per 1,000) and ORs for asthma hospitalizations (OR: 1.25, CI: 1.12-1.40). Data suggested that non-Hispanic Blacks using federal insurance in the Northeast region had the highest odds for asthma hospitalizations (OR: 4.88, CI: 3.06-7.79; p-interaction = 0.001). Across all regions, a 1 μg/m3 increase in particulate matter 2.5 was associated with a 27% higher likelihood of asthma hospitalization (OR: 1.27, 95% CI: 1.23-1.31). Conclusion In this study, geographic disparities in asthma hospitalizations were observed within Lubbock County and were significantly influenced by a disparate distribution of socioeconomic factors related to health insurance and race/ethnicity. The potential contributory role of particulate matter needs further investigation.
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Affiliation(s)
- Noah De La Cruz
- College of Osteopathic Medicine, Sam Houston State University, Conroe, USA
| | - Jonathon H Hines
- College of Osteopathic Medicine, Sam Houston State University, Conroe, USA
| | - Chip Shaw
- Public Health, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Duke Appiah
- Public Health, Texas Tech University Health Sciences Center, Lubbock, USA
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24
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Dey T, Tyagi P, Sabath MB, Kamareddine L, Henneman L, Braun D, Dominici F. Counterfactual time series analysis of short-term change in air pollution following the COVID-19 state of emergency in the United States. Sci Rep 2021; 11:23517. [PMID: 34876601 PMCID: PMC8651777 DOI: 10.1038/s41598-021-02776-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/19/2021] [Indexed: 12/23/2022] Open
Abstract
Lockdown measures implemented in response to the COVID-19 pandemic produced sudden behavioral changes. We implement counterfactual time series analysis based on seasonal autoregressive integrated moving average models (SARIMA), to examine the extent of air pollution reduction attained following state-level emergency declarations. We also investigate whether these reductions occurred everywhere in the US, and the local factors (geography, population density, and sources of emission) that drove them. Following state-level emergency declarations, we found evidence of a statistically significant decrease in nitrogen dioxide (NO2) levels in 34 of the 36 states and in fine particulate matter (PM2.5) levels in 16 of the 48 states that were investigated. The lockdown produced a decrease of up to 3.4 µg/m3 in PM2.5 (observed in California) with range (- 2.3, 3.4) and up to 11.6 ppb in NO2 (observed in Nevada) with range (- 0.6, 11.6). The state of emergency was declared at different dates for different states, therefore the period "before" the state of emergency in our analysis ranged from 8 to 10 weeks and the corresponding "after" period ranged from 8 to 6 weeks. These changes in PM2.5 and NO2 represent a substantial fraction of the annual mean National Ambient Air Quality Standards (NAAQS) of 12 µg/m3 and 53 ppb, respectively. As expected, we also found evidence that states with a higher percentage of mobile source emissions (obtained from 2014) experienced a greater decline in NO2 levels after the lockdown. Although the socioeconomic restrictions are not sustainable, our results provide a benchmark to estimate the extent of achievable air pollution reductions. Identification of factors contributing to pollutant reduction can help guide state-level policies to sustainably reduce air pollution.
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Affiliation(s)
- Tanujit Dey
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Pooja Tyagi
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - M Benjamin Sabath
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- Faculty of Arts and Sciences, Research Computing, Harvard University, 38 Oxford Street, Cambridge, MA, 02138, USA
| | - Leila Kamareddine
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Lucas Henneman
- Department of Civil, Environmental, and Infrastructure Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- Department of Data Science, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
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25
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Guan Y, Xiao Y, Wang Y, Zhang N, Chu C. Assessing the health impacts attributable to PM 2.5 and ozone pollution in 338 Chinese cities from 2015 to 2020. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 287:117623. [PMID: 34171728 DOI: 10.1016/j.envpol.2021.117623] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 05/13/2023]
Abstract
China has effectively reduced the fine particulate (PM2.5) pollution from 2015 to 2020. Ozone pollution and related health impacts have become severe contemporaneously. The coordinated control of PM2.5 and ozone is becoming a new issue for China's air pollution control. This study quantitatively assessed the health impacts attributed to PM2.5 and ozone pollution in 338 Chinese cities from 2015 to 2020 and estimated the possible health benefits from achieving dual concentration targets during 2021-2025. Results show PM2.5 caused a total health impact of 2.45 × 107 disability-adjusted life years (DALYs) in 2020. All-cause and respiratory ozone-related health impact in 2020 was 1.04 × 107 DALYs and 1.56 × 106 DALYs. Between 2015 and 2020, the PM2.5-related health impacts decreased by 14.97%, while those ozone-related increased by 94.61% and 96.54% for all-cause and respiratory. Cities in the North China Plain have suffered higher health impacts attributable to PM2.5 and ozone pollution, indicating that the two-pollutant coordinated control is primarily needed. By achieving aggressive concentration target (decreasing 10%) between 2020 and 2025, China will reduce the PM2.5-related health impacts in 338 cities by 1.56 × 106 DALYs (improving 6.37%). By achieving general target (decreasing 10% or within the Interim target-1 of World Health Organization), the PM2.5-related health benefit will be 7.98 × 105 DALYs (improving 3.25%). The deteriorating ozone health risks will also be improved. Controlling air pollution in large cities and regional center cities can achieve remarkable health benefits. Due to the inter-region, inter-province, and inter-city difference of health impacts, targeted and differentiated pollution prevention and control need to be implemented.
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Affiliation(s)
- Yang Guan
- Institute of Strategic Planning, Chinese Academy of Environmental Planning, Beijing, 100012, China
| | - Yang Xiao
- Institute of Strategic Planning, Chinese Academy of Environmental Planning, Beijing, 100012, China
| | - Yameng Wang
- Institute of Strategic Planning, Chinese Academy of Environmental Planning, Beijing, 100012, China
| | - Nannan Zhang
- Institute of Strategic Planning, Chinese Academy of Environmental Planning, Beijing, 100012, China; State Key Joint Laboratory of Environment Simulation and Pollution Control, School of Environment, Tsinghua University, Beijing, 100084, China.
| | - Chengjun Chu
- Center of Environmental Status and Plan Assessment, Chinese Academy of Environmental Planning, Beijing, 100012, China
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26
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Abstract
The acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in the intensive care unit. Improving outcomes depends on not only evidence-based care once ARDS has already developed but also preventing ARDS incidence. Several environmental exposures have now been shown to increase the risk of ARDS and related adverse outcomes. How environmental factors impact the risk of developing ARDS is a growing and important field of research that should inform the care of individual patients as well as public health policy.
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Affiliation(s)
- Katherine D Wick
- Department of Anesthesia, University of California, San Francisco, 513 Parnassus Avenue, HSE 760, San Francisco, CA 94143, USA; Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Michael A Matthay
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, M-917, San Francisco, CA 94143, USA; Department of Anesthesia, University of California, San Francisco, 505 Parnassus Avenue, M-917, San Francisco, CA 94143, USA.
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27
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28
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Risk of Acute Respiratory Distress Syndrome Among Older Adults Living Near Construction and Manufacturing Sites. Epidemiology 2021; 31:468-477. [PMID: 32483064 DOI: 10.1097/ede.0000000000001195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Construction and manufacturing sites produce airborne toxins that may affect nearby residents' respiratory health. Living in heavy industrial sites has been linked to respiratory conditions such as asthma and pneumonia. However, limited information is available for risk of acute respiratory distress syndrome (ARDS), a form of acute respiratory failure with high incidence among older adults. METHODS We conducted a nationwide ecologic study to investigate associations between annual ZIP code-level changes in industrial activity and annual changes in ZIP code-level hospital admission rates for older community residents. Using adjusted generalized linear mixed models, we analyzed data from nearly 30 million yearly Medicare beneficiaries for the years 2006 through 2012. RESULTS We found on average 92,363 hospital admissions for ARDS per year and 646,542 admissions over the course of 7 years. We found that an increase of 10 construction sites per year was associated with a 0.77% (95% confidence interval [CI] = 0.71, 0.84) increase in annual hospital admission rates for ARDS and an increase of 10 manufacturing industries per year was associated with a 1.21% (95% CI = 1.09, 1.33) increase in annual hospital admission rates for ARDS across all ZIP codes. The estimated effect of chemical product manufacturing industry on ARDS was higher than that of total manufacturing industries. Residing in ZIP codes with a high number of construction or manufacturing sites was associated with increased ARDS hospital admissions. CONCLUSIONS This nationwide ecologic study of older adults suggests that residence in areas with more construction and manufacturing sites is associated with increased ARDS risk.
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29
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Abstract
COVID-19 pandemic is a public health emergency. Exposure to air pollution represents a serious health issue in overall mortality worldwide. The health risks of some racial subgroups are spiraling as they have higher levels of exposure to air pollutants, hence being more susceptible to mortality from COVID-19.
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Affiliation(s)
- Tanujit Dey
- Center for Surgery and Public Health, Department of
Surgery, Brigham and Women’s Hospital, Harvard Medical
School, Boston, Massachusetts 02120, United
States
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.
H. Chan School of Public Health, Boston, Massachusetts 02446,
United States
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30
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Gowdy KM, Kilburg-Basnyat B, Hodge MX, Reece SW, Yermalitsk V, Davies SS, Manke J, Armstrong ML, Reisdorph N, Tighe RM, Shaikh SR. Novel Mechanisms of Ozone-Induced Pulmonary Inflammation and Resolution, and the Potential Protective Role of Scavenger Receptor BI. Res Rep Health Eff Inst 2021; 2021:1-49. [PMID: 33998222 PMCID: PMC8126671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Increases in ambient levels of ozone (O3), a criteria air pollutant, have been associated with increased susceptibility and exacerbations of chronic pulmonary diseases through lung injury and inflammation. O3 induces pulmonary inflammation, in part by generating damage-associated molecular patterns (DAMPs), which are recognized by pattern recognition receptors (PRRs), such as toll-like receptors (TLRs) and scavenger receptors (SRs). This inflammatory response is mediated in part by alveolar macrophages (AMs), which highly express PRRs, including scavenger receptor BI (SR-BI). Once pulmonary inflammation has been induced, an active process of resolution occurs in order to prevent secondary necrosis and to restore tissue homeostasis. The processes known to promote the resolution of inflammation include the clearance by macrophages of apoptotic cells, known as efferocytosis, and the production of specialized pro-resolving mediators (SPMs). Impaired efferocytosis and production of SPMs have been associated with the pathogenesis of chronic lung diseases; however, these impairments have yet to be linked with exposure to air pollutants. SPECIFIC AIMS The primary goals of this study were: Aim 1 - to define the role of SR-BI in O3-derived pulmonary inflammation and resolution of injury; and Aim 2 - to determine if O3 exposure alters pulmonary production of SPMs and processes known to promote the resolution of pulmonary inflammation and injury. METHODS To address Aim 1, female wild-type (WT) and SR-BI-deficient, or knock-out (SR-BI KO), mice were exposed to either O3 or filtered air. In one set of experiments mice were instilled with an oxidized phospholipid (oxPL). Bronchoalveolar lavage fluid (BALF) and lung tissue were collected for the analyses of inflammatory and injury markers and oxPL. To estimate efferocytosis, mice were administered apoptotic cells (derived from the Jurkat T cell line) after O3 or filtered air exposure. To address Aim 2, male WT mice were exposed to either O3 or filtered air, and levels of SPMs were assessed in the lung, as well as markers of inflammation and injury in BALF. In some experiments SPMs were administered before exposure to O3or filtered air, to determine whether SPMs could mitigate inflammatory or resolution responses. Efferocytosis was measured as in Aim 1. RESULTS For Aim 1, SR-BI protein levels increased in the lung tissue of mice exposed to O3, compared with mice exposed to filtered air. Compared with WT controls, SR-BI KO mice had a significant increase in the number of neutrophils in their airspace 24 hours post O3 exposure. The oxPL levels increased in the airspace of both WT and SR-BI KO mice after O3 exposure, compared with filtered air controls. Four hours after instillation of an oxPL, SR-BI KO mice had an increase in BALF neutrophils and total protein, and a nonsignificant increase in macrophages compared with WT controls. O3 exposure decreased efferocytosis in both WT and SR-BI KO female mice. For Aim 2, mice given SPM supplementation before O3 exposure showed significantly increased AM efferocytosis when compared with the O3exposure control mice and also showed some mitigation of the effects of O3 on inflammation and injury. Several SPMs and their precursors were measured in lung tissue using reverse-phase high performance liquid chromatography (HPLC) with tandem mass spectrometry (MS/MS). At 24 hours after O3 exposure 14R-hydroxydocosahexaenoic acid (HDHA) and 10,17-dihydroxydocosahexaenoic acid (diHDoHE) were significantly decreased in lung tissue, but at 6 hours after exposure, levels of these SPMs increased. CONCLUSIONS Our findings identify novel mechanisms by which O3 may induce pulmonary inflammation and also increase susceptibility to and exacerbations of chronic lung diseases.
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Affiliation(s)
- K M Gowdy
- Department of Pharmacology & Toxicology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - B Kilburg-Basnyat
- Department of Pharmacology & Toxicology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - M X Hodge
- Department of Pharmacology & Toxicology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - S W Reece
- Department of Pharmacology & Toxicology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - V Yermalitsk
- Division of Clinical Pharmacology, Department of Pharmacology, Vanderbilt University, Nashville, Tennessee
| | - S S Davies
- Division of Clinical Pharmacology, Department of Pharmacology, Vanderbilt University, Nashville, Tennessee
| | - J Manke
- Pharmaceutical Science, University of Colorado School of Medicine, Aurora, Colorado
| | - M L Armstrong
- Pharmaceutical Science, University of Colorado School of Medicine, Aurora, Colorado
| | - N Reisdorph
- Pharmaceutical Science, University of Colorado School of Medicine, Aurora, Colorado
| | - R M Tighe
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - S R Shaikh
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina, Chapel Hill
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31
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Circadian Deregulation as Possible New Player in Pollution-Induced Tissue Damage. ATMOSPHERE 2021. [DOI: 10.3390/atmos12010116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Circadian rhythms are 24-h oscillations driven by a hypothalamic master oscillator that entrains peripheral clocks in almost all cells, tissues and organs. Circadian misalignment, triggered by industrialization and modern lifestyles, has been linked to several pathological conditions, with possible impairment of the quality or even the very existence of life. Living organisms are continuously exposed to air pollutants, and among them, ozone or particulate matters (PMs) are considered to be among the most toxic to human health. In particular, exposure to environmental stressors may result not only in pulmonary and cardiovascular diseases, but, as it has been demonstrated in the last two decades, the skin can also be affected by pollution. In this context, we hypothesize that chronodistruption can exacerbate cell vulnerability to exogenous damaging agents, and we suggest a possible common mechanism of action in deregulation of the homeostasis of the pulmonary, cardiovascular and cutaneous tissues and in its involvement in the development of pathological conditions.
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Kim DI, Song MK, Lee K. Diesel Exhaust Particulates Enhances Susceptibility of LPS-Induced Acute Lung Injury through Upregulation of the IL-17 Cytokine-Derived TGF-β 1/Collagen I Expression and Activation of NLRP3 Inflammasome Signaling in Mice. Biomolecules 2021; 11:67. [PMID: 33419073 PMCID: PMC7825418 DOI: 10.3390/biom11010067] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/31/2020] [Accepted: 01/01/2021] [Indexed: 12/12/2022] Open
Abstract
Diesel exhaust particulates (DEP) adversely affect the respiratory system and exacerbate lung diseases, resulting in high mortality rates. However, its pathogenesis is complicated, and the mechanisms involved are incompletely understood. We investigated the effects of DEP pre-exposure on lipopolysaccharide (LPS)-induced acute lung injury (ALI) and identified the roles of interleukin (IL)-17 in mice. Mice were divided into vehicle control, DEP, LPS, and DEP pre-exposed and LPS-instilled groups. Pre-exposure to DEP enhanced the number of total cells, neutrophils, and lymphocytes in the BAL fluid of LPS-instilled mice. Pre-exposure to DEP synergistically exacerbated pulmonary acute lung inflammation and granulomatous inflammation/pulmonary fibrosis, concomitant with the enhanced expression of inflammatory cytokines in the BAL fluid and of collagen I and TGF-β1 in the lungs of LPS-instilled mice. The number of TGF-β1-positive cells in the DEP pre-exposed and LPS-instilled group was higher than that in the LPS group. The expression of NLR family pyrin domain containing 3 (NLRP3) inflammasome components was markedly increased in the DEP pre-exposed and LPS-instilled group. IL-17 levels in the BAL fluid and IL-17-positive cells in the lungs were significantly increased by pre-exposure to DEP in the LPS-induced group compared to that in the DEP or LPS group. These results suggest that DEP predominantly contributes to fibrotic lung disease in LPS-related acute lung injury by upregulating IL-17 cytokine-mediated collagen I and TGF-β1 and, at least in part, by activating LPS-induced NLRP3 inflammasome signaling. The study should be useful in devising better strategies for prevention and management of ALI.
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Affiliation(s)
- Dong Im Kim
- National Center for Efficacy Evaluation of Respiratory Disease Products, Korea Institute of Toxicology, 30 Baehak1-gil, Jeongeup 56212, Korea; (D.I.K.); (M.-K.S.)
| | - Mi-Kyung Song
- National Center for Efficacy Evaluation of Respiratory Disease Products, Korea Institute of Toxicology, 30 Baehak1-gil, Jeongeup 56212, Korea; (D.I.K.); (M.-K.S.)
- Department of Human and Environmental Toxicology, University of Science & Technology, Daejeon 34113, Korea
| | - Kyuhong Lee
- National Center for Efficacy Evaluation of Respiratory Disease Products, Korea Institute of Toxicology, 30 Baehak1-gil, Jeongeup 56212, Korea; (D.I.K.); (M.-K.S.)
- Department of Human and Environmental Toxicology, University of Science & Technology, Daejeon 34113, Korea
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Copat C, Cristaldi A, Fiore M, Grasso A, Zuccarello P, Signorelli SS, Conti GO, Ferrante M. The role of air pollution (PM and NO 2) in COVID-19 spread and lethality: A systematic review. ENVIRONMENTAL RESEARCH 2020; 191:110129. [PMID: 32853663 PMCID: PMC7444490 DOI: 10.1016/j.envres.2020.110129] [Citation(s) in RCA: 200] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/03/2020] [Accepted: 08/18/2020] [Indexed: 05/19/2023]
Abstract
A new coronavirus (SARS-CoV-2) has determined a pneumonia outbreak in China (Wuhan, Hubei Province) in December 2019, called COVID-19 disease. In addition to the person-to person transmission dynamic of the novel respiratory virus, it has been recently studied the role of environmental factors in accelerate SARS-CoV-2 spread and its lethality. The time being, air pollution has been identified as the largest environmental cause of disease and premature death in the world. It affects body's immunity, making people more vulnerable to pathogens. The hypothesis that air pollution, resulting from a combination of factors such as meteorological data, level of industrialization as well as regional topography, can acts both as a carrier of the infection and as a worsening factor of the health impact of COVID-19 disease, has been raised recently. With this review, we want to provide an update state of art relating the role of air pollution, in particular PM2.5, PM10 and NO2, in COVID-19 spread and lethality. The Authors, who first investigated this association, often used different research methods or not all include confounding factors whenever possible. In addition, to date incidence data are underestimated in all countries and to a lesser extent also mortality data. For this reason, the cases included in the reviewed studies cannot be considered conclusive. Although it determines important limitations for direct comparison of results, and more studies are needed to strengthen scientific evidences and support firm conclusions, major findings are consistent, highlighting the important contribution of PM2.5 and NO2 as triggering of the COVID-19 spread and lethality, and with a less extent also PM10, although the potential effect of airborne virus exposure it has not been still demonstrated.
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Affiliation(s)
- Chiara Copat
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia 87, Catania, 95123, Italy.
| | - Antonio Cristaldi
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia 87, Catania, 95123, Italy
| | - Maria Fiore
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia 87, Catania, 95123, Italy
| | - Alfina Grasso
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia 87, Catania, 95123, Italy
| | - Pietro Zuccarello
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia 87, Catania, 95123, Italy
| | - Salvatore Santo Signorelli
- Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, Catania, 95123, Italy
| | - Gea Oliveri Conti
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia 87, Catania, 95123, Italy
| | - Margherita Ferrante
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia 87, Catania, 95123, Italy
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Benmarhnia T. Linkages Between Air Pollution and the Health Burden From COVID-19: Methodological Challenges and Opportunities. Am J Epidemiol 2020; 189:1238-1243. [PMID: 32676643 PMCID: PMC7454309 DOI: 10.1093/aje/kwaa148] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 12/18/2022] Open
Abstract
The COVID-19 pandemic revealed and exacerbated existing social and economic health disparities and actionable epidemiological evidence is needed to identify potential vulnerability factors to help inform targeted responses. In this commentary, methodological challenges and opportunities regarding the links between air pollution and COVID-19 are discussed with a focus on: i) the role of differential exposure to air pollution across populations and explain spatio-temporal variability of the epidemic spread and resultant mortality; ii) the indirect impacts of interventions treated as natural experiments to control COVID-19 person-to-person spread on air pollution and population health. I first discuss the potential mechanisms between exposure to air pollution and COVID-19 and the opportunity to clearly formulate causal questions of interest through the target trial framework. Then, I discuss challenges regarding the use of quasi-experimental designs that capitalize on the differential timing of COVID-19 policies including the selection of control groups and potential violations of the common shock assumption. Finally, I discuss environmental justice implications of this many-headed beast of a crisis.
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Affiliation(s)
- Tarik Benmarhnia
- Department of Family Medicine and Public Health & Scripps Institution of Oceanography, University of California, San Diego, CA, USA
- Address correspondence to Tarik Benmarhnia, Department of Family Medicine and Public Health & Scripps Institution of Oceanography University of California, San Diego, 9500 Gilman Drive, La Jolla, 92093 CA, USA. Tel: +18589991428, E-mail:
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Wu X, Nethery RC, Sabath MB, Braun D, Dominici F. Air pollution and COVID-19 mortality in the United States: Strengths and limitations of an ecological regression analysis. SCIENCE ADVANCES 2020; 6:6/45/eabd4049. [PMID: 33148655 DOI: 10.1101/2020.04.05.20054502v2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/18/2020] [Indexed: 05/23/2023]
Abstract
Assessing whether long-term exposure to air pollution increases the severity of COVID-19 health outcomes, including death, is an important public health objective. Limitations in COVID-19 data availability and quality remain obstacles to conducting conclusive studies on this topic. At present, publicly available COVID-19 outcome data for representative populations are available only as area-level counts. Therefore, studies of long-term exposure to air pollution and COVID-19 outcomes using these data must use an ecological regression analysis, which precludes controlling for individual-level COVID-19 risk factors. We describe these challenges in the context of one of the first preliminary investigations of this question in the United States, where we found that higher historical PM2.5 exposures are positively associated with higher county-level COVID-19 mortality rates after accounting for many area-level confounders. Motivated by this study, we lay the groundwork for future research on this important topic, describe the challenges, and outline promising directions and opportunities.
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Affiliation(s)
- X Wu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - R C Nethery
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - M B Sabath
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - D Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - F Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Wu X, Nethery RC, Sabath MB, Braun D, Dominici F. Air pollution and COVID-19 mortality in the United States: Strengths and limitations of an ecological regression analysis. SCIENCE ADVANCES 2020; 6:6/45/eabd4049. [PMID: 33148655 DOI: 10.1126/sciadv.abd404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/18/2020] [Indexed: 05/26/2023]
Abstract
Assessing whether long-term exposure to air pollution increases the severity of COVID-19 health outcomes, including death, is an important public health objective. Limitations in COVID-19 data availability and quality remain obstacles to conducting conclusive studies on this topic. At present, publicly available COVID-19 outcome data for representative populations are available only as area-level counts. Therefore, studies of long-term exposure to air pollution and COVID-19 outcomes using these data must use an ecological regression analysis, which precludes controlling for individual-level COVID-19 risk factors. We describe these challenges in the context of one of the first preliminary investigations of this question in the United States, where we found that higher historical PM2.5 exposures are positively associated with higher county-level COVID-19 mortality rates after accounting for many area-level confounders. Motivated by this study, we lay the groundwork for future research on this important topic, describe the challenges, and outline promising directions and opportunities.
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Affiliation(s)
- X Wu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - R C Nethery
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - M B Sabath
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - D Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - F Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Wu X, Nethery RC, Sabath MB, Braun D, Dominici F. Air pollution and COVID-19 mortality in the United States: Strengths and limitations of an ecological regression analysis. SCIENCE ADVANCES 2020; 6:6/45/eabd4049. [PMID: 33148655 DOI: 10.1101/2020.04.05.20054502v1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/18/2020] [Indexed: 05/22/2023]
Abstract
Assessing whether long-term exposure to air pollution increases the severity of COVID-19 health outcomes, including death, is an important public health objective. Limitations in COVID-19 data availability and quality remain obstacles to conducting conclusive studies on this topic. At present, publicly available COVID-19 outcome data for representative populations are available only as area-level counts. Therefore, studies of long-term exposure to air pollution and COVID-19 outcomes using these data must use an ecological regression analysis, which precludes controlling for individual-level COVID-19 risk factors. We describe these challenges in the context of one of the first preliminary investigations of this question in the United States, where we found that higher historical PM2.5 exposures are positively associated with higher county-level COVID-19 mortality rates after accounting for many area-level confounders. Motivated by this study, we lay the groundwork for future research on this important topic, describe the challenges, and outline promising directions and opportunities.
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Affiliation(s)
- X Wu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - R C Nethery
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - M B Sabath
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - D Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - F Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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38
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Wu X, Nethery RC, Sabath MB, Braun D, Dominici F. Air pollution and COVID-19 mortality in the United States: Strengths and limitations of an ecological regression analysis. SCIENCE ADVANCES 2020; 6:eabd4049. [PMID: 33148655 PMCID: PMC7673673 DOI: 10.1126/sciadv.abd4049] [Citation(s) in RCA: 524] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/18/2020] [Indexed: 05/17/2023]
Abstract
Assessing whether long-term exposure to air pollution increases the severity of COVID-19 health outcomes, including death, is an important public health objective. Limitations in COVID-19 data availability and quality remain obstacles to conducting conclusive studies on this topic. At present, publicly available COVID-19 outcome data for representative populations are available only as area-level counts. Therefore, studies of long-term exposure to air pollution and COVID-19 outcomes using these data must use an ecological regression analysis, which precludes controlling for individual-level COVID-19 risk factors. We describe these challenges in the context of one of the first preliminary investigations of this question in the United States, where we found that higher historical PM2.5 exposures are positively associated with higher county-level COVID-19 mortality rates after accounting for many area-level confounders. Motivated by this study, we lay the groundwork for future research on this important topic, describe the challenges, and outline promising directions and opportunities.
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Affiliation(s)
- X Wu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - R C Nethery
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - M B Sabath
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - D Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - F Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Angelini S, Pinto A, Hrelia P, Malaguti M, Buccolini F, Donini LM, Hrelia S. The "Elderly" Lesson in a "Stressful" Life: Italian Holistic Approach to Increase COVID-19 Prevention and Awareness. Front Endocrinol (Lausanne) 2020; 11:579401. [PMID: 33101211 PMCID: PMC7556109 DOI: 10.3389/fendo.2020.579401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/19/2020] [Indexed: 01/22/2023] Open
Abstract
It's a frightening time due to COVID-19, but the great elderly/centenarians, apparently with more frailty, seem to have a better response to the pandemic. "The South Italy" lifestyle seems an "effective strategy" promoting the well-being embedded in a holistic solution: healthy diet, less exposure to PM10 pollution, protected environment, and moderate physical activity. The European FP7 Project RISTOMED results, since 2010, have shown that dietary intervention improved a heathy status in the elderly people. Based on the RISTOMED results, in addition to sociocultural and environmental factors, the authors suggest an integrated approach for resilience to COVID-19. Such an approach during the next months could make the difference for the success of any government progress policy to fight COVID-19, finalizing long-term well-being and successful aging.
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Affiliation(s)
- Sabrina Angelini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Alessandro Pinto
- Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Patrizia Hrelia
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Marco Malaguti
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | | | | | - Silvana Hrelia
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
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40
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Groves CP, Butland BK, Atkinson RW, Delaney AP, Pilcher DV. Intensive care admissions and outcomes associated with short-term exposure to ambient air pollution: a time series analysis. Intensive Care Med 2020; 46:1213-1221. [PMID: 32355989 DOI: 10.1007/s00134-020-06052-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/10/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Short-term exposure to outdoor air pollution has been positively associated with numerous measures of acute morbidity and mortality, most consistently as excess cardiorespiratory disease associated with fine particulate matter (PM2.5), particularly in vulnerable populations. It is unknown if the critically ill, a vulnerable population with high levels of cardiorespiratory disease, is affected by air pollution. METHODS We performed a time series analysis of emergency cardiorespiratory, stroke and sepsis intensive care (ICU) admissions for the years 2008-2016, using data from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS-APD). Case-crossover analysis was conducted to assess the relationship between air pollution and the frequency and severity of ICU admissions having adjusted for temperature, humidity, public holidays and influenza activity. RESULTS 46,965 episodes in 87 separate ICUs were analysed. We found no statistically significant associations with admission counts. However, ICU admissions ending in death within 30 days were significantly positively associated with short-term exposure to PM2.5 [RR 1.18, 95% confidence interval (CI) 1.02-1.37, per 10 µg/m3 increase]. This association was more pronounced in those aged 65 and over (RR 1.33, 95% CI 1.11-1.58, per 10 µg/m3). CONCLUSIONS Increased ICU mortality was associated with higher levels of PM2.5. Larger studies are required to determine if the frequency of ICU admissions is positively associated with short-term exposure to air pollution.
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Affiliation(s)
- Christopher P Groves
- Department of Intensive Care, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Barbara K Butland
- Population Health Research Institute, St George's, University of London, London, UK
| | - Richard W Atkinson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Anthony P Delaney
- Department of Intensive Care, Royal North Shore Hospital, Sydney, NSW, Australia
| | - David V Pilcher
- Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia.,Australia and New Zealand Intensive Care Society (ANZICS), Centre for Outcomes and Resource Evaluation (CORE), Carlton, VIC, Australia
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Exposure to air pollution and COVID-19 mortality in the United States: A nationwide cross-sectional study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32511651 DOI: 10.1101/2020.04.05.20054502] [Citation(s) in RCA: 387] [Impact Index Per Article: 96.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES United States government scientists estimate that COVID-19 may kill tens of thousands of Americans. Many of the pre-existing conditions that increase the risk of death in those with COVID-19 are the same diseases that are affected by long-term exposure to air pollution. We investigated whether long-term average exposure to fine particulate matter (PM 2.5 ) is associated with an increased risk of COVID-19 death in the United States. DESIGN A nationwide, cross-sectional study using county-level data. DATA SOURCES COVID-19 death counts were collected for more than 3,000 counties in the United States (representing 98% of the population) up to April 22, 2020 from Johns Hopkins University, Center for Systems Science and Engineering Coronavirus Resource Center. MAIN OUTCOME MEASURES We fit negative binomial mixed models using county-level COVID-19 deaths as the outcome and county-level long-term average of PM 2.5 as the exposure. In the main analysis, we adjusted by 20 potential confounding factors including population size, age distribution, population density, time since the beginning of the outbreak, time since state issuance of the stay-at-home order, hospital beds, number of individuals tested, weather, and socioeconomic and behavioral variables such as obesity and smoking. We included a random intercept by state to account for potential correlation in counties within the same state. We conducted more than 68 additional sensitivity analyses. RESULTS We found that an increase of only 1 μg/m 3 in PM 2.5 is associated with an 8% increase in the COVID-19 death rate (95% confidence interval [CI]: 2%, 15%). The results were statistically significant and robust to secondary and sensitivity analyses. CONCLUSIONS A small increase in long-term exposure to PM 2.5 leads to a large increase in the COVID-19 death rate. Despite the inherent limitations of the ecological study design, our results underscore the importance of continuing to enforce existing air pollution regulations to protect human health both during and after the COVID-19 crisis. The data and code are publicly available so our analyses can be updated routinely.
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Pre-admission air pollution exposure prolongs the duration of ventilation in intensive care patients. Intensive Care Med 2020; 46:1204-1212. [PMID: 32185459 PMCID: PMC7224020 DOI: 10.1007/s00134-020-05999-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/03/2020] [Indexed: 12/15/2022]
Abstract
Purpose Air pollutant exposure constitutes a serious risk factor for the emergence or aggravation of (existing) pulmonary disease. The impact of pre-intensive care ambient air pollutant exposure on the duration of artificial ventilation was, however, not yet established. Methods The medical records of 2003 patients, admitted to the intensive care unit (ICU) of the Antwerp University Hospital (Flanders, Belgium), who were artificially ventilated on ICU admission or within 48 h after admission, for the duration of at least 48 h, were analyzed. For each patient’s home address, daily air pollutant exposure [particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5) and ≤ 10 µm (PM10), nitrogen dioxide (NO2) and black carbon (BC)] up to 10 days prior to hospital admission was modeled using a high-resolution spatial–temporal model. The association between duration of artificial ventilation and air pollution exposure during the last 10 days before ICU admission was assessed using distributed lag models with a negative binomial regression fit. Results Controlling for pre-specified confounders, an IQR increment in BC (1.2 µg/m3) up to 10 days before admission was associated with an estimated cumulative increase of 12.4% in ventilation duration (95% CI 4.7–20.7). Significant associations were also observed for PM2.5, PM10 and NO2, with cumulative estimates ranging from 7.8 to 8.0%. Conclusion Short-term ambient air pollution exposure prior to ICU admission represents an unrecognized environmental risk factor for the duration of artificial ventilation in the ICU. Electronic supplementary material The online version of this article (10.1007/s00134-020-05999-3) contains supplementary material, which is available to authorized users.
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Rich DQ, Frampton MW, Balmes JR, Bromberg PA, Arjomandi M, Hazucha MJ, Thurston SW, Alexis NE, Ganz P, Zareba W, Koutrakis P, Thevenet-Morrison K. Multicenter Ozone Study in oldEr Subjects (MOSES): Part 2. Effects of Personal and Ambient Concentrations of Ozone and Other Pollutants on Cardiovascular and Pulmonary Function. Res Rep Health Eff Inst 2020; 2020:1-90. [PMID: 32239870 PMCID: PMC7325421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION The Multicenter Ozone Study of oldEr Subjects (MOSES) was a multi-center study evaluating whether short-term controlled exposure of older, healthy individuals to low levels of ozone (O3) induced acute changes in cardiovascular biomarkers. In MOSES Part 1 (MOSES 1), controlled O3 exposure caused concentration-related reductions in lung function with evidence of airway inflammation and injury, but without convincing evidence of effects on cardiovascular function. However, subjects' prior exposures to indoor and outdoor air pollution in the few hours and days before each MOSES controlled O3 exposure may have independently affected the study biomarkers and/or modified biomarker responses to the MOSES controlled O3 exposures. METHODS MOSES 1 was conducted at three clinical centers (University of California San Francisco, University of North Carolina, and University of Rochester Medical Center) and included healthy volunteers 55 to 70 years of age. Consented participants who successfully completed the screening and training sessions were enrolled in the study. All three clinical centers adhered to common standard operating procedures and used common tracking and data forms. Each subject was scheduled to participate in a total of 11 visits: screening visit, training visit, and three sets of exposure visits consisting of the pre-exposure day, the exposure day, and the post-exposure day. After completing the pre-exposure day, subjects spent the night in a nearby hotel. On exposure days, the subjects were exposed for 3 hours in random order to 0 ppb O3 (clean air), 70 ppb O3, and 120 ppm O3. During the exposure period the subjects alternated between 15 minutes of moderate exercise and 15 minutes of rest. A suite of cardiovascular and pulmonary endpoints was measured on the day before, the day of, and up to 22 hours after each exposure. In MOSES Part 2 (MOSES 2), we used a longitudinal panel study design, cardiopulmonary biomarker data from MOSES 1, passive cumulative personal exposure samples (PES) of O3 and nitrogen dioxide (NO2) in the 72 hours before the pre-exposure visit, and hourly ambient air pollution and weather measurements in the 96 hours before the pre-exposure visit. We used mixed-effects linear regression and evaluated whether PES O3 and NO2 and these ambient pollutant concentrations in the 96 hours before the pre-exposure visit confounded the MOSES 1 controlled O3 exposure effects on the pre- to post-exposure biomarker changes (Aim 1), whether they modified these pre- to post-exposure biomarker responses to the controlled O3 exposures (Aim 2), whether they were associated with changes in biomarkers measured at the pre-exposure visit or morning of the exposure session (Aim 3), and whether they were associated with differences in the pre- to post-exposure biomarker changes independently of the controlled O3 exposures (Aim 4). RESULTS Ambient pollutant concentrations at each site were low and were regularly below the National Ambient Air Quality Standard levels. In Aim 1, the controlled O3 exposure effects on the pre- to post-exposure biomarker differences were little changed when PES or ambient pollutant concentrations in the previous 96 hours were included in the model, suggesting these were not confounders of the controlled O3 exposure/biomarker difference associations. In Aim 2, effects of MOSES controlled O3 exposures on forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were modified by ambient NO2 and carbon monoxide (CO), and PES NO2, with reductions in FEV1 and FVC observed only when these concentrations were "Medium" or "High" in the 72 hours before the pre-exposure visit. There was no such effect modification of the effect of controlled O3 exposure on any other cardiopulmonary biomarker. As hypothesized for Aim 3, increased ambient O3 concentrations were associated with decreased pre-exposure heart rate variability (HRV). For example, high frequency (HF) HRV decreased in association with increased ambient O3 concentrations in the 96 hours before the pre-exposure visit (-0.460 ln[ms2]; 95% CI, -0.743 to -0.177 for each 10.35-ppb increase in O3; P = 0.002). However, in Aim 4 these increases in ambient O3 were also associated with increases in HF and low frequency (LF) HRV from pre- to post-exposure, likely reflecting a "recovery" of HRV during the MOSES O3 exposure sessions. Similar patterns across Aims 3 and 4 were observed for LF (the other primary HRV marker), and standard deviation of normal-to-normal sinus beat intervals (SDNN) and root mean square of successive differences in normal-to-normal sinus beat intervals (RMSSD) (secondary HRV markers). Similar Aim 3 and Aim 4 patterns were observed for FEV1 and FVC in association with increases in ambient PM with an aerodynamic diameter ≤ 2.5 μm (PM2.5), CO, and NO2 in the 96 hours before the pre-exposure visit. For Aim 3, small decreases in pre-exposure FEV1 were significantly associated with interquartile range (IQR) increases in PM2.5 concentrations in the 1 hour before the pre-exposure visit (-0.022 L; 95% CI, -0.037 to -0.006; P = 0.007), CO in the 3 hours before the pre-exposure visit (-0.046 L; 95% CI, -0.076 to -0.016; P = 0.003), and NO2 in the 72 hours before the pre-exposure visit (-0.030 L; 95% CI, -0.052 to -0.008; P = 0.007). However, FEV1 was not associated with ambient O3 or sulfur dioxide (SO2), or PES O3 or NO2 (Aim 3). For Aim 4, increased FEV1 across the exposure session (post-exposure minus pre-exposure) was marginally significantly associated with each 4.1-ppb increase in PES O3 concentration (0.010 L; 95% CI, 0.004 to 0.026; P = 0.010), as well as ambient PM2.5 and CO at all lag times. FVC showed similar associations, with patterns of decreased pre-exposure FVC associated with increased PM2.5, CO, and NO2 at most lag times, and increased FVC across the exposure session also associated with increased concentrations of the same pollutants, reflecting a similar recovery. However, increased pollutant concentrations were not associated with adverse changes in pre-exposure levels or pre- to post-exposure changes in biomarkers of cardiac repolarization, ST segment, vascular function, nitrotyrosine as a measure of oxidative stress, prothrombotic state, systemic inflammation, lung injury, or sputum polymorphonuclear leukocyte (PMN) percentage as a measure of airway inflammation. CONCLUSIONS Our previous MOSES 1 findings of controlled O3 exposure effects on pulmonary function, but not on any cardiovascular biomarker, were not confounded by ambient or personal O3 or other pollutant exposures in the 96 and 72 hours before the pre-exposure visit. Further, these MOSES 1 O3 effects were generally not modified, blunted, or lessened by these same ambient and personal pollutant exposures. However, the reductions in markers of pulmonary function by the MOSES 1 controlled O3 exposure were modified by ambient NO2 and CO, and PES NO2, with reductions observed only when these pollutant concentrations were elevated in the few hours and days before the pre-exposure visit. Increased ambient O3 concentrations were associated with reduced HRV, with "recovery" during exposure visits. Increased ambient PM2.5, NO2, and CO were associated with reduced pulmonary function, independent of the MOSES-controlled O3 exposures. Increased pollutant concentrations were not associated with pre-exposure or pre- to post-exposure changes in other cardiopulmonary biomarkers. Future controlled exposure studies should consider the effect of ambient pollutants on pre-exposure biomarker levels and whether ambient pollutants modify any health response to a controlled pollutant exposure.
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Affiliation(s)
- D Q Rich
- University of Rochester Medical Center, Rochester, New York
| | - M W Frampton
- University of Rochester Medical Center, Rochester, New York
| | - J R Balmes
- University of California at San Francisco
| | | | | | | | - S W Thurston
- University of Rochester Medical Center, Rochester, New York
| | - N E Alexis
- University of North Carolina at Chapel Hill
| | - P Ganz
- University of California at San Francisco
| | - W Zareba
- University of Rochester Medical Center, Rochester, New York
| | - P Koutrakis
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Mumby S, Chung KF, Adcock IM. Transcriptional Effects of Ozone and Impact on Airway Inflammation. Front Immunol 2019; 10:1610. [PMID: 31354743 PMCID: PMC6635463 DOI: 10.3389/fimmu.2019.01610] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/27/2019] [Indexed: 12/24/2022] Open
Abstract
Epidemiological and challenge studies in healthy subjects and in individuals with asthma highlight the health impact of environmental ozone even at levels considered safe. Acute ozone exposure in man results in sputum neutrophilia in 30% of subjects particularly young children, females, and those with ongoing cardiopulmonary disease. This may be associated with systemic inflammation although not in all cases. Chronic exposure amplifies these effects and can result in the formation of asthma-like symptoms and immunopathology. Asthmatic patients who respond to ozone (responders) induce a greater number of genes in bronchoalveolar (BAL) macrophages than healthy responders with up-regulation of inflammatory and immune pathways under the control of cytokines and chemokines and the enhanced expression of remodeling and repair programmes including those associated with protease imbalances and cell-cell adhesion. These pathways are under the control of several key transcription regulatory factors including nuclear factor (NF)-κB, anti-oxidant factors such as nuclear factor (erythroid-derived 2)-like 2 NRF2, the p38 mitogen activated protein kinase (MAPK), and priming of the immune system by up-regulating toll-like receptor (TLR) expression. Murine and cellular models of acute and chronic ozone exposure recapitulate the inflammatory effects seen in humans and enable the elucidation of key transcriptional pathways. These studies emphasize the importance of distinct transcriptional networks in driving the detrimental effects of ozone. Studies indicate the critical role of mediators including IL-1, IL-17, and IL-33 in driving ozone effects on airway inflammation, remodeling and hyperresponsiveness. Transcription analysis and proof of mechanisms studies will enable the development of drugs to ameliorate the effects of ozone exposure in susceptible individuals.
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Affiliation(s)
- Sharon Mumby
- Respiratory Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Kian Fan Chung
- Respiratory Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Ian M Adcock
- Respiratory Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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