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El Homsi M, Sclison S, Huguet D, Dessimond B, Tanno LK, Prud'homme J, Collette A, Annesi-Maesano I. Association between air pollution levels and drug sales for asthma and allergy in 63 million people in metropolitan France. J Asthma 2023; 60:1246-1254. [PMID: 36332169 DOI: 10.1080/02770903.2022.2144348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/01/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Air pollution is known to have an impact on respiratory health. However, the assessment of this relationship is far from complete and is rarely extended to the country level. We used drug sales data, both Over-The-Counter (OTC) and prescription drugs, to assess exhaustively the impact of air pollution on asthma and allergy at the national level in France. METHODS The WHO Anatomical Therapeutic Chemical (ATC) classification system was used to describe the distribution of sales of drugs of class R03 (Drugs for obstructive airways diseases, overall for asthma) and R06 (Antihistamines for systemic use). We performed a Quasi-Poisson regression model with a generalized additive model (GAM) to estimate the relationship (Relative Risks and 95% Confidence Interval) between drug sales and air pollutants, that is Particulate Matter with a diameter less than 2.5 micrometers (PM2.5) and less than 10 micrometers (PM10) and Nitrogen dioxide (NO2), as assessed using the high-resolution CHIMERE dispersion model. We designed unadjusted and adjusted single-pollutant models as well as two-pollutant models. RESULTS PM2.5, PM10, and NO2 were significantly and positively associated with sales of R03 and R06 class drugs, after adjustment for potential confounders. Results were confirmed in the two-pollutant model for PM10 and NO2 but not for PM2.5. CONCLUSIONS Our study confirms the presence of an association between major air pollutants and the sales of drugs against asthma and allergies. Further studies on larger databases and over several years are necessary to confirm and better understand these results.
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Affiliation(s)
- Marwan El Homsi
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | | | | | - Boris Dessimond
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Luciana Kase Tanno
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Julie Prud'homme
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Augustin Collette
- Institut National de l'Environnement Industriel et des Risques (INERIS), Verneuil-en-Halatte, France
| | - Isabella Annesi-Maesano
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
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2
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Roca-Barceló A, Nardocci A, de Aguiar BS, Ribeiro AG, Failla MA, Hansell AL, Cardoso MR, Piel FB. Risk of cardiovascular mortality, stroke and coronary heart mortality associated with aircraft noise around Congonhas airport, São Paulo, Brazil: a small-area study. Environ Health 2021; 20:59. [PMID: 33985498 PMCID: PMC8120910 DOI: 10.1186/s12940-021-00746-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Noise pollution is increasingly recognised as a public health hazard, yet limited evidence is available from low- and middle-income countries (LMIC), particularly for specific sources. Here, we investigated the association between day-night average (Ldn) aircraft noise and the risk of death due to cardiovascular disease (CVD), stroke and coronary heart disease (CHD) at small-area level around São Paulo's Congonhas airport, Brazil during the period 2011-2016. METHODS We selected 3259 census tracts across 16 districts partially or entirely exposed to ≥50 dB aircraft noise levels around the Congonhas airport, using pre-modelled 5 dB Ldn noise bands (≤50 dB to > 65 dB). We estimated the average noise exposure per census tract using area-weighting. Age, sex and calendar year-specific death counts for CVD, stroke and CHD were calculated by census tract, according to the residential address at time of death. We fitted Poisson regression models to quantify the risk associated with aircraft noise exposure, adjusting for age, sex, calendar year and area-level covariates including socioeconomic development, ethnicity, smoking and road traffic related noise and air pollution. RESULTS After accounting for all covariates, areas exposed to the highest levels of noise (> 65 dB) showed a relative risk (RR) for CVD and CHD of 1.06 (95% CI: 0.94; 1.20) and 1.11 (95%CI: 0.96; 1.27), respectively, compared to those exposed to reference noise levels (≤50 dB). The RR for stroke ranged between 1.05 (95%CI: 0.95;1.16) and 0.91 (95%CI: 0.78;1.11) for all the noise levels assessed. We found a statistically significant positive trend for CVD and CHD mortality risk with increasing levels of noise (p = 0.043 and p = 0.005, respectively). No significant linear trend was found for stroke. Risk estimates were generally higher after excluding road traffic density, suggesting that road traffic air and noise pollution are potentially important confounders. CONCLUSIONS This study provides some evidence that aircraft noise is associated with increased risk of CVD and CHD mortality in a middle-income setting. More research is needed to validate these results in other LMIC settings and to further explore the influence of residual confounding and ecological bias. Remarkably, 60% of the study population living near the Congonhas airport (~ 1.5 million) were exposed to aircraft noise levels > 50 dB, well above those recommended by the WHO (45 dB), highlighting the need for public health interventions.
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Affiliation(s)
- Aina Roca-Barceló
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Adelaide Nardocci
- Department of Environmental Health, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Breno Souza de Aguiar
- Epidemiology and Information Department, Municipal Health Secretariat of São Paulo, São Paulo, Brazil
| | - Adeylson G. Ribeiro
- Department of Environmental Health, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Marcelo Antunes Failla
- Epidemiology and Information Department, Municipal Health Secretariat of São Paulo, São Paulo, Brazil
| | - Anna L. Hansell
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Maria Regina Cardoso
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Frédéric B. Piel
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Environmental Exposures and Health, London, UK
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Danesh Yazdi M, Wang Y, Di Q, Wei Y, Requia WJ, Shi L, Sabath MB, Dominici F, Coull BA, Evans JS, Koutrakis P, Schwartz JD. Long-Term Association of Air Pollution and Hospital Admissions Among Medicare Participants Using a Doubly Robust Additive Model. Circulation 2021; 143:1584-1596. [PMID: 33611922 PMCID: PMC8055197 DOI: 10.1161/circulationaha.120.050252] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Studies examining the nonfatal health outcomes of exposure to air pollution have been limited by the number of pollutants studied and focus on short-term exposures. METHODS We examined the relationship between long-term exposure to fine particulate matter with an aerodynamic diameter <2.5 micrometers (PM2.5), NO2, and tropospheric ozone and hospital admissions for 4 cardiovascular and respiratory outcomes (myocardial infarction, ischemic stroke, atrial fibrillation and flutter, and pneumonia) among the Medicare population of the United States. We used a doubly robust method for our statistical analysis, which relies on both inverse probability weighting and adjustment in the outcome model to account for confounding. The results from this regression are on an additive scale. We further looked at this relationship at lower pollutant concentrations, which are consistent with typical exposure levels in the United States, and among potentially susceptible subgroups. RESULTS Long-term exposure to fine PM2.5 was associated with an increased risk of all outcomes with the highest effect seen for stroke with a 0.0091% (95% CI, 0.0086-0.0097) increase in the risk of stroke for each 1-µg/m3 increase in annual levels. This translated to 2536 (95% CI, 2383-2691) cases of hospital admissions with ischemic stroke per year, which can be attributed to each 1-unit increase in fine particulate matter levels among the study population. NO2 was associated with an increase in the risk of admission with stroke by 0.00059% (95% CI, 0.00039-0.00075) and atrial fibrillation by 0.00129% (95% CI, 0.00114-0.00148) per ppb and tropospheric ozone was associated with an increase in the risk of admission with pneumonia by 0.00413% (95% CI, 0.00376-0.00447) per parts per billion. At lower concentrations, all pollutants were consistently associated with an increased risk for all our studied outcomes. CONCLUSIONS Long-term exposure to air pollutants poses a significant risk to cardiovascular and respiratory health among the elderly population in the United States, with the greatest increase in the association per unit of exposure occurring at lower concentrations.
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Affiliation(s)
- Mahdieh Danesh Yazdi
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.)
| | - Yan Wang
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.).,Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (Y.W., M.B.S., F.D., B.A.C.)
| | - Qian Di
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.).,Vanke School of Public Health, Tsinghua University, Beijing, China (Q.D.).,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA (Q.D., J.D.S.)
| | - Yaguang Wei
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.)
| | - Weeberb J. Requia
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.)
| | - Liuhua Shi
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.).,Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA (L.S.)
| | - Matthew Benjamin Sabath
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (Y.W., M.B.S., F.D., B.A.C.)
| | - Francesca Dominici
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (Y.W., M.B.S., F.D., B.A.C.)
| | - Brent A. Coull
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA (Y.W., M.B.S., F.D., B.A.C.)
| | - John S. Evans
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.)
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.)
| | - Joel D. Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA (M.D.Y., Y.W., Q.D., Y.W., W.J.R., L.S., J.S.E., P.K., J.D.S.).,Vanke School of Public Health, Tsinghua University, Beijing, China (Q.D.)
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Li Z, Bian Y, Zeng L, Li W, Yang L. Life Expectancy, Causes of Death, Risk Factors in China and the U.S. Ann Glob Health 2017; 83:407-414. [PMID: 29221513 DOI: 10.1016/j.aogh.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/06/2017] [Accepted: 10/17/2017] [Indexed: 12/29/2022] Open
Affiliation(s)
- Zhengjun Li
- Management School, Lancaster University, Bailrigg, Lancaster, United Kingdom
| | - Yaoyao Bian
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Li Zeng
- School of First Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China; Jingwen Library, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Wenlin Li
- Jingwen Library, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Lili Yang
- School of First Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China; Jingwen Library, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
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d’Onofrio A, Mazzetta C, Robertson C, Smans M, Boyle P, Boniol M. Maps and atlases of cancer mortality: a review of a useful tool to trigger new questions. Ecancermedicalscience 2016; 10:670. [PMID: 27610196 PMCID: PMC5014559 DOI: 10.3332/ecancer.2016.670] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Indexed: 01/09/2023] Open
Abstract
In this review we illustrate our view on the epidemiological relevance of geographically mapping cancer mortality. In the first part of this work, after delineating the history of cancer mapping with a view on interpretation of Cancer Mortality Atlases, we briefly illustrate the 'art' of cancer mapping. Later we summarise in a non-mathematical way basic methods of spatial statistics. In the second part of this paper, we employ the 'Atlas of Cancer Mortality in the European Union and the European Economic Area 1993-1997' in order to illustrate spatial aspects of cancer mortality in Europe. In particular, we focus on the cancer related to tobacco and alcohol epidemics and on breast cancer which is of particular interest in cancer mapping. Here we suggest and reiterate two key concepts. The first is that a cancer atlas is not only a visual tool, but it also contain appropriate spatial statistical analyses that quantify the qualitative visual impressions to the readers even though at times revealing fallacy. The second is that a cancer atlas is by no means a book where answers to questions can be found. On the contrary, it ought to be considered as a tool to trigger new questions.
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Affiliation(s)
| | - Chiara Mazzetta
- IstitutoEuropeo di Oncologia Milano 20141, Italy
- Chiara passed away in November 2010
| | | | - Michel Smans
- International Prevention Research Institute, Lyon 69006, France
| | - Peter Boyle
- International Prevention Research Institute, Lyon 69006, France
- Strathclyde University, Glasgow G1 1XQ, Scotland, UK
| | - Mathieu Boniol
- International Prevention Research Institute, Lyon 69006, France
- Strathclyde University, Glasgow G1 1XQ, Scotland, UK
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