Exposures to nitrogen dioxide in EXPOLIS-Helsinki: microenvironment, behavioral and sociodemographic factors

[Societal inequalities and the urban exposome: Social origins for different exposures]

Today, many epidemiological studies have proved the adverse health consequences of environmental exposure. For instance, air pollution exposure is recognized to be related with respiratory and cardiovascular diseases as well as adverse pregnancy outcomes. Noise nuisances are also known to increase cardiovascular diseases and to disturb the sleeping quality. Inversely, the access and availability of various resources, as parks, green spaces, and playgrounds positively affect health, psychological and physical well-being, and favorable health behaviors. In this present literature review, we will focus on the urban dimension of exposome, defined by Robinson et al. as the accumulation of all urban settings favorable or unfavorable to health, from the time of life in utero [1].

A novel approach of creating sustainable urban planning solutions that optimise the local air quality and environmental equity in Helsinki, Finland: The CouSCOUS study protocol

Background

Air pollution is one of the major environmental challenges cities worldwide face today. Planning healthy environments for all future populations, whilst considering the ongoing demand for urbanisation and provisions needed to combat climate change, remains a difficult task.

Objective

To combine artificial intelligence (AI), atmospheric and social sciences to provide urban planning solutions that optimise local air quality by applying novel methods and taking into consideration population structures and traffic flows.

Methods

We will use high-resolution spatial data and linked electronic population cohort for Helsinki Metropolitan Area (Finland) to model (a) population dynamics and urban inequality related to air pollution; (b) detailed aerosol dynamics, aerosol and gas-phase chemistry together with detailed flow characteristics; (c) high-resolution traffic flow addressing dynamical changes at the city environment, such as accidents, construction work and unexpected congestion. Finally, we will fuse the information resulting from these models into an optimal city planning model balancing air quality, comfort, accessibility and travelling efficiency.

Impact of COVID-19 lockdown on NO2 and PM2.5 exposure inequalities in London, UK

Amid the COVID-19 pandemic, a nationwide lockdown was imposed in the United Kingdom (UK) on March 23, 2020. These sudden control measures led to radical changes in human activities in the Greater London Area (GLA). During this lockdown, transportation use was significantly reduced and non-key workers were required to work from home. This study aims to understand how population exposure to PM_2.5 and NO₂ changed spatially and temporally across London, in different microenvironments, following the lockdown period relative to the previous three-year average in the same calendar period. Our research shows that population exposure to NO₂ declined significantly (52.3% ± 6.1%), while population exposure to PM_2.5 showed a smaller relative reduction (15.7% ± 4.1%). Changes in population activity had the strongest relative influence on exposure levels during morning rush hours, when prior to the lockdown a large percentage of people would normally commute or be at the workplace. In particular, a very high exposure decrease was observed for both pollutants (approximately 66% for NO₂ and 19% for PM_2.5) at 08:00am, consistent with the radical changes in population commuting. The infiltration of outdoor air pollution into housing modifies the degree of exposure change both temporally and spatially. Moreover, this study shows that the impacts on air pollution exposure vary across groups with different socioeconomic status (SES), with a disproportionate positive effect on the areas of the city home to more economically deprived communities.

Association of Air Pollution With Increased Risk of Peritonsillar Abscess Formation

Importance

Several studies reported an association between peritonsillar abscess formation and climate conditions, including seasonal changes; however, the results were inconsistent.

Objective

To evaluate the association between meteorological conditions and/or air pollution and peritonsillar abscess formation.

Design, Setting, and Participants

In this nested case-control study, 3819 participants with peritonsillar abscesses were matched (1:4) for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia with 15 276 control participants. The Korean Health Insurance Review and Assessment Service-National Sample Cohort (HIRA-NSC) data from 2002 through 2013 were used.

Exposures and Main Outcomes and Measures

The meteorological data included the mean daily temperature (°C), highest daily temperature (°C), lowest daily temperature (°C), daily temperature difference (°C), relative humidity (%), spot atmospheric pressure (hPa), sulfur dioxide ([SO2], parts per million [ppm]), nitrogen dioxide (NO2, ppm), ozone (O3, ppm), carbon monoxide (CO, ppm), and particulate matter less than 10 μg (PM10, μg/m3) for the previous 14 days, 10 days, 7 days, 5 days, or 3 days before the matched index date. These factors were measured in 94 or 273 locations hourly. The crude and adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of meteorological data for peritonsillar abscess formation were analyzed using unconditional logistic regression analysis. Subgroup analyses were conducted according to age and sex.

Results

The male to female ratio of study participants was 1.43 (11 260 to 7835). Because the age groups were classified using 5-year intervals, the mean age could not be defined. The mean differences of NO2 and PM10 concentrations for the 14 days between peritonsillar abscess group and control group were 1.78 ppb (95% CI, 1.47-2.09) and 1.33 μg/m3 (95% CI, 0.67-1.99), respectively. The aORs of NO2 (0.1 ppm) and PM10 (10 μg/m3) during the 14 days prior to the index date for peritonsillar abscess formation were 12.8 (95% CI, 8.4-19.5) and 1.04 (95% CI, 1.02-1.06), respectively. The other meteorological conditions did not reach statistical significance.

Conclusions and Relevance

Peritonsillar abscess formation was associated with high concentrations of NO2 and PM10.

Short-term effects of fine particulate matter on non-accidental and circulatory diseases mortality: A time series study among the elder in Changchun

Background and objectives

Fine particulate matter (PM_2.5, particulate matter with an aerodynamic diameter less than or equal to 2.5 μm) has multiple adverse effects on human health, especially on the respiratory and circulatory system. The purpose of this study was to evaluate the short-term effect of PM_2.5 on the mortality risk of non-accidental and circulatory diseases, and to explore the potential effect modification by sex, education and death location.

Methods

We collected daily mortality counts of Changchun (China) residents, daily meteorology and air pollution data, from January 1, 2014, to January 1, 2017. We focused on the elderly (≥65 years old) population who died from non-accidental causes and circulatory diseases, and stratified them by sex, education, and death location. A generalized additive Poisson regression model (GAM) was used to analyse the impact of air pollutants on mortality. We fit single pollutant models to examine PM_2.5 effects with different lag structures of single-day (distributed lag:lag0-lag3) and multi-day (moving average lag: lag01-lag03). To test the sensitivity of the model, a multi-pollutant model was established when the PM_2.5 effect was strongest.

Results

In the single pollutant models, an increment of PM_2.5 by 10 μg/m³ at lag0-3 was associated with a 0.385% (95% CI: 0.069% to 0.702%) increase in daily non-accidental mortality and a 0.442% (95% CI: 0.038% to 0.848%) increase in daily circulatory disease mortality. NO₂ (lag1) and O₃ (lag0, lag1, lag2, lag01,lag02, lag03) were associated with daily non-accidental death and NO₂ (lag1, lag3, lag03) and O₃ (lag0, lag1, lag01,lag02, lag03) were associated with daily circulatory disease mortality. In the co-pollutant models, the risk estimates for PM_2.5 changed slightly. The excess mortality risk of non-accidental and circulatory diseases was higher for women, people with low education, and died outside hospital.

Conclusions

We found that short-term exposure to PM_2.5 increased the mortality risk of non-accidental and circulatory diseases among the elderly in Changchun. Women, people with low education and died outside hospital are more susceptible to PM_2.5. NO₂ and O₃ were also associated with an increase in mortality from non-accidental and circulatory diseases and the O₃ is a high effect.

Socioeconomic and ethnic inequalities in exposure to air and noise pollution in London

BACKGROUND

Transport-related air and noise pollution, exposures linked to adverse health outcomes, varies within cities potentially resulting in exposure inequalities. Relatively little is known regarding inequalities in personal exposure to air pollution or transport-related noise.

OBJECTIVES

Our objectives were to quantify socioeconomic and ethnic inequalities in London in 1) air pollution exposure at residence compared to personal exposure; and 2) transport-related noise at residence from different sources.

METHODS

We used individual-level data from the London Travel Demand Survey (n = 45,079) between 2006 and 2010. We modeled residential (CMAQ-urban) and personal (London Hybrid Exposure Model) particulate matter <2.5 μm and nitrogen dioxide (NO₂), road-traffic noise at residence (TRANEX) and identified those within 50 dB noise contours of railways and Heathrow airport. We analyzed relationships between household income, area-level income deprivation and ethnicity with air and noise pollution using quantile and logistic regression.

RESULTS

We observed inverse patterns in inequalities in air pollution when estimated at residence versus personal exposure with respect to household income (categorical, 8 groups). Compared to the lowest income group (<£10,000), the highest group (>£75,000) had lower residential NO₂ (-1.3 (95% CI -2.1, -0.6) μg/m³ in the 95th exposure quantile) but higher personal NO₂ exposure (1.9 (95% CI 1.6, 2.3) μg/m³ in the 95th quantile), which was driven largely by transport mode and duration. Inequalities in residential exposure to NO₂ with respect to area-level deprivation were larger at lower exposure quantiles (e.g. estimate for NO₂ 5.1 (95% CI 4.6, 5.5) at quantile 0.15 versus 1.9 (95% CI 1.1, 2.6) at quantile 0.95), reflecting low-deprivation, high residential NO₂ areas in the city centre. Air pollution exposure at residence consistently overestimated personal exposure; this overestimation varied with age, household income, and area-level income deprivation. Inequalities in road traffic noise were generally small. In logistic regression models, the odds of living within a 50 dB contour of aircraft noise were highest in individuals with the highest household income, white ethnicity, and with the lowest area-level income deprivation. Odds of living within a 50 dB contour of rail noise were 19% (95% CI 3, 37) higher for black compared to white individuals.

CONCLUSIONS

Socioeconomic inequalities in air pollution exposure were different for modeled residential versus personal exposure, which has important implications for environmental justice and confounding in epidemiology studies. Exposure misclassification was dependent on several factors related to health, a potential source of bias in epidemiological studies. Quantile regression revealed that socioeconomic and ethnic inequalities in air pollution are often not uniform across the exposure distribution.

Is atmospheric pollution exposure during pregnancy associated with individual and contextual characteristics? A nationwide study in France

Background

Exposure to atmospheric pollutants is a danger for the health of pregnant mother and children. Our objective was to identify individual (socioeconomic and behavioural) and contextual factors associated with atmospheric pollution pregnancy exposure at the nationwide level.

Method

Among 14 921 women from the French nationwide ELFE (French Longitudinal Study of Children) mother-child cohort recruited in 2011, outdoor exposure levels of PM2.5, PM10 (particulate matter <2.5 µm and <10 µm in diameter) and NO2 (nitrogen dioxide) were estimated at the pregnancy home address from a dispersion model with 1 km resolution. We used classification and regression trees (CART) and linear regression to characterise the association of atmospheric pollutants with individual (maternal age, body mass index, parity, education level, relationship status, smoking status) and contextual (European Deprivation Index, urbanisation level) factors.

Results

Patterns of associations were globally similar across pollutants. For the CART approach, the highest tertile of exposure included mainly women not in a relationship living in urban and socially deprived areas, with lower education level. Linear regression models identified different determinants of atmospheric pollutants exposure according to the residential urbanisation level. In urban areas, atmospheric pollutants exposure increased with social deprivation, while in rural areas a U-shaped relationship was observed.

Conclusion

We highlighted social inequalities in atmospheric pollutants exposure according to contextual characteristics such as urbanisation level and social deprivation and also according to individual characteristics such as education, being in a relationship and smoking status. In French urban areas, pregnant women from the most deprived neighbourhoods were those most exposed to health-threatening atmospheric pollutants.

Socioeconomic position and outdoor nitrogen dioxide (NO2) exposure in Western Europe: A multi-city analysis

BACKGROUND

Inconsistent associations between socioeconomic position (SEP) and outdoor air pollution have been reported in Europe, but methodological differences prevent any direct between-study comparison.

OBJECTIVES

Assess and compare the association between SEP and outdoor nitrogen dioxide (NO₂) exposure as a marker of traffic exhaust, in 16 cities from eight Western European countries.

METHODS

Three SEP indicators, two defined at individual-level (education and occupation) and one at neighborhood-level (unemployment rate) were assessed in three European multicenter cohorts. NO₂ annual concentration exposure was estimated at participants' addresses with land use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE; http://www.escapeproject.eu/). Pooled and city-specific linear regressions were used to analyze associations between each SEP indicator and NO₂. Heterogeneity across cities was assessed using the Higgins' I-squared test (I²).

RESULTS

The study population included 5692 participants. Pooled analysis showed that participants with lower individual-SEP were less exposed to NO₂. Conversely, participants living in neighborhoods with higher unemployment rate were more exposed. City-specific results exhibited strong heterogeneity (I²>76% for the three SEP indicators) resulting in variation of the individual- and neighborhood-SEP patterns of NO₂ exposure across cities. The coefficients from a model that included both individual- and neighborhood-SEP indicators were similar to the unadjusted coefficients, suggesting independent associations.

CONCLUSIONS

Our study showed for the first time using homogenized measures of outcome and exposure across 16 cities the important heterogeneity regarding the association between SEP and NO₂ in Western Europe. Importantly, our results showed that individual- and neighborhood-SEP indicators capture different aspects of the association between SEP and exposure to air pollution, stressing the importance of considering both in air pollution health effects studies.

Seasonal variation of indoor and outdoor air quality of nitrogen dioxide in homes with gas and electric stoves

Indoor air pollution significantly influences personal exposure to air pollution and increases health risks. Nitrogen dioxide (NO2) is one of the major air pollutants, and therefore it is important to properly determine indoor concentration of this pollutant considering the fact that people spend most of their time inside. The aim of this study was to assess indoor and outdoor concentration of NO2 during each season; for this purpose, passive sampling was applied. We analyzed homes with gas and electric stoves to determine and compare the concentrations of NO2 in kitchen, living room, and bedroom microenvironments (MEs). The accuracy of passive sampling was evaluated by comparing the sampling results with the data from air quality monitoring stations. The highest indoor concentration of NO2 was observed in kitchen ME during the winter period, the median concentration being 28.4 μg m(-3). Indoor NO2 levels in homes with gas stoves were higher than outdoor levels during all seasons. The concentration of NO2 was by 2.5 times higher in kitchen MEs with gas stoves than with electric stoves. This study showed that the concentration of NO2 in indoor MEs mainly depended on the stove type used in the kitchen. Homes with gas stoves had significantly higher levels of NO2 in all indoor MEs compared with homes where electric stoves were used.

Association of Exposure to particular matter and Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis

Background: Long time exposure to particular matter has been linked to myocardial infarction, stroke and blood pressure, but its association with atherosclerosis is not clear. This meta-analysis was aimed at assessing whether PM_2.5 and PM₁₀ have an effect on subclinical atherosclerosis measured by carotid intima-media thickness (CIMT). Methods: Pubmed, Ovid Medline, Embase and NICK between 1948 and 31 March 2015 were searched by combining the keywords about exposure to the outcome related words. The random-effects model was applied in computing the change of CIMT and their corresponding 95% confidence interval (95% CI). The effect of potential confounding factors was assessed by stratified analysis and the impact of traffic proximity was also estimated. Results: Among 56 identified studies, 11 articles satisfied the inclusion criteria. In overall analysis increments of 10 μg/m³ in PM_2.5 and PM₁₀ were associated with an increase of CIMT (16.79 μm; 95% CI, 4.95–28.63 μm and 4.13 μm; 95% CI, −5.79–14.04 μm, respectively). Results shown in subgroup analysis had reference value for comparing with those of the overall analysis. The impact of traffic proximity on CIMT was uncertain. Conclusions: Exposure to PM_2.5 had a significant association with CIMT and for women the effect may be more obvious.

Can the Air Pollution Index be used to communicate the health risks of air pollution?

The validity of using the Air Pollution Index (API) to assess health impacts of air pollution and potential modification by individual characteristics on air pollution effects remain uncertain. We applied distributed lag non-linear models (DLNMs) to assess associations of daily API, specific pollution indices for PM10, SO2, NO2 and the weighted combined API (APIw) with mortality during 2003-2011 in Guangzhou, China. An increase of 10 in API was associated with a 0.88% (95% confidence interval (CI): 0.50, 1.27%) increase of non-accidental mortality at lag 0-2 days. Harvesting effects appeared after 2 days' exposure. The effect estimate of API over lag 0-15 days was statistically significant and similar with those of pollutant-specific indices and APIw. Stronger associations between API and mortality were observed in the elderly, females and residents with low educational attainment. In conclusion, the API can be used to communicate health risks of air pollution.

Long-Term Ambient Residential Traffic-Related Exposures and Measurement Error-Adjusted Risk of Incident Lung Cancer in the Netherlands Cohort Study on Diet and Cancer

BACKGROUND

The International Agency for Research on Cancer (IARC) recently declared air pollution carcinogenic to humans. However, no study of air pollution and lung cancer to date has incorporated adjustment for exposure measurement error, and few have examined specific histological subtypes.

OBJECTIVES

Our aim was to assess the association of air pollution and incident lung cancer in the Netherlands Cohort Study on Diet and Cancer and the impact of measurement error on these associations.

METHODS

The cohort was followed from 1986 through 2003, and 3,355 incident cases were identified. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals, for long-term exposures to nitrogen dioxide (NO2), black smoke (BS), PM2.5 (particulate matter with diameter ≤ 2.5 μm), and measures of roadway proximity and traffic volume, adjusted for potential confounders. Information from a previous validation study was used to correct the effect estimates for measurement error.

RESULTS

We observed elevated risks of incident lung cancer with exposure to BS [hazard ratio (HR) = 1.16; 95% CI: 1.02, 1.32, per 10 μg/m3], NO2 (HR = 1.29; 95% CI: 1.08, 1.54, per 30 μg/m3), PM2.5 (HR = 1.17; 95% CI: 0.93, 1.47, per 10 μg/m3), and with measures of traffic at the baseline address. The exposures were positively associated with all lung cancer subtypes. After adjustment for measurement error, the HRs increased and the 95% CIs widened [HR = 1.19 (95% CI: 1.02, 1.39) for BS and HR = 1.37 (95% CI: 0.86, 2.17) for PM2.5].

CONCLUSIONS

These findings add support to a growing body of literature on the effects of air pollution on lung cancer. In addition, they highlight variation in measurement error by pollutant and support the implementation of measurement error corrections when possible.

CITATION

Hart JE, Spiegelman D, Beelen R, Hoek G, Brunekreef B, Schouten LJ, van den Brandt P. 2015. Long-term ambient residential traffic-related exposures and measurement error-adjusted risk of incident lung cancer in the Netherlands Cohort Study on Diet and Cancer. Environ Health Perspect 123:860-866; http://dx.doi.org/10.1289/ehp.1408762.

Impacts of travel activity and urbanicity on exposures to ambient oxides of nitrogen and on exposure disparities

Daily exposures to ambient oxides of nitrogen were estimated here for residents of Hillsborough County, FL. The 2009 National Household Travel Survey provided geocoded data on fixed activity locations during each person-day sampled. Routes between activity locations were calculated from transportation network data, assuming the quickest travel path. To estimate daily exposure concentrations for each person-day, the exposure locations were matched with diurnally and spatially varying ambient pollutant concentrations derived from CALPUFF dispersion model results. The social distribution of exposures was analyzed by comparing frequency distributions of grouped daily exposure concentrations and by regression modeling. To investigate exposure error, the activity-based exposure estimates were also compared with estimates derived using residence location alone. The mean daily activity-based exposure concentration for the study sample was 17 μg/m³, with values for individual person-day records ranging from 7.0 to 43 μg/m³. The highest mean exposure concentrations were found for the following groups: black (20 μg/m³), below poverty (18 μg/m³), and urban residence location (22 μg/m³). Urban versus rural residence was associated with the largest increase in exposure concentration in the regression (8.3 μg/m³). Time in nonresidential activities, including travel, was associated with an increase of 0.2 μg/m³ per hour. Time spent travelling and at nonresidential locations contributed an average of 6 and 24 %, respectively, to the daily estimate. A mean error of 3.6 %, with range from -64 to 58 %, was found to result from using residence location alone. Exposure error was highest for those who travel most, but lowest for the sociodemographic subgroups with higher mean exposure concentrations (including blacks and those from below poverty households). This work indicates the importance of urbanicity to social disparities in activity-based air pollution exposures. It also suggests that exposure error due to using residence location may be smaller for more exposed groups.

Air quality and social deprivation in four French metropolitan areas--a localized spatio-temporal environmental inequality analysis

Several studies have documented that more deprived populations tend to live in areas characterized by higher levels of environmental pollution. Yet, time trends and geographic patterns of this disproportionate distribution of environmental burden remain poorly assessed, especially in Europe. We investigated the spatial and temporal relationship between ambient air nitrogen dioxide (NO2) concentrations and socioeconomic and demographic data in four French metropolitan areas (Lille in the North, Lyon in the center, Marseille in the South, and Paris) during two different time periods. The geographical unit used was the census block. The dependent variable was the NO2 annual average concentration (μg/m(3)) per census block, and the explanatory variables were a neighborhood deprivation index and socioeconomic and demographic data derived from the national census. Generalized additive models were used to account for spatial autocorrelation. We found that the strength and direction of the association between deprivation and NO2 estimates varied between cities. In Paris, census blocks with the higher social categories are exposed to higher mean concentrations of NO2. However, in Lille and Marseille, the most deprived census blocks are the most exposed to NO2. In Lyon, the census blocks in the middle social categories were more likely to have higher concentrations than in the lower social categories. Despite a general reduction in NO2 concentrations over the study period in the four metropolitan areas, we found contrasting results in the temporal trend of environmental inequalities. There is clear evidence of city-specific spatial and temporal environmental inequalities that relate to the historical socioeconomic make-up of the cities and its evolution. Hence, general statements about environmental and social inequalities can be made.

Outdoor, but not indoor, nitrogen dioxide exposure is associated with persistent cough during the first year of life

BACKGROUND AND AIMS

Because their lungs and immune system are not completely developed, children are more susceptible to respiratory disease and more vulnerable to ambient pollution. We assessed the relation between prenatal and postnatal nitrogen dioxide (NO(2)) levels and the development of lower respiratory tract infections (LRTI), wheezing and persistent cough during the first year of life.

METHODS

The study population consisted of 352 children from a birth cohort in Valencia, Spain. Prenatal exposure to NO(2), a marker of traffic related air pollution was measured at 93 sampling sites spread over the study area during four different sampling periods of 7 days each. It was modeled for each residential address through land use regression using the empirical measurements and data from geographic information systems. Postnatal exposure was measured once inside and outside each home using passive samplers for a period of 14 days. Outcomes studied were any episode of LRTI during the child's first year of life diagnosed by a doctor (bronchitis, bronchiolitis or pneumonia), wheezing (defined as whistling sounds coming from the chest), and persistent cough (more than three consecutive weeks). Outcomes and potential confounders were obtained from structured questionnaires. Multiple logistic regression was used to identify associations.

RESULTS

The cumulative incidence (CI) at first year of life was 30.4% for LRTI (23.0% bronchiolitis, 11.9% bronchitis and 1.4% pneumonia), 26.1% for wheezing and 6.3% for persistent cough. The adjusted odds ratio (95% confidence interval) per 10μg/m(3) increment in postnatal outdoor NO(2) concentration was 1.40 (1.02-1.92) for persistent cough. We also found some pattern of association with LRTI, bronchiolitis, bronchitis, wheezing and persistent cough in different prenatal periods, although it was not statistically significant.

CONCLUSIONS

Our results indicate that exposure to outdoor, but not indoor, NO(2) during the first year of life increases the risk of persistent cough.

Do indoor environments influence asthma and asthma-related symptoms among adults in homes?: a review of the literature

This review summarizes the results of epidemiological studies focusing on the detrimental effects of home environmental factors on asthma morbidity in adults. We reviewed the literature on indoor air quality (IAQ), physical and sociodemographic factors, and asthma morbidity in homes, and identified commonly reported asthma, allergic, and respiratory symptoms involving the home environment. Reported IAQ and asthma morbidity data strongly indicated positive associations between indoor air pollution and adverse health effects in most studies. Indoor factors most consistently associated with asthma and asthma-related symptoms in adults included fuel combustion, mold growth, and environmental tobacco smoke. Environmental exposure may increase an adult's risk of developing asthma and also may increase the risk of asthma exacerbations. Evaluation of present IAQ levels, exposure characteristics, and the role of exposure to these factors in relation to asthma morbidity is important for improving our understanding, identifying the burden, and for developing and implementing interventions aimed at reducing asthma morbidity.

Indoor and outdoor concentrations and determinants of NO2 in a cohort of 1-year-old children in Valencia, Spain

Nitrogen dioxide (NO2) is produced from the exhausts of vehicles and gas appliances and is known to pose certain health risks. In this study, we characterize the exposure to this substance during the first year of life, which is an important period of development. To this end, we used passive samplers to measure indoor and outdoor NO2 levels for 2 weeks in the homes of 352 children. To compensate for the fact that NO2 levels were measured only once in each home, a correction factor was calculated to assign each child an outdoor NO2 exposure value for the first year of life. The outdoor NO2 concentrations were 26.1 microg/m(3) while those measured indoors averaged 18.0 microg/m(3). A multivariate linear regression analysis showed that the main determinants of outdoor NO2 levels were the degree of urbanization and the frequency of vehicle traffic at the location of the residence while for indoor NO2 levels the principal determinants were the type of cooking range and water heater present in the home, the season of the year, and both the country of origin and educational level of the mother.

PRACTICAL IMPLICATIONS

Exposure to NO2 has been related to respiratory and other health problems among children. Precise identification of the main sources of both indoor and outdoor NO2 should shed light on appropriate intervention periods and methods. Our results indicate that while population density and traffic-related variables are the main determinants of outdoor NO2 levels, the use of gas appliances have the greatest impact on indoor levels. Strategies should thus be developed to reduce such exposure, especially with regard to reducing emissions from vehicle traffic.

Social inequalities resulting from health risks related to ambient air quality--A European review

BACKGROUND

Environmental nuisances, including ambient air pollution, are thought to contribute to social inequalities in health. There are two major mechanisms, which may act independently or synergistically, through which air pollution may play this role. Disadvantaged groups are recognized as being more often exposed to air pollution (differential exposure) and may also be more susceptible to the resultant health effects (differential susceptibility).

METHOD

European research articles were obtained through a literature search in the Medline database using keywords 'Socioeconomic Factors, Air Pollution, Health' and synonymous expressions.

RESULTS

Some studies found that poorer people were more exposed to air pollution whereas the reverse was observed in other papers. A general pattern, however, is that, irrespective of exposure, subjects of low socio-economic status experience greater health effects of air pollution. So far as we are aware, no European study has explored this relationship among children.

CONCLUSION

The housing market biases land use decisions and may explain why some subgroups suffer from both a low socio-economic status and high exposure to air pollution. Some data may be based on inaccurate exposure assessment. Cumulative exposures should be taken into account to explore health problems more accurately. The issue of exposure and health inequalities in relation to ambient air quality is complex and calls for global appraisal. There is no single pattern. Policies aimed at reducing the root causes of these inequalities could be based on urban multipolarity and diversity, two attributes that require long-term urban planning.

The design and field implementation of the Detroit Exposure and Aerosol Research Study

The US Environmental Protection Agency recently conducted the Detroit Exposure and Aerosol Research Study (DEARS). The study began in 2004 and involved community, residential, and personal-based measurements of air pollutants targeting 120 participants and their residences. The primary goal of the study was to evaluate and describe the relationship between air toxics, particulate matter (PM), PM constituents, and PM from specific sources measured at a central site monitor with those from the residential and personal locations. The impact of regional, local (point and mobile), and personal sources on pollutant concentrations and the role of physical and human factors that might influence these concentrations were investigated. A combination of active and passive sampling methodologies were employed in the collection of PM mass, criteria gases, semivolatile organics, and volatile organic compound air pollutants among others. Monitoring was conducted in six selected neighborhoods along with one community site using a repeated measure design. Households from each of the selected communities were monitored for 5 consecutive days in the winter and again in the summer. Household, participant and a variety of other surveys were utilized to better understand human and household factors that might affect the impact of ambient-based pollution sources upon personal and residential locations. A randomized recruitment strategy was successful in enrolling nearly 140 participants over the course of the study. Over 36,000 daily-based environmental data points or records were ultimately collected. This paper fully describes the design of the DEARS and the approach used to implement this field monitoring study and reports select preliminary findings.

Predicting personal nitrogen dioxide exposure in an elderly population: integrating residential indoor and outdoor measurements, fixed-site ambient pollution concentrations, modeled pollutant levels, and time-activity patterns

Predicting chronic exposure to air pollution at the intra-urban scale has been recognized as a priority area of research for environmental epidemiology. Exposure assessment models attempt to predict and proxy for individuals' personal exposure to ambient air pollution, and there are no studies to date that explicitly attempt to compare and cross-validate personal exposure concentrations with pollutants modeled at the intra-urban level using methods such as interpolated surfaces and land-use regression (LUR) models. This study aimed to identify how well personal exposure to NO(2) (nitrogen dioxide) can be predicted from ambient exposure measurements and intra-urban exposure estimates using LUR and what other factors contribute to predicting variations in personal exposure beyond measured pollutant levels within home. Personal, indoor and outdoor NO(2) were measured in a population of older adults (>65 yr old) living in Hamilton, Canada. Our results show that personal NO(2) was most strongly associated with contemporaneously collected indoor and outdoor concentrations of NO(2). Predicted NO(2) exposures from intra-urban LUR models were not associated with personal NO(2), whereas interpolated surfaces of particulates and ozone were modestly associated. Combinations of variables that best predicted personal NO(2) variability were derived from time-activity diaries, interpolated surfaces of ambient particulate pollutants, and a city wide temporally matched average of NO(2). The nonsignificant associations between personal NO(2) and the modeled ambient NO(2) concentrations suggest that observed associations between NO(2) generated by LUR models and health effects are probably not produced by NO(2), but by other pollutants that follow a similar spatial pattern.

Season, sex, age, and education as modifiers of the effects of outdoor air pollution on daily mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study

BACKGROUND

Various factors can modify the health effects of outdoor air pollution. Prior findings about modifiers are inconsistent, and most of these studies were conducted in developed countries.

OBJECTIVES

We conducted a time-series analysis to examine the modifying effect of season, sex, age, and education on the association between outdoor air pollutants [particulate matter < 10 microm in aerodynamic diameter (PM(10)), sulfur dioxide, nitrogen dioxide, and ozone] and daily mortality in Shanghai, China, using 4 years of daily data (2001-2004).

METHODS

Using a natural spline model to analyze the data, we examined effects of air pollution for the warm season (April-September) and cool season (October-March) separately. For total mortality, we examined the association stratified by sex and age. Stratified analysis by educational attainment was conducted for total, cardiovascular, and respiratory mortality.

RESULTS

Outdoor air pollution was associated with mortality from all causes and from cardiorespiratory diseases in Shanghai. An increase of 10 mug/m(3) in a 2-day average concentration of PM(10), SO(2), NO(2), and O(3) corresponds to increases in all-cause mortality of 0.25% [95% confidence interval (CI), 0.14-0.37), 0.95% (95% CI, 0.62-1.28), 0.97% (95% CI, 0.66-1.27), and 0.31% (95% CI, 0.04-0.58), respectively. The effects of air pollutants were more evident in the cool season than in the warm season, and females and the elderly were more vulnerable to outdoor air pollution. Effects of air pollution were generally greater in residents with low educational attainment (illiterate or primary school) compared with those with high educational attainment (middle school or above).

CONCLUSIONS

Season, sex, age, and education may modify the health effects of outdoor air pollution in Shanghai. These findings provide new information about the effects of modifiers on the relationship between daily mortality and air pollution in developing countries and may have implications for local environmental and social policies.

Spatial variations in estimated chronic exposure to traffic-related air pollution in working populations: a simulation

Background

Chronic exposure to traffic-related air pollution is associated with a variety of health impacts in adults and recent studies show that exposure varies spatially, with some residents in a community more exposed than others. A spatial exposure simulation model (SESM) which incorporates six microenvironments (home indoor, work indoor, other indoor, outdoor, in-vehicle to work and in-vehicle other) is described and used to explore spatial variability in estimates of exposure to traffic-related nitrogen dioxide (not including indoor sources) for working people. The study models spatial variability in estimated exposure aggregated at the census tracts level for 382 census tracts in the Greater Vancouver Regional District of British Columbia, Canada. Summary statistics relating to the distributions of the estimated exposures are compared visually through mapping. Observed variations are explored through analyses of model inputs.

Results

Two sources of spatial variability in exposure to traffic-related nitrogen dioxide were identified. Median estimates of total exposure ranged from 8 μg/m³ to 35 μg/m³ of annual average hourly NO₂ for workers in different census tracts in the study area. Exposure estimates are highest where ambient pollution levels are highest. This reflects the regional gradient of pollution in the study area and the relatively high percentage of time spent at home locations. However, for workers within the same census tract, variations were observed in the partial exposure estimates associated with time spent outside the residential census tract. Simulation modeling shows that some workers may have exposures 1.3 times higher than other workers residing in the same census tract because of time spent away from the residential census tract, and that time spent in work census tracts contributes most to the differences in exposure. Exposure estimates associated with the activity of commuting by vehicle to work were negligible, based on the relatively short amount of time spent in this microenvironment compared to other locations. We recognize that this may not be the case for pollutants other than NO_2. These results represent the first time spatially disaggregated variations in exposure to traffic-related air pollution within a community have been estimated and reported.

Conclusion

The results suggest that while time spent in the home indoor microenvironment contributes most to between-census tract variation in estimates of annual average exposures to traffic-related NO₂, time spent in the work indoor microenvironment contributes most to within-census tract variation, and time spent in transit by vehicle makes a negligible contribution. The SESM has potential as a policy evaluation tool, given input data that reflect changes in pollution levels or work flow patterns due to traffic demand management and land use development policy.

Socioeconomic disparities in air pollution-associated mortality

This study aimed to determine whether individuals with lower socioeconomic status (SES) were more susceptible to the acute effects of ambient air pollution than those with higher SES. We included 24,357 Hong Kong Chinese aged 30 or above who died of natural causes in 1998. Information on individual socioeconomic characteristics was obtained by interviewing proxy informants with a standardized questionnaire in all four death registries. Individual SES was indicated by three measures: type of housing, occupational group and education attainment. Poisson regression was performed to assess the short-term effects of ambient air pollution measured by PM(10), NO(2), SO(2) and O(3) on mortality for each SES group. The differences in the effects between SES groups were estimated by the interaction between air pollution and SES. We found that PM(10) and NO(2) were associated with greater risk of mortality on people living in public rental housing than in private housing. The effects of all four pollutants were significantly greater in blue-collar workers than the never-employed and white-collar groups (p<0.05). However, we found no compelling evidence of effect modification by education attainment. Our results provide new evidence on the role of individual's SES as effect modifiers of the short-term effects of air pollution on mortality. The reduction of risks associated with air pollution for socially disadvantaged populations should be a high priority in public health and environmental policies.

Associations between measures of socioeconomic position and chronic nitrogen dioxide exposure in Worcester, Massachusetts

Census block-group-specific predicted outdoor nitrogen dioxide (NO(2); a marker of traffic pollution) levels and four census block group socioeconomic position (SEP) measures were used to evaluate whether chronic exposures to traffic-related air pollutants are higher in areas with lower SEP, after controlling for spatial autocorrelation in mixed models. NO(2) levels were predicted using a geographic information system (GIS)-based spatiotemporal model that was validated with measured NO(2) concentrations. The GIS-based model predicted weekly NO(2) concentrations with high accuracy (slope of 0.98 from regression of held-out observations on predictions) and precision (cross-validation mean absolute error of 2.2 ppb). The model performed well in both rural and urban areas and warm and cold seasons. Estimated mean block group NO(2) concentrations were significantly negatively associated with median household income, and positively associated with poverty, crowding, and low educational attainment rates after controlling for spatial autocorrelation. Results indicated that a standard deviation (3.5 ppb) increase in block group NO(2) concentrations was associated with a $9090 decrease in median household income. Results suggest that on average those with lower SEP experience higher chronic exposure to outdoor NO(2).

A predictive model for the home outdoor exposure to nitrogen dioxide

The aim of this study is to find and test a predictive model that could be suitable to estimate the outdoor NO(2) concentrations at individual level, by integrating ecological measurements recorded by local monitoring stations with individual information collected by a questionnaire. For this purpose, the data from the Italian centres of the European Community Respiratory Health Survey II (ECRHS II) has been used. Outdoor NO(2) concentrations were measured using NO(2) passive sampling tubes (PS-NO(2)), exposed outdoor for 14 days, between January 2001 and January 2003. Simultaneously, average NO(2) concentrations were collected from all the monitoring stations of the three centres (MS-NO(2)). Individual measurements carried out with passive samplers were compared with the corresponding NO(2) 2-week concentrations obtained as the average of all local (background and traffic) monitoring stations (MS-NO(2)). A multiple linear regression model was fitted to the data using the 2-week PS-NO(2) concentrations as the response variable and questionnaire information and MS-NO(2) concentrations as predictors. The model minimizing the root mean square error (RMSE), obtained from a ten-fold cross validation, was selected. The model with the best predictive ability included centre, season of the survey, MS-NO(2) concentrations, type and age of building, residential area and reported intensity of heavy-duty traffic and explained the 68.9% of the variance. The non-parametric correlation between PS-NO(2) and the concentrations estimated by the model is 0.81 (95% CI: 0.77-0.85). This study shows that over short periods (2 weeks) a good prediction of home outdoor exposure to NO(2) can be achieved by simply combining routinely collected ecological data with dwelling characteristics and self-reported intensity of heavy traffic. Further studies are needed to extend this prediction to long-term exposure.

Predictors of concentrations of nitrogen dioxide, fine particulate matter, and particle constituents inside of lower socioeconomic status urban homes

Air pollution exposure patterns may contribute to known spatial patterning of asthma morbidity within urban areas. While studies have evaluated the relationship between traffic and outdoor concentrations, few have considered indoor exposure patterns within low socioeconomic status (SES) urban communities. In this study, part of a prospective birth cohort study assessing asthma etiology in urban Boston, we collected indoor and outdoor 3-4 day samples of nitrogen dioxide (NO2) and fine particulate matter (PM2.5) in 43 residences across multiple seasons from 2003 to 2005. Homes were chosen to represent low SES households, including both cohort and non-cohort residences in similar neighborhoods, and consisted almost entirely of multiunit residences. Reflectance analysis and X-ray fluorescence spectroscopy were performed on the particle filters to determine elemental carbon (EC) and trace element concentrations, respectively. Additionally, information on home characteristics (e.g. type, age, stove fuel) and occupant behaviors (e.g. smoking, cooking, cleaning) were collected via a standardized questionnaire. The contributions of outdoor and indoor sources to indoor concentrations were quantified with regression analyses using mass balance principles. For NO2 and most particle constituents (except outdoor-dominated constituents like sulfur and vanadium), the addition of selected indoor source terms improved the model's predictive power. Cooking time, gas stove usage, occupant density, and humidifiers were identified as important contributors to indoor levels of various pollutants. A comparison between cohort and non-cohort participants provided another means to determine the influence of occupant activity patterns on indoor-outdoor ratios. Although the groups had similar housing characteristics and were located in similar neighborhoods, cohort members had significantly higher indoor concentrations of PM2.5 and NO2, associated with indoor activities. We conclude that the effect of indoor sources may be more pronounced in high-density multiunit dwellings, and that future epidemiological studies in these populations should explicitly consider these sources in assigning exposures.

Air pollution, socioeconomic position, and emergency hospital visits for asthma in Seoul, Korea

OBJECTIVE

Some epidemiological literature has observed that air pollution effects on health differed across regional or individual socioeconomic position. This study evaluated whether regional and individual socioeconomic position, as indicated by health insurance premiums, modified the effect of air pollution on hospital visits for asthma.

METHODS

Effects of ambient air pollutants (particulate matter, carbon monoxide, sulfur dioxide, nitrogen dioxide, and ozone) on 92,535 emergency out-patient hospital visits for asthma in Seoul, Korea during 2002 were estimated using case-crossover analysis, adjusting for time trend, weather conditions, and seasonality. Next, interactions between air pollutants and Korean National Health Insurance premium (1) for the individual patient and (2) averaged across the patient's residence district, were entered, first singly then jointly, in the models.

RESULTS

Relative risks of emergency outpatient hospital visits were all positively and significantly associated with interquartile increases for selected lags for all air pollutants. In the regression model with interaction terms for both individual premium and regional-average premium, associations with all five-air pollutants ranged from 1.03 to 1.09 times higher among the lowest premium districts compared to the highest premium districts. Of all the pollutants, nitrogen dioxide showed the strongest associations in lower premium districts compared to the higher premium districts. Individual socioeconomic position did not modify the associations in either the single or joint interaction models.

CONCLUSION

In Seoul, community but not individual socioeconomic conditions modified risk of asthma hospital visits on high air pollution days.

Indoor time-microenvironment-activity patterns in seven regions of Europe

Personal exposure to environmental substances is largely determined by time-microenvironment-activity patterns while moving across locations or microenvironments. Therefore, time-microenvironment-activity data are particularly useful in modeling exposure. We investigated determinants of workday time-microenvironment-activity patterns of the adult urban population in seven European cities. The EXPOLIS study assessed workday time-microenvironment-activity patterns among a total of 1427 subjects (age 19-60 years) in Helsinki (Finland), Athens (Greece), Basel (Switzerland), Grenoble (France), Milan (Italy), Prague (Czech Republic), and Oxford (UK). Subjects completed time-microenvironment-activity diaries during two working days. We present time spent indoors--at home, at work, and elsewhere, and time exposed to tobacco smoke indoors for all cities. The contribution of sociodemographic factors has been assessed using regression models. More than 90% of the variance in indoor time-microenvironment-activity patterns originated from differences between and within subjects rather than between cities. The most common factors that were associated with indoor time-microenvironment-activity patterns, with similar contributions in all cities, were the specific work status, employment status, whether the participants were living alone, and whether the participants had children at home. Gender and season were associated with indoor time-microenvironment-activity patterns as well but the effects were rather heterogeneous across the seven cities. Exposure to second-hand tobacco smoke differed substantially across these cities. The heterogeneity of these factors across cities may reflect city-specific characteristics but selection biases in the sampled local populations may also explain part of the findings. Determinants of time-microenvironment-activity patterns need to be taken into account in exposure assessment, epidemiological analyses, exposure simulations, as well as in the development of preventive strategies that focus on time-microenvironment-activity patterns that ultimately determine exposures.

Air pollution and respiratory hospital admissions in greater Paris: exploring sex differences

The subject of sex and gender differences is relevant to the study of health effects of environmental exposures. In this study the authors aim at assessing the differences that may exist between males and females regarding short-term air pollution health effects. They studied the short-term relationships between air pollution levels and respiratory hospital admissions in greater Paris area for patients older than 15 years between 2000 and 2003. They also conducted time series analyses by using generalized additive models. For an increase of 10 microg/m3 in the air pollutant levels, the increase in relative risk of hospitalization was higher for males than for females and was significant only for males. These differences may not result solely from differences in biological susceptibility to air pollution because other factors related to gender (differences in individual exposures, in health care management, and so on) may play a role.

The EXPOLIS study: implications for exposure research and environmental policy in Europe

Exposure analysis is a crucial part of effective management of public health risks caused by pollutants and chemicals in our environment. During the last decades, more data required for exposure analysis has become available, but the need for direct population based measurements of exposures is still clear. The current work (i) describes the European EXPOLIS study, designed to produce this kind of exposure data for major air pollutants in Europe, and the database created to make the collected data available for researchers (ii) reviews the exposure analysis conducted and results published so far using these data and (iii) discusses the implications of the results from the point of view of research and environmental policy in Europe. Fine particle (with 37 elements and black smoke), nitrogen dioxide, volatile organic compounds (30 compounds) and carbon monoxide inhalation exposures and exposure-related questionnaire data were measured in seven European cities during 1996-2000. The EXPOLIS database has been used for exposure analysis of these pollutants for 4 years now and results have been published in approximately 30 peer-reviewed journal papers, demonstrating the versatility, usability and scientific value of such a data set. The multipollutant exposure data from the same subjects in the random population samples allows for analyses of the determinants, microenvironments and sources of exposures to multipollutant mixtures and associations between the different air pollutants. This information is necessary and useful for developing effective policies and control strategies for healthier environment.

Indoor and outdoor air concentrations of BTEX and NO2: correlation of repeated measurements

Studies on health effects of air pollutants ideally define exposure through the collection of air samples in the participants' homes. Concentrations derived from these samples are then considered as an estimate for the average concentration of air pollutants in the homes. Conclusions drawn from such studies therefore depend very much on the validity of the measured air pollution concentrations. In this paper we analysed repeated BTEX and NO(2) measurements with a time period of several months lying between the two conducted home visits. We investigated the variability of their concentrations over time by determining correlation coefficients and calculating within- and between-home variances. Our population consisted of 631 homes of participants from two cohort studies within the framework of the German study on Indoor Factors and Genetics in Asthma. Air pollutants were measured using passive samplers both indoors and outdoors. The measured BTEX concentrations were poorly correlated, with Pearson's correlation coefficient r ranging from -0.19 to 0.27. Additionally, a considerable seasonal effect could be observed. A higher correlation was found for the NO(2) concentrations with r ranging between 0.24 and 0.55. For the BTEX, the between-home variance was bigger than the within-home variance, for NO(2) both variances were of about the same order. Our results indicate that in a setting of moderate climate like in Germany, the variability of BTEX and NO(2) concentrations over time is high and a single measurement is a poor surrogate for the long-term concentrations of these air pollutants.