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Moorthy S, Chen Z, Zhang T, Ponnana SR, Sirasapalli SK, Shivanantham K, Khraishah H, Dazard JE, Al-Kindi SG, Deo SV, Rajagopalan S. The built environment and adverse cardiovascular events in US veterans with cardiovascular disease. THE SCIENCE OF THE TOTAL ENVIRONMENT 2025; 980:179596. [PMID: 40319806 DOI: 10.1016/j.scitotenv.2025.179596] [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: 03/12/2025] [Revised: 04/30/2025] [Accepted: 05/01/2025] [Indexed: 05/07/2025]
Abstract
QUESTION Can AI-extracted interpretable built environment features predict major adverse cardiovascular events (MACE) in a national veteran population? FINDINGS In this cohort study of 770,990 U.S. veterans, seven built environment features were significantly associated with an increased risk of MACE. Two features, old/dilapidated buildings and visible wire, were associated with a decreased risk. Greenery was only linked to increased risk in higher social deprivation index quartiles. MEANING Built environment features can serve as predictors of MACE, highlighting the potential role of neighborhood characteristics in cardiovascular risk stratification beyond traditional factors. IMPORTANCE The relationship between built environment features and major adverse cardiovascular events (MACE) in patients with atherosclerotic cardiovascular disease (ASCVD) remains understudied. Our study aims to discover what specific built environmental features influence cardiovascular mortality. DESIGN Retrospective cohort study of US Veterans (2016-2021) (98 % male, 86 % white) with stable ASCVD (coronary artery disease, cerebrovascular disease, or peripheral artery disease). EXPOSURES Built environment features were assessed using 164 million Google Street View images (2019) sampled every 50 m across the US. Eleven features, including greenery, sidewalks, and non-single-family homes, were analyzed as the percentage of images containing each element. These were summarized at the census tract level and linked to participant healthcare data via residential addresses. OUTCOME The primary outcome was first MACE occurrence (non-fatal myocardial infarction, non-fatal stroke, or cardiovascular mortality). Associations were analyzed using multivariable Fine Gray models, adjusting for demographics, clinical factors, the social deprivation index, and competing risks. RESULTS Over a 4-year median follow-up, features associated with increased MACE risk included greenery (subHR: 1.054, 95 % CI: 1.047-1.061), single-lane roads (subHR: 1.059, 95 % CI: 1.054-1.065), sidewalks (subHR: 1.023, 95 % CI: 1.020-1.026), crosswalks (subHR: 1.062, 95 % CI: 1.040-1.083), non-single-family homes (subHR: 1.088, 95 % CI: 1.083-1.094), and two or more cars (subHR: 1.013, 95 % CI: 1.006-1.019). Features linked to lower MACE risk included old buildings (subHR: 0.976, 95 % CI: 0.971-0.982) and visible wiring (subHR: 0.972, 95 % CI: 0.967-0.976). CONCLUSIONS Built environment features influence MACE risk in US Veterans with ASCVD, emphasizing the role of the exposome in cardiovascular health.
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Affiliation(s)
- Skanda Moorthy
- Department of Medicine, Cardiovascular Research Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Zhuo Chen
- Department of Medicine, Cardiovascular Research Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Tong Zhang
- Department of Medicine, Cardiovascular Research Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Sai Rahul Ponnana
- Department of Medicine, Cardiovascular Research Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Santosh Kumar Sirasapalli
- Department of Medicine, Cardiovascular Research Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Kanimozhi Shivanantham
- Department of Medicine, Cardiovascular Research Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Haitham Khraishah
- Department of Medicine, Cardiovascular Research Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Jean-Eudes Dazard
- Department of Medicine, Cardiovascular Research Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Sadeer G Al-Kindi
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, TX, USA
| | - Salil V Deo
- Department of Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
| | - Sanjay Rajagopalan
- Department of Medicine, Cardiovascular Research Institute, Case Western Reserve University, Cleveland, OH, USA; University Hospitals, Harrington Heart & Vascular Institute, Department of Internal Medicine and Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
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Raab H, Breen M, Weaver AM, Moyer J, Cascio WE, Diaz-Sanchez D, Ward-Caviness CK. Comparison of associations between proximity to major roads and all-cause mortality across a spectrum of cardiovascular diseases. Environ Epidemiol 2024; 8:e351. [PMID: 39525964 PMCID: PMC11548901 DOI: 10.1097/ee9.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 09/27/2024] [Indexed: 11/16/2024] Open
Abstract
Background Global urbanization is leading to increased exposure to traffic-related air pollution (TRAP), which is associated with adverse health events. While individuals with cardiovascular disease (CVD) are known to have elevated susceptibility to air pollution exposure, no studies have evaluated how mortality risks associated with TRAP exposure differ based on the presence of CVD. Methods We used three electronic health record-based cohorts to examine associations between proximity to major roadways and all-cause mortality. The three cohorts were a random sample of the hospital population, individuals with a prior myocardial infarction, and individuals with diagnosed heart failure (HF). We used Cox proportional hazards models to evaluate associations while adjusting for age, race, sex, and census block group socioeconomic status. Results Residing <250 m from a major roadway was associated with a hazard ratio (HR) of 1.13 (95% confidence interval = 1.05, 1.23) for individuals with HF, an HR of 1.07 (95% confidence interval = 0.96, 1.20) for those with a prior myocardial infarction, and an HR of 1.03 (95% confidence interval = 0.89, 1.20) for a random sample of hospital patients. This pattern persisted across several sensitivity analyses including alternative definitions of proximity to major roadways and matching the cohorts on demographics. Conclusion These results highlight the differences in air quality-related health risks based on underlying CVD. Individuals with HF consistently had the highest environmental health risks. These results may better inform risks related to TRAP exposure in populations with differing underlying CVD.
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Affiliation(s)
- Henry Raab
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Miyuki Breen
- Center for Computational Toxicology and Exposure, US Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Anne M. Weaver
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Joshua Moyer
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Wayne E. Cascio
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Research Triangle Park, North Carolina
| | - David Diaz-Sanchez
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Cavin K. Ward-Caviness
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Research Triangle Park, North Carolina
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Chen X, Wang J, Zhang X, Xiao G, Luo S, Liu L, Kong W, Zhang X, Yan LL, Zhang S. Residential proximity to major roadways and hearing impairment in Chinese older adults: a population-based study. BMC Public Health 2023; 23:2462. [PMID: 38066478 PMCID: PMC10709848 DOI: 10.1186/s12889-023-17433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND With rapid urban sprawl, growing people are living in the vicinity of major roadways. However, little is known about the relationship between residential proximity to major roadways and hearing impairment (HI). METHODS We derived data from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey, and included 13,775 participants aged 65 years or older. Multivariate logistic regressions were employed to examine the association between residential proximity to major roadways and HI. The effects of corresponding potentially modifiable factors were studied by three-way interaction analyses. Sensitivity analyses were performed to verify the robustness of the results. RESULTS The prevalence of HI was 38.3%. Participants living near major roadways were more likely to have a higher socioeconomic status. An exposure-response relation between residential proximity to major roadways and HI was observed (Ptrend < 0.05). Compared with individuals living > 300 m away from major roadways, the adjusted odds ratios (OR) were 1.07 (95% CI: 0.96-1.24), 1.15 (95% CI: 1.07-1.34), and 1.12 (95% CI: 1.01-1.31) for those living 101-200 m, 50-100 m, and < 50 m away from the roadways, respectively. Particularly, the association was more pronounced among individuals exposed to carbon monoxide (CO) pollution or opening windows frequently (Pinteraction < 0.05). Three-way interaction analyses confirmed that participants exposed to CO pollution and frequently leaving windows open had the highest OR of 1.73 (95% CI: 1.58-1.89). CONCLUSIONS This nation-wide cohort study suggested that residential proximity to major roadways was significantly associated with an increased exposure-response risk of HI in Chinese older adults. Exposure to CO pollution and opening windows frequently might strengthen the relations.
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Affiliation(s)
- Xingxing Chen
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xian Zhang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Gui Xiao
- Xiangya School of Nursing, Central South University, Changsha, China
- Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Siran Luo
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Lei Liu
- The First People's Hospital of Kunshan, Suzhou, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaomin Zhang
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Lijing L Yan
- School of Public Health, Wuhan University, Wuhan, China.
- Global Health Research Center, Duke Kunshan University, Kunshan, China.
- Duke Global Health Institute, Duke University, Durham, United States of America.
- Institute for Global Health and Management, Peking University, Beijing, China.
| | - Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Robichaux C, Aron J, Wendt CH, Berman JD, Rau A, Bangerter A, Dudley RA, Baldomero AK. Sociodemographic and Geographic Risk Factors for All-Cause Mortality in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:1587-1593. [PMID: 37521023 PMCID: PMC10386845 DOI: 10.2147/copd.s406899] [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: 02/02/2023] [Accepted: 05/14/2023] [Indexed: 08/01/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide. Identifying both individual and community risk factors associated with higher mortality is essential to improve outcomes. Few population-based studies of mortality in COPD include both individual characteristics and community risk factors. Objective We used geocoded, patient-level data to describe the associations between individual demographics, neighborhood socioeconomic status, and all-cause mortality. Methods We performed a nationally representative retrospective cohort analysis of all patients enrolled in the Veteran Health Administration with at least one ICD-9 or ICD-10 code for COPD in 2016-2019. We obtained demographic characteristics, comorbidities, and geocoded residential address. Area Deprivation Index and rurality were classified using individual geocoded residential addresses. We used logistic regression models to assess the association between these characteristics and age-adjusted all-cause mortality. Results Of 1,106,163 COPD patients, 33.4% were deceased as of January 2021. In age-adjusted models, having more comorbidities, Black/African American race (OR 1.09 [95% CI: 1.08-1.11]), and higher neighborhood disadvantage (OR 1.30 [95% CI: 1.28-1.32]) were associated with all-cause mortality. Female sex (OR 0.67 [95% CI: 0.65-0.69]), Asian race (OR 0.64, [95% CI: 0.59-0.70]), and living in a more rural area were associated with lower odds of all-cause mortality. After adjusting for age, comorbidities, neighborhood socioeconomic status, and rurality, the association with Black/African American race reversed. Conclusion All-cause mortality in COPD patients is disproportionately higher in patients living in poorer neighborhoods and urban areas, suggesting the impact of social determinants of health on COPD outcomes. Black race was associated with higher age-adjusted all-cause mortality, but this association was abrogated after adjusting for gender, socioeconomic status, comorbidities, and urbanicity. Future studies should focus on exploring mechanisms by which disparities arise and developing interventions to address these.
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Affiliation(s)
- Camille Robichaux
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jordan Aron
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Chris H Wendt
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Jesse D Berman
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Austin Rau
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Ann Bangerter
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - R Adams Dudley
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Arianne K Baldomero
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
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Weichenthal S, Ripley S, Korsiak J. Fine Particulate Air Pollution and the "No-Multiple-Versions-of-Treatment" Assumption: Does Particle Composition Matter for Causal Inference? Am J Epidemiol 2023; 192:147-153. [PMID: 36331277 DOI: 10.1093/aje/kwac191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/31/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Here we discuss possible violations of the "no-multiple-versions-of-treatment" assumption in studies of outdoor fine particulate air pollution (particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5)) owing to differences in particle composition, which in turn influence health. This assumption is part of the potential outcomes framework for causal inference, and it is needed for well-defined potential outcomes, as multiple versions of the same treatment could lead to different health risks for the same level of treatment. Since 2 locations can have the same outdoor PM2.5 mass concentration (i.e., treatment) but different chemical compositions (i.e., versions of treatment), violations of the "no-multiple-versions-of-treatment" assumption seem likely. Importantly, violations of this assumption will not bias health risk estimates for PM2.5 mass concentrations if there are no unmeasured confounders of the "version of treatment"-outcome relationship. However, confounding can occur if these factors are not identified and controlled for in the analysis. We describe situations in which this may occur and provide simulations to estimate the magnitude and direction of this possible bias. In general, violations of the "no-multiple-versions-of-treatment" assumption could be an underappreciated source of bias in studies of outdoor PM2.5. Analysis of the health impacts of outdoor PM2.5 mass concentrations across spatial domains with similar composition could help to address this issue.
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Hadley MB, Nalini M, Adhikari S, Szymonifka J, Etemadi A, Kamangar F, Khoshnia M, McChane T, Pourshams A, Poustchi H, Sepanlou SG, Abnet C, Freedman ND, Boffetta P, Malekzadeh R, Vedanthan R. Spatial environmental factors predict cardiovascular and all-cause mortality: Results of the SPACE study. PLoS One 2022; 17:e0269650. [PMID: 35749347 PMCID: PMC9231727 DOI: 10.1371/journal.pone.0269650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/25/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Environmental exposures account for a growing proportion of global mortality. Large cohort studies are needed to characterize the independent impact of environmental exposures on mortality in low-income settings. METHODS We collected data on individual and environmental risk factors for a multiethnic cohort of 50,045 individuals in a low-income region in Iran. Environmental risk factors included: ambient fine particular matter air pollution; household fuel use and ventilation; proximity to traffic; distance to percutaneous coronary intervention (PCI) center; socioeconomic environment; population density; local land use; and nighttime light exposure. We developed a spatial survival model to estimate the independent associations between these environmental exposures and all-cause and cardiovascular mortality. FINDINGS Several environmental factors demonstrated associations with mortality after adjusting for individual risk factors. Ambient fine particulate matter air pollution predicted all-cause mortality (per μg/m3, HR 1.20, 95% CI 1.07, 1.36) and cardiovascular mortality (HR 1.17, 95% CI 0.98, 1.39). Biomass fuel use without chimney predicted all-cause mortality (reference = gas, HR 1.23, 95% CI 0.99, 1.53) and cardiovascular mortality (HR 1.36, 95% CI 0.99, 1.87). Kerosene fuel use without chimney predicted all-cause mortality (reference = gas, HR 1.09, 95% CI 0.97, 1.23) and cardiovascular mortality (HR 1.19, 95% CI 1.01, 1.41). Distance to PCI center predicted all-cause mortality (per 10km, HR 1.01, 95% CI 1.004, 1.022) and cardiovascular mortality (HR 1.02, 95% CI 1.004, 1.031). Additionally, proximity to traffic predicted all-cause mortality (HR 1.13, 95% CI 1.01, 1.27). In a separate validation cohort, the multivariable model effectively predicted both all-cause mortality (AUC 0.76) and cardiovascular mortality (AUC 0.81). Population attributable fractions demonstrated a high mortality burden attributable to environmental exposures. INTERPRETATION Several environmental factors predicted cardiovascular and all-cause mortality, independent of each other and of individual risk factors. Mortality attributable to environmental factors represents a critical opportunity for targeted policies and programs.
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Affiliation(s)
- Michael B. Hadley
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
| | - Mahdi Nalini
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Samrachana Adhikari
- New York University Grossman School of Medicine, New York, New York, United States of America
| | - Jackie Szymonifka
- New York University Grossman School of Medicine, New York, New York, United States of America
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, Maryland, United States of America
| | - Masoud Khoshnia
- Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Tyler McChane
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Akram Pourshams
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf G. Sepanlou
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Christian Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Neal D. Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, United States of America
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Reza Malekzadeh
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajesh Vedanthan
- New York University Grossman School of Medicine, New York, New York, United States of America
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Zhu W, Cai J, Hu Y, Zhang H, Han X, Zheng H, Wu J. Long-term exposure to fine particulate matter relates with incident myocardial infarction (MI) risks and post-MI mortality: A meta-analysis. CHEMOSPHERE 2021; 267:128903. [PMID: 33213879 DOI: 10.1016/j.chemosphere.2020.128903] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/18/2020] [Accepted: 11/04/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Air pollution has become a global challenge, and a growing number of studies have suggested possible relationships between long-term exposure to fine particulate matter (PM2.5) and risks of cardiovascular events, specifically, myocardial infarction (MI). However, the recently reported results were inconsistent. We thus performed a meta-analysis and sought to assess whether long-term exposure to PM2.5 relates with incident MI risks and post-MI mortality. METHODS EMBASE, Web of Science and PubMed were searched for all potentially eligible studies published before August 2, 2020 using a combination of keywords related to PM2.5 exposure, its long-term effects and myocardial infarction. Key information was extracted, and calculated hazard ratio (HR) values were combined by selecting corresponding models according to heterogeneity test. A sensitivity analysis and a publication bias assessment were also performed to determine the reliability of the results. RESULTS Of the initially identified 2100 citations, 12 studies met our inclusion criteria and observed a total population of approximately 7.2 million. Pooled estimates (per 10 μg/m3 increase) indicated a statistically significant association between long-term PM2.5 exposure and MI incidence (HR = 1.10, 95% CI: 1.02-1.18) or post-MI mortality (HR = 1.07, 95% CI: 1.04-1.09). Results for MI incidence from Egger's linear regression method (P = 0.515) and Begg's test (P = 0.711) showed no obvious publication bias. CONCLUSION Our quantitative analysis reveals a significant link between long-term PM2.5 exposure and greater MI incidence risks or higher post-MI mortality. Our findings may therefore have implications for individual protection and policy support to improve public health.
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Affiliation(s)
- Wentao Zhu
- Department of Toxicology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, 215123, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, 215123, China
| | - Jiajie Cai
- Department of Toxicology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, 215123, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, 215123, China
| | - Yuchen Hu
- Department of Toxicology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, 215123, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, 215123, China
| | - Haodan Zhang
- Department of Toxicology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, 215123, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, 215123, China
| | - Xiao Han
- Department of Toxicology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, 215123, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, 215123, China
| | - Huiqiu Zheng
- Department of Child and Adolescent Health and Health Education, School of Public Health, Inner Mongolia Medical University, Hohhot, Inner Mongolia, 010110, China.
| | - Jing Wu
- Department of Toxicology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, 215123, China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, 215123, China.
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Anderson ML. As the Wind Blows: The Effects of Long-Term Exposure to Air Pollution on Mortality. JOURNAL OF THE EUROPEAN ECONOMIC ASSOCIATION 2020; 18:1886-1927. [PMID: 32863794 PMCID: PMC7445412 DOI: 10.1093/jeea/jvz051] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
There is strong evidence that short-run fluctuations in air pollution negatively impact infant health and contemporaneous adult health, but there is less evidence on the causal link between long-term exposure to air pollution and increased adult mortality. This project estimates the impact of long-term exposure to air pollution on mortality by leveraging quasi-random variation in pollution levels generated by wind patterns near major highways. I combine geocoded data on the residence of every decedent in Los Angeles over three years, high-frequency wind data, and Census short form data. Using these data, I estimate the effect of downwind exposure to highway-generated pollutants on the age-specific mortality rate by using orientation to the nearest major highway as an instrument for pollution exposure. I find that doubling the percentage of time spent downwind of a highway increases mortality among individuals 75 or older by 3.8%-6.5%. These estimates are robust and imply significant loss of life years.
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Cohen G, Steinberg DM, Keinan-Boker L, Yuval, Levy I, Chen S, Shafran-Nathan R, Levin N, Shimony T, Witberg G, Bental T, Shohat T, Broday DM, Kornowski R, Gerber Y. Preexisting coronary heart disease and susceptibility to long-term effects of traffic-related air pollution: A matched cohort analysis. Eur J Prev Cardiol 2020; 28:2047487320921987. [PMID: 32389024 DOI: 10.1177/2047487320921987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals with coronary heart disease are considered susceptible to traffic-related air pollution exposure. Yet, cohort-based evidence on whether preexisting coronary heart disease modifies the association of traffic-related air pollution with health outcomes is lacking. AIM Using data of four Israeli cohorts, we compared associations of traffic-related air pollution with mortality and cancer between coronary heart disease patients and matched controls from the general population. METHODS Subjects hospitalized with acute coronary syndrome from two patient cohorts (inception years: 1992-1993 and 2006-2014) were age- and sex-matched to coronary heart disease-free participants of two cycles of the Israeli National Health and Nutrition Surveys (inception years: 1999-2001 and 2005-2006). Ambient concentrations of nitrogen oxides at the residential place served as a proxy for traffic-related air pollution exposure across all cohorts, based on a high-resolution national land use regression model (50 m). Data on all-cause mortality (last update: 2018) and cancer incidence (last update: 2016) were retrieved from national registries. Cox-derived stratum-specific hazard ratios with 95% confidence intervals were calculated, adjusted for harmonized covariates across cohorts, including age, sex, ethnicity, neighborhood socioeconomic status, smoking, diabetes, hypertension, prior stroke and prior malignancy (the latter only in the mortality analysis). Effect-modification was examined by testing nitrogen oxides-by-coronary heart disease interaction term in the entire matched cohort. RESULTS The cohort (mean (standard deviation) age 61.5 (14) years; 44% women) included 2393 matched pairs, among them 2040 were cancer-free at baseline. During a median (25th-75th percentiles) follow-up of 13 (10-19) and 11 (7-17) years, 1458 deaths and 536 new cancer cases were identified, respectively. In multivariable-adjusted models, a 10-parts per billion nitrogen oxides increment was positively associated with all-cause mortality among coronary heart disease patients (hazard ratio = 1.13, 95% confidence interval 1.05-1.22), but not among controls (hazard ratio = 1.00, 0.93-1.08) (pinteraction = 0.003). A similar pattern was seen for all-cancer incidence (hazard ratioCHD = 1.19 (1.03-1.37), hazard ratioCHD-Free = 0.93 (0.84-1.04) (pinteraction = 0.01)). Associations were robust to multiple sensitivity analyses. CONCLUSIONS Coronary heart disease patients might be at increased risk for traffic-related air pollution-associated mortality and cancer, irrespective of their age and sex. Patients and clinicians should be more aware of the adverse health effects on coronary heart disease patients of chronic exposure to vehicle emissions.
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Affiliation(s)
- Gali Cohen
- Department of Epidemiology and Preventive Medicine, Tel Aviv University, Israel
- Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Israel
| | - David M Steinberg
- Department of Statistics and Operations Research, Tel Aviv University, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Israel Ministry of Health, Israel
- School of Public Health, University of Haifa, Israel
| | - Yuval
- Technion Center of Excellence in Exposure Science and Environmental Health, Technion Israel Institute of Technology, Israel
| | - Ilan Levy
- Technion Center of Excellence in Exposure Science and Environmental Health, Technion Israel Institute of Technology, Israel
| | - Shimon Chen
- Technion Center of Excellence in Exposure Science and Environmental Health, Technion Israel Institute of Technology, Israel
| | - Rakefet Shafran-Nathan
- Technion Center of Excellence in Exposure Science and Environmental Health, Technion Israel Institute of Technology, Israel
| | - Noam Levin
- Department of Geography, Hebrew University of Jerusalem, Israel
- Remote Sensing Research Centre, School of Earth and Environmental Sciences, The University of Queensland, Australia
| | - Tal Shimony
- Israel Center for Disease Control, Israel Ministry of Health, Israel
| | - Guy Witberg
- Remote Sensing Research Centre, School of Earth and Environmental Sciences, The University of Queensland, Australia
- Department of Cardiology, Rabin Medical Center (Beilinson and Hasharon Hospitals), Israel
| | - Tamir Bental
- Remote Sensing Research Centre, School of Earth and Environmental Sciences, The University of Queensland, Australia
| | - Tamar Shohat
- Department of Epidemiology and Preventive Medicine, Tel Aviv University, Israel
| | - David M Broday
- Technion Center of Excellence in Exposure Science and Environmental Health, Technion Israel Institute of Technology, Israel
| | - Ran Kornowski
- Remote Sensing Research Centre, School of Earth and Environmental Sciences, The University of Queensland, Australia
- Deptartment of Cardiovascular Medicine, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yariv Gerber
- Department of Epidemiology and Preventive Medicine, Tel Aviv University, Israel
- Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Israel
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10
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Jhun I, Kim J, Cho B, Gold DR, Schwartz J, Coull BA, Zanobetti A, Rice MB, Mittleman MA, Garshick E, Vokonas P, Bind MA, Wilker EH, Dominici F, Suh H, Koutrakis P. Synthesis of Harvard Environmental Protection Agency (EPA) Center studies on traffic-related particulate pollution and cardiovascular outcomes in the Greater Boston Area. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2019; 69:900-917. [PMID: 30888266 PMCID: PMC6650311 DOI: 10.1080/10962247.2019.1596994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/11/2019] [Indexed: 05/24/2023]
Abstract
The association between particulate pollution and cardiovascular morbidity and mortality is well established. While the cardiovascular effects of nationally regulated criteria pollutants (e.g., fine particulate matter [PM2.5] and nitrogen dioxide) have been well documented, there are fewer studies on particulate pollutants that are more specific for traffic, such as black carbon (BC) and particle number (PN). In this paper, we synthesized studies conducted in the Greater Boston Area on cardiovascular health effects of traffic exposure, specifically defined by BC or PN exposure or proximity to major roadways. Large cohort studies demonstrate that exposure to traffic-related particles adversely affect cardiac autonomic function, increase systemic cytokine-mediated inflammation and pro-thrombotic activity, and elevate the risk of hypertension and ischemic stroke. Key patterns emerged when directly comparing studies with overlapping exposure metrics and population cohorts. Most notably, cardiovascular risk estimates of PN and BC exposures were larger in magnitude or more often statistically significant compared to those of PM2.5 exposures. Across multiple exposure metrics (e.g., short-term vs. long-term; observed vs. modeled) and different population cohorts (e.g., elderly, individuals with co-morbidities, young healthy individuals), there is compelling evidence that BC and PN represent traffic-related particles that are especially harmful to cardiovascular health. Further research is needed to validate these findings in other geographic locations, characterize exposure errors associated with using monitored and modeled traffic pollutant levels, and elucidate pathophysiological mechanisms underlying the cardiovascular effects of traffic-related particulate pollutants. Implications: Traffic emissions are an important source of particles harmful to cardiovascular health. Traffic-related particles, specifically BC and PN, adversely affect cardiac autonomic function, increase systemic inflammation and thrombotic activity, elevate BP, and increase the risk of ischemic stroke. There is evidence that BC and PN are associated with greater cardiovascular risk compared to PM2.5. Further research is needed to elucidate other health effects of traffic-related particles and assess the feasibility of regulating BC and PN or their regional and local sources.
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Affiliation(s)
- Iny Jhun
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jina Kim
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
| | | | - Diane R. Gold
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Brent A. Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Mary B. Rice
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Murray A. Mittleman
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA
| | - Eric Garshick
- Harvard Medical School, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
- Pulmonary, Allergy, Sleep and Critical Care Medicine, Veterans Affairs Boston Healthcare System, Boston, MA
| | - Pantel Vokonas
- Veterans Affairs Normative Aging Study, Veterans Affairs Boston Healthcare System, Boston, MA
- Department of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
| | - Marie-Abele Bind
- Faculty of Arts and Sciences, Science Center, Harvard University, Cambridge, MA
| | - Elissa H. Wilker
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA
- Sanofi Genzyme, Cambridge, MA
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Helen Suh
- Tufts University, Department of Civil and Environmental Engineering, Medford, MA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
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11
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Requia WJ, Koutrakis P. Mapping distance-decay of premature mortality attributable to PM 2.5-related traffic congestion. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 243:9-16. [PMID: 30170207 DOI: 10.1016/j.envpol.2018.08.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 08/11/2018] [Accepted: 08/18/2018] [Indexed: 06/08/2023]
Abstract
Although several air pollution studies have examined the relationship between people living close to roadways and human health, we are unaware of studies that have examined the distance-decay of this effect based on a snapshot of congestion and focused on a micro-level traffic emission inventory. In this paper we estimate the distance-decay of premature mortality risk related to PM2.5 emitted by traffic congestion in Hamilton, Canada, in 2011 We employ the Stochastic User Equilibrium (SUE) traffic assignment algorithm to estimate congested travel times for each road link in our study area. Next, we used EPA's MOVES model to estimate mass of PM2.5, and then R-line dispersion model to predict concentration of PM2.5. Finally, we apply Integrated Exposure Response Function (IERF) to estimate PM2.5-related premature mortality at 100 m × 100 m grid resolution. We estimated total premature mortality over Hamilton to be 73.10 (95%CI: 39.05; 82.11) deaths per year. We observed that the proximity to a roadway increases the risk of premature mortality and the strength of this risk decreases as buffer sizes are increased. For example, we estimated that the premature mortality risk within buffer 0-100 m is 29.5% higher than for the buffer 101-200 m, 179.3% higher than for the buffer 201-300 m, and 566% higher than for the buffer 301-400 m. Our study provides a new perspective on exposure increments from traffic congestion. In particular, our findings show health effects gradients across neighborhoods, capturing microscale near-road exposure up to 2000 m of the roadway. Results from this research can be useful for policymakers to develop new strategies for the challenges of regulating transportation, land use, and air pollution.
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Affiliation(s)
- Weeberb J Requia
- McMaster University, McMaster Institute for Transportation and Logistics, Canada; Harvard University, School of Public Health, 401 Park Drive, Landmark Center 4th Floor West, Boston, MA, 02115, United States.
| | - Petros Koutrakis
- Harvard University, School of Public Health, 401 Park Drive, Landmark Center 4th Floor West, Boston, MA, 02115, United States.
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12
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Huang S, Lawrence J, Kang CM, Li J, Martins M, Vokonas P, Gold DR, Schwartz J, Coull BA, Koutrakis P. Road proximity influences indoor exposures to ambient fine particle mass and components. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 243:978-987. [PMID: 30248605 DOI: 10.1016/j.envpol.2018.09.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 05/09/2023]
Abstract
Exposure to traffic-related PM2.5 mass and its components can affect human health. Meanwhile, indoor concentrations are better exposure predictors as compared to outdoor concentrations because individuals spend the majority of their time indoors. We estimated the impact of traffic emissions on indoor PM2.5 mass and its species as a function of road proximity in Massachusetts. A linear regression model was built using 662 indoor samples and 580 ambient samples. Analysis shows that indoor exposures to traffic-related particles increased dramatically with road proximity. We defined relative concentration decrease, R(α), as the ratio of the indoor concentration at perpendicular distance α in meters from the closest major road to the indoor concentration at 1800 m from the major road. R(13) values for PM2.5 mass and Black Carbon (BC) were 1.3 (95%CI: 1.4, 1.6) and 2.1 (95%CI: 1.3, 2.8) for A12 roads, and 1.3 (95%CI: 1.2, 1.4) and 1.2 (95%CI: 1.1, 1.3) for A3 roads. R(α) values were also estimated for Fe, Mn, Mo, Sr and Ti for A12 roads, and Ca, Cu, Fe, Mn, Mo, Ni, Si, Sr, V and Zn for A3 roads. R(α) values for species associated mainly with brakes, tires or road dust (e.g., Mn, Mo and Sr) were higher than others. For A12 roads, R(13) values for Mn and Mo were 10.9 (95%CI: 0.9, 20.9) and 6.5 (95%CI: 1.4, 11.5), and ranged from 1.3 to 2.1 for other species; for A3 roads, R(13) values for Mn, Mo and Sr were 1.9 (95%CI: 1.1, 2.9), 1.8 (95%CI: 1.1, 2.4), and 8.5 (95%CI: 5.9, 10.9), and ranged from 1.2 to 1.6 for others. Our results indicate a significant impact of local traffic emissions on indoor air, which depends on road proximity. Thus road proximity which has been used in many epidemiological studies is a reasonable exposure metric.
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Affiliation(s)
- Shaodan Huang
- Department of Environmental Health, Harvard T.H. Chan School of Public Healtlh, Boston 02115, USA
| | - Joy Lawrence
- Department of Environmental Health, Harvard T.H. Chan School of Public Healtlh, Boston 02115, USA
| | - Choong-Min Kang
- Department of Environmental Health, Harvard T.H. Chan School of Public Healtlh, Boston 02115, USA
| | - Jing Li
- Department of Environmental Health, Harvard T.H. Chan School of Public Healtlh, Boston 02115, USA
| | - Marco Martins
- Department of Environmental Health, Harvard T.H. Chan School of Public Healtlh, Boston 02115, USA
| | - Pantel Vokonas
- VA Normative Aging Study, VA Boston Healthcare System, Boston 02130, USA; Boston University School of Medicine, Boston, 02118, USA
| | - Diane R Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Healtlh, Boston 02115, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Healtlh, Boston 02115, USA
| | - Brent A Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Healtlh, Boston 02115, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, 02115, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Healtlh, Boston 02115, USA.
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13
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Quintana PJE, Khalighi M, Castillo Quiñones JE, Patel Z, Guerrero Garcia J, Martinez Vergara P, Bryden M, Mantz A. Traffic pollutants measured inside vehicles waiting in line at a major US-Mexico Port of Entry. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 622-623:236-243. [PMID: 29216464 DOI: 10.1016/j.scitotenv.2017.11.319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
At US-Mexico border Ports of Entry, vehicles idle for long times waiting to cross northbound into the US. Long wait times at the border have mainly been studied as an economic issue, however, exposures to emissions from idling vehicles can also present an exposure risk. Here we present the first data on in-vehicle exposures to driver and passengers crossing the US-Mexico border at the San Ysidro, California Port of Entry (SYPOE). Participants were recruited who regularly commuted across the border in either direction and told to drive a scripted route between two border universities, one in the US and one in Mexico. Instruments were placed in participants' cars prior to commute to monitor-1-minute average levels of the traffic pollutants ultrafine particles (UFP), black carbon (BC) and carbon monoxide (CO) in the breathing zone of drivers and passengers. Location was determined by a GPS monitor. Results reported here are for 68 northbound participant trips. The highest median levels of in-vehicle UFP were recorded during the wait to cross at the SYPOE (median 29,692particles/cm3) significantly higher than the portion of the commute in the US (median 20,508particles/cm3) though not that portion in Mexico (median 22, 191particles/cm3). In-vehicle BC levels at the border were significantly lower than in other parts of the commute. Our results indicate that waiting in line at the SYPOE contributes a median 62.5% (range 15.5%-86.0%) of a cross-border commuter's exposure to UFP and a median 44.5% (range (10.6-79.7%) of exposure to BC inside the vehicle while traveling in the northbound direction. Reducing border wait time can significantly reduce in-vehicle exposures to toxic air pollutants such as UFP and BC, and these preventable exposures can be considered an environmental justice issue.
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Affiliation(s)
- Penelope J E Quintana
- San Diego State University Graduate School of Public Health, 5500 Campanile Drive, San Diego, CA 92182-4162, USA.
| | - Mehdi Khalighi
- Millersville University, Department of Applied Engineering, Safety & Technology Occupational Safety & Environmental Health Program, 40 East Frederick Street, Millersville, PA 17551, USA
| | - Javier Emmanuel Castillo Quiñones
- Universidad Autónoma de Baja California Facultad de Ciencias Quimicas e Ingenieria, Calzada Universidad 14418 Parque Industrial Internacional, Tijuana B.C. 22427, Mexico
| | - Zalak Patel
- San Diego State University Graduate School of Public Health, 5500 Campanile Drive, San Diego, CA 92182-4162, USA
| | - Jesus Guerrero Garcia
- Universidad Autónoma de Baja California Facultad de Ciencias Quimicas e Ingenieria, Calzada Universidad 14418 Parque Industrial Internacional, Tijuana B.C. 22427, Mexico
| | - Paulina Martinez Vergara
- Universidad Autónoma de Baja California Facultad de Ciencias Quimicas e Ingenieria, Calzada Universidad 14418 Parque Industrial Internacional, Tijuana B.C. 22427, Mexico
| | - Megan Bryden
- San Diego State University Graduate School of Public Health, 5500 Campanile Drive, San Diego, CA 92182-4162, USA
| | - Antoinette Mantz
- San Diego State University Graduate School of Public Health, 5500 Campanile Drive, San Diego, CA 92182-4162, USA
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14
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Rice MB, Li W, Dorans KS, Wilker EH, Ljungman P, Gold DR, Schwartz J, Koutrakis P, Kloog I, Araki T, Hatabu H, San Jose Estepar R, O'Connor GT, Mittleman MA, Washko GR. Exposure to Traffic Emissions and Fine Particulate Matter and Computed Tomography Measures of the Lung and Airways. Epidemiology 2018; 29:333-341. [PMID: 29384790 PMCID: PMC6095201 DOI: 10.1097/ede.0000000000000809] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Exposure to ambient air pollution has been associated with lower lung function in adults, but few studies have investigated associations with radiographic lung and airway measures. METHODS We ascertained lung volume, mass, density, visual emphysema, airway size, and airway wall area by computed tomography (CT) among 2,545 nonsmoking Framingham CT substudy participants. We examined associations of home distance to major road and PM2.5 (2008 average from a spatiotemporal model using satellite data) with these outcomes using linear and logistic regression models adjusted for age, sex, height, weight, census tract median household value and population density, education, pack-years of smoking, household tobacco exposure, cohort, and date. We tested for differential susceptibility by sex, smoking status (former vs. never), and cohort. RESULTS The mean participant age was 60.1 years (standard deviation 11.9 years). Median PM2.5 level was 9.7 µg/m (interquartile range, 1.6). Living <100 m from a major road was associated with a 108 ml (95% CI = 8, 207) higher lung volume compared with ≥400 m away. There was also a log-linear association between proximity to road and higher lung volume. There were no convincing associations of proximity to major road or PM2.5 with the other pulmonary CT measures. In subgroup analyses, road proximity was associated with lower lung density among men and higher odds of emphysema among former smokers. CONCLUSIONS Living near a major road was associated with higher average lung volume, but otherwise, we found no association between ambient pollution and radiographic measures of emphysema or airway disease.
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15
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Cohen G, Levy I, Yuval, Kark JD, Levin N, Witberg G, Iakobishvili Z, Bental T, Broday DM, Steinberg DM, Kornowski R, Gerber Y. Chronic exposure to traffic-related air pollution and cancer incidence among 10,000 patients undergoing percutaneous coronary interventions: A historical prospective study. Eur J Prev Cardiol 2018; 25:659-670. [PMID: 29482439 DOI: 10.1177/2047487318760892] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Exposure to traffic-related air pollution (TRAP) is considered to have a carcinogenic effect. The authors previously reported a nonsignificant association between TRAP and cancer risk in a relatively small cohort of myocardial infarction survivors. This study assessed whether TRAP exposure is associated with subsequent cancer in a large cohort of coronary patients. Methods & results Consecutive patients undergoing percutaneous coronary interventions in a major medical centre in central Israel from 2004 to 2014 were followed for cancer through 2015. Residential levels of nitrogen oxides (NOx) - a proxy for TRAP - were estimated based on a high-resolution national land use regression model. Cox proportional hazards models were constructed to study relationships with cancer. Among 12,784 candidate patients, 9816 had available exposure data and no history of cancer (mean age, 68 years; 77% men). During a median (25th-75th percentiles) follow-up of 7.0 (3.9-9.3) years, 773 incident cases of cancer (8%) were diagnosed. In a multivariable-adjusted model, a 10-ppb increase in mean NOx exposure was associated with hazard ratios (HRs) of 1.07 (95% confidence interval [CI] 1.00-1.15) for all-site cancer and 1.16 (95% CI 1.05-1.28) for cancers previously linked to TRAP (lung, breast, prostate, kidney and bladder). A stronger association was observed for breast cancer (HR = 1.43; 95% CI 1.12-1.83). Associations were slightly strengthened after limiting the cohort to patients with more precise exposure assessment. Conclusion Coronary patients exposed to TRAP are at increased risk of several types of cancer, particularly lung, prostate and breast. As these cancers are amenable to prevention strategies, identifying highly exposed patients may provide an opportunity to improve clinical care.
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Affiliation(s)
- Gali Cohen
- 1 Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ilan Levy
- 2 Technion Center of Excellence in Exposure Science and Environmental Health, Technion - Israel Institute of Technology, Israel
| | - Yuval
- 2 Technion Center of Excellence in Exposure Science and Environmental Health, Technion - Israel Institute of Technology, Israel
| | - Jeremy D Kark
- 3 Epidemiology Unit, Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Organization, Jerusalem, Israel
| | - Noam Levin
- 4 Department of Geography, Hebrew University of Jerusalem, Israel
| | - Guy Witberg
- 5 Department of Cardiology, Rabin Medical Center (Beilinson and Hasharon Hospitals), Petach-Tikva, Israel
| | - Zaza Iakobishvili
- 5 Department of Cardiology, Rabin Medical Center (Beilinson and Hasharon Hospitals), Petach-Tikva, Israel
| | - Tamir Bental
- 5 Department of Cardiology, Rabin Medical Center (Beilinson and Hasharon Hospitals), Petach-Tikva, Israel
| | - David M Broday
- 2 Technion Center of Excellence in Exposure Science and Environmental Health, Technion - Israel Institute of Technology, Israel
| | - David M Steinberg
- 6 Department of Statistics and Operations Research, School of Mathematical Sciences, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Israel
| | - Ran Kornowski
- 5 Department of Cardiology, Rabin Medical Center (Beilinson and Hasharon Hospitals), Petach-Tikva, Israel.,7 Department of Cardiovascular Medicine, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yariv Gerber
- 1 Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel
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16
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Wilker EH, Martinez-Ramirez S, Kloog I, Schwartz J, Mostofsky E, Koutrakis P, Mittleman MA, Viswanathan A. Fine Particulate Matter, Residential Proximity to Major Roads, and Markers of Small Vessel Disease in a Memory Study Population. J Alzheimers Dis 2018; 53:1315-23. [PMID: 27372639 DOI: 10.3233/jad-151143] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Long-term exposure to ambient air pollution has been associated with impaired cognitive function and vascular disease in older adults, but little is known about these associations among people with concerns about memory loss. OBJECTIVE To examine associations between exposures to fine particulate matter and residential proximity to major roads and markers of small vessel disease. METHODS From 2004-2010, 236 participants in the Massachusetts Alzheimer's Disease Research Center Longitudinal Cohort participated in neuroimaging studies. Residential proximity to major roads and estimated 2003 residential annual average of fine particulate air pollution (PM2.5) were linked to measures of brain parenchymal fraction (BPF), white matter hyperintensities (WMH), and cerebral microbleeds. Associations were modeled using linear and logistic regression and adjusted for clinical and lifestyle factors. RESULTS In this population (median age [interquartile range] = 74 [12], 57% female) living in a region with median 2003 PM2.5 annual average below the current Environmental Protection Agency (EPA) standard, there were no associations between living closer to a major roadway or for a 2μg/m3 increment in PM2.5 and smaller BPF, greater WMH volume, or a higher odds of microbleeds. However, a 2μg/m3 increment in PM2.5 was associated with -0.19 (95% Confidence Interval (CI): -0.37, -0.005) lower natural log-transformed WMH volume. Other associations had wide confidence intervals. CONCLUSIONS In this population, where median 2003 estimated PM2.5 levels were below the current EPA standard, we observed no pattern of association between residential proximity to major roads or 2003 average PM2.5 and greater burden of small vessel disease or neurodegeneration.
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Affiliation(s)
- Elissa H Wilker
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sergi Martinez-Ramirez
- Hemorrhagic Stroke Research Group, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Joel Schwartz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elizabeth Mostofsky
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Murray A Mittleman
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Group, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Li W, Dorans KS, Wilker EH, Rice MB, Long MT, Schwartz J, Coull BA, Koutrakis P, Gold DR, Fox CS, Mittleman MA. Residential Proximity to Major Roadways, Fine Particulate Matter, and Hepatic Steatosis: The Framingham Heart Study. Am J Epidemiol 2017; 186:857-865. [PMID: 28605427 DOI: 10.1093/aje/kwx127] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/21/2016] [Indexed: 01/18/2023] Open
Abstract
We examined associations between ambient air pollution and hepatic steatosis among 2,513 participants from the Framingham (Massachusetts) Offspring Study and Third Generation Cohort who underwent a computed tomography scan (2002-2005), after excluding men who reported >21 drinks/week and women who reported >14 drinks/week. We calculated each participant's residential-based distance to a major roadway and used a spatiotemporal model to estimate the annual mean concentrations of fine particulate matter. Liver attenuation was measured by computed tomography, and liver-to-phantom ratio (LPR) was calculated. Lower values of LPR represent more liver fat. We estimated differences in continuous LPR using linear regression models and prevalence ratios for presence of hepatic steatosis (LPR ≤ 0.33) using generalized linear models, adjusting for demographics, individual and area-level measures of socioeconomic position, and clinical and lifestyle factors. Participants who lived 58 m (25th percentile) from major roadways had lower LPR (β = -0.003, 95% confidence interval: -0.006, -0.001) and higher prevalence of hepatic steatosis (prevalence ratio = 1.16, 95% confidence interval: 1.05, 1.28) than those who lived 416 m (75th percentile) away. The 2003 annual average fine particulate matter concentration was not associated with liver-fat measurements. Our findings suggest that living closer to major roadways was associated with more liver fat.
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Crinnion W. Particulate Matter Is a Surprisingly Common Contributor to Disease. Integr Med (Encinitas) 2017; 16:8-12. [PMID: 30881250 PMCID: PMC6415634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Particulate matter is a huge contributor to indoor and outdoor air pollution and a significant factor in many major diseases. Those living in cities, and especially those working in traffic or living near roads, have substantially increased risk of several diseases, especially autoimmune, cardiovascular, respiratory, and neoplastic. Intervention is primarily based on reducing exposure and using appropriately sophisticated air cleaning systems.
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Dorans KS, Wilker EH, Li W, Rice MB, Ljungman PL, Schwartz J, Coull BA, Kloog I, Koutrakis P, D'Agostino RB, Massaro JM, Hoffmann U, O'Donnell CJ, Mittleman MA. Residential proximity to major roads, exposure to fine particulate matter and aortic calcium: the Framingham Heart Study, a cohort study. BMJ Open 2017; 7:e013455. [PMID: 28302634 PMCID: PMC5372069 DOI: 10.1136/bmjopen-2016-013455] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Traffic and ambient air pollution exposure are positively associated with cardiovascular disease, potentially through atherosclerosis promotion. Few studies have assessed associations of these exposures with thoracic aortic calcium Agatston score (TAC) or abdominal aortic calcium Agatston score (AAC), systemic atherosclerosis correlates. We assessed whether living close to a major road and residential fine particulate matter (PM2.5) exposure were associated with TAC and AAC in a Northeastern US cohort. DESIGN Cohort study. SETTING Framingham Offspring and Third Generation participants residing in the Northeastern USA. PARTICIPANTS AND OUTCOME MEASURES Among 3506 participants, mean age was 55.8 years; 50% female. TAC was measured from 2002 to 2005 and AAC up to two times (2002-2005; 2008-2011) among participants from the Framingham Offspring or Third Generation cohorts. We first assessed associations with detectable TAC (logistic regression) and AAC (generalised estimating equation regression, logit link). As aortic calcium scores were right skewed, we used linear regression models and mixed-effects models to assess associations with natural log-transformed TAC and AAC, respectively, among participants with detectable aortic calcium. We also assessed associations with AAC progression. Models were adjusted for demographic variables, socioeconomic position indicators and time. RESULTS There were no consistent associations of major roadway proximity or PM2.5 with the presence or extent of TAC or AAC, or with AAC progression. Some estimates were in the opposite direction than expected. CONCLUSIONS In this cohort from a region with relatively low levels of and variation in PM2.5, there were no strong associations of proximity to a major road or PM2.5 with the presence or extent of aortic calcification, or with AAC progression.
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Affiliation(s)
- Kirsten S Dorans
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Elissa H Wilker
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Wenyuan Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary B Rice
- Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Petter L Ljungman
- Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joel Schwartz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brent A Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ralph B D'Agostino
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts, USA
| | - Joseph M Massaro
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher J O'Donnell
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Massachusetts, USA
- Cardiology Section, Department of Medicine, Boston Veteran's Administration Health System, Boston, Massachusetts, USA
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Murray A Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Cardiovascular Epidemiology Research Unit, Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Weaver AM, Wellenius GA, Wu WC, Hickson DA, Kamalesh M, Wang Y. Residential distance to major roadways and cardiac structure in African Americans: cross-sectional results from the Jackson Heart Study. Environ Health 2017; 16:21. [PMID: 28270143 PMCID: PMC5341411 DOI: 10.1186/s12940-017-0226-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 02/28/2017] [Indexed: 05/03/2023]
Abstract
BACKGROUND Heart failure (HF) is a significant source of morbidity and mortality among African Americans. Ambient air pollution, including from traffic, is associated with HF, but the mechanisms remain unknown. The objectives of this study were to estimate the cross-sectional associations between residential distance to major roadways with markers of cardiac structure: left ventricular (LV) mass index, LV end-diastolic diameter, LV end-systolic diameter, and LV hypertrophy among African Americans. METHODS We studied baseline participants of the Jackson Heart Study (recruited 2000-2004), a prospective cohort of cardiovascular disease (CVD) among African Americans living in Jackson, Mississippi, USA. All cardiac measures were assessed from echocardiograms. We assessed the associations between residential distance to roads and cardiac structure indicators using multivariable linear regression or multivariable logistic regression, adjusting for potential confounders. RESULTS Among 4826 participants, residential distance to road was <150 m for 103 participants, 150-299 m for 158, 300-999 for 1156, and ≥1000 m for 3409. Those who lived <150 m from a major road had mean 1.2 mm (95% CI 0.2, 2.1) greater LV diameter at end-systole compared to those who lived ≥1000 m. We did not observe statistically significant associations between distance to roads and LV mass index, LV end-diastolic diameter, or LV hypertrophy. Results did not materially change after additional adjustment for hypertension and diabetes or exclusion of those with CVD at baseline; results strengthened when modeling distance to A1 roads (such as interstate highways) as the exposure of interest. CONCLUSIONS We found that residential distance to roads may be associated with LV end-systolic diameter, a marker of systolic dysfunction, in this cohort of African Americans, suggesting a potential mechanism by which exposure to traffic pollution increases the risk of HF.
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Grants
- HHSN268201300049C National Heart, Lung, and Blood Institute
- HHSN268201300047C National Heart, Lung, and Blood Institute
- R01 ES020871 NIEHS NIH HHS
- HHSN268201300050C National Heart, Lung, and Blood Institute
- HHSN268201300048C National Heart, Lung, and Blood Institute
- R21 NR013231 National Institute of Nursing Research
- HHSN268201300046C National Heart, Lung, and Blood Institute
- National Heart, Lung, and Blood Institute (US); National Institute on Minority Health and Health Disparities (US)
- National Institute of Nursing Research (US); National Institute on Minority Health and Health Disparities (US)
- National Institute of Environmental Health Sciences
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Affiliation(s)
- Anne M. Weaver
- Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd., RG 6082, Indianapolis, IN 46202 USA
| | - Gregory A. Wellenius
- The School of Public Health at Brown University, 121 South Main Street, Providence, RI 02903 USA
| | - Wen-Chih Wu
- The School of Public Health at Brown University, 121 South Main Street, Providence, RI 02903 USA
| | - DeMarc A. Hickson
- Jackson State University School of Public Health Initiative, 350 West Woodrow Wilson Drive, Jackson Medical Mall, Suite 320, Jackson, MS 39213 USA
| | - Masoor Kamalesh
- Department of Cardiology, Richard L. Roudebush VA Medical Center, 1481 W 10th St., Indianapolis, IN 46202 USA
| | - Yi Wang
- Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd., RG 6082, Indianapolis, IN 46202 USA
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Mendola P, Sundaram R, Louis GMB, Sun L, Wallace ME, Smarr MM, Sherman S, Zhu Y, Ying Q, Liu D. Proximity to major roadways and prospectively-measured time-to-pregnancy and infertility. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 576:172-177. [PMID: 27783935 PMCID: PMC5164942 DOI: 10.1016/j.scitotenv.2016.10.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/26/2016] [Accepted: 10/05/2016] [Indexed: 05/22/2023]
Abstract
We aimed to study the potential impact of proximity to major roadways on time-to-pregnancy and infertility in couples attempting pregnancy in the Longitudinal Investigation of Fertility and Environment (LIFE) study (2005-2009), a population-based, prospective cohort study. Couples attempting pregnancy (n=500) were enrolled and followed prospectively until pregnancy or 12months of trying and 393 couples (78%) had complete data and full follow-up. Time-to-pregnancy was based on a standard protocol using fertility monitors, tracking estrone-3-glucuonide and luteinizing hormone, and pregnancy test kits to detect human chorionic gonadotropin (hCG). The fecundability odds ratio (FOR) and 95% confidence interval (CI) were estimated using proportional odds models. Infertility was defined as 12months of trying to conceive without an hCG pregnancy and the relative risk (RR) and 95% CI were estimated with log-binomial regression. Final models were adjusted for age, parity, study site, and salivary alpha-amylase, a stress marker. Infertile couples (53/393; 14%) tended to live closer to major roadways on average than fertile couples (689m vs. 843m, respectively) but the difference was not statistically significant. The likelihood of pregnancy was increased 3% for every 200m further away the couples residence was from a major roadway (FOR=1.03; CI=1.01-1.06). Infertility also appeared elevated at moderate distances compared to 1000m or greater, but estimates lacked precision. Our findings suggest that proximity to major roadways may be related to reductions in fecundity. Prospective data from larger populations is warranted to corroborate these findings.
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Affiliation(s)
- Pauline Mendola
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20892, USA.
| | - Rajeshwari Sundaram
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20892, USA
| | - Germaine M Buck Louis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20892, USA
| | - Liping Sun
- Glotech, Inc., 1801 Research Blvd # 605, Rockville, MD 20850, USA
| | - Maeve E Wallace
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20892, USA
| | - Melissa M Smarr
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20892, USA
| | - Seth Sherman
- Emmes Corporation, 401 N. Washington Street #700, Rockville, MD 20850, USA
| | - Yeyi Zhu
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20892, USA
| | - Qi Ying
- Texas A&M University, 401 Joe Routt Blvd., College Station, TX 77843, USA
| | - Danping Liu
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20892, USA
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Parks and Green Areas Are Associated with Decreased Risk for Hyperlipidemia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121205. [PMID: 27918478 PMCID: PMC5201346 DOI: 10.3390/ijerph13121205] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/10/2016] [Accepted: 11/21/2016] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the association between parks and green areas and hyperlipidemia in adults with groups stratified by moderate physical activity as a behavioral modification using the 2009 Korean Community Health Survey data and 212,584 participants enrolled in this study. The geographical codes of study participants were all matched on the basis of the amount of parks and green areas in each administrative district. Compared with participants living in the highest quartile of parks and green areas (Quartile 4), those living in the lowest quartile of green and park area (Quartile 1) were at an increased risk of physician-diagnosed hyperlipidemia and hyperlipidemia currently under treatment. Participants in the lowest quartile of parks and green areas were likely not to engage in any moderate physical activity. After classifying hyperlipidemia risk depending on the presence of moderate physical activity, those participating in moderate physical activity were less likely to have hyperlipidemia in all quartiles of parks and green areas than those not engaging in moderate physical activity. We found that parks and green areas were associated with decreased hyperlipidemia risk. Physical activity, which may benefit from the presence of parks and green areas, may reduce hyperlipidemia risk.
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Li W, Dorans KS, Wilker EH, Rice MB, Schwartz J, Coull BA, Koutrakis P, Gold DR, Fox CS, Mittleman MA. Residential proximity to major roadways, fine particulate matter, and adiposity: The framingham heart study. Obesity (Silver Spring) 2016; 24:2593-2599. [PMID: 27804220 PMCID: PMC5125859 DOI: 10.1002/oby.21630] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/12/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Higher traffic-related air pollution has been associated with higher body mass index (BMI) among children. However, few studies have assessed the associations among adults. METHODS Participants (N = 2,372) from the Framingham Offspring and Third Generation cohorts who underwent multidetector-computed tomography scans (2002-2005) were included. Residential-based proximity to the nearest major roadway and 1-year average levels of fine particulate matter (PM2.5 ) air pollution were estimated. BMI was measured at Offspring examination 7 (1998-2001) and Third Generation examination 1 (2002-2005); subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were measured using multidetector-computed tomography. Linear regression models were used for continuous BMI, SAT, and VAT and logistic models for the binary indicator of obesity (BMI ≥30 kg/m2 ), adjusting for demographic variables, individual- and area-level measures of socioeconomic position, and clinical and lifestyle factors. RESULTS Participants who lived 60 m from a major roadway had 0.37 kg/m2 higher BMI (95% CI: 0.10 to 0.65 kg/m2 ), 78.4 cm3 higher SAT (95% CI: 4.5 to 152.3 cm3 ), and 41.8 cm3 higher VAT (95% CI: -4.7 to 88.2 cm3 ) than those who lived 440 m away. CONCLUSIONS Living closer to a major roadway was associated with higher overall and abdominal adiposity.
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Affiliation(s)
- Wenyuan Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Cardiovascular Epidemiology Research Unit, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kirsten S. Dorans
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Cardiovascular Epidemiology Research Unit, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Elissa H. Wilker
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Cardiovascular Epidemiology Research Unit, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mary B. Rice
- Cardiovascular Epidemiology Research Unit, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Joel Schwartz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Brent A. Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Diane R. Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Caroline S. Fox
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA
- Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Murray A. Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Cardiovascular Epidemiology Research Unit, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Van Brusselen D, Arrazola de Oñate W, Maiheu B, Vranckx S, Lefebvre W, Janssen S, Nawrot TS, Nemery B, Avonts D. Health Impact Assessment of a Predicted Air Quality Change by Moving Traffic from an Urban Ring Road into a Tunnel. The Case of Antwerp, Belgium. PLoS One 2016; 11:e0154052. [PMID: 27167124 PMCID: PMC4863966 DOI: 10.1371/journal.pone.0154052] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/07/2016] [Indexed: 11/19/2022] Open
Abstract
Background The Antwerp ring road has a traffic density of 300,000 vehicles per day and borders the city center. The ‘Ringland project’ aims to change the current ‘open air ring road’ into a ‘filtered tunneled ring road’, putting the entire urban ring road into a tunnel and thus filtering air pollution. We conducted a health impact assessment (HIA) to quantify the possible benefit of a ‘filtered tunneled ring road’, as compared to the ‘open air ring road’ scenario, on air quality and its long-term health effects. Materials and Methods We modeled the change in annual ambient PM2.5 and NO2 concentrations by covering 15 kilometers of the Antwerp ring road in high resolution grids using the RIO-IFDM street canyon model. The exposure-response coefficients used were derived from a literature review: all-cause mortality, life expectancy, cardiopulmonary diseases and childhood Forced Vital Capacity development (FVC). Results Our model predicts changes between -1.5 and +2 μg/m³ in PM2.5 within a 1,500 meter radius around the ring road, for the ‘filtered tunneled ring road’ scenario as compared to an ‘open air ring road’. These estimated annual changes were plotted against the population exposed to these differences. The calculated change of PM2.5 is associated with an expected annual decrease of 21 deaths (95% CI 7 to 41). This corresponds with 11.5 deaths avoided per 100,000 inhabitants (95% CI 3.9–23) in the first 500 meters around the ring road every year. Of 356 schools in a 1,500 meter perimeter around the ring road changes between -10 NO2 and + 0.17 μg/m³ were found, corresponding to FVC improvement of between 3 and 64ml among school-age children. The predicted decline in lung cancer mortality and incidence of acute myocardial infarction were both only 0.1 per 100,000 inhabitants or less. Conclusion The expected change in PM2,5 and NO2 by covering the entire urban ring road in Antwerp is associated with considerable health gains for the approximate 352,000 inhabitants living in a 1,500 meter perimeter around the current open air ring road.
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Affiliation(s)
- Daan Van Brusselen
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
- * E-mail:
| | | | - Bino Maiheu
- VITO, Flemish Institute of Technologic Research, Mol, Belgium
| | - Stijn Vranckx
- VITO, Flemish Institute of Technologic Research, Mol, Belgium
| | - Wouter Lefebvre
- VITO, Flemish Institute of Technologic Research, Mol, Belgium
| | - Stijn Janssen
- VITO, Flemish Institute of Technologic Research, Mol, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Department of Public Health & Primary Care, University of Leuven, Leuven, Belgium
| | - Ben Nemery
- Department of Public Health & Primary Care, University of Leuven, Leuven, Belgium
| | - Dirk Avonts
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
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Woodward N, Levine M. Minimizing Air Pollution Exposure: A Practical Policy to Protect Vulnerable Older Adults from Death and Disability. ENVIRONMENTAL SCIENCE & POLICY 2016; 56:49-55. [PMID: 26640413 PMCID: PMC4667368 DOI: 10.1016/j.envsci.2015.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Air pollution causes an estimated 200,000 deaths per year in the United States alone. Older adults are at greater risk of mortality caused by air pollution. Here we quantify the number of older adult facilities in Los Angeles County that are exposed to high levels of traffic derived air pollution, and propose policy solutions to reduce pollution exposure to this vulnerable subgroup. Distances between 20,362 intersections and 858 elder care facilities were estimated, and roads or highways within 500 of facilities were used to estimate traffic volume exposure. Of the 858 facilities, 54 were located near at least one major roadway, defined as a traffic volume over 100,000 cars/day. These 54 facilities house approximately 6,000 older adults. Following standards established for schools, we recommend legislation mandating the placement of new elder care facilities a minimum of 500 feet from major roadways in order to reduce unnecessary mortality risk from pollution exposure.
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Affiliation(s)
- Nick Woodward
- University of Southern California, Davis School of Gerontology. McClintock ave 3715, Los Angeles, CA 90089
| | - Morgan Levine
- University of California Los Angeles, Department of Human Genetics. 695 Charles E Young Dr., Los Angeles, CA 90095
- University of California Los Angeles, Center for Neurobehavioral Genetics. 695 Charles E Young Dr., Los Angeles, CA 90095
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Tonne C, Halonen JI, Beevers SD, Dajnak D, Gulliver J, Kelly FJ, Wilkinson P, Anderson HR. Long-term traffic air and noise pollution in relation to mortality and hospital readmission among myocardial infarction survivors. Int J Hyg Environ Health 2016; 219:72-8. [DOI: 10.1016/j.ijheh.2015.09.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/07/2015] [Accepted: 09/15/2015] [Indexed: 11/27/2022]
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Long-term exposure to ambient air pollution and serum leptin in older adults: results from the MOBILIZE Boston study. J Occup Environ Med 2015; 56:e73-7. [PMID: 25192230 DOI: 10.1097/jom.0000000000000253] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Long-term exposure to traffic-related air pollution has been linked to increased risk of obesity and diabetes and may be associated with higher serum levels of the adipokine leptin, but this hypothesis has not been previously evaluated in humans. METHODS In a cohort of older adults, we estimated the association between serum leptin concentrations and two markers of long-term exposure to traffic pollution, adjusting for participant characteristics, temporal trends, socioeconomic factors, and medical history. RESULTS An interquartile range increase (0.11 μg/m) in annual mean residential black carbon was associated with 12% (95% confidence interval: 3%, 22%) higher leptin levels. Leptin levels were not associated with residential distance to major roadway. CONCLUSIONS If confirmed, these findings support the emerging evidence suggesting that certain sources of traffic pollution may be associated with adverse cardiometabolic effects.
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Kingsley SL, Eliot MN, Whitsel EA, Wang Y, Coull BA, Hou L, Margolis HG, Margolis KL, Mu L, Wu WCC, Johnson KC, Allison MA, Manson JE, Eaton CB, Wellenius GA. Residential proximity to major roadways and incident hypertension in post-menopausal women. ENVIRONMENTAL RESEARCH 2015; 142:522-8. [PMID: 26282224 PMCID: PMC4609282 DOI: 10.1016/j.envres.2015.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/30/2015] [Accepted: 08/05/2015] [Indexed: 05/07/2023]
Abstract
Living near major roadways has been associated with increased risk of cardiovascular morbidity and mortality, presumably from exposure to elevated levels of traffic-related air and/or noise pollution. This association may potentially be mediated through increased risk of incident hypertension, but results from prior studies are equivocal. Using Cox proportional hazards models we examined residential proximity to major roadways and incident hypertension among 38,360 participants of the Women's Health Initiative (WHI) Clinical Trial cohorts free of hypertension at enrollment and followed for a median of 7.9 years. Adjusting for participant demographics and lifestyle, trial participation, and markers of individual and neighborhood socioeconomic status, the hazard ratios for incident hypertension were 1.13 (95% CI: 1.00, 1.28), 1.03 (0.95, 1.11), 1.05 (0.99, 1.11), and 1.05 (1.00, 1.10) for participants living ≤50, >50-200, >200-400, and >400-1000 m vs >1000 m from the nearest major roadway, respectively (ptrend=0.013). This association varied substantially by WHI study region with hazard ratios for women living ≤50 m from a major roadway of 1.61 (1.18, 2.20) in the West, 1.51 (1.22, 1.87) in the Northeast, 0.89 (0.70, 1.14) in the South, and 0.94 (0.75, 1.19) in the Midwest. In this large, national cohort of post-menopausal women, residential proximity to major roadways was associated with incident hypertension in selected regions of the U.S. If causal, these results suggest residential proximity to major roadways, as a marker for air, noise and other traffic-related pollution, may be a risk factor for hypertension.
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Affiliation(s)
- Samantha L Kingsley
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Melissa N Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Eric A Whitsel
- Department of Epidemiology, University of North Carolina Gillings School of Public Health, Chapel Hill, NC, USA
| | - Yi Wang
- Department of Environmental Health Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Helene G Margolis
- Department of Internal Medicine, School of Medicine, University of California, Davis, CA, USA
| | - Karen L Margolis
- Health Partners Institute for Education and Research, Minneapolis, MN, USA
| | - Lina Mu
- Department of Social and Preventive Medicine, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY, USA
| | - Wen-Chih C Wu
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Matthew A Allison
- Department of Family and Preventive Medicine, University of California San Diego School of Medicine, San Diego, CA, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Charles B Eaton
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Memorial Hospital of Rhode Island, Pawtucket, RI, USA
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
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29
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DeJarnett N, Yeager R, Conklin DJ, Lee J, O'Toole TE, McCracken J, Abplanalp W, Srivastava S, Riggs DW, Hamzeh I, Wagner S, Chugh A, DeFilippis A, Ciszewski T, Wyatt B, Becher C, Higdon D, Ramos KS, Tollerud DJ, Myers JA, Rai SN, Shah J, Zafar N, Krishnasamy SS, Prabhu SD, Bhatnagar A. Residential Proximity to Major Roadways Is Associated With Increased Levels of AC133+ Circulating Angiogenic Cells. Arterioscler Thromb Vasc Biol 2015; 35:2468-77. [PMID: 26293462 DOI: 10.1161/atvbaha.115.305724] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/04/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Previous studies have shown that residential proximity to a roadway is associated with increased cardiovascular disease risk. Yet, the nature of this association remains unclear, and its effect on individual cardiovascular disease risk factors has not been assessed. The objective of this study was to determine whether residential proximity to roadways influences systemic inflammation and the levels of circulating angiogenic cells. APPROACH AND RESULTS In a cross-sectional study, cardiovascular disease risk factors, blood levels of C-reactive protein, and 15 antigenically defined circulating angiogenic cell populations were measured in participants (n=316) with moderate-to-high cardiovascular disease risk. Attributes of roadways surrounding residential locations were assessed using geographic information systems. Associations between road proximity and cardiovascular indices were analyzed using generalized linear models. Close proximity (<50 m) to a major roadway was associated with lower income and higher rates of smoking but not C-reactive protein levels. After adjustment for potential confounders, the levels of circulating angiogenic cells in peripheral blood were significantly elevated in people living in close proximity to a major roadway (CD31(+)/AC133(+), AC133(+), CD34(+)/AC133(+), and CD34(+)/45(dim)/AC133(+) cells) and positively associated with road segment distance (CD31(+)/AC133(+), AC133(+), and CD34(+)/AC133(+) cells), traffic intensity (CD31(+)/AC133(+) and AC133(+) cells), and distance-weighted traffic intensity (CD31(+)/34(+)/45(+)/AC133(+) cells). CONCLUSIONS Living close to a major roadway is associated with elevated levels of circulating cells positive for the early stem marker AC133(+). This may reflect an increased need for vascular repair. Levels of these cells in peripheral blood may be a sensitive index of cardiovascular injury because of residential proximity to roadways.
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Affiliation(s)
- Natasha DeJarnett
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Ray Yeager
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Daniel J Conklin
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Jongmin Lee
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Timothy E O'Toole
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - James McCracken
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Wes Abplanalp
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Sanjay Srivastava
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Daniel W Riggs
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Ihab Hamzeh
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Stephen Wagner
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Atul Chugh
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Andrew DeFilippis
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Tiffany Ciszewski
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Brad Wyatt
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Carrie Becher
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Deirdre Higdon
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Kenneth S Ramos
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - David J Tollerud
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - John A Myers
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Shesh N Rai
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Jasmit Shah
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Nagma Zafar
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Sathya S Krishnasamy
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Sumanth D Prabhu
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
| | - Aruni Bhatnagar
- From the Diabetes and Obesity Center (N.D., R.Y., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., A.C., A.D., T.C., B.W., S.N.R., J.S., N.Z., S.S.K., A.B.), Department of Environmental and Occupational Health Sciences (N.D., R.Y., D.J.T.), Institute of Molecular Cardiology (N.D., D.J.C., J.L., T.E.O., J.M., W.A., S.S., D.W.R., S.W., A.C., A.D., T.C., B.W., C.B., D.H., J.S., S.D.P., A.B.), Department of Pediatrics (J.A.M.), Department of Bioinformatics and Biostatics (S.N.R.), Biostatistics Shared Facility, JG Brown Cancer Center (S.N.R.), Division of Endocrinology, Metabolism and Diabetes, Department of Medicine (S.S.K.), and Department of Biochemistry and Molecular Biology (K.S.R., A.B.), University of Louisville, KY; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (I.H.); Department of Medicine, Johns Hopkins University, Baltimore, MD (A.D.); and Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.D.P.)
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Rice MB, Ljungman PL, Wilker EH, Dorans KS, Gold DR, Schwartz J, Koutrakis P, Washko GR, O'Connor GT, Mittleman MA. Long-term exposure to traffic emissions and fine particulate matter and lung function decline in the Framingham heart study. Am J Respir Crit Care Med 2015; 191:656-64. [PMID: 25590631 DOI: 10.1164/rccm.201410-1875oc] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Few studies have examined associations between long-term exposure to fine particulate matter (PM2.5) and lung function decline in adults. OBJECTIVES To determine if exposure to traffic and PM2.5 is associated with longitudinal changes in lung function in a population-based cohort in the Northeastern United States, where pollution levels are relatively low. METHODS FEV1 and FVC were measured up to two times between 1995 and 2011 among 6,339 participants of the Framingham Offspring or Third Generation studies. We tested associations between residential proximity to a major roadway and PM2.5 exposure in 2001 (estimated by a land-use model using satellite measurements of aerosol optical thickness) and lung function. We examined differences in average lung function using mixed-effects models and differences in lung function decline using linear regression models. Current smokers were excluded. Models were adjusted for age, sex, height, weight, pack-years, socioeconomic status indicators, cohort, time, season, and weather. MEASUREMENTS AND MAIN RESULTS Living less than 100 m from a major roadway was associated with a 23.2 ml (95% confidence interval [CI], -44.4 to -1.9) lower FEV1 and a 5.0 ml/yr (95% CI, -9.0 to -0.9) faster decline in FEV1 compared with more than 400 m. Each 2 μg/m(3) increase in average of PM2.5 was associated with a 13.5 ml (95% CI, -26.6 to -0.3) lower FEV1 and a 2.1 ml/yr (95% CI, -4.1 to -0.2) faster decline in FEV1. There were similar associations with FVC. Associations with FEV1/FVC ratio were weak or absent. CONCLUSIONS Long-term exposure to traffic and PM2.5, at relatively low levels, was associated with lower FEV1 and FVC and an accelerated rate of lung function decline.
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Affiliation(s)
- Mary B Rice
- 1 Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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31
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Rice MB, Rifas-Shiman SL, Oken E, Gillman MW, Ljungman PL, Litonjua AA, Schwartz J, Coull BA, Zanobetti A, Koutrakis P, Melly SJ, Mittleman MA, Gold DR. Exposure to traffic and early life respiratory infection: A cohort study. Pediatr Pulmonol 2015; 50:252-259. [PMID: 24678045 PMCID: PMC4177521 DOI: 10.1002/ppul.23029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/29/2014] [Indexed: 11/08/2022]
Abstract
We examined whether proximity to a major roadway and traffic density around the home during pregnancy are associated with risk of early life respiratory infection in a pre-birth cohort in the Boston area. We geocoded addresses for 1,263 mother-child pairs enrolled during the first trimester of pregnancy in Project Viva during 1999-2002. We calculated distance from home to nearest major roadway and traffic density in a 100 m buffer around the home. We defined respiratory infection as maternal report of ≥1 doctor-diagnosed pneumonia, bronchiolitis, croup, or other respiratory infection from birth until the early childhood visit (median age 3.3). We used relative risk regression models adjusting for potential confounders to estimate associations between traffic exposures and risk of respiratory infection. Distance to roadway during pregnancy was associated with risk of respiratory infection. In fully adjusted models, relative risks (95% CI) for respiratory infection were: 1.30 (1.08, 1.55) for <100 m, 1.15 (0.93, 1.41) for 100 to <200 m, and 0.95 (0.84, 1.07) for 200 to <1,000 m compared with living ≥1,000 m away from a major roadway. Each interquartile range increase in distance to roadway was associated with an 8% (95% CI 0.87, 0.98) lower risk, and each interquartile range increase in traffic density was associated with a 5% (95% CI 0.98, 1.13) higher risk of respiratory infection. Our findings suggest that living close to a major roadway during pregnancy may predispose the developing lung to infection in early life. Pediatr Pulmonol. 2015; 50:252-259. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Mary B Rice
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, Massachusetts.,Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sheryl L Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachsetts
| | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachsetts
| | - Matthew W Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachsetts
| | - Petter L Ljungman
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Augusto A Litonjua
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joel Schwartz
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
| | - Brent A Coull
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
| | - Petros Koutrakis
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
| | - Steven J Melly
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
| | - Murray A Mittleman
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Diane R Gold
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
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Bhinder S, Chen H, Sato M, Copes R, Evans GJ, Chow CW, Singer LG. Air pollution and the development of posttransplant chronic lung allograft dysfunction. Am J Transplant 2014; 14:2749-57. [PMID: 25358842 DOI: 10.1111/ajt.12909] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 06/25/2014] [Accepted: 06/29/2014] [Indexed: 01/25/2023]
Abstract
Chronic lung allograft dysfunction (CLAD) is the leading cause of mortality following lung transplantation. We conducted a retrospective cohort study including 397 bilateral lung recipients transplanted in from 1996 to 2009 to determine the association between ambient air pollution, CLAD and mortality. Pollution exposure was assessed using satellite-based estimates of nitrogen dioxide, distance to major roadway and total length of roadways around a patient's home. Cumulative exposures to ozone and particulate matter were estimated from concentrations measured at fixed-site stations near patients' homes using inverse distance weighted interpolation. Cox proportional hazards models were used to estimate the associations of CLAD with air pollution exposure, adjusting for various individual and neighborhood characteristics. During the follow-up, 185 patients developed CLAD (47%) and 101 patients died (25%). Fifty-four deaths (53%) were due to CLAD. We observed an association between CLAD development and road density within 200 m of a patient's home (HR 1.30 [95% CI 1.07-1.58]). Although based on a subgroup of 14 patients, living within 100 m of a highway was associated with a high risk for developing CLAD (HR 4.91 [95% CI 2.22, 10.87]). These data suggest that exposure to traffic-related air pollution is associated with development of CLAD among lung transplant recipients.
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Affiliation(s)
- S Bhinder
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Kirwa K, Eliot MN, Wang Y, Adams MA, Morgan CG, Kerr J, Norman GJ, Eaton CB, Allison MA, Wellenius GA. Residential proximity to major roadways and prevalent hypertension among postmenopausal women: results from the Women's Health Initiative San Diego Cohort. J Am Heart Assoc 2014; 3:e000727. [PMID: 25274494 PMCID: PMC4323802 DOI: 10.1161/jaha.113.000727] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 09/02/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Living near major roadways has been linked with increased risk of cardiovascular events and worse prognosis. Residential proximity to major roadways may also be associated with increased risk of hypertension, but few studies have evaluated this hypothesis. METHODS AND RESULTS We examined the cross-sectional association between residential proximity to major roadways and prevalent hypertension among 5401 postmenopausal women enrolled into the San Diego cohort of the Women's Health Initiative. We used modified Poisson regression with robust error variance to estimate the association between prevalence of hypertension and residential distance to nearest major roadway, adjusting for participant demographics, medical history, indicators of individual and neighborhood socioeconomic status, and for local supermarket/grocery and fast food/convenience store density. The adjusted prevalence ratios for hypertension were 1.22 (95% CI: 1.07, 1.39), 1.13 (1.00, 1.27), and 1.05 (0.99, 1.12) for women living ≤100, >100 to 200, and >200 to 1000 versus >1000 m from a major roadway (P for trend=0.006). In a model treating the natural log of distance to major roadway as a continuous variable, a shift in distance from 1000 to 100 m from a major roadway was associated with a 9% (3%, 16%) higher prevalence of hypertension. CONCLUSIONS In this cohort of postmenopausal women, residential proximity to major roadways was positively associated with the prevalence of hypertension. If causal, these results suggest that living close to major roadways may be an important novel risk factor for hypertension.
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Affiliation(s)
- Kipruto Kirwa
- Department of Epidemiology, Brown University School of Public Health, Providence, RI (K.K., M.N.E., Y.W., C.B.E., G.A.W.)
- Department of Epidemiology and Nutrition, Moi University School of Public Health, Eldoret, Kenya (K.K.)
| | - Melissa N. Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI (K.K., M.N.E., Y.W., C.B.E., G.A.W.)
| | - Yi Wang
- Department of Epidemiology, Brown University School of Public Health, Providence, RI (K.K., M.N.E., Y.W., C.B.E., G.A.W.)
| | - Marc A. Adams
- Exercise and Wellness Program, School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ (M.A.A.)
| | - Cindy G. Morgan
- Department of Family and Preventive Medicine, University of California, San Diego, CA (C.G.M., J.K., G.J.N., M.A.A.)
| | - Jacqueline Kerr
- Department of Family and Preventive Medicine, University of California, San Diego, CA (C.G.M., J.K., G.J.N., M.A.A.)
| | - Gregory J. Norman
- Department of Family and Preventive Medicine, University of California, San Diego, CA (C.G.M., J.K., G.J.N., M.A.A.)
| | - Charles B. Eaton
- Department of Epidemiology, Brown University School of Public Health, Providence, RI (K.K., M.N.E., Y.W., C.B.E., G.A.W.)
| | - Matthew A. Allison
- Department of Family and Preventive Medicine, University of California, San Diego, CA (C.G.M., J.K., G.J.N., M.A.A.)
| | - Gregory A. Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI (K.K., M.N.E., Y.W., C.B.E., G.A.W.)
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Jones MR, Diez-Roux AV, Hajat A, Kershaw KN, O'Neill MS, Guallar E, Post WS, Kaufman JD, Navas-Acien A. Race/ethnicity, residential segregation, and exposure to ambient air pollution: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Public Health 2014; 104:2130-7. [PMID: 25211756 DOI: 10.2105/ajph.2014.302135] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We described the associations of ambient air pollution exposure with race/ethnicity and racial residential segregation. METHODS We studied 5921 White, Black, Hispanic, and Chinese adults across 6 US cities between 2000 and 2002. Household-level fine particulate matter (PM2.5) and nitrogen oxides (NOX) were estimated for 2000. Neighborhood racial composition and residential segregation were estimated using US census tract data for 2000. RESULTS Participants in neighborhoods with more than 60% Hispanic populations were exposed to 8% higher PM2.5 and 31% higher NOX concentrations compared with those in neighborhoods with less than 25% Hispanic populations. Participants in neighborhoods with more than 60% White populations were exposed to 5% lower PM2.5 and 18% lower NOX concentrations compared with those in neighborhoods with less than 25% of the population identifying as White. Neighborhoods with Whites underrepresented or with Hispanics overrepresented were exposed to higher PM2.5 and NOX concentrations. No differences were observed for other racial/ethnic groups. CONCLUSIONS Living in majority White neighborhoods was associated with lower air pollution exposures, and living in majority Hispanic neighborhoods was associated with higher air pollution exposures. This new information highlighted the importance of measuring neighborhood-level segregation in the environmental justice literature.
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Affiliation(s)
- Miranda R Jones
- Miranda R. Jones and Eliseo Guallar are with the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. Wendy S. Post is with the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Ana Navas-Acien is with the Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health. Ana V. Diez-Roux and Marie S. O'Neill are with the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor. Anjum Hajat and Joel D. Kaufman are with the Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle. Kiarri N. Kershaw is with the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Isakov V, Arunachalam S, Batterman S, Bereznicki S, Burke J, Dionisio K, Garcia V, Heist D, Perry S, Snyder M, Vette A. Air quality modeling in support of the Near-Road Exposures and Effects of Urban Air Pollutants Study (NEXUS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:8777-93. [PMID: 25166917 PMCID: PMC4198990 DOI: 10.3390/ijerph110908777] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 08/15/2014] [Accepted: 08/18/2014] [Indexed: 11/21/2022]
Abstract
A major challenge in traffic-related air pollution exposure studies is the lack of information regarding pollutant exposure characterization. Air quality modeling can provide spatially and temporally varying exposure estimates for examining relationships between traffic-related air pollutants and adverse health outcomes. A hybrid air quality modeling approach was used to estimate exposure to traffic-related air pollutants in support of the Near-Road Exposures and Effects of Urban Air Pollutants Study (NEXUS) conducted in Detroit (Michigan, USA). Model-based exposure metrics, associated with local variations of emissions and meteorology, were estimated using a combination of the American Meteorological Society/Environmental Protection Agency Regulatory Model (AERMOD) and Research LINE-source dispersion model for near-surface releases (RLINE) dispersion models, local emission source information from the National Emissions Inventory, detailed road network locations and traffic activity, and meteorological data from the Detroit City Airport. The regional background contribution was estimated using a combination of the Community Multi-scale Air Quality (CMAQ) and the Space-Time Ordinary Kriging (STOK) models. To capture the near-road pollutant gradients, refined "mini-grids" of model receptors were placed around participant homes. Exposure metrics for CO, NOx, PM2.5 and its components (elemental and organic carbon) were predicted at each home location for multiple time periods including daily and rush hours. The exposure metrics were evaluated for their ability to characterize the spatial and temporal variations of multiple ambient air pollutants compared to measurements across the study area.
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Affiliation(s)
- Vlad Isakov
- National Exposure Research Laboratory, United States Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711 USA.
| | - Saravanan Arunachalam
- Institute for the Environment, University of North Carolina at Chapel Hill, 100 Europa Drive, Chapel Hill, NC 27517, USA.
| | - Stuart Batterman
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Room 6075 SPH2, 1420 Washington Heights, Ann Arbor, MI 48109-2029 USA.
| | - Sarah Bereznicki
- National Exposure Research Laboratory, United States Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711 USA.
| | - Janet Burke
- National Exposure Research Laboratory, United States Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711 USA.
| | - Kathie Dionisio
- National Exposure Research Laboratory, United States Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711 USA.
| | - Val Garcia
- National Exposure Research Laboratory, United States Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711 USA.
| | - David Heist
- National Exposure Research Laboratory, United States Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711 USA.
| | - Steve Perry
- National Exposure Research Laboratory, United States Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711 USA.
| | - Michelle Snyder
- Institute for the Environment, University of North Carolina at Chapel Hill, 100 Europa Drive, Chapel Hill, NC 27517, USA.
| | - Alan Vette
- National Exposure Research Laboratory, United States Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27711 USA.
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Wilker EH, Wu CD, McNeely E, Mostofsky E, Spengler J, Wellenius GA, Mittleman MA. Green space and mortality following ischemic stroke. ENVIRONMENTAL RESEARCH 2014; 133:42-8. [PMID: 24906067 PMCID: PMC4151551 DOI: 10.1016/j.envres.2014.05.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/02/2014] [Accepted: 05/04/2014] [Indexed: 05/20/2023]
Abstract
BACKGROUND Residential proximity to green space has been associated with physical and mental health benefits, but whether green space is associated with post-stroke survival has not been studied. METHODS Patients ≥ 21 years of age admitted to the Beth Israel Deaconess Medical Center (BIDMC) between 1999 and 2008 with acute ischemic stroke were identified. Demographics, presenting symptoms, medical history and imaging results were abstracted from medical records at the time of hospitalization for stroke onset. Addresses were linked to average Normalized Difference Vegetation Index, distance to roadways with more than 10,000 cars/day, and US census block group. Deaths were identified through June 2012 using the Social Security Death Index. RESULTS There were 929 deaths among 1645 patients with complete data (median follow up: 5 years). In multivariable Cox models adjusted for indicators of medical history, demographic and socioeconomic factors, the hazard ratio for patients living in locations in the highest quartile of green space compared to the lowest quartile was 0.78 (95% Confidence Interval: 0.63-0.97) (p-trend = 0.009). This association remained statistically significant after adjustment for residential proximity to a high traffic road. CONCLUSIONS Residential proximity to green space is associated with higher survival rates after ischemic stroke in multivariable adjusted models. Further work is necessary to elucidate the underlying mechanisms for this association, and to better understand the exposure-response relationships and susceptibility factors that may contribute to higher mortality in low green space areas.
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Affiliation(s)
- Elissa H Wilker
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA 02215 USA; Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.
| | - Chih-Da Wu
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA; Department of Forestry and Natural Resources, College of Agriculture, National Chiayi University, Chiayi, Taiwan
| | - Eileen McNeely
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Elizabeth Mostofsky
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA 02215 USA
| | - John Spengler
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | | | - Murray A Mittleman
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA 02215 USA; Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
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Wilker EH, Ljungman PL, Rice MB, Kloog I, Schwartz J, Gold DR, Koutrakis P, Vita JA, Mitchell GF, Vasan RS, Benjamin EJ, Hamburg NM, Mittleman MA. Relation of long-term exposure to air pollution to brachial artery flow-mediated dilation and reactive hyperemia. Am J Cardiol 2014; 113:2057-63. [PMID: 24793676 DOI: 10.1016/j.amjcard.2014.03.048] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 11/15/2022]
Abstract
Long-term exposure to ambient air pollution has been associated with cardiovascular morbidity and mortality. Impaired vascular responses may, in part, explain these findings, but the association of such long-term exposure with measures of both conduit artery and microvascular function has not been widely reported. We evaluated the association between residential proximity to a major roadway (primary or secondary highway) and spatially resolved average fine particulate matter (PM2.5) and baseline brachial artery diameter and mean flow velocity, flow-mediated dilation%, and hyperemic flow velocity, in the Framingham Offspring and Third Generation Cohorts. We examined 5,112 participants (2,731 [53%] women, mean age 49 ± 14 years). Spatially resolved average PM2.5 was associated with lower flow-mediated dilation% and hyperemic flow velocity. An interquartile range difference in PM2.5 (1.99 μg/m(3)) was associated with -0.16% (95% confidence interval [CI] -0.27%, -0.05%) lower flow-mediated dilation% and -0.72 (95% CI -1.38, -0.06) cm/s lower hyperemic flow velocity%. Residential proximity to a major roadway was negatively associated with flow-mediated dilation%. Compared with living ≥400 m away, living <50 m from a major roadway was associated with 0.32% lower flow-mediated dilation (95% CI -0.58%, -0.06%), but results for hyperemic flow velocity had wide confidence intervals -0.68 cm/s (95% CI -2.29, 0.93). In conclusion, residential proximity to a major roadway and higher levels of spatially resolved estimates of PM2.5 at participant residences are associated with impaired conduit artery and microvascular function in this large community-based cohort of middle-aged and elderly adults.
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Affiliation(s)
- Elissa H Wilker
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts.
| | - Petter L Ljungman
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Mary B Rice
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Joel Schwartz
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
| | - Diane R Gold
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
| | - Petros Koutrakis
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
| | - Joseph A Vita
- NHLBI and Boston University's Framingham Heart Study, Framingham, Massachusetts; Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | | | - Ramachandran S Vasan
- NHLBI and Boston University's Framingham Heart Study, Framingham, Massachusetts; Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts; Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Emelia J Benjamin
- NHLBI and Boston University's Framingham Heart Study, Framingham, Massachusetts; Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Naomi M Hamburg
- NHLBI and Boston University's Framingham Heart Study, Framingham, Massachusetts; Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Murray A Mittleman
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
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Arcaya M, Glymour MM, Chakrabarti P, Christakis NA, Kawachi I, Subramanian SV. Effects of proximate foreclosed properties on individuals' systolic blood pressure in Massachusetts, 1987 to 2008. Circulation 2014; 129:2262-8. [PMID: 24891622 DOI: 10.1161/circulationaha.113.006205] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND No studies have examined the effects of local foreclosure activity on neighbors' blood pressure, despite the fact that spillover effects of nearby foreclosures include many known risk factors for increased blood pressure. We assessed the extent to which living near foreclosed properties is associated with subsequent systolic blood pressure (SBP) measurements. METHODS AND RESULTS We used 6590 geocoded observations collected from 1740 participants in the Framingham Offspring Cohort across 5 waves (1987-2008) of the Framingham Heart Study to create a longitudinal record of exposure to nearby foreclosure activity. We distinguished between real estate-owned foreclosures, which typically sit vacant, and foreclosures purchased by third-party buyers, which are generally put into productive use. Counts of lender-owned foreclosed properties within 100 m of participants' homes were used to predict measured SBP and odds of being hypertensive. We assessed whether self-reported alcoholic drinks per week and measured body mass index helped to explain the relationship between foreclosure activity and SBP. Each additional real estate-owned foreclosure located within 100 m of a participant's home was associated with an increase in SBP of 1.71 mm Hg (P=0.03; 95% confidence interval, 0.18-3.24) after adjustment for individual- and area-level confounders but not with odds of hypertension. The presence of foreclosures purchased by third-party buyers was not associated with SBP or with hypertension. Body mass index and alcohol consumption attenuated the effect of living near real estate-owned foreclosures on SBP in fully adjusted models. CONCLUSIONS Real estate-owned foreclosed properties may put nearby neighbors at risk for increased SBP, with higher alcohol consumption and body mass index partially mediating this relationship.
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Affiliation(s)
- Mariana Arcaya
- From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA (M.A., I.K., S.V.S.); Department of Epidemiology and Biostatistics, University of California-San Francisco School of Medicine (M.M.G.); Federal Reserve Bank of Boston, Boston, MA (P.C.); and Yale Institute for Network Science, Yale University, New Haven, CT (N.A.C.).
| | - M Maria Glymour
- From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA (M.A., I.K., S.V.S.); Department of Epidemiology and Biostatistics, University of California-San Francisco School of Medicine (M.M.G.); Federal Reserve Bank of Boston, Boston, MA (P.C.); and Yale Institute for Network Science, Yale University, New Haven, CT (N.A.C.)
| | - Prabal Chakrabarti
- From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA (M.A., I.K., S.V.S.); Department of Epidemiology and Biostatistics, University of California-San Francisco School of Medicine (M.M.G.); Federal Reserve Bank of Boston, Boston, MA (P.C.); and Yale Institute for Network Science, Yale University, New Haven, CT (N.A.C.)
| | - Nicholas A Christakis
- From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA (M.A., I.K., S.V.S.); Department of Epidemiology and Biostatistics, University of California-San Francisco School of Medicine (M.M.G.); Federal Reserve Bank of Boston, Boston, MA (P.C.); and Yale Institute for Network Science, Yale University, New Haven, CT (N.A.C.)
| | - Ichiro Kawachi
- From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA (M.A., I.K., S.V.S.); Department of Epidemiology and Biostatistics, University of California-San Francisco School of Medicine (M.M.G.); Federal Reserve Bank of Boston, Boston, MA (P.C.); and Yale Institute for Network Science, Yale University, New Haven, CT (N.A.C.)
| | - S V Subramanian
- From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA (M.A., I.K., S.V.S.); Department of Epidemiology and Biostatistics, University of California-San Francisco School of Medicine (M.M.G.); Federal Reserve Bank of Boston, Boston, MA (P.C.); and Yale Institute for Network Science, Yale University, New Haven, CT (N.A.C.)
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Wrenn KC, Mostofsky E, Tofler GH, Muller JE, Mittleman MA. Anxiety, anger, and mortality risk among survivors of myocardial infarction. Am J Med 2013; 126:1107-13. [PMID: 24083642 PMCID: PMC3933314 DOI: 10.1016/j.amjmed.2013.07.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 07/30/2013] [Accepted: 07/31/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although there is evidence that anxiety and anger are associated with a higher risk of cardiovascular events, studies examining the relationship between these stressors and prognosis following myocardial infarction have been mixed. METHODS We conducted a prospective cohort study of 1968 participants (average age 60.2 years, 30.6% women) in the Determinants of Myocardial Infarction Onset Study recruited at the time of admission for myocardial infarction between 1989 and 1996. We used the state anxiety and anger subscales of the State-Trait Personality Inventory. Participants were followed for all-cause mortality through December 31, 2007 using the National Death Index. We constructed multivariable Cox proportional hazards models adjusted for demographic, behavioral, and clinical confounders and calculated hazard ratios (HR) and 95% confidence intervals (CI) to examine the relationship between high levels of anxiety and anger and all-cause mortality. RESULTS Over 10 years of follow-up, 525 participants died. Compared with those scoring lower, an anxiety score >90(th) percentile was associated with a 1.31-times (95% CI, 0.93-1.84) higher mortality rate. The association was apparent in the first 3 years (HR 1.78; 95% CI 1.08-2.93), but not thereafter. Likewise, an anger score >90(th) percentile was associated with a 1.25-times (95% CI, 0.87-1.80) higher mortality rate. The association was higher in the first 3 years (HR 1.58; 95% CI, 0.91-2.74) than in subsequent years, but it was not statistically significant during either follow-up period. CONCLUSIONS In this study of myocardial infarction survivors, a high level of anxiety was associated with all-cause mortality, with the strongest association in the first 3 years of follow-up.
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Affiliation(s)
- Katherine C Wrenn
- Department of Cardiology and Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
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Acute and subacute effects of urban air pollution on cardiopulmonary emergencies and mortality: time series studies in Austrian cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:4728-51. [PMID: 24157504 PMCID: PMC3823330 DOI: 10.3390/ijerph10104728] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/29/2013] [Accepted: 09/29/2013] [Indexed: 11/16/2022]
Abstract
Daily pollution data (collected in Graz over 16 years and in the Linz over 18 years) were used for time series studies (GAM and case-crossover) on the relationship with daily mortality (overall and specific causes of death). Diagnoses of patients who had been transported to hospitals in Linz were also available on a daily basis from eight years for time series analyses of cardiopulmonary emergencies. Increases in air pollutant levels over several days were followed by increases in mortality and the observed effects increased with the length of the exposure window considered, up to a maximum of 15 days. These mortality changes in Graz and Linz showed similar patterns like the ones found before in Vienna. A significant association of mortality could be demonstrated with NO2, PM2.5 and PM10 even in summer, when concentrations are lower and mainly related to motor traffic. Cardiorespiratory ambulance transports increased with NO2/PM2.5/PM10 by 2.0/6.1/1.7% per 10 µg/m3 on the same day. Monitoring of NO2 (related to motor traffic) and fine particulates at urban background stations predicts acute effects on cardiopulmonary emergencies and extended effects on cardiopulmonary mortality. Both components of urban air pollution are indicators of acute cardiopulmonary health risks, which need to be monitored and reduced, even below current standards.
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Koton S, Molshatzki N, Yuval, Myers V, Broday DM, Drory Y, Steinberg DM, Gerber Y. Cumulative exposure to particulate matter air pollution and long-term post-myocardial infarction outcomes. Prev Med 2013; 57:339-44. [PMID: 23777671 DOI: 10.1016/j.ypmed.2013.06.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/03/2013] [Accepted: 06/06/2013] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Chronic environmental exposure to particulate matter <2.5μm in diameter (PM2.5) has been associated with cardiovascular disease; however, the effect of air pollution on myocardial infarction (MI) survivors is not clear. We studied the association of chronic exposure to PM2.5 with death and recurrent cardiovascular events in MI survivors. METHODS Consecutive patients aged ≤65years admitted to all medical centers in central Israel after first-MI in 1992-1993 were followed through 2005 for cardiovascular events and 2011 for survival. Data on sociodemographic and prognostic factors were collected at baseline and during follow-up. Residential exposure to PM2.5 was estimated for each patient based on data recorded at air quality monitoring stations. Cox and Andersen-Gill proportional hazards models were used to study the pollution-outcome association. RESULTS Among the 1120 patients, 469 (41.9%) died and 541 (48.3%) experienced one or more recurrent cardiovascular event. The adjusted hazard ratios associated with a 10μg/m(3) increase in PM2.5 exposure were 1.3 (95% CI 0.8-2.1) for death and 1.5 (95% CI 1.1-1.9) for multiple recurrences of cardiovascular events (MI, heart failure and stroke). CONCLUSION When adjustment for socio-demographic factors is performed, cumulative chronic exposure to PM2.5 is positively associated with recurrence of cardiovascular events in patients after a first MI.
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Affiliation(s)
- Silvia Koton
- School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Wilker EH, Mittleman MA, Coull BA, Gryparis A, Bots ML, Schwartz J, Sparrow D. Long-term exposure to black carbon and carotid intima-media thickness: the normative aging study. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:1061-7. [PMID: 23820848 PMCID: PMC3764069 DOI: 10.1289/ehp.1104845] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 06/27/2013] [Indexed: 05/20/2023]
Abstract
BACKGROUND Evidence suggests that air pollution is associated with atherosclerosis and that traffic-related particles are a particularly important contributor to the association. OBJECTIVES We investigated the association between long-term exposure to black carbon, a correlate of traffic particles, and intima-media thickness of the common carotid artery (CIMT) in elderly men residing in the greater Boston, Massachusetts, area. METHODS We estimated 1-year average exposures to black carbon at the home addresses of Normative Aging Study participants before their first CIMT measurement. The association between estimated black carbon levels and CIMT was estimated using mixed effects models to account for repeated outcome measures. In secondary analyses, we examined whether living close to a major road or average daily traffic within 100 m of residence was associated with CIMT. RESULTS There were 380 participants (97% self-reported white race) with an initial visit between 2004 and 2008. Two or three follow-up CIMT measurements 1.5 years apart were available for 340 (89%) and 260 (68%) men, respectively. At first examination, the average ± SD age was 76 ± 6.4 years and the mean ± SD CIMT was 0.99 ± 0.18 mm. A one-interquartile range increase in 1-year average black carbon (0.26 µg/m3) was associated with a 1.1% higher CIMT (95% CI: 0.4, 1.7%) based on a fully adjusted model. CONCLUSIONS Annual mean black carbon concentration based on spatially resolved exposure estimates was associated with CIMT in a population of elderly men. These findings support an association between long-term air pollution exposure and atherosclerosis.
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Affiliation(s)
- Elissa H Wilker
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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Lue SH, Wellenius GA, Wilker EH, Mostofsky E, Mittleman MA. Residential proximity to major roadways and renal function. J Epidemiol Community Health 2013; 67:629-34. [PMID: 23669275 PMCID: PMC4167787 DOI: 10.1136/jech-2012-202307] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Living near major roadways has been associated with increased risk of cardiovascular events, but little is known about its impact on renal function. METHODS We calculated the estimated glomerular filtration rate (eGFR) for 1103 consecutive Boston-area patients hospitalised with confirmed acute ischaemic stroke between 1999 and 2004. We used linear regression to evaluate the association between eGFR and categories of residential distance to major roadway (0 to ≤50, >50 to ≤100, >100 to ≤200, >200 to ≤400, >400 to ≤1000 and >1000 m) adjusting for age, sex, race, smoking, comorbid conditions, treatment with ACE inhibitor and neighbourhood-level socioeconomic characteristics. In a second analysis, we considered the log of distance to major roadway as a continuous variable. RESULTS Patients living closer to a major roadway had lower eGFR than patients living farther away (Ptrend=0.01). Comparing patients living 50 m versus 1000 m from a major roadway was associated with a 3.9 ml/min/1.73 m(2) lower eGFR (95% CI 1.0 to 6.7; p=0.007): a difference comparable in magnitude to the reduction in eGFR observed for a 4-year increase in age in population-based studies. The magnitude of this association did not differ significantly across categories of age, sex, race, history of hypertension, diabetes or socioeconomic status. CONCLUSIONS Living near a major roadway is associated with lower eGFR in a cohort of patients presenting with acute ischaemic stroke. If causal, these results imply that exposures associated with living near a major roadway contribute to reduced renal function, an important risk factor for cardiovascular events.
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Affiliation(s)
- Shih-Ho Lue
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Wilker EH, Mostofsky E, Lue SH, Gold D, Schwartz J, Wellenius GA, Mittleman MA. Residential proximity to high-traffic roadways and poststroke mortality. J Stroke Cerebrovasc Dis 2013; 22:e366-72. [PMID: 23721619 DOI: 10.1016/j.jstrokecerebrovasdis.2013.03.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 03/30/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Living in areas with higher levels of ambient air pollution has been associated with a higher incidence of ischemic stroke and all-cause mortality but less is known about the relationship between traffic-related pollution and long-term survival after stroke. METHODS We identified consecutive patients admitted to Beth Israel Deaconess Medical Center with ischemic stroke between 1999 and 2008 and determined the distance to the nearest roadway with an average daily traffic count of more than 10,000 vehicles/day. Categories of residential proximity were defined as 100 m or less, 100-200 m, 200-400 m or less, or more than 400 m from a busy roadway. We identified deaths through June 2012 using the Social Security Death Index and used Cox proportional hazards models adjusted for medical history and socioeconomic factors to calculate hazard ratios for the association between residential proximity to a high-traffic roadway and all-cause mortality. RESULTS Among 1683 stroke patients with complete data, there were 950 deaths (median follow-up=4.6 years). We observed higher poststroke mortality among people living closer to high-traffic roadways. Patients living 100 m or less from high-traffic roadways had a 20% (95% confidence interval: 1%, 43%) higher rate of poststroke mortality than patients living more than 400 m away (P trend=.02). CONCLUSIONS In this study, living close to a high-traffic roadway was associated with an elevated mortality rate. This relationship remained statistically significant after adjustment for individual- and neighborhood-level factors, providing evidence that traffic-related pollution is associated with a higher mortality rate among stroke survivors.
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Affiliation(s)
- Elissa H Wilker
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Environmental Epidemiology and Risk Program, Harvard School of Public Health, Boston, Massachusetts.
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Tonne C, Wilkinson P. Long-term exposure to air pollution is associated with survival following acute coronary syndrome. Eur Heart J 2013; 34:1306-11. [PMID: 23423735 PMCID: PMC3640199 DOI: 10.1093/eurheartj/ehs480] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims The aim of this study was to determine (i) whether long-term exposure to air pollution was associated with all-cause mortality using the Myocardial Ischaemia National Audit Project (MINAP) data for England and Wales, and (ii) the extent to which exposure to air pollution contributed to socioeconomic inequalities in prognosis. Methods and results Records of patients admitted to hospital with acute coronary syndrome (ACS) in MINAP collected under the National Institute for Cardiovascular Outcomes Research were linked to modelled annual average air pollution concentrations for 2004–10. Hazard ratios for mortality starting 28 days after admission were estimated using Cox proportional hazards models. Among the 154 204 patients included in the cohort, the average follow-up was 3.7 years and there were 39 863 deaths. Mortality rates were higher for individuals exposed to higher levels of particles with a diameter of ≤2.5 µm (PM2.5; PM, particulate matter): the fully adjusted hazard ratio for a 10 µg/m3 increase in PM2.5 was 1.20 (95% CI 1.04–1.38). No associations were observed for larger particles or oxides of nitrogen. Air pollution explained socioeconomic inequalities in survival to only a small extent. Conclusion Mortality from all causes was higher among individuals with greater exposure to PM2.5 in survivors of hospital admission for ACS in England and Wales. Despite higher exposure to PM2.5 among those from more deprived areas, such exposure was a minor contribution to the socioeconomic inequalities in prognosis following ACS. Our findings add to the evidence of mortality associated with long-term exposure to fine particles.
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Affiliation(s)
- Cathryn Tonne
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Franchini M, Guida A, Tufano A, Coppola A. Air pollution, vascular disease and thrombosis: linking clinical data and pathogenic mechanisms. J Thromb Haemost 2012; 10:2438-51. [PMID: 23006215 DOI: 10.1111/jth.12006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The public health burden of air pollution has been increasingly recognized over the last decades. Following the first assessed adverse effects on respiratory diseases and lung cancer, a large body of epidemiologic and clinical studies definitely documented an even stronger association of air pollution exposure with cardiovascular mortality and morbidity, particularly related to atherothrombotic (coronary and cerebrovascular) disease. Particulate matter (PM), mainly that with lower aerodynamic diameter (fine and ultrafine PM), is responsible for the most severe effects, due to its capacity to transport toxic substances deep into the lower airways. These effects have been shown to occur not only after short-term exposure to elevated concentrations of pollutants, but even after long-term relatively low levels of exposure. Vulnerable subjects (elderly persons and those with preexisting cardiopulmonary diseases) show the highest impact. Fewer and conflicting data also suggest an association with venous thromboembolism. Although not completely elucidated, a series of mechanisms have been hypothesized and tested in experimental settings. These phenomena, including vasomotor and cardiac autonomic dysfunction, hemostatic unbalance, oxidative stress and inflammatory response, have been shown to change over time and differently contribute to the short-term and long-term adverse effects of pollution exposure. Beyond environmental health policies, crucial for improving air quality and reducing the impact of such an elusive threat to public health, the recognition and assessment of the individual risk, together with specific advice, should be routinely implemented in the strategies of primary and secondary cardiovascular prevention.
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Affiliation(s)
- M Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
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