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Pirkle CM, Velez MP, Sentell TL, Bassani DG, Domingues MR, Câmara SMA. The contributions of fertility during adolescence to disability across the life-course: hypothesized causal pathways, research gaps, and future directions. Ann Hum Biol 2024; 51:2390829. [PMID: 39206847 PMCID: PMC11371383 DOI: 10.1080/03014460.2024.2390829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024]
Abstract
CONTEXT Robust associations have been identified between fertility during adolescence and the disablement process, including pathologies, impairments, functional limitations and disability. Limited theoretical or empirical research considers how and why such relationships exist generally or with the individual associated components of disablement. OBJECTIVE To consolidate and critically evaluate literature to describe testable, theory-based hypotheses to guide future research on the mechanisms by which fertility during adolescence contributes to disablement. METHODS Targeted literature review of research from diverse global settings contextualised in two well-accepted theoretical frameworks in life-course epidemiology: the cumulative risk model and the critical period approach. RESULTS Five hypothesised causal pathways linking adolescent fertility to disablement in later life are described: 1) Causal relationship initiated by fertility during adolescence; 2) Common cause(s) for both, such as adverse childhood experiences; 3) Contributing cause(s) to adolescent fertility; 4) Interaction between adolescent fertility and other risk factors; and 5) Critical period effects unique to adolescence. Most research on the topic is on pathologies versus functional limitations and disability. CONCLUSION We highlight promising research avenues to inform future research and interventions on adolescent fertility and the disablement process. This work provides theoretical clarity, identifies research gaps, and offers hypotheses-testing opportunities for future research.
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Affiliation(s)
- Catherine M Pirkle
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Maria P Velez
- Departments of Obstetrics and Gynaecology & Public Health Sciences, Queen's University, Kingston, Canada
| | - Tetine L Sentell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Department of Paediatrics, Faculty of Medicine & Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Marlos R Domingues
- Postgraduate Programme in Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Saionara M A Câmara
- Postgraduate Program in Physiotherapy, Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
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Peck KE, Bassani D, Camara SM, Domingues MR, Sentell T, Velez MP, Pirkle CM. Adolescent childbirth and mobility disability among women ages 15-49: an analysis of population health surveys from 14 low-income and middle-income countries. BMJ Open 2023; 13:e072535. [PMID: 37474178 PMCID: PMC10360427 DOI: 10.1136/bmjopen-2023-072535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Adolescent childbirth is associated with older adult adverse health outcomes that negatively affect mobility function, but these associations have not been studied globally in large samples of reproductive-age women. This study examines the association between age at first childbirth and mobility disability in national surveys from low-income and middle-income countries, and hypotheses that adolescent childbirth is associated with mobility disability. DESIGN Cross-sectional analysis. SETTING Population health surveys from 2013 to 2018 containing mobility disability measures among ever-pregnant women ages 15-49. These included 13 Demographic Health Surveys from Haiti, Pakistan, Uganda, Cambodia, Colombia, South Africa, Timor-Leste, Albania, Gambia, Maldives, Peru, Senegal and Yemen and 1 Maternal Health Survey from Ghana. PARTICIPANTS The sample included 157 988 women ages 15-49 years. PRIMARY OUTCOME MEASURE Adolescent childbirth was defined as 10-19 years of age. Poisson regression models were used to estimate prevalence ratios (PRs) of mobility disability among women who first gave birth during adolescence and in adult life (ages 20-45 years) in each country and across the whole sample. Countries were also analysed according to the use of standard and non-standard mobility disability measures. Covariates included current age, urban/rural residence, education and household wealth. RESULTS Prevalence of adolescent childbirth (17.5%-66.2%) and mobility disability (0.32%-21.45%) varied widely across countries. Adolescent childbirth was significantly (p<0.05) associated with greater mobility disability in six of eight countries using standard disability measures. Among the six countries that did not use standard disability measures, none showed a statistically significant association between adolescent childbirth and mobility disability. Considering the whole sample and adjusting for all covariates, women who gave birth during adolescence had greater prevalence of mobility disability (pooled PR 1.19, 95% CI 1.06-1.31). CONCLUSIONS This analysis suggests a moderate and consistent association of adolescent childbearing with subsequent mobility disability.
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Affiliation(s)
- Katherine E Peck
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - D Bassani
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Saionara Ma Camara
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Marlos R Domingues
- Postgraduate Programme in Physical Education, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Tetine Sentell
- Thompson School of Social Work and Public Health, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Maria P Velez
- Departments of Obstetrics and Gynaecology & Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Catherine M Pirkle
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
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Boman A, Kokkonen H, Berglin E, Alenius GM, Rantapää-Dahlqvist S. Hormonal and Reproductive Factors in Relation to Cardiovascular Events in Women with Early Rheumatoid Arthritis. J Clin Med 2022; 12:jcm12010208. [PMID: 36615009 PMCID: PMC9820904 DOI: 10.3390/jcm12010208] [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: 11/16/2022] [Revised: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Hormonal and reproductive factors affect the risk for cardiovascular events (CVE) in the general population. Although the risk of CVE is increased in rheumatoid arthritis (RA), the knowledge about the impact of hormonal factors for CVE in RA is sparse. Female postmenopausal patients ≤80 years with early RA were consecutively included in this observational study (n = 803) between 1 January 1996 until 31 December 2017. Questionnaires regarding hormonal factors were distributed from the index date. Data regarding CVE were obtained from the Swedish National Health Register and Cause of Death Register. Associations between CVE and hormonal factors were analyzed using Cox proportional hazard regression. Of the postmenopausal women, 64 women had a CVE after RA onset. The time period from menopause to RA onset was significantly longer for CVE cases with higher proportion of postmenopausal women. In Cox proportional hazard regression models, years from last childbirth and multiparity were associated with higher CVE risk. Adjustments for traditional risk factors did not affect the results except for hypertension. RA onset after menopause and a longer duration from menopause until onset increased the CVE risk. Multiparity was associated with higher CVE risk whilst oral contraceptives decreased the risk. These results can contribute to identification of high-risk patients for CVE beyond traditional risk factors.
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Datta B, Tiwari A, Glenn L. Stolen childhood taking a toll at young adulthood: The higher risk of high blood pressure and high blood glucose comorbidity among child brides. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000638. [PMID: 36962354 PMCID: PMC10021810 DOI: 10.1371/journal.pgph.0000638] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/20/2022] [Indexed: 01/28/2023]
Abstract
Despite notable progress being made in preventing child marriage, a significant proportion of women worldwide are still married before reaching adulthood. Though many aspects of child marriage have been widely studied, little is known on the later life health outcomes of child brides, let alone the critical need for healthcare during adulthood. This paper examines whether child brides at a young adult age bear a greater risk of high blood pressure (HBP) and high blood glucose (HBG) comorbidity than those who were married as adults. Using nationally representative data from India, we categorized married young adult (aged 20-34 years) women in four categories: neither HBP nor HBG, HBP only, HBG only, and both HBP and HBG. We estimated multinomial logistic regressions to obtain unadjusted and adjusted relative risk ratios in favor of these mutually exclusive outcomes for the child marriage indicator. Around 0.5% of the women in our sample had high blood pressure and high blood glucose comorbidity. While the prevalence of comorbidity was 0.4% among women who were married as adults, comorbidity was 40% higher (p < 0.000) among women who were married as children. The relative risk of the comorbidity among child brides was 1.4 (95%CI: 1.2-1.7) times that of their peers who were not married as children. The findings, thus, suggest that child brides at young adult age are at greater risk of having high blood pressure and high blood glucose comorbidity. Concerted public health efforts, therefore, are necessary to improve their long-term health and wellbeing.
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Affiliation(s)
- Biplab Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, United States of America
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, United States of America
| | - Ashwini Tiwari
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, United States of America
| | - Lynn Glenn
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, United States of America
- Department of Biobehavioral Nursing, College of Nursing, Augusta University, Augusta, GA, United States of America
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A path to a healthier middle age in adolescents with early menarche: avoid teen pregnancy? Menopause 2021; 28:971-972. [PMID: 34342285 DOI: 10.1097/gme.0000000000001836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The role of multiparity and maternal age at first pregnancy in the association between early menarche and metabolic syndrome among middle-aged and older women. ACTA ACUST UNITED AC 2021; 28:1004-1011. [PMID: 34183563 DOI: 10.1097/gme.0000000000001809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze whether maternal age at first pregnancy and parity are mediators of the association between early menarche and metabolic syndrome in a sample of middle-aged and older women. METHODS Cross-sectional study of 428 women (40 to 80 y), who had experienced a pregnancy in their lifetime, was performed between 2014 and 2016. Age at first pregnancy, parity, and early menarche were self-reported. Metabolic syndrome was assessed using the criteria described by the National Cholesterol Education Program's Adult Treatment Panel III. The association between metabolic syndrome and early menarche was assessed by logistic regression analysis. The mediating role of age at first pregnancy and multiparity in the relationship between early menarche and metabolic syndrome was assessed through mediation analysis, adjusted for covariates. RESULTS According to adjusted logistic regression models, early menarche was associated with higher odds of prevalent metabolic syndrome (OR: 2.26; 95% CI: 1.15-4.46). Mediation analysis showed a significant direct effect of early menarche on metabolic syndrome (β: 0.808; 95% CI: 0.107-1.508). Of the two mediators tested, age at first pregnancy was significant (β: 0.065; 95% CI: 0.004-0.221), ie, participants with and without early menarche differ, on average, by 0.879 SDs in the log odds of MetS (total effect), of which 0.065 SDs (8%), on average, would be attributable to the effect of early menarche on age at first pregnancy (indirect effect), which, in turn, affects MetS. CONCLUSIONS Age at first pregnancy may partially contribute to the association between early menarche and metabolic syndrome among middle-aged and older women who had experienced a pregnancy over their lifetime.
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Longitudinal changes in HDL-cholesterol concentration are associated with different risk factors in primiparous and nulliparous young women: The NHLBI Growth and Health Study (NGHS). J Clin Lipidol 2021; 15:488-499. [PMID: 33875403 DOI: 10.1016/j.jacl.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous studies report that first pregnancy is associated with persistent decreases in HDL-cholesterol (HDL-C) concentrations. OBJECTIVE This study evaluated factors associated with declines in HDL-C concentration in parous and nulliparous young women. METHODS This study leverages data from African-American and white women from the NHLBI Growth and Health Study. Parity-related changes in lipids, BMI and percent body fat were assessed longitudinally. A subset of primiparous and nulliparous women with paired lipid measurements were analyzed regarding changes in HDL-C concentrations. RESULTS Among 870 women in longitudinal analyses, African-American women had higher parity (p<0.0001), with baseline measurements of each parity group being similar. HDL-C concentration decreased significantly and remained lower after the first pregnancy, while BMI and percent body fat increased with increasing parity. In the subset of 401 women, HDL-C concentration decreased among primiparous women (-4.81 ± 0.93 mg/dl), with no overall change in nulliparous (p = 0.003). In both groups, greater HDL-C concentration declines were independently associated with higher initial HDL-C concentration and greater increases in BMI (both p<0.0001). Among primiparous women, younger delivery age (p = 0.0001) and birth control use (p = 0.004) were associated with greater HDL-C concentration decline. Nulliparous white women's HDL-C concentration increased over time, with no change in African-American women (p = 0.008); no racial difference was seen in primiparous women. CONCLUSION Persistent decreases in HDL-C concentration were associated with the first pregnancy, and were greater with higher initial HDL-C concentration. Racial differences in HDL-C concentration emerged over time in nulliparous women, but not primiparous women. Potential impacts of these findings on women's long-term cardiometabolic health should be evaluated.
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Frailty syndrome and risk of cardiovascular disease: Analysis from the International Mobility in Aging Study. Arch Gerontol Geriatr 2021; 92:104279. [DOI: 10.1016/j.archger.2020.104279] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022]
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Jasienska G. Costs of reproduction and ageing in the human female. Philos Trans R Soc Lond B Biol Sci 2020; 375:20190615. [PMID: 32951546 PMCID: PMC7540952 DOI: 10.1098/rstb.2019.0615] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 12/27/2022] Open
Abstract
Evolutionary theories of ageing point to reproduction as a significant factor to consider when asking why ageing occurs and why there is inter-individual variation in its progression. Reproduction in human females is costly, in terms of energy, nutrients and metabolic adjustments. Thus, it is expected that women who experienced high reproductive effort resulting from multiple reproductive events will age faster. However, the evidence for long-term negative effects of reproduction is not conclusive. The lack of understanding of whether there are trade-offs between reproduction and ageing in women is partly due to methodological challenges. The costs of reproduction are often calculated based only on parity, while other elements contributing to these costs (e.g. breastfeeding, timing of reproduction) are neglected, which may significantly underestimate the total costs and obscure the all-important inter-individual variation in such costs. Costs must be evaluated in relation to individual characteristics, including developmental conditions, nutritional status and social support that a mother receives during reproduction. Furthermore, ageing and health must be assessed based on comprehensive markers rather than arbitrarily assembled variables. Finally, longitudinal rather than cross-sectional studies and new statistical approaches are needed to reveal how much of a decline in health and progressing ageing can actually be attributed to past reproductive processes. This article is part of the theme issue 'Evolution of the primate ageing process'.
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Affiliation(s)
- Grazyna Jasienska
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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Wallace JM. Competition for nutrients in pregnant adolescents: consequences for maternal, conceptus and offspring endocrine systems. J Endocrinol 2019; 242:T1-T19. [PMID: 30615597 DOI: 10.1530/joe-18-0670] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 11/08/2022]
Abstract
The competition for nutrients that arises when pregnancy coincides with continuing or incomplete growth in young adolescent girls increases the risk of preterm delivery and low birthweight with negative after-effects for mother and child extending beyond the perinatal period. Sheep paradigms involving nutritional management of weight and adiposity in young, biologically immature adolescents have allowed the consequences of differential maternal growth status to be explored. Although nutrient reserves at conception play a modest role, it is the dietary manipulation of the maternal growth trajectory thereafter which has the most negative impact on pregnancy outcome. Overnourishing adolescents to promote rapid maternal growth is particularly detrimental as placental growth, uteroplacental blood flows and fetal nutrient delivery are perturbed leading to a high incidence of fetal growth restriction and premature delivery of low birthweight lambs, whereas in undernourished adolescents further maternal growth is prevented, and depletion of the maternal body results in a small reduction in birthweight independent of placental size. Maternal and placental endocrine systems are differentially altered in both paradigms with downstream effects on fetal endocrine systems, organ development and body composition. Approaches to reverse these effects have been explored, predominantly targeting placental growth or function. After birth, growth-restricted offspring born to overnourished adolescents and fed to appetite have an altered metabolic phenotype which persists into adulthood, whereas offspring of undernourished adolescents are largely unaffected. This body of work using ovine paradigms has public health implications for nutritional advice offered to young adolescents before and during pregnancy, and their offspring thereafter.
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Hipp SL, Wu YY, Rosendaal NTA, Pirkle CM. Association of Parenthood With Incident Heart Disease in United States' Older Men and Women: A Longitudinal Analysis of Health and Retirement Study Data. J Aging Health 2019; 32:517-529. [PMID: 30854914 DOI: 10.1177/0898264319831512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To examine the association of number of children birthed/fathered with incident heart disease, accounting for socioeconomic and lifestyle characteristics. Methods: We analyzed data from 24,923 adults 50 and older (55% women) in the Health and Retirement Study. Participants self-reported number of children and doctor-diagnosed incident heart disease. Cox proportional hazards models estimated heart disease risk. Results: Compared to women with one to two children, those with five or more had increased risk of heart disease (hazard ratio [HR] = 1.13, 95% confidence interval [CI] = [1.03, 1.25]). Compared to men with one to two children, those with five or more had a marginally increased risk of heart disease (HR = 1.11, 95% CI = [0.99, 1.25]), but this association attenuated in models adjusting for socioeconomic and lifestyle variables. Compared to men with no children, those with five or more retained a borderline significant association in the fully adjusted model (HR = 1.15, 95% CI = [0.99, 1.35]). Discussion: Social and lifestyle pathways appear to link parenthood to cardiovascular health.
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Affiliation(s)
| | - Yan Yan Wu
- University of Hawai'i at Mānoa, Honolulu, USA
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Wang B, Zhou Y, Xiao L, Guo Y, Ma J, Zhou M, Shi T, Tan A, Yuan J, Chen W. Association of lung function with cardiovascular risk: a cohort study. Respir Res 2018; 19:214. [PMID: 30400894 PMCID: PMC6219159 DOI: 10.1186/s12931-018-0920-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 10/23/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The potential effects of pulmonary dysfunction on cardiovascular diseases (CVD) are receiving attention. We aimed to investigate and quantify the cross-sectional and longitudinal associations between lung function and overall cardiovascular risk among Chinese general population. METHODS We studied 4019 participants from the Wuhan-Zhuhai cohort, with a follow-up of 3 years. A multivariable risk algorithm generated from the Framingham study was used to calculate individuals' overall cardiovascular risk i.e. 10-Year CVD Risk, which was further classified into 2 categories: low (< 10%) and high (≥10%) CVD risk. General linear model and logistic regression model were separately used to assess the associations of lung function with continuous and dichotomous 10-Year CVD Risk. RESULTS Cross-sectionally, each 5% decrease in FEV1/FVC was associated with a 0.47% increase in 10-Year CVD Risk (P < 0.001). The adjusted odds ratio (OR) (95% confidence interval [CI]) for the prevalence of high CVD risk (10-Year CVD Risk≥10%) was 1.12 (1.07, 1.17) corresponding to each 5% decrease in FEV1/FVC. The OR (95% CI) for high CVD risk in the lowest group of FEV1/FVC (< 70% i.e. chronic obstructive pulmonary disease [COPD]) was 2.37 (1.43, 3.91) when compared with the highest group. Longitudinally, the adjusted risk ratio (RR) (95% CI) for the incidence of high CVD risk was 1.14 (1.03, 1.25) with each 5% decrease in baseline FEV1/FVC. Compared with the highest group of FEV1/FVC, the RR (95% CI) for high CVD risk in the lowest group (COPD) was 4.06 (1.46, 11.26). Analyses of 10-Year CVD Risk with FVC or FEV1 showed similar trends and significant associations (all P < 0.05). CONCLUSION Reduced lung function was cross-sectionally and longitudinally associated with increased cardiovascular risk in Chinese general population.
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Affiliation(s)
- Bin Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Yun Zhou
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Lili Xiao
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Yanjun Guo
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Jixuan Ma
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Min Zhou
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Tingming Shi
- Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, Hubei, China
| | - Aijun Tan
- Zhuhai Center for Disease Control and Prevention, Zhuhai, 519060, Guangdong, China
| | - Jing Yuan
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Weihong Chen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China. .,Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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