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Austhof E, Warner S, Helfrich K, Pogreba-Brown K, Brown HE, Klimentidis YC, Scallan Walter E, Jervis RH, White AE. Exploring the association of weather variability on Campylobacter - A systematic review. ENVIRONMENTAL RESEARCH 2024; 252:118796. [PMID: 38582433 DOI: 10.1016/j.envres.2024.118796] [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: 01/17/2024] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Previous work has found climate change-induced weather variability is suspected to increase the transmission of enteric pathogens, including Campylobacter, a leading cause of bacterial gastroenteritis. While the relationship between extreme weather events and diarrheal diseases has been documented, the specific impact on Campylobacter infections remains underexplored. OBJECTIVE To synthesize the peer-reviewed literature exploring the effect of weather variability on Campylobacter infections in humans. METHODS The review included English language, peer-reviewed articles, published up to September 1, 2022 in PubMed, Embase, GEOBASE, Agriculture and Environmental Science Database, and CABI Global Health exploring the effect of an antecedent weather event on human enteric illness caused by Campylobacter (PROSPERO Protocol # 351884). We extracted study information including data sources, methods, summary measures, and effect sizes. Quality and weight of evidence reported was summarized and bias assessed for each article. RESULTS After screening 278 articles, 47 articles (34 studies, 13 outbreak reports) were included in the evidence synthesis. Antecedent weather events included precipitation (n = 35), temperature (n = 30), relative humidity (n = 7), sunshine (n = 6), and El Niño and La Niña (n = 3). Reviewed studies demonstrated that increases in precipitation and temperature were correlated with Campylobacter infections under specific conditions, whereas low relative humidity and sunshine were negatively correlated. Articles estimating the effect of animal operations (n = 15) found presence and density of animal operations were significantly associated with infections. However, most of the included articles did not assess confounding by seasonality, presence of animal operations, or describe estimates of risk. DISCUSSION This review explores what is known about the influence of weather events on Campylobacter and identifies previously underreported negative associations between low relative humidity and sunshine on Campylobacter infections. Future research should explore pathogen-specific estimates of risk, which can be used to influence public health strategies, improve source attribution and causal pathways, and project disease burden due to climate change.
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Affiliation(s)
- Erika Austhof
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
| | - Shaylee Warner
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Kathryn Helfrich
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Kristen Pogreba-Brown
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Heidi E Brown
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Yann C Klimentidis
- Department of Epidemiology & Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Rachel H Jervis
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Alice E White
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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MacDonald LA, Johnson CY, Lu ML, Santiago-Colón A, Adam GP, Kimmel HJ, Napolitano PG, Saldanha IJ. Physical job demands in pregnancy and associated musculoskeletal health and employment outcomes: a systematic review. Am J Obstet Gynecol 2024; 230:583-599.e16. [PMID: 38109950 PMCID: PMC11139607 DOI: 10.1016/j.ajog.2023.12.014] [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: 08/10/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE A decline in musculoskeletal health during pregnancy is an underappreciated adverse outcome of pregnancy that can have immediate and long-term health consequences. High physical job demands are known risk factors for nontraumatic musculoskeletal disorders in the general working population. Evidence from meta-analyses suggest that occupational lifting and prolonged standing during pregnancy may increase risk of adverse pregnancy outcomes. This systematic review examined associations between occupational lifting or postural load in pregnancy and associated musculoskeletal disorders and related sequalae. DATA SOURCES Five electronic databases (Medline, Embase, CINAHL, NIOSHTIC-2, and Ergonomic Abstracts) were searched from 1990 to July 2022 for studies in any language. A Web of Science snowball search was performed in December 2022. Reference lists were manually reviewed. STUDY ELIGIBILITY CRITERIA Eligible studies reported associations between occupational lifting or postural load and musculoskeletal health or sequelae (eg, employment outcomes) among pregnant and postpartum workers. METHODS Data were extracted using a customized form to document study and sample characteristics; and details of exposures, outcomes, covariates, and analyses. Investigators independently assessed study quality for 7 risk-of-bias domains and overall utility, with discrepant ratings resolved through discussion. A narrative synthesis was conducted due to heterogeneity. RESULTS Sixteen studies (11 cohort studies, 2 nested case-control studies, and 3 cross-sectional studies) from 8 countries were included (N=142,320 pregnant and N=1744 postpartum workers). Limited but consistent evidence with variable quality ratings, ranging from critical concern to high, suggests that pregnant workers exposed to heavy lifting (usually defined as ≥22 lbs or ≥10 kg) may be at increased risk of functionally limiting pelvic girdle pain and antenatal leave. Moreover, reports of dose-response relationships suggest graded risk levels according to lifting frequency, ranging from 21% to 45% for pelvic girdle pain and 58% to 202% for antenatal leave. Limited but consistent evidence also suggests that postural load increases the risk of employment cessation. CONCLUSION Limited but consistent evidence suggests that pregnant workers exposed to heavy lifting and postural load are at increased risk of pelvic girdle pain and employment cessation. Job accommodations to reduce exposure levels may promote safe sustainable employment for pregnant workers.
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Affiliation(s)
- Leslie A MacDonald
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH.
| | - Candice Y Johnson
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH; Division of Occupational and Environmental Medicine, Department of Family Medicine and Community Health, Duke University, Durham, NC
| | - Ming-Lun Lu
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH
| | - Albeliz Santiago-Colón
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Gaelen P Adam
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI
| | | | - Peter G Napolitano
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI; Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Park YH, Lee DH, Lee JH. A Comprehensive Review: Robot-Assisted Treatments for Gait Rehabilitation in Stroke Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:620. [PMID: 38674266 PMCID: PMC11052271 DOI: 10.3390/medicina60040620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
Robot-assisted gait training (RAGT) is at the cutting edge of stroke rehabilitation, offering a groundbreaking method to improve motor recovery and enhance the quality of life for stroke survivors. This review investigates the effectiveness and application of various RAGT systems, including both end-effector and exoskeleton robots, in facilitating gait enhancements. The selection process for this comprehensive analysis involved a meticulous review of the literature from databases such as PubMed, the Cochrane Library, and EMBASE, focusing on studies published between 2018 and 2023. Ultimately, 27 studies met the criteria and were included in the final analysis. The focus of these studies was on the various RAGT systems and their role in promoting gait and balance improvements. The results of these studies conclusively show that patients experience significant positive effects from RAGT, and when combined with other physiotherapy methods, the outcomes are notably superior in enhancing functional ambulation and motor skills. This review emphasizes RAGT's capability to deliver a more customized and effective rehabilitation experience, highlighting the importance of tailoring interventions to meet the specific needs of each patient.
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Affiliation(s)
- Yong-Hwa Park
- Immanuel Medical Rehabilitation Hospital, 2140, Cheongnam-ro, Cheongju-si 28702, Republic of Korea; (Y.-H.P.); (D.-H.L.)
| | - Dae-Hwan Lee
- Immanuel Medical Rehabilitation Hospital, 2140, Cheongnam-ro, Cheongju-si 28702, Republic of Korea; (Y.-H.P.); (D.-H.L.)
| | - Jung-Ho Lee
- Department of Physical Therapy, University of Kyungdong, 815, Gyeonhwon-ro, Munmak-eup, Wonju-si 26495, Republic of Korea
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Higgins JPT, Morgan RL, Rooney AA, Taylor KW, Thayer KA, Silva RA, Lemeris C, Akl EA, Bateson TF, Berkman ND, Glenn BS, Hróbjartsson A, LaKind JS, McAleenan A, Meerpohl JJ, Nachman RM, Obbagy JE, O'Connor A, Radke EG, Savović J, Schünemann HJ, Shea B, Tilling K, Verbeek J, Viswanathan M, Sterne JAC. A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E). ENVIRONMENT INTERNATIONAL 2024; 186:108602. [PMID: 38555664 PMCID: PMC11098530 DOI: 10.1016/j.envint.2024.108602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/26/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Observational epidemiologic studies provide critical data for the evaluation of the potential effects of environmental, occupational and behavioural exposures on human health. Systematic reviews of these studies play a key role in informing policy and practice. Systematic reviews should incorporate assessments of the risk of bias in results of the included studies. OBJECTIVE To develop a new tool, Risk Of Bias In Non-randomized Studies - of Exposures (ROBINS-E) to assess risk of bias in estimates from cohort studies of the causal effect of an exposure on an outcome. METHODS AND RESULTS ROBINS-E was developed by a large group of researchers from diverse research and public health disciplines through a series of working groups, in-person meetings and pilot testing phases. The tool aims to assess the risk of bias in a specific result (exposure effect estimate) from an individual observational study that examines the effect of an exposure on an outcome. A series of preliminary considerations informs the core ROBINS-E assessment, including details of the result being assessed and the causal effect being estimated. The assessment addresses bias within seven domains, through a series of 'signalling questions'. Domain-level judgements about risk of bias are derived from the answers to these questions, then combined to produce an overall risk of bias judgement for the result, together with judgements about the direction of bias. CONCLUSION ROBINS-E provides a standardized framework for examining potential biases in results from cohort studies. Future work will produce variants of the tool for other epidemiologic study designs (e.g. case-control studies). We believe that ROBINS-E represents an important development in the integration of exposure assessment, evidence synthesis and causal inference.
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Affiliation(s)
- Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Bristol Evidence Synthesis Group, University of Bristol, Bristol, UK; NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew A Rooney
- National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Kyla W Taylor
- National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Kristina A Thayer
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | | | | | - Elie A Akl
- Faculty of Medicine, American University of Beirut, Riad El-Solh, Lebanon
| | - Thomas F Bateson
- Center for Public Health and Environmental Assessment, Chemical and Pollutant Assessment Division, US Environmental Protection Agency, Washington, DC, USA
| | | | - Barbara S Glenn
- Center for Public Health and Environmental Assessment, Chemical and Pollutant Assessment Division, US Environmental Protection Agency, Washington, DC, USA
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, University of Southern Denmark, Odense, Denmark
| | | | - Alexandra McAleenan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Rebecca M Nachman
- Center for Public Health and Environmental Assessment, Chemical and Pollutant Assessment Division, US Environmental Protection Agency, Washington, DC, USA
| | - Julie E Obbagy
- Nutrition Evidence Systematic Review Branch, Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA, USA
| | - Annette O'Connor
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Elizabeth G Radke
- Center for Public Health and Environmental Assessment, Chemical and Pollutant Assessment Division, US Environmental Protection Agency, Washington, DC, USA
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Bristol Evidence Synthesis Group, University of Bristol, Bristol, UK; NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Holger J Schünemann
- Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Beverley Shea
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kate Tilling
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Jos Verbeek
- Cochrane Work, Department of Public and Occupational Health, Academic Medical Centers Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Health Data Research UK South-West, Bristol, UK
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Romero Starke K, Bolm-Audorff U, Reissig D, Seidler A. Dose-response-relationship between occupational exposure to diesel engine emissions and lung cancer risk: A systematic review and meta-analysis. Int J Hyg Environ Health 2024; 256:114299. [PMID: 38194821 DOI: 10.1016/j.ijheh.2023.114299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND In 2012, the International Agency for Research on Cancer (IARC) concluded that diesel engine emissions (DEE) emissions cause cancer in humans. However, there is still controversy surrounding this conclusion, due to several studies since the IARC decision citing a lack of evidence of a dose-response relationship. OBJECTIVES Through a systematic review, we aimed to evaluate all evidence on the association between occupational DEE and lung cancer to investigate whether there is an increased risk of lung cancer for workers exposed to DEE and if so, to describe the dose-response relationship. METHODS We registered the review protocol with PROSPERO and searched for observational studies in relevant literature databases. Two independent reviewers screened the studies' titles/abstracts and full texts, and extracted and assessed their quality. Studies with no direct DEE measurement but with information on length of exposure for high-risk occupations were assigned exposure values based on the DEE Job-Exposure-Matrix (DEE-JEM). After assessing quality and informativeness, we selected appropriate studies for the dose-response meta-analysis. RESULTS Sixty-five reports (from thirty-seven studies) were included in the review; one had a low risk of bias (RoB) (RR per 10 μg/m3-years: 1.014 [95%CI 1.007-1.021]). There was an increased, statistically significant risk of lung cancer with increasing DEE exposure for all studies (RR per 10 μg/m3-years = 1.013 [95%CI 1.004-1.021]) as well as for studies with a low RoB in the exposure category (RR per 10 μg/m3-years = 1.008 [95% CI1.001-1.015]). We obtained a doubling dose of 555 μg/m3-years for all studies and 880 μg/m3-years for studies with high quality in the exposure assessment. DISCUSSION We found a linear positive dose-response relationship for studies with high quality in the exposure domain, even though all studies had an overall high risk of bias. Current threshold levels for DEE exposure at the workplace should be reconsidered.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Ulrich Bolm-Audorff
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - David Reissig
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Boogaard H, Atkinson RW, Brook JR, Chang HH, Hoek G, Hoffmann B, Sagiv SK, Samoli E, Smargiassi A, Szpiro AA, Vienneau D, Weuve J, Lurmann FW, Forastiere F. Evidence Synthesis of Observational Studies in Environmental Health: Lessons Learned from a Systematic Review on Traffic-Related Air Pollution. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:115002. [PMID: 37991444 PMCID: PMC10664749 DOI: 10.1289/ehp11532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/12/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND There is a long tradition in environmental health of using frameworks for evidence synthesis, such as those of the U.S. Environmental Protection Agency for its Integrated Science Assessments and the International Agency for Research on Cancer Monographs. The framework, Grading of Recommendations Assessment, Development, and Evaluation (GRADE), was developed for evidence synthesis in clinical medicine. The U.S. Office of Health Assessment and Translation (OHAT) elaborated an approach for evidence synthesis in environmental health building on GRADE. METHODS We applied a modified OHAT approach and a broader "narrative" assessment to assess the level of confidence in a large systematic review on traffic-related air pollution and health outcomes. DISCUSSION We discuss several challenges with the OHAT approach and its implementation and suggest improvements for synthesizing evidence from observational studies in environmental health. We consider the determination of confidence using a formal rating scheme of up- and downgrading of certain factors, the treatment of every factor as equally important, and the lower initial confidence rating of observational studies to be fundamental issues in the OHAT approach. We argue that some observational studies can offer high-confidence evidence in environmental health. We note that heterogeneity in magnitude of effect estimates should generally not weaken the confidence in the evidence, and consistency of associations across study designs, populations, and exposure assessment methods may strengthen confidence in the evidence. We mention that publication bias should be explored beyond statistical methods and is likely limited when large and collaborative studies comprise most of the evidence and when accrued over several decades. We propose to identify possible key biases, their most likely direction, and their potential impacts on the results. We think that the OHAT approach and other GRADE-type frameworks require substantial modification to align better with features of environmental health questions and the studies that address them. We emphasize that a broader, "narrative" evidence assessment based on the systematic review may complement a formal GRADE-type evaluation. https://doi.org/10.1289/EHP11532.
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Affiliation(s)
| | - Richard W. Atkinson
- Population Health Research Institute, St. George’s University of London, London, United Kingdom
| | - Jeffrey R. Brook
- Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Howard H. Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Environmental Epidemiology, Utrecht University, Utrecht, the Netherlands
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Sharon K. Sagiv
- Center for Environmental Research and Children’s Health, Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Audrey Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Adam A. Szpiro
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Francesco Forastiere
- Environmental Research Group, School of Public Health, Imperial College London, London, United Kingdom
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de Bont J, Pickford R, Åström C, Colomar F, Dimakopoulou K, de Hoogh K, Ibi D, Katsouyanni K, Melén E, Nobile F, Pershagen G, Persson Å, Samoli E, Stafoggia M, Tonne C, Vlaanderen J, Wolf K, Vermeulen R, Peters A, Ljungman P. Mixtures of long-term exposure to ambient air pollution, built environment and temperature and stroke incidence across Europe. ENVIRONMENT INTERNATIONAL 2023; 179:108136. [PMID: 37598594 DOI: 10.1016/j.envint.2023.108136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION The complex interplay of multiple environmental factors and cardiovascular has scarcely been studied. Within the EXPANSE project, we evaluated the association between long-term exposure to multiple environmental indices and stroke incidence across Europe. METHODS Participants from three traditional adult cohorts (Germany, Netherlands and Sweden) and four administrative cohorts (Catalonia [region Spain], Rome [city-wide], Greece and Sweden [nationwide]) were followed until incident stroke, death, migration, loss of follow-up or study end. We estimated exposures at residential addresses from different exposure domains: air pollution (nitrogen dioxide (NO2), particulate matter < 2.5 μm (PM2.5), black carbon (BC), ozone), built environment (green/blue spaces, impervious surfaces) and meteorology (seasonal mean and standard deviation of temperatures). Associations between environmental exposures and stroke were estimated in single and multiple-exposure Cox proportional hazard models, and Principal Component (PC) Analyses derived prototypes for specific exposures domains. We carried out random effects meta-analyses by cohort type. RESULTS In over 15 million participants, increased levels of NO2 and BC were associated with increased higher stroke incidence in both cohort types. Increased Normalized Difference Vegetation Index (NDVI) was associated with a lower stroke incidence in both cohort types, whereas an increase in impervious surface was associated with an increase in stroke incidence. The first PC of the air pollution domain (PM2.5, NO2 and BC) was associated with an increase in stroke incidence. For the built environment, higher levels of NDVI and lower levels of impervious surfaces were associated with a protective effect [%change in HR per 1 unit = -2.0 (95 %CI, -5.9;2.0) and -1.1(95 %CI, -2.0; -0.3) for traditional adult and administrative cohorts, respectively]. No clear patterns were observed for distance to blue spaces or temperature parameters. CONCLUSIONS We observed increased HRs for stroke with exposure to PM2.5, NO2 and BC, lower levels of greenness and higher impervious surface in single and combined exposure models.
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Affiliation(s)
- Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Regina Pickford
- Institute of Epidemiology (EPI), Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt GmbH, Neuherberg, Germany
| | - Christopher Åström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Fabian Colomar
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Konstantina Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Dorina Ibi
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, UK; NIHR HPRU in Environmental Exposures and Health, Imperial College London, London, UK
| | - Erik Melén
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Federica Nobile
- Department of Epidemiology, Lazio Region Health Service /ASL Roma 1, Rome, Italy
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Persson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service /ASL Roma 1, Rome, Italy
| | - Cathryn Tonne
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jelle Vlaanderen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology (EPI), Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt GmbH, Neuherberg, Germany
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Annette Peters
- Institute of Epidemiology (EPI), Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt GmbH, Neuherberg, Germany; Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany; Munich Heart Alliance, German Center for Cardiovascular Health (DZHK e.V., partner-site Munich), Munich, Germany
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
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Rahmanian M, Zare Sakhvidi MJ, Mehrparvar AH, Zare Sakhvidi F, Dadvand P. Association between occupational noise exposure and diabetes: A systematic review and meta-analysis. Int J Hyg Environ Health 2023; 252:114222. [PMID: 37454581 DOI: 10.1016/j.ijheh.2023.114222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND In addition to the well-known risk factors of diabetes, evidence is accumulating on the negative role of environmental and occupational factors such as noise exposure. We conducted a systematic review and meta-analysis on the association between long-term occupational noise exposure and diabetes. METHODS We systematically searched evidence in PubMed, Scopus, and Web of Science (until August 2022) according to the PRISMA protocol. Risk of bias was assessed using the Newcastle-Ottawa scale. Random-effects meta-analysis was applied separately for risk ratio (odds ratio, relative risk) and hazard ratio. We evaluated the heterogeneity and publication bias. We applied meta-regressions to identify sources of heterogeneity. The overall body of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. RESULTS Of 533 retrieved articles, twelve studies (11 on non-gestational, and one on gestational diabetes) on total 106,045 population (23,996 diabetic cases) met our inclusion criteria; of which eight studies were cross-sectional, three were cohorts, and one was case-control. Only 40% of papers (five out of 12) had fair, good or very good quality, and most of the papers had poor or very poor quality in terms of risk of bias. We observed a non-significant increased risk of diabetes in association with occupational noise exposure (combined risk estimates: 1.16, 95% confidence interval [CI]: 0.97: 1.34; I2 = 57.7%). Doing separate meta-analyses on cohort and rest of studies, we found similar findings (cohort studies (n = 3): combined risk estimate: 1.17; 95% CI: 0.84: 1.50; I2 = 79%; cross-sectional studies (n = 8): combined risk estimate: 1.26; 95% CI: 0.93: 1.58; I2 = 50.4%). We found no indication of publication bias. CONCLUSIONS The overall evidence on the association between occupational noise exposure and diabetes is heterogeneous, limited, and mostly with low quality. More robust studies in terms of population selection, exposure and outcome assessment, and adjustment for confounders are necessary.
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Affiliation(s)
- Masoud Rahmanian
- Department of Endocrinology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Javad Zare Sakhvidi
- Department of Occupational Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Industrial Diseases Research Center, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Amir Houshang Mehrparvar
- Industrial Diseases Research Center, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fariba Zare Sakhvidi
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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9
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Boogaard H, Samoli E, Patton AP, Atkinson RW, Brook JR, Chang HH, Hoffmann B, Kutlar Joss M, Sagiv SK, Smargiassi A, Szpiro AA, Vienneau D, Weuve J, Lurmann FW, Forastiere F, Hoek G. Long-term exposure to traffic-related air pollution and non-accidental mortality: A systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2023; 176:107916. [PMID: 37210806 DOI: 10.1016/j.envint.2023.107916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 04/01/2023] [Accepted: 04/02/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND The health effects of traffic-related air pollution (TRAP) continue to be of important public health interest across the globe. Following its 2010 review, the Health Effects Institute appointed a new expert Panel to systematically evaluate the epidemiological evidence regarding the associations between long-term exposure to TRAP and selected health outcomes. This paper describes the main findings of the systematic review on non-accidental mortality. METHODS The Panel used a systematic approach to conduct the review. An extensive search was conducted of literature published between 1980 and 2019. A new exposure framework was developed to determine whether a study was sufficiently specific to TRAP, which included studies beyond the near-roadway environment. We performed random-effects meta-analysis when at least three estimates were available of an association between a specific exposure and outcome. We evaluated confidence in the evidence using a modified Office of Health Assessment and Translation (OHAT) approach, supplemented with a broader narrative synthesis. RESULTS Thirty-six cohort studies were included. Virtually all studies adjusted for a large number of individual and area-level covariates-including smoking, body mass index, and individual and area-level socioeconomic status-and were judged at a low or moderate risk for bias. Most studies were conducted in North America and Europe, and a few were based in Asia and Australia. The meta-analytic summary estimates for nitrogen dioxide, elemental carbon and fine particulate matter-pollutants with more than 10 studies-were 1.04 (95% CI 1.01, 1.06), 1.02 (1.00, 1.04) and 1.03 (1.01, 1.05) per 10, 1 and 5 µg/m3, respectively. Effect estimates are interpreted as the relative risk of mortality when the exposure differs with the selected increment. The confidence in the evidence for these pollutants was judged as high, because of upgrades for monotonic exposure-response and consistency across populations. The consistent findings across geographical regions, exposure assessment methods and confounder adjustment resulted in a high confidence rating using a narrative approach as well. CONCLUSIONS The overall confidence in the evidence for a positive association between long-term exposure to TRAP and non-accidental mortality was high.
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Affiliation(s)
- H Boogaard
- Health Effects Institute, Boston, MA, United States.
| | - E Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A P Patton
- Health Effects Institute, Boston, MA, United States
| | - R W Atkinson
- Population Health Research Institute, St. George's University of London, United Kingdom
| | - J R Brook
- Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - H H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - B Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - M Kutlar Joss
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany; Swiss Tropical and Public Health Institute, Allschwill, Switzerland; University of Basel, Switzerland
| | - S K Sagiv
- Center for Environmental Research and Children's Health, Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA, United States
| | - A Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, QC, Canada
| | - A A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - D Vienneau
- Swiss Tropical and Public Health Institute, Allschwill, Switzerland; University of Basel, Switzerland
| | - J Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - F W Lurmann
- Sonoma Technology, Inc., Petaluma, CA, United States
| | - F Forastiere
- Environmental Research Group, School of Public Health, Imperial College, London, United Kingdom
| | - G Hoek
- Institute for Risk Assessment Sciences, Environmental Epidemiology, Utrecht University, Netherlands
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10
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M Filho A, Turner MC, Warnakulasuriya S, Richardson DB, Hosseini B, Kamangar F, Pourshams A, Sewram V, Cronin-Fenton D, Etemadi A, Glass DC, Rahimi-Movaghar A, Sheikh M, Malekzadeh R, Schubauer-Berigan MK. The carcinogenicity of opium consumption: a systematic review and meta-analysis. Eur J Epidemiol 2023; 38:373-389. [PMID: 36773182 PMCID: PMC10082119 DOI: 10.1007/s10654-023-00969-7] [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: 07/16/2022] [Accepted: 01/15/2023] [Indexed: 02/12/2023]
Abstract
The carcinogenicity of opium consumption was recently evaluated by a Working Group convened by the International Agency for Research on Cancer (IARC). We supplement the recent IARC evaluation by conducting an extended systematic review as well as a quantitative meta-analytic assessment of the role of opium consumption and risk for selected cancers, evaluating in detail various aspects of study quality on meta-analytic findings. We searched the published literature to identify all relevant studies on opium consumption and risk of selected cancers in humans through 31 October, 2022. Meta-relative risks (mRRs) and associated 95% confidence intervals (CIs) were estimated using random-effects models for studies of cancer of the urinary bladder, larynx, lung, oesophagus, pancreas, and stomach. Heterogeneity among studies was assessed using the I2 statistic. We assessed study quality and conducted sensitivity analyses to evaluate the impact of potential reverse causation, protopathic bias, selection bias, information bias, and confounding. In total, 2 prospective cohort studies and 33 case-control studies were included. The overall pooled mRR estimated for 'ever or regular' versus 'never' use of opium ranged from 1.50 (95% CI 1.13-1.99, I2 = 0%, 6 studies) for oesophageal cancer to 7.97 (95% CI 4.79-13.3, I2 = 62%, 7 studies) for laryngeal cancer. Analyses of cumulative opium exposure suggested greater risk of cancer associated with higher opium consumption. Findings were robust in sensitivity analyses excluding studies prone to potential methodological sources of biases and confounding. Findings support an adverse association between opium consumption and cancers of the urinary bladder, larynx, lung, oesophagus, pancreas and stomach.
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Affiliation(s)
| | - Michelle C Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | | | - David B Richardson
- International Agency for Research On Cancer, Lyon, France
- University of California, Irvine, CA, USA
| | - Bayan Hosseini
- International Agency for Research On Cancer, Lyon, France
| | | | - Akram Pourshams
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Vikash Sewram
- Department of Global Health, African Cancer Institute, Stellenbosch University, Stellenbosch, South Africa
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Arash Etemadi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Maryland, USA
| | - Deborah C Glass
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sheikh
- International Agency for Research On Cancer, Lyon, France
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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11
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Schubauer-Berigan MK, Richardson DB, Fox MP, Fritschi L, Guseva Canu I, Pearce N, Stayner L, Berrington de Gonzalez A. IARC-NCI workshop on an epidemiological toolkit to assess biases in human cancer studies for hazard identification: beyond the algorithm. Occup Environ Med 2023; 80:119-120. [PMID: 36717257 DOI: 10.1136/oemed-2022-108724] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Mary K Schubauer-Berigan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - David B Richardson
- Department of Environmental and Occupational Health, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California Irvine, Irvine, California, USA
| | - Matthew P Fox
- Department of Epidemiology and Department of Global Health, Boston University, Boston, Massachusetts, USA
| | - Lin Fritschi
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | | | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Leslie Stayner
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - Amy Berrington de Gonzalez
- Division of Cancer Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
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12
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Johnson B, White B, Lancaster P, Larson R. An Evaluation of Temporal Distributions of High, Low, and Zero Cohort Morbidity of Cumulative First Treatment Bovine Respiratory Disease and Their Associations with Demographic, Health, and Performance Outcomes in US Feedlot Cattle. Vet Sci 2023; 10:vetsci10020089. [PMID: 36851393 PMCID: PMC9964310 DOI: 10.3390/vetsci10020089] [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: 11/25/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Timing and magnitude of bovine respiratory disease (BRD) can impact intervention and overall economics of cattle on feed. Furthermore, there is a need to better describe when cattle are being treated for BRD. The first objective was to perform a cluster analysis on the temporal distributions of cumulative first treatment BRD from HIGH (≥15% of cattle received treated for BRD) and LOW cohorts (>0 and <15% of cattle received treated for BRD) to assess cohort-level timing (days on feed) of BRD first treatments. The second objective was to determine associations among cluster groups (temporal patterns) and demographic risk factors, health outcomes, and performance. Cluster analysis determined that optimal number of clustering groups for the HIGH morbidity cohort was six clusters and LOW morbidity cohort was seven clusters. Cohorts with zero BRD treatment records were added for statistical comparisons. Total death loss, BRD morbidity, average daily gain (ADG), railing rate, days to 50% BRD, cattle received, shrink, arrival weight, and sex were associated with temporal groups (p < 0.05). These data could be used as a tool for earlier identification and potential interventions for cohorts based on the BRD temporal pattern.
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Affiliation(s)
- Blaine Johnson
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66505, USA
| | - Brad White
- Department of Clinical Sciences, College of Veterinary Medicine, Beef Cattle Institute, Kansas State University, Manhattan, KS 66505, USA
- Correspondence: ; Tel.: +1-785-564-7459
| | - Phillip Lancaster
- Department of Clinical Sciences, College of Veterinary Medicine, Beef Cattle Institute, Kansas State University, Manhattan, KS 66505, USA
| | - Robert Larson
- Department of Clinical Sciences, College of Veterinary Medicine, Beef Cattle Institute, Kansas State University, Manhattan, KS 66505, USA
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13
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Zhang Y, Liu N, Li Y, Long Y, Baumgartner J, Adamkiewicz G, Bhalla K, Rodriguez J, Gemmell E. Neighborhood infrastructure-related risk factors and non-communicable diseases: a systematic meta-review. Environ Health 2023; 22:2. [PMID: 36604680 PMCID: PMC9814186 DOI: 10.1186/s12940-022-00955-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/29/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND With rapid urbanization, the urban environment, especially the neighborhood environment, has received increasing global attention. However, a comprehensive overview of the association between neighborhood risk factors and human health remains unclear due to the large number of neighborhood risk factor-human health outcome pairs. METHOD On the basis of a whole year of panel discussions, we first obtained a list of 5 neighborhood domains, containing 33 uniformly defined neighborhood risk factors. We only focused on neighborhood infrastructure-related risk factors with the potential for spatial interventions through urban design tools. Subsequently, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic meta-review of 17 infrastructure-related risk factors of the 33 neighborhood risk factors (e.g., green and blue spaces, proximity to major roads, and proximity to landfills) was conducted using four databases, Web of Science, PubMed, OVID, and Cochrane Library, from January 2000 to May 2021, and corresponding evidence for non-communicable diseases (NCDs) was synthesized. The review quality was assessed according to the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) standard. RESULTS Thirty-three moderate-and high-quality reviews were included in the analysis. Thirteen major NCD outcomes were found to be associated with neighborhood infrastructure-related risk factors. Green and blue spaces or walkability had protective effects on human health. In contrast, proximity to major roads, industry, and landfills posed serious threats to human health. Inconsistent results were obtained for four neighborhood risk factors: facilities for physical and leisure activities, accessibility to infrastructure providing unhealthy food, proximity to industry, and proximity to major roads. CONCLUSIONS This meta-review presents a comprehensive overview of the effects of neighborhood infrastructure-related risk factors on NCDs. Findings on the risk factors with strong evidence can help improve healthy city guidelines and promote urban sustainability. In addition, the unknown or uncertain association between many neighborhood risk factors and certain types of NCDs requires further research.
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Affiliation(s)
- Yuyang Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | - Ningrui Liu
- School of Architecture, Tsinghua University, Beijing, China
| | - Yan Li
- School of Architecture, Tsinghua University, Beijing, China
| | - Ying Long
- School of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of Education, Tsinghua University, No. 1 Qinghuayuan, Haidian District, Beijing, 100084, China.
| | - Jill Baumgartner
- Institute for Health and Social Policy & Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan, School of Public Health, Boston, MA, USA
| | - Kavi Bhalla
- Public Health Sciences, University of Chicago, Chicago, IL, USA
| | | | - Emily Gemmell
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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14
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LaKind JS, Burns CJ, Mattison DR. Commentary: Systematic reviews and observational epidemiology: The more things change…. GLOBAL EPIDEMIOLOGY 2022; 4:100088. [PMID: 37637020 PMCID: PMC10446007 DOI: 10.1016/j.gloepi.2022.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/04/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Judy S. LaKind
- LaKind Associates, LLC, 106 Oakdale Avenue, Catonsville, Maryland 21228 USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Carol J. Burns
- Burns Epidemiology Consulting, LLC, 255 W. Sunset Ct., Sanford, MI 48657, USA
| | - Donald R. Mattison
- Arnold School of Public Health, Department of Biostatistics and Epidemiology University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
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15
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Shaffer RM, Forsyth JE, Ferraro G, Till C, Carlson LM, Hester K, Haddock A, Strawbridge J, Lanfear CC, Hu H, Kirrane E. Lead exposure and antisocial behavior: A systematic review protocol. ENVIRONMENT INTERNATIONAL 2022; 168:107438. [PMID: 35994796 DOI: 10.1016/j.envint.2022.107438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Lead exposure remains highly prevalent worldwide despite decades of research highlighting its link to numerous adverse health outcomes. In addition to well-documented effects on cognition, there is growing evidence of an association with antisocial behavior, including aggression, conduct problems, and crime. An updated systematic review on this topic, incorporating study evaluation and a developmental perspective on the outcome, can advance the state of the science on lead and inform global policy interventions to reduce exposure. OBJECTIVES We aim to evaluate the link between lead exposure and antisocial behavior. This association will be investigated via a systematic review of human epidemiological and experimental nonhuman mammalian studies. METHODS The systematic review protocol presented in this publication is informed by recommendations for the conduct of systematic reviews in toxicology and environmental health research (COSTER) and follows the study evaluation approach put forth by the U.S. EPA Integrated Risk Information System (IRIS) program. DATA SOURCES We will search the following electronic databases for relevant literature: PubMed, BIOSIS and Web of Science. Search results will be stored in EPA's Health and Environmental Research Online (HERO) database. STUDY ELIGIBILITY AND CRITERIA Eligible human epidemiological studies will include those evaluating any population exposed to lead at any lifestage via ingestion or inhalation exposure and considering an outcome of antisocial behavior based on any of the following criteria: psychiatric diagnoses (e.g., oppositional defiant disorder (ODD), conduct disorder (CD), disruptive behavior disorders (DBD)); violation of social norms (e.g., delinquency, criminality); and aggression. Eligible experimental animal studies will include those evaluating nonhuman mammalian studies exposed to lead via ingestion, inhalation, or injection exposure during any lifestage. The following outcomes will be considered relevant: aggression; antisocial behavior; and altered fear, anxiety, and stress response. STUDY APPRAISAL AND SYNTHESIS METHODS Screening will be conducted with assistance from an artificial intelligence application. Two independent reviewers for each data stream (human, animal) will screen studies with highest predicted relevance against pre-specified inclusion criteria at the title/abstract and full-text level. Study evaluation will be conducted using methods adapted from the U.S. EPA IRIS program. After data extraction, we will conduct a narrative review and quantitative meta-analysis on the human epidemiological studies as well as a narrative review of the experimental animal studies. We will evaluate the strength of each evidence stream separately and then will develop a summary evidence integration statement based on inference across evidence streams.
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Affiliation(s)
- Rachel M Shaffer
- US Environmental Protection Agency, Center for Public Health and Environmental Assessment, Washington, DC, and Research Triangle Park, NC, United States
| | - Jenna E Forsyth
- Stanford University, Woods Institute for the Environment, Stanford, CA, United States
| | - Greg Ferraro
- North Carolina State University, Raleigh, NC, United States
| | | | - Laura M Carlson
- US Environmental Protection Agency, Center for Public Health and Environmental Assessment, Washington, DC, and Research Triangle Park, NC, United States
| | - Kirstin Hester
- US Environmental Protection Agency, Center for Public Health and Environmental Assessment, Washington, DC, and Research Triangle Park, NC, United States
| | - Amanda Haddock
- US Environmental Protection Agency, Center for Public Health and Environmental Assessment, Washington, DC, and Research Triangle Park, NC, United States
| | - Jenna Strawbridge
- Oak Ridge Associated Universities, US Environmental Protection Agency, Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States
| | - Charles C Lanfear
- Nuffield College, University of Oxford, Oxford, England, United Kingdom
| | - Howard Hu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ellen Kirrane
- US Environmental Protection Agency, Center for Public Health and Environmental Assessment, Washington, DC, and Research Triangle Park, NC, United States.
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16
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Lunn RM, Mehta SS, Jahnke GD, Wang A, Wolfe MS, Berridge BR. Cancer Hazard Evaluations for Contemporary Needs: Highlights From New National Toxicology Program Evaluations and Methodological Advancements. J Natl Cancer Inst 2022; 114:1441-1448. [PMID: 36029241 PMCID: PMC9949597 DOI: 10.1093/jnci/djac164] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/10/2022] [Accepted: 08/23/2022] [Indexed: 01/04/2023] Open
Abstract
The National Toxicology Program strives to raise awareness of cancer hazards in our environment. Identifying cancer hazards is key to primary prevention, informing public health decision making, and decreasing the global cancer burden. In December 2021, the US congressionally mandated 15th Report on Carcinogens was released, adding 8 new substances to the cumulative report. Chronic infection with Helicobacter pylori is listed as "known to be a human carcinogen." Antimony trioxide and 6 haloacetic acids found as water disinfection by-products-dichloroacetic acid, dibromoacetic acid, bromochloroacetic acid, tribromoacetic acid, bromodichloroacetic acid, chlorodibromoacetic acid-are listed as "reasonably anticipated to be a human carcinogen." A new dashboard provides interactive visualization and interrogation of the 256 listed substances, their uses, and associated cancers. Also, the National Toxicology Program recently published a Cancer Hazard Assessment Report on exposure scenarios associated with circadian disruption, concluding that persistent night shift work can cause breast cancer and certain lighting conditions may cause cancer. As highlighted in these reports and evaluations, we are evolving our approaches to meet contemporary challenges. These approaches include focusing on real-world exposures and advancing our methods to address challenges in cancer hazard assessments (eg, developing more structured approaches to evaluate mechanistic data and incorporating read-across approaches to assess chemicals lacking adequate human or animal cancer data). To promote public health, we provide information on environmental health disparities and disease prevention. Building on these efforts, we aim to continue our contributions to the war on cancer, declared 50 years ago.
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Affiliation(s)
- Ruth M Lunn
- Correspondence to: Ruth M. Lunn, DrPH, Division of the National Toxicology Program, National Institute of Environmental Health Sciences, P.O. Box 12233, MD K2-14, Research Triangle Park, NC 27709, USA (e-mail: )
| | | | - Gloria D Jahnke
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Amy Wang
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Mary S Wolfe
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Brian R Berridge
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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17
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Sargeant JM, Brennan ML, O'Connor AM. Levels of Evidence, Quality Assessment, and Risk of Bias: Evaluating the Internal Validity of Primary Research. Front Vet Sci 2022; 9:960957. [PMID: 35903128 PMCID: PMC9315339 DOI: 10.3389/fvets.2022.960957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/24/2022] [Indexed: 12/27/2022] Open
Abstract
Clinical decisions in human and veterinary medicine should be based on the best available evidence. The results of primary research are an important component of that evidence base. Regardless of whether assessing studies for clinical case management, developing clinical practice guidelines, or performing systematic reviews, evidence from primary research should be evaluated for internal validity i.e., whether the results are free from bias (reflect the truth). Three broad approaches to evaluating internal validity are available: evaluating the potential for bias in a body of literature based on the study designs employed (levels of evidence), evaluating whether key study design features associated with the potential for bias were employed (quality assessment), and applying a judgement as to whether design elements of a study were likely to result in biased results given the specific context of the study (risk of bias assessment). The level of evidence framework for assessing internal validity assumes that internal validity can be determined based on the study design alone, and thus makes the strongest assumptions. Risk of bias assessments involve an evaluation of the potential for bias in the context of a specific study, and thus involve the least assumptions about internal validity. Quality assessment sits somewhere between the assumptions of these two. Because risk of bias assessment involves the least assumptions, this approach should be used to assess internal validity where possible. However, risk of bias instruments are not available for all study designs, some clinical questions may be addressed using multiple study designs, and some instruments that include an evaluation of internal validity also include additional components (e.g., evaluation of comprehensiveness of reporting, assessments of feasibility or an evaluation of external validity). Therefore, it may be necessary to embed questions related to risk of bias within existing quality assessment instruments. In this article, we overview the approaches to evaluating internal validity, highlight the current complexities, and propose ideas for approaching assessments of internal validity.
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Affiliation(s)
- Jan M. Sargeant
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
- *Correspondence: Jan M. Sargeant
| | - Marnie L. Brennan
- Centre for Evidence-Based Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, United Kingdom
| | - Annette M. O'Connor
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
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Pega F, Momen NC, Bero L, Whaley P. Towards a framework for systematic reviews of the prevalence of exposure to environmental and occupational risk factors. Environ Health 2022; 21:64. [PMID: 35794579 PMCID: PMC9258093 DOI: 10.1186/s12940-022-00878-4] [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: 02/21/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Exposure prevalence studies (as here defined) record the prevalence of exposure to environmental and occupational risk factors to human health. Applying systematic review methods to the synthesis of these studies would improve the rigour and transparency of normative products produced based on this evidence (e.g., exposure prevalence estimates). However, a dedicated framework, including standard methods and tools, for systematically reviewing exposure prevalence studies has yet to be created. We describe the need for this framework and progress made towards it through a series of such systematic reviews that the World Health Organization and the International Labour Organization conducted for their WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates).We explain that existing systematic review frameworks for environmental and occupational health cannot be directly applied for the generation of exposure prevalence estimates because they seek to synthesise different types of evidence (e.g., intervention or exposure effects on health) for different purposes (e.g., identify intervention effectiveness or exposure toxicity or carcinogenicity). Concepts unique to exposure prevalence studies (e.g., "expected heterogeneity": the real, non-spurious variability in exposure prevalence due to exposure changes over space and/or time) also require new assessment methods. A framework for systematic reviews of prevalence of environmental and occupational exposures requires adaptation of existing methods (e.g., a standard protocol) and development of new tools or approaches (e.g., for assessing risk of bias and certainty of a body of evidence, including exploration of expected heterogeneity).As part of the series of systematic reviews for the WHO/ILO Joint Estimates, the World Health Organization collaborating with partners has created a preliminary framework for systematic reviews of prevalence studies of exposures to occupational risk factors. This included development of protocol templates, data extraction templates, a risk of bias assessment tool, and an approach for assessing certainty of evidence in these studies. Further attention and efforts are warranted from scientific and policy communities, especially exposure scientists and policy makers, to establish a standard framework for comprehensive and transparent systematic reviews of studies estimating prevalence of exposure to environmental and occupational risk factors, to improve estimates, risk assessments and guidelines.
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Affiliation(s)
- Frank Pega
- Department of Environment, Climate Change and Health, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland.
| | - Natalie C Momen
- Department of Environment, Climate Change and Health, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Lisa Bero
- General Internal Medicine/Public Health/Center for Bioethics and Humanities, University of Colorado-Anschutz Medical Campus, Denver, CO, USA
| | - Paul Whaley
- Lancaster Environment Center, Lancaster University, Lancaster, UK
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Menon JML, Struijs F, Whaley P. The methodological rigour of systematic reviews in environmental health. Crit Rev Toxicol 2022; 52:167-187. [DOI: 10.1080/10408444.2022.2082917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- J. M. L. Menon
- Systematic Review Center for Laboratory Animal Experimentation, Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - F. Struijs
- Systematic Review Center for Laboratory Animal Experimentation, Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P. Whaley
- Evidence-Based Toxicology Collaboration, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
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20
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Frampton G, Whaley P, Bennett M, Bilotta G, Dorne JLCM, Eales J, James K, Kohl C, Land M, Livoreil B, Makowski D, Muchiri E, Petrokofsky G, Randall N, Schofield K. Principles and framework for assessing the risk of bias for studies included in comparative quantitative environmental systematic reviews. ENVIRONMENTAL EVIDENCE 2022; 11:1-23. [PMID: 38264537 PMCID: PMC10805236 DOI: 10.1186/s13750-022-00264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/05/2022] [Indexed: 01/25/2024]
Abstract
The internal validity of conclusions about effectiveness or impact in systematic reviews, and of decisions based on them, depends on risk of bias assessments being conducted appropriately. However, a random sample of 50 recently-published articles claiming to be quantitative environmental systematic reviews found 64% did not include any risk of bias assessment, whilst nearly all that did omitted key sources of bias. Other limitations included lack of transparency, conflation of quality constructs, and incomplete application of risk of bias assessments to the data synthesis. This paper addresses deficiencies in risk of bias assessments by highlighting core principles that are required for risk of bias assessments to be fit-for-purpose, and presenting a framework based on these principles to guide review teams on conducting risk of bias assessments appropriately and consistently. The core principles require that risk of bias assessments be Focused, Extensive, Applied and Transparent (FEAT). These principles support risk of bias assessments, appraisal of risk of bias tools, and the development of new tools. The framework follows a Plan-Conduct-Apply-Report approach covering all stages of risk of bias assessment. The scope of this paper is comparative quantitative environmental systematic reviews which address PICO or PECO-type questions including, but not limited to, topic areas such as environmental management, conservation, ecosystem restoration, and analyses of environmental interventions, exposures, impacts and risks.
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Affiliation(s)
- Geoff Frampton
- Southampton Health Technology Assessments Centre (SHTAC), Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Whaley
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
- Evidence-Based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Micah Bennett
- U.S. Environmental Protection Agency, Region 5, Chicago, IL 60604, USA
| | - Gary Bilotta
- School of Environment and Technology, University of Brighton, Brighton, UK
| | - Jean-Lou C. M. Dorne
- Scientific Committee and Emerging Risks Unit, European Food Safety Authority, Via Carlo Magno 1A, 43121 Parma, Italy
| | - Jacqualyn Eales
- European Centre for Environment and Human Health, College of Medicine and Health, University of Exeter, Knowledge Spa, Truro TR1 3HD, UK
| | - Katy James
- Centre for Evidence-Based Agriculture, Harper Adams University, Newport, Shropshire TF10 8NB, UK
| | - Christian Kohl
- Institute for Biosafety in Plant Biotechnology (SB), Julius Kühn Institute (JKI) - Federal Research Centre for Cultivated Plants, Berlin, Germany
| | | | | | - David Makowski
- UMR518, University Paris-Saclay, INRAE, AgroParistech, 16 rue Claude Bernard, 75231 Paris, France
| | - Evans Muchiri
- Centre for Anthropological Research, University of Johannesburg, Johannesburg, South Africa
| | - Gillian Petrokofsky
- Oxford Long-Term Ecology Lab, Department of Zoology, University of Oxford, Oxford, UK
| | - Nicola Randall
- Centre for Evidence-Based Agriculture, Harper Adams University, Newport, Shropshire TF10 8NB, UK
| | - Kate Schofield
- Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC 20460, USA
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Ye D, Brown JS, Umbach DM, Adams J, Thayer W, Follansbee MH, Kirrane EF. Estimating the Effects of Soil Remediation on Children's Blood Lead near a Former Lead Smelter in Omaha, Nebraska, USA. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:37008. [PMID: 35319254 PMCID: PMC8941937 DOI: 10.1289/ehp8657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND Lead exposures from legacy sources threaten children's health. Soil in Omaha, Nebraska, was contaminated by emissions from a lead smelter and refinery. The U.S. Environmental Protection Agency excavated and replaced contaminated soil at the Omaha Lead Superfund Site between 1999 and 2016. OBJECTIVES The goal of this study was to assess the association of soil lead level (SLL) and soil remediation status with blood lead levels (BLLs) in children living near or on the site. METHODS We linked information on SLL at residential properties with children's BLLs and assigned remediation status to children's BLL measurements based on whether their measurements occurred during residence at remediated or unremediated properties. We examined the association of SLL and remediation status with elevated BLL (EBLL). We distinguished the roles of temporal trend and the intervention with time-by-intervention-status interaction contrasts. All analyses estimated odds ratios (ORs) with a generalized estimating equations approach to ensure robustness under the complex correlations among BLL measurements. All analyses controlled for relevant covariates including children's characteristics. RESULTS EBLL (>5μg/dL) was associated with both residential SLL [e.g., OR=2.00; 95% confidence interval (CI): 1.83, 2.19; >400-800 vs. ≤200 ppm] and neighborhood SLL [e.g., OR=1.85 (95% CI: 1.62, 2.11; >400-800 vs. ≤200 ppm)] before remediation but only with neighborhood SLL after remediation. The odds of EBLL were higher before remediation [OR 1.52 (95% CI: 1.34, 1.72)]. Similarly, EBLL was positively associated with preremediation status in our interaction analysis [interaction OR=1.18 (95%CI: 1.02, 1.37)]. DISCUSSION Residential and neighborhood SLLs were important predictors of EBLLs in children residing near or on this Superfund site. Neighborhood SLL remained a strong predictor following remediation. Our data analyses showed the benefit of soil remediation. Results from the interaction analyses should be interpreted cautiously due to imperfect correspondence of remediation times between remediation and comparison groups. https://doi.org/10.1289/EHP8657.
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Affiliation(s)
- Dongni Ye
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - James S. Brown
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - David M. Umbach
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | | | | | | | - Ellen F. Kirrane
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
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22
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Forastiere F, Peters A. Response to "Comment on 'Invited Perspective: The NO2 and Mortality Dilemma Solved? Almost There!'". ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:38002. [PMID: 35294263 PMCID: PMC8926162 DOI: 10.1289/ehp11156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Francesco Forastiere
- Institute for Biomedical Research and Innovation – National Research Council, Palermo, Italy
- Environmental Research Group, Imperial College, London, UK
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology, Ludwig-Maximilians Universität, Munich, Germany
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Zhao M, Xu Z, Guo Q, Gan Y, Wang Q, Liu JA. Association between long-term exposure to PM 2.5 and hypertension: A systematic review and meta-analysis of observational studies. ENVIRONMENTAL RESEARCH 2022; 204:112352. [PMID: 34762927 DOI: 10.1016/j.envres.2021.112352] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Numerous studies have examined the association between long-term exposure to particulate matter with an aerodynamic diameter of ≤2.5 μm (PM2.5) and hypertension. However, the results are inconsistent. OBJECTIVES Considering the limitations of previous meta-analyses and the publication of many new studies in recent years, we conducted this meta-analysis to assess the relationship between long-term PM2.5 exposure and the incidence and prevalence of hypertension in a healthy population. METHODS We searched PubMed, Web of Science, Embase, and Scopus for relevant studies published until April 2, 2021 and reviewed the reference lists of previous reviews. A total of 28 observational studies reporting RR or OR with 95% CI for the association between long-term PM2.5 exposure and the risk of hypertension were included. RESULTS After the sensitivity analysis, we excluded one study with a high degree of heterogeneity, resulting in 27 studies and 28 independent reports. Approximately 42 million participants were involved, and the cases of hypertension in cohort and cross-sectional studies were 508,749 and 1,793,003, respectively. The meta-analysis showed that each 10 μg/m3 increment in PM2.5 was significantly associated with the risks of hypertension incidence (RR = 1.21, 95% CI: 1.07, 1.35) and prevalence (OR = 1.06, 95% CI: 1.03, 1.09). Subgroup analyses showed that occupational exposure had a significant effect on the association of PM2.5 and hypertension incidence (p for interaction = 0.042) and that the PM2.5 concentration level and physical activity had a noticeable effect on the association of PM2.5 and hypertension prevalence (p for interaction = 0.005; p for interaction = 0.022). CONCLUSIONS A significantly positive correlation was observed between long-term PM2.5 exposure and risks of hypertension incidence and prevalence, and a high PM2.5 concentration resulted in an increased risk of hypertension.
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Affiliation(s)
- Mingqing Zhao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ziyuan Xu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qianqian Guo
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jun-An Liu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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24
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Suhr F, Steinert JI. Epidemiology of floods in sub-Saharan Africa: a systematic review of health outcomes. BMC Public Health 2022; 22:268. [PMID: 35144560 PMCID: PMC8830087 DOI: 10.1186/s12889-022-12584-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022] Open
Abstract
Background Floods have affected 2.3 billion people worldwide in the last 20 years, and are associated with a wide range of negative health outcomes. Climate change is projected to increase the number of people exposed to floods due to more variable precipitation and rising sea levels. Vulnerability to floods is highly dependent on economic wellbeing and other societal factors. Therefore, this systematic review synthesizes the evidence on health effects of flood exposure among the population of sub-Saharan Africa. Methods We systematically searched two databases, Web of Science and PubMed, to find published articles. We included studies that (1) were published in English from 2010 onwards, (2) presented associations between flood exposure and health indicators, (3) focused on sub-Saharan Africa, and (4) relied on a controlled study design, such as cohort studies, case-control studies, cross-sectional studies, or quasi-experimental approaches with a suitable comparator, for instance individuals who were not exposed to or affected by floods or individuals prior to experiencing a flood. Results Out of 2306 screened records, ten studies met our eligibility criteria. We included studies that reported the impact of floods on water-borne diseases (n = 1), vector-borne diseases (n = 8) and zoonotic diseases (n = 1). Five of the ten studies assessed the connection between flood exposure and malaria. One of these five evaluated the impact of flood exposure on malaria co-infections. The five non-malaria studies focused on cholera, scabies, taeniasis, Rhodesian sleeping sickness, alphaviruses and flaviviruses. Nine of the ten studies reported significant increases in disease susceptibility after flood exposure. Conclusion The majority of included studies of the aftermath of floods pointed to an increased risk of infection with cholera, scabies, taeniasis, Rhodesian sleeping sickness, malaria, alphaviruses and flaviviruses. However, long-term health effects, specifically on mental health, non-communicable diseases and pregnancy, remain understudied. Further research is urgently needed to improve our understanding of the health risks associated with floods, which will inform public policies to prevent and reduce flood-related health risks. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12584-4.
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Affiliation(s)
- Friederike Suhr
- School of Social Sciences and Technology, Technical University of Munich, Richard-Wagner Str. 1, 80333, Munich, Germany.
| | - Janina Isabel Steinert
- School of Social Sciences and Technology, Technical University of Munich, Richard-Wagner Str. 1, 80333, Munich, Germany.,Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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25
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Holy CE, Zhang S, Perkins LE, Hasgall P, Katz LB, Brown JR, Orlandini L, Fessel G, Nasseri-Aghbosh B, Eichenbaum G, Egnot NS, Marcello S, Coplan PM. Site-specific cancer risk following cobalt exposure via orthopedic implants or in occupational settings: A systematic review and meta-analysis. Regul Toxicol Pharmacol 2021; 129:105096. [PMID: 34896478 DOI: 10.1016/j.yrtph.2021.105096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
In 2020, the European Commission up-classified metal cobalt as Class 1B Carcinogen (presumed to have carcinogenic potential) based primarily on data from rodent inhalation carcinogenicity studies. This up-classification requires an assessment under the Medical Device Regulations of cobalt cancer risk from medical devices. We performed a systematic review and meta-analysis to evaluate site-specific cancer risks with cobalt exposure from either total joint replacement (TJR) or occupational exposure (OC). Results were stratified by exposure type (OC or TJR), exposure level (metal-on-metal (MoM) or non-MoM), follow-up duration (latency period: <5, 5-10 or >10 years), and cancer incidence or mortality (detection bias assessment). From 30 studies (653,104 subjects, average 14.5 years follow-up), the association between TJR/OC and cancer risk was null for 22 of 27 cancer sites, negative for 3 sites, and positive for prostate cancer and myeloma. Significant heterogeneity and large estimate ranges were observed for many cancer sites. No significant increase in estimates was observed by exposure level or follow-up duration. The current evidence, including weak associations, heterogeneity across studies and no increased association with exposure level or follow-up duration, is insufficient to conclude that there exists an increased risk for people exposed to cobalt in TJR/OC of developing site-specific cancers.
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Affiliation(s)
- Chantal E Holy
- Johnson & Johnson, 410 George St, New Brunswick, NJ, 08901, United States.
| | - Shumin Zhang
- Johnson & Johnson, 410 George St, New Brunswick, NJ, 08901, United States
| | - Laura E Perkins
- Abbott Vascular, 3200 Lakeside Dr, Santa Clara, CA, 95054, United States
| | | | - Laurence B Katz
- LifeScan Global Corporation, 20 Valley Stream Parkway, Malvern, PA, 19355, United States
| | - Jason R Brown
- Medtronic PLC, 8200 Coral Sea St NE, Minneapolis, MN, 55112, United States
| | - Luca Orlandini
- Smith and Nephew, Oberneuhofstasse 10D, 6340, Baar, Switzerland
| | - Gion Fessel
- Smith and Nephew, Oberneuhofstasse 10D, 6340, Baar, Switzerland
| | | | - Gary Eichenbaum
- Johnson & Johnson, 410 George St, New Brunswick, NJ, 08901, United States
| | - Natalie S Egnot
- Cardno ChemRisk, 20 Stanwix St, Pittsburgh, PA, 15222, United States
| | | | - Paul M Coplan
- Johnson & Johnson, 410 George St, New Brunswick, NJ, 08901, United States; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, United States
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Zeraatkar D, Kohut A, Bhasin A, Morassut RE, Churchill I, Gupta A, Lawson D, Miroshnychenko A, Sirotich E, Aryal K, Azab M, Beyene J, de Souza RJ. Assessments of risk of bias in systematic reviews of observational nutritional epidemiologic studies are often not appropriate or comprehensive: a methodological study. BMJ Nutr Prev Health 2021; 4:487-500. [PMID: 35028518 PMCID: PMC8718856 DOI: 10.1136/bmjnph-2021-000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND An essential component of systematic reviews is the assessment of risk of bias. To date, there has been no investigation of how reviews of non-randomised studies of nutritional exposures (called 'nutritional epidemiologic studies') assess risk of bias. OBJECTIVE To describe methods for the assessment of risk of bias in reviews of nutritional epidemiologic studies. METHODS We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (Jan 2018-Aug 2019) and sampled 150 systematic reviews of nutritional epidemiologic studies. RESULTS Most reviews (n=131/150; 87.3%) attempted to assess risk of bias. Commonly used tools neglected to address all important sources of bias, such as selective reporting (n=25/28; 89.3%), and frequently included constructs unrelated to risk of bias, such as reporting (n=14/28; 50.0%). Most reviews (n=66/101; 65.3%) did not incorporate risk of bias in the synthesis. While more than half of reviews considered biases due to confounding and misclassification of the exposure in their interpretation of findings, other biases, such as selective reporting, were rarely considered (n=1/150; 0.7%). CONCLUSION Reviews of nutritional epidemiologic studies have important limitations in their assessment of risk of bias.
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Affiliation(s)
- Dena Zeraatkar
- Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alana Kohut
- McMaster University, Hamilton, Ontario, Canada
| | - Arrti Bhasin
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rita E Morassut
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Isabella Churchill
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Gupta
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daeria Lawson
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anna Miroshnychenko
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Emily Sirotich
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Komal Aryal
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maria Azab
- McMaster University, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
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27
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Lagorio S, Blettner M, Baaken D, Feychting M, Karipidis K, Loney T, Orsini N, Röösli M, Paulo MS, Elwood M. The effect of exposure to radiofrequency fields on cancer risk in the general and working population: A protocol for a systematic review of human observational studies. ENVIRONMENT INTERNATIONAL 2021; 157:106828. [PMID: 34433115 PMCID: PMC8484862 DOI: 10.1016/j.envint.2021.106828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND The World Health Organization (WHO) has an ongoing project to assess potential health effects of exposure to radiofrequency electromagnetic fields (RF-EMF) in the general and working population. Here we present the protocol for a systematic review of the scientific literature on cancer hazards from exposure to RF-EMF in humans, commissioned by the WHO as part of that project. OBJECTIVE To assess the quality and strength of the evidence provided by human observational studies for a causal association between exposure to RF-EMF and risk of neoplastic diseases. ELIGIBILITY CRITERIA We will include cohort and case-control studies investigating neoplasia risks in relation to three types of exposure to RF-EMF: near-field, head-localized, exposure from wireless phone use (SR-A); far-field, whole body, environmental exposure from fixed-site transmitters (SR-B); near/far-field occupational exposures from use of handheld transceivers or RF-emitting equipment in the workplace (SR-C). While no restriction on tumour type will be applied, we will focus on selected neoplasms of the central nervous system (brain, meninges, pituitary gland, acoustic nerve) and salivary gland tumours (SR-A); brain tumours and leukaemias (SR-B, SR-C). INFORMATION SOURCES Eligible studies will be identified through Medline, Embase, and EMF-Portal. RISK-OF-BIAS ASSESSMENT We will use a tailored version of the OHAT's tool to evaluate the study's internal validity. DATA SYNTHESIS We will consider separately studies on different tumours, neoplasm-specific risks from different exposure sources, and a given exposure-outcome pair in adults and children. When a quantitative synthesis of findings can be envisaged, the main aims of the meta-analysis will be to assess the strength of association and the shape of the exposure-response relationship; to quantify the degree of heterogeneity across studies; and explore the sources of inconsistency (if any). When a meta-analysis is judged inappropriate, we will perform a narrative synthesis, complemented by a structured tabulation of results and appropriate visual displays. EVIDENCE ASSESSMENT Confidence in evidence will be assessed in line with the GRADE approach. FUNDING This project is supported by the World Health Organization. Co-financing was provided by the New Zealand Ministry of Health; the Istituto Superiore di Sanità in its capacity as a WHO Collaborating Centre for Radiation and Health; ARPANSA as a WHO Collaborating Centre for Radiation Protection. REGISTRATION PROSPERO CRD42021236798.
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Affiliation(s)
- Susanna Lagorio
- Department of Oncology and Molecular Medicine, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy.
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University of Mainz, Germany.
| | - Dan Baaken
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University of Mainz, Germany.
| | - Maria Feychting
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Ken Karipidis
- Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), Yallambie, VIC, Australia.
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Marilia Silva Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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28
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Moon J, Yoo H. Residential radon exposure and leukemia: A meta-analysis and dose-response meta-analyses for ecological, case-control, and cohort studies. ENVIRONMENTAL RESEARCH 2021; 202:111714. [PMID: 34274332 DOI: 10.1016/j.envres.2021.111714] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION In this study, the authors conducted a comprehensive systematic review and meta-analysis (including a dose-response meta-analysis) for a possible causal association between residential radon exposure and leukemia. All 3 types of study design, including ecological, case-control, and cohort studies, were included in this study. In particular, different measurement units of radon exposure among studies were dealt with and analyzed thoroughly. METHODS A medical librarian searched MEDLINE (PubMed), EMBASE, and the Cochrane Library (from January 01, 1970 to November 05, 2020). For ecological studies, a conventional meta-analysis and subgroup analyses with meta-ANOVA analyses were conducted. For case-control and cohort studies, a two-stage dose-response meta-analysis was conducted. RESULTS A total of 8 ecological, 9 case-control, and 15 ecological-cohort studies were analyzed. For ecological studies, the pooled correlation coefficient was 0.48 (95% CI 0.41-0.54). In the meta-analysis of variance (ANOVA) analyses, the age group (childhood vs. adult) showed a statistically significant result (Q = 7.93 and p = 0.019) with the pooled correlation coefficient for childhood, adult, and all age group of 0.67 (95% CI 0.53-0.77), 0.46 (95% CI 0.05-0.74), and 0.44 (95% CI 0.36-0.51), respectively. For case-control studies, the dose-response meta-analysis showed the pooled OR increase of 1.0308 (95% CI 1.0050-1.0573) for each 100 Bq/m3 increase of radon dose. The pooled OR increase was 1.0361 (95% CI 1.0014-1.0720) for each 100 Bq/m3 increase of radon dose for lymphoid leukemia subgroup and 1.0309 (95% CI 1.0050-1.0575) for each 100 Bq/m3 increase of radon dose for childhood leukemia subgroup. Because of the inclusion of ecological studies with larger exposure assessment units, the pooled RR from ecological-cohort studies should be interpreted conservatively (a tendency towards a higher risk estimate). The overall pooled RR increase for each 100 Bq/m3 increase of radon dose was 1.1221 (95% CI 1.0184-1.2363). The pooled RR increase was 1.2257 (95% CI 1.0034-1.4972) for each 100 Bq/m3 increase of radon dose for the myeloid leukemia subgroup and 1.2503 (95% CI 1.0233-1.5276) for each 100 Bq/m3 increase of radon dose for adult leukemia subgroup. DISCUSSION A number of epidemiologic concepts, including the issue of sample size justification, the possibility of differential participation selection bias for case-control studies, the possibility of random and systematic errors in radon measurement, ecological fallacy for ecological studies, were discussed. The effect of age group, socioeconomic status, and gamma radiation exposure was also discussed. Future more accurate and conclusive large-scale case-control and cohort studies are needed.
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Affiliation(s)
- Jinyoung Moon
- Department of Environmental Health Science, Graduate School of Public Health, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea; Department of Occupational and Environmental Medicine, Seoul Saint Mary's Hospital, Banpo-daero 222, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - HyeKyoung Yoo
- Department of Environmental Health Science, Graduate School of Public Health, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea
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Soskolne CL, Kramer S, Ramos-Bonilla JP, Mandrioli D, Sass J, Gochfeld M, Cranor CF, Advani S, Bero LA. Toolkit for detecting misused epidemiological methods. Environ Health 2021; 20:90. [PMID: 34412643 PMCID: PMC8375462 DOI: 10.1186/s12940-021-00771-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/09/2021] [Indexed: 05/08/2023]
Abstract
BACKGROUND Critical knowledge of what we know about health and disease, risk factors, causation, prevention, and treatment, derives from epidemiology. Unfortunately, its methods and language can be misused and improperly applied. A repertoire of methods, techniques, arguments, and tactics are used by some people to manipulate science, usually in the service of powerful interests, and particularly those with a financial stake related to toxic agents. Such interests work to foment uncertainty, cast doubt, and mislead decision makers by seeding confusion about cause-and-effect relating to population health. We have compiled a toolkit of the methods used by those whose interests are not aligned with the public health sciences. Professional epidemiologists, as well as those who rely on their work, will thereby be more readily equipped to detect bias and flaws resulting from financial conflict-of-interest, improper study design, data collection, analysis, or interpretation, bringing greater clarity-not only to the advancement of knowledge, but, more immediately, to policy debates. METHODS The summary of techniques used to manipulate epidemiological findings, compiled as part of the 2020 Position Statement of the International Network for Epidemiology in Policy (INEP) entitled Conflict-of-Interest and Disclosure in Epidemiology, has been expanded and further elucidated in this commentary. RESULTS Some level of uncertainty is inherent in science. However, corrupted and incomplete literature contributes to confuse, foment further uncertainty, and cast doubt about the evidence under consideration. Confusion delays scientific advancement and leads to the inability of policymakers to make changes that, if enacted, would-supported by the body of valid evidence-protect, maintain, and improve public health. An accessible toolkit is provided that brings attention to the misuse of the methods of epidemiology. Its usefulness is as a compendium of what those trained in epidemiology, as well as those reviewing epidemiological studies, should identify methodologically when assessing the transparency and validity of any epidemiological inquiry, evaluation, or argument. The problems resulting from financial conflicting interests and the misuse of scientific methods, in conjunction with the strategies that can be used to safeguard public health against them, apply not only to epidemiologists, but also to other public health professionals. CONCLUSIONS This novel toolkit is for use in protecting the public. It is provided to assist public health professionals as gatekeepers of their respective specialty and subspecialty disciplines whose mission includes protecting, maintaining, and improving the public's health. It is intended to serve our roles as educators, reviewers, and researchers.
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Affiliation(s)
- Colin L Soskolne
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Shira Kramer
- Epidemiology International, Hunt Valley, MD, USA
| | | | - Daniele Mandrioli
- Cesare Maltoni Cancer Research Centre, Ramazzini Institute, Bologna, Italy
| | - Jennifer Sass
- Natural Resources Defense Council, Washington, DC, USA
- George Washington University, Washington, DC, USA
| | - Michael Gochfeld
- Environmental and Occupational Health Sciences Institute, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Carl F Cranor
- Departments of Philosophy and Environmental Toxicology, University of California, Riverside, CA, USA
| | - Shailesh Advani
- Terasaki Institute of Biomedical Innovation, Los Angeles, CA, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Lisa A Bero
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Miller MD, Golub MS, Marty MA. Gentry et al. (2021) integration of evidence to evaluate the potential for neurobehavioral effects following exposure to USFDA-approved food colors. Food Chem Toxicol 2021; 152:112211. [PMID: 33915229 DOI: 10.1016/j.fct.2021.112211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Mark D Miller
- Children's Environmental Health Center, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, California, USA.
| | - Mari S Golub
- Children's Environmental Health Center, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, California, USA
| | - Melanie A Marty
- Children's Environmental Health Center, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, California, USA
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Gentry R, Rodricks J, Clewell H, Greene T, Chappell G, Lea I, Borghoff S, Yang C, Rathman J, Ribeiro JV, Hobocienski B, Mostrag A. RE: Response to the Office of Environmental Health Hazard Assessment on comments related to Gentry et al. (2021). Food Chem Toxicol 2021; 152:112202. [PMID: 33872725 DOI: 10.1016/j.fct.2021.112202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Katoto PDMC, Brand AS, Bakan B, Obadia PM, Kuhangana C, Kayembe-Kitenge T, Kitenge JP, Nkulu CBL, Vanoirbeek J, Nawrot TS, Hoet P, Nemery B. Acute and chronic exposure to air pollution in relation with incidence, prevalence, severity and mortality of COVID-19: a rapid systematic review. Environ Health 2021; 20:41. [PMID: 33838685 PMCID: PMC8035877 DOI: 10.1186/s12940-021-00714-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/05/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Air pollution is one of the world's leading mortality risk factors contributing to seven million deaths annually. COVID-19 pandemic has claimed about one million deaths in less than a year. However, it is unclear whether exposure to acute and chronic air pollution influences the COVID-19 epidemiologic curve. METHODS We searched for relevant studies listed in six electronic databases between December 2019 and September 2020. We applied no language or publication status limits. Studies presented as original articles, studies that assessed risk, incidence, prevalence, or lethality of COVID-19 in relation with exposure to either short-term or long-term exposure to ambient air pollution were included. All patients regardless of age, sex and location diagnosed as having COVID-19 of any severity were taken into consideration. We synthesised results using harvest plots based on effect direction. RESULTS Included studies were cross-sectional (n = 10), retrospective cohorts (n = 9), ecological (n = 6 of which two were time-series) and hypothesis (n = 1). Of these studies, 52 and 48% assessed the effect of short-term and long-term pollutant exposure, respectively and one evaluated both. Pollutants mostly studied were PM2.5 (64%), NO2 (50%), PM10 (43%) and O3 (29%) for acute effects and PM2.5 (85%), NO2 (39%) and O3 (23%) then PM10 (15%) for chronic effects. Most assessed COVID-19 outcomes were incidence and mortality rate. Acutely, pollutants independently associated with COVID-19 incidence and mortality were first PM2.5 then PM10, NO2 and O3 (only for incident cases). Chronically, similar relationships were found for PM2.5 and NO2. High overall risk of bias judgments (86 and 39% in short-term and long-term exposure studies, respectively) was predominantly due to a failure to adjust aggregated data for important confounders, and to a lesser extent because of a lack of comparative analysis. CONCLUSION The body of evidence indicates that both acute and chronic exposure to air pollution can affect COVID-19 epidemiology. The evidence is unclear for acute exposure due to a higher level of bias in existing studies as compared to moderate evidence with chronic exposure. Public health interventions that help minimize anthropogenic pollutant source and socio-economic injustice/disparities may reduce the planetary threat posed by both COVID-19 and air pollution pandemics.
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Affiliation(s)
- Patrick D. M. C. Katoto
- Department of Medicine and Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
- Department of Internal Medicine, Division of Respiratory Medicine & Centre for Global Health and Tropical Diseases, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo
| | - Amanda S. Brand
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Buket Bakan
- Department of Molecular Biology and Genetics, Faculty of Science, Ataturk University, 25240 Erzurum, Turkey
| | - Paul Musa Obadia
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
- Unit of Toxicology and Environment, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Carsi Kuhangana
- Unit of Toxicology and Environment, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Department of Public Health, Faculty of Medicine and Public Health, University of Kolwezi, Kolwezi, Democratic Republic of the Congo
| | - Tony Kayembe-Kitenge
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
- Unit of Toxicology and Environment, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Joseph Pyana Kitenge
- Occupational Medicine and Environmental Health, Department of Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Celestin Banza Lubaba Nkulu
- Unit of Toxicology and Environment, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Jeroen Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
| | - Tim S. Nawrot
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
- Centre of Environmental Health, University of Hasselt, Hasselt, Belgium
| | - Peter Hoet
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
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Moon J. The effect of the heatwave on the morbidity and mortality of diabetes patients; a meta-analysis for the era of the climate crisis. ENVIRONMENTAL RESEARCH 2021; 195:110762. [PMID: 33515577 DOI: 10.1016/j.envres.2021.110762] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION From the perspective of public health, the climate crisis is also causing many health problems worldwide. In contrast with the cardiovascular, respiratory, and urinary system, the adverse effects of heatwaves on the endocrine system, particularly in people with diabetes mellitus (DM), are not well established to date. In this study, the author investigated the morbidity and mortality changes of DM patients during heatwave periods, using the meta-analysis method. METHODS The author searched MEDLINE, EMBASE, and the Cochrane Library until March 12, 2020. The quality of each included study was assessed using the National Institutes of Health (NIH) Quality Assessment tools. The meta-analysis was conducted using the studies with a relative risk (RR) estimate and odds ratio (OR) estimate. The subgroup analysis and the meta-ANOVA analysis were conducted using various covariates, including lag days considered. RESULTS Only 36 articles were included in the meta-analysis. The pooled RR of mortality and of morbidity for diabetics under the heatwave were 1.18 (95% CI 1.13-1.25) and 1.10 (95% CI 1.06-1.14). For mortality studies, whether or not the lag days considered were 10 days or more was only a significant covariate for the meta-ANOVA analysis (Q = 3.17, p = 0.075). For morbidity studies, the definition of the heatwave (Q = 65.94, p < 0.0001), whether or not the maximum temperature was 40 °C or more (Q = 4.78, p = 0.0288), and the type of morbidity (Q = 60.23, p < 0.0001) were significant covariates for the analysis. DISCUSSION The mortality and morbidity risks of diabetes patients under the heatwave were mildly increased by about 18 percent for mortality and 10 percent for overall morbidity. The mortality risk of diabetics can increase more when lag days of 10 days or more are considered than when lag days of less than 10 days are considered. These valuable findings can be used in developing public health strategies to cope with heatwaves in the current era of aggravating global warming and climate crisis.
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Affiliation(s)
- Jinyoung Moon
- Seoul National University Graduate School of Public Health, Department of Environmental Health Science, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea; Department of Occupational and Environmental Medicine, Seoul Saint Mary's Hospital, Republic of Korea.
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Pearce N, Vandenbroucke JP. Arguments about face masks and Covid-19 reflect broader methodologic debates within medical science. Eur J Epidemiol 2021; 36:143-147. [PMID: 33725291 PMCID: PMC7961168 DOI: 10.1007/s10654-021-00735-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/18/2021] [Indexed: 11/26/2022]
Abstract
There has perhaps been no issue as contentious in Covid-19 as face masks. The most contentious scientific debate has been between those who argue that "there is no scientific evidence", by which they mean that there are no randomized controlled trials (RCTs), versus those who argue that when the evidence is considered together, "the science supports that face coverings save lives". It used to be a 'given' that to decide whether a particular factor, either exogenous or endogenous, can cause a particular disease, and in what order of magnitude, one should consider all reasonably cogent evidence. This approach is being increasingly challenged, both scientifically and politically. The scientific challenge has come from methodologic views that focus on the randomized controlled trial (RCT) as the scientific gold standard, with priority being given, either to evidence from RCTs or to observational studies which closely mimic RCTs. The political challenge has come from various interests calling for the exclusion of epidemiological evidence from consideration by regulatory and advisory committees.
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Affiliation(s)
- Neil Pearce
- Department of Medical Statistics, London School
of Hygiene and Tropical Medicine, London, UK
| | - Jan Paul Vandenbroucke
- Department of Medical Statistics, London School
of Hygiene and Tropical Medicine, London, UK
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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Kitahara CM, Slettebø Daltveit D, Ekbom A, Engeland A, Gissler M, Glimelius I, Grotmol T, Trolle Lagerros Y, Madanat-Harjuoja L, Männistö T, Sørensen HT, Troisi R, Bjørge T. Maternal health, in-utero, and perinatal exposures and risk of thyroid cancer in offspring: a Nordic population-based nested case-control study. Lancet Diabetes Endocrinol 2021; 9:94-105. [PMID: 33347809 PMCID: PMC7875310 DOI: 10.1016/s2213-8587(20)30399-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Thyroid cancer tends to be diagnosed at a younger age (median age 51 years) compared with most other malignancies (such as breast cancer [62 years] or lung cancer [71 years]). The incidence of thyroid cancer is higher in women than men diagnosed from early adolescence. However, few in-utero and early life risk exposures associated with increased risk of thyroid cancer have been identified. METHODS In this population-based nested case-control study we used registry data from four Nordic countries to assess thyroid cancer risk in offspring in relation to maternal medical history, pregnancy complications, and birth characteristics. Patient with thyroid cancer (cases) were individuals born and subsequently diagnosed with first primary thyroid cancer from 1973 to 2013 in Denmark, 1987 to 2014 in Finland, 1967 to 2015 in Norway, or 1973 to 2014 in Sweden. Each case was matched with up to ten individuals without thyroid cancer (controls) based on birth year, sex, country, and county of birth. Cases and matched controls with a previous diagnosis of any cancer, other than non-melanoma skin cancer, at the time of thyroid cancer diagnosis were excluded. Cases and matched controls had to reside in the country of birth at the time of thyroid cancer diagnosis. Conditional logistic regression models were used to calculate odds ratios (ORs) with 95% CIs. RESULTS Of the 2437 cases, 1967 (81·4%) had papillary carcinomas, 1880 (77·1%) were women, and 1384 (56·7%) were diagnosed before age 30 years (range 0-48). Higher birth weight (OR per kg 1·14 [95% CI 1·05-1·23]) and congenital hypothyroidism (4·55 [1·58-13·08]); maternal diabetes before pregnancy (OR 1·69 [0·98-2·93]) and postpartum haemorrhage (OR 1·28 [1·06-1·55]); and (from registry data in Denmark) maternal hypothyroidism (18·12 [10·52-31·20]), hyperthyroidism (11·91 [6·77-20·94]), goiter (67·36 [39·89-113·76]), and benign thyroid neoplasms (22·50 [6·93-73·06]) were each associated with an increased risk of thyroid cancer in offspring. INTERPRETATION In-utero exposures, particularly those related to maternal thyroid disorders, might have a long-term influence on thyroid cancer risk in offspring. FUNDING Intramural Research Program of the National Cancer Institute (National Institutes of Health).
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Affiliation(s)
- Cari M Kitahara
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | | | - Anders Ekbom
- Department of Medicine, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Glimelius
- Department of Medicine, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Ylva Trolle Lagerros
- Department of Medicine, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Laura Madanat-Harjuoja
- Cancer Society of Finland, Finnish Cancer Registry, Helsinki, Finland; Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuija Männistö
- Northern Finland Laboratory Center NordLab, Oulu, Finland
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rebecca Troisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Cancer Registry of Norway, Oslo, Norway
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Cai Y, Ramakrishnan R, Rahimi K. Long-term exposure to traffic noise and mortality: A systematic review and meta-analysis of epidemiological evidence between 2000 and 2020. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 269:116222. [PMID: 33307398 DOI: 10.1016/j.envpol.2020.116222] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
We aimed to update the evidence-base of long-term noise exposures from road, rail, and aircraft traffic on both non-accidental and cardiovascular mortality. A systematic review and meta-analysis were conducted following PRISMA guidelines. The literature was searched using PubMed, Scopus, Web of Science, and EMBASE for the period between January 01, 2000 and October 05, 2020. 13 studies were selected for final review. The risk of bias and overall quality of evidence was evaluated using a pre-defined list of criteria. Risk estimates from each study were converted into per 10 dB higher of Lden for each traffic source. Inverse-Variance heterogeneity (I-Vhet) meta-analysis was used to pool these individual risk estimates, along with assessment of heterogeneity and publication bias. Sensitivity analyses include using random-effect model and leave-one-out meta-analysis. Subgroup analyses by study design and noise exposure assessment were conducted to explore potential sources of heterogeneity. For road traffic, the pooled relative risk (RR) per 10 dB higher Lden for mortality from non-accidental causes was 1.01 (95% CI: 0.98, 1.05) (5 studies, I2 = 78%), CVD was 1.01 (95% CI: 0.98, 1.05) (5 studies, I2 = 41%), ischemic heart disease (IHD) was 1.03 (95% CI: 0.99, 1.08) (7 studies, I2 = 46%), and stroke was 1.05 (95% CI: 0.97, 1.14) (5 studies, I2 = 62%). The overall quality of evidence for most meta-analyses was rated as very low to low, except for CVD or IHD mortality, for which the quality of evidence was rated as moderate. A possible threshold of 53 dB was visually suggested for CVD-related mortality from road traffic noise in the trend analysis. For aircraft noise, pooled estimates were based on fewer studies and varied by mortality outcomes. Evidence of long-term exposure to traffic noise on mortality remains weak except the association between road traffic noise and IHD mortality. High-quality longitudinal studies are required to better characterise mortality effects of traffic noise.
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Affiliation(s)
- Yutong Cai
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom; Deep Medicine Programme, Oxford Martin School, University of Oxford, Oxford, United Kingdom.
| | - Rema Ramakrishnan
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom; Deep Medicine Programme, Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Kazem Rahimi
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom; Deep Medicine Programme, Oxford Martin School, University of Oxford, Oxford, United Kingdom
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