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Guo F, Chen X, Howland S, Danza P, Niu Z, Gauderman WJ, Habre R, McConnell R, Yan M, Whitfield L, Li Y, Hodis HN, Breton CV, Bastain TM, Farzan SF. Perceived Stress From Childhood to Adulthood and Cardiometabolic End Points in Young Adulthood: An 18-Year Prospective Study. J Am Heart Assoc 2024; 13:e030741. [PMID: 38230530 PMCID: PMC11056127 DOI: 10.1161/jaha.123.030741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/27/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND We investigated how childhood-to-adulthood perceived stress patterns predict adult cardiometabolic risk. METHODS AND RESULTS This study included 276 participants from the Southern California Children's Health Study (2003-2014), and a follow-up assessment (2018-2021). Perceived stress (Perceived Stress Scale) was initially reported by participants' parents for themselves during early childhood (mean age, 6.3 years), and later self-reported during adolescence (13.3 years) and young adulthood (23.6 years). Participants were grouped into 4 stress patterns: consistently high, decreasing, increasing, and consistently low. Cardiometabolic risk was assessed in young adulthood by carotid artery intima-media thickness, systolic and diastolic blood pressure, obesity, percent body fat, android/gynoid ratio, and glycated hemoglobin. A cardiometabolic risk score was generated by summing the clinically abnormal markers. Multivariable linear and logistic regression models were used to (1) examine the associations between Perceived Stress Scale at 3 time points and adult cardiometabolic risk, and (2) assess the impact of stress pattern on adult cardiometabolic risk. Findings suggested that in adulthood, higher Perceived Stress Scale score was associated with increased overall cardiometabolic risk (β=0.12 [95% CI, 0.01-0.22]), carotid artery intima-media thickness (β=0.01 [95% CI, 0.0003-0.02]), systolic blood pressure (β=1.27 [95% CI, 0.09-2.45]), and diastolic blood pressure (β=0.94 [95% CI, 0.13-1.75]). Individuals with a consistently high adolescence-to-adulthood stress pattern had greater overall cardiometabolic risk (β=0.31 [95% CI, 0.02-0.60]), android/gynoid ratio (β=0.07 [95% CI, 0.02-0.13]), percent body fat (β=2.59 [95% CI, 0.01-5.17]), and greater odds of obesity (odds ratio, 5.57 [95% CI, 1.62-19.10]) in adulthood, compared with those with a consistently low Perceived Stress Scale score. CONCLUSIONS Consistently high perceived stress from adolescence to adulthood may contribute to greater cardiometabolic risk in young adulthood.
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Affiliation(s)
- Fangqi Guo
- Department of Population and Public Health Sciences, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Xinci Chen
- Department of Population and Public Health Sciences, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Steve Howland
- Department of Population and Public Health Sciences, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Phoebe Danza
- Department of Population and Public Health Sciences, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Zhongzheng Niu
- Department of Population and Public Health Sciences, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - W. James Gauderman
- Department of Population and Public Health Sciences, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Rima Habre
- Department of Population and Public Health Sciences, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Rob McConnell
- Department of Population and Public Health Sciences, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Mingzhu Yan
- Atherosclerosis Research UnitUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Lora Whitfield
- Atherosclerosis Research UnitUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Yanjie Li
- Atherosclerosis Research UnitUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Howard N. Hodis
- Atherosclerosis Research UnitUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Theresa M. Bastain
- Department of Population and Public Health Sciences, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Shohreh F. Farzan
- Department of Population and Public Health Sciences, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
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Weaver EB, Gad L, Zota AR. Climate change as a threat multiplier to environmental reproductive justice. Semin Perinatol 2023; 47:151843. [PMID: 37839904 PMCID: PMC10841484 DOI: 10.1016/j.semperi.2023.151843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Legacies of racial capitalism and colonialism drive present day racial disparities in perinatal health outcomes. Climate change amplifies existing social inequalities associated with environmental exposures and reproductive health, of which BIPOC (Black, Indigenous, and people of color) communities bear a disproportionate burden. Through case studies, this article summarizes three examples of climate justice issues with reproductive healthcare outcomes: traffic related air pollution exposure, chemical exposures in personal care products and plastics, and natural disaster frequency. We advocate for incorporation of climate justice and environmental health impact into medical school curriculum, increased prenatal screening for environmental toxins, and physician engagement with local environmental issues.
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Affiliation(s)
- Emily B Weaver
- Department of Environmental Health Sciences Mailman School of Public Health Columbia University New York NY 10032 United States
| | - Laila Gad
- Department of Environmental Health Sciences Mailman School of Public Health Columbia University New York NY 10032 United States
| | - Ami R Zota
- Department of Environmental Health Sciences Mailman School of Public Health Columbia University New York NY 10032 United States.
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Balogun AO, Weigel MM, Estévez E, Armijos RX. Chronic Occupational Exposure to Traffic Pollution Is Associated with Increased Carotid Intima-Media Thickness in Healthy Urban Traffic Control Police. Int J Environ Res Public Health 2023; 20:6701. [PMID: 37681841 PMCID: PMC10487607 DOI: 10.3390/ijerph20176701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
Urban traffic officers in many low- and middle-income countries are exposed to high levels of traffic-related air pollutants (TRAP) while working vehicle control on heavily congested streets. The impact of chronic TRAP exposure on the cardiovascular health, including the carotid intima-media thickness (CIMT), of this outdoor occupational group remains unclear. This cross-sectional study compared the average mean and maximum CIMT measurements of two groups of relatively young, healthy traffic police (32 ± 7 years; 77% male) in Quito, Ecuador, who were without clinical evidence of serious cardiovascular or other disease. Previously published background data on PM10 (a TRAP surrogate) indicated that street levels of the pollutant were several orders of magnitude higher at the street intersections worked by traffic police compared to those working only in an office. Accordingly, officers permanently assigned to daily traffic control duties requiring them to stand 0-3 m from heavily trafficked street intersections were assigned to the high exposure group (n = 61). The control group (n = 54) consisted of officers from the same organization who were permanently assigned to office duties inside an administration building. Mean and maximum CIMT were measured with ultrasound. General linear models were used to compare the CIMT measurements of the high exposure and control groups, adjusting for covariates. The adjusted average mean and maximum CIMT measures of the high exposure group were increased by 11.5% and 10.3%, respectively, compared to the control group (p = 0.0001). These findings suggest that chronic occupational exposure to TRAP is associated with increased CIMT in traffic police. This is important since even small increases in arterial thickening over time may promote earlier progression to clinical disease and increased premature mortality risk.
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Affiliation(s)
- Abdulrazak O. Balogun
- Department of Safety and Occupational Health Applied Sciences, Keene State College, Keene, NH 03431, USA;
| | - M. Margaret Weigel
- Department of Environmental & Occupational Health, School of Public Health, Indiana University-Bloomington, 1025 E. 7th Street, Bloomington, IN 47403, USA;
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, IN 47405, USA
- Center for Latin American & Caribbean Studies, Indiana University-Bloomington, Bloomington, IN 47405, USA
- IU Center for Global Health Equity, Indiana University, 702 Rotary Circle, Indianapolis, IN 46202, USA
| | - Edmundo Estévez
- Centro de Biomedicina, Universidad Central del Ecuador, Quito 170129, Ecuador;
- Postgraduate Program in Public Health, Universidad Autónoma Regional de los Andes (UNIANDES), Ambato 180150, Ecuador
| | - Rodrigo X. Armijos
- Department of Environmental & Occupational Health, School of Public Health, Indiana University-Bloomington, 1025 E. 7th Street, Bloomington, IN 47403, USA;
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, IN 47405, USA
- Center for Latin American & Caribbean Studies, Indiana University-Bloomington, Bloomington, IN 47405, USA
- IU Center for Global Health Equity, Indiana University, 702 Rotary Circle, Indianapolis, IN 46202, USA
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Abstract
As the world's population becomes increasingly urbanized, there is growing concern about the impact of urban environments on cardiovascular health. Urban residents are exposed to a variety of adverse environmental exposures throughout their lives, including air pollution, built environment, and lack of green space, which may contribute to the development of early cardiovascular disease and related risk factors. While epidemiological studies have examined the role of a few environmental factors with early cardiovascular disease, the relationship with the broader environment remains poorly defined. In this article, we provide a brief overview of studies that have examined the impact of the environment including the built physical environment, discuss current challenges in the field, and suggest potential directions for future research. Additionally, we highlight the clinical implications of these findings and propose multilevel interventions to promote cardiovascular health among children and young adults.
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Affiliation(s)
- Kai Zhang
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Robert D Brook
- Division of Cardiovascular Diseases, Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Yuanfei Li
- Department of Sociology, University at Albany, State University of New York, Albany, NY, USA
| | - Sanjay Rajagopalan
- Cardiovascular Research Institute, University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Juyong Brian Kim
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
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Han Z, Zhao X, Xu Z, Wang J, Jin R, Liu Y, Wu Z, Zhang J, Li X, Guo X, Tao L. Associations of time-weighted individual exposure to ambient particulate matter with carotid atherosclerosis in Beijing, China. Environ Health 2023; 22:45. [PMID: 37248518 DOI: 10.1186/s12940-023-00995-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/05/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Time-location information (time spent on commuting, indoors and outdoors around residential and work places and physical activity) and infiltrated outdoor pollution was less considered estimating individual exposure to ambient air pollution. Studies investigating the association between individual exposure to particulate matter (PM) with aerodynamic diameter < 10 μm (PM10) and < 2.5 μm (PM2.5) and carotid atherosclerosis presented inconsistent results. Moreover, combined effect of pollutants on carotid atherosclerosis was not fully explored. We aimed to investigate the association between long-term individual time-weighted average exposure to PM2.5 and PM10 and the risk of carotid atherosclerosis, and further explore the overall effect of co-exposure to pollutants on carotid atherosclerosis. METHODS The study population included 3069 participants derived from the Beijing Health Management Cohort (BHMC) study. Daily concentration of ambient air pollutants was estimated by land-use regression model at both residential and work addresses, and one- and two-year time-weighted average individual exposure was calculated by further considering personal activity pattern and infiltration of ambient air pollution indoors. We explored the association of PM2.5 and PM10 with carotid atherosclerosis and pooled the overall effect of co-exposure to ambient air pollutants by quantile g-computation. RESULTS A significant association between time-weighted average exposure to PM2.5 and PM10 and carotid atherosclerosis was observed. Per interquartile range increase in two-year exposure to PM2.5 (Hazard ratio (HR): 1.322, 95% confidence interval (CI): 1.219-1.434) and PM10 (HR:1.213, 95% CI: 1.116-1.319) showed the strongest association with carotid atherosclerosis, respectively. Individuals in higher quartiles of pollutants were at higher risk for carotid atherosclerosis compared with those in the lowest quartile group. Concentration response functions documented the nearly linear and nonlinear relationship and interpreted the upward trends of the risk for carotid atherosclerosis with increasing level of pollutant concentrations. Moreover, effect estimates for the mixture of pollutants and carotid atherosclerosis were larger than any of the individual pollutants (HR (95% CI) was 1.510 (1.338-1.704) and 1.613 (1.428-1.822) per quartile increase for one-year and two-year time-weighted average exposure, respectively). CONCLUSIONS Individual time-weighted average exposure to PM2.5 and PM10 was associated with carotid atherosclerosis. Co-exposure to ambient air pollution was also positively associated with carotid atherosclerosis.
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Affiliation(s)
- Ze Han
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Xiaoyu Zhao
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Zongkai Xu
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Jinqi Wang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Rui Jin
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Yueruijing Liu
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Zhiyuan Wu
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
- Department of Public Health, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Jie Zhang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Melbourne, 3086, Australia
| | - Xiuhua Guo
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China
| | - Lixin Tao
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmenWai, Fengtai District, Beijing, 100069, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
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Dondi A, Carbone C, Manieri E, Zama D, Del Bono C, Betti L, Biagi C, Lanari M. Outdoor Air Pollution and Childhood Respiratory Disease: The Role of Oxidative Stress. Int J Mol Sci 2023; 24. [PMID: 36901776 DOI: 10.3390/ijms24054345] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
The leading mechanisms through which air pollutants exert their damaging effects are the promotion of oxidative stress, the induction of an inflammatory response, and the deregulation of the immune system by reducing its ability to limit infectious agents' spreading. This influence starts in the prenatal age and continues during childhood, the most susceptible period of life, due to a lower efficiency of oxidative damage detoxification, a higher metabolic and breathing rate, and enhanced oxygen consumption per unit of body mass. Air pollution is involved in acute disorders like asthma exacerbations and upper and lower respiratory infections, including bronchiolitis, tuberculosis, and pneumoniae. Pollutants can also contribute to the onset of chronic asthma, and they can lead to a deficit in lung function and growth, long-term respiratory damage, and eventually chronic respiratory illness. Air pollution abatement policies, applied in the last decades, are contributing to mitigating air quality issues, but more efforts should be encouraged to improve acute childhood respiratory disease with possible positive long-term effects on lung function. This narrative review aims to summarize the most recent studies on the links between air pollution and childhood respiratory illness.
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Yim G, Reynaga L, Nunez V, Howe CG, Romano ME, Chen Y, Karagas MR, Toledo-Corral C, Farzan SF. Perinatal Metal and Metalloid Exposures and Offspring Cardiovascular Health Risk. Curr Environ Health Rep 2022; 9:714-34. [PMID: 35980568 DOI: 10.1007/s40572-022-00377-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Toxic metal exposures have been associated with cardiovascular disease in adults and growing evidence suggests metal exposures also adversely affect cardiovascular phenotypes in childhood and adolescence. However, to our knowledge, the influence of perinatal metals exposure, particularly metal mixtures, in relation to cardiovascular-related outcomes have not been comprehensively reviewed. RECENT FINDINGS We summarized 17 contemporary studies (2017-2021) that investigated the impact of perinatal metal exposures on measures of cardiovascular health in children. Accumulating evidence supports a potential adverse impact of perinatal Pb exposure on BP in children. Fewer recent studies have focused on perinatal As, Hg, and Cd; thus, the cardiovascular impacts of these metals are less clear. Studies of metal mixtures demonstrate that interactions between metals may be complex and have identified numerous understudied elements and essential metals, including Mo, Co, Ni, Se, Zn, and Mn, which may influence cardiovascular risk. A key question that remains is whether perinatal metals exposure influences cardiovascular health into adulthood. Comparisons across studies remain challenging due to several factors, including differences in the timing of exposure/outcome assessments and exposure biomarkers, as well as variability in exposure levels and mixture compositions across populations. Future studies longitudinally investigating trajectories of cardiovascular outcomes could help determine the influence of perinatal metals exposure on long-term effects of clinical relevance in later life and whether interventions, which reduce metals exposures during this key developmental window, could alter disease development.
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Farzan SF, Habre R, Danza P, Lurmann F, Gauderman WJ, Avol E, Bastain T, Hodis HN, Breton C. Correction: Childhood traffic-related air pollution and adverse changes in subclinical atherosclerosis measures from childhood to adulthood. Environ Health 2022; 21:110. [PMID: 36380345 PMCID: PMC9667685 DOI: 10.1186/s12940-022-00931-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Shohreh F Farzan
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA.
| | - Rima Habre
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
| | - Phoebe Danza
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
| | | | - W James Gauderman
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
| | - Edward Avol
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
| | - Theresa Bastain
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
| | - Howard N Hodis
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
- Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90089, USA
- Atherosclerosis Research Unit, University of Southern California, Los Angeles, CA, 90089, USA
| | - Carrie Breton
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
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Elkama A, Şüküroğlu AA, Çakmak G. Exposure to particulate matter: a brief review with a focus on cardiovascular effects, children, and research conducted in Turkey. Arh Hig Rada Toksikol 2021; 72:244-53. [PMID: 34985835 DOI: 10.2478/aiht-2021-72-3563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/01/2021] [Indexed: 11/20/2022] Open
Abstract
Exposure to environmental particulate matter (PM), outdoor air pollution in particular, has long been associated with adverse health effects. Today, PM has widely been accepted as a systemic toxicant showing adverse effects beyond the lungs. There are numerous studies, from those in vitro to epidemiological ones, suggesting various direct and indirect PM toxicity mechanisms associated with cardiovascular risks, including inflammatory responses, oxidative stress, changes in blood pressure, autonomic regulation of heart rate, suppression of endothelium-dependent vasodilation, thrombogenesis, myocardial infarction, and fibrinolysis. In addition to these and other health risks, considerations about air quality standards should include individual differences, lifestyle, and vulnerable populations such as children. Urban air pollution has been a major environmental issue for Turkey, and this review will also address current situation, research, and measures taken in our country.
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Chen Z, Huang BZ, Sidell MA, Chow T, Eckel SP, Pavlovic N, Martinez MP, Lurmann F, Thomas DC, Gilliland FD, Xiang AH. Near-roadway air pollution associated with COVID-19 severity and mortality - Multiethnic cohort study in Southern California. Environ Int 2021; 157:106862. [PMID: 34507232 PMCID: PMC8416551 DOI: 10.1016/j.envint.2021.106862] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/04/2021] [Accepted: 09/01/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Air pollution exposure has been associated with increased risk of COVID-19 incidence and mortality by ecological analyses. Few studies have investigated the specific effect of traffic-related air pollution on COVID-19 severity. OBJECTIVE To investigate the associations of near-roadway air pollution (NRAP) exposure with COVID-19 severity and mortality using individual-level exposure and outcome data. METHODS The retrospective cohort includes 75,010 individuals (mean age 42.5 years, 54% female, 66% Hispanic) diagnosed with COVID-19 at Kaiser Permanente Southern California between 3/1/2020-8/31/2020. NRAP exposures from both freeways and non-freeways during 1-year prior to the COVID-19 diagnosis date were estimated based on residential address history using the CALINE4 line source dispersion model. Primary outcomes include COVID-19 severity defined as COVID-19-related hospitalizations, intensive respiratory support (IRS), intensive care unit (ICU) admissions within 30 days, and mortality within 60 days after COVID-19 diagnosis. Covariates including socio-characteristics and comorbidities were adjusted for in the analysis. RESULT One standard deviation (SD) increase in 1-year-averaged non-freeway NRAP (0.5 ppb NOx) was associated with increased odds of COVID-19-related IRS and ICU admission [OR (95% CI): 1.07 (1.01, 1.13) and 1.11 (1.04, 1.19) respectively] and increased risk of mortality (HR = 1.10, 95% CI = 1.03, 1.18). The associations of non-freeway NRAP with COVID-19 outcomes were largely independent of the effect of regional fine particulate matter and nitrogen dioxide exposures. These associations were generally consistent across age, sex, and race/ethnicity subgroups. The associations of freeway and total NRAP with COVID-19 severity and mortality were not statistically significant. CONCLUSIONS Data from this multiethnic cohort suggested that NRAP, particularly non-freeway exposure in Southern California, may be associated with increased risk of COVID-19 severity and mortality among COVID-19 infected patients. Future studies are needed to assess the impact of emerging COVID-19 variants and chemical components from freeway and non-freeway NRAP.
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Affiliation(s)
- Zhanghua Chen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Brian Z Huang
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Margo A Sidell
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Ting Chow
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Sandrah P Eckel
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | | | - Mayra P Martinez
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | | | - Duncan C Thomas
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Frank D Gilliland
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Anny H Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
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