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Nagel G, Chen J, Jaensch A, Skodda L, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Katsouyanni K, Ketzel M, Leander K, Magnusson PKE, Pershagen G, Rizzuto D, Samoli E, Severi G, Stafoggia M, Tjønneland A, Vermeulen RCH, Wolf K, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O, Weinmayr G. Long-term exposure to air pollution and incidence of gastric and the upper aerodigestive tract cancers in a pooled European cohort: The ELAPSE project. Int J Cancer 2024; 154:1900-1910. [PMID: 38339851 DOI: 10.1002/ijc.34864] [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] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 02/12/2024]
Abstract
Air pollution has been shown to significantly impact human health including cancer. Gastric and upper aerodigestive tract (UADT) cancers are common and increased risk has been associated with smoking and occupational exposures. However, the association with air pollution remains unclear. We pooled European subcohorts (N = 287,576 participants for gastric and N = 297,406 for UADT analyses) and investigated the association between residential exposure to fine particles (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone in the warm season (O3w) with gastric and UADT cancer. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. During 5,305,133 and 5,434,843 person-years, 872 gastric and 1139 UADT incident cancer cases were observed, respectively. For gastric cancer, we found no association with PM2.5, NO2 and BC while for UADT the hazard ratios (95% confidence interval) were 1.15 (95% CI: 1.00-1.33) per 5 μg/m3 increase in PM2.5, 1.19 (1.08-1.30) per 10 μg/m3 increase in NO2, 1.14 (1.04-1.26) per 0.5 × 10-5 m-1 increase in BC and 0.81 (0.72-0.92) per 10 μg/m3 increase in O3w. We found no association between long-term ambient air pollution exposure and incidence of gastric cancer, while for long-term exposure to PM2.5, NO2 and BC increased incidence of UADT cancer was observed.
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Affiliation(s)
- Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Lea Skodda
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- iClimate - Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Faculty of Technical Sciences, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, UK
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, 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
| | - Anne Tjønneland
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Danish Cancer Institute, Copenhagen, Denmark
| | - Roel C H Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
- Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ole Raaschou-Nielsen
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- The Danish Cancer Institute, Copenhagen, Denmark
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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Kadelbach P, Weinmayr G, Chen J, Jaensch Dipl-Dok A, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Cesaroni G, Fecht D, Forastiere PF, Gulliver PJ, Hertel O, Hoffmann B, Hvidtfeldt UA, Katsouyanni PK, Ketzel M, Leander K, Ljungman P, Magnusson PKE, Pershagen G, Rizzuto D, Samoli E, Severi G, Stafoggia M, Tjønneland PA, Vermeulen R, Peters A, Wolf K, Raaschou-Nielsen PO, Brunekreef B, Hoek G, Zitt E, Nage PG. Long-term exposure to air pollution and chronic kidney disease-associated mortality - results from the pooled cohort of the European multicentre ELAPSE-study. Environ Res 2024:118942. [PMID: 38649012 DOI: 10.1016/j.envres.2024.118942] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/12/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024]
Abstract
Despite the known link between air pollution and cause-specific mortality, its relation to chronic kidney disease (CKD)-associated mortality is understudied. Therefore, we investigated the association between long-term exposure to air pollution and CKD-related mortality in a large multicentre population-based European cohort. Cohort data were linked to local mortality registry data. CKD-death was defined as ICD10 codes N18-N19 or corresponding ICD9 codes. Mean annual exposure at participant's home address was determined with fine spatial resolution exposure models for nitrogen dioxide (NO2), black carbon (BC), ozone (O3), particulate matter ≤2.5μm (PM2.5) and several elemental constituents of PM2.5. Cox regression models were adjusted for age, sex, cohort, calendar year of recruitment, smoking status, marital status, employment status and neighbourhood mean income. Over a mean follow-up time of 20.4 years, 313 of 289 564 persons died from CKD. Associations were positive for PM2.5 (hazard ratio (HR) with 95% confidence interval (CI) of 1.31 (1.03-1.66) per 5μg/m3, BC (1.26 (1.03-1.53) per 0.5×10- 5/m), NO2 (1.13 (0.93-1.38) per 10μg/m3) and inverse for O3 (0.71 (0.54-0.93) per 10μg/m3). Results were robust to further covariate adjustment. Exclusion of the largest sub-cohort contributing 226 cases, led to null associations. Among the elemental constituents, Cu, Fe, K, Ni, S and Zn, representing different sources including traffic, biomass and oil burning and secondary pollutants, were associated with CKD-related mortality. In conclusion, our results suggest an association between air pollution from different sources and CKD-related mortality.
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Affiliation(s)
- Pauline Kadelbach
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Giulia Cesaroni
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Prof Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - Prof John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Faculty of Technical Sciences, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Prof Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, 182 88 Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805, Villejuif, France
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Prof Anne Tjønneland
- The Danish Cancer Institute, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Prof Ole Raaschou-Nielsen
- The Danish Cancer Institute, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria; Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Prof Gabriele Nage
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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Ma Y, Nobile F, Marb A, Dubrow R, Kinney PL, Peters A, Stafoggia M, Breitner S, Chen K. Air pollution changes due to COVID-19 lockdowns and attributable mortality changes in four countries. Environ Int 2024; 187:108668. [PMID: 38640613 DOI: 10.1016/j.envint.2024.108668] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/20/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
COVID-19 lockdowns reduced nitrogen dioxide (NO2) and fine particulate matter (PM2.5) emissions in many countries. We aim to quantify the changes in these pollutants and to assess the attributable changes in mortality in Jiangsu, China; California, U.S.; Central-southern Italy; and Germany during COVID-19 lockdowns in early 2020. Accounting for meteorological impacts and air pollution time trends, we use a machine learning-based meteorological normalization technique and the difference-in-differences approach to quantify the changes in NO2 and PM2.5 concentrations due to lockdowns. Using region-specific estimates of the association between air pollution and mortality derived from a causal modeling approach using data from 2015 to 2019, we assess the changes in mortality attributable to the air pollution changes caused by the lockdowns in early 2020. During the lockdowns, NO2 reductions avoided 1.41 (95% empirical confidence interval [eCI]: 0.94, 1.88), 0.44 (95% eCI: 0.17, 0.71), and 4.66 (95% eCI: 2.03, 7.44) deaths per 100,000 people in Jiangsu, China; California, U.S.; and Central-southern Italy, respectively. Mortality benefits attributable to PM2.5 reductions were also significant, albeit of a smaller magnitude. For Germany, the mortality benefits attributable to NO2 changes were not significant (0.11; 95% eCI: -0.03, 0.25), and an increase in PM2.5 concentrations was associated with an increase in mortality of 0.35 (95% eCI: 0.22, 0.48) deaths per 100,000 people during the lockdown. COVID-19 lockdowns overall improved air quality and brought attributable health benefits, especially associated with NO2 improvements, with notable heterogeneity across regions. This study underscores the importance of accounting for local characteristics when policymakers adapt successful emission control strategies from other regions.
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Affiliation(s)
- Yiqun Ma
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA; Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT, USA
| | - Federica Nobile
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
| | - Anne Marb
- Chair of Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA; Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT, USA
| | - Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Annette Peters
- Chair of Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
| | - Susanne Breitner
- Chair of Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA; Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT, USA.
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Pedersen M, Nobile F, Stayner LT, de Hoogh K, Brandt J, Stafoggia M. Ambient air pollution and hypertensive disorders of pregnancy in Rome. Environ Res 2024; 251:118630. [PMID: 38452913 DOI: 10.1016/j.envres.2024.118630] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/25/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Ambient air pollution has been associated with hypertensive disorders of pregnancy (HDP), but few studies rely on assessment of fine-scale variation in air quality, specific subtypes and multi-pollutant exposures. AIM To study the impact of long-term exposure to individual and mixture of air pollutants on all and specific subtypes of HDP. METHODS We obtained data from 130,470 liveborn singleton pregnacies in Rome during 2014-2019. Spatiotemporal land-use random-forest models at 1 km spatial resolution assigned to the maternal residential addresses were used to estimate the exposure to particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), and ozone (O3). RESULTS For PM2.5, PM10 and NO2, there was suggestive evidence of increased risk of preeclampsia (PE, n = 442), but no evidence of increased risk for all subtypes of HDP (n = 2297) and gestational hypertension (GH, n = 1901). For instance, an interquartile range of 7.0 μg/m3 increase in PM2.5 exposure during the first trimester of pregnancy was associated with an odds ratio (OR) of 1.06 (95% confidence interval: 0.81, 1.39) and 1.04 (0.92, 1.17) after adjustment for NO2 and the corresponding results for a 15.7 μg/m3 increase in NO2 after adjustment for PM2.5 were 1.11 (0.92, 1.34) for PE and 0.83 (0.76, 0.90) for HDP. Increased risks for HDP and GH were suggested for O3 in single-pollutant models and for PM after adjustment for NO2, but all other associations were stable or attenuated in two-pollutant models. CONCLUSIONS The results of our study suggest that PM2.5, PM10 and NO2 increases the risk of PE and that these effects are robust to adjustment for O3 while the increased risks for GH and HDP suggested for O3 attenuated after adjustment for PM or NO2. Additional studies are needed to evaluate the effects of source-specific component of PM on subtypes as well as all types of HDP which would help to target preventive actions.
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Affiliation(s)
- Marie Pedersen
- Department of Epidemiology, Lazio Region Health Service/ASL Roma, Rome, Italy.
| | - Federica Nobile
- Department of Epidemiology, Lazio Region Health Service/ASL Roma, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Kees de Hoogh
- The Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Ma Y, Nobile F, Marb A, Dubrow R, Stafoggia M, Breitner S, Kinney PL, Chen K. Short-Term Exposure to Fine Particulate Matter and Nitrogen Dioxide and Mortality in 4 Countries. JAMA Netw Open 2024; 7:e2354607. [PMID: 38427355 PMCID: PMC10907920 DOI: 10.1001/jamanetworkopen.2023.54607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/22/2023] [Indexed: 03/02/2024] Open
Abstract
Importance The association between short-term exposure to air pollution and mortality has been widely documented worldwide; however, few studies have applied causal modeling approaches to account for unmeasured confounders that vary across time and space. Objective To estimate the association between short-term changes in fine particulate matter (PM2.5) and nitrogen dioxide (NO2) concentrations and changes in daily all-cause mortality rates using a causal modeling approach. Design, Setting, and Participants This cross-sectional study used air pollution and mortality data from Jiangsu, China; California; central-southern Italy; and Germany with interactive fixed-effects models to control for both measured and unmeasured spatiotemporal confounders. A total of 8 963 352 deaths in these 4 regions from January 1, 2015, to December 31, 2019, were included in the study. Data were analyzed from June 1, 2021, to October 30, 2023. Exposure Day-to-day changes in county- or municipality-level mean PM2.5 and NO2 concentrations. Main Outcomes and Measures Day-to-day changes in county- or municipality-level all-cause mortality rates. Results Among the 8 963 352 deaths in the 4 study regions, a 10-μg/m3 increase in daily PM2.5 concentration was associated with an increase in daily all-cause deaths per 100 000 people of 0.01 (95% CI, 0.001-0.01) in Jiangsu, 0.03 (95% CI, 0.004-0.05) in California, 0.10 (95% CI, 0.07-0.14) in central-southern Italy, and 0.04 (95% CI, 0.02- 0.05) in Germany. The corresponding increases in mortality rates for a 10-μg/m3 increase in NO2 concentration were 0.04 (95% CI, 0.03-0.05) in Jiangsu, 0.03 (95% CI, 0.01-0.04) in California, 0.10 (95% CI, 0.05-0.15) in central-southern Italy, and 0.05 (95% CI, 0.04-0.06) in Germany. Significant effect modifications by age were observed in all regions, by sex in Germany (eg, 0.05 [95% CI, 0.03-0.06] for females in the single-pollutant model of PM2.5), and by urbanicity in Jiangsu (0.07 [95% CI, 0.04-0.10] for rural counties in the 2-pollutant model of NO2). Conclusions and Relevance The findings of this cross-sectional study contribute to the growing body of evidence that increases in short-term exposures to PM2.5 and NO2 may be associated with increases in all-cause mortality rates. The interactive fixed-effects model, which controls for unmeasured spatial and temporal confounders, including unmeasured time-varying confounders in different spatial units, can be used to estimate associations between changes in short-term exposure to air pollution and changes in health outcomes.
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Affiliation(s)
- Yiqun Ma
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
- Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, Connecticut
| | - Federica Nobile
- Department of Epidemiology, Lazio Region Health Service ASL Roma 1, Rome, Italy
| | - Anne Marb
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
| | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
- Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, Connecticut
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service ASL Roma 1, Rome, Italy
| | - Susanne Breitner
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
| | - Patrick L. Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
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6
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Weinmayr G, Chen J, Jaensch A, Skodda L, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Katsouyanni K, Ketzel M, Leander K, Magnusson PKE, Pershagen G, Rizzuto D, Samoli E, Severi G, Stafoggia M, Tjønneland A, Vermeulen R, Wolf K, Zitt E, Brunekreef B, Thurston G, Hoek G, Raaschou-Nielsen O, Nagel G. Long-term exposure to several constituents and sources of PM 2.5 is associated with incidence of upper aerodigestive tract cancers but not gastric cancer: Results from the large pooled European cohort of the ELAPSE project. Sci Total Environ 2024; 912:168789. [PMID: 37996018 DOI: 10.1016/j.scitotenv.2023.168789] [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] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
It is unclear whether cancers of the upper aerodigestive tract (UADT) and gastric cancer are related to air pollution, due to few studies with inconsistent results. The effects of particulate matter (PM) may vary across locations due to different source contributions and related PM compositions, and it is not clear which PM constituents/sources are most relevant from a consideration of overall mass concentration alone. We therefore investigated the association of UADT and gastric cancers with PM2.5 elemental constituents and sources components indicative of different sources within a large multicentre population based epidemiological study. Cohorts with at least 10 cases per cohort led to ten and eight cohorts from five countries contributing to UADT- and gastric cancer analysis, respectively. Outcome ascertainment was based on cancer registry data or data of comparable quality. We assigned home address exposure to eight elemental constituents (Cu, Fe, K, Ni, S, Si, V and Zn) estimated from Europe-wide exposure models, and five source components identified by absolute principal component analysis (APCA). Cox regression models were run with age as time scale, stratified for sex and cohort and adjusted for relevant individual and neighbourhood level confounders. We observed 1139 UADT and 872 gastric cancer cases during a mean follow-up of 18.3 and 18.5 years, respectively. UADT cancer incidence was associated with all constituents except K in single element analyses. After adjustment for NO2, only Ni and V remained associated with UADT. Residual oil combustion and traffic source components were associated with UADT cancer persisting in the multiple source model. No associations were found for any of the elements or source components and gastric cancer incidence. Our results indicate an association of several PM constituents indicative of different sources with UADT but not gastric cancer incidence with the most robust evidence for traffic and residual oil combustion.
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Affiliation(s)
- Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Lea Skodda
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Faculty of Technical Sciences, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, UK
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805, Villejuif, France
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; The Danish Cancer Institute, Copenhagen, Denmark
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - George Thurston
- Division of Environmental Medicine, Depts of Medicine and Population Health, New York University Grossman School of Medicine, New York, USA
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ole Raaschou-Nielsen
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; The Danish Cancer Institute, Copenhagen, Denmark
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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7
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Domingo NG, Fiore AM, Lamarque JF, Kinney PL, Jiang L, Gasparrini A, Breitner S, Lavigne E, Madureira J, Masselot P, das Neves Pereira da Silva S, Sheng Ng CF, Kyselý J, Guo Y, Tong S, Kan H, Urban A, Orru H, Maasikmets M, Pascal M, Katsouyanni K, Samoli E, Scortichini M, Stafoggia M, Hashizume M, Alahmad B, Diaz MH, la Cruz Valencia CD, Scovronick N, Garland RM, Kim H, Lee W, Tobias A, Íñiguez C, Forsberg B, Åström C, Ragettli MS, Guo YL, Pan SC, Colistro V, Bell M, Zanobetti A, Schwartz J, Schneider A, Vicedo-Cabrera AM, Chen K. Ozone-related acute excess mortality projected to increase in the absence of climate and air quality controls consistent with the Paris Agreement. One Earth 2024; 7:325-335. [PMID: 38420618 PMCID: PMC7615682 DOI: 10.1016/j.oneear.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Short-term exposure to ground-level ozone in cities is associated with increased mortality and is expected to worsen with climate and emission changes. However, no study has yet comprehensively assessed future ozone-related acute mortality across diverse geographic areas, various climate scenarios, and using CMIP6 multi-model ensembles, limiting our knowledge on future changes in global ozone-related acute mortality and our ability to design targeted health policies. Here, we combine CMIP6 simulations and epidemiological data from 406 cities in 20 countries or regions. We find that ozone-related deaths in 406 cities will increase by 45 to 6,200 deaths/year between 2010 and 2014 and between 2050 and 2054, with attributable fractions increasing in all climate scenarios (from 0.17% to 0.22% total deaths), except the single scenario consistent with the Paris Climate Agreement (declines from 0.17% to 0.15% total deaths). These findings stress the need for more stringent air quality regulations, as current standards in many countries are inadequate.
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Affiliation(s)
- Nina G.G. Domingo
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT 06510, USA
- Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT 06510, USA
| | - Arlene M. Fiore
- Department of Earth, Atmospheric, and Planetary Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jean-Francois Lamarque
- Climate and Global Dynamics Laboratory, National Center for Atmospheric Research, Boulder, CO, USA
| | - Patrick L. Kinney
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02118, USA
| | - Leiwen Jiang
- Asian Demographic Research Institute, Shanghai University, Shanghai 200444, China
- Population Council, New York, NY 10017, USA
| | - Antonio Gasparrini
- Environment & Health Modelling (EHM) Lab, Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Susanne Breitner
- IBE-Chair of Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany
| | - Eric Lavigne
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Environmental Health and Science Bureau, Heatlh Canada, Ottawa, ON, Canada
| | - Joana Madureira
- Environmental Health Department of the National Health Institute of Health Dr. Ricardo Jorge, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Pierre Masselot
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, NSW, Australia
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, NSW, Australia
| | - Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- School of Public Health and Institute of Environment and Human Health, Anhui Medical University, Hefei, China
- Shanghai Children’s Medical Centre, Shanghai Jiao-Tong University, Shanghai, China
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Aleš Urban
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Hans Orru
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Mathilde Pascal
- Santé Publique France, Department of Environmental Health, French National Public Health Agency, Saint Maurice, France
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
- Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Barrak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Magali Hurtado Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - César De la Cruz Valencia
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Noah Scovronick
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rebecca M. Garland
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Whanhee Lee
- Department of Occupational and Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- Institute of Ewha-SCL for Environmental Health (IESEH), Seoul, Republic of Korea
| | - Aurelio Tobias
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - Carmen Íñiguez
- Department of Statistics and Computational Research, Universitat de València, València, Spain
- Ciberesp, Madrid, Spain
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Martina S. Ragettli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Yue Leon Guo
- Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital, Taipei, Taiwan
| | - Shih-Chun Pan
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
| | - Valentina Colistro
- The Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Quantitative Methods, School of Medicine, University of the Republic, Montevideo, Uruguay
| | - Michelle Bell
- School of the Environment, Yale University, New Haven, CT, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany
| | - Ana M. Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT 06510, USA
- Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT 06510, USA
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8
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Taj T, Chen J, Rodopoulou S, Strak M, de Hoogh K, Poulsen AH, Andersen ZJ, Bellander T, Brandt J, Zitt E, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Jørgensen JT, Katsouyanni K, Ketzel M, Lager A, Leander K, Liu S, Ljungman P, Severi G, Besson C, Magnusson PKE, Nagel G, Pershagen G, Peters A, Rizzuto D, Samoli E, Sørensen M, Stafoggia M, Tjønneland A, Weinmayr G, Wolf K, Brunekreef B, Hoek G, Raaschou-Nielsen O. Long-term exposure to ambient air pollution and risk of leukemia and lymphoma in a pooled European cohort. Environ Pollut 2024; 343:123097. [PMID: 38065336 DOI: 10.1016/j.envpol.2023.123097] [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] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/08/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
Leukemia and lymphoma are the two most common forms of hematologic malignancy, and their etiology is largely unknown. Pathophysiological mechanisms suggest a possible association with air pollution, but little empirical evidence is available. We aimed to investigate the association between long-term residential exposure to outdoor air pollution and risk of leukemia and lymphoma. We pooled data from four cohorts from three European countries as part of the "Effects of Low-level Air Pollution: a Study in Europe" (ELAPSE) collaboration. We used Europe-wide land use regression models to assess annual mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone (O3) at residences. We also estimated concentrations of PM2.5 elemental components: copper (Cu), iron (Fe), zinc (Zn); sulfur (S); nickel (Ni), vanadium (V), silicon (Si) and potassium (K). We applied Cox proportional hazards models to investigate the associations. Among the study population of 247,436 individuals, 760 leukemia and 1122 lymphoma cases were diagnosed during 4,656,140 person-years of follow-up. The results showed a leukemia hazard ratio (HR) of 1.13 (95% confidence intervals [CI]: 1.01-1.26) per 10 μg/m3 NO2, which was robust in two-pollutant models and consistent across the four cohorts and according to smoking status. Sex-specific analyses suggested that this association was confined to the male population. Further, the results showed increased lymphoma HRs for PM2.5 (HR = 1.16; 95% CI: 1.02-1.34) and potassium content of PM2.5, which were consistent in two-pollutant models and according to sex. Our results suggest that air pollution at the residence may be associated with adult leukemia and lymphoma.
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Affiliation(s)
- Tahir Taj
- Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | | | - Zorana J Andersen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark.
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria.
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom.
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom.
| | - Ole Hertel
- Department of Ecoscience, Aarhus University, Roskilde, Denmark.
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany.
| | | | - Jeanette T Jørgensen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom.
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Shuo Liu
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805, Villejuif, France; Department of Statistics, Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy.
| | - Caroline Besson
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805, Villejuif, France.
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Chair of Epidemiology, Ludwig Maximilians Universität München, Munich, Germany.
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Mette Sørensen
- Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark.
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy.
| | - Anne Tjønneland
- Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Ole Raaschou-Nielsen
- Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark.
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9
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de Bont J, Nori-Sarma A, Stafoggia M, Banerjee T, Ingole V, Jaganathan S, Mandal S, Rajiva A, Krishna B, Kloog I, Lane K, Mall RK, Tiwari A, Wei Y, Wellenius GA, Prabhakaran D, Schwartz J, Prabhakaran P, Ljungman P. Impact of heatwaves on all-cause mortality in India: A comprehensive multi-city study. Environ Int 2024; 184:108461. [PMID: 38340402 DOI: 10.1016/j.envint.2024.108461] [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: 10/24/2023] [Revised: 01/12/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Heatwaves are expected to increase with climate change, posing a significant threat to population health. In India, with the world's largest population, heatwaves occur annually but have not been comprehensively studied. Accordingly, we evaluated the association between heatwaves and all-cause mortality and quantifying the attributable mortality fraction in India. METHODS We obtained all-cause mortality counts for ten cities in India (2008-2019) and estimated daily mean temperatures from satellite data. Our main extreme heatwave was defined as two-consecutive days with an intensity above the 97th annual percentile. We estimated city-specific heatwave associations through generalised additive Poisson regression models, and meta-analysed the associations. We reported effects as the percentage change in daily mortality, with 95% confidence intervals (CI), comparing heatwave vs non-heatwave days. We further evaluated heatwaves using different percentiles (95th, 97th, 99th) for one, two, three and five-consecutive days. We also evaluated the influence of heatwave duration, intensity and timing in the summer season on heatwave mortality, and estimated the number of heatwave-related deaths. FINDINGS Among ∼ 3.6 million deaths, we observed that temperatures above 97th percentile for 2-consecutive days was associated with a 14.7 % (95 %CI, 10.3; 19.3) increase in daily mortality. Alternative heatwave definitions with higher percentiles and longer duration resulted in stronger relative risks. Furthermore, we observed stronger associations between heatwaves and mortality with higher heatwave intensity. We estimated that around 1116 deaths annually (95 %CI, 861; 1361) were attributed to heatwaves. Shorter and less intense definitions of heatwaves resulted in a higher estimated burden of heatwave-related deaths. CONCLUSIONS We found strong evidence of heatwave impacts on daily mortality. Longer and more intense heatwaves were linked to an increased mortality risk, however, resulted in a lower burden of heatwave-related deaths. Both definitions and the burden associated with each heatwave definition should be incorporated into planning and decision-making processes for policymakers.
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Affiliation(s)
- Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Amruta Nori-Sarma
- Center for Climate and Health, Boston University School of Public Health, Boston, MA, United States
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service /ASL Roma 1, Rome, Italy
| | - Tirthankar Banerjee
- Institute of Environment and Sustainable Development, Banaras Hindu University, Varanasi, India
| | - Vijendra Ingole
- Office for National Statistics, Wales, Newport, United Kingdom
| | - Suganthi Jaganathan
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | - Siddhartha Mandal
- Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | - Ajit Rajiva
- Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | | | - Itai Kloog
- Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin Lane
- Center for Climate and Health, Boston University School of Public Health, Boston, MA, United States
| | - Rajesh K Mall
- DST-Mahamana Center of Excellence in Climate Change Research, Institute of Environment and Sustainable Futures Collaborative, New Delhi, India
| | | | - Yaguang Wei
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gregory A Wellenius
- Center for Climate and Health, Boston University School of Public Health, Boston, MA, United States
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Poornima Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Ashoka University, Sonipat, India
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
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10
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Zafeiratou S, Samoli E, Analitis A, Dimakopoulou K, Giannakopoulos C, Varotsos KV, Schneider A, Stafoggia M, Aunan K, Katsouyanni K. Modification of heat-related effects on mortality by air pollution concentration, at small-area level, in the Attica prefecture, Greece. Environ Health 2024; 23:10. [PMID: 38267931 PMCID: PMC10809516 DOI: 10.1186/s12940-024-01053-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND The independent effects of short-term exposure to increased air temperature and air pollution on mortality are well-documented. There is some evidence indicating that elevated concentrations of air pollutants may lead to increased heat-related mortality, but this evidence is not consistent. Most of these effects have been documented through time-series studies using city-wide data, rather than at a finer spatial level. In our study, we examined the possible modification of the heat effects on total and cause-specific mortality by air pollution at municipality level in the Attica region, Greece, during the warm period of the years 2000 to 2016. METHODS A municipality-specific over-dispersed Poisson regression model during the warm season (May-September) was used to investigate the heat effects on mortality and their modification by air pollution. We used the two-day average of the daily mean temperature and daily mean PM10, NO2 and 8 hour-max ozone (O3), derived from models, in each municipality as exposures. A bivariate tensor smoother was applied for temperature and each pollutant alternatively, by municipality. Α random-effects meta-analysis was used to obtain pooled estimates of the heat effects at different pollution levels. Heterogeneity of the between-levels differences of the heat effects was evaluated with a Q-test. RESULTS A rise in mean temperature from the 75th to the 99th percentile of the municipality-specific temperature distribution resulted in an increase in total mortality of 12.4% (95% Confidence Interval (CI):7.76-17.24) on low PM10 days, and 21.25% (95% CI: 17.83-24.76) on high PM10 days. The increase on mortality was 10.09% (95% CI: - 5.62- 28.41) on low ozone days, and 14.95% (95% CI: 10.79-19.27) on high ozone days. For cause-specific mortality an increasing trend of the heat effects with increasing PM10 and ozone levels was also observed. An inconsistent pattern was observed for the modification of the heat effects by NO2, with higher heat effects estimated in the lower level of the pollutant. CONCLUSIONS Our results support the evidence of elevated heat effects on mortality at higher levels of PM10 and 8 h max O3. Under climate change, any policy targeted at lowering air pollution levels will yield significant public health benefits.
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Affiliation(s)
- Sofia Zafeiratou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Analitis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Giannakopoulos
- Institute for Environmental Research and Sustainable Development, National Observatory of Athens, Athens, Greece
| | - Konstantinos V Varotsos
- Institute for Environmental Research and Sustainable Development, National Observatory of Athens, Athens, Greece
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München (HMGU), Neuherberg, Germany
| | - Massimo Stafoggia
- Department of Epidemiology of the Lazio Region Health Service (ASL ROMA 1), Rome, Italy
| | - Kristin Aunan
- CICERO Center for International Climate Research, Oslo, Norway
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
- Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, London, UK.
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11
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Squillacioti G, Bellisario V, Ghelli F, Marcon A, Marchetti P, Corsico AG, Pirina P, Maio S, Stafoggia M, Verlato G, Bono R. Air pollution and oxidative stress in adults suffering from airway diseases. Insights from the Gene Environment Interactions in Respiratory Diseases (GEIRD) multi-case control study. Sci Total Environ 2024; 909:168601. [PMID: 37977381 DOI: 10.1016/j.scitotenv.2023.168601] [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: 09/14/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
Air pollution is a leading risk factor for global mortality and morbidity. Oxidative stress is a key mechanism underlying air-pollution-mediated health effects, especially in the pathogenesis/exacerbation of airway impairments. However, evidence lacks on subgroups at higher risk of developing more severe outcomes in response to air pollution. This multi-centre study aims to evaluate the association between air pollution and oxidative stress in healthy adults and in patients affected by airway diseases from the Italian GEIRD (Gene Environment Interactions in Respiratory Diseases) multi-case control study. Overall, 1841 adults (49 % females, 20-83 years) were included from four Italian centres: Pavia, Sassari, Turin, and Verona. Following a 2-stage screening process, we identified 1273 cases of asthma, chronic bronchitis, rhinitis, or COPD and 568 controls. Systemic oxidative stress was quantified by urinary 8-isoprostane and 8-OH-dG. Individual residential exposures to NO2, PM10, PM2.5, and O3 were derived using an innovative five-stage machine-learning-based approach. Linear mixed regression models tested the association between oxidative stress biomarkers and air pollution tertiles, adjusting by age, sex, BMI, smoking, education and season, with recruiting centres as random intercept. Only cases exhibited higher levels of log-transformed 8-isoprostane and 8-OH-dG in association with NO2 (β: 0.30 95 % CI: 0.08-0.52 and 0.20 95 % CI: 0.03-0.37), PM10 (0.34 95 % CI: 0.12-0.55 and 0.21 95 % CI: 0.05-0.37) and PM2.5 (0.27 95 % CI: 0.09-0.49 and 0.18 95 % CI: 0.02-0.34) as compared to the first tertile of exposure. No significant associations were observed for summer O3. Our findings suggest that exposure to air pollution may increase systemic oxidative stress levels in people suffering from airway diseases. This introduces a potential novel approach available for future epidemiological studies and Public Health for effective prevention strategies oriented at the quantification of early biological effects in susceptible people, whose additional risk level might be currently underrated. Air-pollution-mediated exacerbations, driven by oxidative stress, still deserve our attention.
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Affiliation(s)
- Giulia Squillacioti
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy.
| | - Valeria Bellisario
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy.
| | - Federica Ghelli
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy.
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Angelo G Corsico
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; SC Pneumologia, Fondazione IRCCS Policlinico San Matteo, Italy.
| | - Pietro Pirina
- Clinical and Interventional Pulmonology, University Hospital Sassari (AOU), Sassari, Italy; Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
| | - Sara Maio
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.
| | - Massimo Stafoggia
- Department of Epidemiology of the Lazio Region Health Service, ASL Roma 1, Rome, Italy.
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy.
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12
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Dimakopoulou K, Nobile F, de Bont J, Wolf K, Vienneau D, Ibi D, Coloma F, Pickford R, Åström C, Sommar JN, Kasdagli MI, Souliotis K, Tsolakidis A, Tonne C, Melén E, Ljungman P, de Hoogh K, Vermeulen RCH, Vlaanderen JJ, Katsouyanni K, Stafoggia M, Samoli E. Disentangling associations between multiple environmental exposures and all-cause mortality: an analysis of European administrative and traditional cohorts. Front Epidemiol 2024; 3:1328188. [PMID: 38455945 PMCID: PMC10910955 DOI: 10.3389/fepid.2023.1328188] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 03/09/2024]
Abstract
Background We evaluated the independent and joint effects of air pollution, land/built environment characteristics, and ambient temperature on all-cause mortality as part of the EXPANSE project. Methods We collected data from six administrative cohorts covering Catalonia, Greece, the Netherlands, Rome, Sweden, and Switzerland and three traditional cohorts in Sweden, the Netherlands, and Germany. Participants were linked to spatial exposure estimates derived from hybrid land use regression models and satellite data for: air pollution [fine particulate matter (PM2.5), nitrogen dioxide (NO₂), black carbon (BC), warm season ozone (O3)], land/built environment [normalized difference vegetation index (NDVI), distance to water, impervious surfaces], and ambient temperature (the mean and standard deviation of warm and cool season temperature). We applied Cox proportional hazard models accounting for several cohort-specific individual and area-level variables. We evaluated the associations through single and multiexposure models, and interactions between exposures. The joint effects were estimated using the cumulative risk index (CRI). Cohort-specific hazard ratios (HR) were combined using random-effects meta-analyses. Results We observed over 3.1 million deaths out of approximately 204 million person-years. In administrative cohorts, increased exposure to PM2.5, NO2, and BC was significantly associated with all-cause mortality (pooled HRs: 1.054, 1.033, and 1.032, respectively). We observed an adverse effect of increased impervious surface and mean season-specific temperature, and a protective effect of increased O3, NDVI, distance to water, and temperature variation on all-cause mortality. The effects of PM2.5 were higher in areas with lower (10th percentile) compared to higher (90th percentile) NDVI levels [pooled HRs: 1.054 (95% confidence interval (CI) 1.030-1.079) vs. 1.038 (95% CI 0.964-1.118)]. A similar pattern was observed for NO2. The CRI of air pollutants (PM2.5 or NO2) plus NDVI and mean warm season temperature resulted in a stronger effect compared to single-exposure HRs: [PM2.5 pooled HR: 1.061 (95% CI 1.021-1.102); NO2 pooled HR: 1.041 (95% CI 1.025-1.057)]. Non-significant effects of similar patterns were observed in traditional cohorts. Discussion The findings of our study not only support the independent effects of long-term exposure to air pollution and greenness, but also highlight the increased effect when interplaying with other environmental exposures.
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Affiliation(s)
- Konstantina Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Federica Nobile
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Danielle Vienneau
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Dorina Ibi
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
| | - Fabián Coloma
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Regina Pickford
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Johan Nilsson Sommar
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Maria-Iosifina Kasdagli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriakos Souliotis
- Department of Social and Education Policy, University of Peloponnese, Corinth, Greece
- Health Policy Institute, Athens, Greece
| | | | - Cathryn Tonne
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Erik Melén
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachś Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Kees de Hoogh
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Roel C. H. Vermeulen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
| | - Jelle J. Vlaanderen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, United Kingdom NIHR HPRU in Environmental Exposures and Health, Imperial College London, London, United Kingdom
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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13
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Hvidtfeldt UA, Chen J, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Forastiere F, Brynedal B, Hertel O, Hoffmann B, Katsouyanni K, Ketzel M, Leander K, Magnusson PKE, Nagel G, Pershagen G, Rizzuto D, Samoli E, So R, Stafoggia M, Tjønneland A, Weinmayr G, Wolf K, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O. Multiple myeloma risk in relation to long-term air pollution exposure - A pooled analysis of four European cohorts. Environ Res 2023; 239:117230. [PMID: 37806476 DOI: 10.1016/j.envres.2023.117230] [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: 07/03/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Air pollution is a growing concern worldwide, with significant impacts on human health. Multiple myeloma is a type of blood cancer with increasing incidence. Studies have linked air pollution exposure to various types of cancer, including leukemia and lymphoma, however, the relationship with multiple myeloma incidence has not been extensively investigated. METHODS We pooled four European cohorts (N = 234,803) and assessed the association between residential exposure to nitrogen dioxide (NO2), fine particles (PM2.5), black carbon (BC), and ozone (O3) and multiple myeloma. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. RESULTS During 4,415,817 person-years of follow-up (average 18.8 years), we observed 404 cases of multiple myeloma. The results of the fully adjusted linear analyses showed hazard ratios (95% confidence interval) of 0.99 (0.84, 1.16) per 10 μg/m³ NO2, 1.04 (0.82, 1.33) per 5 μg/m³ PM2.5, 0.99 (0.84, 1.18) per 0.5 10-5 m-1 BCE, and 1.11 (0.87, 1.41) per 10 μg/m³ O3. CONCLUSIONS We did not observe an association between long-term ambient air pollution exposure and incidence of multiple myeloma.
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Affiliation(s)
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - Boel Brynedal
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ole Hertel
- Departments of Ecoscience, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, GU2 7XH, United Kingdom
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, And Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rina So
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- The Danish Cancer Institute, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ole Raaschou-Nielsen
- The Danish Cancer Institute, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
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14
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Nikolaou N, Bouwer LM, Dallavalle M, Valizadeh M, Stafoggia M, Peters A, Wolf K, Schneider A. Improved daily estimates of relative humidity at high resolution across Germany: A random forest approach. Environ Res 2023; 238:117173. [PMID: 37734577 DOI: 10.1016/j.envres.2023.117173] [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: 02/08/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 09/23/2023]
Abstract
The lack of readily available methods for estimating high-resolution near-surface relative humidity (RH) and the incapability of weather stations to fully capture the spatiotemporal variability can lead to exposure misclassification in studies of environmental epidemiology. We therefore aimed to predict German-wide 1 × 1 km daily mean RH during 2000-2021. RH observations, longitude and latitude, modelled air temperature, precipitation and wind speed as well as remote sensing information on topographic elevation, vegetation, and the true color band composite were incorporated in a Random Forest (RF) model, in addition to date for capturing the temporal variations of the response-explanatory variables relationship. The model achieved high accuracy (R2 = 0.83) and low errors (Root Mean Square Error (RMSE) of 5.07%, Mean Absolute Percentage Error (MAPE) of 5.19% and Mean Percentage Error (MPE) of - 0.53%), calculated via ten-fold cross-validation. A comparison of our RH predictions with measurements from a dense monitoring network in the city of Augsburg, South Germany confirmed the good performance (R2 ≥ 0.86, RMSE ≤ 5.45%, MAPE ≤ 5.59%, MPE ≤ 3.11%). The model displayed high German-wide RH (22y-average of 79.00%) and high spatial variability across the country, exceeding 12% on yearly averages. Our findings indicate that the proposed RF model is suitable for estimating RH for a whole country in high-resolution and provide a reliable RH dataset for epidemiological analyses and other environmental research purposes.
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Affiliation(s)
- Nikolaos Nikolaou
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany.
| | - Laurens M Bouwer
- Climate Service Center Germany (GERICS), Helmholtz-Zentrum Hereon, Hamburg, Germany.
| | - Marco Dallavalle
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany.
| | - Mahyar Valizadeh
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service - ASL Roma 1, Rome, Italy.
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany.
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
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15
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Spano G, Nobile F, Giannico V, Elia M, Michelozzi P, Bosco A, Dadvand P, Sanesi G, Stafoggia M. Two- and three-dimensional indicators of green and grey space exposure and psychiatric conditions and medicine use: A longitudinal study in a large population-based Italian cohort. Environ Int 2023; 182:108320. [PMID: 37976839 DOI: 10.1016/j.envint.2023.108320] [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: 08/03/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Evidence available on the associations between urban greenness and mental health is mainly based on cross-sectional studies and has relied on 2D indicators of greenness. This longitudinal study aimed at investigating the association between 2D and 3D indicators of green and grey spaces and incident mental health-related outcomes in a large population-based cohort. METHODS Our study used data from 593,894 Italian adults (≥30 years) from the Rome Longitudinal Study. Mental health outcomes were defined using either drug prescriptions (antidepressants, antipsychotics, lithium and other mood stabilisers, and anxiolytics, hypnotics and sedatives), or hospitalisation records (for schizophrenia spectrum disorder, depression, anxiety, stress-related and somatoform, or substance use disorders). We obtained 2D and 3D indicators of green and grey exposures including Normalized Difference Vegetation Index (NDVI), green volume, grey volume, number of trees, and Normalized Difference Green-Grey Volume Index around participants' homes. Cox proportional hazards regression models were developed to estimate the association of green and grey space exposure and psychiatric conditions and medicine use, adjusted for relevant covariates. RESULTS We found beneficial associations of NDVI and the number of trees with antipsychotic and lithium and other mood stabiliser drugs. We also observed detrimental associations between grey volume and lithium and other mood stabilisers and anxiolytic, hypnotic and sedative drugs. Finally, we found a protective association of the NDGG with lithium and other mood stabilisers (HR: 0.977; 95% CI: 0.965-0.990) and anxiolytic, hypnotic and sedative drugs (HR: 0.851; 95% CI: 0.762-0.950). The associations for hospitalisation for psychiatric conditions were less consistent and generally not statistically significant. CONCLUSIONS Findings suggested that higher greenness areas around residential addresses are associated with reduced use of drugs for psychiatric conditions, while the opposite is true for higher grey space exposure. The study highlights the importance of accurately characterising green and grey spaces, using novel exposure indicators.
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Affiliation(s)
- Giuseppina Spano
- Department of Education, Psychology, Communication Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Federica Nobile
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy
| | - Vincenzo Giannico
- Department of Education, Psychology, Communication Sciences, University of Bari Aldo Moro, Bari, Italy.
| | - Mario Elia
- Department of Soil, Plant and Food Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy
| | - Andrea Bosco
- Department of Education, Psychology, Communication Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Payam Dadvand
- ISGlobal, Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029 Madrid, Spain
| | - Giovanni Sanesi
- Department of Soil, Plant and Food Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy
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Chen J, Braun D, Christidis T, Cork M, Rodopoulou S, Samoli E, Stafoggia M, Wolf K, Wu X, Yuchi W, Andersen ZJ, Atkinson R, Bauwelinck M, de Hoogh K, Janssen NA, Katsouyanni K, Klompmaker JO, Kristoffersen DT, Lim YH, Oftedal B, Strak M, Vienneau D, Zhang J, Burnett RT, Hoek G, Dominici F, Brauer M, Brunekreef B. Long-Term Exposure to Low-Level PM2.5 and Mortality: Investigation of Heterogeneity by Harmonizing Analyses in Large Cohort Studies in Canada, United States, and Europe. Environ Health Perspect 2023; 131:127003. [PMID: 38039140 PMCID: PMC10691665 DOI: 10.1289/ehp12141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 08/10/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Studies across the globe generally reported increased mortality risks associated with particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ) exposure with large heterogeneity in the magnitude of reported associations and the shape of concentration-response functions (CRFs). We aimed to evaluate the impact of key study design factors (including confounders, applied exposure model, population age, and outcome definition) on PM 2.5 effect estimates by harmonizing analyses on three previously published large studies in Canada [Mortality-Air Pollution Associations in Low Exposure Environments (MAPLE), 1991-2016], the United States (Medicare, 2000-2016), and Europe [Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), 2000-2016] as much as possible. METHODS We harmonized the study populations to individuals 65 + years of age, applied the same satellite-derived PM 2.5 exposure estimates, and selected the same sets of potential confounders and the same outcome. We evaluated whether differences in previously published effect estimates across cohorts were reduced after harmonization among these factors. Additional analyses were conducted to assess the influence of key design features on estimated risks, including adjusted covariates and exposure assessment method. A combined CRF was assessed with meta-analysis based on the extended shape-constrained health impact function (eSCHIF). RESULTS More than 81 million participants were included, contributing 692 million person-years of follow-up. Hazard ratios and 95% confidence intervals (CIs) for all-cause mortality associated with a 5 - μ g / m 3 increase in PM 2.5 were 1.039 (1.032, 1.046) in MAPLE, 1.025 (1.021, 1.029) in Medicare, and 1.041 (1.014, 1.069) in ELAPSE. Applying a harmonized analytical approach marginally reduced difference in the observed associations across the three studies. Magnitude of the association was affected by the adjusted covariates, exposure assessment methodology, age of the population, and marginally by outcome definition. Shape of the CRFs differed across cohorts but generally showed associations down to the lowest observed PM 2.5 levels. A common CRF suggested a monotonically increased risk down to the lowest exposure level. https://doi.org/10.1289/EHP12141.
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Affiliation(s)
- Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Danielle Braun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tanya Christidis
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Michael Cork
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodstrian University of Athens, Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodstrian University of Athens, Athens, Greece
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Xiao Wu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Weiran Yuchi
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Zorana J. Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Richard Atkinson
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Mariska Bauwelinck
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole A.H. Janssen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodstrian University of Athens, Athens, Greece
- MRC Center for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - Jochem O. Klompmaker
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Doris Tove Kristoffersen
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bente Oftedal
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Maciej Strak
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
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Dahlquist M, Frykman V, Hollenberg J, Jonsson M, Stafoggia M, Wellenius GA, Ljungman PLS. Short-Term Ambient Air Pollution Exposure and Risk of Out-of-Hospital Cardiac Arrest in Sweden: A Nationwide Case-Crossover Study. J Am Heart Assoc 2023; 12:e030456. [PMID: 37818697 PMCID: PMC10727387 DOI: 10.1161/jaha.123.030456] [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: 05/26/2023] [Accepted: 08/22/2023] [Indexed: 10/12/2023]
Abstract
Background Air pollution is one of the main risk factors for cardiovascular disease globally, but its association with out-of-hospital cardiac arrest at low air pollution levels is unclear. This nationwide study in Sweden aims to investigate if air pollution is associated with a higher risk of out-of-hospital cardiac arrest in an area with relatively low air pollution levels. Methods and Results This study was a nationwide time-stratified case-crossover study investigating the association between short-term air pollution exposures and out-of-hospital cardiac arrest using data from the SRCR (Swedish Registry for Cardiopulmonary Resuscitation) between 2009 and 2019. Daily air pollution levels were estimated in 1×1-km grids for all of Sweden using a satellite-based machine learning model. The association between daily air pollutant levels and out-of-hospital cardiac arrest was quantified using conditional logistic regression adjusted for daily air temperature. Particulate matter <2.5 μm exposure was associated with a higher risk of out-of-hospital cardiac arrest among a total of 29 604 cases. In a multipollutant model, the association was most pronounced for intermediate daily lags, with an increased relative risk of 6.2% (95% CI, 1.0-11.8) per 10 μg/m3 increase of particulate matter <2.5 μm 4 days before the event. A similar pattern of association was observed for particulate matter <10 μm. No clear association was observed for O3 and NO2. Conclusions Short-term exposure to air pollution was associated with higher risk of out-of-hospital cardiac arrest. The findings add to the evidence of an adverse effect of particulate matter on out-of-hospital cardiac arrest, even at very low levels below current regulatory standards.
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Affiliation(s)
- Marcus Dahlquist
- Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
- Department of CardiologyDanderyd University HospitalSweden
| | - Viveka Frykman
- Department of CardiologyDanderyd University HospitalSweden
- Department of Clinical SciencesDanderyd University Hospital, Karolinska InstitutetDanderydSweden
| | - Jacob Hollenberg
- Center for Resuscitation Science, Department of Clinical Science and Education, SödersjukhusetKarolinska InstitutetStockholmSweden
| | - Martin Jonsson
- Center for Resuscitation Science, Department of Clinical Science and Education, SödersjukhusetKarolinska InstitutetStockholmSweden
| | - Massimo Stafoggia
- Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
- Department of EpidemiologyLazio Region Health ServiceRoma 1Italy
| | - Gregory A. Wellenius
- Department of Environmental HealthBoston University School of Public HealthMAUSA
| | - Petter L. S. Ljungman
- Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
- Department of CardiologyDanderyd University HospitalSweden
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Nobile F, Forastiere A, Michelozzi P, Forastiere F, Stafoggia M. Long-term exposure to air pollution and incidence of mental disorders. A large longitudinal cohort study of adults within an urban area. Environ Int 2023; 181:108302. [PMID: 37944432 DOI: 10.1016/j.envint.2023.108302] [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: 06/09/2023] [Revised: 10/02/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Recent epidemiological evidence suggests associations between air pollution exposure and major depressive disorders, but the literature is inconsistent for other mental illnesses. We investigated the associations of several air pollutants and road traffic noise with the incidence of different categories of mental disorders in a large population-based cohort. METHODS We enrolled 1,739,277 individuals 30 + years from the 2011 census in Rome, Italy, and followed them up until 2019. In detail, we analyzed 1,733,331 participants (mean age 56.43 +/- 15.85 years; 54.96 % female) with complete information on covariates of interest. We excluded subjects with prevalent mental disorders at baseline to evaluate the incidence (first hospitalization or co-pay exemption) of schizophrenia spectrum disorders, bipolar, anxiety, personality, or substance use disorders. In addition, we studied subjects with first prescriptions of antipsychotics, antidepressants, and mood stabilizers. Annual average concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO₂), Black Carbon (BC), ultrafine particles (UFP), and road traffic noise were assigned to baseline residential addresses. We applied Cox regression models adjusted for individual and area-level covariates. RESULTS Each interquartile range (1.13 µg/m3) increase in PM2.5 was associated with a hazard ratio (HR) of 1.070 (95 % confidence interval [CI]: 1.017, 1.127) for schizophrenia spectrum disorder, 1.135 (CI: 1.086, 1.186) for depression, 1.097 (CI: 1.030, 1.168) for anxiety disorders. Positive associations were also detected for BC and UFP, and with the three categories of drug prescriptions. Bipolar, personality, and substance use disorders did not show clear associations. The effects were highest in the age group 30-64 years, except for depression. CONCLUSIONS Long-term exposure to ambient air pollution, especially fine and ultrafine particles, was associated with increased risks of schizophrenia spectrum disorder, depression, and anxiety disorders. The association of the pollutants with the prescriptions of specific drugs increases the credibility of the results.
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Affiliation(s)
- Federica Nobile
- Department of Epidemiology, Lazio Region Health Service/ASL Rome 1, Rome, Italy.
| | | | - Paola Michelozzi
- Department of Epidemiology, Lazio Region Health Service/ASL Rome 1, Rome, Italy
| | - Francesco Forastiere
- Environmental Research Group, Imperial College, London, UK; National Research Council, IFT, Palermo, Italy
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Rome 1, Rome, Italy
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Ranzi A, Giannini S, Nobile F, Caranci N, Adorno V, Gariazzo C, Maio S, Viegi G, Zengarini N, Serinelli M, Galise I, Bisceglia L, Michelozzi P, Stafoggia M. [Long-term exposure to air pollution and natural mortality: variations related to the use of different exposure indicators in the cohorts of BIGEPI project]. Epidemiol Prev 2023; 47:46-55. [PMID: 38639300 DOI: 10.19191/ep23.6.s3.007] [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] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVES appropriate assessment of exposure to air pollution is crucial for the estimation of adverse effects on human health, both in the short and long term. Within the BIGEPI project, different indicators of long-term exposure to air pollution, in association with mortality by cause, were tested within the Italian longitudinal metropolitan studies (LMS). This allowed an evaluation of differences in effect estimates using the different exposure indicators. DESIGN closed cohort. SETTING AND PARTICIPANTS subjects aged >=30, who took part in the 2011 census, residents in 5 cities (Turin, Bologna, Rome, Brindisi and Taranto). MAIN OUTCOME MEASURES at the time of enrolment, residential exposure levels to particulate matter <=10 μm (PM10), PM <=2.5 μm (PM2.5), nitrogen dioxide (NO2) and ozone (O3) for the period April-September (O3 warm season) were obtained from models at different spatial resolutions, from 1x1km to 200x200m (from the BEEP project) to 100x100m (ELAPSE project). In addition, locally developed models were used in each area (FARM photochemical model at 1x1-km for the cities of Rome, Taranto and Brindisi, Land-Use Regression (LUR) model for the city of Turin, PESCO model for Bologna). Cox proportional hazards models were applied to assess the association between exposure to air pollution (assessed using different exposure indicators) and natural mortality, adjusting for both individual and area covariates. RESULTS the exposure levels derived by the different models varied between pollutants, with differences between the averages ranging from 3 to 20% for PM10, from 1 to 23% for PM2.5, and from 3 to 28% for NO2; the results for O3 were more heterogeneous. A total of 267,350 deaths from natural causes were observed. There is low heterogeneity in the effect estimates calculated from different environmental models, while there is greater variability in average exposure values, with different behaviour depending on the model and the characteristics of the area investigated. Differences are more pronounced where local risk factors are relevant, e.g., in industrial cities, thus suggesting the need of considering industrial exposure separately from other sources. CONCLUSIONS the numerous heterogeneities in the data used make it difficult to draw conclusions about the comparisons studied. Nevertheless, this study suggests that different approaches to the assessment of environmental exposure should be evaluated depending on the national or local level of interest, also according to the specifities of the investigated areas.
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Affiliation(s)
- Andrea Ranzi
- Struttura tematica ambiente prevenzione e salute, Arpae Emilia-Romagna, Modena;
| | - Simone Giannini
- Struttura tematica ambiente prevenzione e salute, Arpae Emilia-Romagna, Modena
| | - Federica Nobile
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Nicola Caranci
- Settore innovazione nei Servizi sanitari e sociali, Direzione generale cura della persona, salute e welfare, Regione Emilia-Romagna, Bologna
| | - Valentina Adorno
- Settore innovazione nei servizi sanitari e sociali, Direzione generale cura della persona, salute e welfare, Regione Emilia-Romagna, Bologna
| | - Claudio Gariazzo
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale (INAIL-DIMEILA), Roma
| | - Sara Maio
- Istituto di fisiologia clinica del Consiglio nazionale delle ricerche (IFC-CNR), Pisa
| | - Giovanni Viegi
- Istituto di fisiologia clinica del Consiglio nazionale delle ricerche (IFC-CNR), Pisa
| | | | - Maria Serinelli
- UOS Ambiente e salute, Direzione scientifica, Arpa Puglia, Bari
| | - Ida Galise
- UOS Ambiente e salute, Direzione scientifica, Arpa Puglia, Bari
| | - Lucia Bisceglia
- UOS Ambiente e salute, Direzione scientifica, Arpa Puglia, Bari
| | - Paola Michelozzi
- Dipartimento di epidemiologia del servizio sanitario regionale, Regione Lazio / ASL Roma 1, Roma
| | - Massimo Stafoggia
- Dipartimento di epidemiologia del servizio sanitario regionale, Regione Lazio / ASL Roma 1, Roma
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Di Blasi C, Stafoggia M, Gariazzo C, Michelozzi P, De Sario M, Marinaccio A, Maio S, Viegi G, De' Donato F. [Impact of heat and cold on cause -specific mortality in Italy]. Epidemiol Prev 2023; 47:19-26. [PMID: 38639297 DOI: 10.19191/ep23.6.s3.004] [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] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVES to estimate the impact of daily exposure to extreme air temperatures (heat and cold) on cause-specific mortality in Italy and to evaluate the differences in the association between urban, suburban and rural municipalities. DESIGN time series analyses with two-stage approach were applied: in the first stage, multiple Poisson regression models and distributed lag non-linear models (DLNM) were used to define the association between temperature and mortality; in the second one, meta-analytic results were obtained by adopting BLUP (Best Linear Unbiased Prediction) coefficients at provincial level, which were then used to estimate the Attributable Fractions of cause-specific deaths. SETTING AND PARTICIPANTS cause-specific deaths from 2006to 2015 in Italy have been analysed by region and overall. MAIN OUTCOME MEASURES 5,648,299 total deaths included. Fractions (and relative 95% empirical confidence interval) of deaths attributable to increases from 75th to 99th percentiles of temperature, for heat, and decreases from 25th to 1st percentile, for cold. RESULTS the overall impact of air temperature on causespecificmortality is higher for heat than for cold. When considering heat, the attributable fraction is higher for diseases of the central nervous system (3.6% 95% CI 1.9-4.9) and mental health disease (3.1% 95% CI 1.7-4.4), while considering cold, ischemic disease (1.3% 95% CI 1.1-1.6) and diabetes (1.3% 95% CI 0.7-1.8) showed the greater impact. By urbanization level, similar impacts were found for cold temperature, while for heat there was an indication of higher vulnerability in rural areas emerged. CONCLUSIONS results are relevant for the implementation and promotion of preventive measures according to climate change related increase in temperature. The available evidence can provide the basis to identify vulnerable areas and population subgroups to which address current and future heat and cold adaptation plans in Italy.
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Affiliation(s)
| | | | - Claudio Gariazzo
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Inail, Roma
| | | | | | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Inail, Roma
| | - Sara Maio
- Istituto di fisiologia clinica, Consiglio nazionale delle ricerche, Pisa
| | - Giovanni Viegi
- Istituto di fisiologia clinica, Consiglio nazionale delle ricerche, Pisa
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Maio S, Gariazzo C, Stafoggia M, Ancona C, Bisceglia L, Caranci N, Cernigliaro A, Cesaroni G, Costa G, Marcon A, Massari S, Nobile F, Ranzi A, Renzi M, Scondotto S, Zengarini N, Verlato G, Viegi G. [BIGEPI project: environmental and health data]. Epidemiol Prev 2023; 47:8-18. [PMID: 38639296 DOI: 10.19191/ep23.6.s3.003] [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] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVES the BIGEPI project, co-funded by INAIL, has used big data to identify the health risks associated with short and long-term exposure to air pollution, extreme temperatures and occupational exposures. DESIGN the project consists of 5 specific work packages (WP) aimed at assessing: 1. the acute effects of environmental exposures over the national territory; 2. the acute effects of environmental exposures in contaminated areas, such as Sites of National Interest (SIN) and industrial sites; 3. the chronic effects of environmental exposures in 6 Italian longitudinal metropolitan studies; 4. the acute and chronic effects of environmental exposures in 7 epidemiological surveys on population samples; 5. the chronic effects of occupational exposures in the longitudinal metropolitan studies of Rome and Turin. SETTING AND PARTICIPANTS BIGEPI analyzed environmental and health data at different levels of detail: the whole Italian population (WP1); populations living in areas contaminated by pollutants of industrial origin (WP2); the entire longitudinal cohorts of the metropolitan areas of Bologna, Brindisi, Rome, Syracuse, Taranto and Turin (WP3 and WP5); population samples participating in the epidemiological surveys of Ancona, Palermo, Pavia, Pisa, Sassari, Turin and Verona (WP4). MAIN OUTCOME MEASURES environmental exposure: PM10, PM2,5, NO2 and O3 concentrations and air temperature at 1 Km2 resolution at national level. Occupational exposures: employment history of subjects working in at least one of 25 sectors with similar occupational exposures to chemicals/carcinogens; self-reported exposure to dust/fumes/gas in the workplace. Health data: cause-specific mortality/hospitalisation; symptoms/diagnosis of respiratory/allergic diseases; respiratory function and bronchial inflammation. RESULTS BIGEPI analyzed data at the level of the entire Italian population, data on 2.8 million adults (>=30 yrs) in longitudinal metropolitan studies and on about 14,500 individuals (>=18 yrs) in epidemiological surveys on population samples. The population investigated in the longitudinal metropolitan studies had an average age of approximately 55 years and that of the epidemiological surveys was about 48 years; in both cases, 53% of the population was female. As regards environmental exposure, in the period 2013-2015, at national level average values for PM10, PM2.5, NO2 and summer O3 were: 21.1±13.6, 15.1±10.9, 14.7±9.1 and 80.3±17.3 µg/m3, for the temperature the average value was 13.9±7.2 °C. Data were analyzed for a total of 1,769,660 deaths from non-accidental causes as well as 74,392 incident cases of acute coronary event and 45,513 of stroke. Epidemiological investigations showed a high prevalence of symptoms/diagnoses of rhinitis (range: 14.2-40.5%), COPD (range: 4.7-19.3%) and asthma (range: 3.2-13.2%). The availability of these large datasets has made it possible to implement advanced statistical models for estimating the health effects of short- and long-term exposures to pollutants. The details are reported in the BIGEPI papers already published in other international journals and in those published in this volume of E&P. CONCLUSIONS BIGEPI has confirmed the great potential of using big data in studies of the health effects of environmental and occupational factors, stimulating new directions of scientific research and confirming the need for preventive action on air quality and climate change for the health of the general population and the workers.
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Affiliation(s)
- Sara Maio
- Istituto di fisiologia clinica del Consiglio nazionale delle ricerche, Pisa;
| | - Claudio Gariazzo
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale di INAIL, Roma
| | - Massimo Stafoggia
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Carla Ancona
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Lucia Bisceglia
- Agenzia regionale per la salute e il sociale della Puglia, Bari
| | - Nicola Caranci
- Settore innovazione nei Servizi sanitari e sociali, Direzione generale cura della persona, salute e welfare, Regione Emilia-Romagna, Bologna
| | - Achille Cernigliaro
- Dipartimento attività sanitarie e Osservatorio epidemiologico, Assessorato salute, Regione Sicilia, Palermo
| | - Giulia Cesaroni
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Giuseppe Costa
- Servizio sovrazonale di epidemiologia ASL TO3, Grugliasco, Torino
| | - Alessandro Marcon
- Sezione di epidemiologia e statistica medica, Dipartimento di diagnostica e sanità pubblica, Università di Verona
| | - Stefania Massari
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale di INAIL, Roma
| | - Federica Nobile
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Andrea Ranzi
- ARPAE Emilia-Romagna - Dir. Tecnica, struttura ambiente, prevenzione e salute, Bologna
| | - Matteo Renzi
- Dipartimento di epidemiologia del Servizio sanitario regionale, regione Lazio / ASL Roma 1, Roma
| | - Salvatore Scondotto
- Dipartimento attività sanitarie e osservatorio epidemiologico, Assessorato salute, Regione Sicilia, Palermo
| | | | - Giuseppe Verlato
- Sezione di epidemiologia e statistica medica, Dipartimento di diagnostica e sanità pubblica, Università di Verona
| | - Giovanni Viegi
- Istituto di fisiologia clinica del Consiglio nazionale delle ricerche, Pisa
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Strippoli E, Nobile F, Caranci N, Adorno V, Galise I, Serinelli M, Bisceglia L, Allotta A, Rubino C, Pollina Addario W, Gariazzo C, Maio S, Viegi G, Ranzi A, Michelozzi P, Stafoggia M, Zengarini N. [Long-term exposure to air pollution and incidence of coronary heart diseases and stroke in the longitudinal metropolitan studies (LMS) network: the BIGEPI project]. Epidemiol Prev 2023; 47:35-45. [PMID: 38639299 DOI: 10.19191/ep23.6.s3.006] [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] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVES to assess the potential of using longitudinal metropolitan studies (LMS) to study the association between long-term exposure to air pollution and the incidence of acute coronary events and stroke. DESIGN closed cohort. SETTING AND PARTICIPANTS subjects aged >=30 years, who took part in the 2011 census, residents in 5 cities (Turin, Bologna, Rome, Brindisi and Taranto). Annual concentrations of particulate matter (PM10 and PM2.5), nitrogen dioxide (NO2) and warm-season ozone (O3) (annual O3 in Taranto and Brindisi), estimated through satellite (Turin, Bologna, Rome) or photochemical models (Taranto and Brindisi) with a spatial resolution of 1 km2, were assigned to the census address. MAIN OUTCOME MEASURES incidence of coronary heart disease (CHD) and stroke until 31.12.2018 (2019 in Bologna). Cohort-specific Hazard Ratios (HRs), estimated using Cox regression models progressively adjusting for individual and contextual covariates, were pooled with random-effect meta-analysis. RESULTS there were 71,872 incident CHD cases and 43,884 incident cases of stroke in almost 18 million person-years. No association was observed between the exposures studied and incidence of CHD and stroke, except for an increase in the incidence of CHD associated with warm-season O3 exposure (HR 1.034 per 5 μg/m3 increase). Some positive associations were found in specific cities (both outcomes in Brindisi with PM10 exposure and in Taranto with NO2 exposure, stroke in Rome with both PM10 and PM2.5), although estimates were not significant in some instances. CONCLUSIONS LMS are a high potential tool for the study of comparative medium- and long-term effects of air pollution. Their further development (different definitions of exposure, outcomes, characteristics of the urban areas and extension to other LMS) may make them even more valuable tools for monitoring and planning public health interventions.
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Affiliation(s)
- Elena Strippoli
- Servizio sovrazonale di epidemiologia ASL TO3, Grugliasco, Torino;
| | | | - Nicola Caranci
- Settore innovazione nei Servizi sanitari e sociali, Direzione generale cura della persona, salute e welfare, Regione Emilia-Romagna, Bologna
| | - Valentina Adorno
- Settore innovazione nei servizi sanitari e sociali, Direzione generale cura della persona, salute e welfare, Regione Emilia-Romagna, Bologna
| | - Ida Galise
- UOS Ambiente e salute direzione scientifica - ARPA Puglia, Bari
| | - Maria Serinelli
- UOS Ambiente e salute direzione scientifica - ARPA Puglia, Bari
| | - Lucia Bisceglia
- Agenzia regionale per la salute e il sociale della Puglia, AReSS, Bari
| | - Alessandra Allotta
- Dipartimento per le attività sanitarie e Osservatorio epidemiologico, Assessorato della salute - Regione Sicilia, Palermo
| | - Claudio Rubino
- Dipartimento per le attività sanitarie e Osservatorio epidemiologico, Assessorato della salute - Regione Sicilia, Palermo
| | - Walter Pollina Addario
- Dipartimento per le attività sanitarie e Osservatorio epidemiologico, Assessorato della salute - Regione Sicilia, Palermo
| | - Claudio Gariazzo
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale di INAIL (INAIL-DIMEILA), Roma
| | - Sara Maio
- Istituto di fisiologia clinica (IFC-CNR), Pisa
| | | | - Andrea Ranzi
- Agenzia regionale per la Prevenzione, l'ambiente e l'energia dell'Emilia-Romagna, Bologna
| | | | - Massimo Stafoggia
- Dipartimento di epidemiologia SSR Lazio/ASL Roma 1, Roma
- Da considerare entrambi come ultimo autore
| | - Nicolás Zengarini
- Servizio sovrazonale di epidemiologia ASL TO3, Grugliasco, Torino
- Da considerare entrambi come ultimo autore
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23
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Renzi M, Tinarelli G, Bauleo L, Maio S, Gariazzo C, Stafoggia M, Galise I, Serinelli M, Morabito A, Nocioni A, Viegi G, Michelozzi P, Ancona C. [Short-term effects of PM10 on cause-specific mortality and the role of long-term environmental pressures in the industrial areas of Brindisi and Civitavecchia]. Epidemiol Prev 2023; 47:27-34. [PMID: 38639298 DOI: 10.19191/ep23.6.s3.005] [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] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVES the health status of people living near industrial plants is often exposed to several environmental risk factors, including air pollution. The aim of this study is to assess the relationship between daily PM10 levels and cause-specific mortality in a selection of municipalities near two industrial plants from 2006 to 2015. DESIGN a time-series design with Poisson regression adjusted for a predefined set of confounders was used to quantify the association between exposure, calculated as daily PM10 levels extrapolated from machine-learning models using satellite data, and cause-specific mortality. SETTING AND PARTICIPANTS twenty municipalities near the thermal power plants in Civitavecchia and Brindisi were selected. The municipalities were then divided into three scenarios of chronic exposure derived from SPRAY simulation models of pollutant deposition. MAIN OUTCOME MEASURES daily cause-specific non-accidental, cardiovascular, and respiratory deaths defined according to the International Classification of Diseases code at the municipality level. RESULTS a total of 41,942 deaths were observed in the entire area (10,503 in the Civitavecchia area and 31,439 in the Brindisi area), of which approximately 41% were due to cardiovascular causes and 8% due to respiratory causes. The association showed an increase in shortterm effects in municipalities with higher chronic levels of pollution exposure. For example, risk estimates reported as percentage increases per 10-unit increase in PM10 were 6.7% (95% CI 0.9, 12.7%) in scenario 3 (highest exposure) compared to 4.2% (-1.2, 9.9%) and 2.7% (-4.2, 10.2%) in scenarios 2 and 1, respectively, in the area near the Civitavecchia plant. Similar effects were observed for the Brindisi area. CONCLUSIONS despite the well-documented relationship between short-term pollution and mortality, it appears that greater chronic exposure to industrial pollutants leads to increased short-term effects of PM10. The limited number of events suggests that this study could serve as a starting point for a larger investigation.
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Affiliation(s)
- Matteo Renzi
- Dipartimento di Epidemiologia SSR Lazio, ASL Roma1, Roma;
| | | | - Lisa Bauleo
- Dipartimento di Epidemiologia SSR Lazio, ASL Roma1, Roma
| | - Sara Maio
- Istituto di fisiologia clinica, CNR, Pisa
| | - Claudio Gariazzo
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Inail, Roma
| | | | - Ida Galise
- Agenzia regionale per la prevenzione e protezione dell'ambiente della Regione Puglia, Bari
| | - Meri Serinelli
- Agenzia regionale per la prevenzione e protezione dell'ambiente della Regione Puglia, Bari
| | - Angela Morabito
- Agenzia regionale per la prevenzione e protezione dell'ambiente della Regione Puglia, Bari
| | - Alessandra Nocioni
- Agenzia regionale per la prevenzione e protezione dell'ambiente della Regione Puglia, Bari
| | | | | | - Carla Ancona
- Dipartimento di Epidemiologia SSR Lazio, ASL Roma1, Roma
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24
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Stafoggia M, Michelozzi P, Schneider A, Armstrong B, Scortichini M, Rai M, Achilleos S, Alahmad B, Analitis A, Åström C, Bell ML, Calleja N, Krage Carlsen H, Carrasco G, Paul Cauchi J, Dszs Coelho M, Correa PM, Diaz MH, Entezari A, Forsberg B, Garland RM, Leon Guo Y, Guo Y, Hashizume M, Holobaca IH, Íñiguez C, Jaakkola JJK, Kan H, Katsouyanni K, Kim H, Kyselý J, Lavigne E, Lee W, Li S, Maasikmets M, Madureira J, Mayvaneh F, Fook Sheng Ng C, Nunes B, Orru H, V Ortega N, Osorio S, Palomares ADL, Pan SC, Pascal M, Ragettli MS, Rao S, Raz R, Roye D, Ryti N, Hn Saldiva P, Samoli E, Schwartz J, Scovronick N, Sera F, Tobias A, Tong S, Dlc Valencia C, Maria Vicedo-Cabrera A, Urban A, Gasparrini A, Breitner S, De' Donato FK. Joint effect of heat and air pollution on mortality in 620 cities of 36 countries. Environ Int 2023; 181:108258. [PMID: 37837748 PMCID: PMC10702017 DOI: 10.1016/j.envint.2023.108258] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/08/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND The epidemiological evidence on the interaction between heat and ambient air pollution on mortality is still inconsistent. OBJECTIVES To investigate the interaction between heat and ambient air pollution on daily mortality in a large dataset of 620 cities from 36 countries. METHODS We used daily data on all-cause mortality, air temperature, particulate matter ≤ 10 μm (PM10), PM ≤ 2.5 μm (PM2.5), nitrogen dioxide (NO2), and ozone (O3) from 620 cities in 36 countries in the period 1995-2020. We restricted the analysis to the six consecutive warmest months in each city. City-specific data were analysed with over-dispersed Poisson regression models, followed by a multilevel random-effects meta-analysis. The joint association between air temperature and air pollutants was modelled with product terms between non-linear functions for air temperature and linear functions for air pollutants. RESULTS We analyzed 22,630,598 deaths. An increase in mean temperature from the 75th to the 99th percentile of city-specific distributions was associated with an average 8.9 % (95 % confidence interval: 7.1 %, 10.7 %) mortality increment, ranging between 5.3 % (3.8 %, 6.9 %) and 12.8 % (8.7 %, 17.0 %), when daily PM10 was equal to 10 or 90 μg/m3, respectively. Corresponding estimates when daily O3 concentrations were 40 or 160 μg/m3 were 2.9 % (1.1 %, 4.7 %) and 12.5 % (6.9 %, 18.5 %), respectively. Similarly, a 10 μg/m3 increment in PM10 was associated with a 0.54 % (0.10 %, 0.98 %) and 1.21 % (0.69 %, 1.72 %) increase in mortality when daily air temperature was set to the 1st and 99th city-specific percentiles, respectively. Corresponding mortality estimate for O3 across these temperature percentiles were 0.00 % (-0.44 %, 0.44 %) and 0.53 % (0.38 %, 0.68 %). Similar effect modification results, although slightly weaker, were found for PM2.5 and NO2. CONCLUSIONS Suggestive evidence of effect modification between air temperature and air pollutants on mortality during the warm period was found in a global dataset of 620 cities.
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Affiliation(s)
- Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy.
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Ben Armstrong
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matteo Scortichini
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy
| | - Masna Rai
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Barrak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Antonis Analitis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Greece
| | - Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven CT, USA
| | | | - Hanne Krage Carlsen
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gabriel Carrasco
- Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Micheline Dszs Coelho
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Patricia M Correa
- Department of Public Health, Universidad de los Andes, Santiago, Chile
| | - Magali H Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Alireza Entezari
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar 9617916487, Khorasan Razavi, Iran
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Rebecca M Garland
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa
| | - Yue Leon Guo
- Environmental and Occupational Medicine, and Institute of Environmental and Occupational Health Sciences, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Carmen Íñiguez
- Department of Statistics and Computational Research, Universitat de València, València, Spain
| | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Greece; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic; Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Eric Lavigne
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Whanhee Lee
- School of the Environment, Yale University, New Haven CT, USA
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Joana Madureira
- Department of Environmental Health, Instituto Nacional de Saúde Dr. Ricardo Jorge, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Fatemeh Mayvaneh
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar 9617916487, Khorasan Razavi, Iran
| | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Baltazar Nunes
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Hans Orru
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Nicolás V Ortega
- Department of Public Health, Universidad de los Andes, Santiago, Chile
| | - Samuel Osorio
- Department of Environmental Health, University of São Paulo, São Paulo, Brazil
| | | | - Shih-Chun Pan
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
| | - Mathilde Pascal
- Santé Publique France, Department of Environmental Health, French National Public Health Agency, Saint Maurice, France
| | | | - Shilpa Rao
- Norwegian Institute of Public Health, Oslo, Norway
| | - Raanan Raz
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Israel
| | - Dominic Roye
- Climate Research Foundation, Madrid, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
| | - Niilo Ryti
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
| | - Paulo Hn Saldiva
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Greece
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Francesco Sera
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom; Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - César Dlc Valencia
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Aleš Urban
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic; Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Antonio Gasparrini
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Francesca K De' Donato
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy
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25
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Zafeiratou S, Samoli E, Analitis A, Gasparrini A, Stafoggia M, de’ Donato FK, Rao S, Zhang S, Breitner S, Masselot P, Aunan K, Schneider A, Katsouyanni K. Assessing heat effects on respiratory mortality and location characteristics as modifiers of heat effects at a small area scale in Central-Northern Europe. Environ Epidemiol 2023; 7:e269. [PMID: 37840857 PMCID: PMC10569755 DOI: 10.1097/ee9.0000000000000269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/06/2023] [Accepted: 08/02/2023] [Indexed: 10/17/2023] Open
Abstract
Background Heat effects on respiratory mortality are known, mostly from time-series studies of city-wide data. A limited number of studies have been conducted at the national level or covering non-urban areas. Effect modification by area-level factors has not been extensively investigated. Our study assessed the heat effects on respiratory mortality at a small administrative area level in Norway, Germany, and England and Wales, in the warm period (May-September) within 1996-2018. Also, we examined possible effect modification by several area-level characteristics in the framework of the EU-Horizon2020 EXHAUSTION project. Methods Daily respiratory mortality counts and modeled air temperature data were collected for Norway, Germany, and England and Wales at a small administrative area level. The temperature-mortality association was assessed by small area-specific Poisson regression allowing for overdispersion, using distributed lag non-linear models. Estimates were pooled at the national level and overall using a random-effect meta-analysis. Age- and sex-specific models were also applied. A multilevel random-effects model was applied to investigate the modification of the heat effects by area-level factors. Results A rise in temperature from the 75th to 99th percentile was associated with a 27% (95% confidence interval [CI] = 19%, 34%) increase in respiratory mortality, with higher effects for females. Increased population density and PM2.5 concentrations were associated with stronger heat effects on mortality. Conclusions Our study strengthens the evidence of adverse heat effects on respiratory mortality in Northern Europe by identifying vulnerable subgroups and subregions. This may contribute to the development of targeted policies for adaptation to climate change.
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Affiliation(s)
- Sofia Zafeiratou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Antonis Analitis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service (ASL ROMA 1), Rome, Italy
| | | | - Shilpa Rao
- Division for Climate and Environment, Norwegian Institute of Public Health (NIPH), Oslo, Norway
| | - Siqi Zhang
- Institute of Epidemiology, Helmholtz Zentrum München (HMGU), Neuherberg, Germany
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München (HMGU), Neuherberg, Germany
| | - Pierre Masselot
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kristin Aunan
- CICERO Center for International Climate Research, Norway
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München (HMGU), Neuherberg, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
- Environmental Research Group, MRC Centre for Environment and Health, Imperial College, London, United Kingdom
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26
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Hvidtfeldt UA, Chen J, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Katsouyanni K, Ketzel M, Leander K, Magnusson PKE, Nagel G, Pershagen G, Rizzuto D, Samoli E, So R, Stafoggia M, Tjønneland A, Weinmayr G, Wolf K, Zhang J, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O. Long-term air pollution exposure and malignant intracranial tumours of the central nervous system: a pooled analysis of six European cohorts. Br J Cancer 2023; 129:656-664. [PMID: 37420001 PMCID: PMC10421949 DOI: 10.1038/s41416-023-02348-1] [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] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 06/06/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Risk factors for malignant tumours of the central nervous system (CNS) are largely unknown. METHODS We pooled six European cohorts (N = 302,493) and assessed the association between residential exposure to nitrogen dioxide (NO2), fine particles (PM2.5), black carbon (BC), ozone (O3) and eight elemental components of PM2.5 (copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc) and malignant intracranial CNS tumours defined according to the International Classification of Diseases ICD-9/ICD-10 codes 192.1/C70.0, 191.0-191.9/C71.0-C71.9, 192.0/C72.2-C72.5. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. RESULTS During 5,497,514 person-years of follow-up (average 18.2 years), we observed 623 malignant CNS tumours. The results of the fully adjusted linear analyses showed a hazard ratio (95% confidence interval) of 1.07 (0.95, 1.21) per 10 μg/m³ NO2, 1.17 (0.96, 1.41) per 5 μg/m³ PM2.5, 1.10 (0.97, 1.25) per 0.5 10-5m-1 BC, and 0.99 (0.84, 1.17) per 10 μg/m³ O3. CONCLUSIONS We observed indications of an association between exposure to NO2, PM2.5, and BC and tumours of the CNS. The PM elements were not consistently associated with CNS tumour incidence.
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Affiliation(s)
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- iClimate-interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Departments of Ecoscience, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, GU2 7XH, UK
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rina So
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jiawei Zhang
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
- Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
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27
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Zhang S, Breitner S, Rai M, Nikolaou N, Stafoggia M, De' Donato F, Samoli E, Zafeiratou S, Katsouyanni K, Rao S, Palomares ADL, Gasparrini A, Masselot P, Aunan K, Peters A, Schneider A. Assessment of short-term heat effects on cardiovascular mortality and vulnerability factors using small area data in Europe. Environ Int 2023; 179:108154. [PMID: 37603993 DOI: 10.1016/j.envint.2023.108154] [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: 04/21/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Short-term associations between heat and cardiovascular disease (CVD) mortality have been examined mostly in large cities. However, different vulnerability and exposure levels may contribute to spatial heterogeneity. This study assessed heat effects on CVD mortality and potential vulnerability factors using data from three European countries, including urban and rural settings. METHODS We collected daily counts of CVD deaths aggregated at the small-area level in Norway (small-area level: municipality), England and Wales (lower super output areas), and Germany (district) during the warm season (May-September) from 1996 to 2018. Daily mean air temperatures estimated by spatial-temporal models were assigned to each small area. Within each country, we applied area-specific Quasi-Poisson regression using distributed lag nonlinear models to examine the heat effects at lag 0-1 days. The area-specific estimates were pooled by random-effects meta-analysis to derive country-specific and overall heat effects. We examined individual- and area-level heat vulnerability factors by subgroup analyses and meta-regression, respectively. RESULTS We included 2.84 million CVD deaths in analyses. For an increase in temperature from the 75th to the 99th percentile, the pooled relative risk (RR) for CVD mortality was 1.14 (95% CI: 1.03, 1.26), with the country-specific RRs ranging from 1.04 (1.00, 1.09) in Norway to 1.24 (1.23, 1.26) in Germany. Heat effects were stronger among women [RRs (95% CIs) for women and men: 1.18 (1.08, 1.28) vs. 1.12 (1.00, 1.24)]. Greater heat vulnerability was observed in areas with high population density, high degree of urbanization, low green coverage, and high levels of fine particulate matter. CONCLUSION This study provides evidence for the heat effects on CVD mortality in European countries using high-resolution data from both urban and rural areas. Besides, we identified individual- and area-level heat vulnerability factors. Our findings may facilitate the development of heat-health action plans to increase resilience to climate change.
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Affiliation(s)
- Siqi Zhang
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, LMU, Munich, Germany
| | - Masna Rai
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, LMU, Munich, Germany
| | - Nikolaos Nikolaou
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, LMU, Munich, Germany
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service - ASL ROMA 1, Rome, Italy
| | - Francesca De' Donato
- Department of Epidemiology, Lazio Regional Health Service - ASL ROMA 1, Rome, Italy
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Zafeiratou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Shilpa Rao
- Department of Air Pollution and Noise, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Pierre Masselot
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Kristin Aunan
- CICERO Center for International Climate Research, Norway
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, LMU, Munich, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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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. Environ Int 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Parkes B, Stafoggia M, Fecht D, Davies B, Bonander C, de’ Donato F, Michelozzi P, Piel FB, Strömberg U, Blangiardo M. Community factors and excess mortality in the COVID-19 pandemic in England, Italy and Sweden. Eur J Public Health 2023; 33:695-703. [PMID: 37263602 PMCID: PMC10393497 DOI: 10.1093/eurpub/ckad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Analyses of coronavirus disease 19 suggest specific risk factors make communities more or less vulnerable to pandemic-related deaths within countries. What is unclear is whether the characteristics affecting vulnerability of small communities within countries produce similar patterns of excess mortality across countries with different demographics and public health responses to the pandemic. Our aim is to quantify community-level variations in excess mortality within England, Italy and Sweden and identify how such spatial variability was driven by community-level characteristics. METHODS We applied a two-stage Bayesian model to quantify inequalities in excess mortality in people aged 40 years and older at the community level in England, Italy and Sweden during the first year of the pandemic (March 2020-February 2021). We used community characteristics measuring deprivation, air pollution, living conditions, population density and movement of people as covariates to quantify their associations with excess mortality. RESULTS We found just under half of communities in England (48.1%) and Italy (45.8%) had an excess mortality of over 300 per 100 000 males over the age of 40, while for Sweden that covered 23.1% of communities. We showed that deprivation is a strong predictor of excess mortality across the three countries, and communities with high levels of overcrowding were associated with higher excess mortality in England and Sweden. CONCLUSION These results highlight some international similarities in factors affecting mortality that will help policy makers target public health measures to increase resilience to the mortality impacts of this and future pandemics.
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Affiliation(s)
- Brandon Parkes
- UK Small Area Health Statistics Unit, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Daniela Fecht
- UK Small Area Health Statistics Unit, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Bethan Davies
- UK Small Area Health Statistics Unit, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Carl Bonander
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Frédéric B Piel
- UK Small Area Health Statistics Unit, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards, Imperial College London, London, UK
| | - Ulf Strömberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Marta Blangiardo
- UK Small Area Health Statistics Unit, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Stafoggia M, De' Donato F, Michelozzi P, Viegi G, Maio S, Gariazzo C. [Acute effects of air pollution and extreme temperatures on cause-specific mortality in Italy. Results of the BIGEPI project.]. Recenti Prog Med 2023; 114:441-446. [PMID: 37392107 DOI: 10.1701/4062.40463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
INTRODUCTION Air pollution and extreme temperatures have been associated with multiple adverse health effects, especially on the cardiovascular and respiratory systems. The evidence of a relationship between daily exposures and mortality from metabolic, nervous and mental causes needs to be strengthened. The aim of this study is to investigate the association between daily exposure to fine particulate matter (PM2.5) and extreme temperatures (heat and cold) with cause-specific mortality in the entire Italian population. METHODS The daily counts of deaths from natural, cardiovascular, respiratory, metabolic, diabetes, nervous and mental causes were provided by Istat at the municipal level for the period 2006-2015. Through the application of machine-learning models based on satellite data and spatiotemporal variables, population-weighted exposures to daily mean PM2.5 (2013-2015) and air temperature (2006-2015) were estimated at municipality level. Time-series models adjusted for seasonal and long-term trends were applied, and associations between the above exposures and different causes of death at the national level were estimated. RESULTS The study found a marked effect of PM2.5 on deaths from nervous causes, with a % increase of risk (IR%) of 6.55% (95% confidence interval: 3.38%-9.81%) per PM2.5 increases of 10 µg/m3. The study also highlighted significant effects of low and high temperatures on all study outcomes. The effects were greater for high temperatures. In particular, the effects of heat, expressed as a % increase in risk per temperature increase from the 75th to the 99th percentile, show the highest associations with mortality from nervous causes (58.3%; 95%CI: 49.7%-67.5%), mental causes (48.4%; 95%CI: 40.4%-56.9%), respiratory causes 45.8%; 95%CI: 39.7%-52.1%) and metabolic causes (36.9%; 95%CI: 30.6%-43.5%). DISCUSSION The study showed a strong association between daily exposure to PM2.5 and extreme temperatures, especially heat, with mortality outcomes, especially those under-investigated, such as diabetes, metabolic, nervous and mental causes.
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Affiliation(s)
- Massimo Stafoggia
- Dipartimento di Epidemiologia del Servizio sanitario regionale, Regione Lazio, Asl Roma 1, Roma
| | - Francesca De' Donato
- Dipartimento di Epidemiologia del Servizio sanitario regionale, Regione Lazio, Asl Roma 1, Roma
| | - Paola Michelozzi
- Dipartimento di Epidemiologia del Servizio sanitario regionale, Regione Lazio, Asl Roma 1, Roma
| | - Giovanni Viegi
- Istituto di Fisiologia clinica, Consiglio nazionale delle ricerche, Pisa
| | - Sara Maio
- Istituto di Fisiologia clinica, Consiglio nazionale delle ricerche, Pisa
| | - Claudio Gariazzo
- Dipartimento di Medicina, epidemiologia, igiene del lavoro e ambientale, Inail, Roma
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Wolf K, Rodopoulou S, Chen J, Andersen ZJ, Atkinson RW, Bauwelinck M, Janssen NAH, Kristoffersen DT, Lim YH, Oftedal B, Strak M, Vienneau D, Zhang J, Brunekreef B, Hoek G, Stafoggia M, Samoli E. Comparison of traditional Cox regression and causal modeling to investigate the association between long-term air pollution exposure and natural-cause mortality within European cohorts. Environ Pollut 2023; 327:121515. [PMID: 36967008 DOI: 10.1016/j.envpol.2023.121515] [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: 01/23/2023] [Revised: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 06/18/2023]
Abstract
Most studies investigating the health effects of long-term exposure to air pollution used traditional regression models, although causal inference approaches have been proposed as alternative. However, few studies have applied causal models and comparisons with traditional methods are sparse. We therefore compared the associations between natural-cause mortality and exposure to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) using traditional Cox and causal models in a large multicenter cohort setting. We analysed data from eight well-characterized cohorts (pooled cohort) and seven administrative cohorts from eleven European countries. Annual mean PM2.5 and NO2 from Europe-wide models were assigned to baseline residential addresses and dichotomized at selected cut-off values (PM2.5: 10, 12, 15 μg/m³; NO2: 20, 40 μg/m³). For each pollutant, we estimated the propensity score as the conditional likelihood of exposure given available covariates, and derived corresponding inverse-probability weights (IPW). We applied Cox proportional hazards models i) adjusting for all covariates ("traditional Cox") and ii) weighting by IPW ("causal model"). Of 325,367 and 28,063,809 participants in the pooled and administrative cohorts, 47,131 and 3,580,264 died from natural causes, respectively. For PM2.5 above vs. below 12 μg/m³, the hazard ratios (HRs) of natural-cause mortality were 1.17 (95% CI 1.13-1.21) and 1.15 (1.11-1.19) for the traditional and causal models in the pooled cohort, and 1.03 (1.01-1.06) and 1.02 (0.97-1.09) in the administrative cohorts. For NO2 above vs below 20 μg/m³, the HRs were 1.12 (1.09-1.14) and 1.07 (1.05-1.09) for the pooled and 1.06 (95% CI 1.03-1.08) and 1.05 (1.02-1.07) for the administrative cohorts. In conclusion, we observed mostly consistent associations between long-term air pollution exposure and natural-cause mortality with both approaches, though estimates partly differed in individual cohorts with no systematic pattern. The application of multiple modelling methods might help to improve causal inference. 299 of 300 words.
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Affiliation(s)
- Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany.
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jie Chen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Richard W Atkinson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Mariska Bauwelinck
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nicole A H Janssen
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bente Oftedal
- Department of Air Quality and Noise, Norwegian Institute of Public Health, Oslo, Norway
| | - Maciek Strak
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Conti S, Fornari C, Ferrara P, Antonazzo IC, Madotto F, Traini E, Levi M, Cernigliaro A, Armocida B, Bragazzi NL, Cadum E, Carugno M, Crotti G, Deandrea S, Cortesi PA, Guido D, Iavicoli I, Iavicoli S, La Vecchia C, Lauriola P, Michelozzi P, Scondotto S, Stafoggia M, Violante FS, Abbafati C, Albano L, Barone-Adesi F, Biondi A, Bosetti C, Buonsenso D, Carreras G, Castelpietra G, Catapano A, Cattaruzza MS, Corso B, Damiani G, Esposito F, Gallus S, Golinelli D, Hay SI, Isola G, Ledda C, Mondello S, Pedersini P, Pensato U, Perico N, Remuzzi G, Sanmarchi F, Santoro R, Simonetti B, Unim B, Vacante M, Veroux M, Villafañe JH, Monasta L, Mantovani LG. Time-Trends in Air Pollution Impact on Health in Italy, 1990-2019: An Analysis From the Global Burden of Disease Study 2019. Int J Public Health 2023; 68:1605959. [PMID: 37347013 PMCID: PMC10280378 DOI: 10.3389/ijph.2023.1605959] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives: We explored temporal variations in disease burden of ambient particulate matter 2.5 μm or less in diameter (PM2.5) and ozone in Italy using estimates from the Global Burden of Disease Study 2019. Methods: We compared temporal changes and percent variations (95% Uncertainty Intervals [95% UI]) in rates of disability adjusted life years (DALYs), years of life lost, years lived with disability and mortality from 1990 to 2019, and variations in pollutant-attributable burden with those in the overall burden of each PM2.5- and ozone-related disease. Results: In 2019, 467,000 DALYs (95% UI: 371,000, 570,000) were attributable to PM2.5 and 39,600 (95% UI: 18,300, 61,500) to ozone. The crude DALY rate attributable to PM2.5 decreased by 47.9% (95% UI: 10.3, 65.4) from 1990 to 2019. For ozone, it declined by 37.0% (95% UI: 28.9, 44.5) during 1990-2010, but it increased by 44.8% (95% UI: 35.5, 56.3) during 2010-2019. Age-standardized rates declined more than crude ones. Conclusion: In Italy, the burden of ambient PM2.5 (but not of ozone) significantly decreased, even in concurrence with population ageing. Results suggest a positive impact of air quality regulations, fostering further regulatory efforts.
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Affiliation(s)
- Sara Conti
- Research Center on Public Health, University of Milan Bicocca, Monza, Italy
| | - Carla Fornari
- Research Center on Public Health, University of Milan Bicocca, Monza, Italy
| | - Pietro Ferrara
- Research Center on Public Health, University of Milan Bicocca, Monza, Italy
- Laboratory of Public Health, Auxologico Research Hospital—IRCCS, Milan, Italy
| | | | - Fabiana Madotto
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Eugenio Traini
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands
| | - Miriam Levi
- Epidemiology Unit, Department of Prevention, Central Tuscany Local Health Authority, Florence, Italy
| | - Achille Cernigliaro
- Health Activities and Epidemiological Observatory Department, Health Authority Sicily Region, Parlemo, Italy
- Clinical Pathology Complex Hospital Unit, Health Authority Trapani Province, Trapani, Italy
| | - Benedetta Armocida
- Department of Cardiovascular, Endocrine-Metabolic Disease and Aging, National Institute of Health (ISS), Rome, Italy
| | - Nicola L. Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, Faculty of Science, York University, Toronto, ON, Canada
| | - Ennio Cadum
- Department of Hygiene and Health Prevention and Complex Operative Unit Environmental Health and Innovative Projects, Health Protection Agency, Pavia, Italy
| | - Michele Carugno
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Crotti
- Servizio Epidemiologico Aziendale, Agenzia di Tutela della Salute di Bergamo, Bergamo, Italy
| | - Silvia Deandrea
- Department of Hygiene and Health Prevention and Complex Operative Unit Environmental Health and Innovative Projects, Health Protection Agency, Pavia, Italy
| | - Paolo A. Cortesi
- Research Center on Public Health, University of Milan Bicocca, Monza, Italy
| | - Davide Guido
- Neurology, Public Health and Disability Unit, Carlo Besta Neurological Institute, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ivo Iavicoli
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine Epidemiology and Hygiene, Italian National Workers Compensation Authority (IIL), Monteporzio Catone, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Lauriola
- International Society Doctors for the Environment, Milan, Italy
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Region Health Authority (ASL RM1), Rome, Italy
| | - Salvatore Scondotto
- Health Activities and Epidemiological Observatory Department, Health Authority Sicily Region, Parlemo, Italy
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Authority (ASL RM1), Rome, Italy
| | - Francesco S. Violante
- Occupational Health Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Cristiana Abbafati
- Department of Juridical and Economic Studies, Faculty of Law, Sapienza University of Rome, Rome, Italy
| | - Luciana Albano
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Antonio Biondi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Cristina Bosetti
- Department of Oncology, Mario Negri Pharmacological Research Institute (IRCCS), Milano, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS (Agostino Gemelli University Polyclinic IRCCS), Rome, Italy
- Global Health Research Institute, Università Cattolica del Sacro Cuore (Catholic University of Sacred Heart), Rome, Italy
| | - Giulia Carreras
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Giulio Castelpietra
- Department of Medicine, University of Udine, Udine, Italy
- Department of Mental Health, Healthcare Agency “Friuli Occidentale”, Pordenone, Italy
| | - Alberico Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- MultiMedica, IRCCS, Sesto San Giovanni, Italy
| | - Maria S. Cattaruzza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Barbara Corso
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - Giovanni Damiani
- IRCCS Istituto Ortopedico Galeazzi (Galeazzi Orthopedic Institute IRCCS), University of Milan, Milan, Italy
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States
| | - Francesco Esposito
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Gaetano Isola
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Caterina Ledda
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Messina University, Messina, Italy
| | - Paolo Pedersini
- Clinical Research Department, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Umberto Pensato
- Department of Neurology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Norberto Perico
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Biagio Simonetti
- Department of Law, Economics, Management and Quantitative Methods, University of Sannio, Benevento, Italy
- WSB University in Gdańsk, Gdańsk, Poland
| | - Brigid Unim
- Department of Cardiovascular, Endocrine-Metabolic Disease and Aging, National Institute of Health (ISS), Rome, Italy
| | - Marco Vacante
- Department of Oncology, Mario Negri Pharmacological Research Institute (IRCCS), Milano, Italy
| | - Massimiliano Veroux
- Department of Medical, Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Jorge H. Villafañe
- Clinical Research Department, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Lorenzo G. Mantovani
- Research Center on Public Health, University of Milan Bicocca, Monza, Italy
- Laboratory of Public Health, Auxologico Research Hospital—IRCCS, Milan, Italy
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Nobile F, Forastiere A, Michelozzi P, Forastiere F, Stafoggia M. [Air pollution and incidence of psychiatric disorders in the Rome longitudinal study.]. Recenti Prog Med 2023; 114:382-384. [PMID: 37229690 DOI: 10.1701/4042.40236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The literature on the impact of long-term exposure to air pollution on the incidence of psychiatric disorders is steadily increasing reflecting a growing interest. In the 2011 Rome longitudinal study, strong associations between long-term exposure to air pollution and the incidence of some psychiatric conditions and medication prescriptions were observed. More studies investigating this relationship in large populations are needed to provide consistent scientific evidence even on the etiology of mental disorders, which are a public health priority.
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Affiliation(s)
- Federica Nobile
- Dipartimento di Epidemiologia del Servizio sanitario regionale, Regione Lazio - Asl Roma 1, Roma
| | | | - Paola Michelozzi
- Dipartimento di Epidemiologia del Servizio sanitario regionale, Regione Lazio - Asl Roma 1, Roma
| | | | - Massimo Stafoggia
- Dipartimento di Epidemiologia del Servizio sanitario regionale, Regione Lazio - Asl Roma 1, Roma
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Bauleo L, Massari S, Gariazzo C, Michelozzi P, Dei Bardi L, Zengarini N, Maio S, Stafoggia M, Davoli M, Viegi G, Marinaccio A, Cesaroni G. Sector of Employment and Mortality: A Cohort Based on Different Administrative Archives. Int J Environ Res Public Health 2023; 20:ijerph20105767. [PMID: 37239502 DOI: 10.3390/ijerph20105767] [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] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/27/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
Administrative data can be precious in connecting information from different sectors. For the first time, we used data from the National Social Insurance Agency (INPS) to investigate the association between the occupational sectors and both non-accidental and accidental mortality. We retrieved information on occupational sectors from 1974 to 2011 for private sector workers included in the 2011 census cohort of Rome. We classified the occupational sectors into 25 categories and analyzed occupational exposure as ever/never have been employed in a sector or as the lifetime prevalent sector. We followed the subjects from the census reference day (9 October 2011) to 31 December 2019. We calculated age-standardized mortality rates for each occupational sector, separately in men and women. We used Cox regression to investigate the association between the occupational sectors and mortality, producing hazard ratios (HRs) and 95% confidence intervals (95%CI). We analyzed 910,559 30+-year-olds (53% males) followed for 7 million person-years. During the follow-up, 59,200 and 2560 died for non-accidental and accidental causes, respectively. Several occupational sectors showed high mortality risks in men in age-adjusted models: food and tobacco production with HR = 1.16 (95%CI: 1.09-8.22), metal processing (HR = 1.66, 95%CI: 1.21-11.8), footwear and wood (HR = 1.19, 95%CI: 1.11-1.28), construction (HR = 1.15, 95%CI: 1.12-1.18), hotels, camping, bars, and restaurants (HR = 1.16, 95%CI: 1.11-1.21) and cleaning (HR = 1.42, 95%CI: 1.33-1.52). In women, the sectors that showed higher mortality than the others were hotels, camping, bars, and restaurants (HR = 1.17, 95%CI: 1.10-1.25) and cleaning services (HR = 1.23, 95%CI: 1.17-1.30). Metal processing and construction sectors showed elevated accidental mortality risks in men. Social Insurance Agency data have the potential to characterize high-risk sectors and identify susceptible groups in the population.
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Affiliation(s)
- Lisa Bauleo
- Department of Epidemiology-Lazio Regional Health Service, ASL Roma 1, 00147 Rome, Italy
| | - Stefania Massari
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian National Institute for Insurance against Accidents at Work (INAIL), 00143 Rome, Italy
| | - Claudio Gariazzo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian National Institute for Insurance against Accidents at Work (INAIL), 00143 Rome, Italy
| | - Paola Michelozzi
- Department of Epidemiology-Lazio Regional Health Service, ASL Roma 1, 00147 Rome, Italy
| | - Luca Dei Bardi
- Department of Epidemiology-Lazio Regional Health Service, ASL Roma 1, 00147 Rome, Italy
- Department of Statistical Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Nicolas Zengarini
- Regional Public Health Observatory (SEPI), ASL TO3, 10095 Grugliasco, Italy
| | - Sara Maio
- Institute of Clinical Physiology, CNR, 56124 Pisa, Italy
| | - Massimo Stafoggia
- Department of Epidemiology-Lazio Regional Health Service, ASL Roma 1, 00147 Rome, Italy
| | - Marina Davoli
- Department of Epidemiology-Lazio Regional Health Service, ASL Roma 1, 00147 Rome, Italy
| | - Giovanni Viegi
- Institute of Clinical Physiology, CNR, 56124 Pisa, Italy
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian National Institute for Insurance against Accidents at Work (INAIL), 00143 Rome, Italy
| | - Giulia Cesaroni
- Department of Epidemiology-Lazio Regional Health Service, ASL Roma 1, 00147 Rome, Italy
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Ranzi A, Stafoggia M, Giannini S, Ancona C, Bella A, Cattani G, Pezzotti P, Iavarone I. [Long-term exposure to ambient air pollution and the incidence of SARS-CoV-2 infections in Italy: The EpiCovAir study]. Epidemiol Prev 2023; 47:In press. [PMID: 37154300 DOI: 10.19191/ep23.3.a605.025] [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] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND after the outbreak of the SARS-CoV-2 pandemic in 2020, several waves of pandemic cases have occurred in Italy. The role of air pollution has been hypothesized and investigated in several studies. However, to date, the role of chronic exposure to air pollutants in increasing incidence of SARS-CoV-2 infections is still debated. OBJECTIVES to investigate the association between long-term exposure to air pollutants and the incidence of SARS-CoV-2 infections in Italy. DESIGN a satellite-based air pollution exposure model with 1-km2 spatial resolution for entire Italy was applied and 2016-2019 mean population-weighted concentrations of particulate matter < 10 micron (PM10), PM <2.5 micron (PM2.5), and nitrogen dioxide (NO2) was calculated to each municipality as estimates of chronic exposures. A principal component analysis (PCA) approach was applied to 50+ area-level covariates (geography and topography, population density, mobility, population health, socioeconomic status) to account for the major determinants of the spatial distribution of incidence rates of SARS-CoV-2 infection. Detailed information was further used on intra- and inter-municipal mobility during the pandemic period. Finally, a mixed longitudinal ecological design with the study units consisting of individual municipalities in Italy was applied. Generalized negative binomial models controlling for age, gender, province, month, PCA variables, and population density were estimated. SETTING AND PARTICIPANTS individual records of diagnosed SARS-2-CoV-2 infections in Italy from February 2020 to June 2021 reported to the Italian Integrated Surveillance of COVID-19 were used. MAIN OUTCOME MEASURES percentage increases in incidence rate (%IR) and corresponding 95% confidence intervals (95% CI) per unit increase in exposure. RESULTS 3,995,202 COVID-19 cases in 7,800 municipalities were analysed (total population: 59,589,357 inhabitants). It was found that long-term exposure to PM2.5, PM10, and NO2 was significantly associated with the incidence rates of SARS-CoV-2 infection. In particular, incidence of COVID-19 increased by 0.3% (95%CI 0.1%-0.4%), 0.3% (0.2%-0.4%), and 0.9% (0.8%-1.0%) per 1 μg/m3 increment in PM2.5, PM10 and NO2, respectively. Associations were higher among elderly subjects and during the second pandemic wave (September 2020-December 2020). Several sensitivity analyses confirmed the main results. The results for NO2 were especially robust to multiple sensitivity analyses. CONCLUSIONS evidence of an association between long-term exposure to ambient air pollutants and the incidence of SARS-CoV-2 infections in Italy was found.
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Affiliation(s)
- Andrea Ranzi
- Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Modena (Italy);
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome (Italy)
| | - Simone Giannini
- Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Modena (Italy)
| | - Carla Ancona
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome (Italy)
| | - Antonino Bella
- Italian National Institute of Health (ISS), Rome (Italy)
| | - Giorgio Cattani
- Italian Institute for Environmental Protection and Research - ISPRA, Rome (Italy)
| | | | - Ivano Iavarone
- Italian National Institute of Health (ISS), Rome (Italy)
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So R, Chen J, Stafoggia M, de Hoogh K, Katsouyanni K, Vienneau D, Samoli E, Rodopoulou S, Loft S, Lim YH, Westendorp RGJ, Amini H, Cole-Hunter T, Bergmann M, Shahri SMT, Zhang J, Maric M, Mortensen LH, Bauwelinck M, Klompmaker JO, Atkinson RW, Janssen NAH, Oftedal B, Renzi M, Forastiere F, Strak M, Brunekreef B, Hoek G, Andersen ZJ. Long-term exposure to elemental components of fine particulate matter and all-natural and cause-specific mortality in a Danish nationwide administrative cohort study. Environ Res 2023; 224:115552. [PMID: 36822536 DOI: 10.1016/j.envres.2023.115552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/30/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Fine particulate matter (PM2.5) is a well-recognized risk factor for premature death. However, evidence on which PM2.5 components are most relevant is unclear. METHODS We evaluated the associations between mortality and long-term exposure to eight PM2.5 elemental components [copper (Cu), iron (Fe), zinc (Zn), sulfur (S), nickel (Ni), vanadium (V), silicon (Si), and potassium (K)]. Studied outcomes included death from diabetes, chronic kidney disease (CKD), dementia, and psychiatric disorders as well as all-natural causes, cardiovascular disease (CVD), respiratory diseases (RD), and lung cancer. We followed all residents in Denmark (aged ≥30 years) from January 1, 2000 to December 31, 2017. We used European-wide land-use regression models at a 100 × 100 m scale to estimate the residential annual mean levels of exposure to PM2.5 components. The models were developed with supervised linear regression (SLR) and random forest (RF). The associations were evaluated by Cox proportional hazard models adjusting for individual- and area-level socioeconomic factors and total PM2.5 mass. RESULTS Of 3,081,244 individuals, we observed 803,373 death from natural causes during follow-up. We found significant positive associations between all-natural mortality with Si and K from both exposure modeling approaches (hazard ratios; 95% confidence intervals per interquartile range increase): SLR-Si (1.04; 1.03-1.05), RF-Si (1.01; 1.00-1.02), SLR-K (1.03; 1.02-1.04), and RF-K (1.06; 1.05-1.07). Strong associations of K and Si were detected with most causes of mortality except CKD and K, and diabetes and Si (the strongest associations for psychiatric disorders mortality). In addition, Fe was relevant for mortality from RD, lung cancer, CKD, and psychiatric disorders; Zn with mortality from CKD, RD, and lung cancer, and; Ni and V with lung cancer mortality. CONCLUSIONS We present novel results of the relevance of different PM2.5 components for different causes of death, with K and Si seeming to be most consistently associated with mortality in Denmark.
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Affiliation(s)
- Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Bergmann
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Matija Maric
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Denmark Statistics, Copenhagen, Denmark
| | - Mariska Bauwelinck
- Interface Demography - Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jochem O Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Richard W Atkinson
- Population Health Research Institute, St George's University of London, London, UK
| | - Nicole A H Janssen
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bente Oftedal
- Department of air quality and noise, Norwegian Institute of Public Health, Oslo, Norway
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Science Policy & Epidemiology Environmental Research Group King's College London, London, UK
| | - Maciek Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Stafoggia M, Ranzi A, Ancona C, Bauleo L, Bella A, Cattani G, Nobile F, Pezzotti P, Iavarone I. Long-Term Exposure to Ambient Air Pollution and Mortality among Four Million COVID-19 Cases in Italy: The EpiCovAir Study. Environ Health Perspect 2023; 131:57004. [PMID: 37167483 PMCID: PMC10174641 DOI: 10.1289/ehp11882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND The role of chronic exposure to ambient air pollutants in increasing COVID-19 fatality is still unclear. OBJECTIVES The study aimed to investigate the association between long-term exposure to air pollutants and mortality among 4 million COVID-19 cases in Italy. METHODS We obtained individual records of all COVID-19 cases identified in Italy from February 2020 to June 2021. We assigned 2016-2019 mean concentrations of particulate matter (PM) with aerodynamic diameter ≤10μm (PM10), PM with aerodynamic diameter ≤2.5μm (PM2.5), and nitrogen dioxide (NO2) to each municipality (n=7,800) as estimates of chronic exposures. We applied a principal component analysis (PCA) and a generalized propensity score (GPS) approach to an extensive list of area-level covariates to account for major determinants of the spatial distribution of COVID-19 case-fatality rates. Then, we applied generalized negative binomial models matched on GPS, age, sex, province, and month. As additional analyses, we fit separate models by pandemic periods, age, and sex; we quantified the numbers of COVID-19 deaths attributable to exceedances in annual air pollutant concentrations above predefined thresholds; and we explored associations between air pollution and alternative outcomes of COVID-19 severity, namely hospitalizations or accesses to intensive care units. RESULTS We analyzed 3,995,202 COVID-19 cases, which generated 124,346 deaths. Overall, case-fatality rates increased by 0.7% [95% confidence interval (CI): 0.5%, 0.9%], 0.3% (95% CI: 0.2%, 0.5%), and 0.6% (95% CI: 0.5%, 0.8%) per 1 μg/m3 increment in PM2.5, PM10, and NO2, respectively. Associations were higher among elderly subjects and during the first (February 2020-June 2020) and the third (December 2020-June 2021) pandemic waves. We estimated ∼8% COVID-19 deaths were attributable to pollutant levels above the World Health Organization 2021 air quality guidelines. DISCUSSION We found suggestive evidence of an association between long-term exposure to ambient air pollutants with mortality among 4 million COVID-19 cases in Italy. https://doi.org/10.1289/EHP11882.
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Affiliation(s)
- Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Andrea Ranzi
- Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Modena, Italy
| | - Carla Ancona
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Lisa Bauleo
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | | | - Giorgio Cattani
- Italian Institute for Environmental Protection and Research (ISPRA), Rome, Italy
| | - Federica Nobile
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
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Maio S, Fasola S, Marcon A, Angino A, Baldacci S, Bilò MB, Bono R, La Grutta S, Marchetti P, Sarno G, Squillacioti G, Stanisci I, Pirina P, Tagliaferro S, Verlato G, Villani S, Gariazzo C, Stafoggia M, Viegi G. Relationship of long-term air pollution exposure with asthma and rhinitis in Italy: an innovative multipollutant approach. Environ Res 2023; 224:115455. [PMID: 36791835 DOI: 10.1016/j.envres.2023.115455] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 12/06/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND air pollution is a complex mixture; novel multipollutant approaches could help understanding the health effects of multiple concomitant exposures to air pollutants. AIM to assess the relationship of long-term air pollution exposure with the prevalence of respiratory/allergic symptoms and diseases in an Italian multicenter study using single and multipollutant approaches. METHODS 14420 adults living in 6 Italian cities (Ancona, Pavia, Pisa, Sassari, Turin, Verona) were investigated in 2005-2011 within 11 different study cohorts. Questionnaire information about risk factors and health outcomes was collected. Machine learning derived mean annual concentrations of PM10, PM2.5, NO2 and mean summer concentrations of O3 (μg/m3) at residential level (1-km resolution) were used for the period 2013-2015. The associations between the four pollutants and respiratory/allergic symptoms/diseases were assessed using two approaches: a) logistic regression models (single-pollutant models), b) principal component logistic regression models (multipollutant models). All the models were adjusted for age, sex, education level, smoking habits, season of interview, climatic index and included a random intercept for cohorts. RESULTS the three-year average (± standard deviation) pollutants concentrations at residential level were: 20.3 ± 6.8 μg/m3 for PM2.5, 29.2 ± 7.0 μg/m3 for PM10, 28.0 ± 11.2 μg/m3 for NO2, and 70.9 ± 4.3 μg/m3 for summer O3. Through the multipollutant models the following associations emerged: PM10 and PM2.5 were related to 14-25% increased odds of rhinitis, 23-34% of asthma and 30-33% of night awakening; NO2 was related to 6-9% increased odds of rhinitis, 7-8% of asthma and 12% of night awakening; O3 was associated with 37% increased odds of asthma attacks. Overall, the Odds Ratios estimated through the multipollutant models were attenuated when compared to those of the single-pollutant models. CONCLUSIONS this study enabled to obtain new information about the health effects of air pollution on respiratory/allergic outcomes in adults, applying innovative methods for exposure assessment and multipollutant analyses.
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Affiliation(s)
- Sara Maio
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.
| | - Salvatore Fasola
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Anna Angino
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Sandra Baldacci
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Maria Beatrice Bilò
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy; Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Torino, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
| | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giuseppe Sarno
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Giulia Squillacioti
- Department of Public Health and Pediatrics, University of Turin, Torino, Italy
| | - Ilaria Stanisci
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Pietro Pirina
- Respiratory Unit, Sassari University, Sassari, Italy
| | - Sofia Tagliaferro
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simona Villani
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Claudio Gariazzo
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Roma, Italy
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | - Giovanni Viegi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
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Stafoggia M, De' Donato F, Ancona C, Ranzi A, Michelozzi P. Impatto sanitario dell'inquinamento atmosferico e della temperatura dell'aria in Italia: evidenze per azioni concrete. Epidemiol Prev 2023; 47:22-31. [PMID: 37455629 DOI: 10.19191/ep23.3.s1.a619.040] [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] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVES to estimate the impact (number of deaths and attributable fraction) of air pollution (chronic exposure to PM2.5 and NO2) and high summer temperatures (acute exposure) on mortality in Italy. DESIGN observational study. Time series analysis (for estimating acute effects of air temperature), and computation of deaths attributable to heat/pollution using standard health impact assessment functions. SETTING AND PARTICIPANTS for the assessment of the impact due to chronic exposure to air pollutants, the study period considered was 2016-2019. For the assessment of the acute effects of air temperature and related impacts, the municipal daily series of deaths from all causes relating to the period 2003-2015 were used. MAIN OUTCOME MEASURES mortality for all causes (effects and impacts of acute exposure to air temperature), cause-specific mortality (impact of chronic exposure to pollution). RESULTS concerning chronic exposure to PM2.5, each year during 2016-2019, 72,083 deaths (11.7%) were estimated to be attributable to annual mean levels of PM2.5 above 5 µg/m3 (WHO-2021 Air Quality Guideline value). Of these, 39,628 were estimated in the regions of the Po Valley and 10,232 in the 6 Italian cities with >500,000 inhabitants. With reference to acute effects of air temperature, over 14,500 deaths (2.3%) were estimated to be attributable to daily temperature increases from the 75th to the 99th percentile of the municipality-specific distribution for the year 2015. Conclusions: high air pollution concentrations and summer temperatures are two environmental risk factors extremely relevant for public health. Although the prevention and mitigation interventions carried out in recent years have contributed to reducing the exposure of the population, there are still alarming numbers of deaths attributable to high levels of particulate matter, nitrogen oxides, and air temperature in the Italian population.
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Affiliation(s)
- Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome (Italy)
| | - Francesca De' Donato
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome (Italy);
| | - Carla Ancona
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome (Italy)
| | - Andrea Ranzi
- Environmental Health Reference Centre, Regional Agency for Environmental Preven-tion of Emilia-Romagna, Modena (Italy)
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome (Italy)
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Marchetti P, Miotti J, Locatelli F, Antonicelli L, Baldacci S, Battaglia S, Bono R, Corsico A, Gariazzo C, Maio S, Murgia N, Pirina P, Silibello C, Stafoggia M, Torroni L, Viegi G, Verlato G, Marcon A. Long-term residential exposure to air pollution and risk of chronic respiratory diseases in Italy: The BIGEPI study. Sci Total Environ 2023; 884:163802. [PMID: 37127163 DOI: 10.1016/j.scitotenv.2023.163802] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
Long-term exposure to air pollution has adverse respiratory health effects. We investigated the cross-sectional relationship between residential exposure to air pollutants and the risk of suffering from chronic respiratory diseases in some Italian cities. In the BIGEPI project, we harmonised questionnaire data from two population-based studies conducted in 2007-2014. By combining self-reported diagnoses, symptoms and medication use, we identified cases of rhinitis (n = 965), asthma (n = 328), chronic bronchitis/chronic obstructive pulmonary disease (CB/COPD, n = 469), and controls (n = 2380) belonging to 13 cohorts from 8 Italian cities (Pavia, Turin, Verona, Terni, Pisa, Ancona, Palermo, Sassari). We derived mean residential concentrations of fine particulate matter (PM10, PM2.5), nitrogen dioxide (NO2), and summer ozone (O3) for the period 2013-2015 using spatiotemporal models at a 1 km resolution. We fitted logistic regression models with controls as reference category, a random-intercept for cohort, and adjusting for sex, age, education, BMI, smoking, and climate. Mean ± SD exposures were 28.7 ± 6.0 μg/m3 (PM10), 20.1 ± 5.6 μg/m3 (PM2.5), 27.2 ± 9.7 μg/m3 (NO2), and 70.8 ± 4.2 μg/m3 (summer O3). The concentrations of PM10, PM2.5, and NO2 were higher in Northern Italian cities. We found associations between PM exposure and rhinitis (PM10: OR 1.62, 95%CI: 1.19-2.20 and PM2.5: OR 1.80, 95%CI: 1.16-2.81, per 10 μg/m3) and between NO2 exposure and CB/COPD (OR 1.22, 95%CI: 1.07-1.38 per 10 μg/m3), whereas asthma was not related to environmental exposures. Results remained consistent using different adjustment sets, including bi-pollutant models, and after excluding subjects who had changed residential address in the last 5 years. We found novel evidence of association between long-term PM exposure and increased risk of rhinitis, the chronic respiratory disease with the highest prevalence in the general population. Exposure to NO2, a pollutant characterised by strong oxidative properties, seems to affect mainly CB/COPD.
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Affiliation(s)
- Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jessica Miotti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Francesca Locatelli
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Sandra Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | | | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Torino, Italy
| | - Angelo Corsico
- Respiratory Diseases Division, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Claudio Gariazzo
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Roma, Italy
| | - Sara Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Nicola Murgia
- Department of Environmental and Prevention Sciences, University of Ferrara, Italy
| | - Pietro Pirina
- Respiratory Unit, Sassari University, Sassari, Italy
| | | | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service ASL Roma 1, Roma, Italy
| | - Lorena Torroni
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giovanni Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
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Rai M, Stafoggia M, de'Donato F, Scortichini M, Zafeiratou S, Vazquez Fernandez L, Zhang S, Katsouyanni K, Samoli E, Rao S, Lavigne E, Guo Y, Kan H, Osorio S, Kyselý J, Urban A, Orru H, Maasikmets M, Jaakkola JJK, Ryti N, Pascal M, Hashizume M, Fook Sheng Ng C, Alahmad B, Hurtado Diaz M, De la Cruz Valencia C, Nunes B, Madureira J, Scovronick N, Garland RM, Kim H, Lee W, Tobias A, Íñiguez C, Forsberg B, Åström C, Maria Vicedo-Cabrera A, Ragettli MS, Leon Guo YL, Pan SC, Li S, Gasparrini A, Sera F, Masselot P, Schwartz J, Zanobetti A, Bell ML, Schneider A, Breitner S. Heat-related cardiorespiratory mortality: Effect modification by air pollution across 482 cities from 24 countries. Environ Int 2023; 174:107825. [PMID: 36934570 DOI: 10.1016/j.envint.2023.107825] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 08/31/2022] [Revised: 01/11/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Evidence on the potential interactive effects of heat and ambient air pollution on cause-specific mortality is inconclusive and limited to selected locations. OBJECTIVES We investigated the effects of heat on cardiovascular and respiratory mortality and its modification by air pollution during summer months (six consecutive hottest months) in 482 locations across 24 countries. METHODS Location-specific daily death counts and exposure data (e.g., particulate matter with diameters ≤ 2.5 µm [PM2.5]) were obtained from 2000 to 2018. We used location-specific confounder-adjusted Quasi-Poisson regression with a tensor product between air temperature and the air pollutant. We extracted heat effects at low, medium, and high levels of pollutants, defined as the 5th, 50th, and 95th percentile of the location-specific pollutant concentrations. Country-specific and overall estimates were derived using a random-effects multilevel meta-analytical model. RESULTS Heat was associated with increased cardiorespiratory mortality. Moreover, the heat effects were modified by elevated levels of all air pollutants in most locations, with stronger effects for respiratory than cardiovascular mortality. For example, the percent increase in respiratory mortality per increase in the 2-day average summer temperature from the 75th to the 99th percentile was 7.7% (95% Confidence Interval [CI] 7.6-7.7), 11.3% (95%CI 11.2-11.3), and 14.3% (95% CI 14.1-14.5) at low, medium, and high levels of PM2.5, respectively. Similarly, cardiovascular mortality increased by 1.6 (95%CI 1.5-1.6), 5.1 (95%CI 5.1-5.2), and 8.7 (95%CI 8.7-8.8) at low, medium, and high levels of O3, respectively. DISCUSSION We observed considerable modification of the heat effects on cardiovascular and respiratory mortality by elevated levels of air pollutants. Therefore, mitigation measures following the new WHO Air Quality Guidelines are crucial to enhance better health and promote sustainable development.
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Affiliation(s)
- Masna Rai
- Institute of Epidemiology, Helmholtz Munich, - German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Pettenkofer School of Public Health, LMU Munich, Munich, Germany.
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | - Francesca de'Donato
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | - Matteo Scortichini
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | - Sofia Zafeiratou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School,National and Kapodistrian University of Athens, Greece
| | | | - Siqi Zhang
- Institute of Epidemiology, Helmholtz Munich, - German Research Center for Environmental Health, Neuherberg, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School,National and Kapodistrian University of Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School,National and Kapodistrian University of Athens, Greece
| | - Shilpa Rao
- Department of Air Pollution and Noise, Norwegian Institute of Public Health, Oslo, Norway
| | - Eric Lavigne
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada and Environmental Health Science & Research Bureau, Health Canada, Ottawa, Canada
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Samuel Osorio
- Department of Environmental Health, University of São Paulo, São Paulo, Brazil
| | - Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Aleš Urban
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Hans Orru
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Jouni J K Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
| | - Niilo Ryti
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
| | - Mathilde Pascal
- Santé Publique France, Department of Environmental Health, French National Public Health Agency, Saint Maurice, France
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Barrak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Magali Hurtado Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - César De la Cruz Valencia
- Department of Environmental Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Baltazar Nunes
- Department of Environmental Health, Instituto Nacional de Saúde Dr. Ricardo Jorge, Porto, Portugal
| | - Joana Madureira
- Department of Environmental Health, Instituto Nacional de Saúde Dr. Ricardo Jorge, Porto, Portugal
| | - Noah Scovronick
- Department of Environmental Health. Rollins School of Public Health, Emory University, Atlanta, USA
| | - Rebecca M Garland
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa
| | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Whanhee Lee
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan, South Korea
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - Carmen Íñiguez
- Department of Statistics and Computational Research. Universitat de València, València, Spain
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | | | | | - Yue-Liang Leon Guo
- Environmental and Occupational Medicine, and Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
| | - Shih-Chun Pan
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Antonio Gasparrini
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Francesco Sera
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
| | - Pierre Masselot
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven CT, USA
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Munich, - German Research Center for Environmental Health, Neuherberg, Germany
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Munich, - German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
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Masselot P, Mistry M, Vanoli J, Schneider R, Iungman T, Garcia-Leon D, Ciscar JC, Feyen L, Orru H, Urban A, Breitner S, Huber V, Schneider A, Samoli E, Stafoggia M, de'Donato F, Rao S, Armstrong B, Nieuwenhuijsen M, Vicedo-Cabrera AM, Gasparrini A. Excess mortality attributed to heat and cold: a health impact assessment study in 854 cities in Europe. Lancet Planet Health 2023; 7:e271-e281. [PMID: 36934727 DOI: 10.1016/s2542-5196(23)00023-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Heat and cold are established environmental risk factors for human health. However, mapping the related health burden is a difficult task due to the complexity of the associations and the differences in vulnerability and demographic distributions. In this study, we did a comprehensive mortality impact assessment due to heat and cold in European urban areas, considering geographical differences and age-specific risks. METHODS We included urban areas across Europe between Jan 1, 2000, and Dec 12, 2019, using the Urban Audit dataset of Eurostat and adults aged 20 years and older living in these areas. Data were extracted from Eurostat, the Multi-country Multi-city Collaborative Research Network, Moderate Resolution Imaging Spectroradiometer, and Copernicus. We applied a three-stage method to estimate risks of temperature continuously across the age and space dimensions, identifying patterns of vulnerability on the basis of city-specific characteristics and demographic structures. These risks were used to derive minimum mortality temperatures and related percentiles and raw and standardised excess mortality rates for heat and cold aggregated at various geographical levels. FINDINGS Across the 854 urban areas in Europe, we estimated an annual excess of 203 620 (empirical 95% CI 180 882-224 613) deaths attributed to cold and 20 173 (17 261-22 934) attributed to heat. These corresponded to age-standardised rates of 129 (empirical 95% CI 114-142) and 13 (11-14) deaths per 100 000 person-years. Results differed across Europe and age groups, with the highest effects in eastern European cities for both cold and heat. INTERPRETATION Maps of mortality risks and excess deaths indicate geographical differences, such as a north-south gradient and increased vulnerability in eastern Europe, as well as local variations due to urban characteristics. The modelling framework and results are crucial for the design of national and local health and climate policies and for projecting the effects of cold and heat under future climatic and socioeconomic scenarios. FUNDING Medical Research Council of UK, the Natural Environment Research Council UK, the EU's Horizon 2020, and the EU's Joint Research Center.
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Affiliation(s)
- Pierre Masselot
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| | - Malcolm Mistry
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Jacopo Vanoli
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Rochelle Schneider
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK; ϕ-Lab, European Space Agency, Frascati, Italy
| | - Tamara Iungman
- Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | - Luc Feyen
- Joint Research Centre, European Commission, Ispra, Italy
| | - Hans Orru
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Aleš Urban
- Institute of Atmospheric Physics, Academy of Sciences of the Czech Republic, Prague, Czech Republic; Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; IBE-Chair of Epidemiology, LMU Munich, Munich, Germany
| | - Veronika Huber
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; IBE-Chair of Epidemiology, LMU Munich, Munich, Germany
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service/ASL Roma 1, Rome, Italy
| | - Francesca de'Donato
- Department of Epidemiology, Lazio Regional Health Service/ASL Roma 1, Rome, Italy
| | - Shilpa Rao
- Norwegian Institute of Public Health, Oslo, Norway
| | - Ben Armstrong
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Nieuwenhuijsen
- Institute for Global Health (ISGlobal), Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
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Stafoggia M, Analitis A, Chen J, Rodopoulou S, Brunekreef B, Hoek G, Wolf K, Samoli E. Comparing "causal" and "traditional" approaches in the association of long-term exposure to ambient air pollution on mortality: How sensitive are the results? Environ Int 2023; 174:107872. [PMID: 36934573 DOI: 10.1016/j.envint.2023.107872] [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: 01/11/2023] [Revised: 02/24/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Few comparisons between causal inference and traditional approaches have been performed. We applied "causal" and "traditional" methods to investigate the association between long-term air pollution exposure (PM2.5 and NO2) and mortality. METHODS We analyzed pooled data from eight well-characterized cohorts and one administrative cohort. We defined the generalized propensity score (GPS) as the conditional likelihood of exposure given confounders, and derived corresponding inverse-probability weights (IPW). We applied Cox-proportional hazard models weighted by IPW, adjusted for GPS, and directly adjusting for all confounders. RESULTS In IPW models, PM2.5 5 µg/m3 increases were associated with hazard ratios (HR) = 1.141 (95% confidence interval (CI): 1.107, 1.176) and 1.050 (1.014, 1.088) in the pooled and administrative cohorts. Corresponding estimates for traditional Cox models were 1.132 (1.107, 1.158) and 1.057 (1.025, 1.089). Almost identical results were found for all approaches and both pollutants, when unbalanced covariates were adjusted for in causal models. CONCLUSIONS Traditional and causal approaches provided consistent associations between long-term exposure to air pollution and mortality.
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Affiliation(s)
- Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Antonis Analitis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jie Chen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Neuherberg, Germany
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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44
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Vienneau D, Stafoggia M, Rodopoulou S, Chen J, Atkinson RW, Bauwelinck M, Klompmaker JO, Oftedal B, Andersen ZJ, Janssen NAH, So R, Lim YH, Flückiger B, Ducret-Stich R, Röösli M, Probst-Hensch N, Künzli N, Strak M, Samoli E, de Hoogh K, Brunekreef B, Hoek G. Association between exposure to multiple air pollutants, transportation noise and cause-specific mortality in adults in Switzerland. Environ Health 2023; 22:29. [PMID: 36967400 PMCID: PMC10041702 DOI: 10.1186/s12940-023-00983-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/13/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Long-term exposure to air pollution and noise is detrimental to health; but studies that evaluated both remain limited. This study explores associations with natural and cause-specific mortality for a range of air pollutants and transportation noise. METHODS Over 4 million adults in Switzerland were followed from 2000 to 2014. Exposure to PM2.5, PM2.5 components (Cu, Fe, S and Zn), NO2, black carbon (BC) and ozone (O3) from European models, and transportation noise from source-specific Swiss models, were assigned at baseline home addresses. Cox proportional hazards models, adjusted for individual and area-level covariates, were used to evaluate associations with each exposure and death from natural, cardiovascular (CVD) or non-malignant respiratory disease. Analyses included single and two exposure models, and subset analysis to study lower exposure ranges. RESULTS During follow-up, 661,534 individuals died of natural causes (36.6% CVD, 6.6% respiratory). All exposures including the PM2.5 components were associated with natural mortality, with hazard ratios (95% confidence intervals) of 1.026 (1.015, 1.038) per 5 µg/m3 PM2.5, 1.050 (1.041, 1.059) per 10 µg/m3 NO2, 1.057 (1.048, 1.067) per 0.5 × 10-5/m BC and 1.045 (1.040, 1.049) per 10 dB Lden total transportation noise. NO2, BC, Cu, Fe and noise were consistently associated with CVD and respiratory mortality, whereas PM2.5 was only associated with CVD mortality. Natural mortality associations persisted < 20 µg/m3 for PM2.5 and NO2, < 1.5 10-5/m BC and < 53 dB Lden total transportation noise. The O3 association was inverse for all outcomes. Including noise attenuated all outcome associations, though many remained significant. Across outcomes, noise was robust to adjustment to air pollutants (e.g. natural mortality 1.037 (1.033, 1.042) per 10 dB Lden total transportation noise, after including BC). CONCLUSION Long-term exposure to air pollution and transportation noise in Switzerland contribute to premature mortality. Considering co-exposures revealed the importance of local traffic-related pollutants such as NO2, BC and transportation noise.
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Affiliation(s)
- Danielle Vienneau
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, CH-4123, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Richard W Atkinson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Mariska Bauwelinck
- Interface Demography - Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, Brussels, 1050, Belgium
| | - Jochem O Klompmaker
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Bente Oftedal
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, 1165, Denmark
| | - Nicole A H Janssen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, 1165, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, 1165, Denmark
| | - Benjamin Flückiger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, CH-4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Regina Ducret-Stich
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, CH-4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Martin Röösli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, CH-4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, CH-4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Nino Künzli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, CH-4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Maciek Strak
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kees de Hoogh
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, CH-4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
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45
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Panunzi S, Marchetti P, Stafoggia M, Badaloni C, Caranci N, de Hoogh K, Giorgi Rossi P, Guarda L, Locatelli F, Ottone M, Silocchi C, Ricci P, Marcon A. Residential exposure to air pollution and adverse respiratory and allergic outcomes in children and adolescents living in a chipboard industrial area of Northern Italy. Sci Total Environ 2023; 864:161070. [PMID: 36565877 DOI: 10.1016/j.scitotenv.2022.161070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Chipboard production is a source of wood dust, formaldehyde, and combustion-related pollutants such as nitrogen dioxide (NO2) and particulate matter (PM). In this cohort study, we assessed whether exposures to NO2, formaldehyde, PM10, PM2.5, and black carbon were associated with adverse respiratory and allergic outcomes among all 7525 people aged 0-21 years residing in the Viadana district, an area in Northern Italy including the largest chipboard industrial park in the country. METHODS Data on hospitalizations, emergency room (ER) admissions, and specialist visits in pneumology, allergology, ophthalmology, and otorhinolaryngology were obtained from the Local Health Unit. Residential air pollution concentrations in 2013 (baseline) were derived using local (Viadana II), national (EPISAT), and continental (ELAPSE) exposure models. Associations were estimated using negative binomial regression models for counts of events occurred during 2013-2017, with follow-up time as an offset term and adjustment for sex, age, nationality, and a census-block socio-economic indicator. RESULTS Median annual exposures to NO2, PM10, and PM2.5 were below the European Union annual air quality standards (40, 40, and 25 μg/m3) but above the World Health Organization 2021 air quality guideline levels (10, 15, and 5 μg/m3). Exposures to NO2 and PM2.5 were significantly associated with higher rates of ER pneumology admissions (13 to 30 % higher rates per interquartile range exposure differences, all p < 0.01). Higher rates of allergology and ophthalmology visits were found for participants exposed to higher pollutants' concentrations. When considering the 4-km buffer around the industries, associations with respiratory hospitalizations became significant, and associations with ER pneumology admissions, allergology and ophthalmology visits became stronger. Formaldehyde was not associated with the outcomes considered. CONCLUSION Using administrative indicators of health effects a priori attributable to air pollution, we documented the adverse impact of long-term air pollution exposure in residential areas close to the largest chipboard industries in Italy. These findings, combined with evidence from previous studies, call for an action to improve air quality through preventive measures especially targeting emissions related to the industrial activities.
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Affiliation(s)
- Silvia Panunzi
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Italy.
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service ASL Roma 1, Rome, Italy
| | - Chiara Badaloni
- Department of Epidemiology, Lazio Regional Health Service ASL Roma 1, Rome, Italy
| | - Nicola Caranci
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | | | - Linda Guarda
- UOC Osservatorio Epidemiologico, Agenzia di Tutela della Salute della Val Padana, Mantova, Italy
| | - Francesca Locatelli
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Marta Ottone
- Epidemiology Unit, AUSL - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Caterina Silocchi
- UOS Salute e Ambiente, Agenzia di Tutela della Salute della Val Padana, Mantova, Italy
| | - Paolo Ricci
- UOC Osservatorio Epidemiologico, Agenzia di Tutela della Salute della Val Padana, Mantova, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Italy
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46
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Lwin KS, Tobias A, Chua PL, Yuan L, Thawonmas R, Ith S, Htay ZW, Yu LS, Yamasaki L, Roqué M, Querol X, Fussell JC, Nadeau KC, Stafoggia M, Saliba NA, Sheng Ng CF, Hashizume M. Effects of Desert Dust and Sandstorms on Human Health: A Scoping Review. Geohealth 2023; 7:e2022GH000728. [PMID: 36874170 PMCID: PMC9976568 DOI: 10.1029/2022gh000728] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/04/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Desert dust and sandstorms are recurring environmental phenomena that are reported to produce serious health risks worldwide. This scoping review was conducted to identify the most likely health effects of desert dust and sandstorms and the methods used to characterize desert dust exposure from the existing epidemiological literature. We systematically searched PubMed/MEDLINE, Web of Science, and Scopus to identify studies that reported the effects of desert dust and sandstorms on human health. Search terms referred to desert dust or sandstorm exposure, names of major deserts, and health outcomes. Health effects were cross-tabulated with study design variables (e.g., epidemiological design and methods to quantify dust exposure), desert dust source, health outcomes and conditions. We identified 204 studies that met the inclusion criteria for the scoping review. More than half of the studies (52.9%) used a time-series study design. However, we found a substantial variation in the methods used to identify and quantify desert dust exposure. The binary metric of dust exposure was more frequently used than the continuous metric for all desert dust source locations. Most studies (84.8%) reported significant associations between desert dust and adverse health effects, mainly for respiratory and cardiovascular mortality and morbidity causes. Although there is a large body of evidence on the health effects of desert dust and sandstorms, the existing epidemiological studies have significant limitations related to exposure measurement and statistical analysis that potentially contribute to inconsistencies in determining the effect of desert dust on human health.
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Affiliation(s)
- Kaung Suu Lwin
- Department of Global Health PolicyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water ResearchSpanish Council for Scientific ResearchBarcelonaSpain
- School of Tropical Medicine and Global HealthNagasaki UniversityNagasakiJapan
| | - Paul Lester Chua
- Department of Global Health PolicyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Lei Yuan
- Department of Global Health PolicyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Ramita Thawonmas
- Department of Global Health PolicyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Sophearen Ith
- Department of Global Health PolicyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Zin Wai Htay
- Department of Global Health PolicyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Lin Szu Yu
- Department of Global Health PolicyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Lisa Yamasaki
- Department of Global Health PolicyGraduate School of MedicineThe University of TokyoTokyoJapan
- School of MedicineNagasaki UniversityNagasakiJapan
| | - Marta Roqué
- Iberoamerican Cochrane Centre ‐ Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU)BarcelonaSpain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
| | - Xavier Querol
- Institute of Environmental Assessment and Water ResearchSpanish Council for Scientific ResearchBarcelonaSpain
| | - Julia C. Fussell
- National Institute for Health ResearchHealth Protection Research Unit in Environmental Exposures and HealthSchool of Public HealthImperial College LondonLondonUK
| | - Kari Christine Nadeau
- Sean N Parker Center for Allergy & Asthma ResearchStanford UniversityMountain ViewCAUSA
| | | | - Najat A. Saliba
- Faculty of Arts and SciencesAmerican University of BeirutBeirutLebanon
| | - Chris Fook Sheng Ng
- Department of Global Health PolicyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Masahiro Hashizume
- Department of Global Health PolicyGraduate School of MedicineThe University of TokyoTokyoJapan
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47
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Agewall S, Breitner S, Rai M, Stafoggia M, De'Donato F, Samoli E, Zafeiratou S, Fernandez LV, Rao S, Gasparrini A, Masselot P, Aunan K, Schneider A, Zhang S. SMALL-AREA ANALYSIS OF SHORT-TERM ASSOCIATIONTWEEN HEAT AND CARDIOVASCULAR MORTALITY IN FOUR EUROPEAN COUNTRIES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02558-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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48
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Yu Z, Merid SK, Bellander T, Bergström A, Eneroth K, Georgelis A, Hallberg J, Kull I, Ljungman P, Klevebro S, Stafoggia M, Wang G, Pershagen G, Gruzieva O, Melén E. Associations of improved air quality with lung function growth from childhood to adulthood: The BAMSE study. Eur Respir J 2023; 61:13993003.01783-2022. [PMID: 36822631 PMCID: PMC10160798 DOI: 10.1183/13993003.01783-2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/29/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND The beneficial effect of improving air quality on lung function development remains understudied. We assessed associations of changes in ambient air pollution levels with lung function growth from childhood until young adulthood in a Swedish cohort study. METHODS In the prospective birth cohort BAMSE (Children, Allergy, Environment, Stockholm, Epidemiology), spirometry was conducted at the 8-year (2002-2004), 16-year (2011-2013) and 24-year follow-ups (2016-2019). Participants with spirometry data at 8 years and at least one another measurement in subsequent follow-ups were included (1509 participants with 3837 spirometry measurements). Ambient air pollution levels (particulate matter≤2.5 μm [PM2.5], particulate matter≤10 μm [PM10], black carbon [BC] and nitrogen oxides [NOx]) at residential addresses were estimated using dispersion modelling. Linear mixed-effect models were used to estimate associations between air pollution exposure change and lung function development. RESULTS Overall, air pollution levels decreased progressively during the study period. For example, the median (interquartile range, IQR) of PM2.5 decreased from 8.24 (0.92) μg·m-3 during 2002-2004 to 5.21 (0.67) μg·m-3 during 2016-2019. At the individual level, for each IQR reduction of PM2.5 the lung function growth rate increased by 4.63 ml year-1 (95%CI:1.64-7.61, p<0.001) for FEV1 and 9.38 ml year-1 (95%CI: 4.76-14.00, p<0.001) for FVC. Similar associations were also observed for reductions of BC and NOx. Associations persisted after adjustment for potential confounders, and were not modified by asthma, allergic sensitization, overweight, early-life air pollution exposure or antioxidant dietary intake. CONCLUSIONS Long-term reduction of air pollution is associated with positive lung function development from childhood to young adulthood.
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Affiliation(s)
- Zhebin Yu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Simon Kebede Merid
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Kristina Eneroth
- SLB-analys, Environment and Health Administration, Stockholm, Sweden
| | - Antonios Georgelis
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jenny Hallberg
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachś Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachś Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Susanna Klevebro
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachś Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Gang Wang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Olena Gruzieva
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Erik Melén
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachś Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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49
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Nikolaou N, Dallavalle M, Stafoggia M, Bouwer LM, Peters A, Chen K, Wolf K, Schneider A. High-resolution spatiotemporal modeling of daily near-surface air temperature in Germany over the period 2000-2020. Environ Res 2023; 219:115062. [PMID: 36535393 DOI: 10.1016/j.envres.2022.115062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/03/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
The commonly used weather stations cannot fully capture the spatiotemporal variability of near-surface air temperature (Tair), leading to exposure misclassification and biased health effect estimates. We aimed to improve the spatiotemporal coverage of Tair data in Germany by using multi-stage modeling to estimate daily 1 × 1 km minimum (Tmin), mean (Tmean), maximum (Tmax) Tair and diurnal Tair range during 2000-2020. We used weather station Tair observations, satellite-based land surface temperature (LST), elevation, vegetation and various land use predictors. In the first stage, we built a linear mixed model with daily random intercepts and slopes for LST adjusted for several spatial predictors to estimate Tair from cells with both Tair and LST available. In the second stage, we used this model to predict Tair for cells with only LST available. In the third stage, we regressed the second stage predictions against interpolated Tair values to obtain Tair countrywide. All models achieved high accuracy (0.91 ≤ R2 ≤ 0.98) and low errors (1.03 °C ≤ Root Mean Square Error (RMSE) ≤ 2.02 °C). Validation with external data confirmed the good performance, locally, i.e., in Augsburg for all models (0.74 ≤ R2 ≤ 0.99, 0.87 °C ≤ RMSE ≤ 2.05 °C) and countrywide, for the Tmean model (0.71 ≤ R2 ≤ 0.99, 0.79 °C ≤ RMSE ≤ 1.19 °C). Annual Tmean averages ranged from 8.56 °C to 10.42 °C with the years beyond 2016 being constantly hotter than the 21-year average. The spatial variability within Germany exceeded 15 °C annually on average following patterns including mountains, rivers and urbanization. Using a case study, we showed that modeling leads to broader Tair variability representation for exposure assessment of participants in health cohorts. Our results indicate the proposed models as suitable for estimating nationwide Tair at high resolution. Our product is critical for temperature-based epidemiological studies and is also available for other research purposes.
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Affiliation(s)
- Nikolaos Nikolaou
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany.
| | - Marco Dallavalle
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Laurens M Bouwer
- Climate Service Center Germany (GERICS), Helmholtz-Zentrum Hereon, Hamburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA; Yale Center on Climate Change and Health, Yale School of Public Health, New Haven, CT, USA
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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50
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Hvidtfeldt UA, Chen J, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann BH, Katsouyanni K, Ketzel M, Brynedal B, Leander K, Ljungman PLS, Magnusson PKE, Nagel G, Pershagen G, Rizzuto D, Boutron-Ruault MC, Samoli E, So R, Stafoggia M, Tjønneland A, Vermeulen R, Verschuren WMM, Weinmayr G, Wolf K, Zhang J, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O. Breast Cancer Incidence in Relation to Long-Term Low-Level Exposure to Air Pollution in the ELAPSE Pooled Cohort. Cancer Epidemiol Biomarkers Prev 2023; 32:105-113. [PMID: 36215200 DOI: 10.1158/1055-9965.epi-22-0720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Established risk factors for breast cancer include genetic disposition, reproductive factors, hormone therapy, and lifestyle-related factors such as alcohol consumption, physical inactivity, smoking, and obesity. More recently a role of environmental exposures, including air pollution, has also been suggested. The aim of this study, was to investigate the relationship between long-term air pollution exposure and breast cancer incidence. METHODS We conducted a pooled analysis among six European cohorts (n = 199,719) on the association between long-term residential levels of ambient nitrogen dioxide (NO2), fine particles (PM2.5), black carbon (BC), and ozone in the warm season (O3) and breast cancer incidence in women. The selected cohorts represented the lower range of air pollutant concentrations in Europe. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. RESULTS During 3,592,885 person-years of follow-up, we observed a total of 9,659 incident breast cancer cases. The results of the fully adjusted linear analyses showed a HR (95% confidence interval) of 1.03 (1.00-1.06) per 10 μg/m³ NO2, 1.06 (1.01-1.11) per 5 μg/m³ PM2.5, 1.03 (0.99-1.06) per 0.5 10-5 m-1 BC, and 0.98 (0.94-1.01) per 10 μg/m³ O3. The effect estimates were most pronounced in the group of middle-aged women (50-54 years) and among never smokers. CONCLUSIONS The results were in support of an association between especially PM2.5 and breast cancer. IMPACT The findings of this study suggest a role of exposure to NO2, PM2.5, and BC in development of breast cancer.
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Affiliation(s)
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.,National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark.,iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy.,Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.,Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Ole Hertel
- Departments of Ecoscience, Aarhus University, Roskilde, Denmark
| | - Barbara H Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark.,Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom
| | - Boel Brynedal
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter L S Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | | | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rina So
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Roel Vermeulen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jiawei Zhang
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria.,Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Environmental Science, Aarhus University, Roskilde, Denmark
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