RESUMEN
Although concentrations of ambient air pollution continue to decline in high-income regions, epidemiological studies document adverse health effects at levels below current standards in many countries. The Health Effects Institute (HEI) recently completed a comprehensive research initiative to investigate the health effects of long-term exposure to low levels of air pollution in the United States (U.S.), Canada, and Europe. We provide an overview and synthesis of the results of this initiative along with other key research, the strengths and limitations of the research, and remaining research needs. The three studies funded through the HEI initiative estimated the effects of long-term ambient exposure to fine particulate matter (PM2.5), nitrogen dioxide, ozone, and other pollutants on a broad range of health outcomes, including cause-specific mortality and cardiovascular and respiratory morbidity. To ensure high quality research and comparability across studies, HEI worked actively with the study teams and engaged independent expert panels for project oversight and review. All three studies documented positive associations between mortality and exposure to PM2.5 below the U.S. National Ambient Air Quality Standards and current and proposed European Union limit values. Furthermore, the studies observed nonthreshold linear (U.S.), or supra-linear (Canada and Europe) exposure-response functions for PM2.5 and mortality. Heterogeneity was found in both the magnitude and shape of this association within and across studies. Strengths of the studies included the large populations (7-69 million), state-of-the-art exposure assessment methods, and thorough statistical analyses that applied novel methods. Future work is needed to better understand potential sources of heterogeneity in the findings across studies and regions. Other areas of future work include the changing and evolving nature of PM components and sources, including wildfires, and the role of indoor environments. This research initiative provided important new evidence of the adverse effects of long-term exposures to low levels of air pollution at and below current standards, suggesting that further reductions could yield larger benefits than previously anticipated.
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Contaminantes Atmosféricos , Contaminación del Aire , Exposición a Riesgos Ambientales , Material Particulado , Humanos , Contaminantes Atmosféricos/análisis , Canadá , Estados Unidos , Europa (Continente)RESUMEN
BACKGROUND: Residential proximity to greenness in urban areas has been shown to confer a number of health benefits, including improved mental health. We investigated whether greenness was associated with self-reported stress, distress, and mental health among adult participants of multiple cycles of a national Canadian health survey, and whether these associations varied by sex, age, income, and neighbourhood characteristics. METHODS: Our study population included 397,900 participants of the Canadian Community Health Survey, 18 years of age or older, who lived in census metropolitan areas between 2000 and 2015. We used the Normalized Difference Vegetation Index (NDVI) to characterize participants' exposure to greenness within 250 m, 500 m, and 1 km buffers from a representative location of their postal code. Health outcomes included: self-reported perceptions of life stress, psychological distress, and self-rated mental health. We used multiple regression models, adjusted for relevant individual and neighbourhood-level variables to estimate associations (and 95% confidence intervals) between each outcome and exposure to greenness. FINDINGS: In models with all participants, we observed 6% lower odds of poor self-rated mental health per increase in the interquartile range (i.e., 0.12) of NDVI within a 500 m buffer. Across the three outcomes, we found substantial heterogeneity in effect size across categories of sex, age, and community-level indicators of deprivation and urban form. For example, each incremental increase in greenness exposure was associated with a reduction of 0.61 (95% CI: 0.81 to -0.51) on the K10 psychological distress score among those living in the active core of cities, and with an increase of 0.07 (95% CI: 0.03-0.12) on this score among those living in the most suburban areas. CONCLUSIONS: Our results indicate that the potential benefits of residential greenness on mental health vary across personal and neighbourhood-level characteristics and are sensitive to how the outcome is measured. Additional research is needed to understand which features of greenness are most relevant to different sub-groups of the population to maximize these health benefits.
Asunto(s)
Salud Mental , Características de la Residencia , Adolescente , Adulto , Canadá , Ciudades , Encuestas Epidemiológicas , HumanosRESUMEN
BACKGROUND: Residential greenness has been associated with health benefits, such as lower risk of mortality, cardiovascular disease, obesity, adverse birth outcomes and asthma and better psychological health. However, the variation in greenness across socioeconomic and demographic characteristics in urban areas of Canada has not been well documented. DATA AND METHODS: Respondents to the 2016 Census long-form questionnaire were assigned estimates of exposure to residential greenness based on the mean Normalized Difference Vegetation Index (NDVI) (from 2012 or the most recent year available) within a 500 m buffer around their home, based on postal code. Census weights were used to determine differences in average exposure to greenness according to selected demographic and socioeconomic characteristics. RESULTS: Mean residential greenness among the 5.3 million census respondents in urban Canada was 0.44 units of the NDVI (standard deviation = 0.18 units). Greenness was lower among immigrants (particularly recent immigrants), some groups designated as visible minorities (particularly people of Filipino ancestry), lower-income households and tenants (i.e., NDVI values ranging from 0.40 to 0.43 units). Greenness values were highest among White non-immigrants and higher-income households (i.e., NDVI values ranging from 0.46 to 0.47 units). DISCUSSION: Given the potentially multifaceted role that greenness plays in health outcomes, the inequalities in residential greenness described here may contribute to producing or exacerbating existing health inequalities in the Canadian population.
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Emigrantes e Inmigrantes , Renta , Canadá , Censos , Humanos , ObesidadRESUMEN
BACKGROUND: The temporal and spatial scales of exposure assessment may influence observed associations between fine particulate air pollution (PM2.5) and mortality, but few studies have systematically examined this question. METHODS: We followed 2.4 million adults in the 2001 Canadian Census Health and Environment Cohort for nonaccidental and cause-specific mortality between 2001 and 2011. We assigned PM2.5 exposures to residential locations using satellite-based estimates and compared three different temporal moving averages (1, 3, and 8 years) and three spatial scales (1, 5, and 10 km) of exposure assignment. In addition, we examined different spatial scales based on age, employment status, and urban/rural location, and adjustment for O3, NO2, or their combined oxidant capacity (Ox). RESULTS: In general, longer moving averages resulted in stronger associations between PM2.5 and mortality. For nonaccidental mortality, we observed a hazard ratio of 1.11 (95% CI = 1.08, 1.13) for the 1-year moving average compared with 1.23 (95% CI = 1.20, 1.27) for the 8-year moving average. Respiratory and lung cancer mortality were most sensitive to the spatial scale of exposure assessment with stronger associations observed at smaller spatial scales. Adjustment for oxidant gases attenuated associations between PM2.5 and cardiovascular mortality and strengthened associations with lung cancer. Despite these variations, PM2.5 was associated with increased mortality in nearly all of the models examined. CONCLUSIONS: These findings support a relationship between outdoor PM2.5 and mortality at low concentrations and highlight the importance of longer-exposure windows, more spatially resolved exposure metrics, and adjustment for oxidant gases in characterizing this relationship.
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Contaminación del Aire , Exposición a Riesgos Ambientales , Mortalidad , Material Particulado , Adulto , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Canadá/epidemiología , Estudios de Cohortes , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/análisis , Humanos , Mortalidad/tendencias , Material Particulado/efectos adversos , Material Particulado/análisis , Análisis Espacio-TemporalRESUMEN
INTRODUCTION: It is unknown whether urban green space is associated with reduced risk of major neurological conditions, especially dementia and stroke. METHODS: Retrospective, population-based cohorts were created for each study outcome, including 1.7 and 4.3 million adults in Ontario, Canada for dementia and stroke, respectively. Residential green space was quantified using the satellite-derived Normalized Difference Vegetation Index. Incidence was ascertained using health administrative data with validated algorithms. Mixed-effects Cox models were used to estimate hazard ratios per interquartile range increase in green space exposure. RESULTS: Between 2001 and 2013, 219,013 individuals were diagnosed with dementia and 89,958 had a stroke. The hazard ratio per interquartile range increase in green space was 0.97 (95% CI: 0.96-0.98) for dementia and 0.96 (0.95-0.98) for stroke. Estimates remained generally consistent in sensitivity analyses. DISCUSSION: Increased exposure to urban green space was associated with reduced incidence of dementia and stroke. To our knowledge, this is the first population-based cohort study to assess these relationships.
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Demencia , Accidente Cerebrovascular , Adulto , Estudios de Cohortes , Demencia/epidemiología , Humanos , Ontario/epidemiología , Estudios Retrospectivos , Accidente Cerebrovascular/epidemiologíaRESUMEN
BACKGROUND: A large literature search suggests a relationship between hospital/surgeon caseload volume and surgical complications. In this study, we describe associations between post-operative maternal complications following Caesarean section and provider caseload volume, provider years since graduation, and provider specialization, while adjusting for hospital volumes and patient characteristics. METHODS: Our analysis is based on population-based discharge abstract data for the period of April 2004 to March 2014, linked to patient and physician universal coverage registry data. We consider all hospital admissions (N = 20,914) in New Brunswick, Canada, where a Caesarean Section surgery was recorded, as identified by a Canadian Classification of Health Intervention code of 5.MD.60.XX. We ran logistic regression models to identify the odds of occurrence of post-surgical complications during the hospital stay. RESULTS: Roughly 2.6% of admissions had at least one of the following groups of complications: disseminated intravascular coagulation, postpartum sepsis, postpartum hemorrhage, and postpartum infection. The likelihood of complication was negatively associated with provider volume and provider years of experience, and positively associated with having a specialization other than maternal-fetal medicine or obstetrics and gynecology. CONCLUSIONS: Our results suggest that measures of physician training and experience are associated with the likelihood of Caesarean Section complications. In the context of a rural province deciding on the number of rural hospitals to keep open, this suggests a trade off between the benefits of increased volume versus the increased travel time for patients.
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Cesárea/estadística & datos numéricos , Coagulación Intravascular Diseminada/epidemiología , Complicaciones Posoperatorias/epidemiología , Hemorragia Posparto/epidemiología , Infección Puerperal/epidemiología , Sepsis/epidemiología , Cirujanos/estadística & datos numéricos , Adulto , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Femenino , Cirugía General , Hospitales de Alto Volumen/estadística & datos numéricos , Hospitales de Bajo Volumen/estadística & datos numéricos , Humanos , Modelos Logísticos , Nuevo Brunswick/epidemiología , Obstetricia , Oportunidad Relativa , Hemorragia Posoperatoria/epidemiología , Embarazo , Infección de la Herida Quirúrgica/epidemiologíaRESUMEN
BACKGROUND: Marked disparities by socioeconomic status in the risk of potentially avoidable hospitalization for chronic illnesses have been observed in many contexts, including those with universal health coverage. Less well known is how gender mediates such differences. We conducted a population-based cohort study to describe associations between household and community-level income and rehospitalizations for types 1 and 2 diabetes mellitus among Canadian women and men. METHODS: Our cohorts were drawn from respondents to the 2006 mandatory long-form census linked longitudinally to 3 years of nationally standardized hospital records. We included adults 30-69 years hospitalized with diabetes at least once during the study period. We used logistic regressions to estimate odds ratios for 12-month diabetes rehospitalization associated with indicators of household and community-level income, with separate models by gender, and controlling for a range of other sociodemographic characteristics. Since diabetes may not always be recognized as the main reason for hospitalization, we accounted for disease progression through consideration of admissions where diabetes was previously identified as a secondary diagnosis. RESULTS: Among persons hospitalized at least once with diabetes (n = 41,290), 1.5% were readmitted within 12 months where the initial admission had diabetes as the primary diagnosis, and 1.8% were readmitted where the initial admission had diabetes as a secondary diagnosis. For men, being in the lowest household income quintile was associated with higher odds of rehospitalization in cases where the initial admission listed diabetes as either the primary diagnosis (OR = 2.21; 95% CI = 1.38-3.51) or a secondary diagnosis (OR = 1.51; 95% CI = 1.02-2.24). For women, we found no association with income and rehospitalization, but having less than university education was associated with higher odds of rehospitalization where diabetes was a secondary diagnosis of the initial admission (OR = 1.88; 95% CI = 1.21-2.92). We also found positive, but insignificant associations between community-level poverty and odds of rehospitalization. CONCLUSIONS: Universal health coverage remains insufficient to eliminate socioeconomic inequalities in preventable diabetes-related hospitalizations, as illustrated in this Canadian context. Decision-makers should tread cautiously with gender-blind poverty reduction actions aiming to enhance population health that may inadequately respond to the different needs of disadvantaged women and men with chronic illness.
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Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Disparidades en el Estado de Salud , Renta/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Adulto , Anciano , Canadá , Estudios de Cohortes , Composición Familiar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Factores SexualesRESUMEN
BACKGROUND: American studies have shown that higher provider and hospital volumes are associated with reduced risk of mortality following colorectal surgical interventions. Evidence from Canada is limited, and to our knowledge only a single study has considered outcomes other than death. We describe associations between provider surgical volume and all-cause mortality and postoperative complications following colorectal surgical interventions in New Brunswick. METHODS: We used hospital discharge abstracts linked to vital statistics, the provincial cancer registry and patient registry data. We considered all admissions for colorectal surgeries from 2007 through 2013. We used logistic regression to identify odds of dying and odds of complications (from any of anastomosis leak, unplanned colostomy, intra-abdominal sepsis or pneumonia) within 30 days of discharge from hospital according to provider volume (i.e., total interventions performed over the preceding 2 years) adjusted for personal, contextual, provider and hospital characteristics. RESULTS: Overall, 9170 interventions were performed by 125 providers across 18 hospitals. We found decreased odds of experiencing a complication following colorectal surgery per increment of 10 interventions performed per year (odds ratio 0.94, 95% confidence interval 0.91-0.96). We found no associations with mortality. Associations remained consistent across models restricted to cancer patients or to interventions performed by general surgeons and across models that also considered overall hospital volumes. CONCLUSION: Our results suggest that increased caseloads are associated with reduced odds of complications, but not with all-cause mortality, following colorectal surgery in New Brunswick. We also found no evidence of volume having differential effects on outcomes from colon and rectal procedures.
CONTEXTE: Des études américaines ont montré que le volume d'activité des chirurgiens et des hôpitaux est inversement proportionnel au risque de mortalité après la chirurgie colorectale. Les données pour le Canada sont limitées, et à notre connaissance, une seule étude a porté sur d'autres paramètres que le décès. Nous avons décrit les liens entre volume d'activité des chirurgiens et mortalité de toute cause/complications postopératoires après la chirurgie colorectale au Nouveau-Brunswick. MÉTHODES: Nous avons utilisé les registres de congés des hôpitaux reliés aux données de la Statistique de l'état civil, du registre provincial du cancer et du registre des patients. Nous avons recensé toutes les admissions pour chirurgie colorectale de 2007 à 2013. Nous avons utilisé la régression logistique pour établir le risque de décès et le risque de complications (fuite anastomotique, colostomie non planifiée, infection intra-abdominale ou pneumonie) dans les 30 jours suivant le congé de l'hôpital par rapport au volume d'activité des chirurgiens (c.-à-d., interventions totales des 2 années précédentes) ajusté en fonction des caractéristiques individuelles et contextuelles, propres aux chirurgiens et aux hôpitaux. RÉSULTATS: En tout, 125 chirurgiens ont effectué 9170 interventions dans 18 hôpitaux. Nous avons observé un risque moindre de complications après la chirurgie colorectale pour chaque palier de 10 interventions effectuées annuellement (risque relatif 0,94, intervalle de confiance de 95 %, 0,910,96). Nous n'avons observé aucun lien avec la mortalité. Les liens sont demeurés constants, peu importe que les modèles soient restreints aux patients cancéreux ou aux interventions effectuées par des chirurgiens généraux et entre les modèles qui tenaient également compte du volume global d'activité des hôpitaux. CONCLUSION: Selon nos résultats, l'augmentation du volume d'activité est associée à un risque moindre de complications, mais n'a pas de lien avec la mortalité de toute cause après la chirurgie colorectale au Nouveau-Brunswick. Nous n'avons pas non plus constaté de lien entre le volume d'activité et l'issue différentielle de la chirurgie du côlon et du rectum.
Asunto(s)
Enfermedades del Colon/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Enfermedades del Recto/cirugía , Carga de Trabajo/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Colon/cirugía , Enfermedades del Colon/mortalidad , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Femenino , Mortalidad Hospitalaria , Hospitales de Alto Volumen/estadística & datos numéricos , Hospitales de Bajo Volumen/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Nuevo Brunswick/epidemiología , Oportunidad Relativa , Complicaciones Posoperatorias/etiología , Enfermedades del Recto/mortalidad , Recto/cirugía , Sistema de Registros/estadística & datos numéricos , Resultado del TratamientoRESUMEN
BACKGROUND: Several international studies have reported negative associations between hospital and/or provider volume and risk of postoperative death following total hip arthroplasty (THA). The only Canadian studies to report on this have been based in Ontario and have found no such association. We describe associations between postoperative deaths following THA and provider caseload volume, also adjusted for hospital volume, in a population-based cohort in New Brunswick. METHODS: Our analyses are based on hospital discharge abstract data linked to vital statistics and to patient registry data. We considered all first known admissions for THA in New Brunswick between Jan. 1, 2007, and Dec. 31, 2013. Provider volume was defined as total THAs performed over the preceding 2 years. We fit logistic regression models to identify odds of dying within 30 and 90 days according to provider caseload volume adjusted for selected personal and contextual characteristics. RESULTS: About 7095 patients were admitted for THA in New Brunswick over the 7-year study period and 170 died within 30 days. We found no associations with provider volume and postoperative mortality in any of our models. Adjustment for contextual characteristics or hospital volume had no effects on this association. CONCLUSION: Our results suggest that patients admitted for hip replacements in New Brunswick can expect to have similar risk of death regardless of whether they are admitted to see a provider with high or low THA volumes and of whether they are admitted to the province's larger or smaller hospitals.
CONTEXTE: Plusieurs études internationales rapportent un lien négatif entre le volume d'activité de l'hôpital ou du fournisseur de soins de santé et le risque de décès postopératoire lié à une arthroplastie totale de la hanche. Les seules études canadiennes qui se sont intéressées à cette question ont été réalisées en Ontario et n'ont pas rapporté ce lien. Dans notre étude, nous tentons de décrire des liens entre le décès postopératoire lié à une arthroplastie totale de la hanche et le volume de la charge de travail du fournisseur de soins de santé, également ajustés pour tenir compte du volume d'activité de l'hôpital, au sein d'une cohorte basée sur la population au Nouveau-Brunswick. MÉTHODES: Nos analyses reposent sur les données portant sur les congés des hôpitaux, associées aux statistiques de l'état civil et aux données des registres des patients. Nous avons examiné toutes les premières hospitalisations connues en vue d'une arthroplastie totale de la hanche au Nouveau-Brunswick entre le 1er janvier 2007 et le 31 décembre 2013. Le volume d'activité du fournisseur de soins de santé a été défini comme étant la totalité des arthroplasties totales de la hanche pratiquées au cours des 2 années précédentes. Nous avons ajusté les modèles de régression logistique de manière à identifier le risque de décès dans les 30 et 90 jours en fonction du volume de la charge de travail du fournisseur de soins de santé, pour tenir compte de caractéristiques personnelles et contextuelles choisies. RÉSULTATS: Environ 7095 patients ont été admis pour une arthroplastie totale de la hanche au Nouveau-Brunswick au cours de la période de 7 ans à l'étude, et 170 patients sont décédés dans les 30 jours. Nous n'avons pas observé de liens entre le volume d'activité du fournisseur de soins de santé et la mortalité postopératoire dans nos modèles. L'ajustement pour tenir compte des caractéristiques contextuelles ou du volume d'activité de l'hôpital n'a eu aucune incidence sur ce lien. CONCLUSION: Nos résultats suggèrent que les patients hospitalisés afin de subir une arthroplastie de la hanche au Nouveau-Brunswick peuvent s'attendre à un risque similaire de décès, peu importe que leur fournisseur de soins de santé pratique un volume faible ou élevé d'arthroplasties totales de la hanche ou que le patient soit admis dans un petit ou un grand hôpital de la province.
Asunto(s)
Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Complicaciones Posoperatorias/mortalidad , Sistema de Registros/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nuevo Brunswick , Periodo PosoperatorioRESUMEN
BACKGROUND: In previous studies investigating the short-term health effects of ambient air pollution the exposure metric that is often used is the daily average across monitors, thus assuming that all individuals have the same daily exposure. Studies that incorporate space-time exposures of individuals are essential to further our understanding of the short-term health effects of ambient air pollution. OBJECTIVES: As part of a longitudinal cohort study of the acute effects of air pollution that incorporated subject-specific information and medical histories of subjects throughout the follow-up, the purpose of this study was to develop and compare different prediction models using data from fixed-site monitors and other monitoring campaigns to estimate daily, spatially-resolved concentrations of ozone (O3) and nitrogen dioxide (NO2) of participants' residences in Montreal, 1991-2002. METHODS: We used the following methods to predict spatially-resolved daily concentrations of O3 and NO2 for each geographic region in Montreal (defined by three-character postal code areas): (1) assigning concentrations from the nearest monitor; (2) spatial interpolation using inverse-distance weighting; (3) back-extrapolation from a land-use regression model from a dense monitoring survey, and; (4) a combination of a land-use and Bayesian maximum entropy model. We used a variety of indices of agreement to compare estimates of exposure assigned from the different methods, notably scatterplots of pairwise predictions, distribution of differences and computation of the absolute agreement intraclass correlation (ICC). For each pairwise prediction, we also produced maps of the ICCs by these regions indicating the spatial variability in the degree of agreement. RESULTS: We found some substantial differences in agreement across pairs of methods in daily mean predicted concentrations of O3 and NO2. On a given day and postal code area the difference in the concentration assigned could be as high as 131ppb for O3 and 108ppb for NO2. For both pollutants, better agreement was found between predictions from the nearest monitor and the inverse-distance weighting interpolation methods, with ICCs of 0.89 (95% confidence interval (CI): 0.89, 0.89) for O3 and 0.81 (95%CI: 0.80, 0.81) for NO2, respectively. For this pair of methods the maximum difference on a given day and postal code area was 36ppb for O3 and 74ppb for NO2. The back-extrapolation method showed a higher degree of disagreement with the nearest monitor approach, inverse-distance weighting interpolation, and the Bayesian maximum entropy model, which were strongly constrained by the sparse monitoring network. The maps showed that the patterns of agreement differed across the postal code areas and the variability depended on the pair of methods compared and the pollutants. For O3, but not NO2, postal areas showing greater disagreement were mostly located near the city centre and along highways, especially in maps involving the back-extrapolation method. CONCLUSIONS: In view of the substantial differences in daily concentrations of O3 and NO2 predicted by the different methods, we suggest that analyses of the health effects from air pollution should make use of multiple exposure assessment methods. Although we cannot make any recommendations as to which is the most valid method, models that make use of higher spatially resolved data, such as from dense exposure surveys or from high spatial resolution satellite data, likely provide the most valid estimates.
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Contaminantes Atmosféricos/análisis , Exposición a Riesgos Ambientales , Monitoreo del Ambiente/métodos , Dióxido de Nitrógeno/análisis , Ozono/análisis , Humanos , Modelos Teóricos , Quebec , Análisis Espacial , Factores de TiempoRESUMEN
Previous evidence suggests that exposure to outdoor air pollution during pregnancy could alter fetal metabolic function, which could increase the risk of obesity in childhood. However, to our knowledge, no epidemiologic study has investigated the association between prenatal exposure to air pollution and indicators of fetal metabolic function. We investigated the association between maternal exposure to nitrogen dioxide and fine particulate matter (aerodynamic diameter ≤2.5 µm) and umbilical cord blood leptin and adiponectin levels with mixed-effects linear regression models among 1,257 mother-infant pairs from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, conducted in Canada (2008-2011). We observed that an interquartile-range increase in average exposure to fine particulate matter (3.2 µg/m(3)) during pregnancy was associated with an 11% (95% confidence interval: 4, 17) increase in adiponectin levels. We also observed 13% (95% confidence interval: 6, 20) higher adiponectin levels per interquartile-range increase in average exposure to nitrogen dioxide (13.6 parts per billion) during pregnancy. Significant associations were seen between air pollution markers and cord blood leptin levels in models that adjusted for birth weight z score but not in models that did not adjust for birth weight z score. The roles of prenatal exposure to air pollution and fetal metabolic function in the potential development of childhood obesity should be further explored.
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Adiponectina/metabolismo , Contaminantes Atmosféricos/efectos adversos , Contaminación del Aire/efectos adversos , Sangre Fetal/química , Leptina/metabolismo , Exposición Materna , Adulto , Biomarcadores , Índice de Masa Corporal , Femenino , Conductas Relacionadas con la Salud , Humanos , Dióxido de Nitrógeno/efectos adversos , Material Particulado/efectos adversos , Embarazo , Factores Socioeconómicos , Adulto JovenRESUMEN
OBJECTIVES: Urban greenness has been shown to confer many health benefits including reduced risks of chronic disease, depression, anxiety, and, in a limited number of studies, loneliness. In this first Canadian study on this topic, we investigated associations between residential surrounding greenness and loneliness and social isolation among older adults. METHODS: This cross-sectional analysis of the Canadian Longitudinal Study on Aging included 26,811 urban participants between 45 and 86 years of age. The Normalized Difference Vegetation Index (NDVI), a measure of greenness, was assigned to participants' residential addresses using a buffer distance of 500 m. We evaluated associations between the NDVI and (i) self-reported loneliness using the Center for Epidemiological Studies Depression Scale, (ii) whether participants reported "feeling lonely living in the local area", and (iii) social isolation. Logistic regression models were used to characterize associations between greenness and loneliness/social isolation while adjusting for individual socio-economic and health behaviours. RESULTS: Overall, 10.8% of participants perceived being lonely, while 6.5% reported "feeling lonely in their local area". Furthermore, 16.2% of participants were characterized as being socially isolated. In adjusted models, we observed no statistically significant difference (odds ratio (OR) = 0.99; 95% confidence interval (CI) 0.93-1.04) in self-reported loneliness in relation to an interquartile range (IQR) increase of NDVI (0.06). However, for the same change in greenness, there was a 15% (OR = 0.85; 95% CI 0.72-0.99) reduced risk for participants who strongly agreed with "feeling lonely living in the local area". For social isolation, for an IQR increase in the NDVI, we observed a 7% (OR = 0.93; 95% CI 0.88-0.97) reduction in prevalence. CONCLUSION: Our findings suggest that urban greenness plays a role in reducing loneliness and social isolation among Canadian urbanites.
RéSUMé: OBJECTIFS: Il est démontré que la verdure urbaine confère de nombreux avantages pour la santé; elle réduit notamment les risques de maladies chroniques, de dépression et d'anxiété et, selon un petit nombre d'études, le risque de solitude. Dans cette première étude canadienne sur le sujet, nous avons étudié les associations entre la verdure de l'environnement résidentiel et la solitude et l'isolement social chez les adultes d'âge mûr. MéTHODE: Cette analyse transversale de l'Étude longitudinale canadienne sur le vieillissement a inclus 26 811 participantes et participants urbains de 45 à 86 ans. L'indice de végétation par différence normalisée (IVDN), un indicateur de verdure, a été assigné à l'adresse domiciliaire dans une zone tampon de 500 m. Nous avons évalué les associations entre l'IVDN et i) la solitude autodéclarée selon l'échelle de dépression du Center for Epidemiological Studies, ii) le fait de déclarer « vivre de la solitude dans sa zone locale ¼ et iii) l'isolement social. Des modèles de régression logistique ont servi à caractériser les associations entre la verdure et la solitude/l'isolement social, et nous avons apporté des ajustements pour tenir compte du statut socioéconomique et des comportements de santé individuels. RéSULTATS: Globalement, 10,8 % des participantes et des participants se sentaient seuls, et 6,5 % disaient « vivre de la solitude dans leur zone locale ¼. De plus, 16,2 % des participantes et des participants ont été caractérisés comme étant socialement isolés. Dans nos modèles ajustés, nous n'avons observé aucun écart significatif (rapport de cotes (RC) = 0,99; IC de 95 % : 0,931,04) dans la solitude autodéclarée en lien avec une augmentation de l'écart interquartile (EI) de l'IVDN (0,06). Cependant, pour le même changement dans la verdure, la probabilité pour les participantes et les participants d'être tout à fait d'accord avec l'énoncé qu'ils « vivent de la solitude dans leur zone locale ¼ était réduite de 15 % (RC = 0,85, IC de 95 % : 0,720,99). Et pour chaque augmentation de l'EI de l'IVDN, nous avons observé une baisse de 7 % (RC = 0,93, IC de 95 % : 0,880,97) de la prévalence de l'isolement social. CONCLUSION: Nos constatations indiquent que la verdure urbaine joue un rôle dans la réduction de la solitude et de l'isolement social chez les citadins et citadines au Canada.
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Soledad , Pueblos de América del Norte , Aislamiento Social , Anciano , Humanos , Persona de Mediana Edad , Envejecimiento , Canadá , Estudios Transversales , Estudios Longitudinales , Anciano de 80 o más AñosRESUMEN
OBJECTIVES: There is a paucity of information on environmental risk factors for prostate cancer. We conducted a case-control study in Montreal to estimate associations with exposure to ground-level nitrogen dioxide (NO2), a marker for traffic-related air pollution. METHODS: Cases were 803 men with incident prostate cancer, ≤75 years of age, and diagnosed across all French hospitals in Montreal. Concurrently, 969 controls were drawn from electoral lists of French-speaking individuals residing in the same electoral districts as the cases and frequency-matched by age. Concentrations of NO2 were measured across Montreal in 2005-2006. We developed a land use regression model to predict concentrations of NO2 across Montreal for 2006. These estimates were back-extrapolated to 1996. Estimates were linked to residential addresses at the time of diagnosis or interview. Unconditional logistic regression was used, adjusting for potential confounding variables. RESULTS: For each increase of 5 parts per billion of NO2, as estimated from the original land use regression model in 2006, the OR5ppb adjusted for personal factors was 1.44 (95% CI 1.21 to 1.73). Adding in contextual factors attenuated the OR5ppb to 1.27 (95% CI 1.03 to 1.58). One method for back-extrapolating concentrations of NO2 to 1996 (about 10 years before the index date) gave the following OR5ppb: 1.41 (95% CI 1.24 to 1.62) when personal factors were included, and 1.30 (95% CI 1.11 to 1.52) when contextual factors were added. CONCLUSIONS: Exposure to ambient concentrations of NO2 at the current address was associated with an increased risk of prostate cancer. This novel finding requires replication.
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Contaminación del Aire/efectos adversos , Exposición a Riesgos Ambientales/efectos adversos , Dióxido de Nitrógeno/toxicidad , Neoplasias de la Próstata/inducido químicamente , Emisiones de Vehículos/toxicidad , Adulto , Anciano , Contaminación del Aire/análisis , Estudios de Casos y Controles , Exposición a Riesgos Ambientales/análisis , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Dióxido de Nitrógeno/análisis , Neoplasias de la Próstata/epidemiología , Quebec/epidemiología , Factores de RiesgoRESUMEN
In the early 2000s, the Province of New Brunswick, Canada, undertook health system restructuring, including closing some rural hospitals. We examined whether changes in geographic access to hospitals and primary care were associated with changes in patterns of hospital use. We described three measures of hospital use for ambulatory care sensitive conditions (ACSCs) among adults 75 years and younger annually during the period 2004-2013 overall, and at the community scale. We described spatial and temporal patterns in: age-standardized hospitalization rates, age-standardized incidence of hospital admissions, and rates of admissions via ambulance. Overall, rates and incidence of hospitalizations for ACSCs declined while admissions via ambulance remained largely unchanged. We observed considerable regional variation in rates between communities in 2004. This regional variation decreased over time, with rural areas demonstrating the sharpest declines. Changes in hospital service provision within individual communities had little impact on rates of ACSC admissions. Results were consistent across urban and rural communities and were robust to analyses that included older patients and those admitted for reasons other than ACSCs. Our results suggest that the restructuring and hospital closures did not result in substantial changes to regional patterns or rates of service use.
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Atención Ambulatoria , Hospitales Rurales , Adulto , Clausura de las Instituciones de Salud , Hospitalización , Humanos , Nuevo Brunswick/epidemiología , Población RuralRESUMEN
BACKGROUND: Using a nationally representative cohort of Canadian adults, we assessed associations between neighbourhood walkability and cause-specific mortality and investigated whether they differed by socioeconomic status. METHODS: The study population was drawn from the 2001 Canadian Census Health and Environment Cohort, which contains individual-level data from a random sample of 20% of Canadian households mandated to complete the long-form census. We included those aged ≥ 25 years at baseline who lived in urban and suburban areas. The national death registry was used to ascertain annual vital status. Linkages to annual income tax data provided place of residence. The Canadian Active Living Environments, a national index that summarizes walkability across Canadian neighbourhoods, was assigned to individuals' residential history. The Cox proportional hazards model was used to assess associations between walkability and cause-specific mortality. RESULTS: A total of 1.8 million participants (52.5% female) accrued 27.3 million person-years and 265 710 deaths during the 15-year follow-up. The adjusted hazard ratio (HR) for living in a highly walkable neighbourhood relative to living in the least walkable neighbourhoods was associated with a 9% (HR: 0.91 [0.88, 0.95]) and 3% (HR: 0.97 [0.94, 0.99]) reduced risk of cardiovascular and all non-accidental mortality, respectively. The strongest benefits of walkability were found among individuals within the lowest education and household income categories, and who lived in the most deprived neighbourhoods. There were no significant associations (most [class 5] versus least [class 1] walkable HR: 0.84 [0.61-1.16]) seen for accidental traffic mortality. CONCLUSIONS: Canadian adults who live in walkable neighbourhoods have lower rates of cardiovascular and non-accidental mortality, with the greatest benefits seen in those from the lowest socioeconomic groups.
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Características de la Residencia , Caminata , Adulto , Canadá/epidemiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , MasculinoRESUMEN
The World Health Organization (WHO) recently released new guidelines for outdoor fine particulate air pollution (PM2.5) recommending an annual average concentration of 5 µg/m3. Yet, our understanding of the concentration-response relationship between outdoor PM2.5 and mortality in this range of near-background concentrations remains incomplete. To address this uncertainty, we conducted a population-based cohort study of 7.1 million adults in one of the world's lowest exposure environments. Our findings reveal a supralinear concentration-response relationship between outdoor PM2.5 and mortality at very low (<5 µg/m3) concentrations. Our updated global concentration-response function incorporating this new information suggests an additional 1.5 million deaths globally attributable to outdoor PM2.5 annually compared to previous estimates. The global health benefits of meeting the new WHO guideline for outdoor PM2.5 are greater than previously assumed and indicate a need for continued reductions in outdoor air pollution around the world.
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BACKGROUND: Associations between mortality and exposure to ambient air pollution are usually explored using concentrations of residential outdoor fine particulate matter (PM2.5) to estimate individual exposure. Such studies all have an important limitation in that they do not capture data on individual mobility throughout the day to areas where concentrations may be substantially different, leading to possible exposure misclassification. We examine the possible role of outdoor PM2.5 concentrations at work for a large population-based mortality cohort. METHODS: Using the 2001 Canadian Census Health and Environment Cohort (CanCHEC), we created a time-weighted average that incorporates employment hours worked in the past week and outdoor PM2.5 concentration at work and home. We used a Cox proportional hazard model with a 15-year follow-up (2001 to 2016) to explore whether inclusion of workplace estimates had an impact on hazard ratios for mortality for this cohort. RESULTS: Hazard ratios relying on outdoor PM2.5 concentration at home were not significantly different from those using a time-weighted estimate, for the full cohort, nor for those who commute to a regular workplace. When exploring cohort subgroups according to neighborhood type and commute distance, there was a notable but insignificant change in risk of nonaccidental death for those living in car-oriented neighborhoods, and with commutes greater than 10 km. CONCLUSIONS: Risk analyses performed with large cohorts in low-pollution environments do not seem to be biased if relying solely on outdoor PM2.5 concentrations at home to estimate exposure.
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BACKGROUND: Living in greener areas of cities was linked to increased physical activity levels, improved mental well-being, and lowered harmful environmental exposures, all of which may affect human health. However, whether living in greener areas may be associated with lower risk of cardiovascular disease incidence, progression, and premature mortality is unclear. OBJECTIVES: We conducted a cohort study to examine the associations between residential green spaces and the incidence of acute myocardial infarction (AMI) and heart failure (HF), post-AMI and HF hospital readmissions, and mortality. METHODS: We simultaneously followed four large population-based cohorts in Ontario, Canada, including the entire adult population, adults free of AMI and HF, and survivors of AMI or HF from 2000 to 2014. We estimated residential exposure to green spaces using satellite-derived observations and ascertained health outcomes using validated disease registries. We estimated the associations using spatial random-effects Cox proportional hazards models. We conducted various sensitivity analyses, including further adjusting for property values and performing exploratory mediation analysis. RESULTS: Each interquartile range increase in residential greenness was associated with a 7% [95% confidence interval (CI): 4%, 9%] decrease in incident AMI and a 6% (95% CI: 4%, 7%) decrease in incident HF. Residential greenness was linked to a â¼10% decrease in cardiovascular mortality in both adults free of AMI and HF and the entire adult population. These associations remained consistent in sensitivity analyses and were accentuated among younger adults. Additionally, we estimated that the decreases in AMI and HF incidence associated with residential greenness explained â¼53% of the protective association between residential greenness and cardiovascular mortality. Conversely, residential greenness was not associated with any delay in readmission or mortality among AMI and HF patients. CONCLUSIONS: Living in urban areas with more green spaces was associated with improved cardiovascular health in people free of AMI and HF but not among individuals who have already developed these conditions. https://doi.org/10.1289/EHP6161.
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Entorno Construido , Enfermedades Cardiovasculares/epidemiología , Exposición a Riesgos Ambientales/estadística & datos numéricos , Adulto , Ciudades , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Readmisión del Paciente , Modelos de Riesgos Proporcionales , Características de la ResidenciaRESUMEN
BACKGROUND: Epidemiological studies have consistently demonstrated that exposure to fine particulate matter (PM2.5) is associated with increased risks of mortality. To a lesser extent, a series of studies suggest that living in greener areas is associated with reduced risks of mortality. Only a handful of studies have examined the interplay between PM2.5, greenness, and mortality. METHODS: We investigated the role of residential greenness in modifying associations between long-term exposures to PM2.5 and non-accidental and cardiovascular mortality in a national cohort of non-immigrant Canadian adults (i.e., the 2001 Canadian Census Health and Environment Cohort). Specifically, we examined associations between satellite-derived estimates of PM2.5 exposure and mortality across quintiles of greenness measured within 500â¯m of individual's place of residence during 11â¯years of follow-up. We adjusted our survival models for many personal and contextual measures of socioeconomic position, and residential mobility data allowed us to characterize annual changes in exposures. RESULTS: Our cohort included approximately 2.4 million individuals at baseline, 194,270 of whom died from non-accidental causes during follow-up. Adjustment for greenness attenuated the association between PM2.5 and mortality (e.g., hazard ratios (HRs) and 95% confidence intervals (CIs) per interquartile range increase in PM2.5 in models for non-accidental mortality decreased from 1.065 (95% CI: 1.056-1.075) to 1.041 (95% CI: 1.031-1.050)). The strength of observed associations between PM2.5 and mortality decreased as greenness increased. This pattern persisted in models restricted to urban residents, in models that considered the combined oxidant capacity of ozone and nitrogen dioxide, and within neighbourhoods characterised by high or low deprivation. We found no increased risk of mortality associated with PM2.5 among those living in the greenest areas. For example, the HR for cardiovascular mortality among individuals in the least green areas was 1.17 (95% CI: 1.12-1.23) compared to 1.01 (95% CI: 0.97-1.06) among those in the greenest areas. CONCLUSIONS: Studies that do not account for greenness may overstate the air pollution impacts on mortality. Residents in deprived neighbourhoods with high greenness benefitted by having more attenuated associations between PM2.5 and mortality than those living in deprived areas with less greenness. The findings from this study extend our understanding of how living in greener areas may lead to improved health outcomes.
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Contaminantes Atmosféricos/efectos adversos , Contaminación del Aire/efectos adversos , Enfermedades Cardiovasculares/mortalidad , Ambiente , Exposición a Riesgos Ambientales/efectos adversos , Material Particulado/efectos adversos , Características de la Residencia/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Enfermedades Cardiovasculares/inducido químicamente , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dióxido de Nitrógeno/análisis , Ozono/análisis , Adulto JovenRESUMEN
BACKGROUND: Ambient fine particulate air pollution with aerodynamic diameter ≤2.5 µm (PM2.5) is an important contributor to the global burden of disease. Information on the shape of the concentration-response relationship at low concentrations is critical for estimating this burden, setting air quality standards, and in benefits assessments. OBJECTIVES: We examined the concentration-response relationship between PM2.5 and nonaccidental mortality in three Canadian Census Health and Environment Cohorts (CanCHECs) based on the 1991, 1996, and 2001 census cycles linked to mobility and mortality data. METHODS: Census respondents were linked with death records through 2016, resulting in 8.5 million adults, 150 million years of follow-up, and 1.5 million deaths. Using annual mailing address, we assigned time-varying contextual variables and 3-y moving-average ambient PM2.5 at a 1×1 km spatial resolution from 1988 to 2015. We ran Cox proportional hazards models for PM2.5 adjusted for eight subject-level indicators of socioeconomic status, seven contextual covariates, ozone, nitrogen dioxide, and combined oxidative potential. We used three statistical methods to examine the shape of the concentration-response relationship between PM2.5 and nonaccidental mortality. RESULTS: The mean 3-y annual average estimate of PM2.5 exposure ranged from 6.7 to 8.0 µg/m3 over the three cohorts. We estimated a hazard ratio (HR) of 1.053 [95% confidence interval (CI): 1.041, 1.065] per 10-µg/m3 change in PM2.5 after pooling the three cohort-specific hazard ratios, with some variation between cohorts (1.041 for the 1991 and 1996 cohorts and 1.084 for the 2001 cohort). We observed a supralinear association in all three cohorts. The lower bound of the 95% CIs exceeded unity for all concentrations in the 1991 cohort, for concentrations above 2 µg/m3 in the 1996 cohort, and above 5 µg/m3 in the 2001 cohort. DISCUSSION: In a very large population-based cohort with up to 25 y of follow-up, PM2.5 was associated with nonaccidental mortality at concentrations as low as 5 µg/m3. https://doi.org/10.1289/EHP5204.