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BACKGROUND: Extreme ambient heat is unambiguously associated with higher risk of illness and death. The Optum Labs Data Warehouse (OLDW), a database of medical claims from US-based patients with commercial or Medicare Advantage health insurance, has been used to quantify heat-related health impacts. Whether results for the insured sub-population are generalizable to the broader population has to our knowledge not been documented. We sought to address this question, for the US population in California from 2012 to 2019. METHODS: We examined changes in daily rates of emergency department (ED) encounters and in-patient hospitalization encounters for all-causes, heat-related outcomes, renal disease, mental/behavioral disorders, cardiovascular disease, and respiratory disease. OLDW was the source for health data for insured individuals in California, and health data for the broader population were gathered from the California Department of Health Care Access and Information (HCAI). We defined extreme heat exposure as any day in a group of 2 or more days with maximum temperatures exceeding the county-specific 97.5 th percentile and used a space-time-stratified case-crossover design to assess and compare the impacts of heat on health. RESULTS: Average incidence rates of medical encounters differed by dataset. However, rate ratios for ED encounters were similar across datasets for all causes (ratio of incidence rate ratios (rIRR) = 0.989; 95% confidence interval (CI) = 0.973, 1.011), heat-related causes (rIRR = 1.080; 95% CI = 0.999, 1.168), renal disease (rIRR = 0.963; 95% CI = 0.718, 1.292), and mental health disorders (rIRR = 1.098; 95% CI = 1.004, 1.201). Rate ratios for inpatient encounters were also similar. CONCLUSIONS: This work presents evidence that OLDW can continue to be a resource for estimating the health impacts of extreme heat.
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Smoke from wildfires poses a substantial threat to health in communities near and far. To mitigate the extent and potential damage of wildfires, prescribed burning techniques are commonly employed as land management tools; however, they introduce their own smoke-related risks. This study investigates the impact of prescribed fires on daily average PM2.5 and maximum daily 8-h averaged O3 (MDA8-O3) concentrations and estimates premature deaths associated with short-term exposure to prescribed fire PM2.5 and MDA8-O3 in Georgia and surrounding areas of the Southeastern US from 2015 to 2020. Our findings indicate that over the study domain, prescribed fire contributes to average daily PM2.5 by 0.94 ± 1.45 µg/m3 (mean ± standard deviation), accounting for 14.0% of year-round ambient PM2.5. Higher average daily contributions were predicted during the extensive burning season (January-April): 1.43 ± 1.97 µg/m3 (20.0% of ambient PM2.5). Additionally, prescribed burning is also responsible for an annual average increase of 0.36 ± 0.61 ppb in MDA8-O3 (approximately 0.8% of ambient MDA8-O3) and 1.3% (0.62 ± 0.88 ppb) during the extensive burning season. We estimate that short-term exposure to prescribed fire PM2.5 and MDA8-O3 could have caused 2665 (95% confidence interval (CI): 2249-3080) and 233 (95% CI: 148-317) excess deaths, respectively. These results suggest that smoke from prescribed burns increases the mortality. However, refraining from such burns may escalate the risk of wildfires; therefore, the trade-offs between the health impacts of wildfires and prescribed fires, including morbidity, need to be taken into consideration in future studies.
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Poluentes Atmosféricos , Poluição do Ar , Incêndios , Material Particulado , Georgia , Humanos , Mortalidade Prematura , Incêndios Florestais , FumaçaRESUMO
Rising ambient temperatures due to climate change will impact both indoor temperatures and heating and cooling utility costs. In traditionally colder climates, there are potential tradeoffs in how to meet the reduced heating and increased cooling demands, and issues related to lack of air conditioning (AC) access in older homes and among lower-income populations to prevent extreme heat exposure. We modeled a typical multi-family home in Boston (MA) in the building simulation program EnergyPlus to assess indoor temperature and energy consumption in current (2020) and projected future (2050) weather conditions. Selected households were those without AC (no AC), those who ran AC sometimes (some AC), and those with sufficient resources to run AC always (full AC). We considered stylized cooling subsidy policies that allowed households to move between groups, both independently and in conjunction with energy efficiency retrofits. Results showed that future weather conditions without policy changes yielded an increase in indoor summer temperatures of 2.1 °C (no AC), increased cooling demand (range: 34-50%), but led to a decrease in net yearly total utility costs per apartment (range: - $21 to - $38). Policies that allowed households to move to greater AC utilization yielded average indoor summer temperature decreases (- 3.5 °C to - 6.2 °C) and net yearly total utility increases (range: + $2 to + $94) per apartment unit, with greater savings for retrofitted homes primarily due to large decreases in heating use. Our model results reinforce the importance of coordinated public policies addressing climate change that have an equity lens for both health and climate goals.
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Calor Extremo , Habitação , Humanos , Idoso , Temperatura , Boston , Estações do AnoRESUMO
Most epidemiologic studies fail to capture the impact of spatiotemporal fluctuations in traffic on exposure to traffic-related air pollutants in the near-road population. Using a case-crossover design and the Research LINE source (R-LINE) dispersion model with spatiotemporally resolved highway traffic data, we quantified associations between primary pollutants generated by highway traffic-particulate matter with an aerodynamic diameter less than or equal to 2.5 µm (PM2.5), oxides of nitrogen (NOx), and black carbon (BC)-and daily nonaccidental, respiratory, cardiovascular, and cerebrovascular mortality among persons who had resided within 1 km (0.6 mile) of major highways in the Puget Sound area of Washington State between 2009 and 2013. We estimated these associations using conditional logistic regression, adjusting for time-varying covariates. Although highly resolved modeled concentrations of PM2.5, NOx, and BC from highway traffic in the hours before death were used, we found no evidence of an association between mortality and the preceding 24-hour average PM2.5 exposure (odds ratio = 0.99, 95% confidence interval: 0.96, 1.02) or exposure during shorter averaging periods. This work did not support the hypothesis that mortality risk was meaningfully higher with greater exposures to PM2.5, NOx, and BC from highways in near-road populations, though we did incorporate a novel approach to estimate exposure to traffic-generated air pollution based on detailed traffic congestion data.
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Poluentes Atmosféricos/análise , Poluição do Ar/análise , Mortalidade/tendências , Emissões de Veículos/análise , Idoso , Idoso de 80 Anos ou mais , Carbono/análise , Causas de Morte , Estudos Cross-Over , Monitoramento Ambiental , Humanos , Pessoa de Meia-Idade , Óxidos de Nitrogênio/análise , Material Particulado , Fatores Sociodemográficos , Análise Espaço-Temporal , Fatores de Tempo , WashingtonRESUMO
Heating and cooling requirement differences across climates not only have carbon emissions and energy efficiency implications but also impact indoor air quality (IAQ) and health. Energy and IAQ building simulation models help understand tradeoffs or co-benefits, but these have not been applied to evaluate climate zone or multi-family home differences. We modeled a four-story multi-family home in six U.S. climate zones and quantified energy, IAQ, and health outcomes with EnergyPlus, CONTAM, and a pediatric asthma systems science model. Pollutant sources included cooking and ambient. Outputs were daily PM2.5 and NO2 indoor concentrations, infiltration, energy for heating and cooling, and asthma exacerbations, which were compared across climate zones, apartment units, and resident behaviors. Daily ambient-sourced PM2.5 decreased and cooking-sourced PM2.5 increased with higher ambient temperatures. Infiltration air changes per hour were higher on the first versus the fourth floor and in colder climates. Window opening during cooking led to decreases in total pollutant concentrations (11%-18% for PM2.5 and 9%-15% for NO2 ), 3%-4% decreases in asthma exacerbations within climate zones, and minimal impacts on cooling, but led to increased heating demand (4%-8%). Our results demonstrate the influence of meteorology, multi-family building characteristics, and resident behavior on IAQ, energy, and health, focused on multi-zone methodology.
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Poluentes Atmosféricos , Poluição do Ar em Ambientes Fechados , Poluição do Ar , Asma , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Poluição do Ar em Ambientes Fechados/análise , Asma/epidemiologia , Criança , Monitoramento Ambiental/métodos , Humanos , Meteorologia , Dióxido de Nitrogênio/análise , Material Particulado/análise , Estados UnidosRESUMO
The growing frequency, intensity, and duration of extreme heat events necessitates interventions to reduce heat exposures. Local opportunities for heat adaptation may be optimally identified through collection of both quantitative exposure metrics and qualitative data on perceptions of heat. In this study, we used mixed methods to characterize heat exposure among urban residents in the area of Boston, Massachusetts, US, in summer 2020. Repeated interviews of N = 24 study participants ascertained heat vulnerability and adaptation strategies. Participants also used low-cost sensors to collect temperature, location, sleep, and physical activity data. We saw significant differences across temperature metrics: median personal temperature exposures were 3.9 °C higher than median ambient weather station temperatures. Existing air conditioning (AC) units did not adequately control indoor temperatures to desired thermostat levels: even with AC use, indoor maximum temperatures increased by 0.24 °C per °C of maximum outdoor temperature. Sleep duration was not associated with indoor or outdoor temperature. On warmer days, we observed a range of changes in time-at-home, expected given our small study size. Interview results further indicated opportunities for heat adaptation interventions including AC upgrades, hydration education campaigns, and amelioration of energy costs during high heat periods. Our mixed methods design informs heat adaptation interventions tailored to the challenges faced by residents in the study area. The strength of our community-academic partnership was a large part of the success of the mixed methods approach.
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Temperatura Alta , Termotolerância , Humanos , Ar Condicionado , Sono , Exercício FísicoRESUMO
BACKGROUND: Pediatric asthma is currently the most prevalent chronic disease in the United States, with children in lower income families disproportionately affected. This increased health burden is partly due to lower-quality and insufficient maintenance of affordable housing. A movement towards 'green' retrofits that improve energy efficiency and increase ventilation in existing affordable housing offers an opportunity to provide cost-effective interventions that can address these health disparities. METHODS: We combine indoor air quality modeling with a previously developed discrete event model for pediatric asthma exacerbation to simulate the effects of different types of energy retrofits implemented at an affordable housing site in Boston, MA. RESULTS: Simulation results show that retrofits lead to overall better health outcomes and healthcare cost savings if reduced air exchange due to energy-saving air tightening is compensated by mechanical ventilation. Especially when exposed to indoor tobacco smoke and intensive gas-stove cooking such retrofit would lead to an average annual cost saving of over USD 200, while without mechanical ventilation the same children would have experienced an increase of almost USD 200/year in health care utilization cost. CONCLUSION: The combination of indoor air quality modeling and discrete event modeling applied in this paper can allow for the inclusion of health impacts in cost-benefit analyses of proposed affordable housing energy retrofits.
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Poluição do Ar em Ambientes Fechados/análise , Asma/epidemiologia , Conservação de Recursos Energéticos , Modelos Teóricos , Asma/fisiopatologia , Boston/epidemiologia , Criança , Volume Expiratório Forçado , Habitação , Humanos , Exacerbação dos SintomasRESUMO
PURPOSE: Exposures of nail salon technicians have received attention due to the potentially toxic materials used in nail products, which include volatile organic compounds (VOCs) such as formaldehyde and methyl methacrylate (MMA). This study characterized area and personal concentrations and other indoor air parameters in 17 nail salons in fall and winter seasons in three areas of Michigan. METHODS: VOC samples were analyzed using thermal desorption, gas chromatography and mass spectroscopy, and the VOC composition of 35 nail products (e.g., polish, top coat, base coat) was measured using headspace sampling. Ventilation rates were derived using CO2 concentrations, occupancy and building information, and VOC sources were apportioned by a novel application of chemical mass balance models. RESULTS: We detected ethyl acetate, propyl acetate, butyl acetate, MMA, n-heptane and toluene in most salons, and benzene, D-limonene, formaldehyde, and ethyl methacrylate in some salons. While MMA was not measured in the consumer and professional products, and the use of pure MMA in salons has been not been permitted since the 1970s, MMA was found in air at concentrations from 100 to 36,000 µg/m3 in 15 of 17 salons; thus its use appears to be commonplace in the industry. Personal measurements, representing exposures to workers and clients, were about twice those of the area measurements for many VOCs. CONCLUSION: This study identifies the products responsible for emissions, shows the widespread presence of MMA, and documents low ventilation rates in some salons. It also demonstrates that "informal" short-term sampling approaches can evaluate chemical exposures in nail salons, providing measurements that can be used to protect a potentially susceptible and vulnerable population. Additional controls, including restrictions on the VOC compositions and improved ventilation, can reduce exposures to salon workers and clients.
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Poluentes Ocupacionais do Ar/análise , Cosméticos/química , Ventilação , Compostos Orgânicos Voláteis/análise , Poluição do Ar em Ambientes Fechados/análise , Dióxido de Carbono/análise , Formaldeído/análise , Humanos , Metilmetacrilatos/análise , Michigan , Exposição Ocupacional/análise , Projetos Piloto , Estações do AnoRESUMO
Exposure to traffic-related air pollutants (TRAP) remains a key public health issue, and improved exposure measures are needed to support health impact and epidemiologic studies and inform regulatory responses. The recently developed Research LINE source model (RLINE), a Gaussian line source dispersion model, has been used in several epidemiologic studies of TRAP exposure, but evaluations of RLINE's performance in such applications have been limited. This study provides an operational evaluation of RLINE in which predictions of NOx, CO and PM2.5 are compared to observations at air quality monitoring stations located near high traffic roads in Detroit, MI. For CO and NOx, model performance was best at sites close to major roads, during downwind conditions, during weekdays, and during certain seasons. For PM2.5, the ability to discern local and particularly the traffic-related portion was limited, a result of high background levels, the sparseness of the monitoring network, and large uncertainties for certain processes (e.g., formation of secondary aerosols) and non-mobile sources (e.g., area, fugitive). Overall, RLINE's performance in near-road environments suggests its usefulness for estimating spatially- and temporally-resolved exposures. The study highlights considerations relevant to health impact and epidemiologic applications, including the importance of selecting appropriate pollutants, using appropriate monitoring approaches, considering prevailing wind directions during study design, and accounting for uncertainty.
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The development of accurate and appropriate exposure metrics for health effect studies of traffic-related air pollutants (TRAPs) remains challenging and important given that traffic has become the dominant urban exposure source and that exposure estimates can affect estimates of associated health risk. Exposure estimates obtained using dispersion models can overcome many of the limitations of monitoring data, and such estimates have been used in several recent health studies. This study examines the sensitivity of exposure estimates produced by dispersion models to meteorological, emission and traffic allocation inputs, focusing on applications to health studies examining near-road exposures to TRAP. Daily average concentrations of CO and NOx predicted using the Research Line source model (RLINE) and a spatially and temporally resolved mobile source emissions inventory are compared to ambient measurements at near-road monitoring sites in Detroit, MI, and are used to assess the potential for exposure measurement error in cohort and population-based studies. Sensitivity of exposure estimates is assessed by comparing nominal and alternative model inputs using statistical performance evaluation metrics and three sets of receptors. The analysis shows considerable sensitivity to meteorological inputs; generally the best performance was obtained using data specific to each monitoring site. An updated emission factor database provided some improvement, particularly at near-road sites, while the use of site-specific diurnal traffic allocations did not improve performance compared to simpler default profiles. Overall, this study highlights the need for appropriate inputs, especially meteorological inputs, to dispersion models aimed at estimating near-road concentrations of TRAPs. It also highlights the potential for systematic biases that might affect analyses that use concentration predictions as exposure measures in health studies, e.g., to estimate health impacts.
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Comparative evaluations are needed to assess the suitability of near-road air pollution models for traffic-related ultrafine particle number concentration (PNC). Our goal was to evaluate the ability of dispersion (CALINE4, AERMOD, R-LINE, and QUIC) and regression models to predict PNC in a residential neighborhood (Somerville) and an urban center (Chinatown) near highways in and near Boston, Massachusetts. PNC was measured in each area, and models were compared to each other and measurements for hot (>18 °C) and cold (<10 °C) hours with wind directions parallel to and perpendicular downwind from highways. In Somerville, correlation and error statistics were typically acceptable, and all models predicted concentration gradients extending â¼100 m from the highway. In contrast, in Chinatown, PNC trends differed among models, and predictions were poorly correlated with measurements likely due to effects of street canyons and nonhighway particle sources. Our results demonstrate the importance of selecting PNC models that align with study area characteristics (e.g., dominant sources and building geometry). We applied widely available models to typical urban study areas; therefore, our results should be generalizable to models of hourly averaged PNC in similar urban areas.
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Poluentes Atmosféricos , Material Particulado , Poluição do Ar , Monitoramento Ambiental , Modelos Teóricos , Emissões de VeículosRESUMO
This study used a health care claims data set of enrollees in commercial and Medicare Advantage insurance plans to assess the association between the June 2021 heat wave and the rates of emergency department visits in Portland, Oregon, and Seattle, Washington.
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Serviço Hospitalar de Emergência , Temperatura Alta , Raios Infravermelhos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Temperatura Alta/efeitos adversos , Medicaid , Oregon/epidemiologia , Washington/epidemiologia , Raios Infravermelhos/efeitos adversosRESUMO
PM2.5 concentrations throughout much of the U.S. have decreased over the last 15 years, but emissions and concentration trends can vary by location and source type. Such trends should be understood to inform air quality management and policies. This work examines trends in emissions, concentrations and source apportionments in two large Midwest U.S. cities, Detroit, Michigan, and Chicago, Illinois. Annual and seasonal trends were investigated using National Emission Inventory (NEI) data for 2002 to 2011, speciated ambient PM2.5 data from 2001 to 2014, apportionments from positive matrix factorization (PMF) receptor modeling, and quantile regression. Over the study period, county-wide data suggest emissions from point sources decreased (Detroit) or held constant (Chicago), while emissions from on-road mobile sources were constant (Detroit) or increased (Chicago), however changes in methodology limit the interpretation of inventory trends. Ambient concentration data also suggest source and apportionment trends, e.g., annual median concentrations of PM2.5 in the two cities declined by 3.2 to 3.6 %/yr (faster than national trends), and sulfate concentrations (due to coal-fired facilities and other point source emissions) declined even faster; in contrast, organic and elemental carbon (tracers of gasoline and diesel vehicle exhaust) declined more slowly or held constant. The PMF models identified nine sources in Detroit and eight in Chicago, the most important being secondary sulfate, secondary nitrate and vehicle emissions. A minor crustal dust source, metals sources, and a biomass source also were present in both cities. These apportionments showed that the median relative contributions from secondary sulfate sources decreased by 4.2 to 5.5% per year in Detroit and Chicago, while contributions from metals sources, biomass sources, and vehicles increased from 1.3 to 9.2% per year. This first application of quantile regression to trend analyses of speciated PM2.5 data reveals that source contributions to PM2.5 varied as PM2.5 concentrations decreased, and that the fraction of PM2.5 due to emissions from vehicles and other local emissions has increased. Each data source has uncertainties, but emissions, monitoring and PMF data provide complementary information that can help to discern trends and identify contributing sources. Study results emphasize the need to target specific sources in policies and regulations aimed at decreasing PM2.5 concentrations in urban areas.
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OBJECTIVE: To estimate the excess relative and absolute risks of hospital admissions and emergency department visits for natural causes, cardiovascular disease, and respiratory disease associated with daily exposure to fine particulate matter (PM2.5) at concentrations below the new World Health Organization air quality guideline limit among adults with health insurance in the contiguous US. DESIGN: Case time series study. SETTING: US national administrative healthcare claims database. PARTICIPANTS: 50.1 million commercial and Medicare Advantage beneficiaries aged ≥18 years between 1 January 2010 and 31 December 2016. MAIN OUTCOME MEASURES: Daily counts of hospital admissions and emergency department visits for natural causes, cardiovascular disease, and respiratory disease based on the primary diagnosis code. RESULTS: During the study period, 10.3 million hospital admissions and 24.1 million emergency department visits occurred for natural causes among 50.1 million adult enrollees across 2939 US counties. The daily PM2.5 levels were below the new WHO guideline limit of 15 µg/m3 for 92.6% of county days (7 360 725 out of 7 949 713). On days when daily PM2.5 levels were below the new WHO air quality guideline limit of 15 µg/m3, an increase of 10 µg/m3 in PM2.5 during the current and previous day was associated with higher risk of hospital admissions for natural causes, with an excess relative risk of 0.91% (95% confidence interval 0.55% to 1.26%), or 1.87 (95% confidence interval 1.14 to 2.59) excess hospital admissions per million enrollees per day. The increased risk of hospital admissions for natural causes was observed exclusively among adults aged ≥65 years and was not evident in younger adults. PM2.5 levels were also statistically significantly associated with relative risk of hospital admissions for cardiovascular and respiratory diseases. For emergency department visits, a 10 µg/m3 increase in PM2.5 during the current and previous day was associated with respiratory disease, with an excess relative risk of 1.34% (0.73% to 1.94%), or 0.93 (0.52 to 1.35) excess emergency department visits per million enrollees per day. This association was not found for natural causes or cardiovascular disease. The higher risk of emergency department visits for respiratory disease was strongest among middle aged and young adults. CONCLUSIONS: Among US adults with health insurance, exposure to ambient PM2.5 at concentrations below the new WHO air quality guideline limit is statistically significantly associated with higher rates of hospital admissions for natural causes, cardiovascular disease, and respiratory disease, and with emergency department visits for respiratory diseases. These findings constitute an important contribution to the debate about the revision of air quality limits, guidelines, and standards.
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Poluentes Atmosféricos , Poluição do Ar , Doenças Cardiovasculares , Medicare Part C , Transtornos Respiratórios , Doenças Respiratórias , Pessoa de Meia-Idade , Adulto Jovem , Humanos , Idoso , Estados Unidos/epidemiologia , Adolescente , Adulto , Material Particulado/efeitos adversos , Material Particulado/análise , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Doenças Cardiovasculares/induzido quimicamente , Fatores de Tempo , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Doenças Respiratórias/etiologia , Doenças Respiratórias/induzido quimicamente , Exposição Ambiental/efeitos adversos , MorbidadeRESUMO
Particulate matter (PM) exposure is associated with adverse health outcomes, including respiratory illness. A large fraction of exposure to airborne contaminants occurs in the home. This study, conducted over 5 months in a community with high asthma rates (Chelsea, MA, USA), investigated the use of portable air cleaners (PACs) to reduce indoor PM. Seven asthma-affected households participated, receiving a PAC (Austin Air Health Mate HEPA filter), a QuantAQ sensor to measure PM1, PM2.5, PM10 (µg/m3), and a HOBO plug-load data logger to track PAC usage. Results describe hourly and daily PM concentrations and PAC usage for each household. Hourly average PM concentrations decreased when PACs were turned on (vs. when they were turned off) across households during the study period: PM1 decreased by 0.46 µg/m3, PM2.5 decreased by 0.69 µg/m3, and PM10 decreased by 3.22 µg/m3. PAC usage varied for each household, including constant usage in one household and only usage at certain times of day in others. Higher filtration settings led to lower PM, with significant reductions in some, but not all, homes. Our findings highlight some difficulties in implementing household PAC interventions, yet also provide evidence to support household-level interventions to reduce PM and other indoor sources of air pollution. We also highlight academic-community partnerships as contributing to evidence-based solutions.
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BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) are endocrine-disrupting chemicals with neurotoxic properties. PFAS have been associated with depressive symptoms among women in some studies, but little research has evaluated the effects of PFAS mixtures. Further, no study has investigated interactions of PFAS-depression associations by perceived stress, which has been shown to modify the effects of PFAS on other health outcomes. OBJECTIVE: In a prospective cohort study of reproductive-aged Black women, we investigated associations between PFAS and depressive symptoms and the extent to which perceived stress modified these associations. METHODS: We analyzed data from 1499 participants (23-35 years) in the Study of Environment, Lifestyle, and Fibroids. We quantified concentrations of nine PFAS in baseline plasma samples using online solid-phase extraction-liquid chromatography-isotope dilution tandem mass spectrometry. Participants reported perceived stress via the Perceived Stress Scale (PSS-4; range = 0-16) at baseline and depressive symptoms via the Center for Epidemiologic Studies Depression Scale (CESD; range = 0-44) at the 20-month follow-up visit. We used Bayesian Kernel Machine Regression to estimate associations between PFAS concentrations, individually and as a mixture, and depressive symptoms, and to assess effect modification by PSS-4 scores, adjusting for confounders. RESULTS: Baseline perfluorodecanoic acid concentrations were associated with greater depressive symptoms at the 20-month follow-up, but associations for other PFAS were null. The PFAS were not associated with depressive symptoms when evaluated as a mixture. The association between the 90th percentile (vs. 50th percentile) of the PFAS mixture with CES-D scores was null at the 10th (ß = 0.03; 95 % CrI = 0.20, 0.25), 50th (ß = 0.02; 95 % CrI = -0.16, 0.19), and 90th (ß = 0.01; 95 % CrI = 0.18, 0.20) percentiles of PSS-4 scores, suggesting perceived stress did not modify the PFAS mixture. CONCLUSION: In this prospective cohort study, PFAS concentrations-assessed individually or as a mixture-were not appreciably associated with depressive symptoms, and there was no evidence of effect modification by perceived stress.
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Depressão , Poluentes Ambientais , Fluorocarbonos , Estresse Psicológico , Humanos , Feminino , Fluorocarbonos/sangue , Adulto , Estudos Prospectivos , Depressão/epidemiologia , Poluentes Ambientais/sangue , Adulto Jovem , Exposição Ambiental/estatística & dados numéricos , Negro ou Afro-Americano/estatística & dados numéricos , Disruptores EndócrinosRESUMO
High ambient temperatures have become more likely due to climate change and are linked to higher rates of heat-related illness, respiratory and cardiovascular diseases, mental health disorders, and other diseases. To date, far fewer studies have examined the effects of high temperatures on children versus adults, and studies including children have seldom been conducted on a national scale. Compared to adults, children have behavioral and physiological differences that may give them differential heat vulnerability. We acquired medical claims data from a large database of commercially insured US children aged 0-17 from May to September (warm-season) 2016-2019. Daily maximum ambient temperature and daily mean relative humidity estimates were aggregated to the county level using the Parameter-elevation Relationships on Independent Slopes dataset, and extreme heat was defined as the 95th percentile of the county-specific daily maximum temperature distribution. Using a case-crossover design and temperature lags 0-5 days, we estimated the associations between extreme heat and cause-specific emergency department visits (ED) in children aged <18 years, using the median county-specific daily maximum temperature distribution as the reference. Approximately 1.2 million ED visits in children from 2489 US counties were available during the study period. The 95th percentile of warm-season temperatures ranged from 71 °F to 112 °F (21.7 °C to 44.4 °C). Comparing 95th to the 50th percentile, extreme heat was associated with higher rates of ED visits for heat-related illness; endocrine, nutritional and metabolic diseases; and otitis media and externa, but not for all-cause admissions. Subgroup analyses suggested differences by age, with extreme heat positively associated with heat-related illness for both the 6-12 year (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.16, 1.56) and 13-17 year age groups (OR: 1.55, 95% CI: 1.37, 1.76). Among children with health insurance across the US, days of extreme heat were associated with higher rates of healthcare utilization. These results highlight the importance of individual and population-level actions to protect children and adolescents from extreme heat, particularly in the context of continued climate change.
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Many techniques for estimating exposure to airborne contaminants do not account for building characteristics that can magnify contaminant contributions from indoor and outdoor sources. Building characteristics that influence exposure can be challenging to obtain at scale, but some may be incorporated into exposure assessments using public datasets. We present a methodology for using public datasets to generate housing models for a test cohort, and examined sensitivity of predicted fine particulate matter (PM2.5) exposures to selected building and source characteristics. We used addresses of a cohort of children with asthma and public tax assessor's data to guide selection of floorplans of US residences from a public database. This in turn guided generation of coupled multi-zone models (CONTAM and EnergyPlus) that estimated indoor PM2.5 exposure profiles. To examine sensitivity to model parameters, we varied building floors and floorplan, heating, ventilating and air-conditioning (HVAC) type, room or floor-level model resolution, and indoor source strength and schedule (for hypothesized gas stove cooking and tobacco smoking). Occupant time-activity and ambient pollutant levels were held constant. Our address matching methodology identified two multi-family house templates and one single-family house template that had similar characteristics to 60 % of test addresses. Exposure to infiltrated ambient PM2.5 was similar across selected building characteristics, HVAC types, and model resolutions (holding all else equal). By comparison, exposures to indoor-sourced PM2.5 were higher in the two multi-family residences than the single family residence (e.g., for cooking PM2.5 exposure, by 26 % and 47 % respectively) and were sensitive to HVAC type and model resolution. We derived the influence of building characteristics and HVAC type on PM2.5 exposure indoors using public data sources and coupled multi-zone models. With the important inclusion of individualized resident behavior data, similar housing modeling can be used to incorporate exposure variability in health studies of the indoor residential environment.
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Poluentes Atmosféricos , Poluição do Ar em Ambientes Fechados , Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Boston , Criança , Exposição Ambiental/análise , Monitoramento Ambiental , Habitação , Humanos , Tamanho da Partícula , Material Particulado/análiseRESUMO
PURPOSE: Children may be exposed to numerous in-home environmental exposures (IHEE) that trigger asthma exacerbations. Spatially linking social and environmental exposures to electronic health records (EHR) can aid exposure assessment, epidemiology, and clinical treatment, but EHR data on exposures are missing for many children with asthma. To address the issue, we predicted presence of indoor asthma trigger allergens, and estimated effects of their key geospatial predictors. METHODS: Our study samples were comprised of children with asthma who provided self-reported IHEE data in EHR at a safety-net hospital in New England during 2004-2015. We used an ensemble machine learning algorithm and 86 multilevel features (e.g., individual, housing, neighborhood) to predict presence of cockroaches, rodents (mice or rats), mold, and bedroom carpeting/rugs in homes. We reduced dimensionality via elastic net regression and estimated effects by the G-computation causal inference method. RESULTS: Our models reasonably predicted presence of cockroaches (area under receiver operating curves [AUC] = 0.65), rodents (AUC = 0.64), and bedroom carpeting/rugs (AUC = 0.64), but not mold (AUC = 0.54). In models adjusted for confounders, higher average household sizes in census tracts were associated with more reports of pests (cockroaches and rodents). Tax-exempt parcels were associated with more reports of cockroaches in homes. Living in a White-segregated neighborhood was linked with lower reported rodent presence, and mixed residential/commercial housing and newer buildings were associated with more reports of bedroom carpeting/rugs in bedrooms. CONCLUSIONS: We innovatively applied a machine learning and causal inference mixture methodology to detail IHEE among children with asthma using EHR and geospatial data, which could have wide applicability and utility.
Assuntos
Poluição do Ar em Ambientes Fechados , Asma , Baratas , Poluição do Ar em Ambientes Fechados/efeitos adversos , Animais , Asma/epidemiologia , Asma/etiologia , Ambiente Construído , Registros Eletrônicos de Saúde , Exposição Ambiental/efeitos adversos , Habitação , Humanos , Camundongos , RatosRESUMO
BACKGROUND: Many vulnerable populations experience elevated exposures to environmental and social stressors, with deleterious effects on health. Multi-stressor epidemiological models can be used to assess benefits of exposure reductions. However, requisite individual-level risk factor data are often unavailable at adequate spatial resolution. OBJECTIVE: To leverage public data and novel simulation methods to estimate birthweight changes following simulated environmental interventions in two environmental justice communities in Massachusetts, USA. METHODS: We gathered risk factor data from public sources (US Census, Behavioral Risk Factor Surveillance System, and Massachusetts Department of Health). We then created synthetic individual-level data sets using combinatorial optimization, and probabilistic and logistic modeling. Finally, we used coefficients from a multi-stressor epidemiological model to estimate birthweight and birthweight improvement associated with simulated environmental interventions. RESULTS: We created geographically resolved synthetic microdata. Mothers with the lowest predicted birthweight were those identifying as Black or Hispanic, with parity > 1, utilization of government prenatal support, and lower educational attainment. Birthweight improvements following greenness and temperature improvements were similar for all high-risk groups and were larger than benefits from smoking cessation. SIGNIFICANCE: Absent private health data, this methodology allows for assessment of cumulative risk and health inequities, and comparison of individual-level impacts of localized health interventions.