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BACKGROUND: Premature and small-for-gestational-age (SGA) infants tend to have long-term growth morbidities such as short stature, failure to thrive, and obesity. Although most of these infants show catch-up growth at 2-4 years of age, they are still more susceptible to childhood obesity and related metabolic disorders. Those who fail to achieve catch-up will suffer from pathological short stature and neurodevelopmental impairment through adulthood. This study aims to depict the growth pattern of premature or SGA infants and their growth morbidities in Taiwan. METHODS: Data were obtained from a nationally representative cohort of 24,200 pairs of postpartum women and newborns in the Taiwan Birth Cohort Study (TBCS), using structured questionnaire interviews. A total of 16,358 infants were included and three follow-up surveys were completed at 6, 18, and 36 months after the deliveries. We constructed growth curves to conduct an in-depth investigation into anthropometric data, applying a linear mixed model. Logistic regression was used to model the relevant outcomes, with adjustment for various potential confounding factors. RESULTS: Despite being born shorter and lighter, preterm and SGA infants generally showed catch-up growth and had no higher odds ratios (ORs) of developing short stature or failure to thrive compared to appropriate-for-gestational-age (AGA) term infants before 3 years of age. Preterm SGA infants, particularly females, had higher ORs for obesity at the 36-month follow-up. CONCLUSION: This is the first nationwide population-based study depicting the growth of SGA infants in Taiwan. The growth patterns of preterm and term SGA infants are different from those of preterm and term AGA infants. Further research is necessary to understand the growth trajectories of preterm and SGA infants and their associations with later diseases.
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Long-term exposure to ambient PM2.5 is known associated with cardiovascular and respiratory health effects. However, the heterogeneous concentrationresponse function (CRF) between PM2.5 exposure across different concentration range and cardiopulmonary disease and diabetes mellitus (DM) incidence, and their implications on attributable years lived with disability (YLD) and regulation policy has not been well-studied. In this retrospective longitudinal cohort study, disease-free participants (approximately 170,000 individuals, aged ≥ 30 years) from the MJ Health Database were followed up (2007-2017) regarding incidents of coronary heart disease (CHD), ischemic stroke, chronic obstructive pulmonary disease (COPD), lower respiratory tract infections (LRIs), and DM. We used a time-dependent nonlinear weight-transformation Cox regression model for the CRF with an address-matched 3-year mean PM2.5 exposure estimate. Town/district-specific PM2.5-attributable YLD were calculated by multiplying the disease incidence rate, population attributable fraction, disability weight, and sex-age group specific subpopulation for each disease separately. The estimated CRFs for cardiopulmonary diseases were heterogeneously with the hazard ratios (HRs) increased rapidly for CHD and ischemic stroke at PM2.5 concentration lower than 10 µg/m3, whereas the HRs for DM (LRIs) increased with PM2.5 higher than 15 (20) µg/m3. Women had higher HRs for ischemic stroke and DM but not CHD. Relative to the lowest observed PM2.5 concentration of 6 µg/m3 of the study population, the PM2.5 level with an extra risk of 0.1 % (comparable to the disease incidence) for CHD, ischemic stroke, DM, and LRIs were 8.59, 11.85, 22.09, and 24.23 µg/m3, respectively. The associated attributable YLD decreased by 51.4 % with LRIs reduced most (83.6 %), followed by DM (63.7 %) as a result of PM2.5 concentration reduction from 26.10 to 16.82 µg/m3 during 2011-2019 in Taiwan. The proportion of YLD due to CHD and ischemic stroke remained dominant (56.4 %-69.9 %). The cost-benefit analysis for the tradeoff between avoidable YLD and mitigation cost suggested an optimal PM2.5 exposure level at 12 µg/m3. CRFs for cardiopulmonary diseases, attributable YLD, and regulation level, may vary depending on the national/regional background and spatial distribution of PM2.5 concentrations, as well as demographic characteristics.
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Contaminantes Atmosféricos , Diabetes Mellitus , Exposición a Riesgos Ambientales , Material Particulado , Humanos , Material Particulado/análisis , Incidencia , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Adulto , Contaminantes Atmosféricos/análisis , Diabetes Mellitus/epidemiología , Anciano , Estudios Longitudinales , Taiwán/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/inducido químicamente , Contaminación del Aire/estadística & datos numéricos , Contaminación del Aire/efectos adversosRESUMEN
Shift work is a prevalent workplace exposure, which increases the possibility of unhealthy behaviours and circadian rhythm disruptions and elevates the risk of metabolic diseases and adverse reproductive outcomes. But its potential of increasing the risk of postpartum weight retention remains uncertain. This study aimed to investigate the association between maternal shift work prior to conception and postpartum weight retention, and to identify modifiable factors during pregnancy for prevention. We analysed data from the Taiwan Birth Cohort Study, a prospective cohort of Taiwanese women who gave birth in 2005. We examined the pre-conceptional shift work status of 13,575 mothers and their body weight before pregnancy, before delivery, six and eighteen months after delivery. We used multivariable linear models to examine associations and effect modifications. Maternal shift work before pregnancy was significantly associated with increased postpartum weight retention at six and eighteen months (ß-estimate for six months: 0.19-kilogram, 95% CI: 0.03-0.34; eighteen months: 0.23-kilogram, 95% CI: 0.04-0.40). The association between shift work and weight retention at six months postpartum was stronger among mothers who were overweight or obese before pregnancy than mothers with normal weight. This study showed the impact of shift work on postpartum weight retention and suggested a stronger association among mothers with overweight or obesity before pregnancy.
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OBJECTIVES: This study aims to assess the specific PM2.5-bound metallic elements that contribute to asthma emergency department visits by using a case-crossover study design. METHODS: This study analyzed data from 11,410 asthma emergency department visits as case group and 22,820 non-asthma onset dates occurring one week and two weeks preceding the case day as controls from 2017 to 2020. PM2.5 monitoring data and 35 PM.2.5-bound metallic elements from six different regions in Taiwan were collected. Conditional logistic regression models were used to assess the relationship between asthma and PM2.5-bound metallic elements. RESULTS: Our investigation revealed a statistically significant risk of asthma emergency department visits associated with PM2.5 exposure at lag 0, 1, 2, and 3 during autumn. Additionally, PM2.5-bound hafnium (Hf), thallium (Tl), rubidium (Rb), and aluminum (Al) exhibited a consistently significant positive correlation with asthma emergency department visits at lags 1, 2, and 3. In stratified analyses by area, age, and sex, PM2.5-bound Hf showed a significant and consistent correlation. CONCLUSIONS: This study provides evidence of PM2.5-bound metallic elements effects in asthma exacerbations, particularly for Hf. It emphasizes the importance of understanding the origins of these metallic elements and pursuing emission reductions to mitigate regional health risks.
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Contaminantes Atmosféricos , Asma , Estudios Cruzados , Servicio de Urgencia en Hospital , Material Particulado , Asma/epidemiología , Asma/inducido químicamente , Taiwán/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Material Particulado/análisis , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Contaminantes Atmosféricos/análisis , Anciano , Adolescente , Adulto Joven , Metales/análisis , Niño , Exposición a Riesgos Ambientales/efectos adversos , Preescolar , Lactante , Visitas a la Sala de EmergenciasRESUMEN
Nitrogen dioxide (NO2) is a major air pollutant primarily emitted from traffic and industrial activities, posing health risks. However, current air pollution models often underestimate exposure risks by neglecting the bimodal pattern of NO2 levels throughout the day. This study aimed to address this gap by developing ensemble mixed spatial models (EMSM) using geo-artificial intelligence (Geo-AI) to examine the spatial and temporal variations of NO2 concentrations at a high resolution of 50m. These EMSMs integrated spatial modelling methods, including kriging, land use regression, machine learning, and ensemble learning. The models utilized 26 years of observed NO2 measurements, meteorological parameters, geospatial layers, and social and season-dependent variables as representative of emission sources. Separate models were developed for daytime and nighttime periods, which achieved high reliability with adjusted R2 values of 0.92 and 0.93, respectively. The study revealed that mean NO2 concentrations were significantly higher at nighttime (9.60 ppb) compared to daytime (5.61 ppb). Additionally, winter exhibited the highest NO2 levels regardless of time period. The developed EMSMs were utilized to generate maps illustrating NO2 levels pre and during COVID restrictions in Taiwan. These findings could aid epidemiological research on exposure risks and support policy-making and environmental planning initiatives.
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Contaminantes Atmosféricos , Contaminación del Aire , Inteligencia Artificial , Monitoreo del Ambiente , Dióxido de Nitrógeno , Dióxido de Nitrógeno/análisis , Taiwán , Contaminación del Aire/análisis , Contaminantes Atmosféricos/análisis , Monitoreo del Ambiente/métodos , Estaciones del AñoRESUMEN
OBJECTIVE: Parabens are a group of substances commonly employed as antimicrobial preservatives. The effect of parabens on the development of neurotoxicity in children is still controversial. This study aimed to explore the associations between parabens exposure and children's neurodevelopmental performance, emphasizing potential sex differences and the combined effects of parabens. METHODS: We used the long-term follow-up study of Taiwanese generation, Taiwan Birth Panel Study II (TBPS II). We recruited the group of children at 6-8 years old. And, we measured parabens in children urine, including methylparaben (MP), ethylparaben (EP), propylparaben (PP) and butylparaben (BP). Children's attention-related performance was evaluated using the Conners Kiddie Continuous Performance Test 2nd Edition (K-CPT 2). The study employed both linear regression and mixture analysis quantile g-computation (QGC) methods to discern associations. A stratified analysis by sex and QGC was implemented to delve deeper into the cumulative effects of parabens. RESULTS: A total of 446 subjects completed both the parabens analysis and the K-CPT 2 survey. The overall association between parabens and neurodevelopmental performance was not pronounced, but discernible sex differences emerged. In the single pollutant analysis, elevated PP concentrations were associated with higher K-CPT 2 scores particularly in detectability (d') (ß = 0.92 [95 % CI = 0.15 to 1.69]) and commissions (ß = 0.95 [95 % CI = 0.12 to 1.78]), among girls. Further, in the mixture analysis, a significant association between PP and detectability (d') was observed in girls (ß = 1.68 [95 % CI = 0.11 to 3.26]). CONCLUSIONS: This study identified sex-specific associations between parabens and attention performance. Consistent outcomes across single and mixture analysis methods. Further research is crucial to clarify these causal associations.
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Parabenos , Parabenos/análisis , Humanos , Niño , Femenino , Masculino , Taiwán , Exposición a Riesgos Ambientales , Estudios de Seguimiento , Conservadores Farmacéuticos , Desarrollo Infantil/efectos de los fármacos , Trastornos del Neurodesarrollo/inducido químicamenteRESUMEN
BACKGROUND: Taiwan was a coronavirus disease 2019 (COVID-19) outlier, with an extraordinarily long transmission-free record: 253 days without locally transmitted infections while the rest of the world battled wave after wave of infection. The appearance of the alpha variant in May 2021, closely followed by the delta variant, disrupted this transmission-free streak. However, despite low vaccination coverage (<1%), outbreaks were well-controlled. METHODS: This study analyzed the time to border closure and conducted one-sample t test to compare between Taiwan and Non-Taiwan countries prior to vaccine introduction. The study also collected case data to observe the dynamics of omicron transmission. Time-varying reproduction number,Rt, was calculated and was used to reflect infection impact at specified time points and model trends of future incidence. RESULTS: The study analyzed and compare the time to border closure in Taiwan and non-Taiwan countries. The mean times to any border closure from the first domestic case within each country were -21 and 5.98 days, respectively (P < .0001). The Taiwanese government invested in quick and effective contact tracing with a precise quarantine strategy in lieu of a strict lockdown. Residents followed recommendations based on self-discipline and unity. The self-discipline in action is evidenced in Google mobility reports. The central and local governments worked together to enact non-pharmaceutical interventions (NPIs), including universal masking, social distancing, limited unnecessary gatherings, systematic contact tracing, and enhanced quarantine measures. The people cooperated actively with pandemic-prevention regulations, including vaccination and preventive NPIs. CONCLUSIONS: This article describes four key factors underlying Taiwan's success in controlling COVID-19 transmission: quick responses; effective control measures with new technologies and rolling knowledge updates; unity and cooperation among Taiwanese government agencies, private companies and organizations, and individual citizens; and Taiwanese self-discipline.
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COVID-19 , SARS-CoV-2 , Humanos , SARS-CoV-2/genética , COVID-19/epidemiología , COVID-19/prevención & control , Control de Enfermedades Transmisibles , Taiwán/epidemiologíaRESUMEN
Air pollution is inextricable from human activity patterns. This is especially true for nitrogen oxide (NOx), a pollutant that exists naturally and also as a result of anthropogenic factors. Assessing exposure by considering diurnal variation is a challenge that has not been widely studied. Incorporating 27 years of data, we attempted to estimate diurnal variations in NOx across Taiwan. We developed a machine learning-based ensemble model that integrated hybrid kriging-LUR, machine-learning, and an ensemble learning approach. Hybrid kriging-LUR was performed to select the most influential predictors, and machine-learning algorithms were applied to improve model performance. The three best machine-learning algorithms were suited and reassessed to develop ensemble learning that was designed to improve model performance. Our ensemble model resulted in estimates of daytime, nighttime, and daily NOx with high explanatory powers (Adj-R2) of 0.93, 0.98, and 0.94, respectively. These explanatory powers increased from the initial model that used only hybrid kriging-LUR. Additionally, the results depicted the temporal variation of NOx, with concentrations higher during the daytime than the nighttime. Regarding spatial variation, the highest NOx concentrations were identified in northern and western Taiwan. Model evaluations confirmed the reliability of the models. This study could serve as a reference for regional planning supporting emission control for environmental and human health.
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Contaminantes Atmosféricos , Contaminación del Aire , Humanos , Contaminantes Atmosféricos/análisis , Monitoreo del Ambiente/métodos , Taiwán , Reproducibilidad de los Resultados , Contaminación del Aire/análisis , Óxidos de Nitrógeno/análisis , Óxido Nítrico , Aprendizaje Automático , Material Particulado/análisisRESUMEN
BACKGROUND: Air pollution is a risk factor for hepatocellular carcinoma (HCC). However, the effect of air pollution on HCC risk in patients with hepatitis remains unclear. METHODS: This cross-sectional study recruited 348 patients with chronic hepatitis who were tested for serum hepatitis B surface antigen (HBsAg) and for antibodies against hepatitis B core antigen (HBcIgG) and hepatitis C virus (anti-HCV) in 2022. The diagnosis of HCC was based on the International Classification of Diseases, 10th revision (ICD-10). Daily estimates of air pollutants were aggregated into mean estimates for the previous year based on the date of recruitment or HCC diagnosis. RESULTS: Out of 348 patients, 12 had HCC (3.4%). Patients with HCC were older (71.7 vs 50.9 years; p = 0.004), had higher proportion of HBsAg seropositivity (41.7% vs 5.1%; p < 0.001), and substantially higher levels of particulate matter 2.5 (PM 2.5 ) (21.5 vs 18.2 µg/m 3 ; p = 0.05). Logistic regression analysis revealed that the factors associated with HCC were age (odds ratio [OR]: 1.10; CI, 1.03-1.17; p = 0.01), PM 2.5 level (OR: 1.51; CI, 1.02-2.23; p = 0.04), and HBsAg seropositivity (OR: 6.60; CI, 1.51-28.85; p = 0.01) ( Table 3 ). There was a combined effect of PM 2.5 and HBsAg seropositivity on the risk of HCC development (OR: 22.17; CI, 3.33-147.45; p = 0.001). CONCLUSION: In this study, we demonstrated that PM 2.5 and HBsAg seropositivity were associated with HCC occurrence and had synergistic effects after adjusting for confounding factors.
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Contaminación del Aire , Carcinoma Hepatocelular , Hepatitis B Crónica , Hepatitis C , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/etiología , Neoplasias Hepáticas/complicaciones , Antígenos de Superficie de la Hepatitis B , Estudios Transversales , Factores de Riesgo , Hepatitis Crónica/complicaciones , Hepatitis C/complicaciones , Contaminación del Aire/efectos adversos , Material Particulado , Hepatitis B Crónica/complicaciones , Virus de la Hepatitis BRESUMEN
We aimed to investigate the association between air pollution and advanced fibrosis among patients with metabolic associated fatty liver disease (MAFLD) and chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. A total of 1376 participants who were seropositive for HBV surface antigen (HBsAg) or antibodies to HCV (anti-HCV) or had abnormal liver function in a community screening program from 2019 to 2021 were enrolled for the assessment of liver fibrosis using transient elastography. Daily estimates of air pollutants (particulate matter ≤2.5 µm in diameter [PM2.5 ], nitrogen dioxide [NO2 ], ozone [O3 ] and benzene) were aggregated into mean estimates for the previous year based on the date of enrolment. Of the 1376 participants, 767 (52.8%) and 187 (13.6) had MAFLD and advanced fibrosis, respectively. A logistic regression analysis revealed that the factors associated with advanced liver fibrosis were HCV viremia (odds ratio [OR], 3.13; 95% confidence interval [CI], 2.05-4.77; p < 0.001), smoking (OR, 1.79; 95% CI, 1.16-2.74; p = 0.01), age (OR, 1.04; 95% CI, 1.02-1.05; p < 0.001) and PM2.5 (OR, 1.10; 95% CI, 1.05-1.16; p < 0.001). Linear regression analysis revealed that LSM was independently correlated with PM2.5 (ß: 0.134; 95% CI: 0.025, 0.243; p = 0.02). There was a dose-dependent relationship between different fibrotic stages and the PM2.5 level (the PM2.5 level in patients with fibrotic stages 0, 1-2 and 3-4: 27.9, 28.4, and 29.3 µg/m3 , respectively; trend p < 0.001). Exposure to PM2.5 , as well as HBV and HCV infections, is associated with advanced liver fibrosis in patients with MAFLD. There was a dose-dependent correlation between PM2.5 levels and the severity of hepatic fibrosis.
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Contaminación del Aire , Hepatitis B Crónica , Hepatitis C , Humanos , Hepatitis B Crónica/complicaciones , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/análisis , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Material Particulado/efectos adversos , Material Particulado/análisis , Cirrosis Hepática/etiología , FibrosisRESUMEN
Elevated levels of ground-level ozone (O3) can have harmful effects on health. While previous studies have focused mainly on daily averages and daytime patterns, it's crucial to consider the effects of air pollution during daily commutes, as this can significantly contribute to overall exposure. This study is also the first to employ an ensemble mixed spatial model (EMSM) that integrates multiple machine learning algorithms and predictor variables selected using Shapley Additive exExplanations (SHAP) values to predict spatial-temporal fluctuations in O3 concentrations across the entire island of Taiwan. We utilized geospatial-artificial intelligence (Geo-AI), incorporating kriging, land use regression (LUR), machine learning (random forest (RF), categorical boosting (CatBoost), gradient boosting (GBM), extreme gradient boosting (XGBoost), and light gradient boosting (LightGBM)), and ensemble learning techniques to develop ensemble mixed spatial models (EMSMs) for morning and evening commute periods. The EMSMs were used to estimate long-term spatiotemporal variations of O3 levels, accounting for in-situ measurements, meteorological factors, geospatial predictors, and social and seasonal influences over a 26-year period. Compared to conventional LUR-based approaches, the EMSMs improved performance by 58% for both commute periods, with high explanatory power and an adjusted R2 of 0.91. Internal and external validation procedures and verification of O3 concentrations at the upper percentile ranges (in 1%, 5%, 10%, 15%, 20%, and 25%) and other conditions (including rain, no rain, weekday, weekend, festival, and no festival) have demonstrated that the models are stable and free from overfitting issues. Estimation maps were generated to examine changes in O3 levels before and during the implementation of COVID-19 restrictions. These findings provide accurate variations of O3 levels in commute period with high spatiotemporal resolution of daily and 50m * 50m grid, which can support control pollution efforts and aid in epidemiological studies.
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Contaminantes Atmosféricos , Contaminación del Aire , Contaminantes Atmosféricos/análisis , Inteligencia Artificial , Monitoreo del Ambiente/métodos , Taiwán , Contaminación del Aire/análisis , Material Particulado/análisisRESUMEN
AIM: Cesarean section delivery is associated with microbiota disruption and immuno-dysregulation during childhood, but the association with Kawasaki disease remains uncertain. We aimed to evaluate the association between Cesarean section and Kawasaki disease. METHODS: We examined the association between Kawasaki disease between six and eighteen months and Cesarean section within a birth cohort of 15,796 mother-infant pairs in Taiwan. The associations were assessed with Poisson regression in the study population, in the 1:2 propensity score-matched subpopulation, and compared with febrile convulsion, trauma and accidents during the same interval as negative control outcomes. RESULTS: Cesarean section was found to increase the risk of Kawasaki disease among overall population (adjusted relative risk [aRR]: 2.22, 95 % confidence interval (CI): 1.14-4.34) and the matched subpopulation (aRR: 2.29, 95 % CI: 1.14-4.68 in PS-matched subpopulation). Meanwhile, there was no association between Cesarean section and the clinic visits for febrile convulsion, trauma and accidents. CONCLUSION: In conclusion, this study identified a potential association between Cesarean section delivery and a higher risk of Kawasaki disease during six-to eighteen months of the prospective birth cohort in Taiwan.
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Cesárea , Síndrome Mucocutáneo Linfonodular , Humanos , Síndrome Mucocutáneo Linfonodular/epidemiología , Cesárea/efectos adversos , Cesárea/estadística & datos numéricos , Taiwán/epidemiología , Femenino , Lactante , Embarazo , Masculino , Factores de Riesgo , Adulto , Estudios Prospectivos , Puntaje de Propensión , Distribución de PoissonRESUMEN
Biochemical response is an important prognostic indicator in chronic hepatitis B (CHB) patients receiving nucleotide/nucleoside analogues (NAs). However, the effects of air pollution in alanine aminotransferase (ALT) normalization remain elusive. This longitudinal study recruited 80 hepatitis B e antigen-negative CHB patients who received NAs. ALT levels were measured during the first year of anti-hepatitis B virus therapy. Normal ALT levels were defined asâ <19 U/L for females andâ <30 U/L for males, and the risk factors associated with ALT abnormalities were analyzed. The daily estimations of air pollutants (particulate matterâ ≤2.5 µm in diameter (PM2.5), nitrogen dioxide, ozone (O3), and benzene) were aggregated into the mean estimation for the previous month based on the date of recruitment (baseline) and 1 year later. Sixteen patients (20.0%) had a baseline ALTâ >â 40 U/L; overall, 41 (51.6%) had an abnormal ALT (≥19 U/L for females andâ ≥â 30 U/L for males). After 1 year of NA therapy, 75 patients (93.8%) had undetectable hepatitis B virus DNA levels. Mean post-treatment ALT levels were significantly lower than mean pretreatment levels (21.3 vs 30.0 U/L, respectively; Pâ <â .001). The proportion of patients with a normal ALT was also significantly higher after versus before treatment (71.2% vs 51.2%, respectively; Pâ =â .001). The strongest factors associated with ALT abnormality after 1 year of NA treatment were body mass index (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.05-1.54; Pâ =â .01) and ozone level (OR, 1.11; 95% CI, 1.02-1.22; Pâ =â .02). Among hepatitis B e antigen-negative CHB patients with relatively low viral loads, 1 year of NA treatment improved ALT levels after the adjustment for confounding factors and increased the proportion of patients with normal ALT levels. Air pollution affects the efficacy of ALT normalization.
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Contaminación del Aire , Hepatitis B Crónica , Ozono , Masculino , Femenino , Humanos , Hepatitis B Crónica/tratamiento farmacológico , Antivirales/uso terapéutico , Nucleósidos/uso terapéutico , Nucleótidos/uso terapéutico , Antígenos e de la Hepatitis B , Estudios Longitudinales , Virus de la Hepatitis B/genética , Alanina Transaminasa , Contaminación del Aire/efectos adversos , Ozono/uso terapéutico , ADN ViralRESUMEN
Environmental exposure to fine particulate matter PM2.5 is known to be associated with many hazardous health effects, including cardiovascular diseases (CVDs). To reduce the related health burden, it is crucial that policy-makers throughout the world set regulation levels according to their own evidence-based study outcomes. However, there appears to be a lack of decision-making methods for the control level of PM2.5 based on the burden of disease. In this study, 117,882 CVD-free participants (≥30-years-old) of the MJ Health Database were followed-up (for a median of 9 years) between 2007 and 2017. Each participant's residential address was matched to the 3× 3 km grid PM2.5 concentration estimates with a 5-year average for long-term exposure. We used a time-dependent nonlinear weight-transformation Cox regression model for the concentration-response function (CRF) between exposure to PM2.5 and CVD incidence. Town/district-specific PM2.5-attributable years of life in disability (YLDs) in CVD incidence were calculated by using the relative risk (RR) of the PM2.5 concentration level relative to the reference level. A cost-benefit analysis was proposed by assessing the trade-off between the gain in avoidable YLDs (given a reference level at u and considering mitigation cost) versus the loss in unavoidable YLDs by not setting at the lowest observed health effect level u0. The CRF varied across different areas with dissimilar PM2.5 exposure ranges. Areas with low PM2.5 concentrations and population sizes provided crucial information for the CVD health effect at the lower end. Additionally, women and older participants were more susceptible. The avoided town/district-specific YLDs in CVD incidence due to lower RRs ranged from 0 to 3000 person-years comparing the PM2.5 concentration levels in 2019 with the levels in 2011. Based on the cost-benefit analysis, an annual PM2.5 concentration of 13 µg/m3 would be optimal, which provides a guideline for the updated regulation level (currently at 15 µg/m3). The proposed cost-benefit analysis method may be applied to other countries/regions for regulation levels that are most suitable for their air pollution status and population health.
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Contaminantes Atmosféricos , Contaminación del Aire , Enfermedades Cardiovasculares , Humanos , Femenino , Adulto , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Análisis Costo-Beneficio , Material Particulado/análisis , Contaminación del Aire/análisis , Exposición a Riesgos Ambientales/análisis , Contaminantes Atmosféricos/efectos adversos , Contaminantes Atmosféricos/análisisRESUMEN
Human biomonitoring (HBM) provides information to identify chemicals that need to be assessed regarding potential health risks to human populations. We established a population-representative sample in Taiwan, namely the Taiwan Environmental Survey for Toxicants (TESTs) in 2013-2016. In total, 1871 participants (aged 7-97 years) were recruited from throughout Taiwan. A questionnaire survey was applied to obtain individuals' demographic characteristics, and urine samples were obtained to assess metal concentrations. Inductively coupled plasma-mass spectrometry was used to determine concentrations of urinary As (total), Cd, Co, Cr, Cu, Fe, Ga, In, Mn, Ni, Pb, Se, Sr, Tl, and Zn. The purpose of this study was to establish the human urinary reference levels (RVs) for metals in the general population of Taiwan. We found that median concentrations of urinary Cu, Fe, Pb, and Zn in males were statistically significant (p < 0.05) higher than in females (Cu: 11.48 vs. 10.00 µg/L; Fe: 11.48 vs. 10.46 µg/L; Pb: 0.87 vs. 0.76 µg/L; and Zn: 448.93 vs. 348.35 µg/L). On the contrary, Cd and Co were significantly lower in males than in females (Cd: 0.61 vs. 0.64 µg/L; and Co: 0.27 vs. 0.40 µg/L). Urinary Cd levels in the ≥18-year-old group (0.69 µg/L) were significantly higher than those in the 7-17-year-old group (0.49 µg/L, p < 0.001). Among the investigated metals, most were significantly higher in the 7-17-year-old group than in the ≥18-year-old group, except for Cd, Ga, and Pb. Participants who lived in central Taiwan had higher median levels of urinary Cd, Cu, Ga, Ni, and Zn than those in other regions. Median levels of urinary As, Cd, Pb, and Se were significantly higher in participants who lived in harbor (94.12 µg/L), suburban (0.68 µg/L), industrial (0.92 µg/L), and rural (50.29 µg/L) areas, respectively, than the others who lived in other areas. RV95 percentiles of urinary metals (ng/mL) for 7-17/≥18-year-old groups were As (346.9/370.0), Cd (1.41/2.21), Co (2.30/1.73), Cr (0.88/0.88), Cu (28.02/22.78), Fe (42.27/42.36), Ga (0.13/0.12), In (0.05/0.04), Mn (3.83/2.91), Ni (8.09/6.17), Pb (8.09/5.75), Se (122.4/101.9), Sr (556.5/451.3), Tl (0.57/0.49), and Zn (1314.6/1058.8). In this study, we have highlighted the importance of As, Cd, Pb, and Mn exposure in the general population of Taiwan. The established RV95 of urinary metals in Taiwanese would be fundamental information to promote the reduction of metal exposure or policy intervention. We concluded that urinary levels of exposure to certain metals in the general Taiwanese population varied by sex, age, region, and urbanization level. References of metal exposure in Taiwan were established in the current study.
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Cadmio , Metales Pesados , Masculino , Femenino , Humanos , Adolescente , Niño , Cadmio/orina , Monitoreo Biológico , Taiwán , Plomo/análisis , Valores de Referencia , Monitoreo del Ambiente/métodos , Sustancias Peligrosas , Encuestas y Cuestionarios , Metales Pesados/análisisRESUMEN
Since low-level lead exposure is still of concern for neonates, it is worth further characterizing the temporal transition trends of cord blood lead levels (CBLLs) globally and locally in Taipei, Taiwan, after the cessation of leaded gasoline use. A literature review on CBLLs around the world was performed by searching three databanks, i.e., PubMed, Google Scholar and Web of Science, with the search keywords "cord blood" combined with "lead" or "Pb" for studies published from 1975 to May 2021. In total, 66 articles were included. Linear regressions for the reciprocal of sample size weighed CBLLs against calendar year presented a high r2 value (0.722) for the very high Human Development Index (HDI) countries and a moderate r2 value (0.308) for the combined high and medium HDI countries. The predicted CBLLs in 2030 and 2040 were 6.92 (95% CI: 6.02-7.81) µg/L and 5.85 (95% CI: 5.04-6.66) µg/L, respectively, for the very high HDI countries and 13.10 (95% CI: 7.12-19.09) µg/L and 10.63 (95% CI: 5.37-15.89) µg/L, respectively, for the combined high and medium HDI countries. To characterize the CBLL transitions in the Great Taipei metropolitan area, data from five studies conducted from 1985 to 2018 were employed. Although the results of the early four studies indicated that the Great Taipei metropolitan area did not reach the pace in CBLL reduction among the very high HDI countries, the CBLLs of the latest study during 2016-2018 were pretty low (8.1 ± 4.5 µg/L), approximately 3 years in advance of the very high HDI countries as one group to reach this low CBLL. In conclusion, further effective reduction in environmental lead exposure is challenging and must be based on the efforts from the aspects reflected by the HDI index compositions, i.e., economics, education and health, mostly implying health disparity and inequality.
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Exposición a Riesgos Ambientales , Plomo , Recién Nacido , Humanos , Plomo/análisis , Exposición a Riesgos Ambientales/análisis , Escolaridad , Taiwán , Países en DesarrolloRESUMEN
The currently used air quality index (AQI) is not able to capture the additive effects of air pollution on health risks and reflect non-threshold concentration-response relationships, which has been criticized. We proposed the air quality health index (AQHI) based on daily air pollution-mortality associations, and compared its validity in predicting daily mortality and morbidity risks with the existing AQI. We examined the excess risk (ER) of daily elderly (≥65-year-old) mortality associated with 6 air pollutants (PM2.5, PM10, SO2, CO, NO2, and O3) in 72 townships across Taiwan from 2006 to 2014 by performing a time-series analysis using a Poisson regression model. Random effect meta-analysis was used to pool the township-specified ER for each air pollutant in the overall and seasonal scenarios. The integrated ERs for mortality were calculated and used to construct the AQHI. The association of the AQHI with daily mortality and morbidity were compared by calculating the percentage change per interquartile range (IQR) increase in the indices. The magnitude of the ER on the concentration-response curve was used to evaluate the performance of the AQHI and AQI, regarding specific health outcomes. Sensitivity analysis was conducted using coefficients from the single- and two-pollutant models. The coefficients of PM2.5, NO2, SO2, and O3 associated with mortality were included to form the overall and season-specific AQHI. An IQR increase in the overall AQHI at lag 0 was associated with 1.90%, 2.96%, and 2.68% increases in mortality, asthma, and respiratory outpatient visits, respectively. The AQHI had higher ERs for mortality and morbidity on the validity examinations than the current AQI. The AQHI, which captures the combined effects of air pollution, can serve as a health risk communication tool to the public.
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Contaminantes Atmosféricos , Contaminación del Aire , Humanos , Anciano , Contaminantes Atmosféricos/toxicidad , Contaminantes Atmosféricos/análisis , Dióxido de Nitrógeno/toxicidad , Dióxido de Nitrógeno/análisis , Taiwán/epidemiología , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Material Particulado/toxicidad , Material Particulado/análisis , ChinaRESUMEN
STUDY OBJECTIVE: Carbon monoxide (CO) poisoning causes central nervous system toxicity resulting in delayed neurologic sequelae. This study aims to evaluate the risk of epilepsy in patients with a history of CO intoxication. METHODS: We conducted a retrospective population-based cohort study using the Taiwan National Health Insurance Research Database and enrolled patients with and without CO poisoning matched for age, sex, and index year in a 1:5 ratio, between 2000 and 2010. Multivariable survival models were used to assess the risk of epilepsy. The primary outcome was newly developed epilepsy after the index date. All patients were followed until a new diagnosis of epilepsy, death, or December 31, 2013. Stratification analyses by age and sex were also conducted. RESULTS: This study included 8,264 patients with CO poisoning and 41,320 without. Patients with a history of CO poisoning were strongly associated with subsequent epilepsy (adjusted hazard ratio [HR] 8.40; 95% confidence interval [CI], 6.48 to 10.88). In the age-stratified analysis, intoxicated patients aged 20 to 39 years had the highest HR (adjusted HR 11.06; 95% CI, 7.17 to 17.08). In the sex-stratified analysis, adjusted HRs for male and female patients were 8.00 (95% CI, 5.86 to 10.92) and 9.53 (95% CI, 5.95 to 15.26), respectively. CONCLUSION: Patients with CO poisoning were associated with an increased risk of developing epilepsy compared with those without CO poisoning. This association was more prominent in the young population.
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Intoxicación por Monóxido de Carbono , Epilepsia , Humanos , Masculino , Femenino , Estudios Retrospectivos , Estudios de Cohortes , Intoxicación por Monóxido de Carbono/epidemiología , Intoxicación por Monóxido de Carbono/complicaciones , Epilepsia/epidemiología , Epilepsia/complicaciones , Modelos de Riesgos Proporcionales , Factores de RiesgoRESUMEN
OBJECTIVES: To assess the effects of empiric antibiotics with different degrees of appropriateness based on hospital cumulative antibiograms in patients with bacteraemic sepsis presenting to the emergency department (ED). METHODS: This retrospective cohort study included adult patients with sepsis and positive blood culture reports in the ED from February 2016 to December 2018. Based on isolated pathogens and empiric antibiotics which the patients received, these patients were divided into two groups using a cut-off of 70% for overall antimicrobial susceptibility (OAS) on hospital cumulative antibiograms 6 months prior to ED admission. Multivariate regression and sensitivity analyses were performed. RESULTS: In this study, 1055 patients were included. We used multivariate regression models which were adjusted for age, sex, co-morbidities, site of infection, organ dysfunction, and septic shock. Empiric antibiotics with OAS of ≥70% were associated with reduced in-hospital deaths (adjusted odds ratio, 0.46; 95% CI, 0.28-0.77) and 30-day mortality (adjusted odds ratio, 0.53; 95% CI, 0.33-0.86). They were more likely to result in a shortened length of intensive care unit stay by 1.60 days (95% CI, -3.00 to -0.20). CONCLUSIONS: Treatment with empiric antibiotics with OAS of ≥70% based on hospital cumulative antibiograms is associated with lower mortality and shorter length of intensive care unit stay in patients with bacteraemic sepsis in the ED.
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Antibacterianos , Sepsis , Adulto , Humanos , Antibacterianos/uso terapéutico , Estudios Retrospectivos , Sepsis/tratamiento farmacológico , Pruebas de Sensibilidad Microbiana , Servicio de Urgencia en Hospital , Hospitales , Mortalidad HospitalariaRESUMEN
High levels of ground level ozone (O3) are associated with detrimental health concerns. Most of the studies only focused on daily average and daytime trends due to the presence of sunlight that initiates its formation. However, atmospheric chemical reactions occur all day, thus, nighttime concentrations should be given equal importance. In this study, geospatial-artificial intelligence (Geo-AI) which combined kriging, land use regression (LUR), machine learning, an ensemble learning, was applied to develop ensemble mixed spatial models (EMSMs) for daily, daytime, and nighttime periods. These models were used to estimate the long-term O3 spatio-temporal variations using a two-decade worth of in-situ measurements, meteorological parameters, geospatial predictors, and social and season-dependent factors. From the traditional LUR approach, the performance of EMSMs improved by 60% (daytime), 49% (nighttime), and 57% (daily). The resulting daily, daytime, and nighttime EMSMs had a high explanatory power with and adjusted R2 of 0.91, 0.91, and 0.88, respectively. Estimation maps were produced to examine the changes before and during the implementation of nationwide COVID-19 restrictions. These results provide accurate estimates and its diurnal variation that will support pollution control measure and epidemiological studies.