Influence of the COVID-19 pandemic on births and induced abortions in Southern Sweden: a register-based study.

BACKGROUND: Pandemics are linked with declining birth rates, but little is known about how the COVID-19 pandemic has influenced childbearing decisions. We aimed to investigate the associations between the COVID-19 pandemic and reproductive decisions, specifically to identify potential changes in the frequency of deliveries and induced abortions in Skåne, Sweden. METHODS: Using the Skåne Healthcare Register, we identified women aged 15-45 years who had at least one pregnancy-related care visit registered between 1 January 2013 and 11 November 11 2021. Deliveries and induced abortions were identified, and changes in weekly delivery and abortion counts were assessed using an interrupted time series design. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated from a Poisson regression model. RESULTS: During the study period we identified 129 131 deliveries and 38 591 abortions. Compared with the counterfactual (exposed interval assuming COVID-19 had not occurred), pandemic exposure was associated with fewer deliveries (RR 0.93; 95% CI 0.89 to 0.98). For abortions, pandemic exposure appeared to be associated with fewer abortions (RR 0.95; 95% CI 0.90 to 1.00); however, age-related differences were found. Among women aged 25 years and over, pandemic exposure was more strongly associated with fewer abortions. Contrastingly, among women aged under 25 years, abortions appeared to increase. CONCLUSIONS: The COVID-19 pandemic seemed to have contributed to a decline in births in Southern Sweden. During the same period, abortions declined in women in the older age range, but contrastingly increased among younger women.

Detection of the fungicide transformation product 4-hydroxychlorothalonil in serum of pregnant women from Sweden and Costa Rica.

BACKGROUND: 4-hydroxychlorothalonil (HCT, R182281), a transformation product of the fungicide chlorothalonil, was recently identified in human serum and breast milk. There are indications that HCT may be more toxic and environmentally persistent than chlorothalonil. OBJECTIVE: Our aim was to investigate serum concentrations of HCT in pregnant women in Sweden and Costa Rica. METHODS: We developed a quantitative analytical method for HCT using liquid chromatography tandem mass spectrometry. We measured HCT in 1808 serum samples from pregnant women from the general population in Sweden (1997-2015) and in 632 samples from 393 pregnant women from an agricultural population in Costa Rica (2010-2011). In Swedish samples, we assessed time trends and investigated seasonality. In the Costa Rican samples, we evaluated variability between and within women and explanatory variables of HCT concentrations. RESULTS: HCT was detected in all serum samples, and the limit of detection was 0.1 µg/L. The median HCT concentration in the Swedish samples was 4.1 µg/L (interquartile range [IQR] of 2.9 - 5.8 µg/L), and 3.9 times higher in the Costa Rican samples (median: 16.1 µg/L; IQR: 10.6 - 25.0 µg/L). We found clear seasonal variation with higher concentrations in the first half of each year among Swedish women. In the Costa Rican study, women working in agriculture and living near banana plantations had higher HCT concentrations, whilst higher parity and having a partner working in agriculture were associated with decreased HCT, and no clear seasonal pattern was observed. IMPACT STATEMENT: For the first time, this study quantifies human exposure to the fungicide chlorothalonil and/or its transformation product 4-hydroxychlorothalonil (HCT, R182281) and finds higher serum concentrations in women from a tropical agricultural setting as compared with women from the general population in Sweden.

Estimated Transfer of Perfluoroalkyl Substances (PFAS) from Maternal Serum to Breast Milk in Women Highly Exposed from Contaminated Drinking Water: A Study in the Ronneby Mother-Child Cohort.

BACKGROUND: Infancy perfluoroalkyl substances (PFAS) exposure from breastfeeding is partially determined by the transfer efficiencies (TEs) of PFAS from maternal serum into breast milk. However, to our knowledge there are no studies of such TEs in highly exposed populations. OBJECTIVES: We estimated the TEs of PFAS from maternal serum into colostrum and breast milk in a cohort of women with a wide range of PFAS exposures. METHODS: The Ronneby Mother-Child Cohort was established in 2015 after PFAS contamination was discovered in the public drinking water of Ronneby, Sweden. We measured seven PFAS in matched samples of maternal serum at delivery and colostrum and breast milk. We calculated the TE (in percentage) as the ratio of PFAS in colostrum or breast milk to serum multiplied by 100 and evaluated whether TEs varied by PFAS, lactation stage, or exposure level using a series of linear mixed-effects models with a random intercept for each woman. RESULTS: This study included 126 mothers. PFAS associated with firefighting foams [i.e., perfluorohexane sulfonic acid (PFHxS) and perfluorooctane sulfonic acid (PFOS)] were substantially elevated in the serum, colostrum, and breast milk samples of highly exposed women in the cohort and showed strong correlation. PFHxS and PFOS also contributed the largest fraction of total PFAS on average in colostrum and breast milk. Median TEs varied from 0.9% to 4.3% and were higher for perfluoroalkyl carboxylic acids, including perfluorooctanoic acid, than perfluoroalkane sulfonic acids, including PFHxS and PFOS. TEs varied by exposure level, but there was not a consistent pattern in this variation. DISCUSSION: PFAS concentrations in the colostrum and breast milk of highly exposed women were higher than the concentrations in low-exposed women, and TEs were of a similar magnitude across exposure categories. This implies that breastfeeding may be an important route of PFAS exposure for breastfeeding infants with highly exposed mothers, although the relative contribution of breastfeeding vs. prenatal transplacental transfer remains to be clarified. https://doi.org/10.1289/EHP11292.

Changes in perfluoroalkyl substances (PFAS) concentrations in human milk over the course of lactation: A study in Ronneby mother-child cohort.

BACKGROUND: Little is known about how PFAS concentrations in human milk change over the course of lactation, although this is an important determinant of cumulative infant exposure from breastfeeding. OBJECTIVE: To estimate changes in PFAS concentrations in human milk over the course of lactation in a population with a wide range of exposure from background-to high-exposed. METHODS: We measured PFAS concentrations in colostrum and mature milk samples from women in the Ronneby Mother-Child Cohort. For each PFAS, we estimated the change in concentration from colostrum collected 3-4 days postpartum to mature milk collected 4-12 weeks postpartum using linear mixed-effects models. We evaluated whether this estimated change varied by quartiles of colostrum concentrations. In a subset of mothers with at least three mature milk samples, we estimated the change in concentration per month over the first eight months of lactation. RESULTS: Our study included 77 mother-child pairs, of whom 74 had colostrum and initial mature milk samples and 11 had three or more repeated samples. The concentration change from colostrum to mature milk varied by PFAS. While PFOS increased by 21% (95% CI: 8.9, 35), PFOA decreased by 17% (95% CI: -28, -3.5) and PFHxS decreased by 12% (95% CI: -24, 3.3). In addition, PFAS concentrations tended to increase in women with lower colostrum levels, but decreased or remained the same in women with high colostrum concentrations. When we estimated changes over the course of lactation, we found that PFOA concentrations decreased the most (-12% per month; 95% CI: -22, -1.5), whereas PFHxS and PFOS showed small nonsignificant decreases. CONCLUSIONS: Models for cumulative infancy exposure from breastfeeding need to account for differences in concentration trajectories by PFAS and possibly by maternal exposure level. Additional research is needed to evaluate the relative exposure from breastfeeding vs prenatal exposure, especially in highly exposed communities where breastfeeding guidance is urgently needed.

Exposure to Unconventional Oil and Gas Development and All-cause Mortality in Medicare Beneficiaries.

Little is known about whether exposure to unconventional oil and gas development is associated with higher mortality risks in the elderly and whether related air pollutants are exposure pathways. We studied a cohort of 15,198,496 Medicare beneficiaries (136,215,059 person-years) in all major U.S. unconventional exploration regions from 2001 to 2015. We gathered data from records of more than 2.5 million oil and gas wells. For each beneficiary's ZIP code of residence and year in the cohort, we calculated a proximity-based and a downwind-based pollutant exposure. We analyzed the data using two methods: Cox proportional hazards model and Difference-in-Differences. We found evidence of statistically significant higher mortality risk associated with living in proximity to and downwind of unconventional oil and gas wells. Our results suggest that primary air pollutants sourced from unconventional oil and gas exploration can be a major exposure pathway with adverse health effects in the elderly.

Early-life exposure to perfluoroalkyl substances in relation to serum adipokines in a longitudinal birth cohort.

BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) exposure has been linked to metabolic health outcomes such as obesity, and changes in adipokine hormones may be one of the underlying biological mechanisms. We prospectively evaluated the associations between prenatal and early childhood exposures to PFASs and adipokines in children. MATERIAL AND METHODS: PFAS concentrations were measured in serum samples collected at birth, 18 months, and 5 and 9 years, and adiponectin, leptin, leptin receptor, and resistin were measured in serum samples collected at birth and 9 years. We used multivariable linear regression models to estimate the percent change in serum-adipokine concentrations for a doubling in serum-PFAS concentrations. The potential sex-specific effect of PFAS was assessed by including an interaction term between PFAS and sex in each model. Bayesian kernel machine regression (BKMR) was implemented to evaluate the overall effect of PFAS mixtures. RESULTS: Significant associations with leptin, leptin receptor, and resistin at age 9 years were observed for serum-PFAS concentrations at 18 months and 5 and 9 years, whereas associations for PFAS concentrations at birth were mostly null. However, we observed a positive association between serum-PFHxS at birth and leptin receptor at birth. We found limited evidence regarding modification effect of sex on serum-PFAS concentrations. BKMR findings were consistent and suggested some significant effects of the overall PFAS mixtures at 18 months and 5 and 9 years on adipokine concentrations at 9 years. CONCLUSIONS: Given the associations of PFAS exposure with both adipokine hormones and metabolic functions, future studies should include assessment of adipokine hormones when examining PFAS-associated metabolic alterations.

Early-life associations between per- and polyfluoroalkyl substances and serum lipids in a longitudinal birth cohort.

BACKGROUND: Exposures to per- and polyfluoroalkyl substances (PFASs) may affect metabolic outcomes, including lipid concentrations in the blood. However, few studies have evaluated potential associations between PFASs and lipids longitudinally. OBJECTIVES: We estimated associations between PFAS and lipid concentrations at birth and at several points in childhood. METHODS: We measured concentrations of five major PFASs in cord serum and in serum collected at 18 months, five years and nine years in 490 children from a prospective cohort in the Faroe Islands. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) concentrations were measured at birth, 18 months and nine years. We estimated associations between PFAS and lipid concentrations and evaluated possible effect modification by sex. We also tested whether PFAS associations with age-nine lipids varied by exposure period. RESULTS: Serum PFAS concentrations at ages five and nine were positively associated with lipid concentrations at age nine. Cross-sectional associations between PFASs and lipids at age nine were the strongest, with increases in serum concentrations of perfluorodecanoic acid (PFDA), perfluorononanoic acid (PFNA) and perfluorooctanesulfonic acid (PFOS) associated with increases in TC, HDL-C and LDL-C. We found statistically significant differences in estimated PFAS effects by sex, where girls had stronger positive associations between PFASs and TC and LDL-C and boys had stronger positive associations with HDL-C. In repeated measure models, exposure period was a significant modifier of PFAS effects. CONCLUSIONS: Our findings suggest that childhood PFAS exposures may be associated with elevated serum lipid concentrations. This is a public health concern, as a detrimental lipid profile in childhood is a risk factor for later development of hyperlipidemia and cardiovascular disease.

Serum vaccine antibody concentrations in adults exposed to per- and polyfluoroalkyl substances: A birth cohort in the Faroe Islands.

Per- and polyfluoroalkyl substances (PFASs) are highly persistent in the environment and may cause depressed immune function. Previous studies have linked PFAS exposure to lower vaccine responses in children, but research in adults is limited. Therefore, the present study evaluated the associations between exposure to PFASs and serum antibody concentrations in adults vaccinated at age 28 years in the Faroe Islands. PFAS concentrations were determined from cord-blood collected at birth and serum samples collected at ages 7, 14, 22, and 28 years. Serum antibody concentrations against hepatitis type A and B, diphtheria, and tetanus were analyzed from blood samples collected about 6 mo after the first vaccine inoculation at age 28 years. Linear regression models were used to estimate changes in antibody concentration for each doubling of PFAS concentration. Potential effect modification by sex was assessed by including an interaction term between PFAS and sex. Although the 95% confidence intervals contain the null value, inverse trends were observed between serum perfluorooctanoate (PFOA) at ages 14 and 28 years and hepatitis type A antibody (anti-HAV) concentrations, as revealed by an estimated decrease of 0.71 (95% CI: -1.52, 0.09) and 0.24 (95% CI: -0.59, 0.10) signal-to-cutoff ratio for each doubling of exposure, respectively. Inverse trends were also observed between serum PFOA at ages 22 and 28 years and hepatitis type B antibody (anti-HBs) concentration, with an estimated decrease of 21% (95% CI: -42.20%, 7.34%) and of 17% (95% CI: -35.47%, 7.35%) in anti-HBs for each doubling of exposure, respectively. Sex-specific associations with anti-HAV were observed for cord-blood PFASs and serum PFAS concentrations at ages 7 and 14 years. No inverse associations of PFAS exposure were found with diphtheria and tetanus antibody concentrations. Future studies are needed to confirm these findings and further investigate the effects of PFASs on adult immune function.

A spatiotemporal ensemble model to predict gross beta particulate radioactivity across the contiguous United States.

Particulate radioactivity, a characteristic of particulate matter, is primarily determined by the abundance of radionuclides that are bound to airborne particulates. Exposure to high levels of particulate radioactivity has been associated with negative health outcomes. However, there are currently no spatially and temporally resolved particulate radioactivity data for exposure assessment purposes. We estimated the monthly distributions of gross beta particulate radioactivity across the contiguous United States from 2001 to 2017 with a spatial resolution of 32 km, via a multi-stage ensemble-based model. Particulate radioactivity was measured at 129 RadNet monitors across the contiguous U.S. In stage one, we built 264 base learning models using six methods, then selected nine base models that provide different predictions. In stage two, we used a non-negative geographically and temporally weighted regression method to aggregate the selected base learner predictions based on their local performance. The results of block cross-validation analysis suggested that the non-negative geographically and temporally weighted regression ensemble learning model outperformed all base learning model with the smallest rooted mean square error (0.094 mBq/m3). Our model provided an accurate estimation of particulate radioactivity, thus can be used in future health studies.

Predicting Monthly Community-Level Domestic Radon Concentrations in the Greater Boston Area with an Ensemble Learning Model.

Inhaling radon and its progeny is associated with adverse health outcomes. However, previous studies of the health effects of residential exposure to radon in the United States were commonly based on a county-level temporally invariant radon model that was developed using measurements collected in the mid- to late 1980s. We developed a machine learning model to predict monthly radon concentrations for each ZIP Code Tabulation Area (ZCTA) in the Greater Boston area based on 363,783 short-term measurements by Spruce Environmental Technologies, Inc., during the period 2005-2018. A two-stage ensemble-based model was developed to predict radon concentrations for all ZCTAs and months. Stage one included 12 base statistical models that independently predicted ZCTA-level radon concentrations based on geological, architectural, socioeconomic, and meteorological factors for each ZCTA. Stage two aggregated the predictions of these 12 base models using an ensemble learning method. The results of a 10-fold cross-validation showed that the stage-two model has a good prediction accuracy with a weighted R2 of 0.63 and root mean square error of 22.6 Bq/m3. The community-level time-varying predictions from our model have good predictive precision and accuracy and can be used in future prospective epidemiological studies in the Greater Boston area.

Unconventional oil and gas development and ambient particle radioactivity.

Unconventional oil and natural gas development (UOGD) expanded extensively in the United States from the early 2000s. However, the influence of UOGD on the radioactivity of ambient particulate is not well understood. We collected the ambient particle radioactivity (PR) measurements of RadNet, a nationwide environmental radiation monitoring network. We obtained the information of over 1.5 million wells from the Enverus database. We investigated the association between the upwind UOGD well count and the downwind gross-beta radiation with adjustment for environmental factors governing the natural emission and transport of radioactivity. Our statistical analysis found that an additional 100 upwind UOGD wells within 20 km is associated with an increase of 0.024 mBq/m3 (95% confidence interval [CI], 0.020, 0.028 mBq/m3) in the gross-beta particle radiation downwind. Based on the published health analysis of PR, the widespread UOGD could induce adverse health effects to residents living close to UOGD by elevating PR.

Ambient particle radioactivity and gestational diabetes: A cohort study of more than 1 million pregnant women in Massachusetts, USA.

BACKGROUND: Exposure to ionizing radiation increases the risk of chronic metabolic disorders such as insulin resistance and type 2 diabetes. Internal ionizing radiation from inhaled radioactive aerosol may contribute to the associations between fine particulate matter (PM2.5) and gestational diabetes mellitus (GDM). METHODS: We used the Massachusetts Registry of Vital Records to study 1,061,937 pregnant women from 2001 to 2015 with a singleton pregnancy without pre-existing diabetes. Gross ß activity measured by seven monitors of the U.S. Environmental Protection Agency's RadNet monitoring network was utilized to represent ambient particle radioactivity (PR). We obtained GDM status from birth certificates and used logistic regression analyses adjusted for socio-demographics, maternal comorbidities, PM2.5, temperature and relative humidity. We also examined effect modification by smoking habits. RESULTS: Ambient particle radioactivity exposure during first and second trimester of pregnancy was associated with higher odds of GDM (OR: 1.18 (95% CI 1.10 to 1.22). Controlling for PM2.5 did not substantially change the effects of PR on GDM. In women that reported being former or current smokers, the association between PR and GDM was null. In the full cohort, the overall effect of PM2.5 on GDM without adjusting for PR was not significant. CONCLUSION: This is the first population-based study to examine the association between particle radioactivity and gestational diabetes mellitus - one of the most common pregnancy-related diseases with lifelong effects for the mother and the fetus. This finding has important public health policy implications because it enhances our understanding about the toxicity of PR, a modifiable risk factor, which to date, has been considered only as an indoor and occupational air quality risk.

Exposure to Particle Beta Radiation in Greater Massachusetts and Factors Influencing Its Spatial and Temporal Variability.

Particle radioactivity is a property of airborne particles caused by the presence of naturally occurring or anthropogenic radionuclides. Recent studies have found associations between particle radioactivity and adverse health outcomes, including changes in blood pressure and lung function. However, the spatiotemporal distribution of particle radioactivity and factors influencing its variability have not been extensively studied. We address these knowledge gaps using measurements of gross beta activity, collected at seven Environmental Protection Agency (EPA) RadNet monitors located in and around Massachusetts. We apply back-trajectory analysis to identify prevailing air mass trajectories and find that these trajectories strongly influence seasonal trends in beta activity. We also evaluate the effects of different meteorological predictors on daily beta activity concentrations using a mixed-effect model. Important predictors of beta activity include air mass trajectories, temperature, and relative humidity. Finally, we create a series of random forest models to impute missing beta activity concentrations at each RadNet monitor for use in future health studies. This is the first study to analyze spatiotemporal trends in particle radioactivity using measurements from the EPA RadNet system.

The Role of Ambient Particle Radioactivity in Inflammation and Endothelial Function in an Elderly Cohort.

BACKGROUND: The mechanisms by which exposure to particulate matter might increase risk of cardiovascular morbidity and mortality are not fully known. However, few existing studies have investigated the potential role of particle radioactivity. Naturally occurring radionuclides attach to particulate matter and continue to release ionizing radiation after inhalation and deposition in the lungs. We hypothesize that exposure to particle radioactivity increases biomarkers of inflammation. METHODS: Our repeated-measures study included 752 men in the greater Boston area. We estimated regional particle radioactivity as a daily spatial average of gross beta concentrations from five monitors in the study area. We used linear mixed-effects regression models to estimate short- and medium-term associations between particle radioactivity and biomarkers of inflammation and endothelial dysfunction, with and without adjustment for additional particulate air pollutants. RESULTS: We observed associations between particle radioactivity on C-reactive protein (CRP), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1), but no associations with fibrinogen. An interquartile range width increase in mean 7-day particle radioactivity (1.2 × 10 Bq/m) was associated with a 4.9% increase in CRP (95% CI = 0.077, 9.9), a 2.8% increase in ICAM-1 (95% CI = 1.4, 4.2), and a 4.3% increase in VCAM-1 (95% CI = 2.5, 6.1). The main effects of particle radioactivity remained similar after adjustment in most cases. We also obtained similar effect estimates in a sensitivity analysis applying a robust causal model. CONCLUSION: Regional particle radioactivity is positively associated with inflammatory biomarkers, indicating a potential pathway for radiation-induced cardiovascular effects.

Short-term exposure to ambient particle gamma radioactivity is associated with increased risk for all-cause non-accidental and cardiovascular mortality.

BACKGROUND: Recent studies have found that particulate matter (PM) attached radioactivity was associated with certain adverse health effects including increased blood pressure and lung dysfunction. However, there has been no investigation on the direct effect of PM radioactivity on mortality. METHODS: Exposures to ambient PM gamma activities were determined using U.S. EPA RadNet data. Data on daily deaths were obtained from individual state Departments of Public Health. We used a generalized additive quasi-Poisson model to estimate the associations between two-day average ambient PM gamma activities (gamma2 through gamma9) with all-cause non-accidental and cardiovascular daily deaths for each of 18 US cities, for each season, adjusting for two-day average PM2.5 exposure, temperature, relative humidity, day of week and long-term trends. Subsequently, we used random-effects meta-analysis to estimate the overall effect in the 18 cities for each season. RESULTS: We found that all-cause non-accidental daily mortality in spring season was positively associated with two-day average ambient PM gamma activities in spring, with significant results for gamma2, gamma5 and gamma6. Similarly, cardiovascular daily mortality was positively associated with two-day average ambient PM gamma activities, with significant results for gamma2, gamma4, gamma5, gamma6, gamma7 and gamma9. For the spring season, each interquartile range (IQR) increase of two-day averaged ambient PM gamma activity was associated with increase in all-cause daily deaths, ranging from 0.15% (95% Confidence Interval (CI): -0.36%, 0.65%) to 1.03 (95%CI: 0.18%, 1.89%). Each IQR was also associated with increase in cardiovascular daily deaths, ranging from 0.01% (95%CI: -0.89, 0.92) to 2.95% (95%CI: 1.33, 4.59). For other seasons overall we found statistically insignificant associations of PM radioactivity with mortality. CONCLUSIONS: Our findings suggest that there are potential systemic toxic effects of inhalation of radionuclides attached to ambient air particles.

Short-term ambient particle radioactivity level and renal function in older men: Insight from the Normative Aging Study.

BACKGROUND: Whole-body and thoracic ionizing radiation exposure are both associated with the development of renal dysfunction. However, whether low-level environmental radiation from air pollution affects renal function remains unknown. OBJECTIVES: We investigated the association of particle radioactivity (PR) with renal function defined by the estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD) in the Normative Aging Study. METHODS: This longitudinal analysis included 2491 medical visits from 809 white males enrolled between 1999 and 2013. The eGFR was calculated using the CKD-EPI and MDRD equations, and CKD cases were identified as those with an eGFR <60 mL/min/1.73 m2. Gross ß activity measured by five monitors of the U.S. Environmental Protection Agency's RadNet monitoring network was utilized to represent PR. RESULTS: Ambient PR levels from 1 to 28 days prior to clinical visit demonstrated robust negative associations with both forms of eGFR, but not with the increased odds of CKD. An interquartile range higher 28-day average ambient PR level was significantly associated with 0.83-mL/min/1.73 m2 lower eGFR estimated by the CKD-EPI equation (95% confidence interval: -1.46, -0.20, p-value = 0.01). Controlling for PM2.5 or black carbon in the model slightly attenuated the PR effects on eGFR. However, in individuals with the highest levels (3rd tertile) of C-reactive protein (CRP) or fibrinogen, we observed robust associations of PR with eGFR and CKD, suggesting that systemic inflammation may modify the PR-eGFR and PR-CKD relationships. CONCLUSIONS: Our study reveals adverse health effects of short-term low-level ambient PR on the renal function, providing evidence to guide further study of the interplay between PR, inflammation, and renal health.

County-level radon exposure and all-cause mortality risk among Medicare beneficiaries.

BACKGROUND: Radon is an inert gas formed from the decay of naturally-occurring materials in the earth's crust. It infiltrates into homes from soil, water, and construction materials. Its decay products are radionuclides, which attach to ambient particles. Residential radon is one of the leading risk factors for lung cancer. The scarce evidence for associations with other mortality causes originates mostly from occupational studies. METHODS: In a cohort study with 14 years of follow-up (2000-2013), we evaluated the association between chronic radon exposure and all-cause mortality, and explored whether there are subpopulations who are more vulnerable to radon effects. We included 87,296,195 person-years of follow-up from all Medicare beneficiaries in the Mid-Atlantic and Northeastern U.S. states. We examined the association between the logarithm of county-averaged radon (ln(Rn)) and mortality and assessed effect modification by chronic conditions. RESULTS: An interquartile range increase in the ln(Rn) was associated with a 2·62% increase (95% CI 2·52%; 2·73%) in mortality, independent of PM2.5 exposure. Larger mortality risks were observed among individuals with respiratory, cardiovascular and metabolic diseases, with the highest associations observed among those with diabetes (4·98% increase), heart failure (4·58% increase), and chronic obstructive pulmonary disease (4·49% increase). CONCLUSION: We found an increased risk for all-cause mortality associated with increased radon exposure. The risk was enhanced among susceptible individuals with chronic conditions. We believe this is the first cohort study to identify populations at higher risk for non-malignant health consequences of radon exposure. Due to the limitations in exposure assessment and availability of individual confounders, these findings should be interpreted with caution.

Effect modification of ambient particle mortality by radon: A time series analysis in 108 U.S. cities.

Numerous studies have reported a positive association between ambient fine particles and daily mortality, but little is known about the particle properties or environmental factors that may contribute to these effects. This study assessed potential modification of radon on PM2.5 (particulate matter with an aerodynamic diameter <2.5 µm)-associated daily mortality in 108 U.S. cities using a two-stage statistical approach. First, city- and season-specific PM2.5 mortality risks were estimated using over-dispersed Poisson regression models. These PM2.5 effect estimates were then regressed against mean city-level residential radon concentrations to estimate overall PM2.5 effects and potential modification by radon. Radon exposure estimates based on measured short-term basement concentrations and modeled long-term living-area concentrations were both assessed. Exposure to PM2.5 was associated with total, cardiovascular, and respiratory mortality in both the spring and the fall. In addition, higher mean city-level radon concentrations increased PM2.5-associated mortality in the spring and fall. For example, a 10 µg/m3 increase in PM2.5 in the spring at the 10th percentile of city-averaged short-term radon concentrations (21.1 Bq/m3) was associated with a 1.92% increase in total mortality (95% CI: 1.29, 2.55), whereas the same PM2.5 exposure at the 90th radon percentile (234.2 Bq/m3) was associated with a 3.73% increase in total mortality (95% CI: 2.87, 4.59). Results were robust to adjustment for spatial confounders, including average planetary boundary height, population age, percent poverty and tobacco use. While additional research is necessary, this study suggests that radon enhances PM2.5 mortality. This is of significant regulatory importance, as effective regulation should consider the increased risk for particle mortality in cities with higher radon levels. Implications: In this large national study, city-averaged indoor radon concentration was a significant effect modifier of PM2.5-associated total, cardiovascular, and respiratory mortality risk in the spring and fall. These results suggest that radon may enhance PM2.5-associated mortality. In addition, local radon concentrations partially explain the significant variability in PM2.5 effect estimates across U.S. cities, noted in this and previous studies. Although the concept of PM as a vector for radon progeny is feasible, additional research is needed on the noncancer health effects of radon and its potential interaction with PM. Future air quality regulations may need to consider the increased risk for particle mortality in cities with higher radon levels.

Associations Between Ambient Particle Radioactivity and Blood Pressure: The NAS (Normative Aging Study).

BACKGROUND: The cardiovascular effects of low-level environmental radiation exposures are poorly understood. Although particulate matter (PM) has been linked to cardiovascular morbidity and mortality, and elevated blood pressure (BP), the properties promoting its toxicity remain uncertain. Addressing a knowledge gap, we evaluated whether BP increased with higher exposures to radioactive components of ambient PM, herein referred to as particle radioactivity (PR). METHODS AND RESULTS: We performed a repeated-measures analysis of 852 men to examine associations between PR exposure and BP using mixed-effects regression models. As a surrogate for PR, we used gross ß activity, measured by the US Environmental Protection Agency's radiation monitoring network. Higher PR exposure was associated with increases in both diastolic BP and systolic BP, for exposures from 1 to 28 days. An interquartile range increase in 28-day PR exposure was associated with a 2.95-mm Hg increase in diastolic BP (95% confidence interval, 2.25-3.66; P<0.001) and a 3.94-mm Hg increase in systolic BP (95% confidence interval, 2.62-5.27; P<0.001). For models including both PR and PM ≤2.5 µm, the PR-BP associations remained stable and significant. For models including PR and black carbon or PR and particle number, the PR-BP associations were attenuated; however, they remained significant for many exposure durations. CONCLUSIONS: This is the first study to demonstrate the potential adverse effects of PR on both systolic and diastolic BPs. These were independent and similar in magnitude to those of PM ≤2.5 µm, black carbon, and particle number. Understanding the effects of particle-bound radionuclide exposures on BP may have important implications for environmental and public health policy.