PM10 air pollution exposure during pregnancy and term low birth weight in Allegheny County, PA, 1994-2000.

PURPOSE: Low birth weight has been associated with increased risks of mortality and/or morbidity in childhood and adulthood. Epidemiological studies suggest that maternal exposure to air pollution, especially particulate matter during pregnancy, is associated with an increased risk of delivering a low birth weight infant. The aim of this study is to explore the association between exposure to particulate matter (PM10) during pregnancy and term low birth weight (LBW: birth weight <2,500 g and gestation age ≥ 37 weeks). METHODS: Birth data from the Allegheny County Health Department, Pittsburgh, PA, USA and PM10 air data generated with inverse-distance interpolation by RAND's Center for Population Health and Health Disparities, were obtained. The study population consisted of all term singleton live births (gestational age ≥ 37 weeks) born between January 1, 1994 to December 31, 2000. Infants with birth weight <2,500 g were classified as LBW. Logistic regression with robust variance estimation was performed to estimate the odds ratios of LBW per inter-quartile range increase in PM10. RESULTS: The results showed that the odds ratios of term LBW per inter-quartile range increase in PM10 were 1.13 (95% CI: 1.02-1.25) during the first trimester and 1.10 (95% CI: 1.00-1.22) during the second trimester after adjustment for other important covariates, respectively. CONCLUSION: The findings of the study support the hypothesis that exposure to PM10 is associated with increased levels of term LBW. Further studies are warranted to corroborate these findings.

Case-crossover analysis of air pollution and cardiorespiratory hospitalizations: using routinely collected health and environmental data for tracking: science and data.

BACKGROUND: From the early 1900s until its closure in February 1998, a Steel coke oven in Pittsburgh, Pennsylvania, was a key source of air pollution. A case-crossover study was performed to assess the associations between daily air pollution and cardiorespiratory (International Classification of Disease Ninth Revision [ICD-9]: 390-519) hospitalizations before and after plant closure and to evaluate how closure influenced these associations. METHODS: Air pollution data, climatic data, and cardiorespiratory hospitalizations among residents ages 65 years and older were obtained for the period of 1996 through 2000 for the study area. Data were analyzed using a case-crossover design and conditional logistical regression. Two distinct referent-sampling approaches were compared. RESULTS: Significant associations were observed between the fourth quartile in PM10 and cardiorespiratory hospitalizations (odds ratio [OR]: 1.12; 95% CI: 1.02-1.23) and cardiovascular hospitalizations only (ICD-9: 390-459) (OR: 1.13; 95% CI: 1.01-1.26) before the plant closure. After closure of the plant, PM10 was not significantly associated with cardiorespiratory or cardiovascular disease hospitalizations. Moreover, the referent sampling approaches did not greatly alter the estimations in the case-crossover analysis. CONCLUSIONS: Existing secondary data are an economical source to assess the impact of point source pollution on the environmental landscape. The findings suggest that closure of the steel coke plant was associated with a reduction risk of the cardiovascular hospitalizations.

Connecting environmental health data to people and policy: integrating information and mobilizing communities for environmental public health tracking.

Evaluation of available data is a critical preliminary step in the assessment of local environmental health. As part of a multi-organizational initiative to improve environmental health in the Pittsburgh, Pennsylvania region, the University of Pittsburgh Center for Healthy Environments and Communities (CHEC) interviewed 70 experts in the academic, government, non-profit, and private sectors and reviewed print and electronic resources to characterize environmental and public health data available in the region. The objectives of this undertaking were: to provide a conceptual framework for categorizing data locally on environmental hazards, exposures and health endpoints, to describe and evaluate the types of environmental public health data available nationally and locally, to identify existing endeavors to gather and categorize such data, and to present case studies on the real-life relevance of the availability or lack of availability of environmental health data. The purpose and relevance of this project, the evolution of the methodology, successes and challenges met, and anticipated next steps are presented. This process description and resulting comprehensive report is available to communities, at both the state and local health department level as well as lay community members, engaged in similar endeavors, to characterize their local and regional environmental health landscape. The framework outlined serves as background for a related statewide environmental health project sponsored by the Pennsylvania Department of Health through the Pennsylvania Consortium on Interdisciplinary Environmental Policy (PCIEP) and potentially as a foundation for community-based data evaluation for the National Environmental Public Health Tracking Program.

Polycystic ovarian syndrome (PCOS): a significant contributor to the overall burden of type 2 diabetes in women.

BACKGROUND: Given the high prevalence of polycystic ovarian syndrome (PCOS) in the population, the increased risk for the development of type 2 diabetes in these women, and the role of type 2 diabetes in mediating adverse long-term sequelae, the objective of this analysis was to quantify the contribution of this early-life exposure (e.g., PCOS) to the burden of type 2 diabetes in the total population of middle-aged women. METHODS: The cumulative incidence and relative risk (RR) of type 2 diabetes were examined in a group of women with PCOS (n = 149) and unaffected women (n = 166), aged 35-64, who were part of an ongoing investigation of cardiovascular risk factors in women with PCOS. The population attributable risk percent (PAR%) was calculated using Levin's formula to estimate the percentage of type 2 diabetes in the total population among middle-aged women that can be attributed to the presence of PCOS at young adulthood. RESULTS: When the RR of type 2 diabetes among women with PCOS observed in our current study and others (4.0-6.0) was applied to an estimated 6%-10% prevalence of PCOS in the female population, 15.0%-35.6% of all incident cases of type 2 diabetes in white women were estimated to be attributable to PCOS. Moreover, other investigators have noted this proportion of undiagnosed PCOS in populations of women with type 2 diabetes. CONCLUSIONS: These results support the recommendation that all women with PCOS should be periodically rescreened for diabetes and underscores the importance of the early identification of young women with PCOS and the need for early lifestyle intervention.

Cigarette smoking and the risk of adult leukemia: results from the Three Mile Island cohort study.

Smoking is an unconfirmed risk factor for the development of leukemia. The authors examined the potential link using data from the Three Mile Island cohort for the period 1979-1995. Eligible for analysis were 24,539 individuals aged 14 years or older who were followed up over 16 years from the Three Mile Island cohort. The authors identified all incident leukemia cases through the Pennsylvania Department of Health Cancer Registry. They used the Cox proportional hazards model to evaluate the relationships and observed 42 incident leukemia cases, including 15 acute myeloid leukemia (AML) cases, in the cohort. After controlling for other confounding factors, the authors found current smoking to be associated with an increased risk of adult AML (relative risk = 3.47; 95% confidence interval = 1.002-11.99). The authors also observed a marginally significant linear trend of risk of AML associated with the number of years smoked (p = .06). The results from this study suggested that cigarette smoking was associated with an increased risk of adult AML. Further investigation is required to confirm these findings.

A retrospective investigation of PM10 in ambient air and cardiopulmonary hospital admissions in Allegheny County, Pennsylvania: 1995-2000.

OBJECTIVE: Air quality in Allegheny County, Pennsylvania, has improved over the last decade, and we investigated whether the lower concentrations of fine particulate matter (PM10) are still associated with adverse health outcomes. METHODS: Daily cardiopulmonary hospital admissions in elderly residents of Allegheny County and countywide average PM10 measures were available from 1995 through 2000. Using generalized additive models (GAM), a Poisson regression model was fit to the number of daily admissions using predictor variables: lags of PM10, daily temperature and humidity, day of the week, and time. RESULTS: Our findings suggest that there is a positive association of PM10 with hospital admissions, and the effect is related to current-day PM10 levels. CONCLUSIONS: Even at the lower levels of ambient air pollution as measured by PM10, there is still a suggestion of an adverse health effect in the elderly.

Risk of cancer as a result of community exposure to gasoline vapors.

The Tranguch Gasoline Spill leaked 50,000-900,000 gallons of gasoline from underground storage tanks, potentially exposing an area of Hazle Township and Hazleton, Pennsylvania, to chronic low levels of benzene since at least 1990. A retrospective cohort study of 663 individuals representing 275 households assessed whether affected residents were at increased risk for cancer from 1990-2000 compared with the Pennsylvania populace. Age-adjusted standard incidence ratios (SIRs) were calculated using Pennsylvania rates to determine expected numbers. The age-adjusted SIR for the gasoline-affected area was 4.40 (95% confidence interval: 1.09-10.24) for leukemia. These results suggest an association between living within the area affected by the Tranguch Gasoline Spill and increased risk for leukemia.

Long-term follow-up of the residents of the Three Mile Island accident area: 1979-1998.

The Three Mile Island (TMI) nuclear power plant accident (1979) prompted the Pennsylvania Department of Health to initiate a cohort mortality study in the TMI accident area. This study is significant because of the long follow-up (1979-1998), large cohort size (32,135), and evidence from earlier reports indicating increased cancer risks. Standardized mortality ratios (SMRs) were calculated to assess the mortality experience of the cohort compared with a local population. Relative risk (RR) regression modeling was performed to assess cause-specific mortality associated with radiation-related exposure variables after adjustment for individual smoking and lifestyle factors. Overall cancer mortality in this cohort was similar to the local population [SMRs = 103.7 (male); 99.8 (female)]. RR modeling showed neither maximum gamma nor likely gamma exposure was a significant predictor of all malignant neoplasms; bronchus, trachea, and lung; or heart disease mortality after adjusting for known confounders. The RR estimates for maximum gamma exposure (less than or equal to 8, 8-19, 20-34, greater than or equal to 35 mrem) in relation to all lymphatic and hematopoietic tissue (LHT) are significantly elevated (RRs = 1.00, 1.16, 2.54, 2.45, respectively) for males and are suggestive of a potential dose-response relationship, although the test for trend was not significant. An upward trend of RRs and SMRs for levels of maximum gamma exposure in relation to breast cancer in females (RRs = 1.00, 1.08, 1.13, 1.31; SMRs = 104.2, 113.2, 117.9) was also noted. Although the surveillance within the TMI cohort provides no consistent evidence that radioactivity released during the nuclear accident has had a significant impact on the overall mortality experience of these residents, several elevations persist, and certain potential dose-response relationships cannot be definitively excluded.

Evidence for competing effects of body mass, hyperinsulinemia, insulin resistance, and androgens on leptin levels among lean, overweight, and obese women with polycystic ovary syndrome.

OBJECTIVE: To evaluate the relationships between leptin, body composition, insulin resistance, androgens, and reproductive indices among women with polycystic ovary syndrome (PCOS). DESIGN: Matched case-control study. SETTING: Academic reproductive endocrine practice; school of public health. PATIENT(S): Forty-six Caucasian women with PCOS and 46 population-based controls matched by age and body mass index (BMI). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Leptin, insulin, androgenic hormones, body composition parameters; reproductive parameters. RESULT(S): Overall, leptin levels among women with PCOS did not differ significantly from those of control women (20.4 +/- 14.9 vs. 21.9 +/- 14.3 ng/mL). However, within the lowest BMI tertile, women with PCOS had significantly lower leptin levels (9.6 vs. 18.3 ng/mL), comparable insulin, and higher testosterone concentrations than controls of similar body mass. Within the overweight and obese subgroups, both insulin and testosterone levels were increased among women with PCOS; leptin levels, although higher among obese cases, were not statistically different than those in controls. CONCLUSION(S): Below a certain BMI, hyperandrogenic women with PCOS have lower leptin levels than controls. Conversely, overweight and obese PCOS subjects appear to produce insufficient leptin for a given fat mass, relative to the degree of hyperinsulinemia, potentially because of the competing effects of adipocyte insulin resistance and androgens on leptin.