Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 93
Filtrar
1.
Proc Natl Acad Sci U S A ; 118(51)2021 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-34903648

RESUMO

Decades of air pollution regulation have yielded enormous benefits in the United States, but vehicle emissions remain a climate and public health issue. Studies have quantified the vehicle-related fine particulate matter (PM2.5)-attributable mortality but lack the combination of proper counterfactual scenarios, latest epidemiological evidence, and detailed spatial resolution; all needed to assess the benefits of recent emission reductions. We use this combination to assess PM2.5-attributable health benefits and also assess the climate benefits of on-road emission reductions between 2008 and 2017. We estimate total benefits of $270 (190 to 480) billion in 2017. Vehicle-related PM2.5-attributable deaths decreased from 27,700 in 2008 to 19,800 in 2017; however, had per-mile emission factors remained at 2008 levels, 48,200 deaths would have occurred in 2017. The 74% increase from 27,700 to 48,200 PM2.5-attributable deaths with the same emission factors is due to lower baseline PM2.5 concentrations (+26%), more vehicle miles and fleet composition changes (+22%), higher baseline mortality (+13%), and interactions among these (+12%). Climate benefits were small (3 to 19% of the total). The percent reductions in emissions and PM2.5-attributable deaths were similar despite an opportunity to achieve disproportionately large health benefits by reducing high-impact emissions of passenger light-duty vehicles in urban areas. Increasingly large vehicles and an aging population, increasing mortality, suggest large health benefits in urban areas require more stringent policies. Local policies can be effective because high-impact primary PM2.5 and NH3 emissions disperse little outside metropolitan areas. Complementary national-level policies for NOx are merited because of its substantial impacts-with little spatial variability-and dispersion across states and metropolitan areas.


Assuntos
Saúde Pública , Transportes , Emissões de Veículos/prevenção & controle , Poluentes Atmosféricos/economia , Poluição do Ar/economia , Poluição do Ar/prevenção & controle , Causas de Morte/tendências , Mudança Climática/economia , Mudança Climática/mortalidade , Efeitos Psicossociais da Doença , Gases de Efeito Estufa/economia , Humanos , Exposição por Inalação/economia , Exposição por Inalação/prevenção & controle , Material Particulado/economia , Transportes/classificação , Estados Unidos
3.
Environ Res ; : 112271, 2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34710436

RESUMO

While associations between short-term exposure to fine particulate matter (PM2.5) and risk of hospitalization are well documented and evidence suggests that such associations change over time, it is unclear whether these temporal changes exist in understudied less-urban areas or differ by sub-population. We analyzed daily time-series data of 968 continental U.S. counties for 2000-2016, with cause-specific hospitalization from Medicare claims and population-weighted PM2.5 concentrations originally estimated at 1km × 1 km from a hybrid model. Circulatory and respiratory hospitalizations were categorized based on primary diagnosis codes at discharge. Using modified Bayesian hierarchical modelling, we evaluated the temporal trend in association between PM2.5 and hospitalizations and whether disparities in this trend exist across individual-level characteristics (e.g., sex, age, race, and Medicaid eligibility as a proxy for socio-economic status) and urbanicity. Urbanicity was categorized into three levels by county-specific percentage of urban population based on urban rural delineation from the U.S. Census. In this cohort with understudied less-urban areas without regulatory monitors, we still found positive association between circulatory and respiratory hospitalization and short-term exposure to PM2.5, with higher effect estimates towards the end of study period. Consistent with current literature, we identified significant disparity in associations by race, socioeconomic status and urbanicity. We found that the percentage change in circulatory hospitalization rate per 10 µg/m3 increase in PM2.5 was higher in the 2008-2016 time period compared to the 2000-2007 period by 0.33% (95% posterior credible interval 0.22, 0.44%), 0.52% (0.33, 0.69%), and 0.67% (0.53, 0.83%) for low, medium and high tertiles of urban areas, respectively. We also observed significant differences in temporal trends of associations across socioeconomic status, sex, and age, indicating a possible widening in disparity of PM2.5-related health burden. This study raises the importance of considering environmental justice issues in PM2.5-related health impacts with respect to how associations may change over time.

4.
Lancet Planet Health ; 5(10): e689-e697, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34627473

RESUMO

BACKGROUND: Long-term exposure to air pollution has been linked with an increase in risk of mortality. Whether existing US Environmental Protection Agency standards are sufficient to protect health is unclear. Our study aimed to examine the relationship between exposure to lower concentrations of air pollution and the risk of mortality. METHODS: Our nationwide cohort study investigated the effect of annual average exposure to air pollutants on all-cause mortality among Medicare enrolees from the beginning of 2000 to the end of 2016. Patients entered the cohort in the month of January following enrolment and were followed up until the end of the study period in 2016 or death. We restricted our analyses to participants who had only been exposed to lower concentrations of pollutants over the study period, specifically particulate matter less than 2·5 µg/m3 in diameter (PM2·5) at a concentration of up to 12 µg/m3, nitrogen dioxide (NO2) at a concentration of up to 53 parts per billion (ppb), and summer ozone (O3) at concentrations of up to 50 ppb. We adjusted for two types of covariates, which were individual level and postal code-level variables. We used a doubly-robust additive model to estimate the change in risk. We further looked at effect-measure modification by stratification on the basis of demographic and socioeconomic characteristics. FINDINGS: We found an increased risk of mortality with all three pollutants. Each 1 µg/m3 increase in annual PM2·5 concentrations increased the absolute annual risk of death by 0·073% (95% CI 0·071-0·076). Each 1 ppb increase in annual NO2 concentrations increased the annual risk of death by 0·003% (0·003-0·004), and each 1 ppb increase in summer O3 concentrations increased the annual risk of death by 0·081% (0·080-0·083). This increase translated to approximately 11 540 attributable deaths (95% CI 11 087-11 992) for PM2·5, 1176 attributable deaths (998-1353) for NO2, and 15 115 attributable deaths (14 896-15 333) for O3 per year for each unit increase in pollution concentrations. The effects were higher in certain subgroups, including individuals living in areas of low socioeconomic status. Long-term exposure to permissible concentrations of air pollutants increases the risk of mortality. FUNDING: The US Environmental Protection Agency, National Institute of Environmental Health Services, and Health Effects Institute.

5.
Environ Int ; 157: 106861, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34507231

RESUMO

BACKGROUND: Many studies have reported that long-term air pollution exposure is associated with increased mortality rates. These investigations have been criticized for failure to control for omitted, generally personal, confounders. Study designs that are robust to such confounders can address this issue. METHODS: We used a self-controlled design for survival analysis. We stratified on each person in the Medicare cohort between 2000 and 2015 who died, and examined whether PM2.5, O3 and NO2 exposures predicted in which follow-up period the death occurred. We used conditional logistic regression stratified on person and controlled for nonlinear terms in calendar year and age. By design slowly varying covariates such as smoking history, BMI, diabetes and other pre-existing conditions, usual alcohol consumption, sex, race, socioeconomic status, and green space were controlled by matching each person to themselves. RESULTS: There were 6,452,618 deaths in the study population in the study period. We observed a 5.37% increase in the mortality rate (95% CI 4.67%, 6.08%) for every 5 µg/m3 increase in PM2.5, a 1.98% (95% CI 1.61%, 2.36%) increase for 5 ppb increment in O3, and a 2.10% decrease (95% CI 1.88%, 2.33%) for a 5 ppb increase in NO2. When restricted to persons whose PM2.5 exposure never exceeded 12 µg/m3 in any year between 2000 and 2015, the effect size increased for PM2.5 (12.71% (11.30, 14.15)), and the signs of O3 and NO2 reversed (-0.26% (-0.88, 0.35) for O3 and 1.77% increase (1.40, 2.13) for NO2). Effect sizes were larger for Blacks (e.g. 7.71% (5.46, 10.02) for PM2.5). CONCLUSION: There is strong evidence that the association between annual exposure to PM2.5 and mortality is not confounded by individual or neighborhood covariates, and continues below the standard. The effects of O3 and NO2 are difficult to disentangle.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Idoso , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Medicare , Mortalidade , Dióxido de Nitrogênio/análise , Material Particulado/análise , Análise de Sobrevida , Estados Unidos
6.
Environ Int ; 156: 106737, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34218185

RESUMO

Although research indicates health and well-being benefits of greenspace, little is known regarding how greenspace may influence adaptation to health risks from heat, particularly how these risks change over time. Using daily hospitalization rates of Medicare beneficiaries ≥65 years for 2000-2016 in 40 U.S. Northeastern urban counties, we assessed how temperature-related hospitalizations from cardiovascular causes (CVD) and heat stroke (HS) changed over time. We analyzed effect modification of those temporal changes by Enhanced Vegetation Index (EVI), approximating greenspace. We used a two-stage analysis including a generalized additive model and meta-analysis. Results showed that relative risk (RR) (per 1 °C increase in lag0-3 temperature) for temperature-HS hospitalization was higher in counties with the lowest quartile EVI (RR = 2.7, 95% CI: 2.0, 3.4) compared to counties with the highest quartile EVI (RR = 0.40, 95% CI: 0.14, 1.13) in the early part of the study period (2000-2004). RR of HS decreased to 0.88 (95% CI: 0.31, 2.53) in 2013-2016 in counties with the lowest quartile EVI. RR for HS changed over time in counties in the highest quartile EVI, with RRs of 0.4 (95% CI: -0.7, 1.4) in 2000-2004 and 2.4 (95% CI: 1.6, 3.2) in 2013-2016. Findings suggest that adaptation to heat-health associations vary by greenness. Greenspace may help lower risks from heat but such health risks warrant continuous local efforts such as heat-health plans.


Assuntos
Temperatura Alta , Parques Recreativos , Idoso , Hospitalização , Humanos , Medicare , Temperatura , Estados Unidos
7.
Environ Res ; 201: 111604, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34186076

RESUMO

The relationship between ambient fine particulate matter (PM2.5) and metabolic syndrome (MetS) is understudied. It also remains unknown whether familial factors play a role in this relationship. In a study of 566 middle-aged twins, we examined the association of PM2.5 with MetS risk factors, measured by a MetS score as a summation of individual risk factors (range, 0 to 5). High-resolution PM2.5 estimates were obtained through previously validated models that incorporated monitor and satellite derived data. We estimated two-year average PM2.5 concentrations based on the ZIP code of each twin's residence. We used ordinal response models adapted for twin studies. When treating twins as individuals, the odds ratio of having 1-point higher MetS score was 1.78 for each 10 µg/m3-increase in exposure to PM2.5 (confidence interval [CI]: 1.01, 3.15), after adjusting for potential confounders. This association was mainly between pairs; the odds ratio was 1.97 (CI: 1.01, 3.84) for each 10 µg/m3-increase in the average pairwise exposure level. We found no significant difference in MetS scores within pairs who were discordant for PM2.5 exposure. In conclusion, higher PM2.5 in residence area is associated with more MetS risk factors. This association, however, is confounded by shared familial factors.


Assuntos
Síndrome Metabólica , Humanos , Síndrome Metabólica/induzido quimicamente , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Material Particulado/toxicidade , Prevalência , Fatores de Risco
8.
J Am Heart Assoc ; 10(10): e019430, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-33942627

RESUMO

Background Long-term air pollution exposure is a significant risk factor for inpatient hospital admissions in the general population. However, we lack information on whether long-term air pollution exposure is a risk factor for hospital readmissions, particularly in individuals with elevated readmission rates. Methods and Results We determined the number of readmissions and total hospital visits (outpatient visits+emergency room visits+inpatient admissions) for 20 920 individuals with heart failure. We used quasi-Poisson regression models to associate annual average fine particulate matter at the date of heart failure diagnosis with the number of hospital visits and 30-day readmissions. We used inverse probability weights to balance the distribution of confounders and adjust for the competing risk of death. Models were adjusted for age, race, sex, smoking status, urbanicity, year of diagnosis, short-term fine particulate matter exposure, comorbid disease, and socioeconomic status. A 1-µg/m3 increase in fine particulate matter was associated with a 9.31% increase (95% CI, 7.85%-10.8%) in total hospital visits, a 4.35% increase (95% CI, 1.12%-7.68%) in inpatient admissions, and a 14.2% increase (95% CI, 8.41%-20.2%) in 30-day readmissions. Associations were robust to different modeling approaches. Conclusions These results highlight the potential for air pollution to play a role in hospital use, particularly hospital visits and readmissions. Given the elevated frequency of hospitalizations and readmissions among patients with heart failure, these results also represent an important insight into modifiable environmental risk factors that may improve outcomes and reduce hospital use among patients with heart failure.


Assuntos
Poluição do Ar/efeitos adversos , Insuficiência Cardíaca/terapia , Material Particulado/efeitos adversos , Readmissão do Paciente/tendências , Idoso , Exposição Ambiental/efeitos adversos , Feminino , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Morbidade/tendências , Fatores de Risco , Estados Unidos/epidemiologia
9.
Environ Health ; 20(1): 53, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33957920

RESUMO

BACKGROUND: Fine particulate matter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) are major air pollutants that pose considerable threats to human health. However, what has been mostly missing in air pollution epidemiology is causal dose-response (D-R) relations between those exposures and mortality. Such causal D-R relations can provide profound implications in predicting health impact at a target level of air pollution concentration. METHODS: Using national Medicare cohort during 2000-2016, we simultaneously emulated causal D-R relations between chronic exposures to fine particulate matter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) and all-cause mortality. To relax the contentious assumptions of inverse probability weighting for continuous exposures, including distributional form of the exposure and heteroscedasticity, we proposed a decile binning approach which divided each exposure into ten equal-sized groups by deciles, treated the lowest decile group as reference, and estimated the effects for the other groups. Binning continuous exposures also makes the inverse probability weights robust against outliers. RESULTS: Assuming the causal framework was valid, we found that higher levels of PM2.5, O3, and NO2 were causally associated with greater risk of mortality and that PM2.5 posed the greatest risk. For PM2.5, the relative risk (RR) of mortality monotonically increased from the 2nd (RR, 1.022; 95% confidence interval [CI], 1.018-1.025) to the 10th decile group (RR, 1.207; 95% CI, 1.203-1.210); for O3, the RR increased from the 2nd (RR, 1.050; 95% CI, 1.047-1.053) to the 9th decile group (RR, 1.107; 95% CI, 1.104-1.110); for NO2, the DR curve wiggled at low levels and started rising from the 6th (RR, 1.005; 95% CI, 1.002-1.018) till the highest decile group (RR, 1.024; 95% CI, 1.021-1.027). CONCLUSIONS: This study provided more robust evidence of the causal relations between air pollution exposures and mortality. The emulated causal D-R relations provided significant implications for reviewing the national air quality standards, as they inferred the number of potential early deaths prevented if air pollutants were reduced to specific levels; for example, lowering each air pollutant concentration from the 70th to 60th percentiles would prevent 65,935 early deaths per year.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Exposição Ambiental/efeitos adversos , Mortalidade , Dióxido de Nitrogênio/efeitos adversos , Ozônio/efeitos adversos , Material Particulado/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Relação Dose-Resposta a Droga , Exposição Ambiental/análise , Feminino , Humanos , Masculino , Medicare , Dióxido de Nitrogênio/análise , Ozônio/análise , Material Particulado/análise , Risco , Estados Unidos/epidemiologia
10.
Epidemiology ; 32(4): 469-476, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34042074

RESUMO

BACKGROUND: Many studies have reported associations of air pollutants and death, but fewer examined multiple pollutants, or used causal methods. We present a method for directly estimating changes in the distribution of age at death using propensity scores. METHODS: We included all participants in Medicare from 2000 to 2016 (637,207,589 person-years of follow-up). We fit separate logistic regressions modeling the probability of death at each year of age from 65 to 98 or older as a function of exposure to particulate matter less tha 2.5 µM in diameter (PM2.5), NO2, and O3, using separate propensity scores for each age. We estimated the propensity score using gradient boosting. We estimated the distribution of life expectancy at three counterfactual exposures for each pollutant. RESULTS: The estimated increase in mean life expectancy had the population been exposed to 7 versus 12 µg/m3 PM2.5 was 0.29 years (95% CI = 0.28, 0.30). The change in life expectancy had the population been exposed to 10 versus 20 ppb of NO2 was -0.01 years (95% CI = -0.015, -0.006). The increase in mean life expectancy had the population been exposed to 35 versus 45 ppb of O3 was 0.15 years (95% CI = 0.14, 0.16). Each of these effects was independent and additive. CONCLUSIONS: We estimated that reducing PM2.5 and O3 concentrations to levels below current standards would increase life expectancy by substantial amounts compared with the recent increase of life expectancy at age 65 of 0.7 years in a decade. Our results are not consistent with the hypothesis that exposure to NO2 decreases life expectancy.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Idoso , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Exposição Ambiental/análise , Humanos , Expectativa de Vida , Medicare , Dióxido de Nitrogênio/análise , Material Particulado/análise , Pontuação de Propensão , Estados Unidos/epidemiologia
11.
Environ Epidemiol ; 5(2): e143, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33870015

RESUMO

Exposure to higher levels of ambient air pollution is a known risk factor for cardiovascular disease but long-term effects of pollution exposure on the pulmonary vessels are unknown. Methods: Among 2428 Framingham Heart Study participants who underwent chest computed tomography (CT) between 2008 and 2011, pulmonary vascular volumes were calculated by image analysis, including the total vascular volume and small vessel volume (cross-sectional area <5 mm2; BV5 defined as small vessel volume). Using spatiotemporal models and participant home address, we assigned 1-year (2008) and 5-year (2004-2008) average concentrations of fine particulate matter (PM2.5), elemental carbon (EC), and ground-level ozone (O3), and distance to major roadway. We examined associations of 1- and 5-year exposures, and distance to road, with CT vascular volumes using multivariable linear regression models. Results: There was a consistent negative association of higher O3 with lower small vessel volumes, which persisted after adjustment for distance to road. Per interquartile range (IQR) of 2008 O3, BV5 was 0.34 mL lower (95% confidence intervals [CI], -0.61 to -0.06; P = 0.02), with similar results for 5-year exposure. One-year EC exposure and closer proximity to road were weakly associated with small vessel volumes; BV5 was 0.18 mL higher per IQR of 2008 EC (95% CI, -0.05 to 0.42; P = 0.13) and 0.40 mL higher per IQR closer proximity to road (95% CI: -0.10 to 0.89; P = 0.12). PM2.5 was not associated with small vascular volumes; BV5 was 0.26 mL lower per IQR of 2008 PM2.5 (95% CI: -0.68 to 0.16; P = 0.22). Conclusions: Among community-dwelling adults living in the northeastern United States, higher exposure to O3 was associated with lower small pulmonary vessel volumes on CT.

12.
Epidemiology ; 32(4): 477-486, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33788795

RESUMO

BACKGROUND: Although many studies demonstrated reduced mortality risk with higher greenness, few studies examined the modifying effect of greenness on air pollution-health associations. We evaluated residential greenness as an effect modifier of the association between long-term exposure to fine particles (PM2.5) and mortality. METHODS: We used data from all Medicare beneficiaries in North Carolina (NC) and Michigan (MI) (2001-2016). We estimated annual PM2.5 averages using ensemble prediction models. We estimated mortality risk per 1 µg/m3 increase using Cox proportional hazards modeling, controlling for demographics, Medicaid eligibility, and area-level covariates. We investigated health disparities by greenness using the Normalized Difference Vegetation Index with measures of urbanicity and socioeconomic status. RESULTS: PM2.5 was positively associated with mortality risk. Hazard ratios (HRs) were 1.12 (95% confidence interval (CI) = 1.12 to 1.13) for NC and 1.01 (95% CI = 1.00 to 1.01) for MI. HRs were higher for rural than urban areas. Within each category of urbanicity, HRs were generally higher in less green areas. For combined disparities, HRs were higher in low greenness or low SES areas, regardless of the other factor. HRs were lowest in high-greenness and high-SES areas for both states. CONCLUSIONS: In our study, those in low SES and high-greenness areas had lower associations between PM2.5 and mortality than those in low SES and low greenness areas. Multiple aspects of disparity factors and their interactions may affect health disparities from air pollution exposures. Findings should be considered in light of uncertainties, such as our use of modeled PM2.5 data, and warrant further investigation.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Idoso , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Exposição Ambiental/análise , Humanos , Medicare , Michigan/epidemiologia , North Carolina/epidemiologia , Material Particulado/análise , Estados Unidos/epidemiologia
13.
Circulation ; 143(16): 1584-1596, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33611922

RESUMO

BACKGROUND: Studies examining the nonfatal health outcomes of exposure to air pollution have been limited by the number of pollutants studied and focus on short-term exposures. METHODS: We examined the relationship between long-term exposure to fine particulate matter with an aerodynamic diameter <2.5 micrometers (PM2.5), NO2, and tropospheric ozone and hospital admissions for 4 cardiovascular and respiratory outcomes (myocardial infarction, ischemic stroke, atrial fibrillation and flutter, and pneumonia) among the Medicare population of the United States. We used a doubly robust method for our statistical analysis, which relies on both inverse probability weighting and adjustment in the outcome model to account for confounding. The results from this regression are on an additive scale. We further looked at this relationship at lower pollutant concentrations, which are consistent with typical exposure levels in the United States, and among potentially susceptible subgroups. RESULTS: Long-term exposure to fine PM2.5 was associated with an increased risk of all outcomes with the highest effect seen for stroke with a 0.0091% (95% CI, 0.0086-0.0097) increase in the risk of stroke for each 1-µg/m3 increase in annual levels. This translated to 2536 (95% CI, 2383-2691) cases of hospital admissions with ischemic stroke per year, which can be attributed to each 1-unit increase in fine particulate matter levels among the study population. NO2 was associated with an increase in the risk of admission with stroke by 0.00059% (95% CI, 0.00039-0.00075) and atrial fibrillation by 0.00129% (95% CI, 0.00114-0.00148) per ppb and tropospheric ozone was associated with an increase in the risk of admission with pneumonia by 0.00413% (95% CI, 0.00376-0.00447) per parts per billion. At lower concentrations, all pollutants were consistently associated with an increased risk for all our studied outcomes. CONCLUSIONS: Long-term exposure to air pollutants poses a significant risk to cardiovascular and respiratory health among the elderly population in the United States, with the greatest increase in the association per unit of exposure occurring at lower concentrations.

14.
Artigo em Inglês | MEDLINE | ID: mdl-33401605

RESUMO

This study aimed to assess the effectiveness of an online high-intensity interval training (HIIT) intervention and health education on the behaviors, mental health, and cognitive function of sedentary young females. A single-blinded, six-week, randomized controlled pilot trial involving 70 sedentary young Chinese females, aged 18-30 years, was conducted. An intervention group (IG) (n = 33) underwent a HIIT intervention and health education, while a waitlist group (WG) (n = 37) only received health education. In pre-, mid-, and post-tests, both groups filled out questionnaires about physical activity, sedentary behavior, and mental health. Cognitive functions were assessed at the pre- and post-tests by computer-administered cognitive tests. A mixed-effect model with repeated measures was used to analyze outcomes of interest. The retention rate of the IG and WG was 100% and 78.38%, respectively. The IG were found to have significantly increased rates of moderate-to-vigorous physical activity (MVPA) (Mdiff = 940.61, p < 0.001, 95% confidence interval (95% CI): 576.67, 1304.55) from pre-test to post-test, while the WG demonstrated a more marked reduction in sedentary time (Mdiff = -73.02, p = 0.038, 95% CI: -141.90, -4.14) compared with the IG in the post-test. Moreover, anxiety and stress levels were shown to significantly reduce in the IG over the six-week period (Mdiff = -4.73, p = 0.002, 95% CI: -7.30, -2.15 and Mdiff = -5.09, p = 0.001, 95% CI: -8.29, -1.89, respectively). In addition, we observed a significant improvement in verbal ability (p = 0.008, ηp2 = 0.19) following the HIIT intervention and effects of the interaction with time on processing speed (p = 0.050, ηp2 = 0.10) and episodic memory (p = 0.048, ηp2 = 0.11). Moreover, the IG had better global cognitive performance than the WG in the post-test (Mdiff = 8.28, p = 0.003, 95% CI: 3.06, 13.50). In summary, both an online bodyweight HIIT intervention combined with health education, or health education alone, can effectively improve health-related behaviors, but the behavioral consequences may differ based on the emphasis of different intervention modalities. Furthermore, the "bodyweight HIIT plus health education" modality might be a more promising online intervention strategy to mitigate against negative emotions and improve cognitive function.


Assuntos
Cognição , Educação em Saúde , Treinamento Intervalado de Alta Intensidade , Intervenção Baseada em Internet , Saúde Mental , Adolescente , Adulto , Peso Corporal , China , Cognição/fisiologia , Feminino , Educação em Saúde/métodos , Treinamento Intervalado de Alta Intensidade/métodos , Humanos , Saúde Mental/estatística & dados numéricos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Comportamento Sedentário , Método Simples-Cego , Adulto Jovem
15.
Environ Res ; 194: 110649, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33385394

RESUMO

Many studies have reported that PM2.5 was associated with mortality, but these were criticized for unmeasured confounding, not using causal modeling, and not focusing on changes in exposure and mortality rates. Recent studies have used propensity scores, a causal modeling approach that requires the assumption of no unmeasured confounders. We used differences in differences, a causal modeling approach that focuses on exposure changes, and controls for unmeasured confounders by design to analyze PM2.5 and mortality in the U.S. Medicare population, with 623, 036, 820 person-years of follow-up, and 29, 481, 444 deaths. We expanded the approach by clustering ZIP codes into 32 groups based on racial, behavioral and socioeconomic characteristics, and analyzing each cluster separately. We controlled for multiple time varying confounders within each cluster. A separate analysis examined participants whose exposure was always below 12 µg/m3. We found an increase of 1 µg/m3 in PM2.5 produced an increased risk of dying in that year of 3.85 × 10-4 (95% CI 1.95 × 10-4, 5.76 × 10-4). This corresponds to 14,000 early deaths per year per 1 µg/m3. When restricted to exposures below 12 µg/m3, the increased mortality risk was 4.26 × 10-4 (95% CI 1.43 × 10-4, 7.09 × 10-4). Using a causal modeling approach robust to omitted confounders, we found associations of PM2.5 with increased death rates, including below U.S. and E.U. standards.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Causalidade , Exposição Ambiental/análise , Humanos , Mortalidade , Material Particulado/análise , Material Particulado/toxicidade , Estados Unidos/epidemiologia
16.
Environ Res ; 196: 110432, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33166538

RESUMO

Epidemiologic studies have found associations between fine particulate matter (PM2.5) exposure and adverse health effects using exposure models that incorporate monitoring data and other relevant information. Here, we use nine PM2.5 concentration models (i.e., exposure models) that span a wide range of methods to investigate i) PM2.5 concentrations in 2011, ii) potential changes in PM2.5 concentrations between 2011 and 2028 due to on-the-books regulations, and iii) PM2.5 exposure for the U.S. population and four racial/ethnic groups. The exposure models included two geophysical chemical transport models (CTMs), two interpolation methods, a satellite-derived aerosol optical depth-based method, a Bayesian statistical regression model, and three data-rich machine learning methods. We focused on annual predictions that were regridded to 12-km resolution over the conterminous U.S., but also considered 1-km predictions in sensitivity analyses. The exposure models predicted broadly consistent PM2.5 concentrations, with relatively high concentrations on average over the eastern U.S. and greater variability in the western U.S. However, differences in national concentration distributions (median standard deviation: 1.00 µg m-3) and spatial distributions over urban areas were evident. Further exploration of these differences and their implications for specific applications would be valuable. PM2.5 concentrations were estimated to decrease by about 1 µg m-3 on average due to modeled emission changes between 2011 and 2028, with decreases of more than 3 µg m-3 in areas with relatively high 2011 concentrations that were projected to experience relatively large emission reductions. Agreement among models was closer for population-weighted than uniformly weighted averages across the domain. About 50% of the population was estimated to experience PM2.5 concentrations less than 10 µg m-3 in 2011 and PM2.5 improvements of about 2 µg m-3 due to modeled emission changes between 2011 and 2028. Two inequality metrics were used to characterize differences in exposure among the four racial/ethnic groups. The metrics generally yielded consistent information and suggest that the modeled emission reductions between 2011 and 2028 would reduce absolute exposure inequality on average.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Aerossóis/análise , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Teorema de Bayes , Monitoramento Ambiental , Modelos Estatísticos , Material Particulado/análise
17.
Sci Total Environ ; 755(Pt 2): 142524, 2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33065503

RESUMO

BACKGROUND: Although long-term exposure to particulate matter<2.5 µm (PM2.5) has been linked to chronic debilitating brain disorders (CDBD), the role of short-term exposure in health care demand, and increased susceptibility for PM2.5-related health conditions, among Medicare enrollees with CDBD has received little attention. We used a causal modeling approach to assess the effect of short-term high PM2.5 exposure on all-cause admissions, and prevalent cause-specific admissions among Medicare enrollees with CDBD (Parkinson's disease-PD, Alzheimer's disease-AD and other dementia). METHODS: We constructed daily zipcode counts of hospital admissions of Medicare beneficiaries older than 65 across the United-States (2000-2014). We obtained daily PM2.5 estimates from a satellite-based model. A propensity score matching approach was applied to match high-pollution (PM2.5 > 17.4 µg/m3) to low-pollution zip code-days with similar background characteristics. Then, we estimated the percent change in admissions attributable to high pollution. We repeated the models restricting the analysis to zipcode-days with PM2.5 below of 35 µg/m3. RESULTS: We observed significant increases in all-cause hospital admissions (2.53% in PD and 2.49% in AD/dementia) attributable to high PM2.5 exposure. The largest observed effect for common causes was for pneumonia and urinary tract infection. All the effects were larger in CDBD compared to the general Medicare population, and similarly strong at levels of exposure considered safe by the EPA. CONCLUSION: We found Medicare beneficiaries with CDBD to be at higher risk of being admitted to the hospital following acute exposure to PM2.5 levels well below the National Ambient Air Quality Standard defined as safe by the EPA.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Encefalopatias , Idoso , Poluentes Atmosféricos/análise , Exposição Ambiental/análise , Hospitalização , Hospitais , Humanos , Medicare , Material Particulado/análise , Estados Unidos/epidemiologia
19.
Biostatistics ; 22(2): 381-401, 2021 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-31545341

RESUMO

We propose a computationally and statistically efficient divide-and-conquer (DAC) algorithm to fit sparse Cox regression to massive datasets where the sample size $n_0$ is exceedingly large and the covariate dimension $p$ is not small but $n_0\gg p$. The proposed algorithm achieves computational efficiency through a one-step linear approximation followed by a least square approximation to the partial likelihood (PL). These sequences of linearization enable us to maximize the PL with only a small subset and perform penalized estimation via a fast approximation to the PL. The algorithm is applicable for the analysis of both time-independent and time-dependent survival data. Simulations suggest that the proposed DAC algorithm substantially outperforms the full sample-based estimators and the existing DAC algorithm with respect to the computational speed, while it achieves similar statistical efficiency as the full sample-based estimators. The proposed algorithm was applied to extraordinarily large survival datasets for the prediction of heart failure-specific readmission within 30 days among Medicare heart failure patients.


Assuntos
Algoritmos , Medicare , Idoso , Simulação por Computador , Humanos , Análise dos Mínimos Quadrados , Modelos de Riscos Proporcionais , Estados Unidos
20.
Environ Int ; 160: 107070, 2021 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-34973588

RESUMO

BACKGROUND: As physical activity benefits brain health whereas air pollution damages it, the cognitive response to these exposures may interact. PURPOSE: This study aimed to assess the short-term joint effect of physical activity and air pollution on cognitive function in a panel of healthy young adults. METHODS: We followed ninety healthy subjects aged around 22 years from September 2020 to June 2021 and measured their personal exposure to fine particulate matter (PM2.5) (µg/m3) and daily accelerometer-based moderate-to-vigorous physical activity (MVPA) (min/day) in 4 one-week-long sessions over the study period. At the end of each measurement session, we assessed executive function using Stroop color-word test and collected resting-state electroencephalogram (EEG) signals. RESULTS: We found short-term PM2.5 exposure damaged executive function (ßPM25 = 0.0064, p = 0.039) but physical activity could counterbalance it (ßMVPA = -0.0047, p = 0.048), whereby beta-3 wave played as a potential mediating role. MVPA-induced improvement on executive function was larger in polluted air (ßMVPA = -0.010, p = 0.035) than that in clean air (ßMVPA = -0.003, p = 0.45). To offset the negative effect of air pollution on cognitive function, individuals should do extra 13.6 min MVPA every day for every 10 µg/m3 increase in daily PM2.5. CONCLUSION: This study implies that physical activity could be used as a preventive approach to compensate the cognitive damages of air pollution.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...