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1.
Environ Int ; 133(Pt B): 105268, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31675564

RESUMO

Studies on health effects of long-term exposure to specific PM2.5 constituents are few. Previous studies have reported an association between black carbon (BC) exposure and cardiovascular diseases (CVD) and a few studies have found an association between sulfate exposure and mortality. These studies, however, relied mainly on exposure data from centrally located air-monitoring stations, which is a crude approximation of personal exposure. We focused on specific chemical constituents of PM2.5, i.e. elemental and primary organic carbonaceous particles (BC/OC), sea salt, secondary inorganic aerosols (SIA, i.e. NO3-, NH4+, and SO42-), and secondary organic aerosols (SOA), in relation to all-cause, CVD and respiratory disease mortality. We followed a Danish cohort of 49,564 individuals from enrollment in 1993-1997 through 2015. We combined residential address history from 1979 onwards with mean annual air pollution concentrations obtained by the AirGIS air pollution modelling system, lifestyle information from baseline questionnaires and socio-demography obtained by register linkage. During 895,897 person-years of follow-up, 10,193 deaths from all causes occurred - of which 2319 were CVD-related and 870 were related to respiratory disease. The 15-year time-weighted average concentrations of PM2.5, BC/OC, sea salt, SIA and SOA were 13.8, 2.8, 3.4, 4.9, and 0.3 µg/m3, respectively. For all-cause mortality, a higher risk was observed with higher exposure to PM2.5, BC/OC and SOA with adjusted hazard ratios of 1.03 (95% confidence intervals: 1.01, 1.05), 1.06 (1.03, 1.09), and 1.08 (1.03, 1.13) per interquartile range, respectively. The associations for BC/OC and SOA remained after adjustment for PM2.5 in two-pollutant models. For CVD mortality, we observed elevated risks with higher exposure to PM2.5, BC/OC and SIA. The results showed no clear relationship between sea salt and mortality. In this study, we observed a relationship between long-term exposure to PM2.5, BC/OC, and SOA and all-cause mortality and between PM2.5, BC/OC, and SIA and CVD mortality.


Assuntos
Poluentes Atmosféricos/toxicidade , Doenças Cardiovasculares/mortalidade , Exposição Ambiental , Material Particulado/toxicidade , Doenças Respiratórias/mortalidade , Fuligem/toxicidade , Poluição do Ar/análise , Estudos de Coortes , Dinamarca , Humanos , Modelos de Riscos Proporcionais
2.
Environ Int ; 133(Pt B): 105272, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31675571

RESUMO

Climate change is a major public health concern. In addition to its direct impacts on temperature patterns and extreme weather events, climate change affects public health indirectly through its influence on air quality. Pollution trends are not only affected by emissions changes but also by weather changes. In this paper we analyze air quality trends in Spain of important air pollutants (C6H6, CO, NO2, NOx, O3, PM10, PM2.5, and SO2) recorded during the last 25 years, from 1993 to 2017. We found substantial reductions in ambient concentration levels for all the pollutants studied except for O3. To assess the influence of recent weather changes on air quality trends we applied generalized additive models (GAMs) using nonparametric smoothing; with and without adjusting for weather parameters including temperature, wind speed, humidity and precipitation frequency. The difference of annual slopes estimated by the models without and with adjusting for these meteorological variables represents the impact of weather changes on pollutant trends, i.e. the 'weather penalty'. The analyses were seasonally and geographically stratified to account for temporal and regional differences across Spain. The results were meta-analyzed to estimate weather penalties on ambient concentration trends at a national level as well as the impact on mortality for the most relevant pollutants. We found significant penalties for most pollutants, implying that air quality would have improved even more during our study period if weather conditions had remained constant. The largest weather influences were found for PM10, with seasonal penalties up to 22 µg⋅m-3 accumulated over the 25-year period in some regions. The national meta-analysis shows penalties of 0.060 µg⋅m-3 per year (95% Confidence Interval, CI: 0.004, 0.116) in cold months and 0.127 µg⋅m-3 per year (95% CI: 0.089, 0.164) in warm months. Penalties of this magnitude would correspond to 129 annual deaths (95% CI: 25, 233), i.e. approximately 3200 deaths over the 25-year period in Spain. According to our results, the health benefits of recent emission abatements for this pollutant in Spain would have been up to 10% greater if weather conditions had remained constant during the last 25 years.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Material Particulado/análise , Doenças Respiratórias/epidemiologia , Tempo (Meteorologia) , Mudança Climática , Humanos , Umidade , Mortalidade/tendências , Saúde Pública , Doenças Respiratórias/mortalidade , Espanha/epidemiologia , Temperatura Ambiente
3.
Sci Total Environ ; 694: 133757, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31756804

RESUMO

BACKGROUND: Coal-fired thermal power plants represent a significant source of air pollutants, especially sulfur dioxide (SO2) that has been associated with an increased risk of mortality and morbidity for respiratory and cardiovascular disease. A coal power plant in Vado Ligure (Italy) (CPPVL) started in 1970 was stopped in 2014 by the Prosecutor's Office on the grounds of environmental and health culpable disaster. OBJECTIVE: To investigate the association between the exposure of residents to atmospheric pollutants emitted by CPPVL and the risk of mortality and hospitalization, considering both cancer and non-cancer causes in a population-based cohort study. METHODS: SO2 and nitrogen oxides (NOx), estimated using the ABLE-MOLOCH-ADMS-Urban dispersion model, were selected as representative surrogates of exposure to CPPVL emissions (SO2-CPPVL) and cumulative emissions from other sources of pollution (NOx-MS), respectively. The relationship between each health outcome and categories of exposure to SO2-CPPVL was estimated by the Hazard Ratio (HR) using multiple sex-specific Cox regression models, adjusted for age, exposure to NOx-MS, and socio-economic deprivation index using SO2-CPPVL first quartile as a reference. RESULTS: 144,019 individuals were recruited (follow-up 2001-2013). An excess of mortality was found for all natural causes (men: 1.49; 95% CI 1.38-1.60; women: 1.49; 95% CI 1.39-1.59), diseases of the circulatory system (men: 1.41; 95% CI 1.24-1.56; women: 1.59; 95% CI 1.44-1.77), of the respiratory system (men: 1.90; 95% CI 1.47-2.45; women: 1.62; 95% CI 1.25-2.09), and of the nervous system and sense organs (men: 1.34; 95% CI 0.97-1.86; women: 1.38; 95% CI 1.03-1.83), and in men for trachea, bronchus, and lung cancers (1.59; 95% CI 1.26-2.00). Results of hospitalization analysis were consistent with those of mortality. CONCLUSION: Results obtained, also when considering multiple sources of exposure, indicate that exposure to CPP emissions represents a risk factor for selected health outcomes as well as the urgently adoption of primary prevention measures and of a specific surveillance programme.


Assuntos
Poluição do Ar/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Centrais Elétricas , Poluentes Atmosféricos/análise , Doenças Cardiovasculares/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Itália/epidemiologia , Doenças Respiratórias/mortalidade
4.
Int Health ; 11(6): 417-421, 2019 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-31613318

RESUMO

Air pollution is now recognized by governments, international institutions and civil society as a major global public health risk factor. This is the result of the remarkable growth of scientific knowledge enabled by advances in epidemiology and exposure assessment. There is now a broad scientific consensus that exposure to air pollution increases mortality and morbidity from cardiovascular and respiratory disease and lung cancer and shortens life expectancy. Although air pollution has markedly declined in high-income countries, it was still responsible for some 4.9 million deaths in 2017, largely in low- and middle-income countries, where air pollution has increased over the past 25 y. As governments act to reduce air pollution there is a continuing need for research to strengthen the evidence on disease risk at very low and very high levels of air pollution, identify the air pollution sources most responsible for disease burden and assess the public health effectiveness of actions taken to improve air quality.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Saúde Global/tendências , Doenças Cardiovasculares/mortalidade , Carga Global da Doença , Humanos , Expectativa de Vida , Doenças Respiratórias/mortalidade , Fatores de Risco
5.
Environ Pollut ; 255(Pt 1): 113147, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31522002

RESUMO

This study investigated the spatial and temporal distributions of particulate and gaseous air pollutants in a primary school in Beijing and assessed their health impact on the children. The results show that air quality inside the classroom was greatly affected by the input of outdoor pollutants; high levels of pollution were observed during both the heating and nonheating periods and indicate that indoor and outdoor air pollution posed a threat to the children's health. Traffic sources near the primary school were the main contributors to indoor and outdoor pollutants during both periods. Moreover, air quality in this primary school was affected by coal combustion and atmospheric reactions during the heating and nonheating periods, respectively. Based on the estimation by exposure-response functions and the weighting of indoor and outdoor pollutants during different periods, the levels of PM2.5, PM 10 and O3 at school had adverse respiratory health effects on children. Longer exposures during the nonheating period contributed to higher health risks. These results emphasized that emission sources nearby had a direct impact on air quality in school and children's respiratory health. Therefore, measures should be taken for double control on air pollution inside and outside the classroom to protect children from it.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Monitoramento Ambiental , Doenças Respiratórias/etiologia , Instituições Acadêmicas , Poluentes Atmosféricos/toxicidade , Poluição do Ar em Ambientes Fechados/efeitos adversos , Pequim/epidemiologia , Criança , Carvão Mineral , Exposição Ambiental , Monitoramento Ambiental/métodos , Humanos , Material Particulado/análise , Material Particulado/toxicidade , Doenças Respiratórias/mortalidade
6.
Artigo em Inglês | MEDLINE | ID: mdl-31546750

RESUMO

Ambient air pollution from energy use and other sources is a major environmental risk factor in the incidence and progression of serious diseases, such as cardiovascular and respiratory diseases. This study elucidates the health effects of energy consumption from air pollution in China based on multiple threshold effects of the population-weighted exposure to PM2.5 (fine particles less than 2.5 microns in diameter) on particle-related mortality rate. We firstly estimate the causal relationship between coal consumption and PM2.5 in China for 2004-2010 using a panel regression model. Panel threshold models are applied to access the non-linear relationships between PM2.5 and cause-specific mortality rates that indicate the health effects are dependent on the PM2.5 ranges. By combining these steps, we calculate the health impacts of coal consumption based on threshold effects of PM2.5. We find that a 1% coal consumption increase induces a 0.23% increase in PM2.5. A triple threshold effect is found between PM2.5 and cardiovascular mortality; for example, increasing PM2.5 exposure causes cardiovascular mortality rate to increase when PM2.5 lies in 17.7-21.6 µg/m3 and 21.6-34.3 µg/m3, with the estimated increments being 0.81% and 0.26%, respectively, corresponding to 1% PM2.5 increase. A single threshold effect of SO2 on respiratory mortality rate is identified and allows the estimation of the mortality effects of PM2.5 regarding the two regimes of SO2. Finally, we access the health impacts of coal consumption under specific estimated thresholds. This study provides a better understanding of sources contributing to related-air pollution mortality. The multi-threshold effect of PM2.5 could be considered for further applications in harmonizing emission standards in China and other developing countries.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/mortalidade , Exposição Ambiental/análise , Material Particulado/análise , Doenças Respiratórias/mortalidade , Doenças Cardiovasculares/induzido quimicamente , China/epidemiologia , Carvão Mineral , Doenças Respiratórias/induzido quimicamente
7.
Eur J Epidemiol ; 34(10): 917-926, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31392470

RESUMO

The aim of our study was to assess the association between green tea consumption and all-cause and cause-specific mortality in a pooled analysis of eight Japanese population-based cohort studies. Pooled hazard ratios (HR) and 95% confidence intervals (CI), derived from random effects models, were used to evaluate the associations between green tea consumption, based on self-report at baseline, and risk of all-cause and cause-specific mortality. During a mean follow-up of 17.3 years, among 313,381 persons, 52,943 deaths occurred. Compared with individuals who consumed < 1 cup/day, those in the highest consumption category (≥ 5 cups/day) had a decreased risk of all-cause mortality [the multivariate-adjusted HR was 0.90 (95% CI 0.87-0.94) for men and 0.82 (0.74-0.90) for women]. A similar inverse association was observed for heart disease mortality [HR 0.82 (0.75-0.90) for men, and 0.75 (0.68-0.84) for women], and cerebrovascular disease mortality [HR 0.76 (0.68-0.85) for men, and 0.78 (0.68-0.89) for women]. Among women, green tea consumption was associated with decreased risk of total cancer mortality: 0.89 (0.83-0.96) for the 1-2 cups/day category and 0.91 (0.85-0.98) for the 3-4 cups/day category. Results for respiratory disease mortality were [HR 0.75 (0.61-0.94)] among 3-4 cup daily consumers and [HR 0.66 (0.55-0.79)] for ≥ 5 cups/day. Higher consumption of green tea is associated with lower risk for all-cause mortality in Japanese, especially for heart and cerebrovascular disease. Moderate consumption decreased the risk of total cancer and respiratory disease mortality in women.


Assuntos
Causas de Morte , Mortalidade , Neoplasias/etiologia , Chá , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Doenças Cardiovasculares/mortalidade , Estudos de Coortes , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Neoplasias/epidemiologia , Estudos Prospectivos , Doenças Respiratórias/mortalidade , Fatores de Risco , Fatores Sexuais
8.
N Engl J Med ; 381(8): 705-715, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31433918

RESUMO

BACKGROUND: The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias. METHODS: We evaluated the associations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 µm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 µm or less (PM2.5) with daily all-cause, cardiovascular, and respiratory mortality across multiple countries or regions. Daily data on mortality and air pollution were collected from 652 cities in 24 countries or regions. We used overdispersed generalized additive models with random-effects meta-analysis to investigate the associations. Two-pollutant models were fitted to test the robustness of the associations. Concentration-response curves from each city were pooled to allow global estimates to be derived. RESULTS: On average, an increase of 10 µg per cubic meter in the 2-day moving average of PM10 concentration, which represents the average over the current and previous day, was associated with increases of 0.44% (95% confidence interval [CI], 0.39 to 0.50) in daily all-cause mortality, 0.36% (95% CI, 0.30 to 0.43) in daily cardiovascular mortality, and 0.47% (95% CI, 0.35 to 0.58) in daily respiratory mortality. The corresponding increases in daily mortality for the same change in PM2.5 concentration were 0.68% (95% CI, 0.59 to 0.77), 0.55% (95% CI, 0.45 to 0.66), and 0.74% (95% CI, 0.53 to 0.95). These associations remained significant after adjustment for gaseous pollutants. Associations were stronger in locations with lower annual mean PM concentrations and higher annual mean temperatures. The pooled concentration-response curves showed a consistent increase in daily mortality with increasing PM concentration, with steeper slopes at lower PM concentrations. CONCLUSIONS: Our data show independent associations between short-term exposure to PM10 and PM2.5 and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe. These data reinforce the evidence of a link between mortality and PM concentration established in regional and local studies. (Funded by the National Natural Science Foundation of China and others.).


Assuntos
Poluição do Ar/efeitos adversos , Exposição Ambiental/análise , Mortalidade , Material Particulado/efeitos adversos , Poluição do Ar/análise , Doenças Cardiovasculares/mortalidade , Causas de Morte , Exposição Ambiental/efeitos adversos , Exposição Ambiental/legislação & jurisprudência , Saúde Global , Humanos , Tamanho da Partícula , Material Particulado/análise , Doenças Respiratórias/mortalidade , Risco
9.
Environ Health Perspect ; 127(6): 67004, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31166133

RESUMO

BACKGROUND: The link between particulate matter (PM) exposure and adverse health outcomes has been widely evaluated using large cohort studies. However, the possibility of residual confounding and lack of information about the health effects of PM in rural and suburban areas are unsolved issues. OBJECTIVE: Our aim was to estimate the effect of annual PM≤10µg (PM10) exposure on cause-specific mortality in the Latium region (central Italy, of which Rome is the main city) during 2006-2012 using a difference-in-differences approach. METHODS: We estimated daily PM10 concentrations for each 1 km2 of the region from 2006 to 2012 by use of satellite data, land-use predictors, and meteorological parameters. For each of the 378 regional municipalities and each year, we averaged daily PM10 values to obtain annual mean PM10 exposures. We applied a variant of the difference-in-differences approach to estimate the association between PM10 and cause-specific mortality by focusing on within-municipality fluctuations of mortality rates and annual PM exposures around municipality means, therefore controlling by design for confounding from all spatial and temporal potential confounders. Analyses were also stratified by population size of the municipalities to obtain effect estimates in rural and suburban areas of the region. RESULTS: In the period 2006-2012, we observed deaths due to three causes: 347,699 nonaccidental; 92,787 cardiovascular; and 16,509 respiratory causes. The annual average (standard deviation, SD) PM10 concentration was 21.9 (±4.9) µg/km3 in Latium. For each 1-µg/m3 increase in annual PM10 we estimated increases of 0.8% (95% confidence intervals (CIs): 0.2%, 1.3%), 0.9% (0.0%, 1.8%), and 1.4% (-0.4%, 3.3%) in nonaccidental, cardiovascular, and respiratory mortality, respectively. Similar results were found when we excluded the metropolitan area of Rome from the analysis. Higher effects were estimated in the smaller municipalities, e.g., those with population < 5,000 inhabitants. CONCLUSION: Our study suggests a significant association of annual PM10 exposure with nonaccidental and cardiorespiratory mortality in the Latium region, even outside Rome and in suburban and rural areas. https://doi.org/10.1289/EHP3759.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Doenças Cardiovasculares/mortalidade , Mortalidade , Material Particulado/efeitos adversos , Doenças Respiratórias/mortalidade , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Causas de Morte , Exposição Ambiental/estatística & dados numéricos , Humanos , Itália/epidemiologia , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos
10.
Environ Health Perspect ; 127(6): 67007, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170008

RESUMO

BACKGROUND: Studies found approximately linear short-term associations between particulate matter (PM) and mortality in Western communities. However, in China, where the urban PM levels are typically considerably higher than in Western communities, some studies suggest nonlinearity in this association. Health impact assessments (HIA) of PM in China have generally not incorporated nonlinearity in the concentration-response (C-R) association, which could result in large discrepancies in estimates of excess deaths if the true association is nonlinear. OBJECTIVES: We investigated nonlinearity in the C-R associations between with PM with aerodynamic diameter [Formula: see text] ([Formula: see text]) and mortality in Beijing, China, and the sensitivity of HIA to linearity assumptions. METHODS: We modeled the C-R association between [Formula: see text] and cause-specific mortality in Beijing, China (2009-2012), using generalized linear models (GLM). [Formula: see text] was included through either linear, piecewise-linear, or spline functions to investigate evidence of nonlinearity. To determine the sensitivity of HIA to linearity assumptions, we estimated [Formula: see text]-attributable deaths using both linear- and nonlinear-based C-R associations between [Formula: see text] and mortality. RESULTS: We found some evidence that, for nonaccidental and circulatory mortality, the shape of the C-R association was relatively flat at lower concentrations of [Formula: see text], but then had a positive slope at higher concentrations, indicating nonlinearity. Conversely, the shape for respiratory mortality was positive and linear at lower concentrations of [Formula: see text], but then leveled off at the higher concentrations. Estimates of excess deaths attributable to short-term [Formula: see text] exposure were, in some cases, very sensitive to the linearity assumption in the association, but in other cases robust to this assumption. CONCLUSIONS: Our results demonstrate some evidence of nonlinearity in [Formula: see text]-mortality associations and that an assumption of linearity in this association can influence HIAs, highlighting the importance of understanding potential nonlinearity in the [Formula: see text]-mortality association at the high concentrations of [Formula: see text] in developing megacities like Beijing. https://doi.org/10.1289/EHP4464.


Assuntos
Avaliação do Impacto na Saúde/métodos , Mortalidade , Material Particulado/efeitos adversos , Poluentes Atmosféricos/efeitos adversos , Pequim/epidemiologia , Doenças Cardiovasculares/mortalidade , Exposição Ambiental/efeitos adversos , Humanos , Modelos Lineares , Tamanho da Partícula , Doenças Respiratórias/mortalidade
11.
Artigo em Inglês | MEDLINE | ID: mdl-31117163

RESUMO

Background: After political transformation in 1989/1990, Poland experienced a general improvement in living conditions and quality of life, but the benefits did not extend evenly across all segments of the society. We hypothesized that the regional differences in mortality due to diseases of the respiratory system are related to socioeconomic status (SES) and its changes over time. Materials and methods: An ecological study was carried out in 66 sub-regions of Poland using the data from the period of 2010 to 2014. Age-standardized mortality rates (SMRs) were calculated separately for men and women in three age categories: ≥15, 25-64 years, and ≥65 years. An area-based SES index was derived from the characteristics of the sub-regions using the z-score method. Multiple weighted linear regression models were constructed to estimate a real socioeconomic gradient for mortality resulting from lung cancer and respiratory diseases. Results: In the regions studied, the SMRs for respiratory disease varied from 70/100,000 to 215/100,000 in men and from 18/100,000 to 53/100,000 in women. The SMRs for lung cancer varied from 36/100,000 to 110/100,000 among men and from 26/100,000 to 77/100,000 among women. After adjusting for the prevalence of smoking and environmental pollution, the SES index was found to be inversely associated with the SMR for lung cancer in each category of age among men, and in the age group of 25-64 years among women. An increase of the SES index between 2010 and 2014 was associated with a decrease of SMR for respiratory disease both in men and women, but this change was not significantly associated with the SMR for lung cancer. Conclusion: SES appears to be an important correlate of mortality from respiratory diseases and lung cancer at the population level, particularly in men. A lower SES was associated with greater mortality from lung cancer and respiratory diseases. An increase in SES over time was related to a decrease in mortality from respiratory disease, but not from lung cancer.


Assuntos
Neoplasias Pulmonares/mortalidade , Doenças Respiratórias/mortalidade , Fatores Socioeconômicos , Adulto , Idoso , Poluição Ambiental , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Prevalência , Qualidade de Vida , Fumar , Adulto Jovem
12.
Sci Total Environ ; 677: 564-570, 2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31067477

RESUMO

Transregional transport plays an important role in air pollution. This study investigated the impact of transregional transport on particle pollution in Shanghai from 2013 to 2017. A conditional potential source contribution function (CPSCF) method with high time resolution (1 h) PM2.5 and PM10 data was used to quantify the contribution of transregional transport. The corresponding health impact was also assessed. The average annual contribution of transregional transport to PM2.5 (PM2.5_CTRT) and PM10 (PM10_CTRT) was 22 and 30 µg/m3, 18 and 24 µg/m3, 19 and 24 µg/m3, 14 and 19 µg/m3, and 14 and 19 µg/m3, for 2013 to 2017, respectively, thus accounting for 31-37% of total PM2.5 and PM10. As PM2.5_CTRT is a dominant component of PM10_CTRT, the health effects related to PM2.5_CTRT were assessed to avoid double counting. The number of annual deaths associated with PM2.5_CTRT in Shanghai during the study period ranged from 636 (95% confidence intervals: 350, 936) to 1039 (573, 1530), among which cardiovascular disease and respiratory disease accounted for 62.8-67.6% and 16.6-19.5% of mortality, respectively. PM2.5_CTRT-related deaths accounted for 5.3-8.2‰ of the total mortality in Shanghai during the study period. Between 9764 (9251, 10,277) and 12,190 (11,549, 12,830) cases of all-cause hospital admissions were attributable to PM2.5_CTRT in Shanghai in one year, among which cardiovascular disease and respiratory disease hospital admissions accounted for 15.9-20.0% and 7.9-9.2%, respectively. Internal medicine and pediatrics outpatient visits related to PM2.5_CTRT ranged from 70,684 (39,009, 100,829) to 97,380 (53,788, 138,793) cases and 23,185 (8302, 37,173) to 32,702 (11,726, 52,361) cases, respectively. The current work provides scientific evidence of the impact of transregional transport on air pollution and its health burden in Shanghai.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Doenças Cardiovasculares/mortalidade , Exposição Ambiental/efeitos adversos , Material Particulado/efeitos adversos , Doenças Respiratórias/mortalidade , Poluentes Atmosféricos/análise , Doenças Cardiovasculares/induzido quimicamente , China/epidemiologia , Cidades , Exposição Ambiental/análise , Humanos , Tamanho da Partícula , Material Particulado/análise , Doenças Respiratórias/induzido quimicamente , População Urbana
13.
BMC Public Health ; 19(1): 501, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053065

RESUMO

BACKGROUND: Our study aimed to determine the association between forced expiratory volume in one second (FEV1) and subsequent fatal and non-fatal events in a general population. METHODS: The Norfolk (UK) based European Prospective Investigation into Cancer (EPIC-Norfolk) recruited 25,639 participants between 1993 and 1997. FEV1 measured by portable spirometry, was categorized into sex-specific quintiles. Mortality and morbidity from all causes, cardiovascular disease (CVD) and respiratory disease were collected from 1997 up to 2015. Cox proportional hazard regression analysis was used with adjustment for socio-economic factors, physical activity and co-morbidities. RESULTS: Mean age of the population was 58.7 ± 9.3 years, mean FEV1 for men was 294± 74 cL/s and 214± 52 cL/s for women. The adjusted hazard ratios for all-cause mortality for participants in the highest fifth of the FEV1 category was 0.63 (0.52, 0.76) for men and 0.62 (0.51, 0.76) for women compared to the lowest quintile. Adjusted HRs for every 70 cL/s increase in FEV1 among men and women were 0.77 (p < 0.001) and 0.68 (p < 0.001) for total mortality, 0.85 (p<0.001) and 0.77 (p<0.001) for CVD and 0.52 (p <0.001) and 0.42 (p <0.001) for respiratory disease. CONCLUSIONS: Participants with higher FEV1 levels had a lower risk of CVD and all-cause mortality. Measuring the FEV1 with a portable handheld spirometry measurement may be used as a surrogate marker for cardiovascular risk. Every effort should be made to identify those with poorer lung function even in the absence of cardiovascular disease as they are at greater risk of total and CV mortality.


Assuntos
Doenças Cardiovasculares/mortalidade , Doença da Artéria Coronariana/mortalidade , Volume Expiratório Forçado/fisiologia , Doenças Respiratórias/mortalidade , Adulto , Idoso , Estudos de Coortes , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Neoplasias/epidemiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Projetos de Pesquisa , Testes de Função Respiratória , Fatores de Risco , Espirometria/métodos , Capacidade Vital/fisiologia
14.
S Afr Med J ; 109(4): 272-277, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-31084694

RESUMO

BACKGROUND: High-flow nasal cannula (HFNC) oxygen is a non-invasive alternative to nasal continuous positive airway pressure (CPAP) therapy for infants and children requiring respiratory support. There is a paucity of data to support its use in children, with no published data from sub-Saharan Africa. OBJECTIVES: To describe the outcomes of and adverse events related to HFNC in the first year of its use in a level 2 (L2) general paediatric ward, and to compare these outcomes with those of a historical cohort when this intervention was unavailable. METHODS: This retrospective descriptive study included children aged <13 years who received HFNC in the first 12 months after its introduction (HFNC-availability group, n=66). Demographic data, clinical characteristics and outcomes (death, treatment failure, length of HFNC and HFNC-related adverse events) were assessed. A comparative description of children who required transfer to level 3 (L3) for any form of respiratory support (other than the available standard low-flow oxygen) during the 12-month period prior to HFNC availability (pre-HFNC group, n=54) was made. All analyses were performed in the paediatric wards, New Somerset Hospital, Cape Town, South Africa. Outcomes were compared using standard descriptive and comparative statistics. RESULTS: The median age of the cohort was 5 months (interquartile range (IQR) 1.9 - 14.6). Sixteen children (13.3%) were malnourished, 10 (8.3%) were HIV-infected, and 30 (25.0%) had been born prematurely. The most common diagnoses were pneumonia, bronchiolitis and asthma. Asthma, anaemia and cardiac abnormalities were the most prevalent underlying comorbidities. Two children died in each group. All 54 children in the pre-HFNC group were transferred to L3; 38 (70.4%) needed CPAP or invasive ventilation. In the HFNC-availability period, 85 children were assessed as needing more than standard low-flow oxygen therapy: of the 19 immediately transferred to L3, 17 (89.4%) received CPAP or invasive ventilation; of the 66 who received HFNC at L2, 16 (24.2%) subsequently required transfer to L3 for CPAP or invasive ventilation. The median duration of HFNC was 46.3 hours (IQR 19.5 - 93.5) overall, and it was 12 hours (IQR 4 - 28) and 58.5 hours (IQR 39.5 - 106) for those who failed or were successfully managed on HFNC, respectively. No HFNC-related serious adverse events were recorded. CONCLUSIONS: HFNC is a safe, effective, feasible option for non-invasive ventilation of children with respiratory illnesses in a resource-limited L2 setting. A greater proportion of children with lower respiratory tract infections in the HFNC-availability group than in the pre-HFNC group required support, but the intervention reduced the bed pressure on L3. Improved ways to identify HFNC failures would be beneficial.


Assuntos
Oxigenoterapia/métodos , Doenças Respiratórias/terapia , Adolescente , Cânula , Criança , Pré-Escolar , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Masculino , Oxigenoterapia/instrumentação , Doenças Respiratórias/mortalidade , Estudos Retrospectivos , África do Sul , Resultado do Tratamento
15.
Environ Sci Pollut Res Int ; 26(18): 18876-18885, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31065985

RESUMO

For assessing the effect and threshold of PM2.5 on mortality in highly polluted areas and further studying the standard applicability, daily data on meteorological factors, air pollutants, and mortality were obtained in Jinan, China, from 2011 to 2017. A generalized additive model (GAM) and a distributed lag non-linear model (DLNM) were employed to assess the nonlinearity and the hysteresis of associations. We further explored the breakpoints to evaluate the existence of the threshold. The correlation between mortality and PM2.5 was nonlinear. The impact of average PM2.5 on non-accidental mortality (RR = 1.11; 95% CI = 1.06, 1.16), cardiovascular disease (CVD) mortality (RR = 1.17; 95% CI = 1.10, 1.24), and respiratory disease (RD) mortality (RR = 1.17; 95% CI = 1.10, 1.24) reached the highest in the current day (lag 0). The excess risks of PM2.5 at secondary standard level to non-accidental, CVD, and RD mortality are 8.79% (95% CI = 3.84, 13.98), 14.41% (95% CI = 7.79, 21.43), 15.35% (95% CI = 1.76, 30.74), respectively. The saturation points exist in highly polluted areas. Above the saturation points of 247 µg/m3 for non-accidental mortality, 245 µg/m3 for CVD mortality, and 250 µg/m3 for RD mortality, the model of all three relationships presented a harvesting effect. This study underscores the necessity of the ongoing efforts of reducing particulate air pollution and the adjustment of the standards in seriously polluted areas to adapt to regional conditions. At the same time, for highly polluted areas, it is advocated to strengthen personal protection to decrease the saturation point and control the concentration of pollutants as much as possible, which will substantially save more cost that benefits the public.


Assuntos
Poluentes Atmosféricos/análise , Doenças Cardiovasculares/mortalidade , Material Particulado/análise , Doenças Respiratórias/mortalidade , China/epidemiologia , Humanos , Conceitos Meteorológicos , Mortalidade/tendências , Tamanho da Partícula
16.
Wei Sheng Yan Jiu ; 48(2): 312-319, 2019 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-31133114

RESUMO

OBJECTIVE: To introduce the Meta-analysis of acute health effects caused by atmospheric particulate matter and explore the R software implementation. METHODS: Used literature data as an example, pooled the risk estimates of mortality due to respiratory disease exposure to PM_(10) in the Chinese population from 1990 to 2013 using R software. RESULTS: The overall risk estimates RR was 1. 0041(95% CI 1. 0028-1. 0054), there was publication bias, the RR was reduced to 1. 0015(95%CI 1. 0002-1. 0029)after adjust the asymmetry with the trim-and-fill method. CONCLUSION: R software has relatively abundant software packages to conduct the Meta-analysis for assessing the acute health impact exposure to atmospheric particulate matter.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar , Material Particulado/efeitos adversos , Doenças Respiratórias/etiologia , Grupo com Ancestrais do Continente Asiático , Humanos , Doenças Respiratórias/mortalidade , Software
18.
Microb Ecol ; 78(2): 446-456, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30918994

RESUMO

Bovine respiratory disease (BRD) continues to be a serious health problem in beef cattle production. A multifactorial condition, BRD encompasses several types of pneumonia that are associated with multiple viral and bacterial agents. Comprehensive identification of microbes associated with BRD fatalities could enhance our understanding of the range of pathogens that contribute to the disease and identify new therapeutic targets. This study used metagenomic analysis to describe the lower respiratory tract microbiome and resistome of 15 feedlot cattle BRD and 3 non-BRD mortalities along with any affiliated integrative and conjugative elements (ICEs). Known bacterial pathogens associated with BRD, including Histophilus somni, Mannheimia haemolytica, and Mycoplasma bovis, were relatively abundant (> 5%) in most, but not all samples. Other relatively abundant genera (> 1%) included Acinetobacter, Bacillus, Bacteroides, Clostridium, Enterococcus, and Pseudomonas. Antimicrobial resistance genes (ARGs) comprised up to 0.5% of sequences and many of these genes were associated with ICEs previously described within the Pasteurellaceae family. A total of 20 putative ICEs were detected among 16 samples. These results document the wide diversity of microorganisms in the lower respiratory tract of cattle that have succumbed to BRD. The data also strongly suggest that antimicrobial-resistant Pasteurellaceae strains are prevalent in BRD cases in Alberta and that the resistance observed is associated with ICEs. The presence of ICEs harboring a wide array of ARGs holds significant consequence for the effectiveness of drug therapies for the control of BRD in beef cattle.


Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/veterinária , Doenças dos Bovinos/microbiologia , Farmacorresistência Bacteriana , Microbiota , Sistema Respiratório/microbiologia , Doenças Respiratórias/veterinária , Alberta , Animais , Antibacterianos/farmacologia , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Bovinos , Doenças dos Bovinos/mortalidade , Doenças Respiratórias/microbiologia , Doenças Respiratórias/mortalidade
19.
Artigo em Inglês | MEDLINE | ID: mdl-30832258

RESUMO

Objective: To compare the performance of frequentist and Bayesian generalized additive models (GAMs) in terms of accuracy and precision for assessing the association between daily exposure to fine particles and respiratory mortality using simulated data based on a real time-series study. Methods: In our study, we examined the estimates from a fully Bayesian GAM using simulated data based on a genuine time-series study on fine particles with a diameter of 2.5 µm or less (PM2.5) and respiratory deaths conducted in Shanghai, China. The simulation was performed by multiplying the observed daily death with a random error. The underlying priors for Bayesian analysis are estimated using the real world time-series data. We also examined the sensitivity of Bayesian GAM to the choice of priors and to true parameter. Results: The frequentist GAM and Bayesian GAM show similar means and variances of the estimates of the parameters of interest. However, the estimates from Bayesian GAM show relatively more fluctuation, which to some extent reflects the uncertainty inherent in Bayesian estimation. Conclusions: Although computationally intensive, Bayesian GAM would be a better solution to avoid potentially over-confident inferences. With the increasing computing power of computers and statistical packages available, fully Bayesian methods for decision making may become more widely applied in the future.


Assuntos
Poluentes Atmosféricos/toxicidade , Interpretação Estatística de Dados , Mortalidade/tendências , Doenças Respiratórias/induzido quimicamente , Doenças Respiratórias/mortalidade , Teorema de Bayes , China/epidemiologia , Humanos , Material Particulado/análise , Doenças Respiratórias/epidemiologia , Incerteza
20.
Medicine (Baltimore) ; 98(10): e14694, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855460

RESUMO

The health effects of short-term exposure to air pollutants on respiratory deaths and its modifiers such as meteorological indexes have been widely investigated. However, most of the previous studies are limited to single pollutants or total respiratory deaths, and their findings are inconsistent.To comprehensively examine the short-term effects of air pollutants on daily respiratory mortality.Our analysis included 16,931 nonaccidental respiratory deaths (except lung cancer and tuberculosis) among older adults (>65 years) from 2011 to 2017 in Jinan, China. We used a generalized additive Poisson models adjusted for meteorology and population dynamics to examine the associations between air pollutants (particulate matter with an aerodynamic diameter of b2.5µm [PM2.5], particulate matter with an aerodynamic diameter of b10µm [PM10], SO2, NO2, O3) and daily mortality for the total patients, males, females, chronic airway diseases, pneumonia patients, and rest patients in Jinan.Outdoor air pollution was significantly related to mortality from all respiratory diseases especially from chronic airway disease in Jinan, China. The effects of air pollutants had lag effects and harvesting effects, and the effects estimates usually reached a peak at lag 1 or 2 day. An increase of 10 µg/m or 10 ppb of PM2.5, PM10, SO2, NO2, and O3 corresponds to increments in mortality caused by chronic airway disease of 0.243% (95% confidence interval [CI]: -0.172-0.659) at lag 1 day, 0.127% (95% CI: -0.161-0.415) at lag 1 day, 0.603% (95% CI: 0.069-1.139) at lag 3 day, 0.649% (95% CI: -0.808-2.128) at lag 0 day and 0.944% (95% CI: 0.156-0.1598) at lag 1 day, respectively. The effects of air pollutants were usually greater in females and varied by respiratory subgroups. Spearman correlation analysis suggested that there was a significant association between meteorological indexes and air pollutants.Sex, age, temperature, humidity, pressure, and wind speed may modify the short-term effects of outdoor air pollution on mortality in Jinan. Compared with the other pollutants, O3 had a stronger effect on respiratory deaths among the elderly. Moreover, chronic airway diseases were more susceptible to air pollution. Our findings provided new evidence for new local environmental and health policies making.


Assuntos
Poluição do Ar , Exposição Ambiental , Mortalidade , Material Particulado , Doenças Respiratórias , Tempo (Meteorologia) , Idoso , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Poluição do Ar/estatística & dados numéricos , China/epidemiologia , Correlação de Dados , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Exposição Ambiental/prevenção & controle , Feminino , Humanos , Masculino , Material Particulado/efeitos adversos , Material Particulado/análise , Saúde Pública/métodos , Doenças Respiratórias/classificação , Doenças Respiratórias/etiologia , Doenças Respiratórias/mortalidade , Fatores de Risco , Estações do Ano , Fatores Sexuais , Fatores de Tempo
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