Lifetime losses due to cardiovascular and respiratory diseases attributable to air pollution in polluted and unpolluted areas.

The article assesses differences in lifetime losses caused by premature deaths from cardiopulmonary disease in populations living in areas with different environmental burdens. The results provide different perspectives on data on total years lost and lifetime losses attributable to air pollution. Such lifetime losses in the industrial area related to cardiovascular causes of death are 7.6 or 5.1 years per male or female deceased, representing an average lifetime loss of 0.01907 years (i.e. 7 days) per 1 male or 0.01273 years (i.e. 4.6 days) per 1 female in the entire population. Losses related to cerebrovascular or respiratory causes of death are about 5.4 or 5.9 years per 1 deceased male or 3.9 or 5 years per 1 deceased female, respectively, which represents a loss of 0.00481 (1.8 days), or 0.00148 years (0.5 days) per 1 male or 0.00466 (1.7 days), or 0.00058 years (0.2 days) per 1 female.

MicroRNAs as a Potential Biomarker in the Diagnosis of Cardiovascular Diseases.

Cardiovascular diseases (CVD) are the leading cause of death in most developed countries. MicroRNAs (miRNAs) are highly investigated molecules not only in CVD but also in other diseases. Several studies on miRNAs continue to reveal novel miRNAs that may play a role in CVD, in their pathogenesis in diagnosis or prognosis, but evidence for clinical implementation is still lacking. The aim of this study is to clarify the diagnostic potential of miRNAs in some CVDs.

Genome-Wide DNA Methylation in Policemen Working in Cities Differing by Major Sources of Air Pollution.

DNA methylation is the most studied epigenetic mechanism that regulates gene expression, and it can serve as a useful biomarker of prior environmental exposure and future health outcomes. This study focused on DNA methylation profiles in a human cohort, comprising 125 nonsmoking city policemen (sampled twice), living and working in three localities (Prague, Ostrava and Ceske Budejovice) of the Czech Republic, who spent the majority of their working time outdoors. The main characterization of the localities, differing by major sources of air pollution, was defined by the stationary air pollution monitoring of PM2.5, B[a]P and NO2. DNA methylation was analyzed by a genome-wide microarray method. No season-specific DNA methylation pattern was discovered; however, we identified 13,643 differentially methylated CpG loci (DML) for a comparison between the Prague and Ostrava groups. The most significant DML was cg10123377 (log2FC = -1.92, p = 8.30 × 10-4) and loci annotated to RPTOR (total 20 CpG loci). We also found two hypomethylated loci annotated to the DNA repair gene XRCC5. Groups of DML annotated to the same gene were linked to diabetes mellitus (KCNQ1), respiratory diseases (PTPRN2), the dopaminergic system of the brain and neurodegenerative diseases (NR4A2). The most significant possibly affected pathway was Axon guidance, with 86 potentially deregulated genes near DML. The cluster of gene sets that could be affected by DNA methylation in the Ostrava groups mainly includes the neuronal functions and biological processes of cell junctions and adhesion assembly. The study demonstrates that the differences in the type of air pollution between localities can affect a unique change in DNA methylation profiles across the human genome.

A study evaluating noise levels at selected schools in the Czech Republic.

OBJECTIVE: Worldwide, primary schools are the most important segment of childhood education. The main disturbing source of noise in schools is human speech, the primary component of the learning process. School noise has a negative impact on information processing, teachers and pupils, and communication in the classroom. The study aimed at assessing A-weighted sound pressure levels in primary school classrooms. It was concerned with A-weighted sound pressure levels and their fluctuation during various classes. METHODS: The noise was measured with the static calibrated Brüel and Kjær 2260 Investigator sound level meter. The sound pressure levels were measured twice in 12 classes as 11 different subjects were taught to reduce the uncertainty of results due to their potential variability in time. From the instantaneous values, LA (t), equivalent continuous A-weighted sound pressure levels (LAeq,T) and LAmax were calculated. RESULTS: The mean equivalent A-weighted sound pressure level during lessons irrespective of age and subjects taught was 68.0 ± 3.4 dB (uncertainty of measurement). The highest levels of noise were in physical education and arts; the lowest levels were found for English taught as a foreign language. There were no statistically significant differences in LAeq,T depending on the numbers of children in the classes. The main source of noise is pupils. Attention should be paid to negative feelings of noise to reduce LAeq,T in schools. CONCLUSIONS: Continuous noise pollution, in combination with stress and the mentally demanding nature of the teaching profession, may lead to numerous negative effects on human personality.

Associations between air pollution in the industrial and suburban parts of Ostrava city and their use.

Selecting the locations and numbers of air quality monitoring stations is challenging as these are expensive to operate. Representative concentrations of pollutants in certain areas are usually determined by measuring. If there are significant correlations with concentrations of other pollutants or with other monitoring sites, however, concentrations could also be computed, partly reducing the costs. The aim of this study is to provide an overview of such possible relationships using data on concentrations of ambient air pollutants obtained in different areas of a larger city. Presented are associations between industrial (IP) and suburban parts (SP) as well as correlations between concentrations of various pollutants at the same site. Results of air pollutant monitoring come from Ostrava, an industrial city in Central Europe with a population of over 300,000. The study showed that certain pollutants were strongly correlated, especially particulate matter (r = 0.940) and ozone (r = 0.923) between the IP and SP. Statistically significant correlations were also found between different pollutants at the same site. The highest correlations were between PM10 and NO2 (r IP = 0.728; r SP = 0.734), NO2 and benzo(a)pyrene (r IP = 0.787; r SP = 0.697), and NO2 and ozone (r IP = -0.706; r SP = -0.686). This could contribute to more cost-effective solutions for air pollution monitoring in cities and their surroundings by using computational models based on the correlations, optimization of the network of monitoring stations, and the best selection of measuring devices.

Epidemiology and risk factors of schizophrenia.

Schizophrenia is a severe mental disorder that affects approximately one percent of the general population. The pathogenesis of schizophrenia is influenced by many risk factors, both environmental and genetic. The environmental factors include the date of birth, place of birth and seasonal effects, infectious diseases, complications during pregnancy and delivery, substance abuse and stress. At the present time, in addition to environmental factors, genetic factors are assumed to play a role in the development of the schizophrenia. The heritability of schizo- phrenia is up to 80%. If one parent suffers from the condition, the probability that it will be passed down to the offspring is 13%. If it is present in both parents, the risk is more than 20%. The opinions are varied as to the risk factors affecting the development of schizophrenia. Knowing these factors may greatly contribute to prevention of the condition.

Editorial.

This special issue of the CEJPH focuses on air pollution and its public health effects. Despite the fact that the body of knowledge of possible health effects of air pollutants is growing over the last two decades, mainly as a result of multiple epidemiological studies conducted all over the world, many questions still remain unanswered. As the air pollution in the Silesian part of the Czech Republic, and in the Ostrava Region in particular, is a significant environmental phenomenon in Europe, the data on pollution exposure, types, and health effects at various levels could be an important contribution to the body of evidence on this (sometimes) seemingly local issue. Although this is one of the most polluted areas of Europe, apart from the conclusions of the Silesia Project (with the participation of the US EPA) and Caesar Project (with the participation of the WHO) from the 1990s, only a few studies addressing some aspects of air pollution appeared. To collect all available and credible data on air quality in this region and related impacts on human health and to submit them to the reader in a single issue (this issue contains three review articles) was the first reason for publishing this special issue.

Environmental and Socioeconomic Health Inequalities: a Review and an Example of the Industrial Ostrava Region.

BACKGROUND AND AIM: According to the World Health Organization (WHO) more than 2 million premature deaths and 7 million of total deaths each year can be attributed to the effects of air pollution. The contribution of air pollution to the health status of population is estimated to be about 20%. Health is largely determined by factors outside the reach of healthcare sector, including low income, unemployment, poor environment, poor education, and substandard housing. The aim of the paper was to review a current knowledge of relationships among air pollution, socioeconomic health inequalities, socio-spatial differentiation, and environmental inequity. The relationships were demonstrated on an example of the Ostrava region. Also basic approaches to health valuation were reviewed. RESULTS: Social differences are reasons both for health inequalities and spatial patterns of unprivileged area housing. In urban environments with poor air quality there is also a large concentration of low income residents. Less affluent population groups are more often affected by inadequate housing conditions including second-hand smoking and higher environmental burden in their residential neighbourhoods. Environmental injustice is highly correlated with other factors that link poverty with poor health, including inadequate access to medical and preventive care, lack of availability of healthful food, lack of safe play spaces for children, absence of good jobs, crime, and violence. CONCLUSIONS: The theoretical background and also results of the studies brought evidence that population health is affected by both socioeconomic and environmental inequalities. Air pollution is unevenly distributed in Ostrava and is related to distribution of socially disadvantaged environment and social exclusion as well.

Air Pollution and Potential Health Risk in Ostrava Region - a Review.

AIM: The aim of this review was to collect all available data about air pollution in Ostrava, which is one of the most polluted area in central Europe and to make a concise assessment of health risks resulting from historical exposures of air pollutants since the beginning of the monitoring, i.e. since 1970 to the present time. METHODS: All available information sources (the Czech Hydrometeorological Institute, the Institute of Public Health in Ostrava or publications) were used. To evaluate the exposures both short-term (hourly and daily) data and long term (yearly) data during 45 years were analysed. For health risk assessment the relationship between exposure and biological effects of pollutants published by the WHO and the US EPA were employed. RESULTS: During the studied period annual average concentrations of PM10 ranged from 25 to 96 µg/m3; PM2.5 from 24 to 45 µg/m3; SO2 from 3.4 to 101.5 µg/m3; NO2 from 17.76 to 51.17 µg/m3; benzene from 0.24 to 9.2 µg/m3; benzo[a]pyrene from 2.1 to 14 ng/m3; arsenic from 1.2 to 9.5 ng/m3. Since the turn of the 80s and 90s of the 20th century trend of air pollutant concentrations has been decreasing until the turn of millennium, when it stopped, and it has been constant until present time. However, presented results demonstrate that the citizens of Ostrava have been exposed to relatively high concentrations of pollutants in comparison to other similar cities. The most significant pollutants contributing to health risks are airborne dust (PM10, PM2.5), benzene and benzo[a]pyrene. The long-term average health risk of PM10 has increased in case of postneonatal infant mortality up to 30%; prevalence of bronchitis in children up to 61%; and incidence of chronic bronchitis in adults up to 89%. The long-term average health risk of PM2.5 increased for all-cause mortality in persons aged 30+ years up to 22%; cardiopulmonary related mortality up to 25%; and lung cancer related mortality up to 39%. The highest carcinogenic risk is observed in benzo[a]pyrene, when the range of individual lifetime carcinogenic risk is up to 1.25*10-3. This assessment is valid according to the strict carcinogenic risk by the WHO, while the maximum carcinogenic risk according the US EPA is 7.2*10-5. CONCLUSIONS: A significant reduction of the pollutants' concentrations in Ostrava in the nineties of the last century does not mean a required improvement of outdoor air quality to the desired level. Persisting episodes with a very strong short-term increase of the concentration of PM10 and PM2.5, as well as long-term load of these substances on the population is very high. Health risks from such burdens are likely to lead to a higher mortality and morbidity especially from specific diseases.

A Summary of Environmental Health Studies in the City of Ostrava and the Surrounding Region in the Czech Republic.

AIM: This study is concerned with environmental health studies conducted in Ostrava (Czech Republic) and the surrounding region since the early nineties. METHODS: Various databases, journals and reports, including internal or unpublished reports, were reviewed to assess the individual publications. A brief description of the studies and main results were collated. RESULTS: The city of Ostrava and the surrounding region is an important industrial centre in the Czech Republic with a long-term heavy environmental and occupational disease burden. In spite of the theoretically assessed decline of health risks related to decreasing concentrations of compounds in the environment in recent years, it still poses a disproportionally high risk for the city residents. There are a number of studies suggesting supportive evidence, but they are highly variable in their approach to this topic resulting in a high uncertainty of observed associations and consistency of results. Most of the studies were focused on specific contexts, without any relation to environmental factors. CONCLUSIONS: A more systematic approach is needed to assess environmental health burden of diseases especially in relation to air pollution, based on the prospective cohort study, that would lead to sufficient new evidence for accurate and updated description of the environmental health burden in Ostrava.

Bioaerosols in the Suburbs of Ostrava during a One Year Period.

AIM: The aim of this paper is to provide information about the concentrations of airborne bioaerosols (airborne bacteria, fungi and endotoxins) in outdoor suburban environments in Ostrava, Moravian-Silesian region, Czech Republic. METHODS: The methods were based on systematic bioaerosol monitoring during one calendar year, subsequent analysis of the samples and statistical processing. The regression, correlation analysis and analysis of variance for one factor and pairwise comparisons were performed on bioaerosol data to determine their dependence on season, daytime, temperature, humidity and dew point. RESULTS: The results show higher fungi concentrations especially in summer (corrected mean 365 colony forming units - CFU per m3) compared to other seasons (75-209 CFU/m3) and higher concentrations of bacteria in the evening (380 CFU/m3) compared to other parts of the day and seasons (in summer 206-252 CFU/m3 and in winter 81-87 CFU/m3). Concentrations of endotoxins were relatively low throughout the year, on average 0,056 endotoxin units (EU) per m3. CONCLUSIONS: The concentration of bioaerosol (bacteria, fungi and endotoxins) were found in ambient air at substantially lower levels than in an indoor environment. Although the concentrations of this bioaerosol greatly fluctuate with temperature, dew point, season and daytime, they do not represent increased health risks.

Asthma Exacerbations and Symptom Variability in Children Due to Short-term Ambient Air Pollution Changes in Ostrava, Czech Republic.

AIM: The Ostrava region suffers from high levels of air pollution during winter inversions. We investigated the association between short-term elevations of air pollutant concentrations and worsening of respiratory problems, use of asthma medication and restriction of daily activities in asthmatic patients in Ostrava. METHODS: One-hundred and forty-seven child and adolescent patients (aged 6-18 years) with a confirmed diagnosis of mild to moderate persistent asthma were included in the study. Participants' parents completed diaries covering the period of November 2013 to February 2014; this analysis included 18,228 person-days. Daily smoothed maps of outdoor concentrations of particulate matter (PM10), nitrogen dioxide (NO2) and sulphur dioxide (SO2) were constructed from routine monitoring data, and participants' daily exposures were estimated on the basis of time spent at home and at school. The associations between health outcomes and exposure to air pollutants were estimated using the multiple logistic regression method. RESULTS: The odds ratios (OR) of the combined outcome for wheezing and/or difficulty in breathing, per 10 µg/m³ increase in the mean 24-h exposure were 1.07 (95% confidence interval 1.04-1.11) for PM10, 1.30 (1.18-1.44) for NO2, and 1.37 (1.18-1.59) for SO2. Additional inhaler use (in addition to usual medication) was also more frequent at higher air pollutant concentrations; the odds ratios per 10 µg/m³ increase in the mean 24-h exposure were 1.05 (1.02-1.07) for PM10, 1.19 (1.10-1.30) for NO2, and 1.26 (1.11-1.43) for SO2. Associations were less consistent for other health outcomes. CONCLUSIONS: These results suggest moderately strong associations between air pollutant concentrations and respiratory difficulties among asthmatic children and adolescents. More detailed analyses are required to confirm these preliminary findings.

Associations between migraine and possible risk factors in the Czech Republic.

Introduction: Migraine is a widespread neurological disorder, growing increasingly common. However, the pathogenesis of the disease is often unclear and the evidence for the role of various risk factors is limited. This study aimed to identify risk factors associated with migraine and to contribute towards a better understanding of this disease. Methods: Data from 3,247 questionnaires were analyzed for associations between migraine and sex, age, BMI, degree of education, and air pollution, along with other factors such as contact with friends, physical condition, health, anxiety, and depression. A cross-sectional study was conducted with an approximately equal distribution of the sample by age, gender and two analysed regions. Data were presented using basic descriptive statistics using the chi-square test. The model output was presented using a crude odds ratio (OR) and a fully adjusted OR. Three hundred and eight-six individuals (12%) suffered from migraine. Results: In an adjusted model, the presented study found associations between the prevalence of migraine and sex, age, and level of education. Individuals with migraine statistically significantly more often suffered from depression, anxiety and other selected factors. However, the assumed significant association between the occurrence of migraine and pollution in the region has not been found.

Association between childhood leukaemia and exposure to power-frequency magnetic fields in Middle Europe.

OBJECTIVE: Higher levels of exposure to extremely low-frequency magnetic fields (ELF-MF) are associated with a slightly increased risk of childhood leukaemia. Compared with more-developed Western countries, higher exposure levels are evident in the Czech Republic, probably because of the different types of housing. In light of this, we aimed to examine the association between ELF-MF exposure and childhood leukaemia in the Czech Republic. METHODS: We conducted a paired case-control study. The cases (children with leukaemia) were age- sex- and permanent residence-matched to controls (children without leukaemia). Although this limited potential bias and confounding, it also limited our number of participants. RESULTS: The matched analyses included 79 case-control pairs. No significant association between ELF-MF exposure and childhood leukaemia was observed for exposures over 0.2 µT (odds ratio [OR]=0.93, confidence interval [CI]=0.45-1.93), 0.3 µT (OR=0.77, CI=0.34-1.75), or 0.4 µT (OR=0.9, CI=0.37-2.22). CONCLUSION: Despite higher levels of exposure in Middle and Eastern Europe, no indication of an association between ELF-MF exposure and childhood leukaemia was determined. This in contrast to the findings of previous studies conducted in different countries.

The Effectiveness of ddPCR for Detection of Point Mutations in Poor-Quality Saliva Samples.

BACKGROUND: The noninvasive collection of saliva samples for DNA analyses is simple, and its potential for research and diagnostic purposes is great. However, DNA isolates from such samples are often of inferior quality to those from blood. AIM: The aim of this study was to investigate the robustness and sensitivity of the ddPCR instrument for genetic analyses from saliva samples of poor quality by comparing their results to those obtained using an established method from blood samples. METHODS: Blood and saliva were collected from 47 university students, which was followed by manual isolation of DNA and analysis on droplet digital PCR (ddPCR). Results of analyses were supplemented with values of fractional abundances. RESULTS: ddPCR proved to be highly suitable for analysis of even low-quality saliva samples (concentrations as low as 0.79 ng/µL), especially when augmented by fractional abundance data. This combination yielded 100% agreement with results obtained from blood samples. CONCLUSION: This study verified the applicability of ddPCR as a sensitive and robust method of genetic diagnostic testing even from low-quality saliva isolates. This makes it potentially suitable for a wide range of applications and facilitates the performance of large epidemiological studies, even if sampling or sample processing is suboptimal.

Examination of in Factor V Leiden and Prothrombin II Thrombophilic Mutations in Czech Young Women Using ddPCR-Prevalence and Cost-Benefit Analysis.

BACKGROUND: Thrombophilic mutations in genes for factor V Leiden and factor II prothrombin are among the most important risk factors for developing the thromboembolic disease (TED), along with the use of oral contraceptives (OCs) or smoking. AIM: This study aimed to investigate the occurrence of risk factors in young women using droplet digital PCR (ddPCR) and, based on the results of this investigation, to perform a cost-benefit analysis of ddPCR-based screening in young women starting to take OCs compared to the treatment costs of patients who develop preventable TED in the Czech Republic. METHODS: In this cross-sectional study, female university students filled in a questionnaire and provided a blood sample for DNA isolation and ddPCR analysis of both aforementioned genetic risk factors. The results, along with data from literature and web search, were used for cost-benefit analysis valid for the Czech Republic. RESULTS: Out of 148 participants, 30 (20%) were smokers and 49 (33%) took OCs. A mutation was confirmed in 6 women (4.1%) in the factor V gene and in 3 women (2%) in the factor II gene, respectively. A model calculation on a cohort of 50,000 women starting to use contraceptives in the Czech Republic every year showed that at maximum compliance, (i.e., non-use of OC and smoking cessation), screening could prevent 68 cases of TED over the course of the mean period of OC use (5.7 years). Economically, the costs of testing in this cohort (2.25 mil. USD) would be significantly lower than prevented treatment costs (16 mil. USD at maximum compliance); the cost-benefit break-even point would be at 14.1% compliance. CONCLUSION: The cost-benefit analysis based on our results indicates that screening for factor V Leiden and factor II prothrombin in young women before starting to use OCs would, in the conditions of the Czech Republic, likely be highly economically effective.

Lifetime Carcinogenic Risk Proportions from Inhalation Exposures in Industrial and Non-Industrial Regions.

The aim of this work was to estimate the share of selected significant risk factors for respiratory cancer in the overall incidence of this disease and their comparison in two environmentally different burdened regions. A combination of a longitudinal cross-sectional population study with a US EPA health risk assessment methodology was used. The result of this procedure is the expression of lifelong carcinogenic risks and their contribution in the overall incidence of the disease. Compared to exposures to benzo[a]pyrene in the air and fibrogenic dust in the working air, several orders of magnitude higher share of the total incidence of respiratory cancer was found in radon exposures, for women 60% in the industrial area, respectively 100% in the non-industrial area, for men 24%, respectively 15%. The share of risks in workers exposed to fibrogenic dust was found to be 0.35% in the industrial area. For benzo[a]pyrene, the share of risks was below 1% and the share of other risk factors was in the monitored areas was up to 85%. The most significant share in the development of respiratory cancer in both monitored areas is represented by radon for women and other risk factors for men.

The mediating role of lung function on air pollution-induced cardiopulmonary mortality in elderly women: The SALIA cohort study with 22-year mortality follow-up.

BACKGROUND: Air pollution exposure is associated with reduced lung function and increased cardio-pulmonary mortality (CPM). OBJECTIVES: We analyzed the potential mediating effect of reduced lung function on the association between air pollution exposure and CPM. METHODS: We used data from the German SALIA cohort including 2527 elderly women (aged 51-56 years at baseline 1985-1994) with 22-year follow-up to CPM. Exposures to PM10, PM2.5, PM2.5 absorbance, NO2 and NOx were assessed by land-use regression modelling and back-extrapolated to estimate exposures at baseline. Lung function (FVC, FEV1) was measured by spirometry and transformed to GLI z-scores. Adjusted Cox proportional hazards and causal proportional hazards mediation analysis models were fitted. RESULTS: The survival analysis showed that reduced lung function (z-scores of FVC or FEV1 below 5% predicted) reflected significantly lower survival probability from CPM (p < 0.0001). Longterm exposures to NOx and NO2 were associated with increased risks of CPM (eg. HR = 1.215; 95%CI: 1.017-1.452 for IQR increase in NOx and HR = 1.209; 95%CI: 1.011-1.445 for IQR increase in NO2) after adjusting for reduced lung function and additional covariates. The associations of PM2.5 absorbance and CPM remained significant in models adjusted for FEV1/FVC, but the associations with PM10 and PM2.5 were not significant. The mediation analysis showed significant indirect effects of NO2 and NOx on CPM mediated through reduced FEV1 and FVC. The largest indirect effects were found for exposures to NO2 (HR = 1.037; 95%CI: 1.005-1.070) and NOx (HR = 1.028; 95%CI: 1.004-1.052) mediated through reduced FVC. The mediated proportion effect ranged from 13.9% to 19.6% in fully adjusted models. DISCUSSION: This study provides insights into the mechanism of reduced lung function in association between long-term air pollution exposure and CPM. The mediated effect was substantial for exposure to nitrogen oxides (NOx and NO2), but less pronounced for PM10 and PM2.5.

Evaluation of Fine and Ultrafine Particles Proportion in Airborne Dust in an Industrial Area.

The health impacts of suspended particulate matter (SPM) are significantly associated with size-the smaller the aerosol particles, the stronger the biological effect. Quantitative evaluation of fine and ultrafine particles (FP and UFP) is, therefore, an integral part of ongoing epidemiological studies. The mass concentrations of SPM fractions (especially PM2.5, PM1.0, PM0.25) were measured in an industrial area using cascade personal samplers and a gravimetric method, and their mass ratio was determined. The results of PM2.5, PM1.0 were also compared with the reference measurement at stationary stations. The mean ratios PM2.5/SPM, PM1.0/SPM, and PM1.0/PM2.5 were 0.76, 0.65, and 0.86, respectively. Surprisingly, a mass dominance of UFP with an aerodynamic diameter <0.25 µm (PM0.25) was found with mean ratios of 0.43, 0.57, 0.67 in SPM, PM2.5 and PM1.0. The method used showed satisfactory agreement in comparison with reference measurements. The respirable fraction may consist predominantly of UFP. Despite the measures currently being taken to improve air quality, the most biologically efficient UFP can escape and remain in the air. UFP are currently determined primarily as particle number as opposed to the mass concentration used for conventional fractions. This complicates their mutual comparison and determination of individual fraction ratios.

How serious are health impacts in one of the most polluted regions of Central Europe?

BACKGROUND: The long-term exposure to pollutants in ambient air is associated with higher mortality and occurrence of respiratory and cardiopulmonary diseases. The longitudinal cross-section study focuses on the associations between long-term exposures to carcinogenic and non-carcinogenic pollutants and the prevalence and incidence of such specific diseases including immunodeficiencies. METHODS: The data on health status from industrial and non-industrial regions were obtained from health documentation for a 5-year period from 2007 to 2011 and represent the whole population living in polluted (1,249,323 inhabitants) and unpolluted (631,387 inhabitants) regions. The data on concentrations of PM10, PM2,5, NO2, SO2, benzene and benzo[a]pyrene were collected. The concentrations of pollutants were estimated from measured data by using dispersion models. The average population-weighted concentration of pollutants, which is representative for a defined geographic area and time period from 2007 to 2011, was calculated from the obtained data. The logistic regression and the Mantel-Haenszel χ2 test were used to determine the odds ratios (OR) and p-values for a linear trend. Moreover, the relative risks of mortality and morbidity to specific diseases were calculated according to theoretical dose-response association published by World Health Organization (WHO). RESULTS: The probability of incidence of chronic obstructive pulmonary disease and bronchial asthma is statistically significantly higher in the population living in the polluted region compared to the population living in the unpolluted region. The association between long-term exposure to pollutants and the prevalence of immunodeficiency with predominantly antibody defects (D80) was confirmed. The strongest association was found for exposures to particulate matter (PM2,5). The prevalence of immunodeficiency with predominantly antibody defects was also observed in both regions depending on the age of the population and statistically significant difference was only found in the group of adults (20 and over). CONCLUSION: These associations encourage the hypothesis, that the long-term exposure to PM2.5 might cause the activation of cellular immune response. Further research is needed to explore the correlative immunoregulatory mechanism linking PM2.5 (or other pollutants - SO2) and immune cells. Nowadays, it is also believed that these associations are important in the increase of incidence of immune inflammatory response which is proven risk factor for cardiovascular disease (atherosclerotic disease, coronary heart disease and sudden cardiac death). Positive association between long-term exposure and prevalence of bronchial asthma and chronic obstructive pulmonary disease might be skewed due to important socio-economic factors (especially smoking).