Short-term impact of particulate matter (PM2.5) on daily mortality among the over-75 age group in Madrid (Spain)

Background

The 2006 World Health Organization Air Quality Guidelines recommend using particulate matter having a diameter of under 2.5 micra (PM_2.5) rather than PM₁₀ as an indicator of air particle concentration, a pattern followed by new European directives. Nevertheless, few studies have analysed this new indicator's impact at a European level on daily mortality among a high-risk group, such as persons aged over 75 years.

Objective

This study sought to analyse and quantify the effect of PM_2.5 on daily cause-specific mortality among the over-75 age group in the city of Madrid.

Methods

Using Poisson regression with Generalized Additive Models (GAM), a longitudinal, ecological time-series study examined the following causes of death: all causes except accidents (International Classification of Diseases-9th revision (ICD 9): 1-799); circulatory causes (ICD 9: 390-459); and respiratory causes (ICD 9: 460-519). These were adjusted for other chemical, biotic and acoustic pollutants. Further control variables considered were: trend; seasonality; influenza epidemics; and autocorrelation between mortality series.

Results

A significant statistical association was detected between daily mean PM_2.5 particle concentrations and all-cause mortality in the city of Madrid. This association was not in evidence for PM₁₀ concentrations. The Relative Risks found for an increase of 25 µg/m³ in PM_2.5 concentrations were as follows: all-cause mortality, 1.057 (1.025-1.088); circulatory-cause mortality, 1.088 (1.041-1.135); and respiratory-cause mortality, 1.122 (1.056-1.189). The Attributable Risks were 5.41%, 8.12% and 10.90% respectively. This effect was observed in the short term (lags 1-2).

Conclusion

Our results indicate a strong impact of PM_2.5 concentrations on daily mortality among the over-75 age group in Madrid, and underscore the need for measures aimed at lowering the concentration levels of this primary air pollutant in large cities, particularly by reducing motor vehicle traffic, the main source of such pollutant emission in urban atmospheres.     

Is the association between temperature and mortality modified by age, gender and socio-economic status?

Background

A number of studies have examined the relationship between high ambient temperature and mortality. Recently, concern has arisen about whether this relationship is modified by socio-demographic factors. However, data for this type of study is relatively scarce in subtropical/tropical regions where people are well accustomed to warm temperatures.

Objective

To investigate whether the relationship between daily mean temperature and daily all-cause mortality is modified by age, gender and socio-economic status (SES) in Brisbane, Australia.

Methods

We obtained daily mean temperature and all-cause mortality data for Brisbane, Australia during 1996-2004. A generalised additive model was fitted to assess the percentage increase in all deaths with every one degree increment above the threshold temperature. Different age, gender and SES groups were included in the model as categorical variables and their modification effects were estimated separately.

Results

A total of 53,316 non-external deaths were included during the study period. There was a clear increasing trend in the harmful effect of high temperature on mortality with age. The effect estimate among women was more than 20 times that among men. We did not find an SES effect on the percent increase associated with temperature.

Conclusions

The effects of high temperature on all deaths were modified by age and gender but not by SES in Brisbane, Australia.     

Mortality due to lung, laryngeal and bladder cancer in towns lying in the vicinity of combustion installations

Background

Installations that burn fossil fuels to generate power may represent a health problem due to the toxic substances which they release into the environment.

Objectives

To investigate whether there might be excess mortality due to tumors of lung, larynx and bladder in the population residing near Spanish combustion installations included in the European Pollutant Emission Register.

Methods

Ecologic study designed to model sex-specific standardized mortality ratios for the above three tumors in Spanish towns, over the period 1994-2003. Population exposure to pollution was estimated on the basis of distance from town of residence to pollution source. Using mixed Poisson regression models, we analyzed: risk of dying from cancer in a 5-kilometer zone around installations that commenced operations before 1990; effect of type of fuel used; and risk gradient within a 50-kilometer radius of such installations.

Results

Excess mortality (relative risk, 95% confidence interval) was detected in the vicinity of pre-1990 installations for lung cancer (1.066, 1.041-1.091 in the overall population; 1.084, 1.057-1.111 in men), and laryngeal cancer among men (1.067, 0.992-1.148). Lung cancer displayed excess mortality for all types of fuel used, whereas in laryngeal and bladder cancer, the excess was associated with coal-fired industries. There was a risk gradient effect in the proximity of a number of installations.

Conclusions

Our results could support the hypothesis of an association between risk of lung, laryngeal and bladder cancer mortality and proximity to Spanish combustion installations.     

Sub-micrometer particulate air pollution and cardiovascular mortality in Beijing, China

Background

While the link between particulate matter and cardiovascular mortality is well established, it is not fully investigated and understood which properties of the aerosol might be responsible for the health effects, especially in polluted mega-city areas.

Objectives

Our goal was to explore the association between daily cardiovascular mortality and different particle metrics in the sub-micrometer range in Beijing, China.

Methods

We obtained daily counts of cause-specific cardiovascular deaths in the Beijing urban area for the period March 2004 to August 2005. Concurrently, continuous measurements of particle number size distributions were performed. Particle number concentrations (NC) between 0.003 μm and 0.8 μm were converted to particle mass and surface area concentrations assuming spherical particles. Semi-parametric Poisson regression models adjusting for trend, seasonality, day of the week, and meteorology were used to estimate immediate, delayed and cumulative particle effects. Additionally, effect modification by air mass origin was investigated.

Results

We observed associations between daily cardiovascular mortality and particle NC for a 2-days delay. Moreover, nearly all particle metrics showed 2-days delayed associations with ischemic heart disease mortality. The strongest association was found for particle NC in the size range 0.03-0.1 μm (7.1% increase in daily mortality with a 95%-confidence interval of 2.9%-11.5%, per an increase of 6250 particles/cm³). Results for surface and mass concentrations with a lag of two days indicated effect modification by air mass origin, whereas effects of particle NC were not modified.

Conclusions

Results show an elevated risk of cardiovascular mortality in Beijing from short-term exposure to particulate air pollution in the sub-micrometer range. Results also indicate that locally produced smaller particles and regionally transported particles may exhibit different effects in Beijing.     

An estimation of the health impact of groundwater pollution caused by dumping of chlorinated solvents

Background

Hazardous waste sites are major environmental concerns, but few studies have quantified their expected utility loss on health.

Objectives

To evaluate the health impact of groundwater pollution by an electronics manufacturing factory, we conducted a health risk assessment based on expected utility loss from liver cancer.

Methods

Based on measurements of major pollutants, we estimated the likelihood of developing liver cancer after exposure to groundwater contamination. All patients with liver cancer between 1990 and 2005 in the Taiwan Cancer Registry were followed through 2007 using the National Mortality Registry to obtain survival function. Quality of life was assessed with two cross-sectional surveys, one employing the standard gamble method, and the other using the EQ-5D instrument. Quality-adjusted life expectancy (QALE) was estimated by multiplying the utility values with survival function under the unit of quality-adjusted life year (QALY). The difference of QALE between the cancer cohort and the age- and gender-matched reference population was calculated to represent the utility loss due to liver cancer.

Results

A total of 94,144 patients with liver cancer were identified. The average utility loss to development of liver cancer was 17.5 QALYs. Based on toxicological approach, we estimated that groundwater pollution caused 1.7 extra cases of liver cancer, with an overall loss of 29.8 QALYs. Based on epidemiological approach, the expected annual excess number of liver cancer would be 3.65, which would have been accumulated through the years, had the pollution not mitigated.

Conclusions

We demonstrated a practical approach for comparative health risk assessment using QALY as the common unit. This approach can be used for policy decisions based on possible health risks.     

Mercury exposure in female artisanal small-scale gold miners (ASGM) in Mongolia: An analysis of human biomonitoring (HBM) data from 2008

Background

Many poor in developing countries have turned to artisanal small-scale gold mining (ASGM) in an attempt to improve their situation. However, the mercury used to extract gold from ore is discharged in vaporized form into the environment, where it poses a hazard for human health.

Methods

As part of an environmental epidemiological study in Mongolia—to evaluate the burden of environmental mercury contamination—urine, blood and hair samples were collected from residents of areas with or without mercury contamination. A total of 200 blood, urine and hair samples were analyzed for mercury and divided into three subgroups according to mercury content: (1) occupational exposure (high/medium); (2) environmental exposure (low); and (3) no exposure. Internal mercury distributions of the subgroups were compared using the Kruskal-Wallis and Mann-Whitney U-test. The Chi-square test and likelihood ratio proportion were used to compare the findings with threshold limits.

Results

The highest values and greatest differences were seen in the urine samples (p < 0.001, Kruskal-Wallis). The occupational group showing the highest exposure with a median mercury level of 4.36 μg/l (control group: 0.10 μg/l, p < 0.001), 7.18 μg/g creatinine and 12 results above the threshold limit HBM I (Human Biomonitoring I). Even participants from the low-exposure subgroup showed elevated mercury levels (median 2.88 μg/l urine and 2.98 μg/g creatinine, p < 0.001), with 10 individuals above the HBM I threshold limits.

Discussion

The body burden resulting from the use of mercury in artisanal gold mining is high not only in the miners themselves, an increased mercury hazard was also found for inhabitants of mining areas who were not actively involved in mining. Public health support measures are urgently needed to alleviate the situation.     

Sensitization to profilin in the Central region of Portugal

Background

Profilin is a panallergen found in pollens and fruits. Sensitization to this protein may explain some sensitization to multiple pollen species. We aimed to evaluate sensitization to profilin in patients suffering from respiratory allergy sensitized to pollens, in the Central region of Portugal.

Methods

Patients were evaluated for asthma symptoms, rhinitis, conjunctivitis and food allergy. Skin prick tests (SPT) to aeroallergens including 12 different pollens and profilin (nPho d 2) were performed. The patients were divided into two study groups according to the region of residence: A — inland region and B — coastal region.

Results

A total of 370 patients were evaluated (277-group A; 93-group B). 65.9% showed positive skin prick tests and 76.2% were positive to pollens (87.1%-group A; 42.85%-group B; p < 0.0001). All the patients sensitized to pollens had rhinitis (p = 0.001). Sensitization to profilin was associated with pollen sensitization (p = 0.014). 43 patients were sensitized to profilin (40-group A; 3-group B; p = 0.006). 21.0% of patients sensitized to pollens, were also sensitized to profilin. 39 patients were sensitized to at least two pollens (p < 0.0001). Four profilin and pollen sensitized patients had oral allergy syndrome complaints to melon. This syndrome was related with profilin sensitization (p = 0.001).

Conclusions

It is advisable to perform SPT to profilin, particularly in the Inland region, for a better differential diagnosis between cross-reactivity and true sensitization to pollens. The results together with the medical history may support the choice for a specific immunotherapy option.     

Respiratory effects of indoor particles in young children are size dependent

Background

Extensive epidemiological studies have provided evidence of an association between elevated outdoor particulate air pollution and adverse health effects. However, while people typically spend majority of time indoors, there is limited knowledge on airborne indoor particles and on the correlation between the concentrations of indoor particles and health effects. Even insights into the influence of differently sized indoor particles on human health are still rare.

Objective

The association between differentially sized indoor air particles and the development of respiratory diseases was studied for three year aged children.

Methods

Short-term measurements of particle mass and number concentrations were carried out in children's rooms. Information on possible particle sources (smoking habits, type of heating, and traffic) and respiratory outcomes were obtained from questionnaires. Measured indoor particle concentrations were correlated with possible sources of indoor particles and with respiratory health impacts.

Results

Daily smoking, smoking more than 5 cigarettes per day at home and traffic density in front of the window of children's room were found to be related to indoor exposure by particles of different diameters. High indoor particle exposures were associated with an increased risk for the development of obstructive bronchitis and in some extent of non-obstructive bronchitis. The strongest impact was observed for the mass concentration of particles < 1 μm and the number concentration of particles > 0.5 μm. The risk increases still remain significant if tested for stability changing the number of adjustment variables or omitting randomly selected cases, respectively.

Conclusion

Our results show significant associations between indoor particle concentrations and the risks for respiratory diseases in young children. The applied short-term measurements can help to assess the health risks of indoor particles with different sizes within epidemiological studies.     

Relationship between the presence of newborn and the house dust endotoxin

Background

Exposure to house dust endotoxin induces of airways' inflammation. Endotoxin are produced by the Gram-negative bacteria, which are released into the stools and could contaminate domestic environment.

Objective

The newborn could contaminate his mattress by endotoxin.

Methods

The dusts of mattress and carpets of 97 newborn' dwellings were sampled at birth and after six months of life. Samplings were made in the bedroom from the baby and in the second place where the baby spent the longer time. The endotoxin concentration was measured by a quantitative Limulus assay and the bacterial contamination was evaluated using 3 selective agar media.

Results

Endotoxin concentration at birth was positively associated with the presence of both sibling and the number of inhabitants (p < 0.01). At 6 months of life, the endotoxin concentration raised significantly not only in the mattresses (from a median of 17.6 (ranges: 0.4-346.7) to 79.6 (3.8-518.8) EU/mg) (p < 0.0001), but also in the dust from the second place where the baby is sleeping (from 20.4 (0.8-226.3) to 101.8 (6.5-634.3) EU/mg) (p < 0.001). Importantly, there was no change in endotoxin concentration from the carpets dust, and the environmental dwelling characteristics remained unchanged. The total bacterial contamination was also positively associated with endotoxin concentration in newborn mattress at birth (p < 0.01) and showed a significant increase at 6 months of life of the newborn (p < 0.01).

Conclusion

The newborn is a significant source of house dust's endotoxin.     

The effect of various temperature indicators on different mortality categories in a subtropical city of Brisbane, Australia

Background

The relationship between temperature and mortality has been explored for decades and many temperature indicators have been applied separately. However, few data are available to show how the effects of different temperature indicators on different mortality categories, particularly in a typical subtropical climate.

Objective

To assess the associations between various temperature indicators and different mortality categories in Brisbane, Australia during 1996-2004.

Methods

We applied two methods to assess the threshold and temperature indicator for each age and death groups: mean temperature and the threshold assessed from all cause mortality was used for all mortality categories; the specific temperature indicator and the threshold for each mortality category were identified separately according to the minimisation of AIC. We conducted polynomial distributed lag non-linear model to identify effect estimates in mortality with one degree of temperature increase (or decrease) above (or below) the threshold on current days and lagged effects using both methods.

Results

Akaike's Information Criterion was minimized when mean temperature was used for all non-external deaths and deaths from 75 to 84 years; when minimum temperature was used for deaths from 0 to 64 years, 65-74 years, ≥ 85 years, and from the respiratory diseases; when maximum temperature was used for deaths from cardiovascular diseases. The effect estimates using certain temperature indicators were similar as mean temperature both for current day and lag effects.

Conclusion

Different age groups and death categories were sensitive to different temperature indicators. However, the effect estimates from certain temperature indicators did not significantly differ from those of mean temperature.     

Time trends of persistent organic pollutants in Sweden during 1993-2007 and relation to age, gender, body mass index, breast-feeding and parity

Background

Persistent organic pollutants (POPs) are lipophilic chemicals that bioaccumulate. Most of them were resticted or banned in the 1970s and 1980s to protect human health and the environment. The main source for humans is dietary intake of dairy products, meat and fish. Little data exist on changes of the concentration of POPs in the Swedish population over time.

Objective

To study if the concentrations of polychlorinated biphenyls (PCBs), DDE, hexachlorobenzene (HCB) and chlordanes have changed in the Swedish population during 1993-2007, and certain factors that may influence the concentrations.

Methods

During 1993-2007 samples from 537 controls in different human cancer studies were collected and analysed. Background information such as body mass index, breast-feeding and parity was assessed by questionaires. Wilcoxon rank-sum test was used to analyse the explanatory factors specimen (blood or adipose tissue), gender, BMI, total breast-feeding and parity in relation to POPs. Time trends for POPs were analysed using linear regression analysis, adjusted for specimen, gender, BMI and age.

Results

The concentration decreased for all POPs during 1993−2007. The annual change was statistically significant for the sum of PCBs −7.2%, HCB −8.8%, DDE −13.5% and the sum of chlordanes −10.3%. BMI and age were determinants of the concentrations. Cumulative breast-feeding > 8 months gave statistically significantly lower concentrations for the sum of PCBs, DDE and the sum of chlordanes. Parity with > 2 children yielded statistically significantly lower sum of PCBs.

Conclusions

All the studied POPs decreased during the time period, probably due to restrictions of their use.     

The association between fine particulate air pollution and hospital emergency room visits for cardiovascular diseases in Beijing, China

Background

Because epidemiological studies have yielded different results, the association between exposure to fine particulate matter less than 2.5 μm in aerodynamic diameter (PM_2.5) and acute events of cardiovascular diseases (CVD) is unknown. Additionally, no research has been conducted to explore the association between PM_2.5 and hospital emergency room (ER) visits of cardiovascular diseases in Beijing, China.

Objective

To explore the association between PM_2.5 and the hospital ER visits in Beijing, China for CVD {(International Classification of Diseases, 10th vision (ICD-10): I00~I99)}.

Methods

We collected data for daily hospital ER visits for CVD from the Peking University Third Hospital, daily ambient PM_2.5 data from a fixed monitor site at Peking University, and data on the daily level of gaseous air pollutants {sulfur dioxide (SO₂) and nitrogen dioxide (NO₂)} from the Beijing Municipal Environmental Monitoring Center between June 1, 2004 and December 31, 2006. A time-stratified case-crossover design was used to evaluate associations between CVD health outcomes and ambient air pollutants.

Results

8377 hospital ER visits of CVD were collected in our study. After adjusting the temperature and the relative humidity, the associations for 10 μg/m³ increases in levels of PM_2.5, SO₂, or NO₂ and hospital ER visits for cardiovascular diseases were statistically significant with odds ratios (ORs) of 1.005{95% confidence interval (CI): 1.001-1.009}, 1.014(95% CI: 1.004-1.024), and 1.016(95% CI: 1.003-1.029), respectively.

Conclusion

These findings suggest that elevated levels of ambient air pollutants are associated with the increase in hospital ER visits for CVD in Beijing, China.     

Heavy metal exposure in patients suffering from electromagnetic hypersensitivity

Background

Risks from electromagnetic devices are of considerable concern. Electrohypersensitive (EHS) persons attribute a variety of rather unspecific symptoms to the exposure to electromagnetic fields. The pathophysiology of EHS is unknown and therapy remains a challenge.

Objectives

Heavy metal load has been discussed as a potential factor in the symptomatology of EHS patients. The main objective of the study was to test the hypothesis of a link between EHS and heavy metal exposure.

Methods

We measured lead, mercury and cadmium concentrations in the blood of 132 patients (n = 42 males and n = 90 females) and 101 controls (n = 34 males and n = 67 females).

Results

Our results show that heavy metal load is of no concern in most cases of EHS but might play a role in exceptional cases.

Conclusions

The data do not support the general advice to heavy metal detoxification in EHS.     

Short-term effect of fine particulate matter (PM2.5) on daily mortality due to diseases of the circulatory system in Madrid (Spain)

Introduction

Owing to their small size, fine particles, i.e., those having a diameter ≤ 2.5 μm (PM_2.5), have a high alveolar penetration capacity, thereby triggering a local inflammatory process with circulatory repercussion. Despite being linked to respiratory and cardiovascular morbidities, there is limited evidence of an association between this type of particulate matter and short-term increases in mortality.

Objective

The aim of this study was to analyse and quantify the short-term impact of PM_2.5 on daily mortality due to diseases of the circulatory system, registered in Madrid from 1 January 2003 to 31 December 2005.

Methods

An ecological longitudinal time-series study was conducted, with risks being quantified by means of Poisson regression models. As a dependent variable, we took daily mortality registered in Madrid from 1 January 2003 to 31 December 2005, attributed to all diseases of the circulatory system as classified under heads I00-I99 of the International Classification of Diseases-10th revision (ICD-10) and broken down as follows: I21, acute myocardial infarction (AMI); I20, I22-I25, other ischemic heart diseases; and I60-I69, cerebrovascular diseases. The independent variable was daily mean PM_2.5 concentration. The other variables controlled for were: chemical pollution (PM₁₀, O₃, SO₂, NO₂ and NO_x); acoustic and biotic pollution; influenza; minimum and maximum temperatures; seasonalities; trend; and autocorrelation of the series.

Results

A linear relationship was observed between PM_2.5 levels and mortality due to diseases of the circulatory system. For every increase of 10 μg/m³ in daily mean PM_2.5 concentration, the relative risks (RR) were as follows: for overall circulatory mortality, associations were established at lags 2 and 6, with RR of 1.022 (1.005-1.039) and 1.025 (1.007-1.043) respectively; and for AMI mortality, there was an association at lag 6, with an RR of 1.066 (1.032-1.100). The corresponding attributable risks percent (AR%) were 2.16%, 2.47% and 6.21% respectively. No statistically significant association was found with other ischemic heart diseases or with cerebrovascular diseases.

Conclusion

PM_2.5 concentrations are an important risk factor for daily circulatory-cause mortality in Madrid. From a public health point of view, the planning and implementation of specific measures targeted at reducing these levels constitute a pressing need.     

High temperature effects on out-patient visits and hospital admissions in Chiang Mai, Thailand

Objectives

This study investigated the short-term effects of temperature on out-patient visits and hospital admissions in Chiang Mai, Thailand. While mortality outcomes in the literature have been reported, there is less evidence of morbidity effects with very few studies conducted in developing countries with subtropical or tropical climate.

Methods

Time-series regression analysis was employed using generalized negative binomial regression to model the short-term relationships between temperature and morbidity after controlling for seasonal patterns and other potential confounders. Lag effects up to 13 days and effect modification by age (0-14 years, 15-64 years, ≥ 65 years) were examined.

Results

Temperature effects with wide confidence intervals were found, with an increase in diabetic visits of 26.3% (95% CI: 7.1%-49.0%), and circulatory visits of 19.2% (95% CI: 7.0%-32.8%) per 1 °C increase in temperature above an identified threshold of 29 °C. Additionally, there was a rise of both visits (3.7% increase, 95% CI: 1.5%-5.9%) and admissions (5.8% increase, 95% CI: 2.3%-9.3%) due to intestinal infectious disease in association with each 1 °C increase across the whole temperature range. The effects of temperature were stronger in the elderly though not statistically significant.

Conclusions

Daily morbidity in Chiang Mai was positively associated with temperature with a lag effect of up to 2 weeks, which was longer than lag effects previously reported. Public health preparedness and interventions should be considered to minimise possible increased hospital visits and admissions during hot weather.     

Lead exposure is associated with a delay in the onset of puberty in South African adolescent females: Findings from the Birth to Twenty cohort

Introduction

One of the suggested, yet under-researched, causes of pubertal delay is lead exposure. In South Africa blood lead levels are generally higher than in resource-rich countries. Thus the effects of lead exposure on pubertal development may be significant.

Objective

The objective of this study is to determine the association between lead exposure and pubertal development in adolescent females in the Birth to Twenty cohort (Bt20).

Methods

Bt20 is a Johannesburg based birth cohort study that commenced in 1990 and includes 1682 girls. At 13 years of age venous blood samples were collected from 725 adolescent female participants for lead content analyses; of these, 712 had menarche data. Pubertal measurement was based on age of menarche and self-reported Tanner staging for pubic hair (n = 684) and breast development (n = 682).

Results

The mean blood lead level for the sample was 4.9 μg/dl. Fifty percent had blood lead levels < 5.0 μg/dl, 49% were ≥ 5.0 μg/dl and 1% was > 10.0 μg/dl. The average age of menarche was 12.7 years. At 13 years, 4% and 7% had reached Tanner stage 5 for pubic hair and breast development, respectively. Analyses showed that higher blood lead levels were associated with significant delays in the onset of puberty (p < 0.001).

Conclusion

The study found that higher blood lead levels were associated with a delay in the onset of puberty, after adjustment for confounders. Lead exposure in resource-poor countries is generally higher compared to resource-rich countries and thus the effects of high blood levels have personal and public health significance.     

Health impacts associated with the implementation of a national petrol-lead phase-out program (PLPOP): evidence from Taiwan between 1981 and 2007

Background and objective

In 1981, a petrol-lead phase-out program (PLPOP) was launched in Taiwan for the abatement of environmental lead emissions. The present study was set out to examine whether the reduction of environmental lead emissions would result in the decrease in mortality rates of various diseases based on national data between 1981 and 2007.

Method

The national mortality data were obtained from the Office of Statistics of the Taiwan Department of Health (Taiwan DOH). Standardized mortality ratios (SMRs) were calculated based on 2000 WHO world standard population. Gasoline consumptions were obtained from the Bureau of Energy.

Results

The mean blood lead levels (BLLs) had decreased dramatically from approximately 20.14 μg/dl in the leaded petrol phase to 3 μg/dl or lower in the unleaded petrol phase. From 1981 to 2007, the mortality (per 100,000 people) was decreased from 146.2 to 43.8 for cerebrovascular disease, from 85.3 to 44.4 for heart disease, from 35.4 to 6.6 for hypertensive disease, from 21.3 to 17.3 for nephrosis, and from 810.2 to 491.6 for all causes. By taking the confounders (including economic growth rate, per capita income, tobacco consumption, and medical resources) into account, the decreases in SMRs for all causes, cerebrovascular disease, and nephrosis were found to be highly correlated with the decrease in petrol lead emissions (p-values = 0.001, < 0.001, 0.020, respectively).

Conclusion

Our results clearly show that the implementation of the PLPOP was associated with a decline in mortality rates in several diseases that have been associated with lead exposure, even after adjustment for a number of relevant confounders.     

Mortality due to tumours of the digestive system in towns lying in the vicinity of metal production and processing installations

Background

Releases to the environment of pollutants from industrial metal production and processing installations can pose a health problem to humans, owing to the toxic substances that such emissions contain.

Objectives

To investigate whether there might be excess mortality due to tumours of the digestive system among the population residing near Spanish metal production and processing installations included in the European Pollutant Emission Register.

Methods

Ecological study designed to examine mortality due to malignant tumours of the digestive system (oral cavity and pharynx, oesophagus, stomach, pancreas, liver, gallbladder, and colon-rectum) at the municipal level, over the period 1994-2003. Population exposure to pollution was estimated on the basis of distance from town of residence to the pollution source. Using mixed Poisson regression models, we analysed: risk of dying from cancer in a 5-kilometre zone around installations by year of commencement of operations; effect of pollution discharge route (air or water) and type of industrial activity; and risk gradient within a 50-kilometre radius of such installations.

Results

Excess mortality (relative risk, 95% confidence interval) was detected in the vicinity of pre-1990 installations for colorectal cancer (1.05, 1.02-1.08 in men; 1.04, 1.00-1.07 in women) and liver cancer (1.06, 1.00-1.12 in men), with this risk being concentrated in installations that released pollution to air. On stratifying by type of industrial activity, statistically significant associations were also observed between the remaining tumours and certain metal production and processing activities. There was also a gradient effect in the proximity to a number of installations.

Conclusions

The results support the existence of an association between risk of dying due to some tumours of the digestive system and residential proximity to the Spanish metal production and processing installations studied.     

The short-term effect of air pollution on cardiovascular mortality in Tianjin, China: comparison of time series and case-crossover analyses

Background

Many studies have illustrated that ambient air pollution negatively impacts on health. However, little evidence is available for the effects of air pollution on cardiovascular mortality (CVM) in Tianjin, China. Also, no study has examined which strata length for the time-stratified case-crossover analysis gives estimates that most closely match the estimates from time series analysis.

Objectives

The purpose of this study was to estimate the effects of air pollutants on CVM in Tianjin, China, and compare time-stratified case-crossover and time series analyses.

Method

A time-stratified case-crossover and generalized additive model (time series) were applied to examine the impact of air pollution on CVM from 2005 to 2007. Four time-stratified case-crossover analyses were used by varying the stratum length (Calendar month, 28, 21 or 14 days). Jackknifing was used to compare the methods. Residual analysis was used to check whether the models fitted well.

Results

Both case-crossover and time series analyses show that air pollutants (PM₁₀, SO₂ and NO₂) were positively associated with CVM. The estimates from the time-stratified case-crossover varied greatly with changing strata length. The estimates from the time series analyses varied slightly with changing degrees of freedom per year for time. The residuals from the time series analyses had less autocorrelation than those from the case-crossover analyses indicating a better fit.

Conclusion

Air pollution was associated with an increased risk of CVM in Tianjin, China. Time series analyses performed better than the time-stratified case-crossover analyses in terms of residual checking.     

Maternal exposure to floricultural work during pregnancy, PON1 Q192R polymorphisms and the risk of low birth weight

Background

Although there is evidence from animal studies of impaired reproductive function by exposure to organophosphates (OP), the effects on birth weight have not been sufficiently evaluated in epidemiological studies. Paraoxonase (PON1) detoxifies organophosphates by cleavage of active oxons. Some PON1 gene polymorphisms could reduce the enzyme activity and increase susceptibility to OP toxicity.

Objective

To assess the association between maternal exposure to floriculture during pregnancy and the risk of low birth weight (< 2500 g) in their offspring, as well as to evaluate the interaction between this exposure and maternal genotype for PON1 Q192R polymorphisms.

Materials and methods

A cross sectional study was carried out in two Mexican states (States of Mexico and Morelos) with high frequencies of greenhouse activity. We interviewed and collected blood samples from 264 females (floriculturists or partners of floricultural workers) who became pregnant during the 10 years prior to the interview. The questionnaire measured socioeconomic characteristics, tobacco and alcohol consumption, diseases and occupational and reproductive history. We also applied a food frequency questionnaire. Information was obtained pertaining to 467 pregnancies. DNA was extracted from white cells, and PON1 genotype was determined by Restriction Fragment Length Polymorphism for Q192R polymorphisms. Results were analyzed with generalized estimating equations models.

Results

After adjusting for potential confounders, we detected a statistically significant interaction between maternal exposure to flower growing work during pregnancy and PON1 Q192R polymorphisms on risk of low birth weight. The risk of having a baby with LBW is nearly six times higher if a mother is a floriculture worker during pregnancy and has PON1 192RR genotype (OR 5.93, 95% CI 1.28, 27.5).

Conclusion

These results suggest that the interaction between maternal floriculture work during pregnancy and 192RR PON1 genotype increases the probability of having children with LBW.