The relationship between particulate air pollution and emergency hospital visits for hypertension in Beijing, China

Background

A number of epidemiological studies have examined the adverse effect of air pollution on mortality and morbidity. Also, several studies have investigated the associations between air pollution and specific-cause diseases including arrhythmia, myocardial infarction, and heart failure. However, little is known about the relationship between air pollution and the onset of hypertension.

Objective

To explore the risk effect of particulate matter air pollution on the emergency hospital visits (EHVs) for hypertension in Beijing, China.

Methods

We gathered data on daily EHVs for hypertension, fine particulate matter less than 2.5 μm in aerodynamic diameter (PM_2.5), particulate matter less than 10 μm in aerodynamic diameter (PM₁₀), sulfur dioxide, and nitrogen dioxide in Beijing, China during 2007. A time-stratified case-crossover design with distributed lag model was used to evaluate associations between ambient air pollutants and hypertension. Daily mean temperature and relative humidity were controlled in all models.

Results

There were 1,491 EHVs for hypertension during the study period. In single pollutant models, an increase in 10 μg/m³ in PM_2.5 and PM₁₀ was associated with EHVs for hypertension with odds ratios (overall effect of five days) of 1.084 (95% confidence interval (CI): 1.028, 1.139) and 1.060% (95% CI: 1.020, 1.101), respectively.

Conclusion

Elevated levels of ambient particulate matters are associated with an increase in EHVs for hypertension in Beijing, China.     

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.     

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.     

Exposures to PM₂.₅ components and heart rate variability in taxi drivers around the Beijing 2008 Olympic Games

Background

Carbonaceous and metallic components of particles have been shown to play a role in particles' effects on cardiac autonomic function as measured by heart rate variability (HRV). Previously we reported the association of HRV with marked changes in traffic-related particulate air pollution around the Beijing 2008 Olympic Games in a panel of taxi drivers.

Objective

We further investigated the relationship between exposures to the carbonaceous and metallic components of traffic-related particles and HRV in the same population.

Methods

Repeated measurements of in-car exposures to particulate matter ≤ 2.5 μm in aerodynamic diameter (PM_2.5), carbon monoxide and nitrogen oxides were conducted in a group of 14 taxi drivers for one work shift in four study periods around the Beijing 2008 Olympics. The quantities of organic/elemental carbons and 27 elements of the in-car PM_2.5 mass were determined laboratorially. Linear mixed-effects models were used to evaluate the impact of exposures to different PM_2.5 components on HRV while controlling for potential confounders.

Results

Taxi drivers' exposures to in-car PM_2.5 and its components showed dramatic changes across the four study periods around the Beijing 2008 Olympics. Differences in associations of in-car PM_2.5 components with HRV were found. An interquartile range (IQR: 917.9 ng/m³) increase in calcium was associated with a 5.48 millisecond [ms, 95% confidence interval (CI): 0.71, 10.24] increase in standard deviations of normal-to-normal (SDNN) intervals, while an IQR (4.1 ng/m³) increase in nickel was associated with a 1.53 ms (95% CI: 0.14, 2.92) increase in SDNN index. Additionally, a decline of 8.11 ms (95% CI: − 15.26, − 0.97) in SDNN per IQR (481.4 ng/m³) increase in iron was also found.

Conclusion

The results support associations of PM_2.5 metallic components with HRV in younger healthy individuals. Future studies are needed to clarify the interaction among different PM_2.5 components or the role of PM_2.5 mixtures.     

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.     

An emission-weighted proximity model for air pollution exposure assessment

Background

Among the most common spatial models for estimating personal exposure are Traditional Proximity Models (TPMs). Though TPMs are straightforward to configure and interpret, they are prone to extensive errors in exposure estimates and do not provide prospective estimates.

Method

To resolve these inherent problems with TPMs, we introduce here a novel Emission Weighted Proximity Model (EWPM) to improve the TPM, which takes into consideration the emissions from all sources potentially influencing the receptors. EWPM performance was evaluated by comparing the normalized exposure risk values of sulfur dioxide (SO₂) calculated by EWPM with those calculated by TPM and monitored observations over a one-year period in two large Texas counties. In order to investigate whether the limitations of TPM in potential exposure risk prediction without recorded incidence can be overcome, we also introduce a hybrid framework, a ‘Geo-statistical EWPM’. Geo-statistical EWPM is a synthesis of Ordinary Kriging Geo-statistical interpolation and EWPM. The prediction results are presented as two potential exposure risk prediction maps. The performance of these two exposure maps in predicting individual SO₂ exposure risk was validated with 10 virtual cases in prospective exposure scenarios.

Results

Risk values for EWPM were clearly more agreeable with the observed concentrations than those from TPM. Over the entire study area, the mean SO₂ exposure risk from EWPM was higher relative to TPM (1.00 vs. 0.91). The mean bias of the exposure risk values of 10 virtual cases between EWPM and ‘Geo-statistical EWPM’ are much smaller than those between TPM and ‘Geo-statistical TPM’ (5.12 vs. 24.63).

Conclusion

EWPM appears to more accurately portray individual exposure relative to TPM. The ‘Geo-statistical EWPM’ effectively augments the role of the standard proximity model and makes it possible to predict individual risk in future exposure scenarios resulting in adverse health effects from environmental pollution.     

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.     

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.     

Role of Saharan dust in the relationship between particulate matter and short-term daily mortality among the elderly in Madrid (Spain)

Background

Saharan dust outbreaks are a common phenomenon in the Madrid atmosphere. The current Directive 2008/50 CE governing air quality in European cities, draws no distinction between which particulate matter (PM₁₀, PM_2.5 or PM_10-2.5) would be the best indicator on days with/without Saharan dust intrusions. This study sought to identify the role played by Saharan dust in the relationship between particulate matter (PM₁₀, PM_2.5 and PM_10-2.5) concentrations and daily mortality among the elderly in the city of Madrid.

Methods

We conducted an ecological longitudinal time-series study on daily mortality among the over-75 age group, from 2003 to 2005. Poisson regression models were constructed for days with and without Saharan dust intrusions. The following causes of daily mortality were analysed: total organic causes except accidents (International Classification of Diseases-10th revision (ICD-10): A00-R99); circulatory causes (ICD-10: I00-I99); and respiratory causes (ICD-10: J00-J99). Daily mean PM₁₀, PM_2.5 and PM_10-2.5 levels were used as independent variables. Control variables were: other ambient pollutants (chemical, biotic and acoustic); trend; seasonalities; influenza epidemics; and autocorrelations between mortality series.

Results

While daily mean PM_2.5 concentrations in Madrid displayed a significant statistical association with daily mortality for all the above causes on days without Saharan dust intrusions, this association was not in evidence for PM₁₀ or PM_10-2.5 in the multivariate models. The relative risks (RRs) obtained for an increase of 10 μg/m³ in PM_2.5 concentrations were: 1.023 (1.010-1.036) for total organic causes; 1.033 (1.031-1.035) for circulatory causes; and 1.032 (1.004-1.059) for respiratory causes. On Saharan dust days, a significant statistical association was detected between PM₁₀ (though not PM_2.5 or PM_10-2.5) and mortality for all 3 causes analysed, with RRs statistically similar to those reported for PM_2.5.

Conclusions

The best air quality indicators for evaluating the short-term health effects of particulate matter in Madrid are therefore PM₁₀ concentrations on days with, and PM_2.5 concentrations on days without Saharan dust outbreaks. This fact should be taken into account in a European Directive regulating ambient air quality in almost all countries in the Mediterranean area.     

Visibility, air quality and daily mortality in Shanghai, China

This study was designed to assess the association between visibility and air quality, and to determine whether the variations in daily mortality were associated with fluctuations in visibility levels in Shanghai, China. Mortality data were extracted from the death certificates, provided by Shanghai Municipal Center of Disease Control and Prevention, and visibility data were obtained from Shanghai Municipal Bureau of Meteorology. Air quality data (PM₁₀, PM_2.5, PM_10-2.5, SO₂, NO₂ and O₃) were obtained from Shanghai Environmental Monitoring Center. Generalized additive model (GAM) with penalized splines was used to analyze the mortality, visibility, air pollution, and covariate data. Among various pollutants, PM_2.5 showed strongest correlation with visibility. Visibility, together with humidity, was found appropriate in predicting PM_2.5 (R-squared: 0.64) and PM₁₀ (R-squared: 0.62). Decreased visibility was significantly associated with elevated death rates from all causes and from cardiovascular disease in Shanghai; one inter-quartile range (8 km) decrease in visibility corresponded to 2.17% (95%CI: 0.46%, 3.85%), 3.36% (95%CI: 0.96%, 5.70%), and 3.02% (95%CI: − 1.32%, 7.17%) increase of total, cardiovascular and respiratory mortality, respectively. The effect estimates using predicted PM_2.5 and PM₁₀ concentrations were similar to those assessed using actual concentrations. This is the first study in Mainland China assessing the association between visibility and adverse health outcomes. Our findings suggest the possibility of using visibility as a surrogate of air quality in health research in developing countries where air pollution data might be scarce and not routinely monitored.     

Outdoor, but not indoor, nitrogen dioxide exposure is associated with persistent cough during the first year of life

Background and aims

Because their lungs and immune system are not completely developed, children are more susceptible to respiratory disease and more vulnerable to ambient pollution. We assessed the relation between prenatal and postnatal nitrogen dioxide (NO₂) levels and the development of lower respiratory tract infections (LRTI), wheezing and persistent cough during the first year of life.

Methods

The study population consisted of 352 children from a birth cohort in Valencia, Spain. Prenatal exposure to NO₂, a marker of traffic related air pollution was measured at 93 sampling sites spread over the study area during four different sampling periods of 7 days each. It was modeled for each residential address through land use regression using the empirical measurements and data from geographic information systems. Postnatal exposure was measured once inside and outside each home using passive samplers for a period of 14 days. Outcomes studied were any episode of LRTI during the child's first year of life diagnosed by a doctor (bronchitis, bronchiolitis or pneumonia), wheezing (defined as whistling sounds coming from the chest), and persistent cough (more than three consecutive weeks). Outcomes and potential confounders were obtained from structured questionnaires. Multiple logistic regression was used to identify associations.

Results

The cumulative incidence (CI) at first year of life was 30.4% for LRTI (23.0% bronchiolitis, 11.9% bronchitis and 1.4% pneumonia), 26.1% for wheezing and 6.3% for persistent cough. The adjusted odds ratio (95% confidence interval) per 10 μg/m³ increment in postnatal outdoor NO₂ concentration was 1.40 (1.02-1.92) for persistent cough. We also found some pattern of association with LRTI, bronchiolitis, bronchitis, wheezing and persistent cough in different prenatal periods, although it was not statistically significant.

Conclusions

Our results indicate that exposure to outdoor, but not indoor, NO₂ during the first year of life increases the risk of persistent cough.     

Community response to environmental noise and the impact on cardiovascular risk score

Objective

The objective of our study was to investigate and evaluate the relationship between road traffic noise and cardiovascular risk.

Methods

The study sample (n = 659; 36.9% male, 63.1% female university students, mean age 22.83 ± 1.58 years) included a group exposed to road traffic noise (n = 280, L_eq,24 h = 67 ± 2 dB(A)) and a control group (n = 379, L_eq,24 h = 58.7 ± 6 dB(A)). Subjective response was determined by a validated noise annoyance questionnaire. The ten year risk of developing a coronary heart disease event was quantified as an evaluation of cardiovascular risk (SCORE60, Framingham 10-year risk estimation and projection to the age of 60, relative risk SCORE chart).

Results

Cardiovascular risk scores were significantly higher in the exposed group based on the Framingham scores projected to the age of 60, SCORE60 (AOR = 2.72 (95% CI = 1.21-6.15)) and the relative risk SCORE chart (AOR = 2.81 (1.46-5.41)).

Conclusions

These findings highlight the association between road traffic noise and cardiovascular risk.     

Spatial variability in mortality inequalities, socioeconomic deprivation, and air pollution in small areas of the Barcelona Metropolitan Region, Spain

Background

There is evidence that geographic variability of social health inequalities continues to exist even after individual risk factors have been taken into account. However, relatively few studies have examined the contribution of exposure to air pollutants to those inequalities.

Objectives

To study the geographic variability of inequalities in mortality and their associations with socioeconomic and environmental inequalities in small areas of the metropolitan of Barcelona during the period 1994 to 2003.

Methods

As in the MEDEA Project, the small area unit was the census tract. Study population consisted of the residents of the metropolitan area of Barcelona. Response variables were all-cause and specific-cause standardized mortality ratio (SMR). Explanatory variables were deprivation index, summarizing socioeconomic variables of the census tracts, and estimates of air pollutant exposures. Bayesian hierarchical models were used in order to reduce the extra variability when using SMR and to assess associations between mortality and deprivation and air pollution.

Results

Statistically significant associations with deprivation were found for the causes of death related to consumption of tobacco and alcohol for men and, besides lung cancer, diet-related causes for women. Statistically significant pollution coefficients were only found in the metropolitan area of Barcelona and in men. A positive interaction between pollutants and the deprivation index was statistically significant for respiratory mortality and PM₁₀, and ischemic disease mortality and NO₂, both for men.

Conclusions

We found deprivation to be associated in a statistically significant way with the geographical variation in mortality in the census tracts of the metropolitan area of Barcelona, in the period 1994 to 2003. Those air pollutants more directly related with traffic modify some of these associations.     

The effect of particle size on cardiovascular disorders--the smaller the worse

Background

Previous studies observed associations between airborne particles and cardio-vascular disease. Questions, however, remain as to which size of the inhalable particles (coarse, fine, or ultrafine) exerts the most significant impact on health.

Methods

For this retrospective study, data of the total number of 23,741 emergency service calls, registered between February 2002 and January 2003 in the City of Leipzig, were analysed, identifying 5326 as being related to cardiovascular incidences. Simultaneous particle exposure was determined for the particle sizes classes < 100 nm (UFP), < 2.5 μm (PM2.5) and < 10 μm (PM10). We used a time resolution of 1 day for both parameters, emergency calls and exposure.

Results

Within the group of cardiovascular diseases, the diagnostic category of hypertensive crisis showed a significant association with particle exposure. The significant effect on hypertensive crisis was found for particles with a size of < 100 nm in diameter and starting with a lag of 2 days after exposure. No consistent influence could be observed for PM2.5 and PM10. The Odds Ratios on hypertensive crisis were significant for the particle size < 100 nm in diameter from day 2 post exposure OR = 1.06 (95%CI: 1.02-1.10, p = 0.002) up to day 7 OR = 1.05 (95%CI 1.02-1.09, p = 0.005).

Conclusion

Ultrafine particles affect cardiovascular disease adversely, particularly hypertensive crises. Their effect is significant compared with PM2.5 and PM10. It appears necessary, from a public health point of view, to consider regulating this type of particles using appropriate measurands as particle number.     

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.     

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.     

Mapping of background air pollution at a fine spatial scale across the European Union

Background

There is a need to understand much more about the geographic variation of air pollutants. This requires the ability to extrapolate from monitoring stations to unsampled locations. The aim was to assess methods to develop accurate and high resolution maps of background air pollution across the EU.

Methods

We compared the validity of ordinary kriging, universal kriging and regression mapping in developing EU-wide maps of air pollution on a 1 × 1 km resolution. Predictions were made for the year 2001 for nitrogen dioxide (NO₂), fine particles < 10 µm (PM₁₀), ozone (O₃), sulphur dioxide (SO₂) and carbon monoxide (CO) using routine monitoring data in Airbase. Predictor variables from EU-wide databases were land use, road traffic, population density, meteorology, altitude, topography and distance to sea. Models were developed for the global, rural and urban scale separately. The best method to model concentrations was selected on the basis of predefined performance measures (R², Root Mean Square Error (RMSE)).

Results

For NO₂, PM₁₀ and O₃ universal kriging performed better than regression mapping and ordinary kriging. Validation of the final universal kriging estimates with results from all validation sites gave R²-values and RMSE-values of 0.61 and 6.73 µg/m³ for NO₂; 0.45 and 5.19 µg/m³ for PM₁₀; and 0.70 and 7.69 µg/m³ for O₃. For SO₂ and CO none of the three methods was able to provide a satisfactory prediction.

Conclusion

Reasonable prediction models were developed for NO₂, PM₁₀ and O₃ on an EU-wide scale. Our study illustrates that it is possible to develop detailed maps of background air pollution using EU-wide databases.     

Relative survival after exposure to polychlorinated biphenyls and dioxins: a follow-up of Japanese patients affected in the Yusho incident

Objectives

Little information is available on conditional survival among Yusho patients, who were accidentally exposed to PCBs and other dioxin-related compounds. In this study, we estimated relative survival among Yusho patients to quantify time trends in excess mortality compared to the general population.

Methods

A total of 1664 Yusho patients (860 males, and 804 females) were analyzed as Yusho cohort subjects. Relative survival ratio (RSR) was calculated as a measure of patient survival.

Results

Overall, 1-, 5-, 10-, and 15-year RSRs were 1.00 (95% confidence interval (CI): 0.99, 1.00), 1.00 (95% CI: 0.99, 1.01), 0.99 (95% CI: 0.98, 1.00), and 0.99 (95% CI: 0.98, 1.01), respectively. We did not observe meaningful increases or decreases in RSRs in either sex, which remained the same in all age groups for 1-, 5-, 10-, and 15-year RSRs.

Conclusions

This study provides quantitative evidence that Yusho patients have no significant difference in relative survival compared with the general Japanese population. Our results suggest that PCBs and dioxin exposure confers no excess mortality. This information may be important for both the clinical management of and patient coping with Yusho disease.     

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.