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Dan Norback - One of the best experts on this subject based on the ideXlab platform.
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sources of indoor particulate matter pm and Outdoor Air Pollution in china in relation to asthma wheeze rhinitis and eczema among pre school children synergistic effects between antibiotics use and pm10 and second hand smoke
Environment International, 2019Co-Authors: Dan Norback, Zhuohui Zhao, Yinping Zhang, Chen Huang, Xin Zhang, Hua Qian, Yuexia Sun, Wei Liu, Juan Wang, Jan SundellAbstract:Abstract We studied indoor sources of indoor particulate matter (PM), Outdoor Air Pollution and antibiotic use in relation to asthma, rhinitis and eczema among pre-school children and investigated synergistic effects between PM and antibiotics use. Children (3-6y) from randomly selected day care centres in seven cities across China were included (n = 39,782). Data on ambient temperature and Air Pollution were collected from local monitoring stations. Data on indoor PM sources (ETS, burning of incense or mosquito coils and biomass for cooking), antibiotics use and health (doctor diagnosed asthma and rhinitis, lifetime eczema, current wheeze and current rhinitis) were assessed by a parental questionnAire. Associations were calculated by multilevel logistic regression. Asthma diagnosis was associated with Outdoor temperature, NO2 and burning mosquito coils. Rhinitis diagnosis was associated with NO2, ETS, gas cooking and burning biomass for cooking. Lifetime eczema was associated with temperature, PM10, NO2, ETS, biomass cooking and burning mosquito coils. Burning incense was associated with current wheeze and current rhinitis. Children using antibiotics had more asthma, wheeze, rhinitis, and eczema. Excluding children with respiratory infections did not change associations with antibiotics use. Antibiotics use enhanced the effects of ETS and PM10 (a synergistic effect). In conclusion, a warmer climate, Outdoor NO2 and PM10, ETS, gas cooking and burning biomass, incense and mosquito coils can increase the risk of asthma, wheeze, rhinitis and eczema among pre-school children in China. Antibiotics use is a risk factor for childhood asthma, wheeze, rhinitis and eczema and ETS and Outdoor PM10 can enhance the effect.
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onset and remission of childhood wheeze and rhinitis across china associations with early life indoor and Outdoor Air Pollution
Environment International, 2019Co-Authors: Dan Norback, Zhuohui Zhao, Jan Sundell, Yinping Zhang, Chen Huang, Xin Zhang, Hua Qian, Yuexia Sun, Wang Juan, Wei LiuAbstract:Abstract Objective Few longitudinal studies exist on childhood exposure to indoor and Outdoor Air Pollution and respiratory illness in China. We studied associations between indoor and Outdoor environment and prevalence, onset and remission of wheeze and rhinitis among children across China. Methods Children (3–6 y) were recruited from randomized day care centres in six cities. The main data analysis was restricted to children not moving since birth (N = 17,679). Data on wheeze, rhinitis and the home environment were assessed by a parental questionnAire. Prevalence in the first two years of life (baseline) and the last year (follow-up) was used to calculate onset and remission. Outdoor PM2.5, PM10, and NO2 at the day care centre were modelled from monitoring station data. Associations were calculated by multilevel logistic regression. Results Prenatal NO2 was associated with decreased remission of wheeze and increased prevalence and increased onset of rhinitis. Prenatal PM2.5 was associated with increased prevalence of wheeze. Postnatal NO2 and postnatal PM10 were associated with increased prevalence and lower remission of wheeze and rhinitis. Mould, window pane condensation, renovation and cockroaches at home were associated with increased prevalence and increased onset of wheeze and rhinitis. Gas cooking was associated with increased onset of rhinitis. Children of mothers with industrial work had more wheeze. Conclusions Outdoor PM2.5, PM10 and NO2 can increase childhood wheeze and rhinitis. Dampness and mould can increase onset and decrease remission. Crowdedness, cockroaches at home and emissions from new building materials and gas cooking can be risk factors for wheeze and rhinitis.
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asthma and rhinitis among chinese children indoor and Outdoor Air Pollution and indicators of socioeconomic status ses
Environment International, 2018Co-Authors: Zhuohui Zhao, Dan Norback, Yinping Zhang, Chen Huang, Xin Zhang, Hua Qian, Yuexia Sun, Juan Wang, Jan SundellAbstract:Abstract Background Few data exist on asthma and rhinitis across China in relation to indoor and Outdoor Air Pollution, climate and socioeconomic factors. The main aim was to study associations between asthma, rhinitis and current respiratory symptoms among pre-school children across China and selected indoor and Outdoor exposure and indicators of socio-economic status (SES) in mutually adjusted models. Methods Chinese children (3–6 yr.) (n = 39,782) were recruited from randomly selected day care centres in seven cities in China. Data on asthma, respiratory symptoms, rhinitis, indoor and Outdoor exposure at home and SES were assessed by a parentally administered questionnAire. Lifetime mean ambient temperature, PM 10 , NO 2, and GDP per capita on city level were calculated. Results Totally 7.4% had ever doctors' diagnosed (DD) asthma and 8.7% DD-rhinitis, 19.7% had current wheeze, 45.0% rhinitis and 16.9% cough. DD-asthma was associated with ambient temperature (OR = 1.15, 95% CI 1.11–1.20 per °C), NO 2 (OR = 1.16, 95% CI 1.02–1.33 per 10 μg/m 3 ), indoor mould/dampness (OR = 1.25, 95% CI 1.13–1.39) and living near major roads (OR = 1.13, 95% CI 1.02–1.25). DD-rhinitis was associated with ambient temperature (OR = 1.07, 95% CI 1.05–1.10 per °C), NO 2 (OR = 1.20, 95% CI 1.09–1.32 per 10 μg/m 3 ), GDP (OR = 1.03, 95% CI 1.01–1.06 per 10,000 RenMinBi/year), indoor mould/dampness (OR = 1.23, 95% CI 1.11–1.35), passive smoking (OR = 1.11, 95% CI 1.01–1.21), and living near major roads (OR = 1.14, 95% CI 1.03–1.25). Children in suburban or rural areas, in larger families (≥5 persons) and with prenatal farm exposure had less DD-asthma and DD-rhinitis. Conclusions Economic development level of the city, higher SES, ambient temperature, NO 2 , PM 10 , traffic Air Pollution and mould/dampness can be risk factors for asthma and rhinitis and respiratory symptoms among pre-school children in China. Breastfeeding, large family size and early-life farm exposure could be protective factors.
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exposure to Outdoor Air Pollution during trimesters of pregnancy and childhood asthma allergic rhinitis and eczema
Environmental Research, 2016Co-Authors: Qihong Deng, Dan Norback, Chan Lu, Yuguo Li, Jan SundellAbstract:Abstract Background Mounting evidence suggests that exposure to ambient Air Pollution is associated with the development of childhood allergic diseases, but the effect of prenatal exposure to Air Pollution on the risk of childhood asthma and allergy is unclear. Objectives We evaluated the association between maternal exposure to Outdoor Air Pollution during different trimesters of pregnancy and incidence of asthma, allergic rhinitis, and eczema in 2598 preschool children aged 3–6 years in China. Methods Children's lifetime incidence of allergic diseases was obtained using questionnAire. Individual exposure to Outdoor Air pollutants during trimesters of pregnancy was estimated by an inverse distance weighted (IDW) method based on the measured concentrations at monitoring stations. We used multiple logistic regression method to estimate the odds ratio (OR) of asthma, allergic rhinitis, and eczema for per interquartile range (IQR) increase in the exposure to Air pollutant in each trimester, which was adjusted for the effect of other Air pollutants and its effect in other trimesters by a multi-pollutant/trimester model. Results Incidence of asthma (6.8%), allergic rhinitis (7.3%), and eczema (28.6%) in children was associated with maternal exposure to traffic-related pollutant NO2 during entire pregnancy with OR (95% confidence interval [CI]) respectively 1.63 (0.99–2.70), 1.69 (1.03–2.77), and 1.37 (1.04–1.80). After adjustment for other pollutants and trimesters, we found the association was significant only in specific trimester: the first trimester for eczema (1.54, 1.14–2.09), the second trimester for asthma (1.72, 1.02–2.97), and the third trimester for allergic rhinitis (1.77, 1.09–2.89). Sensitivity analysis indicated that the trimester sensitive to the development of allergic diseases was stable. Conclusion Maternal exposure to traffic-related Air pollutant NO2 during pregnancy, especially in specific trimesters, is associated with an increased risk of developing asthma, rhinitis, and eczema in children. Our results support the hypothesis that childhood allergic diseases originate in fetal life and are triggered by traffic-related Air Pollution in sensitive trimesters.
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Outdoor Air Pollution meteorological conditions and indoor factors in dwellings in relation to sick building syndrome sbs among adults in china
Science of The Total Environment, 2016Co-Authors: Qihong Deng, Jan Sundell, Dan NorbackAbstract:Indoor environment is associated with the sick building syndrome (SBS), but little is known about the contribution of Outdoor Air Pollution and meteorological conditions to SBS. We studied associations between Outdoor Air Pollution, meteorological parameters and selected indoor exposure and building characteristics at home and weekly SBS symptoms in a standardized questionnAire study among 3485 randomly selected adults in China. Outdoor factors included particulate matters with diameter <10μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), Outdoor temperature (T), relative Air humidity (RH), and wind speed (WS) during last three months. Multiple logistic regression was applied calculating odds ratios (OR) with 95% confidence interval (95% CI). Asthma or allergic rhinitis (atopy) was associated with all types of SBS symptoms except fatigue. Indoor factors played a major role in SBS symptoms. Mold/dampness on the floor/ceiling was associated with fatigue OR=1.60 (1.11-2.30) and headache OR=1.80 (1.07-3.04). Moldy odor was associated with fatigue OR=1.59 (1.07-2.37) and dermal symptoms OR=1.91 (1.21-3.02). Window pane condensation in winter was associated with fatigue OR=1.73 (1.30-2.31) and throat symptoms OR=1.53 (1.01-2.31). Damp bed clothing was related with throat symptom OR=1.62 (1.09-2.40). Home redecoration was associated with fatigue OR=1.49 (1.07-2.06). Frequent window opening was associated with less nose symptoms OR=0.54 (0.36-0.82) and mechanical ventilation in the bathroom reduced dermal symptoms OR=0.66 (0.44-0.99). Females were more susceptible to redecoration and window pane condensation than men. No associations with SBS were observed for Outdoor Air pollutants or meteorological parameters in the final models combining indoor and Outdoor factors, although SO2, T, and RH were associated with some SBS symptoms (fatigue, eyes and nose symptoms) in the separate Outdoor models. In conclusion, indoor mold/dampness, Air Pollution from redecoration and poorer ventilation conditions in dwellings can be risk factors for SBS symptoms in an adult Chinese population, especially among females.
H R Anderson - One of the best experts on this subject based on the ideXlab platform.
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long term exposure to Outdoor Air Pollution and the incidence of chronic obstructive pulmonary disease in a national english cohort
Occupational and Environmental Medicine, 2015Co-Authors: Richard Atkinson, H R Anderson, Iain M Carey, Andrew J Kent, T P Van Staa, Derek G CookAbstract:Objectives The role of Outdoor Air Pollution in the incidence of chronic obstructive pulmonary disease (COPD) remains unclear. We investigated this question using a large, nationally representative cohort based on primary care records linked to hospital admissions. Methods A cohort of 812 063 patients aged 40– 89 years registered with 205 English general practices in 2002 without a COPD diagnosis was followed from 2003 to 2007. First COPD diagnoses recorded either by a general practitioner (GP) or on admission to hospital were identified. Annual average concentrations in 2002 for particulate matter with an aerodynamic diameter <10 mm (PM10) and <2.5 mm (PM2.5), nitrogen dioxide (NO2), ozone and sulfur dioxide (SO2 )a t 1 km 2 resolution were estimated from emission-based dispersion models. Hazard ratios (HRs) per interquartile range change were estimated from Cox models adjusting for age, sex, smoking, body mass index and area-level deprivation. Results 16 034 participants (1.92%) received a COPD diagnosis from their GP and 2910 participants (0.35%) were admitted to hospital for COPD. After adjustment, HRs for GP recorded COPD and PM10 ,P M2.5 and NO2 were close to unity, positive for SO2 (HR=1.07 (95% CI 1.03 to 1.11) per 2.2 mg/m 3 ) and negative for ozone (HR=0.94 (0.89 to 1.00) per 3 mg/m 3 ). For admissions HRs for PM2.5 and NO2 remained positive (HRs=1.05 (0.98 to 1.13) and 1.06 (0.98 to 1.15) per 1.9 mg/m 3 and 10.7 mg/m 3 , respectively). Conclusions This large population-based cohort study found limited, inconclusive evidence for associations between Air Pollution and COPD incidence. Further work, utilising improved estimates of Air Pollution over time and enhanced socioeconomic indicators, is required to clarify the association between Air Pollution and COPD incidence.
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systematic review and meta analysis of epidemiological time series studies on Outdoor Air Pollution and health in asia
Air Quality Atmosphere & Health, 2012Co-Authors: Richard Atkinson, Aaron Cohen, Sumi Mehta, H R AndersonAbstract:Asia is experiencing rapid increases in industrialization, urbanization, and motor vehicle transport with correspondingly high levels of Pollution. We undertook a systematic review and meta-analysis of the Asian time-series literature to assess the evidence from health effects of short-term exposure to Outdoor Air Pollution. Eighty-two studies provided estimates suitable for quantitative meta-analysis. Summary estimates for daily mortality and hospital admissions were calculated for particulate matter with aerodynamic diameters less than 10 and 2.5 μm (PM10 and PM2.5), nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide. For 10 μg/m3 increases in PM10, daily mean numbers of deaths increased by 0.27% (95% confidence interval: 0.12%, 0.42%), 0.86% (0.34%, 1.39%), and 0.36% (0.09%, 0.62%) for all cause, respiratory, and cardiovascular deaths, respectively. Associations in the 65+ age group tended to be larger than those for all ages combined. All other pollutants were positively associated with both mortality and hospital admissions. We found no evidence to suggest that the size and direction of PM10 estimates were modified by either the average level of particles in the city or the year of publication (a proxy for more up-to-date statistical methods and the most recent pollutant concentrations and sources). There were insufficient reports for PM2.5 to enable a quantitative meta-analysis. Our findings were generally consistent with the range of effects found in other parts of the world and suggest that global guidelines and health impacts based largely on evidence derived from the USA and Europe are likely to be reasonably reliable.
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chronic exposure to Outdoor Air Pollution and lung function in adults
Thorax, 2009Co-Authors: Lindsay J L Forbes, Alicja R Rudnicka, Derek G Cook, Tony Bush, John R Stedman, Peter H Whincup, Venediktos V Kapetanakis, D P Strachan, H R AndersonAbstract:Background: The extent to which chronic exposure to Outdoor Air pollutants influences lung function in adults is unclear. The aim of this study was to measure the association between chronic exposure to Outdoor Air pollutants and adult lung function. Methods: The relationship between measures of lung function (forced expiratory volume in 1 s (FEV1) and FEV1 as a percentage of forced vital capacity (FVC)) and average exposure to particulate matter <10 μm in diameter, nitrogen dioxide, sulfur dioxide and ozone was examined in four representative cross-sectional surveys of the English population aged ⩾16 in 1995, 1996, 1997 and 2001. Year-specific estimates were pooled using fixed effects meta-analysis. Results: Greater exposure to particulate matter <10 μm in diameter, nitrogen dioxide and sulfur dioxide was associated with lower adult FEV1. The size of the effect on population mean FEV1 was about 3% for particulate matter <10 μm, and 0.7% for nitrogen dioxide and sulfur dioxide, for a 10 μg/m3 increase in pollutant concentration. The effects were most marked in men, older adults and ex-smokers. FEV1 was not associated with ozone concentration. No associations were found between the pollutants and FEV1 as a percentage of FVC. Conclusions: Chronic exposure to Outdoor Air Pollution is associated with modestly reduced FEV1 in adults.
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short term associations between Outdoor Air Pollution and visits to accident and emergency departments in london for respiratory complaints
European Respiratory Journal, 1999Co-Authors: Richard Atkinson, Stephen Bremner, D P Strachan, H R Anderson, J M Bland, Ponce A De LeonAbstract:Many epidemiological studies have shown positive short-term associations between health and current levels of Outdoor Air Pollution. The aim of this study was to investigate the association between Air Pollution and the number of visits to accident and emergency (A&E) departments in London for respiratory complaints. A&E visits include the less severe cases of acute respiratory disease and are unrestricted by bed availability. Daily counts of visits to 12 London A&E departments for asthma, other respiratory complaints, and both combined for a number of age groups were constructed from manual registers of visits for the period 1992-1994. A Poisson regression allowing for seasonal patterns, meteorological conditions and influenza epidemics was used to assess the associations between the number of visits and six pollutants: nitrogen dioxide, ozone, sulphur dioxide, carbon monoxide, and particles measured as black smoke (BS) and particles with a median aerodynamic diameter of <10 microm (PM10). After making an allowance for the multiplicity of tests, there remained strong associations between visits for all respiratory complaints and increases in SO2: a 2.8% (95% confidence interval (CI) 0.7-4.9) increase in the number of visits for a 18 microg x (-3) increase (10th-90th percentile range) and a 3.0% (95% CI 0.8-5.2) increase for a 31 microg x m(-3) increase in PM10. There were also significant associations between visits for asthma and SO2, NO2 and PM10. No significant associations between O3 and any of the respiratory complaints investigated were found. Because of the strong correlation between pollutants, it was difficult to identify a single pollutant responsible for the associations found in the analyses. This study suggests that the levels of Air Pollution currently experienced in London are linked to short-term increases in the number of people visiting accident and emergency departments with respiratory complaints.
Haidong Kan - One of the best experts on this subject based on the ideXlab platform.
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association between ambient Air Pollution and outpatient visits for acute bronchitis in a chinese city
Biomedical and Environmental Sciences, 2014Co-Authors: Li Juan Guo, Ang Zhao, Renjie Chen, Haidong Kan, Xing Ya KuangAbstract:Objective To investigate the short-term association between Outdoor Air Pollution and outpatient visits for acute bronchitis, which is a rare subject of research in the mainland of China.
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association between long term exposure to Outdoor Air Pollution and mortality in china a cohort study
Journal of Hazardous Materials, 2011Co-Authors: Jie Cao, Renjie Chen, Haidong Kan, Bingheng Chen, Chunxue YangAbstract:No prior cohort studies exist in China examining the association of Outdoor Air Pollution with mortality. We studied 70,947 middle-aged men and women in the China National Hypertension Survey and its follow-up study. Baseline data were obtained in 1991 using a standard protocol. The follow-up evaluation was conducted in 1999 and 2000. Annual average Air Pollution exposure between 1991 and 2000, including total suspended particle (TSP), sulfur dioxide (SO(2)) and nitrogen oxides (NO(x)), were estimated by linking fixed-site monitoring data with resident zip code. We examined the association of Air Pollution with mortality using proportional hazards regression model. We found significant associations between Air Pollution levels and mortality from cardiopulmonary diseases and from lung cancer. Each 10 μg/m(3) elevation of TSP, SO(2) and NO(x) was associated with a 0.9% (95%CI: 0.3%, 1.5%), 3.2% (95%CI: 2.3%, 4.0%), and 2.3% (95%CI: 0.6%, 4.1%) increased risk of cardiovascular mortality, respectively. We found significant effects of SO(2) on mortality after adjustment for TSP. Conclusively, ambient Air Pollution was associated with increased cardiopulmonary and lung cancer mortality in China. These data contribute to the scientific literature on long-term effects of Air Pollution for high exposure settings typical in developing countries.
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health impact of Outdoor Air Pollution in china current knowledge and future research needs
Environmental Health Perspectives, 2009Co-Authors: Haidong Kan, Bingheng Chen, Chuanjie HongAbstract:Outdoor Air Pollution is one of China’s most serious environmental problems. Coal is still the major source of energy, constituting about 75% of all energy sources. Consequently, Air Pollution in China predominantly consists of coal smoke, with suspended particulate matter (PM) and sulfur dioxide (SO2) as the principal Air pollutants. In large cities, however, with the rapid increase in the number of motor vehicles, Air Pollution has gradually changed from the conventional coal combustion type to the mixed coal combustion/motor vehicle emission type. Currently, inhalable particles (PM <10 μm in aerodynamic diameter; PM10), SO2, and nitrogen dioxide (NO2) are the criteria pollutants of concern in China. Generally, PM levels in cities in the north are higher than those in the south, whereas SO2 and NO2 levels do not differ much. In 2004, the annual average PM10 concentrations for major Chinese cities were 102 μg/m3 in southern cities, 140 μg/m3 in northern cities, and 121 μg/m3 in cities nationwide. The annual average concentrations of SO2 and NO2 nationwide were 66 μg/m3 and 38 μg/m3, respectively (China State Environmental Protection Agency 2005). Although its ambient Air quality has improved substantially, China is still facing the worst Air Pollution problem in the world. Outdoor Air Pollution has become a major concern for public health. The World Bank (2007) estimated that the total health cost associated with Outdoor Air Pollution in urban areas of China in 2003 was between 157 and 520 billion Chinese yuan, accounting for 1.2–3.3% of China’s gross domestic product. Health end points studied in China in association with Air Pollution include all-cause mortality, mortality and morbidity due to cardiopulmonary disease, and numbers of outpatient and emergency department visits (Chen et al. 2004). Changes in respiratory and other clinical symptoms, lung function, and immune function are also studied. Dozens of time-series studies have been conducted in large Chinese cities, including Beijing, Shanghai, Chongqing, Shenyang, Wuhan, and Taiyuan, to assess the association of short-term exposure to Air Pollution with mortality or morbidity (Chen et al. 2004). Mortality or morbidity risk estimates per unit increase in Air Pollution level among Chinese populations are generally similar in magnitude to risks estimated in other parts of the world. A recent multicity time-series analysis in Hong Kong, Shanghai, and Wuhan provided further evidence of short-term risks (Wong et al. 2008), with significant health effects detected at Air Pollution levels below minimum Air quality standards in China. Currently, a new national-level Air Pollution time-series study, the China Air Pollution and Health Effects Study (CAPES), is under way. In addition, several ongoing panel studies are examining associations between Air Pollution and subclinical health outcomes before, during, and after the 2008 Summer Olympic Games in Beijing. These panel studies should provide a unique opportunity to assess the public health benefits of Air Pollution reduction in a city where Air Pollution levels have been high. Relatively few studies have examined long-term effects of Air Pollution in China. Several prospective cohort studies in North America and Europe have estimated effects of long-term exposure to Air Pollution on mortality (Pope and Dockery 2006), but it is not clear whether the findings from developed countries apply to China, given differences in the levels and characteristics of Air Pollution, and in sociodemographic characteristics. So far, there has been no cohort study of Air Pollution in China, but results of cross-sectional analyses in Beijing, Shenyang, and Benxi have suggested that long-term exposure to Air Pollution is associated with increased mortality (Chen et al. 2004). However, results of these analyses are difficult to interpret because of the lack of information on potential confounders. In short, there is sufficient evidence that exposure to Outdoor Air Pollution is a health hazard in China. The importance of these increased health risks is greater than in developed countries because Air Pollution in China is at much higher levels and because the Chinese population accounts for more than one-fourth of the world’s total population. Most of the Chinese studies discussed above were ecologic in nature, thus limiting their power for causal inference. Future research will need to clarify the lifetime course of Air Pollution effects with full control of potential confounders (e.g., prospective cohort studies), examine the relevance of cumulative exposures, disentangle effects of multiple pollutants, investigate gene–environment inter actions and other factors that may modify Air Pollution health effects, and identify pathophysiologic links between Air Pollution and health hazards for the Chinese population. Finally, Pollution needs to be reduced and Air quality and health indicators need to be monitored; this will enable the people and relevant authorities to be aware of the trends and consequences of Air Pollution, so they can determine how to ameliorate the situation.
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season sex age and education as modifiers of the effects of Outdoor Air Pollution on daily mortality in shanghai china the public health and Air Pollution in asia papa study
Environmental Health Perspectives, 2008Co-Authors: Haidong Kan, Stephanie J London, Guohai Chen, Yunhui Zhang, Guixiang Song, Naiqing Zhao, Lili Jiang, Bingheng ChenAbstract:BackgroundVarious factors can modify the health effects of Outdoor Air Pollution. Prior findings about modifiers are inconsistent, and most of these studies were conducted in developed countries.Ob...
Richard Atkinson - One of the best experts on this subject based on the ideXlab platform.
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long term exposure to Outdoor Air Pollution and the incidence of chronic obstructive pulmonary disease in a national english cohort
Occupational and Environmental Medicine, 2015Co-Authors: Richard Atkinson, H R Anderson, Iain M Carey, Andrew J Kent, T P Van Staa, Derek G CookAbstract:Objectives The role of Outdoor Air Pollution in the incidence of chronic obstructive pulmonary disease (COPD) remains unclear. We investigated this question using a large, nationally representative cohort based on primary care records linked to hospital admissions. Methods A cohort of 812 063 patients aged 40– 89 years registered with 205 English general practices in 2002 without a COPD diagnosis was followed from 2003 to 2007. First COPD diagnoses recorded either by a general practitioner (GP) or on admission to hospital were identified. Annual average concentrations in 2002 for particulate matter with an aerodynamic diameter <10 mm (PM10) and <2.5 mm (PM2.5), nitrogen dioxide (NO2), ozone and sulfur dioxide (SO2 )a t 1 km 2 resolution were estimated from emission-based dispersion models. Hazard ratios (HRs) per interquartile range change were estimated from Cox models adjusting for age, sex, smoking, body mass index and area-level deprivation. Results 16 034 participants (1.92%) received a COPD diagnosis from their GP and 2910 participants (0.35%) were admitted to hospital for COPD. After adjustment, HRs for GP recorded COPD and PM10 ,P M2.5 and NO2 were close to unity, positive for SO2 (HR=1.07 (95% CI 1.03 to 1.11) per 2.2 mg/m 3 ) and negative for ozone (HR=0.94 (0.89 to 1.00) per 3 mg/m 3 ). For admissions HRs for PM2.5 and NO2 remained positive (HRs=1.05 (0.98 to 1.13) and 1.06 (0.98 to 1.15) per 1.9 mg/m 3 and 10.7 mg/m 3 , respectively). Conclusions This large population-based cohort study found limited, inconclusive evidence for associations between Air Pollution and COPD incidence. Further work, utilising improved estimates of Air Pollution over time and enhanced socioeconomic indicators, is required to clarify the association between Air Pollution and COPD incidence.
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long term exposure to Outdoor Air Pollution and the prevalence of asthma meta analysis of multi community prevalence studies
Air Quality Atmosphere & Health, 2013Co-Authors: Ross H Anderson, Graziella Favarato, Richard AtkinsonAbstract:The effect of Outdoor Air Pollution on variations in asthma prevalence is unclear. We have conducted a meta-analysis of multi-community studies to evaluate and quantify the evidence for an association between community levels of Pollution and asthma prevalence. We identified peer-reviewed articles reporting associations between community levels of Air Pollution and the prevalence of wheeze symptom or asthma diagnosis which were based on five or more communities. Associations were investigated by meta-analysis and by analysis of the direction and statistical significance of estimates. We identified 21 studies of more than five communities (range 6 to 62). The proportion of studies reporting at least one significantly positive association was 43% but, of the total of 178 Pollution-outcome estimates, only 11% were statistically significantly positive. Thirteen studies reported associations with Pollution analysed as a quantitative variable, and these results were meta-analysed. For period prevalence (mainly wheeze symptom), the results were null: Random effects estimates (95% confidence intervals) for the odds ratios of nitrogen dioxide, particulate matter with aerodynamic diameter <10 μm, ozone and sulphur dioxide were 1.00 (0.95, 1.06), 1.00 (0.94, 1.07), 1.01 (0.96, 1.07) and 1.03 (0.97, 1.09), respectively. For lifetime prevalence (mainly asthma diagnosis), the random effects estimates were similar: 1.00 (0.99, 1.01), 0.99 (0.96, 1.02), 1.06 (0.98, 1.14) and 1.00 (0.96, 1.05), respectively. We found no evidence of an association between community levels of Outdoor Air Pollution and asthma prevalence.
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systematic review and meta analysis of epidemiological time series studies on Outdoor Air Pollution and health in asia
Air Quality Atmosphere & Health, 2012Co-Authors: Richard Atkinson, Aaron Cohen, Sumi Mehta, H R AndersonAbstract:Asia is experiencing rapid increases in industrialization, urbanization, and motor vehicle transport with correspondingly high levels of Pollution. We undertook a systematic review and meta-analysis of the Asian time-series literature to assess the evidence from health effects of short-term exposure to Outdoor Air Pollution. Eighty-two studies provided estimates suitable for quantitative meta-analysis. Summary estimates for daily mortality and hospital admissions were calculated for particulate matter with aerodynamic diameters less than 10 and 2.5 μm (PM10 and PM2.5), nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide. For 10 μg/m3 increases in PM10, daily mean numbers of deaths increased by 0.27% (95% confidence interval: 0.12%, 0.42%), 0.86% (0.34%, 1.39%), and 0.36% (0.09%, 0.62%) for all cause, respiratory, and cardiovascular deaths, respectively. Associations in the 65+ age group tended to be larger than those for all ages combined. All other pollutants were positively associated with both mortality and hospital admissions. We found no evidence to suggest that the size and direction of PM10 estimates were modified by either the average level of particles in the city or the year of publication (a proxy for more up-to-date statistical methods and the most recent pollutant concentrations and sources). There were insufficient reports for PM2.5 to enable a quantitative meta-analysis. Our findings were generally consistent with the range of effects found in other parts of the world and suggest that global guidelines and health impacts based largely on evidence derived from the USA and Europe are likely to be reasonably reliable.
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short term associations between emergency hospital admissions for respiratory and cardiovascular disease and Outdoor Air Pollution in london
Archives of Environmental Health, 1999Co-Authors: Richard Atkinson, Ross H Anderson, Stephen Bremner, David P Strachan, Martin J Bland, Ponce A De LeonAbstract:Abstract There are concerns about the possible short-term effects of Outdoor Air Pollution on health in the United Kingdom. In a study conducted during the time period between 1987 and 1992, investigators determined that ozone had small, but significant effects on emergency respiratory admissions. In the current study, the authors investigated associations between emergency admissions and Outdoor Air Pollution for the time period from 1992 to 1994, inclusive, and compared the results with those obtained in the earlier study. The authors also examined particulate matter less than 10 μmlm in diameter (PM10) and carbon monoxide in the current study. Appropriate confounding factors, such as seasonal patterns, temperature, and humidity, were controlled for, and the authors used Poisson regression to estimate the association between daily emergency admissions for respiratory and cardiovascular diseases and ozone, nitrogen dioxide, sulfur dioxide, carbon monoxide, particles measured as Black Smoke, and PM10. Sig...
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short term associations between Outdoor Air Pollution and visits to accident and emergency departments in london for respiratory complaints
European Respiratory Journal, 1999Co-Authors: Richard Atkinson, Stephen Bremner, D P Strachan, H R Anderson, J M Bland, Ponce A De LeonAbstract:Many epidemiological studies have shown positive short-term associations between health and current levels of Outdoor Air Pollution. The aim of this study was to investigate the association between Air Pollution and the number of visits to accident and emergency (A&E) departments in London for respiratory complaints. A&E visits include the less severe cases of acute respiratory disease and are unrestricted by bed availability. Daily counts of visits to 12 London A&E departments for asthma, other respiratory complaints, and both combined for a number of age groups were constructed from manual registers of visits for the period 1992-1994. A Poisson regression allowing for seasonal patterns, meteorological conditions and influenza epidemics was used to assess the associations between the number of visits and six pollutants: nitrogen dioxide, ozone, sulphur dioxide, carbon monoxide, and particles measured as black smoke (BS) and particles with a median aerodynamic diameter of <10 microm (PM10). After making an allowance for the multiplicity of tests, there remained strong associations between visits for all respiratory complaints and increases in SO2: a 2.8% (95% confidence interval (CI) 0.7-4.9) increase in the number of visits for a 18 microg x (-3) increase (10th-90th percentile range) and a 3.0% (95% CI 0.8-5.2) increase for a 31 microg x m(-3) increase in PM10. There were also significant associations between visits for asthma and SO2, NO2 and PM10. No significant associations between O3 and any of the respiratory complaints investigated were found. Because of the strong correlation between pollutants, it was difficult to identify a single pollutant responsible for the associations found in the analyses. This study suggests that the levels of Air Pollution currently experienced in London are linked to short-term increases in the number of people visiting accident and emergency departments with respiratory complaints.
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Outdoor Air Pollution low birth weight and prematurity
Environmental Health Perspectives, 2000Co-Authors: Martin BobakAbstract:This study tested the hypothesis, suggested by several recent reports, that Air Pollution may increase the risk of adverse birth outcomes. This study analyzed all singleton live births registered by the Czech national birth register in 1991 in 67 districts where at least one pollutant was monitored in 1990-1991 (n = 108,173). Maternal exposures to sulfur dioxide (SO(2)), total suspended particles (TSP), and nitrous oxides (NO(x)) in each trimester of pregnancy were estimated as the arithmetic means of all daily measurements taken by all monitors in the district of birth of each infant. Odds ratios of low birth weight (< 2,500 g), prematurity (< 37 weeks of gestation), and intrauterine growth retardation (IUGR; < 10th percentile of birth weight for gestational age and sex) were estimated by robust logistic regression. The median (and 25th and 75th percentile) trimester exposures were 32 (18, 56) microg/m(3) for SO(2); 72 (55, 87) microg/m(3) for TSP; and 38 (23, 59) microg/m(3) for NO(x). Low birth weight (prevalence 5.2%) and prematurity (prevalence 4.8%) were associated with SO(2) and somewhat less strongly with TSP. IUGR was not associated with any pollutant. The effects on low birth weight and prematurity were marginally stronger for exposures in the first trimester, and were not attenuated at all by adjustment for socioeconomic factors or the month of birth. Adjusted odds ratios of low birth weight were 1.20 [95% confidence interval (CI), 1.11-1.30] and 1.15 (CI, 1.07-1.24) for a 50 microg/m(3) increase in SO(2) and TSP, respectively, in the first trimester; adjusted odds ratios of prematurity were 1.27 (CI, 1.16-1.39) and 1.18 (CI, 1.05-1.31) for a 50 microg/m(3) increase in SO(2) and TSP, respectively, in the first trimester. Low gestational age accounted for the association between SO(2) and low birth weight. These findings provide further support for the hypothesis that Air Pollution can affect the outcome of pregnancy.
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Outdoor Air Pollution low birth weight and prematurity
Environmental Health Perspectives, 2000Co-Authors: Martin BobakAbstract:This study tested the hypothesis, suggested by several recent reports, that Air Pollution may increase the risk of adverse birth outcomes. This study analyzed all singleton live births registered b...
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pregnancy outcomes and Outdoor Air Pollution an ecological study in districts of the czech republic 1986 8
Occupational and Environmental Medicine, 1999Co-Authors: Martin Bobak, David A LeonAbstract:OBJECTIVES: Outdoor Air Pollution has consistently been shown to predict mortality. The finding that this association is stronger in infants than in children or adults raises the question whether Air Pollution could also be related to pregnancy outcomes--such as birthweight and stillbirth. The association between Outdoor Air Pollution and stillbirths and low birthweight in the Czech Republic, where Air Pollution was high, was examined. METHODS: An ecological study was conducted, with routinely collected data on stillbirths and low birthweight (< 2500 g), Air Pollution (total suspended particulates, sulphur dioxide (SO2), and nitrogen oxides (NOx)), and socioeconomic factors (mean income, car ownership, divorce rate, etc). The analyses were restricted to 45 districts on which data on Air Pollution were available for the period 1986-8. The effects of exposure variables on frequency of pregnancy outcomes were estimated by logistic regression with district-years as the units of analysis. RESULTS: Stillbirth rate (4.2/1000 births in monitored districts) was not significantly associated with any indicator of Air Pollution, and was weakly related to mean income and proportion of births outside marriage. Crude prevalence of low birthweight (prevalence 5.5%) showed highly significant associations with several socioeconomic factors; after controlling for these, odds ratios (ORs)/50 micrograms/m3 increase in pollutant were: 1.04 (95% confidence interval (95% CI) 0.96 to 1.12) for total suspended particles, 1.10 (1.02 to 1.17) for SO2, and 1.07 (0.98 to 1.16) for NOx. When all pollutants were included in one model, SO2 remained related to low birthweight (OR 1.10 (1.01 to 1.20), p = 0.033). CONCLUSION: These results are consistent with a recent study in China where birthweight was also associated with total suspended particles and SO2 but ecological studies must be interpreted cautiously. Residual confounding by socioeconomic factors cannot be ruled out. The association between Air Pollution and birthweight requires further investigation.
