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Health effects for the population living near a cement plant:
An epidemiological assessment
Martina Bertoldi
a,
, Alessandro Borgini
a
, Andrea Tittarelli
a
, Elena Fattore
b
, Alessandro Cau
a
,
Roberto Fanelli
b
, Paolo Crosignani
a
a
Environmental Epidemiology and Cancer Registry Unit, National Cancer Institute, Via G. Venezian 1, 20133 Milano, Italy
b
Department of Environmental Health Sciences, Mario Negri Institute for Pharmacological Research, Via G. La Masa 19, 20154 Milano, Italy
abstractarticle info
Article history:
Received 20 January 2011
Accepted 23 December 2011
Available online 14 January 2012
Keywords:
Cement plant
Health effects
Air pollution
Nitrogen oxides
GIS
Epidemiological studies have shown the association between the exposure to air pollution and several ad-
verse health effects. To evaluate the possible acute health effects of air pollution due to the emissions of a ce-
ment plant in two small municipalities in Italy (Mazzano and Rezzato), a casecontrol study design was used.
The risks of hospital admission for cardiovascular or respiratory diseases for increasing levels of exposure to
cement plant emissions were estimated, separately for adults (age >34 years) and children (014 years).
Odds ratios (OR) were estimated using unconditional regression models. Attributable risks were also calcu-
lated.
Statistically signicant risks were found mainly for respiratory diseases among children: OR 1.67 (95% CI
1.082.58)for the moderately exposedcategory (E1), OR 1.88 (95% CI 1.192.97) for the highlyexposed category
(E2), with an attributable riskof 38% of hospital admissions dueto the exposure to cement plant exhausts. Adults
had a weaker risk: OR 1.38 (95% CI 1.181.61) for group E1, OR 1.31 (95% CI 1.101.56) for group E2; the
attributable risk was 23%. Risks were higher for females and for the age group 3564. These results showed
an association between the exposure to plant emissions and the risk of hospital admission for cardiovascu-
lar or respiratory causes; this association was particularly strong for children.
© 2011 Elsevier Ltd. All rights reserved.
1. Introduction
A cement plant can be an important source of air pollutants. Few
studies have focused on the health effects attributable to the emis-
sions of a cement plant on the population living in the proximity
(Rovira et al., 2010; Schuhmacher et al., 2004), some of them investi-
gating different outcomes, such as respiratory symptoms (Legator et
al., 1998), preterm delivery (Yang et al., 2003) or psychasthenia
(Brockhaus et al., 1981). Occupational studies have focused only on
cement plant workers (Al-Neaimi et al., 2001; Alvear-Galindo et al.,
1999) and other studies analysed the chemicals in soil (Asubiojo et
al., 1991; Schuhmacher et al., 2002) or their impact on air quality
(Kabir and Madugu, 2010).
The local authorities of two small municipalities (Mazzano and
Rezzato, Brescia province, Lombardy region, Northern Italy) asked
the authors of this paper to evaluate the health impact on people living
in the area surrounding a cementplant. The area is highly industrialized
and densely populated and local authorities are more and more in-
volved in decisions whose fallout can have consequences on population
health conditions.
We carried out a risk assessment of the acute health effects due to
the emissions of the cement plant on the population of the two mu-
nicipalities adopting a casecontrol study design. The evaluation of
the health effects was carried out choosing nitrogen oxides (NO
x
)as
a proxy for cement plant emissions (Canpolat et al., 2002; Ekinci et
al., 1998).
We used a Geographic Information System (GIS) to attribute the
exposure to air pollution for all the subjects analysed. As health out-
comes we considered all hospital admissions for respiratory or car-
diovascular causes for residents in the two municipalities.
2. Materials and methods
2.1. Study base
The population considered included all the residents of the munic-
ipalities of Mazzano and Rezzato in the years between 2002 and 2005,
inclusive: 22,721 people per year on average, 9997 resident in Maz-
zano and 12,724 in Rezzato (Italian National Statistical Institute,
ISTAT data on 31 December 2003).
As cases, we considered all hospital admissions of Mazzano or
Rezzato residents between January 1st 2002 and December 31st,
2005. These data were provided by the Brescia Local Health Unit
(ASL). The hospital admissions of interest for this study were selected
Environment International 41 (2012) 17
Corresponding author. Tel.: +39 02 23903540; fax: + 39 02 23902762.
E-mail address: martina.bertoldi@istitutotumori.mi.it (M. Bertoldi).
0160-4120/$ see front matter © 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.envint.2011.12.005
Contents lists available at SciVerse ScienceDirect
Environment International
journal homepage: www.elsevier.com/locate/envint
using the ICD-IX code of the principal diagnosis of discharge. Diagno-
ses of interest were chosen on the basis of evidence in the literature
indicating a signicant association between exposure to air pollutants
and some acute cardiovascular (Ballester et al., 2001; Poloniecki et al.,
1997) and respiratory diseases (Prescott et al., 1998; Wong et al.,
1999). People from 15 to 34 years were excluded from the analysis
because of the small number of hospital admissions. Tables 1 and 2
list the diagnostic codes considered for adults (age from 35 years
on) and for children (younger up to 14 years).
The unit of observation considered was the single hospital admis-
sion, not the person: all admissions were taken as single cases even if
referring to the same patient. Thus some subjects will have been
counted as cases more than once, if they had multiple admissions.
Controls were randomly sampled from the total population of the
two municipalities, extracted from the Lombardy Region Health Ser-
vice archives, excluding all the subjects already included as cases,
proportioning without individual matching for sex and age. For age
classes with more hospital admissions (65 years and over) two con-
trols were extracted for each case, while for age classes with fewer
hospital admissions (children and adults between 35 and 64 years)
four controls were taken for each case, to boost the power of the sta-
tistical analysis.
The same methods were applied to trauma and injuries (3-digit
ICD-IX codes from 800 to 959, considering the principal diagnosis of
discharge), a group of pathologies potentially not related with air
pollution.
2.2. Air pollution data
Air concentrations of cement plant emissions were estimated by
Consulenze Ambientali s.p.a (http://www.comunerezzato.it/comrez/
bin/les/indaginearia.pdf), both by modelling emissions and by direct
measuring. Pollutants were measured using mobile stations placed in
four different areas (two in each municipality) during two 20-day cam-
paigns, one in summer (September 2006) and one in winter (January
2007).
In this study we focused on NO
x
, because the comparison between
cement plant emissions modelling and direct measures showed that
the contribution of the cement plant was particularly signicant for
NO
x
.
2.3. Geocoding
The address of residence (municipality, street and number) of all
the subjects included in the study was retrieved through the Lombar-
dy Region Health Service archives.
From the addresses we obtained the geographical coordinates
(latitude and longitude) for almost all the subjects.
Then, using the ArcGis 9.2 software package, we created a layer
displaying the geographical distribution of subjects (cases and
controls).
2.4. Estimated exposure
To estimate the average exposure to NO
x
for each person we used
the iso-concentration maps of the pollutants for the winter measure-
ment campaign. NO
x
distribution in the considered area was over a
wider range during the winter (from 81 μg/m
3
to 207 μg/m
3
). Although
winter concentrations are not representative of annual average con-
centrations because they are generally higher, the exposure distribu-
tion may give a picture of individual exposure differences for the
whole year.
In the study area there were no security zoneswhere exposure
was low, the minimum winter NO
x
concentration being 81 μg/m
3
.
However, it was possibleto distinguish areaswith higher levels of expo-
sure and areas with lower levels. The health risk estimates were based
on these differences. Fig. 1 shows a map of the iso-concentrations of
NO
x
in the winter campaign.
Using the ArcGis desktop software we created a two layer map in
which we displayed NO
x
concentrations and subjects (cases and con-
trols). Using the spatial join technique we assigned an exposure value
for each subject depending on the location. The subjects were then di-
vided into three groups (less exposed as reference category, moderately
exposed, highly exposed). Exposure categories were chosen consider-
ing the distribution ofthe contaminant in the entire area and to provide
a narrow reference category. Thus the reference category had a low me-
dian value.
The three groups, according to the estimated exposure to NO
x
,
were as follows:
Less exposed (E
0
)81110 μg/m
3
Moderately exposed (E
1
) 111150 μg/m
3
Highly exposed (E
2
) >150 μg/m
3
Fig. 2 shows the division of the area for these groups. The zone
with the highest concentration of NO
x
is in the neighbourhood of
the cement plant.
2.5. Statistics
Odds ratios were calculated applying an unconditional logistic re-
gression model, considering the casecontrol status as dichotomised
Table 1
Diseases considered (adults, age >34 years).
Groups ICD-IX
codes
Description
Cardiovascular 410414 Ischemic heart disease
415416 Diseases of pulmonary circulation
426 Conduction disorders
427 Cardiac dysrhythmias
428 Heart failure
429 Other heart diseases
444 Arterial embolism and thrombosis
785 Symptoms involving cardiovascular system
Respiratory 478 Other diseases of upper respiratory tract
480487 Pneumonia and inuenza
490496 Chronic obstructive pulmonary disease and allied
conditions
510 Empyema
511 Pleurisy
518 Other diseases of lung
786 Symptoms involving respiratory system
Table 2
Diseases considered (children, age 014 years).
Groups ICD-IX codes Description
Respiratory 460 Acute nasopharyngitis
461 Acute sinusitis
462 Acute pharyngitis
463 Acute tonsillitis
464 Acute laryngitis and tracheitis
465 Acute upper respiratory infections
466 Acute bronchitis and bronchiolitis
472 Chronic pharyngitis and nasopharyngitis
473 Chronic sinusitis
474 Chronic disease of tonsils and adenoids
475 Peritonsillar abscess
476 Chronic laryngitis and laryngotracheitis
477 Allergic rhinitis
478 Other diseases of upper respiratory tract
490496 Chronic obstructive pulmonary disease and
allied conditions
2M. Bertoldi et al. / Environment International 41 (2012) 17
dependent variable, and the level of NO
x
exposure (E
0
,E
1
,E
2
)asin-
dependent variable. Sex and age group were used as adjusting vari-
ables. Analyses were also conducted by different subgroups, i.e. by
sex, age group and group of pathologies (this last only for adults).
pfor trend was calculated considering exposure as a continuous
variable.
Fig. 1. NO
x
iso-concentration map (winter campaign).
Fig. 2. Division of the area into three levels of NO
x
exposure.
3M. Bertoldi et al. / Environment International 41 (2012) 17
Attributable risks were also calculated to supply an indicator of
the impact of exposure on the population's health (Breslow and
Day, 1980).
Statistical analyses were done using the package Stata SE, version
8.2.
3. Results
Hospital admissions selected were 2209 for adults (1623 for cardiovascular causes,
586 for respiratory causes) and 277 for children (only respiratory diseases). Controls
totalled 4081 adults and 1108 children. Cases and controls together totalled 7675 sub-
jects, 6290 adults and 1385 children.
Only a small number (55 out of 7675, 0.72%) were excluded from the analysis, be-
cause we could not obtain their precise geographical coordinates. The analysis consid-
ered all geocoded subjects (7620), for whom it was possible to estimate the exposure
to NO
x
, separately for the children (1372 total, 274 cases and 1098 controls) and adults
(6248 total, 2182 cases and 4066 controls).
3.1. Adults
Table 3 reports the analysis on the adults, considered overall and then stratifying
for sex and the two age groups: younger adults (from 35 to 64 years) and older people
(over 65). The overall analysis showed a signicant risk for the subjects in the two cat-
egories most exposed compared to those less exposed (E0): the probability of hospital
admission was about 30% higher for both these categories, though the risk was a little
higher for the moderately exposed (E1) than the highest exposed (E2). This gure
slightly decreased when adjusting for sex and age group, and the risk for E2 group
lost statistical signicance. The attributable risk of 23% indicated that 501 out of the
2182 cases could be due to the excess of exposure to the cement plant pollutants com-
pared with the reference level (E0).
Sub-analysis by sex showed greater risks for females, with OR from 1.70 to 1.88
(from 1.60 to 1.75 when adjusted for age) and an attributable risk over 40% (378 out
of 915 cases). The probabilities of risk for males were much lower (OR about 1.10, or
around 1 when adjusted for age) and not statistically signicant; consequently the attrib-
utable riskwas also very low (less than 10%), estimating that 125 hospital admissions out
of 1267 might have been due to the exposure.
The analysis stratied for age showed a higher risk for those under 65, with a sig-
nicant trend with increasing levels of exposure: about 1.60 for the moderately ex-
posed group and 1.80 for the highest exposed. The attributable risk of 34% indicated
193 hospital admissions out of 565 attributable to the plant pollution. The risks were
not found in the older subjects: OR were near to 1 for both exposure levels (crude or
adjusted for sex).
Table 4 reports sub-analyses on the two groups of pathologies (cardiovascular and
respiratory), overall and separately for age. There were no major differences for the two
pathologies: an association between exposure and risk appeared (though losing some
signicance on adjusting for age and sex), with no exposureresponse trend for respi-
ratory pathologies. For the adults under 65 the association was stronger (particularly
hospital admissions for respiratory symptoms), while for older people the risks were
absent.
3.2. Children
Exposure to air pollution appeared to have a stronger negative effect on children
than on adults (Table 5). The overall risks are higher: 1.67 for the moderately exposed
group (E1) compared to the less exposed (E0), and almost double (OR 1.90) for the
most exposed children (E2), with a signicant pfor trend (b0.001).
The attributable risk indicated that 38% of all hospital admissions involving chil-
dren (105/274) could be avoided if the NO
x
concentration was not higher than
110 μg/m
3
in all the areas considered.
The analysis stratied by sex showed a slightly different situation from adults. The
risk appeared clear in males (but withoutan increasing exposureresponse trend), while
for the females the OR, indicating an increasing risk, were not statistically signicant. This
might dependon the limited number of hospital admissions for young females. The attrib-
utable risks were not really different: 41% for the males (67/163 cases) and 33% for fe-
males (37/111).
Sub-analysis by age group showed lower risks (with a loss of statistical signi-
cance) for pre-school children (from 0 to 5 years), but even higher risks for school-
age children (614), with an attributable risk higher than 50%.
3.3. Check analysis
Table 6 reports the analysis on trauma and injuries, considered overall and then
stratifying for sex. We identied 1018 hospital admissions of all ages and sampled
3868 controls from the same population. The calculated OR did not show the same
risk as for cardiovascular and respiratory causes: 1.15 (95% C.I. 0.891.47) for moder-
ately exposed (E1), 1.11 (95% C.I. 0.851.46) for highest exposed (E2).
4. Discussion
Our results showed an increase in hospital admissions for pathol-
ogies potentially related to the exposure to air pollution due to plant
emissions. This appeared particularly strong for children, that are par-
ticularly susceptible to air pollution (Gouveia and Fletcher, 2000), but
the adults presented signicant risks too.
These results conrmed the ndings of many epidemiological
studies on health effects of air pollution (Boezen et al., 1999; Brauer
et al., 2002; Calderón-Garcidueñas et al., 2007; Van der Zee et al.,
1999; Wilson et al., 2004), showing how children are a particularly
vulnerable population because they spend more time outdoors, are
generally more active, and have higher ventilation rates than adults
(Just et al., 2002; Ostro et al., 2001; Wiley et al., 1993).
The differences in risk between males and females, particularly
adults, might reect the fact that women spend more time at home
than men, so the subjects' addresses are more indicative of the real
exposure for women than for men.
All the sub-analyses on children (by sex or age) might be affected
by the small number of the hospital admissions for children (274 in
total), generating less stable results from a statistical point of view.
For this reason, the risks calculated considering all the children had
to be considered the most signicant information.
Table 3
Adults: exposure to NO
x
and risks of hospital admission.
Exposure
groups
Cases Controls Total Crude
OR
95% CI Adj.
OR
a
95% CI
Overall analysis
E0 267 646 913 1 1
E1 1312 2306 3618 1.377 1.1761.612 1.296 1.1011.525
E2 603 1114 1717 1.310 1.1011.558 1.161 0.9711.388
Tot 2182 4066 6248
p for
trend
0.006
AR
b
22.98%
Males
E0 182 380 562 1 1
E1 747 1368 2115 1.140 0.9351.390 1.079 0.8791.324
E2 338 637 975 1.108 0.8891.381 0.952 0.7571.199
Tot 1267 2385 3652
p for
trend
0.959
AR
b
9.84%
Females
E0 85 266 351 1 1
E1 565 938 1503 1.885 1.4452.458 1.753 1.3362.299
E2 265 477 742 1.739 1.3052.316 1.600 1.1952.140
Tot 915 1681 2596
p for
trend
b0.001
AR
b
41.29%
Age
3564 yrs
E0 72 375 447 1 1
E1 346 1139 1485 1.582 1.1972.092 1.578 1.1932.088
E2 147 423 570 1.810 1.3222.479 1.813 1.3242.483
Tot 565 1937 2502
p for
trend
0.001
AR
b
34.18%
Age>65 yrs
E0 195 271 466 1 1
E1 966 1167 2133 1.150 0.9391.409 1.162 0.9481.424
E2 456 691 1147 0.917 0.7371.141 0.931 0.7471.160
Tot 1617 2129 3746
p for
trend
0.469
AR
b
5.26%
a
OR adjusted for age and sex (overall), for age (males and females), or for sex (age
subgroups).
b
Attributable risk.
4M. Bertoldi et al. / Environment International 41 (2012) 17
The analyses on the older subjects (more than 64 years) depicted
an apparently paradoxical situation: no risk was found, though older
people, like children, are usually more sensitive to air pollution
(Anderson et al., 2003; Katsouyanni et al., 2001). This might be
explained by the presence of two hospices in the two municipalities.
The two hospices are in fact in the area of maximum exposure, and
could have lead to an oversampling of highly exposed controls. More-
over, it is also possible that a number of hospital admissions of these
people were missing because some patients were treated by doctors
inside the hospices.
From the point of view of public health, the attributable risks indi-
cated that almost a quarter of adult hospital admissions and more
than one third of children's admissions could be avoided if the plant
emissions, expressed as average exposure concentrations of NO
x
,
were reduced to expose the whole population to the same level con-
sidered as the reference category in our study.
As the acute effects are often indicators of a chronic effect, the re-
sults can also be read in terms of a general increase of cardiovascular
and respiratory diseases in this population.
It is important to note that the general standing is seriously com-
promised, also due to other air pollution sources (industrial sites,
quarries, highways and major roads). NO
x
values are generally more
elevated in comparison with the average of Brescia province. There
were no secure zonesin the surroundings with null or low
exposure: the lowest winter value is 83 μg/m
3
. But we were able to
distinguish between higher exposure and lower exposure zones.
These differences allowed to assess health risk values.
The results do not describe health effects exclusively attribut-
able to the cement plant. They represent an overall evaluation of
the possible health effects due to the high air pollution levels, but,
considering NO
x
concentrations, the cement plant has a very impor-
tant role.
To check that our ndings were not due to a bias in the casecontrol
selection, we applied the same methods to a group of pathologies po-
tentially not related with air pollution, i.e. trauma and injuries. This
kind of analysis, showing no relation between environmental exposure
and those pathologies, can be read as reinforcement of our results.
5. Conclusions
We found an association between the exposure to the cement
plant emissions and the risk of hospital admission for cardiovascular
or respiratory causes, particularly strong for children. The cement
plant certainly has an important role as a producer of air pollution.
Though in the area considered there are also other important sources,
these could not be considered as confounders for the health effects
brought to light by this analysis, as their spatial distribution is not as-
sociated with the exposure to cement plant emissions.
Table 4
Adults: exposure to NO
x
and risks of hospital admission (sub-analysis for disease groups and age).
Exposure groups Cases Controls Total Crude OR 95% CI Adj. OR
a
95% CI
Cardiovascular diseases
E0 206 646 852 1 1
E1 939 2306 3245 1.277 1.0731.520 1.177 0.9841.409
E2 457 1114 1571 1.287 1.0631.557 1.128 0.9271.373
Tot 1602 4066 5668
p for trend 0.011
AR
b
19.06%
Cardiovascular diseases (age 3564 yrs)
E0 60 375 435 1 1
E1 235 1139 1374 1.290 0.9491.752 1.281 0.9421.741
E2 112 423 535 1.655 1.1742.332 1.654 1.1732.331
Tot 407 1937 2344
p for trend 0.012
AR
b
23.85%
Cardiovascular diseases (age >64 yrs)
E0 146 271 417 1 1
E1 704 1167 1871 1.120 0.8971.398 1.123 0.9001.403
E2 345 691 1036 0.927 0.7301.177 0.933 0.7341.185
Tot 1195 2129 3324
p for trend 0.734
AR
b
4.02%
Respiratory diseases
E0 61 646 707 1 1
E1 373 2306 2679 1.713 1.2892.277 1.612 1.2092.149
E2 146 1114 1260 1.388 1.0141.900 1.182 0.8571.630
Tot 580 4066 4646
p for trend 0.160
AR
b
33.80%
Respiratory diseases (age 3564 yrs)
E0 12 375 387 1 1
E1 111 1139 1250 3.045 1.6605.588 3.052 1.6635.600
E2 35 423 458 2.586 1.3235.054 2.658 1.3575.206
Tot 158 1937 2095
p for trend 0.010
AR
b
60.77%
Respiratories diseases (age >64 yrs)
E0 49 271 320 1 1
E1 262 1167 1429 1.242 0.8911.731 1.257 0.9001.754
E2 111 691 802 0.888 0.6171.279 0.908 0.6281.312
Tot 422 2129 2551
p for trend 0.310
AR
b
8.78%
a
OR adjusted for age and sex (overall cardiovascular and respiratory diseases) or for sex (age subgroups).
b
Attributable risk.
5M. Bertoldi et al. / Environment International 41 (2012) 17
Funding
This work was partially nanced by the municipalities of Mazzano
and Rezzato, Lombardy Region, Italy.
Acknowledgements
The authors are grateful to the municipalities of Mazzano and
Rezzato for nancial support; Brescia Local Health Unit for health
data; Consulenze Ambientali for the iso-concentrations maps of
NO
x
; SEAT for geocoding; GIS Italia for help using ArcGis software;
Roberto Carrara for the precious work of coordination; J. D. Baggott
for revising the English.
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Schuhmacher M, Domingo JL, Garreta J. Pollutants emitted by a cement plant: health
risks for the population living in the neighbourhood. Environ Res 2004;95:
198206.
Table 5
Children: exposure to NO
x
and risk of hospital admission.
Exposure
groups
Cases Controls Total Crude
OR
95% CI Adj.
OR
a
95% CI
Overall analysis
E0 28 182 210 1 1
E1 149 580 729 1.670 1.0792.584 1.676 1.0792.602
E2 97 336 433 1.876 1.1882.965 1.907 1.1963.043
Tot 274 1098 1372
p for
trend
b0.001
AR
b
38.35%
Males
E0 17 115 132 1 1
E1 90 322 412 1.891 1.0803.311 1.913 1.0883.365
E2 56 210 266 1.804 1.0023.249 1.801 0.9873.283
Tot 163 647 810
p for
trend
0.013
AR
b
41.32%
Females
E0 11 67 78 1 1
E1 59 258 317 1.393 0.6932.798 1.358 0.6742.738
E2 41 126 167 1.982 0.9574.107 2.071 0.9854.353
Tot 111 451 562
p for
trend
0.012
AR
b
33.29%
Age 04 yrs
E0 20 106 126 1 1
E1 107 424 531 1.338 0.7932.256 1.342 0.7952.265
E2 72 272 344 1.403 0.8142.417 1.401 0.8132.413
Tot 199 802 1001
p for
trend
0.065
AR
b
23.96%
Age
514 yrs
E0 8 76 84 1 1
E1 42 156 198 2.558 1.1445.716 2.662 1.1865.975
E2 25 64 89 3.711 1.5668.794 3.675 1.5498.720
Tot 75 296 371
p for
trend
0.001
AR
b
58.46%
a
OR adjusted for age and sex (overall), for age (males and females), or for sex (age
subgroups).
b
Attributable risk.
Table 6
Exposure to NO
x
and risks of hospital admission for trauma and injuries.
Exposure
groups
Cases Controls Total Crude
OR
95% CI Adj.
OR
a
95% CI
Overall analysis
E0 122 532 654 1 1
E1 586 2130 2716 1.199 0.9661.490 1.146 0.8941.471
E2 303 1158 1461 1.141 0.9031.442 1.113 0.8511.456
Tot 1011 3820 4831
p for
trend
0.503
Males
E0 78 338 416 1 1
E1 344 1301 1645 1.146 0.8721.506 0.999 0.7221.381
E2 185 705 890 1.137 0.8471.527 1.001 0.7051.423
Tot 607 2344 2951
p for
trend
0.503
Females
E0 44 194 238 1 1
E1 242 829 1071 1.287 0.9001.840 1.383 0.9352.045
E2 118 453 571 1.149 0.7821.688 1.294 0.8501.970
Tot 404 1476 1880
p for
trend
0.828
a
OR adjusted for age and sex (overall) or for age (males and females).
6M. Bertoldi et al. / Environment International 41 (2012) 17
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effects of urban air pollution on respiratory health of children with and without
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missions for respiratory and cardiovascular diseases in Hong Kong. Occup Environ
Med 1999;56:67983.
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people living around Portland cement plants. Environ Res 2003;92:648.
7M. Bertoldi et al. / Environment International 41 (2012) 17
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In cement plants in Turkey CO, NO2, SO2 and particulate emissions were measured using standard measurement techniques and equipment. Emission factors are calculated by dividing the emission rates by capacity of production at the time of measurements for each plant. The results of this study show that the dominant emissions from cement production in Turkey is CO followed by NO2, dust and SO2 in decreasing order. National averages for the emission factors are calculated and compared to international emission factors. On average the Turkish dust emission factor is higher than the German factor, however NO2 and SO2 emission factors are lower in Turkey.
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The Portland cement industry is the main source of particulate air pollution in Kaohsiung city. Data in this study concern outdoor air pollution and the health of individuals living in communities in close proximity to Portland cement plants. The prevalence of delivery of preterm birth infants was significantly higher in mothers living within 0-2 km of a Portland cement plant than in mothers living within 2-4 km. After controlling for several possible confounders (including maternal age, season, marital status, maternal education, and infant sex), the adjusted odds ratio was 1.30 (95% CI=1.09-1.54) for the delivery of preterm infants for mothers living close to the Portland cement plants, chosen at the start to be from 0 to 2 km. These data provide further support for the hypothesis that air pollution can affect the outcome of pregnancy.