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Emergency department visits of young children and long-term exposure to neighbourhood smoke from household heating - The Growing Up in New Zealand child cohort study
Abstract
In developed countries, exposure to wood or coal smoke occurs predominantly from neighbourhood emissions arising from household heating. The effect of this exposure on child health is not well characterized.
Within a birth cohort study in New Zealand we assessed healthcare events associated with exposure to neighbourhood smoke from household heating. Our outcome measure was non-accidental presentations to hospital emergency departments (ED) before age three years. We matched small area-level census information with the geocoded home locations to measure the density of household heating with wood or coal in the neighbourhood and applied a time-weighted average exposure method to account for residential mobility. We then used hierarchical multiple logistic regression to assess the independence of associations of this exposure with ED presentations adjusted for gender, ethnicity, birth weight, breastfeeding, immunizations, number of co-habiting smokers, wood or coal heating at home, bedroom mold, household- and area-level deprivation and rurality.
The adjusted odds ratio of having a non-accidental ED visit was 1.07 [95%CI: 1.03–1.12] per wood or coal heating household per hectare. We found a linear dose-response relationship (p-value for trend = 0.024) between the quartiles of exposure (1st as reference) and the same outcome (odds ratio in 2nd to 4th quartiles: 1.14 [0.95–1.37], 1.28 [1.06–1.54], 1.32 [1.09–1.60]).
Exposure to neighbourhoods with higher density of wood or coal smoke-producing households is associated with an increased odds of ED visits during early childhood. Policies that reduce smoke pollution from domestic heating by as little as one household per hectare using solid fuel burners could improve child health.
... Studies have used case definitions from those specific to pneumonia, 19 to others including a broader range of ARIs. [20][21][22][23] A case-control study in Auckland which enrolled children <5 years old from 2002 to 2004 identified factors associated with community-acquired pneumonia (CAP) and pneumonia requiring hospital admission. 23 Factors independently associated with CAP were lower weight-for-height, spending less time outside, 24 previous chest infections and mould in the child's bedroom. ...
... 21 A subsequent study showed adverse effects of wood burners on the health of children in neighbouring households. 22 As density of wood or coal-smoke producing households/ha increased, the odds of <3-year-old children having a non-accident-related emergency department (ED) visit increased, 22 and of being prescribed respiratory medications increased. 23 Priority Areas for Management of Childhood Pneumonia in NZ Frameworks developed to prevent childhood pneumonia deaths in developing countries are applicable to preventing childhood pneumonia in NZ (Table 3). 1 Some interventions will decrease ARI morbidity, some are pneumonia specific. ...
... 21 A subsequent study showed adverse effects of wood burners on the health of children in neighbouring households. 22 As density of wood or coal-smoke producing households/ha increased, the odds of <3-year-old children having a non-accident-related emergency department (ED) visit increased, 22 and of being prescribed respiratory medications increased. 23 Priority Areas for Management of Childhood Pneumonia in NZ Frameworks developed to prevent childhood pneumonia deaths in developing countries are applicable to preventing childhood pneumonia in NZ (Table 3). 1 Some interventions will decrease ARI morbidity, some are pneumonia specific. ...
While deaths from pneumonia during childhood in New Zealand (NZ) are now infrequent, childhood pneumonia remains a significant cause of morbidity. In this viewpoint, we describe pneumonia epidemiology in NZ and identify modifiable risk factors. During recent decades, pneumonia hospitalisation rates decreased, attributable in part to inclusion of pneumococcal conjugate vaccine in NZ's immunisation schedule. Irrespective of these decreases, pneumonia hospitalisation rates are four times higher for Pacific and 60% higher for Māori compared with children of other ethnic groups. Consistent with other developed countries, hospitalisation rates for pneumonia with pleural empyema increased in NZ during the 2000s. Numerous factors contribute to childhood pneumonia acquisition, hospitalisation and morbidity in NZ include poor quality living environments, malnutrition during pregnancy and early childhood, incomplete and delayed vaccination during pregnancy and childhood and variable primary and secondary care management. To reduce childhood pneumonia disease burden, interventions should focus on addressing modifiable risk factors for pneumonia. These include using non‐polluting forms of household heating; decreasing cigarette smoke exposure; reducing household acute respiratory infection transmission; improving dietary nutritional content and nutrition during pregnancy and early childhood; breastfeeding promotion; vaccination during pregnancy and childhood and improving the quality of and decreasing the variance in primary and secondary care management of pneumonia.
... Other studies did not distinguish between wood and coal or other biomass fuels (Austin and Russell, 1997;Brozek et al., 2016;Duhme et al., 1998;Krzych-Falta et al., 2017;Lai et al., 2017;Lu et al., 2018;Von Mutius et al., 1996). No consistent relationship between respiratory symptoms (wheeze, cough and hay fever) and heating or cooking with coal, peat or wood was found in a study conducted in UK (Austin and Russell, 1997). ...
... A study conducted in Eastern Europe and including more than 12 500 children found a null association between exposure to coal or wood heating or cooking and risk of asthma, wheeze and spastic bronchitis (Brozek et al., 2016). A prospective study conducted in about 4 500 children in New Zealand found no association between wood or coal heating and non-accidental presentations to hospital emergency departments before age 3 years (Lai et al., 2017). ...
... Two studies investigated the impact of coal combustion by measuring levels of SO 2 (Fritz and Herbarth, 2004) and of s PAHs (Jedrychowski et al., 2015). Another study considered the data on the density of households emitting coal or wood smoke (Lai et al., 2017). ...
Epidemiological studies have shown a positive association between exposure to outdoor and indoor solid fuel combustion and adverse health effects.
We reviewed the epidemiological evidence from Europe, North America, Australia and New Zealand on the association between outdoor and indoor exposure to solid fuel combustion and respiratory outcomes in children.
We performed a systematic review and meta-analysis. Pooled relative risks (RRs) and 95% confidence intervals (CI) were calculated using random-effects models.
We identified 74 articles. Due to limited evidence on other exposures and outcomes, we performed meta-analyses on the association between indoor wood burning exposure and respiratory outcomes. The RR for the highest vs the lowest category of indoor wood exposure was 0.90 (95% CI 0.77–1.05) considering asthma as an outcome. The corresponding pooled RRs for lower respiratory infection (LRI) and upper respiratory infection (URI) were 1.11 (95% CI 0.88, 1.41) and 1.11 (95% CI 0.85, 1.44) respectively. No association was found between indoor wood burning exposure and risk of wheeze and cough.
Inconsistent and limited results were found considering the relationship between indoor wood burning exposure and other respiratory outcomes (rhinitis and hay fever, influenza) as well as indoor coal burning exposure and respiratory outcomes in children. Results from epidemiological studies that evaluated the relationship between the exposure to outdoor emissions derived from indoor combustion of solid fuels are too limited to allow firm conclusions.
We found no association between indoor wood burning exposure and risk of asthma. A slight, but not significant, increased risk of LRI and URI was identified, although the available evidence is limited. Epidemiological studies evaluating the relationship between indoor coal burning exposure and respiratory outcomes, as well as, studies considering exposure to outdoor solid fuels, are too limited to draw any firm conclusions.
... Other common related articles (n= 6/21) presented other risks associated with childhood period that are not a disease but may cause the deterioration of children's health and lead to a disease. Other interesting areas covered in literature that are related to these causes are germs and bacteria [197], contaminated drinking water [198,199], childhood cigarette and alcohol use [22], smoke exposure [200], and risk of hospitalization [201]. ...
... The first issue in the other challenges is method, which speaks about the previous method and its inability to measure issues, such as the density of the household that emitted coal smoke in a neighbourhood [200]. The second issue is the mechanism used in some previous studies and how they failed to inform researchers about many phenomena and problems, such as the inability to explain increases in malaria risk through iron supplementation [180], mechanisms to explain the relationship between insufficient sleep and adverse health outcomes [9], mechanisms to show how protein intake in early life is positively associated with the risk of obesity [221], imitation mechanism in the social development aspect [64] a and mechanisms to explain depressive symptoms in fathers with behavioural and emotional problems in children [126].T The next issue is evaluation. ...
... We found that most studies on early childhood came from 37 countries, as seen in Figure 12, (n= 127/233) studies, and more than half were conducted in the Unites States alone [1, 4, 5, 7, 9, 10, 12, 13, 16-18, 21-25, 27-29, 31-33, 35, 40-48, 54, 55, 57, 59, 60, 62, 64, 65, 68-71, 73, 74, 77, 81, 85, 86, 88, 90, 100, 102-109, 112-114, 116, 117, 119, 122, 123, 129, 130, 132-134, 136-139, 142-145, 147, 150, 152-155, 157, 158, 161, 164, 166, 171-174, 179, 180, 182, 184, 186, 187, 193-196, 198, 199, 201, 204, 209, 211, 212, 220-225, 230-236] (n=24/233) studies were conducted in Germany [61, 80, 95-97, 120, 162, 227, 228], Australia [78,91,92,124,141,156,177,218,219] and China [53,93,99,175,210,226]. Canada has (n=8/233) studies from [3,8,36,75,118,121,127,178], Netherlands with (n=5/233) studies from [87,125,149,176,217]. Hong Kong has (n=4/233) studies [11,14,89,115], New Zealand has (n=3/233) studies [63,135,200]; Taiwan has (n=3/233) studies [72,84,183], Brazil has (n=3/233) Studies [6,82,83], France has (n=3/233) studies [56,98,140], Japan has (n=3/233) studies [79,208,216], and South Korea has (n=3/233) studies [2,128,207]. The next group includes countries with two studies each; we start with Norway [51,94], Italy [39,203], Belgium [101,111], Colombia [26,30], South Africa [148,205], Turkey [20,169], Uganda [185,190], Tanzania [191,192] and Switzerland [159,167]. ...
Early childhood is a significant period when transitions take place in children. This period is a hot topic among researchers who pursue this domain across different scientific disciplines. Many studies addressed social, scientific, medical and technical topics during early childhood. Researchers also utilised different analysis measures to conduct experiments on the different types of data related to early childhood to produce research articles. This study aims to review and analyse literature related to early childhood in addition to data analyses and the types of data used. The factors that were considered to boost understanding of contextual aspects in published studies related to early childhood were considered as open challenges, motivations and recommendations of researchers that aimed to advance study in this area of science. We systematically searched articles on topics related to early childhood, the data analysis approaches used, and the types of data applied. The search was conducted on five major databases, namely, ScienceDirect, Scopus, Web of Science, IEEEXplore and PubMed from 2013 to September 2017. These indices were considered sufficiently extensive and reliable to cover our field of literature. Articles were selected on the basis of our inclusion and exclusion criteria (n=233). The first portion of studies (n=103/233) focused on different aspects related to the development of children in early age. They discussed different topics, such as the body growth-development of children, psychology, skills and other related topics that overlap between two or more of the previous topics or do not fall into any of the categories but are still under development. The second portion of studies (n=107/233) focused on different aspects associated with health in early childhood. A number of topics were discussed in this regard, such as those related to family health, medical procedures, interventions, and risk that address health-related aspects, in addition to other related topics that overlap between two or more of the previous topics or do not fall into any of the categories but are still under health. The remaining studies (n=23/233) were categorised to the other main category because they overlap between the previous two major categories, namely, development and health, or they do not fall into any of the previous main categories. Early childhood is a sensitive period in every child’s life. This period was studied using different means of data analysis and with the aid of different data types to produce different findings from previous studies. Research areas on early childhood vary, but they are equally significant. This study emphasises current standpoint and opportunities for research in this area and boost additional efforts towards the understanding of this research field.
... Then we searched for dates of first-time hospital admissions due to waterborne enteric disease, and matched these to the daily weather data at the cluster based on home addresses at interview. Where children had moved address between interviews, we used the mid-point between interviews as the cutoff for change of address (Lai et al., 2017). ...
... We extracted median annual rainfall map grid data (500 m) in 1981-2010 (Tait et al., 2012) at child home locations to obtain the residential annual rainfall total (mm) in each data collection wave. Then we estimated the time-weighted long-term average exposure (Lai et al., 2017) from the birth year up to the firsttime hospital admission year. We transformed this long-term exposure variable into quintiles and tertiles for analysis of the interaction effects. ...
Heavy rainfall is associated with increased risk of waterborne disease. However, it is not known whether the risk increment differs between wet and dry regions. We examined this question in New Zealand, which has a wide geographical variation of annual rainfall totals (10th–90th percentile difference ≥3000 mm).
We conducted a nested case-crossover study within a prospective child cohort (born in 2009–2010) for assessing transient health effects when modified by longitudinal exposures to rainfall. Short-term heavy rainfall effects on hospitalizations due to enteric bacterial and viral infectious causes at lag of 0–14 days were assessed using a Cox regression model adjusted for daily temperature, relative humidity and evapotranspiration. We derived quantiles of time-weighted long-term rainfall levels at the children’s homes and these were added as an interaction term to the short-term effect model.
Hospitalization risks were higher two days after heavy rainfall days (hazard ratio [95% confidence interval]: 1.73 [1.10–2.70]). The lowest-observable-adverse-effect-level was detected at the 94th percentile of daily rainfall total. Hospital admissions 1–2 days after heavy rainfall increased most in locations with the lowest and highest long-term rainfall. An interaction of this kind between short-term weather and long-term climate has not been reported previously. It is relevant to climate change risk assessments given global projections of increasing intensity of precipitation, against a background of more severe, and possibly more frequent, droughts and flooding.
... However, our findings were corroborated by those of a large birth cohort in New Zealand that found that residing in areas with higher proportion of houses heating with wood and/or coal was correlated with nonaccidental ED presentations in the first 3 years of life. 84 Wood heaters are one of the main anthropogenic ambient PM 2:5 sources in winter in both Australia 85 and New Zealand. 86 Conversely, in our sensitivity analysis, we observed lower all-cause ED presentations when using higher thresholds to classify exposure (50 lg=m 3 and 60 lg=m 3 instead of 25 lg=m 3 ) in the children exposed to PM 2:5 from the mine fire IU than children unexposed or exposed to lower concentrations. ...
Background:
Episodic spikes in air pollution due to landscape fires are increasing, and their potential for longer term health impacts is uncertain.
Objective:
Our objective is to evaluate associations between exposure in utero and in infancy to severe pollution from a mine fire, background ambient air pollution, and subsequent hospital care.
Methods:
We linked health records of births, emergency department (ED) visits, and hospitalizations of children born in the Latrobe Valley, Australia, 2012-2015, which included a severe pollution episode from a mine fire (9 February 2014 to 25 March 2014). We assigned modeled exposure estimates for fire-related and ambient particulate matter with an aerodynamic diameter of 2.5μm (PM2.5) to residential address. We used logistic regression to estimate associations with hospital visits for any cause and groupings of infectious, allergic, and respiratory conditions. Outcomes were assessed for the first year of life in the in utero cohort and the year following the fire in the infant cohort. We estimated exposure-response for both fire-related and ambient PM2.5 and also employed inverse probability weighting using the propensity score to compare exposed and not/minimally exposed children.
Results:
Prenatal exposure to fire-related PM2.5 was associated with ED presentations for allergies/skin rash [odds ratio (OR)=1.34, 95% confidence interval (CI): 1.01, 1.76 per 240 μg/m3 increase]. Exposure in utero to ambient PM2.5 was associated with overall presentations (OR=1.18, 95% CI: 1.05, 1.33 per 1.4 μg/m3) and visits for infections (ED: OR=1.13, 95% CI: 0.98, 1.29; hospitalizations: OR=1.23, 95% CI: 1.00, 1.52). Exposure in infancy to fire-related PM2.5 compared to no/minimal exposure, was associated with ED presentations for respiratory (OR=1.37, 95% CI: 1.05, 1.80) and infectious conditions (any: OR=1.21, 95% CI: 0.98, 1.49; respiratory-related: OR=1.39, 95% CI: 1.05, 1.83). Early life exposure to ambient PM2.5 was associated with overall ED visits (OR=1.17, 95% CI: 1.05, 1.30 per 1.4 μg/m3 increase).
Discussion:
Higher episodic and lower ambient concentrations of PM2.5 in early life were associated with visits for allergic, respiratory, and infectious conditions. Our findings also indicated differences in associations at the two developmental stages. https://doi.org/10.1289/EHP12238.
... In developed countries such as Australia, England, and the United States, indoor wood burning is thought to be only somewhat linked to increased risk of respiratory infections in young children -but typically this wood use is for heating rather than cooking, and is relatively well ventilated (WHO, 2014). Lai et al. (2017) conducted a cohort study of about 4,500 children in New Zealand. The study found no significant association between wood or coal heating and respiratory disease prevalence among children under three years of age. ...
... Residents of varying socio-economic status (SES) are exposed to different indoor air pollutants; for example, higher radon concentrations were found in homes with greater wealth, while low SES communities were exposed to a high level of VOCs (Ferguson et al., 2020). Studies related to IAP in the context of developed countries are mainly centralized on housing quality standards, ventilation, toxic chemicals found on household goods such as benzotriazoles, pollution from woodstove and household heating etc. (Asikainen et al., 2016;Xue et al., 2017;Lai et al., 2017;Baker et al., 2006;Rokoff et al., 2017). IAP research has mostly been conducted in various indoor settings such as homes, schools, hospitals, offices, restaurants, subways, owing to wide variations in the sources and characteristics of indoor pollutants in different indoor environments (Morawska et al., 2017;de la Sota et al., 2018;Forns et al., 2017;Verde et al., 2015;Jung et al., 2015;Azuma et al., 2018;Dai et al., 2018;Xu and Hao, 2017). ...
Indoor air pollution (IAP) is one of the leading risk factors for various adverse health outcomes including premature deaths globally. Even though research related to IAP has been carried out, bibliometric studies with particular emphasis on this topic have been lacking. Here, we investigated IAP research from 1990 to 2019 retrieved from the Web of Science database through a comprehensive and systematic scientometric analysis using the CiteSpace 5.7.R2, a powerful tool for visualizing structural, temporal patterns and trends of a scientific field. There was an exponential increase in publications, however, with a stark difference between developed and developing countries. The journals publishing IAP related research had multiple disciplines; ‘Indoor Air’ journal that focuses solely on IAP issues ranked fifth among top-cited journals. The terms like ‘global burden’, ‘comparative risk assessment,’ ‘household air pollution (HAP)', ‘ventilation’, ‘respiratory health’, ‘emission factor’, ‘impact,’ ‘energy’, ‘household’, ‘India’ were the current topical subject where author Kirk R. Smith was identified with a significant contribution. Research related to rural, fossil-fuel toxicity, IAP, and exposure-assessment had the highest citation burst signifying the particular attention of scientific communities to these subjects. Overall, this study examined the evolution of IAP research, identified the gaps and provided future research directions.
... Heating sources also contribute to measures of housing quality. Within Growing Up in New Zealand, approximately 12% of families report the use of un-flued gas heaters and 25% the use of wood-burners, both of which have the potential to negatively influence child health 4,5 . Relative to children in other developed countries, Introduction children in New Zealand experience high rates of respiratory illness including acute respiratory infections and asthma 6 . ...
Decreasing rates of home ownership and increasing rates of both rental housing and residential mobility are intensifying the impact of poor quality housing, especially for the most vulnerable children and whānau. The current study used data from the contemporary Growing Up in New Zealand study to better understand the housing experiences of New Zealand children, particularly those in rental accommodation and for
those living in low incomes households in the first five years of life.
We have used both longitudinal data and sequence state cluster analyses to better understand the pathways and flux in tenure and income states families experience across
time. Greater understanding of families with young children’s journeys has the potential to be translated into policy, service and programme development in order to achieve
better housing pathways and wellbeing outcomes for New Zealand families.
... Acute and chronic health impacts of the PM 10 load range from minor irritation to cardiopulmonary morbidity and mortality [22,23], and societal costs of poor urban air quality in the Waikato region have been estimated at over US$500 million per annum [20]. Recent research, based on data from the 'Growing up in New Zealand' child cohort study, found that living in a neighborhood with a higher density of wood burners was associated with the increased risk of a non-accidental emergency department visit before the age of three by 28% [24].Two key reasons why this issue achieved a high overall score in this ranking model is that population is treated as an aspect of scale, and issues that have the potential to harm human health are emphasized by weighting ( Table 2). Poor urban air quality has become a better characterized problem in New Zealand since the introduction of ambient air monitoring requirements under the Resource Management (National Environmental Standards for Air Quality) Regulations 2004. ...
Management and regulatory agencies face a wide range of environmental issues globally. The challenge is to identify and select the issues to assist the allocation of research and policy resources to achieve maximum environmental gain. A framework was developed to prioritize environmental contamination issues in a sustainable management policy context using a nine-factor ranking model to rank the significance of diffuse sources of stressors. It focuses on contamination issues that involve large geographic scales (e.g., all pastoral soils), significant population exposures (e.g., urban air quality), and multiple outputs from same source on receiving environmental compartments comprising air, surface water, groundwater, and sediment. Factor scores are allocated using a scoring scale and weighted following defined rules. Results are ranked enabling the rational comparison of dissimilar and complex issues. Advantages of this model include flexibility, transparency, ability to prioritize new issues as they arise, and ability to identify which issues are comparatively trivial and which present a more serious challenge to sustainability policy goals. This model integrates well as a planning tool and has been used to inform regional policy development.
... One example is the recent New Zealand study by Lai et al. (2017) investigating the rates of non-accidental presentations to hospital emergency departments (ED) before the age of three in relation to the density of household heating with wood or coal in the neighbourhood. Significant increases were found with increasing density of wood or coal-smoke producing households in the neighbourhood. ...
The project’s objective was to develop relevant methodologies for understanding the
impacts of elevated wood smoke levels on the health of residents of small population
centres (less than 50,000) in New Zealand. The deliverable consisted of a written report
detailing appropriate study designs, including appropriate health metrics
given the available air quality data, that could be used by regional councils to
describe the health impacts of wood smoke on resident populations. This report
is the product of this work. The report was funded by the Ministry of Business, Innovation and Employment through an Envirolink Medium Advice Grant awarded to the Hawke’s Bay Regional Council.
... Because of the substantial variation in DWH smoke and impact of local sources, policies should also protect the health of nearby residents, especially young children and the elderly. In 2005, New Zealand introduced stricter standards for new wood heaters than currently required in Australia, but every additional wood heater per hectare was recently found to increase by 7% the risk of non-accidental hospital emergency presentations in children under 3 [71]. Given this and the NSW Chief Medical Officer's recommendation, allowing new wood heaters to be installed seems inconsistent with the principles of ecologically sustainable development required under section 89 of the NSW Local government Act (LGA). ...
The accuracy and utility of low-cost PM2.5 sensors was evaluated for measuring spatial variation and modeling population exposure to PM2.5 pollution from domestic wood-heating (DWH) in Armidale, a regional town in New South Wales (NSW), Australia, to obtain estimates of health costs and mortality. Eleven ‘PurpleAir’ (PA) monitors were deployed, including five located part of the time at the NSW government station (NSWGov) to derive calibration equations. Calibrated PA PM2.5 were almost identical to the NSWGov tapered element oscillating microbalance (TEOM) and Armidale Regional Council’s 2017 DustTrak measurements. Spatial variation was substantial. National air quality standards were exceeded 32 times from May–August 2018 at NSWGov and 63 times in one residential area. Wood heater use by about 50% of households increased estimated annual PM2.5 exposure by over eight micrograms per cubic meter, suggesting increased mortality of about 10% and health costs of thousands of dollars per wood heater per year. Accurate real-time community-based monitoring can improve estimates of exposure and avoid bias in estimating dose-response relationships. Efforts over the past decade to reduce wood smoke pollution proved ineffective, perhaps partly because some residents do not understand the health impacts or costs of wood-heating. Real-time Internet displays can increase awareness of DWH and bushfire pollution and encourage governments to develop effective policies to protect public health, as recommended by several recent studies in which wood smoke was identified as a major source of health-hazardous air pollution.
... Long-term exposure to wood or coal smoke is associated with non-accidental emergency department visits in the first three years of life. (Lai et al., 2017). ...
A climate report recently released by the National Institute of Water and Atmospheric
Research (NIWA) models possible climate outcomes for Auckland under different
emission scenarios (Pearce et al., 2018). The results reported in this report could
assist the council in the development of targeted climate mitigation and vulnerability
strategies.
... 5 We accounted for residential mobility across the four time points using time-weighted averages of cumulative exposure method. 6 Multilevel logistic regression was used to assess associations between the exposure variables of wood/coal smoke (either as a continuous or quartile categorical variable) and each binary outcome variables (prescriptions for respiratory medications, or dermatological medications or either respiratory or dermatological medications), with adjustment for child's sex, child's main ethnic group, birth weight, exclusive breastfeeding duration, mother's age at child's birth, household tenure at birth, wood/coal heating of own home, presence of smokers at home, specific household hardship (putting up with feeling cold to save heating costs or being forced to buy cheaper food to afford other things needed), and the meshblocklevel NZ Deprivation Index score, as well as the random effects due to clustering in area census units nested within different regional councils. We conducted sensitivity analyses on the association between exposure and outcome in crude and partly adjusted models, and by using the pharmaceutical records that described pre- (meshblock level) and temporal factors (partitioned to cooler season) so that spatial-or temporal-only residual confounding will have been further reduced. ...
Background
The incidence of early childhood acute respiratory infections (ARIs) has been associated with aspects of the indoor environment. In recent years, public awareness about some of these environmental issues has increased, including new laws and subsequent changes in occupant behaviours. This New Zealand study investigated current exposures to specific risk factors in the home during the first five years of life and provided updated evidence on the links between the home environment and childhood ARI hospitalisation. Methods
Pregnant women (n = 6822) were recruited in 2009 and 2010, and their 6853 children created a child cohort that was representative of New Zealand births from 2007-10. Longitudinal data were collected through face-to-face interviews and linkage to routinely collected national datasets. Incidence rates with Poisson distribution confidence intervals were computed and Cox regression modelling for repeated events was performed. ResultsLiving in a rented dwelling (48%), household crowding (22%) or dampness (20%); and, in the child’s room, heavy condensation (20%) or mould or mildew on walls or ceilings (13%) were prevalent. In 14% of the households, the mother smoked cigarettes and in 30%, other household members smoked. Electric heaters were commonly used, followed by wood, flued gas and unflued portable gas heaters. The incidence of ARI hospitalisation before age five years was 33/1000 person-years. The risk of ARI hospitalisation was higher for children living in households where there was a gas heater in the child’s bedroom: hazard ratio for flued gas heater 1.69 (95% CI: 1.21-2.36); and for unflued gas heater 1.68 (95% CI: 1.12-2.53); and where a gas heater was the sole type of household heating (hazard ratio: 1.64 (95% CI: 1.29-2.09)). The risk was reduced in households that used electric heaters (Hazard ratio: 0.74 (95% CI: 0.61-0.89)) or wood burners (hazard ratio: 0.79 (95% CI: 0.66-0.93)) as a form of household heating. The associations with other risk factors were not significant. Conclusions
The risk of early childhood ARI hospitalisation is increased by gas heater usage, specifically in the child’s bedroom. Use of non-gas forms of heating may reduce the risk of early childhood ARI hospitalisation.
Climate change policies have stimulated a shift towards renewable energy sources such as biomass. The economic crisis of 2008 has also increased the practice of household biomass burning as it is often cheaper than using oil, gas or electricity for heating. As a result, household biomass combustion is becoming an important source of air pollutants in the European Union.
This position paper discusses the contribution of biomass combustion to pollution levels in Europe, and the emerging evidence on the adverse health effects of biomass combustion products.
Epidemiological studies in the developed world have documented associations between indoor and outdoor exposure to biomass combustion products and a range of adverse health effects. A conservative estimate of the current contribution of biomass smoke to premature mortality in Europe amounts to at least 40 000 deaths per year.
We conclude that emissions from current biomass combustion products negatively affect respiratory and, possibly, cardiovascular health in Europe. Biomass combustion emissions, in contrast to emissions from most other sources of air pollution, are increasing. More needs to be done to further document the health effects of biomass combustion in Europe, and to reduce emissions of harmful biomass combustion products to protect public health.
Objectives:
We examined the impact of Rule 4901, aimed at reducing residential wood burning, on particulate matter levels and hospitalizations in the San Joaquin Valley Air Basin (SJVAB).
Methods:
Using general linear mixed models and generalized estimating equation models, we compared levels of particulate matter and of hospital admissions (age groups = 45-64 and ≥ 65 years) in the SJVAB for cardiovascular disease (CVD), ischemic heart disease (IHD), and chronic obstructive pulmonary disease during the burn seasons before (2000-2003) and after (2003-2006) implementation.
Results:
After implementation, we observed reductions of 12%, 11%, and 15% in particulate matter 2.5 micrometers in diameter or smaller (PM2.5), and 8%, 7%, and 11% in coarse particles, in the entire SJVAB and in rural and urban regions of the air basin, respectively. Among those aged 65 years and older, Rule 4901 was estimated to prevent 7%, 8%, and 5% of CVD cases, and 16%, 17%, and 13% of IHD cases, in the entire SJVAB and in rural and urban regions, respectively.
Conclusions:
The study suggests that Rule 4901 is effective at reducing wintertime ambient PM2.5 levels and decreasing hospital admissions for heart disease among people aged 65 years and older.
Objective: To compare the birth characteristics of the Growing Up in New Zealand cohort with those of all New Zealand (NZ) births over a similar time period, and to describe cohort alignment to current NZ births.
Method: The Growing Up in New Zealand longitudinal study recruited 6,846 children from before birth via their pregnant mothers who were residing in the greater Auckland and Waikato regions during 2009 and 2010. Data were collected from mothers antenatally and six weeks after their expected delivery date, and from routine perinatal health records. These data were compared to Ministry of Health data for all births in NZ between 2007 and 2010.
Results: The proportion of males and singleton births were not statistically different to national births. Compared to national births fewer of the cohort children were born low birth weight (4.9% vs. 6.1%, p<0.0001) or preterm (6.4% vs. 7.4%, p=0.001) and the cohort was expected to be more ethnically diverse than national births.
Conclusion: Birth parameters for the cohort were generally closely aligned to all NZ births in 2007–2010. Some statistically significant differences reflected small absolute differences, attributable in some part to cohort recruitment requiring survival to six weeks post expected delivery.
Implications: The explicit documentation of the alignment of the cohort to national data provides assurance that the study is well placed to deliver findings that can inform policy development relevant to the diversity of the contemporary NZ child population.
Studies in air pollution epidemiology may suffer from some specific forms of confounding and exposure measurement error. This contribution discusses these, mostly in the framework of cohort studies. Evaluation of potential confounding is critical in studies of the health effects of air pollution. The association between long-term exposure to ambient air pollution and mortality has been investigated using cohort studies in which subjects are followed over time with respect to their vital status. In such studies, control for individual-level confounders such as smoking is important, as is control for area-level confounders such as neighborhood socio-economic status. In addition, there may be spatial dependencies in the survival data that need to be addressed. These issues are illustrated using the American Cancer Society Cancer Prevention II cohort. Exposure measurement error is a challenge in epidemiology because inference about health effects can be incorrect when the measured or predicted exposure used in the analysis is different from the underlying true exposure. Air pollution epidemiology rarely if ever uses personal measurements of exposure for reasons of cost and feasibility. Exposure measurement error in air pollution epidemiology comes in various dominant forms, which are different for time-series and cohort studies. The challenges are reviewed and a number of suggested solutions are discussed for both study domains.
KEY MESSAGES
1. � ‘Growing Up in New Zealand’ is a 21-year longitudinal study commissioned by the Government of New Zealand in 2004, specifically designed to maximise the translation of research evidence to
inform policy development.
2. � A cohort of 6846 children born between March 2009 and May 2010 was enrolled via their pregnant mothers.
�3. Antenatal interviews were undertaken for pregnant mothers as well as their partners, and further face-to-face interviews occurred when the child was 9 months and are underway at 2 years of age.
4. Brief phone calls collected further information when the child was aged 6 and 35 weeks, 16 and 23 months.
�5. The size and diversity of the cohort provides an opportunity to examine developmental trajectories for the whole cohort of children as well as within subgroups who identify as Maori, Pacific Peoples and
Asian.
Particulate air pollution is associated with cardiovascular morbidity. One hypothesized mechanism involves oxidative stress, systemic inflammation, and endothelial dysfunction.
To assess an intervention's impact on particle exposures and endothelial function among healthy adults in a woodsmoke-impacted community. We also investigated the underlying role of oxidative stress and inflammation in relation to exposure reductions.
Portable air filters were used in a randomized crossover intervention study of 45 healthy adults exposed to consecutive 7-day periods of filtered and nonfiltered air.
Reactive hyperemia index was measured as an indicator of endothelial function via peripheral artery tonometry, and markers of inflammation (C-reactive protein, interleukin-6, and band cells) and lipid peroxidation (malondialdehyde and 8-iso-prostaglandin F(2α)) were quantified. Air filters reduced indoor fine particle concentrations by 60%. Filtration was associated with a 9.4% (95% confidence interval, 0.9-18%) increase in reactive hyperemia index and a 32.6% (4.4-60.9%) decrease in C-reactive protein. Decreases in particulate matter and the woodsmoke tracer levoglucosan were associated with reduced band cell counts. There was limited evidence of more pronounced effects on endothelial function and level of systemic inflammation among males, overweight participants, younger participants, and residents of wood-burning homes. No associations were noted for oxidative stress markers.
Air filtration was associated with improved endothelial function and decreased concentrations of inflammatory biomarkers but not markers of oxidative stress. Our results support the hypothesis that systemic inflammation and impaired endothelial function, both predictors of cardiovascular morbidity, can be favorably influenced by reducing indoor particle concentrations.
Temuco is one of the most highly wood-smoke-polluted cities in the world. Its population in 2004 was 340,000 inhabitants with 1587 annual deaths, of which 24% were due to cardiovascular and 11% to respiratory causes. For hospital admissions, cardiovascular diseases represented 6% and respiratory diseases 13%. Emergency room visits for acute respiratory infections represented 28%. The objective of the study presented here was to determine the relationship between air pollution from particulate matter less than or equal to 10 microm in aerodynamic diameter (PM10; mostly PM2.5, or particulate matter <2.5 microm in aerodynamic diameter) and health effects measured as the daily number of deaths, hospital admissions, and emergency room visits for cardiovascular, respiratory, and acute respiratory infection (ARI) diseases. The Air Pollution Health Effects European Approach (APHEA2) protocol was followed, and a multivariate Poisson regression model was fitted, controlling for trend, seasonality, and confounders for Temuco during 1998-2006. The results show that PM10 had a significant association with daily mortality and morbidity, with the elderly (population >65 yr of age) being the group that presented the greatest risk. The relative risk for respiratory causes, with an increase of 100 microg/m3 of PM10, was 1.163 with a 95% confidence interval (CI) of 1.057-1.279 for mortality, 1.137 (CI 1.096-1.178) for hospital admissions, and 1.162 for ARI (CI 1.144-1.181). There is evidence in Temuco of positive relationships between ambient particulate levels and mortality, hospital admissions, and ARI for cardiovascular and respiratory diseases. These results are consistent with those of comparable studies in other similar cities where wood smoke is the most important air pollution problem.
To assess whether non-polluting, more effective home heating (heat pump, wood pellet burner, flued gas) has a positive effect on the health of children with asthma.
Randomised controlled trial.
Households in five communities in New Zealand.
409 children aged 6-12 years with doctor diagnosed asthma.
Installation of a non-polluting, more effective home heater before winter. The control group received a replacement heater at the end of the trial.
The primary outcome was change in lung function (peak expiratory flow rate and forced expiratory volume in one second, FEV(1)). Secondary outcomes were child reported respiratory tract symptoms and daily use of preventer and reliever drugs. At the end of winter 2005 (baseline) and winter 2006 (follow-up) parents reported their child's general health, use of health services, overall respiratory health, and housing conditions. Nitrogen dioxide levels were measured monthly for four months and temperatures in the living room and child's bedroom were recorded hourly.
Improvements in lung function were not significant (difference in mean FEV(1) 130.7 ml, 95% confidence interval -20.3 to 281.7). Compared with children in the control group, however, children in the intervention group had 1.80 fewer days off school (95% confidence interval 0.11 to 3.13), 0.40 fewer visits to a doctor for asthma (0.11 to 0.62), and 0.25 fewer visits to a pharmacist for asthma (0.09 to 0.32). Children in the intervention group also had fewer reports of poor health (adjusted odds ratio 0.48, 95% confidence interval 0.31 to 0.74), less sleep disturbed by wheezing (0.55, 0.35 to 0.85), less dry cough at night (0.52, 0.32 to 0.83), and reduced scores for lower respiratory tract symptoms (0.77, 0.73 to 0.81) than children in the control group. The intervention was associated with a mean temperature rise in the living room of 1.10 degrees C (95% confidence interval 0.54 degrees C to 1.64 degrees C) and in the child's bedroom of 0.57 degrees C (0.05 degrees C to 1.08 degrees C). Lower levels of nitrogen dioxide were measured in the living rooms of the intervention households than in those of the control households (geometric mean 8.5 microg/m(3) v 15.7 microg/m(3), P<0.001). A similar effect was found in the children's bedrooms (7.3 microg/m(3) v 10.9 microg/m(3), P<0.001).
Installing non-polluting, more effective heating in the homes of children with asthma did not significantly improve lung function but did significantly reduce symptoms of asthma, days off school, healthcare utilisation, and visits to a pharmacist.
Clinical Trials NCT00489762.
There is need for the assessment of long-term effects of outdoor air pollution. In fact, a considerable part of the large amount of U.S. research money that has been dedicated to investigate effects of ambient particulate pollution should be invested to address long-term effects. Studies that follow the health status of large numbers of subjects across long periods of time (i.e., cohort studies) should be considered the key research approach to address these questions. However, these studies are time consuming and expensive. We propose efficient strategies to address these questions in less time. Apart from long-term continuation of the few ongoing air pollution cohort studies in the United States, data from large cohorts that were established decades ago may be efficiently used to assess cardiorespiratory effects and to target research on detection of the most susceptible subgroups in the population, which may be related to genetic, molecular, behavioral, societal, and/or environmental factors. This approach will be efficient only if the available air pollution monitoring data will be used to spatially model long-term outdoor pollution concentrations across a given country for each year with available pollution data. Such concentration maps will allow researchers to impute outdoor air pollution levels at any residential location, independent of the location of monitors. Exposure imputation may be based on residential location(s) of participants in long-standing cardiorespiratory cohort studies, which can be matched to pollutant levels using geographic information systems. As shown in European impact assessment studies, such maps may be derived relatively quickly.
It was hypothesised that wood smoke exposure could be a risk factor for chronic obstructive pulmonary disease (COPD) in Spain. The present study was designed as a case–control study of 120 females requiring hospitalisation during 2001–2003 at Hospital del Mar (Barcelona, Spain).
Cases were recruited from hospital records as females who had been admitted for an exacerbation of COPD. Controls were obtained from pulmonary function test laboratory consultations prior to a surgical intervention. All patients answered a standardised questionnaire.
Exposure to wood or charcoal smoke was strongly associated with COPD after adjusting for age and smoking. The association between length of exposure and COPD suggested a dose–response pattern. Intensity of exposure in both summer and winter was also related to COPD. Wood or charcoal alone independently increased risk of COPD (odds ratio (OR) 1.8 and 1.5, respectively), but only the combination of both was statistically significant (OR 4.5).
In conclusion, the present study shows a strong association between wood or charcoal smoke exposure and chronic obstructive pulmonary disease, supporting its existence not only in developing countries, but also in European countries, such as Spain. Further studies assessing whether this association also exists in other European societies are warranted.
Three multivariate receptor algorithms were applied to seven years of chemical speciation data to apportion fine particulate matter to various sources in Spokane, Washington. Source marker compounds were used to assess the associations between atmospheric concentration of these compounds and daily cardiac hospital admissions and/or respiratory emergency department visits. Total carbon and arsenic had high correlations with two different vegetative burning sources and were selected as vegetative burning markers, while zinc and silicon were selected as markers for the motor vehicle and airborne soil sources, respectively. The rate of respiratory emergency department visits increased 2% for a 3.0 microg/m3 interquartile range change in a vegetative burning source marker (1.023, 95% CI 1.009-1.038) at a lag of one day. The other source markers studied were not associated with the health outcomes investigated. Results suggest vegetative burning is associated with acute respiratory events.
Aim:
Infectious disease (ID) hospitalisation rates are increasing in New Zealand (NZ), especially in pre-school children, and Māori and Pacific people. We aimed to identify risk factors for ID hospitalisation in infancy within a birth cohort of NZ children, and to identify differences in risk factors between ethnic groups.
Methods:
We investigated an established cohort of 6846 NZ children, born in 2009-2010, with linkage to a national data set of hospitalisations. We used multivariable logistic regression to obtain odds ratios (OR) for factors associated with ID hospitalisation in the first year of life, firstly for all children, and then separately for Māori or Pacific children.
Results:
In the whole cohort, factors associated with ID hospitalisation were Māori (OR: 1.49, 95% CI: 1.17-1.89) or Pacific (2.51; 2.00-3.15) versus European maternal ethnicity, male gender (1.32; 1.13-1.55), low birthweight (1.94, 1.39-2.66), exclusive breastfeeding for <4 months (1.22, 1.04-1.43), maternal experience of health-care racism (1.60, 1.19-2.12), household deprivation (most vs. least deprived quintile of households (1.50, 1.12-2.02)), day-care attendance (1.43, 1.12-1.81) and maternal smoking (1.55, 1.26-1.91). Factors associated with ID hospitalisation for Māori infants were high household deprivation (2.16, 1.06-5.02) and maternal smoking (1.48, 1.02-2.14); and for Pacific infants were delayed immunisation (1.72, 1.23-2.38), maternal experience of health-care racism (2.20, 1.29-3.70) and maternal smoking (1.59, 1.10-2.29).
Conclusions:
Māori and Pacific children in NZ experience a high burden of ID hospitalisation. Some risk factors, for example maternal smoking, are shared, while others are ethnic-specific. Interventions aimed at preventing ID hospitalisations should address both shared and ethnic-specific factors.
The occurrence of airborne particulate matter has been flagged as "of concern" in several megacities, especially in Asia. Selected Chilean regions have similar problems as wood burning is the major source of heating in homes. This concern has led to mitigation measures restricting the burning of wood at periods when the particulate matter smaller than 2.5 μm (PM2.5) concentrations are predicted to be high. This work investigates the linkage between indoor and outdoor particle concentrations, determines their source through the polyaromatic hydrocarbon (PAH) signature and investigates the efficacy of the current management practice of burning restrictions. The PM2.5 fraction was collected at 12 different properties with coincident indoor and outdoor sampling using a low-volume active sampler for 24 hours. Indoor concentrations of PM2.5 ranged from 6 to 194 μg m(-3) with a mean of 72 μg m(-3) and corresponding outdoor concentrations ranged from 5 to 367 μg m(-3) with a mean of 85 μg m(-3) over the winter periods of 2014 and 2015; the Chilean national permitted maximum in outdoor air is 50 μg m(-3) in 24 hours. Higher concentrations were measured when the outdoor air temperature was lower. The PAHs were analysed on the PM2.5 fraction; the indoor concentrations ranged from 2 to 291 ng m(-3) with a mean of 51 ng m(-3) compared to an outdoor concentration between 3 and 365 ng m(-3) with a mean of 71 ng m(-3). Multivariate statistical analysis of the PAH profiles using principal components analysis (PCA) and polytopic vector analysis (PVA) identified wood burning, static and mobile diesel emissions and kerosene combustion as the major contributors to the particulate matter. When converted to toxicity equivalents (BaP-TEQ), the highest toxicity arising from PAHs in the indoor air was associated with a property that used a "leaky" combined wood stove and heater and also used a wood-fired brazier for local heating. In outdoor air, there was a relationship between the housing density and the BaP-TEQ, such that denser housing had higher BaP-TEQ values. The restrictions in wood burning on selected days may have had a measureable effect on the PM2.5 concentrations in that region but the effects were small and only present for the day of the restriction.
SUMMARY The results of this study provide evidence linking the effectiveness of Rule 4901 residential wood-burning regulations to decreases in the burden of hospital admissions for CVD, and IHD in the elderly, as well as reductions in the wintertime ambient PM2.5 levels. The results of this study suggest that the impact of the reduction in PM2.5 related to the Rule 4901 decreases the burden of hospital admissions for CVD and IHD, particularly for the elderly age group. However, because total exposure is a result of both indoor and outdoor exposure a careful evaluation of indoor particulate matter exposures including wood smoke, is needed to better assess the efficacy of residential wood-burning regulations.
A comprehensive review identified the misguided nature of favourable taxation for diesel vehicles: “global warming has been negatively affected, and air pollution has become alarming in many European locations.”1 Policymakers did not adequately consider the serious health effects of particles less than 2.5 microns in size (PM2.5)—known since 1993 when the Six Cities study was published—and the additional global warming from nitric oxide and nitrogen dioxide, …
Respiratory disease is the major cause of mortality and morbidity worldwide, with infants and young children especially susceptible. The spectrum of disease ranges from acute infections to chronic non-communicable diseases. Five respiratory conditions dominate—acute respiratory infections, chronic obstructive pulmonary disease, asthma, tuberculosis (TB), and lung cancer. Pneumonia remains the predominant cause of childhood mortality, causing nearly 1.3 million deaths each year, most of which are preventable. Asthma is the commonest non-communicable disease in children. Pediatric TB constitutes up to 20% of the TB caseload in high incidence countries. Environmental exposures such as tobacco smoke, indoor air pollution, and poor nutrition are common risk factors for acute and chronic respiratory diseases. Pediatric and adult respiratory disease is closely linked. Early childhood respiratory infection or environmental exposures may lead to chronic disease in adulthood. Childhood immunization can effectively reduce the incidence and severity of childhood pneumonia; childhood immunization is also effective for reducing pneumonia in the elderly. The Forum of International Respiratory Societies (FIRS), representing the major respiratory societies worldwide, has produced a global roadmap of respiratory diseases, Respiratory Disease in the World: Realities of Today—Opportunities for Tomorrow. This highlights the burden of respiratory diseases globally and contains specific recommendations for effective strategies. Greater availability and upscaled implementation of effective strategies for prevention and management of respiratory diseases is needed worldwide to improve global health and diminish the current inequities in health care worldwide. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
Rationale:
Ambient air pollution has been suggested as a risk factor for chronic obstructive pulmonary disease (COPD). However, there is a lack of longitudinal studies to support this assertion.
Objectives:
To investigate the associations of long-term exposure to elevated traffic-related air pollution and woodsmoke pollution with the risk of COPD hospitalization and mortality.
Methods:
This population-based cohort study included a 5-year exposure period and a 4-year follow-up period. All residents aged 45-85 years who resided in Metropolitan Vancouver, Canada, during the exposure period and did not have known COPD at baseline were included in this study (n = 467,994). Residential exposures to traffic-related air pollutants (black carbon, particulate matter <2.5 μm in aerodynamic diameter, nitrogen dioxide, and nitric oxide) and woodsmoke were estimated using land-use regression models and integrating changes in residences during the exposure period. COPD hospitalizations and deaths during the follow-up period were identified from provincial hospitalization and death registration databases.
Measurements and main results:
An interquartile range elevation in black carbon concentrations (0.97 × 10(-5)/m, equivalent to 0.78 μg/m(3) elemental carbon) was associated with a 6% (95% confidence interval, 2-10%) increase in COPD hospitalizations and a 7% (0-13%) increase in COPD mortality after adjustment for covariates. Exposure to higher levels of woodsmoke pollution (tertile 3 vs. tertile 1) was associated with a 15% (2-29%) increase in COPD hospitalizations. There were positive exposure-response trends for these observed associations.
Conclusions:
Ambient air pollution, including traffic-related fine particulate pollution and woodsmoke pollution, is associated with an increased risk of COPD.
The 2009 Academic Emergency Medicine consensus conference focused on “Public Health in the ED: Surveillance, Screening and Intervention.” One conference breakout session discussed the significant research value of health-related data sets. This article represents the proceedings from that session, primarily focusing on emergency department (ED)-related data sets and includes examples of the use of a data set based on ED visits for research purposes. It discusses types of ED-related data sets available, highlights barriers to research use of ED-related data sets, and notes limitations of these data sets. The paper highlights future directions and challenges to using these important sources of data for research, including identification of five main needs related to enhancing the use of ED-related data sets. These are 1) electronic linkage of initial and follow-up ED visits and linkage of information about ED visits to other outcomes, including costs of care, while maintaining deidentification of the data; 2) timely data access with minimal barriers; 3) complete data collection for clinically relevant and/or historical data elements, such as the external cause-of-injury code; 4) easy access to data that can be parsed into smaller jurisdictions (such as states) for policy and/or research purposes, while maintaining confidentiality; and 5) linkages between health survey data and health claims data. ED-related data sets contain much data collected directly from health care facilities, individual patient records, and multiple other sources that have significant potential impact for studying and improving the health of individuals and the population.
: Otitis media is the leading reason young children receive antibiotics or visit a physician. We evaluated the impact of ambient air pollution on outpatient physician visits for otitis media in a population-based birth cohort.
: All children born in southwestern British Columbia during 1999-2000 were followed until the age of 2 years. Residential air pollution exposures were estimated for the first 24 months of life by inverse-distance weighting of monitor data (CO, NO, NO2, O3, PM2.5, PM10, SO2), temporally adjusted land-use regression models (NO, NO2, PM2.5, black carbon, woodsmoke), and proximity to roads and point sources. We used generalized estimating equations to longitudinally assess the relationship between physician visits for otitis media (ICD-9) and average pollutant exposure in the 2 months prior to the visit, after adjustment for covariates.
: Complete exposure and risk-factor data were available for 45,513 children (76% of all births). A total of 42% of subjects had 1 or more physician visits for otitis media during follow-up. Adjusted estimates for NO, PM2.5, and woodsmoke were consistently elevated (eg, relative risk of 1.10 [95% confidence interval = 1.07-1.12] per interquartile range [IQR] increase in NO; 1.32 [1.27-1.36] per IQR increase in days of woodsmoke exposure). No increased risks were observed for the remaining pollutants (eg, 1.00 [0.98-1.03] per IQR increase in PM10; 0.99 [0.97-1.01] per IQR increase in black carbon).
: Modest but consistent associations were found between some measures of air pollution and otitis media in a large birth cohort exposed to relatively low levels of ambient air pollution.
Data regarding the influence of ambient air pollution on infant bronchiolitis are few.
We evaluated the impact of several air pollutants and their sources on infant bronchiolitis.
Infants in the Georgia Air Basin of British Columbia with an inpatient or outpatient clinical encounter for bronchiolitis (n = 11,675) were matched on day of birth to as many as 10 control subjects. Exposure to particulate matter with a diameter of 2.5 mum or less (PM(2.5)), PM(10), NO(2)/NO, SO(2), CO, and O(3) were assessed on the basis of a regional monitoring network. Traffic exposure was assessed using regionally developed land use regression (LUR) models of NO(2), NO, PM(2.5), and black carbon as well as proximity to highways. Exposure to wood smoke and industrial emissions was also evaluated. Risk estimates were derived using conditional logistic regression and adjusted for infant sex and First Nations (Canadian government term for recognized aboriginal groups) status and for maternal education, age, income-level, parity, smoking during pregnancy, and initiation of breastfeeding.
An interquartile increase in lifetime exposure to NO(2), NO, SO(2), CO, wood-smoke exposure days, and point source emissions score was associated with increased risk of bronchiolitis (e.g., adjusted odds ratio [OR(adj)] NO(2), 95% confidence interval [CI], 1.12, 1.09-1.16; OR(adj) wood smoke, 95% CI, 1.08, 1.04-1.11). Infants who lived within 50 meters of a major highway had a 6% higher risk (1.06, 0.97-1.17). No adverse effect of increased exposure to PM(10), PM(2.5), or black carbon, was observed. Ozone exposure was negatively correlated with the other pollutants and negatively associated with the risk of bronchiolitis.
Air pollutants from several sources may increase infant bronchiolitis requiring clinical care. Traffic, local point source emissions, and wood smoke may contribute to this disease.
In epidemiologic studies, analysis of the relationship between exposure intensity and risk is complicated by the fact that exposures often take place over extended periods, during which intensities can vary substantially. To relate exposure to outcome, it is necessary to combine information about duration, intensity and timing into a summary measure of exposure. If the aim of the exposure-response analysis is to estimate the risk associated with differing exposure intensities, the results depend on the manner in which one incorporates intensity into the summary exposure metric. Most metrics used to summarize exposure, such as the cumulative exposure index, are time-weighted summations of intensity. They are thus based on the assumption that for any fixed time point, the effect of a unit of exposure is proportional to its intensity. This paper describes an approach for constructing and fitting summary measures of exposure that one can use to incorporate alternative assumptions about the effect of exposure intensity, as well as effects relating to the timing of exposure. Data from a study of lung cancer mortality in asbestos miners and millers serve to illustrate the method. Exposure metrics based on various functions of intensity and time of exposure are constructed and fitted to the data using conditional logistic regression. The results demonstrate how the choice of a function for quantification of exposure can affect the exposure-response analysis and the risk estimates it yields.
Winter air pollution in Christchurch is dominated by particulate matter from solid fuel domestic heating. The aim of the study was to explore the relationship between particulate air pollution and admissions to hospital with cardio-respiratory illnesses.
Particulate air pollution statistics (PM10) were obtained from the Canterbury Regional Council monitoring station in the city. The New Zealand Health Information Service provided data on admissions to the Princess Margaret and Christchurch Hospitals for the period June 1988 through December 1998 for both adults and children with cardiac and respiratory disorders. The relationship between PM10 and admissions was explored using a time series analysis approach controlling for weather variables. Missing values were interpolated from carbon monoxide data for the same time period, as carbon monoxide and PM10 were highly correlated.
There was a significant association between PM10 levels and cardio-respiratory admissions. For all age groups combined there was a 3.37% increase in respiratory admissions for each interquartile rise in PM10 (interquartile value 14.8 mcg/m3). There was also a 1.26% rise in cardiac admissions for each interquartile rise in PM10. There was no relationship between PM10 and admissions for appendicitis, the control condition selected.
In keeping with overseas studies, there is evidence in Christchurch of a relationship between ambient particulate levels and admissions with cardiac and respiratory illnesses. The size of the effect is consistent with overseas data, with the greatest impact for respiratory disorders. Implications: These results indicate that measures to control ambient particulate levels have the potential to reduce hospital admissions for cardio-respiratory illnesses.
The importance of wood combustion to local air quality was estimated by measuring different air pollutants and conducting chemical mass balance modelling. PM10, PM2.5, PAHs and VOC concentrations in ambient air were measured in a typical Finnish residential area. Measurements were conducted in January-March 2006. For some compounds, wood combustion was clearly the main local source at this site. The effect of wood combustion was more clearly seen for organic compounds than for fine particle mass. For fine particles, background concentrations dominated. However, very high, short-lived concentration peaks were detected, when the wind direction and other weather conditions were favourable. For organic compounds, the effect of wood combustion was seen in diurnal and in two-week average concentrations. PAH-concentrations were often several times higher at the residential area than in the background. Benzene concentrations showed similar diurnal pattern as the use of wood and benzene/toluene ratios indicated that wood combustion is the most important source. A chemical mass balance model was used for studying the effect of wood combustion on the measured concentrations of VOCs. Model results showed that the main local sources for VOCs at Kurkimäki are wood combustion and traffic. Wood combustion was clearly the most important source for many compounds (e.g., benzene).
Fine particulate matter (PM(2.5)) is associated with respiratory effects, and asthmatic children are especially sensitive. Preliminary evidence suggests that combustion-derived particles play an important role. Our objective was to evaluate effect estimates from different PM(2.5) exposure metrics in relation to airway inflammation and lung function among children residing in woodsmoke-impacted areas of Seattle. Nineteen children (ages 6-13 yr) with asthma were monitored during the heating season. We measured 24-h outdoor and personal concentrations of PM(2.5) and light-absorbing carbon (LAC). Levoglucosan (LG), a marker of woodsmoke, was also measured outdoors. We partitioned PM(2.5) exposure into its ambient-generated (E(ag)) and nonambient (E(na)) components. These exposure metrics were evaluated in relation to daily changes in exhaled nitric oxide (FE(NO)), a marker of airway inflammation, and four lung function measures: midexpiratory flow (MEF), peak expiratory flow (PEF), forced expiratory volume in the first second (FEV(1)), and forced vital capacity (FVC). E(ag), but not E(na), was correlated with combustion markers. Significant associations with respiratory health were seen only among participants not using inhaled corticosteroids. Increases in FE(NO) were associated with personal PM(2.5), personal LAC, and E(ag) but not with ambient PM(2.5) or its combustion markers. In contrast, MEF and PEF decrements were associated with ambient PM(2.5), its combustion markers, and E(ag), but not with personal PM(2.5) or personal LAC. FEV(1) was associated only with ambient LG. Our results suggest that lung function may be especially sensitive to the combustion-generated component of ambient PM(2.5), whereas airway inflammation may be more closely related to some other constituent of the ambient PM(2.5) mixture.
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Volume of Non Accidental ED and Outpatient Events for Paediatric and Emergency Health Specialities in 2013 where the Client Was Aged Three Years Old or Less
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