Mark J Nieuwenhuijsen’s research while affiliated with Instituto de Salud Global de Barcelona and other places

Health implications of mobility during pregnancy entail a need to understand pregnant women’s activity spaces. We present ActMAP, a framework for quantifying multiple aspects of activity spaces from distinct trips and stays derived from GPS data. We applied ActMAP to data from 238 pregnant women in Barcelona, Spain (2018–2020) and explored weekday, weekend and intraday associations between pregnancy trimester and activity spaces. Activities were more centred around the home later in pregnancy. However, the number of visited places and daily trips remained largely constant throughout pregnancy. By constructing activity spaces from individual trips and stays, ActMAP could provide a framework for GPS-based holistic assessments of mobility.

This study aimed to develop exposure-response relationships (ERRs) between road, rail, and air traffic noise and high noise annoyance (HNA) and to assess the HNA disease burden. In 2023, 4 640 adults were cross-sectionally sampled from the five largest cities in Bulgaria. Participants’ road, rail/tram, and air traffic HNA was defined as the top two categories (60% cut-off point) of a 5-point scale. A 72% cut-off approximation was also used. European Noise Directive maps were used to assign day-evening-night equivalent sound levels (Lden) to residences. ERRs were derived and used, together with the new WHO disability weight for HNA, to calculate disability-adjusted life years (DALYs). DALYs were monetised based on Bulgaria’s gross domestic product (GDP) per capita and the value of a life year (VOLY). In fully adjusted models, Lden was non-linearly associated with HNA. Road traffic Lden [range 42.5 - 77.5 dB] was positively associated with HNA only above 62.5 dB, whereas the upward trend for rail [range 37.5 - 72.5 dB] and air traffic Lden [range 37.5 - 57.5 dB] started at 40-45 dB. Using this study’s ERRs, the burden among people exposed to ≥ 40 dB was 3 476 (1 896 - 5 056) DALYs, $39 138 953 (21 348 520 - 56 929 386) based on GDP, and € 243 310 984 (94 796 487 - 505 581 266) based on VOLY. Using the WHO’s curves, the burden was 4 312 (2 352 - 6 273) DALYs,$ 48 559 330 (26 486 907 - 70 631 753), and € 301 873 648 (117 613 110 - 627 269 918). In conclusion, we could only derive a plausible ERR for railway noise annoyance. Until better ERRs are derived for the Bulgarian population, we recommend using the WHO curves for road traffic and aircraft noise annoyance.

Neighbourhood socioeconomic status (NSES) has been identified as a determinant of mental health. In this study, we aimed to quantify how many cases of common mental health problems could be prevented by increasing NSES in the most socioeconomically deprived neighbourhoods in Rotterdam, the Netherlands, and how the increases in NSES would affect mental health inequalities. We used publicly available data for conducting a quantitative Health Impact Assessment (HIA) of two counterfactual policy scenarios. In Scenario 1, we set the NSES to the Rotterdam median score for all neighbourhoods which were below the Rotterdam median. In Scenario 2, we set the NSES score to the Dutch national average socioeconomic status score for the neighbourhoods that were below the national average. We estimated that Scenario 1 could prevent 5847 (95% CI, 2700–7999) or 10.7% of annual cases of common mental health problems, and Scenario 2 could prevent 10 713 (95% CI, 4875–14 799) or 19.6% of annual cases in Rotterdam while also reducing mental health inequalities between neighbourhoods in both scenarios. Given the substantial improvements in population mental health that enhanced neighbourhood socioeconomic conditions would bring, policy implementation is urgently needed.

This study investigated the associations between residential environmental characteristics and the prevalence of cardiometabolic diseases in the five largest Bulgarian cities. Representative cross-sectional survey data (N = 4640 adults) was collected in Sofia, Plovdiv, Varna, Burgas, and Ruse. Participants self-reported diagnosis or medication intake for hypertension, ischemic heart disease (IHD), stroke, and diabetes mellitus, as well as domestic burning of solid fuel and having a domestic garden. Residential addresses were linked to greenspace (overall vegetation level, tree cover, urban greenspace), bluespace, walkability, air pollution (NO2), and traffic noise (Lden). In the 300 m buffer, bluespace presence was inversely associated with hypertension (odds ratio [OR] = 0.67; 95% CI: 0.45, 1.00), IHD (OR = 0.45; 95% CI: 0.21, 0.99), and diabetes (OR = 0.51; 95% CI: 0.25, 1.04). Higher walkability and tree cover were inversely associated with hypertension (OR per 2 units = 0.85; 95% CI: 0.75, 0.96) and diabetes (OR per 10% = 0.77; 95% CI: 0.62, 0.97), respectively. These associations were stronger in larger buffers. Solid fuel burning was associated with IHD (OR = 1.63; 95% CI: 1.07, 2.50). There was an indication of a positive association between aircraft Lden and both stroke and IHD. The direction of the associations for domestic gardens, NO2, road traffic and railway Lden was counterintuitive. We detected some nonlinear associations. In conclusion, people living in urban neighborhoods that were more walkable, closer to bluespace, and greener had lower prevalence of cardiometabolic diseases, while solid fuel burning was associated with higher odds of cardiovascular diseases. Unexpected associations with some exposures may be due to unaccounted for urban fabric characteristics. This study is among the first assessing an understudied region in Southeastern Europe. Its findings have the potential to inform public discourse and provide evidence to support the implementation of urban design conducive to cardiometabolic health.

Cardiovascular disease is the leading cause of morbidity and mortality worldwide, with a substantial amount of health-care resources targeted towards its diagnosis and management. Environmental sustainability in cardiovascular care can have an important role in reducing greenhouse gas emissions and pollution and could be beneficial for improving health metrics and societal well-being and minimizing the cost of health care. In this Review, we discuss the motivations and frameworks for sustainable cardiovascular care with an emphasis on the reduction of the climate-related and environmental effects of cardiovascular care. We also provide an overview of greenhouse gas emissions related to the provision of health care, including their measurement and quantification, carbon accounting, carbon disclosures and climate effects. The principles of life-cycle assessment, waste prevention and circular economics in health care are discussed, and the emissions associated with various sectors of cardiovascular care as well as the rationale for prevention as a powerful approach to reduce these emissions are presented. Finally, we highlight the challenges in environmental sustainability and future directions as applicable to cardiovascular practice.

Healthy, uncontaminated soils and clean water support all life on Earth and are essential for human health. Chemical pollution of soil, water, air and food is a major environmental threat, leading to an estimated 9 million premature deaths worldwide. The Global Burden of Disease study estimated that pollution was responsible for 5.5 million deaths related to cardiovascular disease (CVD) in 2019. Robust evidence has linked multiple pollutants, including heavy metals, pesticides, dioxins and toxic synthetic chemicals, with increased risk of CVD, and some reports suggest an association between microplastic and nanoplastic particles and CVD. Pollutants in soil diminish its capacity to produce food, leading to crop impurities, malnutrition and disease, and they can seep into rivers, worsening water pollution. Deforestation, wildfires and climate change exacerbate pollution by triggering soil erosion and releasing sequestered pollutants into the air and water. Despite their varied chemical makeup, pollutants induce CVD through common pathophysiological mechanisms involving oxidative stress and inflammation. In this Review, we provide an overview of the relationship between soil and water pollution and human health and pathology, and discuss the prevalence of soil and water pollutants and how they contribute to adverse health effects, focusing on CVD.