Imperial College London

DrAnnaFreni Sterrantino

Faculty of MedicineSchool of Public Health

Honorary Research Associate
 
 
 
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Contact

 

+44 (0)20 7594 3276a.freni-sterrantino

 
 
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Location

 

531Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
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38 results found

Wang W, Gulliver J, Beevers S, Freni Sterrantino A, Davies B, Atkinson RW, Fecht Det al., 2024, Short-term nitrogen dioxide exposure and emergency hospital admissions for asthma in children: a case-crossover analysis in England, Journal of Asthma and Allergy, ISSN: 1178-6965

Journal article

Freni-Sterrantino A, Fiorito G, D'Errico A, Virtanen M, Ala-Mursula L, Jarvelin M-R, Vineis P, Robinson Oet al., 2022, Association between work characteristics and epigenetic age acceleration: cross-sectional results from UK - Understanding Society study, AGING-US, Vol: 14, ISSN: 1945-4589

Journal article

Freni Sterrantino A, Fiorito G, D'errico A, Virtanen M, Ala-Mursula L, Jarvelin M-R, Vineis P, Robinson Oet al., 2022, Association between work characteristics and epigenetic age acceleration: cross-sectional results from UK – Understanding Society study, Aging, Vol: 14, Pages: 7752-7773, ISSN: 1945-4589

Occupation-related stress and work characteristics are possible determinants of social inequalities in epigenetic aging but have been little investigated. Here, we investigate the association of several work characteristics with epigenetic age acceleration (AA) biomarkers.The study population included employed and unemployed men and women (n=631) from UK Understanding Society study. We evaluated the association of employment and work characteristics related to job type, job stability; job schedule; autonomy and influence at work; occupational physical activity; and feelings regarding the job with four epigenetic age acceleration biomarkers (Hannum, Horvath, PhenoAge, GrimAge) and pace of aging (DunedinPoAm, DunedinPACE). We fitted linear regression models, unadjusted and adjusted for established risk factors, and found the following associations for unemployment (years of acceleration): HorvathAA (1.51, 95%CI 0.08,2.95), GrimAgeAA (1.53, 95%CI 0.16,2.90) and 3.21 years for PhenoAA (95%CI 0.89,5.33). Job insecurity increased PhenoAA (1.83, 95%CI 0.003,3.67), while working at night was associated with an increase of 2.12 years in GrimAgeAA (95%CI 0.69,3.55). We found effects of unemployment to be stronger in men and effects of night shift work to be stronger in women. These results provide evidence of associations between unemployment with accelerated ageing and suggest that insecure employment and night work may also increase age acceleration. Our findings have implications for policies relating to current changes in working conditions and highlight the utility of biological age biomarkers in studies in younger populations without long-term health information.

Journal article

Cappozzo A, McCrory C, Robinson O, Freni Sterrantino A, Sacerdote C, Krogh V, Panico S, Tumino R, Iacoviello L, Sieri S, Ricceri F, Chiodini P, McKay GJ, McKnight AJ, Kee F, Young IS, McGuinness B, Crimmins EM, Arpawong TE, Kenny RA, O'Halloran A, Polidoro S, Solinas G, Vineis P, Ieva F, Fiorito Get al., 2022, A blood DNA methylation biomarker for predicting short-term risk of cardiovascular events, Clinical Epigenetics, Vol: 14, ISSN: 1868-7083

Background:Recent evidence highlights the epidemiological value of blood DNA methylation (DNAm) as surrogate biomarker for exposure to risk factors for non-communicable diseases (NCD). DNAm surrogate of exposures predicts diseases and longevity better than self-reported or measured exposures in many cases. Consequently, disease prediction models based on blood DNAm surrogates may outperform current state-of-the-art prediction models. This study aims to develop novel DNAm surrogates for cardiovascular diseases (CVD) risk factors and develop a composite biomarker predictive of CVD risk. We compared the prediction performance of our newly developed risk score with the state-of-the-art DNAm risk scores for cardiovascular diseases, the ‘next-generation’ epigenetic clock DNAmGrimAge, and the prediction model based on traditional risk factors SCORE2.Results:Using data from the EPIC Italy cohort, we derived novel DNAm surrogates for BMI, blood pressure, fasting glucose and insulin, cholesterol, triglycerides, and coagulation biomarkers. We validated them in four independent data sets from Europe and the USA. Further, we derived a DNAmCVDscore predictive of the time-to-CVD event as a combination of several DNAm surrogates. ROC curve analyses show that DNAmCVDscore outperforms previously developed DNAm scores for CVD risk and SCORE2 for short-term CVD risk. Interestingly, the performance of DNAmGrimAge and DNAmCVDscore was comparable (slightly lower for DNAmGrimAge, although the differences were not statistically significant).Conclusions:We described novel DNAm surrogates for CVD risk factors useful for future molecular epidemiology research, and we described a blood DNAm-based composite biomarker, DNAmCVDscore, predictive of short-term cardiovascular events. Our results highlight the usefulness of DNAm surrogate biomarkers of risk factors in epigenetic epidemiology to identify high-risk populations. In addition, we provide further evidence on the effectiveness of

Journal article

Freni Sterrantino A, Fiorito G, D'errico A, Oliver R, Virtanen M, Ala-Mursula L, Jarvelin MR, Ronkainen J, Vineis Pet al., 2022, Work-related stress and well-being in association with epigenetic age acceleration: a Northern Finland Birth Cohort 1966 Study, Aging, Vol: 14, Pages: 1128-1156, ISSN: 1945-4589

Recent evidence indicates consistent association of low socioeconomic status with epigenetic age acceleration, measured from DNA methylation. As work characteristics and job stressors are crucial components of socioeconomic status, we investigated their association with various measures of epigenetic age acceleration.The study population included employed and unemployed men and women (n=604) from the Northern Finland Birth Cohort 1966. We investigated the association of job strain, effort-reward imbalance and work characteristics with five biomarkers of epigenetic aging (Hannum, Horvath, PhenoAge, GrimAge, and DunedinPoAm).Our results indicate few significant associations between work stress indicators and epigenetic age acceleration, limited to a range of ±2 years, and smoking recording the highest effect on GrimAge age acceleration biomarker between current and no smokers (median difference 4.73 years (IQR 1.18, 8.41). PhenoAgeAA was associated with job strain active work (β=-1.301 95%CI -2.391, -0.212), slowing aging of less than 1.5 years, and working as white-collar slowed aging six months (GrimAgeAA β=-0.683, 95%CI -1.264, -0.102) when compared to blue collars. Association was found for working for more than 40 hours per week that increased the aging over 1.5 years, (HorvathAA β =2.058 95%CI 0.517,3.599, HannumAA β=1.567, 95%CI 0.415,2.719).The pattern of associations was different between women and men and some of the estimated effects are inconsistent with current literature. Our results provide the first evidence of association of work conditions with epigenetic aging biomarkers. However, further epidemiological research is needed to fully understand how work-related stress affects epigenetic age acceleration in men and women in different societies.

Journal article

Makinde J, Nduati EW, Freni-Sterrantino A, Streatfield C, Kibirige C, Dalel J, Black SL, Hayes P, Macharia G, Hare J, McGowan E, Abel B, King D, Joseph S, Hunter E, Sanders EJ, Price M, Gilmour Jet al., 2021, A novel sample selection approach to aid the identification of factors that correlate wth the control of HIV-1 infection, Frontiers in Immunology, Vol: 12, Pages: 1-12, ISSN: 1664-3224

Individuals infected with HIV display varying rates of viral control and disease progression, with a small percentage of individuals being able to spontaneously control infection in the absence of treatment. In attempting to define the correlates associated with natural protection against HIV, extreme heterogeneity in the datasets generated from systems methodologies can be further complicated by the inherent variability encountered at the population, individual, cellular and molecular levels. Furthermore, such studies have been limited by the paucity of well-characterised samples and linked epidemiological data, including duration of infection and clinical outcomes. To address this, we selected 10 volunteers who rapidly and persistently controlled HIV, and 10 volunteers each, from two control groups who failed to control (based on set point viral loads) from an acute and early HIV prospective cohort from East and Southern Africa. A propensity score matching approach was applied to control for the influence of five factors (age, risk group, virus subtype, gender, and country) known to influence disease progression on causal observations. Fifty-two plasma proteins were assessed at two timepoints in the 1st year of infection. We independently confirmed factors known to influence disease progression such as the B*57 HLA Class I allele, and infecting virus Subtype. We demonstrated associations between circulating levels of MIP-1α and IL-17C, and the ability to control infection. IL-17C has not been described previously within the context of HIV control, making it an interesting target for future studies to understand HIV infection and transmission. An in-depth systems analysis is now underway to fully characterise host, viral and immunological factors contributing to control.

Journal article

Freni Sterrantino A, Salerno V, 2021, A plea for the need to investigate the health effects of the gig-economy, Frontiers in Public Health, Vol: 9, ISSN: 2296-2565

Journal article

Makinde J, Nduati EW, Sterrantino AF, Streatfield C, Kibirige C, Dalel J, Black SL, Hayes P, Macharia G, Hare J, King D, Joseph S, McGowan E, Abel B, Hunter Eet al., 2021, Analysis of the early responses to HIV-1 in matched treatment naive individuals reveals early soluble proteins that are associated with <i>in vivo</i> virus control, Publisher: JOHN WILEY & SONS LTD

Conference paper

Yang Z, Freni Sterrantino A, Fuller G, Gulliver Jet al., 2020, Development and Transferability of Ultrafine Particle Land Use Regression Models in London, Science of the Total Environment, Vol: 740, ISSN: 0048-9697

Due to a lack of routine monitoring, bespoke measurements are required to develop ultrafine particle (UFP) land use regression (LUR) models, which is especially challenging in megacities due to their large area. As an alternative, for London, we developed separate models for three urban residential areas, models combining two areas, and models using all three areas. Models were developed against annual mean ultrafine particle count cm−3 estimated from repeated 30-min fixed-site measurements, in different seasons (2016–2018), at forty sites per area, that were subsequently temporally adjusted using continuous measurements from a single reference site within or close to each area. A single model and 10 models were developed for each individual area and combination of areas. Within each area, sites were split into 10 groups using stratified random sampling. Each of the 10 models were developed using 90% of sites. Hold-out validation was performed by pooling the 10% of sites held-out each time. The transferability of models was tested by applying individual and two-area models to external area(s). In model evaluation, within-area mean squared error (MSE) R2 ranged from 14% to 48%. Transferring individual- and combined-area models to external areas without calibration yielded MSE-R2 ranging from −18 to 0. MSE-R2 was in the range 21% to 41% when using particle number count (PNC) measurements in external areas to calibrate models. Our results suggest that the UFP models could be transferred to other areas without calibration in London to assess relative ranking in exposures but not for estimating absolute values of PNC.

Journal article

Lavigne A, Freni Sterrantino A, Fecht D, Liverani S, Blangiardo M, De Hoogh K, Molitor J, Hansell Aet al., 2020, A spatial joint analysis of metal constituents of ambient particulate matter and mortality in England, Environmental Epidemiology, Vol: 4, Pages: e098-e098, ISSN: 2474-7882

Background Few studies have investigated associations between metal components of particulate matter on mortality due to well-known issues of multicollinearity. Here, we analyze these exposures jointly to evaluate their associations with mortality on small area data.Methods We fit a Bayesian Profile Regression (BPR) to account for the multicollinearity in the elemental components (iron, copper and zinc) of PM10 and PM2.5. The models are developed in relation to mortality from cardiovascular and respiratory disease and lung cancer incidence in 2008-11 at small area level, for a population of 13.6 million in the London-Oxford area of England.Results From the BPR, we identified higher risks in the PM10 fraction cluster likely to represent the study area, excluding London, for cardiovascular mortality RR 1.07 (95%CI 1.02, 1.12) and for respiratory mortality RR 1.06 (95%CI 0.99, 1.31), compared to the study mean. For PM2.5 fraction, higher risks were seen for cardiovascular mortality RR 1.55 (CI 95% 1.38, 1.71) and respiratory mortality RR 1.51 (CI 95% 1.33, 1.72), likely to represent the 'highways' cluster. We did not find relevant associations for lung cancer incidence.Conclusion Our analysis showed small but not fully consistent adverse associations between health outcomes and particulate metal exposures. The BPR approach identified subpopulations with unique exposure profiles and provided information about the geographical location of these to help interpret findings.

Journal article

Freni Sterrantino A, Pinelli M, Baronio M, Giuseppe N, Tonini G, Marri M, Baglivo M, Sabatini T, Maltese PE, Chiurazzi P, Michelini S, Morreale G, Aniello A, Notaro P, Bertelli Met al., 2020, Italian SARS-CoV-2 patients in intensive care: towards an identikit for subjects at risk?, European Review for Medical and Pharmacological Sciences

Journal article

Roca-Barceló A, Crabbe H, Ghosh R, Freni-Sterrantino A, Fletcher T, Leonardi G, Hoge C, Hansell A, Piel Fet al., 2020, Temporal trends and demographic risk factors for hospital admissions due to carbon monoxide poisoning in England, Preventive Medicine, Vol: 136, ISSN: 0091-7435

Unintentional non-fire related (UNFR) carbon monoxide (CO) poisoning is a preventable cause of morbidity and mortality. Epidemiological data on UNFR CO poisoning can help monitor changes in the magnitude of this burden, particularly through comparisons of multiple countries, and to identify vulnerable sub-groups of the population which may be more at risk. Here, we collected data on age- and sex- specific number of hospital admissions with a primary diagnosis of UNFR CO poisoning in England (2002–2016), aggregated to small areas, alongside area-level characteristics (i.e. deprivation, rurality and ethnicity). We analysed temporal trends using piecewise log-linear models and compared them to analogous data obtained for Canada, France, Spain and the US. We estimated age-standardized rates per 100,000 inhabitants by area-level characteristics using the WHO standard population (2000–2025). We then fitted the Besag York Mollie (BYM) model, a Bayesian hierarchical spatial model, to assess the independent effect of each area-level characteristic on the standardized risk of hospitalization. Temporal trends showed significant decreases after 2010. Decreasing trends were also observed across all countries studied, yet France had a 5-fold higher risk. Based on 3399 UNFR CO poisoning hospitalizations, we found an increased risk in areas classified as rural (0.69, 95% CrI: 0.67; 0.80), highly deprived (1.77, 95% CrI: 1.66; 2.10) or with the largest proportion of Asian (1.15, 95% CrI: 1.03; 1.49) or Black population (1.35, 95% CrI: 1.20; 1.80). Our multivariate approach provides strong evidence for the identification of vulnerable populations which can inform prevention policies and targeted interventions.

Journal article

Sheehan A, Freni Sterrantino A, Fecht D, Elliott P, Hodgson Set al., 2020, Childhood Type 1 diabetes: an environment wide association study across England, Diabetologia, Vol: 63, Pages: 964-976, ISSN: 0012-186X

Aims:Type 1 Diabetes is an autoimmune disease affecting ~400,000 people across the UK. Environmental factors likely trigger the disease processin genetically susceptible individuals. We assessed the associations between a wide range of environmental factors and childhood type 1 diabetesincidence in England, using an agnostic, ecological Environment Wide Association Study (EnWAS) approach, to generate hypotheses about environmental triggers. Methods:We undertook analyses at the Local Authority District (LAD) level using a national Hospital Episode Statistics (HES) based incident type 1 diabetesdataset, comprising 13,948 cases aged 0-9 years over the period April 2000-March 2011. We compiled LAD-level estimates for a range of potential demographic and environmental risk factors including meteorological, land use and environmental pollution variables. The associations between type 1 diabetesincidence and risk factors were assessed via Poisson regression, disease mapping and ecological regression. 8Results:Case counts by LAD varied from 1 to 236(median 33;inter quartile range: 24-46). Overall type 1 diabetesincidence was 21.2 (95% CI 20.9-21.6) per 100,000individuals. The EnWASand disease mapping indicated that 15out of 53 demographic and environmental risk factors were significantly associated with diabetes incidence after adjusting for multiple testing.These included air pollutants (particulate matter, nitrogen dioxide, nitrogen oxides, carbon monoxide, all inversely associated), as well as lead in soil, radon, outdoor light at night, overcrowding, population density and ethnicity. Disease mapping revealed spatial heterogeneity in type 1 diabetesrisk. The ecological regression found anassociationbetween type 1 diabetesand thelivingenvironmentdomainof the Index of Multiple Deprivation(RR 0.995 (95%Credible Interval (CrI)0.991-0.998))and radon potential class (RR 1.044 95%CrI 1.015-1.074). Conclusions:Our analysis identifiesa range of demographic and environmental facto

Journal article

Toledano MB, Shaddick G, de Hoogh C, Fecht D, Freni Sterrantino A, Matthews J, Wright M, Gulliver J, Elliott Pet al., 2020, Electric field and air ion exposures near high voltage overhead power lines and adult cancers: a case control study across England and Wales, International Journal of Epidemiology, Vol: 49, Pages: i57-i66, ISSN: 0300-5771

Background: Various mechanisms have been postulated to explain how electric fields emitted by high voltage overhead power lines, and the charged ions they produce, might be associated with possible adult cancer risk but this has not previously been systematically explored in large scale epidemiologic research. Methods: We investigated risks of adult cancers in relation to modelled air ion density (per cm3) within 600m (focusing analysis on mouth, lung, respiratory) and calculated electric field within 25m (focusing analysis on non-melanoma skin) of high voltage overhead power lines in England and Wales, 1974-2008. Results: With adjustment for age, sex, deprivation and rurality, odds ratios (OR) in the highest fifth of net air ion density (0.504-1) compared with the lowest (0-0.1879) ranged from 0.94 (95% CI 0.82 – 1.08) for mouth cancers to 1.03 (95% CI 0.97 -1.09) for respiratory system cancers, with no trends in risk. The pattern of cancer risk was similar using corona ion estimates from an alternative model proposed by others. For keratinocyte carcinoma, adjusted OR in the highest (1.06 - 4.11 kV/m) compared with the lowest (<0.70 kV/m) thirds of electric field strength was 1.23 (95% CI 0.65-2.34) with no trend in risk. Conclusions: Our results do not provide evidence to support hypotheses that air ion density or electric fields in the vicinity of power lines are associated with cancer risk in adults.

Journal article

Roca Barcelo A, Douglas P, Fecht D, Freni Sterrantino A, Williams B, Blangiardo M, Gulliver J, Enda T H, Hansell Aet al., 2020, Risk of respiratory hospital admission associated with modelled concentrations of Aspergillus fumigatus from composting facilities in England, Environmental Research, Vol: 183, Pages: 1-10, ISSN: 0013-9351

Bioaerosols have been associated with adverse respiratory-related health effects and are emitted in elevated concentrations from composting facilities. We usedmodelledAspergillus fumigatusconcentrations, a good indicator for bioaerosol emissions,to assess associations with respiratory-related hospital admissions. Mean dailyAspergillus fumigatusconcentrationswere estimated for each composting site for first full year of permit issuefrom2005 onwardsto 2014 for Census Output Areas (COAs) within 4km of 76 composting facilities in England, as previously described (Williams et al. 2019). We fitted ahierarchicalgeneralized mixed modelto examine therisk of hospital admission witha primary diagnosis of(i) any respiratory condition,(ii) respiratory infections,(iii) asthma,(iv) COPD,(v)diseases due to organic dust,and (vi)Cystic Fibrosis,inrelation to quartilesof Aspergillus fumigatusconcentrations. Models included a random intercept for each COAto account for over-dispersion,nested within composting facility, on whicha random intercept was fitted to account for clusteringof the data, with adjustmentsfor age, sex, ethnicity, deprivation, tobacco sales (smoking proxy) and traffic load (as a proxy for traffic-related air pollution). Weincluded 249,748 respiratory-related and 3,163 Cystic Fibrosis hospital admissions in 9,606 COAswith a population-weighted centroid within 4 km of the 76 included composting facilities. After adjustment for confounders, no statistically significant effect was observed for any respiratory-related (Relative Risk (RR)=0.99; 95% Confidence Interval (CI)0.96–1.01)or for Cystic Fibrosis (RR=1.01; 95% CI 0.56-1.83)hospital admissions for COAs in the highest quartile of exposure. Similar results were observed across all respiratory disease sub-groups.This study does not provide evidence for increased risks of respiratory-related hospitalisationsfor those livingnearcomposting facilities.However, given the limitations in the dispersion modelling, risks

Journal article

Sheehan A, Freni Sterrantino A, Fecht D, Elliott P, Hodgson Set al., 2019, Childhood Type 1 Diabetes: an Environment Wide Association Study across England., Diabetologia, ISSN: 0012-186X

Journal article

Lavigne A, Freni Sterrantino A, Liverani S, Blangiardo M, De hoogh K, Molitor J, Hansell Aet al., 2019, Associations between metal constituents of ambient particulate matter and mortality in England; an ecological study, BMJ Open, Vol: 9, ISSN: 2044-6055

Objectives To investigate long-term associations between metal components of particulate matter and mortality and lung cancer incidenceDesign Small area (ecological) study Setting Population living in all wards (~9000 individuals per ward) in the London and Oxford area of England, comprising 13.6 million individuals Exposure and Outcome measures We used land use regression (LUR) models originally used in the Transport related Air Pollution and Health impacts – Integrated Methodologies for Assessing Particulate Matter (TRANSPHORM) study to estimate exposure to copper, iron and zinc in ambient air particulate matter. We examined associations of metal exposure with Office for National Statistics mortality data from cardiovascular (CVD) and respiratory causes and with lung cancer incidence in 2008-11.Results There were 108,478 CVD deaths, 48,483 respiratory deaths and 24,849 incident cases of lung cancer in the study period and area. Using Poisson regression models adjusted for area-level deprivation, tobacco sales and ethnicity, we found associations between cardiovascular mortality and PM2.5 copper with interdecile range (IDR-2.6-5.7 ng/m3) and IDR Relative risk (RR) 1.005 (95%CI 1.001, 1.009) and between respiratory mortality and PM10 zinc (IDR 1135-153 ng/m3) and IDR RR 1.136 (95%CI 1.010, 1.277). We did not find relevant associations for lung cancer incidence. Metal elements were highly correlated.Conclusion Our analysis showed small but not fully consistent adverse associations between mortality and particulate metal exposures likely derived from non-tailpipe road traffic emissions (brake and tyre-wear), which have previously been associated with increases in inflammatory markers in the blood.

Journal article

Freni Sterrantino A, Afoakwah P, Smith RB, Ghosh R, Hansell ALet al., 2019, Birth weight centiles and small for gestational age by sex and ethnicity for England and Wales, Archives of Disease in Childhood, Vol: 104, Pages: 1188-1192, ISSN: 1468-2044

Objectives To construct UK Ethnic Birth Weight Centiles (UK-EBWC) for gestational age and cut-offs for small for gestational age (SGA) for England and Wales and to evaluate the SGA misclassification using the UK centiles.Design Analysis of national birth data.Participants All live singleton births in England and Wales in 2006 to 2012, as recorded by the Office for National Statistics (ONS) and birth registrations, linked with National Health Service (NHS) into Numbers for Babies (NN4B).Main Outcome Measures Both sex-specific and ethnicity-sex-specific birth weight centiles for gestational age, and ethnicity-sex-specific SGA cut-offs. Centiles were computed using the Generalized Additive Model for Location, Scale and Shape (GAMLSS). Results Our sex-specific centiles performed well and showed an agreement between the expected and observed number of births below the centiles. The ethnicity-sex-specific centiles for Black and Asian presented lower values compared to the White centiles. Comparisons of sex-specific and ethnicity-sex-specific centiles shows that use of sex-specific centiles increases the SGA diagnosed cases by 50% for Asian, 30% for South Asian (Indian, Pakistani and Bangladeshi) and 20% for Black ethnicity.Conclusions The centiles show important differences between ethnic groups, in particular the 10th centile used to define SGA. To account for these differences and to minimize misclassification of SGA, we recommend the use of customized birth weight centiles.

Journal article

Freni Sterrantino A, Elliott P, Blangiardo M, Hansell A, Ghosh R, Toledano M, Fecht Det al., 2019, Bayesian spatial modelling for quasi-experimental designs: an interrupted time series study of the opening of Municipal Waste Incinerators in relation to infant mortality and sex ratio, Environment International, Vol: 128, Pages: 109-115, ISSN: 0160-4120

BackgroundThere is limited evidence on potential health risks from Municipal Waste Incinerators (MWIs), and previous studies on birth outcomes show inconsistent results. Here, we evaluate whether the opening of MWIs is associated with infant mortality and sex ratio in the surrounding areas, extending the Interrupted Time Series (ITS) methodological approach to account for spatial dependencies at the small area level.MethodsWe specified a Bayesian hierarchical model to investigate the annual risks of infant mortality and sex-ratio (female relative to male) within 10 km of eight MWIs in England and Wales, during the period 1996–2012. We included comparative areas matched one-to-one of similar size and area characteristics.ResultsDuring the study period, infant mortality rates decreased overall by 2.5% per year in England. The opening of an incinerator in the MWI area was associated with −8 deaths per 100,000 infants (95% CI −62, 40) and with a difference in sex ratio of −0.004 (95% CI −0.02, 0.01), comparing the period after opening with that before, corrected for before-after trends in the comparator areas.ConclusionOur method is suitable for the analysis of quasi-experimental time series studies in the presence of spatial structure and when there are global time trends in the outcome variable. Based on our approach, we do not find evidence of an association of MWI opening with changes in risks of infant mortality or sex ratio in comparison with control areas.

Journal article

Ghosh RE, Freni-Sterrantino A, Douglas P, Parkes B, Fecht D, de Hoogh K, Fuller G, Gulliver J, Font A, Smith RB, Blangiardo M, Elliott P, Toledano MB, Hansell ALet al., 2019, Fetal growth, stillbirth, infant mortality and other birth outcomes near UK municipal waste incinerators; retrospective population based cohort and case-control study, Environment International, Vol: 122, Pages: 151-158, ISSN: 0160-4120

Background: Some studies have reported associations between municipal waste incinerator (MWI) exposures and adverse birth outcomes but there are few studies of modern MWIs operating to current European Union (EU) Industrial Emissions Directive standards. Methods: Associations between modelled ground-level particulate matter ≤10 μm in diameter (PM10) from MWI emissions (as a proxy for MWI emissions) within 10 km of each MWI, and selected birth and infant mortality outcomes were examined for all 22 MWIs operating in Great Britain 2003–10. We also investigated associations with proximity of residence to a MWI. Outcomes used were term birth weight, small for gestational age (SGA) at term, stillbirth, neonatal, post-neonatal and infant mortality, multiple births, sex ratio and preterm delivery sourced from national registration data from the Office for National Statistics. Analyses were adjusted for relevant confounders including year of birth, sex, season of birth, maternal age, deprivation, ethnicity and area characteristics and random effect terms were included in the models to allow for differences in baseline rates between areas and in incinerator feedstock. Results: Analyses included 1,025,064 births and 18,694 infant deaths. There was no excess risk in relation to any of the outcomes investigated during pregnancy or early life of either mean modelled MWI PM10 or proximity to an MWI. Conclusions: We found no evidence that exposure to PM10 from, or living near to, an MWI operating to current EU standards was associated with harm for any of the outcomes investigated. Results should be generalisable to other MWIs operating to similar standards.

Journal article

Freni-Sterrantino A, Ventrucci M, Rue H, 2018, A note on intrinsic conditional autoregressive models for disconnected graphs, SPATIAL AND SPATIO-TEMPORAL EPIDEMIOLOGY, Vol: 26, Pages: 25-34, ISSN: 1877-5845

Journal article

Yao Y, Vehtari A, Simpson D, Gelman A, Clarke B, Li M, Grunwald P, de Heide R, Dawid AP, Yoo WW, Winkler RL, Jose VRR, Lichtendahl KC, Grushka-Cockayne Y, McAlinn K, Aastveit KA, West M, Shin M, Zhou T, Hoogerheide L, van Dijk HK, Bakka HC, Castro-Camilo D, Franco-Villoria M, Freni-Sterrantino A, Huser R, Opitz T, Rue H, Ferreira MAR, Pericchi L, Franck CT, Belitser E, Nurushev N, Iacopini M, Tonellato Set al., 2018, Using stacking to average bayesian predictive distributions (with discussion), Bayesian Analysis, Vol: 13, Pages: 917-1003, ISSN: 1931-6690

Bayesian model averaging is flawed in the M-open setting in which the true data-generating process is not one of the candidate models being fit. We take the idea of stacking from the point estimation literature and generalize to the combination of predictive distributions. We extend the utility function to any proper scoring rule and use Pareto smoothed importance sampling to efficiently compute the required leave-one-out posterior distributions. We compare stacking of predictive distributions to several alternatives: stacking of means, Bayesian model averaging (BMA), Pseudo-BMA, and a variant of Pseudo-BMA that is stabilized using the Bayesian bootstrap. Based on simulations and real-data applications, we recommend stacking of predictive distributions, with bootstrapped-Pseudo-BMA as an approximate alternative when computation cost is an issue.

Journal article

Ghosh R, Dag Berild J, Freni Sterrantino A, Toledano MB, Hansell ALet al., 2017, Birth weight trends in England and Wales (1986– 2012): babies are getting heavier, Archives of Disease in Childhood-Fetal and Neonatal Edition, Vol: 103, Pages: F264-F270, ISSN: 1468-2052

Introduction Birth weight is a strong predictor of infant mortality, morbidity and later disease risk. Previous work from the 1980s indicated a shift in the UK towards heavier births; this descriptive analysis looks at more recent trends.Methods Office for National Statistics (ONS) registration data on 17.2 million live, single births from 1986 to 2012 were investigated for temporal trends in mean birth weight, potential years of birth weight change and changes in the proportions of very low (<1500 g), low (<2500 g) and high (≥4000 g) birth weight. Analysis used multiple linear and logistic regression adjusted for maternal age, marital status, area-level deprivation and ethnicity. Additional analyses used the ONS NHS Numbers for Babies data set for 2006–2012, which has information on individual ethnicity and gestational age.Results Over 27 years there was an increase in birth weight of 43 g (95% CI 42 to 44) in females and 44 g (95% CI 43 to 45) in males, driven by birth weight increases between 1986–1990 and 2007–2012. There was a concurrent decreased risk of having low birth weight but an 8% increased risk in males and 10% increased risk in females of having high birth weight. For 2006–2012 the birth weight increase was greater in preterm as compared with term births.Conclusions Since 1986 the birth weight distribution of live, single births in England and Wales has shifted towards heavier births, partly explained by increases in maternal age and non-white ethnicity, as well as changes in deprivation levels. Other potential influences include increases in maternal obesity and reductions in smoking prevalence particularly following the introduction of legislation restricting smoking in public places in 2007.

Journal article

Douglas P, Freni-Sterrantino A, Leal Sanchez M, Ashworth DC, Ghosh RE, Fecht D, Font A, Blangiardo M, Gulliver J, Toledano MB, Elliott P, De Hoogh K, Fuller GW, Hansell ALet al., 2017, Estimating Particulate Exposure from Modern Municipal Waste Incinerators in Great Britain, Environmental science & technology, Vol: 51, Pages: 7511-7519, ISSN: 0013-936X

Municipal Waste Incineration (MWI) is regulated through the European Union Directive on Industrial Emissions (IED), but there is ongoing public concern regarding potential hazards to health. Using dispersion modeling, we estimated spatial variability in PM10 concentrations arising from MWIs at postcodes (average 12 households) within 10 km of MWIs in Great Britain (GB) in 2003-2010. We also investigated change points in PM10 emissions in relation to introduction of EU Waste Incineration Directive (EU-WID) (subsequently transposed into IED) and correlations of PM10 with SO2, NOx, heavy metals, polychlorinated dibenzo-p-dioxins/furan (PCDD/F), polycyclic aromatic hydrocarbon (PAH) and polychlorinated biphenyl (PCB) emissions. Yearly average modeled PM10 concentrations were 1.00 × 10-5 to 5.53 × 10-2 μg m-3, a small contribution to ambient background levels which were typically 6.59-2.68 × 101 μg m-3, 3-5 orders of magnitude higher. While low, concentration surfaces are likely to represent a spatial proxy of other relevant pollutants. There were statistically significant correlations between PM10 and heavy metal compounds (other heavy metals (r = 0.43, p = <0.001)), PAHs (r = 0.20, p = 0.050), and PCBs (r = 0.19, p = 0.022). No clear change points were detected following EU-WID implementation, possibly as incinerators were operating to EU-WID standards before the implementation date. Results will be used in an epidemiological analysis examining potential associations between MWIs and health outcomes.

Journal article

Sampaolo L, Tommaso G, Gherardi B, Carrozzi G, Sterrantino AF, Ottone M, Goldoni CA, Bertozzi N, Scaringi M, Bolognesi L, Masocco M, Salmaso S, Lauriola Pet al., 2017, The perception of the relationship between environment and health according to data from Italian Behavioural Risk Factor Surveillance System (PASSI), EPIDEMIOLOGIA & PREVENZIONE, Vol: 41, Pages: 20-28, ISSN: 1120-9763

Journal article

Ranzi A, Freni Sterrantino A, Forastiere F, Sartini C, Casale G, Cavallini R, De Togni A, Gallo L, Lauriola Pet al., 2015, Asthmatic symptoms and air pollution: a panel study on children living in the Italian Po Valley, Geospatial Health, Vol: 10, ISSN: 1970-7096

The Po Valley (Northern Italy) has elevated levels of air-pollution due to various sources of pollution and adverse weather conditions. This study evaluates the short-term effects of exposure to particulate matter with a diameter of 10 microns or less (PM10) on asthma symptoms in school-aged children. An initial cross-sectional survey was conducted in the area to estimate asthma prevalence in children. Out of a total of 250 asthmatic children identified by the study, 69 agreed to participate in a panel study. The PM10 exposure assessment was based on a combination of geographic and environmental measurements leading to a focus on three different areas, each characterised by its own daily PM10 level. Participants were monitored daily for respiratory symptoms for eight weeks (January-March 2006). We assessed the relationship between daily PM10 exposure and occurrence of asthma symptoms with a generalised linear model based on a total of 3864 person-days of observation. Exposure to PM10 per m3 was found to be particularly associated with cough (OR=1.03, CI 95% 0.99; 1.08) and phlegm (OR=1.05, CI 95% 1.00; 1.10). In the most polluted area, exposure to PM10 was also associated with wheezing (OR=1.18, CI 95% 1.02; 1.37).

Journal article

Takenaka S, Ventura W, Sterrantino AF, Kawashima A, Koide K, Hori K, Farina A, Sekizawa Aet al., 2015, Prediction of Fetal Growth Restriction by Analyzing the Messenger RNAs of Angiogenic Factor in the Plasma of Pregnant Women, REPRODUCTIVE SCIENCES, Vol: 22, Pages: 743-749, ISSN: 1933-7191

Journal article

Cordioli M, Ranzi A, Freni Sterrantino A, Erspamer L, Razzini G, Ferrari U, Gatti MG, Bonora K, Artioli F, Goldoni CA, Lauriola Pet al., 2014, A comparison between self-reported and GIS-based proxies of residential exposure to environmental pollution in a case-control study on lung cancer., Spat Spatiotemporal Epidemiol, Vol: 9, Pages: 37-45

In epidemiological studies both questionnaire results and GIS modeling have been used to assess exposure to environmental risk factors. Nevertheless, few studies have used both these techniques to evaluate the degree of agreement between different exposure assessment methodologies. As part of a case-control study on lung cancer, we present a comparison between self-reported and GIS-derived proxies of residential exposure to environmental pollution. 649 subjects were asked to fill out a questionnaire and give information about residential history and perceived exposure. Using GIS, for each residence we evaluated land use patterns, proximity to major roads and exposure to industrial pollution. We then compared the GIS exposure-index values among groups created on the basis of questionnaire responses. Our results showed a relatively high agreement between the two methods. Although none of these methods is the "exposure gold standard", understanding similarities, weaknesses and strengths of each method is essential to strengthen epidemiological evidence.

Journal article

Candela S, Ranzi A, Bonvicini L, Baldacchini F, Marzaroli P, Evangelista A, Luberto F, Carretta E, Angelini P, Sterrantino AF, Broccoli S, Cordioli M, Ancona C, Forastiere Fet al., 2013, Air Pollution from Incinerators and Reproductive Outcomes <i>A Multisite Study</i>, EPIDEMIOLOGY, Vol: 24, Pages: 863-870, ISSN: 1044-3983

Journal article

Lizio G, Sterrantino AF, Ragazzini S, Marchetti Cet al., 2013, Volume reduction of cystic lesions after surgical decompression: a computerised three-dimensional computed tomographic evaluation, CLINICAL ORAL INVESTIGATIONS, Vol: 17, Pages: 1701-1708, ISSN: 1432-6981

Journal article

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