Publications
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Liu S, Jørgensen JT, Ljungman P, et al., 2021, Long-term exposure to low-level air pollution and incidence of chronic obstructive pulmonary disease: The ELAPSE project., Environment International, Vol: 146, Pages: 1-8, ISSN: 0160-4120
BACKGROUND: Air pollution has been suggested as a risk factor for chronic obstructive pulmonary disease (COPD), but evidence is sparse and inconsistent. OBJECTIVES: We examined the association between long-term exposure to low-level air pollution and COPD incidence. METHODS: Within the 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE) study, we pooled data from three cohorts, from Denmark and Sweden, with information on COPD hospital discharge diagnoses. Hybrid land use regression models were used to estimate annual mean concentrations of particulate matter with a diameter < 2.5 µm (PM2.5), nitrogen dioxide (NO2), and black carbon (BC) in 2010 at participants' baseline residential addresses, which were analysed in relation to COPD incidence using Cox proportional hazards models. RESULTS: Of 98,058 participants, 4,928 developed COPD during 16.6 years mean follow-up. The adjusted hazard ratios (HRs) and 95% confidence intervals for associations with COPD incidence were 1.17 (1.06, 1.29) per 5 µg/m3 for PM2.5, 1.11 (1.06, 1.16) per 10 µg/m3 for NO2, and 1.11 (1.06, 1.15) per 0.5 10-5m-1 for BC. Associations persisted in subset participants with PM2.5 or NO2 levels below current EU and US limit values and WHO guidelines, with no evidence for a threshold. HRs for NO2 and BC remained unchanged in two-pollutant models with PM2.5, whereas the HR for PM2.5 was attenuated to unity with NO2 or BC. CONCLUSIONS: Long-term exposure to low-level air pollution is associated with the development of COPD, even below current EU and US limit values and possibly WHO guidelines. Traffic-related pollutants NO2 and BC may be the most relevant.
Douglas P, Fecht D, Jarvis D, 2020, Characterising populations living close to intensive farming and composting facilities in England, Frontiers of Environmental Science and Engineering, Vol: 15, Pages: 1-13, ISSN: 2095-2201
Bioaerosol exposure has been linked to adverse respiratory conditions. Intensive farming and composting facilities are important anthropogenic sources of bioaerosols. We aimed to characterise populations living close to intensive farming and composting facilities. We also infer whether the public are becoming more concerned about anthropogenic bioaerosol emissions, using reports of air pollution related incidents attributed to facilities. We mapped the location of 1,257 intensive farming and 310 composting facilities in England in relation to the resident population and its characteristics (sex and age), area characteristics (deprivation proxy and rural/urban classification) and school locations stratified by pre-defined distance bands from these bioaerosol sources. We also calculated the average number of air pollution related incidents per year per facility. We found that more than 16% of the population and 15% of schools are located within 4,828 m of an intensive farming facility or 4,000 m of a composting facility; few people (0.01 %) live very close to these sites and tend to be older people. Close to composting facilities, populations are more likely to be urban and more deprived. The number of incidents were attributed to a small proportion of facilities; population characteristics around these facilities were similar. Results indicate that populations living near composting facilities (particularly>250 to ⩽ 4,000 m) are mostly located in urban areas (80%–88% of the population), which supports the need for more community health studies to be conducted. Results could also be used to inform risk management strategies at facilities with higher numbers of incidents.
Bakolis I, Hammoud R, Stewart R, et al., 2020, Mental health consequences of urban air pollution: prospective population-based longitudinal survey, Social Psychiatry and Psychiatric Epidemiology: the international journal for research in social and genetic epidemiology and mental health services, Vol: 56, Pages: 1587-1599, ISSN: 0933-7954
PURPOSE: The World Health Organisation (WHO) recently ranked air pollution as the major environmental cause of premature death. However, the significant potential health and societal costs of poor mental health in relation to air quality are not represented in the WHO report due to limited evidence. We aimed to test the hypothesis that long-term exposure to air pollution is associated with poor mental health. METHODS: A prospective longitudinal population-based mental health survey was conducted of 1698 adults living in 1075 households in South East London, from 2008 to 2013. High-resolution quarterly average air pollution concentrations of nitrogen dioxide (NO2) and oxides (NOx), ozone (O3), particulate matter with an aerodynamic diameter < 10 μm (PM10) and < 2.5 μm (PM2.5) were linked to the home addresses of the study participants. Associations with mental health were analysed with the use of multilevel generalised linear models, after adjusting for large number of confounders, including the individuals' socioeconomic position and exposure to road-traffic noise. RESULTS: We found robust evidence for interquartile range increases in PM2.5, NOx and NO2 to be associated with 18-39% increased odds of common mental disorders, 19-30% increased odds of poor physical symptoms and 33% of psychotic experiences only for PM10. These longitudinal associations were more pronounced in the subset of non-movers for NO2 and NOx. CONCLUSIONS: The findings suggest that traffic-related air pollution is adversely affecting mental health. Whilst causation cannot be proved, this work suggests substantial morbidity from mental disorders could be avoided with improved air quality.
Shoari N, Ezzati M, Baumgartner J, et al., 2020, Accessibility and allocation of public parks and gardens in England and Wales: a COVID-19 social distancing perspective, PLoS One, Vol: 15, Pages: 1-10, ISSN: 1932-6203
Visiting parks and gardens supports physical and mental health. We quantified access to public parks and gardens in urban areas of England and Wales, and the potential for park crowdedness 22during periods of high use. We combined data from the Office for National Statistics and Ordnance Survey to quantify(i) the number of parks within 500and 1,000metresof urban postcodes (i.e., availability), (ii) the distance of postcodes to the nearest park (i.e., accessibility), and (iii) per-capita space in each park for people living within 1,000m.We26examined variability by city and share of flats. Around 25.4 million people(~87%) can access public parks or gardens within a ten-minute walk, while 3.8 million residents (~13%) live farther away; of these 21% are children and 13% are elderly. Areas with a higher share of flats on average are closer to a park but people living in these areas visit parks that are potentially overcrowded during periods of high use. Such disparity in urban areas of England and Wales becomes particularly evident during COVID-19 pandemic and lockdown when local parks, the only available out-of-home space option, hinder social distancing requirements. Cities aiming to facilitate social distancing while keeping public green spaces safe might require implementing measures such as dedicated park times for different age groups or entry allocation systems that, combined with smartphone apps or drones, can monitor and manage the total number of people using the park.
Hamilton SA, Nakanga WP, Prynn JE, et al., 2020, Prevalence and risk factors for chronic kidney disease of unknown cause in Malawi: a cross-sectional analysis in a rural and urban population, BMC Nephrology, Vol: 21, Pages: 1-12, ISSN: 1471-2369
BackgroundAn epidemic of chronic kidney disease of unknown cause (CKDu) is occurring in rural communities in tropical regions of low-and middle-income countries in South America and India. Little information is available from Southern African countries which have similar climatic and occupational characteristics to CKDu-endemic countries. We investigated whether CKDu is prevalent in Malawi and identified its potential risk factors in this setting.MethodsWe conducted a cross-sectional study from January–August 2018 collecting bio samples and anthropometric data in two Malawian populations. The sample comprised adults > 18 years (n = 821) without diabetes, hypertension, and proteinuria. Estimates of glomerular filtration rate (eGFR) were calculated using the CKD-EPI equation. Linear and logistic regression models were applied with potential risk factors, to estimate risk of reduced eGFR.ResultsThe mean eGFR was 117.1 ± 16.0 ml/min per 1.73m2 and the mean participant age was 33.5 ± 12.7 years. The prevalence of eGFR< 60 was 0.2% (95% confidence interval (95% CI) 0.1, 0.9); the prevalence of eGFR< 90 was 5% (95% CI =3.2, 6.3). We observed a higher prevalence in the rural population (5% (3.6, 7.8)), versus urban (3% (1.4, 6.7)). Age and BMI were associated with reduced eGFR< 90 [Odds ratio (OR) (95%CI) =3.59 (2.58, 5.21) per ten-year increment]; [OR (95%CI) =2.01 (1.27, 3.43) per 5 kg/m2 increment] respectively. No increased risk of eGFR < 90 was observed for rural participants [OR (95%CI) =1.75 (0.50, 6.30)].ConclusionsReduced kidney function consistent with the definition of CKDu is not common in the areas of Malawi sampled, compared to that observed in other tropical or sub-tropical countries in Central America and South Asia. Reduced eGFR< 90 was related to age, BMI, and was more common in rural areas. These findings are impor
Jennings N, Fecht D, De Matteis S, 2020, Mapping the co-benefits of climate change action to issues of public concern in the UK: a narrative review, The Lancet Planetary Health, Vol: 4, Pages: e424-e433, ISSN: 2542-5196
To avoid a 1·5°C rise in global temperatures above preindustrial levels, the next phase of reductions in greenhouse gas emissions will need to be comparatively rapid. Linking the co-benefits of climate action to wider issues that the public are concerned about can help decision makers to prioritise decarbonisation options that increase the chance of public support for such changes, while ensuring that a just transition is delivered. We identified key issues of concern to the UK public by use of Ipsos MORI public opinion data from 2007 to 2020 and used these data to guide a narrative review of academic and grey literature on the co-benefits of climate change action for the UK. Correspondence with civil servants, third sector organisations, and relevant academics allowed us to identify omissions and to ensure policy relevance of the recommendations. This evidence-based Review of the various co-benefits of climate change action for the UK identifies four main areas: health and the National Health Service; security; economy and unemployment; and poverty, housing, and inequality. Associated trade-offs are also discussed. City-level and regional-level governments are particularly well placed to incorporate co-benefits into their decision making because it is at this scale that co-benefits most clearly manifest, and where interventions can have the most immediate effects.
Lavigne A, Freni Sterrantino A, Fecht D, et 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.
Cai Y, Hansell AL, Granell R, et al., 2020, Prenatal, early-life and childhood exposure to air pollution and lung function: the ALSPAC cohort, American Journal of Respiratory and Critical Care Medicine, Vol: 202, Pages: 112-123, ISSN: 1073-449X
RATIONALE: Exposure to air pollution during intrauterine development and through childhood may have lasting effects on respiratory health. OBJECTIVES: To investigate lung function at ages 8 and 15 years in relation to air pollution exposures during pregnancy, infancy and childhood in a UK population-based birth cohort. METHODS: Individual exposures to source-specific particulate matter with diameter ≤10µm (PM10) during each trimester, 0-6 months, 7-12 months (1990-1993) and up to age 15 years (1991-2008) were examined in relation to %predicted Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) at ages 8(N=5,276) and 15(N=3,446) years, usinglinear regression models adjusted for potential confounders. A profile regression model was used to identify sensitive time periods. MEASUREMENTS AND MAIN RESULTS: We did not find clear evidence for a sensitive exposure period for PM10 from road-traffic: at age 8 years, 1µg/m3 higher exposure during the first trimester was associated with lower %predicted of FEV1(-0.826, 95%CI:-1.357 to -0.296) and FVC(-0.817, 95%CI:-1.357 to -0.276), but similar associations were seen for exposures for other trimesters, 0-6 months, 7-12 months, and 0-7 years. Associations were stronger among boys, children whose mother had a lower education level or smoked during pregnancy. For PM10 from all sources, the third trimester was associated with lower %predicted of FVC (-1.312, 95%CI: -2.100 to -0.525). At age 15 years, no adverse associations were seen with lung function. CONCLUSIONS: Exposure to road-traffic PM10 during pregnancy may result in small but significant reductions in lung function at age 8 years.
Tayal U, Fecht D, Chadeau M, et al., 2020, RESIDENTIAL EXPOSURE TO FINE PARTICULATE MATTER AIR POLLUTION IS ASSOCIATED WITH IMPAIRED CARDIAC PHENOTYPES IN DILATED CARDIOMYOPATHY, Publisher: BMJ PUBLISHING GROUP, Pages: A2-A3, ISSN: 1355-6037
Sheehan A, Freni Sterrantino A, Fecht D, et 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
Fecht D, Piel F, Cockings S, et al., 2020, Advances in mapping population and demographic characteristics at small area levels, International Journal of Epidemiology, Vol: 49, Pages: i15-i25, ISSN: 1464-3685
Temporally and spatially highly resolved information on population characteristics, including demographic profile (e.g. age and sex), ethnicity and socio-economic status (e.g. income, occupation, education), are essential for observational health studies at the small-area level. Time-relevant population data are critical as denominators for health statistics, analytics and epidemiology, to calculate rates or risks of disease. Demographic and socio-economic characteristics are key determinants of health and important confounders in the relationship of environmental contaminants and health. In many countries, census data have long been the source of small-area population denominators and confounder information. A strength of the traditional census model has been its careful design and high level of population coverage, allowing high-quality detailed data to be released for small areas periodically, e.g. every ten years. The timeliness of data, however, becomes a challenge when temporally and spatially highly accurate annual (or even more frequent) data at high spatial resolution 31are needed, for example, for health surveillance and epidemiological studies. Additionally, the approach to collecting demographic population information is changing in the era of openand big data and may eventually evolve to using combinations of administrative and other data, supplemented by surveys. We discuss different approaches to address these challenges including a) the U. S. American Community Survey, a rolling sample of the U.S. population census, b) the use of spatial analysis techniques to compile temporally and spatially high-resolution demographic data, and c) the use of administrative and big data sources as proxies for demographic characteristics.
Hodgson S, Fecht D, Gulliver J, et al., 2020, Availability, access, analysis and dissemination of small area data, International Journal of Epidemiology, Vol: 49, Pages: i4-i14, ISSN: 1464-3685
In this era of ‘big data’, there is growing recognition of the value of environmental, health, social and demographic data for research. Open government data initiatives are growing in number and in terms of content. Remote sensing data are finding widespread use in environmental research, including in low- and middle-income settings. While our ability to study environment and health associations across countries and continents grows, data protection rules and greater patient control over the use of their data present new challenges to using health data in research. Innovative tools that circumvent the need for the physical sharing of data by supporting non-disclosive sharing of information, or that permit spatial analysis without researchers needing access to underlying patient data can be used to support analyses while protecting data confidentiality. User-friendly visualisations, allowing small area data to be seen and understood by non-expert audiences are revolutionising public and researcher interactions with data. The UK Small Area Health Statistics Unit’s Environment and Health Atlas for England and Wales, and the US National Environmental Public Health Tracking Network offer good examples. Open data facilitates user-generated outputs, and ‘mash-ups’, and user generated inputs from social media, mobile devices, and wearable tech are new data streams which will find utility in future studies, and bring novel dimensions with respect to ethical use of small area data.
Fecht D, Garwood K, Butters O, et al., 2020, Automation of cleaning and reconstructing residential address histories to assign environmental exposures in longitudinal studies, International Journal of Epidemiology, Vol: 49, Pages: i49-i56, ISSN: 1464-3685
Background: We have developed an open-source ALgorithm for Generating Address Exposures (ALGAE) that cleans residential address records to construct address histories and assign spatially-determined exposuresto cohort participants. The first application of this algorithm was to construct prenatal and early-life air pollution exposure for individuals of the Avon Longitudinal Study of Parents and Children (ALSPAC)in the South West of Englandusingpreviously estimated particulate matter ≤10 μm (PM10) concentrations. Methods: ALSPAC recruited 14,541 pregnant women between 1991and 1992. We assignedtrimester-specific estimated PM10exposures for 12,752 pregnancies,and first year of life exposures for 12,525births, based on maternal residence and residential mobility. Results: Average PM10exposure was32.6 μg/m3(StDev. 3.0 μg/m3) during pregnancy and 31.4 μg/m3(StDev. 2.6 μg/m3) during the first year of life. 6.7% ofwomen changedaddress during pregnancy, and 18.0% moved during first year of lifeof their infant. Exposure differences ranged from -5.3 μg/m3 to 12.4 μg/m3(up to 26% difference) during pregnancy and -7.22 μg/m3to 7.64 μg/m3(up to 27% difference) in the first year of life,when comparing estimated exposure using the address at birth and that assessedusing the complete cleaned address history. For the majority of individualsexposure changed by <5% but some relatively large changes were seen both in pregnancy and infancy.Conclusion: ALGAE provides a generic andadaptable, open-source solution to clean addresses stored in acohort contact database and assign life-stage specific exposureestimates with the potential to reduce exposure misclassification.
Piel F, Fecht D, Hodgson S, et al., 2020, Small-area methods for investigation of environment and health, International Journal of Epidemiology, Vol: 49, Pages: 686-699, ISSN: 1464-3685
Small-area studies offer a powerful epidemiological approach to study disease patterns at the population level and assess health risks posed by environmental pollutants. They involve a public health investigation on a geographic scale (e.g. neighbourhood) with overlay of health, environmental, demographic and potential confounder data. Recent methodological advances, including Bayesian approaches, combined with fast growing computational capabilities permit more informative analyses than previously possible, including the incorporation of data at different scales, from satellites to individual-level survey information. Better data availability has widened the scope and utility of small-area studies, but also led to greater complexity, including choice of optimal study area size and extent, duration of study periods, range of covariates and confounders to be considered, and dealing with uncertainty. The availability of data from large, well-phenotyped cohorts such as UK Biobank enables the use of mixed-level study designs and the triangulation of evidence on environmental risks from small-area and individual-level studies, therefore improving causal inference, including use of linked biomarker and -omics data. As a result, there are now improved opportunities to investigate the impacts of environmental risk factors on human health, particularly for the surveillance and prevention of non-communicable diseases.
Roca Barcelo A, Douglas P, Fecht D, et 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
Toledano MB, Shaddick G, de Hoogh C, et 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.
Smith RB, Beevers SD, Gulliver J, et al., 2020, Impacts of air pollution and noise on risk of preterm birth and stillbirth in London, Environment International, Vol: 134, ISSN: 0160-4120
BackgroundEvidence for associations between ambient air pollution and preterm birth and stillbirth is inconsistent. Road traffic produces both air pollutants and noise, but few studies have examined these co-exposures together and none to date with all-cause or cause-specific stillbirths.ObjectivesTo analyse the relationship between long-term exposure to air pollution and noise at address level during pregnancy and risk of preterm birth and stillbirth.MethodsThe study population comprised 581,774 live and still births in the Greater London area, 2006–2010. Outcomes were preterm birth (<37 completed weeks gestation), all-cause stillbirth and cause-specific stillbirth. Exposures during pregnancy to particulate matter with diameter <2.5 μm (PM2.5) and <10 μm (PM10), ozone (O3), primary traffic air pollutants (nitrogen dioxide, nitrogen oxides, PM2.5 from traffic exhaust and traffic non-exhaust), and road traffic noise were estimated based on maternal address at birth.ResultsAn interquartile range increase in O3 exposure was associated with elevated risk of preterm birth (OR 1.15 95% CI: 1.11, 1.18, for both Trimester 1 and 2), all-cause stillbirth (Trimester 1 OR 1.17 95% CI: 1.07, 1.27; Trimester 2 OR 1.20 95% CI: 1.09, 1.32) and asphyxia-related stillbirth (Trimester 1 OR 1.22 95% CI: 1.01, 1.49). Odds ratios with the other air pollutant exposures examined were null or <1, except for primary traffic non-exhaust related PM2.5, which was associated with 3% increased odds of preterm birth (Trimester 1) and 7% increased odds stillbirth (Trimester 1 and 2) when adjusted for O3. Elevated risk of preterm birth was associated with increasing road traffic noise, but only after adjustment for certain air pollutant exposures.DiscussionOur findings suggest that exposure to higher levels of O3 and primary traffic non-exhaust related PM2.5 during pregnancy may increase risk of preterm birth and stillbirth; and a possible relationship between long-term traff
Parkes B, Hansell AL, Ghosh RE, et al., 2020, Risk of congenital anomalies near municipal waste incinerators in England and Scotland, Retrospective population-based cohort study, Vol: 134, ISSN: 0160-4120
Background: Few studies have investigated congenital anomalies in relation to municipal waste incinerators (MWIs) and results are inconclusive. Objectives: To conduct a national investigation into the risk of congenital anomalies in babies born to mothers living within 10 km of an MWI associated with: i) modelled concentrations of PM10 as a proxy for MWI emissions more generally and; ii) proximity of residential postcode to nearest MWI, in areas in England and Scotland that are covered by a congenital anomaly register. Methods: Retrospective population-based cohort study within 10 km of 10 MWIs in England and Scotland operating between 2003 and 2010. Exposure was proximity to MWI and log of daily mean modelled ground-level particulate matter ≤10 μm diameter (PM10) concentrations. Results: Analysis included 219,486 births, stillbirths and terminations of pregnancy for fetal anomaly of which 5154 were cases of congenital anomalies. Fully adjusted odds ratio (OR) per doubling in PM10 was: 1·00 (95% CI 0·98–1·02) for all congenital anomalies; 0·99 (0·97–1·01) for all congenital anomalies excluding chromosomal anomalies. For every 1 km closer to an MWI adjusted OR was: 1·02 (1·00–1·04) for all congenital anomalies combined; 1·02 (1·00–1·04) for all congenital anomalies excluding chromosomal anomalies; and, for specific anomaly groups, 1·04 (1·01–1·08) for congenital heart defect sand 1·07 (1·02–1·12) for genital anomalies. Discussion: We found no increased risk of congenital anomalies in relation to modelled PM10 emissions, but there were small excess risks associated with congenital heart defects and genital anomalies in proximity to MWIs. These latter findings may well reflect incomplete control for confounding, but a possible causal effect cannot be excluded.
Sheehan A, Freni Sterrantino A, Fecht D, et al., 2019, Childhood Type 1 Diabetes: an Environment Wide Association Study across England., Diabetologia, ISSN: 0012-186X
Schofield I, Stevens KB, Pittaway C, et al., 2019, Geographic distribution and environmental risk factors of lymphoma in dogs under primary-care in the UK., Journal of Small Animal Practice, Vol: 60, Pages: 746-754, ISSN: 0022-4510
OBJECTIVES: To integrate external data sources with VetCompass postcode data to explore the spatial distribution and examine potential associations with environmental risk factors in dogs diagnosed with lymphoma at primary care veterinary practices. MATERIALS AND METHODS: Cases of lymphoma were identified from electronic patient records of 455,553 dogs under primary veterinary care during 2013 in the UK. Cases were defined as either laboratory-confirmed or non-laboratory-confirmed. Disease maps at the postcode-district level were used to define the geographic distribution of lymphoma incidence and spatial clustering was explored. Environmental risk factors from external data sources were transferred to a compatible format and logistic regression modelling was used to examine associations between environmental herbicide, fungicide and radon concentrations with lymphoma. RESULTS: From the denominator population of 455,553 dogs, 279 lymphoma cases (187 with laboratory confirmation and 93 without) were identified. Heterogeneous geographic variation was observed with weak evidence of clustering around London and the south-west of England. Herbicide and fungicide exposures were weakly associated with a diagnosis of lymphoma in the univariable analysis. After accounting for the age at diagnosis and breed in the multivariable analysis, herbicide exposure was associated with a diagnosis of lymphoma. CLINICAL SIGNIFICANCE: The heterogeneous distribution of lymphoma in UK dogs provides further evidence for geographic variation of lymphoma, perhaps in part associated with underlying environmental risk factors. The results suggest an association between environmental herbicide and canine lymphoma.
Hansell A, Cai Y, Granell R, et al., 2019, Prenatal, early-life and childhood exposure to air pollution and lung function in the UK Avon Longitudinal Study of Parents and Children (ALSPAC) cohort, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Fecht D, Sheridan CE, Roscoe CJ, et al., 2019, Inequalities in exposure to nitrogen dioxide in parks and playgrounds in Greater London, International Journal of Environmental Research and Public Health, Vol: 16, Pages: 1-11, ISSN: 1660-4601
Elevated levels of nitrogen dioxide (NO2) have been associated with adverse health outcomes in children including reduced lung function and increased rates of asthma. Many parts ofLondon continue to exceed the annual average NO2 concentration of 40µg/m3 set by the EU directive. Using high-resolution maps of annual average NO2 for 2016 from the London Atmospheric Emissions Inventory and detailed maps of open spaces from Britain’s national mapping agency, Ordnance Survey, we estimated average NO2 concentrations for every open space in Greater London and analysed geospatial patterns comparing Inner verses Outer London and the 32 London Boroughs. Across Greater London, 24% of play spaces, 67% of private parks and 27% of public parks had average levels of NO2 that exceeded the EU limit for NO2. Rates of exceedance were higher in Inner London; open spaces in the City of London had the highest average NO2 values among all the London Boroughs. The closest play space for more than 250,000 children (14%) under 16 years old in Greater London had NO2 concentrations above recommended levels. Of these children, 66% (~165,000 children) live in the most deprived areas of London as measured by the Index of Multiple Deprivations where average NO2 concentrations in play spaces where on average 6 µg/m3 higher than for play spaces in the least deprived quintile. More action is needed to reduce NO2 in open spaces to safe levels through pollution reduction and mitigation efforts as currently open spaces in Greater London including play spaces, parks and gardens still have dangerously high levels of NO2 according to the most recent NO2 map.
Boyd A, Thomas R, Hansell AL, et al., 2019, Data resource profile: the ALSPAC birth cohort as a platform to study the relationship of environment and health and social factors, International Journal of Epidemiology, Vol: 48, Pages: 1038-1039k, ISSN: 1464-3685
This resource profile describes the information about the physical and social environment collected within the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. This includes spatial and temporal information gathered on three generations about: area-level built and social characteristics (e.g. density and location of fast-food outlets, crime rates within a neighbourhood); exposure measurements (e.g. air pollution concentrations, temperature records); participant-reported data directly related to the spaces and places they inhabit (e.g. neighbourhood safety, presence of damp within a home); information directly measured from participants (e.g. blood lead and total mercury concentrations, physical activity); the location information needed to link these diverse data.We describe the platform’s previous uses, strengths and weaknesses and access arrangements, emphasizing confidentiality safeguard controls. This profile highlights a particular class of ALSPAC data (with distinct access arrangements) to promote the potential for incorporating physical environment and other spatially-dependent data into research investigations.
Freni Sterrantino A, Elliott P, Blangiardo M, et 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.
Espina C, Bauld L, Bonanni B, et al., 2019, The essential role of prevention in reducing the cancer burden in Europe: A commentary from Cancer Prevention Europe, Tumori Journal, Vol: 105, Pages: 54-56, ISSN: 2038-2529
Jennings N, Fecht D, De Matteis S, 2019, Co-benefits of climate change mitigation in the UK: What issues are the UK public concerned about and how can action on climate change help to address them?
Mitsakou C, Dimitroulopoulou S, Heaviside C, et al., 2019, Environmental public health risks in European metropolitan areas within the EURO-HEALTHY project, Science of the Total Environment, Vol: 658, Pages: 1630-1639, ISSN: 0048-9697
Urban areas in Europe are facing a range of environmental public health challenges, such as air pollution, traffic noise and road injuries. The identification and quantification of the public health risks associated with exposure to environmental conditions is important for prioritising policies and interventions that aim to diminish the risks and improve the health of the population. With this purpose in mind, the EURO-HEALTHY project used a consistent approach to assess the impact of key environmental risk factors and urban environmental determinants on public health in European metropolitan areas. A number of environmental public health indicators, which are closely tied to the physical and built environment, were identified through stakeholder consultation; data were collected from six European metropolitan areas (Athens, Barcelona, Lisbon, London, Stockholm and Turin) covering the period 2000–2014, and a health impact assessment framework enabled the quantification of health effects (attributable deaths) associated with these indicators. The key environmental public health indicators were related to air pollution and certain urban environmental conditions (urban green spaces, road safety). The air pollution was generally the highest environmental public health risk; the associated number of deaths in Athens, Barcelona and London ranged between 800 and 2300 attributable deaths per year. The number of victims of road traffic accidents and the associated deaths were lowest in the most recent year compared with previous years. We also examined the positive impacts on health associated with urban green spaces by calculating reduced mortality impacts for populations residing in areas with greater green space coverage; results in Athens showed reductions of all-cause mortality of 26 per 100,000 inhabitants for populations with benefits of local greenspace. Based on our analysis, we discuss recommendations of potential interventions that could be implemented to r
Ghosh RE, Freni-Sterrantino A, Douglas P, et 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.
Vineis P, Fecht D, 2018, Environment, cancer and inequalities-The urgent need for prevention, European Journal of Cancer, Vol: 103, Pages: 317-326, ISSN: 0959-8049
The proportion of total deaths attributable to environmental factors is estimated to be 23% of global deaths and 22% of global disability-adjusted life years (DALYs) according to one review. These estimates encompass all environmental agents including infectious agents but excluding behavioural factors. The authors of the review also estimated that 16% (95% CI: 7-41%) of cancer deaths are attributable to environmental risk factors (and 36% [95% CI: 17-52%] for lung cancer). In this article, we focus on the reasons why epidemiology is often unable to account for the whole burden of environmental carcinogens. The experience of air pollution is particularly instructive. While in the 1970s and early 1980s, air pollution was considered as a relatively marginal exposure in terms of attributable risks, the most recent estimate is that it accounts for 7.6% of global deaths and 4.2% of global DALYs world-wide (with East and South Asia accounting for 59% of the total). According to a review, ambient fine particulate matter air pollution contributed to 17.1% of ischaemic heart disease, 14.2% of cerebrovascular disease, 16.5% of lung cancer, 24.7% of low respiratory infections, and 27.1% of COPD mortality in 2015. Estimates for cancer as a whole are not available. The change in appreciation of the role of air pollution has been mainly due to the refinement of exposure assessment methods and the new generations of longitudinal studies. Mechanistic evidence via omic technologies is now rapidly increasing, thus lending credibility to previous epidemiological ('black box') associations. Much less is known about other environmental contaminants, some of which are widespread and pervasive, thus suggesting the need for the same rigourous methods as those applied to air pollution. Finally, a crucial issue remains inequality across different population groups, with uneven exposure to hazards and acquired susceptibilities due to multiple concomitant exposures and poorer health status.
Pierotti L, Schofield SJ, Collett D, et al., 2018, Traffic-related air pollution and solid organ transplant failure in Great Britain: A retrospective cohort study, Journal of Transport and Health, Vol: 10, Pages: 124-131, ISSN: 2214-1405
Background: Limited evidence suggests that exposure to traffic related air pollution is associated with graft failure among lung transplant recipients. We explored associations between pollution and transplant failure among lung and other solid organ transplant recipients in Great Britain through a retrospective cohort study. Methods: All patients who received a lung, heart, liver, or kidney transplant between 2000 and 2008 in Great Britain were included, as recorded in the National Health Service Blood and Transplant (NHSBT) register and followed to March 2015. Using residential addresses at time of transplant we calculated distance to nearest (major) road and modelled annual average exposures to airborne nitrogen oxides and particulate matter of diameter ≤10µm and ≤2.5µm for each transplant recipient. All-cause mortality or graft failure (kidney) during follow up was the main outcome; median follow-up was around 10 years for each organ type. We fitted Cox regression models with adjustment for age, sex, year of transplant and donor age/smoking status. Results: 780 lung, 1213 heart, 3650 liver and 11966 graft kidney transplant patients were analysed. We did not find any consistent associations between mortality or graft failure and any of the analysed air pollutants or road metrics. Although, exposure to particulate matter was associated with renal transplant failure in univariable analyses but not after adjustment for confounders. Conclusions: Our analysis does not confirm previously reported associations between traffic-related air pollution exposure and the risk of transplant failure.
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