April 8 | 2019

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Risk of acute respiratory infection from crop burning in India: estimating disease burden and economic welfare from satellite and national health survey data for 250 000 persons.

Suman Chakrabarti, Mohammed Tajuddin Khan, Avinash Kishore, Devesh Roy, Samuel P Scott.

International Journal of Epidemiology, dyz022, https://doi.org/10.1093/ije/dyz022

Published: 28 February 2019

Abstract

Background

Respiratory infections are among the leading causes of death and disability globally. Respirable aerosol particles released by agricultural crop-residue burning (ACRB), practised by farmers in all global regions, are potentially harmful to human health. Our objective was to estimate the health and economic costs of ACRB in northern India.

Methods

The primary outcome was acute respiratory infection (ARI) from India’s fourth District Level Health Survey (DLHS-4). DLHS-4 data were merged with Moderate-Resolution Imaging Spectroradiometer satellite data on fire occurrence. Mutually adjusted generalized linear models were used to generate risk ratios for risk factors of ARI. Overall disease burden due to ACRB was estimated in terms of disability-adjusted life years.

Results

Seeking medical treatment for ARI in the previous 2 weeks was reported by 5050 (2%) of 252 539 persons. Living in a district with intense ACRB—the top quintile of fires per day—was associated with a 3-fold higher risk of ARI (mutually adjusted risk ratio 2.99, 95% confidence interval 2.77 to 3.23) after adjustment for socio-demographic and household factors. Children under 5 years of age were particularly susceptible (3.65, 3.06 to 4.34 in this subgroup). Additional ARI risk factors included motor-vehicle congestion (1.96, 1.72 to 2.23), open drainage (1.91, 1.73 to 2.11), cooking with biomass (1.73, 1.58 to 1.90) and living in urban areas (1.35, 1.26 to 1.44). Eliminating ACRB would avert 14.9 million disability-adjusted life years lost per year, valued at US$152.9 billion over 5 years.

Conclusions

Investments to stop crop burning and offer farmers alternative crop-residue disposal solutions are likely to improve population-level respiratory health and yield major economic returns.

April 1 | 2019

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Temperature-related changes in airborne allergenic pollen abundance and seasonality across the northern hemisphere: a retrospective data analysis.

Ziska LH, Makra L, Harry SK, Bruffaerts N, Hendrickx M, Coates F, Saarto A, Thibaudon M, Oliver G, Damialis A, Charalampopoulos A, Vokou D, Heiđmarsson S, Guđjohnsen E, Bonini M, Oh JW, Sullivan K, Ford L, Brooks GD, Myszkowska D, Severova E, Gehrig R, Ramón GD, Beggs PJ, Knowlton K, Crimmins AR.

Lancet Planet Health. 2019 Mar;3 (3):e124-e131. https://doi.org/10.1016/S2542-5196(19)30015-4

 

Abstract

BACKGROUND:

Ongoing climate change might, through rising temperatures, alter allergenic pollen biology across the northern hemisphere. We aimed to analyse trends in pollen seasonality and pollen load and to establish whether there are specific climate-related links to any observed changes.

METHODS:

For this retrospective data analysis, we did an extensive search for global datasets with 20 years or more of airborne pollen data that consistently recorded pollen season indices (eg, duration and intensity). 17 locations across three continents with long-term (approximately 26 years on average) quantitative records of seasonal concentrations of multiple pollen (aeroallergen) taxa met the selection criteria. These datasets were analysed in the context of recent annual changes in maximum temperature (Tmax) and minimum temperature (Tmin) associated with anthropogenic climate change. Seasonal regressions (slopes) of variation in pollen load and pollen season duration over time were compared to Tmax, cumulative degree day Tmax, Tmin, cumulative degree day Tmin, and frost-free days among all 17 locations to ascertain significant correlations.

FINDINGS:

12 (71%) of the 17 locations showed significant increases in seasonal cumulative pollen or annual pollen load. Similarly, 11 (65%) of the 17 locations showed a significant increase in pollen season duration over time, increasing, on average, 0·9 days per year. Across the northern hemisphere locations analysed, annual cumulative increases in Tmax over time were significantly associated with percentage increases in seasonal pollen load (r=0·52, p=0·034) as were annual cumulative increases in Tmin (r=0·61, p=0·010). Similar results were observed for pollen season duration, but only for cumulative degree days (higher than the freezing point [0°C or 32°F]) for Tmax (r=0·53, p=0·030) and Tmin (r=0·48, p=0·05). Additionally, temporal increases in frost-free days per year were significantly correlated with increases in both pollen load (r=0·62, p=0·008) and pollen season duration (r=0·68, p=0·003) when averaged for all 17 locations.

INTERPRETATION:

Our findings reveal that the ongoing increase in temperature extremes (Tmin and Tmax) might already be contributing to extended seasonal duration and increased pollen load for multiple aeroallergenic pollen taxa in diverse locations across the northern hemisphere. This study, done across multiple continents, highlights an important link between ongoing global warming and public health-one that could be exacerbated as temperatures continue to increase.

March 18 | 2019

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Vegetation diversity protects against childhood asthma: results from a large New Zealand birth cohort.

Donovan GH, Gatziolis D, Longley I, Douwes J.

Nat Plants. 2018 Jun;4(6):358-364. DOI: 10.1038/s41477-018-0151-8

Abstract

We assessed the association between the natural environment and asthma in 49,956 New Zealand children born in 1998 and followed up until 2016 using routinely collected data. Children who lived in greener areas, as measured by the normalized difference vegetation index, were less likely to be asthmatic: a 1 s.d. increase in normalized difference vegetation index was associated with a 6.0% (95% CI 1.9–9.9%) lower risk of asthma. Vegetation diversity was also protective: a 1 s.d. increase in the number of natural land-cover types in a child’s residential meshblock was associated with a 6.7% (95% CI 1.5–11.5%) lower risk. However, not all land-cover types were protective. A 1 s.d. increase in the area covered by gorse (Ulex europaeus) or exotic conifers, both non-native, low-biodiversity land-cover types, was associated with a 3.2% (95% CI 0.0–6.0%) and 4.2% (95% CI 0.9–7.5%) increased risk of asthma, respectively. The results suggest that exposure to greenness and vegetation diversity may be protective of asthma.

March 11 | 2019

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Geospatial analyses of adverse birth outcomes in Southwestern Ontario: Examining the impact of environmental factors.

Jamie A. Seabrook, Alexandra Smith, Andrew F. Clark, Jason A. Gilliland

Environmental Research Volume 172, May 2019, Pages 18-26 https://doi.org/10.1016/j.envres.2018.12.068

 

Abstract

Background

A growing body of research has examined the association between exposure to environmental factors during pregnancy and adverse birth outcomes; however, many studies do not control for potential covariates and findings vary considerably.

Objective

To test the relative influence of environmental factors including exposure to air pollution, major roads, highways, industry, parks, greenspaces, and food retailers on low birth weight (LBW) and preterm birth (PTB) in Southwestern Ontario (SWO), Canada, while accounting for medical (e.g., previous preterm birth, gestational diabetes), behavioral (e.g., alcohol, smoking), demographic (e.g., maternal age, body mass index), and neighborhood-level socioeconomic (e.g., household income, education) factors.

Methods

This retrospective cohort study consisted of a large sample of pregnant women from SWO who gave birth to singleton newborns between February 2009 and February 2014 at London Health Sciences Centre. Data on maternal postal codes were entered into a Geographic Information System to map the distribution of maternal residences and determine selected characteristics of their neighborhood environments (i.e., socioeconomic, built, natural). These variables were developed based on postal codes where the mothers lived prior to giving birth. Logistic regression was used to assess the relative effects of the physical environment, socioeconomic status, clinical history, and behavioral risk factors on mothers having a LBW or PTB infant.

Results

Out of 25,263 live births, 5.7% were LBW and 7.5% were PTB. Exposure to sulfur dioxide was a top predictor of both LBW and PTB. For every one-unit increase in sulfur dioxide, the odds of a LBW and PTB were 3.4 (95% CI: 2.2, 5.2) and 2.0 (95% CI: 1.4, 3.0) times higher, after controlling for other variables in the model, respectively (p < 0.001). Previous PTB was also highly associated with both birth outcomes.

Conclusions

Health care providers should be informed about the hazards of air pollution to developing fetuses so that recommendations can be made to their pregnant patients about limiting exposure when air quality is poor.

March 4 | 2019

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The Lancet Commissions

The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report.

Prof Boyd A Swinburn MD, Vivica I Kraak PhD, Prof Steven Allender PhD, Vincent J Atkins, Phillip I Baker PhD, Jessica R Bogard PhD, Hannah Brinsden,  Alejandro Calvillo, Prof Olivier De Schutter PhD, Raji Devarajank, Prof Majid Ezzat FMedSci,  Prof Sharon Friel PhD, Shifalika Goenka PhD,  Ross A Hammond PhD, Prof Gerard  Hastings PhD, Prof Corinna Hawkes PhD, Mario Herrero PhD, Prof Peter S Hovmand PhD, …Prof William H Dietz MD.

The Lancet Volume 393, Issue 10173, 23 February–1 March 2019, Pages 791-846   https://doi.org/10.1016/S0140-6736(18)32822-8

Executive summary

Malnutrition in all its forms, including obesity, undernutrition, and other dietary risks, is the leading cause of poor health globally. In the near future, the health effects of climate change will considerably compound these health challenges. Climate change can be considered a pandemic because of its sweeping effects on the health of humans and the natural systems we depend on (ie, planetary health). These three pandemics—obesity, undernutrition, and climate change—represent The Global Syndemic that affects most people in every country and region worldwide. They constitute a syndemic, or synergy of epidemics, because they co-occur in time and place, interact with each other to produce complex sequelae, and share common underlying societal drivers. This Commission recommends comprehensive actions to address obesity within the context of The Global Syndemic, which represents the paramount health challenge for humans, the environment, and our planet in the 21st century.

February 25 | 2019

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Spatiotemporal Variations in Ambient Ultrafine Particles and the Incidence of Childhood Asthma.

Lavigne E, Donelle J, Hatzopoulou M, Van Ryswyk K, van Donkelaar A, Martin R, Chen H, Stieb DM, Gasparrini A, Crighton E, Yasseen Iii AS, Burnett RT, Walker M, Weichenthal S.

Am J Respir Crit Care Med. 2019 Feb 20.. [Epub ahead of print]  DOI: 10.1164/rccm.201810-1976OC

 

Abstract

RATIONALE:

Little is known regarding the impact of ambient ultrafine particles (<0.1 μm) (UFPs) on childhood asthma development.

OBJECTIVE:

To examine the association between prenatal and early postnatal life exposure to UFPs and development of childhood asthma.

METHODS:

A total of 160,641 singleton live births occurring in the City of Toronto, Canada between April 1st 2006 and March 31st 2012 were identified from a birth registry. Associations between exposure to ambient air pollutants and childhood asthma incidence (up to age 6) were estimated using random-effects Cox proportional hazards models, adjusting for personal- and neighborhood-level covariates. We investigated both single- and multi-pollutant models accounting for co-exposures to PM2.5 and NO2.

MEASUREMENTS AND MAIN RESULTS:

We identified 27,062 children with incident asthma diagnosis during the follow-up. In adjusted models, second trimester exposure to UFPs (Hazard Ratio (HR) per interquartile (IQR) increase = 1.09, 95% CI: 1.06 – 1.12) was associated with asthma incidence. In models additionally adjusted for PM2.5 and NO2, UFPs exposure during the second trimester of pregnancy remained positively associated with childhood asthma incidence (HR per IQR increase = 1.05, 95% CI: 1.01 – 1.09).

CONCLUSION:

This is the first study to evaluate the association between perinatal exposure to UFPs and the incidence of childhood asthma. Exposure to UFPs during a critical period of lung development was linked to the onset of asthma in children, independent of PM2.5 and NO2.

February 19 | 2019

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Health Benefits of Physical Activity Related to an Urban Riverside Regeneration.

Vert C, Nieuwenhuijsen M, Gascon M, Grellier J, Fleming LE, White MP, Rojas-Rueda D.

Int J Environ Res Public Health. 2019 Feb 5;16(3). pii: E462. Doi: 10.3390/ijerph16030462

 

Abstract

The promotion of physical activity through better urban design is one pathway by which health and well-being improvements can be achieved. This study aimed to quantify health and health-related economic impacts associated with physical activity in an urban riverside park regeneration project in Barcelona, Spain. We used data from Barcelona local authorities and meta-analysis assessing physical activity and health outcomes to develop and apply the “Blue Active Tool”. We estimated park user health impacts in terms of all-cause mortality, morbidity (ischemic heart disease; ischemic stroke; type 2 diabetes; cancers of the colon and breast; and dementia), disability-adjusted life years (DALYs) and health-related economic impacts. We estimated that 5753 adult users visited the riverside park daily and performed different types of physical activity (walking for leisure or to/from work, cycling, and running). Related to the physical activity conducted on the riverside park, we estimated an annual reduction of 7.3 deaths (95% CI: 5.4; 10.2), and 6.2 cases of diseases (95% CI: 2.0; 11.6). This corresponds to 11.9 DALYs (95% CI: 3.4; 20.5) and an annual health-economic impact of 23.4 million euros (95% CI: 17.2 million; 32.8 million). The urban regeneration intervention of this riverside park provides health and health-related economic benefits to the population using the infrastructure.

February 11 | 2019

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Exposure to natural space, sense of community belonging, and adverse mental health outcomes across an urban region.

Rugel EJ, Carpiano RM, Henderson SB, Brauer M.

Environ Res. 2019 Jan 25;171:365-377. DOI: 10.1016/j.envres.2019.01.034

Abstract

In a rapidly urbanizing world, identifying evidence-based strategies to support healthy design is essential. Although urban living offers increased access to critical resources and can help to mitigate climate change, densely populated neighborhood environments are often higher in many of the physical and psychological stressors that are detrimental to health, and lower in the social capital that is beneficial to health. One component of urban form that can reduce these stressors and improve social capital is nature: greenspace, such as parks and street trees, and bluespace, such as rivers and oceans. In this project, we applied measures from a Natural Space Index previously developed for the Vancouver, Canada census metropolitan area to explore the relationship between distinct measures of natural space and prevalence of (1) major depressive disorder, (2) negative mental health, and (3) psychological distress. In addition, we examined direct associations between natural space exposure and neighborhood social capital, as measured via self-reported sense of community belonging (SoC), as well as the potential mental health benefits of natural space mediated via SoC. Using data from the population-based, cross-sectional 2012 Canadian Community Health Survey-Mental Health (weighted n = 1,930,048), we found no direct associations between any measure of natural space and mental health in models adjusted for 11 demographic, socioeconomic, household arrangement, health, and urban design variables. However, publicly accessible neighborhood nature was associated with increased odds of higher SoC. A 1% increase in the percentage of natural space (combined greenspace and bluespace) within 500 m had an odds ratio [95% confidence interval] of 1.05 [1.00, 1.10] for very strong vs. very weak SoC and 1.04 [1.01, 1.08] for somewhat strong vs. very weak SoC. In addition, higher levels of SoC were associated with improvements in all three mental health outcomes. Mediation tests indicated significant indirect effects of both publicly accessible neighborhood nature variables on reductions in psychological distress and reduced odds of negative mental health via increased sense of SoC. This suggests that natural space has the potential to address the pressing issue of social isolation and, in turn, poor mental health faced by residents of dense urban environments.

February 4 | 2019

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Neighbourhood walkability and the incidence of diabetes: an inverse probability of treatment weighting analysis.

Booth GL, Creatore M, Luo J, Fazli GS, Johns A, Rosella LC, Glazier RH, Moineddin R, Gozdyra P, Austin PC.

J Epidemiol Community Health. 2019 Jan 29.. [Epub ahead of print]  DOI:10.1136/jech-2018-210510

Abstract

BACKGROUND:

People living in highly walkable neighbourhoods tend to be more physically active and less likely to be obese. Whether walkable urban design reduces the future risk of diabetes is less clear.

METHODS:

We used inverse probability of treatment weighting to compare 10-year diabetes incidence between residents living in high-walkability and low-walkability neighbourhoods within five urban regions in Ontario, Canada. Adults (aged 30-85 years) who were diabetes-free on 1 April 2002 were identified from administrative health databases and followed until 31 March 2012 (n=958 567). Within each region, weights reflecting the propensity to live in each neighbourhood type were created based on sociodemographic characteristics, comorbidities and healthcare utilisation and incorporated into region-specific Cox proportional hazards models.

RESULTS:

Low-walkability areas were more affluent and had more South Asian residents (6.4%vs3.6%, p<0.001) but fewer residents from other minority groups (16.6%vs21.7%, p<0.001). Baseline characteristics were well balanced between low-walkability and high-walkability neighbourhoods after applying individual weights (standardised differences all <0.1). In each region, high walkability was associated with lower diabetes incidence among adults aged <65 years (overall weighted incidence: 8.2vs9.2 per 1000; HR 0.85, 95% CI 0.78 to 0.93), but not among adults aged ≥65 years (weighted incidence: 20.7vs19.5 per 1000; HR 1.01, 95% CI 0.91 to 1.12). Findings were consistent regardless of income and immigration status.

CONCLUSIONS:

Younger adults living in high-walkability neighbourhoods had a lower 10-year incidence of diabetes than similarly aged adults living in low-walkability neighbourhoods. Urban designs that support walking may have important benefits for diabetes prevention.

January 28 | 2019

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The heat penalty of walkable neighbourhoods. 

O’Brien GA, Ross NA, Strachan IB.

Int J Biometeorol. 2019 Jan 24.. [Epub ahead of print] DOI: 10.1007/s00484-018-01663-0

 

Abstract

“Walkability” or walking-friendliness is generally considered a favourable attribute of a neighbourhood that supports physical activity and improves health outcomes. Walkable neighbourhoods tend to have high-density infrastructure and relatively high amounts of concrete and pavement for sidewalks and streets, all of which can elevate local urban temperatures. The objective of this study was to assess whether there is a “heat penalty” associated with more walkable neighbourhoods in Montréal, Québec, Canada, using air temperature measurements taken in real time at street level during a heat event. The mean temperature of “Car-Dependent” neighbourhoods was 26.2 °C (95% CI 25.8, 26.6) whereas the mean temperature of “Walker’s Paradise” neighbourhoods was 27.9 °C (95% CI 27.8, 28.1)-a difference of 1.7 °C (95% CI 1.3, 2.0). There was a strong association between higher walkability of Montréal neighbourhoods and elevated temperature (r = 0.61, p < 0.01); suggestive of a heat penalty for walkable neighbourhoods. Planning solutions that support increased walking-friendliness of neighbourhoods should consider simultaneous strategies to mitigate heat to reduce potential health consequences of the heat penalty.