Publications by authors named "Barbara Hoffmann"

178 Publications

Population impact of different hypertension management guidelines based on the prospective population-based Heinz Nixdorf Recall study.

BMJ Open 2021 Feb 17;11(2):e039597. Epub 2021 Feb 17.

Department of Neurology, University Hospital Essen, Essen, Germany.

Objective: Hypertension guidelines strongly differ between societies. The current American College of Cardiology/American Heart Association (ACC/AHA) guideline recommends higher proportions of the general population for antihypertensive medication than the previous American and European guidelines. How cardiovascular risk differs between persons with and without antihypertensive medication recommendation has not been examined. Additionally, the population impact of American, European and international guidelines has not been compared systematically within the same study population.

Methods: We compared the prevalence of antihypertensive medication recommendation according to the American (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 (JNC7), ACC/AHA 2017), European (European Society of Hypertension (ESH)/European Society of Cardiology (ESC) 2013/2018), and international (WHO/International Society of Hypertension (ISH) 2003, ISH 2020) guidelines in 3092 participants of the population-based Heinz Nixdorf Recall study not taking antihypertensive medication at the baseline examination (58.1±7.5 years, 48.7% males). We furthermore compared incident cardiovascular events during the 5-year follow-up between participants with and without antihypertensive medication recommendation.

Results: The ACC/AHA 2017 guideline recommended the highest percentage of participants for antihypertensive medication (45.8%) compared with the JNC7 (37.2%), ESH/ESC 2013 (17.8%), ESC/ESH 2018 (26.7%), WHO/ISH 2003 (20.3%) or ISH 2020 (25.0%) guidelines. Participants with antihypertensive medication recommendation according to the ACC/AHA 2017 guideline had a significantly higher incidence of cardiovascular events during the 5-year follow-up compared with participants without this recommendation (2.5% vs 1.1%, p=0.003).

Conclusions: Our results call for randomised controlled trials to investigate whether applying the stricter ACC/AHA 2017 recommendation leads to a reduction in cardiovascular disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2020-039597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893668PMC
February 2021

Air Pollution and Polyclonal Elevation of Serum Free Light Chains: An Assessment of Adaptive Immune Responses in the Prospective Heinz Nixdorf Recall Study.

Environ Health Perspect 2021 Feb 17;129(2):27004. Epub 2021 Feb 17.

Institute for Occupational, Social and Environmental Medicine, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany.

Background: Residential exposure to air pollution (AP) has been shown to activate the immune system (IS). Although innate immune responses to AP have been studied extensively, investigations on the adaptive IS are scarce.

Objectives: The aim of this study was to investigate the association between short- to long-term AP exposure and polyclonal free light chains (FLC) produced by plasma cells.

Methods: We used repeated data from three examinations (: 2000-2003; : 2006-2008; and : 2011-2015) of the population-based German Heinz Nixdorf Recall cohort of initially 4,814 participants (45-75 y old). Residential exposure to total and source-specific particulate matter (PM) with an aerodynamic diameter of 10 or ( and respectively), nitrogen dioxide (), and particle number concentrations (accumulation mode; ) was estimated using a chemistry transport model with different time windows (1- to 365-d mean ± standard deviation) before blood draw. We applied linear mixed models with a random participant intercept to estimate associations between total, traffic- and industry-related AP exposures and log-transformed FLC, controlling for examination time, sociodemographic and lifestyle variables, estimated glomerular filtration rate and season.

Results: Analyzing 9,933 observations from 4,455 participants, we observed generally positive associations between AP exposures and FLC. We observed strongest associations with middle-term exposures, e.g., 3.0% increase in FLC (95% confidence interval: 1.8%, 4.3%) per interquartile range increase in 91-d mean of (). Across the different pollutants, showed strongest associations with FLC, followed by and . Effect estimates for traffic-related exposures were mostly higher compared with total exposures. Although and estimates remained stable upon adjustment for PM, PM estimates decreased considerably upon adjustment for and .

Discussion: Our results suggest that middle-term AP exposures in particular might be positively associated with activation of the adaptive IS. Traffic-related PM, , and showed strongest associations. https://doi.org/10.1289/EHP7164.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1289/EHP7164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7889003PMC
February 2021

Modeling multi-level survival data in multi-center epidemiological cohort studies: Applications from the ELAPSE project.

Environ Int 2021 Feb 12;147:106371. Epub 2021 Jan 12.

Dept. of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str, 115 27 Athens, Greece; NIHR HPRU Health Impact of Environmental Hazards, Environmental Research Group, Analytical, Environmental & Forensic Sciences, King's College London, UK.

Background: We evaluated methods for the analysis of multi-level survival data using a pooled dataset of 14 cohorts participating in the ELAPSE project investigating associations between residential exposure to low levels of air pollution (PM and NO) and health (natural-cause mortality and cerebrovascular, coronary and lung cancer incidence).

Methods: We applied five approaches in a multivariable Cox model to account for the first level of clustering corresponding to cohort specification: (1) not accounting for the cohort or using (2) indicator variables, (3) strata, (4) a frailty term in frailty Cox models, (5) a random intercept under a mixed Cox, for cohort identification. We accounted for the second level of clustering due to common characteristics in the residential area by (1) a random intercept per small area or (2) applying variance correction. We assessed the stratified, frailty and mixed Cox approach through simulations under different scenarios for heterogeneity in the underlying hazards and the air pollution effects.

Results: Effect estimates were stable under approaches used to adjust for cohort but substantially differed when no adjustment was applied. Further adjustment for the small area grouping increased the effect estimates' standard errors. Simulations confirmed identical results between the stratified and frailty models. In ELAPSE we selected a stratified multivariable Cox model to account for between-cohort heterogeneity without adjustment for small area level, due to the small number of subjects and events in the latter.

Conclusions: Our study supports the need to account for between-cohort heterogeneity in multi-center collaborations using pooled individual level data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2020.106371DOI Listing
February 2021

Long-term exposure to low-level air pollution and incidence of asthma: the ELAPSE project.

Eur Respir J 2020 Dec 10. Epub 2020 Dec 10.

Department of Public Health, University of Copenhagen, Copenhagen, Denmark

Background: Long-term exposure to ambient air pollution has been linked to childhood-onset asthma, while evidence is still insufficient. Within the multicentre project "Effects of Low-Level Air Pollution: A Study in Europe" (ELAPSE), we examined the associations of long-term exposures to particulate matter with diameter<2.5 µm (PM), nitrogen dioxide (NO), and black carbon (BC) with asthma incidence in adults.

Methods: We pooled data from three cohorts in Denmark and Sweden with information on asthma hospital diagnoses. The average concentrations of air pollutants in 2010 were modelled by hybrid land use regression models at participants' baseline residential addresses. Associations of air pollution exposures with asthma incidence were explored with Cox proportional hazard models, adjusting for potential confounders.

Results: Of 98 326 participants, 1965 developed asthma during a 16.6 years mean follow-up. We observed associations in fully adjusted models with hazard ratios and 95% confidence intervals of 1.22 (1.04-1.43) per 5 μg·m for PM, 1.17 (1.10-1.25) per 10 µg·m for NO, and 1.15 (1.08-1.23) per 0.5 10m for BC. Hazard ratios were larger in cohort subsets with exposure levels below the EU and US limit values and possibly WHO guidelines for PM and NO. NO and BC estimates remained unchanged in two-pollutant models with PM, whereas PM estimates were attenuated to unity. The concentration response curves showed no evidence of a threshold.

Conclusions: Long-term exposure to air pollution, especially from fossil fuel combustion sources such as motorised traffic, was associated with adult-onset asthma, even at levels below the current limit values.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/13993003.030992020DOI Listing
December 2020

Long-term exposure to fine particle elemental components and lung cancer incidence in the ELAPSE pooled cohort.

Environ Res 2021 Feb 2;193:110568. Epub 2020 Dec 2.

Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen, 2100, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, P.O.Box 358, Roskilde, 4000, Denmark. Electronic address:

Background: An association between long-term exposure to fine particulate matter (PM) and lung cancer has been established in previous studies. PM is a complex mixture of chemical components from various sources and little is known about whether certain components contribute specifically to the associated lung cancer risk. The present study builds on recent findings from the "Effects of Low-level Air Pollution: A Study in Europe" (ELAPSE) collaboration and addresses the potential association between specific elemental components of PM and lung cancer incidence.

Methods: We pooled seven cohorts from across Europe and assigned exposure estimates for eight components of PM representing non-tail pipe emissions (copper (Cu), iron (Fe), and zinc (Zn)), long-range transport (sulfur (S)), oil burning/industry emissions (nickel (Ni), vanadium (V)), crustal material (silicon (Si)), and biomass burning (potassium (K)) to cohort participants' baseline residential address based on 100 m by 100 m grids from newly developed hybrid models combining air pollution monitoring, land use data, satellite observations, and dispersion model estimates. We applied stratified Cox proportional hazards models, adjusting for potential confounders (age, sex, calendar year, marital status, smoking, body mass index, employment status, and neighborhood-level socio-economic status).

Results: The pooled study population comprised 306,550 individuals with 3916 incident lung cancer events during 5,541,672 person-years of follow-up. We observed a positive association between exposure to all eight components and lung cancer incidence, with adjusted HRs of 1.10 (95% CI 1.05, 1.16) per 50 ng/m PM K, 1.09 (95% CI 1.02, 1.15) per 1 ng/m PM Ni, 1.22 (95% CI 1.11, 1.35) per 200 ng/m PM S, and 1.07 (95% CI 1.02, 1.12) per 200 ng/m PM V. Effect estimates were largely unaffected by adjustment for nitrogen dioxide (NO). After adjustment for PM mass, effect estimates of K, Ni, S, and V were slightly attenuated, whereas effect estimates of Cu, Si, Fe, and Zn became null or negative.

Conclusions: Our results point towards an increased risk of lung cancer in connection with sources of combustion particles from oil and biomass burning and secondary inorganic aerosols rather than non-exhaust traffic emissions. Specific limit values or guidelines targeting these specific PM components may prove helpful in future lung cancer prevention strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envres.2020.110568DOI Listing
February 2021

Long-term exposure to low-level air pollution and incidence of chronic obstructive pulmonary disease: The ELAPSE project.

Environ Int 2021 Jan 1;146:106267. Epub 2020 Dec 1.

Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Epidemiological Research, Nykøbing F Hospital, Nykøbing F, Denmark. Electronic address:

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 (PM), nitrogen dioxide (NO), 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/m for PM, 1.11 (1.06, 1.16) per 10 µg/m for NO, and 1.11 (1.06, 1.15) per 0.5 10m for BC. Associations persisted in subset participants with PM or NO levels below current EU and US limit values and WHO guidelines, with no evidence for a threshold. HRs for NO and BC remained unchanged in two-pollutant models with PM, whereas the HR for PM was attenuated to unity with NO 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 NO and BC may be the most relevant.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2020.106267DOI Listing
January 2021

Development of Europe-Wide Models for Particle Elemental Composition Using Supervised Linear Regression and Random Forest.

Environ Sci Technol 2020 12 25;54(24):15698-15709. Epub 2020 Nov 25.

Institute for Risk Assessment Sciences (IRAS), Utrecht University, Postbus 80125, 3508 TC Utrecht, The Netherlands.

We developed Europe-wide models of long-term exposure to eight elements (copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc) in particulate matter with diameter <2.5 μm (PM) using standardized measurements for one-year periods between October 2008 and April 2011 in 19 study areas across Europe, with supervised linear regression (SLR) and random forest (RF) algorithms. Potential predictor variables were obtained from satellites, chemical transport models, land-use, traffic, and industrial point source databases to represent different sources. Overall model performance across Europe was moderate to good for all elements with hold-out-validation -squared ranging from 0.41 to 0.90. RF consistently outperformed SLR. Models explained within-area variation much less than the overall variation, with similar performance for RF and SLR. Maps proved a useful additional model evaluation tool. Models differed substantially between elements regarding major predictor variables, broadly reflecting known sources. Agreement between the two algorithm predictions was generally high at the overall European level and varied substantially at the national level. Applying the two models in epidemiological studies could lead to different associations with health. If both between- and within-area exposure variability are exploited, RF may be preferred. If only within-area variability is used, both methods should be interpreted equally.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/acs.est.0c06595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745532PMC
December 2020

Long-term low-level ambient air pollution exposure and risk of lung cancer - A pooled analysis of 7 European cohorts.

Environ Int 2021 Jan 13;146:106249. Epub 2020 Nov 13.

UK Small Area Health Statistics Unit, MRC Centre for Environment and Health, School of Public Health, Imperial College London, W2 1PG London, UK. Electronic address:

Background/aim: Ambient air pollution has been associated with lung cancer, but the shape of the exposure-response function - especially at low exposure levels - is not well described. The aim of this study was to address the relationship between long-term low-level air pollution exposure and lung cancer incidence.

Methods: The "Effects of Low-level Air Pollution: a Study in Europe" (ELAPSE) collaboration pools seven cohorts from across Europe. We developed hybrid models combining air pollution monitoring, land use data, satellite observations, and dispersion model estimates for nitrogen dioxide (NO), fine particulate matter (PM), black carbon (BC), and ozone (O) to assign exposure to cohort participants' residential addresses in 100 m by 100 m grids. We applied stratified Cox proportional hazards models, adjusting for potential confounders (age, sex, calendar year, marital status, smoking, body mass index, employment status, and neighborhood-level socio-economic status). We fitted linear models, linear models in subsets, Shape-Constrained Health Impact Functions (SCHIF), and natural cubic spline models to assess the shape of the association between air pollution and lung cancer at concentrations below existing standards and guidelines.

Results: The analyses included 307,550 cohort participants. During a mean follow-up of 18.1 years, 3956 incident lung cancer cases occurred. Median (Q1, Q3) annual (2010) exposure levels of NO, PM, BC and O (warm season) were 24.2 µg/m (19.5, 29.7), 15.4 µg/m (12.8, 17.3), 1.6 10m (1.3, 1.8), and 86.6 µg/m (78.5, 92.9), respectively. We observed a higher risk for lung cancer with higher exposure to PM (HR: 1.13, 95% CI: 1.05, 1.23 per 5 µg/m). This association was robust to adjustment for other pollutants. The SCHIF, spline and subset analyses suggested a linear or supra-linear association with no evidence of a threshold. In subset analyses, risk estimates were clearly elevated for the subset of subjects with exposure below the EU limit value of 25 µg/m. We did not observe associations between NO, BC or O and lung cancer incidence.

Conclusions: Long-term ambient PM exposure is associated with lung cancer incidence even at concentrations below current EU limit values and possibly WHO Air Quality Guidelines.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2020.106249DOI Listing
January 2021

Air pollution and airport apron workers: A neglected occupational setting in epidemiological research.

Int J Hyg Environ Health 2021 Jan 25;231:113649. Epub 2020 Oct 25.

Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Mainz, Germany; Institute of Clinical Physiology, National Research Council, Lecce, Italy.

Introduction: Airport apron workers are occupationally exposed to jet exhaust and major concern is related to the exposure to ultrafine particles (UFP) from aircrafts. To date, little attention has been given to occupational exposures to aircraft-related UFP, although aircraft engines have high emissions of ultrafine particles, which are orders of magnitude higher than residential exposure. UFP could possibly contribute to the development of cancer, heart disease, mental illness, and respiratory symptoms. In addition to particulate matter, apron workers are exposed to other polluting substances associated with vehicles, aircraft exhaust or direct fuel emissions.

Methods: We performed a scoping review on occupational health hazards due to air pollution among apron workers.

Results: Only three epidemiological studies were identified: two cross-sectional studies are of limited relevance due to a small sample size and a lack of quantitative exposure data. One sizeable cohort study performed an individual exposure measurement for UFP and considered relevant confounders. However, current studies are not numerous enough to evaluate an association of occupational air pollution with potential health effects among airport workers.

Conclusions: The results suggest that current scientific evidence on this topic is sparse. Further observational studies in this occupational work force is highly recommended. For a better understanding of adverse health effects due to air pollution and especially UFP, studies in different countries are essential, since working environments, medical monitoring of workers or safety standards might differ internationally.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijheh.2020.113649DOI Listing
January 2021

Air Pollution and Progression of Atherosclerosis in Different Vessel Beds-Results from a Prospective Cohort Study in the Ruhr Area, Germany.

Environ Health Perspect 2020 10 5;128(10):107003. Epub 2020 Oct 5.

Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.

Objectives: Due to inconsistent epidemiological evidence on health effects of air pollution on progression of atherosclerosis, we investigated several air pollutants and their effects on progression of atherosclerosis, using carotid intima media thickness (cIMT), coronary calcification (CAC), and thoracic aortic calcification (TAC).

Methods: We used baseline (2000-2003) and 5-y follow-up (2006-2008) data from the German Heinz Nixdorf Recall cohort study, including 4,814 middle-aged adults. Residence-based long-term air pollution exposure, including particulate matter (PM) with aerodynamic diameter (), (), and nitrogen dioxide () was assessed using chemistry transport and land use regression (LUR) models. cIMT was quantified as side-specific median IMT assessed from standardized ultrasound images. CAC and TAC were quantified by computed tomography using the Agatston score. Development (yes/no) and progression of atherosclerosis (change in cIMT and annual growth rate for CAC/TAC) were analyzed with logistic and linear regression models, adjusting for age, sex, lifestyle variables, socioeconomic status, and traffic noise.

Results: While no clear associations were observed in the full study sample (mean age 59.1 () y; 53% female), most air pollutants were marginally associated with progression of atherosclerosis in participants with no or low baseline atherosclerotic burden. Most consistently for CAC, e.g., a higher exposure to (LUR) yielded an estimated odds ratio of 1.19 [95% confidence interval (CI): 1.03, 1.39] for progression of CAC and an increased annual growth rate of 2% (95% CI: 1%, 4%).

Conclusion: Our study suggests that development and progression of subclinical atherosclerosis is associated with long-term air pollution in middle-aged participants with no or minor atherosclerotic burden at baseline, while overall no consistent associations are observed. https://doi.org/10.1289/EHP7077.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1289/EHP7077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535085PMC
October 2020

The role of depressive symptoms within the association of long-term exposure to indoor and outdoor traffic noise and cognitive function - Results from the Heinz Nixdorf Recall study.

Int J Hyg Environ Health 2020 Aug 18;230:113570. Epub 2020 Aug 18.

Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.

Objectives: Traffic noise is negatively associated with cognitive function, and its perception can differ between depressed and non-depressed people. We studied the role of depressive symptoms in the association between traffic noise and cognitive function. We studied the role of depressive symptoms in the association between traffic noise and cognitive function.

Methods: During the first follow-up examination (2006-2008) of the German Heinz Nixdorf Recall study, cognitive function (five subtests and an additive global summary score, GCS) and depressive symptoms (CES-D score) were assessed in 2745 participants (aged 50-80, 49.8% women). Mild cognitive impairment (MCI) was diagnosed according to the Petersen criteria in 380 participants. Long-term exposure to traffic noise was modeled as weighted 24-h mean (L) and night-time mean (L) at the façade of the baseline addresses, and was corrected for indoors (L and L). We developed multiple linear and logistic regression models adjusted for individual-level characteristics to investigate cross-sectionally the role of depressive symptoms in the association of traffic noise with cognitive function.

Results: Overall, 8.6% participants had depressive symptoms. The median noise values were L 52.1 dB(A) and L 34.7 dB(A). Associations were slightly stronger for cognitive subtests in those with severe depression (CES-D>21), i.e., per 10 dB(A) L and verbal fluency: β = -0.04 [-0.11; 0.03] for CES-D≤21 and β = -0.09 [-0.24; -0.06] for CES-D>21. Additional adjustment of the main model for CES-D did not change the association between noise and cognitive outcomes. Estimates using indoor noise exposure were generally stronger and more precise.

Conclusions: Depressed people may be more susceptible to adverse effects of noise than non-depressed. Modeled estimates of indoor noise exposure is possibly a more appropriate measure of exposure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijheh.2020.113570DOI Listing
August 2020

Long-term exposure to air pollution and stroke incidence: A Danish Nurse cohort study.

Environ Int 2020 09 24;142:105891. Epub 2020 Jun 24.

Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Ambient air pollution has been linked to stroke, but few studies have examined in detail stroke subtypes and confounding by road traffic noise, which was recently associated with stroke. Here we examined the association between long-term exposure to air pollution and incidence of stroke (overall, ischemic, hemorrhagic), adjusting for road traffic noise. In a nationwide Danish Nurse Cohort consisting of 23,423 nurses, recruited in 1993 or 1999, we identified 1,078 incident cases of stroke (944 ischemic and 134 hemorrhagic) up to December 31, 2014, defined as first-ever hospital contact. The full residential address histories since 1970 were obtained for each participant and the annual means of air pollutants (particulate matter with diameter < 2.5 µm and < 10 µm (PM and PM), nitrogen dioxide (NO), nitrogen oxides (NOx)) and road traffic noise were determined using validated models. Time-varying Cox regression models were used to estimate hazard ratios (HR) (95% confidence intervals (CI)) for the associations of one-, three, and 23-year running mean of air pollutants with stroke adjusting for potential confounders and noise. In fully adjusted models, the HRs (95% CI) per interquartile range increase in one-year running mean of PM and overall, ischemic, and hemorrhagic stroke were 1.12 (1.01-1.25), 1.13 (1.01-1.26), and 1.07 (0.80-1.44), respectively, and remained unchanged after adjustment for noise. Long-term exposure to ambient PM was associated with the risk of stroke independent of road traffic noise.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2020.105891DOI Listing
September 2020

Long-term exposure to ambient source-specific particulate matter and its components and incidence of cardiovascular events - The Heinz Nixdorf Recall study.

Environ Int 2020 09 24;142:105854. Epub 2020 Jun 24.

Environmental Epidemiology Group, Institute of Occupational, Social and Environmental Medicine, Medical Faculty, Medical Research School Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

Background: Few studies have examined the risk of long-term exposure to source-specific airborne pollutants on incidence of cerebrovascular and cardiovascular events.

Objectives: We aimed to estimate the effect of long-term exposure to source-specific air pollution and particulate matter (PM) components on incidence of stroke, coronary heart disease (CHD), and total cardiovascular events (CVE) in the population-based Heinz Nixdorf Recall study (HNR).

Methods: We used baseline (2000-2003) and 14-year follow-up data of the HNR Study, an ongoing population-based prospective cohort study in Western Germany. Participants' residential mean exposures to NO and total and source-specific PM, PM, accumulation mode particle number concentration (PN), and PM components were modelled using a dispersion and chemical transport model. We used Cox regression to evaluate the effect of pollutants (per 1 μg/m increase and per interquartile range - IQR) on risk of stroke and CHD, adjusting for socio-demographic characteristics, lifestyle risk factors and nighttime traffic noise exposure.

Results: In 4,105 included participants (aged 45-76 at baseline, 52.5% women), we observed 118 cases of first stroke and 373 cases of first CHD during 46,748 person-years under risk. The median survival time within the cohort was 13.3 years. No effect of exposure to ambient air pollution on risk of CHD was observed, but distinct effects were observed for stroke. Ambient traffic-specific PM showed a stronger effect on stroke than industry-specific PM: hazard ratios (95% confidence interval) for total, traffic-specific, and industry-specific PM were 1.16 (1.02-1.34), 2.53 (1.07-5.97), and 1.27 (1.03-1.56) per 1 μg/m increase, respectively. PM components showed no substantially different effects from those of total PM per IQR, but higher associations were observed for NH and SO per 1 μg/m. However, the exposure contrast of ammonium and sulfate components was very low.

Conclusion: Traffic-specific PM exhibited stronger effects than total and industry-specific PM on risk of stroke. Among components, NH and SO showed higher effects. No effect was observed for PM and CHD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2020.105854DOI Listing
September 2020

Associations of Air Pollution and Noise with Local Brain Structure in a Cohort of Older Adults.

Environ Health Perspect 2020 06 15;128(6):67012. Epub 2020 Jun 15.

Environmental Epidemiology Group, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

Background: Despite the importance of understanding associations of air pollution and noise exposure with loss of neurocognitive performance, studies investigating these exposures and local brain structure are limited.

Objective: We estimated associations of residential air pollution and noise exposures with neurocognitive test performance and the local gyrification index (lGI), a marker for local brain atrophy, among older adults.

Methods: For participants from the population-based 1000BRAINS study, based on the German Heinz Nixdorf Recall study, we assessed residential exposures to particulate matter (, , ), accumulation mode particle number (), and nitrogen oxides (, ), using land-use regression and chemistry transport models. Weighted 24-h and nighttime noise were modeled according to the European noise directive. We evaluated associations of air pollution and noise exposure at the participants' 2006-2008 residential addresses with neurocognitive test performance and region-specific lGI values () from magnetic resonance imaging, both assessed in 2011-2015, using linear regression and adjusting for demographic and personal characteristics.

Results: Air pollution and noise were associated with language and short-term/working memory and with local atrophy of the fronto-parietal network (FPN), a functional resting-state network associated with these cognitive processes. For example, per , local brain atrophy was more pronounced in the posterior brain regions of the FPN, with a [95% confidence interval (CI): , 0.00] lower lGI. In contrast, in the anterior regions of the FPN, weighted 24-h and nighttime noise were associated with less local brain atrophy [e.g., 0.02 (95% CI: 0.00, 0.04) for (A) 24-h noise].

Conclusions: Air pollution and noise exposures were associated in opposite directions with markers of local atrophy of the FPN in the right brain hemisphere in older adults, suggesting that both chronic air pollution and noise exposure may influence the physiological aging process of the brain. https://doi.org/10.1289/EHP5859.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1289/EHP5859DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295241PMC
June 2020

Long-Term Exposure to Air Pollution and Incidence of Myocardial Infarction: A Danish Nurse Cohort Study.

Environ Health Perspect 2020 05 6;128(5):57003. Epub 2020 May 6.

Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Background: Air pollution exposure has been linked to coronary heart disease, although evidence on and myocardial infarction (MI) incidence is mixed.

Objectives: This prospective cohort study aimed to investigate associations between long-term exposure to air pollution and MI incidence, adjusting for road traffic noise.

Methods: We used data from the nationwide Danish Nurse Cohort on 22,882 female nurses ( of age) who, at recruitment in 1993 or 1999, reported information on cardiovascular disease risk factors. Data on MI incidence was collected from the Danish National Patient Register until the end of 2014. Annual mean concentrations of particulate matter (PM) with a diameter (), , nitrogen dioxide (), and nitrogen oxides () at the nurses' residences since 1990 ( and ) or 1970 ( and ) were estimated using the Danish Eulerian Hemispheric Model/Urban Background Model/AirGIS (DEHM/UBM/AirGIS) dispersion model. We used time-varying Cox regression models to examine the association between 1- and 3-y running means of these pollutants, as well as 23-y running means of and , with both overall and fatal incident MI. Associations were explored in three progressively adjusted models: Model 1, adjusted for age and baseline year; Model 2, with further adjustment for potential confounding by lifestyle and cardiovascular disease risk factors; and Model 3, with further adjustment for road traffic noise, modeled as the annual mean of a weighted 24-h average ().

Results: Of the 22,882 women, 641 developed MI during a mean follow-up of 18.6 y, 121 (18.9%) of which were fatal. Reported hazard ratios (HRs) were based on interquartile range increases of 5.3, 5.5, 8.1, and for , , , and , respectively. In Model 1, we observed a positive association between a 3-y running mean of and an overall incident MI with an  1.20 (95% CI: 1.07, 1.35), which attenuated to  1.06 (95% CI: 0.92, 1.23) in Model 2. In Model 1 for incident fatal MI, we observed a strong association with a 3-y running mean of , with an  1.69 (95% CI: 1.33, 2.13), which attenuated to  1.35 (95% CI: 1.01, 1.81) in Model 2. Similar associations were seen for , with 3-y, Model 2 estimates for overall and fatal incident MI of  1.06 (95% CI: 0.91, 1.23) and  1.35 (95% CI: 1.01, 1.81), respectively. No evidence of an association was observed for or . For all pollutants, associations in Model 2 were robust to further adjustment for road traffic noise in Model 3 and were similar for a 1-y running mean exposure.

Conclusions: We found no association between long-term exposure to , , , or and overall MI incidence, but we observed positive associations for and with fatal MI. We present novel findings that the association between PM and MI incidence is robust to adjustment for road traffic noise. https://doi.org/10.1289/EHP5818.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1289/EHP5818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263451PMC
May 2020

All-source and source-specific air pollution and 10-year diabetes Incidence: Total effect and mediation analyses in the Heinz Nixdorf recall study.

Environ Int 2020 03 25;136:105493. Epub 2020 Jan 25.

Environmental Epidemiology Group, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.

Background: An increasing number of studies have been published recently on the association between ambient air pollution (AP) and incident diabetes mellitus (DM), but studies investigating source-specific AP toxicity and potential mediating pathways are rare. We investigated the associations of all-source, traffic-specific, and industry-specific outdoor AP exposure with 10-year incidence of DM and potential mediation via inflammation-associated biomarkers.

Methods: Data from participants of the prospective Heinz Nixdorf Recall cohort study who attended the baseline (t; 2000-2003), 5-year follow-up (t; 2006-2008), and 10-year follow-up (t; 2011-2015) examinations was used. For participants without DM at baseline (determined using information on physician diagnosis and glucose-lowering medication), residential long-term exposure (total, traffic-specific, and industry-specific) to particulate matter (PM, PM), nitrogen dioxide (NO), and accumulation mode particle number concentration (PN) were estimated using a chemistry transport model. Covariate-adjusted modified Poisson regression models with robust standard errors were applied to estimate relative risks (RR) for the associations between baseline AP and incident DM at t. Mediation analyses for adiponectin, high-sensitivity C-reactive protein (hsCRP), and interleukin-1 receptor antagonist (IL-1RA) were conducted to estimate natural direct and indirect effects.

Results: Of the 4,814 participants at t, 2,451 participants (mean baseline age: 58.2 years) were included in the main analysis. Interquartile range (IQR) increases in total PM and PN were associated with increased risk of DM (e.g., RR: 1.25 [95% Confidence Interval (CI): 1.02, 1.53] per 3.8 µg/m PM). Whereas traffic-specific exposures were associated with DM risk for all air pollutants (e.g., RR: 1.24 [95% CI: 1.06, 1.46] per 0.3 µg/m PM), significant associations for industry exposures were limited to NO and PN (e.g., RR: 1.24 [95% CI: 1.03, 1.49] per 230 particles/mL PN). Potential mediation of the association between AP and DM was observed for adiponectin but not for hsCRP and IL-1RA.

Conclusion: Our study shows that long-term exposure to total and source-specific ambient AP may increase DM risk, with consistent results observed across traffic-specific exposures. Decreases in adiponectin may play a potential role along the causal pathway.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2020.105493DOI Listing
March 2020

Using statutory health insurance data to evaluate non-response in a cross-sectional study on depression among patients with diabetes in Germany.

Int J Epidemiol 2020 04;49(2):629-637

Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.

Background: Low response rates do not indicate poor representativeness of study populations if non-response occurs completely at random. A non-response analysis can help to investigate whether non-response is a potential source for bias within a study.

Methods: A cross-sectional survey among a random sample of a health insurance population with diabetes (n = 3642, 58.9% male, mean age 65.7 years), assessing depression in diabetes, was conducted in 2013 in Germany. Health insurance data were available for responders and non-responders to assess non-response bias. The response rate was 51.1%. Odds ratios (ORs) for responses to the survey were calculated using logistic regression taking into consideration the depression diagnosis as well as age, sex, antihyperglycaemic medication, medication utilization, hospital admission and other comorbidities (from health insurance data).

Results: Responders and non-responders did not differ in the depression diagnosis [OR 0.99, confidence interval (CI) 0.82-1.2]. Regardless of age and sex, treatment with insulin only (OR 1.73, CI 1.36-2.21), treatment with oral antihyperglycaemic drugs (OAD) only (OR 1.77, CI 1.49-2.09), treatment with both insulin and OAD (OR 1.91, CI 1.51-2.43) and higher general medication utilization (1.29, 1.10-1.51) were associated with responding to the survey.

Conclusion: We found differences in age, sex, diabetes treatment and medication utilization between responders and non-responders, which might bias the results. However, responders and non-responders did not differ in their depression status, which is the focus of the DiaDec study. Our analysis may serve as an example for conducting non-response analyses using health insurance data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ije/dyz278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266537PMC
April 2020

The Effects of Fine Dust, Ozone, and Nitrogen Dioxide on Health.

Dtsch Arztebl Int 2019 12;51-52(51-52):881-886

University of California, Los Angeles, USA; Institute of Occupational, Social, and Environmental Medicine, University of Düsseldorf; Helmholtz Center Munich and University of Munich.

Background: Air pollutants, especially fine dust, ozone, and nitrogen dioxide, pose a danger to health worldwide. In 2005, the World Health Organization (WHO), in order to protect public health, issued global recommendations for maximum levels of fine dust (10 μg/m3 for fine dust particles smaller than 2.5 μm [PM2.5]), ozone, and nitrogen dioxide. The recommended levels are regularly exceeded in many places in Germany.

Methods: This review is based on relevant publications retrieved by a selective search in PubMed and, in part, on an expert statement issued in the name of the International Society for Environmental Epidemiology (ISEE) and the European Respiratory Society (ERS).

Results: Air pollutants affect the entire body, from the beginning of intrauterine development all the way to the end of life, causing premature death mainly through lung and heart disease. An epidemiological study has shown, for example, that mor- tality rises approximately 7% for every incremental long-term exposure to 5 μg/m3 PM2.5 (95% confidence interval: [2; 13]). Aside from lung and heart disease, the carcinogenic effect of fine dust is now well established. High fine-dust exposure has also been linked to metabolic diseases. For example, in a meta-analysis of cohort studies, the incidence of type 2 diabetes mellitus was found to be associated with elevated fine dust concentrations, with a 25% relative risk increase [10; 43] for every 10 µg/m3 of PM2.5. More recent studies have shown that these substances cause harm even in concentrations that are below the recommended limits.

Conclusion: It is very important for public health that the current EU standards for rkedly lowered so that health risks can be further reduced, in accordance with the recommendations of the WHO.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3238/arztebl.2019.0881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6976917PMC
December 2019

The need for clean air: The way air pollution and climate change affect allergic rhinitis and asthma.

Allergy 2020 09 30;75(9):2170-2184. Epub 2020 Jan 30.

Institute for Occupational, Social and Environmental Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.

Air pollution and climate change have a significant impact on human health and well-being and contribute to the onset and aggravation of allergic rhinitis and asthma among other chronic respiratory diseases. In Westernized countries, households have experienced a process of increasing insulation and individuals tend to spend most of their time indoors. These sequelae implicate a high exposure to indoor allergens (house dust mites, pets, molds, etc), tobacco smoke, and other pollutants, which have an impact on respiratory health. Outdoor air pollution derived from traffic and other human activities not only has a direct negative effect on human health but also enhances the allergenicity of some plants and contributes to global warming. Climate change modifies the availability and distribution of plant- and fungal-derived allergens and increases the frequency of extreme climate events. This review summarizes the effects of indoor air pollution, outdoor air pollution, and subsequent climate change on asthma and allergic rhinitis in children and adults and addresses the policy adjustments and lifestyle changes required to mitigate their deleterious effects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/all.14177DOI Listing
September 2020

Effects of short-term exposure to fine and ultrafine particles from indoor sources on arterial stiffness - A randomized sham-controlled exposure study.

Int J Hyg Environ Health 2019 09 20;222(8):1115-1132. Epub 2019 Aug 20.

Institute for Occupational, Social and Environmental Medicine, Center for Health and Society, Heinrich Heine University of Düsseldorf, 40225, Düsseldorf, Germany. Electronic address:

Objectives: Particulate air pollution is linked to adverse cardiovascular effects, including arterial stiffness. The aim of the study was to investigate the effect of short-term exposure to indoor fine and ultrafine particles on augmentation index (AIx), augmentation pressure (AP), and pulse wave velocity (PWV), early signs of vascular damage.

Methods: We analyzed the association of particle emissions from typical indoor sources (candle burning - CB, toasting bread - TB, and frying sausages - FS) with changes in pulse wave analysis indices in 55 healthy adults in a randomized cross-over controlled exposure study. Particle mass concentration (PMC), size-specific particle number concentration (PNC) and lung-deposited particle surface area concentration (PSC) were measured during the 2 h exposure. AIx and AP were measured before, directly, 2, 4 and 24 h after exposure. PWV was measured directly and 24 h after exposure. We performed multiple mixed linear regression analyses of different particle metrics and AIx, AP and PWV.

Results: The highest mean PMC was observed during FS reaching a maximum of 210 μg/m PM. The maximal PNC for UFP <100 nm was reached during CB with 2.3 million particles/cm. PSC was similar across all three exposures (about 3000 μm/cm³). Strongest associations between different particles metrics and arterial stiffness indices could be observed for UFP from CB and FS and for PMC from TB. The highest mean increase could be observed for the UFP fraction <10 nm, measured during CB, and AIx with an increase of 9.5%-points (95%-CI: 3.1; 15.9). PSC seemed to follow the pattern of PNC. PM and PM from TB led to clear changes in AIx with biggest increases for PM of 5.8%-points (95%-CI: 3.2; 8.4) 2 h after exposure and for PM of 8.1%-points (95%-CI: 2.5; 13.7) directly after exposure.

Conclusions: Our study indicates effects of indoor exposure to fine and ultrafine particles on systemic arterial stiffness indices that depend on the indoor source as well as on particle metric. Differences in size-specific physical characteristics of source-specific particles might account for these differential effects. We did not observe clear and stable associations of indoor particle exposure and PWV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijheh.2019.08.002DOI Listing
September 2019

A comparison of linear regression, regularization, and machine learning algorithms to develop Europe-wide spatial models of fine particles and nitrogen dioxide.

Environ Int 2019 09 20;130:104934. Epub 2019 Jun 20.

Institute for Risk Assessment Sciences (IRAS), Utrecht University, Postbus 80125, 3508 TC, Utrecht, the Netherlands. Electronic address:

Empirical spatial air pollution models have been applied extensively to assess exposure in epidemiological studies with increasingly sophisticated and complex statistical algorithms beyond ordinary linear regression. However, different algorithms have rarely been compared in terms of their predictive ability. This study compared 16 algorithms to predict annual average fine particle (PM) and nitrogen dioxide (NO) concentrations across Europe. The evaluated algorithms included linear stepwise regression, regularization techniques and machine learning methods. Air pollution models were developed based on the 2010 routine monitoring data from the AIRBASE dataset maintained by the European Environmental Agency (543 sites for PM and 2399 sites for NO), using satellite observations, dispersion model estimates and land use variables as predictors. We compared the models by performing five-fold cross-validation (CV) and by external validation (EV) using annual average concentrations measured at 416 (PM) and 1396 sites (NO) from the ESCAPE study. We further assessed the correlations between predictions by each pair of algorithms at the ESCAPE sites. For PM, the models performed similarly across algorithms with a mean CV R of 0.59 and a mean EV R of 0.53. Generalized boosted machine, random forest and bagging performed best (CV R~0.63; EV R 0.58-0.61), while backward stepwise linear regression, support vector regression and artificial neural network performed less well (CV R 0.48-0.57; EV R 0.39-0.46). Most of the PM model predictions at ESCAPE sites were highly correlated (R > 0.85, with the exception of predictions from the artificial neural network). For NO, the models performed even more similarly across different algorithms, with CV Rs ranging from 0.57 to 0.62, and EV Rs ranging from 0.49 to 0.51. The predicted concentrations from all algorithms at ESCAPE sites were highly correlated (R > 0.9). For both pollutants, biases were low for all models except the artificial neural network. Dispersion model estimates and satellite observations were two of the most important predictors for PM models whilst dispersion model estimates and traffic variables were most important for NO models in all algorithms that allow assessment of the importance of variables. Different statistical algorithms performed similarly when modelling spatial variation in annual average air pollution concentrations using a large number of training sites.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2019.104934DOI Listing
September 2019

Promoting clean air: combating fake news and denial.

Lancet Respir Med 2019 08 17;7(8):650-652. Epub 2019 Jun 17.

Institute for Occupational, Social, and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2213-2600(19)30182-1DOI Listing
August 2019

Investigation of air pollution and noise on progression of thoracic aortic calcification: results of the Heinz Nixdorf Recall Study.

Eur J Prev Cardiol 2020 06 12;27(9):965-974. Epub 2019 Jun 12.

Alfried Krupp Hospital Essen, Department of Cardiology, Germany.

Aims: Air pollution and noise are potential risk factors for subclinical atherosclerosis. Longitudinal analyses, especially on the interplay of these environmental factors, are scarce and inconsistent. Hence we investigated long-term traffic-related exposure to air pollution and noise with the development and progression of thoracic aortic calcification, a marker of subclinical atherosclerosis.

Methods: We used baseline (2000-2003) and follow-up (2006-2008) data from the German Heinz Nixdorf Recall cohort study, including 4814 middle-aged adults. Residence-based air pollution (PM (aerodynamic diameter ≤ 2.5 µm), PM, nitrogen dioxide and particle number), and noise was assessed with dispersion models. Thoracic aortic calcification was quantified from non-contrast enhanced electron beam computed tomography. The presence and extent of thoracic aortic calcification progression were analysed with multiple logistic and linear regression models, respectively, adjusting for age, sex, lifestyle variables, socioeconomic status and respective co-exposure.

Results: We observed no association in the full study sample ( = 3155, mean age 59.1 (±7.6) years, 52.8% women). While an interquartile range in particle number and night-time noise yielded odds ratios of 1.20 (1.03, 1.40) and 1.21 (1.00, 1.46) for binary thoracic aortic calcification progression, and 0.02 (-0.01, 0.05) and 0.04 (0.00, 0.07) higher growth rates of thoracic aortic calcification in participants with baseline thoracic aortic calcification less than 10, negative findings were observed in those with baseline thoracic aortic calcification of 10 or greater. Results were similar for other pollutants and daytime noise.

Conclusion: Our study shows no overall associations. Subgroup analyses suggest independent associations of traffic-related air pollution and noise with the development and progression of subclinical atherosclerosis in participants with no or minor thoracic aortic calcification at baseline, in contrast to negative findings in those with advanced calcification.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2047487319854818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272124PMC
June 2020

Effects of physical activity and air pollution on blood pressure.

Environ Res 2019 06 16;173:387-396. Epub 2019 Mar 16.

ISGlobal. Barcelona, Spain; Universitat Pompeu Fabra (UPF). Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address:

Aim: To assess the main and interaction effects of black carbon and physical activity on arterial blood pressure in a healthy adult population from three European cities using objective personal measurements over short-term (hours and days) and long-term exposure.

Methods: A panel study of 122 healthy adults was performed in three European cities (Antwerp, Barcelona, and London). In 3 seasons between March 2015 and March 2016, each participant wore sensors for one week to objectively measure their exposure to black carbon and monitor their physical activity continuously. Blood pressure was assessed three times during the week: at the beginning (day 0), in the middle (day 4), and at the end (day 7). Associations of black carbon and physical activity with blood pressure and their interactions were investigated with linear regression models and multiplicative interaction terms, adjusting for all the potential confounders.

Results: In multiple exposure models, we did not see any effects of black carbon on blood pressure but did see effects on systolic blood pressure of moderate-to-vigorous physical activity effect that were statistically significant from 1 h to 8 h after exposure and for long-term exposure. For a 1METhour increase of moderate-to-vigorous physical activity, the difference in the expected mean systolic blood pressure varied from -1.46 mmHg (95%CI -2.11, -0.80) for 1 h mean exposure, to -0.29 mmHg (95%CI -0.55, -0.03) for 8 h mean exposure, and -0.05 mmHg (95%CI -0.09, -0.00) for long-term exposure. There were little to no interaction effects.

Conclusions: Results from this study provide evidence that short-term and long-term exposure to moderate-to-vigorous physical activity is associated with a decrease in systolic blood pressure levels. We did not find evidence for a consistent main effect of black carbon on blood pressure, nor any interaction between black carbon and physical activity levels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envres.2019.03.032DOI Listing
June 2019

Health effects of ultrafine particles: a systematic literature review update of epidemiological evidence.

Int J Public Health 2019 May 21;64(4):547-559. Epub 2019 Feb 21.

Institute for Occupational, Social and Environmental Medicine, Center for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Postfach 101007, 40001, Düsseldorf, Germany.

Objectives: Due to their small size, ultrafine particles (UFP) are believed to exert higher toxicity than larger particles. As numerous studies on health effects of UFP have been published since the last systematic review in 2013, we aim to systematically review the new literature.

Methods: We searched MEDLINE and the specialized LUDOK database for studies published between 01.01.2011 and 11.05.2017 investigating health effects of ambient air pollution-related UFP. We included epidemiologic studies containing UFP measures and quantifiable measures of associations. Relevant data were extracted on the basis of previously developed evaluation criteria.

Results: We identified 85 original studies, conducting short-term (n = 75) and long-term (n = 10) investigations. Panel (n = 32), scripted exposure with predefined settings (n = 16) or time series studies (n = 11) were most frequent. Thirty-four studies adjusted for at least one other pollutant. Most consistent associations were identified for short-term effects on pulmonary/systemic inflammation, heart rate variability and blood pressure.

Conclusions: The evidence suggests adverse short-term associations with inflammatory and cardiovascular changes, which may be at least partly independent of other pollutants. For the other studied health outcomes, the evidence on independent health effects of UFP remains inconclusive or insufficient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00038-019-01202-7DOI Listing
May 2019

Benefits of improved air quality on ageing lungs: impacts of genetics and obesity.

Eur Respir J 2019 04 25;53(4). Epub 2019 Apr 25.

IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany

Introduction: The beneficial effect of improving air quality on lung function in the elderly remains unclear. We examined associations between decline in air pollutants and lung function, and effect modifications by genetics and body mass index (BMI), in elderly German women.

Methods: Data were analysed from the prospective SALIA (Study on the influence of Air pollution on Lung function, Inflammation and Aging) study (n=601). Spirometry was conducted at baseline (1985-1994; age 55 years), in 2007-2010 and in 2012-2013. Air pollution concentrations at home addresses were determined for each time-point using land-use regression models. Global Lung Initiative 2012 z-scores were calculated. Weighted genetic risk scores (GRSs) were determined from lung function-related risk alleles and used to investigate interactions with improved air quality. Multiple linear mixed models were fitted.

Results: Air pollution levels decreased substantially during the study period. Reduction of air pollution was associated with an increase in z-scores for forced expiratory volume in 1 s (FEV) and the FEV/forced vital capacity ratio. For a decrease of 10 µg·m in nitrogen dioxide (NO), the z-score for FEV increased by 0.14 (95% CI 0.01-0.26). However, with an increasing number of lung function-related risk alleles, the benefit from improved air quality decreased (GRS×NO interaction: p=0.029). Interactions with BMI were not significant.

Conclusions: Reduction of air pollution is associated with a relative improvement of lung function in elderly women, but also depends on their genetic make-up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/13993003.01780-2018DOI Listing
April 2019

Herpes zoster incidence in Germany - an indirect validation study for self-reported disease data from pretest studies of the population-based German National Cohort.

BMC Infect Dis 2019 Jan 30;19(1):99. Epub 2019 Jan 30.

Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06110, Halle (Saale), Germany.

Background: Until now, herpes zoster (HZ)-related disease burden in Germany has been estimated based on health insurance data and clinical findings. However, the validity of self-reported HZ is unclear. This study investigated the validity of self-reported herpes zoster (HZ) and its complication postherpetic neuralgia (PHN) using data from the pretest studies of the German National Cohort (GNC) in comparison with estimates based on health insurance data.

Methods: Data of 4751 participants aged between 20 and 69 years from two pretest studies of the GNC carried out in 2011 and 2012 were used. Based on self-reports of physician-diagnosed HZ and PHN, age- and sex-specific HZ incidence rates and PHN proportions were estimated. For comparison, estimates based on statutory health insurance data from the German population were considered.

Results: Eleven percent (95%-CI, 10.4 to 12.3, n = 539) of the participants reported at least one HZ episode in their lifetime. Our estimated age-specific HZ incidence rates were lower than previous estimates based on statutory health insurance data. The PHN proportion in participants older than 50 years was 5.9% (1.9 to 13.9%), which was in line with estimates based on health insurance data.

Conclusion: As age- and sex-specific patterns were comparable with that in health insurance data, self-reported diagnosis of HZ seems to be a valid instrument for overall disease trends. Possible reasons for observed differences in incidence rates are recall bias in self-reported data or overestimation in health insurance data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12879-019-3691-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354372PMC
January 2019

Air pollution and diabetes-related biomarkers in non-diabetic adults: A pathway to impaired glucose metabolism?

Environ Int 2019 03 17;124:370-392. Epub 2019 Jan 17.

Environmental Epidemiology Group, Institute of Occupational, Social and Environmental Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

Background: While prior studies have linked air pollution (AP) to diabetes prevalence and incidence, few have investigated whether AP exposure is also associated with alterations in diabetes-related biomarkers in metabolically healthy adults.

Objective: To evaluate the associations between short-, medium-, and long-term AP and diabetes-related biomarkers (adiponectin, interleukin-1 receptor antagonist [IL-1RA], high sensitivity C-reactive protein [hsCRP], fibrinogen) in persons without diabetes.

Methods: Adiponectin, IL-1RA, hsCRP, and fibrinogen were measured in blood samples collected at the baseline (t; 2000-2003) and first follow-up (t; 2006-2008) examinations of the prospective Heinz Nixdorf Recall (HNR) cohort study in Germany. Participants' residential mean exposures to PM, PM, NO, and accumulation mode particle number concentration (PN) were estimated for several time windows (1- to 365-day) prior to examination using a dispersion and chemistry transport model. We fitted covariate-adjusted linear mixed effects models using a random participant intercept and investigated effect modification by obesity status.

Results: We analyzed 6727 observations (n = 3626, n = 3101) from 4052 participants of the HNR study (52% women; ages 45-76 years at t). For all air pollutants, medium-term exposures (60- to 120-day) were negatively associated with adiponectin (e.g., 91-day PN: -2.51% change [-3.40%, -1.53%] per interquartile [IQR] increase). Several short-, medium-, and long-term AP exposures were positively associated with IL-1RA (e.g., 365-day PM: 2.64% change [1.25%, 4.22%] per IQR increase). Long-term exposures were positively associated with hsCRP level while no consistent patterns were observed for fibrinogen. Stronger associations for adiponectin were observed among non-obese participants.

Conclusion: In persons without diabetes, we observed differing patterns of association between AP and diabetes-related biomarkers across a range of exposure windows, supporting the hypothesis that AP may play a role in the development of diabetes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2019.01.005DOI Listing
March 2019