Publications by authors named "Heresh Amini"

34 Publications

Weather, air pollution, and SARS-CoV-2 transmission: a global analysis.

Lancet Planet Health 2021 10;5(10):e671-e680

Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA; MGH Institute for Technology Assessment, Harvard Medical School, Harvard University, Boston, MA, USA. Electronic address:

Background: Understanding how environmental factors affect SARS-CoV-2 transmission could inform global containment efforts. Despite high scientific and public interest and multiple research reports, there is currently no consensus on the association of environmental factors and SARS-CoV-2 transmission. To address this research gap, we aimed to assess the relative risk of transmission associated with weather conditions and ambient air pollution.

Methods: In this global analysis, we adjusted for the delay between infection and detection, estimated the daily reproduction number at 3739 global locations during the COVID-19 pandemic up until late April, 2020, and investigated its associations with daily local weather conditions (ie, temperature, humidity, precipitation, snowfall, moon illumination, sunlight hours, ultraviolet index, cloud cover, wind speed and direction, and pressure data) and ambient air pollution (ie, PM, nitrogen dioxide, ozone, and sulphur dioxide). To account for other confounding factors, we included both location-specific fixed effects and trends, controlling for between-location differences and heterogeneities in locations' responses over time. We built confidence in our estimations through synthetic data, robustness, and sensitivity analyses, and provided year-round global projections for weather-related risk of global SARS-CoV-2 transmission.

Findings: Our dataset included data collected between Dec 12, 2019, and April 22, 2020. Several weather variables and ambient air pollution were associated with the spread of SARS-CoV-2 across 3739 global locations. We found a moderate, negative relationship between the estimated reproduction number and temperatures warmer than 25°C (a decrease of 3·7% [95% CI 1·9-5·4] per additional degree), a U-shaped relationship with outdoor ultraviolet exposure, and weaker positive associations with air pressure, wind speed, precipitation, diurnal temperature, sulphur dioxide, and ozone. Results were robust to multiple assumptions. Independent research building on our estimates provides strong support for the resulting projections across nations.

Interpretation: Warmer temperature and moderate outdoor ultraviolet exposure result in a slight reduction in the transmission of SARS-CoV-2; however, changes in weather or air pollution alone are not enough to contain the spread of SARS-CoV-2 with other factors having greater effects.

Funding: None.
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http://dx.doi.org/10.1016/S2542-5196(21)00202-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497024PMC
October 2021

Long-Term Exposure to Air Pollution, Road Traffic Noise, and Heart Failure Incidence: The Danish Nurse Cohort.

J Am Heart Assoc 2021 Oct 6;10(20):e021436. Epub 2021 Oct 6.

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

Background We examined the association of long-term exposure to air pollution and road traffic noise with incident heart failure (HF). Methods And Results Using data on female nurses from the Danish Nurse Cohort (aged >44 years), we investigated associations between 3-year mean exposures to air pollution and road traffic noise and incident HF using Cox regression models, adjusting for relevant confounders. Incidence of HF was defined as the first hospital contact (inpatient, outpatient, or emergency) between cohort baseline (1993 or 1999) and December 31, 2014, based on the Danish National Patient Register. Annual mean levels of particulate matter with a diameter <2.5 µm since 1990 and NO and road traffic noise since 1970 were estimated at participants' residences. Of the 22 189 nurses, 484 developed HF. We detected associations with all 3 pollutants, with hazard ratios (HRs) of 1.17 (95% CI, 1.01-1.36), 1.10 (95% CI, 0.99-1.22), and 1.12 (95% CI, 0.99-1.26) per increase of 5.1 µg/m in particulate matter with a diameter <2.5 µm, 8.6 µg/m in NO, and 9.3 dB in road traffic noise, respectively. We observed an enhanced risk of HF incidence for those exposed to high levels of the 3 pollutants; however, the effect modification of coexposure was not statistically significant. Former smokers and nurses with hypertension showed the strongest associations with particulate matter with a diameter <2.5 µm (<0.05). Conclusions We found that long-term exposures to air pollution and road traffic noise were independently associated with HF.
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http://dx.doi.org/10.1161/JAHA.121.021436DOI Listing
October 2021

Long-Term Exposure to Road Traffic Noise and Air Pollution, and Incident Atrial Fibrillation in the Danish Nurse Cohort.

Environ Health Perspect 2021 Aug 2;129(8):87002. Epub 2021 Aug 2.

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

Background: Associations between long-term exposure to air pollution and road traffic noise have been established for ischemic heart disease, but findings have been mixed for atrial fibrillation (AF).

Objectives: The goal of the study was to examine associations of long-term exposure to road traffic noise and air pollution with AF.

Methods: Time-varying Cox regression models were used to estimate associations of 1-, 3-, and 23-y mean road traffic noise and air pollution exposures with AF incidence in 23,528 women enrolled in the Danish Nurse Cohort (age at baseline in 1993 or 1999). AF diagnoses were ascertained via the Danish National Patient Register. Annual mean weighted 24-h average road traffic noise levels () at the nurses' residences, since 1970, were estimated using the Nord2000 model, and annual mean levels of particulate matter with a diameter () and nitrogen dioxide () were estimated using the DEHM/UBM/AirGIS model.

Results: Of 23,528 nurses with no prior AF diagnosis at the cohort baseline, 1,522 developed AF during follow-up. In a fully adjusted model (including ), the estimated risk of AF was 18% higher [hazard ratio (HR); 95% confidence interval (CI): 1.18; 1.02, 1.36] in nurses with residential 3-y mean levels vs. , with similar findings for 1-y mean exposures. A increase in 3-y mean was associated with incident AF before and after adjustment for concurrent exposure to road traffic noise (HR 1.09; 95% CI: 1.00, 1.20 and 1.08; 95% CI: 0.97, 1.19, respectively). Associations with 1-y mean exposures were positive but closer to the null and not significant. Associations with were null for all time periods before and after adjustment for road traffic noise and inverse when adjusted for concurrent .

Conclusion: Our analysis of prospective data from a cohort of Danish female nurses followed for up to 14 y provided suggestive evidence of independent associations between incident AF and 1- and 3-y exposures to road traffic noise and . https://doi.org/10.1289/EHP8090.
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http://dx.doi.org/10.1289/EHP8090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327770PMC
August 2021

Proximity of schools to roads and students' academic performance: A cross-sectional study in the Federal District, Brazil.

Environ Res 2021 Jul 28;202:111770. Epub 2021 Jul 28.

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

Investigations of the educational implications of children's exposure to air pollutants at school are crucial to enhance our understanding of the hazards for children. Most of the existing literature is based on studies performed in North America and Europe. Further investigation is required in low- and middle-income countries, where there are important challenges related to public health, transportation, environment, and education sector. In response, in this present study, we studied the association between proximity of schools to roads and the academic achievement of the students in the Federal District, Brazil. We accessed academic achievement data at the student level. The data consist of 256 schools (all the public schools in the FD) and a total of 344,175 students (all the students enrolled in the public schools in the FD in 2017-2020). We analyzed the association between the length of all roads within buffers around schools and student-level academic performance using mixed-effects regression models. After adjustments for several covariates, the results of the primary analysis indicate that the presence of roads surrounding schools is negatively associated with student-level academic performance in the FD. This association varies significantly depending on the buffer size surrounding schools. We found that the highest effects occur in the first buffer, with 250 m. While in the first buffer we estimated that an increase of 1 km of length of roads around schools was associated with a statistically significant decrease of 0.011 (95%CI: 0.008; 0.013) points in students' grades (students' academic performance varies from 0 to 10), in the buffer of 1 km we found a decrease of 0.002 (95%CI: 0.002; 0.002) points in the student-level academic performance. Findings from our investigation provide support for the creation of effective health, educational and urban planning policies for local intervention in the FD. This is essential to improve the environmental quality surrounding schools to protect children from exposure to environmental hazards.
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http://dx.doi.org/10.1016/j.envres.2021.111770DOI Listing
July 2021

Long-term air pollution and road traffic noise exposure and COPD: the Danish Nurse Cohort.

Eur Respir J 2021 May 13. Epub 2021 May 13.

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

Background: While air pollution has been linked to the development of chronic obstructive pulmonary disease (COPD), evidence on the role of environmental noise is just emerging. We examined the associations of long-term exposure to air pollution and road traffic noise with COPD incidence.

Methods: We defined COPD incidence for 24 538 female nurses from the Danish Nurse Cohort (age>44 years) as the first hospital contact between baseline (1993 or 1999) and 2015. We estimated residential annual mean concentrations of particulate matter with diameter<2.5 µm (PM) since 1990 and nitrogen dioxide (NO) since 1970 by the Danish DEHM/UBM/AirGIS modeling system, and road traffic noise (L) since 1970 by the Nord2000 model. Time-varying Cox regression models were applied to assess the associations of air pollution and road traffic noise with COPD incidence.

Results: 977 nurses developed COPD during 18.6 years' mean follow-up. We observed associations with COPD for all three exposures with hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.19 (1.01, 1.41) per 6.26 µg·m for PM, 1.13 (1.05, 1.20) per 8.19 µg·m for NO, and 1.15 (1.06, 1.25) per 10 dB for L. Associations with NO and L attenuated slightly after mutual adjustment, but were robust to adjustment for PM. Associations with PM were attenuated to null after adjustment for either NO or L. No potential interaction effect was observed between air pollutants and noise.

Conclusions: Long-term exposure to air pollution, especially traffic-related NO, and road traffic noise were independently associated with COPD.
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http://dx.doi.org/10.1183/13993003.04594-2020DOI Listing
May 2021

Multiple air pollutant exposure and lung cancer in Tehran, Iran.

Sci Rep 2021 04 29;11(1):9239. Epub 2021 Apr 29.

Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran.

Lung cancer is the most rapidly increasing malignancy worldwide with an estimated 2.1 million cancer cases in the latest, 2018 World Health Organization (WHO) report. The objective of this study was to investigate the association of air pollution and lung cancer, in Tehran, Iran. Residential area information of the latest registered lung cancer cases that were diagnosed between 2014 and 2016 (N = 1,850) were inquired from the population-based cancer registry of Tehran. Long-term average exposure to PM, SO, NO, NO, NO, benzene, toluene, ethylbenzene, m-xylene, p-xylene, o-xylene (BTEX), and BTEX in 22 districts of Tehran were estimated using land use regression models. Latent profile analysis (LPA) was used to generate multi-pollutant exposure profiles. Negative binomial regression analysis was used to examine the association between air pollutants and lung cancer incidence. The districts with higher concentrations for all pollutants were mostly in downtown and around the railway station. Districts with a higher concentration for NOx (IRR = 1.05, for each 10 unit increase in air pollutant), benzene (IRR = 3.86), toluene (IRR = 1.50), ethylbenzene (IRR = 5.16), p-xylene (IRR = 9.41), o-xylene (IRR = 7.93), m-xylene (IRR = 2.63) and TBTEX (IRR = 1.21) were significantly associated with higher lung cancer incidence. Districts with a higher multiple air-pollution profile were also associated with more lung cancer incidence (IRR = 1.01). Our study shows a positive association between air pollution and lung cancer incidence. This association was stronger for, respectively, p-xylene, o-xylene, ethylbenzene, benzene, m-xylene and toluene.
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http://dx.doi.org/10.1038/s41598-021-88643-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085005PMC
April 2021

Long-term exposure to road traffic noise and incident myocardial infarction: A Danish Nurse Cohort study.

Environ Epidemiol 2021 Jun 22;5(3):e148. Epub 2021 Apr 22.

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

Background: Evidence of nonauditory health effects of road traffic noise exposure is growing. This prospective cohort study aimed to estimate the association between long-term exposure to road traffic noise above a threshold and incident myocardial infarction (MI) in Denmark.

Methods: In the Danish Nurse Cohort study, we used data of 22,378 women, at recruitment in 1993 and 1999, who reported information on MI risk factors. The participants' first hospital contact or out-of-hospital death due to MI were followed-up until 2014. We investigated a relationship between residential exposures to road traffic noise levels (L) up to 23 years and incident MI (overall, nonfatal, and fatal) using time-varying Cox regression models adjusting for potential confounders and air pollutants. We estimated thresholds of road traffic noise (53, 56, and 58 dB) associated with incident MI in a piece-wise linear regression model.

Results: Of the 22,378 participants, 633 developed MI, 502 of which were nonfatal. We observed a non-linear relationship between the 23-year running mean of L and incident MI with a threshold level of 56 dB, above which hazard ratios (95% confidence intervals) were 1.30 (0.97, 1.75) for overall and 1.46 (1.05, 2.03) for nonfatal MI per 10 dB. The association with nonfatal MI attenuated slightly to 1.34 (0.95, 1.90) after adjustment for fine particles.

Conclusions: We found that long-term exposure to road traffic noise above 56 dB may increase the risk of MI. The study findings suggest that road traffic noise above 56 dB may need regulation in addition to the regulation of ambient pollutants.
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http://dx.doi.org/10.1097/EE9.0000000000000148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078417PMC
June 2021

Long-term exposure to ambient air pollution and road traffic noise and asthma incidence in adults: The Danish Nurse cohort.

Environ Int 2021 07 5;152:106464. Epub 2021 Mar 5.

Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. Electronic address:

Background: Ambient air pollution is likely a risk factor for asthma, and recent evidence suggests the possible relevance of road traffic noise.

Objectives: We examined the associations of long-term exposure to air pollution and road traffic noise with adult-asthma incidence.

Methods: We followed 28,731 female nurses (age > 44 years) from the Danish Nurse Cohort, recruited in 1993 and 1999, for first hospital contact for asthma from 1977 until 2015. We estimated residential annual mean concentrations of particulate matter with diameter < 2.5 µm (PM) since 1990 and nitrogen dioxide (NO) since 1970 with the Danish DEHM/UBM/AirGIS modeling system, and road traffic noise (L) since 1970 with the Nord2000 model. Time-varying Cox regression models were used to associate air pollution and road traffic noise exposure with asthma incidence.

Results: During 18.6 years' mean follow-up, 528 out of 23,093 participants had hospital contact for asthma. The hazard ratios (HR) and 95% confidence intervals for asthma incidence associated with 3-year moving average exposures were 1.29 (1.03, 1.61) per 6.3 µg/m for PM, 1.16 (1.07, 1.27) per 8.2 µg/m for NO, and 1.12 (1.00, 1.25) per 10 dB for L. The HR for NO remained unchanged after adjustment for either PM or L, while the HRs for PM and L attenuated to unity after adjustment for NO.

Conclusions: Long-term exposure to air pollution was associated with adult-asthma incidence independently of road traffic noise, with NO most relevant. Road traffic noise was not independently associated with adult-asthma incidence.
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http://dx.doi.org/10.1016/j.envint.2021.106464DOI Listing
July 2021

Outdoor light at night and breast cancer incidence in the Danish Nurse Cohort.

Environ Res 2021 03 17;194:110631. Epub 2020 Dec 17.

Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Seoul National University Medical Research Center, Seoul, Republic of Korea. Electronic address:

Background: Knowledge of the role of melatonin, xenograft experiments, and epidemiological studies suggests that exposure to light at night (LAN) may disturb circadian rhythms, possibly increasing the risk of developing breast cancer.

Objectives: We examined the association between residential outdoor LAN and the incidence of breast cancer: overall and subtypes classified by estrogen (ER) and progesterone (PR) receptor status.

Methods: We used data on 16,941 nurses from the Danish Nurse Cohort who were followed-up from the cohort baseline in 1993 or 1999 through 2012 in the Danish Cancer Registry for breast cancer incidence and the Danish Breast Cancer Cooperative Group for breast cancer ER and PR status. LAN exposure data were obtained from the U.S. Defense Meteorological Satellite Program (DMSP) available for 1996, 1999, 2000, 2003, 2004, 2006, and 2010 in nW/cm/sr unit, and assigned to the study participants' residence addresses during the follow-up. Time-varying Cox regression models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between LAN and breast cancer, adjusting for individual characteristics, road traffic noise, and air pollution.

Results: Of 16,941 nurses, 745 developed breast cancer in total during 320,289 person-years of follow-up. We found no association between exposure to LAN and overall breast cancer. In the fully adjusted models, HRs for the highest (65.8-446.4 nW/cm/sr) and medium (22.0-65.7 nW/cm/sr) LAN tertiles were 0.97 (95% CI: 0.77, 1.23) and 1.09 (95% CI: 0.90, 1.31), respectively, compared to the lowest tertile of LAN exposure (0-21.9 nW/cm/sr). We found a suggestive association between LAN and ER-breast cancer.

Conclusion: This large cohort study of Danish female nurses suggests weak evidence of the association between LAN and breast cancer incidence.
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http://dx.doi.org/10.1016/j.envres.2020.110631DOI Listing
March 2021

Tehran environmental and neurodevelopmental disorders (TEND) cohort study: Phase I, feasibility assessment.

J Environ Health Sci Eng 2020 Dec 9;18(2):733-742. Epub 2020 Sep 9.

Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To advance knowledge about childhood neurodevelopmental disorders and study their environmental determinants, we conducted a study in Tehran, Iran to assess the feasibility of prospective birth cohort study.

Methods: We evaluated participation of pregnant women, feasibility of sampling biological material, and health care services availability in Tehran in four steps: (1) first trimester of pregnancy; (2) third trimester of pregnancy; (3) at delivery; and (4) two to three months after delivery. We collected related data through questionnaires, also various biological samples were obtained from mothers (blood, urine, milk and nails-hands and feet) and newborns (umbilical cord blood, meconium, and urine samples) from February 2016 to October 2017.

Results: overall 838 eligible pregnant women were approached. The participation rate was 206(25%) in our study and about 185(90%) of subjects were recruited in hospitals. Out of 206 participants in the first trimester, blood, urine, hand nail, and foot nail samples were collected from 206(100%),193(93%), 205(99%), and 205(99%), respectively. These values dropped to 65(54%), 83(69%), 84(70%), and 84(70%) for the remaining participants 120(58%) in the third trimester, respectively. Also, we gathered milk samples from 125(60%) of mothers at two to three months after delivery.

Conclusion: Our findings suggest that hospitals were better places for recruitment of subjects in a birth cohort in Tehran. We further concluded that birth cohort study recruitment can be improved by choosing appropriate gestational ages. Obtaining the newborn's urine, meconium, and umbilical cord blood were challenging procedures and require good collaboration between hospital staff and researchers.
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http://dx.doi.org/10.1007/s40201-020-00499-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721759PMC
December 2020

The concentration of BTEX compounds and health risk assessment in municipal solid waste facilities and urban areas.

Environ Res 2020 12 23;191:110068. Epub 2020 Aug 23.

Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Center for Solid Waste Management (CSWM), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

In this study, human exposure to benzene, toluene, ethylbenzene, xylenes (BTEX), along with their respective risk assessment is studied in four major units (n = 14-point sources) of the largest municipal solid waste management facilities (MSWF) in Iran. The results were compared with four urban sites in Tehran, capital of Iran. Workers at the pre-processing unit are exposed to the highest total BTEX (151 μg m). In specific, they were exposed to benzene concentrations of 11 μg m. Moreover, the total BTEX (t-BTEX) concentrations measured over the conveyor belt was 198 μg m at most, followed by trommel (104), and active landfills (43). The mean concentration of ambient t-BTEX in Tehran is 100 μg m. On average, xylenes and toluene have the highest concentrations in both on-site and urban environments, with mean values of 24 and 21, and 41 and 37 μg m, respectively. Even though the non-carcinogenic risk of occupational exposure is negligible, BTEX is likely to increase the chance of carcinogenic risks (1.7E-05) for workers at the pre-processing unit. A definite carcinogenic risk of 1.3E-04, and non-carcinogenic effect, of HI = 1.6 were observed in one urban site. With the exception of the pre-processing unit, the citizens of Tehran had higher exposure to BTEX. Overall, BTEX concentrations in the largest MSWF of Iran remains an issue of public health concern.
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http://dx.doi.org/10.1016/j.envres.2020.110068DOI Listing
December 2020

An Ensemble Learning Approach for Estimating High Spatiotemporal Resolution of Ground-Level Ozone in the Contiguous United States.

Environ Sci Technol 2020 09 1;54(18):11037-11047. Epub 2020 Sep 1.

Department of Environmental Health, Harvard University, TH Chan School of Public Health, Boston, Massachusetts 02115, United States.

In this paper, we integrated multiple types of predictor variables and three types of machine learners (neural network, random forest, and gradient boosting) into a geographically weighted ensemble model to estimate the daily maximum 8 h O with high resolution over both space (at 1 km × 1 km grid cells covering the contiguous United States) and time (daily estimates between 2000 and 2016). We further quantify monthly model uncertainty for our 1 km × 1 km gridded domain. The results demonstrate high overall model performance with an average cross-validated (coefficient of determination) against observations of 0.90 and 0.86 for annual averages. Overall, the model performance of the three machine learning algorithms was quite similar. The overall model performance from the ensemble model outperformed those from any single algorithm. The East North Central region of the United States had the highest , 0.93, and performance was weakest for the western mountainous regions ( of 0.86) and New England ( of 0.87). For the cross validation by season, our model had the best performance during summer with an of 0.88. This study can be useful for the environmental health community to more accurately estimate the health impacts of O over space and time, especially in health studies at an intra-urban scale.
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http://dx.doi.org/10.1021/acs.est.0c01791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498146PMC
September 2020

Long-term exposure to low levels of air pollution and mortality adjusting for road traffic noise: A Danish Nurse Cohort study.

Environ Int 2020 10 28;143:105983. Epub 2020 Jul 28.

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

Background: The association between air pollution and mortality is well established, yet some uncertainties remain: there are few studies that account for road traffic noise exposure or that consider in detail the shape of the exposure-response function for cause-specific mortality outcomes, especially at low-levels of exposure.

Objectives: We examined the association between long-term exposure to particulate matter [(PM) with a diameter of <2.5 µm (PM), <10 µm (PM)], and nitrogen dioxide (NO) and total and cause-specific mortality, accounting for road traffic noise.

Methods: We used data on 24,541 females (age > 44 years) from the Danish Nurse Cohort, who were recruited in 1993 or 1999, and linked to the Danish Causes of Death Register for follow-up on date of death and its cause, until the end of 2013. Annual mean concentrations of PM PM and NO at the participants' residences since 1990 were estimated using the Danish DEHM/UBM/AirGIS dispersion model, and annual mean road traffic noise levels (L) were estimated using the Nord2000 model. We examined associations between the three-year running mean of PM, PM, and NO with total and cause-specific mortality by using time-varying Cox Regression models, adjusting for individual characteristics and residential road traffic noise.

Results: During the study period, 3,708 nurses died: 843 from cardiovascular disease (CVD), 310 from respiratory disease (RD), and 64 from diabetes. In the fully adjusted models, including road traffic noise, we detected associations of three-year running mean of PM with total (hazard ratio; 95% confidence interval: 1.06; 1.01-1.11), CVD (1.14; 1.03-1.26), and diabetes mortality (1.41; 1.05-1.90), per interquartile range of 4.39 μg/m. In a subset of the cohort exposed to PM < 20 µg/m, we found even stronger association with total (1.19; 1.11-1.27), CVD (1.27; 1.01-1.46), RD (1.27; 1.00-1.60), and diabetes mortality (1.44; 0.83-2.48). We found similar associations with PM and none with NO. All associations were robust to adjustment for road traffic noise.

Discussion: Long-term exposure to low-levels of PM and PM is associated with total mortality, and mortality from CVD, RD, and diabetes. Associations were even stronger at the PM levels below EU limit values and were independent of road traffic noise.
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http://dx.doi.org/10.1016/j.envint.2020.105983DOI Listing
October 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.
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http://dx.doi.org/10.1016/j.envint.2020.105891DOI Listing
September 2020

The burden of cardiovascular and respiratory diseases attributed to ambient sulfur dioxide over 26 years.

J Environ Health Sci Eng 2020 Jun 21;18(1):267-278. Epub 2020 Apr 21.

2Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Developing countries, particularly those with a rapid development, are experiencing increasing pollution by sulfur dioxide (SO). Despite the considerable SO exposure effect on health, there is little evidence regarding this fact in Iran, as one of the largest oil and gas producing countries in the world. The present study, therefore, was designed to investigate the burden of cardiovascular and respiratory diseases attributed to the SO exposure in Iran, over a 26-year period.

Materials And Methods: All measured SO levels were collected from 92 air quality monitoring stations (AQMSs) in 29 cities, during 1996-2013. Since the study years were from 1990 to 2015, and also due to missing data at existing stations, the spatiotemporal model was used to estimate the exposure to this gas during this period. To calculate the burden of cardiovascular and respiratory diseases, the population attributable fraction (PAF) value was calculated, and the SO-attributed mortality and years of life lost (YLL) were determined per province, and in the whole country.

Results: The results of this study showed that the SO concentration was increased from 22.00 ppb (7.69-67.28) in 1990 to 27.81 ppb (9.88-82.27), in 2015. The lowest annual value of 11.53 ppb (4.68-32.06) and the highest value of 45.11 ppb (16.58-1226) were estimated at 2004 and 1997, respectively. There was a sinusoidal trend in the gas concentration changes. The highest occurrence of SO-attributed deaths due to cardiovascular and respiratory diseases were 0.080 (0.024-0.168) and 0.076 (0.026-0.165), and the lowest levels were 0.017 (0.004-0.044) and 0.047 (0.017-0.124), respectively.

Conclusions: According to the results in our country, the SO trend was sinusoidal during 26 years, with a recurrent rise occurring after each declining period. It is recommended to design the sustainable national method policies and programs with the continuous evaluation and modification for the reduction of fossil fuel consumption and further implementation in the use of clean energy.
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http://dx.doi.org/10.1007/s40201-020-00464-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203314PMC
June 2020

Maternal exposure to air pollutants and birth weight in Tehran, Iran.

J Environ Health Sci Eng 2019 Dec 22;17(2):711-717. Epub 2019 Jun 22.

1Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Poursina Street, Keshavarz Boulevard, Tehran, 1417613151 Iran.

Background: Air pollution can cause various health outcomes, especially in susceptible groups including pregnant women. Low birth weight (LBW) is among the adverse birth outcomes and is one of the main causes of infant mortality. The aim of this study was to assess the association between air pollutants and LBW in Tehran, Iran.

Methods: In this case-control study, 2144 babies born in three hospitals of Tehran (Iran) during 2011 to 2012 whose mothers were the residents of this city in last 5 years were considered. Of these, 468 infants with birth weight < 2500 g and 1676 with birth weight ≥ 2500 g were regarded as case and control groups, respectively. Gestational age was also considered for definition of cases (small for gestational age (SGA)) and controls (appropriate for gestational age). Land use regression models were used to assess exposure to particulate matter ≤10 μm in aerodynamic diameter (PM), sulfur dioxide (SO), nitrogen dioxide (NO) and volatile organic compounds (benzene, toluene, ethylbenzene, o-xylene, m-xylene, p-xylene (BTEX), and total BTEX) during pregnancy. Logistic regression model was applied to assess the association between air pollutants and LBW.

Results: The concentrations of air pollutants were very high but similar in cases and controls. After adjustment for potential confounding variables, no statistically significant association was observed between air pollutants and LBW. The adjusted odds ratios (95% confidence interval) for PM, SO, and benzene were 0.999 (0.994-1.005), 0.998 (0.993-1.003), and 0.980 (0.901-1.067), respectively.

Conclusions: No association was found between LBW and air pollutants. Further studies with more rigorous designs and access to more comprehensive information are suggested to assess the effect of other air pollutants, such as CO, O, PM, ultrafine particles, and oxidative potential of particles on birth outcomes.
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http://dx.doi.org/10.1007/s40201-019-00386-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985325PMC
December 2019

Assessing NO Concentration and Model Uncertainty with High Spatiotemporal Resolution across the Contiguous United States Using Ensemble Model Averaging.

Environ Sci Technol 2020 02 14;54(3):1372-1384. Epub 2020 Jan 14.

Department of Environmental Health , Harvard T.H. Chan School of Public Heath , Boston , Massachusetts 02215 , United States.

NO is a combustion byproduct that has been associated with multiple adverse health outcomes. To assess NO levels with high accuracy, we propose the use of an ensemble model to integrate multiple machine learning algorithms, including neural network, random forest, and gradient boosting, with a variety of predictor variables, including chemical transport models. This NO model covers the entire contiguous U.S. with daily predictions on 1-km-level grid cells from 2000 to 2016. The ensemble produced a cross-validated R of 0.788 overall, a spatial R of 0.844, and a temporal R of 0.729. The relationship between daily monitored and predicted NO is almost linear. We also estimated the associated monthly uncertainty level for the predictions and address-specific NO levels. This NO estimation has a very high spatiotemporal resolution and allows the examination of the health effects of NO in unmonitored areas. We found the highest NO levels along highways and in cities. We also observed that nationwide NO levels declined in early years and stagnated after 2007, in contrast to the trend at monitoring sites in urban areas, where the decline continued. Our research indicates that the integration of different predictor variables and fitting algorithms can achieve an improved air pollution modeling framework.
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http://dx.doi.org/10.1021/acs.est.9b03358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065654PMC
February 2020

National and sub-national exposure to ambient fine particulate matter (PM) and its attributable burden of disease in Iran from 1990 to 2016.

Environ Pollut 2019 Dec 4;255(Pt 1):113173. Epub 2019 Sep 4.

Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Ambient particulate matter is a public health concern. We aimed (1) to estimate national and provincial long-term exposure of Iranians to ambient particulate matter (PM) < 2.5 μm (PM) from 1990 to 2016, and (2) to estimate the national and provincial burden of disease attributable to PM in Iran. We used all available ground measurements of PM < 10 μm (PM) (used to estimate PM) from 91 monitoring stations. We estimated the annual mean exposure to PM for all Iranian population from 1990 to 2016 through a multi-stage modeling process. By applying comparative risk assessment methodology and using life table for years of life lost (YLL), we estimated the mortality and YLL attributable to PM for five outcomes. The predicted provincial annual mean PM concentrations range was between 21.7 μg/m (UI: 19.03-24.9) and 35.4 μg/m (UI: 31.4-39.4) from 1990 to 2016. We estimated in 2016, about 41,000 deaths (95% uncertainty interval [UI] 35634, 47014) and about 3,000,000 YLL (95% UI: 2632101, 3389342) attributable to the long-term exposure to PM in Iran. Ischemic heart disease was the leading cause of mortality by 31,363 deaths (95% UI: 27520, 35258), followed by stroke (7012 (5999, 8062) deaths), lower respiratory infection (1210 (912, 1519) deaths), chronic obstructive pulmonary disease (1019 (715, 1328) deaths), and lung cancer (668 (489, 848) deaths). In 2016, about 43% of all PM related mortality in Iran was, respectively, in the following provinces: Tehran (12.6%), Isfahan (9.3%), Khorasan Razavi (8.0%), Fars (6.5%), and Khozestan (6.4%). In summary, we found that the majority of Iranians were exposed to the levels of ambient particulate matter exceeding the WHO guidelines from 1990 to 2016. Further, we found that there was an increasing trend of total mortality attributed to PM in Iran from 1990 to 2016 where the slope was higher in western provinces.
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http://dx.doi.org/10.1016/j.envpol.2019.113173DOI Listing
December 2019

Short-term associations between daily mortality and ambient particulate matter, nitrogen dioxide, and the air quality index in a Middle Eastern megacity.

Environ Pollut 2019 Nov 28;254(Pt B):113121. Epub 2019 Aug 28.

Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.

There is limited evidence for short-term association between mortality and ambient air pollution in the Middle East and no study has evaluated exposure windows of about a month prior to death. We investigated all-cause non-accidental daily mortality and its association with fine particulate matter (PM), nitrogen dioxide (NO), and the Air Quality Index (AQI) from March 2011 through March 2014 in the megacity of Tehran, Iran. Generalized additive quasi-Poisson models were used within a distributed lag linear modeling framework to estimate the cumulative effects of PM, NO, and the AQI up to a lag of 45 days. We further conducted multi-pollutant models and also stratified the analyses by sex, age group, and season. The relative risk (95% confidence interval (CI)) for all seasons, both sexes and all ages at lag 0 for PM, NO, and AQI were 1.004 (1.001, 1.007), 1.003 (0.999, 1.007), and 1.004 (1.001, 1.007), respectively, per inter-quartile range (IQR) increment (18.8 μg/m for PM, 12.6 ppb for NO, and 31.5 for AQI). In multi-pollutant models, the PM associations were almost independent from NO. However, the RRs for NO were slightly attenuated after adjustment for PM but they were still largely independent from PM. The cumulative relative risks (95% CI) per IQR increment reached maximum during the cooler months, including: 1.13 (1.06, 1.20) for PM at lag 0-31 (for females, all ages); 1.17 (1.10, 1.25) for NO at lag 0-45 (for males, all ages); and 1.13 (1.07, 1.20) for the AQI at lag 0-30 (for females, all ages). Generally, the RRs were slightly larger for NO than PM and AQI. We found somewhat larger RRs in females, age group >65 years of age, and in cooler months. In summary, positive associations were found in most models. This is the first study to report short-term associations between all-cause non-accidental mortality and ambient PM and NO in Iran.
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http://dx.doi.org/10.1016/j.envpol.2019.113121DOI Listing
November 2019

An ensemble-based model of PM concentration across the contiguous United States with high spatiotemporal resolution.

Environ Int 2019 09 1;130:104909. Epub 2019 Jul 1.

Department of Environmental Health, Harvard T.H. Chan School of Public Heath, Boston, MA, United States.

Various approaches have been proposed to model PM in the recent decade, with satellite-derived aerosol optical depth, land-use variables, chemical transport model predictions, and several meteorological variables as major predictor variables. Our study used an ensemble model that integrated multiple machine learning algorithms and predictor variables to estimate daily PM at a resolution of 1 km × 1 km across the contiguous United States. We used a generalized additive model that accounted for geographic difference to combine PM estimates from neural network, random forest, and gradient boosting. The three machine learning algorithms were based on multiple predictor variables, including satellite data, meteorological variables, land-use variables, elevation, chemical transport model predictions, several reanalysis datasets, and others. The model training results from 2000 to 2015 indicated good model performance with a 10-fold cross-validated R of 0.86 for daily PM predictions. For annual PM estimates, the cross-validated R was 0.89. Our model demonstrated good performance up to 60 μg/m. Using trained PM model and predictor variables, we predicted daily PM from 2000 to 2015 at every 1 km × 1 km grid cell in the contiguous United States. We also used localized land-use variables within 1 km × 1 km grids to downscale PM predictions to 100 m × 100 m grid cells. To characterize uncertainty, we used meteorological variables, land-use variables, and elevation to model the monthly standard deviation of the difference between daily monitored and predicted PM for every 1 km × 1 km grid cell. This PM prediction dataset, including the downscaled and uncertainty predictions, allows epidemiologists to accurately estimate the adverse health effect of PM. Compared with model performance of individual base learners, an ensemble model would achieve a better overall estimation. It is worth exploring other ensemble model formats to synthesize estimations from different models or from different groups to improve overall performance.
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http://dx.doi.org/10.1016/j.envint.2019.104909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063579PMC
September 2019

Air pollution, environmental chemicals, and smoking may trigger vitamin D deficiency: Evidence and potential mechanisms.

Environ Int 2019 01 30;122:67-90. Epub 2018 Nov 30.

Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven (KU, Leuven), Belgium; IDEWE, External Service for Prevention at Protection at Work, Heverlee, Belgium.

Beyond vitamin D (VD) effect on bone homeostasis, numerous physiological functions in human health have been described for this versatile prohormone. In 2016, 95% of the world's population lived in areas where annual mean ambient particulate matter (<2.5 μm) levels exceeded the World Health Organization guideline value (Shaddick et al., 2018). On the other hand, industries disperse thousands of chemicals continually into the environment. Further, considerable fraction of populations are exposed to tobacco smoke. All of these may disrupt biochemical pathways and cause detrimental consequences, such as VD deficiency (VDD). In spite of the remarkable number of studies conducted on the role of some of the above mentioned exposures on VDD, the literature suffers from two main shortcomings: (1) an overview of the impacts of environmental exposures on the levels of main VD metabolites, and (2) credible engaged mechanisms in VDD because of those exposures. To summarize explanations for these unclear topics, we conducted the present review, using relevant keywords in the PubMed database, to investigate the adverse effects of exposure to air pollution, some environmental chemicals, and smoking on the VD metabolism, and incorporate relevant potential pathways disrupting VD endocrine system (VDES) leading to VDD. Air pollution may lead to the reduction of VD cutaneous production either directly by blocking ultraviolet B photons or indirectly by decreasing outdoor activity. Heavy metals may reduce VD serum levels by increasing renal tubular dysfunction, as well as downregulating the transcription of cytochrome P450 mixed-function oxidases (CYPs). Endocrine-disrupting chemicals (EDCs) may inhibit the activity and expression of CYPs, and indirectly cause VDD through weight gain and dysregulation of thyroid hormone, parathyroid hormone, and calcium homeostasis. Smoking through several pathways decreases serum 25(OH)D and 1,25(OH)2D levels, VD intake from diet, and the cutaneous production of VD through skin aging. In summary, disturbance in the cutaneous production of cholecalciferol, decreased intestinal intake of VD, the modulation of genes involved in VD homeostasis, and decreased local production of calcitriol in target tissues are the most likely mechanisms that involve in decreasing the serum VD levels.
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http://dx.doi.org/10.1016/j.envint.2018.11.052DOI Listing
January 2019

Long-term exposure to ambient air pollution and autism spectrum disorder in children: A case-control study in Tehran, Iran.

Sci Total Environ 2018 Dec 4;643:1216-1222. Epub 2018 Jul 4.

Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.

Some recent human and animal studies have suggested that air pollution may affect the central nervous system and contribute to neurodevelopmental outcomes, such as autism spectrum disorder (ASD). We aimed to investigate the association between long-term exposure to ambient air pollution and increased odds of ASD among 2 to 10-year-old children. We conducted a case-control study in Tehran, Iran. Cases were 134 children born between 2004 and 2012 diagnosed with ASD whose mothers were resident in Tehran during their pregnancy, and controls were 388 children without ASD randomly selected from public schools and kindergartens. Land-use regression models were used to estimate their annual mean exposure to ambient particulate matter with aerodynamic diameter ≤10 μm (PM), sulfur dioxide (SO), benzene, toluene, ethylbenzene, p-xylene, o-xylene, m-xylene (BTEX), and total BTEX. Logistic regression was used for the analyses and adjusted for possible confounding variables. The odds ratios per 1 unit increase in pollutants in the adjusted models were 1.00 (95% CI: 0.99, 1.01) for PM, 0.99 (95% CI: 0.99, 1.00) for SO, 0.96 (0.83, 1.11) for benzene, 1.00 (0.96, 1.04) for toluene, 0.95 (0.79, 1.16) for ethylbenzene, 1.00 (0.78, 1.27) for p-xylene, 1.09 (0.94, 1.27) for o-xylene, 1.01 (0.92, 1.12) for m-xylene, and 0.99 (0.97, 1.01) for total BTEX. We did not find the evidence of association between estimated annual mean exposure to abovementioned ambient air pollutants and increased odds of ASD in children. However, our findings might be due to some important limitations. Further research with better control of confounding variables, improved spatiotemporal exposure estimates, and inclusion of other important markers of air pollution is recommended.
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http://dx.doi.org/10.1016/j.scitotenv.2018.06.259DOI Listing
December 2018

Data Integration for the Assessment of Population Exposure to Ambient Air Pollution for Global Burden of Disease Assessment.

Environ Sci Technol 2018 08 30;52(16):9069-9078. Epub 2018 Jul 30.

Institute for Health Metrics and Evaluation , Seattle , Washington 98121 , United States.

Air pollution is a leading global disease risk factor. Tracking progress (e.g., for Sustainable Development Goals) requires accurate, spatially resolved, routinely updated exposure estimates. A Bayesian hierarchical model was developed to estimate annual average fine particle (PM) concentrations at 0.1° × 0.1° spatial resolution globally for 2010-2016. The model incorporated spatially varying relationships between 6003 ground measurements from 117 countries, satellite-based estimates, and other predictors. Model coefficients indicated larger contributions from satellite-based estimates in countries with low monitor density. Within and out-of-sample cross-validation indicated improved predictions of ground measurements compared to previous (Global Burden of Disease 2013) estimates (increased within-sample R from 0.64 to 0.91, reduced out-of-sample, global population-weighted root mean squared error from 23 μg/m to 12 μg/m). In 2016, 95% of the world's population lived in areas where ambient PM levels exceeded the World Health Organization 10 μg/m (annual average) guideline; 58% resided in areas above the 35 μg/m Interim Target-1. Global population-weighted PM concentrations were 18% higher in 2016 (51.1 μg/m) than in 2010 (43.2 μg/m), reflecting in particular increases in populous South Asian countries and from Saharan dust transported to West Africa. Concentrations in China were high (2016 population-weighted mean: 56.4 μg/m) but stable during this period.
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http://dx.doi.org/10.1021/acs.est.8b02864DOI Listing
August 2018

Long-term trends and health impact of PM and O in Tehran, Iran, 2006-2015.

Environ Int 2018 05 22;114:37-49. Epub 2018 Feb 22.

Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

The main objectives of this study were (1) investigation of the temporal variations of ambient fine particulate matter (PM) and ground level ozone (O) concentrations in Tehran megacity, the capital and most populous city in Iran, over a 10-year period from 2006 to 2015, and (2) estimation of their long-term health effects including all-cause and cause-specific mortality. For the first goal, the data of PM and O concentrations, measured at 21 regulatory monitoring network stations in Tehran, were obtained and the temporal trends were investigated. The health impact assessment of PM and O was performed using the World Health Organization (WHO) AirQ+ software updated in 2016 by WHO European Centre for Environment and Health. Local baseline incidences in Tehran level were used to better reveal the health effects associated with PM and O. Our study showed that over 2006-2015, annual mean concentrations of PM and O varied from 24.7 to 38.8 μg m and 35.4 to 76.0 μg m, respectively, and were significantly declining in the recent 6 years (2010-2015) for PM and 8 years (2008-2015) for O. However, Tehran citizens were exposed to concentrations of annual PM exceeding the WHO air quality guideline (WHO AQG) (10 μg m), U.S. EPA and Iranian standard levels (12 μg m) during entire study period. We estimated that long-term exposure to ambient PM contributed to between 24.5% and 36.2% of mortality from cerebrovascular disease (stroke), 19.8% and 24.1% from ischemic heart disease (IHD), 13.6% and 19.2% from lung cancer (LC), 10.7% and 15.3% from chronic obstructive pulmonary disease (COPD), 15.0% and 25.2% from acute lower respiratory infection (ALRI), and 7.6% and 11.3% from all-cause annual mortality in the time period. We further estimated that deaths from IHD accounted for most of mortality attributable to long-term exposure to PM. The years of life lost (YLL) attributable to PM was estimated to vary from 67,970 to 106,706 during the study period. In addition, long-term exposure to O was estimated to be responsible for 0.9% to 2.3% of mortality from respiratory diseases. Overall, long-term exposure to ambient PM and O contributed substantially to mortality in Tehran megacity. Air pollution is a modifiable risk factor. Appropriate sustainable control policies are recommended to protect public health.
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http://dx.doi.org/10.1016/j.envint.2018.02.026DOI Listing
May 2018

Estimating national dioxins and furans emissions, major sources, intake doses, and temporal trends in Iran from 1990-2010.

J Environ Health Sci Eng 2017 10;15:20. Epub 2017 Oct 10.

Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.

Background: Polychlorinated dibenzo-p-dioxins (PCDD) and dibenzofurans (PCDFs) are highly toxic persistent organic pollutants (POPs), which can cause various health outcomes, such as cancer. As a part of the National and Sub-national Burden of Disease Study (NASBOD), we aimed to estimate dioxins and furans national emissions, identify their main sources, estimate daily intake doses, and assess their trend from 1990-2010 in Iran.

Methods: The Toolkit for Identification and Quantification of Releases of Dioxins, Furans and Other Unintentional POPs, which is developed by the United Nations Environment Programme (UNEP 2013), was used to estimate the emissions of PCDD/PCDFs from several sources into the air, water, land, residue, and other products. The daily intake doses were estimated using a linear regression of estimated emissions by UNEP Toolkit and average intake doses in other countries. Finally, the trend of PCDD/PCDFs emissions and daily intake doses were explored from 1990-2010.

Results: The total emissions were estimated as 960 g Toxic Equivalents (g TEQ) for 1990 and 1957 g TEQ for 2010 (18.2 and 26.8 g TEQ per million capita, respectively). The estimations suggest that albeit contribution of open burning to PCDD/PCDFs emissions has been declining from 1990 to 2010, it remained the major source of emissions in Iran contributing to about 45.8% out of total emissions in 1990 to 35.7% in 2010. We further found that PCDD/PCDFs are mostly emitted into the ambient air, followed by residue, land, products, and water. The daily intake doses were estimated to be 3.1 and 5.4 pg TEQ/kg bw/day for 1990 and 2010, respectively. We estimated an increasing trend for PCDD/PCDFs emissions and intake doses in Iran from 1990-2010.

Conclusions: The high levels of emissions, intake doses, and their increasing trend in Iran may pose a substantial health risk to the Iranian population. Further studies with more rigorous methods are recommended but this should not circumvent taking appropriate policy actions against these pollutants. Currently, Iran has no standard for dioxins and furans. Adaptation of the World Health Organization recommended guidelines might be an appropriate starting point to control dioxins and furans emissions.
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http://dx.doi.org/10.1186/s40201-017-0283-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633873PMC
October 2017

Short-term association between ambient air pollution and pneumonia in children: A systematic review and meta-analysis of time-series and case-crossover studies.

Environ Pollut 2017 Nov 25;230:1000-1008. Epub 2017 Jul 25.

Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.

Ambient air pollution has been associated with respiratory diseases in children. However, its effects on pediatric pneumonia have not been meta-analyzed. We conducted a systematic review and meta-analysis of the short-term association between ambient air pollution and hospitalization of children due to pneumonia. We searched the Web of Science and PubMed for indexed publications up to January 2017. Pollutant-specific excess risk percentage (ER%) and confidence intervals (CI) were estimated using random effect models for particulate matter (PM) with diameter ≤ 10 (PM) and ≤2.5 μm (PM), sulfur dioxide (SO), ozone (O), nitrogen dioxide (NO), and carbon monoxide (CO). Results were further stratified by subgroups (children under five, emergency visits versus hospital admissions, income level of study location, and exposure period). Seventeen studies were included in the meta-analysis. The ER% per 10 μg/m increase of pollutants was 1.5% (95% CI: 0.6%-2.4%) for PM and 1.8% (95% CI: 0.5%-3.1%) for PM. The corresponding values per 10 ppb increment of gaseous pollutants were 2.9% (95% CI: 0.4%-5.3%) for SO, 1.7% (95% CI: 0.5%-2.8%) for O, and 1.4% (95% CI: 0.4%-2.4%) for NO. ER% per 1000 ppb increment of CO was 0.9% (95% CI: 0.0%-1.9%). Associations were not substantially different between subgroups. This meta-analysis shows a positive association between daily levels of ambient air pollution markers and hospitalization of children due to pneumonia. However, lack of studies from low-and middle-income countries limits the quantitative generalizability given that susceptibilities to the adverse effects of air pollution may be different in those populations. The meta-regression in our analysis further demonstrated a strong effect of country income level on heterogeneity.
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http://dx.doi.org/10.1016/j.envpol.2017.07.063DOI Listing
November 2017

Land Use Regression Models for Alkylbenzenes in a Middle Eastern Megacity: Tehran Study of Exposure Prediction for Environmental Health Research (Tehran SEPEHR).

Environ Sci Technol 2017 Aug 17;51(15):8481-8490. Epub 2017 Jul 17.

Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute , Basel 4051, Switzerland.

Land use regression (LUR) has not been applied thus far to ambient alkylbenzenes in highly polluted megacities. We advanced LUR models for benzene, toluene, ethylbenzene, p-xylene, m-xylene, o-xylene (BTEX), and total BTEX using measurement based estimates of annual means at 179 sites in Tehran megacity, Iran. Overall, 520 predictors were evaluated, such as The Weather Research and Forecasting Model meteorology predictions, emission inventory, and several new others. The final models with R values ranging from 0.64 for p-xylene to 0.70 for benzene were mainly driven by traffic-related variables but the proximity to sewage treatment plants was present in all models indicating a major local source of alkylbenzenes not used in any previous study. We further found that large buffers are needed to explain annual mean concentrations of alkylbenzenes in complex situations of a megacity. About 83% of Tehran's surface had benzene concentrations above air quality standard of 5 μg/m set by European Union and Iranian Government. Toluene was the predominant alkylbenzene, and the most polluted area was the city center. Our analyses on differences between wealthier and poorer areas also showed somewhat higher concentrations for the latter. This is the largest LUR study to predict all BTEX species in a megacity.
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http://dx.doi.org/10.1021/acs.est.7b02238DOI Listing
August 2017

Spatiotemporal description of BTEX volatile organic compounds in a Middle Eastern megacity: Tehran Study of Exposure Prediction for Environmental Health Research (Tehran SEPEHR).

Environ Pollut 2017 Jul 19;226:219-229. Epub 2017 Apr 19.

Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.

The spatiotemporal variability of ambient volatile organic compounds (VOCs) in Tehran, Iran, is not well understood. Here we present the design, methods, and results of the Tehran Study of Exposure Prediction for Environmental Health Research (Tehran SEPEHR) on ambient concentrations of benzene, toluene, ethylbenzene, p-xylene, m-xylene, o-xylene (BTEX), and total BTEX. To date, this is the largest study of its kind in a low- and middle-income country and one of the largest globally. We measured BTEX concentrations at five reference sites and 174 distributed sites identified by a cluster analytic method. Samples were taken over 25 consecutive 2-weeks at five reference sites (to be used for temporal adjustments) and over three 2-week campaigns in summer, winter, and spring at 174 distributed sites. The annual median (25-75 percentile) for benzene, the most carcinogenic of the BTEX species, was 7.8 (6.3-9.9) μg/m, and was higher than the national and European Union air quality standard of 5 μg/m at approximately 90% of the measured sites. The estimated annual mean concentrations of BTEX were spatially highly correlated for all pollutants (Spearman rank coefficient 0.81-0.98). In general, concentrations and spatial variability were highest during the summer months, most likely due to fuel evaporation in hot weather. The annual median of benzene and total BTEX across the 35 sites in the Tehran regulatory monitoring network (7.7 and 56.8 μg/m, respectively) did a reasonable job of approximating the additional 144 city-wide sites (7.9 and 58.7 μg/m, respectively). The annual median concentrations of benzene and total BTEX within 300 m of gas stations were 9.1 and 67.3 μg/m, respectively, and were higher than sites outside this buffer. We further found that airport did not affect annual BTEX concentrations of sites within 1 km. Overall, the observed ambient concentrations of toxic VOCs are a public health concern in Tehran.
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http://dx.doi.org/10.1016/j.envpol.2017.04.027DOI Listing
July 2017

Annual and seasonal spatial models for nitrogen oxides in Tehran, Iran.

Sci Rep 2016 09 13;6:32970. Epub 2016 Sep 13.

Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.

Very few land use regression (LUR) models have been developed for megacities in low- and middle-income countries, but such models are needed to facilitate epidemiologic research on air pollution. We developed annual and seasonal LUR models for ambient oxides of nitrogen (NO, NO2, and NOX) in the Middle Eastern city of Tehran, Iran, using 2010 data from 23 fixed monitoring stations. A novel systematic algorithm was developed for spatial modeling. The R(2) values for the LUR models ranged from 0.69 to 0.78 for NO, 0.64 to 0.75 for NO2, and 0.61 to 0.79 for NOx. The most predictive variables were: distance to the traffic access control zone; distance to primary schools; green space; official areas; bridges; and slope. The annual average concentrations of all pollutants were high, approaching those reported for megacities in Asia. At 1000 randomly-selected locations the correlations between cooler and warmer season estimates were 0.64 for NO, 0.58 for NOX, and 0.30 for NO2. Seasonal differences in spatial patterns of pollution are likely driven by differences in source contributions and meteorology. These models provide a basis for understanding long-term exposures and chronic health effects of air pollution in Tehran, where such research has been limited.
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http://dx.doi.org/10.1038/srep32970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020732PMC
September 2016

Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Lancet Glob Health 2016 10 25;4(10):e704-13. Epub 2016 Aug 25.

University of Rhode Island, Kingston, RI, USA.

Background: The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013.

Methods: GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically.

Findings: The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60-80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred.

Interpretation: Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts.

Funding: Bill & Melinda Gates Foundation.
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http://dx.doi.org/10.1016/S2214-109X(16)30168-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660972PMC
October 2016
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