Publications by authors named "Joel D Kaufman"

226 Publications

Long-Term Exposures to Urban Noise and Blood Pressure Levels and Control Among Older Adults.

Hypertension 2021 Oct 25:HYPERTENSIONAHA12117708. Epub 2021 Oct 25.

School of Public Health, University of Michigan, Ann Arbor (J.D., S.D.A.).

Urban noise is a common environmental exposure that may increase the burden of hypertension in communities, yet it is largely unstudied in the United States, and it has not been studied in relation to blood pressure (BP) control. We investigated associations of urban noise with BP levels and control in the United States. We used repeated BP and medication data from Chicago-based participants of the Chicago Health and Aging Project (≥65 years) and MESA (Multi-Ethnic Study of Atherosclerosis; ≥45 years). Using a spatial prediction model with project-specific measurements, we estimated noise at participant homes. We imputed BP levels for those on medication and used mixed-effects models to evaluate associations with noise. Logistic regression was used for uncontrolled and apparent treatment-resistant hypertension. Models were run separately by cohort and altogether, all with adjustment for age, sex, sociodemographic factors, and other plausible sources of confounding. We evaluated 16 462 BP measurements from 6764 participants (6073 Chicago Health and Aging Project and 691 MESA) over an average of 4 years. For both cohorts, we found that greater levels of noise were associated with higher BP levels and greater risk of apparent treatment-resistant hypertension. In our pooled models, 10-dBA higher residential noise levels corresponded to 1.2 (95% CI, 0.1-2.2) and 1.1 mm Hg greater (95% CI, 0.6-1.7) systolic and diastolic BPs as well as a 20% increased odds of apparent treatment-resistant hypertension (odds ratio per 10 dBA: 1.2 [95% CI, 1.0-1.4], =0.04). Urban noise may increase BP levels and complicate hypertension treatment in the United States.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.121.17708DOI Listing
October 2021

Publicly available low-cost sensor measurements for PM exposure modeling: Guidance for monitor deployment and data selection.

Environ Int 2021 Sep 30;158:106897. Epub 2021 Sep 30.

Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA.

High-resolution, high-quality exposure modeling is critical for assessing the health effects of ambient PM in epidemiological studies. Using sparse regulatory PM measurements as principal model inputs may result in two issues in exposure prediction: (1) they may affect the models' accuracy in predicting PM spatial distribution; (2) the internal validation based on these measurements may not reliably reflect the model performance at locations of interest (e.g., a cohort's residential locations). In this study, we used the PM measurements from a publicly available commercial low-cost PM network, PurpleAir, with an external validation dataset at the residential locations of a representative sample of participants from the Adult Changes in Thought - Air Pollution (ACT-AP) study, to improve the accuracy of exposure prediction at the cohort participant locations. We also proposed a metric based on principal component analysis (PCA) - the PCA distance - to assess the similarity between monitor and cohort locations to guide monitor deployment and data selection. The analysis was based on a spatiotemporal modeling framework with 51 "gold-standard" monitors and 58 PurpleAir monitors for model development, as well as 105 home monitors at the cohort locations for model validation, in the Puget Sound region of Washington State from June 2017 to March 2019. After including calibrated PurpleAir measurements as part of the dependent variable, the external spatiotemporal validation R and root-mean-square error, RMSE, for two-week concentration averages improved from 0.84 and 2.22 μg/m to 0.92 and 1.63 μg/m, respectively. The external spatial validation R and RMSE for long-term averages over the modeling period improved from 0.72 and 1.01 μg/m to 0.79 and 0.88 μg/m, respectively. The exposure predictions incorporating PurpleAir measurements demonstrated sharper urban-suburban concentration gradients. The PurpleAir monitors with shorter PCA distances improved the model's prediction accuracy more substantially than the monitors with longer PCA distances, supporting the use of this similarity metric.
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http://dx.doi.org/10.1016/j.envint.2021.106897DOI Listing
September 2021

Associations of perinatal exposure to PM with gestational weight gain and offspring birth weight.

Environ Res 2021 Sep 22;204(Pt B):112087. Epub 2021 Sep 22.

Department of Epidemiology, University of Washington, Seattle, WA, 98195, USA.

Background: PM have been associated with weight change in animal models and non-pregnant populations. Evidence of associations between PM and gestational weight gain (GWG), an important determinant of course and outcomes of pregnancy, and subsequent birth outcomes is limited.

Methods: The study was conducted among a subset of participants from the Omega Study, a prospective pregnancy cohort. Exposure to PM (μg/m) was ascertained for participants (N = 855) based on their residential address using a validated national spatiotemporal model. Adjusted multivariable linear regression models were used to estimate associations of trimester-specific and pregnancy-month PM exposures with early (<20 weeks gestation), late (≥20 weeks gestation), and total GWG and infant birth weight. Stratified models and product terms were used to examine whether pre-pregnancy BMI (ppBMI) and infant sex modified the associations.

Results: Average monthly PM exposure during the first, second, and third trimesters were 7.3 μg/m, 7.9 μg/m, and 7.7 μg/m, respectively. Higher third trimester PM exposure was associated with higher late (0.40 kg per 5 μg/m (McDowell et al., 2018); 95%CI: 0.12, 0.67) and total (0.35 kg; 95%CI: 0.01, 0.70) GWG among participants with normal ppBMI. Higher second month PM exposure was associated with lower early (-0.70 kg; 95%CI: 1.22, -0.18), late (-0.84 kg; 95% CI: 1.54, -0.14), and total (-1.70 kg; 95%CI: 2.57, -0.82) GWG among participants with overweight/obese ppBMI. Product terms between PM and ppBMI were significant for second month PM exposure and early (p-value = 0.01) and total GWG (p-value<0.01). Higher third trimester PM exposure was associated with higher birth weight, though higher fourth month PM exposure was associated with lower birth weight, particularly among those with normal ppBMI and male infants.

Conclusions: Associations of PM with GWG vary by exposure window and ppBMI, while associations of PM with birth weight potentially vary by exposure window, ppBMI and infant sex. Further exploration of associations between PM and maternal/child health outcomes are needed.
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http://dx.doi.org/10.1016/j.envres.2021.112087DOI Listing
September 2021

Ambient Air Pollution and Long-Term Trajectories of Episodic Memory Decline among Older Women in the WHIMS-ECHO Cohort.

Environ Health Perspect 2021 Sep 13;129(9):97009. Epub 2021 Sep 13.

Department of Neurology, University of Southern California, Los Angeles, California, USA.

Background: Episodic memory decline varies by age and underlying neuropathology. Whether ambient air pollution contributes to the heterogeneity of episodic memory decline in older populations remains unclear.

Objectives: We estimated associations between air pollution exposures and episodic memory decline according to pollutant, exposure time window, age, and latent class subgroups defined by episodic memory trajectories.

Methods: Participants were from the Women's Health Initiative Memory Study-Epidemiology of Cognitive Health Outcomes. Older women (; 74-92 years of age) completed annual (2008-2018) episodic memory assessments using the telephone-based California Verbal Learning Test (CVLT). We estimated 3-y average fine particulate matter [PM with an aerodynamic diameter of ()] and nitrogen dioxide () exposures at baseline and 10 y earlier (recent and remote exposures, respectively), using regionalized national universal kriging. Separate latent class mixed models were used to estimate associations between interquartile range increases in exposures and CVLT trajectories in women and , adjusting for covariates.

Results: Two latent classes were identified for women (), "slow-decliners" { [95% confidence interval (CI): , ] and "fast-decliners" [ (95% CI: , )]}. In the slow-decliner class, but not the fast-decliner class, exposures were associated with a greater decline in CVLT scores over time, with a stronger association for recent vs. remote exposures [ (95% CI: , ) per and (95% CI: , 0.01) per , respectively]. Among women (), the largest latent class comprised "steady-decliners" [ (95% CI: , )], whereas the second class, "cognitively resilient", had no decline in CVLT on average. was not associated with episodic memory decline in either class. A increase in recent was associated with nonsignificant acceleration of episodic memory decline in the -y-old fast-decliner class [ (95% CI: , 0.04)], and in the cognitively resilient class [ (95% CI: , 0.03)] and steady-decliner class [ (95% CI: , 0.05)]. Associations with recent exposure in women were stronger and statistically significant when 267 women with incident probable dementia were excluded [e.g., (95% CI: , ) for the cognitively resilient class]. In contrast with changes in CVLT over time, there were no associations between exposures and CVLT scores during follow-up in any subgroup.

Discussion: In a community-dwelling U.S. population of older women, associations between late-life exposure to ambient air pollution and episodic memory decline varied by age-related cognitive trajectories, exposure time windows, and pollutants. https://doi.org/10.1289/EHP7668.
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http://dx.doi.org/10.1289/EHP7668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437247PMC
September 2021

Longitudinal Associations between the Neighborhood Built Environment and Cognition in US Older Adults: The Multi-Ethnic Study of Atherosclerosis.

Int J Environ Res Public Health 2021 07 28;18(15). Epub 2021 Jul 28.

Department of Internal Medicine, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27109, USA.

Few studies have examined associations between neighborhood built environments (BE) and longitudinally measured cognition. We examined whether four BE characteristics were associated with six-year change in global cognition and processing speed. We obtained data on 1816 participants without dementia from the Multi-Ethnic Study of Atherosclerosis. BE measures included social destination density, walking destination density, proportion of land dedicated to retail, and network ratio (street connectivity). Global cognition was measured with the Cognitive Abilities Screening Instrument (CASI) and processing speed with the Digit Symbol Coding test (DSC). Multivariable random intercept logistic models tested associations between neighborhood BE at 2010-2012 and maintained/improved cognition (versus decline) from 2010-2018, and mediation by minutes of physical activity (PA)/week. The sample was an average of 67 years old (standard deviation = 8.2) (first cognitive measurement) and racially/ethnically diverse (29% African American, 11% Chinese, 17% Hispanic, 44% White). Compared to individuals with no walking destinations in the 1-mile surrounding their residence, those with 716 walking destinations (maximum observed) were 1.24 times more likely to have maintain/improved DSC score (Odds ratio: 1.24; 95% confidence interval: 1.03-1.45). No other associations were observed between BE and cognition, and PA minutes/week did not mediate the association between walking destination density and DSC change. This study provides limited evidence for an association between greater neighborhood walking destinations and maintained/improved processing speed in older age and no evidence for associations between the other BE characteristics and cognition. Future studies with finer grained BE and cognitive measures and longer-term follow up may be required.
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http://dx.doi.org/10.3390/ijerph18157973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8345405PMC
July 2021

Fine Particulate Matter and Dementia Incidence in the Adult Changes in Thought Study.

Environ Health Perspect 2021 Aug 4;129(8):87001. Epub 2021 Aug 4.

Department of Environmental and Occupational Health Sciences, University of Washington Seattle School of Public Health, Seattle, Washington, USA.

Background: Air pollution may be associated with elevated dementia risk. Prior research has limitations that may affect reliability, and no studies have evaluated this question in a population-based cohort of men and women in the United States.

Objectives: We evaluated the association between time-varying, 10-y average fine particulate matter () exposure and hazard of all-cause dementia. An additional goal was to understand how to adequately control for age and calendar-time-related confounding through choice of the time axis and covariate adjustment.

Methods: Using the Adult Changes in Thought (ACT) population-based prospective cohort study in Seattle, we linked spatiotemporal model-based exposures to participant addresses from 1978 to 2018. Dementia diagnoses were made using high-quality, standardized, consensus-based protocols at biennial follow-ups. We conducted multivariable Cox proportional hazards regression to evaluate the association between time-varying, 10-y average exposure and time to event in a model with age as the time axis, stratified by apolipoprotein E (APOE) genotype, and adjusted for sex, education, race, neighborhood median household income, and calendar time. Alternative models used calendar time as the time axis.

Results: We report 1,136 cases of incident dementia among 4,166 individuals with nonmissing APOE status. Mean [mean ± standard deviation (SD)] 10-y average was . Each increase in the moving average of 10-y was associated with a 16% greater hazard of all-cause dementia [1.16 (95% confidence interval: 1.03, 1.31)]. Results using calendar time as the time axis were similar.

Discussion: In this prospective cohort study with extensive exposure data and consensus-based outcome ascertainment, elevated long-term exposure to was associated with increased hazard of all-cause dementia. We found that optimal control of age and time confounding could be achieved through use of either age or calendar time as the time axis in our study. Our results strengthen evidence on the neurodegenerative effects of . https://doi.org/10.1289/EHP9018.
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http://dx.doi.org/10.1289/EHP9018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336685PMC
August 2021

Deployment, Calibration, and Cross-Validation of Low-Cost Electrochemical Sensors for Carbon Monoxide, Nitrogen Oxides, and Ozone for an Epidemiological Study.

Sensors (Basel) 2021 Jun 19;21(12). Epub 2021 Jun 19.

Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA.

We designed and built a network of monitors for ambient air pollution equipped with low-cost gas sensors to be used to supplement regulatory agency monitoring for exposure assessment within a large epidemiological study. This paper describes the development of a series of hourly and daily field calibration models for Alphasense sensors for carbon monoxide (CO; CO-B4), nitric oxide (NO; NO-B4), nitrogen dioxide (NO; NO2-B43F), and oxidizing gases (OX-B431)-which refers to ozone (O) and NO. The monitor network was deployed in the Puget Sound region of Washington, USA, from May 2017 to March 2019. Monitors were rotated throughout the region, including at two Puget Sound Clean Air Agency monitoring sites for calibration purposes, and over 100 residences, including the homes of epidemiological study participants, with the goal of improving long-term pollutant exposure predictions at participant locations. Calibration models improved when accounting for individual sensor performance, ambient temperature and humidity, and concentrations of co-pollutants as measured by other low-cost sensors in the monitors. Predictions from the final daily models for CO and NO performed the best considering agreement with regulatory monitors in cross-validated root-mean-square error (RMSE) and R measures (CO: RMSE = 18 ppb, R = 0.97; NO: RMSE = 2 ppb, R = 0.97). Performance measures for NO and O were somewhat lower (NO: RMSE = 3 ppb, R = 0.79; O: RMSE = 4 ppb, R = 0.81). These high levels of calibration performance add confidence that low-cost sensor measurements collected at the homes of epidemiological study participants can be integrated into spatiotemporal models of pollutant concentrations, improving exposure assessment for epidemiological inference.
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http://dx.doi.org/10.3390/s21124214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234435PMC
June 2021

Fine-Scale Air Pollution Models for Epidemiologic Research: Insights From Approaches Developed in the Multi-ethnic Study of Atherosclerosis and Air Pollution (MESA Air).

Curr Environ Health Rep 2021 06;8(2):113-126

Departments of Environmental and Occupational Health Sciences, Epidemiology, and Medicine, University of Washington, Seattle, WA, USA.

Purpose Of Review: Epidemiological studies of short- and long-term health impacts of ambient air pollutants require accurate exposure estimates. We describe the evolution in exposure assessment and assignment in air pollution epidemiology, with a focus on spatiotemporal techniques first developed to meet the needs of the Multi-ethnic Study of Atherosclerosis and Air Pollution (MESA Air). Initially designed to capture the substantial variation in pollutant levels and potential health impacts that can occur over small spatial and temporal scales in metropolitan areas, these methods have now matured to permit fine-scale exposure characterization across the contiguous USA and can be used for understanding long- and short-term health effects of exposure across the lifespan. For context, we highlight how the MESA Air models compare to other available exposure models.

Recent Findings: Newer model-based exposure assessment techniques provide predictions of pollutant concentrations with fine spatial and temporal resolution. These validated models can predict concentrations of several pollutants, including particulate matter less than 2.5 μm in diameter (PM), oxides of nitrogen, and ozone, at specific locations (such as at residential addresses) over short time intervals (such as 2 weeks) across the contiguous USA between 1980 and the present. Advances in statistical methods, incorporation of supplemental pollutant monitoring campaigns, improved geographic information systems, and integration of more complete satellite and chemical transport model outputs have contributed to the increasing validity and refined spatiotemporal spans of available models. Modern models for predicting levels of outdoor concentrations of air pollutants can explain a substantial amount of the spatiotemporal variation in observations and are being used to provide critical insights into effects of air pollutants on the prevalence, incidence, progression, and prognosis of diseases across the lifespan. Additional enhancements in model inputs and model design, such as incorporation of better traffic data, novel monitoring platforms, and deployment of machine learning techniques, will allow even further improvements in the performance of pollutant prediction models.
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http://dx.doi.org/10.1007/s40572-021-00310-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278964PMC
June 2021

Associations Between Neighborhood Park Access and Longitudinal Change in Cognition in Older Adults: The Multi-Ethnic Study of Atherosclerosis.

J Alzheimers Dis 2021 ;82(1):221-233

Departments of Internal Medicine and Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Background: Preliminary evidence suggests associations between neighborhood park access and better late-life cognition and reduced Alzheimer's disease (AD) risk.

Objective: Examine associations between neighborhood park access and longitudinal change in cognition among U.S. older adults without dementia.

Methods: We used 2000-2018 observational data from the population-based, multi-site Multi-Ethnic Study of Atherosclerosis (n = 1,733). Measures included proportion of neighborhood park space (park access), distance to nearest park, and 6-year dichotomous and continuous change in scores on the Cognitive Abilities Screening Instrument (CASI; global cognition) and Digit Symbol Coding task (processing speed). Multivariable random intercept models tested main associations and mediation by depressive symptoms, physical activity, and PM2.5 exposure. Effect modification by race (African Americans/Blacks versus Whites) was tested using interaction terms.

Results: Greater park access (equivalent to 10%more in 1/2-mile around home) was associated with maintained/improved CASI score over six years independent of several covariates including individual- and neighborhood-level socioeconomic status (Odds ratio: 1.04; 95%confidence interval: 1.00-1.08). No other associations were observed with the dichotomous or continuous measures of cognitive change and no mediators were found. While a borderline association was seen between greater park access and maintained/improved CASI for African Americans/Blacks but not for Whites, effect modification was not confirmed by testing interaction terms.

Conclusion: Neighborhood park access may help maintain/improve late-life global cognition. However, our findings need replication in other population-based studies and regions. Additionally, studies are needed to determine if associations between park access and change in cognition vary by race/ethnicity to inform intervention efforts.
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http://dx.doi.org/10.3233/JAD-210370DOI Listing
September 2021

Confronting Environmental Racism.

Environ Health Perspect 2021 May 20;129(5):51001. Epub 2021 May 20.

Department of Epidemiology, University of Washington, Seattle, Washington, USA.

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http://dx.doi.org/10.1289/EHP9511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137098PMC
May 2021

Gender differences in the association of insomnia symptoms and coronary artery calcification in the multi-ethnic study of atherosclerosis.

Sleep 2021 Oct;44(10)

Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.

Study Objectives: To quantify the gender-specific associations between insomnia symptoms and subclinical atherosclerosis, measured by coronary artery calcium (CAC) scores, which has strong predictive value for incident cardiovascular disease.

Methods: We analyzed data from 1,429 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Participants completed standardized questionnaires and underwent polysomnography (PSG) and 7-day actigraphy. Insomnia symptoms were defined as: self-reported trouble falling, staying or returning to sleep, early-morning awakenings, or hypnotic use, for ≥5 nights/week. MESA assessed CAC using computed tomography. We employed multivariable linear regression to model the probability of CAC >0 overall and to model the linear continuous effect among those with nonzero CAC.

Results: Our sample was a mean age of 68.1 ± 9.1 years, 53.9% female, and 36.2% white, 28.0% black, 24.2% Hispanic, and 11.5% Chinese-American. Insomnia symptoms were present in 49.7% of men and 47.2% of women. In multivariable-adjusted analyses, insomnia symptoms was associated with an 18% higher prevalence of CAC (PR 1.18, 95% CI 1.04, 1.33) among females, but no association was observed among males (PR 1.00, 95% CI 0.91, 1.08). There was no evidence that the association between insomnia symptoms and prevalence of CAC >0 differed by objective sleep duration status (by single-night PSG or multi-night actigraphy) in females or males.

Conclusions: We found that among women, insomnia symptoms were associated with an 18% higher prevalence of CAC compared to no insomnia. Insomnia symptoms were not associated with CAC prevalence in men. Additionally, there was no evidence that the association between insomnia symptoms and CAC score >0 differed by objective short sleep duration status.
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http://dx.doi.org/10.1093/sleep/zsab116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8503822PMC
October 2021

Racial Segregation and Respiratory Outcomes among Urban Black Residents with and at Risk of Chronic Obstructive Pulmonary Disease.

Am J Respir Crit Care Med 2021 09;204(5):536-545

Division of Pulmonary and Critical Care Medicine and.

Racial residential segregation has been associated with worse health outcomes, but the link with chronic obstructive pulmonary disease (COPD) morbidity has not been established. To investigate whether racial residential segregation is associated with COPD morbidity among urban Black adults with or at risk of COPD. Racial residential segregation was assessed using isolation index, based on 2010 decennial census and baseline address, for Black former and current smokers in the multicenter SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study), a study of adults with or at risk for COPD. We tested the association between isolation index and respiratory symptoms, physiologic outcomes, imaging parameters, and exacerbation risk among urban Black residents, adjusting for established COPD risk factors, including smoking. Additional mediation analyses were conducted for factors that could lie on the pathway between segregation and COPD outcomes, including individual and neighborhood socioeconomic status, comorbidity burden, depression/anxiety, and ambient pollution. Among 515 Black participants, those residing in segregated neighborhoods (i.e., isolation index ⩾0.6) had worse COPD Assessment Test score (β = 2.4; 95% confidence interval [CI], 0.7 to 4.0), dyspnea (modified Medical Research Council scale; β = 0.29; 95% CI, 0.10 to 0.47), quality of life (St. George's Respiratory Questionnaire; β = 6.1; 95% CI, 2.3 to 9.9), and cough and sputum (β = 0.8; 95% CI, 0.1 to 1.5); lower FEV% predicted (β = -7.3; 95% CI, -10.9 to -3.6); higher rate of any and severe exacerbations; and higher percentage emphysema (β = 2.3; 95% CI, 0.7 to 3.9) and air trapping (β = 3.8; 95% CI, 0.6 to 7.1). Adverse associations attenuated with adjustment for potential mediators but remained robust for several outcomes, including dyspnea, FEV% predicted, percentage emphysema, and air trapping. Racial residential segregation was adversely associated with COPD morbidity among urban Black participants and supports the hypothesis that racial segregation plays a role in explaining health inequities affecting Black communities.
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http://dx.doi.org/10.1164/rccm.202009-3721OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491265PMC
September 2021

Disparities in access to food and chronic obstructive pulmonary disease (COPD)-related outcomes: a cross-sectional analysis.

BMC Pulm Med 2021 Apr 27;21(1):139. Epub 2021 Apr 27.

Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.

Background: Millions of Americans are living in food deserts in the United States, however the role of the local food environment on COPD has not been studied. The aim of this study is to determine the association between food deserts and COPD-related outcomes.

Method: In this cross-sectional analysis we linked data collected from SPIROMICS (SubPopulations and InteRmediate Outcome Measures in COPD Study) between 2010 and 2015 and food desert data, defined as an underserved area that lacks access to affordable healthy foods, from the Food Access Research Atlas. COPD outcomes include percentage of predicted forced expiratory volume in one second (FEV1%), St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), 6-min walk distance test (6MWD), exacerbations, and air trapping. We used generalized linear mixed models to evaluate the association between living in food deserts and respiratory outcomes, adjusting for age, gender, race, education, income, marital status, BMI, smoking status, pack years, and urban status RESULTS: Among 2713 participants, 22% lived in food deserts. Participants living in food deserts were less likely to be white and more likely to have a lower income than those who did not live in food deserts. In the adjusted model controlling for demographics and individual income, living in food deserts was associated lower FEV1% (β = - 2.51, P = 0.046), higher air trapping (β = 2.47, P = 0.008), worse SGRQ (β = 3.48, P = 0.001) and CAT (β = 1.20, P = 0.003) scores, and 56% greater odds of severe exacerbations (P = 0.004). Results were consistent when looking at food access alone, regardless of whether participants lived in low income areas.

Conclusions: Findings suggest an independent association between food desert and food access alone with COPD outcomes. Health program planning may benefit from addressing disparities in access to food.
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http://dx.doi.org/10.1186/s12890-021-01485-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077917PMC
April 2021

Epigenome-wide analysis of long-term air pollution exposure and DNA methylation in monocytes: results from the Multi-Ethnic Study of Atherosclerosis.

Epigenetics 2021 Apr 5:1-17. Epub 2021 Apr 5.

Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.

Air pollution might affect atherosclerosis through DNA methylation changes in cells crucial to atherosclerosis, such as monocytes. We conducted an epigenome-wide study of DNA methylation in CD14+ monocytes and long-term ambient air pollution exposure in adults participating in the Multi-Ethnic Study of Atherosclerosis (MESA). We also assessed the association between differentially methylated signals and -gene expression. Using spatiotemporal models, one-year average concentrations of outdoor fine particulate matter (PM) and oxides of nitrogen (NO) were estimated at participants' homes. We assessed DNA methylation and gene expression using Illumina 450k and HumanHT-12 v4 Expression BeadChips, respectively (n = 1,207). We used bump hunting and site-specific approaches to identify differentially methylated signals (false discovery rate of 0.05) and used linear models to assess associations between differentially methylated signals and -gene expression. Four differentially methylated regions (DMRs) located on chromosomes 5, 6, 7, and 16 (within or near , and , respectively) were associated with PM. The DMRs on chromosomes 5 and 6 also associated with NO. The DMR on chromosome 5 had the smallest p-value for both PM (p = 1.4×10) and NO (p = 7.7×10). Three differentially methylated CpGs were identified for PM, and cg05926640 (near ) had the smallest p-value (p = 5.6×10). NO significantly associated with cg11756214 within (p = 5.6×10). Several differentially methylated signals were also associated with -gene expression. The DMR located on chromosome 7 was associated with the expression of , and . The DMRs located on chromosomes 5 and 16 were associated with expression of and , respectively. The CpG cg05926640 was associated with expression of , and . We identified differential DNA methylation in monocytes associated with long-term air pollution exposure. Methylation signals associated with gene expression might help explain how air pollution contributes to cardiovascular disease.
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http://dx.doi.org/10.1080/15592294.2021.1900028DOI Listing
April 2021

Residential proximity to major roads and fecundability in a preconception cohort.

Environ Epidemiol 2020 Dec 11;4(6):e112. Epub 2020 Nov 11.

Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.

Emerging evidence from animal and human studies indicates that exposure to traffic-related air pollution may adversely affect fertility.

Methods: Among 7,342 female pregnancy planners from the United States and 1,448 from Canada, we examined the association between residential proximity to major roads and fecundability, the per-cycle probability of conception. From 2013 to 2019, women 21-45 years old who were trying to conceive without fertility treatment completed an online baseline questionnaire and follow-up questionnaires every 8 weeks for up to 12 months or until pregnancy. We geocoded residential addresses reported at baseline and during follow-up, and calculated distance to nearest major roads and length of major roads within buffers of 50, 100, 300, and 400 meters around the residence as proxies for traffic-related air pollution. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), adjusting for individual- and neighborhood-level characteristics.

Results: In the United States, the FR comparing women who lived <50 meters with those who lived ≥400 meters from the closest major road was 0.88 (95% CI = 0.80, 0.98). The association among Canadian women was similar in magnitude, but less precise (FR = 0.93; 95% CI = 0.74, 1.16). Likewise, length of major roads within buffers of 50 and 100 meters was associated with lower fecundability in both countries; associations were attenuated within larger buffers.

Conclusions: These results are consistent with the hypothesis that traffic-related air pollution or other near-road exposures may adversely affect fecundability.
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http://dx.doi.org/10.1097/EE9.0000000000000112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941774PMC
December 2020

Short-term exposure to air pollution and biomarkers of cardiovascular effect: A repeated measures study.

Environ Pollut 2021 Jun 11;279:116893. Epub 2021 Mar 11.

Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA. Electronic address:

To help understand the pathophysiologic mechanisms linking air pollutants and cardiovascular disease (CVD), we employed a repeated measures design to investigate the associations of four short-term air pollution exposures - particulate matter less than 2.5 μm in diameter (PM), nitrogen dioxide (NO), ozone (O) and sulfur dioxide (SO), with two blood markers involved in vascular effects of oxidative stress, soluble lectin-like oxidized LDL receptor-1 (sLOX-1) and nitrite, using data from the Multi-Ethnic Study of Atherosclerosis (MESA). Seven hundred and forty participants with plasma sLOX-1 and nitrite measurements at three exams between 2002 and 2007 were included. Daily PM, NO, O and SO zero to seven days prior to blood draw were estimated from central monitors in six MESA regions, pre-adjusted using site-specific splines of meteorology and temporal trends, and an indicator for day of the week. Unconstrained distributed lag generalized estimating equations were used to estimate net effects over eight days with adjustment for sociodemographic and behavioral factors. The results showed that higher short-term concentrations of PM, but not other pollutants, were associated with increased sLOX-1 analyzed both as a continuous outcome (percent change per interquartile increase: 16.36%, 95%CI: 0.1-35.26%) and dichotomized at the median (odds ratio per interquartile increase: 1.21, 95%CI: 1.01-1.44). The findings were not meaningfully changed after adjustment for additional covariates or in several sensitivity analyses. Pollutant concentrations were not associated with nitrite levels. This study extends earlier experimental findings of increased sLOX-1 levels following PM inhalation to a much larger population and at ambient concentrations. In light of its known mechanistic role in promoting vascular disease, sLOX-1 may be a suitable translational biomarker linking air pollutant exposures and cardiovascular outcomes.
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http://dx.doi.org/10.1016/j.envpol.2021.116893DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087633PMC
June 2021

Maternal exposure to PM during pregnancy and asthma risk in early childhood: consideration of phases of fetal lung development.

Environ Epidemiol 2021 Apr;5(2)

Department of Epidemiology, University of Washington, Box 357236, Seattle WA, USA 98195-7236.

Background: Increasingly studies suggest prenatal exposure to air pollution may increase risk of childhood asthma. Few studies have investigated exposure during specific fetal pulmonary developmental windows.

Objective: To assess associations between prenatal fine particulate matter exposure and asthma at age 4.

Methods: This study included mother-child dyads from two pregnancy cohorts-CANDLE and TIDES-within the ECHO-PATHWAYS consortium (births in 2007-2013). Three child asthma outcomes were parent-reported: ever asthma, current asthma, and current wheeze. Fine particulate matter (PM) exposures during the pseudoglandular (5-16 weeks gestation), canalicular (16-24 weeks gestation), saccular (24-36 weeks gestation), and alveolar (36+ weeks gestation) phases of fetal lung development were estimated using a national spatiotemporal model. We estimated associations with Poisson regression with robust standard errors, and adjusted for child, maternal, and neighborhood factors.

Results: Children (n=1469) were on average 4.3 (standard deviation 0.5) years old, 49% were male, and 11.7% had ever asthma; 46% of women identified as black and 53% had at least a college/technical school degree. A 2 μg/m higher PM exposure during the saccular phase was associated with 1.29 times higher risk of ever asthma (95% CI: 1.06-1.58). A similar association was observed with current asthma (RR 1.27, 95% CI: 1.04-1.54), but not current wheeze (RR 1.11, 95% CI: 0.92-1.33). Effect estimates for associations during other developmental windows had confidence intervals that included the null.

Conclusions: Later phases of prenatal lung development may be particularly sensitive to the developmental toxicity of PM.
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http://dx.doi.org/10.1097/ee9.0000000000000130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943175PMC
April 2021

Ambient air pollution and risk of respiratory infection among adults: evidence from the multiethnic study of atherosclerosis (MESA).

BMJ Open Respir Res 2021 03;8(1)

Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA.

Background: Air pollution may affect the risk of respiratory infection, though research has focused on uncommon infections or infections in children. Whether ambient air pollutants increase the risk of common acute respiratory infections among adults is uncertain, yet this may help understand whether pollutants influence spread of pandemic respiratory infections like COVID-19.

Objective: To estimate the association between ambient air pollutant exposures and respiratory infections in adults.

Methods: During five study examinations over 12 years, 6536 participants in the multiethnic study of atherosclerosis (MESA) reported upper respiratory tract infections, bronchitis, pneumonia or febrile illness in the preceding 2 weeks. Using a validated spatiotemporal model, we estimated residential concentrations of ambient PM, NO and NO for the 2-6 weeks (short-term) and year (long-term) prior to each examination.

Results: In this population aged 44-84 years at baseline, 10%-32% of participants reported a recent respiratory infection, depending on month of examination and study region. PM, NO and NO concentrations over the prior 2-6 weeks were associated with increased reporting of recent respiratory infection, with risk ratios (95% CIs) of 1.04 (1.00 to 1.09), 1.15 (1.10 to 1.20) and 1.21 (1.10 to 1.33), respectively, per increase from 25th to 75th percentile in residential pollutant concentration.

Conclusion: Higher short-term exposure to PM and traffic-related pollutants are associated with increased risk of symptomatic acute respiratory infections among adults. These findings may provide an insight into the epidemiology of COVID-19.
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http://dx.doi.org/10.1136/bmjresp-2020-000866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934778PMC
March 2021

Improving Air Pollution Predictions of Long-Term Exposure Using Short-Term Mobile and Stationary Monitoring in Two US Metropolitan Regions.

Environ Sci Technol 2021 03 26;55(6):3530-3538. Epub 2021 Feb 26.

Department of Environmental and Occupational Health Sciences, University of Washington, Box 357234, Seattle, Washington 98195, United States.

Mobile monitoring is increasingly employed to measure fine spatial-scale variation in air pollutant concentrations. However, mobile measurement campaigns are typically conducted over periods much shorter than the decadal periods used for modeling chronic exposure for use in air pollution epidemiology. Using the regions of Los Angeles and Baltimore and the time period from 2005 to 2014 as our modeling domain, we investigate whether including mobile or stationary passive sampling device (PSD) monitoring data collected over a single 2-week period in one or two seasons using a unified spatio-temporal air pollution model can improve model performance in predicting NO and NO concentrations throughout the 9-year study period beyond what is possible using only routine monitoring data. In this initial study, we use data from mobile measurement campaigns conducted contemporaneously with deployments of stationary PSDs and only use mobile data collected within 300 m of a stationary PSD location for inclusion in the model. We find that including either mobile or PSD data substantially improves model performance for pollutants and locations where model performance was initially the worst (with the most-improved changing from 0.40 to 0.82) but does not meaningfully change performance in cases where performance was already very good. Results indicate that in many cases, additional spatial information from mobile monitoring and personal sampling is potentially cost-efficient inexpensive way of improving exposure predictions at both 2-week and decadal averaging periods, especially for the predictions that are located closer to features such as roadways targeted by the mobile short-term monitoring campaign.
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http://dx.doi.org/10.1021/acs.est.0c04328DOI Listing
March 2021

Fine Particulate Matter and Markers of Alzheimer's Disease Neuropathology at Autopsy in a Community-Based Cohort.

J Alzheimers Dis 2021 ;79(4):1761-1773

Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA.

Background: Evidence links fine particulate matter (PM2.5) to Alzheimer's disease (AD), but no community-based prospective cohort studies in older adults have evaluated the association between long-term exposure to PM2.5 and markers of AD neuropathology at autopsy.

Objective: Using a well-established autopsy cohort and new spatiotemporal predictions of air pollution, we evaluated associations of 10-year PM2.5 exposure prior to death with Braak stage, Consortium to Establish a Registry for AD (CERAD) score, and combined AD neuropathologic change (ABC score).

Methods: We used autopsy specimens (N = 832) from the Adult Changes in Thought (ACT) study, with enrollment ongoing since 1994. We assigned long-term exposure at residential address based on two-week average concentrations from a newly developed spatiotemporal model. To account for potential selection bias, we conducted inverse probability weighting. Adjusting for covariates with tiered models, we performed ordinal regression for Braak and CERAD and logistic regression for dichotomized ABC score.

Results: 10-year average (SD) PM2.5 from death across the autopsy cohort was 8.2 (1.9) μg/m3. Average age (SD) at death was 89 (7) years. Each 1μg/m3 increase in 10-year average PM2.5 prior to death was associated with a suggestive increase in the odds of worse neuropathology as indicated by CERAD score (OR: 1.35 (0.90, 1.90)) but a suggestive decreased odds of neuropathology as defined by the ABC score (OR: 0.79 (0.49, 1.19)). There was no association with Braak stage (OR: 0.99 (0.64, 1.47)).

Conclusion: We report inconclusive associations between PM2.5 and AD neuropathology at autopsy among a cohort where 94% of individuals experienced 10-year exposures below the current EPA standard. Prior studies of AD risk factors and AD neuropathology are similarly inconclusive, suggesting alternative mechanistic pathways for disease or residual confounding.
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http://dx.doi.org/10.3233/JAD-201005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061707PMC
September 2021

A New Era for 's International Program.

Environ Health Perspect 2021 01 5;129(1):11001. Epub 2021 Jan 5.

Environmental Health Perspectives, National Institute of Environmental Health Sciences, National Institutes of Health, U.S. Department of Health and Human Services, Research Triangle Park, North Carolina, USA.

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http://dx.doi.org/10.1289/EHP8737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785294PMC
January 2021

Outdoor air pollution exposure and inter-relation of global cognitive performance and emotional distress in older women.

Environ Pollut 2021 Feb 14;271:116282. Epub 2020 Dec 14.

University of Southern California, Los Angeles, CA, USA. Electronic address:

The interrelationships among long-term ambient air pollution exposure, emotional distress and cognitive decline in older adulthood remain unclear. Long-term exposure may impact cognitive performance and subsequently impact emotional health. Conversely, exposure may initially be associated with emotional distress followed by declines in cognitive performance. Here we tested the inter-relationship between global cognitive ability, emotional distress, and exposure to PM (particulate matter with aerodynamic diameter <2.5 μm) and NO (nitrogen dioxide) in 6118 older women (aged 70.6 ± 3.8 years) from the Women's Health Initiative Memory Study. Annual exposure to PM (interquartile range [IQR] = 3.37 μg/m) and NO (IQR = 9.00 ppb) was estimated at the participant's residence using regionalized national universal kriging models and averaged over the 3-year period before the baseline assessment. Using structural equation mediation models, a latent factor capturing emotional distress was constructed using item-level data from the 6-item Center for Epidemiological Studies Depression Scale and the Short Form Health Survey Emotional Well-Being scale at baseline and one-year follow-up. Trajectories of global cognitive performance, assessed by the Modified-Mini Mental State Examination (3MS) annually up to 12 years, were estimated. All effects reported were adjusted for important confounders. Increases in PM (β = -0.144 per IQR; 95% CI = -0.261; -0.028) and NO (β = -0.157 per IQR; 95% CI = -0.291; -0.022) were associated with lower initial 3MS performance. Lower 3MS performance was associated with increased emotional distress (β = -0.008; 95% CI = -0.015; -0.002) over the subsequent year. Significant indirect effect of both exposures on increases in emotional distress mediated by exposure effects on worse global cognitive performance were present. No statistically significant indirect associations were found between exposures and 3MS trajectories putatively mediated by baseline emotional distress. Our study findings support cognitive aging processes as a mediator of the association between PM and NO exposure and emotional distress in later-life.
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http://dx.doi.org/10.1016/j.envpol.2020.116282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017598PMC
February 2021

Cardiopulmonary Impact of Particulate Air Pollution in High-Risk Populations: JACC State-of-the-Art Review.

J Am Coll Cardiol 2020 12;76(24):2878-2894

Division of Cardiovascular Diseases, Wayne State University, Detroit, Michigan, USA.

Fine particulate air pollution <2.5 μm in diameter (PM) is a major environmental threat to global public health. Multiple national and international medical and governmental organizations have recognized PM as a risk factor for cardiopulmonary diseases. A growing body of evidence indicates that several personal-level approaches that reduce exposures to PM can lead to improvements in health endpoints. Novel and forward-thinking strategies including randomized clinical trials are important to validate key aspects (e.g., feasibility, efficacy, health benefits, risks, burden, costs) of the various protective interventions, in particular among real-world susceptible and vulnerable populations. This paper summarizes the discussions and conclusions from an expert workshop, Reducing the Cardiopulmonary Impact of Particulate Matter Air Pollution in High Risk Populations, held on May 29 to 30, 2019, and convened by the National Institutes of Health, the U.S. Environmental Protection Agency, and the U.S. Centers for Disease Control and Prevention.
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http://dx.doi.org/10.1016/j.jacc.2020.10.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040922PMC
December 2020

Air Pollution and the Dynamic Association Between Depressive Symptoms and Memory in Oldest-Old Women.

J Am Geriatr Soc 2021 02 17;69(2):474-484. Epub 2020 Nov 17.

Department of Neurology, University of Southern California, Los Angeles, California, USA.

Background/objectives: Exposure to air pollution may contribute to both increasing depressive symptoms and decreasing episodic memory in older adulthood, but few studies have examined this hypothesis in a longitudinal context. Accordingly, we examined the association between air pollution and changes in depressive symptoms (DS) and episodic memory (EM) and their interrelationship in oldest-old (aged 80 and older) women.

Design: Prospective cohort data from the Women's Health Initiative Memory Study-Epidemiology of Cognitive Health Outcomes.

Setting: Geographically diverse community-dwelling population.

Participants: A total of 1,583 dementia-free women aged 80 and older.

Measurements: Women completed up to six annual memory assessments (latent composite of East Boston Memory Test and Telephone Interview for Cognitive Status) and the 15-item Geriatric Depression Scale (GDS-15). We estimated 3-year average exposures to regional particulate matter with aerodynamic diameter below 2.5 μm (PM ) (interquartile range [IQR] = 3.35 μg/m ) and gaseous nitrogen dioxide (NO ) (IQR = 9.55 ppb) at baseline and during a remote period 10 years earlier, using regionalized national universal kriging.

Results: Latent change structural equation models examined whether residing in areas with higher pollutant levels was associated with annual changes in standardized EM and DS while adjusting for potential confounders. Remote NO (β = .287 per IQR; P = .002) and PM (β = .170 per IQR; P = .019) exposure was significantly associated with larger increases in standardized DS, although the magnitude of the difference, less than 1 point on the GDS-15, is of questionable clinical significance. Higher DS were associated with accelerated EM declines (β = -.372; P = .001), with a significant indirect effect of remote NO and PM exposure on EM declines mediated by DS. There were no other significant indirect exposure effects.

Conclusion: These findings in oldest-old women point to potential adverse effects of late-life exposure to air pollution on subsequent interplay between DS and EM, highlighting air pollution as an environmental health risk factor for older women.
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http://dx.doi.org/10.1111/jgs.16889DOI Listing
February 2021

Guidance to Reduce the Cardiovascular Burden of Ambient Air Pollutants: A Policy Statement From the American Heart Association.

Circulation 2020 12 5;142(23):e432-e447. Epub 2020 Nov 5.

In 2010, the American Heart Association published a statement concluding that the existing scientific evidence was consistent with a causal relationship between exposure to fine particulate matter and cardiovascular morbidity and mortality, and that fine particulate matter exposure is a modifiable cardiovascular risk factor. Since the publication of that statement, evidence linking air pollution exposure to cardiovascular health has continued to accumulate and the biological processes underlying these effects have become better understood. This increasingly persuasive evidence necessitates policies to reduce harmful exposures and the need to act even as the scientific evidence base continues to evolve. Policy options to mitigate the adverse health impacts of air pollutants must include the reduction of emissions through action on air quality, vehicle emissions, and renewable portfolio standards, taking into account racial, ethnic, and economic inequality in air pollutant exposure. Policy interventions to improve air quality can also be in alignment with policies that benefit community and transportation infrastructure, sustainable food systems, reduction in climate forcing agents, and reduction in wildfires. The health care sector has a leadership role in adopting policies to contribute to improved environmental air quality as well. There is also potentially significant private sector leadership and industry innovation occurring in the absence of and in addition to public policy action, demonstrating the important role of public-private partnerships. In addition to supporting education and research in this area, the American Heart Association has an important leadership role to encourage and support public policies, private sector innovation, and public-private partnerships to reduce the adverse impact of air pollution on current and future cardiovascular health in the United States.
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http://dx.doi.org/10.1161/CIR.0000000000000930DOI Listing
December 2020

Long-term community noise exposure in relation to dementia, cognition, and cognitive decline in older adults.

Alzheimers Dement 2021 03 20;17(3):525-533. Epub 2020 Oct 20.

School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.

Introduction: Exposure to noise might influence risk of Alzheimer's disease (AD) dementia.

Methods: Participants of the Chicago Health and Aging Project (≥65 years) underwent triennial cognitive assessments. For the 5 years preceding each assessment, we estimated 5227 participants' residential level of noise from the community using a spatial prediction model, and estimated associations of noise level with prevalent mild cognitive impairment (MCI) and AD, cognitive performance, and rate of cognitive decline.

Results: Among these participants, an increment of 10 A-weighted decibels (dBA) in noise corresponded to 36% and 29% higher odds of prevalent MCI (odds ratio [OR] = 1.36; 95% confidence interval [CI], 1.15 to 1.62) and AD (OR = 1.29, 95% CI, 1.08 to 1.55). Noise level was associated with worse global cognitive performance, principally in perceptual speed (-0.09 standard deviation per 10 dBA, 95% CI: -0.16 to -0.03), but not consistently associated with cognitive decline.

Discussion: These results join emerging evidence suggesting that noise may influence late-life cognition and risk of dementia.
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http://dx.doi.org/10.1002/alz.12191DOI Listing
March 2021

Associations between neighborhood park space and cognition in older adults vary by US location: The Multi-Ethnic Study of Atherosclerosis.

Health Place 2020 11 10;66:102459. Epub 2020 Oct 10.

Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, 4225 Roosevelt Way NW, Suite 308, Seattle, WA, 98105, USA. Electronic address:

We used cross-sectional Multi-Ethnic Study of Atherosclerosis data from six US cities/counties and adjusted multilevel linear regression to examine park space-cognition associations among non-demented older adults (n = 4084). We found that greater neighborhood park space 1-mile around the residence (measured continuously) was associated with better processing speed in the overall sample (estimate: 0.48; 95% CI: 0.03, 0.92). However, greater neighborhood park space (½-mile around residence) was associated with worse global cognition in Los Angeles, California (estimate: -2.66; 95% CI: -4.70, -0.62) and worse processing speed in Forsyth County, North Carolina (estimate: -0.72; 95% CI: -1.37, -0.08). Dichotomizing at the mean, having ≥6% park space (½-mile around residence) was associated with better global cognition in Saint Paul, Minnesota (estimate: 0.21; 95% CI: 0.05, 0.38), and better processing speed in New York City (estimate: 0.19; 95% CI: 0.04, 0.35). Park space-cognition associations varied by city/county, suggesting problems with pooling multiple sites without accounting for geographic context or regionally-varying park characteristics (e.g., quality).
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http://dx.doi.org/10.1016/j.healthplace.2020.102459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8274384PMC
November 2020

Modeling residential indoor concentrations of PM , NO , NO , and secondhand smoke in the Subpopulations and Intermediate Outcome Measures in COPD (SPIROMICS) Air study.

Indoor Air 2021 05 28;31(3):702-716. Epub 2020 Dec 28.

Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.

Increased outdoor concentrations of fine particulate matter (PM ) and oxides of nitrogen (NO , NO ) are associated with respiratory and cardiovascular morbidity in adults and children. However, people spend most of their time indoors and this is particularly true for individuals with chronic obstructive pulmonary disease (COPD). Both outdoor and indoor air pollution may accelerate lung function loss in individuals with COPD, but it is not feasible to measure indoor pollutant concentrations in all participants in large cohort studies. We aimed to understand indoor exposures in a cohort of adults (SPIROMICS Air, the SubPopulations and Intermediate Outcome Measures in COPD Study of Air pollution). We developed models for the entire cohort based on monitoring in a subset of homes, to predict mean 2-week-measured concentrations of PM , NO , NO , and nicotine, using home and behavioral questionnaire responses available in the full cohort. Models incorporating socioeconomic, meteorological, behavioral, and residential information together explained about 60% of the variation in indoor concentration of each pollutant. Cross-validated R for best indoor prediction models ranged from 0.43 (NO ) to 0.51 (NO ). Models based on questionnaire responses and estimated outdoor concentrations successfully explained most variation in indoor PM , NO , NO , and nicotine concentrations.
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http://dx.doi.org/10.1111/ina.12760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202242PMC
May 2021

Contribution of Individual and Neighborhood Factors to Racial Disparities in Respiratory Outcomes.

Am J Respir Crit Care Med 2021 04;203(8):987-997

Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.

Black adults have worse health outcomes compared with white adults in certain chronic diseases, including chronic obstructive pulmonary disease (COPD). To determine to what degree disadvantage by individual and neighborhood socioeconomic status (SES) may contribute to racial disparities in COPD outcomes. Individual and neighborhood-scale sociodemographic characteristics were determined in 2,649 current or former adult smokers with and without COPD at recruitment into SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). We assessed whether racial differences in symptom, functional, and imaging outcomes (St. George's Respiratory Questionnaire, COPD Assessment Test score, modified Medical Research Council dyspnea scale, 6-minute-walk test distance, and computed tomography [CT] scan metrics) and severe exacerbation risk were explained by individual or neighborhood SES. Using generalized linear mixed model regression, we compared respiratory outcomes by race, adjusting for confounders and individual-level and neighborhood-level descriptors of SES both separately and sequentially. After adjusting for COPD risk factors, Black participants had significantly worse respiratory symptoms and quality of life (modified Medical Research Council scale, COPD Assessment Test, and St. George's Respiratory Questionnaire), higher risk of severe exacerbations and higher percentage of emphysema, thicker airways (internal perimeter of 10 mm), and more air trapping on CT metrics compared with white participants. In addition, the association between Black race and respiratory outcomes was attenuated but remained statistically significant after adjusting for individual-level SES, which explained up to 12-35% of racial disparities. Further adjustment showed that neighborhood-level SES explained another 26-54% of the racial disparities in respiratory outcomes. Even after accounting for both individual and neighborhood SES factors, Black individuals continued to have increased severe exacerbation risk and persistently worse CT outcomes (emphysema, air trapping, and airway wall thickness). Disadvantages by individual- and neighborhood-level SES each partly explain disparities in respiratory outcomes between Black individuals and white individuals. Strategies to narrow the gap in SES disadvantages may help to reduce race-related health disparities in COPD; however, further work is needed to identify additional risk factors contributing to persistent disparities.
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http://dx.doi.org/10.1164/rccm.202002-0253OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8048743PMC
April 2021
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