Effects of Ultrafine Particles in Ambient Air on Primary Health Care Consultations for Diabetes in Children and Elderly Population in Ljubljana, Slovenia: A 5-Year Time-Trend Study

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Abstract

Epidemiological studies indicate that exposure to ultrafine particles (UFP) in ambient air represents an important environmental public health issue. The aim of this study was to determine the association between UFP in ambient air and the daily number of consultations in the primary health care unit due to diabetes mellitus in children and elderly population of the Municipality of Ljubljana. A 5-year time-trend ecological study was carried out for the period between 1 January 2013 and 31 December 2017. The daily number of primary health care consultations due to diabetes mellitus among children and elderly population was observed as the health outcome. Daily mean UFP concentrations (different size from 10 to 100 nm) were measured and calculated. Poisson regression analysis was used to investigate the association between the observed outcome and the daily UFP, particulate matter fine fraction (PM _2.5), and particulate matter coarse fraction (PM ₁₀) concentrations, adjusted to other covariates. The results show that the daily number of consultations due to diabetes mellitus were highly significantly associated with the daily concentrations of UFP (10 to 20 nm; p ≤ 0.001 and 20 to 30 nm; p ≤ 0.001) in all age groups and in the elderly population. In observed the population of children, we did not confirm the association. Findings indicate that specified environmental challenges should be addressed by comprehensive public health strategies leading to the coordinated cross-sectoral measures for the reduction of UFP in ambient air and the mitigation of adverse health effects.

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Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE).

Ole Raaschou-Nielsen, Zorana J. Andersen, Rob Beelen … (2013)

Ambient air pollution is suspected to cause lung cancer. We aimed to assess the association between long-term exposure to ambient air pollution and lung cancer incidence in European populations. This prospective analysis of data obtained by the European Study of Cohorts for Air Pollution Effects used data from 17 cohort studies based in nine European countries. Baseline addresses were geocoded and we assessed air pollution by land-use regression models for particulate matter (PM) with diameter of less than 10 μm (PM10), less than 2·5 μm (PM2·5), and between 2·5 and 10 μm (PMcoarse), soot (PM2·5absorbance), nitrogen oxides, and two traffic indicators. We used Cox regression models with adjustment for potential confounders for cohort-specific analyses and random effects models for meta-analyses. The 312 944 cohort members contributed 4 013 131 person-years at risk. During follow-up (mean 12·8 years), 2095 incident lung cancer cases were diagnosed. The meta-analyses showed a statistically significant association between risk for lung cancer and PM10 (hazard ratio [HR] 1·22 [95% CI 1·03-1·45] per 10 μg/m(3)). For PM2·5 the HR was 1·18 (0·96-1·46) per 5 μg/m(3). The same increments of PM10 and PM2·5 were associated with HRs for adenocarcinomas of the lung of 1·51 (1·10-2·08) and 1·55 (1·05-2·29), respectively. An increase in road traffic of 4000 vehicle-km per day within 100 m of the residence was associated with an HR for lung cancer of 1·09 (0·99-1·21). The results showed no association between lung cancer and nitrogen oxides concentration (HR 1·01 [0·95-1·07] per 20 μg/m(3)) or traffic intensity on the nearest street (HR 1·00 [0·97-1·04] per 5000 vehicles per day). Particulate matter air pollution contributes to lung cancer incidence in Europe. European Community's Seventh Framework Programme. Copyright © 2013 Elsevier Ltd. All rights reserved.

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Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project

Rob Beelen, Ole Raaschou-Nielsen, Massimo Stafoggia … (2014)

Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants. We used data from 22 European cohort studies, which created a total study population of 367,251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM10), and between 10 μm and 2.5 μm (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and NOx), with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buffer. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects meta-analysis. The total study population consisted of 367,251 participants who contributed 5,118,039 person-years at risk (average follow-up 13.9 years), of whom 29,076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM2.5 of 1.07 (95% CI 1.02-1.13) per 5 μg/m(3) was recorded. No heterogeneity was noted between individual cohort effect estimates (I(2) p value=0.95). HRs for PM2.5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 μg/m(3) (HR 1.06, 95% CI 1.00-1.12) or below 20 μg/m(3) (1.07, 1.01-1.13). Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value. European Community's Seventh Framework Program (FP7/2007-2011). Copyright © 2014 Elsevier Ltd. All rights reserved.

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Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions

Jos Lelieveld, Klaus Klingmüller, Andrea Pozzer … (2019)

Abstract Aims Ambient air pollution is a major health risk, leading to respiratory and cardiovascular mortality. A recent Global Exposure Mortality Model, based on an unmatched number of cohort studies in many countries, provides new hazard ratio functions, calling for re-evaluation of the disease burden. Accordingly, we estimated excess cardiovascular mortality attributed to air pollution in Europe. Methods and results The new hazard ratio functions have been combined with ambient air pollution exposure data to estimate the impacts in Europe and the 28 countries of the European Union (EU-28). The annual excess mortality rate from ambient air pollution in Europe is 790 000 [95% confidence interval (95% CI) 645 000–934 000], and 659 000 (95% CI 537 000–775 000) in the EU-28. Between 40% and 80% are due to cardiovascular events, which dominate health outcomes. The upper limit includes events attributed to other non-communicable diseases, which are currently not specified. These estimates exceed recent analyses, such as the Global Burden of Disease for 2015, by more than a factor of two. We estimate that air pollution reduces the mean life expectancy in Europe by about 2.2 years with an annual, attributable per capita mortality rate in Europe of 133/100 000 per year. Conclusion We provide new data based on novel hazard ratio functions suggesting that the health impacts attributable to ambient air pollution in Europe are substantially higher than previously assumed, though subject to considerable uncertainty. Our results imply that replacing fossil fuels by clean, renewable energy sources could substantially reduce the loss of life expectancy from air pollution.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Environ Res Public Health

Journal ID (iso-abbrev): Int J Environ Res Public Health

Journal ID (publisher-id): ijerph

Title: International Journal of Environmental Research and Public Health

Publisher: MDPI

ISSN (Print): 1661-7827

ISSN (Electronic): 1660-4601

Publication date (Electronic): 10 July 2020

Publication date (Print): July 2020

Volume: 17

Issue: 14

Electronic Location Identifier: 4970

Affiliations

[1 ]National Laboratory of Health, Environment and Food, Prvomajska 1, 2000 Maribor, Slovenia; vesna.viher.hrzenjak@ 123456nlzoh.si

[2 ]Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; andreja.kukec@ 123456mf.uni-lj.si (A.K.); ivan.erzen@ 123456nijz.si (I.E.)

[3 ]National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia

Author notes

[* ]Correspondence: dalibor.stanimirovic@ 123456nijz.si ; Tel.: +386-1244-1413

Article

Publisher ID: ijerph-17-04970

DOI: 10.3390/ijerph17144970

PMC ID: 7400531

PubMed ID: 32664229

SO-VID: ba17bcda-be3d-437d-b68d-dd1ce8891d4b

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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Effects of Ultrafine Particles in Ambient Air on Primary Health Care Consultations for Diabetes in Children and Elderly Population in Ljubljana, Slovenia: A 5-Year Time-Trend Study

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Most cited references 66

Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE).

Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project

Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions

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