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      Geospatial relationships of air pollution and acute asthma events across the Detroit–Windsor international border: Study design and preliminary results

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          Abstract

          The Geospatial Determinants of Health Outcomes Consortium (GeoDHOC) study investigated ambient air quality across the international border between Detroit, Michigan, USA and Windsor, Ontario, Canada and its association with acute asthma events in 5- to 89-year-old residents of these cities. NO 2, SO 2, and volatile organic compounds (VOCs) were measured at 100 sites, and particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) at 50 sites during two 2-week sampling periods in 2008 and 2009. Acute asthma event rates across neighborhoods in each city were calculated using emergency room visits and hospitalizations and standardized to the overall age and gender distribution of the population in the two cities combined. Results demonstrate that intra-urban air quality variations are related to adverse respiratory events in both cities. Annual 2008 asthma rates exhibited statistically significant positive correlations with total VOCs and total benzene, toluene, ethylbenzene and xylene (BTEX) at 5-digit zip code scale spatial resolution in Detroit. In Windsor, NO 2, VOCs, and PM 10 concentrations correlated positively with 2008 asthma rates at a similar 3-digit postal forward sortation area scale. The study is limited by its coarse temporal resolution (comparing relatively short term air quality measurements to annual asthma health data) and interpretation of findings is complicated by contrasts in population demographics and health-care delivery systems in Detroit and Windsor.

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          Most cited references45

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          Spatial analysis of air pollution and mortality in Los Angeles.

          The assessment of air pollution exposure using only community average concentrations may lead to measurement error that lowers estimates of the health burden attributable to poor air quality. To test this hypothesis, we modeled the association between air pollution and mortality using small-area exposure measures in Los Angeles, California. Data on 22,905 subjects were extracted from the American Cancer Society cohort for the period 1982-2000 (5,856 deaths). Pollution exposures were interpolated from 23 fine particle (PM2.5) and 42 ozone (O3) fixed-site monitors. Proximity to expressways was tested as a measure of traffic pollution. We assessed associations in standard and spatial multilevel Cox regression models. After controlling for 44 individual covariates, all-cause mortality had a relative risk (RR) of 1.17 (95% confidence interval=1.05-1.30) for an increase of 10 mug/m PM2.5 and a RR of 1.11 (0.99-1.25) with maximal control for both individual and contextual confounders. The RRs for mortality resulting from ischemic heart disease and lung cancer deaths were elevated, in the range of 1.24-1.6, depending on the model used. These PM results were robust to adjustments for O3 and expressway exposure. Our results suggest the chronic health effects associated with within-city gradients in exposure to PM2.5 may be even larger than previously reported across metropolitan areas. We observed effects nearly 3 times greater than in models relying on comparisons between communities. We also found specificity in cause of death, with PM2.5 associated more strongly with ischemic heart disease than with cardiopulmonary or all-cause mortality.
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            A systematic review of the relation between long-term exposure to ambient air pollution and chronic diseases.

            We conducted a systematic review of all studies published between 1950 and 2007 of associations between long-term exposure to ambient air pollution and the risks in adults of nonaccidental mortality and the incidence and mortality from cancer and cardiovascular and respiratory diseases. We searched bibliographic databases for cohort and case-control studies, abstracted characteristics of their design and conduct, and synthesized the quantitative findings in tabular and graphic form. We assessed heterogeneity, estimated pooled effects for specific pollutants, and conducted sensitivity analyses according to selected characteristics of the studies. Our analysis showed that long-term exposure to PM2.5 increases the risk of nonaccidental mortality by 6% per a 10 microg/m3 increase, independent of age, gender, and geographic region. Exposure to PM2.5 was also associated with an increased risk of mortality from lung cancer (range: 15% to 21% per a 10 microg/m3 increase) and total cardiovascular mortality (range: 12% to 14% per a 10 microg/m3 increase). In addition, living close to busy traffic appears to be associated with elevated risks of these three outcomes. Suggestive evidence was found that exposure to PM2.5 is positively associated with mortality from coronary heart diseases and exposure to SO2 increases mortality from lung cancer. For the other pollutants and health outcomes, the data were insufficient data to make solid conclusions.
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              Ecologic versus individual-level sources of bias in ecologic estimates of contextual health effects.

              A number of authors have attempted to defend ecologic (aggregate) studies by claiming that the goal of those studies is estimation of ecologic (contextual or group-level) effects rather than individual-level effects. Critics of these attempts point out that ecologic effect estimates are inevitably used as estimates of individual effects, despite disclaimers. A more subtle problem is that ecologic variation in the distribution of individual effects can bias ecologic estimates of contextual effects. The conditions leading to this bias are plausible and perhaps even common in studies of ecosocial factors and health outcomes because social context is not randomized across typical analysis units (administrative regions). By definition, ecologic data contain only marginal observations on the joint distribution of individually defined confounders and outcomes, and so identify neither contextual nor individual-level effects. While ecologic studies can still be useful given appropriate caveats, their problems are better addressed by multilevel study designs, which obtain and use individual as well as group-level data. Nonetheless, such studies often share certain special problems with ecologic studies, including problems due to inappropriate aggregation and problems due to temporal changes in covariate distributions.
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                Author and article information

                Journal
                J Expo Sci Environ Epidemiol
                J Expo Sci Environ Epidemiol
                Journal of Exposure Science & Environmental Epidemiology
                Nature Publishing Group
                1559-0631
                1559-064X
                July 2014
                13 November 2013
                : 24
                : 4
                : 346-357
                Affiliations
                [1 ]Department of Geology, Wayne State University , Detroit, Michigan, USA
                [2 ]Department of Public Health Sciences, Henry Ford Health System , Detroit, Michigan, USA
                [3 ]Department of Civil and Environmental Engineering, University of Windsor , Windsor, Ontario, Canada
                [4 ]Department of Academic and Student Programs, Wayne State University , Detroit, Michigan, USA
                [5 ]Institute of Environmental Health Sciences, Wayne State University , Detroit, Michigan, USA
                [6 ]School of Nursing, Eastern Michigan University , Ypsilanti, Michigan, USA
                [7 ]Department of Health Sciences, Carleton University , Ottawa, Ontario, Canada
                [8 ]Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario, Canada
                [9 ]Environmental Issues Division, Public Health Agency of Canada , Ottawa, Ontario, Canada
                [10 ]College of Nursing, Wayne State University , Detroit, Michigan, USA
                Author notes
                [* ]Department of Geology, Wayne State University , Room 0224 Old Main, Detroit, MI 48202, USA. Tel: +1-313-577-6412. Fax: +1-313-577-0517. E-mail: ldlemke@ 123456wayne.edu
                Article
                jes201378
                10.1038/jes.2013.78
                4063324
                24220215
                d5f87683-8fb1-42fc-9564-ad3f41ac2e98
                Copyright © 2014 Nature America, Inc.

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/

                History
                : 12 April 2013
                : 30 July 2013
                : 11 September 2013
                Categories
                Original Article

                Occupational & Environmental medicine
                asthma,air pollution,detroit,windsor,international,geospatial
                Occupational & Environmental medicine
                asthma, air pollution, detroit, windsor, international, geospatial

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