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Combined effects of prenatal polycyclic aromatic hydrocarbons and material hardship on child IQ

May 10th, 2015
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http://www.sciencedirect.com/science/article/pii/S0892036215000380

Highlights
•PAH–DNA adducts in cord blood provided an individual measure of prenatal exposure.
•Material hardship in pregnancy and child’s early life proxied economic deprivation.
•Adverse effects on child IQ at age 7 were seen only among mothers with hardship.
•Interaction between high adducts and hardship on working memory was significant.
•These results indicate the need for a multifaceted approach to prevention.

Abstract

Importance

Polycyclic aromatic hydrocarbons are common carcinogenic and neurotoxic urban air pollutants. Toxic exposures, including air pollution, are disproportionately high in communities of color and frequently co-occur with chronic economic deprivation.

Objectives

We examined whether the association between child IQ and prenatal exposure to polycyclic aromatic hydrocarbons differed between groups of children whose mothers reported high vs. low material hardship during their pregnancy and through child age 5. We tested statistical interactions between hardships and polycyclic aromatic hydrocarbons, as measured by DNA adducts in cord blood, to determine whether material hardship exacerbated the association between adducts and IQ scores.

Design

Prospective cohort. Participants were recruited from 1998 to 2006 and followed from gestation through age 7 years.

Setting

Urban community (New York City)

Participants

A community-based sample of 276 minority urban youth

Exposure measure

Polycyclic aromatic hydrocarbon–DNA adducts in cord blood as an individual biomarker of prenatal polycyclic aromatic hydrocarbon exposure. Maternal material hardship self-reported prenatally and at multiple timepoints through early childhood.

Main outcome measure

Child IQ at 7 years assessed using the Wechsler Intelligence Scale for Children.

Results

Significant inverse effects of high cord PAH–DNA adducts on full scale IQ, perceptual reasoning and working memory scores were observed in the groups whose mothers reported a high level of material hardship during pregnancy or recurring high hardship into the child’s early years, and not in those without reported high hardship. Significant interactions were observed between high cord adducts and prenatal hardship on working memory scores (β = − 8.07, 95% CI (− 14.48, − 1.66)) and between high cord adducts and recurrent material hardship (β = − 9.82, 95% CI (− 16.22, − 3.42)).

Conclusion

The findings add to other evidence that socioeconomic disadvantage can increase the adverse effects of toxic physical “stressors” like air pollutants. Observed associations between high cord adducts and reduced IQ were significant only among the group of children whose mothers reported high material hardship. These results indicate the need for a multifaceted approach to prevention.

Air pollution costs European economies US$ 1.6 trillion a year in diseases and deaths, new WHO study says

Apr 28th, 2015
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A staggering US$ 1.6 trillion is the economic cost of the approximate 600 000 premature deaths and of the diseases caused by air pollution in the WHO European Region in 2010, according to the first-ever study of these costs conducted for the Region. The amount is nearly equivalent to one tenth of the gross domestic product (GDP) of the entire European Union in 2013.

The new study was published today by the WHO Regional Office for Europe and the Organisation for Economic Co-operation and Development (OECD) as a 3-day high-level meeting on environment and health in Europe opens. Over 200 representatives from European countries and international and nongovernmental organizations gather in Haifa, Israel, on 28–30 April 2015 to look at achievements, gaps and challenges and set future priorities.

“Curbing the health effects of air pollution pays dividends. The evidence we have provides decision-makers across the whole of government with a compelling reason to act. If different sectors come together on this, we not only save more lives but also achieve results that are worth astounding amounts of money,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “Cross-sectoral work is the backbone of the environment and health process, which was initiated 26 years ago, and it is even more relevant today in the discussions taking place at this meeting in Haifa.”

A ground-breaking report: economic cost of the health impact of air pollution in Europe

Economic cost of the health impact of air pollution in Europe is the first assessment of the economic burden of deaths and diseases resulting from outdoor and indoor air pollution in the 53 countries of the Region.

The economic cost of deaths alone accounts for over US$ 1.4 trillion. Adding another 10% to this, as the cost of diseases from air pollution, results in a total of almost US$ 1.6 trillion. In no less than 10 of the 53 countries of the Region, this cost is at or above 20% of national GDP (see Annex for data by country). The study uses the methodology applied in a 2014 report by OECD and makes the calculations based on the most recent economic estimates of the health impacts of air pollution.

The economic value of deaths and diseases due to air pollution – US$ 1 600 000 000 000 – corresponds to the amount societies are willing to pay to avoid these deaths and diseases with necessary interventions. In these calculations, a value is attached to each death and disease, independent of the age of the person and which varies according to the national economic context.

Air pollution: the single largest environmental health risk

Over 90% of citizens in the Region are exposed to annual levels of outdoor fine particulate matter that are above WHO’s air quality guidelines. This accounted for 482 000 premature deaths in 2012 from heart and respiratory diseases, blood vessel conditions and strokes, and lung cancer. In the same year, indoor air pollution resulted in an additional 117 200 premature deaths, five times more in low- and middle-income countries than in high-income countries.

“Reducing air pollution has become a top political priority. Air quality will be a key theme at the next Environment for Europe Ministerial Conference in Georgia in 2016”, says Mr Christian Friis Bach, Executive Secretary of the United Nations Economic Commission for Europe (UNECE). “Fifty-one countries are today finding joint solutions in the framework of the UNECE Convention on Long-range Transboundary Air Pollution. This work must be strengthened to reduce air pollution even further and extended to more countries and to other regions.”

“About 2500 people are estimated to die in Israel annually as a result of exposure to air pollutants. The main source of air pollution is transportation, mainly in major city centres,” says Mr Ofir Akunis, Deputy Minister of Environmental Protection and Member of Knesset (Parliament) for Israel. “Since 2011, the Ministry of Environmental Protection’s Clean Air Law regulates pollutants from major sources such as transport, industry and energy in accordance with the most stringent standards. The Ministry aims to use all available resources to reduce air pollution, as this means saving the lives of thousands of people, as well as billions to the Israeli economy”.

Improving environment and health in Europe: how far have we gotten?

The cost of the health impacts of air pollution is only one of many studies that will provide evidence on the environmental impacts on health to be released at the Haifa meeting.

Another new report, Improving environment and health in Europe: how far have we gotten? jointly published by WHO and UNECE, informs that one in four Europeans still falls sick or dies prematurely from environmental pollution. Data from several surveys in priority thematic areas such as water and sanitation, air quality, the day-to-day surroundings of children’s lives, chemicals and asbestos, climate change and health inequalities all show that while progress has been remarkable, it has been uneven (see Fact Sheet on the report).

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Air pollution , stroke, and anxiety

Mar 24th, 2015
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Particulate air pollution is an emerging risk factor for an increasing number of common conditions

The effects of air pollution on the lungs and heart are now widely appreciated, with expanding evidence for an important role in cardiac disease.1 The Global Burden of Disease Study identified fine particulate matter (PM2.5) in outdoor air and household air pollution from use of solid fuels as the ninth and fourth leading risk factors, respectively, for disease worldwide,2 and the World Health Organization attributes one in every eight deaths to air pollution.3 The effects of air pollution are not limited to cardiopulmonary diseases. Recent evidence suggests a role in diverse outcomes, including diabetes,4 low birth weight, and preterm birth.5 This research stems from improved understanding of the role of air pollution in initiating systemic inflammation, a response that may affect multiple organ systems. Two linked studies (doi:10.1136/bmj.h1295, doi:10.1136/bmj.h1111) add to growing evidence that air pollution is an important risk factor for an increasing number of common diseases.6 7

In the first of the two papers, Shah and colleagues6 systematically reviewed and meta-analysed 103 studies conducted in 28 countries and including 6.2 million events to assess the role of short term fluctuations in air pollution as a trigger for stroke. Although evidence from several cohort studies of long term exposure to particulate matter indicates associations with stroke mortality, such findings are not universal.8

The role of air pollution as a possible trigger for stroke has important implications for disease burden, especially in China where air pollution and the incidence of (especially haemorrhagic) stroke are high. In their analysis, Shah and colleagues found that increases in each of the common gaseous and particulate air pollutants were significantly associated with admission to hospital for stroke or stroke related mortality, with associations strongest for strokes on the same day as exposure; increased ozone was only weakly associated with cerebrovascular events.

Air pollution remained significantly associated with stroke in sensitivity analyses that adjusted for potential biases related to quality of outcome ascertainment, assessment of exposure, and adjustment for confounders. This analysis supports a role for air pollution as a modifiable risk factor for stroke, although associations with air pollution were less precise for haemorrhagic stroke than for ischaemic stroke. The impact of chronic exposure to air pollution on development of carotid atherosclerosis (a precursor for stroke) remains unclear. Although this is not covered in the analysis, evidence of an association is growing.9

Since air pollution causes systemic inflammation, it is reasonable that researchers have now turned to the arena of mental health, a leading priority for research given the relative absence of known modifiable risk factors and a high and growing disease burden.10 In the second linked paper, Power and colleagues exploit rich data in the Nurse’s Health Study cohort to assess the role of particulate pollution on prevalent anxiety symptoms.7 They found an exposure dependent association between higher levels of PM2.5 and increased symptoms of anxiety, and indications that associations were stronger for exposures in the month immediately preceding the scoring of anxiety.

These observations were supported by several sensitivity analyses, which indicated that associations were robust to broad geographical region, health status (to control for the possibility of anxiety as a sequela of cardiopulmonary effects of air pollution), and demographic characteristics, although the study was limited to older women. Power and colleagues’ findings add to a growing literature on the mental health effects of air pollution, including a small but intriguing body of research linking short term variability in air pollution to suicide.11

Power and colleagues used spatiotemporal exposure estimates and reported stronger effects for more recent exposures, reducing confounding by spatially varying factors correlated with air pollution. Since effects were observed over all time periods, spatial variation seems to have had an important influence on effect estimates. Furthermore, although effects were observed in all geographical regions, the investigators did not examine other potentially adverse (for example, noise, barometric pressure, solar intensity) or healthy (for example, natural spaces) environmental exposures that may operate at different scales. Indeed, evidence is accumulating that natural spaces may have beneficial effects on stress and social cohesion, both of which deserve further study in relation to mental health.12

As with any observational study, questions remain, as the authors acknowledge, and the findings should be replicated in other populations and with other study designs. Moreover, although these observations are biologically plausible, given links between inflammation and anxiety there is a need for greater mechanistic supporting evidence, of the type that now exists for associations between particulate matter and pulmonary, cardiac, and circulatory disease.

The findings of these two studies support a sharper focus on air pollution as a leading global health concern. They also suggest opportunities for reducing the prevalence of two debilitating and common diseases. One of the unique features of air pollution as a risk factor for disease is that exposure to air pollution is almost universal. While this is a primary reason for the large disease burden attributable to outdoor air pollution, it also follows that even modest reductions in pollution could have widespread benefits throughout populations. The two linked papers in this issue confirm the urgent need to manage air pollution globally as a cause of ill health and offer the promise that reducing pollution could be a cost effective way to reduce the large burden of disease from both stroke and poor mental health.

Notes

Cite this as: BMJ 2015;350:h1510

Footnotes

Research, doi:10.1136/bmj.h1295
Research, doi:10.1136/bmj.h1111

Competing interests: I have read and understood the BMJ policy on declaration of interests and declare the following: none.

Provenance and peer review: Commissioned; not externally peer reviewed.

References
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Newby DE, Mannucci PM, Tell GS, et al. Expert position paper on air pollution and cardiovascular disease. Eur Heart J2015;36:83-93b.
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Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet2012;380:2224-60.
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World Health Organization. Burden of disease from ambient and household air pollution. 2014. www.who.int/phe/health_topics/outdoorair/databases/en/.
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Eze IC, Hemkens LG, Bucher HC, et al. Association between ambient air pollution and diabetes mellitus in Europe and North America: systematic review and meta-analysis. Environ Health Perspect2015; published online 27 Jan.
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Stieb DM, Chen L, Eshoul M, et al. Ambient air pollution, birth weight and preterm birth: a systematic review and meta-analysis. Environ Res2012;117:100-11.
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Shah ASV, Lee KK, McAllister DA, et al. Short term exposure to air pollution and stroke: a systematic review and meta-analysis. BMJ2015;350:h1295.
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Power MC, Kioumourtzoglou M-A, Hart JE, et al. The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study. BMJ2015;350:h1111
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Ljungman PL, Mittleman MA. Ambient air pollution and stroke. Stroke2014;45:3734-41.
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Adar SD, Sheppard L, Vedal S, et al. Fine particulate air pollution and the progression of carotid intima-medial thickness: a prospective cohort study from the multi-ethnic study of atherosclerosis and air pollution. PLoS Med2013;10:e1001430.
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Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 201215;380:2197-223.
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Bakian AV, Huber RS, Coon H, et al. Acute air pollution exposure and risk of suicide completion. Am J Epidemiol2015;181:295-303.
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Hartig T, Mitchell R, de Vries S, et al. Nature and health. Annu Rev Public Health 2014;35:207-28.
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AIR QUALITY IN HONG KONG 2015

Jan 1st, 2015
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‘Cover up’ claim as incinerator study postponed

Feb 3rd, 2014
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http://www.airqualitynews.com/2014/02/03/cover-up-claim-as-incinerator-study-postponed/

Research into effects of waste incineration on human health will be postponed after data had to be ‘manually’ entered

A study aiming to establish whether there is a link between modern municipal waste incinerator emissions and health defects has been postponed until 2015, in what the Breathe Clean Air Group has labelled a government ‘cover-up’.

The research, which was due to be published in March 2014, was approved by the Health Protection Agency in January last year to extend the evidence base and provide further information to the public.

The study involves examining areas of up to 15km around 22 incinerators across England, including Grundon’s Lakeside energy-from-waste facility, the SELCHP plant in Lewisham, the London Waste Edmonton incinerator and SITA UK’s Tees Valley plant in Billingham.

Scientists hope to determine if there is a potential link between incinerator emissions and health outcomes, such as low birth weight, still births and infant deaths.

In addition, a Dundee-based incinerator has also been included in the study, with working relating to the plant funded by a grant from the Scottish Government.

But Public Health England, which is funding King’s College London and Imperial College London to carry out the study, today revealed the preliminary results would not be available until 2015 due to the ‘unanticipated complexity in gathering data’ – caused by having to enter emissions data into an electronic format manually before statistical analysis could begin.

Consequences
Commenting on the postponement, Pete Kilvert, chairman of the anti-incinerator Breathe Clean Air Group – said he feared the government would instruct the research teams to take ‘an average’ sample around each incinerator rather than look at the consequences on people living ‘downwind’ of each facility.

He said: “The Government is hell bent on burning the country’s waste and telling us that it won’t do us any harm. When waste such as plastics, metals and organic material are burnt at low temperatures, then new chemicals such as dioxins and heavy metals will settle out into our community.”

Public Health England today said it continues to stand by its position that well run and regulated municipal waste incinerators are not a significant risk to public health.

Commenting on the delay, Dr Simon Bouffler, deputy director of Public Health England’s Centre for Radiation, Chemical and Environmental Hazards, said: “It was originally envisaged that preliminary results for this study would be available by March 2014 but because of the unanticipated complexity in gathering data this has been delayed.

“A paper with preliminary results is now expected to be prepared for submission to a peer-reviewed journal around the end of 2014, with publication in 2015.”

He added: “Some of the data on emissions from MWIs were unexpectedly held in paper format rather than in electronic files, and had to be entered manually onto computer before the statistical analysis could begin. There was a delay while this process took place.”

Comparative Assessment of Particulate Air Pollution Exposure from Municipal Solid Waste Incinerator Emissions

Jun 8th, 2013
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A Clean Air Plan for Hong Kong

Mar 1st, 2013
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Indoor Air Pollution and Health

Jan 1st, 2013
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