Alexandra Schneider - Academia.edu (original) (raw)
Papers by Alexandra Schneider
Environment International, 2016
Evidence on health effects of ultrafine particles (UFP) is still limited as they are usually not ... more Evidence on health effects of ultrafine particles (UFP) is still limited as they are usually not monitored routinely. The few epidemiological studies on UFP and (cause-specific) mortality so far have reported inconsistent results. The main objective of the UFIREG project was to investigate the short-term associations between UFP and fine particulate matter (PM)<2.5μm (PM2.5) and daily (cause-specific) mortality in five European Cities. We also examined the effects of PM<10μm (PM10) and coarse particles (PM2.5-10). UFP (20-100nm), PM and meteorological data were measured in Dresden and Augsburg (Germany), Prague (Czech Republic), Ljubljana (Slovenia) and Chernivtsi (Ukraine). Daily counts of natural and cardio-respiratory mortality were collected for all five cities. Depending on data availability, the following study periods were chosen: Augsburg and Dresden 2011-2012, Ljubljana and Prague 2012-2013, Chernivtsi 2013-March 2014. The associations between air pollutants and health outcomes were assessed using confounder-adjusted Poisson regression models examining single (lag 0-lag 5) and cumulative lags (lag 0-1, lag 2-5, and lag 0-5). City-specific estimates were pooled using meta-analyses methods. Results indicated a delayed and prolonged association between UFP and respiratory mortality (9.9% [95%-confidence interval: -6.3%; 28.8%] increase in association with a 6-day average increase of 2750particles/cm(3) (average interquartile range across all cities)). Cardiovascular mortality increased by 3.0% [-2.7%; 9.1%] and 4.1% [0.4%; 8.0%] in association with a 12.4μg/m(3) and 4.7μg/m(3) increase in the PM2.5- and PM2.5-10-averages of lag 2-5. We observed positive but not statistically significant associations between prolonged exposures to UFP and respiratory mortality, which were independent of particle mass exposures. Further multi-centre studies are needed investigating several years to produce more precise estimates on health effects of UFP.
Environmental Research, 2016
Epidemiological studies have identified associations between long-term PM2.5 exposure and cardiov... more Epidemiological studies have identified associations between long-term PM2.5 exposure and cardiovascular events, though most have relied on concentrations from central-site air quality monitors. We utilized a cohort of 5679 patients who had undergone cardiac catheterization at Duke University between 2002-2009 and resided in North Carolina. We used estimates of daily PM2.5 concentrations for North Carolina during the study period based on satellite derived Aerosol Optical Depth (AOD) measurements and PM2.5 concentrations from ground monitors, which were spatially resolved with a 10×10km resolution, matched to each patient's residential address and averaged for the year prior to catheterization. The Coronary Artery Disease (CAD) index was used to measure severity of CAD; scores >23 represent a hemodynamically significant coronary artery lesion in at least one major coronary vessel. Logistic regression modeled odds of having CAD or an MI with each 1μg/m(3) increase in annual average PM2.5, adjusting for sex, race, smoking status and socioeconomic status. In adjusted models, a 1μg/m(3) increase in annual average PM2.5 was associated with an 11.1% relative increase in the odds of significant CAD (95% CI: 4.0-18.6%) and a 14.2% increase in the odds of having a myocardial infarction (MI) within a year prior (95% CI: 3.7-25.8%). Satellite-based estimates of long-term PM2.5 exposure were associated with both coronary artery disease (CAD) and incidence of myocardial infarction (MI) in a cohort of cardiac catheterization patients.
Environmental Health Perspectives, 2015
Urban populations are highly vulnerable to the adverse effects of heat, with heat-related mortali... more Urban populations are highly vulnerable to the adverse effects of heat, with heat-related mortality showing intra-urban variations that are likely due to differences in urban characteristics and socioeconomic status. To investigate the influence of urban green and urban blue, i.e., urban vegetation and water bodies, on heat-related excess mortality in the elderly above 65 years in Lisbon, Portugal between 1998 and 2008. We used remotely sensed data and geographic information to determine the amount of urban vegetation and the distance to water bodies (the Atlantic Ocean and the Tagus estuary). Poisson Generalized Additive Models were fitted, allowing for the interaction between equivalent temperature [Universal Thermal Climate Index (UTCI)] and quartiles of urban greenness [classified using the Normalized Differenced Vegetation Index (NDVI)] and proximity to water (≤ 4 km versus > 4 km), while adjusting for potential confounders. The association between mortality and a 1°C in UTCI above the 99th percentile (24.8°C) was stronger for areas in the lowest NDVI quartile (14.7% higher; 95% CI: 1.9, 17.5%) than areas in the highest quartile (3.0%; 95% CI: 2.0, 4.0%). In areas > 4km from water, a 1°C in UTCI above the 99th percentile was associated with a 7.1% increase in mortality (95% CI: 6.2, 8.1%), whereas in areas ≤ 4 km from water, the estimated increase in mortality was only 2.1% (95% CI: 1.2, 3.0%). Urban green and blue appeared to have a mitigating effect on heat-related mortality in the elderly population in Lisbon. Increasing the amount of vegetation may be a good strategy to counteract the adverse effects of heat in urban areas. Our findings also suggest potential benefits of urban blue that may be present several kilometers from a body of water.
International archives of occupational and environmental health, Jan 7, 2015
The link between particulate matter (PM) and cardiovascular morbidity has been investigated in nu... more The link between particulate matter (PM) and cardiovascular morbidity has been investigated in numerous studies. Less evidence exists, however, about how age, gender and season may modify this relationship. The aim of this study was to evaluate the association between ambient PM2.5 (PM ≤ 2.5 µm) and daily hospital emergency room visits (ERV) for cardiovascular diseases in Beijing, China. Moreover, potential effect modification by age, gender, season, air mass origin and the specific period with 2008 Beijing Olympic were investigated. Finally, the temporal lag structure of PM2.5 has also been explored. Daily counts of cardiovascular ERV were obtained from the Peking University Third Hospital from January 2007 to December 2008. Concurrently, data on PM2.5, PM10 (PM ≤ 10 µm), nitrogen dioxide and sulfur dioxide concentrations were obtained from monitoring networks and a fixed monitoring station. Poisson regression models adjusting for confounders were used to estimate immediate, delaye...
Environmental Science & Technology, 2015
Air pollution health studies of fine particulate matter (diameter ≤2.5 μm, PM2.5) often use outdo... more Air pollution health studies of fine particulate matter (diameter ≤2.5 μm, PM2.5) often use outdoor concentrations as exposure surrogates. Failure to account for variability of indoor infiltration of ambient PM2.5 and time indoors can induce exposure errors. We developed and evaluated an exposure model for individuals (EMI), which predicts five tiers of individual-level exposure metrics for ambient PM2.5 using outdoor concentrations, questionnaires, weather, and time-location information. We linked a mechanistic air exchange rate (AER) model to a mass-balance PM2.5 infiltration model to predict residential AER (Tier 1), infiltration factors (Tier 2), indoor concentrations (Tier 3), personal exposure factors (Tier 4), and personal exposures (Tier 5) for ambient PM2.5. Using cross-validation, individual predictions were compared to 591 daily measurements from 31 homes (Tiers 1-3) and participants (Tiers 4-5) in central North Carolina. Median absolute differences were 39% (0.17 h(-1)) for Tier 1, 18% (0.10) for Tier 2, 20% (2.0 μg/m(3)) for Tier 3, 18% (0.10) for Tier 4, and 20% (1.8 μg/m(3)) for Tier 5. The capability of EMI could help reduce the uncertainty of ambient PM2.5 exposure metrics used in health studies.
Casopís lékar̆ů c̆eských, 2015
The project "Ultrafine particles--an evidence based contribution to the development of regio... more The project "Ultrafine particles--an evidence based contribution to the development of regional and European environmental and health policy" (UFIREG) started in July 2011 and ended in December 2014. It was implemented through the Central Europe Programme and co-financed by the European Regional Development Fund. Five cities in four Central European countries participated in the study: Augsburg (Germany), Chernivtsi (Ukraine), Dresden (Germany), Ljubljana (Slovenia) and Prague (Czech Republic). The aim of the UFIREG project was to improve the knowledge base on possible health effects of ambient ultrafine particles (UFP) and to raise overall awareness of environmental and health care authorities and the population. Epidemiological studies in the frame of the UFIREG project have assessed the short-term effects of UFP on human mortality and morbidity, especially in relation to cardiovascular and respiratory diseases. Official statistics were used to determine the association ...
Environmental research, Jan 29, 2015
The link between particulate air pollution and cardiovascular (CVD) mortality has been investigat... more The link between particulate air pollution and cardiovascular (CVD) mortality has been investigated. However, there is little direct evidence that reduction measures which decrease particulate air pollution would lead to a reduction in CVD mortality. In Beijing, China, air quality improvement strategies were developed and actions were taken before and during the 2008 Olympic and Paralympic Games. Taking advantage of this opportunity, the aim of the study was to assess the effects of changes in particulate air pollution before (May 20-July 20, 2008), during (August 1-September 20, 2008) and after (October 1-December 1, 2008) the Olympics period. Concentrations of air pollution, meteorology and CVD death counts were obtained from official networks and monitoring sites located on the Peking University campus. Air pollution effects with lags of 0-4 days as well as of the 5-day average on cause-specific CVD mortality were investigated for the complete study period (May 20-December 1, 200...
International Journal of Hygiene and Environmental Health, 2015
Short-term exposure to increased particulate matter (PM) concentration has been reported to trigg... more Short-term exposure to increased particulate matter (PM) concentration has been reported to trigger myocardial infarction (MI). However, the association with ultrafine particles remains unclear. We aimed to assess the effects of short-term air pollution and especially ultrafine particles on registry-based MI events and coronary deaths in the area of Augsburg, Germany. Between 1995 and 2009, the MONICA/KORA myocardial infarction registry recorded 15,417 cases of MI and coronary deaths. Concentrations of PM<10μm (PM10), PM<2.5μm (PM2.5), particle number concentration (PNC) as indicator for ultrafine particles, and meteorological parameters were measured in the study region. Quasi-Poisson regression adjusting for time trend, temperature, season, and weekday was used to estimate immediate, delayed and cumulative effects of air pollutants on the occurrence of MI. The daily numbers of total MI, nonfatal and fatal events as well as incident and recurrent events were analysed. We observed a 1.3% risk increase (95%-confidence interval: [-0.9%; 3.6%]) for all events and a 4.4% [-0.4%; 9.4%] risk increase for recurrent events per 24.3μg/m(3) increase in same day PM10 concentrations. Nonfatal events indicated a risk increase of 3.1% [-0.1%; 6.5%] with previous day PM10. No association was seen for PM2.5 which was only available from 1999 on. PNC showed a risk increase of 6.0% [0.6%; 11.7%] for recurrent events per 5529 particles/cm(3) increase in 5-day average PNC. Our results suggested an association between short-term PM10 concentration and numbers of MI, especially for nonfatal and recurrent events. For ultrafine particles, risk increases were notably high for recurrent events. Thus, persons who already suffered a MI seemed to be more susceptible to air pollution.
Environmental Research, 2015
Background: Numerous studies showed that chronic noise exposure modeled through noise mapping is ... more Background: Numerous studies showed that chronic noise exposure modeled through noise mapping is associated with adverse health effects. However, knowledge about real individual noise exposure, emitted by several sources, is limited. Objectives: To explain the variation in individual daytime noise exposure regarding different microenvironments, activities and individual characteristics. individuals participated in 305 individual noise measurements with a mean duration of 5.5 h. Whereabouts and activities were recorded in a diary. One-minute averages of A-weighted equivalent continuous sound pressure levels (L eq ) were determined. We used mixed additive models to elucidate the variation of L eq by diary-based information, baseline characteristics and time-invariant variables like long-term noise exposure. Results: Overall noise levels were highly variable (median: 64 dB(A); range: 37-105 dB(A)). Highest noise levels were measured in traffic during bicycling (69 dB(A); 49-97 dB(A)) and lowest while resting at home (54 dB(A); 37-94 dB(A)). Nearly all diary-based information as well as physical activity, sex and age-group had significant influences on individual noise. In an additional analysis restricted to times spent at the residences, long-term noise exposure did not improve the model fit.
Journal of exposure science & environmental epidemiology, Jan 19, 2014
Personal exposure to air pollution is associated with time- and location-specific factors includi... more Personal exposure to air pollution is associated with time- and location-specific factors including indoor and outdoor air pollution, meteorology and time activities. Our investigation aims at the description and identification of factors determining personal exposure to particle number concentration (PNC) in everyday situations. Ten volunteers recorded their personal exposure to PNC and kept an activity diary in three different seasons besides stationary measurements of ambient air pollution and meteorology. Background exposure to PNC was modelled using the most predictive variables. In a second step, the effects of the activities were calculated adjusted for the background exposure. The average personal PNC level was highest in winter and was three times higher than the mean stationary PNC level while staying indoors and two times higher while staying outdoors. Personal indoor PNC levels were significantly increased during the use of candles, cooking and the occurrence of smell of...
Particle and fibre toxicology, 2007
Epidemiological studies on health effects of air pollution have consistently shown adverse cardio... more Epidemiological studies on health effects of air pollution have consistently shown adverse cardiovascular effects. Toxicological studies have provided evidence for thrombogenic effects of particles.A prospective panel study in a susceptible population was conducted in Erfurt, Germany, to study the effects of daily changes in ambient particles on various blood cells and soluble CD40ligand (sCD40L, also known as CD154), a marker for platelet activation that can cause increased coagulation and inflammation. Blood cells and plasma sCD40L levels were repeatedly measured in 57 male patients with coronary heart disease (CHD) during winter 2000/2001. Fixed effects linear regression models were applied, adjusting for trend, weekday and meteorological parameters.Hourly data on ultrafine particles (UFP, number concentration of particles from 0.01 to 0.1 microm), mass concentration of particles less than 10 and 2.5 microm in diameter (PM10, PM2.5), accumulation mode particle counts (AP, 0.1-1.0...
Mutation research, 2007
Ambient particulate air pollution has been associated with altered cardiac function and systemic ... more Ambient particulate air pollution has been associated with altered cardiac function and systemic inflammation. We reported repolarization changes and variations in markers of inflammation in association with ambient particulate exposure in a panel of male coronary artery disease (CAD) patients. The objective of this analysis was to identify the specific sources associated with these effects. A panel of male CAD patients participated in 12 clinical visits in Erfurt, Germany. We used 56 patients' 5min ECG recordings for the analysis of repolarization parameters QT interval and T wave amplitude, and 57 patients' plasma samples to determine the biomarkers von Willebrand factor (vWF) and C-reactive protein (CRP). Linear and logistic regression models were used to analyze the associations between five particle source factors (airborne soil, local traffic-related ultrafine particles, combustion-generated aerosols, diesel traffic-related particles, and secondary aerosols) and these ...
Contributions to Statistics, 2011
The aim of environmental epidemiology is to detect a possible risk or to investigate the exposure... more The aim of environmental epidemiology is to detect a possible risk or to investigate the exposure-response relation with time, duration, location and amount of exposure being the major determinants for that relationship. The assessment of health effects in ...
International Journal of Hygiene and Environmental Health, 2015
Background: Epidemiological studies have demonstrated associations between noise exposure and car... more Background: Epidemiological studies have demonstrated associations between noise exposure and cardiovascular events. However, there have been few studies of possible underlying mechanisms. oBjectives: We examined the association between individual daytime noise exposure and heart rate variability (HRV). , 110 individuals participated in 326 electrocardiogram recordings with a mean duration of 6 hr. Five-minute averages of heart rate (HR) and HRV parameters were determined. Individual noise exposure was measured as A-weighted equivalent continuous sound pressure levels (L eq ). Effects were estimated using additive mixed models adjusted for long-and short-term time trends and physical activity. Due to nonlinear exposure-response functions, we performed piecewise linear analyses with a cut-off point at 65 dB(A). results: Concurrent increases of 5dB(A) in L eq < 65dB(A) were associated with increases in HR (percent change of mean value: 1.48%; 95% CI: 1.37, 1.60%) and the ratio of low-frequency (LF) to high-frequency (HF) power (4.89%; 95% CI: 3.48, 6.32%), and with decreases in LF (-3.77%; 95% CI: -5.49, -2.02%) and HF (-8.56%; 95% CI: -10.31, -6.78%) power. Standard deviation of normal-to-normal intervals (SDNN) was positively associated with concurrent noise < 65dB(A) (5.74%; 95% CI: 5.13, 6.36) but negatively associated with noise lagged by 5-15 min (-0.53% to -0.69%). Associations with cardiac function were less pronounced for noise ≥ 65dB(A), with some in opposite directions from associations with noise < 65dB(A). Concurrent associations were modified by sex and age. conclusions: Individual daytime noise exposure was associated with immediate changes in HRV, suggesting a possible mechanism linking noise to cardiovascular risk. Noise at lower levels may have health consequences beyond those resulting from "fight-or-flight" responses to high levels of noise. key words: autonomic nervous system, epidemiology, heart rate variability, noise exposure, short-term changes. Environ Health Perspect 121:607-612 (2013). http://dx.
Environmental Health, 2010
Background: The present study aimed at developing a standardized heat wave definition to estimate... more Background: The present study aimed at developing a standardized heat wave definition to estimate and compare the impact on mortality by gender, age and death causes in Europe during summers 1990-2004 and 2003, separately, accounting for heat wave duration and intensity.
This time series study aimed to examine the association between daily air temperature and cause-s... more This time series study aimed to examine the association between daily air temperature and cause-specific cardiovascular mortality in Bavaria, Southern Germany. We obtained data from the cities Munich, Nuremberg and Augsburg and two adjacent administrative districts (Augsburg and Aichach-Friedberg), for the period 1990-2006. Data included daily cause-specific cardiovascular death counts, mean daily meteorological variables and air pollution concentrations. In the first stage, data were analysed for Munich, Nuremberg and the Augsburg region separately using Poisson regression models combined with distributed lag non-linear models adjusting for long-term trend, calendar effects and meteorological factors. In a second stage, we combined city-specific exposure-response relationships through a multivariate meta-analysis framework. An increase in the 2-day average temperature from the 90th (20.0°C) to the 99th centiles (24.8°C) resulted in an increase of cardiovascular mortality by 10% (95% CI 5% to 15%) in the pooled analysis, while for a decrease from the 10th (-1.0°C) to the 1st centiles (-7.5°C) in the 15-day average temperature cardiovascular mortality increased by 8% (95% CI 2% to 14%). Strongest consistent risk estimates were seen for high 2-day average temperatures and mortality due to other heart diseases (including arrhythmias and heart failure) and cerebrovascular diseases, especially in the elderly. Results indicate that, in addition to low temperatures, high temperatures increase cause-specific cardiovascular mortality in temperature climates. These findings may guide planning public health interventions to control and prevent the health effects of exposure to air temperature, especially for individuals at risk for mortality due to heart failure, arrhythmias or cerebrovascular diseases.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2014
Research in the field of atmospheric science and epidemiology has long recognized the health effe... more Research in the field of atmospheric science and epidemiology has long recognized the health effects of seasonal and meteorological conditions. However, little scientific knowledge exists to date about the impacts of atmospheric parameters on human mortality in tropical regions. Working within the scope of this systematic review, this investigation conducted a literature search using different databases; original research articles were chosen according to pre-defined inclusion and exclusion criteria. Both seasonal and meteorological effects were considered. The findings suggest that high amounts of rainfall and increasing temperatures cause a seasonal excess in infectious disease mortality and are therefore relevant in regions and populations in which such diseases are prevalent. On the contrary, moderately low and very high temperatures exercise an adverse effect on cardio-respiratory mortality and shape the mortality pattern in areas and sub-groups in which these diseases are domi...
Particle and Fibre Toxicology, 2009
Background: Growing evidence indicates that ambient air pollution is associated with exacerbation... more Background: Growing evidence indicates that ambient air pollution is associated with exacerbation of chronic diseases like chronic pulmonary disease. A prospective panel study was conducted to investigate short-term changes of blood markers of inflammation and coagulation in response to daily changes in air pollution in Erfurt, Germany. 12 clinical visits were scheduled and blood parameters were measured in 38 male patients with chronic pulmonary disease during winter 2001/2002. Additive mixed models with random patient intercept were applied, adjusting for trend, weekday, and meteorological parameters. Hourly data on ultrafine particles (UFP, 0.01-0.1 μm), accumulation mode particles (ACP, 0.1-1.0 μm), PM 10 (particulate matter <10 μm in diameter), elemental (EC) and organic carbon (OC), gaseous pollutants (nitrogen monoxide [NO], nitrogen dioxide [NO 2 ], carbon monoxide [CO], and sulphur dioxide [SO 2 ]) were collected at a central monitoring site and meteorological data were received from an official network. For each person and visit the individual 24-hour average of pollutants immediately preceding the blood withdrawal (lag 0) up to day 5 (lag1-4) and 5-day running means were calculated.
Environmental Research, 2014
Several studies have reported an association between air pollution and endothelial dysfunction, e... more Several studies have reported an association between air pollution and endothelial dysfunction, especially in individuals having diabetes. However, very few studies have examined the impact of air temperature on endothelial function. The objective of this analysis was to investigate short-term effects of temperature and ozone on endothelial function in individuals having diabetes. Moreover, we investigated interactive effects between air temperature and air pollution on markers of endothelial function. Between November 2004 and December 2005 flow-mediated dilatation (FMD), nitroglycerin-mediated dilatation (NTGMD) and several blood markers representing endothelial function were measured using brachial artery ultrasound on four consecutive days in 22 individuals with type-2 diabetes mellitus in Chapel Hill, North Carolina (USA). Daily measurements of meteorological parameters, ozone and particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5) were obtained from fixed monitoring sites. We used additive mixed-models adjusting for time trend, day of the week, relative humidity and barometric pressure to assess temperature and ozone associations with endothelial function. A 1 °C decrease in the 24-h temperature average was associated with a decrease in mean FMD on the same day (-2.2% (95%-confidence interval:[-4.7;0.3%])) and with a delay of one and four days. A temperature decrement also led to an immediate (-1.7%[-3.3;-0.04]) decrease in NTGMD. Moreover, we observed an immediate (-14.6%[-26.3;-2.9%]) and a one day delayed (-13.5%[-27.0; 0.04%]) decrease in FMD in association with a 0.01 ppm increase in the maximum 8-h moving average of ozone. Temperature effects on FMD strengthened when PM2.5 and ozone concentrations were high. The associations were similar during winter and summer. We detected an association between temperature decreases and ozone increases on endothelial dysfunction in individuals having diabetes. We conclude that endothelial dysfunction might be a possible mechanism explaining cardiovascular events in association with environmental stimuli.
Environmental Health, 2011
Background: Associations between air temperature and mortality have been consistently observed in... more Background: Associations between air temperature and mortality have been consistently observed in Europe and the United States; however, there is a lack of studies for Asian countries. Our study investigated the association between air temperature and cardio-respiratory mortality in the urban area of Beijing, China.
Environment International, 2016
Evidence on health effects of ultrafine particles (UFP) is still limited as they are usually not ... more Evidence on health effects of ultrafine particles (UFP) is still limited as they are usually not monitored routinely. The few epidemiological studies on UFP and (cause-specific) mortality so far have reported inconsistent results. The main objective of the UFIREG project was to investigate the short-term associations between UFP and fine particulate matter (PM)&amp;amp;amp;lt;2.5μm (PM2.5) and daily (cause-specific) mortality in five European Cities. We also examined the effects of PM&amp;amp;amp;lt;10μm (PM10) and coarse particles (PM2.5-10). UFP (20-100nm), PM and meteorological data were measured in Dresden and Augsburg (Germany), Prague (Czech Republic), Ljubljana (Slovenia) and Chernivtsi (Ukraine). Daily counts of natural and cardio-respiratory mortality were collected for all five cities. Depending on data availability, the following study periods were chosen: Augsburg and Dresden 2011-2012, Ljubljana and Prague 2012-2013, Chernivtsi 2013-March 2014. The associations between air pollutants and health outcomes were assessed using confounder-adjusted Poisson regression models examining single (lag 0-lag 5) and cumulative lags (lag 0-1, lag 2-5, and lag 0-5). City-specific estimates were pooled using meta-analyses methods. Results indicated a delayed and prolonged association between UFP and respiratory mortality (9.9% [95%-confidence interval: -6.3%; 28.8%] increase in association with a 6-day average increase of 2750particles/cm(3) (average interquartile range across all cities)). Cardiovascular mortality increased by 3.0% [-2.7%; 9.1%] and 4.1% [0.4%; 8.0%] in association with a 12.4μg/m(3) and 4.7μg/m(3) increase in the PM2.5- and PM2.5-10-averages of lag 2-5. We observed positive but not statistically significant associations between prolonged exposures to UFP and respiratory mortality, which were independent of particle mass exposures. Further multi-centre studies are needed investigating several years to produce more precise estimates on health effects of UFP.
Environmental Research, 2016
Epidemiological studies have identified associations between long-term PM2.5 exposure and cardiov... more Epidemiological studies have identified associations between long-term PM2.5 exposure and cardiovascular events, though most have relied on concentrations from central-site air quality monitors. We utilized a cohort of 5679 patients who had undergone cardiac catheterization at Duke University between 2002-2009 and resided in North Carolina. We used estimates of daily PM2.5 concentrations for North Carolina during the study period based on satellite derived Aerosol Optical Depth (AOD) measurements and PM2.5 concentrations from ground monitors, which were spatially resolved with a 10×10km resolution, matched to each patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s residential address and averaged for the year prior to catheterization. The Coronary Artery Disease (CAD) index was used to measure severity of CAD; scores &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;23 represent a hemodynamically significant coronary artery lesion in at least one major coronary vessel. Logistic regression modeled odds of having CAD or an MI with each 1μg/m(3) increase in annual average PM2.5, adjusting for sex, race, smoking status and socioeconomic status. In adjusted models, a 1μg/m(3) increase in annual average PM2.5 was associated with an 11.1% relative increase in the odds of significant CAD (95% CI: 4.0-18.6%) and a 14.2% increase in the odds of having a myocardial infarction (MI) within a year prior (95% CI: 3.7-25.8%). Satellite-based estimates of long-term PM2.5 exposure were associated with both coronary artery disease (CAD) and incidence of myocardial infarction (MI) in a cohort of cardiac catheterization patients.
Environmental Health Perspectives, 2015
Urban populations are highly vulnerable to the adverse effects of heat, with heat-related mortali... more Urban populations are highly vulnerable to the adverse effects of heat, with heat-related mortality showing intra-urban variations that are likely due to differences in urban characteristics and socioeconomic status. To investigate the influence of urban green and urban blue, i.e., urban vegetation and water bodies, on heat-related excess mortality in the elderly above 65 years in Lisbon, Portugal between 1998 and 2008. We used remotely sensed data and geographic information to determine the amount of urban vegetation and the distance to water bodies (the Atlantic Ocean and the Tagus estuary). Poisson Generalized Additive Models were fitted, allowing for the interaction between equivalent temperature [Universal Thermal Climate Index (UTCI)] and quartiles of urban greenness [classified using the Normalized Differenced Vegetation Index (NDVI)] and proximity to water (≤ 4 km versus &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 4 km), while adjusting for potential confounders. The association between mortality and a 1°C in UTCI above the 99th percentile (24.8°C) was stronger for areas in the lowest NDVI quartile (14.7% higher; 95% CI: 1.9, 17.5%) than areas in the highest quartile (3.0%; 95% CI: 2.0, 4.0%). In areas &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 4km from water, a 1°C in UTCI above the 99th percentile was associated with a 7.1% increase in mortality (95% CI: 6.2, 8.1%), whereas in areas ≤ 4 km from water, the estimated increase in mortality was only 2.1% (95% CI: 1.2, 3.0%). Urban green and blue appeared to have a mitigating effect on heat-related mortality in the elderly population in Lisbon. Increasing the amount of vegetation may be a good strategy to counteract the adverse effects of heat in urban areas. Our findings also suggest potential benefits of urban blue that may be present several kilometers from a body of water.
International archives of occupational and environmental health, Jan 7, 2015
The link between particulate matter (PM) and cardiovascular morbidity has been investigated in nu... more The link between particulate matter (PM) and cardiovascular morbidity has been investigated in numerous studies. Less evidence exists, however, about how age, gender and season may modify this relationship. The aim of this study was to evaluate the association between ambient PM2.5 (PM ≤ 2.5 µm) and daily hospital emergency room visits (ERV) for cardiovascular diseases in Beijing, China. Moreover, potential effect modification by age, gender, season, air mass origin and the specific period with 2008 Beijing Olympic were investigated. Finally, the temporal lag structure of PM2.5 has also been explored. Daily counts of cardiovascular ERV were obtained from the Peking University Third Hospital from January 2007 to December 2008. Concurrently, data on PM2.5, PM10 (PM ≤ 10 µm), nitrogen dioxide and sulfur dioxide concentrations were obtained from monitoring networks and a fixed monitoring station. Poisson regression models adjusting for confounders were used to estimate immediate, delaye...
Environmental Science & Technology, 2015
Air pollution health studies of fine particulate matter (diameter ≤2.5 μm, PM2.5) often use outdo... more Air pollution health studies of fine particulate matter (diameter ≤2.5 μm, PM2.5) often use outdoor concentrations as exposure surrogates. Failure to account for variability of indoor infiltration of ambient PM2.5 and time indoors can induce exposure errors. We developed and evaluated an exposure model for individuals (EMI), which predicts five tiers of individual-level exposure metrics for ambient PM2.5 using outdoor concentrations, questionnaires, weather, and time-location information. We linked a mechanistic air exchange rate (AER) model to a mass-balance PM2.5 infiltration model to predict residential AER (Tier 1), infiltration factors (Tier 2), indoor concentrations (Tier 3), personal exposure factors (Tier 4), and personal exposures (Tier 5) for ambient PM2.5. Using cross-validation, individual predictions were compared to 591 daily measurements from 31 homes (Tiers 1-3) and participants (Tiers 4-5) in central North Carolina. Median absolute differences were 39% (0.17 h(-1)) for Tier 1, 18% (0.10) for Tier 2, 20% (2.0 μg/m(3)) for Tier 3, 18% (0.10) for Tier 4, and 20% (1.8 μg/m(3)) for Tier 5. The capability of EMI could help reduce the uncertainty of ambient PM2.5 exposure metrics used in health studies.
Casopís lékar̆ů c̆eských, 2015
The project "Ultrafine particles--an evidence based contribution to the development of regio... more The project "Ultrafine particles--an evidence based contribution to the development of regional and European environmental and health policy" (UFIREG) started in July 2011 and ended in December 2014. It was implemented through the Central Europe Programme and co-financed by the European Regional Development Fund. Five cities in four Central European countries participated in the study: Augsburg (Germany), Chernivtsi (Ukraine), Dresden (Germany), Ljubljana (Slovenia) and Prague (Czech Republic). The aim of the UFIREG project was to improve the knowledge base on possible health effects of ambient ultrafine particles (UFP) and to raise overall awareness of environmental and health care authorities and the population. Epidemiological studies in the frame of the UFIREG project have assessed the short-term effects of UFP on human mortality and morbidity, especially in relation to cardiovascular and respiratory diseases. Official statistics were used to determine the association ...
Environmental research, Jan 29, 2015
The link between particulate air pollution and cardiovascular (CVD) mortality has been investigat... more The link between particulate air pollution and cardiovascular (CVD) mortality has been investigated. However, there is little direct evidence that reduction measures which decrease particulate air pollution would lead to a reduction in CVD mortality. In Beijing, China, air quality improvement strategies were developed and actions were taken before and during the 2008 Olympic and Paralympic Games. Taking advantage of this opportunity, the aim of the study was to assess the effects of changes in particulate air pollution before (May 20-July 20, 2008), during (August 1-September 20, 2008) and after (October 1-December 1, 2008) the Olympics period. Concentrations of air pollution, meteorology and CVD death counts were obtained from official networks and monitoring sites located on the Peking University campus. Air pollution effects with lags of 0-4 days as well as of the 5-day average on cause-specific CVD mortality were investigated for the complete study period (May 20-December 1, 200...
International Journal of Hygiene and Environmental Health, 2015
Short-term exposure to increased particulate matter (PM) concentration has been reported to trigg... more Short-term exposure to increased particulate matter (PM) concentration has been reported to trigger myocardial infarction (MI). However, the association with ultrafine particles remains unclear. We aimed to assess the effects of short-term air pollution and especially ultrafine particles on registry-based MI events and coronary deaths in the area of Augsburg, Germany. Between 1995 and 2009, the MONICA/KORA myocardial infarction registry recorded 15,417 cases of MI and coronary deaths. Concentrations of PM&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10μm (PM10), PM&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2.5μm (PM2.5), particle number concentration (PNC) as indicator for ultrafine particles, and meteorological parameters were measured in the study region. Quasi-Poisson regression adjusting for time trend, temperature, season, and weekday was used to estimate immediate, delayed and cumulative effects of air pollutants on the occurrence of MI. The daily numbers of total MI, nonfatal and fatal events as well as incident and recurrent events were analysed. We observed a 1.3% risk increase (95%-confidence interval: [-0.9%; 3.6%]) for all events and a 4.4% [-0.4%; 9.4%] risk increase for recurrent events per 24.3μg/m(3) increase in same day PM10 concentrations. Nonfatal events indicated a risk increase of 3.1% [-0.1%; 6.5%] with previous day PM10. No association was seen for PM2.5 which was only available from 1999 on. PNC showed a risk increase of 6.0% [0.6%; 11.7%] for recurrent events per 5529 particles/cm(3) increase in 5-day average PNC. Our results suggested an association between short-term PM10 concentration and numbers of MI, especially for nonfatal and recurrent events. For ultrafine particles, risk increases were notably high for recurrent events. Thus, persons who already suffered a MI seemed to be more susceptible to air pollution.
Environmental Research, 2015
Background: Numerous studies showed that chronic noise exposure modeled through noise mapping is ... more Background: Numerous studies showed that chronic noise exposure modeled through noise mapping is associated with adverse health effects. However, knowledge about real individual noise exposure, emitted by several sources, is limited. Objectives: To explain the variation in individual daytime noise exposure regarding different microenvironments, activities and individual characteristics. individuals participated in 305 individual noise measurements with a mean duration of 5.5 h. Whereabouts and activities were recorded in a diary. One-minute averages of A-weighted equivalent continuous sound pressure levels (L eq ) were determined. We used mixed additive models to elucidate the variation of L eq by diary-based information, baseline characteristics and time-invariant variables like long-term noise exposure. Results: Overall noise levels were highly variable (median: 64 dB(A); range: 37-105 dB(A)). Highest noise levels were measured in traffic during bicycling (69 dB(A); 49-97 dB(A)) and lowest while resting at home (54 dB(A); 37-94 dB(A)). Nearly all diary-based information as well as physical activity, sex and age-group had significant influences on individual noise. In an additional analysis restricted to times spent at the residences, long-term noise exposure did not improve the model fit.
Journal of exposure science & environmental epidemiology, Jan 19, 2014
Personal exposure to air pollution is associated with time- and location-specific factors includi... more Personal exposure to air pollution is associated with time- and location-specific factors including indoor and outdoor air pollution, meteorology and time activities. Our investigation aims at the description and identification of factors determining personal exposure to particle number concentration (PNC) in everyday situations. Ten volunteers recorded their personal exposure to PNC and kept an activity diary in three different seasons besides stationary measurements of ambient air pollution and meteorology. Background exposure to PNC was modelled using the most predictive variables. In a second step, the effects of the activities were calculated adjusted for the background exposure. The average personal PNC level was highest in winter and was three times higher than the mean stationary PNC level while staying indoors and two times higher while staying outdoors. Personal indoor PNC levels were significantly increased during the use of candles, cooking and the occurrence of smell of...
Particle and fibre toxicology, 2007
Epidemiological studies on health effects of air pollution have consistently shown adverse cardio... more Epidemiological studies on health effects of air pollution have consistently shown adverse cardiovascular effects. Toxicological studies have provided evidence for thrombogenic effects of particles.A prospective panel study in a susceptible population was conducted in Erfurt, Germany, to study the effects of daily changes in ambient particles on various blood cells and soluble CD40ligand (sCD40L, also known as CD154), a marker for platelet activation that can cause increased coagulation and inflammation. Blood cells and plasma sCD40L levels were repeatedly measured in 57 male patients with coronary heart disease (CHD) during winter 2000/2001. Fixed effects linear regression models were applied, adjusting for trend, weekday and meteorological parameters.Hourly data on ultrafine particles (UFP, number concentration of particles from 0.01 to 0.1 microm), mass concentration of particles less than 10 and 2.5 microm in diameter (PM10, PM2.5), accumulation mode particle counts (AP, 0.1-1.0...
Mutation research, 2007
Ambient particulate air pollution has been associated with altered cardiac function and systemic ... more Ambient particulate air pollution has been associated with altered cardiac function and systemic inflammation. We reported repolarization changes and variations in markers of inflammation in association with ambient particulate exposure in a panel of male coronary artery disease (CAD) patients. The objective of this analysis was to identify the specific sources associated with these effects. A panel of male CAD patients participated in 12 clinical visits in Erfurt, Germany. We used 56 patients' 5min ECG recordings for the analysis of repolarization parameters QT interval and T wave amplitude, and 57 patients' plasma samples to determine the biomarkers von Willebrand factor (vWF) and C-reactive protein (CRP). Linear and logistic regression models were used to analyze the associations between five particle source factors (airborne soil, local traffic-related ultrafine particles, combustion-generated aerosols, diesel traffic-related particles, and secondary aerosols) and these ...
Contributions to Statistics, 2011
The aim of environmental epidemiology is to detect a possible risk or to investigate the exposure... more The aim of environmental epidemiology is to detect a possible risk or to investigate the exposure-response relation with time, duration, location and amount of exposure being the major determinants for that relationship. The assessment of health effects in ...
International Journal of Hygiene and Environmental Health, 2015
Background: Epidemiological studies have demonstrated associations between noise exposure and car... more Background: Epidemiological studies have demonstrated associations between noise exposure and cardiovascular events. However, there have been few studies of possible underlying mechanisms. oBjectives: We examined the association between individual daytime noise exposure and heart rate variability (HRV). , 110 individuals participated in 326 electrocardiogram recordings with a mean duration of 6 hr. Five-minute averages of heart rate (HR) and HRV parameters were determined. Individual noise exposure was measured as A-weighted equivalent continuous sound pressure levels (L eq ). Effects were estimated using additive mixed models adjusted for long-and short-term time trends and physical activity. Due to nonlinear exposure-response functions, we performed piecewise linear analyses with a cut-off point at 65 dB(A). results: Concurrent increases of 5dB(A) in L eq < 65dB(A) were associated with increases in HR (percent change of mean value: 1.48%; 95% CI: 1.37, 1.60%) and the ratio of low-frequency (LF) to high-frequency (HF) power (4.89%; 95% CI: 3.48, 6.32%), and with decreases in LF (-3.77%; 95% CI: -5.49, -2.02%) and HF (-8.56%; 95% CI: -10.31, -6.78%) power. Standard deviation of normal-to-normal intervals (SDNN) was positively associated with concurrent noise < 65dB(A) (5.74%; 95% CI: 5.13, 6.36) but negatively associated with noise lagged by 5-15 min (-0.53% to -0.69%). Associations with cardiac function were less pronounced for noise ≥ 65dB(A), with some in opposite directions from associations with noise < 65dB(A). Concurrent associations were modified by sex and age. conclusions: Individual daytime noise exposure was associated with immediate changes in HRV, suggesting a possible mechanism linking noise to cardiovascular risk. Noise at lower levels may have health consequences beyond those resulting from "fight-or-flight" responses to high levels of noise. key words: autonomic nervous system, epidemiology, heart rate variability, noise exposure, short-term changes. Environ Health Perspect 121:607-612 (2013). http://dx.
Environmental Health, 2010
Background: The present study aimed at developing a standardized heat wave definition to estimate... more Background: The present study aimed at developing a standardized heat wave definition to estimate and compare the impact on mortality by gender, age and death causes in Europe during summers 1990-2004 and 2003, separately, accounting for heat wave duration and intensity.
This time series study aimed to examine the association between daily air temperature and cause-s... more This time series study aimed to examine the association between daily air temperature and cause-specific cardiovascular mortality in Bavaria, Southern Germany. We obtained data from the cities Munich, Nuremberg and Augsburg and two adjacent administrative districts (Augsburg and Aichach-Friedberg), for the period 1990-2006. Data included daily cause-specific cardiovascular death counts, mean daily meteorological variables and air pollution concentrations. In the first stage, data were analysed for Munich, Nuremberg and the Augsburg region separately using Poisson regression models combined with distributed lag non-linear models adjusting for long-term trend, calendar effects and meteorological factors. In a second stage, we combined city-specific exposure-response relationships through a multivariate meta-analysis framework. An increase in the 2-day average temperature from the 90th (20.0°C) to the 99th centiles (24.8°C) resulted in an increase of cardiovascular mortality by 10% (95% CI 5% to 15%) in the pooled analysis, while for a decrease from the 10th (-1.0°C) to the 1st centiles (-7.5°C) in the 15-day average temperature cardiovascular mortality increased by 8% (95% CI 2% to 14%). Strongest consistent risk estimates were seen for high 2-day average temperatures and mortality due to other heart diseases (including arrhythmias and heart failure) and cerebrovascular diseases, especially in the elderly. Results indicate that, in addition to low temperatures, high temperatures increase cause-specific cardiovascular mortality in temperature climates. These findings may guide planning public health interventions to control and prevent the health effects of exposure to air temperature, especially for individuals at risk for mortality due to heart failure, arrhythmias or cerebrovascular diseases.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2014
Research in the field of atmospheric science and epidemiology has long recognized the health effe... more Research in the field of atmospheric science and epidemiology has long recognized the health effects of seasonal and meteorological conditions. However, little scientific knowledge exists to date about the impacts of atmospheric parameters on human mortality in tropical regions. Working within the scope of this systematic review, this investigation conducted a literature search using different databases; original research articles were chosen according to pre-defined inclusion and exclusion criteria. Both seasonal and meteorological effects were considered. The findings suggest that high amounts of rainfall and increasing temperatures cause a seasonal excess in infectious disease mortality and are therefore relevant in regions and populations in which such diseases are prevalent. On the contrary, moderately low and very high temperatures exercise an adverse effect on cardio-respiratory mortality and shape the mortality pattern in areas and sub-groups in which these diseases are domi...
Particle and Fibre Toxicology, 2009
Background: Growing evidence indicates that ambient air pollution is associated with exacerbation... more Background: Growing evidence indicates that ambient air pollution is associated with exacerbation of chronic diseases like chronic pulmonary disease. A prospective panel study was conducted to investigate short-term changes of blood markers of inflammation and coagulation in response to daily changes in air pollution in Erfurt, Germany. 12 clinical visits were scheduled and blood parameters were measured in 38 male patients with chronic pulmonary disease during winter 2001/2002. Additive mixed models with random patient intercept were applied, adjusting for trend, weekday, and meteorological parameters. Hourly data on ultrafine particles (UFP, 0.01-0.1 μm), accumulation mode particles (ACP, 0.1-1.0 μm), PM 10 (particulate matter <10 μm in diameter), elemental (EC) and organic carbon (OC), gaseous pollutants (nitrogen monoxide [NO], nitrogen dioxide [NO 2 ], carbon monoxide [CO], and sulphur dioxide [SO 2 ]) were collected at a central monitoring site and meteorological data were received from an official network. For each person and visit the individual 24-hour average of pollutants immediately preceding the blood withdrawal (lag 0) up to day 5 (lag1-4) and 5-day running means were calculated.
Environmental Research, 2014
Several studies have reported an association between air pollution and endothelial dysfunction, e... more Several studies have reported an association between air pollution and endothelial dysfunction, especially in individuals having diabetes. However, very few studies have examined the impact of air temperature on endothelial function. The objective of this analysis was to investigate short-term effects of temperature and ozone on endothelial function in individuals having diabetes. Moreover, we investigated interactive effects between air temperature and air pollution on markers of endothelial function. Between November 2004 and December 2005 flow-mediated dilatation (FMD), nitroglycerin-mediated dilatation (NTGMD) and several blood markers representing endothelial function were measured using brachial artery ultrasound on four consecutive days in 22 individuals with type-2 diabetes mellitus in Chapel Hill, North Carolina (USA). Daily measurements of meteorological parameters, ozone and particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5) were obtained from fixed monitoring sites. We used additive mixed-models adjusting for time trend, day of the week, relative humidity and barometric pressure to assess temperature and ozone associations with endothelial function. A 1 °C decrease in the 24-h temperature average was associated with a decrease in mean FMD on the same day (-2.2% (95%-confidence interval:[-4.7;0.3%])) and with a delay of one and four days. A temperature decrement also led to an immediate (-1.7%[-3.3;-0.04]) decrease in NTGMD. Moreover, we observed an immediate (-14.6%[-26.3;-2.9%]) and a one day delayed (-13.5%[-27.0; 0.04%]) decrease in FMD in association with a 0.01 ppm increase in the maximum 8-h moving average of ozone. Temperature effects on FMD strengthened when PM2.5 and ozone concentrations were high. The associations were similar during winter and summer. We detected an association between temperature decreases and ozone increases on endothelial dysfunction in individuals having diabetes. We conclude that endothelial dysfunction might be a possible mechanism explaining cardiovascular events in association with environmental stimuli.
Environmental Health, 2011
Background: Associations between air temperature and mortality have been consistently observed in... more Background: Associations between air temperature and mortality have been consistently observed in Europe and the United States; however, there is a lack of studies for Asian countries. Our study investigated the association between air temperature and cardio-respiratory mortality in the urban area of Beijing, China.