The health effects of traffic-related air pollution (TRAP) continue to be of important public health interest. Following its well-cited 2010 critical review, the Health Effects Institute (HEI) ...appointed a new expert Panel to systematically evaluate the epidemiological evidence regarding the associations between long-term exposure to TRAP and selected adverse health outcomes. Health outcomes were selected based on evidence of causality for general air pollution (broader than TRAP) cited in authoritative reviews, relevance for public health and policy, and resources available.
The Panel used a systematic approach to search the literature, select studies for inclusion in the review, assess study quality, summarize results, and reach conclusions about the confidence in the evidence. An extensive search was conducted of literature published between January 1980 and July 2019 on selected health outcomes. A new exposure framework was developed to determine whether a study was sufficiently specific to TRAP.
In total, 353 studies were included in the review. Respiratory effects in children (118 studies) and birth outcomes (86 studies) were the most commonly studied outcomes. Fewer studies investigated cardiometabolic effects (57 studies), respiratory effects in adults (50 studies), and mortality (48 studies).
The findings from the systematic review, meta-analyses, and evaluation of the quality of the studies and potential biases provided an overall high or moderate-to-high level of confidence in an association between long-term exposure to TRAP and the adverse health outcomes all-cause, circulatory, ischemic heart disease and lung cancer mortality, asthma onsetin chilldren and adults, and acute lower respiratory infections in children. The evidence was considered moderate, low or very low for the other selected outcomes.
In light of the large number of people exposed to TRAP – both in and beyond the near-road environment - the Panel concluded that the overall high or moderate-to-high confidence in the evidence for an association between long-term exposure to TRAP and several adverse health outcomes indicates that exposures to TRAP remain an important public health concern and deserve greater attention from the public and from policymakers.
•A systematic review was conducted on associations between long-term exposure to traffic-related air pollution and non-accidental mortality.•A new exposure framework was developed to determine ...whether a study was sufficiently specific to TRAP, which includes studies beyond the near-roadway environment.•The overall confidence in the evidence for a positive association between long-term exposure to TRAP and non-accidental mortality was high.
The health effects of traffic-related air pollution (TRAP) continue to be of important public health interest across the globe. Following its 2010 review, the Health Effects Institute appointed a new expert Panel to systematically evaluate the epidemiological evidence regarding the associations between long-term exposure to TRAP and selected health outcomes. This paper describes the main findings of the systematic review on non-accidental mortality.
The Panel used a systematic approach to conduct the review. An extensive search was conducted of literature published between 1980 and 2019. A new exposure framework was developed to determine whether a study was sufficiently specific to TRAP, which included studies beyond the near-roadway environment. We performed random-effects meta-analysis when at least three estimates were available of an association between a specific exposure and outcome. We evaluated confidence in the evidence using a modified Office of Health Assessment and Translation (OHAT) approach, supplemented with a broader narrative synthesis.
Thirty-six cohort studies were included. Virtually all studies adjusted for a large number of individual and area-level covariates—including smoking, body mass index, and individual and area-level socioeconomic status—and were judged at a low or moderate risk for bias. Most studies were conducted in North America and Europe, and a few were based in Asia and Australia. The meta-analytic summary estimates for nitrogen dioxide, elemental carbon and fine particulate matter—pollutants with more than 10 studies—were 1.04 (95% CI 1.01, 1.06), 1.02 (1.00, 1.04) and 1.03 (1.01, 1.05) per 10, 1 and 5 µg/m3, respectively. Effect estimates are interpreted as the relative risk of mortality when the exposure differs with the selected increment. The confidence in the evidence for these pollutants was judged as high, because of upgrades for monotonic exposure–response and consistency across populations. The consistent findings across geographical regions, exposure assessment methods and confounder adjustment resulted in a high confidence rating using a narrative approach as well.
The overall confidence in the evidence for a positive association between long-term exposure to TRAP and non-accidental mortality was high.
Background:Little attention has been paid to how heat-related health effects vary with the micro-urban variation of outdoor temperatures. This study explored whether people located in micro-urban ...heat islands are at higher risk of mortality during hot summer days.Methods:Data used included (1) daily mortality for Montreal (Canada) for June–August 1990–2003, (2) daily mean ambient outdoor temperatures at the local international airport and (3) two thermal surface images (Landsat satellites, infrared wavelengths). A city-wide temperature versus daily mortality function was established on the basis of a case-crossover design; this function was stratified according to the surface temperature at decedents’ place of death.Results:The risk of death on warm summer days in areas with higher surface temperatures was greater than in areas with lower surface temperatures.Conclusions:This study suggests that measures aimed at reducing the temperature in micro-urban heat islands (eg, urban greening activities) may reduce the health impact of hot temperatures. Further studies are needed to document the variation of heat-related risks within cities and to evaluate the health benefits of measures aimed at reducing the temperature in micro-urban heat islands.
Stroke remains the second cause of death worldwide. The mechanisms underlying the adverse association of exposure to traffic-related air pollution (TRAP) with overall cardiovascular disease may also ...apply to stroke. Our objective was to systematically evaluate the epidemiological evidence regarding the associations of long-term exposure to TRAP with stroke.
PubMed and LUDOK electronic databases were searched systematically for observational epidemiological studies from 1980 through 2019 on long-term exposure to TRAP and stroke with an update in January 2022. TRAP was defined according to a comprehensive protocol based on pollutant and exposure assessment methods or proximity metrics. Study selection, data extraction, risk of bias (RoB) and confidence assessments were conducted according to standardized protocols. We performed meta-analyses using random effects models; sensitivity analyses were assessed by geographic area, RoB, fatality, traffic specificity and new studies.
Nineteen studies were included. The meta-analytic relative risks (and 95% confidence intervals) were: 1.03 (0.98–1.09) per 1 μg/m3 EC, 1.09 (0.96–1.23) per 10 μg/m3 PM10, 1.08 (0.89–1.32) per 5 μg/m3 PM2.5, 0.98 (0.92; 1.05) per 10 μg/m3 NO2 and 0.99 (0.94; 1.04) per 20 μg/m3 NOx with little to moderate heterogeneity based on 6, 5, 4, 7 and 8 studies, respectively. The confidence assessments regarding the quality of the body of evidence and separately regarding the presence of an association of TRAP with stroke considering all available evidence were rated low and moderate, respectively.
The available literature provides low to moderate evidence for an association of TRAP with stroke.
Acute exacerbations (AECOPD) of negatively influence the natural history of chronic obstructive pulmonary (COPD) and they are related to muscle dysfunction. In this pathway hypogonadism could play a ...pivotal role. Our study wants to evaluate possible relationships among prognostic indexes of AECOPD, represented by Acute Physiology and Chronic Health Evaluation (APACHE) II, inflammation (serum amyloid A, SSA) and anabolic hormones, especially less studied steroids, like dihydrotestosterone (DHT) e free-testosterone (f-T).
Twenty-four patients (17 males; age 75 ± 13 yrs) were studied. On admission and at discharge a blood sample for total testosterone (T), DHT, insulin like grow factor 1 (IGF-1) and Serum Amyloid A (SSA) was obtained. f-T was calculated using Vermeulen's formula.
Descriptive statistical analysis shows reduced of T values (1.85 ± 2.28 ng/mL), f-T (0.028 ± 0.030 ng/mL), DHT (0.18 ± 0.19 ng/mL) and IGF-1 (91.840 ± 74.19 pg/mL). Calculating tertile for Apache II and SSA and using them as cut off point, three categories were made and used in the analysis (SSA< 10 mg/mL; 10-160 mg/mL; > 160 mg/mL); (APACHE II ≤ 10; 11-12; > 12). Using this classification, an inverse correlation between SAA and T (P = 0.01), f-T (0.01), DHT (0.001) and IGF-1 (P = 0.05) was found. Data show the same inverse relationship between APACHE II tertiles on one hand and T (P = 0.01) and f-T (P = 0.02) on the other hand.
Our data confirm systemic effects of AECOPD and the role of endocrinological derangements, suggesting a possible mechanism explaining them.
Advances in microsensor technologies for air pollution monitoring encourage a growing use of portable sensors. This study aims at testing their performance in the development of exposure surfaces for ...nitrogen dioxide (NO2) and ozone (O3). In Montreal, Canada, a data-collection campaign was conducted across three seasons in 2014 for 76 sites spanning the range of land uses and built environments of the city; each site was visited from 6 to 12 times, for 20 min, using NO2 and O3 sensors manufactured by Aeroqual. Land-use regression models were developed, achieving R 2 values of 0.86 for NO2 and 0.92 for O3 when adjusted for regional meteorology to control for the fact that all of the locations were not monitored at the same time. A total of two exposure surfaces were then developed for NO2 and O3 as averages over spring, summer, and fall. Validation against the fixed-station data and previous campaigns suggests that Aeroqual sensors tend to overestimate the highest NO2 and O3 concentrations, thus increasing the range of values across the city. However, the sensors suggest a good performance with respect to capturing the spatial variability in NO2 and O3 and are very convenient to use, having great potential for capturing temporal variability.
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