Summary Background Emerging evidence suggests that living near major roads might adversely affect cognition. However, little is known about its relationship with the incidence of dementia, ...Parkinson's disease, and multiple sclerosis. We aimed to investigate the association between residential proximity to major roadways and the incidence of these three neurological diseases in Ontario, Canada. Methods In this population-based cohort study, we assembled two population-based cohorts including all adults aged 20–50 years (about 4·4 million; multiple sclerosis cohort) and all adults aged 55–85 years (about 2·2 million; dementia or Parkinson's disease cohort) who resided in Ontario, Canada on April 1, 2001. Eligible patients were free of these neurological diseases, Ontario residents for 5 years or longer, and Canadian-born. We ascertained the individual's proximity to major roadways based on their residential postal-code address in 1996, 5 years before cohort inception. Incident diagnoses of dementia, Parkinson's disease, and multiple sclerosis were ascertained from provincial health administrative databases with validated algorithms. We assessed the associations between traffic proximity and incident dementia, Parkinson's disease, and multiple sclerosis using Cox proportional hazards models, adjusting for individual and contextual factors such as diabetes, brain injury, and neighbourhood income. We did various sensitivity analyses, such as adjusting for access to neurologists and exposure to selected air pollutants, and restricting to never movers and urban dwellers. Findings Between 2001, and 2012, we identified 243 611 incident cases of dementia, 31 577 cases of Parkinson's disease, and 9247 cases of multiple sclerosis. The adjusted hazard ratio (HR) of incident dementia was 1·07 for people living less than 50 m from a major traffic road (95% CI 1·06–1·08), 1·04 (1·02–1·05) for 50–100 m, 1·02 (1·01–1·03) for 101–200 m, and 1·00 (0·99–1·01) for 201–300 m versus further than 300 m ( p for trend=0·0349). The associations were robust to sensitivity analyses and seemed stronger among urban residents, especially those who lived in major cities (HR 1·12, 95% CI 1·10–1·14 for people living <50 m from a major traffic road), and who never moved (1·12, 1·10–1·14 for people living <50 m from a major traffic road). No association was found with Parkinson's disease or multiple sclerosis. Interpretation In this large population-based cohort, living close to heavy traffic was associated with a higher incidence of dementia, but not with Parkinson's disease or multiple sclerosis. Funding Health Canada (MOA-4500314182).
Current evidence on the relationship between long-term exposure to air pollution and new onset of chronic lung disease is inconclusive.
To examine associations of incident chronic obstructive ...pulmonary disease (COPD) and adult-onset asthma with past exposure to fine particulate matter ≤ 2.5 μm in diameter (PM
), nitrogen dioxide (NO
), ozone (O
), and the redox-weighted average of NO
and O
(O
) and characterize the concentration-response relationship.
We conducted a population-based cohort study of all Ontarians, aged 35-85 years, from 2001 to 2015. A 3-year moving average of residential exposures to selected pollutants with a 1-year lag were estimated during follow-up. We used Cox proportional hazard models and Aalen additive-hazard models to quantify the pollution-disease associations and characterized the shape of these relationships using newly developed nonlinear risk models.
Among 5.1 million adults, we identified 340,733 and 218,005 incident cases of COPD and asthma, respectively. We found positive associations of COPD with PM
per interquartile-range (IQR) increase of 3.4 μg/m
(hazard ratio, 1.07; 95% confidence interval, 1.06-1.08), NO
per IQR increase of 13.9 ppb (1.04; 1.02-1.05), O
per IQR increase of 6.3 ppb (1.04; 1.03-1.04), and O
per IQR increase of 4.4 ppb (1.03; 1.03-1.03). By contrast, we did not find strong evidence linking these pollutants to adult-onset asthma. In addition, we quantified that each IQR increase in pollution exposure yielded 3.0 (2.4-3.6), 3.2 (2.0-4.3), 1.9 (1.3-2.5), and 2.3 (1.7-2.9) excess cases of COPD per 100,000 adults for PM
, NO
, O
, and O
, respectively. Furthermore, most pollutant-COPD relationships exhibited supralinear shapes.
Air pollution was associated with a higher incidence of COPD but was not associated with a higher incidence of adult-onset asthma.
Emerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially at the relatively low levels, on developing dementia. ...We conducted a population-based cohort study in Ontario, Canada, where the concentrations of pollutants are among the lowest in the world, to assess whether air pollution exposure is associated with incident dementia.
The study population comprised all Ontario residents who, on 1 April 2001, were 55–85years old, Canadian-born, and free of physician-diagnosed dementia (~2.1 million individuals). Follow-up extended until 2013. We used population-based health administrative databases with a validated algorithm to ascertain incident diagnosis of dementia as well as prevalent cases. Using satellite observations, land-use regression model, and an optimal interpolation method, we derived long-term average exposure to fine particulate matter (≤2.5μm in diameter) (PM2.5), nitrogen dioxide (NO2), and ozone (O3), respectively at the subjects' historical residences based on a population-based registry. We used multilevel spatial random-effects Cox proportional hazards models, adjusting for individual and contextual factors, such as diabetes, brain injury, and neighborhood income. We conducted various sensitivity analyses, such as lagging exposure up to 10years and considering a negative control outcome for which no (or weaker) association with air pollution is expected.
We identified 257,816 incident cases of dementia in 2001–2013. We found a positive association between PM2.5 and dementia incidence, with a hazard ratio (HR) of 1.04 (95% confidence interval (CI): 1.03–1.05) for every interquartile-range increase in exposure to PM2.5. Similarly, NO2 was associated with increased incidence of dementia (HR=1.10; 95% CI: 1.08–1.12). No association was found for O3. These associations were robust to all sensitivity analyses examined. These estimates translate to 6.1% of dementia cases (or 15,813 cases) attributable to PM2.5 and NO2, based on the observed distribution of exposure relative to the lowest quartile in concentrations in this cohort.
In this large cohort, exposure to air pollution, even at the relative low levels, was associated with higher dementia incidence.
•A population-based cohort of ~2.1 million adult residents in Ontario, Canada.•Exposure to ambient nitrogen dioxide and fine particulate matter was associated higher incidence of dementia.•15,813 cases of dementia (or 6.1% of total cases) were attributable to elevated air pollution exposure in this cohort.•Air pollution levels in Ontario are among the lowest in the world.
Long-term exposure to ambient air pollution has been linked to cardiovascular mortality, but the associations with incidence of major cardiovascular diseases are not fully understood, especially at ...low concentrations. We aimed to investigate the associations between exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2), ozone (O3), redox-weighted average of NO2 and O3 (Ox) and incidence of congestive heart failure (CHF) and acute myocardial infarction (AMI). Our study population included all long-term residents aged 35–85 years who lived in Ontario, Canada, from 2001 to 2015 (~5.1 million). Incidence of CHF and AMI were ascertained from validated registries. We assigned estimates of annual concentrations of pollutants to the residential postal codes of subjects for each year during follow-up. We estimated hazard ratios (HRs) and 95% CIs for each pollutant separately using Cox proportional hazards models. We examined the shape of concentration-response associations using shape-constrained health impact functions. From 2001 to 2015, there were 422,625 and 197,628 incident cases of CHF and AMI, respectively. In the fully adjusted analyses, the HRs of CHF corresponding to each interquartile range increase in exposure were 1.05 (95% CI: 1.04–1.05) for PM2.5, 1.02 (95% CI: 1.01–1.04) for NO2, 1.03 (95% CI: 1.02–1.03) for O3, and 1.02 (95% CI: 1.02–1.03) for Ox, respectively. Similarly, exposure to PM2.5, O3, and Ox were positively associated with AMI. The concentration-response relationships were different for individual pollutant and outcome combinations (e.g., for PM2.5 the relationship was supralinear with CHF, and linear with AMI).
•PM2.5, NO2, O3, and Ox were associated to increased congestive heart failure incidence.•Exposure to PM2.5, O3, and Ox was associated with acute myocardial infarction (AMI).•A near-linear concentration-response relationship was found for PM2.5 and AMI.•Non-linear patterns were observed for other pollutant and outcome combinations.•There was some evidence of effect modification by age and income.
Although growing evidence links air pollution to stroke incidence, less is known about the effect of air pollution on atrial fibrillation (AF), an important risk factor for stroke.
We assessed the ...associations between air pollution and incidence of AF and stroke. We also sought to characterize the shape of pollutant-disease relationships.
The population-based cohort comprised 5,071,956 Ontario residents, age 35–85 y and without the diagnoses of both outcomes on 1 April 2001 and was followed up until 31 March 2015. AF and stroke cases were ascertained using health administrative databases with validated algorithms. Based on annual residential postal codes, we assigned 5-y running average concentrations of fine particulate matter (Formula: see text), nitrogen dioxide (Formula: see text), and ozone (Formula: see text) from satellite-derived data, a land-use regression model, and a fusion-based method, respectively, as well as redox-weighted averages of Formula: see text and Formula: see text (Formula: see text) for each year. Using Cox proportional hazards models, we estimated the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of AF and stroke with each of these pollutants, adjusting for individual- and neighborhood-level variables. We used newly developed nonlinear risk models to characterize the shape of pollutant–disease relationships.
Between 2001 and 2015, we identified 313,157 incident cases of AF and 122,545 cases of stroke. Interquartile range increments of Formula: see text, Formula: see text, Formula: see text, and Formula: see text were associated with increases in the incidence of AF HRs (95% CIs): 1.03 (1.01, 1.04), 1.02 (1.01, 1.03), 1.01 (1.00, 1.02), and 1.01 (1.01, 1.02), respectively and the incidence of stroke HRs (95% CIs): 1.05 (1.03, 1.07), 1.04 (1.01, 1.06), 1.05 (1.03, 1.06), and 1.05 (1.04, 1.06), respectively. Associations of similar magnitude were found in various sensitivity analyses. Furthermore, we found a near-linear association for stroke with Formula: see text, whereas Formula: see text, Formula: see text-, and Formula: see text relationships exhibited sublinear shapes.
Air pollution was associated with stroke and AF onset, even at very low concentrations. https://doi.org/10.1289/EHP4883.
Background Exposure to road traffic noise has been linked to cardiometabolic complications, such as elevated blood pressure and glucose dysregulation. However, epidemiologic evidence linking road ...traffic noise to diabetes mellitus and hypertension remains scarce. We examined associations between road traffic noise and the incidence of diabetes mellitus and hypertension in Toronto, Canada. Methods and Results Using the Ontario Population Health and Environment Cohort, we conducted a retrospective, population-based cohort study of long-term residents of Toronto, aged 35 to 100 years, who were registered for provincial publicly funded health insurance, and were without a history of hypertension (n=701 174) or diabetes mellitus (n=914 607). Road traffic noise exposure levels were assessed by the equivalent continuous A-weighted sound pressure level (dBA) for the 24-hour day and the equivalent continuous A-weighted sound pressure level for the night (11 pm-7am). Noise exposures were assigned to subjects according to their annual residential postal codes during the 15-year follow-up. We used random-effect Cox proportional hazards models adjusting for personal and area-level characteristics. From 2001 to 2015, each interquartile range increase in the equivalent continuous A-weighted sound pressure level (dBA) for the 24-hour day (10.0 dBA) was associated with an 8% increase in incident diabetes mellitus (95% CI, 1.07-1.09) and a 2% increase in hypertension (95% CI, 1.01-1.03). We obtained similar estimates with the equivalent continuous A-weighted sound pressure level for the night (11 pm-7am). These results were robust to all sensitivity analyses conducted, including further adjusting for traffic-related air pollutants (ultrafine particles and nitrogen dioxide). For both hypertension and diabetes mellitus, we observed stronger associations with the equivalent continuous A-weighted sound pressure level (dBA) for the 24-hour day among women and younger adults (aged <60 years). Conclusions Long-term exposure to road traffic noise was associated with an increased incidence of diabetes mellitus and hypertension in Toronto.
AbstractPopulations that are more than just slightly overdue for breast, cervical and colorectal screening should likely be targeted for policy and practice interventions. We used provincial-level ...administrative data to describe the Ontario population who are screen-eligible for breast, cervical and colorectal cancers but overdue by at least five years. For each cancer screening type, we created three cohorts and a binary outcome: screened at least once in the previous five years or not, using March 31, 2017 as our index date. We conducted simple descriptive analyses as well as multivariable logistic regression, where age category, immigrant status, neighbourhood income quintile, region, urban/suburban/rural status, primary care model type, and healthcare utilization were included in the models. More than 20% of Ontarians eligible for each of breast, cervical and colorectal cancer screening respectively had no history of screening in the previous five years. In multivariable analyses, people were significantly more likely to have no recent screening history if they lived in lower-income neighbourhoods (e.g. adjusted odds ratio 95% confidence interval: 0.59 0.58–0.59 for cervical screening), were recent immigrants, did not have a primary care provider, had a provider who practiced in a traditional fee-for-service model. Despite the presence of three provincial organized screening programs, we have found that more than one-fifth of Ontarians who are eligible for each of breast, cervical and colorectal screening respectively have not been screened for five years or more. Ensuring that all Ontarians have access to high-quality primary care, may be crucial to increasing screening uptake.
The Randomized Aldactone Evaluation Study (RALES) showed that spironolactone reduces mortality in patients with severe heart failure; however, the drug can cause hyperkalemia, especially when given ...with angiotensin-converting–enzyme (ACE) inhibitors. The current study found that, after the publication of RALES, there was an abrupt increase in the rate of prescriptions for spironolactone and in hyperkalemia-associated morbidity and mortality in patients with heart failure who were receiving an ACE inhibitor.
The Randomized Aldactone Evaluation Study (RALES) showed reduced mortality in patients with severe heart failure. After its publication, there was an increase in hyperkalemia-associated morbidity and mortality.
Heart failure affects approximately 5 million persons annually in Canada and the United States.
1
Medications are the mainstay of therapy, and in the past two decades there has been a shift away from the use of diuretics and cardiac glycosides and toward neurohumoral manipulation with angiotensin-converting–enzyme (ACE) inhibitors, beta-adrenergic antagonists, and aldosterone antagonists.
1
Published in September 1999, the Randomized Aldactone Evaluation Study (RALES) demonstrated that treatment with spironolactone substantially reduced morbidity and mortality in patients with severe heart failure.
2
Spironolactone is inexpensive and generally well tolerated, but in these patients it can provoke life-threatening hyperkalemia when combined with ACE inhibitors. . . .
•Air pollution was associated with the incidence of diabetes, in particular NO2.•Air pollution was also associated with cardiovascular and diabetes mortality among persons with prevalent ...diabetes.•The strongest associations were observed between NO2 and diabetes mortality.•Results may suggest that traffic-related pollution has the greatest effect on outcomes of diabetes.
Growing evidence implicates ambient air pollutants in the development of major chronic diseases and premature mortality. However, epidemiologic evidence linking air pollution to diabetes remains inconclusive. This study sought to determine the relationships between selected air pollutants (nitrogen dioxide NO2, fine particulate matter PM2.5, ozone O3, and oxidant capacity Ox; the redox-weighted average of O3 and NO2) and the incidence of diabetes, as well as the risk of cardiovascular or diabetes mortality among individuals with prevalent diabetes.
We followed two cohorts, which included 4.8 million Ontario adults free of diabetes and 452,590 Ontario adults with prevalent diabetes, from 2001 to 2015. Area-level air pollution exposures were assigned to subjects’ residential areas, and outcomes were ascertained using health administrative data with validated algorithms. We estimated hazard ratios for the association between each air pollutant and outcome using Cox proportional hazards models, and modelled the shape of the concentration-response relationships.
Over the study period, 790,461 individuals were diagnosed with diabetes. Among those with prevalent diabetes, 26,653 died from diabetes and 64,773 died from cardiovascular diseases. For incident diabetes, each IQR increase in NO2 had a hazard ratio of 1.04 (95% CI: 1.03–1.05). This relationship was relatively robust to all sensitivity analyses considered, and exhibited a near-linear shape. There were also positive associations between incident diabetes and PM2.5, O3, and Ox, but these estimates were somewhat sensitive to different models considered. Among those with prevalent diabetes, almost all pollutants were associated with increased diabetes and cardiovascular mortality risk. The strongest association was observed between diabetes mortality and exposure to NO2 (HR = 1.08, 95% CI: 1.02–1.13).
Selected air pollutants, especially NO2, were linked to an increased risk of incident diabetes, as well as risk of cardiovascular or diabetes mortality among persons with prevalent diabetes. As NO2 is frequently used as a proxy for road traffic exposures, this result may indicate that traffic-related air pollution has the strongest effect on diabetes etiology and survival after diabetes development.
Magnesium (Mg)-based biomaterials are promising candidates for bone and tissue regeneration. Alloying and surface modifications provide effective strategies for optimizing and tailoring their ...degradation kinetics. Nevertheless, biocompatibility analyses of Mg-based materials are challenging due to its special degradation mechanism with continuous hydrogen release. In this context, the hydrogen release and the related (micro-) milieu conditions pretend to strictly follow in vitro standards based on ISO 10993-5/-12. Thus, special adaptions for the testing of Mg materials are necessary, which have been described in a previous study from our group. Based on these adaptions, further developments of a test procedure allowing rapid and effective in vitro cytocompatibility analyses of Mg-based materials based on ISO 10993-5/-12 are necessary. The following study introduces a new two-step test scheme for rapid and effective testing of Mg. Specimens with different surface characteristics were produced by means of plasma electrolytic oxidation (PEO) using silicate-based and phosphate-based electrolytes. The test samples were evaluated for corrosion behavior, cytocompatibility and their mechanical and osteogenic properties. Thereby, two PEO ceramics could be identified for further in vivo evaluations.
PDF
