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Impact of residential mobility on exposure assessment in longitudinal air pollution studies: a sensitivity analysis within the ESCAPE project.

https://arctichealth.org/en/permalink/ahliterature117936
Source
ScientificWorldJournal. 2012;2012:125818
Publication Type
Article
Date
2012
Author
Anna Oudin
Bertil Forsberg
Magnus Strömgren
Rob Beelen
Lars Modig
Author Affiliation
Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden.
Source
ScientificWorldJournal. 2012;2012:125818
Date
2012
Language
English
Publication Type
Article
Keywords
Air Pollutants - analysis - toxicity
Data Interpretation, Statistical
Environmental Exposure - analysis - statistics & numerical data
Environmental Monitoring - methods
Female
Humans
Longitudinal Studies
Male
Nitrogen Oxides - analysis - toxicity
Population Dynamics
Regression Analysis
Sweden
Time Factors
Abstract
Exposure misclassification in longitudinal studies of air pollution exposure and health effects can occur due to residential mobility in a study population over followup. The aim of this study was to investigate to what extent residential mobility during followup can be expected to cause exposure misclassification in such studies, where exposure at the baseline address is used as the main exposure assessment. The addresses for each participant in a large population-based study (N > 25,000) were obtained via national registers. We used a Land Use Regression model to estimate the NO(x) concentration for each participant's all addresses during the entire follow-up period (in average 14.6 years) and calculated an average concentration during followup. The Land Use Regression model explained 83% of the variation in measured levels. In summary, the NO(x) concentration at the inclusion address was similar to the average concentration over followup with a correlation coefficient of 0.80, indicating that air pollution concentration at study inclusion address could be used as indicator of average air pollution concentrations over followup. The differences between an individual's inclusion and average follow-up mean concentration were small and seemed to be nondifferential with respect to a large range of factors and disease statuses, implying that bias due to residential mobility was small.
Notes
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Cites: Epidemiology. 2009 Jan;20(1):119-2618923331
Cites: Eur Respir J. 2009 Jun;33(6):1261-719251785
Cites: Diabetes Care. 2012 Jan;35(1):92-822074722
Cites: Eur J Epidemiol. 2010 Mar;25(3):163-7220127393
Cites: Epidemiology. 2010 Sep;21(5):642-920585255
Cites: Occup Environ Med. 2011 Oct;68(10):765-7021285243
Cites: Thorax. 2009 Aug;64(8):664-7019359271
PubMed ID
23251098 View in PubMed
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Potential health impacts of changes in air pollution exposure associated with moving traffic into a road tunnel.

https://arctichealth.org/en/permalink/ahliterature274133
Source
J Expo Sci Environ Epidemiol. 2015 Sep-Oct;25(5):524-31
Publication Type
Article
Author
Hans Orru
Boel Lövenheim
Christer Johansson
Bertil Forsberg
Source
J Expo Sci Environ Epidemiol. 2015 Sep-Oct;25(5):524-31
Language
English
Publication Type
Article
Keywords
Air Pollutants - adverse effects - analysis
Air Pollution - adverse effects - analysis
Environmental Monitoring - methods
Health status
Humans
Models, Theoretical
Mortality
Nitrogen Oxides - adverse effects - analysis
Particle Size
Particulate Matter - adverse effects - analysis
Risk Assessment - methods
Sweden
Urban Population
Vehicle Emissions - analysis
Abstract
A planned 21?km bypass (18?km within a tunnel) in Stockholm is expected to reduce ambient air exposure to traffic emissions, but same time tunnel users could be exposed to high concentrations of pollutants. For the health impacts calculations in 2030, the change in annual ambient NOX and PM10 exposure of the general population was modelled in 100 × 100?m(2) grids for Greater Stockholm area. The tunnel exposure was estimated based on calculated annual average NOX concentrations, time spent in tunnel and number of tunnel users. For the general population, we estimate annually 23.7 (95% CI: 17.7-32.3) fewer premature deaths as ambient concentrations are reduced. At the same time, tunnel users will be exposed to NOX levels up to 2000?µg/m(-3). Passing through the whole tunnel two times on working days would correspond to an additional annual NOX exposure of 9.6?µg/m(3). Assuming that there will be ~55,000 vehicles daily each way and 1.3 persons of 30-74 years of age in each vehicle, we estimate the tunnel exposure to result in 20.6 (95% CI: 14.1-25.6) premature deaths annually. If there were more persons per vehicle, or older and vulnerable people travelling, or tunnel dispersion conditions worsen, the adverse effect would become larger.
PubMed ID
25921080 View in PubMed
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The clinical expression of asthma in schoolchildren has changed between 1996 and 2006.

https://arctichealth.org/en/permalink/ahliterature97254
Source
Pediatr Allergy Immunol. 2010 Aug;21(5):859-66
Publication Type
Article
Date
Aug-2010
Author
Martin Andersson
Anders Bjerg
Bertil Forsberg
Bo Lundbäck
Eva Rönmark
Author Affiliation
Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
Source
Pediatr Allergy Immunol. 2010 Aug;21(5):859-66
Date
Aug-2010
Language
English
Publication Type
Article
Abstract
Several studies have reported diverging trends in the prevalence of asthma and wheeze. The aim of this study was to investigate the clinical expression of childhood asthma in 1996 and 2006 by studying asthma morbidity, treatment, and environmental exposures in school children with physician-diagnosed asthma and wheeze, respectively. All children enrolled in first or second grade (7-8 yr-old) in three municipalities in northern Sweden were invited to a questionnaire study in 1996 and 2006, respectively. In 1996, 3430 (97%) participated; and in 2006, 2585 (96%) participated. The same parental completed questionnaire, including the ISAAC questions, was used in both surveys. Physician-diagnosed asthma was reported at 5.7% in 1996 and 7.4% in 2006. A significantly greater proportion of children with asthma were using inhaled corticosteroids (ICS) in 2006, 67% vs. 55% in 1996. This increase was parallel to a major decrease in severe asthma symptoms such as disturbed sleep because of wheeze (49% vs. 38%) and troublesome asthma (21% vs. 11%). The prevalence of current wheeze among the asthmatics decreased significantly; however, this was seen only among children not using ICS. Parental smoking decreased significantly as did the proportion living in damp buildings. In conclusion, although asthma remains a major public health issue in school age children, children with asthma had less respiratory symptoms and a better asthma control in 2006 compared to 1996. This parallels with an increase in treatment with ICS, more beneficial environmental conditions, and an increased diagnostic intensity resulting in a larger proportion of children with mild symptoms being diagnosed as having asthma.
PubMed ID
20408972 View in PubMed
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Association between air pollution from residential wood burning and dementia incidence in a longitudinal study in Northern Sweden.

https://arctichealth.org/en/permalink/ahliterature292308
Source
PLoS One. 2018; 13(6):e0198283
Publication Type
Journal Article
Date
2018
Author
Anna Oudin
David Segersson
Rolf Adolfsson
Bertil Forsberg
Author Affiliation
Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Source
PLoS One. 2018; 13(6):e0198283
Date
2018
Language
English
Publication Type
Journal Article
Abstract
There is highly suggestive evidence for an effect of air pollution exposure on dementia-related outcomes, but evidence is not yet present to clearly pinpoint which pollutants are the probable causal agents. The aims of this study was to assess the longitudinal association between exposures of fine ambient particulate matter (PM2.5) from residential wood burning, and vehicle exhaust, with dementia.
We used data from the Betula study, a longitudinal study of dementia in Umeå, Northern Sweden. The study size was 1 806 and the participants were followed from study entry (1993-1995) to 2010. Modelled levels of source-specific fine particulate matter at the residential address were combined with information on wood stoves or wood boilers, and with validated data on dementia diagnosis and individual-level characteristics from the Betula study. Cox proportional hazards models were used to estimate Hazard Ratios (HRs) and their 95% CIs for dementia incidence (vascular dementia and Alzheimer's disease), adjusted for individual-level characteristics.
The emission of PM2.5 from local residential wood burning was associated with dementia incidence with a hazard ratio of 1.55 for a 1 µg/m3 increase in PM2.5 (95% Confidence Interval (CI): 1.00-2.41, p-value 0.05). Study participants with an address in an area with the highest quartile of PM2.5 from residential wood burning and who also had a wood-burning stove were more likely to develop dementia than those in the lower three quartiles without a wood-burning stove with hazard ratios of 1.74 (CI: 1.10-2.75, p-value 0.018). Particulate matter from traffic exhaust seemed to be associated with dementia incidence with hazard ratios of 1.66, (CI: 1.16-2.39), p-value 0.006, and 1.41 (CI: 0.97-2.23), p-value 0.07, in the third and fourth quartiles, respectively.
If the associations we observed are causal, then air pollution from residential wood burning, and air pollution from traffic, might be independent important risk factors for dementia.
Notes
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PubMed ID
29897947 View in PubMed
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Volcanic ash and daily mortality in Sweden after the Icelandic volcano eruption of May 2011.

https://arctichealth.org/en/permalink/ahliterature257134
Source
Int J Environ Res Public Health. 2013 Dec;10(12):6909-19
Publication Type
Article
Date
Dec-2013
Author
Anna Oudin
Hanne K Carlsen
Bertil Forsberg
Christer Johansson
Author Affiliation
Division of Occupational and Environmental Medicine, Umeå University, Umeå 90187, Sweden. anna.oudin@envmed.umu.se.
Source
Int J Environ Res Public Health. 2013 Dec;10(12):6909-19
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Cardiovascular Diseases - mortality
Environmental Exposure
Environmental monitoring
Iceland
Particle Size
Particulate Matter - adverse effects - analysis
Respiratory Tract Diseases - mortality
Risk factors
Seasons
Sweden - epidemiology
Time Factors
Volcanic Eruptions - adverse effects
Abstract
In the aftermath of the Icelandic volcano Grimsvötn's eruption on 21 May 2011, volcanic ash reached Northern Europe. Elevated levels of ambient particles (PM) were registered in mid Sweden. The aim of the present study was to investigate if the Grimsvötn eruption had an effect on mortality in Sweden. Based on PM measurements at 16 sites across Sweden, data were classified into an ash exposed data set (Ash area) and an unexposed data set (No ash area). Data on daily all-cause mortality were obtained from Statistics Sweden for the time period 1 April through 31 July 2011. Mortality ratios were calculated as the ratio between the daily number of deaths in the Ash area and the No ash area. The exposure period was defined as the week following the days with elevated particle concentrations, namely 24 May through 31 May. The control period was defined as 1 April through 23 May and 1 June through 31 July. There was no absolute increase in mortality during the exposure period. However, during the exposure period the mean mortality ratio was 2.42 compared with 2.17 during the control period, implying a relatively higher number of deaths in the Ash area than in the No ash area. The differences in ratios were mostly due to a single day, 31 May, and were not statistically significant when tested with a Mann-Whitney non-parametric test (p > 0.3). The statistical power was low with only 8 days in the exposure period (24 May through 31 May). Assuming that the observed relative differences were not due to chance, the results would imply an increase of 128 deaths during the exposure period 24-31 May. If 31 May was excluded, the number of extra deaths was reduced to 20. The results of the present study are contradicting and inconclusive, but may indicate that all-cause mortality was increased by the ash-fall from the Grimsvötn eruption. Meta-analysis or pooled analysis of data from neighboring countries might make it possible to reach sufficient statistical power to study effects of the Grimsvötn ash on morbidity and mortality. Such studies would be of particular importance for European societies preparing for future large scale volcanic eruptions in Iceland.
Notes
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PubMed ID
24336019 View in PubMed
Less detail

Ozone is associated with cardiopulmonary and stroke emergency hospital visits in Reykjavík, Iceland 2003-2009.

https://arctichealth.org/en/permalink/ahliterature114917
Source
Environ Health. 2013;12:28
Publication Type
Article
Date
2013
Author
Hanne Krage Carlsen
Bertil Forsberg
Kadri Meister
Thorarinn Gíslason
Anna Oudin
Author Affiliation
Centre of Public Health, University of Iceland, Stapi v/Hringbraut, Reykjavik, 101, Iceland. hkc1@hi.is
Source
Environ Health. 2013;12:28
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Air Pollutants - analysis - toxicity
Cardiovascular Diseases - chemically induced - epidemiology
Comorbidity
Emergency Service, Hospital
Environmental Exposure
Environmental monitoring
Female
Hospitalization - statistics & numerical data
Humans
Iceland - epidemiology
Incidence
Male
Middle Aged
Nitrogen Dioxide - analysis - toxicity
Ozone - analysis - toxicity
Particulate Matter - analysis - toxicity
Poisson Distribution
Respiratory Tract Diseases - chemically induced - epidemiology
Seasons
Stroke - chemically induced - epidemiology
Time Factors
Urban health
Abstract
Air pollution exposure is associated with hospital admissions and emergency room visits for cardiopulmonary disease and stroke. Iceland's capital area, Reykjavik, has generally low air pollution levels, but traffic and natural sources contribute to pollution levels. The objective of this study was to investigate temporal associations between emergency hospital visits and air pollutants ozone (O3), nitrogen dioxide (NO2), and particulate matter (PM10) in the Icelandic capital area.
We constructed a time series of the daily number of adults who visited the emergency room, or were acutely admitted for stroke or cardiorespiratory causes to Landspitali University Hospital 1 January 2003 - 31 December 2009 from the hospital in-patient register. We used generalized additive models assuming Poisson distribution, to analyze the daily emergency hospital visits as a function of the pollutant levels, and adjusted for meteorological variables, day of week, and time trend with splines.
Daily emergency hospital visits increased 3.9% (95% confidence interval (CI) 1.7-6.1%) per interquartile (IQR) change in average O3 the same and two previous days. For females, the increase was 7.8% (95% CI 3.6-12.1) for elderly (70+), the increase was 3.9% (95% CI 0.6-7.3%) per IQR increase of NO2. There were no associations with PM10.
We found an increase in daily emergency hospital visits associated with O3, indicating that low-level exposure may trigger cardiopulmonary events or stroke.
Notes
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PubMed ID
23566138 View in PubMed
Less detail

Chronic traffic-induced PM exposure and self-reported respiratory and cardiovascular health in the RHINE Tartu Cohort.

https://arctichealth.org/en/permalink/ahliterature146294
Source
Int J Environ Res Public Health. 2009 Nov;6(11):2740-51
Publication Type
Article
Date
Nov-2009
Author
Hans Orru
Rain Jõgi
Marko Kaasik
Bertil Forsberg
Author Affiliation
Department of Public Health, University of Tartu, Estonia. Hans.Orru@ut.ee
Source
Int J Environ Res Public Health. 2009 Nov;6(11):2740-51
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Adult
Air Pollutants - adverse effects
Automobiles
Cardiovascular Diseases - epidemiology - etiology
Cohort Studies
Confidence Intervals
Environmental Exposure - adverse effects
Estonia - epidemiology
Female
Health status
Humans
Life Style
Logistic Models
Male
Middle Aged
Models, Statistical
Odds Ratio
Particulate Matter - adverse effects
Prevalence
Questionnaires
Respiratory Tract Diseases - epidemiology - etiology
Risk assessment
Sweden - epidemiology
Time Factors
Abstract
The relationship between exposure to traffic induced particles, respiratory health and cardiac diseases was studied in the RHINE Tartu cohort. A postal questionnaire with commonly used questions regarding respiratory symptoms, cardiac disease, lifestyle issues such as smoking habits, indoor environment, occupation, early life exposure and sleep disorders was sent to 2,460 adults. The annual concentrations of local traffic induced particles were modelled with an atmospheric dispersion model with traffic flow data, and obtained PM(exhaust) concentrations in 40 x 40 m grids were linked with home addresses with GIS. The relationship between the level of exhaust particles outside home and self-reported health problems were analyzed using a multiple logistic regression model. We found a significant relation between fine exhaust particles and cardiac disease, OR = 1.64 (95% CI 1.12-2.43) for increase in PM(exhaust) corresponding to the fifth to the 95th percentile range. The associations also were positive but non-significant for hypertension OR = 1.42 (95% CI 0.94-2.13), shortness of breath OR = 1.27 (95% CI 0.84-1.94) and other respiratory symptoms.
Notes
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PubMed ID
20049219 View in PubMed
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Association between neighbourhood air pollution concentrations and dispensed medication for psychiatric disorders in a large longitudinal cohort of Swedish children and adolescents.

https://arctichealth.org/en/permalink/ahliterature288095
Source
BMJ Open. 2016 06 03;6(6):e010004
Publication Type
Article
Date
06-03-2016
Author
Anna Oudin
Lennart Bråbäck
Daniel Oudin Åström
Magnus Strömgren
Bertil Forsberg
Source
BMJ Open. 2016 06 03;6(6):e010004
Date
06-03-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Air Pollution - adverse effects
Antipsychotic Agents - therapeutic use
Child
Drug Prescriptions - statistics & numerical data
Environmental Exposure - adverse effects
Environmental monitoring
Female
Follow-Up Studies
Humans
Incidence
Longitudinal Studies
Male
Mental Disorders - drug therapy - epidemiology
Proportional Hazards Models
Social Class
Sweden - epidemiology
Time Factors
Abstract
To investigate associations between exposure to air pollution and child and adolescent mental health.
Observational study.
Swedish National Register data on dispensed medications for a broad range of psychiatric disorders, including sedative medications, sleeping pills and antipsychotic medications, together with socioeconomic and demographic data and a national land use regression model for air pollution concentrations for NO2, PM10 and PM2.5.
The entire population under 18 years of age in 4 major counties. We excluded cohort members whose parents had dispensed a medication in the same medication group since the start date of the register. The cohort size was 552 221.
Cox proportional hazards models to estimate HRs and their 95% CIs for the outcomes, adjusted for individual-level and group-level characteristics.
The average length of follow-up was 3.5 years, with an average number of events per 1000 cohort members of ~21. The mean annual level of NO2 was 9.8 µg/m(3). Children and adolescents living in areas with higher air pollution concentrations were more likely to have a dispensed medication for a psychiatric disorder during follow-up (HR=1.09, 95% CI 1.06 to 1.12, associated with a 10 µg/m(3) increase in NO2). The association with NO2 was clearly present in 3 out of 4 counties in the study area; however, no statistically significant heterogeneity was detected.
There may be a link between exposure to air pollution and dispensed medications for certain psychiatric disorders in children and adolescents even at the relatively low levels of air pollution in the study regions. The findings should be corroborated by others.
Notes
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PubMed ID
27259522 View in PubMed
Less detail

Traffic-Related Air Pollution and Dementia Incidence in Northern Sweden: A Longitudinal Study.

https://arctichealth.org/en/permalink/ahliterature278570
Source
Environ Health Perspect. 2016 Mar;124(3):306-12
Publication Type
Article
Date
Mar-2016
Author
Anna Oudin
Bertil Forsberg
Annelie Nordin Adolfsson
Nina Lind
Lars Modig
Maria Nordin
Steven Nordin
Rolf Adolfsson
Lars-Göran Nilsson
Source
Environ Health Perspect. 2016 Mar;124(3):306-12
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Air Pollutants - analysis - toxicity
Air Pollution - adverse effects
Alzheimer Disease - epidemiology - etiology
Cities - epidemiology
Dementia, Vascular - epidemiology - etiology
Environmental Exposure - adverse effects
Female
Humans
Longitudinal Studies
Male
Middle Aged
Nitrogen Oxides - analysis
Prospective Studies
Risk factors
Sweden - epidemiology
Vehicle Emissions - analysis - toxicity
Abstract
Exposure to ambient air pollution is suspected to cause cognitive effects, but a prospective cohort is needed to study exposure to air pollution at the home address and the incidence of dementia.
We aimed to assess the association between long-term exposure to traffic-related air pollution and dementia incidence in a major city in northern Sweden.
Data on dementia incidence over a 15-year period were obtained from the longitudinal Betula study. Traffic air pollution exposure was assessed using a land-use regression model with a spatial resolution of 50 m ? 50 m. Annual mean nitrogen oxide levels at the residential address of the participants at baseline (the start of follow-up) were used as markers for long-term exposure to air pollution.
Out of 1,806 participants at baseline, 191 were diagnosed with Alzheimer's disease during follow-up, and 111 were diagnosed with vascular dementia. Participants in the group with the highest exposure were more likely than those in the group with the lowest exposure to be diagnosed with dementia (Alzheimer's disease or vascular dementia), with a hazard ratio (HR) of 1.43 (95% CI: 0.998, 2.05 for the highest vs. the lowest quartile). The estimates were similar for Alzheimer's disease (HR 1.38) and vascular dementia (HR 1.47). The HR for dementia associated with the third quartile versus the lowest quartile was 1.48 (95% CI: 1.03, 2.11). A subanalysis that excluded a younger sample that had been retested after only 5 years of follow-up suggested stronger associations with exposure than were present in the full cohort (HR = 1.71; 95% CI: 1.08, 2.73 for the highest vs. the lowest quartile).
If the associations we observed are causal, then air pollution from traffic might be an important risk factor for vascular dementia and Alzheimer's disease.
Notes
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PubMed ID
26305859 View in PubMed
Less detail

Chronic burden of near-roadway traffic pollution in 10 European cities (APHEKOM network).

https://arctichealth.org/en/permalink/ahliterature115318
Source
Eur Respir J. 2013 Sep;42(3):594-605
Publication Type
Article
Date
Sep-2013
Author
Laura Perez
Christophe Declercq
Carmen Iñiguez
Inmaculada Aguilera
Chiara Badaloni
Ferran Ballester
Catherine Bouland
Olivier Chanel
Francisco B Cirarda
Francesco Forastiere
Bertil Forsberg
Daniela Haluza
Britta Hedlund
Koldo Cambra
Marina Lacasaña
Hanns Moshammer
Peter Otorepec
Miguel Rodríguez-Barranco
Sylvia Medina
Nino Künzli
Author Affiliation
Swiss Tropical and Public Health Institute, Basel, Switzerland. l.perez@unibas.ch
Source
Eur Respir J. 2013 Sep;42(3):594-605
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Adult
Air Pollution - statistics & numerical data
Asthma - epidemiology
Austria - epidemiology
Child
Cities - epidemiology
Coronary Disease - epidemiology
Environmental monitoring
Humans
Inhalation Exposure - statistics & numerical data
Italy - epidemiology
Risk assessment
Slovenia - epidemiology
Spain - epidemiology
Sweden - epidemiology
Vehicle Emissions
Abstract
Recent epidemiological research suggests that near road traffic-related pollution may cause chronic disease, as well as exacerbation of related pathologies, implying that the entire "chronic disease progression" should be attributed to air pollution, no matter what the proximate cause was. We estimated the burden of childhood asthma attributable to air pollution in 10 European cities by calculating the number of cases of 1) asthma caused by near road traffic-related pollution, and 2) acute asthma events related to urban air pollution levels. We then expanded our approach to include coronary heart diseases in adults. Derivation of attributable cases required combining concentration-response function between exposures and the respective health outcome of interest (obtained from published literature), an estimate of the distribution of selected exposures in the target population, and information about the frequency of the assessed morbidities. Exposure to roads with high vehicle traffic, a proxy for near road traffic-related pollution, accounted for 14% of all asthma cases. When a causal relationship between near road traffic-related pollution and asthma is assumed, 15% of all episodes of asthma symptoms were attributable to air pollution. Without this assumption, only 2% of asthma symptoms were attributable to air pollution. Similar patterns were found for coronary heart diseases in older adults. Pollutants along busy roads are responsible for a large and preventable share of chronic disease and related acute exacerbations in European urban areas.
PubMed ID
23520318 View in PubMed
Less detail

The effect of high ambient temperature on the elderly population in three regions of Sweden.

https://arctichealth.org/en/permalink/ahliterature96293
Source
Int J Environ Res Public Health. 2010 Jun;7(6):2607-19
Publication Type
Article
Date
Jun-2010
Author
Joacim Rocklöv
Bertil Forsberg
Author Affiliation
Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, 7 Umeå, Sweden. joacim.rocklov@envmed.umu.se
Source
Int J Environ Res Public Health. 2010 Jun;7(6):2607-19
Date
Jun-2010
Language
English
Publication Type
Article
Abstract
The short-term effects of high temperatures are a serious concern in the context of climate change. In areas that today have mild climates the research activity has been rather limited, despite the fact that differences in temperature susceptibility will play a fundamental role in understanding the exposure, acclimatization, adaptation and health risks of a changing climate. In addition, many studies employ biometeorological indexes without careful investigation of the regional heterogeneity in the impact of relative humidity. We aimed to investigate the effects of summer temperature and relative humidity and regional differences in three regions of Sweden allowing for heterogeneity of the effect over the scale of summer temperature. To do so, we collected mortality data for ages 65+ from Stockholm, G?teborg and Sk?ne from the Swedish National Board of Health and Welfare and the Swedish Meteorological and Hydrological Institute for the years 1998 through 2005. In Stockholm and Sk?ne on average 22 deaths per day occurred, while in G?teborg the mean frequency of daily deaths was 10. We fitted time-series regression models to estimate relative risks of high ambient temperatures on daily mortality using smooth functions to control for confounders, and estimated non-linear effects of exposure while allowing for auto-regressive correlation of observations within summers. The effect of temperature on mortality was found distributed over the same or following day, with statistically significant cumulative combined relative risk of about 5.1% (CI = 0.3, 10.1) per degrees C above the 90th percentile of summer temperature. The effect of high relative humidity was statistically significant in only one of the regions, as was the effect of relative humidity (above 80th percentile) and temperature (above 90th percentile). In the southernmost region studied there appeared to be a significant increase in mortality with decreasing low summer temperatures that was not apparent in the two more northerly situated regions. The effects of warm temperatures on the elderly population in Sweden are rather strong and consistent across different regions after adjustment for mortality displacement. The impact of relative humidity appears to be different in regions, and may be a more important predictor of mortality in some areas.
PubMed ID
20644691 View in PubMed
Less detail

Association between air pollution from residential wood burning and dementia incidence in a longitudinal study in Northern Sweden.

https://arctichealth.org/en/permalink/ahliterature296869
Source
PLoS One. 2018; 13(6):e0198283
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
2018
Author
Anna Oudin
David Segersson
Rolf Adolfsson
Bertil Forsberg
Author Affiliation
Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Source
PLoS One. 2018; 13(6):e0198283
Date
2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Age Distribution
Aged
Aged, 80 and over
Air Pollution - adverse effects - analysis
Dementia - chemically induced - epidemiology
Female
Fires
Housing
Humans
Incidence
Longitudinal Studies
Male
Middle Aged
Particulate Matter - adverse effects - analysis
Risk factors
Sweden - epidemiology
Vehicle Emissions - analysis
Wood - adverse effects - chemistry
Abstract
There is highly suggestive evidence for an effect of air pollution exposure on dementia-related outcomes, but evidence is not yet present to clearly pinpoint which pollutants are the probable causal agents. The aims of this study was to assess the longitudinal association between exposures of fine ambient particulate matter (PM2.5) from residential wood burning, and vehicle exhaust, with dementia.
We used data from the Betula study, a longitudinal study of dementia in Umeå, Northern Sweden. The study size was 1 806 and the participants were followed from study entry (1993-1995) to 2010. Modelled levels of source-specific fine particulate matter at the residential address were combined with information on wood stoves or wood boilers, and with validated data on dementia diagnosis and individual-level characteristics from the Betula study. Cox proportional hazards models were used to estimate Hazard Ratios (HRs) and their 95% CIs for dementia incidence (vascular dementia and Alzheimer's disease), adjusted for individual-level characteristics.
The emission of PM2.5 from local residential wood burning was associated with dementia incidence with a hazard ratio of 1.55 for a 1 µg/m3 increase in PM2.5 (95% Confidence Interval (CI): 1.00-2.41, p-value 0.05). Study participants with an address in an area with the highest quartile of PM2.5 from residential wood burning and who also had a wood-burning stove were more likely to develop dementia than those in the lower three quartiles without a wood-burning stove with hazard ratios of 1.74 (CI: 1.10-2.75, p-value 0.018). Particulate matter from traffic exhaust seemed to be associated with dementia incidence with hazard ratios of 1.66, (CI: 1.16-2.39), p-value 0.006, and 1.41 (CI: 0.97-2.23), p-value 0.07, in the third and fourth quartiles, respectively.
If the associations we observed are causal, then air pollution from residential wood burning, and air pollution from traffic, might be independent important risk factors for dementia.
PubMed ID
29897947 View in PubMed
Less detail

Early life swimming pool exposure and asthma onset in children - a case-control study.

https://arctichealth.org/en/permalink/ahliterature296884
Source
Environ Health. 2018 04 11; 17(1):34
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
04-11-2018
Author
Martin Andersson
Helena Backman
Gunnar Nordberg
Annika Hagenbjörk
Linnea Hedman
Kåre Eriksson
Bertil Forsberg
Eva Rönmark
Author Affiliation
Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187, Umeå, Sweden. martin.andersson@umu.se.
Source
Environ Health. 2018 04 11; 17(1):34
Date
04-11-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Air Pollutants - adverse effects
Air Pollution, Indoor - adverse effects
Asthma - chemically induced - epidemiology
Case-Control Studies
Child
Chlorides - adverse effects
Female
Humans
Inhalation Exposure - adverse effects
Male
Nitrogen Compounds - adverse effects
Prevalence
Sweden - epidemiology
Swimming Pools
Abstract
Trichloramine exposure in indoor swimming pools has been suggested to cause asthma in children. We aimed to investigate the risk of asthma onset among children in relation to individual trichloramine exposure.
A longitudinal nested case-control study of 337 children with asthma (cases) and 633 controls aged 16-17 years was performed within a population-based cohort from The Obstructive Lung Disease in Northern Sweden studies (OLIN). Year of asthma onset and exposure time at different ages were obtained in telephone interviews. Trichloramine concentrations in the pool buildings were measured. Skin prick test results for inhalant allergens were available from previous examinations of the cohort. The risk for asthma was analyzed in relation to the cumulative trichloramine exposure before onset of asthma.
The participation rate was high in the original cohort (88 to 96%), and in the case-control study (80%). Trichloramine concentrations ranged from 0.020 to 0.55 mg/m3 (mean 0.15 mg/m3). Swimming pool exposure in early life was associated with a significantly higher risk of pre-school asthma onset. A dose-response relationship between swimming pool exposure and asthma was indicated in children with asthma onset at 1 year of age. Children who were both sensitized and exposed had a particularly high risk.
Early life exposure to chlorinated swimming pool environments was associated with pre-school asthma onset.
PubMed ID
29642932 View in PubMed
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Acute fatal effects of short-lasting extreme temperatures in Stockholm, Sweden: evidence across a century of change.

https://arctichealth.org/en/permalink/ahliterature107127
Source
Epidemiology. 2013 Nov;24(6):820-9
Publication Type
Article
Date
Nov-2013
Author
Daniel Oudin Åström
Bertil Forsberg
Sören Edvinsson
Joacim Rocklöv
Author Affiliation
From the aDepartment of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden; bAgeing and Living Conditions Programme, Umeå University, Umeå, Sweden; cCentre for Population Studies, Umeå University, Umeå, Sweden; and dDepartment of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Source
Epidemiology. 2013 Nov;24(6):820-9
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Child
Child, Preschool
Extreme Cold - adverse effects
Extreme Heat - adverse effects
Female
Humans
Infant
Male
Middle Aged
Mortality - trends
Risk
Sex Distribution
Sweden - epidemiology
Time Factors
Young Adult
Abstract
Climate change is projected to increase the frequency of extreme weather events. Short-term effects of extreme hot and cold weather and their effects on mortality have been thoroughly documented, as have epidemiologic and demographic changes throughout the 20th century. We investigated whether sensitivity to episodes of extreme heat and cold has changed in Stockholm, Sweden, from the beginning of the 20th century until the present.
We collected daily mortality and temperature data for the period 1901-2009 for present-day Stockholm County, Sweden. Heat extremes were defined as days for which the 2-day moving average of mean temperature was above the 98th percentile; cold extremes were defined as days for which the 26-day moving average was below the 2nd percentile. The relationship between extreme hot/cold temperatures and all-cause mortality, stratified by decade, sex, and age, was investigated through time series modeling, adjusting for time trends.
Total daily mortality was higher during heat extremes in all decades, with a declining trend over time in the relative risk associated with heat extremes, leveling off during the last three decades. The relative risk of mortality was higher during cold extremes for the entire period, with a more dispersed pattern across decades. Unlike for heat extremes, there was no decline in the mortality with cold extremes over time.
Although the relative risk of mortality during extreme temperature events appears to have fallen, such events still pose a threat to public health.
PubMed ID
24051892 View in PubMed
Less detail

Estimated short-term effects of coarse particles on daily mortality in Stockholm, Sweden.

https://arctichealth.org/en/permalink/ahliterature128658
Source
Environ Health Perspect. 2012 Mar;120(3):431-6
Publication Type
Article
Date
Mar-2012
Author
Kadri Meister
Christer Johansson
Bertil Forsberg
Author Affiliation
Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden. kadri.meister@envmed.umu.se
Source
Environ Health Perspect. 2012 Mar;120(3):431-6
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Air Pollutants - toxicity
Carbon Monoxide - toxicity
Dust - analysis
Environmental Exposure
Humans
Mortality
Ozone - toxicity
Particle Size
Particulate Matter - toxicity
Regression Analysis
Seasons
Sweden - epidemiology
Time Factors
Urban health
Abstract
Although serious health effects associated with particulate matter (PM) with aerodynamic diameter = 10 µm (PM10) and = 2.5 µm (PM(2.5); fine fraction) are documented in many studies, the effects of coarse PM (PM(2.5-10)) are still under debate.
In this study, we estimated the effects of short-term exposure of PM(2.5-10) on daily mortality in Stockholm, Sweden.
We collected data on daily mortality for the years 2000 through 2008. Concentrations of PM10, PM(2.5), ozone, and carbon monoxide were measured simultaneously in central Stockholm. We used additive Poisson regression models to examine the association between daily mortality and PM2.5-10 on the day of death and the day before. Effect estimates were adjusted for other pollutants (two-pollutant models) during different seasons.
We estimated a 1.68% increase [95% confidence interval (CI): 0.20%, 3.15%] in daily mortality per 10-µg/m³ increase in PM(2.5-10) (single-pollutant model). The association with PM(2.5-10) was stronger for November through May, when road dust is most important (1.69% increase; 95% CI: 0.21%, 3.17%), compared with the rest of the year (1.31% increase; 95% CI: -2.08%, 4.70%), although the difference was not statistically significant. When adjusted for other pollutants, particularly PM(2.5), the effect estimates per 10 µg/m³ for PM(2.5-10) decreased slightly but were still higher than corresponding effect estimates for PM(2.5).
Our analysis shows an increase in daily mortality associated with elevated urban background levels of PM(2.5-10). Regulation of PM(2.5-10) should be considered, along with actions to specifically reduce PM(2.5-10) emissions, especially road dust suspension, in cities.
Notes
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PubMed ID
22182596 View in PubMed
Less detail

Air Pollution and Dispensed Medications for Asthma, and Possible Effect Modifiers Related to Mental Health and Socio-Economy: A Longitudinal Cohort Study of Swedish Children and Adolescents.

https://arctichealth.org/en/permalink/ahliterature291426
Source
Int J Environ Res Public Health. 2017 11 16; 14(11):
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
11-16-2017
Author
Anna Oudin
Lennart Bråbäck
Daniel Oudin Åström
Bertil Forsberg
Author Affiliation
Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden. anna.oudin@umu.se.
Source
Int J Environ Res Public Health. 2017 11 16; 14(11):
Date
11-16-2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Air Pollutants - analysis
Air Pollution - analysis
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy
Child
Child, Preschool
Cohort Studies
Female
Humans
Logistic Models
Longitudinal Studies
Male
Mental health
Nitrogen Dioxide - analysis
Odds Ratio
Social Class
Socioeconomic Factors
Sweden
Abstract
It has been suggested that children that are exposed to a stressful environment at home have an increased susceptibility for air pollution-related asthma. The aim here was to investigate the association between air pollution exposure and asthma, and effect modification by mental health and by socio-economic status (as markers of a stressful environment). All individuals under 18 years of age in four Swedish counties during 2007 to 2010 (1.2 million people) were included. The outcome was defined as dispensing at least two asthma medications during follow up. We linked data on NO2 from an empirical land use regression to data from national registers on outcome and potential confounders. Data was analyzed with logistic regression. There was an odds ratio (OR) of 1.02 (95% Confidence Interval (CI: 1.01-1.03) for asthma associated with a 10 µg·m-3 increase in NO2. The association only seemed to be present in areas where NO2 was higher than 15 µg·m-3 with an OR of 1.09 (95% CI: 1.07-1.12), and the association seemed stronger in children with parents with a high education, OR = 1.05 (95% CI: 1.02-1.09) and OR = 1.04 (95% CI: 1.01-1.07) in children to mothers and father with a high education, respectively. The association did not seem to depend on medication history of psychiatric disorders. There was weak evidence for the association between air pollution and asthma to be stronger in neighborhoods with higher education levels. In conclusion, air pollution was associated with dispensed asthma medications, especially in areas with comparatively higher levels of air pollution, and in children to parents with high education. We did not observe support for our hypothesis that stressors linked to socio-economy or mental health problems would increase susceptibility to the effects of air pollution on the development of asthma.
Notes
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PubMed ID
29144419 View in PubMed
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Heavy vehicle traffic is related to wheeze among schoolchildren: a population-based study in an area with low traffic flows.

https://arctichealth.org/en/permalink/ahliterature130517
Source
Environ Health. 2011;10:91
Publication Type
Article
Date
2011
Author
Martin Andersson
Lars Modig
Linnea Hedman
Bertil Forsberg
Eva Rönmark
Author Affiliation
Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden. martin.andersson@envmed.umu.se
Source
Environ Health. 2011;10:91
Date
2011
Language
English
Publication Type
Article
Keywords
Air Pollution
Asthma - chemically induced - epidemiology
Child
Environmental Exposure
Female
Humans
Hypersensitivity - etiology
Logistic Models
Male
Odds Ratio
Prevalence
Questionnaires
Respiratory Sounds - etiology
Rhinitis - chemically induced - epidemiology
Risk factors
Sweden - epidemiology
Vehicle Emissions - toxicity
Abstract
An association between traffic air pollution and respiratory symptoms among children has been reported. However, the effects of traffic air pollution on asthma and wheeze have been very sparsely studied in areas with low traffic intensity in cold climate with poor dispersion. We evaluated the impact of vehicle traffic on childhood asthma and wheeze by objective exposure assessment.
As a part of the Obstructive Lung Disease in Northern Sweden (OLIN) studies, a questionnaire was sent to the families of all children attending first or second grade in Luleå (72,000 inhabitants) in Northern Sweden in 2006. The age of the children was 7-8 years and the participation rate was 98% (n = 1357). Skin prick tests were performed in 1224 (89%) children. The home addresses were given geographical coordinates and traffic counts were obtained from the local traffic authorities. A proximity model of average daily traffic and average daily heavy vehicle traffic within 200 meters from each participant's home address was used. The associations between traffic exposure and asthma and wheeze, respectively, were analysed in an adjusted multiple logistic regression model.
Exposure to high traffic flows was uncommon in the study area; only 15% of the children lived within 200 meters from a road with a traffic flow of =8000 vehicles per day. Living closer than 200 meters from a road with =500 heavy vehicles daily was associated with current wheeze, odds ratio 1.7 (confidence interval 1.0-2.7). A dose-response relation was indicated. An increased risk of asthma was also seen, however not significant, odds ratio 1.5 (confidence interval 0.8-2.9). Stratified analyses revealed that the effect of traffic exposure was restricted to the non-sensitized phenotype of asthma and wheeze. The agreement between self-reported traffic exposure and objective measurements of exposure was moderate.
This study showed that already at low levels of exposure, vehicle traffic is related to an increased risk of wheeze among children. Thus, the global burden of traffic air pollution may be underestimated.
Notes
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PubMed ID
21995638 View in PubMed
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Association between precipitation upstream of a drinking water utility and nurse advice calls relating to acute gastrointestinal illnesses.

https://arctichealth.org/en/permalink/ahliterature108558
Source
PLoS One. 2013;8(7):e69918
Publication Type
Article
Date
2013
Author
Andreas Tornevi
Gösta Axelsson
Bertil Forsberg
Author Affiliation
Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. andreas.tornevi@envmed.umu.se
Source
PLoS One. 2013;8(7):e69918
Date
2013
Language
English
Publication Type
Article
Keywords
Drinking Water - analysis
Gastrointestinal Diseases - epidemiology
Humans
Nurses
Rain
Sweden
Water Microbiology
Weather
Abstract
The River Göta Älv is a source of fresh-water for the City of Gothenburg (Sweden). We recently identified a clear association between upstream precipitation and indicator bacteria concentrations in the river water outside the intake to the drinking water utility. This study aimed to determine if variation in the incidence of acute gastrointestinal illnesses is associated with upstream precipitation.
We acquired data, covering 1494 days, on the daily number of telephone calls to the nurse advice line from citizens in Gothenburg living in areas with Göta Älv as a fresh-water supply. We separated calls relating to gastrointestinal illnesses from other medical concerns, and analyzed their association with precipitation using a distributed lag non-linear Poisson regression model, adjusting for seasonal patterns and covariates. We used a 0-21-day lag period for precipitation to account for drinking water delivery times and incubation periods of waterborne pathogens.
The study period contained 25,659 nurse advice calls relating to gastrointestinal illnesses. Heavy rainfall was associated with increased calls the same day and around 5-6 days later. Consecutive days of wet weather were also found to be associated with an increase in the daily number of gastrointestinal concerns. No associations were identified between precipitation and nurse advice calls relating to other medical concerns.
An increase in nurse advice calls relating to gastrointestinal illnesses around 5-6 days after heavy rainfall is consistent with a hypothesis that the cause could be related to drinking water due to insufficient barriers in the drinking water production, suggesting the need for improved drinking water treatment.
Notes
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PubMed ID
23875009 View in PubMed
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Can NO(2) be used to indicate ambient and personal levels of benzene and 1,3-butadiene in air?

https://arctichealth.org/en/permalink/ahliterature177185
Source
J Environ Monit. 2004 Dec;6(12):957-62
Publication Type
Article
Date
Dec-2004
Author
Lars Modig
Anna-Lena Sunesson
Jan-Olof Levin
Margit Sundgren
Annika Hagenbjörk-Gustafsson
Bertil Forsberg
Author Affiliation
Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, University of Umea, SE-901 87 Umea, Sweden. lars.modig@envmed.umu.se
Source
J Environ Monit. 2004 Dec;6(12):957-62
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
Adult
Air - analysis
Air Pollutants - analysis
Benzene - analysis
Butadienes - analysis
Carcinogens, Environmental - analysis
Cities
Environmental Exposure - statistics & numerical data
Female
Humans
Male
Middle Aged
Nitrogen Dioxide - analysis
Sweden
Vehicle Emissions
Abstract
The aim of this study was to investigate the relation between two toxic volatile organic compounds, 1,3-butadiene and benzene, and a commonly used indicator of vehicle exhaust fumes, NO(2). This was to see if NO(2) can be used to indicate personal exposure to carcinogenic substances or at least estimate ambient levels measured at a stationary point. During the winter of 2001, 40 randomly selected persons living in the City of Umea (in the north of Sweden) were recruited to the study. Personal measurements of 1,3-butadiene, benzene and NO(2) were performed for one week, and were repeated for 20 of the 40 participants. Additional information was gathered using a diary kept by each participant. During the same time period weekly stationary measurements were performed at one urban background station and one street station in the city centre. The results from the personal measurements showed a negligible association of NO(2) with 1,3-butadiene (r= 0.06) as well as with benzene (r= 0.10), while the correlation coefficient between 1,3-butadiene and benzene was high and significant (r= 0.67). In contrast to the personal measurements, the stationary measurements showed strong relations between 1,3-butadiene, benzene and NO(2) both within and in-between the street and urban background station. This study supports NO(2) as a potential indicator for 1,3-butadiene and benzene levels in streets or urban background air, while the weak relations found for the personal measurements do not support the use of NO(2) as an indicator for personal 1,3-butadiene and benzene exposure.
PubMed ID
15568043 View in PubMed
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