Geospatial Correlation of Amyopathic Dermatomyositis With Fixed Sources of Airborne Pollution: A Retrospective Cohort Study

Abstract

Objective: Dermatomyositis (DM) may result from exogenous triggers, including airborne pollutants, in genetically susceptible individuals. The United States Environmental Protection Agency's 2011 National Air Toxics Assessment (NATA) models health risks associated with airborne emissions, available by ZIP code tabulation area (ZCTA). Important contributors include point (fixed), on-road, and secondary sources. The objective of this study was to investigate the geospatial distributions of DM and subtypes, classic DM (CDM) and clinically amyopathic DM (CADM), and their associations with airborne pollutants. Methods: This retrospective cohort study identified 642 adult DM patients from 336 unique ZCTAs. GeoDa v.1.10 was used to calculate global and local Moran's indices and generate local indicator of spatial autocorrelation (LISA) maps. All Moran's indices and LISA maps were permuted 999 times. Results: Univariate global Moran's indices for DM, CDM, and CADM prevalence were not significant, but LISA maps demonstrated differential local spatial clustering and outliers. CADM prevalence correlated with point sources (bivariate global Moran's index 0.071, pseudo- p = 0.018), in contrast to CDM (−0.0053, pseudo- p = 0.46). Bivariate global Moran's indices for DM, CDM, and CADM prevalence did not correlate with other airborne toxics, but bivariate LISA maps revealed local spatial clustering and outliers. Conclusion: Prevalence of CADM, but not CDM, is geospatially correlated with fixed sources of airborne emissions. This effect is small but significant and may support the hypothesis that triggering exposures influence disease phenotype. Important limitations are NATA data and ZCTA population estimates were collected from 2011 and ZCTA of residence may not have been where patients had greatest airborne pollutant exposure.

The Geospatial Distribution of Myositis and Its Phenotypes in the United States and Associations With Roadways: Findings From a National Myositis Patient Registry

“…Although application of spatial point processes is more common in ecology ( 42 ), it is an emerging tool in epidemiological research ( 43 ). We observed clustering of IIM and its phenotypes in some regions, and a statistically nonsignificant effect of distance from road network on myositis prevalence, but a significant effect of RUCA, possibly indicating exposure to higher level of air pollutants, consistent with previous studies that also found a significant correlation between clinically amyopathic DM with airborne pollutants ( 22 ) and urban dwellings ( 7 ). More research is needed to understand the role of proximity to roadways and air pollutants, as well as other exposures and risk factors, in the development of myositis, given the geospatial distribution of myositis patients nationwide.…”

“…Adult rheumatoid arthritis and juvenile idiopathic arthritis prevalence have both been linked to exposure to air pollution, identified by residential location near airports or road networks ( 18 – 21 ). Only one study has examined air pollution as a risk factor in myositis, and found a residential association with air emissions in clinically-amyopathic DM, but not classic DM ( 22 ). Exposure to air pollutants and tobacco smoking during fetal development may contribute to juvenile DM risk ( 23 ).…”

Environmental triggers of dermatomyositis: a narrative review

“…Streptococcus pyogenes (59) Mycobacterium tuberculosis (60) Borrelia burgdorferi (61) Ultraviolet radiation (62)(63)(64)(65)(66)(67)(68)(69)(70) Environmental pollution Silica (71)(72)(73) Dust (biological, mineral, gases/fumes) (74) Particulate matter (vehicle/industrial emissions) (75)(76)(77)(78) Cigarette smoking (79,80) Maternal exposure (associated with JDM): Chalk dust, gasoline vapor, maternal smoking, carbon monoxide (81) deemed essential for the goals of this review. We present the following article in accordance with the Narrative Review reporting checklist (available at http://dx.doi.org/10.21037/ atm-20-3719).…”

“…In a population study of Canadian patients, the likelihood of having a systemic autoimmune disease increased with the amount of fine particulate air pollution (76). Moreover, an analysis of the geospatial distribution of DM patients in the Philadelphia metropolitan area found that point sources of airborne pollutant matter, such as emissions from industrial and commercial sources, were associated with the presence of clinically amyopathic DM, but not classic DM (78).…”

Removal of Chromium (Cr) and Formaldehyde [CH₂O (H−CHO)] from Leather Tannery Effluents Using Electrocoagulation Treatment Process

“…A colorless, toxic, potentially carcinogenic, watersoluble gas, with the formula CH 2 O, having a suffocating odor, usually derived from methyl alcohol by oxidation: used chiefly in aqueous solution, as a disinfectant and preservative, and in the manufacture of various resins and plastics. The toxic effects of formaldehyde and formalin were described in literature such as bronchitis, pneumonia, gastritis, myositis [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. The concept of health security corresponds to the control of risks that can alter the state of human health.…”