Using Distributed Lag Non-Linear Models to Estimate Exposure Lag-Response Associations between Long-Term Air Pollution Exposure and Incidence of Cardiovascular Disease

Kriit, Hedi Katre; Andersson, Eva; Carlsen, Hanne Krage; Andersson, Niklas; Ljungman, Petter; Pershagen, Göran; Segersson, David; Eneroth, Kristina; Gidhagen, Lars; Spanne, Mårten; Molnár, Péter; Wennberg, Patrik; Rosengren, Annika; Rizzuto, Debora; Leander, Karin; Yacamán-Méndez, Diego; Magnusson, Patrik K. E.; Forsberg, Bertil; Stockfelt, Leo; Sommar, Johan Nilsson

doi:10.3390/ijerph19052630

Cited by 11 publications

(7 citation statements)

References 40 publications

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“…We applied a DLNM to our data in order to show the impact of air pollution on mortality with delay in time, in accordance to previous studies [18,54,55]. DLNMs are a powerful modeling tool that are capable of simultaneously capturing both non-linear exposure-response dependencies and delayed effects.…”

Section: Discussionmentioning

confidence: 80%

Short-Term Effects of Air Pollution on Mortality in the Urban Area of Thessaloniki, Greece

et al. 2023

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This study examines the effects of short-term exposure to PM10 and O3 on all-cause, cardiorespiratory, and cerebrovascular mortality in the urban area of Thessaloniki, Greece. An analysis was performed on the vulnerable subgroup (the elderly population). The primary effect estimates employed were the relative risks for every 10 µg/m3 increase in air pollutant concentrations. Strong associations between PM10 and O3 levels on mortality were reported, with the elderly people becoming frailer. An increase of 10 μgr/m3 in PM10 concentration resulted in a 2.3% (95% CI: 0.8–3.8) and 2% (95% CI: 0.1–4.5) increase in total and cardiorespiratory mortality, respectively. O3 concentrations showed even stronger associations for all-cause (3.9%, 95% CI: 2.5–5.3) and cardiorespiratory deaths (5.3%, 95% CI: 3.1–7.7) with 10 μgr/m3 increases; no statistically significant associations were found for cerebrovascular causes, while both pollutants presented stronger impacts on health between day 0 and 3. Concerning the elderly, the total mortality rose by 3.2% (95% CI: 1.5–5) due to PM10 concentrations and by 4.4% (95% CI: 2.9–6) due to O3 concentrations. In total, 242 (170) all-cause deaths were annually attributed to the PM10 (O3) level in Thessaloniki. In the efforts towards achieving a sustainable environment for humanity, health benefits resulting from two air pollution abatement scenarios (a 20% reduction in PM10 levels and full compliance to the European Union PM10 limits) were quantified. The analysis led to a respective decrease in total excess mortality by 0.4% and 1.8%, respectively. This outcome stresses the necessity of appropriate civil protection actions and provides valuable scientific knowledge to national and regional administrations in order to develop proper health and air quality plans.

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Section: Discussionmentioning

confidence: 80%

Short-Term Effects of Air Pollution on Mortality in the Urban Area of Thessaloniki, Greece

et al. 2023

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“…We performed conditional logistic regression analysis to estimate the risk of mortality associated with per unit increase in flood index. Year-specific flood index was modelled using a distributed lag non-linear model featuring a non-linear exposure-response association and the additional lag-response association, respectively [33][34][35][36]. The lag-response association refers to how the risk changes over time and provides an estimation of the combined immediate and delayed effects that accumulate throughout the lag period.…”

Section: Discussionmentioning

confidence: 99%

Floods and cause-specific mortality in the UK: a nested case-control study

Wu,

Gasevic,

Wen

et al. 2024

BMC Med

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Background Floods are the most frequent weather-related disaster, causing significant health impacts worldwide. Limited studies have examined the long-term consequences of flooding exposure. Methods Flood data were retrieved from the Dartmouth Flood Observatory and linked with health data from 499,487 UK Biobank participants. To calculate the annual cumulative flooding exposure, we multiplied the duration and severity of each flood event and then summed these values for each year. We conducted a nested case-control analysis to evaluate the long-term effect of flooding exposure on all-cause and cause-specific mortality. Each case was matched with eight controls. Flooding exposure was modelled using a distributed lag non-linear model to capture its nonlinear and lagged effects. Results The risk of all-cause mortality increased by 6.7% (odds ratio (OR): 1.067, 95% confidence interval (CI): 1.063–1.071) for every unit increase in flood index after confounders had been controlled for. The mortality risk from neurological and mental diseases was negligible in the current year, but strongest in the lag years 3 and 4. By contrast, the risk of mortality from suicide was the strongest in the current year (OR: 1.018, 95% CI: 1.008–1.028), and attenuated to lag year 5. Participants with higher levels of education and household income had a higher estimated risk of death from most causes whereas the risk of suicide-related mortality was higher among participants who were obese, had lower household income, engaged in less physical activity, were non-moderate alcohol consumers, and those living in more deprived areas. Conclusions Long-term exposure to floods is associated with an increased risk of mortality. The health consequences of flooding exposure would vary across different periods after the event, with different profiles of vulnerable populations identified for different causes of death. These findings contribute to a better understanding of the long-term impacts of flooding exposure.

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“…Our study has four strengths. First, we simulated the interaction between PM 2.5 and VAP with DLNM which provides a more accurate estimation of the interactions since a number of factors including time-course, exposure–response relationship, and multifactor interaction can be taken into account while controlling for exposures during different time periods simultaneously [ 44 , 45 ]. The DLNM also help to account for the phenomenon of “harvest” where VAP may occur in vulnerable subjects immediately or delayed after exposure, thus reducing the number of subjects at risk and the overall long-term impact of PM 2.5 [ 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Short-term exposure to ambient fine particulate pollution aggravates ventilator-associated pneumonia in pediatric intensive care patients undergoing cardiovascular surgeries

Cui

et al. 2023

Environ Health

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Background Ambient air pollutants can be hazardous to human health, especially for vulnerable children. The impact of ambient air pollutant exposure before and during intensive care unit (ICU) stays on the development of ventilator-associated pneumonia (VAP) in critically ill children has not been established. We aimed to determine the correlations between short-term exposures to ambient fine particulate matter (PM2.5) and VAP in pediatric cardiac surgery patients in the ICU, and explore the effect of delayed exposure. Methods The medical record of 1755 child patients requiring artificial ventilation in the ICU between December 2013 to December 2020, were analyzed. The daily average concentrations of particulate matters (PM2.5 and PM10), sulfur dioxide (SO2), and ozone (O3) were calculated from public data. Interactions between these pollutants and VAP were simulated with the distributed lag non-linear model. Results Three hundred forty-eight cases (19.829%) of VAP were identified in this study, while the average concentrations of PM2.5, PM10, O3 and SO2 were 58, 118, 98 and 26 μg/m3, respectively. Exposure to increased levels of PM2.5 two days prior (lag 2-day) to VAP diagnosis is significantly correlated with an enhanced risk for VAP development. Even a slight increase of 10 μg/m3 in PM2.5 can translate to a 5.4% increase in VAP incidence (95% CI: 1.4%-9.5%) while the VAP incidence increased to 11.1% (95%CI: 4.5–19.5%) when PM2.5 concentration is well below the National Ambient Air Quality standard (NAAQS) of 50 μg/m3. The association was more pronounced in those aged below 3-months, with low body mass index or suffered from pulmonary arterial hypertension. Conclusion Short-term PM2.5 exposure is a significant risk for development of VAP in pediatric patients. This risk is present even with PM2.5 levels below the NAAQS. Ambient PM2.5 may represent a previously unrecognized risk factor for pneumonia and the current environmental pollution standards need to be reevaluated to consider susceptible populations. Trial registration The trial was registered with the National Clinical Trial Center: The correlation between ambient air pollution and the complications in ICU underwent cardiac surgery. Trial registration number: ChiCTR2000030507. Date of registration: March 5, 2020. URL of trial registry record: http://www.chictr.org.cn/index.aspx.

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Using Distributed Lag Non-Linear Models to Estimate Exposure Lag-Response Associations between Long-Term Air Pollution Exposure and Incidence of Cardiovascular Disease

Cited by 11 publications

References 40 publications

Short-Term Effects of Air Pollution on Mortality in the Urban Area of Thessaloniki, Greece

Short-Term Effects of Air Pollution on Mortality in the Urban Area of Thessaloniki, Greece

Floods and cause-specific mortality in the UK: a nested case-control study

Short-term exposure to ambient fine particulate pollution aggravates ventilator-associated pneumonia in pediatric intensive care patients undergoing cardiovascular surgeries

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