Exposure to fine particulate matter and acute upper- and lower-respiratory tract infections (AURI and ALRI) in children under five years of age in India.

As one of the world's polluted regions, we assessed the association between ambient PM2.5 levels and acute lower and upper respiratory infection in India. We assessed 55,118 children from the 2015-2016 Demographic Health Survey in India using the information on levels of PM2.5 in 2015 and 2016 from the Atmospheric Composition Analysis Group. We used the generalized estimating equation for the analysis reported as odds ratios and 95% confidence intervals for every 10 µg/m3 increase and quartiles in PM2.5. Every 10 µg/m3 increase in levels of PM2.5 associated with acute upper respiratory infection (OR 1.02, 95%CI: 1.02-1.03) and acute lower respiratory infection (OR 1.05, 95%CI: 1.03-1.06). This association was confirmed by quartile exposure assessments. Mitigation efforts must be continued implementing higher restrictions in India to ensure safe levels of air.

Exposure to particulate matter (PM2.5) and prevalence of diabetes mellitus in Indonesia.

BACKGROUND: Recently emerging evidence suggests an association between particulate matter less than 2.5 µm in diameter (PM2.5) exposure and diabetes risk. However, evidence from Asia is limited. Here, we evaluated the association between PM2.5 exposure and the prevalence of diabetes mellitus in one of the most populated countries in Asia, Indonesia. METHODS: We used the 2013 Indonesia Basic Health Research, which surveyed households in 487 regencies/municipalities in all 33 provinces in Indonesia (n = 647,947). We assigned individual exposure to PM2.5 using QGIS software. Multilevel logistic regression with a random intercept based on village and cubic spline analysis were used to assess the association between PM2.5 exposure and the prevalence of diabetes mellitus. We also assessed the lower exposure at which PM2.5 has potential adverse effects. RESULTS: We included 647,947 subjects with a mean age of 41.9 years in our study. Exposure to PM2.5 levels was associated with a 10-unit increase in PM2.5 (fully adjusted odds ratio: 1.09; 95% confidence interval: 1.05-1.14). The findings were consistent for quartile increases in PM2.5 levels and the cubic spline function. Even when we restricted to those exposed to PM2.5 concentrations of less than 10.0 µg/m3 in accordance with the recommended guidelines for annual exposure to PM2.5 made by the World Health Organization, the association remained elevated, especially among subjects living in the urban areas. Hence, we were unable to establish a safe threshold for PM2.5 and the risk of diabetes. CONCLUSIONS: Our findings suggest a positive association between PM2.5 exposure and prevalence of diabetes mellitus, which is possibly below the current recommended guidelines. Further studies are needed to ascertain the causal association of this finding.

Nitrogen dioxide and acute respiratory tract infections in children in Indonesia.

We evaluated associations between air pollution (nitrogen dioxide [NO2] and sulfur dioxide [SO2]) and health in children aged 0-3 years in Indonesia. We included 4931 Indonesian children born between 2009 and 2011. We assigned participants provincial-levels of NO2 and SO2 and examined associations with low birth weight, infant death, neonatal death, and acute respiratory infection (ARI). We estimated odds ratios (OR) and 95% confidence intervals (CI) using a generalized estimating equations logistic regression model. NO2 exposure increased the risk for ARI. An interquartile range increase in mean NO2 exposure increased the risk for ARI by 18% (OR 1.18, 95% CI: 1.08-1.28), and was supported by quartile exposure category. SO2 was not associated with the examined child health outcomes. NO2 exposure increased the risk for respiratory infections in early childhood in Indonesia. AbbreviationsARIacute respiratory infectionCIconfidence intervalGDRBGross Domestic Regional BrutoGEEgeneralized estimating equationsIDHSIndonesian Demographic Health SurveyIQRinterquartile rangeLBWlow birth weightNO2nitrogen dioxideORodds ratioSO2sulfur dioxide.

Effects of Household Air Pollution From Solid Fuel Use and Environmental Tobacco Smoke on Child Health Outcomes in Indonesia.

OBJECTIVE: We assessed the combined effect of household air pollution from solid fuel use and from environmental tobacco smoke and child health outcomes in Indonesia. METHODS: Survey subjects self-reported solid fuel use, frequency of indoor smoking, and health outcomes in children. We then evaluated the effect of a combined exposure using multivariate logistic regression. RESULTS: Children exposed to high levels of pollution from solid fuel use had an increased risk of low birth weight, neonatal death, infant death, and acute lower respiratory infection. Exposure to environmental tobacco smoke increased the risk of acute lower respiratory infection. The combined effect of both pollution sources outweighed the independent risk of each exposure alone. CONCLUSIONS: Solid fuel use and environmental tobacco smoke independently increased the risk and child health outcomes and the combined exposure showed the additive effect.

Acute exposure to sulfur dioxide and mortality: Historical data from Yokkaichi, Japan.

We examined the association between acute exposure to sulfur dioxide (SO2) and mortality, using historical data from 1972-1991 in Yokkaichi, Japan. We used a time-stratified case-crossover study design. We included all causes of death, excluding external causes, between 1972 and 1991 in Yokkaichi and the neighboring town, Kusu of the Mie Prefecture (N = 29,839). We obtained daily estimations of SO2 concentrations during the study period. We then conducted conditional logistic regression analysis to examine association between SO2 exposure and all-cause and cause-specific mortality. Exposure to SO2 increased the risk of all-cause and cause-specific mortality in a non-linear manner. The relationship between SO2 exposure and mortality outcomes remained after adjustment for co-pollutants such as particulate matter and nitrogen dioxide. Historical data from Yokkaichi, Japan, showed that SO2 exposure increased the risk of all-cause and cause-specific mortality.

Temporal trends of infant and birth outcomes in Minamata after severe methylmercury exposure.

Severe methylmercury poisoning occurred in Minamata and neighboring communities in Japan during the 1950s and 1960s, causing what is known as Minamata disease. Although an increase in stillbirths and a reduced male proportion at birth (i.e., reduced sex ratio) have been reported, no studies have evaluated the impact of exposure on an entire set of infant and birth outcomes. We therefore evaluated the temporal trends of these outcomes in the Minamata area from 1950 to 1974. We focused on the spontaneous/artificial stillbirth rate, crude fertility rate, male proportion at birth, male proportion among stillbirths, and infant mortality. We obtained the number of stillbirths, live births, and infant deaths in Minamata City and Kumamoto Prefecture (as a reference) from 1950 to 1974. After plotting annual figures for each outcome, we divided the study period into five intervals and compared them between Minamata City and Kumamoto Prefecture using the chi-squared test. We observed a slightly increased spontaneous stillbirth rate and decreased artificial stillbirth rate in Minamata City, followed by a reduced crude fertility rate. The crude fertility rates in Minamata City during the period 1955-1965 were significantly lower compared with those in Kumamoto Prefecture (p < 0.001). An increase in the male proportion among stillbirths was observed, corresponding to a reduction in the proportion of males at birth in the late 1950s. The impact on infant mortality was equivocal. These descriptive analyses demonstrate a severe regional impact of methylmercury exposure on a series of birth outcomes in the Minamata area.