EBoD-FL. Guidelines for mapping the environmental burden of disease in Flanders, 2023

The environment poses a diverse range of health risks. Environmental burden of disease (EBD) studies try to estimate the impact of environmental stressors in terms mortality or morbidity on a population level. Although environmental risks have been studied in Flanders, an effort to routinely quantify the environmental disease burden completely and coherently has thus far not been established. For this reason, Sciensano and Departement Zorg are partnering up in a project to map the Environmental Burden of Disease in Flanders (EBoD-FL). The aim of the research is to inventory the burden of disease attributable to all relevant environmental stressors according to a coherent framework. To tackle this objective, the disease burden attributable to environmental stressors is estimated using comparative risk assessment (CRA). As this method determines the attributable burden proportionally, figures for the total disease burden are required as a baseline to obtain absolute estimates. In EBoD-FL, the EBD is quantified as disability-adjusted life years (DALYs), a summary measure that combines both mortality and&nbsp;morbidity. Given the extensive list of potential risk factor-health outcome pairs, a set of priorities was defined in terms of environmental stressors and health outcomes. The risk factors that were prioritised are those related to air quality, environmental noise and extreme temperature. In terms of outcomes, priority was given to all-cause mortality, respiratory diseases and cardiovascular diseases. This report outlines the CRA methodology in general, and the application on the risk-outcome pairs that have been given priority. The basic steps of CRA&nbsp;are: Selection of risk factors: Which risk factors are included in the study and how is exposure quantified as a&nbsp;metric? Exposure assessment: how to measure or model exposure to the risk factors in the&nbsp;population? Identification of risk-outcome pairs: which health outcomes are caused by the risk&nbsp;factors? Quantification of the risk-outcome relation: what is the risk of developing the outcome in function of&nbsp;exposure? Calculation of the population attributable fraction: what is the proportion of the disease burden attributed to one or multiple risk&nbsp;factors? The purpose of this report is to outline the general methodology used to tackle the objective of EBoD-FL and to apply the CRA methodology to the stressors that are prioritized. Additionally, possibilities for the application of the results for evidence-based policy are explored, as well as some challenges and&nbsp;limitations.</p

EBoD-FL. Guidelines for mapping the environmental burden of disease in Flanders

The environment poses a diverse range of health risks. Environmental burden of disease (EBD) studies try to estimate the impact of environmental stressors in terms of mortality or morbidity on a population level. Although environmental risks have been studied in Flanders, an effort to routinely quantify the environmental disease burden completely and coherently has thus far not been established. For this reason, Sciensano and Agentschap Zorg &amp; Gezondheid are partnering up in a project to map the Environmental Burden of Disease in Flanders (EBoD-FL). The aim of the research is to inventory the burden of disease attributable to all relevant environmental stressors according to a coherent framework. To tackle this objective, the disease burden attributable to environmental stressors is estimated using comparative risk assessment (CRA). As this method determines the attributable burden as a proportion of the total, figures for the recorded disease burden are required to obtain absolute numbers. In EBoD-FL, the EBD is quantified as disability-adjusted life years (DALYs), a summary measure that combines both mortality and&nbsp;morbidity. Given the extensive list of potential stressor-health outcome pairs, a set of priorities was defined in terms of environmental stressors and health outcomes. The risk factors that will be studied first are those related to air quality, environmental noise and extreme temperature. In terms of outcomes, priority was given to all-cause mortality, respiratory diseases and cardiovascular diseases. This report outlines the CRA methodology in general, and applied to the risk factor-outcome pairs that have been given priority. The basic steps of CRA&nbsp;are: Selection of risk factors: Which risk factors are included in the study and how is exposure quantified as a&nbsp;metric? Exposure assessment: how to measure or model exposure to the risk factors in the&nbsp;population? Identification of stressor-outcome pairs: which health outcomes are caused by the risk&nbsp;factors? Quantification of the stressor-outcome relation: what is the risk of developing the outcome in function of&nbsp;exposure? Calculation of the population attributable fraction: what is the proportion of a disease burden attributed to one or multiple risk&nbsp;factors? The purpose of this report is to outline the general methodology used to tackle the objective of EBoD-FL and to apply the CRA methodology to the stressors that are prioritized. Additionally, possibilities for the application of the results for evidence-based policy are explored, as well as some challenges and&nbsp;limitations.</p

The impact of ambient temperature and air pollution on SARS-CoV2 infection and post COVID-19 condition in Belgium (2021–2022)

Introduction The associations between non-optimal ambient temperature, air pollution and SARS-CoV-2 infection and post COVID-19 condition (PCC) remain constrained in current understanding. We conducted a retrospective analysis to explore how ambient temperature affected SARS-CoV-2 infection in individuals who later developed PCC compared to those who did not. We investigated if these associations were modified by air&nbsp;pollution. Methods We conducted a bidirectional time-stratified case-crossover study among individuals who tested positive for SARS-CoV-2 between May 2021 and June 2022. We included 6302 infections, with 2850 PCC cases. We used conditional logistic regression and distributed lag non-linear models to obtain odds ratios (OR) and 95% confidence intervals (CI) for non-optimal temperatures relative to the period median temperature (10.6 °C) on lags 0 to 5. For effect modification, daily average PM2.5&nbsp;concentrations were categorized using the period median concentration (8.8 μg/m3). Z-tests were used to compare the results by PCC status and PM2.5. Results Non-optimal cold temperatures increased the cumulative odds of infection (OR = 1.93; 95%CI:1.67–2.23, OR = 3.53; 95%CI:2.72–4.58, for moderate and extreme cold, respectively), with the strongest associations observed for non-PCC cases. Non-optimal heat temperatures decreased the odds of infection except for moderate heat among PCC cases (OR = 1.32; 95%CI:0.89–1.96). When PM2.5&nbsp;was &gt;8.8 μg/m3, the associations with cold were stronger, and moderate heat doubled the odds of infection with later development of PCC (OR = 2.18; 95%CI:1.01–4.69). When PM2.5&nbsp;was ≤8.8 μg/m3, exposure to non-optimal temperatures reduced the odds of&nbsp;infection. Conclusion Exposure to cold increases SARS-CoV2 risk, especially on days with moderate to high air pollution. Heated temperatures and moderate to high air pollution during infection may cause PCC. These findings stress the need for mitigation and adaptation strategies for climate change to reduce increasing trends in the frequency of weather extremes that have consequences on air pollution&nbsp;concentrations.</p

Tree pollen allergy risks and changes across scenarios in urban green spaces in Brussels, Belgium

Urban green spaces may improve human health and well-being. However, green spaces may also emit allergenic pollen and these may trigger asthma, allergic disease, and respiratory infections.&nbsp; How allergy risks in green spaces may be modified by environmental change is still not widely&nbsp;understood. This study analyzed tree inventory data of 18 urban green spaces (5940 trees; 278 taxa; 93 ha) in the Brussels Capital Region, Belgium. We investigated present tree pollen allergy risk (AR) and changes in AR driven by changes in tree species composition, allergenic potential and pollen season duration.&nbsp; AR was estimated by calculating the allergenicity index IUGZA (range 0–1, 1 worst) for the present situation and 13&nbsp;scenarios. The average AR was 0.08 (SD 0.05; range 0.002–0.17). The AR increased by 11–27% in increased allergenic potential scenarios, and by 44% in the increased pollen season duration scenario. Preventive removal of birch, hazel and alder reduced the AR by 13%. The AR increased by 99–111% in combined scenarios with and without preventive removal of the main allergenic&nbsp;taxa. These findings indicate that tree pollen allergy risks could considerably rise when ongoing environmental changes lead to a combination of longer pollen seasons, increased pollen allergen potency, and increased sensitization for one or more species. &nbsp;The preventive removal of the main allergenic tree species cannot sufficiently counter allergy risks caused by other species and that are amplified by environmental change, highlighting the importance of careful tree species selection in urban green space policy and&nbsp;planning.</p