Short-term air pollution in Reykjavik and health indicators. Drug dispensing, mortality, and hospital visits

Inngangur: Bæði lang- og skammtímaáhrif loftmengunar hafa verið tengd við versnun sjúkdóma og aukningu í dauðsföllum. Markmið þessara rannsókna var að skoða hugsanleg heilsufarsáhrif skammtíma útsetningar loftmengunar af völdum umferðar og jarðvarmavirkjana á íbúa Reykjavíkursvæðisins. Efni og aðferðir: Ritgerðin er samantekt á þremur lýðgrunduðum rannsóknum sem birtar hafa verið í þremur vísindagreinum. Niðurstöður allra rannsóknanna byggja á íslenskum gagnagrunnum einstaklinga 18 ára og eldri sem bjuggu á höfuðborgarsvæðinu á rannsóknartímanum. Rannsóknaraðferðir í greinum I og II eru svipaðar. Í grein I, var tvíátta tilfella víxlrannsóknarsnið (e. symmetrical bidirectional case-crossover analysis) notað til að skoða sambandið milli skammtíma útsetningar loftmengunar og úttektar hjartalyfja (glyceryl trinitrate) við hjartaöng á árunum 2005 til 2009. Í grein II var tíma-lagskipt tilfella-víxlrannsóknarsnið (e. time stratified case crossover analysis) notað til að skoða sambandið milli skammtíma útsetningar loftmengunar og dauðsfalla af náttúrulegum sökum (öll dauðsföll nema slys og eitranir) þar sem sérstaklega voru skoðuð dauðsföll af völdum hjartasjúkdóma. Þeir mengunarþættir sem voru skoðaðir voru: svifryk sem er minna en 10 µm í þvermál (PM10), nitur díoxíð (NO2), óson (O3), brennisteinsvetni (H2S) frá jarðvarmavirkjunum í grend við höfuðborgarsvæðið og brennisteins díoxíð (SO2) (aðeins grein II). Í grein III var línuleg aðhvarfsgreining (e. generalized linear model) notuð. Þar var gert ráð fyrir Poisson dreifingu útkomunnar til að skoða sambandið milli skammtíma útsetningar H2S mengunar og innlagna á Landspítala Háskólasjúkrahús (LSH) og koma á bráðamóttöku sama sjúkrahúss vegna hjartasjúkdóma, lungnasjúkdóma eða heilablóðfalla. Rannsóknartímabilið var frá árinu 2007 til og með júní 2014. Líkan var notað til að áætla styrk H2S á fimm mismunandi svæðum á höfuðborgasvæðinu. Niðurstöður: Í grein I fannst marktækt samband milli 3-daga meðaltalsstyrks loftmengunarefnanna NO2 og O3 og glyceryl trinitrate hjartalyfjaúttektar. Fyrir NO2 var gagnlíkindahlutfallið (OR) 1.136 (95% öryggisbil (95% CI) 1.069-1.207) sama dag og mengunin jókst (lag 0) og 1.096 (95% CI 1.029-1.168) þegar mengunin jókst daginn áður (lag 1). Fyrir O3 fékkst OR 1.094 (95% CI 1.029 1.163) á lag 0 og 1.094 (95% CI 1.028-1.166) á lag 1. Ekkert marktækt samband fannst milli annara loftmengunarefnanna og hjartalyfjaúttekta. Í grein II fannst marktækt samband milli fjórðungsmarkabreytingar (e. interquartile range changes) á 24ra stunda meðaltals styrks H2S yfir sumarmánuðina (maí til október) og dauðsfalla af náttúrulegum orsökum með 5.05% aukinni áhættu (IR%) (95% CI 0.61-9.68) daginn eftir að aukningin í H2S átti sér stað (lag 1) og þegar aukning á styrk H2S var tveimur dögum áður (IR%=5.09, 95% CI 0.44-9.97, lag 2). Sambærilegt samband fannst meðal eldri einstaklinga (lag 0: IR%=1.94, 95% CI 0.12-1.04; lag 1: IR%=1.99, 95% CI 0.21-1.04) og meðal karlmanna (lag 0: IR%=2.26, 95% CI 0.23-4.44). Óháð greining leiddi einnig í ljós marktækt samband milli 24ra stunda H2S mengunarstyrks yfir lyktarmörkum (7 µg/m3) og dauðsfalla af völdum náttúrulegra orsaka. Ekkert marktækt samband fannst milli annara loftmengunarefna og dauðsfalla. Í grein III fannst marktækt samband milli 24ra stunda H2S meðaltals styrks yfir lyktarmörkum (7 µg/m3) og innlagna á LSH og koma á bráðamóttökuna með hjartasjúkdóma sem aðal sjúkdómsgreiningu (lag 0 hlutfallslegri áhættu (RR)=1.067; 95% CI 1.024-1.111, lag 2 RR=1.049; 95% CI 1.005-1.095 og lag 4 RR=1.046; 95% CI 1.004-1.089). Sambærilegt samband fannst einnig meðal eldri einstaklinga (lag 0 RR= 1.075; 95% CI 1.014-1.140 og lag 3 RR=1.072; 95% CI 1.009-1.139) og karlmanna (lag 0 RR=1.087; 95% CI 1.032-1.146 og lag 4 RR=1080; 95% CI 1.025-1.138). Ekki fannst samband milli H2S mengunar og innlagna á LSH og koma á bráðamóttökuna með lungnasjúkdóma eða heilablóðfall sem megin sjúkdómsgreiningu. Ályktun: Í grein I, voru tveir umferðartengdir loftmengunarþættir tengdir við versnandi sjúkdómseinkenni þeirra sem þjást af hjartaöng, í formi úttektar glyceryl trinitrate. Þegar styrkur NO2 eða O3 hækkaði, var aukning í úttektum lyfja við hjartaöng. Einnig benda niðurstöðurnar til að hægt sé að nota hjartalyfjaúttektir sem útkomubreytu þegar könnuð eru möguleg heilsufarsleg áhrif loftmengunar. Niðurstöður úr greinum II og III, gefa til kynna möguleg neikvæð heilsufarsleg skammtíma áhrif brennisteinsvetnis á heilsu manna, einkum ef 24ra stunda meðaltal efnisins fer yfir lyktarmörkin, 7 µg/m3. Sambandið milli H2S og heilsufarsbrest var sterkast yfir sumarmánuðina og meðal karlmanna og eldri einstaklinga.Background and aims: Both short- and long-term air pollution exposure has been associated with increased morbidity and mortality. Here, the aim was to examine the possible adverse health effects associated with short term changes in ambient air pollutant concentrations in the Reykjavik capital area. Traffic-related and geothermal source-specific hydrogen sulfide (H2S) air pollutants were considered. Materials and methods: Papers I, II, and III are population based studies. The outcome data for each paper are derived from nation wide registries and covered individuals (18 years of age and older) living in the Reykjavik capital area during each study period. The methods used in papers I and II were similar. In paper I, a symmetrical bidirectional case-crossover analysis was used to estimate the association between short term air pollution exposure and use of the sublingual medication glyceryl trinitrates, used against attacks of angina pectoris, over the study period of 2005-2009. In paper II, a time-stratified case-crossover analysis was used to estimate the association between short term daily exposure to air pollution and mortality due to natural (other than deaths due to external causes) and cardiovascular causes over the study period of 2003-2009. The pollutants of interest in papers I and II were: particle matter with an aerodynamic diameter less than 10 μm (PM10), nitrogen dioxide (NO2), ozone (O3), geothermal source specific hydrogen sulfide (H2S), and sulfur dioxide (SO2) (only in paper II). In paper III, a generalized linear model was used to estimate the association between short-term H2S exposure and emergency department visits and admissions (jointly known as emergency hospital visits) to the Landspitali University Hospital. A Poisson distribution of the outcome variables was assumed. The main diagnoses of interest were heart disease, respiratory disease, and stroke as primary diagnosis. The study period was January 1, 2007 to June 30, 2014. A model was used to estimate H2S concentrations in five different sections of the Reykjavik capital area. Results: In paper I, a significant association was found between the 3 day average concentrations of NO2 and O3 and daily dispensing of glyceryl trinitrates. For NO2 the odds ratios (OR) were 1.136 (95% confidence intervals (95% CI) 1.069 1.207) at lag 0 and 1.096 (95% CI 1.029-1.168) at lag 1. For O3 the OR were 1.094 (95% CI 1.029-1.163) at lag 0 and 1.094 (95% CI 1.028-1.166) at lag 1. No associations were found between other pollutants and dispensing of glyceryl trinitrate. In paper II, a significant association was found between the interquartile range increases of H2S 24 hour concentrations (2.6 µg/m3) and daily natural cause mortality during the summer season of May to October yielding a percent increased risk (IR%) of 5.05, 95% CI 0.61-9.68 at lag 1 and IR%=5.09, 95% CI 0.44-9.97 at lag 2, and more pronounced among the elderly population (lag 0: IR%=1.94, 95% CI 0.12-1.04; lag 1: IR%=1.99, 95% CI 0.21-1.04) and males (lag 0: IR%=2.26, 95% CI 0.23-4.44). These results were supported by an independent analysis showing an association between H2S concentrations exceeding the odor limit of 7 µg/m3 and natural cause mortality. No associations were found between the other pollutants studied and mortality. In paper III, a significant association was found between H2S concentrations exceeding 7 µg/m3 and emergency hospital visits with heart disease as a primary diagnosis (lag 0 risk ratio (RR)=1.067; 95% CI 1.024-1.111, lag 2 RR=1.049; 95% CI 1.005-1.095, and lag 4 RR=1.046; 95% CI 1.004-1.089), and more pronounced among the elderly population (lag 0 RR= 1.075; 95% CI 1.014 1.140 and lag 3 RR=1.072; 95% CI 1.009-1.139) and males (lag 0 RR=1.087; 95% CI 1.032-1.146 and lag 4 RR=1080; 95% CI 1.025-1.138). No associations were found between H2S exposure and emergency hospital visits with respiratory disease or stroke as a primary diagnosis. Conclusion: Results from paper I indicate that, two traffic-related air pollutants may adversely affect cardiovascular health, as measured by the dispensing of anti angina pectoris medication. When NO2 and O3 increased, there was an increase in daily dispensing of glyceryl trinitrates. Also, the results indicate that dispensing of anti-angina pectoris medication could be used as an outcome measure in relation to ambient air pollution. The results from papers II and III give rise to the assumption of possible adverse cardiovascular health effects of ambient low level concentrations of intermittent H2S, especially if the 24 hour concentrations exceed the odor limit of 7 µg/m3. Additionally, the associations were stronger over the summer months and among males and the elderly.Háskólasjóður Eimskipafélags Íslands/Doktorsstyrkir Rannsóknasjóð

Loftmengun í Reykjavík og notkun lyfja við hjartaöng

Introduction: Ambient air pollution is associated with increase in morbidity from heart diseases. Air pollutant concentrations in the Reykjavík area are known to surpass official health limits many times every year. Objectives: To evaluate the association between ambient air concentration of NO2, O3, PM10, and H2S in the Reykjavík area and the dispensing of drugs for the heart disease, angina pectoris. Methods: Data on the daily dispensing of drugs for angina pectoris were obtained from The Icelandic Pharmaceuticals Data Bank. Data on concentrations of NO2, O3, PM10, and H2S were obtained from The City of Reykjavík, and The Environment Agency of Iceland. A time-stratified case-crossover design was used and the study period was January 1st 2005 to December 31st 2009. Results: The exposure to air pollution was associated with the dispensing of drugs for cardiovascular disease (C01DA). For every 10 µg/m3 increase of NO2 concentration levels the dispensing of glyceril trinitrates (sub-group C01DA02) increased by 11.6% (at lag 0) and 7.1% (at lag 1). Similarly, each 10 µg/m3 increase of O3 concentration was associated with 9.0% (at lag 0) and 7.2% (at lag 1) increase in glyceril trinitrate dispensations. Conclusion: Caution is needed in the conclusion as this is the first study to examine the association between ambient air pollution and dispensing of drugs for angina pectoris. However, the findings suggest that increased air pollution levels are associated with increased dispensing of glyceril trinitrate and this may be used as a sensitive indicator on health effects of air pollution.Inngangur: Sýnt hefur verið fram á að breytingar í styrkleika loftmengunarefna hafa áhrif á heilsufar hjartasjúklinga. Loftgæði á Íslandi eru almennt talin góð en við ákveðnar aðstæður getur styrkleiki loftmengunar farið yfir heilsuverndarmörk í Reykjavík. Markmið: Markmið þessarar rannsóknar var að rannsaka hvort samband er milli loftmengunarefnanna NO2, O3, PM10 og H2S og afgreiðslu á hjartalyfjum sem gefin eru við hjartaöng í Reykjavík. Aðferðir: Gögn um daglegan fjölda afgreiddra lyfja í lyfjaflokki C01DA var fenginn úr lyfjagagnagrunni Landlæknisembættisins. Gögn um magn níturdíoxíðs (NO2), ósóns (O3), svifryks (PM10) og brennisteinsvetnis (H2S) voru fengin frá Umhverfissviði Reykjavíkurborgar og Umhverfisstofnun. Tilfella-víxlunar rannsóknarsnið (e. case-crossover design) var notað og rannsóknartímabilið var frá 1. janúar 2005 til 31. desember 2009. Niðurstöður: Jákvætt samband reyndist vera milli loftmengunar og fjölda afgreiðslna á lyfjum í ATC flokki C01DA. Fyrir hverja 10 µg/m3 hækkun á styrkleika NO2 í lofti jókst afgreiðsla lyfja í undirflokknum C01DA02 (glýserýlnitrat; nitróglýserín) um 11,6% sama daginn. Samsvarandi varð 9% aukning á afgreiddum lyfjum fyrir hverja 10 µg/m3 hækkun á styrkleika O3. Það var 7,1% og 7,2% aukning í afgreiðslum lyfja fyrir hverja 10 µg/m3 hækkun í styrkleika NO2 og O3 miðað við mengun daginn fyrir afgreiðslu. Ályktun: Þar sem þetta er fyrsta rannsóknin, hér á landi og erlendis, sem metur samband milli loftmengunar og fjölda afgreiðslna á hjartalyfjum verður að álykta með varúð. Engu að síður benda niðurstöðurnar til að aukning í loftmengun auki fjölda afgreiðslna á lyfjum við hjartaöng og að þetta gæti verið unnt að nota sem ábendingu um heilsufarsáhrif af loftmengun.Rannís - Námsmannasjóður Orkuveita Reykjavíkur - Umhverfis- og orkurannsóknarsjóðu

Air pollution in Iceland and the effects on human health. Review

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadÍ þessari grein er fjallað um loftmengun á Íslandi og áhrif hennar á heilsu manna. Loftmengun má lýsa sem ástandi þar sem styrkur efna eða efnasambanda í andrúmslofti er orðinn það hár að hann veldur óæskilegum eða skaðlegum áhrifum á heilsu almennings eða óæskilegum áhrifum á náttúru eða mannvirki. Loftmengun getur verið af manna völdum, svo sem vegna bruna jarðefnaeldsneytis, eða náttúruleg, til dæmis vegna eldgosa, frá jarðhitasvæðum og í foki jarðvegsefna. Loftmengun dregur úr lífsgæðum og lífslíkum manna. Áhrifum loftmengunar á heilsu manna má skipta annars vegar í bein heilsufarsleg áhrif þar sem loftmengunin veldur sjúkdómum og hins vegar óbein áhrif þar sem loftmengunin eykur einkenni undirliggjandi sjúkdóma. Heilsuverndarmörk eru skilgreind fyrir ákveðin loftmengunarefni í andrúmslofti. Þeim er ætlað að vera viðmið fyrir hvað telst skaðlaust fyrir einstaklinginn og eru sett til að tryggja heilsu manna til lengri tíma. Loftgæði utandyra hafa verið mæld reglubundið í Reykjavík síðan 1986. Fyrstu árin var eingöngu mælt svifryk á einni mælistöð sem þá var staðsett við Miklatorg. Með árunum hefur fjölgað þeim efnum sem mæld eru og bæst hafa við fleiri mælistöðvar. Loftgæði eru almennt talin mikil á Íslandi og er styrkur mengunarefna í andrúmslofti að jafnaði innan skilgreindra viðmiða. Þetta skýrist af margvíslegum þáttum eins og stærð landsins, legu þess og veðurfari. Náttúruhamfarir geta valdið loftmengun eins og sýndi sig í eldgosum síðustu ára. Rannsóknir hafa verið gerðar á tengslum loftmengunar við heilsufar Íslendinga og æskilegt er að fleiri rannsóknir verði framkvæmdar til að bæta þekkinguna á loftmengun á Íslandi enn frekar.This review is on air pollution in Iceland and how it affects human health. Air pollution can be described as a condition, where levels of compounds in the atmosphere are so high that it has undesirable or harmful effects on the general public or undesirable effects on the nature, flora and fauna, or man-built structures. Air pollution can have anthropogenic sources such as burning of fossil fuels, or natural sources such as volcanic eruptions, geothermal areas, and resuspension of soil (sandstorms). Air pollution decreases quality of health and shortens the lifespan. The health effects of air pollution can be divided into direct effects on health where, air pollution causes diseases and indirect effects, where air pollution increases symptoms of underlying diseases. Health protection limits are defined for certain ambient air pollutants. They are to act as reference levels for safe for individuals and are put forth to protect long-term human health. Outdoor air quality has been measured on a regular basis in Reykjavik since 1986. For the first years, only PM10 was measured on a single station, but over the years the number of pollutants measured has increased and more measuring stations have been added. In Iceland air quality is considered very good in general and the ambient pollutant concentrations are usually within defined limits. This is explained by multiple factors such as size of the country and other geographical features as well as weather conditions. Natural disasters can cause increased air pollutant concentrations, as recent volcano eruptions have shown. Several studies have been conducted on the association of air pollution and health of the Icelandic population, but it is essential that this association be examined further to increase the knowledge of adverse health effects of air pollution in Iceland

Air pollution in Iceland and the effects on human health. Review

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadÍ þessari grein er fjallað um loftmengun á Íslandi og áhrif hennar á heilsu manna. Loftmengun má lýsa sem ástandi þar sem styrkur efna eða efnasambanda í andrúmslofti er orðinn það hár að hann veldur óæskilegum eða skaðlegum áhrifum á heilsu almennings eða óæskilegum áhrifum á náttúru eða mannvirki. Loftmengun getur verið af manna völdum, svo sem vegna bruna jarðefnaeldsneytis, eða náttúruleg, til dæmis vegna eldgosa, frá jarðhitasvæðum og í foki jarðvegsefna. Loftmengun dregur úr lífsgæðum og lífslíkum manna. Áhrifum loftmengunar á heilsu manna má skipta annars vegar í bein heilsufarsleg áhrif þar sem loftmengunin veldur sjúkdómum og hins vegar óbein áhrif þar sem loftmengunin eykur einkenni undirliggjandi sjúkdóma. Heilsuverndarmörk eru skilgreind fyrir ákveðin loftmengunarefni í andrúmslofti. Þeim er ætlað að vera viðmið fyrir hvað telst skaðlaust fyrir einstaklinginn og eru sett til að tryggja heilsu manna til lengri tíma. Loftgæði utandyra hafa verið mæld reglubundið í Reykjavík síðan 1986. Fyrstu árin var eingöngu mælt svifryk á einni mælistöð sem þá var staðsett við Miklatorg. Með árunum hefur fjölgað þeim efnum sem mæld eru og bæst hafa við fleiri mælistöðvar. Loftgæði eru almennt talin mikil á Íslandi og er styrkur mengunarefna í andrúmslofti að jafnaði innan skilgreindra viðmiða. Þetta skýrist af margvíslegum þáttum eins og stærð landsins, legu þess og veðurfari. Náttúruhamfarir geta valdið loftmengun eins og sýndi sig í eldgosum síðustu ára. Rannsóknir hafa verið gerðar á tengslum loftmengunar við heilsufar Íslendinga og æskilegt er að fleiri rannsóknir verði framkvæmdar til að bæta þekkinguna á loftmengun á Íslandi enn frekar.This review is on air pollution in Iceland and how it affects human health. Air pollution can be described as a condition, where levels of compounds in the atmosphere are so high that it has undesirable or harmful effects on the general public or undesirable effects on the nature, flora and fauna, or man-built structures. Air pollution can have anthropogenic sources such as burning of fossil fuels, or natural sources such as volcanic eruptions, geothermal areas, and resuspension of soil (sandstorms). Air pollution decreases quality of health and shortens the lifespan. The health effects of air pollution can be divided into direct effects on health where, air pollution causes diseases and indirect effects, where air pollution increases symptoms of underlying diseases. Health protection limits are defined for certain ambient air pollutants. They are to act as reference levels for safe for individuals and are put forth to protect long-term human health. Outdoor air quality has been measured on a regular basis in Reykjavik since 1986. For the first years, only PM10 was measured on a single station, but over the years the number of pollutants measured has increased and more measuring stations have been added. In Iceland air quality is considered very good in general and the ambient pollutant concentrations are usually within defined limits. This is explained by multiple factors such as size of the country and other geographical features as well as weather conditions. Natural disasters can cause increased air pollutant concentrations, as recent volcano eruptions have shown. Several studies have been conducted on the association of air pollution and health of the Icelandic population, but it is essential that this association be examined further to increase the knowledge of adverse health effects of air pollution in Iceland

Severe volcanic SO2 exposure and respiratory morbidity in the Icelandic population – a register study

The study was funded by the Icelandic Ministry of Health. Publisher Copyright: © 2021, The Author(s).BACKGROUND: The Holuhraun volcanic eruption September 2014 to February 2015 emitted large amounts of sulfur dioxide (SO 2). The aim of this study was to determine the association between volcanic SO 2 gases on general population respiratory health some 250 km from the eruption site, in the Icelandic capital area. METHODS: Respiratory health outcomes were: asthma medication dispensing (AMD) from the Icelandic Medicines Register, medical doctor consultations in primary care (PCMD) and hospital emergency department visits (HED) in Reykjavík (population: 215000) for respiratory disease from 1 January 2010 to 31 December 2014. The associations between daily counts of health events and daily mean SO 2 concentration and high SO 2 levels (24-h mean SO 2  > 125 μg/m3) were analysed using generalized additive models. RESULTS: After the eruption began, AMD was higher than before (129.4 vs. 158.4 individuals per day, p < 0.05). For PCMD and HED, there were no significant differences between the number of daily events before and after the eruption (142.2 vs 144.8 and 18.3 vs 17.5, respectively). In regression analysis adjusted for other pollutants, SO 2 was associated with estimated increases in AMD by 0.99% (95% CI 0.39-1.58%) per 10 μg/m 3 at lag 0-2, in PCMD for respiratory causes 1.26% (95% CI 0.72-1.80%) per 10 μg/m 3 SO 2 at lag 0-2, and in HED by 1.02% (95% CI 0.02-2.03%) per 10 μg/m 3 SO 2 at lag 0-2. For days over the health limit, the estimated increases were 10.9% (95% CI 2.1-19.6%), 17.2% (95% CI 10.0-24.4%) for AMD and PCMD. Dispensing of short-acting medication increased significantly by 1.09% (95% CI 0.49-1.70%), and PCMD for respiratory infections and asthma and COPD diagnoses and increased significantly by 1.12% (95% CI 0.54-1.71%) and 2.08% (1.13-3.04%). CONCLUSION: High levels of volcanic SO 2 are associated with increases in dispensing of AMD, and health care utilization in primary and tertiary care. Individuals with prevalent respiratory disease may be particularly susceptible.Peer reviewe