A distributed geospatial approach to describe community characteristics for multisite studies

Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research

Impact of weather changes on air quality and related mortality in Spain over a 25 year period [1993-2017]

© 2019. The Authors. The authors acknowledge the Air Quality Area of the Ministry for the Ecological Transition for providing hourly concentration data for the pollutants studied in the [1993-2017] period as well as the State Meteorological Agency (AEMET) for providing meteorological observations. We thank John Evans for his help with the analysis and interpretation of the mortality impacts associated with our weather penalties. We would also like to acknowledge the Real Colegio Complutense (RCC) for the Visiting Scholar Fellowship to support the stay of the corresponding author at the Harvard T.H. Chan School of Public Health. The AIRTEC-CM research project (S2018/EMT-4329) partially funded this study. In addition, U.S. EPA grant numbers RD834798 and RD-835872 the U.S. EPA grant RD-834798-01 made this work possible. Its contents are solely the responsibility of the grantee and do not necessarily represent the official views of the U.S. EPA. Further, the U.S. EPA does not endorse the purchase of any commercial products or services mentioned in the publication. Finally, we want to acknowledge the anonymous reviewers whose valuable comments and discussion substantially contributed to improve our work.Climate change is a major public health concern. In addition to its direct impacts on temperature patterns and extreme weather events, climate change affects public health indirectly through its influence on air quality. Pollution trends are not only affected by emissions changes but also by weather changes. In this paper we analyze air quality trends in Spain of important air pollutants (C_(6)H_(6), CO, NO_(2), NO_(x), O_(3), PM_(10), PM_(2.5), and SO_(2)) recorded during the last 25 years, from 1993 to 2017. We found substantial reductions in ambient concentration levels for all the pollutants studied except for O_(3). To assess the influence of recent weather changes on air quality trends we applied generalized additive models (GAMs) using nonparametric smoothing; with and without adjusting for weather parameters including temperature, wind speed, humidity and precipitation frequency. The difference of annual slopes estimated by the models without and with adjusting for these meteorological variables represents the impact of weather changes on pollutant trends, i.e. the ‘weather penalty’. The analyses were seasonally and geographically stratified to account for temporal and regional differences across Spain. The results were meta-analyzed to estimate weather penalties on ambient concentration trends at a national level as well as the impact on mortality for the most relevant pollutants. We found significant penalties for most pollutants, implying that air quality would have improved even more during our study period if weather conditions had remained constant. The largest weather influences were found for PM10, with seasonal penalties up to 22 μg⋅m^(−3) accumulated over the 25-year period in some regions. The national meta-analysis shows penalties of 0.060 μg⋅m^(−3) per year (95% Confidence Interval, CI: 0.004, 0.116) in cold months and 0.127 μg⋅m^(−3) per year (95% CI: 0.089, 0.164) in warm months. Penalties of this magnitude would correspond to 129 annual deaths (95% CI: 25, 233), i.e. approximately 3200 deaths over the 25-year period in Spain. According to our results, the health benefits of recent emission abatements for this pollutant in Spain would have been up to 10% greater if weather conditions had remained constant during the last 25 years.Ministerio para la Transición Ecológica. Dirección General de Biodiversidad y Calidad AmbientalAgencia Española de Meteorología (AEMET)Real Colegio Complutense (RCC)Harvard T.H. Chan School of Public HealthU.S. EPADepto. de Física de la Tierra y AstrofísicaFac. de Ciencias FísicasTRUEpu

Low ambient temperature and hospitalization for cardiorespiratory diseases in Brazil.

Studies have shown that larger temperature-related health impacts may be associated with cold rather than with hot temperatures. Although it remains unclear the cold-related health burden in warmer regions, in particular at the national level in Brazil. We address this gap by examining the association between low ambient temperature and daily hospital admissions for cardiovascular and respiratory diseases in Brazil between 2008 and 2018. We first applied a case time series design in combination with distributed lag non-linear modeling (DLNM) framework to assess the association of low ambient temperature with daily hospital admissions by Brazilian region. Here, we also stratified the analyses by sex, age group (15-45, 46-65, and >65 years), and cause (respiratory and cardiovascular hospital admissions). In the second stage, we performed a meta-analysis to estimate pooled effects across the Brazilian regions. Our sample included more than 23 million hospitalizations for cardiovascular and respiratory diseases nationwide between 2008 and 2018, of which 53% were admissions for respiratory diseases and 47% for cardiovascular diseases. Our findings suggest that low temperatures are associated with a relative risk of 1.17 (95% CI: 1.07; 1.27) and 1.07 (95% CI: 1.01; 1.14) for cardiovascular and respiratory admissions in Brazil, respectively. The pooled national results indicate robust positive associations for cardiovascular and respiratory hospital admissions in most of the subgroup analyses. In particular, for cardiovascular hospital admissions, men and older adults (>65 years old) were slightly more impacted by cold exposure. For respiratory admissions, the results did not indicate differences among the population groups by sex and age. This study can help decision-makers to create adaptive measures to protect public health from the effects of cold temperature

Air Pollution and COVID-19 Mortality in Brazil

Long-term exposure to poor air quality has been associated with respiratory viral infections such as influenza and measles. Some epidemiological studies in North America, Europe, and Asia also suggest that exposure to air pollution is associated with increased SARS-CoV-2 infection and mortality associated with COVID-19. However, few studies have been conducted on this topic in South America. In this study, we investigate the association between ambient PM2.5, NO2, and O3 and their interaction with COVID-19-associated deaths in Brazil, the largest country in South America. We apply a negative binomial mixed model with zero inflation using municipality-level COVID-19 deaths as the endpoint and the long-term average of PM2.5, NO2, and O3 as the exposure. We added a random intercept by state to account for potential correlations between communities within the same state. After adjusting the model for several potential confounders, including meteorological variables, demographic characteristics, socioeconomic aspects, and healthcare conditions, we found a positive association between PM2.5 and COVID-19 deaths in Brazil, where a 1 μg/m3 increase in the long-term average of PM2.5 was associated with a 10.22% (95% CI: 9.35; 11.09) increase in COVID-19 deaths. In contrast, O3 and NO2 showed negative associations. As suggested by the literature in other countries, our results suggest that air pollution is an important cofactor that increases the risk of death from COVID-19 in Brazil. The effects of air pollution in Brazil are pronounced, indicating the need for improved air quality control policies

Short-term air pollution exposure and mortality in Brazil: Investigating the susceptible population groups.

This is the first study to examine the association between ambient air pollution (PM2.5, O3, and NO2) and mortality (in different population groups by sex and age) based on a nationwide death record across Brazil over a 15-year period (2003-2017). We used a time-series analytic approach with a distributed lag model. Our study population includes 2,872,084 records of deaths in Brazil between 2003 and 2017. Men accounted for a higher proportion of deaths, with 58% for all-cause mortality, 54% for respiratory mortality, and 52% for circulatory mortality. Most individuals were over 65 years of age. Our results suggest an association between air pollution and mortality in Brazil. The direction, statistical significance, and effect size of these associations varied considerably by type of air pollutant, region, and population group (sex and age group). In particular, the older population group (>65 years) was most affected. The national meta-analysis for the entire data set (without stratification by sex and age) showed that for every 10 μg/m3 increase in PM2.5 concentration, the risk of death from respiratory diseases increased by 2.93% (95%CI: 1.42; 4.43). For every 10 ppb increase in O3, there is a 2.21% (95%CI: 0.59; 3.83) increase in the risk of all-cause mortality for the group of all people between 46 and 65 years old, and a 3.53% (95%CI: 0.34; 6.72) increase in the risk of circulatory mortality for the group of women, all ages. For every 10 ppb increase in NO2, the risk of respiratory mortality increases by 17.56% (95%CI: 4.44; 30.64) and the risk of all-cause mortality by 5.63% (95%CI: 1.83; 9.44). The results of our study provide epidemiological evidence that air pollution is associated with a higher risk of cardiorespiratory mortality in Brazil. Given the lack of nationwide studies on air pollution in Brazil, our research is an important contribution to the local and international literature that can provide better support to policymakers to improve air quality and public health