The influence of large-scale airborne particle decline and traffic-related exposure on children's lung function

Between 1991 and 2000, ambient air pollution in East Germany changed to resemble West German pollution levels: The concentration of total suspended particles (TSPs) decreased on a broad scale while traffic increased. During that time, we analyzed total lung capacity (TLC) and airway resistance (R(aw)) of East and West German children. We tested children 5-7 years of age (n = 2,574) with cooperation-independent body plethysmography in repeated cross sections. We used random-effect models to determine the mutually adjusted association between lung function and short-term and chronic particle exposure and its interaction with living near a busy road. Annual averages of TSPs declined from 77 to 44 microg/m2; averages on the day of investigation declined from 133 to 30 microg/m2. Differences in lung function between East and West German children vanished during the investigation time. The association of TSPs with R(aw) and TLC was stronger in children living > 50 m away from busy roads. East German children from this group had an R(aw) 2.5% higher [95% confidence interval (CI), 0.0-5.1%] per 40-microg/m2 increase of daily TSP averages. TLC decreased by 6.2% (95% CI, 0.04-11.6%) per 40-microg/m2 increase in annual mean TSPs, and this effect was equally pronounced in East and West Germany. TSP exposure decreased on a broad scale between 1991 and 2000. Lower concentrations of TSPs were associated with better measures of lung function in 6-year-old children. For children living near busy roads, this effect was diminished.     

Is the prevalence of atopic diseases in East and West Germany already converging?

Studies comparing respiratory health of residents in the areas of former East and West Germany have shown higher rates of asthma and allergies in children and young adults in former West Germany. It has been speculated that some factors associated with western lifestyle may be related to higher rates of atopic diseases among residents of former West Germany. We examined if the prevalence rates of self-reported asthma and nasal allergies in adults converged between the areas of former East and West Germany five years after re-unification. During the years 1990–1992 and 1994–1995 two independently drawn random samples of more than 3,000 subjects between the ages of 20 to 44 years answered a screening questionnaire of the European Community Respiratory Health Survey in Erfurt (East Germany) and in Hamburg (West Germany). The prevalence rates of asthma attacks, asthma medication use, allergic rhinitis, and wheezing remained stable in Hamburg but increased significantly in Erfurt approaching those of Hamburg. The data indicate that there is a tendency for the prevalence rates of self-reported allergic rhinitis and asthma-related respiratory symptoms in the eastern part of Germany to increase to West-German levels. It is not yet clear if this is due to a true increase in morbidity or only to a higher awareness for these diseases among doctors and the public.     

南宁市大气污染与呼吸系统疾病的关系

目的探讨南宁市大气污染与呼吸系统疾病的关系。方法根据南宁市1991—2002年大气中主要污染物如总悬浮颗粒物(TSP)、降尘、二氧化硫(SO2)、氮氧化物(NOx)的监测值计算上海大气质量指数并进行评价分级,再与呼吸系统疾病死亡率及同期自治区人民医院慢性阻塞性肺疾病人院病人构成比进行综合分析。结果南宁市大气属煤烟型污染,大气的主要污染物为TSP、降尘、SO2、NOx工业区呼吸系统疾病死亡率是城区的1．4～2．4倍,城区略高于郊区,在污染较重的1991-1995年,呼吸系统疾病死亡率也最高,同期该院慢性阻塞性肺疾病人院水平亦较高。结论南宁市大气污染是呼吸系统疾病死亡及高发的主要环境病因。     

East-West School Beginners Study in Saxony, Saxony-Anhalt, North Rhine-Westphalia 1991-1997

Since 1991, annual questionnaire-based surveys have been conducted in order to document the state of health of school beginners in industrial centres and in non-industrial areas in the German states of Sachsen-Anhalt, Saxony and North Rhine-Westphalia. As early as 1994, the results of these studies had shown that the considerable reduction of air pollution by SO2 and dust had resulted in a noticeable decrease of upper respiratory irritations and infections in children residing in formerly heavily polluted East German regions. There was, however, no evidence of a connection between outdoor air pollution and symptoms of allergy and sensitisation. These symptoms were even more frequent in school beginners living in North Rhine-Westphalia than in East German children. With regard to the improvement of outdoor air quality, from 1997 on the study was focussed on a comparison of the prevalence of respiratory diseases, allergies and sensitizations in East and West German children with respect to other eventual risk factors including those originating from indoor conditions. From the beginning, every three years the school beginners were tested for eventual sensitizations using the skin prick test and RAST. Up to 1997, data were recovered from a total of 26121 children. The response rate amounted to 83%. A total of 5338 children were investigated by RAST and 4293 by skin prick testing. After three school years, a total of 1342 children, now nine years old, were questioned anew. The life prevalence of hay fever was 0.5-1.0% in East German children born before 1990 and 3.5-4.0% in those born after the political shift of 1990. Thus, the latter prevalence rate resembled that of West German children. Notably, the increase was true of hay fever symptoms (running or obstipated nose, reddened eyes) and not of bronchial asthma and atopic eczema. The 9-year-old children questioned in 1997, however, did not declare more often ever having suffered from hay fever than those of the same age questioned in 1994. Up to now, the incidence of sensitizations against specific allergens has not changed. Generally, the pattern of sickness and symptoms of 6-year old East German children has become quite similar to that of West German children.     

Environmental surveys in the areas of Bitterfeld,Hettstedt and a comparative area in 1992-2000

The aim of the environmental epidemiological study was to determine possible adverse effects on the health of children in the environmentally polluted areas of Bitterfeld and Hettstedt compared to the less polluted area of Zerbst (Eastern Germany). The changes of the health parameters were recorded together with the environmental changes during the time period of 6 years. The study design consisted of three repeated regional cross-sectional studies in 1992/93, 1995/96 and 1998/99. In total, 7,611 questionnaires could be analysed (participation rate: 89%, 75% and 75%). Children living in the most polluted area of Hettstedt had a noticeable higher risk for non-allergic respiratory diseases and symptoms compared to children living in the control area of Zerbst. From 1992 to 1999 a statistically significant decrease in the prevalences of these health outcomes was found. Children without indoor pollutants in their homes had the greatest benefit by the improvement of ambient air quality. The increase in lung function (FVC, FEV1) also underlines the improvement of the respiratory health. Children living in the polluted areas reported allergies more often (physician's diagnosis, allergy specific antibodies). The prevalence of asthma, the bronchial hyperreactivity and atopic eczema was increased within the observational period of 6 years. An increased prevalence was also shown for more severe allergic sensitisation (RAST classes > 17.5 kU/l), while the prevalence of hay fever increased slightly on a non-significant level. The burden with lead and cadmium was higher in children living in polluted areas and decreased during the study period except for 1997 where the lead concentration in blood increased according to the higher lead concentration in settled dust in Hettstedt at that time.     

Air quality in postunification Erfurt, East Germany: associating changes in pollutant concentrations with changes in emissions

The unification of East and West Germany in 1990 resulted in sharp decreases in emissions of major air pollutants. This change in air quality has provided an opportunity for a natural experiment to evaluate the health impacts of air pollution. We evaluated airborne particle size distribution and gaseous co-pollutant data collected in Erfurt, Germany, throughout the 1990s and assessed the extent to which the observed changes are associated with changes in the two major emission sources: coal burning for power production and residential heating, and motor vehicles. Continuous data for sulfur dioxide, total suspended particulates (TSP), nitric oxide, carbon monoxide, and meteorologic parameters were available for 1990-1999, and size-selective particle number and mass concentration measurements were made during winters of 1991 and 1998. We used hourly profiles of pollutants and linear regression analyses, stratified by year, weekday/weekend, and hour, using NO and SO(2) as markers of traffic- and heating-related combustion sources, respectively, to study the patterns of various particle size fractions. Supplementary data on traffic and heating-related sources were gathered to support hypotheses linking these sources with observed changes in ambient air pollution levels. Substantially decreased (19-91%) concentrations were observed for all pollutants, with the exception of particles in the 0.01-0.03 microm size range (representing the smallest ultrafine particles that were measured). The number concentration for these particles increased by 115% between 1991 and 1998. The ratio of these ultrafine particles to TSP also increased by more than 500%, indicating a dramatic change in the size distribution of airborne particles. Analysis of hourly concentration patterns indicated that in 1991, concentrations of SO(2) and larger particle sizes were related to residential heating with coal. These peaks were no longer evident in 1998 due to decreases in coal consumption and consequent decreased emissions of SO(2) and larger particles. These decreases in coal combustion and the decreased concentrations of SO(2) and particles of larger size classes may have led to decreased particle scavenging and may be partially responsible for the observed increases in ultrafine particles. Traffic-related changes, such as increased numbers of trucks and increased use of diesel vehicles in Erfurt, were also associated with increased number concentrations of ultrafine particles. Morning particle peaks of all sizes were associated with NO and CO (markers for traffic) in both the 1991 and 1998 periods. There were significant differences in the ultrafine particle levels for morning hours between 1991 and 1998, suggesting that traffic was the cause of this increase.     

Injury mortality in East Germany

OBJECTIVES: This study determined the effects of social changes in East Germany since 1989 on patterns of injury mortality. METHODS: Death certificate data regarding injuries from 1980 through 1995 and police data regarding traffic injuries in East Germany from 1980 through 1998 were compared with similar data from West Germany. RESULTS: The number of motor vehicle-related injuries and deaths in East Germany increased dramatically between 1989 and 1991, whereas those in West Germany declined slightly. The increased mortality in the more rural East has especially involved young men driving automobiles on rural roads and has persisted since reunification of East and West Germany. Falls, other accidents, and suicides have shown no such effect. Homicide among East German men has increased but remains uncommon. CONCLUSIONS: Recent social changes in East Germany, including increased access to motor vehicles and decreased restrictions on personal freedom, have been associated with increased motor vehicle crashes and mortality, especially among young men and on rural roads.     

Respiratory symptoms and air pollution changes in children: the Gardanne Coal-Basin Study

The influence of daily changes in sulfur dioxide (SO2) levels on the induction of respiratory symptoms was studied during the 1983-1984 winter in 450 children, aged 9 to 11 yr, living in the Gardanne coal-basin, France. In this area, SO2 originates mainly from a coal-fueled power plant. The mean SO2 level during the winter was 22 micrograms/m3 in low-pollution areas and 93 micrograms/m3 in polluted areas, with daily SO2 levels up to 356 micrograms/m3. Children completed a daily diary about respiratory symptoms. In the polluted communities only we demonstrated a significant association between daily SO2 levels (after controlling for temperature and respirable particle variations) and prevalence of upper and lower respiratory symptoms. However, in each polluted town, and for each respiratory symptom, there was no evidence for either a latency period or a delay in the effects of pollutants. Mean daily temperature was also closely correlated with upper and lower respiratory symptoms in most of the polluted and some low-pollution communities. In a second step, the prevalence of respiratory symptoms in each town was compared, during two 2-wk periods, with air pollution levels; higher prevalences were found during the pollution period. In conclusion, moderate daily changes in SO2 levels induce a significant but transient increase in the prevalence of respiratory symptoms in children.     

Association of lung function with declining ambient air pollution

Recent studies have found a declining prevalence of respiratory infections in East German children, along with a tremendous improvement of air pollution since 1990. The present study evaluates the effects of improved air quality on lung function. Three consecutive cross-sectional surveys of schoolchildren ages 11-14 years from three communities in East Germany were performed in 1992-1993, 1995-1996, and 1998-1999. Lung function tests were available from 2,493 children. The annual mean of total suspended particulates (TSP) declined from 79 to 25 micro g/m(3), whereas levels for sulfur dioxide declined from 113 to 6 micro g/m(3). Mean forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV(1)) of the children increased from 1992-1993 to 1998-1999. The adjusted percent change of the geometric mean of FVC was 4.7% for a 50 micro g/m(3) decrease of TSP (p = 0.043) and 4.9% for a decrement of 100 micro g/m(3) SO(2) (p = 0.029). Effects on FEV(1) were smaller and not statistically significant. Our study indicates that a reduction of air pollution in a short time period may improve children's lung function.     

Infectious diseases before and after German unification: trends in mortality and morbidity

After the fall of the Berlin Wall in 1989 the former communist countries of central and eastern Europe underwent substantial social and economic changes that had a major impact on health. The situation of the former German Democratic Republic was unique in that its existing institutions were replaced rapidly and it was quickly integrated economically with the West. This study describes recent trends in morbidity and mortality from infectious diseases in East and West Germany before and after unification using routine data from 1980 onwards. Substantial differences in morbidity and mortality resulting from infectious diseases were observed between East and West Germany. These seem to be the complex result of societal and health system differences in both parts of Germany before unification, differing population dynamics and health behaviours, and an increasing westernisation in the eastern part of Germany during recent years.     

本溪市大气污染与急慢性呼吸系统疾病的关系

目的 灯一溪市大气污染治理。方法 于１９９４年和１９９５年连续二年调查室外大气污染对呼呼统健康的影响,经对市内５个衡区２５岁以上成中呼吸系统症状生咳 、气短、突发性喘息）三种疾病（慢性支气管炎,慢性阻塞性疾患及上呼吸道感染）以内外多种暴露的流行病学调查,用多因素Ｌｏｇｉｓｔｉｃ回归分析,调整了年龄、性别、文化程度、职业、室内煤及吸烟状况后,得出室外大气污染和一呼吸系统疾病的联系。结果 ６种呼吸系统     

Air pollution and daily mortality in Seoul and Ulsan, Korea.

The relationship between air pollution and daily mortality for the period 1991-1995 was examined in two Korean cities, Seoul and Ulsan. The observed concentrations of sulfur dioxide (SO2; mean = 28.7 ppb), ozone (O3; mean = 29.2 ppb), and total suspended particulates (TSP; mean = 82.3 microg/m3) during the study period were at levels below Korea's current ambient air quality standards. Daily death counts were regressed separately in the two cities, using Poisson regression on SO2, O3, and/or TSP controlling for variability in the weather and seasons. When considered singly in Poisson regression models controlling for seasonal variations and weather conditions, the nonaccidental mortality associated with a 50-ppb increment in a 3-day moving average of SO2 concentrations, including the concurrent day and the preceding 2 days, was 1.078 [95% confidence interval (CI), 1.057-1.099] for Seoul and 1.051 (CI, 0.991-1.115) for Ulsan. The rate ratio was 1.051 (CI, 1.031-1.072) in Seoul and 0.999 (CI, 0. 961-1.039) in Ulsan per 100 microg/m3 for TSP, and 1.015 (CI, 1. 005-1.025) in Seoul and 1.020 (0.889-1.170) in Ulsan per 50 ppb for 1-hr maximum O3. When TSP was considered simultaneously with other pollutants, the TSP association was no longer significant. We observed independent pollution effects on daily mortality even after using various approaches to control for either weather or seasonal variables in the regression model. This study demonstrated increased mortality associated with air pollution at both SO2 and O3 levels below the current World Health Organization recommendations.     

Asthmatic disease among urban preschoolers: an observational study

Asthma is of increasing concern especially in industrialized countries. This cross-sectional study was to assess the influence of spatial and temporal variations in the urban air pollution profile on asthmatic disease. The prevalences presented are based on physician-diagnosed asthmatic and allergic disease data, collected between 1993 and 1995. Seven hundred and thirty-six preschool children (age 2 to 7, mean 5.7 years) of 37 daycare centres in the City of Leipzig participated in the study. Variations were observed in the lifetime prevalences of asthma and allergy with differences in a residential area's ambient pollution profile. Depending on the level of traffic (high or low), children residing in areas with a dominant coal-heating emission profile had more frequently a diagnosis of asthma, 17.5% and 8.8% (95% confidence intervals [CI]: 10.8...23.5 and 5.8...11.6, respectively), as compared to those, living in centrally heated areas 13.4% and 5.8% (CI: 6.6...19.3 and 1.2...9.6, respectively). Allergic disorders occurred more often in areas with a predominantly traffic-associated pollution profile, 14.3% and 9.6% vs. 5.8% and 3.7% (CI: 7.4...20.3 and 6.4...12.5; 1.2...9.6 and 0.2...6.5, respectively). Interestingly, asthmatic disease was not necessarily associated with a clinical history of allergies. Of the children with physician-diagnosed asthma, 83.7% were not reported to have a concurrent diagnosis of allergies nor to show clinical symptoms. This suggests that environmental exposures (i.e., complex pollution mixtures associated with residential coal-heating and/or traffic) may have differentially influenced the phenotypic expression of asthma. A qualitative discussion is presented on the occurrence of "asthma without reported allergies" in Leipzig.     

Violence and fear of violence in East and West Germany

The purpose of this research was to assess the effect of major social changes in Germany since 1989 on mortality due to intentional injury. Mechanisms and types of fatal intentional injury in East and West Germany between 1970 and 1995 were determined from death certificates and compared with judicial data on violent crime convictions and recent public survey data on citizen fear of crime. The number of homicides among East German males increased between 1989 and 1991, and the homicide rate remains high when compared with West German males (although lower than that of American males). Homicide among German females is less common, presently about equally likely in East and West. Violent crime in general has become more frequent in Germany, and citizen fear of crime has increased markedly, especially in the East. Non-citizens are convicted for an increasing number of homicides and assaults. Rates of suicide were declining in East and West before reunification, and these rates have continued to decline. Social changes in Europe since 1989 have led to noticeable increases in violence and homicide in Germany, which in turn have reduced feelings of security among German citizens, especially in the East. Suicide rates have not been affected.     

Epidemiologie allergischer Erkrankungen bei Kindern Zeitliche Trends in Deutschland und Diskussion möglicher Ursachen eines Trends

For many countries in Europe it was shown that allergies increased in the last decades. Data from Germany are not sufficient. Therefore results from studies in six years old children from West Germany are given which demonstrate an increase of allergies between 1985 and 1995. In this time the lifetime prevalence of bronchial asthma in boys rose from 1.5% to 4% and the lifetime prevalence of eczema rose from 6% to 12%. In East Germany the prevalence of allergies is on the increase. Possible causes are discussed: Increase of aeroallergens outdoors an indoors: Early flowering trees release pollen earlier every year and pollen concentrations increase in tendency. Concentrations of house dust mites increase because of increasing dampness in homes. Introduction of new allergens: As an example latex and salts of platinum are discussed. Their release is increasing but they are most relevant for some professional groups. Adjuvant activity of pollutants: Traffic related pollutants can exhibit an adjuvant activity and modify allergen carriers. Less stimulation of the immune system in early childhood (less infections, parasites, vaccination...) Which of these factors, which are summarised by “western lifestyle” is responsible for the increase is not known up to now.     

Social inequality and environmentally-related diseases in Germany: Review of empirical results

A literature search was conducted aiming at all empirical studies from Germany till mid 1997 containing data on the association between environmentally-related diseases and the socio-economic status (education, occupation, income, social class) and/or on the association between the exposure to harmful substances and the socio-economic status. With respect to the exposures, a clear picture becomes visible: the concentration of harmful substances in the ambient air as well as indoors is considerably higher with regard to the lower social class as compared with the higher social class. This applies to children as well as to adults and to West Germany as well as to East Germany. However, with respect to environmentally-related diseases, no such clear picture becomes visible. For example, several studies indicate that allergies, atopic eczema and croup occur less frequently in the lower social class than in the higher social class. Malignant tumours (lung cancer, kidney cancer or bladder cancer), however, seem to occur more freauently in the lower social class than in the higher social class. Environmental-epidemiological studies should increasingly integrate socio-epidemiological study approaches and explicity present their results.     

Association between air pollution and low birth weight: a community-based study.

The relationship between maternal exposure to air pollution during periods of pregnancy (entire and specific periods) and birth weight was investigated in a well-defined cohort. Between 1988 and 1991, all pregnant women living in four residential areas of Beijing were registered and followed from early pregnancy until delivery. Information on individual mothers and infants was collected. Daily air pollution data were obtained independently. The sample for analysis included 74,671 first-parity live births were gestational age 37-44 weeks. Multiple linear regression and logistic regression were used to estimate the effects of air pollution on birth weight and low birth weight (< 2,500 g), adjusting for gestational age, residence, year of birth, maternal age, and infant gender. There was a significant exposure-response relationship between maternal exposures to sulfur dioxide (SO2) and total suspended particles (TSP) during the third trimester of pregnancy and infant birth weight. The adjusted odds ratio for low birth weight was 1.11 (95% CI, 1.06-1.16) for each 100 micrograms/m3 increase in SO2 and 1.10 (95% CI, 1.05-1.14) for each 100 micrograms/m3 increase in TSP. The estimated reduction in birth weight was 7.3 g and 6.9 g for each 100 micrograms/m3 increase in SO2 and in TSP, respectively. The birth weight distribution of the high-exposure group was more skewed toward the left tail (i.e., with higher proportion of births < 2,500 g) than that of the low-exposure group. Although the effects of other unmeasured risk factors cannot be excluded with certainty, our data suggests that TSP and SO2, or a more complex pollution mixture associated with these pollutants, contribute to an excess risk of low birth weight in the Beijing population.     

1990～1991年北京市城区大气污染与每日居民死亡关系的研究

本研究使用时间序列分析对北京市主要城区（西城区、东城区）１９９０～１９９１年大气污染和每日死亡数进行连续观察，并使用泊松回归模型分析空气中总飘尘（ＴＳＰ）和二氧化硫（ＳＯ２）的对数测定值对每日居民死亡的影响，结果显示：大气污染物有增加每日居民死亡数的危险性，心血管病患者受ＴＳＰ的影响和呼吸系统疾病患者受ＳＯ２的影响比其他疾病患者更大，６５岁及以上老年病人所受影响较大。     

Individual risk factors, health behaviour and mortality developments in Germany from 1984 to 1998

The aim of the study is to investigate the contribution by the risk factors smoking, overweight, high blood pressure, physical inactivity and regular alcohol consumption to the total mortality development of the general population in Germany. Data are a mortality follow-up conducted by the Federal Institute for Population Research during 1984 - 1998 in West Germany and 1991-1998 in East Germany. 8474 persons participated at baseline in West Germany in the age group 31-69 years, and 1546 persons participated at baseline in East Germany in the age-group 40-79 years. The vital status in the year 1998 could be determined in West Germany for 86.5% and in East Germany for 97.0%. In the observation period 1986-1998 for West Germany 17.2% of the males died and 8.6% of the females. In East Germany between 1991-1998 9.6% of the males died and 6.7% of the females. The statistical analysis, based on the Cox regression showed for West Germany except for overweight in males throughout a significant contribution of the risk factor load on total mortality. The highest relative risks were found for strong smokers (males: RR = 3.47, p < 0.001, females: RR = 3.62, p < 0.001). The relative mortality risk for persons with three and more risk factors yielded in males 4.88 (p < 0.001) and in females 5.05 (p < 0.001). These findings clearly demonstrate that already a few risk markers of the individual health behaviour have a strong impact on the total mortality development in Germany. The mortality risk is about five times higher for persons with three and more risk factors. This indicates the need for preventive measures targeting high-risk population groups.     

Food and nutrient intake in East and West Germany, 8 years after the reunification--The German Nutrition Survey 1998

OBJECTIVE: To explore differences in food and nutrient intake as well as cardiovascular risk factors between the eastern and western parts of Germany in 1998 and to compare food consumption information between 1991 and 1998. DESIGN AND SUBJECTS: In all, 4030 people, aged 18-79 y, sampled from the East and West parts of Germany participated in the German Nutrition Survey (1998) by completing dietary histories and being assessed for cardiovascular risk factors. In a separate analysis, two food frequency data sets were compared from National Health Surveys conducted in 1991 (n = 7466) and in 1998 (n = 4556). RESULTS: In 1998, East Germans consumed more bread, fruit, fish, sausage, offal, and men additionally more cakes/cookies, beer and soft drinks than West Germans. They consumed less cereals, pasta, sweets, leafy vegetables, tea and drinking water, and men less vegetables and wine and women less pastry/crackers, potatoes and animal fat compared with their counterparts in West Germany. East Germans had a higher intake of total vitamin A, retinol, vitamin D, vitamin B12 and chloride, and in addition men of alcohol, and women of monosaccharides. They had a lower intake of total water, vitamin K, calcium, magnesium and manganese, and men of linoleic acid, and women of vitamin E than their West German counterparts. In East Germany, higher mean systolic blood pressure, and total and high-density lipoprotein cholesterol concentrations were found in men, and a lower mean total serum cholesterol concentration found in women compared with West Germany. CONCLUSION: Differences in food intake between the eastern and western parts of Germany still existed in 1998, although these differences were smaller than those observed 1 y after the reunification.