Prioritizing hazardous pollutants in two Nigerian water supply schemes: a risk-based approach

Objective

To rank pollutants in two Nigerian water supply schemes according to their effect on human health using a risk-based approach.

Methods

Hazardous pollutants in drinking-water in the study area were identified from a literature search and selected pollutants were monitored from April 2010 to December 2011 in catchments, treatment works and consumer taps. The disease burden due to each pollutant was estimated in disability-adjusted life years (DALYs) using data on the pollutant’s concentration, exposure to the pollutant, the severity of its health effects and the consumer population.

Findings

The pollutants identified were microbial organisms, cadmium, cobalt, chromium, copper, iron, manganese, nickel, lead and zinc. All were detected in the catchments but only cadmium, cobalt, chromium, manganese and lead exceeded World Health Organization (WHO) guideline values after water treatment. Post-treatment contamination was observed. The estimated disease burden was greatest for chromium in both schemes, followed in decreasing order by cadmium, lead, manganese and cobalt. The total disease burden of all pollutants in the two schemes was 46 000 and 9500 DALYs per year or 0.14 and 0.088 DALYs per person per year, respectively, much higher than the WHO reference level of 1 × 10⁻⁶ DALYs per person per year. For each metal, the disease burden exceeded the reference level and was comparable with that due to microbial contamination reported elsewhere in Africa.

Conclusion

The estimated disease burden of metal contamination of two Nigerian water supply systems was high. It could best be reduced by protection of water catchment and pretreatment by electrocoagulation.     

Comparative impact assessment of child pneumonia interventions

Objective

To compare the cost-effectiveness of interventions to reduce pneumonia mortality through risk reduction, immunization and case management.

Methods

Country-specific pneumonia burden estimates and intervention costs from WHO were used to review estimates of pneumonia risk in children under 5 years of age and the efficacy of interventions (case management, pneumonia-related vaccines, improved nutrition and reduced indoor air pollution from household solid fuels). We calculated health benefits (disability-adjusted life years, DALYs, averted) and intervention costs over a period of 10 years for 40 countries, accounting for 90% of pneumonia child deaths.

Findings

Solid fuel use contributes 30% (90% confidence interval: 18–44) to the burden of childhood pneumonia. Efficacious community-based treatment, promotion of exclusive breastfeeding, zinc supplementation and Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae immunization through existing programmes showed cost-effectiveness ratios of 10–60 International dollars (I$) per DALY in low-income countries and less than I$ 120 per DALY in middle-income countries. Low-emission biomass stoves and cleaner fuels may be cost-effective in low-income regions. Facility-based treatment is potentially cost-effective, with ratios of I$ 60–120 per DALY. The cost-effectiveness of community case management depends on home visit cost.

Conclusion

Vaccines against Hib and S. pneumoniae, efficacious case management, breastfeeding promotion and zinc supplementation are cost-effective in reducing pneumonia mortality. Environmental and nutritional interventions reduce pneumonia and provide other benefits. These strategies combined may reduce total child mortality by 17%.     

Peri-operative pulse oximetry in low-income countries: a cost–effectiveness analysis

Objective

To evaluate the cost–effectiveness of pulse oximetry – compared with no peri-operative monitoring – during surgery in low-income countries.

Methods

We considered the use of tabletop and portable, hand-held pulse oximeters among patients of any age undergoing major surgery in low-income countries. From earlier studies we obtained baseline mortality and the effectiveness of pulse oximeters to reduce mortality. We considered the direct costs of purchasing and maintaining pulse oximeters as well as the cost of supplementary oxygen used to treat hypoxic episodes identified by oximetry. Health benefits were measured in disability-adjusted life-years (DALYs) averted and benefits and costs were both discounted at 3% per year. We used recommended cost–effectiveness thresholds – both absolute and relative to gross domestic product (GDP) per capita – to assess if pulse oximetry is a cost–effective health intervention. To test the robustness of our results we performed sensitivity analyses.

Findings

In 2013 prices, tabletop and hand-held oximeters were found to have annual costs of 310 and 95 United States dollars (US$), respectively. Assuming the two types of oximeter have identical effectiveness, a single oximeter used for 22 procedures per week averted 0.83 DALYs per annum. The tabletop and hand-held oximeters cost US$ 374 and US$ 115 per DALY averted, respectively. For any country with a GDP per capita above US$ 677 the hand-held oximeter was found to be cost–effective if it prevented just 1.7% of anaesthetic-related deaths or 0.3% of peri-operative mortality.

Conclusion

Pulse oximetry is a cost–effective intervention for low-income settings.     

Evaluating the cost-effectiveness of combination antiretroviral therapy for the prevention of mother-to-child transmission of HIV in Uganda

Objective

To model the cost-effectiveness in Uganda of combination antiretroviral therapy (ART) to prevent mother-to-child transmission of human immunodeficiency virus (HIV).

Methods

The cost-effectiveness of ART was evaluated on the assumption that ART reduces the risk of an HIV-positive pregnant woman transmitting HIV to her baby from 40% (when the woman is left untreated) to 25.8%, 17.4% and 3.8%, respectively, when the woman is given: (i) single-dose nevirapine (at an estimated total drug cost of 0.06 United States dollars [US$]); (ii) dual therapy with zidovudine and lamivudine for 7 weeks (at a total drug cost of US$ 15.63); or (iii) ART for 18 months (at a total annual cost of US$ 469.77). Lifetime ART (US$ 6883), recommended for pregnant women with < 350 CD4+ T lymphocytes per mm³, was assumed to give the same reduction in transmission risk in each subsequent pregnancy.

Findings

Compared with single-dose nevirapine, dual therapy and no therapy, 18 months of ART averted 5.21, 3.22 and 8.58 disability-adjusted life years (DALYs), respectively, at a cost of US$ 46, US$ 99 and US$ 34 per DALY averted. The corresponding figures for lifetime ART are, respectively, 19.20, 11.87 and 31.60 DALYs averted, at a cost of US$ 205, US$ 354 and US$ 172 per DALY averted.

Conclusion

In Uganda, ART appears highly cost-effective for the prevention of mother-to-child HIV transmission, even if continued over the patients’ lifetimes. Given the additional public health benefits of ART, efforts to ensure that all HIV-positive pregnant women have access to lifelong ART should be intensified.     

Spatial Modeling of PM10 and NO2 in the Continental United States, 1985–2000

Background

Epidemiologic studies of air pollution have demonstrated a link between long-term air pollution exposures and mortality. However, many have been limited to city-specific average pollution measures or spatial or land-use regression exposure models in small geographic areas.

Objectives

Our objective was to develop nationwide models of annual exposure to particulate matter < 10 μm in diameter (PM₁₀) and nitrogen dioxide during 1985–2000.

Methods

We used generalized additive models (GAMs) to predict annual levels of the pollutants using smooth spatial surfaces of available monitoring data and geographic information system–derived covariates. Model performance was determined using a cross-validation (CV) procedure with 10% of the data. We also compared the results of these models with a commonly used spatial interpolation, inverse distance weighting.

Results

For PM₁₀, distance to road, elevation, proportion of low-intensity residential, high-intensity residential, and industrial, commercial, or transportation land use within 1 km were all statistically significant predictors of measured PM₁₀ (model R² = 0.49, CV R² = 0.55). Distance to road, population density, elevation, land use, and distance to and emissions of the nearest nitrogen oxides–emitting power plant were all statistically significant predictors of measured NO₂ (model R² = 0.88, CV R² = 0.90). The GAMs performed better overall than the inverse distance models, with higher CV R² and higher precision.

Conclusions

These models provide reasonably accurate and unbiased estimates of annual exposures for PM₁₀ and NO₂. This approach provides the spatial and temporal variability necessary to describe exposure in studies assessing the health effects of chronic air pollution.     

Workplace Secondhand Smoke Exposure in the U.S. Trucking Industry

Background

Although the smoking rate in the United States is declining because of an increase of smoke-free laws, among blue-collar workers it remains higher than that among many other occupational groups.

Objectives

We evaluated the factors influencing workplace secondhand smoke (SHS) exposures in the U.S. unionized trucking industry.

Methods

From 2003 through 2005, we measured workplace SHS exposure among 203 nonsmoking and 61 smoking workers in 25 trucking terminals. Workers in several job groups wore personal vapor-phase nicotine samplers on their lapels for two consecutive work shifts and completed a workplace SHS exposure questionnaire at the end of the personal sampling.

Results

Median nicotine level was 0.87 μg/m³ for nonsmokers and 5.96 μg/m³ for smokers. As expected, smokers experienced higher SHS exposure duration and intensity than did nonsmokers. For nonsmokers, multiple regression analyses indicated that self-reported exposure duration combined with intensity, lack of a smoking policy as reported by workers, having a nondriver job, and lower educational level were independently associated with elevated personal nicotine levels (model R² = 0.52). Nondriver job and amount of active smoking were associated with elevated personal nicotine level in smokers, but self-reported exposure, lack of a smoking policy, and lower educational level were not.

Conclusions

Despite movements toward smoke-free laws, this population of blue-collar workers was still exposed to workplace SHS as recently as 2005. The perceived (reported by the workers), rather than the official (reported by the terminal managers), smoking policy was associated with measured SHS exposure levels among the nonsmokers. Job duties and educational level might also be important predictors of workplace SHS exposure.     

Estimating the measles effective reproduction number in Australia from routine notification data

Objective

To estimate the measles effective reproduction number (R) in Australia by modelling routinely collected notification data.

Methods

R was estimated for 2009–2011 by means of three methods, using data from Australia’s National Notifiable Disease Surveillance System. Method 1 estimated R as 1 − P, where P equals the proportion of cases that were imported, as determined from data on place of acquisition. The other methods estimated R by fitting a subcritical branching process that modelled the spread of an infection with a given R to the observed distributions of outbreak sizes (method 2) and generations of spread (method 3). Stata version 12 was used for method 2 and Matlab version R2012 was used for method 3. For all methods, calculation of 95% confidence intervals (CIs) was performed using a normal approximation based on estimated standard errors.

Findings

During 2009–2011, 367 notifiable measles cases occurred in Australia (mean annual rate: 5.5 cases per million population). Data were 100% complete for importation status but 77% complete for outbreak reference number. R was estimated as < 1 for all years and data types, with values of 0.65 (95% CI: 0.60–0.70) obtained by method 1, 0.64 (95% CI: 0.56–0.72) by method 2 and 0.47 (95% CI: 0.38–0.57) by method 3.

Conclusion

The fact that consistent estimates of R were obtained from all three methods enhances confidence in the validity of these methods for determining R.     

What are the health costs of uranium mining? A case study of miners in Grants,New Mexico

Background:

Uranium mining is associated with lung cancer and other health problems among miners. Health impacts are related with miner exposure to radon gas progeny.

Objectives:

This study estimates the health costs of excess lung cancer mortality among uranium miners in the largest uranium-producing district in the USA, centered in Grants, New Mexico.

Methods:

Lung cancer mortality rates on miners were used to estimate excess mortality and years of life lost (YLL) among the miner population in Grants from 1955 to 2005. A cost analysis was performed to estimate direct (medical) and indirect (premature mortality) health costs.

Results:

Total health costs ranged from $2.2 million to $7.7 million per excess death. This amounts to between $22.4 million and $165.8 million in annual health costs over the 1955–1990 mining period. Annual exposure-related lung cancer mortality was estimated at 2185.4 miners per 100 000, with a range of 1419.8–2974.3 per 100 000.

Conclusions:

Given renewed interest in uranium worldwide, results suggest a re-evaluation of radon exposure standards and inclusion of miner long-term health into mining planning decisions.     

Exposure to Dichlorodiphenyltrichloroethane and the Risk of Breast Cancer: A Systematic Review and Meta-analysis

Objectives

This study extended and updated a meta-analysis of the association between exposure to dichlorodiphenyltrichloroethane (DDT) and the risk of breast cancer.

Methods

We reviewed the published literature on exposure to DDE and breast cancer risk to update a meta-analysis from 2004. The total of 35 studies included 16 hospital-based case–control studies, 11 population-based case–control studies, and 10 nested case–control studies identified through keyword searches in the PubMed and EMBASE databases.

Results

The summary odds ratio (OR) for the identified studies was 1.03 (95% confidence interval 0.95–1.12) and the overall heterogeneity in the OR was observed (I² = 40.9; p = 0.006). Subgroup meta-analyses indicated no significant association between exposure to DDE and breast cancer risk by the type of design, study years, biological specimen, and geographical region of the study, except from population-based case–control studies with estimated DDE levels in serum published in 1990s.

Conclusion

Existing studies do not support the view that DDE increases the risk of breast cancer in humans. However, further studies incorporating more detailed information on DDT exposure and other potential risk factors for breast cancer are needed.     

Maternal Arsenic Exposure and Impaired Glucose Tolerance during Pregnancy

Background

Accumulating evidence has shown an increased risk of type 2 diabetes in general populations exposed to arsenic, but little is known about exposures during pregnancy and the association with gestational diabetes (GD).

Objectives

We studied 532 women living proximate to the Tar Creek Superfund Site to investigate whether arsenic exposure is associated with impaired glucose tolerance during pregnancy.

Methods

Blood glucose was measured between 24 and 28 weeks gestation after a 1-hr oral glucose tolerance test (GTT) as part of routine prenatal care. Blood and hair were collected at delivery and analyzed for arsenic using inductively coupled plasma mass spectrometry with dynamic reaction cell.

Results

Arsenic concentrations ranged from 0.2 to 24.1 μg/L (ppb) (mean ± SD, 1.7 ±1.5) and 1.1 to 724.4 ng/g (ppb) (mean ± SD, 27.4 ± 61.6) in blood and hair, respectively. One-hour glucose levels ranged from 40 to 284 mg/dL (mean ± SD, 108.7 ± 29.5); impaired glucose tolerance was observed in 11.9% of women when using standard screening criterion (> 140 mg/dL). Adjusting for age, Native-American race, prepregnancy body mass index, Medicaid use, and marital status, women in the highest quartile of blood arsenic exposure had 2.8 higher odds of impaired GTT than women in the lowest quartile of exposure (95% confidence interval, 1.1–6.9) (p-trend = 0.008).

Conclusions

Among this population of pregnant women, arsenic exposure was associated with increased risk of impaired GTT at 24–28 weeks gestation and therefore may be associated with increased risk of GD.     

A Unified Spatiotemporal Modeling Approach for Predicting Concentrations of Multiple Air Pollutants in the Multi-Ethnic Study of Atherosclerosis and Air Pollution

Background:

Cohort studies of the relationship between air pollution exposure and chronic health effects require predictions of exposure over long periods of time.

Objectives:

We developed a unified modeling approach for predicting fine particulate matter, nitrogen dioxide, oxides of nitrogen, and black carbon (as measured by light absorption coefficient) in six U.S. metropolitan regions from 1999 through early 2012 as part of the Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air).

Methods:

We obtained monitoring data from regulatory networks and supplemented those data with study-specific measurements collected from MESA Air community locations and participants’ homes. In each region, we applied a spatiotemporal model that included a long-term spatial mean, time trends with spatially varying coefficients, and a spatiotemporal residual. The mean structure was derived from a large set of geographic covariates that was reduced using partial least-squares regression. We estimated time trends from observed time series and used spatial smoothing methods to borrow strength between observations.

Results:

Prediction accuracy was high for most models, with cross-validation R² (R²_CV) > 0.80 at regulatory and fixed sites for most regions and pollutants. At home sites, overall R²_CV ranged from 0.45 to 0.92, and temporally adjusted R²_CV ranged from 0.23 to 0.92.

Conclusions:

This novel spatiotemporal modeling approach provides accurate fine-scale predictions in multiple regions for four pollutants. We have generated participant-specific predictions for MESA Air to investigate health effects of long-term air pollution exposures. These successes highlight modeling advances that can be adopted more widely in modern cohort studies.

Citation:

Keller JP, Olives C, Kim SY, Sheppard L, Sampson PD, Szpiro AA, Oron AP, Lindström J, Vedal S, Kaufman JD. 2015. A unified spatiotemporal modeling approach for predicting concentrations of multiple air pollutants in the Multi-Ethnic Study of Atherosclerosis and Air Pollution. Environ Health Perspect 123:301–309; http://dx.doi.org/10.1289/ehp.1408145     

Selenium and Mercury in the Brazilian Amazon: Opposing Influences on Age-Related Cataracts

Background

Age-related cataracts (ARCs) are an important cause of blindness in developing countries. Although antioxidants may be part of the body’s defense to prevent ARC, environmental contaminants may contribute to cataractogenesis. In fish-eating populations of the lower Tapajós region, elevated exposure to mercury (Hg) has been reported, and blood levels of selenium (Se) range from normal to very high (> 1,000 μg/L).

Objectives

We examined ARCs in relation to these elements among adults (≥ 40 years of age) from 12 riverside communities.

Methods

Participants (n = 211) provided blood samples and underwent an extensive ocular examination. Inductively coupled plasma mass spectrometry was used to assess Hg and Se in blood and plasma.

Results

One-third (n = 69; 32.7%) of the participants had ARC. Lower plasma Se (P-Se; < 25th percentile, 110 μg/L) and higher blood Hg (B-Hg; ≥ 25th percentile, 25 μg/L) were associated with a higher prevalence odds ratio (POR) of ARC [adjusted POR (95% confidence interval), 2.69 (1.11–6.56) and 4.45 (1.43–13.83), respectively]. Among participants with high P-Se, we observed a positive but nonsignificant association with high B-Hg exposure, whereas among those with low B-Hg, we observed no association for P-Se. However, compared with the optimum situation (high P-Se, low B-Hg), the POR for those with low P-Se and high B-Hg was 16.4 (3.0–87.9). This finding suggests a synergistic effect.

Conclusion

Our results suggest that persons in this population with elevated Hg, the cataractogenic effects of Hg may be offset by Se. Because of the relatively small sample size and possible confounding by other dietary nutrients, additional studies with sufficient power to assess multiple nutrient and toxic interactions are required to confirm these findings.     

Linking Contact Behavior and Droplet Patterns to Dynamically Model Indoor Respiratory Infections Among Schoolchildren

Background

We used the results of a contact behavior survey in conjunction with droplet pattern measurement to investigate the indoor population transmission dynamics of respiratory infections.

Methods

A total of 404 questionnaires on all contact behaviors were distributed to junior high school students. Droplet number concentration and size distribution generated by coughing and talking were measured by droplet experimentation. A deterministic susceptible–exposed–infected–recovery (SEIR) model was used to simulate the indoor transmission dynamics of influenza infection among schoolchildren.

Results

Results indicated that the average contact rates ranged from 9.44 to 11.18 person⁻¹ day⁻¹ for grades 7 to 9. We showed that total median droplet number concentrations were 9.01 × 10⁷ and 8.23 × 10⁷ droplets per cubic meter for coughing and talking, respectively. Population dynamic simulations indicated that the size-dependent median number of droplets per person resulted in a maximum of 8 and 10 infected persons on day 4, respectively, for talking and coughing activities.

Conclusions

Human contact behavior and airborne droplet characteristics may substantially change predicted indoor population transmission dynamics of influenza infection.Key words: airborne infectious droplets, indoor aerosol transmission, indoor air quality, modeling, influenza     

PM10 Exposure and Non-accidental Mortality in Asian Populations: A Meta-analysis of Time-series and Case-crossover Studies

Objectives

We investigated the association between particulate matter less than 10 µm in aerodynamic diameter (PM₁₀) exposure and non-accidental mortality in Asian populations by meta-analysis, using both time-series and case-crossover analysis.

Methods

Among the 819 published studies searched from PubMed and EMBASE using key words related to PM₁₀ exposure and non-accidental mortality in Asian countries, 8 time-series and 4 case-crossover studies were selected for meta-analysis after exclusion by selection criteria. We obtained the relative risk (RR) and 95% confidence intervals (CI) of non-accidental mortality per 10 µg/m³ increase of daily PM₁₀ from each study. We used Q statistics to test the heterogeneity of the results among the different studies and evaluated for publication bias using Begg funnel plot and Egger test.

Results

Testing for heterogeneity showed significance (p<0.001); thus, we applied a random-effects model. RR (95% CI) per 10 µg/m³ increase of daily PM₁₀ for both the time-series and case-crossover studies combined, time-series studies relative risk only, and case-crossover studies only, were 1.0047 (1.0033 to 1.0062), 1.0057 (1.0029 to 1.0086), and 1.0027 (1.0010 to 1.0043), respectively. The non-significant Egger test suggested that this analysis was not likely to have a publication bias.

Conclusions

We found a significant positive association between PM₁₀ exposure and non-accidental mortality among Asian populations. Continued investigations are encouraged to contribute to the health impact assessment and public health management of air pollution in Asian countries.     

Social capital and suicide: an ecological study in Tokyo,Japan

Objective

The aim of this study is to clarify the association between area-based social capital and suicide rate among municipalities of Tokyo.

Methods

The study areas were 20 administrative municipalities of Tokyo. Social capital (i.e., organizational membership, social trust, fairness, helpfulness, and confidence in organizations) was measured based on data from a previous survey (response rate 28 %). Gender-specific age-adjusted suicide rates averaged over 5 years, sociodemographic, and other area characteristics were obtained from relevant national statistics. Multiple linear regression analysis of suicide rates was applied on each social capital variable, adjusting for the other area characteristics.

Results

There was no significant crude Pearson’s correlation between any social capital variable and suicide rate. Multiple regression analyses revealed a significant negative association between social trust and suicide rate for men (p = 0.04).

Conclusions

While based on only limited evidence from a cross-sectional ecological study, area-based social trust may be associated with decreased suicide rates for men in Tokyo.     

Does exposure type impact differentially over time on the development of mental health disturbances after a technological disaster?

Background

A longitudinal study was conducted in order to assess the impact of the Ghislenghien disaster (July 30th, 2004) on physical, mental and social health in the affected population. The present study explored the risk for the development of four types of mental health disturbances (MHD) due to exposure to different aspects of this technological disaster in comparison with data obtained from previous health surveys among the population of the same province.

Methods

Surveys were conducted 5 months (T1) and 14 months (T2) after the disaster. Potential adult victims (≥15 years) were included (n = 1027 and 579 at T1 and T2 respectively). The “Symptom Checklist-90-Revised” (SCL-90-R) has been used in order to compute actual prevalence rates of somatization-, depression-, anxiety- and sleeping disturbances for three defined exposure categories: direct witnesses who have seen human damage (SHD), direct witnesses who have not seen human damage (NSHD) and indirect witnesses (IW). Those prevalence rates were compared with overall rates using the inhabitants of the province of Hainaut (n = 2308) as reference population. A mental health co-morbidity index was computed. Relative risks were estimated using logistic regression models.

Results

Prevalence rates of the four MHD were much higher for the SHD than for the other exposure groups, at T1 and T2. Moreover, NSHD and IW had no increased risk to develop one of the 4 types of MHD compared to the reference population. The SHD had at T1 and T2 good 5-times a higher risk for somatization, about 4-times for depression and sleeping disorders, and 5- to 6-times for anxiety disorders respectively. Further, they suffered 13 times, respectively 17 times more from all mental disorders together.

Conclusions

The present study calls attention to the fact that mental health problems disturbances are significantly more prevalent and long-lasting among survivors who have directly been exposed to human damage.     

Prevalence of Brucella spp in humans

Objective:

to determine the seroprevalence of Brucella spp in humans.

Method:

this is an observational study, developed with 455 individuals between 18 and 64 years old, who use the Estratégia de Saúde da Família (Brazil''s family health strategy). The serum samples of volunteers underwent buffered acid antigen tests, such as screening, agar gel immunodiffusion and slow seroagglutination test in tubes and 2-Mercaptoethanol.

Results:

among the samples, 1.98% has responded to buffered-acid antigen, 2.85% to agar gel immunodiffusion test and 1.54% to the slow seroagglutination tests on tubes/2-Mercaptoethanol. The prevalence of Brucella spp was 4.4%, represented by the last two tests.

Conclusion:

the results of this research suggest that the studied population is exposed to Brucella spp infection.     

Blood and Urine Cadmium,Blood Pressure,and Hypertension: A Systematic Review and Meta-analysis

Background

Cadmium exposure has been inconsistently related to blood pressure.

Objectives

We updated and reevaluated the evidence regarding the relationships of blood cadmium (BCd) and urine cadmium (UCd) with blood pressure (BP) and hypertension (HTN) in nonoccupationally exposed populations.

Data sources and extraction

We searched PubMed and Web of Science for articles on BCd or UCd and BP or HTN in nonoccupationally exposed populations and extracted information from studies that provided sufficient data on population, smoking status, exposure, outcomes, and design.

Data synthesis

Twelve articles met inclusion criteria: eight provided data adequate for comparison, and five reported enough data for meta-analysis. Individual studies reported significant positive associations between BCd and systolic BP (SBP) among nonsmoking women [β = 3.14 mmHg per 1 μg/L untransformed BCd; 95% confidence interval (CI), 0.14–6.14] and among premenopausal women (β = 4.83 mmHg per 1 nmol/L log-transformed BCd; 95% CI, 0.17–9.49), and between BCd and diastolic BP (DBP) among women (β = 1.78 mmHg comparing BCd in the 90th and 10th percentiles; 95% CI, 0.64–2.92) and among premenopausal women (β = 3.84 mmHg per 1 nmol/L log-transformed BCd; 95% CI, 0.86–6.82). Three meta-analyses, each of three studies, showed positive associations between BCd and SBP (p = 0.006) and DBP (p < 0.001) among women, with minimal heterogeneity (I² = 3%), and a significant inverse association between UCd and HTN among men and women, with substantial heterogeneity (I² = 80%).

Conclusion

Our results suggest a positive association between BCd and BP among women; the results, however, are inconclusive because of the limited number of representative population-based studies of never-smokers. Associations between UCd and HTN suggest inverse relationships, but inconsistent outcome definitions limit interpretation. We believe a longitudinal study is merited.     

Asbestos-related occupational cancers compensated under the Spanish National Insurance System, 1978–2011

Background:

In 1978, asbestos-related occupational cancers were added to the Spanish list of occupational diseases. However, there are no full accounts of compensated cases since their inclusion.

Objective:

To analyze the cases of asbestos-related cancer recognized as occupational in Spain between 1978 and 2011.

Methods:

Cases were obtained from the Spanish Employment Ministry. Specific incidence rates by year, economic activity, and occupation were obtained. We compared mortality rates of mesothelioma and bronchus and lung cancer mortality in Spain and the European Union.

Results:

Between 1978 and 2011, 164 asbestos-related occupational cancers were recognized in Spain, with a mean annual rate of 0·08 per 10⁵ employees (0·13 in males, 0·002 in females). Under-recognition rates were an estimated 93·6% (males) and 99·7% (females) for pleural mesothelioma and 98·8% (males) and 100% (females) for bronchus and lung cancer. In Europe for the year 2000, asbestos-related occupational cancer rates ranged from 0·04 per 10⁵ employees in Spain to 7·32 per 10⁵ employees in Norway.

Conclusions:

These findings provide evidence of gross under-recognition of asbestos-related occupational cancers in Spain. Future work should investigate cases treated in the National Healthcare System to better establish the impact of asbestos on health in Spain.