Chih Ching Chang

Arsenic in drinking water and adverse pregnancy outcome in an arseniasis-endemic area in northeastern Taiwan

The well water in Lanyang Basin, which is located in the northeastern portion of Taiwan island, was found to have high levels of arsenic ranging from undetectable levels (<0.15 ppb) to 3.59 ppm. We performed a study to compare the risk of adverse pregnancy outcomes (preterm delivery and birthweight) between an area with historic high well water arsenic levels (arsenic-exposed area (AE)) and a comparison area with no historic evidence of arsenic water contamination (non-arsenic-exposed area (NAE)). The mean birth weight in the AEs and NAEs were 3132.6 and 3162.6 g, respectively. Babies born in AEs were on average 30 g lighter than those born in NAEs. AEs had a higher rate of preterm delivery than NAEs (3.74% vs 3.43%). The results of this study suggest that, after adjustment for potential confounders, arsenic exposure from drinking well water was associated, although not significantly, with the risk of preterm delivery, with an odds ratio of 1.10 (0.91-1.33). The estimated reduction in birth weight was 29.05 g (95% CI=13.55-44.55). The findings from this investigation provide evidence for a potential role for arsenic exposure through drinking water in increasing the risk of low birthweight.

Effects of Asian Dust Storm Events on Daily Admissions for Asthma in Taipei, Taiwan

In spring, windblown dust storms originating in the deserts of Mongolia and China make their way to Taipei city. These occurrences are known as Asian dust storm (ADS) events. The objective of this study was to assess the possible associations of ADS on the hospital asthma admissions of residents in Taipei, Taiwan, during the period 1996–2001. We identified 54 dust storm episodes, which were classified as index days. Daily asthma admissions on the index days were compared with admissions on the comparison days. We selected two comparison days for each index day, 7 days before the index days and 7 days after the index days. The effects of dust storms on asthma admissions were prominent 2 days after the event (8%). However, the association was not statistically significant. There may not have been enough power to detect associations resulting from the inadequate sample size of asthma admissions on ADS events days. However, it seems worthwhile to pay more attention to the ADS events and health in the future.

Correlation of Asian Dust Storm Events with Daily Clinic Visits for Allergic Rhinitis in Taipei, Taiwan

In spring, windblown dust storms originating in the deserts of Mongolia and China head toward Taipei city. These occurrences are known as Asian dust storm (ADS) events. The objective of this study was to assess the possible associations of ADS on the daily clinical visits for allergic rhinitis of residents in Taipei, Taiwan, during the period 1997–2001. Forty-nine dust storms were identified and classified as index days. Daily clinical visits for allergic rhinitis on the index days were compared with clinical visits on the comparison (non-ADS) days. Two non-ADS days for each index day, 7 d before the index day and 7 d after the index day, were selected. The effects of dust storms on clinic visits for allergic rhinitis were prominent 2 d after the event (19%). However, the association was not statistically significant. There may not have been enough power to detect associations resulting from the inadequate sample size of allergic rhinitis visits on ADS days. Further study is needed to clarify this association.

ISCHEMIC HEART DISEASE MORTALITY REDUCTION IN AN ARSENIASIS-ENDEMIC AREA IN SOUTHWESTERN TAIWAN AFTER A SWITCH IN THE TAP-WATER SUPPLY SYSTEM

Arsenic has been identified as a major contributing risk factor for development of blackfoot disease (BFD), a unique peripheral vascular disease that was endemic to the southwestern coast of Taiwan, where residents imbibed artesian well water continuing high amounts of arsenic for more than 50 yr. Chronic arsenic exposure was found to be associated with ischemic heart disease (CHD) in a dose-dependent manner. A tap-water supply system was implemented in the early 1960s in the BFD-endemic areas. Artesian well water was no longer used for drinking and cooking after the mid-1970s. The objective of this study was to examine whether CHD-related mortality decreased after consumption of high-arsenic-containing artesian well water ceased and, if so, when the reduction occurred. Standardized mortality ratios (SMRs) for CHD were calculated for the BFD endemic area for the years 1971–2000. Cumulative-sum techniques were used to detect the occurrence of changes in the SMRs. Data show that mortality attributed to CHD declined gradually for approximately 17 to 20 yr following cessation of consumption of high-arsenic artesian well water. Based on the reversibility criterion, the association between arsenic exposure an1rd CHD-related mortality is likely to be causal.

Biological monitoring of exposures to aluminium, gallium, indium, arsenic, and antimony in optoelectronic industry workers

The main objective of this study was to investigate aluminum, gallium, indium, arsenic, and antimony exposures on blood and urine levels in the optoelectronic workers. One hundred seventy subjects were enrolled in this cohort study. Whole blood and urine levels were determined by inductively coupled plasma-mass spectrometry. Blood indium and urine gallium and arsenic levels in the 103 workers were significantly higher than that in 67 controls during the follow-up period. In regression models, the significant risk factors of exposure were job title, preventive equipment, Quetelet’s index, sex, and education level. The findings of this study suggest that gallium, indium, and arsenic exposure levels may affect their respective levels in blood and urine. The use of clean, preventive equipment is recommended when prioritizing the administration of safety and hygiene in optoelectronics industries.

Short-term effects of fine particulate air pollution on hospital admissions for cardiovascular diseases: a case-crossover study in a tropical city.

This study was undertaken to determine whether there was an association between fine particles (PM2.5) levels and hospital admissions for cardiovascular diseases (CVD) in Kaohsiung, Taiwan. Hospital admissions for CVD (including ischemic heart disease [IHD], stroke, congestive heart failure [CHF], and arrhythmias) and ambient air pollution data for Kaohsiung were obtained for the period from 2006–2010. The relative risk of hospital admissions for CVD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), elevated number of admissions for CVD were significantly associated with higher PM2.5 levels only on cool days (<25°C), with an interquartile range rise associated with a 47% (95% CI = 39–56%), 48% (95% CI = 40–56%), 47% (95% CI = 34–61%), and 51% (95% CI = 34–70%) increase in IHD, stroke, CHF, and arrhythmias admissions, respectively. No significant associations between PM2.5 and hospital admissions for CVD were observed on warm days. In the two-pollutant models, PM2.5 levels remained significant even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. This study provides evidence that higher levels of PM2.5 enhance the risk of hospital admissions for CVD in Kaohsiung, Taiwan.

Relationship of blood pressure control and hospitalization risk to medication adherence among patients with hypertension in Taiwan

BACKGROUND Despite the efficacy of antihypertensive treatment in preventing cardiovascular complications, there are often problems with medication adherence in hypertensive patients. The objective of this study was to examine the medication adherence and its association with blood pressure (BP) control, cardiovascular disease (CVD) hospitalization, and all-cause hospitalization. METHODS We conducted a retrospective cohort observation of patients who were treated for hypertension from January 2005 to December 2006. Medical and pharmacy claims were obtained from Taiwans National Health Insurance (NHI) database, whereas electronic records, including demographic characteristics and clinical information, were retrieved from a disease management program. To determine the degree of medication adherence, we calculated the proportion of days covered (PDC) by filled prescriptions. The associations of medication adherence with BP control, CVD hospitalization, and all-cause hospitalization were examined using multiple logistic regression models. RESULTS The study subjects comprised a total of 29,685 hypertensive patients. Of which, 40.1% of the patients had hypertension history of >5 years and 39.7% of patients had some comorbidity. In total, 85.5% of patients were categorized as adherent, with PDC >or=80; 60% of adherent patients had good BP control. Poor medication adherence was associated with poor BP control (odds ratio (OR) = 1.20, 1.13-1.29), CVD hospitalization (OR = 1.43, 1.14-1.81), and all-cause hospitalization (OR = 1.47, 1.21-1.78). CONCLUSION Our observation study clearly indicates that lower medication adherence is associated with poor BP control and higher risk of CVD and all-cause hospitalization in hypertensive patients.

Effects of Air Pollution on Birth Weight Among Children Born Between 1995 and 1997 in Kaohsiung, Taiwan

Recent studies have suggested that exposure to air pollution might be associated with low birth weight. The effects of sulfur dioxide (SO 2 ) and particulate matter less than 10 w m (PM 10 ) were examined on birth weight in each trimester of pregnancy. The study group included all full-term singleton live births during 1995-1997 to women living within about 2 km of an air pollution monitoring site in Kaohsiung. Measurements of SO 2 and PM 10 collected at six air quality monitoring stations were used to estimate the influence of exposures on different pregnancy trimesters. This was done by averaging daily ambient air pollution concentrations during the corresponding days based on the birth date and gestational age of each child. Multiple linear regression analysis was used to estimate the effects of air pollution on birth weight adjusting for possible confounders including maternal age, season, marital status, maternal education, and infant gender. The estimated reduction in birth weight was 0.52 g for 1 w g/m 3 increase in either SO 2 or PM 10 in the first trimester of pregnancy. Data provide further support for the hypothesis that air pollution can affect the outcome of pregnancy.

Fine particulate air pollution and hospital admissions for chronic obstructive pulmonary disease: a case-crossover study in Taipei.

We undertook this study to investigate whether there is an association between atmospheric fine particles (PM2.5) levels and inpatient admissions for chronic obstructive pulmonary disease (COPD) in Taipei, Taiwan. Data on inpatient admissions for COPD and ambient on air pollution levels in Taipei were obtained for years 2006 to 2010. We estimated the relative risk of inpatient admissions for COPD using a case-crossover design with the following control variables: weather measures, day of the week, seasonality, and long-term time trends. For the single-pollutant model (not controlling for other atmospheric pollutants), COPD admissions were significantly and positively associated with higher PM2.5 levels during both warm days (>23 °C) and cool days (<23 °C), with an interquartile range increase of 12% (95% CI = 8–16%) and 3% (95% CI = 0–7%) in COPD admissions, respectively. In the two-pollutant models, PM2.5 remained significant even controlling for SO2 or O3 on both warm and cool days. Taken as a whole, our study demonstrates that higher levels of PM2.5 may increase the risk of inpatient admissions for COPD.

Statins Increase the Risk of Prostate Cancer: A Population-Based Case^Control Study

Experimental studies have shown that statins have potential protective effects against cancer. The aim of this study was to investigate whether the use of statins was associated with prostate cancer risk.