Jamson S. Lwebuga-Mukasa

Geographic clustering of adult asthma hospitalization and residential exposure to pollution at a United States-Canada border crossing

OBJECTIVES We conducted a case-control study of adulthood asthma and point-source respirable particulate air pollution with asthma-diagnosed case patients (n = 3717) and gastroenteritis-diagnosed control patients (n = 4129) to determine effects of particulate air pollution on public health. METHODS We used hospitalization data from Buffalo, NY, neighborhoods for a 5-year period (1996 through 2000), geographic information systems techniques, the Diggle method, and statistical analysis to compare the locations of case patients and control patients in terms of proximity to different known pollution sources in the study area. RESULTS We found a clustering of asthma cases in close proximity to the Peace Bridge Complex and the freeways and a dose-response relationship indicating a decreased risk of asthma prevalence the farther an individual resides from the source of exposure. CONCLUSIONS These findings provide a basis for the development of new hypotheses relating to the spatial distribution of asthma prevalence and morbidity in this community.

Induction of interleukin-1/and interleukin-8 mRNAs and proteins by TGFβ1 in rat lung alveolar epithelial cells

The transforming growth factor‐β (TGF‐β) has been shown to increase in lung injury and in fibrotic states of the lung. In the current study, we sought to investigate whether TGFβ1 induced the expression of IL‐1α and IL‐8 in rat alveolar epithelial cells. We evaluated TGFβ1, IL‐1α, and IL‐8 expression by immunofluorescence in silica‐injured and saline‐treated control rat lungs. Antibodies to IL‐1α, IL‐8, and TGFβ1 showed intense staining in silica‐injured lungs as compared to saline‐instilled lungs. Primary isolated type II cells from silica‐injured lungs showed increased expression of IL‐1α as compared to saline‐instilled lungs. To evaluate the effects of TGFβ1, we treated an immortalized rat type II cell‐derived cell line (LM5) with 100 pg/ml of TGFβ1 in serum‐free medium for 0–24 hours and analyzed the expression of IL‐1α and IL‐8 mRNAs and proteins using semi‐quantitative RT‐PCR, Northern blot analysis, Western blot analysis, and immunohistochemistry. Densitometric analysis of Northern blots showed modest constitutive expression of IL‐1α gene in untreated control LM5 cells. TGFβ1 treatment resulted in an increase in IL‐1α mRNA, that reached maximum levels (4‐fold) by 2 hours and remained elevated for 4–16 hours, with a subsequent decline by 24 hours. Similarly, Northern blot and RT‐PCR analysis demonstrated that TGFβ1 treatment resulted in maximum induction of IL‐8 mRNA (6–8.5‐fold) within 1–4 hours. The levels remained elevated for up to 24 hours afterwards. Western blot analysis results further confirmed the expression of both IL‐1α and IL‐8 proteins by LM5 cells. TGFβ1 treatment resulted in increased expression of both IL‐1α and IL‐8 proteins. Immunofluorescence studies demonstrated increased staining of IL‐1α by TGFβ1 as compared to untreated cells. These results suggest that TGFβ1 may regulate IL‐1α and IL‐8 expression in alveolar epithelial cells and contribute to polymorphonuclear leukocyte recruitment and lung injury in clinical states with increased TGFβ1.

Association Between Traffic Volume and Health Care Use for Asthma Among Residents at a U.S.–Canadian Border Crossing Point

Little information is available about health impacts of the North American Free Trade Agreement (NAFTA) traffic‐related pollution on residents near the major traffic corridors along the U.S.–Canadian border. Here we report on a 10 year (1991–2000) retrospective study of commercial traffic volumes across the Peace Bridge and health care use for asthma in a residential community, which serves as a conduit for traffic crossing between Fort Erie, Ontario, Canada, and Buffalo, New York. We hypothesized that commercial traffic pollution was impacting on residents in close proximity to the trade corridor. Commercial traffic volumes, hospital discharges for asthma, and outpatient visits to area hospitals and clinics were analyzed before and after implementation of NAFTA. Results showed a positive association between increased commercial traffic volume and increased health care use for asthma. Zip codes 14201 and 14213, which surround the Peace Bridge Plaza Complex (PBC), had the highest prevalence rates and health care use rates for asthma. Statistical analysis showed the findings to be significant (p < 0.05) in that residential proximity to the PBC was associated with greater hospital discharge rates for asthma. The findings were strongest (p < 0.000) in the zip codes where the PBC was located (14213) and the major highway I‐190 passed through (14201). A yearly excess of 230.2 adult asthma hospital discharges was associated with an increase in traffic volume during the period from 1991 to 1996 in the study area. This is in contrast to an overall decrease in the national rate of hospitalizations for asthma by 7.5% in the same period. The results suggest that NAFTA‐related commercial traffic has a negative health impact on asthmatics living in close proximity to the trade corridor. Health and social costs due to traffic pollution need to be included in cost estimates of transport decisions related to the NAFTA corridors. Similar health effects due to NAFTA traffic need to be studied at other U.S.–Canada border crossing points.

The prevalence of asthma in children of elementary school age in western New York.

To determine the prevalence of caregiver-reported asthma in children 4 to 13 years old in metropolitan western New York State, surveys were conducted during 1997–1999 in the Buffalo, Niagara Falls, Iroquois, and Gowanda school systems. Questionaires (3,889) were sent to the homes of elementary school children in nine schools in western New York. The caregivers were asked to complete a 13-item questionnaire for the child. Of the questionnaires, 60.5% (2,353/3,889) were completed.Of all children, 18% had physician-diagnosed asthma. Of children diagnosed with asthma, 86% were taking medication. Symptoms were consistent with suspected undiagnosed asthma for 13% of the children. Buffalo had the highest rate of diagnosed asthma (20%) for the age group. Gowanda had a prevalence of 18%, Iroquois 16%, and Niagara Falls 15%. Variations were observed in asthma prevalence rates among different racial/ ethnic groups. In general, boys had a significantly (P=.001) increased odds of being asthmatic compared with girls. Overall, African-Americans and Hispanic/Latino children had significantly (P=.012 andP=.005, respectively) higher asthma prevalence rates, two to five times those of their Caucasian peers. In Gowanda, the prevalence of diagnosed asthma among Native American children was 23%, compared to 15% among Caucasian children. Of diagnosed Native American children, 71% were female. In Gowanda, a significant association (P=.007) of asthma among children in split-grade classes was observed compared to nonsplit grades. Of Native American children in split grades, 60% were diagnosed asthmatics. These observations reveal a high prevalence of asthma in the age group of 4 to 13 year olds in western New York. Local variations in potential triggers of asthma need to be considered when advising asthmatics. The results suggest that some grades have a disproportionate amount of children with asthma. The implications of asthma for childrens early education need to be examined further.To determine the prevalence of caregiver-reported asthma in children 4 to 13 years old in metropolitan western New York State, surveys were conducted during 1997–1999 in the Buffalo, Niagara Falls, Iroquois, and Gowanda school systems. Questionaires (3,889) were sent to the homes of elementary school children in nine schools in western New York. The caregivers were asked to complete a 13-item questionnaire for the child. Of the questionnaires, 60.5% (2,353/3,889) were completed. Of all children, 18% had physician-diagnosed asthma. Of children diagnosed with asthma, 86% were taking medication. Symptoms were consistent with suspected undiagnosed asthma for 13% of the children. Buffalo had the highest rate of diagnosed asthma (20%) for the age group. Gowanda had a prevalence of 18%, Iroquois 16%, and Niagara Falls 15%. Variations were observed in asthma prevalence rates among different racial/ ethnic groups. In general, boys had a significantly (P=.001) increased odds of being asthmatic compared with girls. Overall, African-Americans and Hispanic/Latino children had significantly (P=.012 andP=.005, respectively) higher asthma prevalence rates, two to five times those of their Caucasian peers. In Gowanda, the prevalence of diagnosed asthma among Native American children was 23%, compared to 15% among Caucasian children. Of diagnosed Native American children, 71% were female. In Gowanda, a significant association (P=.007) of asthma among children in split-grade classes was observed compared to nonsplit grades. Of Native American children in split grades, 60% were diagnosed asthmatics. These observations reveal a high prevalence of asthma in the age group of 4 to 13 year olds in western New York. Local variations in potential triggers of asthma need to be considered when advising asthmatics. The results suggest that some grades have a disproportionate amount of children with asthma. The implications of asthma for childrens early education need to be examined further.

Home Environmental Factors Associated with Asthma Prevalence in Two Buffalo Inner-City Neighborhoods

To identify factors that may contribute to asthma morbidity, 214 households were surveyed in two Buffalo inner-city neighborhoods. Asthma was reported by 41 percent of households. Race, gender, and age of head of household were significantly associated with prevalence of asthma in a house. Caucasians and Latinos had a significantly higher rate of asthma compared with African Americans. All household triggers were significantly more likely to be present on the west than east side of Buffalo. Overall, smoking, pets, humidifier, and cockroaches were all significantly associated with asthma in the home. There was no significant difference in the treatment for asthma or the age or gender of asthmatics based on residential area. This study suggests that asthma prevalence in the inner city may be affected by multiple factors that must be taken account by policy makers and professionals designing interventions.

Risk factors for asthma prevalence and chronic respiratory illnesses among residents of different neighbourhoods in Buffalo, New York.

Study objective: The aim of this study is to identify risk factors for asthma prevalence and chronic respiratory illnesses in Buffalo’s neighbourhoods after previous studies reported increased levels of asthma among residents on Buffalo’s west side. Design: Cross sectional surveys. Setting: Buffalo neighbourhoods along a US-Canada border crossing point. Subjects: A systematic random survey of 82% of the 2000 targeted households was conducted between January and August 2002. Main results: A multivariate logistic regression model shows that the risk of persons with asthma and chronic respiratory illnesses is significantly (p⩽0.05) high among children and young adults living in Buffalo’s west side, newer housing units, and of Latino ethnicity. In a separate analysis of the nine risk factors, it was observed that location, gender, age, and race were significant risk factors even after adjusting for age of housing, pets, moulds, animal trigger, and smoking. Conclusions: These findings confirm the hypothesis that a considerable risk of asthma and chronic respiratory illnesses exists particularly among Buffalo’s west side residents. Further evaluation of these risk factors is warranted to determine the severity of asthma and the reasons for such a significant disease burden.

Traffic volumes and respiratory health care utilization among residents in close proximity to the Peace Bridge before and after September 11, 2001.

A recent study based on data over a 10‐year period (1991–2000) showed a positive association between health care utilization and prevalence of asthma, and commercial traffic at a U.S.–Canada border crossing. We wanted to determine whether decreases in total traffic would also be associated with decreases in health care utilization for respiratory illnesses. Following September 11, 2001, there was a 50% drop in total traffic at the Peace Bridge border crossing point between Buffalo, New York and Fort Erie, Ontario, Canada. To investigate the impact of such a traffic decline on health care utilization for respiratory illnesses, weekly respiratory admissions to Kaleida Health System, Western New Yorks largest health care provider were analyzed according to ICD9CM classification and compared with total weekly traffic volumes for 3‐month periods in 2000 and 2001 (August, September, and October). The total number of patients admitted to hospital or seen in emergency departments for respiratory illnesses during the 3‐month periods of both years was 5288. A 50% drop in total traffic following Labor Day and September 11, 2001, from week 4 to week 7 was found to be statistically significant (p = 0.031) when a one‐way ANOVA was performed. Likewise, the drop in total respiratory cases approached statistical significance (p = 0.052) when a one‐way ANOVA was conducted. The results suggest an association between decrease in traffic volumes with decrease in health care utilization for respiratory diseases. These results suggest that current levels of traffic may be impacting on the respiratory health of residents in the nearby community.

Patterns of Inpatient and Outpatient Care for Asthma in Erie and Niagara Counties, Western New York State

The prevalence of asthma, as well as the morbidity and mortality due to asthma, has increased in the United States, especially among poor minority subpopulations. The causes of these increases are complex and not well understood. Our findings from an analysis of emergency room (ER) visits and hospitalizations for Erie and Niagara Counties in western New York State for the period 1984–1991 provides important background to this problem. Of all respiratory disorders, asthma was the most frequent reason for ER visits and was second only to pneumonia as a reason for hospital admissions. In Erie County the hospitalization rates for asthma in two inner-city communities with predominantly minority populations were 1.48 and 2.09 times higher than those in the rest of the county. Furthermore, the hospitalization rates for these communities showed an increasing trend over the study period. Gender differences were also found. Boys age 0 to 9 years were hospitalized for asthma twice as often as girls. However, over 15 years of age, females had admission rates that were twice those of males. In contrast, hospitalization rates for pneumonia were equal for males and females, which would suggest gender differences particular to asthma. Hospitalizations for asthma in the western New York region cost an estimated

Local ecological factors, ultrafine particulate concentrations, and asthma prevalence rates in Buffalo, New York, neighborhoods.

6,000,000 in 1990. We conclude that asthma is a major cause of morbidity in this region with excessive and increasing impact on inner-city communities.

Geographic Variations in Asthma Mortality in Erie and Niagara Counties, Western New York, 1991–1996

Previous to this study various healthcare utilization studies and house-to-house surveys had shown that Buffalos west side had a high utilization rate for asthma and high asthma prevalence in comparison with neighboring communities. The relative contributions of traffic-related pollution and personal and local ecological factors to the high asthma rates were still unknown. To investigate the potential roles of personal home environmental factors and local ecological factors in variations of asthma prevalence in Buffalo neighborhoods, we conducted a cross-sectional survey of a systematic random sample of 2000 households in the city of Buffalo, New York, with a response rate of 80.4%. We found that the odds of having at least one person with asthma per household on Buffalos west side was 2.57 times [95% confidence interval (CI) = 1.85–3.57] that of Buffalos east side. There were no statistically significant differences in the odds of finding at least one person with asthma in households of other Buffalo neighborhoods. We further found no difference in the odds of having asthma on Buffalos west side even after correcting for race/ethnicity, household triggers of asthma, and socioeconomic factors. Monitoring ultrafine particulates showed increased levels in communities downwind of the Peace Bridge Complex and major roadways supplying it. A multiple-regression model showed that asthma prevalence may be influenced by humidity and ultrafine particulate concentrations. These results suggest that increased asthma risk may be influenced by chronic exposure to personal and local ecological factors.