Murray M. Finkelstein

The relationship between diabetes mellitus and traffic-related air pollution.

Objective: Air pollution is associated with an increased risk for cardiovascular events. Many of the biological pathways involved could also promote diabetes mellitus (DM). We therefore investigated the association between DM prevalence and exposure to traffic-related air pollution (nitrogen dioxide [NO 2]). Methods: Study participants were patients who attended two respiratory clinics in Hamilton (n = 5228) and Toronto (n = 2406). The diagnosis of DM was ascertained by linkage to administrative databases of the Ontario universal Health Insurance Plan for patients aged 40 years and above. Geographic Information systems methodology was used to assign individual estimates of NO2 based on a network of samplers in each city. Logistic regression was used to estimate the relations between NO2 exposures and the odds of DM diagnosis. Results: After adjusting for age, body mass index, and neighborhood income there were positive effects in women on the odds ratio for DM for each 1 ppb NO2 exposure in Toronto (OR 1.055, 95% CI: 0.99 to 1.11) and Hamilton (OR 1.029, 95% CI: 0.98 to 1.08). In a meta-analytic model including both cities, there was a significant effect in women (OR = 1.04; 95% CI: 1.00 to 1.08). Across the inter-quartile range (∼4 ppb NO2) there was nearly a 17% increase in the odds of DM for women. There were no positive associations among men. Conclusions: Exposure to NO2, a marker of traffic-related air pollutants, was associated with DM prevalence among women. Exposure estimate errors in men may explain the apparent gender difference. These results suggest that common air pollutants are associated with DM and warrant more investigation to determine if this is a cause-and-effect relationship.

A cohort study of traffic-related air pollution and mortality in Toronto, Ontario, Canada.

Background Chronic exposure to traffic-related air pollution (TRAP) may contribute to premature mortality, but few studies to date have addressed this topic. Objectives In this study we assessed the association between TRAP and mortality in Toronto, Ontario, Canada. Methods We collected nitrogen dioxide samples over two seasons using duplicate two-sided Ogawa passive diffusion samplers at 143 locations across Toronto. We calibrated land use regressions to predict NO2 exposure on a fine scale within Toronto. We used interpolations to predict levels of particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5) and ozone levels. We assigned predicted pollution exposures to 2,360 subjects from a respiratory clinic, and abstracted health data on these subjects from medical billings, lung function tests, and diagnoses by pulmonologists. We tracked mortality between 1992 and 2002. We used standard and multilevel Cox proportional hazard models to test associations between air pollution and mortality. Results After controlling for age, sex, lung function, obesity, smoking, and neighborhood deprivation, we observed a 17% increase in all-cause mortality and a 40% increase in circulatory mortality from an exposure contrast across the interquartile range of 4 ppb NO2. We observed no significant associations with other pollutants. Conclusions Exposure to TRAP was significantly associated with increased all-cause and circulatory mortality in this cohort. A high prevalence of cardiopulmonary disease in the cohort probably limits inference of the findings to populations with a substantial proportion of susceptible individuals.

Environmental inequality and circulatory disease mortality gradients

Study objective: Studies in Europe and North America have reported that living in a disadvantaged neighbourhood is associated with an increased incidence of coronary heart disease. The aim of this study was to test the hypotheses that exposure to traffic and air pollution might account for some of the socioeconomic differences in mortality rates in a city where residents are covered by universal health insurance. Design: Cohort mortality study. Individual postal codes used to derive: (1) socioeconomic status from census data; (2) mean air pollution levels from interpolation between governmental monitoring stations; (3) proximity to traffic from the geographical information system. Analysis conducted with Cox proportional hazards models. Setting: Hamilton Census Metropolitan Area, Ontario, Canada, on the western tip of Lake Ontario (population about 480 000). Participants: 5228 people, aged 40 years or more, identified from register of lung function laboratory at an academic respirology clinic between 1985 and 1999. Main results: Circulatory disease (cardiovascular and stroke) mortality rates were related to measures of neighbourhood deprivation. Circulatory disease mortality rates were also associated with indices of long term ambient pollution at the subjects’ residences (relative risk 1.06, 1.00 to 1.13) and with proximity to traffic (relative risk 1.40, 1.08 to 1.81). Subjects in more deprived neighbourhoods had greater exposure to ambient particulate and gaseous pollutants and to traffic. Conclusions: At least some of the observed social gradients in circulatory mortality arise from inequalities in environmental exposure to background and traffic air pollutants.

A Land Use Regression Model for Predicting Ambient Concentrations of Nitrogen Dioxide in Hamilton, Ontario, Canada

Abstract This paper reports on the development of a land use regression (LUR) model for predicting the intraurban variation of traffic-related air pollution in Hamilton, Ontario, Canada, an industrial city at the western end of Lake Ontario. Although land use regression has been increasingly used to characterize exposure gradients within cities, research to date has yet to test whether this method can produce reliable estimates in an industrialized location. Ambient concentrations of nitrogen dioxide (NO2)were measured for a 2-week period in October 2002 at >100 locations across the city and subsequently at 30 of these locations in May 2004 to assess seasonal effects. Predictor variables were derived for land use types, transportation, demography, and physical geography using geographic information systems. The LUR model explained 76% of the variation in NO2. Traffic density, proximity to a highway, and industrial land use were all positively correlated with NO2 concentrations, whereas open land use and distance from the lake were negatively correlated with NO2. Locations downwind of a major highway resulted in higher NO2 levels. Cross-validation of the results confirmed model stability over different seasons. Our findings demonstrate that land use regression can effectively predict NO2 variation at the intra-urban scale in an industrial setting. Models predicting exposure within smaller areas may lead to improved detection of health effects in epidemiologic studies.

Exposure estimation in the presence of nondetectable values: another look.

A common problem faced by industrial hygienists is the selection of a valid way of dealing with those samples reported to contain nondetectable values of the contaminant. In 1990, Hornung and Reed compared a maximum likelihood estimation (MLE) statistical method and two methods involving the limit of detection, L. The MLE method was shown to produce unbiased estimates of both the mean and standard deviation under a variety of conditions. That method, however, was complicated, requiring difficult mathematical calculations. Two simpler alternatives involved the substitution of L/2 or L/square root of 2 for each nondetectable value. The L/square root of 2 method was recommended when the data were not highly skewed. Although the MLE method produces the best estimates of the mean and standard deviation of an industrial hygiene data set containing values below the detection limit, it was not practical to recommend this method in 1990. However, with advances in desktop computing in the past decade the MLE method is now easily implemented in commonly available spreadsheet software. This article demonstrates how this method may be implemented using spreadsheet software.

Geographies of Risk in Studies Linking Chronic Air Pollution Exposure to Health Outcomes

This article addresses the question of how to incorporate spatial processes into the assessment of chronic health effects from air pollution exposure. An analytic framework is developed around three related concepts: (1) the geography of susceptibility; (2) the geography of exposure; and (3) points of intersection between these two, termed the geography of risk. The article discusses how each concept encompasses many lower level issues such as meteorological dispersion of pollutants, time–space activity patterns, and population distributions of susceptible individuals in time and space. A key premise is that researchers should target studies with high degrees of overlap between geographies of exposure and susceptibility. Instances where the overlap remains incomplete, or systematically biased, usually produce attenuated or unreliable risk estimates, and some of this discordance may find expression in spatially autocorrelated residuals.

Mortality among miners receiving workmen's compensation for silicosis in Ontario: 1940-1975.

We investigated mortality among 1,190 Ontario miners who received Workmens Compensation awards for silicosis from 1940 through 1975. In comparison with the general population of Ontario these men had elevated all-cause mortality rates, with deaths attributed to nonmalignant respiratory diseases and tuberculosis being primarily responsible. The group of miners receiving their compensation awards between 1940 and 1959 has experienced more than twice as many lung cancer deaths as expected while men receiving compensation awards after 1959 have had lung cancer rates similar to the general population. It is concluded that silicosis is not a benign disease and that efforts must be continued to prevent its occurrence.

Asbestos Fibre Concentrations in the Lungs of Brake Workers: Another Look

OBJECTIVE To reanalyse data on the lung content of asbestos fibres among brake mechanics. METHODS I re-analysed data published by Butnor, Roggli and colleagues on the lung content of chrysotile and tremolite asbestos fibres among brake mechanics and controls. Statistics of the distributions were estimated by maximum likelihood to accommodate observations below the detection limit. Mean concentrations were compared by the t-test, bootstrap resampling and interval-censored survival methods. RESULTS The mean concentrations of fibres were higher among the brake workers than the controls. The concentration of tremolite fibres was higher than the concentration of chrysotile, a pattern similar to that observed among Quebec chrysotile miners and millers. CONCLUSIONS Re-analysis of published data does not support the interpretation that, in automotive brake repair workers with malignant mesothelioma, asbestos content is within the normal range. The alternative interpretation that brake mechanics have a greater than background burden of asbestos fibres, attributable to occupational exposure to dusts from friction products manufactured from Canadian chrysotile, appears more credible. This asbestos burden might be associated with an increased risk of asbestos-associated cancers.

Silica Exposure Assessment in a Mortality Study of Vermont Granite Workers

A study of past silica and respirable dust exposures in the Vermont granite industry was conducted to develop a job exposure matrix (JEM) that used 5204 industrial hygiene measurements made from 1924–2004. The construction of the JEM involved data entry from several original sources into an Excel database that was reviewed later to ensure accuracy. Exposure measurements by job or location were grouped in two broad categories of quarry or shed and then into 22 job classes. Missing exposure data by time period were computed, taking into account improvements in dust control and periods of significant reduction in dustiness. Percent free silica (α-quartz) in respirable dust was estimated to be 11.0% based on previous published studies in Vermont and on data in the current database. About 60% of all measurement data (primarily from years prior to 1972) were obtained using the impinger and expressed in millions of particles per cubic foot (mppcf), which were converted to equivalent respirable free silica concentrations using the conversion of 10 mppcf = 0.1 mg/m3 of respirable silica. For impinger data, respirable dust was calculated by multiplying respirable silica by a factor of 9.091 to reflect that the respirable silica was 11.0% respirable dust. This JEM has been used in a recent epidemiologic study to assess mortality in Vermont granite workers and to examine the relationships among mortality from silicosis, lung cancer, and other nonmalignant respiratory diseases.

Occupational Health and Safety Issues in Ontario Sawmills and Veneer/Plywood Plants: A Pilot Study

A pilot study was conducted within the Ontario sawmill and veneer/plywood manufacturing industry. Information was collected by postal questionnaire and observational walk-through surveys. Industrial hygiene walk-through surveys were conducted at 22 work sites, and measurements for wood dust, noise, and bioaerosol were taken. The aim of the study was to obtain data on the current status regarding health and safety characteristics and an estimate of wood dust, noise, and bioaerosol exposures. The occupational exposure to wood dust and noise are similar to what has been reported in this industry in Canada and elsewhere. Airborne wood dust concentration ranged between 0.001 mg/m3 and 4.87 mg/m3 as total dust and noise exposure ranged between 55 and 117 dB(A). The study indicates the need for a more comprehensive industry-wide study of wood dust, noise, and bioaersols.